Sample records for care plan template
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Are care plans suitable for the management of multiple conditions?
Young, Charlotte E.; Boyle, Frances M.; Mutch, Allyson J.
2016-01-01
Background Care plans have been part of the primary care landscape in Australia for almost two decades. With an increasing number of patients presenting with multiple chronic conditions, it is timely to consider whether care plans meet the needs of patients and clinicians. Objectives To review and benchmark existing care plan templates that include recommendations for comorbid conditions, against four key criteria: (i) patient preferences, (ii) setting priorities, (iii) identifying conflicts and synergies between conditions, and (iv) setting dates for reviewing the care plan. Design Document analysis of Australian care plan templates published from 2006 to 2014 that incorporated recommendations for managing comorbid conditions in primary care. Results Sixteen templates were reviewed. All of the care plan templates addressed patient preference, but this was not done comprehensively. Only three templates included setting priorities. None assisted in identifying conflicts and synergies between conditions. Fifteen templates included setting a date for reviewing the care plan. Conclusions Care plans are a well-used tool in primary care practice, but their current format perpetuates a single-disease approach to care, which works contrary to their intended purpose. Restructuring care plans to incorporate shared decision-making and attention to patient preferences may assist in shifting the focus back to the patient and their care needs. PMID:29090181
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Development and evaluation of an aged care specific Advance Care Plan.
Silvester, William; Parslow, Ruth A; Lewis, Virginia J; Fullam, Rachael S; Sjanta, Rebekah; Jackson, Lynne; White, Vanessa; Hudson, Rosalie
2013-06-01
To report on the quality of advance care planning (ACP) documents in use in residential aged care facilities (RACF) in areas of Victoria Australia prior to a systematic intervention; to report on the development and performance of an aged care specific Advance Care Plan template used during the intervention. An audit of the quality of pre-existing documentation used to record resident treatment preferences and end-of-life wishes at participating RACFs; development and pilot of an aged care specific Advance Care Plan template; an audit of the completeness and quality of Advance Care Plans completed on the new template during a systematic ACP intervention. 19 selected RACFs (managed by 12 aged care organisations) in metropolitan and regional areas of Victoria. Documentation in use at facilities prior to the ACP intervention most commonly recorded preferences regarding hospital transfer, life prolonging treatment and personal/cultural/religious wishes. However, 7 of 12 document sets failed to adequately and clearly specify the resident's preferences as regards life prolonging medical treatment. The newly developed aged care specific Advance Care Plan template was met with approval by participating RACFs. Of 203 Advance Care Plans completed on the template throughout the project period, 49% included the appointment of a Medical Enduring Power of Attorney. Requests concerning medical treatment were specified in almost all completed documents (97%), with 73% nominating the option of refusal of life-prolonging treatment. Over 90% of plans included information concerning residents' values and beliefs, and future health situations that the resident would find to be unacceptable were specified in 78% of completed plans. Standardised procedures and documentation are needed to improve the quality of processes, documents and outcomes of ACP in the residential aged care sector.
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Luckett, Tim; Bhattarai, Priyanka; Phillips, Jane; Agar, Meera; Currow, David; Krastev, Yordanka; Davidson, Patricia M
2015-11-01
A drive to promote advance care planning at a population level has led to a proliferation of online advance care directive (ACD) templates but little information to guide consumer choice. The current study aimed to appraise the quality of online ACD templates promoted for use in Australia. A systematic review of online Australian ACD templates was conducted in February 2014. ACD templates were identified via Google searches, and quality was independently appraised by two reviewers against criteria from the 2011 report A National Frameworkfor Advance Care Directives. Bias either towards or against future medical treatment was assessed using criteria designed to limit subjectivity. Fourteen online ACD templates were included, all of which were available only in English. Templates developed by Southern Cross University best met the framework criteria. One ACD template was found to be biased against medical treatment--the Dying with Dignity Victoria Advance Healthcare Directive. More research is needed to understand how online resources can optimally elicit and record consumers' individual preferences for future care. Future iterations of the framework should address online availability and provide a simple rating system to inform choice and drive quality improvement.
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Adams, Sherri; Cohen, Eyal; Mahant, Sanjay; Friedman, Jeremy N; Macculloch, Radha; Nicholas, David B
2013-01-19
The Medical Home model recommends that Children with Special Health Care Needs (CSHCN) receive a medical care plan, outlining the child's major medical issues and care needs to assist with care coordination. While care plans are a primary component of effective care coordination, the creation and maintenance of care plans is time, labor, and cost intensive, and the desired content of the care plan has not been studied. The purpose of this qualitative study was to understand the usefulness and desired content of comprehensive care plans by exploring the perceptions of parents and health care providers (HCPs) of children with medical complexity (CMC). This qualitative study utilized in-depth semi-structured interviews and focus groups. HCPs (n = 15) and parents (n = 15) of CMC who had all used a comprehensive care plan were recruited from a tertiary pediatric academic health sciences center. Themes were identified through grounded theory analysis of interview and focus group data. A multi-dimensional model of perceived care plan usefulness emerged. The model highlights three integral aspects of the care plan: care plan characteristics, activating factors and perceived outcomes of using a care plan. Care plans were perceived as a useful tool that centralized and focused the care of the child. Care plans were reported to flatten the hierarchical relationship between HCPs and parents, resulting in enhanced reciprocal information exchange and strengthened relationships. Participants expressed that a standardized template that is family-centered and includes content relevant to both the medical and social needs of the child is beneficial when integrated into overall care planning and delivery for CMC. Care plans are perceived to be a useful tool to both health care providers and parents of CMC. These findings inform the utility and development of a comprehensive care plan template as well as a model of how and when to best utilize care plans within family-centered models of care.
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Transdisciplinary Pedagogical Templates and Their Potential for Adaptive Reuse
ERIC Educational Resources Information Center
Dobozy, Eva; Dalziel, James
2016-01-01
This article explores the use and usefulness of carefully designed transdisciplinary pedagogical templates (TPTs) aligned to different learning theories. The TPTs are based on the Learning Design Framework outlined in the Larnaca Declaration (Dalziel et al. in this collection). The generation of pedagogical plans or templates is not new. However,…
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Abboud, Salim E; Soriano, Stephanie; Abboud, Rayan; Patel, Indravadan; Davidson, Jon; Azar, Nami R; Nakamoto, Dean A
Preprocedural evaluation of patients in an interventional radiology (IR) clinic is a complex synthesis of physical examination and imaging findings, and as IR transitions to an independent clinical specialty, such evaluations will become an increasingly critical component of a successful IR practice and quality patient care. Prior research suggests that preprocedural evaluations increased patient's perceived quality of care and may improve procedural technical success rates. Appropriate documentation of a preprocedural evaluation in the medical record is also paramount for an interventional radiologist to add value and function as an effective member of a larger IR service and multidisciplinary health care team. The purpose of this study is to examine the quality of radiology resident notes for patients seen in an outpatient IR clinic at a single academic medical center before and after the adoption of clinic note template with reminders to include platelet count, international normalized ratio, glomerular filtration rate, and plan for periprocedural coagulation status. Before adoption of the template, platelet count, international normalized ratio, glomerular filtration rate and an appropriate plan for periprocedural coagulation status were documented in 72%, 82%, 42%, and 33% of patients, respectively. After adoption of the template, appropriate documentation of platelet count, international normalized ratio, and glomerular filtration rate increased to 96%, and appropriate plan for periprocedural coagulation status was documented in 83% of patients. Patient evaluation and clinical documentation skills may not be adequately practiced during radiology residency, and tools such as templates may help increase documentation quality by radiology residents. Copyright © 2017 Elsevier Inc. All rights reserved.
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MO-F-CAMPUS-T-05: SQL Database Queries to Determine Treatment Planning Resource Usage
DOE Office of Scientific and Technical Information (OSTI.GOV)
Fox, C; Gladstone, D
2015-06-15
Purpose: A radiation oncology clinic’s treatment capacity is traditionally thought to be limited by the number of machines in the clinic. As the number of fractions per course decrease and the number of adaptive plans increase, the question of how many treatment plans a clinic can plan becomes increasingly important. This work seeks to lay the ground work for assessing treatment planning resource usage. Methods: Care path templates were created using the Aria 11 care path interface. Care path tasks included key steps in the treatment planning process from the completion of CT simulation through the first radiation treatment. SQLmore » Server Management Studio was used to run SQL queries to extract task completion time stamps along with care path template information and diagnosis codes from the Aria database. 6 months of planning cycles were evaluated. Elapsed time was evaluated in terms of work hours within Monday – Friday, 7am to 5pm. Results: For the 195 validated treatment planning cycles, the average time for planning and MD review was 22.8 hours. Of those cases 33 were categorized as urgent. The average planning time for urgent plans was 5 hours. A strong correlation between diagnosis code and range of elapsed planning time was as well as between elapsed time and select diagnosis codes was observed. It was also observed that tasks were more likely to be completed on the date due than the time that they were due. Follow-up confirmed that most users did not look at the due time. Conclusion: Evaluation of elapsed planning time and other tasks suggest that care paths should be adjusted to allow for different contouring and planning times for certain diagnosis codes and urgent cases. Additional clinic training around task due times vs dates or a structuring of care paths around due dates is also needed.« less
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Stereolithographic Surgical Template: A Review
Dandekeri, Shilpa Sudesh; Sowmya, M.K.; Bhandary, Shruthi
2013-01-01
Implant placement has become a routine modality of dental care.Improvements in surgical reconstructive methods as well as increased prosthetic demands,require a highly accurate diagnosis, planning and placement. Recently,computer-aided design and manufacturing have made it possible to use data from computerised tomography to not only plan implant rehabilitation,but also transfer this information to the surgery.A review on one of this technique called Stereolithography is presented in this article.It permits graphic and complex 3D implant placement and fabrication of stereolithographic surgical templates. Also offers many significant benefits over traditional procedures. PMID:24179955
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Ward round template: enhancing patient safety on ward rounds.
Gilliland, Niall; Catherwood, Natalie; Chen, Shaouyn; Browne, Peter; Wilson, Jacob; Burden, Helena
2018-01-01
Concerns had been raised at clinical governance regarding the safety of our inpatient ward rounds with particular reference to: documentation of clinical observations and National Early Warning Score (NEWS), compliance with Trust guidance for venous thromboembolism (VTE) risk assessment, antibiotic stewardship, palliative care and treatment escalation plans (TEP). This quality improvement project was conceived to ensure these parameters were considered and documented during the ward round, thereby improving patient care and safety. These parameters were based on Trust patient safety guidance and CQUIN targets. The quality improvement technique of plan-do-study-act (PDSA) was used in this project. We retrospectively reviewed ward round entries to record baseline measurements, based on the above described parameters, prior to making any changes. Following this, the change applied was the introduction of a ward round template to include the highlighted important baseline parameters. Monthly PDSA cycles are performed, and baseline measurements are re-examined, then relevant changes were made to the ward round template. Documentation of baseline measurements was poor prior to introduction of the ward round template; this improved significantly following introduction of a standardised ward round template. Following three cycles, documentation of VTE risk assessments increased from 14% to 92%. Antibiotic stewardship documentation went from 0% to 100%. Use of the TEP form went from 29% to 78%. Following introduction of the ward round template, compliance improved significantly in all safety parameters. Important safety measures being discussed on ward rounds will lead to enhanced patient safety and will improve compliance to Trust guidance and comissioning for quality and innovation (CQUIN) targets. Ongoing change implementation will focus on improving compliance with usage of the template on all urology ward rounds.
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Development of a scalable mental healthcare plan for a rural district in Ethiopia
Fekadu, Abebaw; Hanlon, Charlotte; Medhin, Girmay; Alem, Atalay; Selamu, Medhin; Giorgis, Tedla W.; Shibre, Teshome; Teferra, Solomon; Tegegn, Teketel; Breuer, Erica; Patel, Vikram; Tomlinson, Mark; Thornicroft, Graham; Prince, Martin; Lund, Crick
2016-01-01
Background Developing evidence for the implementation and scaling up of mental healthcare in low- and middle-income countries (LMIC) like Ethiopia is an urgent priority. Aims To outline a mental healthcare plan (MHCP), as a scalable template for the implementation of mental healthcare in rural Ethiopia. Method A mixed methods approach was used to develop the MHCP for the three levels of the district health system (community, health facility and healthcare organisation). Results The community packages were community case detection, community reintegration and community inclusion. The facility packages included capacity building, decision support and staff well-being. Organisational packages were programme management, supervision and sustainability. Conclusions The MHCP focused on improving demand and access at the community level, inclusive care at the facility level and sustainability at the organisation level. The MHCP represented an essential framework for the provision of integrated care and may be a useful template for similar LMIC. PMID:26447174
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Neumann, Peter J
2005-07-01
Managed care plans have traditionally resisted using economic evidence explicitly in drug formulary decisions, even as they used ever more aggressive and sophisticated processes for managing care. In recent years, this has changed as health plans have begun to adopt evidence-based and value-based formulary submission guidelines. The guidelines have the potential to serve as a national unifying template for pharmacy and therapeutics committees to consider clinical and economic information in a systematic and rigorous fashion. However, many questions remain about their use and about the nature of communications (called "unsolicited requests") from plans to drug companies for information. This article describes the unsolicited request process and its potential impact on the use of economic evidence in formulary decisions.
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Federal Register 2010, 2011, 2012, 2013, 2014
2011-08-22
...The Departments of the Health and Human Services, Labor, and the Treasury (the Departments) are simultaneously publishing in the Federal Register this document and proposed regulations (2011 proposed regulations) under the Patient Protection and Affordable Care Act to implement the disclosure for group health plans and health insurance issuers of the summary of benefits and coverage (SBC) and the uniform glossary. This document proposes a template for an SBC; instructions, sample language, and a guide for coverage examples calculations to be used in completing the template; and a uniform glossary that would satisfy the disclosure requirements under section 2715 of the Public Health Service (PHS) Act. Comments are invited on these materials.
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Successful reentry: the perspective of private correctional health care providers.
Mellow, Jeff; Greifinger, Robert B
2007-01-01
Due to public health and safety concerns, discharge planning is increasingly prioritized by correctional systems when preparing prisoners for their reintegration into the community. Annually, private correctional health care vendors provide $3 billion of health care services to inmates in correctional facilities throughout the U.S., but rarely are contracted to provide transitional health care. A discussion with 12 people representing five private nationwide correctional health care providers highlighted the barriers they face when implementing transitional health care and what templates of services health care companies could provide to state and counties to enhance the reentry process.
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PechaKucha Presentations: Teaching Storytelling, Visual Design, and Conciseness
ERIC Educational Resources Information Center
Lucas, Kristen; Rawlins, Jacob D.
2015-01-01
When speakers rely too heavily on presentation software templates, they often end up stultifying audiences with a triple-whammy of bullet points. In this article, Lucas and Rawlins present an alternative method--PechaKucha (the Japanese word for "chit chat")--a presentation style driven by a carefully planned, automatically timed…
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Developing academic surgery in a socialized health care system: a 35-year experience.
Duranceau, Andre; Martin, Jocelyne; Liberman, Moishe; Ferraro, Pasquale
2012-07-01
The most important benefit of a socialized health care system is the elimination of the threat of personal financial ruin to pay for medical care. Serious disadvantages of a socialized health care system, particularly in a university hospital setting, include restricted financial resources for education and patient care, limited working facilities, and loss of physician-directed decision making in planning and prioritizing. This article describes how a group practice model has supported clinical and academic activities within the faculty of medicine of our university and offers this model as a possible template for other surgical and medical disciplines working in an academic socialized environment.
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Dimethyl Disulfide (DMDS) Fumigant Management Plan Template Phase 2
These templates provide a framework for developing your FMP, including sections on your supervising pesticide applicator, buffer zones, emergency response plan, handler information, tarp plan, soil conditions, signage, and air monitoring plan.
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Wang, H; Wang, J J; Jiang, Y L; Tian, S Q; Ji, Z; Guo, F X; Sun, H T; Fan, J H; Xu, Y P
2016-12-20
Objective: To analyze the difference of dosimetric parameters between pre-plan and post-plan of 125 I radioactive seed implantation assisted by 3D printing individual non-coplanar template (3D printing template) for locally recurrent rectal cancer (LRRC). Methods: From February 2016 to April 2016, a total of 10 patients with locally recurrent rectal cancer received 125 I seeds implantation under CT guidance assisted by 3D printing template in Department of Radiation Oncology, Peking University Third Hospital.Each patient underwent CT simulation, three-dimentional treatment planning pre-implantation, 3D printing template design, radioactive seed implantation assisted by 3D printing template and dosimetric verification post implantation. The median activity of seed was 0.63 mCi (0.58 to 0.7 mCi) (2.15- 2.59×10 7 Bq), and the median number of seeds was 80 (19 to 192). D 90 , D 100 , V 100 , V 150 , CI, EI, HI, D 5cc , D 2cc of bladder and bowel of pre-plan and post-plan were calculated, respectively.Paired t test was used to evaluate the difference of dosimetric parameters between pre-plan and post-plan. Results: The median D 90 of pre-plan and post-plan were 13 761.0 and 12 798.8 cGy, respectively.The median D 100 of pre-plan and post-plan were 5 293.6 and 5 397.9 cGy, respectively.The median V 100 of pre-plan and post-plan were 90.0% and 90.0%, respectively.The median V 150 of pre-plan and post-plan were 63.8% and 62.4%, respectively.The median CI of pre-plan and post-plan were 0.73 and 0.67.The median EI of pre-plan and post-plan were 0.22 and 0.30, respectively. The median HI of pre-plan and post-plan were 0.29 and 0.31.The median bladder D 2cc of pre-plan and post-plan were 3 088.8 and 4 240.4 cGy, respectively.The median bowel D 2cc of pre-plan and post-plan were 7 051.6 and 7 903.9 cGy, respectively. Conclusions: 3D printing template might be helpful for locally recurrent rectal cancer patients who received 125 I radioactive seed implantation assisted by 3D printing individual template.Seed implantation might have more chances to achieve prescription dose and dose limitation of organs at risk of pre-plan, which is important for precise implantation and quality control.
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Turusbekova, N; Popa, C; Dragos, M; van der Werf, M J; Dinca, I
2016-02-01
In 2012, the tuberculosis (TB) notification rate among Romanian TB facility doctors and nurses was 7.2 times higher than in the general population. This indicates that transmission is ongoing inside TB facilities and that TB infection control measures are insufficient. To help prevent nosocomial TB transmission a project was implemented that aimed at providing nationwide tailor-made technical assistance in TB infection control (TB-IC) in TB treatment facilities, including the development of TB infection control plans. The objective of the present article is to describe the implementation of the project and to discuss successes and challenges. The project was an implementation study using two methods of evaluation: (1) a cross sectional questionnaire study; and (2) collection of information, during the training, on challenges related to infection control and to the project implementation. The project team developed a TB facility infection control (TB-IC) plan template, together with the Romanian experts. The template was discussed and agreed upon with the experts at a meeting and thereafter distributed by email to all TB facilities. Afterwards, a training of trainers (TOT) seminar was organized which included the provision of information about different training methods, as well as information about TB-IC. The TOT was followed by training for key TB-IC providers. Information about use of the TB-IC template was gathered through a self-administered questionnaire sent to all participants of the expert meeting and the training (42 people). Additionally, non-systematized discussions were held on broader challenges in TB-IC implementation during the training. Within the project 42 key TB-IC service providers were trained in TB-IC, including 9 who were trained at a TOT seminar. The trainees were specialists working at the national level, such as country TB coordinators, or at the TB facility level: TB doctors, epidemiologists, laboratory specialists and maintenance engineers. Out of 42 key TB-IC service providers who were trained, only eighteen responded to the questionnaire (no reminders were sent). Out of these, 14 had used the TB-IC plan template after the project team disseminated it to them by email. The remaining four TB-IC service providers indicated that they were planning to use the template to develop or update their facility TB-IC plans. Related to the use of TB-IC plan template, the following broader challenges in TB-IC were identified: a lack of authority of the individuals responsible for TB-IC to implement the TB-IC measures, lack of training among facility epidemiologists on TB, underdeveloped system for reporting TB in healthcare workers, difficulties with triage of the TB suspects, and poor facility infrastructure hampering implementation of TB-IC measures. Implementing TB-IC plans in Romanian health care facilities proved to be challenging, mainly due to the fact that the national infection control plan for TB was not yet adopted at the time of project implementation, and therefore there was neither a regulatory framework to support TB facility-IC planning nor any related budget allocations for the implementation of the facilities' TB-IC plans. Nonetheless, most respondents who answered the questionnaire (18 of 42 responded) indicated that they had started using the TB-IC plan template, which represents a full package of infection control measures that, when implemented effectively and in its entirety, may be expected to reduce nosocomial transmission. The study's limitations are: very low survey response rate, thus there is a likelihood of responder bias. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.
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Operating and Maintaining Energy Smart Schools Action Plan Template - All Action Plans
DOE Office of Scientific and Technical Information (OSTI.GOV)
none,
2009-07-01
EnergySmart Schools action plan templates for benchmarking, lighting, HVAC, water heating, building envelope, transformer, plug loads, kitchen equipment, swimming pool, building automation system, other.
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Koh, Vicky Y; Buhari, Shaik A; Tan, Poh Wee; Tan, Yun Inn; Leong, Yuh Fun; Earnest, Arul; Tang, Johann I
2014-06-01
Currently, there are two described methods of catheter insertion for women undergoing multicatheter interstitial accelerated partial breast irradiation (APBI). These are a volume based template approach (template) and a non-template ultrasound guidance freehand approach (non-template). We aim to compare dosimetric endpoints between the template and non-template approach. Twenty patients, who received adjuvant multicatheter interstitial APBI between August 2008 to March 2010 formed the study cohort. Dosimetric planning was based on the RTOG 04-13 protocol. For standardization, the planning target volume evaluation (PTV-Eval) and organs at risk were contoured with the assistance of the attending surgeon. Dosimetric endpoints include D90 of the PTV-Eval, Dose Homogeneity Index (DHI), V200, maximum skin dose (MSD), and maximum chest wall dose (MCD). A median of 18 catheters was used per patient. The dose prescribed was 34 Gy in 10 fractions BID over 5 days. The average breast volume was 846 cm(3) (526-1384) for the entire cohort and there was no difference between the two groups (p = 0.6). Insertion time was significantly longer for the non-template approach (mean 150 minutes) compared to the template approach (mean: 90 minutes) (p = 0.02). The planning time was also significantly longer for the non-template approach (mean: 240 minutes) compared to the template approach (mean: 150 minutes) (p < 0.01). The template approach yielded a higher D90 (mean: 95%) compared to the non-template approach (mean: 92%) (p < 0.01). There were no differences in DHI (p = 0.14), V200 (p = 0.21), MSD (p = 0.7), and MCD (p = 0.8). Compared to the non-template approach, the template approach offered significant shorter insertion and planning times with significantly improved dosimetric PTV-Eval coverage without significantly compromising organs at risk dosimetrically.
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Overholser, Linda S; Moss, Kerry M; Kilbourn, Kristin; Risendal, Betsy; Jones, Alison F; Greffe, Brian S; Garrington, Timothy; Leonardi-Warren, Kristin; Yamashita, Traci E; Kutner, Jean S
2015-01-01
Describe the development and evolution of a primary-care-based, multidisciplinary clinic to support the ongoing care of adult survivors of childhood cancer. A consultative clinic for adult survivors of childhood cancer has been developed that is located in an adult, academic internal medicine setting and is based on a long-term follow-up clinic model available at Children's Hospital Colorado. The clinic opened in July 2008. One hundred thirty-five patients have been seen as of April 2014. Referrals and clinic capacity have gradually increased over time, and a template has been developed in the electronic medical record to help facilitate completion of individualized care plan letters. A primary care-based, multidisciplinary consultative clinic for adults with a history of childhood cancer survivor is feasible and actively engages adult primary care resources to provide risk-based care for long-term pediatric cancer survivors. This model of care planning can help support adult survivors of pediatric cancer and their primary care providers in non-academic, community settings as well. Copyright © 2015 Elsevier Inc. All rights reserved.
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Metam Sodium and Metam Potassium Fumigant Management Plan Phase 2 Templates
These templates provide a framework for structuring and reporting a plan for this type of pesticide product. Required data fields include application block size, buffer zone signage, soil conditions, and tarp plans.
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Dazomet Fumigant Management Plan Phase 2 Templates
These templates provide a framework for reporting application block information, buffer zones, emergency response plan, tarp plan, soil conditions, air monitoring, and more for pesticide products containing the active ingredient dazomet, such as Basamid G.
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Wood, Maree; Fonseca, Amara; Sampson, David; Kovendy, Andrew; Westhuyzen, Justin; Shakespeare, Thomas; Turnbull, Kirsty
2016-01-01
The aim of the retrospective study was to develop a planning class solution for prostate intensity-modulated radiotherapy (IMRT) that achieved target and organs-at-risk (OAR) doses within acceptable departmental protocol criteria using the Monaco treatment planning system (Elekta-CMS Software, MO, USA). Advances in radiation therapy technology have led to a re-evaluation of work practices. Class solutions have the potential to produce highly conformal plans in a time-efficient manner. Using data from intermediate and high risk prostate cancer patients, a stepwise quality improvement model was employed. Stage 1 involved the development of a broadly based treatment template developed across 10 patients. Stage 2 involved template refinement and clinical audit ( n = 20); Stage 3, template review ( n = 50) and Stage 4 an assessment of a revised template against the actual treatment plan involving 72 patients. The computer algorithm that comprised the Stage 4 template met clinical treatment criteria for 82% of patients. Minor template changes were required for a further 13% of patients. Major changes were required in 4%; one patient could not be assessed. The average calculation time was 13 min and involved seven mouse clicks by the planner. Thus, the new template met treatment criteria or required only minor changes in 95% of prostate patients; this is an encouraging result suggesting improvements in planning efficiency and consistency. It is feasible to develop a class solution for prostate IMRT using a stepwise quality improvement model which delivers clinically acceptable plans in the great majority of prostate cases.
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SU-F-BRD-10: Lung IMRT Planning Using Standardized Beam Bouquet Templates
DOE Office of Scientific and Technical Information (OSTI.GOV)
Yuan, L; Wu, Q J.; Yin, F
2014-06-15
Purpose: We investigate the feasibility of choosing from a small set of standardized templates of beam bouquets (i.e., entire beam configuration settings) for lung IMRT planning to improve planning efficiency and quality consistency, and also to facilitate automated planning. Methods: A set of beam bouquet templates is determined by learning from the beam angle settings in 60 clinical lung IMRT plans. A k-medoids cluster analysis method is used to classify the beam angle configuration into clusters. The value of the average silhouette width is used to determine the ideal number of clusters. The beam arrangements in each medoid of themore » resulting clusters are taken as the standardized beam bouquet for the cluster, with the corresponding case taken as the reference case. The resulting set of beam bouquet templates was used to re-plan 20 cases randomly selected from the database and the dosimetric quality of the plans was evaluated against the corresponding clinical plans by a paired t-test. The template for each test case was manually selected by a planner based on the match between the test and reference cases. Results: The dosimetric parameters (mean±S.D. in percentage of prescription dose) of the plans using 6 beam bouquet templates and those of the clinical plans, respectively, and the p-values (in parenthesis) are: lung Dmean: 18.8±7.0, 19.2±7.0 (0.28), esophagus Dmean: 32.0±16.3, 34.4±17.9 (0.01), heart Dmean: 19.2±16.5, 19.4±16.6 (0.74), spinal cord D2%: 47.7±18.8, 52.0±20.3 (0.01), PTV dose homogeneity (D2%-D99%): 17.1±15.4, 20.7±12.2 (0.03).The esophagus Dmean, cord D02 and PTV dose homogeneity are statistically better in the plans using the standardized templates, but the improvements (<5%) may not be clinically significant. The other dosimetric parameters are not statistically different. Conclusion: It's feasible to use a small number of standardized beam bouquet templates (e.g. 6) to generate plans with quality comparable to that of clinical plans. Partially supported by NIH/NCI under grant #R21CA161389 and a master research grant by Varian Medical System.« less
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Wave Energy Prize - General Information
Scharmen, Wesley
2016-12-01
All the informational files, templates, rules and guidelines for Wave Energy Prize (WEP), including the Wave Energy Prize Rules, Participant Terms and Conditions Template, WEC Prize Name, Logo, Branding, WEC Publicity, Technical Submission Template , Numerical Modeling Template, SSTF Submission Template, 1/20th Scale Model Design and Construction Plan Template, Final Report template, and Webinars.
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Digital templating for THA: a simple computer-assisted application for complex hip arthritis cases.
Hafez, Mahmoud A; Ragheb, Gad; Hamed, Adel; Ali, Amr; Karim, Said
2016-10-01
Total hip arthroplasty (THA) is the standard procedure for end-stage arthritis of the hip. Its technical success relies on preoperative planning of the surgical procedure and virtual setup of the operative performance. Digital hip templating is one methodology of preoperative planning for THA which requires a digital preoperative radiograph and a computer with special software. This is a prospective study involving 23 patients (25 hips) who were candidates for complex THA surgery (unilateral or bilateral). Digital templating is done by radiographic assessment using radiographic magnification correction, leg length discrepancy and correction measurements, acetabular component and femoral component templating as well as neck resection measurement. The overall accuracy for templating the stem implant's exact size is 81%. This percentage increased to 94% when considering sizing within 1 size. Digital templating has proven effective, reliable and essential technique for preoperative planning and accurate prediction of THA sizing and alignment.
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Berkeley Lab - Materials Sciences Division
; Finance Templates Travel One-Stop Acknowledging MSD Support Human Resources Facilities & Space Planning Procurement and Property Proposals & Finance Templates Travel Facilities & Space Planning
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Optimization of spine surgery planning with 3D image templating tools
NASA Astrophysics Data System (ADS)
Augustine, Kurt E.; Huddleston, Paul M.; Holmes, David R., III; Shridharani, Shyam M.; Robb, Richard A.
2008-03-01
The current standard of care for patients with spinal disorders involves a thorough clinical history, physical exam, and imaging studies. Simple radiographs provide a valuable assessment but prove inadequate for surgery planning because of the complex 3-dimensional anatomy of the spinal column and the close proximity of the neural elements, large blood vessels, and viscera. Currently, clinicians still use primitive techniques such as paper cutouts, pencils, and markers in an attempt to analyze and plan surgical procedures. 3D imaging studies are routinely ordered prior to spine surgeries but are currently limited to generating simple, linear and angular measurements from 2D views orthogonal to the central axis of the patient. Complex spinal corrections require more accurate and precise calculation of 3D parameters such as oblique lengths, angles, levers, and pivot points within individual vertebra. We have developed a clinician friendly spine surgery planning tool which incorporates rapid oblique reformatting of each individual vertebra, followed by interactive templating for 3D placement of implants. The template placement is guided by the simultaneous representation of multiple 2D section views from reformatted orthogonal views and a 3D rendering of individual or multiple vertebrae enabling superimposition of virtual implants. These tools run efficiently on desktop PCs typically found in clinician offices or workrooms. A preliminary study conducted with Mayo Clinic spine surgeons using several actual cases suggests significantly improved accuracy of pre-operative measurements and implant localization, which is expected to increase spinal procedure efficiency and safety, and reduce time and cost of the operation.
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Methyl Bromide Fumigant Management Plan Phase 2 Templates
Templates provide a checklist and framework for elements including certified pesticide applicator details, application block, buffer zones, sign posting, tarp plan, soil conditions, air monitoring, and good agricultural practices (GAPs).
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Frogel, Michael; Flamm, Avram; Sagy, Mayer; Uraneck, Katharine; Conway, Edward; Ushay, Michael; Greenwald, Bruce M; Pierre, Louisdon; Shah, Vikas; Gaffoor, Mohamed; Cooper, Arthur; Foltin, George
2017-08-01
A mass casualty event can result in an overwhelming number of critically injured pediatric victims that exceeds the available capacity of pediatric critical care (PCC) units, both locally and regionally. To address these gaps, the New York City (NYC) Pediatric Disaster Coalition (PDC) was established. The PDC includes experts in emergency preparedness, critical care, surgery, and emergency medicine from 18 of 25 major NYC PCC-capable hospitals. A PCC surge committee created recommendations for making additional PCC beds available with an emphasis on space, staff, stuff (equipment), and systems. The PDC assisted 15 hospitals in creating PCC surge plans by utilizing template plans and site visits. These plans created an additional 153 potential PCC surge beds. Seven hospitals tested their plans through drills. The purpose of this article was to demonstrate the need for planning for disasters involving children and to provide a stepwise, replicable model for establishing a PDC, with one of its primary goals focused on facilitating PCC surge planning. The process we describe for developing a PDC can be replicated to communities of any size, setting, or location. We offer our model as an example for other cities. (Disaster Med Public Health Preparedness. 2017;11:473-478).
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Sample transportation management plans and templates.
DOT National Transportation Integrated Search
2010-08-01
This Guide consisting of samples, templates, and tips is designed to help transportation agencies with the : development and implementation of their own Transportation Management Plans (TMPs). Understanding : the work zone impacts is critical to deve...
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78 FR 47329 - Agency Information Collection Activities: Proposed Collection; Comment Request
Federal Register 2010, 2011, 2012, 2013, 2014
2013-08-05
... planning communities, plans, protocols, and procedures to manage a catastrophic event. The RCPGP is... collection. FEMA Forms: FEMA Form 089-19, RCPGP Investment Justification Template; FEMA Form 089-26, RCGCP (Sample) Detailed Project Plan Template; FEMA Form 089-17, RCPT Membership List. Abstract: The RCPGP is an...
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Plotting performance improvement progress through the development of a trauma dashboard.
Hochstuhl, Diane C; Elwell, Sean
2014-01-01
Performance improvement processes are the core of a pediatric trauma program. The ability to identify, resolve, and trend specific indicators related to patient care and to show effective loop closure can be especially challenging. Using the hospital's overall quality process as a template, the trauma program built its own electronic dashboard. Our maturing trauma PI program now guides the overall trauma care. All departments own at least one performance indicator and must provide action plans for improvement. Utilization of an electronic dashboard for trauma performance improvement has provided a highly visible scorecard, which highlights successes and tracks areas needing improvement.
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Environmental Learning Centers: A Template.
ERIC Educational Resources Information Center
Vozick, Eric
1999-01-01
Provides a working model, or template, for community-based environmental learning centers (ELCs). The template presents a philosophy as well as a plan for staff and administration operations, educational programming, and financial support. The template also addresses "green" construction and maintenance of buildings and grounds and…
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Marchack, Christopher B; Charles, Allan; Pettersson, Andreas
2011-12-01
The traditional technique for creating a CAD/CAM surgical template with a NobelGuide protocol is to fabricate a radiographic template that depicts the planned tooth position first. Multiple appointments are needed for the fabrication of the radiographic template with Cone Beam Computed Tomography (CBCT) before the surgical procedure can start. An alternative technique is described for fabricating a radiographic template at the initial examination appointment and capturing the necessary DICOM data to plan and fabricate a CAD/CAM surgical template in a 1-appointment protocol, thereby saving the patient and clinician time and reducing the need for multiple appointments. Copyright © 2011 The Editorial Council of the Journal of Prosthetic Dentistry. Published by Mosby, Inc. All rights reserved.
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A New Planning Template for Transit-Oriented Development
DOT National Transportation Integrated Search
2001-09-01
The Mineta Transportation Institute (MTI) at San Josi State University assigned a project team to design a planning template for transit-oriented development (TOD) that incorporates an understanding of nonwork travel, that is, trips for shopping, eat...
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Small city synthesis of transportation planning and economic development : user's guide
DOT National Transportation Integrated Search
1999-10-01
Using Alice, Texas, as a model, a template has been developed to increase the cooperation and communication between transportation planning and economic development groups. The template establishes a foundation for coordinating traffic forecasts with...
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Fumigant Management Plan Templates - Phase 2 Files Listed by Chemical
FMP templates are in PDF and Word formats for each type of soil fumigant pesticide, with samples of filled out plans. Types are by active ingredient chemical: Chloropicrin, dazomet, dimethyl disulfide, metam sodium/potassium, and methyl bromide.
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Berkeley Lab - Materials Sciences Division
MSD Support Human Resources Facilities & Space Planning Procurement and Property Proposals & ; Finance Templates Travel One-Stop Acknowledging MSD Support Human Resources Facilities & Space Planning Procurement and Property Proposals & Finance Templates Travel Human Resources General
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Coffey, Michael; Cohen, Rachel; Faulkner, Alison; Hannigan, Ben; Simpson, Alan; Barlow, Sally
2017-06-01
Communication and information sharing are considered crucial to recovery-focused mental health services. Effective mental health care planning and coordination includes assessment and management of risk and safety. Using data from our cross-national mixed-method study of care planning and coordination, we examined what patients, family members and workers say about risk assessment and management and explored the contents of care plans. Thematic analysis of qualitative research interviews (n = 117) with patients, family members and workers, across four English and two Welsh National Health Service sites. Care plans were reviewed (n = 33) using a structured template. Participants have contrasting priorities in relation to risk. Patients see benefit in discussions about risk, but cast the process as a worker priority that may lead to loss of liberty. Relationships with workers are key to family members and patients; however, worker claims of involving people in the care planning process do not extend to risk assessment and management procedures for fear of causing upset. Workers locate risk as coming from the person rather than social or environmental factors, are risk averse and appear to prioritize the procedural aspects of assessment. Despite limitations, risk assessment is treated as legitimate work by professionals. Risk assessment practice operates as a type of fiction in which poor predictive ability and fear of consequences are accepted in the interests of normative certainty by all parties. As a consequence, risk adverse options are encouraged by workers and patients steered away from opportunities for ordinary risks thereby hindering the mobilization of their strengths and abilities. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.
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Maratt, Joseph D; Srinivasan, Ramesh C; Dahl, William J; Schilling, Peter L; Urquhart, Andrew G
2012-08-01
As digital radiography becomes more prevalent, several systems for digital preoperative planning have become available. The purpose of this study was to evaluate the accuracy and efficiency of an inexpensive, cloud-based digital templating system, which is comparable with acetate templating. However, cloud-based templating is substantially faster and more convenient than acetate templating or locally installed software. Although this is a practical solution for this particular medical application, regulatory changes are necessary before the tremendous advantages of cloud-based storage and computing can be realized in medical research and clinical practice. Copyright 2012, SLACK Incorporated.
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Fumigant Management Plan - Phase 1 Templates
FMPs are required by pesticide labels, so EPA provides chemical-specific soil fumigant templates and samples in PDF and Word formats. Choose the appropriate template for products containing chloropicrin, dazomet, metam sodium/potassium, or methyl bromide.
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Kuperman, Gilad J; Boyer, Aurelia; Cole, Curt; Forman, Bruce; Stetson, Peter D; Cooper, Mary
2006-01-01
At NewYork-Presbyterian Hospital, we are committed to the delivery of high quality care. We have implemented a strategic planning process to determine the information technology initiatives that will best help us improve quality. The process began with the creation of a Clinical Quality and IT Committee. The Committee identified 2 high priority goals that would enable demonstrably high quality care: 1) excellence at data warehousing, and 2) optimal use of automated clinical documentation to capture encounter-related quality and safety data. For each high priority goal, a working group was created to develop specific recommendations. The Data Warehousing subgroup has recommended the implementation of an architecture management process and an improved ability for users to get access to aggregate data. The Structured Documentation subgroup is establishing recommendations for a documentation template creation process. The strategic planning process at times is slow, but assures that the organization is focusing on the information technology activities most likely to lead to improved quality.
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Kuperman, Gilad J.; Boyer, Aurelia; Cole, Curt; Forman, Bruce; Stetson, Peter D.; Cooper, Mary
2006-01-01
At NewYork-Presbyterian Hospital, we are committed to the delivery of high quality care. We have implemented a strategic planning process to determine the information technology initiatives that will best help us improve quality. The process began with the creation of a Clinical Quality and IT Committee. The Committee identified 2 high priority goals that would enable demonstrably high quality care: 1) excellence at data warehousing, and 2) optimal use of automated clinical documentation to capture encounter-related quality and safety data. For each high priority goal, a working group was created to develop specific recommendations. The Data Warehousing subgroup has recommended the implementation of an architecture management process and an improved ability for users to get access to aggregate data. The Structured Documentation subgroup is establishing recommendations for a documentation template creation process. The strategic planning process at times is slow, but assures that the organization is focusing on the information technology activities most likely to lead to improved quality. PMID:17238381
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Sampling and Analysis Plan - Guidance and Template v.4 - General Projects - 04/2014
This Sampling and Analysis Plan (SAP) guidance and template is intended to assist organizations in documenting the procedural and analytical requirements for one-time, or time-limited, projects involving the collection of water, soil, sediment, or other
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Chen, Xiaojun; Xu, Lu; Wang, Wei; Li, Xing; Sun, Yi; Politis, Constantinus
2016-09-01
The surgical template is a guide aimed at directing the implant placement, tumor resection, osteotomy and bone repositioning. Using it, preoperative planning can be transferred to the actual surgical site, and the precision, safety and reliability of the surgery can be improved. However, the actual workflow of the surgical template design and manufacturing is quite complicated before the final clinical application. The major goal of the paper is to provide a comprehensive reference source of the current and future development of the template design and manufacturing for relevant researchers. Expert commentary: This paper aims to present a review of the necessary procedures in the template-guided surgery including the image processing, 3D visualization, preoperative planning, surgical guide design and manufacturing. In addition, the template-guided clinical applications for various kinds of surgeries are reviewed, and it demonstrated that the precision of the surgery has been improved compared with the non-guided operations.
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Osmani, Feroz A; Thakkar, Savyasachi; Ramme, Austin; Elbuluk, Ameer; Wojack, Paul; Vigdorchik, Jonathan M
2017-12-01
Preoperative total hip arthroplasty templating can be performed with radiographs using acetate prints, digital viewing software, or with computed tomography (CT) images. Our hypothesis is that 3D templating is more precise and accurate with cup size prediction as compared to 2D templating with acetate prints and digital templating software. Data collected from 45 patients undergoing robotic-assisted total hip arthroplasty compared cup sizes templated on acetate prints and OrthoView software to MAKOplasty software that uses CT scan. Kappa analysis determined strength of agreement between each templating modality and the final size used. t tests compared mean cup-size variance from the final size for each templating technique. Interclass correlation coefficient (ICC) determined reliability of digital and acetate planning by comparing predictions of the operating surgeon and a blinded adult reconstructive fellow. The Kappa values for CT-guided, digital, and acetate templating with the final size was 0.974, 0.233, and 0.262, respectively. Both digital and acetate templating significantly overpredicted cup size, compared to CT-guided methods ( P < .001). There was no significant difference between digital and acetate templating ( P = .117). Interclass correlation coefficient value for digital and acetate templating was 0.928 and 0.931, respectively. CT-guided planning more accurately predicts hip implant cup size when compared to the significant overpredictions of digital and acetate templating. CT-guided templating may also lead to better outcomes due to bone stock preservation from a smaller and more accurate cup size predicted than that of digital and acetate predictions.
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A template for integrated community sustainability planning.
Ling, Christopher; Hanna, Kevin; Dale, Ann
2009-08-01
This article describes a template for implementing an integrated community sustainability plan. The template emphasizes community engagement and outlines the components of a basic framework for integrating ecological, social and economic dynamics into a community plan. The framework is a series of steps that support a sustainable community development process. While it reflects the Canadian experience, the tools and techniques have applied value for a range of environmental planning contexts around the world. The research is case study based and draws from a diverse range of communities representing many types of infrastructure, demographics and ecological and geographical contexts. A critical path for moving local governments to sustainable community development is the creation and implementation of integrated planning approaches. To be effective and to be implemented, a requisite shift to sustainability requires active community engagement processes, political will, and a commitment to political and administrative accountability, and measurement.
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NASA Astrophysics Data System (ADS)
Eggers, Georg; Cosgarea, Raluca; Rieker, Marcus; Kress, Bodo; Dickhaus, Hartmut; Mühling, Joachim
2009-02-01
An oral imaging template was developed to address the shortcomings of MR image data for image guided dental implant planning and placement. The template was conctructed as a gadolinium filled plastic shell to give contrast to the dentition and also to be accurately re-attachable for use in image guided dental implant placement. The result of segmentation and modelling of the dentition from MR Image data with the template was compared to plaster casts of the dentition. In a phantom study dental implant placement was performed based on MR image data. MR imaging with the contrast template allowed complete representation of the existing dentition. In the phantom study, a commercially available system for image guided dental implant placement was used. Transformation of the imaging contrast template into a surgical drill guide based on the MR image data resulted in pilot burr hole placement with an accuracy of 2 mm. MRI based imaging of the existing dentition for proper image guided planning is possible with the proposed template. Using the image data and the template resulted in less accurate pilot burr hole placement in comparison to CT-based image guided implant placement.
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Huang, Ming-Wei; Liu, Shu-Ming; Zheng, Lei; Shi, Yan; Zhang, Jie; Li, Yan-Sheng; Yu, Guang-Yan; Zhang, Jian-Guo
2012-11-01
To enhance the accuracy of radioactive seed implants in the head and neck, a digital model individual template, containing information simultaneously on needle pathway and facial features, was designed to guide implantation with CT imaging. Thirty-one patients with recurrent and local advanced malignant tumors of head and neck after prior surgery and radiotherapy were involved in this study. Before (125)I implants, patients received CT scans based on 0.75mm thickness. And the brachytherapy treatment planning system (BTPS) software was used to make the implantation plan based on the CT images. Mimics software and Geomagic software were used to read the data containing CT images and implantation plan, and to design the individual template. Then the individual template containing the information of needle pathway and face features simultaneously was made through rapid prototyping (RP) technique. All patients received (125)I seeds interstitial implantation under the guide of the individual template and CT. The individual templates were positioned easily and accurately, and were stable. After implants, treatment quality evaluation was made by CT and TPS. The seeds and dosages distribution (D(90),V(100),V(150)) were well meet the treatment requirement. Clinical practice confirms that this approach can facilitate easier and more accurate implantation.
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Plan to procedure: combining 3D templating with rapid prototyping to enhance pedicle screw placement
NASA Astrophysics Data System (ADS)
Augustine, Kurt E.; Stans, Anthony A.; Morris, Jonathan M.; Huddleston, Paul M.; Matsumoto, Jane M.; Holmes, David R., III; Robb, Richard A.
2010-02-01
Spinal fusion procedures involving the implantation of pedicle screws have steadily increased over the past decade because of demonstrated improvement in biomechanical stability of the spine. However, current methods of spinal fusion carries a risk of serious vascular, visceral, and neurological injury caused by inaccurate placement or inappropriately sized instrumentation, which may lead to patient paralysis or even fatality. 3D spine templating software developed by the Biomedical Imaging Resource (BIR) at Mayo Clinic allows the surgeon to virtually place pedicle screws using pre-operative 3D CT image data. With the template plan incorporated, a patient-specific 3D anatomic model is produced using a commercial rapid prototyping system. The pre-surgical plan and the patient-specific model then are used in the procedure room to provide real-time visualization and quantitative guidance for accurate placement of each pedicle screw, significantly reducing risk of injury. A pilot study was conducted at Mayo Clinic by the Department of Radiology, the Department of Orthopedics, and the BIR, involving seven complicated pediatric spine cases. In each case, pre-operative 3D templating was carried out and patient specific models were generated. The plans and the models were used intra-operatively, providing precise pedicle screw starting points and trajectories. Postoperative assessment by the surgeon confirmed all seven operations were successful. Results from the study suggest that patient-specific, 3D anatomic models successfully acquired from 3D templating tools are valuable for planning and conducting pedicle screw insertion procedures.
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Semi-automated intra-operative fluoroscopy guidance for osteotomy and external-fixator.
Lin, Hong; Samchukov, Mikhail L; Birch, John G; Cherkashin, Alexander
2006-01-01
This paper outlines a semi-automated intra-operative fluoroscopy guidance and monitoring approach for osteotomy and external-fixator application in orthopedic surgery. Intra-operative Guidance module is one component of the "LegPerfect Suite" developed for assisting the surgical correction of lower extremity angular deformity. The Intra-operative Guidance module utilizes information from the preoperative surgical planning module as a guideline to overlay (register) its bone outline semi-automatically with the bone edge from the real-time fluoroscopic C-Arm X-Ray image in the operating room. In the registration process, scaling factor is obtained automatically through matching a fiducial template in the fluoroscopic image and a marker in the module. A triangle metal plate, placed on the operating table is used as fiducial template. The area of template image within the viewing area of the fluoroscopy machine is obtained by the image processing techniques such as edge detection and Hough transformation to extract the template from other objects in the fluoroscopy image. The area of fiducial template from fluoroscopic image is then compared with the area of the marker from the planning so as to obtain the scaling factor. After the scaling factor is obtained, the user can use simple operations by mouse to shift and rotate the preoperative planning to overlay the bone outline from planning with the bone edge from fluoroscopy image. In this way osteotomy levels and external fixator positioning on the limb can guided by the computerized preoperative plan.
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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.
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Palsbo, Susan E; Diao, Guoqing; Palsbo, Gregory A; Tang, Liansheng; Rosenberger, William F; Mastal, Margaret F
2010-09-01
To develop activity limitation clusters for case-mix adjustment of health care ratings and as a population profiler, and to develop a cognitively accessible report of statistically reliable quality and access measures comparing the health care experiences of adults with and without disabilities, within and across health delivery organizations. Observational study. Three California Medicaid health care organizations. Adults (N = 1086) of working age enrolled for at least 1 year in Medicaid because of disability. Not applicable. Principal components analysis created 4 clusters of activity limitations that we used to characterize case mix. We identified and calculated 28 quality measures using responses from a proposed enabled version of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. We calculated scores for overall care as the weighted mean of the case-mix adjusted ratings. Disability caused a greater bias on health plan ratings and specialist ratings than did demographic factors. Proxy respondents rated care the same as self-respondents. Telephone and mail administration were equivalent for service reports, but telephone respondents tended to offer more positive global ratings. Plan-level reliability estimates for new composites on shared decision making and advice on healthy living are .79 and .87, respectively. Plan-level reliability estimates for a new composite measure on family planning did not discriminate between health plans because respondents rated all health plans poorly. Approximately 125 respondents per site are necessary to detect group differences. Self-reported activity limitations incorporating standard questions from the American Community Survey can be used to create a disability case-mix index and to construct profiles of a population's activity limitations. The enabled comparative report, which we call the Assessment of Health Plans and Providers by People with Activity Limitations, is more cognitively accessible than typical CAHPS report templates for state Medicaid plans. The CAHPS Medicaid reporting tools may provide misleading ratings of health plan and physician quality by people with disabilities because the mean ratings do not account for systematic biases associated with disability. More testing on larger populations would help to quantify the strength of various reporting biases.
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Cornelius, Carl-Peter; Giessler, Goetz Andreas; Wilde, Frank; Metzger, Marc Christian; Mast, Gerson; Probst, Florian Andreas
2016-03-01
Computer-assisted planning and intraoperative implementation using templates have become appreciated modalities in craniofacial reconstruction with fibula and DCIA flaps due to saving in operation time, improved accuracy of osteotomies and easy insetting. Up to now, a similar development for flaps from the subscapular vascular system, namely the lateral scapular border and tip, has not been addressed in the literature. A cohort of 12 patients who underwent mandibular (n = 10) or maxillary (n = 2) reconstruction with free flaps containing the lateral scapular border and tip using computer-assisted planning, stereolithography (STL) models and selective laser sintered (SLS) templates for bone contouring and sub-segmentation osteotomies was reviewed focussing on iterations in the design of computer generated tools and templates. The technical evolution migrated from hybrid STL models over SLS templates for cut out as well as sub-segmentation with a uniplanar framework to plug-on tandem template assemblies providing a biplanar access for the in toto cut out from the posterior aspect in succession with contouring into sub-segments from the medial side. The latest design version is the proof of concept that virtual planning of bone flaps from the lateral scapular border can be successfully transferred into surgery by appropriate templates. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.
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Chen, Xiaojun; Yuan, Jianbing; Wang, Chengtao; Huang, Yuanliang; Kang, Lu
2010-09-01
In the field of oral implantology, there is a trend toward computer-aided implant surgery, especially the application of computerized tomography (CT)-derived surgical templates. However, because of relatively unsatisfactory match between the templates and receptor sites, conventional surgical templates may not be accurate enough for the severely resorbed edentulous cases during the procedure of transferring the preoperative plan to the actual surgery. The purpose of this study is to introduce a novel bone-tooth-combined-supported surgical guide, which is designed by utilizing a special modular software and fabricated via stereolithography technique using both laser scanning and CT imaging, thus improving the fit accuracy and reliability. A modular preoperative planning software was developed for computer-aided oral implantology. With the introduction of dynamic link libraries and some well-known free, open-source software libraries such as Visualization Toolkit (Kitware, Inc., New York, USA) and Insight Toolkit (Kitware, Inc.) a plug-in evolutive software architecture was established, allowing for expandability, accessibility, and maintainability in our system. To provide a link between the preoperative plan and the actual surgery, a novel bone-tooth-combined-supported surgical template was fabricated, utilizing laser scanning, image registration, and rapid prototyping. Clinical studies were conducted on four partially edentulous cases to make a comparison with the conventional bone-supported templates. The fixation was more stable than tooth-supported templates because laser scanning technology obtained detailed dentition information, which brought about the unique topography between the match surface of the templates and the adjacent teeth. The average distance deviations at the coronal and apical point of the implant were 0.66 mm (range: 0.3-1.2) and 0.86 mm (range: 0.4-1.2), and the average angle deviation was 1.84 degrees (range: 0.6-2.8 degrees ). This pilot study proves that the novel combined-supported templates are superior to the conventional ones. However, more clinical cases will be conducted to demonstrate their feasibility and reliability.
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Business planning: a template for success.
Dye, Judy
2002-01-01
Because managing a laboratory, or any health-care entity, is as much a business as a service, it is important for you to have a good grasp on how you can take opportunities from idea conception to implementation to assessment/revision. Regardless of the size of your proposed project, you need to consider a number of factors, among them: your history and what opportunities you can seize from your strengths and weaknesses; the overall business climate; anticipated costs; staff involvement; how you will market your project; and what measures to use to determine your success. Above all else, you need to set goals, both ultimate and intermediate, to instill focus, incentive, and a sense of achievement. The next time someone on your staff says, "Why don't we try that?," refer to this Template Topic. It can serve as a tool to help you determine whether you should try "that" and be the compass that helps guide your efforts.
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Comparison of five-axis milling and rapid prototyping for implant surgical templates.
Park, Ji-Man; Yi, Tae-Kyoung; Koak, Jai-Young; Kim, Seong-Kyoon; Park, Eun-Jin; Heo, Seong-Joo
2014-01-01
This study aims to compare and evaluate the accuracy of surgical templates fabricated using coordinate synchronization processing with five-axis milling and design-related processing with rapid prototyping (RP). Master phantoms with 10 embedded gutta-percha cylinders hidden under artificial gingiva were fabricated and imaged using cone beam computed tomography. Vectors of the hidden cylinders were extracted and transferred to those of the planned implants through reverse engineering using virtual planning software. An RP-produced template was fabricated by stereolithography in photopolymer at the RP center according to planned data. Metal sleeves were bonded after holes were bored (group RP). For the milled template, milling coordinates were synchronized using the conversion process for the coordinate synchronization platform located on the model's bottom. Metal bushings were set on holes milled on the five-axis milling machine, on which the model was fixed through the coordinate synchronization plate, and the framework was constructed on the model using orthodontic resin (group CS). A computed tomography image was taken with templates firmly fixed on models using anchor pins (RP) or anchor screws (CS). The accuracy was analyzed via reverse engineering. Differences between the two groups were compared by repeated measures two-factor analysis. From the reverse-engineered image of the template on the experimental model, RP-produced templates showed significantly larger deviations than did milled surgical guides. Maximum deviations of the group RP were 1.58 mm (horizontal), 1.68 mm (vertical), and 8.51 degrees (angular); those of the group CS were 0.68 mm (horizontal), 0.41 mm (vertical), and 3.23 degrees (angular). A comparison of milling and RP template production methods showed that a vector-milled surgical guide had significantly smaller deviations than did an RP-produced template. The accuracy of computer-guided milled surgical templates was within the safety margin of previous studies.
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Computer templates in chronic disease management: ethnographic case study in general practice.
Swinglehurst, Deborah; Greenhalgh, Trisha; Roberts, Celia
2012-01-01
To investigate how electronic templates shape, enable and constrain consultations about chronic diseases. Ethnographic case study, combining field notes, video-recording, screen capture with a microanalysis of talk, body language and data entry-an approach called linguistic ethnography. Two general practices in England. Ethnographic observation of administrative areas and 36 nurse-led consultations was done. Twenty-four consultations were directly observed and 12 consultations were video-recorded alongside computer screen capture. Consultations were transcribed using conversation analysis conventions, with notes on body language and the electronic record. The analysis involved repeated rounds of viewing video, annotating field notes, transcription and microanalysis to identify themes. The data was interpreted using discourse analysis, with attention to the sociotechnical theory. Consultations centred explicitly or implicitly on evidence-based protocols inscribed in templates. Templates did not simply identify tasks for completion, but contributed to defining what chronic diseases were, how care was being delivered and what it meant to be a patient or professional in this context. Patients' stories morphed into data bytes; the particular became generalised; the complex was made discrete, simple and manageable; and uncertainty became categorised and contained. Many consultations resembled bureaucratic encounters, primarily oriented to completing data fields. We identified a tension, sharpened by the template, between different framings of the patient-as 'individual' or as 'one of a population'. Some clinicians overcame this tension, responding creatively to prompts within a dialogue constructed around the patient's narrative. Despite their widespread implementation, little previous research has examined how templates are actually used in practice. Templates do not simply document the tasks of chronic disease management but profoundly change the nature of this work. Designed to assure standards of 'quality' care they contribute to bureaucratisation of care and may marginalise aspects of quality care which lie beyond their focus. Creative work is required to avoid privileging 'institution-centred' care over patient-centred care.
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Computer templates in chronic disease management: ethnographic case study in general practice
Swinglehurst, Deborah; Greenhalgh, Trisha; Roberts, Celia
2012-01-01
Objective To investigate how electronic templates shape, enable and constrain consultations about chronic diseases. Design Ethnographic case study, combining field notes, video-recording, screen capture with a microanalysis of talk, body language and data entry—an approach called linguistic ethnography. Setting Two general practices in England. Participants and methods Ethnographic observation of administrative areas and 36 nurse-led consultations was done. Twenty-four consultations were directly observed and 12 consultations were video-recorded alongside computer screen capture. Consultations were transcribed using conversation analysis conventions, with notes on body language and the electronic record. The analysis involved repeated rounds of viewing video, annotating field notes, transcription and microanalysis to identify themes. The data was interpreted using discourse analysis, with attention to the sociotechnical theory. Results Consultations centred explicitly or implicitly on evidence-based protocols inscribed in templates. Templates did not simply identify tasks for completion, but contributed to defining what chronic diseases were, how care was being delivered and what it meant to be a patient or professional in this context. Patients’ stories morphed into data bytes; the particular became generalised; the complex was made discrete, simple and manageable; and uncertainty became categorised and contained. Many consultations resembled bureaucratic encounters, primarily oriented to completing data fields. We identified a tension, sharpened by the template, between different framings of the patient—as ‘individual’ or as ‘one of a population’. Some clinicians overcame this tension, responding creatively to prompts within a dialogue constructed around the patient's narrative. Conclusions Despite their widespread implementation, little previous research has examined how templates are actually used in practice. Templates do not simply document the tasks of chronic disease management but profoundly change the nature of this work. Designed to assure standards of ‘quality’ care they contribute to bureaucratisation of care and may marginalise aspects of quality care which lie beyond their focus. Creative work is required to avoid privileging ‘institution-centred’ care over patient-centred care. PMID:23192245
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2014-01-01
Background This study aimed to evaluate the accuracy of surgical outcomes in free iliac crest mandibular reconstructions that were carried out with virtual surgical plans and rapid prototyping templates. Methods This study evaluated eight patients who underwent mandibular osteotomy and reconstruction with free iliac crest grafts using virtual surgical planning and designed guiding templates. Operations were performed using the prefabricated guiding templates. Postoperative three-dimensional computer models were overlaid and compared with the preoperatively designed models in the same coordinate system. Results Compared to the virtual osteotomy, the mean error of distance of the actual mandibular osteotomy was 2.06 ± 0.86 mm. When compared to the virtual harvested grafts, the mean error volume of the actual harvested grafts was 1412.22 ± 439.24 mm3 (9.12% ± 2.84%). The mean error between the volume of the actual harvested grafts and the shaped grafts was 2094.35 ± 929.12 mm3 (12.40% ± 5.50%). Conclusions The use of computer-aided rapid prototyping templates for virtual surgical planning appears to positively influence the accuracy of mandibular reconstruction. PMID:24957053
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Nickenig, Hans-Joachim; Eitner, Stephan
2007-01-01
We assessed the reliability of implant placement after virtual planning of implant positions using cone-beam CT data and surgical guide templates. A total of 102 patients (250 implants, 55.4% mandibular; mean patient age, 40.4 years) who had undergone implant treatment therapy in an armed forces dental clinic (Cologne, Germany) between July 1, 2005 and December 1, 2005. They were treated with a system that allows transfer of virtual planning to surgical guide templates. Only in eight cases the surgical guides were not used because a delayed implant placement was necessary. In four posterior mandibular cases, handling was limited because of reduced interocclusal distance, requiring 50% shortening of the drill guides. The predictability of implant size was high: only one implant was changed to a smaller diameter (because of insufficient bone). In all cases, critical anatomical structures were protected and no complications were detected in postoperative panoramic radiographs. In 58.1% (147) of the 250 implants, a flapless surgery plan was realized. Implant placement after virtual planning of implant positions using cone beam CT data and surgical templates can be reliable for preoperative assessment of implant size, position, and anatomical complications. It is also indicative of cases amenable to flapless surgery.
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Effect of digital template in the assistant of a giant condylar osteochondroma resection.
Bai, Guo; He, Dongmei; Yang, Chi; Lu, Chuan; Huang, Dong; Chen, Minjie; Yuan, Jianbing
2014-05-01
Exostosis osteochondroma is usually resected with the whole condyle even part of it is not involved. This study was to report the effect of using digital template in the assistant of resection while protecting the uninvolved condyle. We used computer-aided design technique in the assistant of making preoperative plan of a patient with giant condylar osteochondroma of exogenous type, including determining the boundary between the tumor and the articular surface of condyle, and designing the virtual tumor resection plane, surgical approach, and remove-out path of the tumor. The digital osteotomy template was made by rapid prototyping technique based on the preoperative plan. Postoperative CT scan was performed and merged with the preoperative CT by the Proplan 1.3 system to evaluate the accuracy of surgical resection with the guide of digital template. The osteotomy template was attached to the lateral surface of condyle accurately, and the tumor was removed totally by the guide of the template without injuries to adjacent nerves and vessels. Postoperative CT showed that the osteochondroma was removed completely and the unaffected articular surface of condyle was preserved well. The merging of postoperative and preoperative CT by Proplan 1.3 system showed the outcome of the operation matched with the preoperative planning quite well with an error of 0.92 mm. There was no sign of recurrence after 6 months of follow-up. The application of digital template could improve the accuracy of the giant condylar tumor resection and help to preserve the uninvolved condyle. The use of digital template could reduce injuries to the nerves and vessels as well as save time for the operation.
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Berkeley Lab - Materials Sciences Division
; Finance Templates Travel One-Stop Acknowledging MSD Support Human Resources Facilities & Space Planning Procurement and Property Proposals & Finance Templates Travel Travel This page has been moved
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Remedial training for the radiology resident: a template for optimization of the learning plan.
Mar, Colin; Chang, Silvia; Forster, Bruce
2015-02-01
All radiology residency programs should strive for the early identification of individuals in need of remedial training and have an approach ready to address this situation. This article provides a template for a step-by-step approach which is team based. It includes definition of the learning or performance issues, creation of suitable learning objectives and learning plan, facilitation of feedback and assessment, and definition of outcomes. Using such a template will assist the resident in returning to the path toward a safe and competent radiologist. Copyright © 2015 AUR. Published by Elsevier Inc. All rights reserved.
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This is a charter template which includes decisions made during the project planning phase, as well as local project goals, a communication strategy, an outreach strategy, distribution of responsibilities and a schedule.
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76 FR 44006 - Information Collection Being Reviewed by the Federal Communications Commission
Federal Register 2010, 2011, 2012, 2013, 2014
2011-07-22
...) Attachment 1--Community Mental Health Center Verification Template; (2) Attachment 2--Invoice Template; (3... community's ability to provide a rapid and coordinated response in the event of a public health crisis.... Title: Universal Service--Rural Health Care Program/Rural Health Care Pilot Program. Form Nos.: FCC...
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Jamjoom, Faris Z; Kim, Do-Gyoon; Lee, Damian J; McGlumphy, Edwin A; Yilmaz, Burak
2018-02-05
Effects of length and location of the edentulous area on the accuracy of prosthetic treatment plan incorporation into cone-beam computed tomography (CBCT) scans has not been investigated. To evaluate the effect of length and location of the edentulous area on the accuracy of prosthetic treatment plan incorporation into CBCT scans using different methods. Direct digital scans of a completely dentate master model with removable radiopaque teeth were made using an intraoral scanner, and digital scans of stone duplicates of the master model were made using a laboratory scanner. Specific teeth were removed to simulate different clinical situations and their CBCT scans were made. Surface scans were registered onto the CBCT scans. Radiographic templates for each clinical situation were also fabricated and used during CBCT scans of the master models. Using metrology software, three-dimensional (3D) deviation was measured on standard tesselation language (STL) files created from the CBCT scans against an STL file of the master model created from a CBCT scan. Statistical analysis was done using the MIXED procedure in a statistical software and Tukey HSD test (α =.05). The interaction between location and method was significant (P = .009). Location had no significant effect on registration methods (P > .05), but on the radiographic templates (P = .011). Length of the edentulous area did not have any significant effect (P > .05). Accuracy of digital image registration methods was similar and higher than that of radiographic templates in all clinical situations. Tooth-bound radiographic templates were significantly more accurate than the free-end templates. The results of this study suggest using image registration instead of radiographic templates when planning dental implants, particularly in free-end situations. © 2018 Wiley Periodicals, Inc.
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Heeke, Sheila; Wood, Felecia; Schuck, Jennifer
2014-01-01
A task force at a multihospital health care system partnered with home health agencies to improve gaps during the discharge transition process. A standardized order template for home health nursing and remote telemonitoring was developed to decrease discrepancies in communication between hospital health care providers and home health nurses caring for patients with heart failure. Pilot results showed significantly improved communication with no readmissions, using the order template.
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Divall, Bernie; Spiby, Helen; Nolan, Mary; Slade, Pauline
2017-11-01
To explore women's views of birth plans, and experiences of their completion and use. A qualitative, descriptive study, using Internet-mediated research methods. The discussion boards of two well-known, UK-based, online parenting forums, where a series of questions relating to birth plans were posted. Members of the selected parenting forums who had written and used, or who had chosen not to write or use, a birth plan. Women responded with a range of views and experiences relating to the completion and use of birth plans. The benefits of birth plans were described in terms of communication with healthcare professionals, potentially enhancing awareness of available options, and maintaining a sense of control during labour and birth. However, many respondents believed the idea of 'planning' birth was problematic, and described a reluctance to write a formal plan. The support of healthcare professionals, particularly midwives, was considered essential to the success of both writing and using birth plans. Our findings show a continued debate among women on the benefits and challenges involved in writing and using birth plans, suggesting problems for a 'one size fits all' approach often seen in the use of birth plan templates. In the context of maternity policy supporting women's choice and personalised care, and as a way of acknowledging perceived problems of 'planning' for birth, a flexible approach to birth plans is required, including the consideration of employing alternative nomenclature. Birth plans remain a point of contention in care contexts around the world. Midwives and other healthcare providers play a central role in supporting women to discuss available options, whether or not they decide to complete a formal birth plan. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Kolls, Brad J; Olson, Daiwai M; Gallentine, William B; Skeen, Mark B; Skidmore, Christopher T; Sinha, Saurabh R
2012-02-01
The purpose of this study was to compare the quality of the electroencephalographic (EEG) data obtained with a BraiNet template in a practical use setting, to that obtained with standard 10/20 spaced, technologist-applied, collodion-based disk leads. Pairs of 8-hour blocks of EEG data were prospectively collected from 32 patients with a Glasgow coma score of ≤9 and clinical concern for underlying nonconvulsive status epilepticus over a 6-month period in the Neurocritical Care Unit at the Duke University Medical Center. The studies were initiated with the BraiNet template system applied by critical care nurse practitioners or physicians, followed by standard, collodion leads applied by registered technologists using the 10/20 system of placement. Impedances were measured at the beginning and end of each block recorded and variance in impedance, mean impedance, and the largest differences in impedances found within a given lead set were compared. Physicians experienced in reading EEG performed a masked review of the EEG segments obtained to assess the subjective quality of the recordings obtained with the templates. We found no clinically significant differences in the impedance measures. There was a 3-hour reduction in the time required to initiate EEG recording using the templates (P < 0.001). There was no difference in the overall subjective quality distributions for template-applied versus technologist-applied EEG leads. The templates were also found to be well accepted by the primary users in the intensive care unit. The findings suggest that the EEG data obtained with this approach are comparable with that obtained by registered technologist-applied leads and represents a possible solution to the growing clinical need for continuous EEG recording availability in the critical care setting.
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Chae, Michael P; Hunter-Smith, David J; Rostek, Marie; Smith, Julian A; Rozen, Warren Matthew
2018-01-01
Optimizing preoperative planning is widely sought in deep inferior epigastric artery perforator (DIEP) flap surgery. One reason for this is that rates of fat necrosis remain relatively high (up to 35%), and that adjusting flap design by an improved understanding of individual perforasomes and perfusion characteristics may be useful in reducing the risk of fat necrosis. Imaging techniques have substantially improved over the past decade, and with recent advances in 3D printing, an improved demonstration of imaged anatomy has become available. We describe a 3D-printed template that can be used preoperatively to mark out a patient's individualized perforasome for flap planning in DIEP flap surgery. We describe this "perforasome template" technique in a case of a 46-year-old woman undergoing immediate unilateral breast reconstruction with a DIEP flap. Routine preoperative computed tomographic angiography was performed, with open-source software (3D Slicer, Autodesk MeshMixer and Cura) and a desktop 3D printer (Ultimaker 3E) used to create a template used to mark intra-flap, subcutaneous branches of deep inferior epigastric artery (DIEA) perforators on the abdomen. An individualized 3D printed template was used to estimate the size and boundaries of a perforasome and perfusion map. The information was used to aid flap design. We describe a new technique of 3D printing a patient-specific perforasome template that can be used preoperatively to infer perforasomes and aid flap design.
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Data for decision making: strategic information tools for hospital management during a pandemic.
Farias, Daniel R; Raffo, Lucrecia; Bacigalupo, Silvia; Cremaschi, Maria; Vence, Liliana; Ramos, Susana; Salguero, Ana; Claudio, Martin; Meites, Elissa; Cubito, Alejandro
2010-10-01
During the 2009 influenza A (H1N1) pandemic, Argentina's Hospital Nacional Profesor Alejandro Posadas, a referral center in the capital province of Buenos Aires, treated a large urban patient population. Beginning in April, after severe influenza had been reported in North America but before any suspected cases of H1N1 had been reported in Argentina, the authors formed a pandemic planning committee to direct our hospital's response. An important strategy of the management team was to create a single daily monitoring tool that could integrate multiple information sources. We describe our pandemic planning strategy so that it may serve as a template for other hospitals. We describe our integrated data management system and the indicators it measured. We also describe the iterative process used to develop these tools and the current versions we use in surveillance for possible new waves of pandemic influenza. We present 3 examples of strategic decision making applied to data from our integrated information system. Daily pandemic surveillance data motivated the planning committee to reallocate hospital resources to care for patients during the peak pandemic period. This report illustrates the importance of pandemic planning and advanced integrated information tools for management of a health care facility during a pandemic.
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Loeslie, Vicki; Abcejo, Ma Sunnimpha; Anderson, Claudia; Leibenguth, Emily; Mielke, Cathy; Rabatin, Jeffrey
Substantial evidence in critical care literature identifies a lack of quality and quantity of communication between patients, families, and clinicians while in the intensive care unit. Barriers include time, multiple caregivers, communication skills, culture, language, stress, and optimal meeting space. For patients who are chronically critically ill, the need for a structured method of communication is paramount for discussion of goals of care. The objective of this quality improvement project was to identify barriers to communication, then develop, implement, and evaluate a process for semistructured family meetings in a 9-bed respiratory care unit. Using set dates and times, family meetings were offered to patients and families admitted to the respiratory care unit. Multiple avenues of communication were utilized to facilitate attendance. Utilizing evidence-based family meeting literature, a guide for family meetings was developed. Templates were developed for documentation of the family meeting in the electronic medical record. Multiple communication barriers were identified. Frequency of family meeting occurrence rose from 31% to 88%. Staff satisfaction with meeting frequency, meeting length, and discussion of congruent goals of care between patient/family and health care providers improved. Patient/family satisfaction with consistency of message between team members; understanding of medications, tests, and dismissal plan; and efficacy to address their concerns with the medical team improved. This quality improvement project was implemented to address the communication gap in the care of complex patients who require prolonged hospitalizations. By identifying this need, engaging stakeholders, and developing a family meeting plan to meet to address these needs, communication between all members of the patient's care team has improved.
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Hsu, Sam Sheng-Pin; Gateno, Jaime; Bell, R. Bryan; Hirsch, David L.; Markiewicz, Michael R.; Teichgraeber, John F.; Zhou, Xiaobo; Xia, James J.
2012-01-01
Purpose The purpose of this prospective multicenter study was to assess the accuracy of a computer-aided surgical simulation (CASS) protocol for orthognathic surgery. Materials and Methods The accuracy of the CASS protocol was assessed by comparing planned and postoperative outcomes of 65 consecutive patients enrolled from 3 centers. Computer-generated surgical splints were used for all patients. For the genioplasty, one center utilized computer-generated chin templates to reposition the chin segment only for patients with asymmetry. Standard intraoperative measurements were utilized without the chin templates for the remaining patients. The primary outcome measurements were linear and angular differences for the maxilla, mandible and chin when the planned and postoperative models were registered at the cranium. The secondary outcome measurements were: maxillary dental midline difference between the planned and postoperative positions; and linear and angular differences of the chin segment between the groups with and without the use of the template. The latter was measured when the planned and postoperative models were registered at mandibular body. Statistical analyses were performed, and the accuracy was reported using root mean square deviation (RMSD) and Bland and Altman's method for assessing measurement agreement. Results In the primary outcome measurements, there was no statistically significant difference among the 3 centers for the maxilla and mandible. The largest RMSD was 1.0mm and 1.5° for the maxilla, and 1.1mm and 1.8° for the mandible. For the chin, there was a statistically significant difference between the groups with and without the use of the chin template. The chin template group showed excellent accuracy with largest positional RMSD of 1.0mm and the largest orientational RSMD of 2.2°. However, larger variances were observed in the group not using the chin template. This was significant in anteroposterior and superoinferior directions, as in pitch and yaw orientations. In the secondary outcome measurements, the RMSD of maxillary dental midline positions was 0.9mm. When registered at the body of the mandible, the linear and angular differences of the chin segment between the groups with and without the use of the chin template were consistent with the results found in the primary outcome measurements. Conclusion Using the CASS protocol, the computerized plan can be accurately and consistently transferred to the patient to position the maxilla and mandible at the time of surgery. The computer-generated chin template provides more accuracy in repositioning the chin segment than the intraoperative measurements. PMID:22695016
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Federal Register 2010, 2011, 2012, 2013, 2014
2011-09-22
... Mental Health Center Verification Template; (2) Attachment 2--Invoice Template; (3) Attachment 3--FCC.... SUPPLEMENTARY INFORMATION: OMB Control Number: 3060-0804. Title: Universal Service--Rural Health Care Program/Rural Health Care Pilot Program. Form No.: FCC Forms 465, 466, 466-A and 467. Type of Review: Revision...
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Weighing the evidence: trends in managed care formulary decision making.
de Lissovoy, Gregory
2003-01-01
Health plans, pharmacy benefit managers, and other organizations use drug formularies to promote quality care while controlling costs. However, restrictive formularies are often viewed as constraints on physician practice and potential barriers to optimal patient care. Reluctance to add new drugs to an established formulary is rational economic behavior. Innovative compounds may have unknown properties with uncertain outcomes and therefore may impose costs in the form of risk. Products that seemingly duplicate drugs already on formulary may increase transaction costs without additional benefit. In evaluating new products, formulary managers face the task of identifying, assembling, and synthesizing a wide range of complex information. Manufacturers, who may be in the best position to supply that information, have been severely restricted by U.S. Food and Drug Administration (FDA) regulations that limited marketing communications to findings from well-controlled clinical trials. The FDA Modernization Act of 1997 eased these restrictions somewhat by acknowledging that sophisticated purchasers such as organized health plans were capable of weighing the quality and impartiality of manufacturer-supplied evidence. The Academy of Managed Care Pharmacy (AMCP) created a standardized template that formularies can use to request comprehensive information about specific drugs from manufacturers. Widespread adoption of the AMCP format by health plans and manufacturers will greatly increase access to information about new drugs, speeding the process of formulary committee deliberation, and instilling greater confidence in the outcome of those decisions. Wider access to new drugs may result.
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Creating a culture of professional development: a milestone pathway tool for registered nurses.
Cooper, Elizabeth
2009-11-01
The nursing shortage continues to be a significant threat to health care. Creating a culture of professional development in health care institutions is one way to combat this shortage. Professional development refers to a constant commitment to maintain one's knowledge and skill base. Increasing professional development opportunities in the health care setting has been shown to affect nurse retention and satisfaction. Several approaches have been developed to increase professional development among nurses. However, for the most part, these are "one size fits all" approaches that direct nurses to progress in lock step fashion in skill and knowledge acquisition within a specialty. This article introduces a milestone pathway tool for registered nurses designed to enhance professional development that is unique to the individual nurse and the specific nursing unit. This tool provides a unit-specific concept map, a milestone pathway template, and a personal professional development plan. Copyright 2009, SLACK Incorporated.
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NASA Technical Reports Server (NTRS)
Vairo, Daniel M.
1998-01-01
The removal and installation of sting-mounted wind tunnel models in the National Transonic Facility (NTF) is a multi-task process having a large impact on the annual throughput of the facility. Approximately ten model removal and installation cycles occur annually at the NTF with each cycle requiring slightly over five days to complete. The various tasks of the model changeover process were modeled in Microsoft Project as a template to provide a planning, tracking, and management tool. The template can also be used as a tool to evaluate improvements to this process. This document describes the development of the template and provides step-by-step instructions on its use and as a planning and tracking tool. A secondary role of this document is to provide an overview of the model changeover process and briefly describe the tasks associated with it.
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Berkley, Holly; Barnes, Matthew; Carnahan, David; Hayhurst, Janet; Bockhorst, Archie; Neville, James
2017-03-01
To describe the use of template-based screening for risk of infectious disease exposure of patients presenting to primary care medical facilities during the 2014 West African Ebola virus outbreak. The Military Health System implemented an Ebola risk-screening tool in primary care settings in order to create early notifications and early responses to potentially infected persons. Three time-sensitive, evidence-based screening questions were developed and posted to Tri-Service Workflow (TSWF) AHLTA templates in conjunction with appropriate training. Data were collected in January 2015, to assess the adoption of the TSWF-based Ebola risk-screening tool. Among encounters documented using TSWF templates, 41% of all encounters showed use of the TSWF-based Ebola risk-screening questions by the fourth day. The screening rate increased over the next 3 weeks, and reached a plateau at approximately 50%. This report demonstrates the MHS capability to deploy a standardized, globally applicable decision support aid that could be seen the same day by all primary care clinics across the military health direct care system, potentially improving rapid compliance with screening directives. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.
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Zehnder, M S; Connert, T; Weiger, R; Krastl, G; Kühl, S
2016-10-01
To present a novel method utilizing 3D printed templates to gain guided access to root canals and to evaluate its accuracy in vitro. Sixty extracted human teeth were placed into six maxillary jaw models. Preoperative CBCT scans were matched with intra-oral scans using the coDiagnostix(™) software. Access cavities, sleeves and templates for guidance were virtually planned. Templates were produced by a 3D printer. After access cavity preparation by two operators, a postoperative CBCT scan was superimposed on the virtual planning. Accuracy was measured by calculating the deviation of planned and prepared cavities in three dimensions and angle. Ninety-five per cent confidence intervals were calculated for both operators. All root canals were accessible after cavity preparation with 'Guided Endodontics'. Deviations of planned and prepared access cavities were low with means ranging from 0.16 to 0.21 mm for different aspects at the base of the bur and 0.17-0.47 mm at the tip of the bur. Mean of angle deviation was 1.81°. Overlapping 95% confidence intervals revealed no significant difference between operators. 'Guided Endodontics' allowed an accurate access cavity preparation up to the apical third of the root utilizing printed templates for guidance. All root canals were accessible after preparation. © 2015 International Endodontic Journal. Published by John Wiley & Sons Ltd.
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Chloropicrin Fumigant Management Plan Phase 2 Templates
These forms provide a framework for detailing the FMP elements of pesticide products containing the active ingredient chloropicrin, including application block, buffer zones, emergency response plan, tarp plan, soil conditions, and air monitoring.
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Options in virtual 3D, optical-impression-based planning of dental implants.
Reich, Sven; Kern, Thomas; Ritter, Lutz
2014-01-01
If a 3D radiograph, which in today's dentistry often consists of a CBCT dataset, is available for computerized implant planning, the 3D planning should also consider functional prosthetic aspects. In a conventional workflow, the CBCT is done with a specially produced radiopaque prosthetic setup that makes the desired prosthetic situation visible during virtual implant planning. If an exclusively digital workflow is chosen, intraoral digital impressions are taken. On these digital models, the desired prosthetic suprastructures are designed. The entire datasets are virtually superimposed by a "registration" process on the corresponding structures (teeth) in the CBCTs. Thus, both the osseous and prosthetic structures are visible in one single 3D application and make it possible to consider surgical and prosthetic aspects. After having determined the implant positions on the computer screen, a drilling template is designed digitally. According to this design (CAD), a template is printed or milled in CAM process. This template is the first physically extant product in the entire workflow. The article discusses the options and limitations of this workflow.
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Hsu, Sam Sheng-Pin; Gateno, Jaime; Bell, R Bryan; Hirsch, David L; Markiewicz, Michael R; Teichgraeber, John F; Zhou, Xiaobo; Xia, James J
2013-01-01
The purpose of this prospective multicenter study was to assess the accuracy of a computer-aided surgical simulation (CASS) protocol for orthognathic surgery. The accuracy of the CASS protocol was assessed by comparing planned outcomes with postoperative outcomes of 65 consecutive patients enrolled from 3 centers. Computer-generated surgical splints were used for all patients. For the genioplasty, 1 center used computer-generated chin templates to reposition the chin segment only for patients with asymmetry. Standard intraoperative measurements were used without the chin templates for the remaining patients. The primary outcome measurements were the linear and angular differences for the maxilla, mandible, and chin when the planned and postoperative models were registered at the cranium. The secondary outcome measurements were the maxillary dental midline difference between the planned and postoperative positions and the linear and angular differences of the chin segment between the groups with and without the use of the template. The latter were measured when the planned and postoperative models were registered at the mandibular body. Statistical analyses were performed, and the accuracy was reported using root mean square deviation (RMSD) and the Bland-Altman method for assessing measurement agreement. In the primary outcome measurements, there was no statistically significant difference among the 3 centers for the maxilla and mandible. The largest RMSDs were 1.0 mm and 1.5° for the maxilla and 1.1 mm and 1.8° for the mandible. For the chin, there was a statistically significant difference between the groups with and without the use of the chin template. The chin template group showed excellent accuracy, with the largest positional RMSD of 1.0 mm and the largest orientation RMSD of 2.2°. However, larger variances were observed in the group not using the chin template. This was significant in the anteroposterior and superoinferior directions and the in pitch and yaw orientations. In the secondary outcome measurements, the RMSD of the maxillary dental midline positions was 0.9 mm. When registered at the body of the mandible, the linear and angular differences of the chin segment between the groups with and without the use of the chin template were consistent with the results found in the primary outcome measurements. Using this computer-aided surgical simulation protocol, the computerized plan can be transferred accurately and consistently to the patient to position the maxilla and mandible at the time of surgery. The computer-generated chin template provides greater accuracy in repositioning the chin segment than the intraoperative measurements. Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.
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Tuli, Sanjeev Y; Thompson, Lindsay A; Ryan, Kathleen A; Srinivas, Ganga L; Fillipps, Donald J; Young, Christopher M; Tuli, Sonal S
2010-06-01
To evaluate the impact of advanced access scheduling in a pediatric residency clinic on resident and patient satisfaction, medical education, practice quality, and efficiency. Residents were assigned to either the advanced access template (10 appointments available to patients and 2 physician overbooks) or the prior template (5 available and 8 overbooks). Outcomes included resident and patient satisfaction, appointment availability, and continuity of care and clinic costs. Patient satisfaction improved in 7 areas (P < .001). Residents in either template did not report an impact on medical education experiences. Significant increases were realized with appointment availability and the number of patients seen. Continuity also increased as the overflow/acute visits decreased (P < .001). Overall costs per visit decreased 22%. Because of the significant improvements in access, continuity, and efficiency, all residents were switched to the advanced access template after completion of the study. Improvement in access to the primary physician has a significant impact on patient satisfaction with health care delivery. This model optimizes the limited time that residents have in continuity clinic, and it has implications for health care delivery quality improvement.
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Hunter-Smith, David J.; Rostek, Marie; Smith, Julian A.; Rozen, Warren Matthew
2018-01-01
Summary: Optimizing preoperative planning is widely sought in deep inferior epigastric artery perforator (DIEP) flap surgery. One reason for this is that rates of fat necrosis remain relatively high (up to 35%), and that adjusting flap design by an improved understanding of individual perforasomes and perfusion characteristics may be useful in reducing the risk of fat necrosis. Imaging techniques have substantially improved over the past decade, and with recent advances in 3D printing, an improved demonstration of imaged anatomy has become available. We describe a 3D-printed template that can be used preoperatively to mark out a patient’s individualized perforasome for flap planning in DIEP flap surgery. We describe this “perforasome template” technique in a case of a 46-year-old woman undergoing immediate unilateral breast reconstruction with a DIEP flap. Routine preoperative computed tomographic angiography was performed, with open-source software (3D Slicer, Autodesk MeshMixer and Cura) and a desktop 3D printer (Ultimaker 3E) used to create a template used to mark intra-flap, subcutaneous branches of deep inferior epigastric artery (DIEA) perforators on the abdomen. An individualized 3D printed template was used to estimate the size and boundaries of a perforasome and perfusion map. The information was used to aid flap design. We describe a new technique of 3D printing a patient-specific perforasome template that can be used preoperatively to infer perforasomes and aid flap design. PMID:29464169
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Chloropicrin and 1,3-D Fumigant Management Plan Phase 2 Templates
Plans for soil fumigant pesticide products that contain chloropicrin or 1,3-dichloropropene should include application block information, tarp plan, sign posting for treated area and buffer zone, and other requirements.
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Rethinking the Educator Portfolio: An Innovative Criteria-Based Model.
Shinkai, Kanade; Chen, Chen Amy; Schwartz, Brian S; Loeser, Helen; Ashe, Cynthia; Irby, David M
2017-11-07
Academic medical centers struggle to achieve parity in advancement and promotions between educators and discovery-oriented researchers in part because of narrow definitions of scholarship, lack of clear criteria for measuring excellence, and barriers to making educational contributions available for peer review. Despite recent progress in expanding scholarship definitions and identifying excellence criteria, these advances are not integrated into educator portfolio (EP) templates or curriculum vitae platforms. From 2013 to 2015, a working group from the Academy of Medical Educators (AME) at the University of California, San Francisco (UCSF) designed a streamlined, criteria-based EP (EP 2.0) template highlighting faculty members' recent activities in education and setting rigorous evaluation methods to enable educational scholarship to be objectively evaluated for academic advancement, AME membership, and professional development. The EP 2.0 template was integrated into the AME application, resulting in high overall satisfaction among candidates and the selection committee and positive feedback on the template's transparency, ease of use, and streamlined format. In 2016, the EP 2.0 template was integrated into the campus-wide curriculum vitae platform and academic advancement system. The authors plan to increase awareness of the EP 2.0 template by educating promotions committees and faculty at UCSF and partnering with other institutions to disseminate it for use. They also plan to study the impact of the template on supporting educators by making their important scholarly contributions available for peer review, providing guidance for professional development, and decreasing disparities in promotions.
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A semi-automatic computer-aided method for surgical template design
NASA Astrophysics Data System (ADS)
Chen, Xiaojun; Xu, Lu; Yang, Yue; Egger, Jan
2016-02-01
This paper presents a generalized integrated framework of semi-automatic surgical template design. Several algorithms were implemented including the mesh segmentation, offset surface generation, collision detection, ruled surface generation, etc., and a special software named TemDesigner was developed. With a simple user interface, a customized template can be semi- automatically designed according to the preoperative plan. Firstly, mesh segmentation with signed scalar of vertex is utilized to partition the inner surface from the input surface mesh based on the indicated point loop. Then, the offset surface of the inner surface is obtained through contouring the distance field of the inner surface, and segmented to generate the outer surface. Ruled surface is employed to connect inner and outer surfaces. Finally, drilling tubes are generated according to the preoperative plan through collision detection and merging. It has been applied to the template design for various kinds of surgeries, including oral implantology, cervical pedicle screw insertion, iliosacral screw insertion and osteotomy, demonstrating the efficiency, functionality and generality of our method.
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A semi-automatic computer-aided method for surgical template design
Chen, Xiaojun; Xu, Lu; Yang, Yue; Egger, Jan
2016-01-01
This paper presents a generalized integrated framework of semi-automatic surgical template design. Several algorithms were implemented including the mesh segmentation, offset surface generation, collision detection, ruled surface generation, etc., and a special software named TemDesigner was developed. With a simple user interface, a customized template can be semi- automatically designed according to the preoperative plan. Firstly, mesh segmentation with signed scalar of vertex is utilized to partition the inner surface from the input surface mesh based on the indicated point loop. Then, the offset surface of the inner surface is obtained through contouring the distance field of the inner surface, and segmented to generate the outer surface. Ruled surface is employed to connect inner and outer surfaces. Finally, drilling tubes are generated according to the preoperative plan through collision detection and merging. It has been applied to the template design for various kinds of surgeries, including oral implantology, cervical pedicle screw insertion, iliosacral screw insertion and osteotomy, demonstrating the efficiency, functionality and generality of our method. PMID:26843434
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A semi-automatic computer-aided method for surgical template design.
Chen, Xiaojun; Xu, Lu; Yang, Yue; Egger, Jan
2016-02-04
This paper presents a generalized integrated framework of semi-automatic surgical template design. Several algorithms were implemented including the mesh segmentation, offset surface generation, collision detection, ruled surface generation, etc., and a special software named TemDesigner was developed. With a simple user interface, a customized template can be semi- automatically designed according to the preoperative plan. Firstly, mesh segmentation with signed scalar of vertex is utilized to partition the inner surface from the input surface mesh based on the indicated point loop. Then, the offset surface of the inner surface is obtained through contouring the distance field of the inner surface, and segmented to generate the outer surface. Ruled surface is employed to connect inner and outer surfaces. Finally, drilling tubes are generated according to the preoperative plan through collision detection and merging. It has been applied to the template design for various kinds of surgeries, including oral implantology, cervical pedicle screw insertion, iliosacral screw insertion and osteotomy, demonstrating the efficiency, functionality and generality of our method.
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Hunter, Paulette V; Kaasalainen, Sharon; Froggatt, Katherine A; Ploeg, Jenny; Dolovich, Lisa; Simard, Joyce; Salsali, Mahvash
2017-10-01
Higher acuity of care at the time of admission to long-term care (LTC) is resulting in a shorter period to time of death, yet most LTC homes in Canada do not have formalized approaches to palliative care. Namaste Care is a palliative care approach specifically tailored to persons with advanced cognitive impairment who are living in LTC. The purpose of this study was to employ the ecological framework to identify barriers and enablers to an implementation of Namaste Care. Six group interviews were conducted with families, unlicensed staff, and licensed staff at two Canadian LTC homes that were planning to implement Namaste Care. None of the interviewees had prior experience implementing Namaste Care. The resulting qualitative data were analyzed using a template organizing approach. We found that the strongest implementation enablers were positive perceptions of need for the program, benefits of the program, and fit within a resident-centred or palliative approach to care. Barriers included a generally low resource base for LTC, the need to adjust highly developed routines to accommodate the program, and reliance on a casual work force. We conclude that within the Canadian LTC system, positive perceptions of Namaste Care are tempered by concerns about organizational capacity to support new programming.
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Collett, Gemma K; Brown, Clare M; Shaw, Tim J; White, Kahren M; Beale, Philip J; Anderiesz, Cleola; Barnes, David J
2017-01-01
Objectives Few interventions have been designed that provide standardised information to primary care clinicians about the diagnostic and treatment recommendations resulting from cancer multidisciplinary team (MDT) (tumour board) meetings. This study aimed to develop, implement and evaluate a standardised template for lung cancer MDTs to provide clinical information and treatment recommendations to general practitioners (GPs). Specific objectives were to (1) evaluate template feasibility (acceptability, appropriateness and timeliness) with GPs and (2) document processes of preimplementation, implementation and evaluation within the MDT setting. Design A mixed-method study design using structured interviews with GPs and qualitative documentation of project logs about implementation processes. Setting Two hospitals in Central Sydney, New South Wales, Australia. Participants: 61 GPs evaluated the template. Two lung cancer MDTs, consisting of 33 clinicians, and eight researchers participated in template development and implementation strategy. Results The MDT-reporting template appears to be a feasible way of providing clinical information to GPs following patient presentation at a lung cancer MDT meeting. Ninety-five per cent of GPs strongly agreed or agreed that the standardised template provided useful and relevant information, that it was received in a timely manner (90%) and that the information was easy to interpret and communicate to the patient (84%). Implementation process data show that the investment made in the preimplementation stage to integrate the template into standard work practices was a critical factor in successful implementation. Conclusions This study demonstrates that it is feasible to provide lung cancer MDT treatment recommendations to GPs through implementation of a standardised template. A simple intervention, such as a standardised template, can help to address quality gaps and ensure that timely information is communicated between tertiary and primary care healthcare providers. PMID:29288182
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Developing a Strategic Plan for Transitioning to Healthcare Knowledge Services Centers (HKSCs)
Goldstein, H. Mark; Coletti, Margaret H.
2012-01-01
Facing a negative trend in the form of downsizing, layoffs, and closures, a small committee of hospital librarians in New England was formed in 2004 to provide library advocacy. Between 2008 and 2010, 23 hospital libraries closed in New England. In 2010, the committee shifted its focus from advocacy to a platform for change. This resulted in the creation of the Healthcare Knowledge Services Center (HKSC) Template. The Template is the basis for a 3-phased, 5-year strategic plan to establish several regional pilots, transitioning traditional hospital libraries to healthcare knowledge services centers. This article focuses on Phase One of the strategic plan, Development. PMID:23125551
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Zhang, Nan; Liu, Shuguang; Hu, Zhiai; Hu, Jing; Zhu, Songsong; Li, Yunfeng
2016-08-01
This study aims to evaluate the accuracy of virtual surgical planning in two-jaw orthognathic surgery via quantitative comparison of preoperative planned and postoperative actual skull models. Thirty consecutive patients who required two-jaw orthognathic surgery were included. A composite skull model was reconstructed by using Digital Imaging and Communications in Medicine (DICOM) data from spiral computed tomography (CT) and STL (stereolithography) data from surface scanning of the dental arch. LeFort I osteotomy of the maxilla and bilateral sagittal split ramus osteotomy (of the mandible were simulated by using Dolphin Imaging 11.7 Premium (Dolphin Imaging and Management Solutions, Chatsworth, CA). Genioplasty was performed, if indicated. The virtual plan was then transferred to the operation room by using three-dimensional (3-D)-printed surgical templates. Linear and angular differences between virtually simulated and postoperative skull models were evaluated. The virtual surgical planning was successfully transferred to actual surgery with the help of 3-D-printed surgical templates. All patients were satisfied with the postoperative facial profile and occlusion. The overall mean linear difference was 0.81 mm (0.71 mm for the maxilla and 0.91 mm for the mandible); and the overall mean angular difference was 0.95 degrees. Virtual surgical planning and 3-D-printed surgical templates facilitated the diagnosis, treatment planning, and accurate repositioning of bony segments in two-jaw orthognathic surgery. Copyright © 2016 Elsevier Inc. All rights reserved.
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Electronic health records and support for primary care teamwork.
O'Malley, Ann S; Draper, Kevin; Gourevitch, Rebecca; Cross, Dori A; Scholle, Sarah Hudson
2015-03-01
Consensus that enhanced teamwork is necessary for efficient and effective primary care delivery is growing. We sought to identify how electronic health records (EHRs) facilitate and pose challenges to primary care teams as well as how practices are overcoming these challenges. Practices in this qualitative study were selected from those recognized as patient-centered medical homes via the National Committee for Quality Assurance 2011 tool, which included a section on practice teamwork. We interviewed 63 respondents, ranging from physicians to front-desk staff, from 27 primary care practices ranging in size, type, geography, and population size. EHRs were found to facilitate communication and task delegation in primary care teams through instant messaging, task management software, and the ability to create evidence-based templates for symptom-specific data collection from patients by medical assistants and nurses (which can offload work from physicians). Areas where respondents felt that electronic medical record EHR functionalities were weakest and posed challenges to teamwork included the lack of integrated care manager software and care plans in EHRs, poor practice registry functionality and interoperability, and inadequate ease of tracking patient data in the EHR over time. Practices developed solutions for some of the challenges they faced when attempting to use EHRs to support teamwork but wanted more permanent vendor and policy solutions for other challenges. EHR vendors in the United States need to work alongside practicing primary care teams to create more clinically useful EHRs that support dynamic care plans, integrated care management software, more functional and interoperable practice registries, and greater ease of data tracking over time. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association.
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Companion Guides for Lesson Planning: A Planning Template and the Lesson Plan Pro Forma
ERIC Educational Resources Information Center
Pang, May
2016-01-01
Jason Anderson's proposal, in "ELT Journal" (2015), for an affordance-based approach to lesson planning raises important issues in teacher education. However, his arguments against the role of planned outcomes in favour of an affordance-based focus using learning opportunities as units of planning fail to acknowledge the complexities…
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Cifuentes, Maribel; Davis, Melinda; Fernald, Doug; Gunn, Rose; Dickinson, Perry; Cohen, Deborah J
2015-01-01
This article describes the electronic health record (EHR)-related experiences of practices striving to integrate behavioral health and primary care using tailored, evidenced-based strategies from 2012 to 2014; and the challenges, workarounds and initial health information technology (HIT) solutions that emerged during implementation. This was an observational, cross-case comparative study of 11 diverse practices, including 8 primary care clinics and 3 community mental health centers focused on the implementation of integrated care. Practice characteristics (eg, practice ownership, federal designation, geographic area, provider composition, EHR system, and patient panel characteristics) were collected using a practice information survey and analyzed to report descriptive information. A multidisciplinary team used a grounded theory approach to analyze program documents, field notes from practice observation visits, online diaries, and semistructured interviews. Eight primary care practices used a single EHR and 3 practices used 2 different EHRs, 1 to document behavioral health and 1 to document primary care information. Practices experienced common challenges with their EHRs' capabilities to 1) document and track relevant behavioral health and physical health information, 2) support communication and coordination of care among integrated teams, and 3) exchange information with tablet devices and other EHRs. Practices developed workarounds in response to these challenges: double documentation and duplicate data entry, scanning and transporting documents, reliance on patient or clinician recall for inaccessible EHR information, and use of freestanding tracking systems. As practices gained experience with integration, they began to move beyond workarounds to more permanent HIT solutions ranging in complexity from customized EHR templates, EHR upgrades, and unified EHRs. Integrating behavioral health and primary care further burdens EHRs. Vendors, in cooperation with clinicians, should intentionally design EHR products that support integrated care delivery functions, such as data documentation and reporting to support tracking patients with emotional and behavioral problems over time and settings, integrated teams working from shared care plans, template-driven documentation for common behavioral health conditions such as depression, and improved registry functionality and interoperability. This work will require financial support and cooperative efforts among clinicians, EHR vendors, practice assistance organizations, regulators, standards setters, and workforce educators. © Copyright 2015 by the American Board of Family Medicine.
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Müller, Birgit S; Shih, Helen A; Efstathiou, Jason A; Bortfeld, Thomas; Craft, David
2017-11-06
The purpose of this study was to demonstrate the feasibility of physician driven planning in intensity modulated radiotherapy (IMRT) with a multicriteria optimization (MCO) treatment planning system and template based plan optimization. Exploiting the full planning potential of MCO navigation, this alternative planning approach intends to improve planning efficiency and individual plan quality. Planning was retrospectively performed on 12 brain tumor and 10 post-prostatectomy prostate patients previously treated with MCO-IMRT. For each patient, physicians were provided with a template-based generated Pareto surface of optimal plans to navigate, using the beam angles from the original clinical plans. We compared physician generated plans to clinically delivered plans (created by dosimetrists) in terms of dosimetric differences, physician preferences and planning times. Plan qualities were similar, however physician generated and clinical plans differed in the prioritization of clinical goals. Physician derived prostate plans showed significantly better sparing of the high dose rectum and bladder regions (p(D1) < 0.05; D1: dose received by 1% of the corresponding structure). Physicians' brain tumor plans indicated higher doses for targets and brainstem (p(D1) < 0.05). Within blinded plan comparisons physicians preferred the clinical plans more often (brain: 6:3 out of 12, prostate: 2:6 out of 10) (not statistically significant). While times of physician involvement were comparable for prostate planning, the new workflow reduced the average involved time for brain cases by 30%. Planner times were reduced for all cases. Subjective benefits, such as a better understanding of planning situations, were observed by clinicians through the insight into plan optimization and experiencing dosimetric trade-offs. We introduce physician driven planning with MCO for brain and prostate tumors as a feasible planning workflow. The proposed approach standardizes the planning process by utilizing site specific templates and integrates physicians more tightly into treatment planning. Physicians' navigated plan qualities were comparable to the clinical plans. Given the reduction of planning time of the planner and the equal or lower planning time of physicians, this approach has the potential to improve departmental efficiencies.
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Berkeley Lab - Materials Sciences Division
MSD Support Human Resources Facilities & Space Planning Procurement and Property Proposals & Planning Procurement and Property Proposals & Finance Templates Travel Procurement and Property This
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Zhang, Shengwei; Arfanakis, Konstantinos
2012-01-01
Purpose To investigate the effect of standardized and study-specific human brain diffusion tensor templates on the accuracy of spatial normalization, without ignoring the important roles of data quality and registration algorithm effectiveness. Materials and Methods Two groups of diffusion tensor imaging (DTI) datasets, with and without visible artifacts, were normalized to two standardized diffusion tensor templates (IIT2, ICBM81) as well as study-specific templates, using three registration approaches. The accuracy of inter-subject spatial normalization was compared across templates, using the most effective registration technique for each template and group of data. Results It was demonstrated that, for DTI data with visible artifacts, the study-specific template resulted in significantly higher spatial normalization accuracy than standardized templates. However, for data without visible artifacts, the study-specific template and the standardized template of higher quality (IIT2) resulted in similar normalization accuracy. Conclusion For DTI data with visible artifacts, a carefully constructed study-specific template may achieve higher normalization accuracy than that of standardized templates. However, as DTI data quality improves, a high-quality standardized template may be more advantageous than a study-specific template, since in addition to high normalization accuracy, it provides a standard reference across studies, as well as automated localization/segmentation when accompanied by anatomical labels. PMID:23034880
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Kleczka, Bernadette; Musiega, Anita; Rabut, Grace; Wekesa, Phoebe; Mwaniki, Paul; Marx, Michael; Kumar, Pratap
2018-06-01
The United Nations' Sustainable Development Goal #3.8 targets 'access to quality essential healthcare services'. Clinical practice guidelines are an important tool for ensuring quality of clinical care, but many challenges prevent their use in low-resource settings. Monitoring the use of guidelines relies on cumbersome clinical audits of paper records, and electronic systems face financial and other limitations. Here we describe a unique approach to generating digital data from paper using guideline-based templates, rubber stamps and mobile phones. The Guidelines Adherence in Slums Project targeted ten private sector primary healthcare clinics serving informal settlements in Nairobi, Kenya. Each clinic was provided with rubber stamp templates to support documentation and management of commonly encountered outpatient conditions. Participatory design methods were used to customize templates to the workflows and infrastructure of each clinic. Rubber stamps were used to print templates into paper charts, providing clinicians with checklists for use during consultations. Templates used bubble format data entry, which could be digitized from images taken on mobile phones. Besides rubber stamp templates, the intervention included booklets of guideline compilations, one Android phone for digitizing images of templates, and one data feedback/continuing medical education session per clinic each month. In this paper we focus on the effect of the intervention on documentation of three non-communicable diseases in one clinic. Seventy charts of patients enrolled in the chronic disease program (hypertension/diabetes, n=867; chronic respiratory diseases, n=223) at one of the ten intervention clinics were sampled. Documentation of each individual patient encounter in the pre-intervention (January-March 2016) and post-intervention period (May-July) was scored for information in four dimensions - general data, patient assessment, testing, and management. Control criteria included information with no counterparts in templates (e.g. notes on presenting complaints, vital signs). Documentation scores for each patient were compared between both pre- and post-intervention periods and between encounters documented with and without templates (post-intervention only). The total number of patient encounters in the pre-intervention (282) and post-intervention periods (264) did not differ. Mean documentation scores increased significantly in the post-intervention period on average by 21%, 24% and 17% for hypertension, diabetes and chronic respiratory diseases, respectively. Differences were greater (47%, 43% and 27%, respectively) when documentation with and without templates was compared. Changes between pre- vs.post-intervention, and with vs.without template, varied between individual dimensions of documentation. Overall, documentation improved more for general data and patient assessment than in testing or management. The use of templates improves paper-based documentation of patient care, a first step towards improving the quality of care. Rubber stamps provide a simple and low-cost method to print templates on demand. In combination with ubiquitously available mobile phones, information entered on paper can be easily and rapidly digitized. This 'frugal innovation' in m-Health can empower small, private sector facilities, where large numbers of urban patients seek healthcare, to generate digital data on routine outpatient care. These data can form the basis for evidence-based quality improvement efforts at large scale, and help deliver on the SDG promise of quality essential healthcare services for all. Copyright © 2017 Elsevier B.V. All rights reserved.
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Deufel, Christopher L; Furutani, Keith M; Dahl, Robert A; Haddock, Michael G
2016-01-01
The ability to create treatment plans for intraoperative high-dose-rate (IOHDR) brachytherapy is limited by lack of imaging and time constraints. An automated method for creation of a library of high-dose-rate brachytherapy plans that can be used with standard planar applicators in the intraoperative setting is highly desirable. Nonnegative least squares algebraic methods were used to identify dwell time values for flat, rectangular planar applicators. The planar applicators ranged in length and width from 2 cm to 25 cm. Plans were optimized to deliver an absorbed dose of 10 Gy to three different depths from the patient surface: 0 cm, 0.5 cm, and 1.0 cm. Software was written to calculate the optimized dwell times and insert dwell times and positions into a .XML plan template that can be imported into the Varian brachytherapy treatment planning system. The user may import the .XML template into the treatment planning system in the intraoperative setting to match the patient applicator size and prescribed treatment depth. A total of 1587 library plans were created for IOHDR brachytherapy. Median plan generation time was approximately 1 minute per plan. Plan dose was typically 100% ± 1% (mean, standard deviation) of the prescribed dose over the entire length and width of the applicator. Plan uniformity was best for prescription depths of 0 cm and 0.5 cm from the patient surface. An IOHDR plan library may be created using automated methods. Thousands of plan templates may be optimized and prepared in a few hours to accommodate different applicator sizes and treatment depths and reduce treatment planning time. The automated method also enforces dwell time symmetry for symmetrical applicator geometries, which simplifies quality assurance. Copyright © 2016 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.
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Effective communication of molecular genetic test results to primary care providers.
Scheuner, Maren T; Edelen, Maria Orlando; Hilborne, Lee H; Lubin, Ira M
2013-06-01
We evaluated a template for molecular genetic test reports that was developed as a strategy to reduce communication errors between the laboratory and ordering clinician. We surveyed 1,600 primary care physicians to assess satisfaction, ease of use, and effectiveness of genetic test reports developed using our template and reports developed by clinical laboratories. Mean score differences of responses between the reports were compared using t-tests. Two-way analysis of variance evaluated the effect of template versus standard reports and the influence of physician characteristics. There were 396 (24%) respondents. Template reports had higher scores than the standard reports for each survey item. The gender and specialty of the physician did not influence scores; however, younger physicians gave higher scores regardless of report type. There was significant interaction between report type and whether physicians ordered or reviewed any genetic tests (none versus at least one) in the past year, P = 0.005. For each survey item assessing satisfaction, ease of use, and effectiveness, physicians gave higher ratings to genetic test reports developed with the template than standard reports used by clinical laboratories. Physicians least familiar with genetic test reports, and possibly having the greatest need for better communication, were best served by the template reports.
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Lesson Plans: Road Maps for the Active Learning Classroom.
Moore-Cox, Annie
2017-11-01
Lesson planning is a documentation process used extensively in education from kindergarten through 12th grade, but rarely in higher education, including undergraduate, prelicensure nursing education. Lesson plans help teachers plan what will happen during a class period from moment to moment. Trends in nursing education, such as the incorporation of active learning strategies in the classroom, make lesson plans a timely addition to the nurse educator's toolkit. This article describes the components of a lesson plan and offers an author-developed template for use in nursing education. Using the template helps nurse educators map out activities for all class participants, such as students, student pairs and teams, and faculty. The lesson plan enables faculty to plot out the many dynamic components of an active learning class period. It also serves as a road map for subsequent faculty, which is an important feature as the profession faces a wave of retirements in the coming decade. [J Nurs Educ. 2017;56(11):697-700.]. Copyright 2017, SLACK Incorporated.
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Introduction to Sample Plan Package for Farms
An example of a completed and self-certified Tier I Qualified Facility SPCC Plan using the template found in Appendix G of the SPCC rule (40 CFR part 112). This example illustrates how to develop an SPCC Plan using a farm scenario.
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Introduction to Soil Fumigant Management Plans
Soil fumigant pesticide labels require users to prepare a site-specific fumigation management plan (FMP) before the application begins. EPA has developed templates that outline the elements required by the labels.
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Using Arden Syntax for the Generation of Intelligent Intensive Care Discharge Letters.
Kraus, Stefan; Castellanos, Ixchel; Albermann, Matthias; Schuettler, Christina; Prokosch, Hans-Ulrich; Staudigel, Martin; Toddenroth, Dennis
2016-01-01
Discharge letters are an important means of communication between physicians and nurses from intensive care units and their colleagues from normal wards. The patient data management system (PDMS) used at our local intensive care units provides an export tool to create discharge letters by inserting data items from electronic medical records into predefined templates. Local intensivists criticized the limitations of this tool regarding the identification and the further processing of clinically relevant data items for a flexible creation of discharge letters. As our PDMS supports Arden Syntax, and the demanded functionalities are well within the scope of this standard, we set out to investigate the suitability of Arden Syntax for the generation of discharge letters. To provide an easy-to-understand facility for integrating data items into document templates, we created an Arden Syntax interface function which replaces the names of previously defined variables with their content in a way that permits arbitrary custom formatting by clinical users. Our approach facilitates the creation of flexible text sections by conditional statements, as well as the integration of arbitrary HTML code and dynamically generated graphs. The resulting prototype enables clinical users to apply the full set of Arden Syntax language constructs to identify and process relevant data items in a way that far exceeds the capabilities of the PDMS export tool. The generation of discharge letters is an uncommon area of application for Arden Syntax, considerably differing from its original purpose. However, we found our prototype well suited for this task and plan to evaluate it in clinical production after the next major release change of our PDMS.
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Ji, Z; Jiang, Y L; Guo, F X; Peng, R; Sun, H T; Fan, J H; Wang, J J
2017-04-04
Objective: To compare the dose distributions of postoperative plans with preoperative plans for seeds implantations of paravertebral/retroperitoneal tumors assisted by 3D printing guide template and CT guidance, explore the effects of the technology for seeds implantations in dosimetry level and provide data support for the optimization and standardization in seeds implantation. Methods: Between December 2015 and July 2016, a total of 10 patients with paravertebral/retroperitoneal tumors (12 lesions) received 3D printing template assist radioactive seeds implantations in department of radiation oncology of Peking University Third Hospital, and included in the study. The diseases included cervical cancer, kidney cancer, abdominal stromal tumor, leiomyosarcoma of kidney, esophageal cancer and carcinoma of ureter. The prescribed doses was 110-150 Gy. All patients received preoperative planning design, individual template design and production, and the dose distribution of postoperative plan was compared with preoperative plan. Dose parameters including D(90), MPD, V(100), V(150,)conformal index(CI), EI of target volume and D(2cc) of organs at risk (spinal cord, aorta, kidney). Statistical software was SPSS 19.0 and statistical method was non-parameters Wilcoxon symbols test. Results: A total of 10 3D printing templates were designed and produced which were including 12 treatment areas.The mean D(90) of postoperative target area (GTV) was 131.1 (97.8-167.4 Gy) Gy. The actual seeds number of post operation increased by 3 to 12 in 5 cases (42.0%). The needle was well distributed. For postoperative plans, the mean D(90,)MPD, V(100,)V(150) was 131.1 Gy, 69.3 Gy, 90.2% and 65.2%, respectively, and which was 140.2 Gy, 65.6 Gy, 91.7% and 26.8%, respectively, in preoperative plans. This meant that the actual dose of target volume was slightly lower than preplanned dose, and the high dose area of target volume was larger than preplanned range, but there was no statistical difference in P value between the two groups except V(150)( P =0.004). The actual dose conformity of target volume was worse than preplanned (CI was 0.58 and 0.62, respectively) and the difference was statistically significant( P =0.019). The actual dose of external target volume was higher than preplanned (EI was 55% and 45.9%, respectively) and the difference had no significance. For organs at risk, the actual mean D(2cc) of spinal cord, aorta and kidney was 24.7, 54.4 and 29.7 Gy, respectively, which was higher than preplanned(20.6, 51.6 and 28.6 Gy, respectively), and there was no significant difference in two groups. Conclusions: Most parameters of postoperative validations for 3D printing template assisted seeds implantation in paravertebral/retroperitoneal are closed to the expectations of preoperative plans which means the improvement of accuracy in treatment.
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Development and validation of a tool to improve paediatric referral/consultation communication.
Stille, Christopher J; Mazor, Kathleen M; Meterko, Vanessa; Wasserman, Richard C
2011-08-01
To develop a template to promote brief but high-quality communication between paediatric primary care clinicians and consulting specialists. Through an iterative process with academic and community-based paediatric primary care providers and specialists, the authors identified what content elements would be of value when communicating around referrals. The authors then developed a one-page template to encourage both primary care and specialty clinicians to include these elements when communicating about referrals. Trained clinician reviewers examined a sample of 206 referrals from community primary care providers (PCPs) to specialists in five paediatric specialties at an academic medical centre, coding communication content and rating the overall value of the referral communication. The relationship between the value ratings and each content element was examined to determine which content elements contributed to perceived value. Almost all content elements were associated with increased value as rated by clinician reviewers. The most valuable communications from PCP to specialist contained specific questions for the specialist and/or physical exam features, and the most valuable from specialist to PCP contained brief education for the PCP about the condition; all three elements were found in a minority of communications reviewed. A limited set of communication elements is suitable for a brief communication template in communication from paediatric PCPs to specialists. The use of such a template may add value to interphysician communication.
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Fan, Shi-Qi; Li, Sen; Liu, Jin-Ling; Yang, Jiao; Hu, Chao; Zhu, Jun-Ping; Xiao, Xiao-Qin; Liu, Wen-Long; He, Fu-Yuan
2017-01-01
The molecular connectivity index was adopted to explore the characteristics of supramolecular imprinting template of herbs distributed to liver meridian, in order to provide scientific basis for traditional Chinese medicines(TCMs) distributed to liver meridian. In this paper, with "12th five-year plan" national planning textbooks Science of Traditional Chinese Medicine and Chemistry of Traditional Chinese Medicine as the blueprint, literatures and TCMSP sub-databases in TCM pharmacology of northwest science and technology university of agriculture and forestry were retrieved to collect and summarize active constituents of TCM distributed to liver meridian, and calculate the molecular connectivity index. The average molecular connectivity index of ingredients distributed to liver meridian was 9.47, which was close to flavonoid glycosides' (9.17±2.11) and terpenes (9.30±3.62). Therefore, it is inferred that template molecule of liver meridian is similar to physicochemical property of flavonoid glycosides and terpenes, which could be best matched with imprinting template of liver meridian. Copyright© by the Chinese Pharmaceutical Association.
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Scheuner, Maren T; Hilborne, Lee; Brown, Julie; Lubin, Ira M
2012-07-01
Errors are most likely to occur during the pre- and postanalytic phases of the genetic testing process, which can contribute to underuse, overuse, and misuse of genetic tests. To mitigate these errors, we created a template for molecular genetic test reports that utilizes the combined features of synoptic reporting and narrative interpretation. A variation of the Delphi consensus process with an expert panel was used to create a draft report template, which was further informed by focus group discussions with primary care physicians. There was agreement that molecular genetic test reports should present information in groupings that flow in a logical manner, and most participants preferred the following order of presentation: patient and physician information, test performed, test results and interpretation, guidance on next steps, and supplemental information. We define data elements for the report as "required," "optional," "possible," and "not necessary"; provide recommendations regarding the grouping of these data elements; and describe the ideal design of the report template, including the preferred order of the report sections, formatting of data, and length of the report. With input from key stakeholders and building upon prior work, we created a template for molecular genetic test reports designed to improve clinical decision making at the point of care. The template design should lead to more effective communication between the laboratory and ordering clinician. Studies are needed to assess the usefulness and effectiveness of molecular genetic test reports generated using this template.
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Panesar, Rahul S; Albert, Ben; Messina, Catherine; Parker, Margaret
2016-01-01
The Situation, Background, Assessment, Recommendation (SBAR) handoff tool is designed to improve communication. The effects of integrating an electronic medical record (EMR) with a SBAR template are unclear. The research team hypothesizes that an electronic SBAR template improves documentation and communication between nurses and physicians. In all, 84 patient events were recorded from 542 admissions to the pediatric intensive care unit. Three time periods were studied: (a) paper documentation only, (b) electronic documentation, and (c) electronic documentation with an SBAR template. Documentation quality was assessed using a 4-point scoring system. The frequency of event notes increased progressively during the 3 study periods. Mean quality scores improved significantly from paper documentation to EMR free-text notes and to electronic SBAR-template notes, as did nurse and attending physician notification. The implementation of an electronic SBAR note is associated with more complete documentation and increased frequency of documentation of communication among nurses and physicians. © The Author(s) 2014.
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Template-directed instrumentation in total knee arthroplasty: cost savings analysis.
Hsu, Andrew R; Gross, Christopher E; Bhatia, Sanjeev; Levine, Brett R
2012-11-01
The use of digital radiography and templating software in total knee arthroplasty (TKA) continues to become more prevalent as the number of procedures performed increases every year. Template-directed instrumentation (TDI) is a novel approach to surgical planning that combines digital templating with limited intraoperative instruments. The purpose of this study was to evaluate the financial implications and radiographic outcomes of using TDI to direct instrumentation during primary TKA. Over a 1-year period, 82 consecutive TKAs using TDI were retrospectively reviewed. Patient demographics and preoperative templated sizes of predicted components were recorded, and OrthoView digital planning software (OrthoView LLC, Jacksonville, Florida was used to determine the 2 most likely tibial and femoral component sizes for each case. This sizing information was used to direct component vendors to prepare 3 lightweight instrument trays based on these sizes. The sizes of implanted components and the number of total trays required were documented. A cost savings analysis was performed to compare TDI and non-TDI surgical expenses for TKA. In 80 (97%) of 82 cases, the prepared sizes determined by TDI using 3 instrument trays were sufficient. Preoperative templating correctly predicted the size of the tibial and femoral component sizes in 90% and 83% of cases, respectively. The average number of trays used with TDI was 3.0 (range, 3-5 trays) compared with 7.5 (range, 6-9 trays) used in 82 preceding non-TDI TKAs. Based on standard fees to sterilize and package implant trays (approximately $26 based on a survey of 10 orthopedic hospitals performing TKA), approximately $9612 was saved by using TDI over the 1-year study period. Overall, digital templating and TDI were a simple and cost-effective approach when performing primary TKA. Copyright 2012, SLACK Incorporated.
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Ryu, Bon; Imaging Research Laboratories, Robarts Research Institute, University of Western Ontario, London, Ontario; Bax, Jeff
2012-08-01
Purpose: First, to show that low-dose-rate prostate brachytherapy plans using oblique needle trajectories are more successful than parallel trajectories for large prostates with pubic arch interference (PAI); second, to test the accuracy of delivering an oblique plan by using a three-dimensional (3D) transrectal ultrasonography (TRUS)-guided mechatronic system. Methods and Materials: Prostates were contoured for 5 subjects' 3D TRUS images showing a maximum PAI of {<=}1 cm and a prostate volume of <50 cc. Two planning studies were done. First, prostate contours were artificially enlarged to 45 to 80 cc in 5- to 10-cc increments for a single subject. Second, allmore » subject prostate contours were enlarged to 60 cc. For each study, three types of plans were manually created for comparison: a parallel needle template (PT) plan, a parallel needle no-template (PNT) plan, and an oblique needle no-template (OBL) plan. Needle positions and angles were not discretized for nontemplate plans. European Society for Therapeutic Radiology and Oncology dose-volume histogram guidelines, iodine-125 (145-Gy prescription, 0.43 U), and needle angles of <15 Degree-Sign were used. An OBL plan was delivered to a pubic arch containing a 60-cc prostate phantom that mimicked the anatomy of the subject with the greatest PAI (23% by volume). Results: In the increasing-prostate volume study, OBL plans were successful for prostates of {<=}80 cc, and PT plans were successful for prostates of <65 cc. In paired, one-sided t tests for the 60-cc volume study, OBL plans showed dosimetric improvements for all organs compared to both of the parallel type plans (p < 0.05); PNT plans showed a benefit only in planning target volumes receiving more than 100 Gy compared to PT plans. A computed tomography scan of the phantom showed submillimeter seed placement accuracy in all directions. Conclusion: OBL plans were significantly better than parallel plans, and an OBL plan was accurately delivered to a 60-cc prostate phantom with 23% PAI by volume.« less
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Pediatric hospital medicine: a strategic planning roundtable to chart the future.
Rauch, Daniel A; Lye, Patricia S; Carlson, Douglas; Daru, Jennifer A; Narang, Steve; Srivastava, Rajendu; Melzer, Sanford; Conway, Patrick H
2012-04-01
Given the growing field of Pediatric Hospital Medicine (PHM) and the need to define strategic direction, the Society of Hospital Medicine, the American Academy of Pediatrics, and the Academic Pediatric Association sponsored a roundtable to discuss the future of the field. Twenty-one leaders were invited plus a facilitator utilizing established health care strategic planning methods. A "vision statement" was developed. Specific initiatives in 4 domains (clinical practice, quality of care, research, and workforce) were identified that would advance PHM with a plan to complete each initiative. Review of the current issues demonstrated gaps between the current state of affairs and the full vision of the potential impact of PHM. Clinical initiatives were to develop an educational plan supporting the PHM Core Competencies and a clinical practice monitoring dashboard template. Quality initiatives included an environmental assessment of PHM participation on key committees, societies, and agencies to ensure appropriate PHM representation. Three QI collaboratives are underway. A Research Leadership Task Force was created and the Pediatric Research in Inpatient Settings (PRIS) network was refocused, defining a strategic framework for PRIS, and developing a funding strategy. Workforce initiatives were to develop a descriptive statement that can be used by any PHM physician, a communications tool describing "value added" of PHM; and a tool to assess career satisfaction among PHM physicians. We believe the Roundtable was successful in describing the current state of PHM and laying a course for the near future. Copyright © 2011 Society of Hospital Medicine.
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Huynh-Ba, G; Alexander, P; Vargas, A; Vierra, M; Oates, TW
2012-01-01
This article introduces a technique for modifying an existing mandibular complete denture for use as a radiographic template with a radiopaque light-activated calcium hydroxide (Ca(OH)2) preparation. This allows prosthetically-driven treatment planning and surgical placement of 2 implants to support the existing mandibular denture. PMID:23328197
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48 CFR 307.104 - General procedures.
Code of Federal Regulations, 2011 CFR
2011-10-01
... regarding the specific acquisition method the contracting activity plans to use. (5) HHS requires use of a standard format for an AAP. The template for the plan is available on the ASFR/OGAPA/DA Internet Web site...
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Pre-operative digital templating in cemented hip hemiarthroplasty for neck of femur fractures.
Kwok, Iris H Y; Pallett, Scott J C; Massa, Edward; Cundall-Curry, Duncan; Loeffler, Mark D
2016-03-01
Pre-operative digital templating allows the surgeon to foresee any anatomical anomalies which may lead to intra-operative problems, and anticipate appropriate instruments and implants required during surgery. Although its role is well-established in successful elective total hip arthroplasty, little work has been done on its use in hip hemiarthroplasty in neck of femur fractures. We describe our initial experience of digital templating in 40 consecutive patients who have undergone cemented hip hemiarthroplasty, assessing templating accuracy between templated implant sizes to actual implant sizes. 81% of implanted heads were templated to within two head sizes, and 89% of implanted stems were templated to within two sizes. Although there was a moderately strong correlation of 0.52 between templated and actual head sizes, this correlation was not demonstrated in femoral stem sizes. Mean leg length discrepancy was -2.5mm (S.D. 8.5), and the mean difference in femoral offset between the operated and non-operated hip was -1mm (S.D. 4.4). Digital templating is a useful adjunct to the surgeon in pre-operative planning of hip hemiarthroplasty in the restoration of leg length and femoral offset. However, its accuracy is inferior to that of elective total hip arthroplasty. Copyright © 2016 Elsevier Ltd. All rights reserved.
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Sugawara, Taku; Higashiyama, Naoki; Kaneyama, Shuichi; Sumi, Masatoshi
2017-03-15
Prospective clinical trial of the screw insertion method for posterior C1-C2 fixation utilizing the patient-specific screw guide template technique. To evaluate the efficacy of this method for insertion of C1 lateral mass screws (LMS), C2 pedicle screws (PS), and C2 laminar screws (LS). Posterior C1LMS and C2PS fixation, also known as the Goel-Harms method, can achieve immediate rigid fixation and high fusion rate, but the screw insertion carries the risk of injury to neuronal and vascular structures. Dissection of venous plexus and C2 nerve root to confirm the insertion point of the C1LMS may also cause problems. We have developed an intraoperative screw guiding method using patient-specific laminar templates. Preoperative bone images of computed tomography (CT) were analyzed using three-dimensional (3D)/multiplanar imaging software to plan the trajectories of the screws. Plastic templates with screw guiding structures were created for each lamina using 3D design and printing technology. Three types of templates were made for precise multistep guidance, and all templates were specially designed to fit and lock on the lamina during the procedure. Surgery was performed using this patient-specific screw guide template system, and placement of the screws was postoperatively evaluated using CT. Twelve patients with C1-C2 instability were treated with a total of 48 screws (24 C1LMS, 20 C2PS, 4 C2LS). Intraoperatively, each template was found to exactly fit and lock on the lamina and screw insertion was completed successfully without dissection of the venous plexus and C2 nerve root. Postoperative CT showed no cortical violation by the screws, and mean deviation of the screws from the planned trajectories was 0.70 ± 0.42 mm. The multistep, patient-specific screw guide template system is useful for intraoperative screw navigation in posterior C1-C2 fixation. This simple and economical method can improve the accuracy of screw insertion, and reduce operation time and radiation exposure of posterior C1-C2 fixation surgery. 3.
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Template for Conceptual Model Construction: Model Components and Application of the Template
2007-09-01
stressors, focused through EECs, result in endpoints (Lubinski and Barko 2003). Endpoints are quantifiable, ecologically significant, and important to...Monitoring Plan (Thomas et al. 2001) Lake Okeechobee (Havens 1999) EPA Ecological Risk Assessment on Terrestrial Ecosystem (Suter 1996) Grassland...endpoints (Havens 1999) are examples of Hydrologic Resources: Water Quality, and Terrestrial Resources: Biota. The EPA Ecological Risk Assessment (Suter
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Service-based health human resources planning for older adults.
Tomblin Murphy, Gail; MacKenzie, Adrian; Rigby, Janet; Rockwood, Kenneth; Gough, Amy; Greeley, Gogi; Montpetit, Frederick; Dill, Donna; Alder, Robert; Lackie, Kelly
2013-08-01
To test a service-based health human resources (HHR) planning approach for older adults in the context of home and long term care (LTC); to create a practical template/tools for use in various jurisdictions and/or health care settings. The most serious health needs of seniors in 2 Canadian jurisdictions were identified and linked to the specific services and associated competencies required of health care providers (HCPs) to address those needs. The amounts of each service required were quantified and compared against the capacity of HCPs to perform the services, measured using a self-assessment survey, by using a previously developed analytical framework. Home and LTC sectors in Nova Scotia and Nunavut, Canada. Regulated and nonregulated HCPs were invited to complete either an online or paper-based competency self-assessment survey. Survey response rates in Nova Scotia and Nunavut were 11% (160 responses) and 20% (22 responses), respectively. Comparisons of the estimated number of seniors likely to need each service with the number who can be served by the workforces in each jurisdiction indicated that the workforces in both jurisdictions are sufficiently numerous, active, productive, and competent to provide most of the services likely to be required. However, significant gaps were identified in pharmacy services, ongoing client assessment, client/family education and involvement, and client/family functional and social supports. Service-based HHR planning is feasible for identifying gaps in services required by older adults, and can guide policy makers in planning hiring/recruitment, professional development, and provider education curricula. Implementation will require commitment of policy makers and other stakeholders, as well as ongoing evaluation of its effectiveness. More broadly, the ongoing effectiveness of the approach will depend on workforce planning being conducted in an iterative way, driven by regular reevaluation of population health needs and HHR effectiveness. Copyright © 2013 American Medical Directors Association, Inc. Published by Elsevier Inc. All rights reserved.
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Arunyanak, Sirikarn P; Harris, Bryan T; Grant, Gerald T; Morton, Dean; Lin, Wei-Shao
2016-07-01
This report describes a digital approach for computer-guided surgery and immediate provisionalization in a partially edentulous patient. With diagnostic data obtained from cone-beam computed tomography and intraoral digital diagnostic scans, a digital pathway of virtual diagnostic waxing, a virtual prosthetically driven surgical plan, a computer-aided design and computer-aided manufacturing (CAD/CAM) surgical template, and implant-supported screw-retained interim restorations were realized with various open-architecture CAD/CAM systems. The optional CAD/CAM diagnostic casts with planned implant placement were also additively manufactured to facilitate preoperative inspection of the surgical template and customization of the CAD/CAM-fabricated interim restorations. Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.
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US radiation oncology practice patterns for posttreatment survivor care.
Koontz, Bridget F; Benda, Rashmi; De Los Santos, Jennifer; Hoffman, Karen E; Huq, M Saiful; Morrell, Rosalyn; Sims, Amber; Stevens, Stephanie; Yu, James B; Chen, Ronald C
2016-01-01
Increasing numbers of cancer survivors have driven a greater focus on care of cancer patients after treatment. Radiation oncologists have long considered follow-up of patients an integral part of practice. We sought to document current survivor-focused care patterns and identify barriers to meeting new regulatory commission guidelines for survivorship care plans (SCPs) and provide guidance for survivorship care. A 23-question electronic survey was e-mailed to all practicing US physician American Society of Radiation Oncology members. Responses were collected for 25 days in March 2014. Survey data were descriptively analyzed. A total of 574 eligible providers responded, for a response percentage of 14.7%. Almost all providers follow their patients after treatment (97%). Length of follow-up was frequently extensive: 17% followed up to 2 years, 40% for 3-5 years, 12% for 6-10 years, and 31% indefinitely. Ancillary services, particularly social work and nutrition services, are commonly available onsite to patients in follow-up. Fewer than half of respondents (40%) indicated that they currently use SCPs for curative intent patients and those who do generally use internally developed templates. SCPs typically go to patients (91%), but infrequently to primary care providers (22%). The top 3 barriers to implementation of SCPs were cost (57%), duplicative survivorship care plans provided by other physicians (43%), and lack of consensus or professional guidelines (40%). Eighty-seven percent indicated that SCPs built into an electronic medical record system would be useful. A significant part of radiation oncology practice includes the care of those in the surveillance of follow-up phase of care. SCPs may be beneficial in improving communication with the patient and other care but are not widely used within our field. This survey identified key barriers to use of SCPs and provides specialty guidance for important information to be included in a radiation oncology oriented SCP. Copyright © 2016 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.
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Nursing Information Flow in Long-Term Care Facilities.
Wei, Quan; Courtney, Karen L
2018-04-01
Long-term care (LTC), residential care requiring 24-hour nursing services, plays an important role in the health care service delivery system. The purpose of this study was to identify the needed clinical information and information flow to support LTC Registered Nurses (RNs) in care collaboration and clinical decision making. This descriptive qualitative study combines direct observations and semistructured interviews, conducted at Alberta's LTC facilities between May 2014 and August 2015. The constant comparative method (CCM) of joint coding was used for data analysis. Nine RNs from six LTC facilities participated in the study. The RN practice environment includes two essential RN information management aspects: information resources and information spaces. Ten commonly used information resources by RNs included: (1) RN-personal notes; (2) facility-specific templates/forms; (3) nursing processes/tasks; (4) paper-based resident profile; (5) daily care plans; (6) RN-notebooks; (7) medication administration records (MARs); (8) reporting software application (RAI-MDS); (9) people (care providers); and (10) references (i.e., books). Nurses used a combination of shared information spaces, such as the Nurses Station or RN-notebook, and personal information spaces, such as personal notebooks or "sticky" notes. Four essential RN information management functions were identified: collection, classification, storage, and distribution. Six sets of information were necessary to perform RN care tasks and communication, including: (1) admission, discharge, and transfer (ADT); (2) assessment; (3) care plan; (4) intervention (with two subsets: medication and care procedure); (5) report; and (6) reference. Based on the RN information management system requirements, a graphic information flow model was constructed. This baseline study identified key components of a current LTC nursing information management system. The information flow model may assist health information technology (HIT) developers to consolidate the design of HIT solutions for LTC, and serve as a communication tool between nurses and information technology (IT) staff to refine requirements and support further LTC HIT research. Schattauer GmbH Stuttgart.
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Template for success: using a resident-designed sign-out template in the handover of patient care.
Clark, Clancy J; Sindell, Sarah L; Koehler, Richard P
2011-01-01
Report our implementation of a standardized handover process in a general surgery residency program. The standardized handover process, sign-out template, method of implementation, and continuous quality improvement process were designed by general surgery residents with support of faculty and senior hospital administration using standard work principles and business models of the Virginia Mason Production System and the Toyota Production System. Nonprofit, tertiary referral teaching hospital. General surgery residents, residency faculty, patient care providers, and hospital administration. After instruction in quality improvement initiatives, a team of general surgery residents designed a sign-out process using an electronic template and standard procedures. The initial implementation phase resulted in 73% compliance. Using resident-driven continuous quality improvement processes, real-time feedback enabled residents to modify and improve this process, eventually attaining 100% compliance and acceptance by residents. The creation of a standardized template and protocol for patient handovers might eliminate communication failures. Encouraging residents to participate in this process can establish the groundwork for successful implementation of a standardized handover process. Integrating a continuous quality-improvement process into such an initiative can promote active participation of busy general surgery residents and lead to successful implementation of standard procedures. Copyright © 2011 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
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Tolbert, Elliott; Hannum, Susan M; Radhakrishnan, Archana; Zorn, Kelsey; Blackford, Amanda; Greco, Stephen; Smith, Karen; Snyder, Claire F
2016-01-01
Background Survivorship care plans (SCPs) are intended to facilitate communication and coordination between patients, oncologists, and primary care providers. Most SCP initiatives have focused on oncology providers initiating the SCP process, but time and resource barriers have limited uptake. Objective This trial compares the feasibility and value of 2 Web-based SCP tools: provider-initiated versus patient-initiated. Methods This mixed-methods study recruited clinicians from 2 academically-affiliated community oncology practices. Eligible patients were treated by a participating oncologist, had nonmetastatic cancer, completed acute treatment ≤ 2 months before enrollment, and had no evidence of disease. Patients were randomized 1:1 to either provider-initiated or patient-initiated SCPs—both are Web-based tools. We conducted qualitative interviews with providers at baseline and follow-up and with patients 2 months after enrollment. In addition, patients were administered the Preparing for Life as a (New) Survivor (PLANS) and Cancer Survivors’ Unmet Needs (CaSUN) surveys at baseline and 2 months. Results A total of 40 providers were approached for the study, of whom 13 (33%) enrolled. Providers or clinic staff required researcher assistance to identify eligible patients; 41 patients were randomized, of whom 25 completed follow-up (61%; 13 provider-initiated, 12 patient-initiated). Of the 25, 11 (44%) had initiated the SCP; 5 (20%) provided the SCP to their primary care provider. On the Preparing for Life as a (New) Survivor and Cancer Survivors’ Unmet Needs, patients in both arms tended to report high knowledge and confidence and few unmet needs. In qualitative interviews, providers and patients discussed SCPs’ value. Conclusions Regardless of patient- versus provider-initiated templates and the Web-based design of these tools, barriers to survivorship care planning persist. Further efforts should emphasize workflow functions for identifying and completing SCPs—regardless of the SCP form used. Trial Registration ClinicalTrials.gov NCT02405819; https://clinicaltrials.gov/ct2/show/NCT02405819 (Archived by WebCite at http://www.webcitation.org/6jWqcWOvK) PMID:28410187
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Kerber, Kevin A; Hofer, Timothy P; Meurer, William J; Fendrick, A Mark; Morgenstern, Lewis B
2011-03-24
Clinical documentation systems, such as templates, have been associated with process utilization. The T-System emergency department (ED) templates are widely used but lacking are analyses of the templates association with processes. This system is also unique because of the many different template options available, and thus the selection of the template may also be important. We aimed to describe the selection of templates in ED dizziness presentations and to investigate the association between items on templates and process utilization. Dizziness visits were captured from a population-based study of EDs that use documentation templates. Two relevant process outcomes were assessed: head computerized tomography (CT) scan and nystagmus examination. Multivariable logistic regression was used to estimate the probability of each outcome for patients who did or did not receive a relevant-item template. Propensity scores were also used to adjust for selection effects. The final cohort was 1,485 visits. Thirty-one different templates were used. Use of a template with a head CT item was associated with an increase in the adjusted probability of head CT utilization from 12.2% (95% CI, 8.9%-16.6%) to 29.3% (95% CI, 26.0%-32.9%). The adjusted probability of documentation of a nystagmus assessment increased from 12.0% (95%CI, 8.8%-16.2%) when a nystagmus-item template was not used to 95.0% (95% CI, 92.8%-96.6%) when a nystagmus-item template was used. The associations remained significant after propensity score adjustments. Providers use many different templates in dizziness presentations. Important differences exist in the various templates and the template that is used likely impacts process utilization, even though selection may be arbitrary. The optimal design and selection of templates may offer a feasible and effective opportunity to improve care delivery.
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A C++11 implementation of arbitrary-rank tensors for high-performance computing
NASA Astrophysics Data System (ADS)
Aragón, Alejandro M.
2014-06-01
This article discusses an efficient implementation of tensors of arbitrary rank by using some of the idioms introduced by the recently published C++ ISO Standard (C++11). With the aims at providing a basic building block for high-performance computing, a single Array class template is carefully crafted, from which vectors, matrices, and even higher-order tensors can be created. An expression template facility is also built around the array class template to provide convenient mathematical syntax. As a result, by using templates, an extra high-level layer is added to the C++ language when dealing with algebraic objects and their operations, without compromising performance. The implementation is tested running on both CPU and GPU.
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A C++11 implementation of arbitrary-rank tensors for high-performance computing
NASA Astrophysics Data System (ADS)
Aragón, Alejandro M.
2014-11-01
This article discusses an efficient implementation of tensors of arbitrary rank by using some of the idioms introduced by the recently published C++ ISO Standard (C++11). With the aims at providing a basic building block for high-performance computing, a single Array class template is carefully crafted, from which vectors, matrices, and even higher-order tensors can be created. An expression template facility is also built around the array class template to provide convenient mathematical syntax. As a result, by using templates, an extra high-level layer is added to the C++ language when dealing with algebraic objects and their operations, without compromising performance. The implementation is tested running on both CPU and GPU.
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Huang, Y; Verduzco, S
2015-01-01
Patient wait time is a critical element of access to care that has long been recognized as a major problem in modern outpatient health care delivery systems. It impacts patient and medical staff productivity, stress, quality and efficiency of medical care, as well as health-care cost and availability. This study was conducted in a Women's Health Clinic. The objective was to improve clinic service quality by redesigning patient appointment template using the clinical constraints. The proposed scheduling template consisted of two key elements: the redesign of appointment types and the determination of the length of time slots using defined constraints. The re-classification technique was used for the redesign of appointment visit types to capture service variation for scheduling purposes. Then, the appointment length was determined by incorporating clinic constraints or goals, such as patient wait time, physician idle time, overtime, finish time, lunch hours, when the last appointment was scheduled, and the desired number of appointment slots, to converge the optimal length of appointment slots for each visit type. The redesigned template was implemented and the results indicated a 73% reduction in average patient waiting from the reported 40 to 11 minutes. The patient no-show rate was reduced by 4% from 24% to 20%. The morning section on average finished about 11:50 am. The clinic day was finished around 4:45 pm. Provider average idle time was estimated to be about 5 minutes, which can be used for charting/documenting patients. This study provided an alternative method of redesigning appointment scheduling templates using only the clinical constraints rather than the traditional way that required an objective function. This paper also documented the employed methods step by step in a real clinic setting. The implementation results concluded a significant improvement on patient wait time and no-show rate.
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Verduzco, S.
2015-01-01
Summary Background Patient wait time is a critical element of access to care that has long been recognized as a major problem in modern outpatient health care delivery systems. It impacts patient and medical staff productivity, stress, quality and efficiency of medical care, as well as health-care cost and availability. Objectives This study was conducted in a Women’s Health Clinic. The objective was to improve clinic service quality by redesigning patient appointment template using the clinical constraints. Methods The proposed scheduling template consisted of two key elements: the redesign of appointment types and the determination of the length of time slots using defined constraints. The re-classification technique was used for the redesign of appointment visit types to capture service variation for scheduling purposes. Then, the appointment length was determined by incorporating clinic constraints or goals, such as patient wait time, physician idle time, overtime, finish time, lunch hours, when the last appointment was scheduled, and the desired number of appointment slots, to converge the optimal length of appointment slots for each visit type. Results The redesigned template was implemented and the results indicated a 73% reduction in average patient waiting from the reported 40 to 11 minutes. The patient no-show rate was reduced by 4% from 24% to 20%. The morning section on average finished about 11:50 am. The clinic day was finished around 4:45 pm. Provider average idle time was estimated to be about 5 minutes, which can be used for charting/documenting patients. Conclusions This study provided an alternative method of redesigning appointment scheduling templates using only the clinical constraints rather than the traditional way that required an objective function. This paper also documented the employed methods step by step in a real clinic setting. The implementation results concluded a significant improvement on patient wait time and no-show rate. PMID:26171075
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Qiu, L L; Li, S; Bai, Y X
2016-06-01
To develop surgical templates for orthodontic miniscrew implantation based on cone-beam CT(CBCT)three-dimensional(3D)images and to evaluate the safety and stability of implantation guided by the templates. DICOM data obtained in patients who had CBCT scans taken were processed using Mimics software, and 3D images of teeth and maxillary bone were acquired. Meanwhile, 3D images of miniscrews were acquired using Solidworks software and processed with Mimics software. Virtual position of miniscrews was determined based on 3D images of teeth, bone, and miniscrews. 3D virtual templates were designed according to the virtual implantation plans. STL files were output and the real templates were fabricated with stereolithographic appliance(SLA). Postoperative CBCT scans were used to evaluate the implantation safety and the stability of miniscrews were investigated. All the templates were positioned accurately and kept stable throughout the implantation process. No root damage was found. The deviations were(1.73±0.65)mm at the corona, and(1.28±0.82)mm at the apex, respectively. The stability of miniscrews was fairly well. Surgical templates for miniscrew implantation could be acquired based on 3D CBCT images and fabricated with SLA. Implantation guided by these templates was safe and stable.
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Yu, Jian-Hong; Lo, Lun-Jou; Hsu, Pin-Hsin
2017-01-01
This study integrates cone-beam computed tomography (CBCT)/laser scan image superposition, computer-aided design (CAD), and 3D printing (3DP) to develop a technology for producing customized dental (orthodontic) miniscrew surgical templates using polymer material. Maxillary bone solid models with the bone and teeth reconstructed using CBCT images and teeth and mucosa outer profile acquired using laser scanning were superimposed to allow miniscrew visual insertion planning and permit surgical template fabrication. The customized surgical template CAD model was fabricated offset based on the teeth/mucosa/bracket contour profiles in the superimposition model and exported to duplicate the plastic template using the 3DP technique and polymer material. An anterior retraction and intrusion clinical test for the maxillary canines/incisors showed that two miniscrews were placed safely and did not produce inflammation or other discomfort symptoms one week after surgery. The fitness between the mucosa and template indicated that the average gap sizes were found smaller than 0.5 mm and confirmed that the surgical template presented good holding power and well-fitting adaption. This study addressed integrating CBCT and laser scan image superposition; CAD and 3DP techniques can be applied to fabricate an accurate customized surgical template for dental orthodontic miniscrews. PMID:28280726
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Wåhlberg, Henrik; Valle, Per Christian; Malm, Siri; Broderstad, Ann Ragnhild
2013-01-07
The referral letter plays a key role both in the communication between primary and secondary care, and in the quality of the health care process. Many studies have attempted to evaluate and improve the quality of these referral letters, but few have assessed the impact of their quality on the health care delivered to each patient. A cluster randomized trial, with the general practitioner office as the unit of randomization, has been designed to evaluate the effect of a referral intervention on the quality of health care delivered. Referral templates have been developed covering four diagnostic groups: dyspepsia, suspected colonic malignancy, chest pain, and chronic obstructive pulmonary disease. Of the 14 general practitioner offices primarily served by University Hospital of North Norway Harstad, seven were randomized to the intervention group. The primary outcome is a collated quality indicator score developed for each diagnostic group. Secondary outcomes include: quality of the referral, health process outcome such as waiting times, and adequacy of prioritization. In addition, information on patient satisfaction will be collected using self-report questionnaires. Outcome data will be collected on the individual level and analyzed by random effects linear regression. Poor communication between primary and secondary care can lead to inappropriate investigations and erroneous prioritization. This study's primary hypothesis is that the use of a referral template in this communication will lead to a measurable increase in the quality of health care delivered. This trial has been registered at ClinicalTrials.gov. The trial registration number is NCT01470963.
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Fu, Xi; Qiao, Jia; Girod, Sabine; Niu, Feng; Liu, Jian Feng; Lee, Gordon K; Gui, Lai
2017-09-01
Mandible contour surgery, including reduction gonioplasty and genioplasty, has become increasingly popular in East Asia. However, it is technically challenging and, hence, leads to a long learning curve and high complication rates and often needs secondary revisions. The increasing use of 3-dimensional (3D) technology makes accurate single-stage mandible contour surgery with minimum complication rates possible with a virtual surgical plan (VSP) and 3-D surgical templates. This study is to establish a standardized protocol for VSP and 3-D surgical templates-assisted mandible contour surgery and evaluate the accuracy of the protocol. In this study, we enrolled 20 patients for mandible contour surgery. Our protocol is to perform VSP based on 3-D computed tomography data. Then, design and 3-D print surgical templates based on preoperative VSP. The accuracy of the method was analyzed by 3-D comparison of VSP and postoperative results using detailed computer analysis. All patients had symmetric, natural osteotomy lines and satisfactory facial ratios in a single-stage operation. The average relative error of VSP and postoperative result on the entire skull was 0.41 ± 0.13 mm. The average new left gonial error was 0.43 ± 0.77 mm. The average new right gonial error was 0.45 ± 0.69 mm. The average pognion error was 0.79 ± 1.21 mm. Patients were very satisfied with the aesthetic results. Surgeons were very satisfied with the performance of surgical templates to facilitate the operation. Our standardized protocol of VSP and 3-D printed surgical templates-assisted single-stage mandible contour surgery results in accurate, safe, and predictable outcome in a single stage.
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A conceptual model and assessment template for capacity evaluation in adult guardianship.
Moye, Jennifer; Butz, Steven W; Marson, Daniel C; Wood, Erica
2007-10-01
We develop a conceptual model and associated assessment template that is usable across state jurisdictions for evaluating the independent-living capacity of older adults in guardianship proceedings. We used an iterative process in which legal provisions for guardianship and prevailing clinical practices for capacity assessment were integrated, through expert group consensus and external review by legal and health care professionals, to form a conceptual model and template. The model and template provide a structure for conducting and documenting a capacity evaluation in guardianship by using six assessment domains of interest to the courts: (a) medical condition, (b) cognition, (c) functional abilities, (d) values, (e) risk of harm and level of supervision needed, and (f) means to enhance capacity. The template also addresses the participation of the person in the guardianship hearing, confidentiality and privilege issues, and certification by the examiner. An online version of the template can be adapted to address specific jurisdictional requirements. A conceptual model and evaluation template provide a useful cross-jurisdictional format for conducting and documenting capacity assessments of older adults in guardianship proceedings. The template may be particularly useful to clinicians for providing courts with information to support limited guardianship orders.
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Magnification of digital hip radiographs differs between clinical workplaces.
Hornová, Jana; Růžička, Pavel; Hrubina, Maroš; Šťastný, Eduard; Košková, Andrea; Fulín, Petr; Gallo, Jiří; Daniel, Matej
2017-01-01
Preoperative planning for total hip arthroplasty includes templating on anteroposterior radiographs. It is necessary to consider radiographic magnification in order to scale templates accurately. Studies dealing with hip templating report different values of radiographic magnification. It is not clear if the observed difference in magnification between the studies is caused by variability in studied groups, methodology or instrumentation. We hypothesize that there is a difference in magnification between clinical workplaces. Within this study, radiographic magnification was estimated on 337 radiographs of patients after total hip surgery from five orthopaedic departments in the Czech Republic. Magnification was determined for each patient as a ratio between diameter of implanted femoral head measured on radiogram and its true size. One-way ANOVA revealed significant differences in magnification between workplaces (F(4,332) = 132, p≤0.001). These results suggest that radiographic magnification depends on the workplace where it is taken or more precisely on radiographic device. It indicates potential limits in generalizability of results of studies dealing with preoperative planning accuracy to other institutions.
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Ten Steps to Create Virtual Smile Design Templates With Adobe Photoshop® CS6.
Sundar, Manoj Kumar; Chelliah, Venkataraman
2018-03-01
Computer design software has become a primary tool for communication among the dentist, patient, and ceramist. Virtual smile design can be carried out using various software programs, most of which use assorted forms of teeth templates that are made based on the concept of "golden proportion." Despite current advances in 3-dimensional imaging and smile designing, many clinicians still employ conventional design methods and analog (ie, man-made) mock-ups in assessing and establishing esthetic makeovers. To simplify virtual smile designing, the teeth templates should be readily available. No literature has provided details as to how to create these templates. This article explains a technique for creating different forms of teeth templates using Adobe Photoshop® CS6 that eventually can be used for smile design purposes, either in Photoshop or Microsoft Powerpoint. Clinically speaking, various smile design templates created using set proportions in Adobe Photoshop CS6 can be used in virtual smile designing, a valuable resource in diagnosis, treatment planning, and communicating with patients and ceramists, thus providing a platform for a successful esthetic rehabilitation.
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PREP: Portal for Readiness Exercises & Planning v. 1.0
DOE Office of Scientific and Technical Information (OSTI.GOV)
Noel, Todd; Le, Tam; McNeil, Carrie
2016-10-28
The software includes a web-based template for recording actions taken during emergency preparedness exercises and planning workshops. In addition, a virtual outbreak prevention simulation exercise is also included. Both tools interact with a server which records user decisions and communications.
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Collins, Elizabeth A; Cody, Anna M; McDonald, Shelby Elaine; Nicotera, Nicole; Ascione, Frank R; Williams, James Herbert
2018-03-01
This study explores the intersection of intimate partner violence (IPV) and animal cruelty in an ethnically diverse sample of 103 pet-owning IPV survivors recruited from community-based domestic violence programs. Template analysis revealed five themes: (a) Animal Maltreatment by Partner as a Tactic of Coercive Power and Control, (b) Animal Maltreatment by Partner as Discipline or Punishment of Pet, (c) Animal Maltreatment by Children, (d) Emotional and Psychological Impact of Animal Maltreatment Exposure, and (e) Pets as an Obstacle to Effective Safety Planning. Results demonstrate the potential impact of animal maltreatment exposure on women and child IPV survivors' health and safety.
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Collins, Elizabeth A.; Cody, Anna M.; McDonald, Shelby Elaine; Nicotera, Nicole; Ascione, Frank R.; Williams, James Herbert
2018-01-01
This study explores the intersection of intimate partner violence (IPV) and animal cruelty in an ethnically diverse sample of 103 pet-owning IPV survivors recruited from community-based domestic violence programs. Template analysis revealed five themes: (a) Animal Maltreatment by Partner as a Tactic of Coercive Power and Control, (b) Animal Maltreatment by Partner as Discipline or Punishment of Pet, (c) Animal Maltreatment by Children, (d) Emotional and Psychological Impact of Animal Maltreatment Exposure, and (e) Pets as an Obstacle to Effective Safety Planning. Results demonstrate the potential impact of animal maltreatment exposure on women and child IPV survivors’ health and safety. PMID:29332521
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Visual environment recognition for robot path planning using template matched filters
NASA Astrophysics Data System (ADS)
Orozco-Rosas, Ulises; Picos, Kenia; Díaz-Ramírez, Víctor H.; Montiel, Oscar; Sepúlveda, Roberto
2017-08-01
A visual approach in environment recognition for robot navigation is proposed. This work includes a template matching filtering technique to detect obstacles and feasible paths using a single camera to sense a cluttered environment. In this problem statement, a robot can move from the start to the goal by choosing a single path between multiple possible ways. In order to generate an efficient and safe path for mobile robot navigation, the proposal employs a pseudo-bacterial potential field algorithm to derive optimal potential field functions using evolutionary computation. Simulation results are evaluated in synthetic and real scenes in terms of accuracy of environment recognition and efficiency of path planning computation.
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Wang, Y Y; Zhang, H Q; Fan, S; Zhang, D M; Huang, Z Q; Chen, W L; Ye, J T; Li, J S
2016-11-01
This study evaluated the accuracy of mandibular reconstruction and assessed clinical outcomes in both virtual planning and conventional surgery patients. ProPlan CMF surgical planning software was used preoperatively in the virtual planning group. In the virtual planning group, fibula flaps were harvested and osteotomized, and the mandibles were resected and reconstructed assisted by the prefabricated cutting guides and templates. The main outcome measures included the operative time, postoperative computed tomography (CT) scans, facial appearance, and occlusal function. The ischemia time and total operation time were shorter in the virtual planning group than in the conventional surgery group. High precision with the use of the cutting guides and templates was found for both the fibula and mandible, and a good fit was noted among the pre-bent plate, mandible, and fibula segments in the virtual planning group. Postoperative CT scans also showed excellent mandibular contours of the fibula flaps in accordance with virtual plans in the virtual planning group. This study demonstrated that virtual surgical planning was able to achieve more accurate mandibular reconstruction than conventional surgery. The use of prefabricated cutting guides and plates makes fibula flap moulding and placement easier, minimizes the operating time, and improves clinical outcomes. Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
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Guthier, Christian V; Damato, Antonio L; Hesser, Juergen W; Viswanathan, Akila N; Cormack, Robert A
2017-12-01
Interstitial high-dose rate (HDR) brachytherapy is an important therapeutic strategy for the treatment of locally advanced gynecologic (GYN) cancers. The outcome of this therapy is determined by the quality of dose distribution achieved. This paper focuses on a novel yet simple heuristic for catheter selection for GYN HDR brachytherapy and their comparison against state of the art optimization strategies. The proposed technique is intended to act as a decision-supporting tool to select a favorable needle configuration. The presented heuristic for catheter optimization is based on a shrinkage-type algorithm (SACO). It is compared against state of the art planning in a retrospective study of 20 patients who previously received image-guided interstitial HDR brachytherapy using a Syed Neblett template. From those plans, template orientation and position are estimated via a rigid registration of the template with the actual catheter trajectories. All potential straight trajectories intersecting the contoured clinical target volume (CTV) are considered for catheter optimization. Retrospectively generated plans and clinical plans are compared with respect to dosimetric performance and optimization time. All plans were generated with one single run of the optimizer lasting 0.6-97.4 s. Compared to manual optimization, SACO yields a statistically significant (P ≤ 0.05) improved target coverage while at the same time fulfilling all dosimetric constraints for organs at risk (OARs). Comparing inverse planning strategies, dosimetric evaluation for SACO and "hybrid inverse planning and optimization" (HIPO), as gold standard, shows no statistically significant difference (P > 0.05). However, SACO provides the potential to reduce the number of used catheters without compromising plan quality. The proposed heuristic for needle selection provides fast catheter selection with optimization times suited for intraoperative treatment planning. Compared to manual optimization, the proposed methodology results in fewer catheters without a clinically significant loss in plan quality. The proposed approach can be used as a decision support tool that guides the user to find the ideal number and configuration of catheters. © 2017 American Association of Physicists in Medicine.
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Pozzi, A; Tallarico, M; Barlattani, A
2012-06-01
The aim of the study was to describe an unusual method to stabilize the surgical template during the treatment of a severely resorbed edentulous mandible by means of computer-guided implant surgery. Pre-operative computer-based planning revealed the difficulty to stabilize the surgical template in a 67-year-old healthy woman. A deviation of the original NobelGuide™ protocol was performed to ensure the stability of the surgical template: four anchor pins were used to stabilize the surgical template, two in the buccal side of the anterior template and two unusual pins were placed in the lingual site. Four straight TiUnite® Nobel Biocare™ implants were then placed, according to a modified All-on-4™ concept procedure, to avoid graft procedures and to reduce the cumulative chair-side treatment time and costs. A temporary restoration was placed immediately after implant placement. Three months later a definitive, full acrylic restoration was delivered.
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Generic project definitions for improvement of health care delivery: a case-based approach.
Niemeijer, Gerard C; Does, Ronald J M M; de Mast, Jeroen; Trip, Albert; van den Heuvel, Jaap
2011-01-01
The purpose of this article is to create actionable knowledge, making the definition of process improvement projects in health care delivery more effective. This study is a retrospective analysis of process improvement projects in hospitals, facilitating a case-based reasoning approach to project definition. Data sources were project documentation and hospital-performance statistics of 271 Lean Six Sigma health care projects from 2002 to 2009 of general, teaching, and academic hospitals in the Netherlands and Belgium. Objectives and operational definitions of improvement projects in the sample, analyzed and structured in a uniform format and terminology. Extraction of reusable elements of earlier project definitions, presented in the form of 9 templates called generic project definitions. These templates function as exemplars for future process improvement projects, making the selection, definition, and operationalization of similar projects more efficient. Each template includes an explicated rationale, an operationalization in the form of metrics, and a prototypical example. Thus, a process of incremental and sustained learning based on case-based reasoning is facilitated. The quality of project definitions is a crucial success factor in pursuits to improve health care delivery. We offer 9 tried and tested improvement themes related to patient safety, patient satisfaction, and business-economic performance of hospitals.
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Evaluation of State Plans and the Livestock Emergency Response Plan (LERP).
Schaffer, Amy M; Burton, Kenneth R
The Livestock Emergency Response Plan (LERP) was published in 2014 as a toolkit to assist state agricultural emergency planners in writing or modifying state foreign animal disease/high-consequence disease (FAD/HCD) plans. This research serves as a follow-up to and expands on an initial survey conducted in 2011 by the Department of Homeland Security Office of Health Affairs, Food, Ag, and Veterinary Defense Branch. The purpose of this project is to describe the status of current state animal disease response plans in relation to how closely their content, order, and terminology relate to that described in the LERP template. The analysis was compared to the 2011 study to identify advances, trends, continued areas for increased alignment, and fulfillment of planning gaps in individual state plans. While vast improvements were made in the status of state animal disease response plans from 2011 to 2016, there is nonetheless significant room for enhancing consistency between and identifying gaps in FAD/HCD plans. As awareness of the LERP toolkit grows, the authors hope its use as a template by the states will expand accordingly, thereby increasing consistency between plans and more thoroughly addressing challenges in an FAD/HCD outbreak. The results of this study support the need for curriculum planning resources at the state level. Development of a training curriculum and planning workshops for state agriculture emergency planners will produce a consistent planning philosophy and skill set among state planners-another means of indirectly addressing current planning gaps in agricultural emergency response.
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NASA Astrophysics Data System (ADS)
Zhou, Yuhong; Klages, Peter; Tan, Jun; Chi, Yujie; Stojadinovic, Strahinja; Yang, Ming; Hrycushko, Brian; Medin, Paul; Pompos, Arnold; Jiang, Steve; Albuquerque, Kevin; Jia, Xun
2017-06-01
High dose rate (HDR) brachytherapy treatment planning is conventionally performed manually and/or with aids of preplanned templates. In general, the standard of care would be elevated by conducting an automated process to improve treatment planning efficiency, eliminate human error, and reduce plan quality variations. Thus, our group is developing AutoBrachy, an automated HDR brachytherapy planning suite of modules used to augment a clinical treatment planning system. This paper describes our proof-of-concept module for vaginal cylinder HDR planning that has been fully developed. After a patient CT scan is acquired, the cylinder applicator is automatically segmented using image-processing techniques. The target CTV is generated based on physician-specified treatment depth and length. Locations of the dose calculation point, apex point and vaginal surface point, as well as the central applicator channel coordinates, and the corresponding dwell positions are determined according to their geometric relationship with the applicator and written to a structure file. Dwell times are computed through iterative quadratic optimization techniques. The planning information is then transferred to the treatment planning system through a DICOM-RT interface. The entire process was tested for nine patients. The AutoBrachy cylindrical applicator module was able to generate treatment plans for these cases with clinical grade quality. Computation times varied between 1 and 3 min on an Intel Xeon CPU E3-1226 v3 processor. All geometric components in the automated treatment plans were generated accurately. The applicator channel tip positions agreed with the manually identified positions with submillimeter deviations and the channel orientations between the plans agreed within less than 1 degree. The automatically generated plans obtained clinically acceptable quality.
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Evaluating patients' comprehensibility of a standardized medication plan.
Botermann, Lea; Monzel, Katharina; Krueger, Katrin; Eickhoff, Christiane; Wachter, Angelika; Kloft, Charlotte; Laufs, Ulrich; Schulz, Martin
2016-10-01
A standardized medication plan for patients has been developed and recently enacted into German law depicting all medicines taken. It can only increase medication safety if patients use and understand it. We evaluated patients' comprehensibility of the medication plan and analyzed potential variables influencing patients' understanding. The medication plan template v2.0 was first tested in N = 40 patients, and the "Evaluation Tool to test the handling of the Medication Plan" (ET-MP) was developed, rating patients' understanding from 0 to 100 %. The cut-off, distinguishing if patients understand the medication plan, was set at 90 %. The ET-MP was then applied to an amended medication plan questioning N = 40 general internal medicine (GIM) and N = 50 patients with chronic heart failure (CHF). The mean (± standard deviation (SD)) age of the study cohort was 69 ± 13 years, 47 % female. Patients took 8 ± 3 drugs chronically. The CHF patients had a lower level of education compared to the GIM group (p = 0.004). The overall ET-MP score was 82 ± 21 % (GIM 86 ± 19 %, CHF 78 ± 23 %; p = 0.16). Forty-three percent achieved a score >90 %. A moderate correlation was found between the ET-MP score and the level of education (r = 0.45) and age (r = -0.46), respectively (both p < 0.001). Cognitively impaired CHF patients (p = 0.03) and patients with advanced CHF (p = 0.006) achieved a lower ET-MP score. In the CHF cohort, signs of depression or a lower level of self-care behaviour were not associated with a lower ET-MP score. The ET-MP is suitable to explore patients' understanding of a medication plan. Less than 50 % of the patients reached a score above 90 %. Higher age and lower level of education but not the diagnosis of CHF seem to correlate with impaired understanding of the standardized medication plan. In addition to a medication plan, a significant number of patients are in need of further and continuous care to improve medication safety.
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Making the Most of What We Have Got: Enhancing the RADAR Repository to Support Research Planning
ERIC Educational Resources Information Center
Pike, Dawn; Siminson, Nicola Jane
2017-01-01
This article discusses how RADAR, the institutional repository (IR) at the Glasgow School of Art (GSA), has been modified to house an Annual Research Planning (ARP) template. A case study on the implementation of this research planning tool will outline the role that a repository and its staff can play in supporting individuals, enhancing…
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Kolls, Brad J; Lai, Amy H; Srinivas, Anang A; Reid, Robert R
2014-06-01
The purpose of this study was to determine the relative cost reductions within different staffing models for continuous video-electroencephalography (cvEEG) service by introducing a template system for 10/20 lead application. We compared six staffing models using decision tree modeling based on historical service line utilization data from the cvEEG service at our center. Templates were integrated into technologist-based service lines in six different ways. The six models studied were templates for all studies, templates for intensive care unit (ICU) studies, templates for on-call studies, templates for studies of ≤ 24-hour duration, technologists for on-call studies, and technologists for all studies. Cost was linearly related to the study volume for all models with the "templates for all" model incurring the lowest cost. The "technologists for all" model carried the greatest cost. Direct cost comparison shows that any introduction of templates results in cost savings, with the templates being used for patients located in the ICU being the second most cost efficient and the most practical of the combined models to implement. Cost difference between the highest and lowest cost models under the base case produced an annual estimated savings of $267,574. Implementation of the ICU template model at our institution under base case conditions would result in a $205,230 savings over our current "technologist for all" model. Any implementation of templates into a technologist-based cvEEG service line results in cost savings, with the most significant annual savings coming from using the templates for all studies, but the most practical implementation approach with the second highest cost reduction being the template used in the ICU. The lowered costs determined in this work suggest that a template-based cvEEG service could be supported at smaller centers with significantly reduced costs and could allow for broader use of cvEEG patient monitoring.
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Matta, Ragai-Edward; Bergauer, Bastian; Adler, Werner; Wichmann, Manfred; Nickenig, Hans-Joachim
2017-06-01
The use of a surgical template is a well-established method in advanced implantology. In addition to conventional fabrication, computer-aided design and computer-aided manufacturing (CAD/CAM) work-flow provides an opportunity to engineer implant drilling templates via a three-dimensional printer. In order to transfer the virtual planning to the oral situation, a highly accurate surgical guide is needed. The aim of this study was to evaluate the impact of the fabrication method on the three-dimensional accuracy. The same virtual planning based on a scanned plaster model was used to fabricate a conventional thermo-formed and a three-dimensional printed surgical guide for each of 13 patients (single tooth implants). Both templates were acquired individually on the respective plaster model using an optical industrial white-light scanner (ATOS II, GOM mbh, Braunschweig, Germany), and the virtual datasets were superimposed. Using the three-dimensional geometry of the implant sleeve, the deviation between both surgical guides was evaluated. The mean discrepancy of the angle was 3.479° (standard deviation, 1.904°) based on data from 13 patients. Concerning the three-dimensional position of the implant sleeve, the highest deviation was in the Z-axis at 0.594 mm. The mean deviation of the Euclidian distance, dxyz, was 0.864 mm. Although the two different fabrication methods delivered statistically significantly different templates, the deviations ranged within a decimillimeter span. Both methods are appropriate for clinical use. Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.
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Water Management Plan for Fort Buchanan, Puerto Rico
DOE Office of Scientific and Technical Information (OSTI.GOV)
Chvala, William D.; Sullivan, Gregory P.; Mcmordie, Katherine
2004-06-01
This document reports findings and recommendations as a result of a design assistance project with Fort Buchanan with the goals of developing a Water Management Plan (WMP). The WRMP developed during this task is an amalgam of the templates and guidelines from the Federal Energy Management Program and Army regulations.
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ERIC Educational Resources Information Center
Newman, William
1989-01-01
Discusses an integrated approach for presenting production planning and control fundamentals at the survey level using a Lotus 1-2-3 template. This approach provides an overview of the relationships between the problem components and highlights managerial decision-making points. (Author/JOW)
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Preparing Teacher Candidates for the Instruction of English Language Learners
ERIC Educational Resources Information Center
Gonzalez, Monica Marie
2016-01-01
This inquiry utilizes a sheltered instruction approach to lesson planning with the intention of improving teacher candidates' instruction to English Language Learners (ELLs). In this study a web-based questionnaire and a sheltered instruction lesson plan template were used to facilitate opportunities for teacher candidates to reflect on and…
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Dietrich, Richard E.
2016-07-01
This document serves as the System-Level Acceptance Test (SLAT) Plan for Site Name, City, Country. This test plan is to provide independent testing of the Radiation Detection System (RDS) installed at Site Name to verify that Customs has been delivered a fully-functioning system as required by all contractual commitments. The system includes all installed hardware and software components. The SLAT plan will verify that separate components are working individually and collectively from a system perspective.
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Petretta, Robert; Strelzow, Jason; Ohly, Nicholas E; Misur, Peter; Masri, Bassam A
2015-12-01
Templating is an important aspect of preoperative planning for total hip arthroplasty and can help determine the size and positioning of the prosthesis. Historically, templating has been performed using acetate templates over printed radiographs. As a result of the increasing use of digital imaging, surgeons now either obtain additional printed radiographs solely for templating purposes or use specialized digital templating software, both of which carry additional cost. The purposes of this study was to compare acetate templating of digitally calibrated images on an LCD monitor to digital templating in terms of (1) accuracy; (2) reproducibility; and (3) time efficiency. Acetate onlay templating was performed directly over digital radiographs on an LCD monitor and was compared with digital templating. Five separate observers participated in this study templating on 52 total hip arthroplasties. For the acetate templating, the digital images were magnified to the scaled reference on the templates provided by the manufacturer (ratio 1.2:1) before templating using a 25-mm marker as a reference. Both the acetate and digital templating results were then compared with the actual implanted components to determine accuracy. Interobserver and intraobserver variability was determined by an intraclass correlation coefficient. Observers recorded time to complete templating from the time of complete upload of patients' imaging onto the system to completion of templating. Both acetate and digital templates demonstrated moderate accuracy in predicting within one size of the eventual implanted acetabular cup (77% [199 of 260]; 70% [181 of 260], respectively; p = 0.050; 95% confidence interval [CI], 0.058-0.32), whereas acetate templating was better at predicting the femoral stem compared to digital templating (75% [195 of 260]; 60% [155 of 260], respectively; p < 0.001; 95% CI, 0.084-0.32). Acetate templating showed moderate to substantial interobserver agreement (cup intraclass correlation coefficient [ICC] = 0.55; 95% CI, 0.14-0.86; femoral ICC = 0.75; 95% CI, 0.39-0.95) and both methods showed almost perfect intraobserver agreement in reproducibility (acetate cup ICC = 0.82; 95% CI, 0.66-0.97; acetate femoral ICC = 0.86; 95% CI, 0.74-0.97; digital cup ICC = 0.82; 95% CI, 0.68-0.97; digital femoral ICC = 0.88; 95% CI, 0.77-1.0). Acetate templating could be performed more quickly (acetate mean 119 seconds; range, 37-220 seconds versus 154 seconds; range, 73-343 seconds; p < 0.001). Acetate onlay templating on digitally calibrated images can be a reliable substitute for digital templating using specialized software. It is quicker to perform and much less expensive. Hospitals and practices need not purchase expensive software, particularly at lower volume centers. Level III, diagnostic study.
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Jayme, Sérgio J; Muglia, Valdir A; de Oliveira, Rafael R; Novaes, Arthur B Júnior
2008-01-01
Immediate loading of dental implants shortens the treatment time and makes it possible to give the patient an esthetic appearance throughout the treatment period. Placement of dental implants requires precise planning that accounts for anatomic limitations and restorative goals. Diagnosis can be made with the assistance of computerized tomographic scanning, but transfer of planning to the surgical field is limited. Recently, novel CAD/CAM techniques such as stereolithographic rapid prototyping have been developed to build surgical guides in an attempt to improve precision of implant placement. The aim of this case report was to show a modified surgical template used throughout implant placement as an alternative to a conventional surgical guide.
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Wierenga, Janelle; Thiede, Hanne; Helms, Leah; Hopkins, Sharon
2016-01-01
New regulations were implemented in King County, Washington, in 2010 requiring pet businesses to obtain a permit from Public Health-Seattle & King County (Public Health) and undergo annual inspections to provide education and ensure compliance with regulatory standards. The regulations were developed as a tool for zoonotic disease control and prevention education for businesses and their customers, as well as for environmental protection. To assess the acceptance, benefits, and challenges of the new regulations and identify ways for Public Health to improve educational efforts and assist businesses with compliance. Cross-sectional survey. King County, Washington. Pet businesses with Public Health permits in 2013. Self-administered survey responses. The response rate was 40.5%. The majority of respondents provided grooming, pet day care, and kennel/boarding services from small, independent businesses. Sixty-one percent reported Public Health inspections as beneficial, especially concerning disinfection procedures and using an infection control plan. Almost three-fourths of respondents used the Public Health template to develop the infection control plan. Forty-four percent reported using the educational materials provided by Public Health, and 62% used educational materials from other sources. Most respondents reported that they gained benefits from the pet business permit, although fewer agreed that they obtained a good value from the permit and fee. The most common benefits reported were protection of animal and human health and establishing the credibility of the pet business. Major challenges with the implementation of the pet business regulations were not generally reported by respondents. Most respondents reported a collaborative relationship between Public Health and the pet businesses. Improvements in infection control practices and positive responses to the inspections were reported by pet businesses. Survey results were used to improve infection control plan templates, increase the use of educational materials, and improve the Web site and business portal performance.
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Franceschi, J-P; Sbihi, A
2014-10-01
The precision of bone cuts and the positioning of components influence the functionality and longevity of total knee arthroplasty (TKA). The objective of this study was to evaluate the results of TKA, performed after 3D preoperative templating, with the prosthesis implanted using custom cutting guides (Knee-Plan system, Symbios Orthopédie SA). This prospective study investigated 107 TKAs. Three-dimensional preoperative templating was carried out on the surface views and CT views to analyze the deformation of the lower limb and plan the implantation. The components were positioned in an individualized manner to realign the lower limb and provide ligament balance based on bone landmarks. Final component positioning was analyzed in the three planes with a postoperative CT scan. The preoperative and 1 year follow-up IKS and WOMAC scores were collected and compared. All the cutting guides were stable and functional. Femoral component planning was reproduced with 0 ± 2 precision in the frontal plane (94%± 3), 2 ± 3 in the sagittal plane, and 0 ± 2 in the transverse plane. The precision of the tibial component was reproduced with 0 ± 2 precision in the frontal plane (93%± 3) and 0 ± 4 in the sagittal plane. The HKA angle increased from 177 ± 7 preoperatively to 180 ± 3 at 1 year of follow-up. The IKS and WOMAC scores were significantly improved at 1 year (P<0.0001). The Knee-Plan system can be a realistic, simple, and reliable alternative to conventional cutting guides and to computer-assisted surgery for TKA implantation. IV; prospective cohort study. Copyright © 2014. Published by Elsevier Masson SAS.
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Lamba, Sangeeta; Berlin, Ana; Goett, Rebecca; Ponce, Christopher B; Holland, Bart; Walther, Susanne
2016-07-01
Documentation of the emotional or psychological needs of seriously ill patients receiving specialty palliative care is endorsed by the "Measuring What Matters" project as a quality performance metric and recommended for use by hospice and palliative care programs for program improvement. The aim of this study was to increase the proportion of inpatient palliative care team encounters in which emotional or psychological needs of patients and family members were documented and to qualitatively enrich the nature of this documentation. This is a mixed-methods retrospective study of 200 patient charts reviewed before and after implementation of a structured note template (SmartPhrase) for palliative care encounters. Patterns of documentation of emotional needs pre- and post-implementation were assessed quantitatively and qualitatively using thematic analysis. A total of 158 of 200 pre-intervention charts and 185 of 200 post-intervention charts included at least one note from the palliative care team. Documentation of emotional assessment increased after SmartPhrase implementation (63.9% [101 of 158] vs. 74.6% [138 of 185]; P < 0.03). Qualitative analysis revealed a post-intervention reduction in the use of generic phrases ("emotional support provided") and an increase in the breadth and depth of emotion-related documentation. A structured note template with a prompt for emotional assessment increases the overall quantity and richness of documentation related to patient and family emotions. However, this documentation remains mostly descriptive. Additional prompting for documentation of recommendations to address identified emotional needs, and the use of screening tools for depression and anxiety, when appropriate, may be necessary for clinically meaningful quality improvements in patient care. Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
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Challenges for Successful Planning of Open and Distance Learning (ODL) : A Template Analysis
ERIC Educational Resources Information Center
Minnaar, Ansie
2013-01-01
How to plan an open and distance learning (ODL) unit in higher education is not clearly described in the literature. A number of ODL facilities at residential universities have not been successful because of a lack of planning or because of failure to ensure that all the different systems for ODL delivery were in place and functioning. This paper…
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Deng, Ting; Jiang, Minghui; Lei, Qing; Cai, Lihong; Chen, Li
2016-12-01
Clinical trial for cervical screw insertion by using individualized 3-dimensional (3D) printing screw insertion templates device. The objective of this study is to evaluate the safety and accuracy of the individualized 3D printing screw insertion template in the cervical spine. Ten patients who underwent posterior cervical fusion surgery with cervical pedicle screws, laminar screws or lateral mass screws between December 2014 and December 2015 were involved in this study. The patients were examined by CT scan before operation. The individualized 3D printing templates were made with photosensitive resin by a 3D printing system to ensure the screw shafts entered the vertebral body without breaking the pedicle or lamina cortex. The templates were sterilized by a plasma sterilizer and used during the operation. The accuracy and the safety of the templates were evaluated by CT scans at the screw insertion levels after operation. The accuracy of this patient-specific template technique was demonstrated. Only one screw axis greatly deviated from the planned track and breached the cortex of the pedicle because the template was split by rough handling and then we inserted the screws under the fluoroscopy. The remaining screws were inserted in the track as preoperative design and the screw axis deviated by less than 2 mm. Vascular or neurologic complications or injuries did not happen. And no infection, broken nails, fracture of bone structure, or screw pullout occurred. This study verified the safety and the accuracy of the individualized 3D printing screw insertion templates in the cervical spine as a kind of intraoperative screw navigation. This individualized 3D printing screw insertion template was user-friendly, moderate cost, and enabled a radiation-free cervical screw insertion.
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Jones, Emma; Lees, Nicholas; Martin, Graham; Dixon-Woods, Mary
2014-09-05
Quality improvement (QI) methods are widely used in surgery in an effort to improve care, often using techniques such as Plan-Do-Study-Act cycles to implement specific interventions. Explicit definition of both the QI method and quality intervention is necessary to enable the accurate replication of effective interventions in practice, facilitate cumulative learning, reduce research waste and optimise benefits to patients. This systematic review aims to assess quality of reporting of QI methods and quality interventions in perioperative care. Studies reporting on quality interventions implemented in perioperative care settings will be identified. Searches will be conducted in the Ovid SP version of Medline, Scopus, the Cochrane Central Register of Controlled Trials, the Cochrane Effective Practice and Organisation of Care database and the related articles function of PubMed. The journal BMJ Quality will be searched separately. Search strategy terms will relate to (i) surgery, (ii) QI and (iii) evaluation methods. Explicit exclusion and inclusion criteria will be applied. Data from studies will be extracted using a data extraction form. The Template for Intervention Description and Replication (TIDieR) checklist will be used to evaluate quality of reporting, together with additional items aimed at assessing QI methods specifically. PROSPERO http://CRD42014012845.
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Customization of electronic medical record templates to improve end-user satisfaction.
Gardner, Carrie Lee; Pearce, Patricia F
2013-03-01
Since 2004, increasing importance has been placed on the adoption of electronic medical records by healthcare providers for documentation of patient care. Recent federal regulations have shifted the focus from adoption alone to meaningful use of an electronic medical record system. As proposed by the Technology Acceptance Model, the behavioral intention to use technology is determined by the person's attitude toward usage. The purpose of this quality improvement project was to devise and implement customized templates into an existent electronic medical record system in a single clinic and measure the satisfaction of the clinic providers with the system before and after implementation. Provider satisfaction with the electronic medical record system was evaluated prior to and following template implementation using the current version 7.0 of the Questionnaire for User Interaction Satisfaction tool. Provider comments and improvement in the Questionnaire for User Interaction Satisfaction levels of rankings following template implementation indicated a positive perspective by the providers in regard to the templates and customization of the system.
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Treatment planning for SBRT using automated field delivery: A case study
DOE Office of Scientific and Technical Information (OSTI.GOV)
Ritter, Timothy A., E-mail: timritte@med.umich.edu; Department of Radiation Oncology, Veterans Affairs Ann Arbor Health Care System, Ann Arbor, MI; Owen, Dawn
Stereotactic body radiation therapy (SBRT) treatment planning and delivery can be accomplished using a variety of techniques that achieve highly conformal dose distributions. Herein, we describe a template-based automated treatment field approach that enables rapid delivery of more than 20 coplanar fields. A case study is presented to demonstrate how modest adaptations to traditional SBRT planning can be implemented to take clinical advantage of this technology. Treatment was planned for a left-sided lung lesion adjacent to the chest wall using 25 coplanar treatment fields spaced at 11° intervals. The plan spares the contralateral lung and is in compliance with themore » conformality standards set forth in Radiation Therapy and Oncology Group protocol 0915, and the dose tolerances found in the report of the American Association of Physicists in Medicine Task Group 101. Using a standard template, treatment planning was accomplished in less than 20 minutes, and each 10 Gy fraction was delivered in approximately 5.4 minutes. For those centers equipped with linear accelerators capable of automated treatment field delivery, the use of more than 20 coplanar fields is a viable SBRT planning approach and yields excellent conformality and quality combined with rapid planning and treatment delivery. Although the case study discusses a laterally located lung lesion, this technique can be applied to centrally located tumors with similar results.« less
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Social insurance for dental care in Iran: a developing scheme for a developing country.
Jadidfard, Mohammad-Pooyan; Yazdani, Shahram; Khoshnevisan, Mohammad-Hossein
2012-12-01
This study aimed to describe the current situation with regard to dental care provided under social insurance in Iran in qualitative terms and to assess it critically with regard to equity and efficiency. After a thorough review of the relevant literature, a template of topics, which included population coverage, range of treatment provided, contracting mechanisms, fees, level of co-payments and dental share of total health expenditures, was developed by a panel of Iranian health finance experts. It was used during interviews with informed persons from the different Iranian social funds. These interviews were recorded and transcribed. The transcriptions were checked for accuracy by those who had been interviewed and were then analysed. It was found that, currently, four major social funds are involved in health (including dental) insurance in Iran, under the supervision of The Supreme Council of Health Insurance, located at the newly integrated Ministry of Cooperatives, Labour & Social Welfare. Around 90% of Iranians are covered for health insurance within a Bismarckian system to which the employed, the employers, and the Government contribute. The system has developed piecemeal over the years and is characterised by a complexity of revenue-collection schemes, fragmented insurance pools, and passive purchasing of dental services. The dental sector of Iranian social insurance should establish a strategic purchasing plan for dental care with the aim of improving performance and access to care. Within the plan, there should be a basic benefit package of dental services based on the relative cost-effectiveness of interventions, educating an adequate number of allied dental professionals to provide simple services, and introducing mixed payment methods.
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Federal Register 2010, 2011, 2012, 2013, 2014
2010-05-26
... PHA and the goals, objectives, policies, or programs for servicing victims of domestic violence, dating violence, sexual assault, or stalking and submit the template every 5 years. Qualified PHAs no... Violence Against Women Act (Section 5.3); incorporates a table identifying all Annual PHA Plan elements...
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Making a Meal out of Mathematics
ERIC Educational Resources Information Center
Penny, Robert Ward
2010-01-01
When planning a lesson, many teachers will start by listing content-based objectives; after all, this is how the majority of textbooks, schemes of work and lesson planning templates are constructed. This is understandable, as for many years now teachers have been legally required to teach the national curriculum which was a list of content-based…
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Makam, Anil N; Lanham, Holly J; Batchelor, Kim; Samal, Lipika; Moran, Brett; Howell-Stampley, Temple; Kirk, Lynne; Cherukuri, Manjula; Santini, Noel; Leykum, Luci K; Halm, Ethan A
2013-08-09
Despite considerable financial incentives for adoption, there is little evidence available about providers' use and satisfaction with key functions of electronic health records (EHRs) that meet "meaningful use" criteria. We surveyed primary care providers (PCPs) in 11 general internal medicine and family medicine practices affiliated with 3 health systems in Texas about their use and satisfaction with performing common tasks (documentation, medication prescribing, preventive services, problem list) in the Epic EHR, a common commercial system. Most practices had greater than 5 years of experience with the Epic EHR. We used multivariate logistic regression to model predictors of being a structured documenter, defined as using electronic templates or prepopulated dot phrases to document at least two of the three note sections (history, physical, assessment and plan). 146 PCPs responded (70%). The majority used free text to document the history (51%) and assessment and plan (54%) and electronic templates to document the physical exam (57%). Half of PCPs were structured documenters (55%) with family medicine specialty (adjusted OR 3.3, 95% CI, 1.4-7.8) and years since graduation (nonlinear relationship with youngest and oldest having lowest probabilities) being significant predictors. Nearly half (43%) reported spending at least one extra hour beyond each scheduled half-day clinic completing EHR documentation. Three-quarters were satisfied with documenting completion of pneumococcal vaccinations and half were satisfied with documenting cancer screening (57% for breast, 45% for colorectal, and 46% for cervical). Fewer were satisfied with reminders for overdue pneumococcal vaccination (48%) and cancer screening (38% for breast, 37% for colorectal, and 31% for cervical). While most believed the problem list was helpful (70%) and kept an up-to-date list for their patients (68%), half thought they were unreliable and inaccurate (51%). Dissatisfaction with and suboptimal use of key functions of the EHR may mitigate the potential for EHR use to improve preventive health and chronic disease management. Future work should optimize use of key functions and improve providers' time efficiency.
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Base Preferences in Non-Templated Nucleotide Incorporation by MMLV-Derived Reverse Transcriptases
Zajac, Pawel; Islam, Saiful; Hochgerner, Hannah; Lönnerberg, Peter; Linnarsson, Sten
2013-01-01
Reverse transcriptases derived from Moloney Murine Leukemia Virus (MMLV) have an intrinsic terminal transferase activity, which causes the addition of a few non-templated nucleotides at the 3´ end of cDNA, with a preference for cytosine. This mechanism can be exploited to make the reverse transcriptase switch template from the RNA molecule to a secondary oligonucleotide during first-strand cDNA synthesis, and thereby to introduce arbitrary barcode or adaptor sequences in the cDNA. Because the mechanism is relatively efficient and occurs in a single reaction, it has recently found use in several protocols for single-cell RNA sequencing. However, the base preference of the terminal transferase activity is not known in detail, which may lead to inefficiencies in template switching when starting from tiny amounts of mRNA. Here, we used fully degenerate oligos to determine the exact base preference at the template switching site up to a distance of ten nucleotides. We found a strong preference for guanosine at the first non-templated nucleotide, with a greatly reduced bias at progressively more distant positions. Based on this result, and a number of careful optimizations, we report conditions for efficient template switching for cDNA amplification from single cells. PMID:24392002
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The implementation of an end-of-life integrated care pathway in a Chinese population.
Lo, S-H; Chan, C-Y; Chan, C-H; Sze, W-k; Yuen, K-K; Wong, C-S; Ng, T-Y; Tung, Y
2009-08-01
The integrated care pathway is used in end-of-life care to improve quality of care; the Liverpool Care Pathway (LCP) has been used in Europe and North America. Tuen Mun Hospital is a regional hospital in Hong Kong, China. The End-of-life Care Pathway (ECP) based on the concepts used in the Liverpool Care Pathway, was developed, with modification to suit the local condition. Criteria for entry onto the ECP were that the multidisciplinary team agreed the patient was dying, and was at least two of the following: bedbound; semi-comatose; only able to take sips of fluid; no longer able to take tablets. The ECP template replaced all other inpatient documents. The ECP was implemented in the palliative care unit for terminal cancer patients. An audit was performed to review the result. Fifty-one Chinese patients were included in the audit with mean age 64. The median duration of ECP use was 24 hours. All patients had current medication assessed and non-essential drugs were discontinued. The audit result suggested integrated care pathway in end-of-life care could be implemented successfully in an Oriental culture. The acceptance of using the ECP as a standard clinical practice takes time and education. Appropriate template design and supervision are the keys to success.
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Leadership: a central tenet for postgraduate dementia services curricula development in Australia.
Angus, Jocelyn
2009-04-01
In the next decades of the twenty-first century, the global aging of populations will challenge every nation's ability to provide leadership by qualified health professionals to reshape and improve health care delivery systems. The challenge for educators is to design and deliver courses that will give students the knowledge and skills they need to fill that leadership role confidently in dementia care services. This paper explores the ways in which a curriculum can develop graduates who are ready to become leaders in shaping their industry. The Master of Health Science-Aged Services (MHSAS) program at Victoria University, Melbourne, Australia is applied as a case study to describe the process by which the concept of leadership is applied as the key driver in curriculum development, teaching practices and learning outcomes. Evaluation instruments employed in a variety of purposes including teaching, curriculum planning and unit appraisal are discussed. Challenges for the future are proposed including the need for postgraduate programs in dementia to seek stronger national and international benchmarks and associations with other educational institutions to promote leadership and a vision of what is possible and desirable in dementia care provision. In the twenty-first century, effective service provision in the aged health care sector will require postgraduate curricula that equip students for dementia care leadership. The MHSAS program provides an established template for such curricula.
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Day, Julie; Scammon, Debra L.; Kim, Jaewhan; Sheets-Mervis, Annie; Day, Rachel; Tomoaia-Cotisel, Andrada; Waitzman, Norman J.; Magill, Michael K.
2013-01-01
PURPOSE We examined quality, satisfaction, financial, and productivity outcomes associated with implementation of Care by Design (CBD), the University of Utah’s version of the patient-centered medical home. METHODS We measured the implementation of individual elements of CBD using a combination of observation, chart audit, and collection of data from operational reports. We assessed correlations between level of implementation of each element and measures of quality, patient and clinician satisfaction, financial performance, and efficiency. RESULTS Team function elements had positive correlations (P ≤.05) with 6 quality measures, 4 patient satisfaction measure, and 3 clinician satisfaction measures. Continuity elements had positive correlations with 2 satisfaction measures and 1 quality measure. Clinician continuity was the key driver in the composite element of appropriate access. Unexpected findings included the negative correlation of use of templated questionnaires with 3 patient satisfaction measures. Trade-offs were observed for performance of blood draws in the examination room and the efficiency of visits, with some positive and some negative correlations depending on the outcome. CONCLUSIONS Elements related to care teams and continuity appear to be key elements of CBD as they influence all 3 CBD organizing principles: appropriate access, care teams, and planned care. These relationships, as well as unexpected, unfavorable ones, require further study and refined analyses to identify causal associations. PMID:23690386
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Stapleton, Brandon M; Lin, Wei-Shao; Ntounis, Athanasios; Harris, Bryan T; Morton, Dean
2014-09-01
This clinical report demonstrated the use of an implant-supported fixed dental prosthesis fabricated with a contemporary digital approach. The digital diagnostic data acquisition was completed with a digital diagnostic impression with an intraoral scanner and cone-beam computed tomography with a prefabricated universal radiographic template to design a virtual prosthetically driven implant surgical plan. A surgical template fabricated with computer-aided design and computer-aided manufacturing (CAD/CAM) was used to perform computer-guided implant surgery. The definitive digital data were then used to design the definitive CAD/CAM-fabricated fixed dental prosthesis. Copyright © 2014 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.
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Evaluation of clinical pharmacy services in a hematology/oncology outpatient setting.
Shah, Sachin; Dowell, Jonathan; Greene, Shane
2006-09-01
The Veterans Affairs North Texas Health Care System in Dallas, TX, provides a unique opportunity for clinical pharmacists to work as providers. Even though clinical pharmacists are actively involved in patient care, many of their efforts remain undocumented, resulting in an underestimation of the importance of their services and missed opportunities for improvements and new directions. To document and evaluate the services of a hematology/oncology clinical pharmacy in the outpatient setting. Pendragon Forms 3.2 software was used to design the documentation template. The template was designed to collect diagnoses, supportive care issues, drug-specific interventions, and prescriptions written. This template was uploaded to the personal digital assistant (PDA) for documentation. Patient-specific information was documented in a password-protected PDA. Data collected from November 1, 2002, to October 31, 2003, were retrospectively analyzed. Clinical pharmacists were involved in 423 patient visits for chemotherapy follow-up or disease management. Cancer diagnoses included colorectal (n = 99), multiple myeloma (59), non-small cell lung (56), chronic lymphocytic leukemia (44), myelodysplastic syndromes (22), and chronic myelogenous leukemia (19). During the 423 patient visits, 342 supportive care issues were addressed including anemia (34%), pain management (22%), constipation/diarrhea (15%), and nausea/vomiting (8%). Major drug-specific interventions included drug addition (41%), discontinuation (23%), and adjustment (21%). Four hundred forty-five prescriptions were filled, of which 181 were new and 150 were refilled. This is the first study, as of July 25, 2006, to document considerable contribution of an outpatient clinical pharmacist in direct cancer patient care. Although the disease management and supportive care issues addressed here may differ based on institution and patient population, the results of our study show that clinical pharmacists have ever-growing roles in the management of these patients.
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Development of a synoptic MRI report for primary rectal cancer.
Spiegle, Gillian; Leon-Carlyle, Marisa; Schmocker, Selina; Fruitman, Mark; Milot, Laurent; Gagliardi, Anna R; Smith, Andy J; McLeod, Robin S; Kennedy, Erin D
2009-12-02
Although magnetic resonance imaging (MRI) is an important imaging modality for pre-operative staging and surgical planning of rectal cancer, to date there has been little investigation on the completeness and overall quality of MRI reports. This is important because optimal patient care depends on the quality of the MRI report and clear communication of these reports to treating physicians. Previous work has shown that the use of synoptic pathology reports improves the quality of pathology reports and communication between physicians. The aims of this project are to develop a synoptic MRI report for rectal cancer and determine the enablers and barriers toward the implementation of a synoptic MRI report for rectal cancer in the clinical setting. A three-step Delphi process with an expert panel will extract the key criteria for the MRI report to guide pre-operative chemoradiation and surgical planning following a review of the literature, and a synoptic template will be developed. Furthermore, standardized qualitative research methods will be used to conduct interviews with radiologists to determine the enablers and barriers to the implementation and sustainability of the synoptic MRI report in the clinic setting. Synoptic MRI reports for rectal cancer are currently not used in North America and may improve the overall quality of MRI report and communication between physicians. This may, in turn, lead to improved patient care and outcomes for rectal cancer patients.
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Brown, Corinne; Bornstein, Elizabeth; Wilcox, Catina
2012-02-01
The Partnership and Empowerment Program model offers a comprehensive, patient-centered, and cost-effective template for coordinating care for underinsured and uninsured patients with cancer. Attention to effective coordination, including use of internal and external resources, may result in decreased costs of care and improved patient compliance and health outcomes.
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Semenic, Sonia; Edwards, Nancy; Premji, Shahirose; Olson, Joanne; Williams, Beverly; Montgomery, Phyllis
2015-03-31
Prenatal records are potentially powerful tools for the translation of best-practice evidence into routine prenatal care. Although all jurisdictions in Canada use standardized prenatal records to guide care and provide data for health surveillance, their content related to risk factors such as maternal smoking and alcohol use varies widely. Literature is lacking on how prenatal records are developed or updated to integrate research evidence. This multiphase project aimed to identify key contextual factors influencing decision-making and evidence use among Canadian prenatal record committees (PRCs), and formulate recommendations for the prenatal record review process in Canada. Phase 1 comprised key informant interviews with PRC leaders across 10 Canadian jurisdictions. Phase 2, was a qualitative comparative case study of PRC factors influencing evidence-use and decision-making in five selected jurisdictions. Interview data were analysed using qualitative content analysis. Phase 3 involved a dissemination workshop with key stakeholders to review and refine recommendations derived from Phases 1 and 2. Prenatal record review processes differed considerably across Canadian jurisdictions. PRC decision-making was complex, revealing the competing functions of the prenatal record as a clinical guide, documentation tool and data source. Internal contextual factors influencing evidence use included PRC resources to conduct evidence reviews; group composition and dynamics; perceived function of the prenatal record; and expert opinions. External contextual factors included concerns about user buy-in; health system capacities; and pressures from public health stakeholders. Our recommendations highlight the need for: broader stakeholder involvement and explicit use of decision-support strategies to support the revision process; a national template of evidence-informed changes that can be used across jurisdictions; consideration of both clinical and surveillance functions of the prenatal record; and dissemination plans to communicate prenatal record modifications. Decision-making related to prenatal record content involves a negotiated effort to balance research evidence with the needs and preferences of prenatal care providers, health system capacities as well as population health priorities. The development of a national template for prenatal records would reduce unnecessary duplication of PRC work and enhance the consistency of prenatal care delivery and perinatal surveillance data across Canada.
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Thomas, Thaddeus P.; Anderson, Donald D.; Willis, Andrew R.; Liu, Pengcheng; Marsh, J. Lawrence; Brown, Thomas D.
2010-01-01
Background Highly comminuted intra-articular fractures are complex and difficult injuries to treat. Once emergent care is rendered, the definitive treatment objective is to restore the original anatomy while minimizing surgically induced trauma. Operations that use limited or percutaneous approaches help preserve tissue vitality, but reduced visibility makes reconstruction more difficult. A pre-operative plan of how comminuted fragments would best be re-positioned to restore anatomy helps in executing a successful reduction. Methods In this study, methods for virtually reconstructing a tibial plafond fracture were developed and applied to clinical cases. Building upon previous benchtop work, novel image analysis techniques and puzzle solving algorithms were developed for clinical application. Specialty image analysis tools were used to segment the fracture fragment geometries from CT data. The original anatomy was then restored by matching fragment native (periosteal and subchondral) bone surfaces to an intact template, generated from the uninjured contralateral limb. Findings Virtual reconstructions obtained for ten tibial plafond fracture cases had average alignment errors of 0.39 (0.5 standard deviation) mm. In addition to precise reduction planning, 3D puzzle solutions can help identify articular deformities and bone loss. Interpretation The results from this study indicate that 3D puzzle solving provides a powerful new tool for planning the surgical reconstruction of comminuted articular fractures. PMID:21215501
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78 FR 50075 - Statewide Communication Interoperability Plan Template and Annual Progress Report
Federal Register 2010, 2011, 2012, 2013, 2014
2013-08-16
... of Cybersecurity and Communications (CS&C), Office of Emergency Communications (OEC), will submit the... Directorate, Office of Cybersecurity and Communications, Office of Emergency Communications. Title: Statewide...
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Coordinating sensing and local navigation
NASA Technical Reports Server (NTRS)
Slack, Marc G.
1991-01-01
Based on Navigation Templates (or NaTs), this work presents a new paradigm for local navigation which addresses the noisy and uncertain nature of sensor data. Rather than creating a new navigation plan each time the robot's perception of the world changes, the technique incorporates perceptual changes directly into the existing navigation plan. In this way, the robot's navigation plan is quickly and continuously modified, resulting in actions that remain coordinated with its changing perception of the world.
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Managing multimorbidity in primary care in patients with chronic respiratory conditions.
Morrison, Deborah; Agur, Karolina; Mercer, Stewart; Eiras, Andreia; González-Montalvo, Juan I; Gruffydd-Jones, Kevin
2016-09-15
The term multimorbidity is usually defined as the coexistence of two or more chronic conditions within an individual, whereas the term comorbidity traditionally describes patients with an index condition and one or more additional conditions. Multimorbidity of chronic conditions markedly worsens outcomes in patients, increases treatment burden and increases health service costs. Although patients with chronic respiratory disease often have physical comorbidities, they also commonly experience psychological problems such as depression and anxiety. Multimorbidity is associated with increased health-care utilisation and specifically with an increased number of prescription drugs in individuals with multiple chronic conditions such as chronic obstructive pulmonary disease. This npj Primary Care Respiratory Medicine Education Section case study involves a patient in a primary care consultation presenting several common diseases prevalent in people of this age. The patient takes nine different drugs at this moment, one or more pills for each condition, which amounts to polypharmacy. The problems related with polypharmacy recommend that a routine medication review by primary care physicians be performed to reduce the risk of adverse effects of polypharmacy among those with multiple chronic conditions. The primary care physician has the challenging role of integrating all of the clinical problems affecting the patient and reviewing all medicaments (including over-the-counter medications) taken by the patient at any point in time, and has the has the key to prevent the unwanted consequences of polypharmacy. Multimorbid chronic disease management can be achieved with the use of care planning, unified disease templates, use of information technology with appointment reminders and with the help of the wider primary care and community teams.
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Franse, Carmen B; Voorham, Antonius J J; van Staveren, Rob; Koppelaar, Elin; Martijn, Rens; Valía-Cotanda, Elisa; Alhambra-Borrás, Tamara; Rentoumis, Tasos; Bilajac, Lovorka; Marchesi, Vanja Vasiljev; Rukavina, Tomislav; Verma, Arpana; Williams, Greg; Clough, Gary; Garcés-Ferrer, Jorge; Mattace Raso, Francesco; Raat, Hein
2017-09-11
Older persons often have interacting physical and social problems and complex care needs. An integrated care approach in the local context with collaborations between community-, social-, and health-focused organisations can contribute to the promotion of independent living and quality of life. In the Urban Health Centres Europe (UHCE) project, five European cities (Greater Manchester, United Kingdom; Pallini (in Greater Athens Area), Greece; Rijeka, Croatia; Rotterdam, the Netherlands; and Valencia, Spain) develop and implement a care template that integrates health and social care and includes a preventive approach. The UHCE project includes an effect and process evaluation. In a one-year pre-post controlled trial, in each city 250 participants aged 75+ years are recruited to receive the UHCE approach and are compared with 250 participants who receive 'care as usual'. Benefits of UHCE approach in terms of healthy life styles, fall risk, appropriate medication use, loneliness level and frailty, and in terms of level of independence and health-related quality of life and health care use are assessed. A multilevel modeling approach is used for the analyses. The process evaluation is used to provide insight into the reach of the target population, the extent to which elements of the UHCE approach are executed as planned and the satisfaction of the participants. The UHCE project will provide new insight into the feasibility and effectiveness of an integrated care approach for older persons in different European settings. ISRCTN registry number is ISRCTN52788952 . Date of registration is 13/03/2017.
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Dynamic traversal of large gaps by insects and legged robots reveals a template.
Gart, Sean W; Yan, Changxin; Othayoth, Ratan; Ren, Zhiyi; Li, Chen
2018-02-02
It is well known that animals can use neural and sensory feedback via vision, tactile sensing, and echolocation to negotiate obstacles. Similarly, most robots use deliberate or reactive planning to avoid obstacles, which relies on prior knowledge or high-fidelity sensing of the environment. However, during dynamic locomotion in complex, novel, 3D terrains, such as a forest floor and building rubble, sensing and planning suffer bandwidth limitation and large noise and are sometimes even impossible. Here, we study rapid locomotion over a large gap-a simple, ubiquitous obstacle-to begin to discover the general principles of the dynamic traversal of large 3D obstacles. We challenged the discoid cockroach and an open-loop six-legged robot to traverse a large gap of varying length. Both the animal and the robot could dynamically traverse a gap as large as one body length by bridging the gap with its head, but traversal probability decreased with gap length. Based on these observations, we developed a template that accurately captured body dynamics and quantitatively predicted traversal performance. Our template revealed that a high approach speed, initial body pitch, and initial body pitch angular velocity facilitated dynamic traversal, and successfully predicted a new strategy for using body pitch control that increased the robot's maximal traversal gap length by 50%. Our study established the first template of dynamic locomotion beyond planar surfaces, and is an important step in expanding terradynamics into complex 3D terrains.
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Siden, Rivka; Kem, Ravie; Ostrenga, Andrew; Nicksy, Darcy; Bernhardt, Brooke; Bartholomew, Joy
2014-06-01
The increased use of oral chemotherapy for the treatment of cancer introduces new challenges for patients and caregivers. Among them are the ability to swallow oral solid dosage forms, the proper administration of the agents and the safe-handling of chemotherapeutic drugs in the home. Since these drugs are hazardous, proper preparation, administration, and disposition introduces a variety of safety issues. The increased toxicity of these drugs coupled with complicated dosing regimens and the occasional need to dilute the drug or measure a liquid dosage form require careful instruction of the patient and/or caregivers. The purpose of this project was to create templates for writing patient instruction brochures. A group of clinicians specializing in oncology from several institutions in the United States and Canada met through a series of conference calls. The group included pharmacists with a specialty in pediatric oncology, investigational drug pharmacists, and an oncology nurse practitioner. National guidelines and practices at each institution were used for the creation of templates to be used in developing templates for medication and formulation-specific instruction brochures. The group developed six templates. The templates ranged in scope from instructions on the administration of intact tablets or capsules to directions on opening capsules or crushing tablets and mixing the content with foods or liquids. Thirty-three drug-specific brochures were developed using the templates. Templates of patient brochures and drug-specific brochures on the safe handling of chemotherapy in the home can be created using a collaborative, multi-institutional approach.
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Trouilloud, P; Gonzalvez, M; Martz, P; Charles, H; Handelberg, F; Nyffeler, R W; Baulot, E
2014-05-01
We describe our experience with a new system of patient-specific template called Personal Fit(®), which is unique in shoulder surgery and used in combination with Duocentric(®) prosthesis. The reverse prosthesis's concept is the invention of Paul Grammont, developed with Grammont's team of Dijon University as from 1981, which led to the first reversed total shoulder prosthesis called Trumpet in 1985. The Duocentric(®) prosthesis developed in 2001 is the third-generation prosthesis, coming from the Trumpet and the second-generation prosthesis Delta(®) (DePuy). This prosthesis provides a novel solution to the notching problem with an inferior overhang integrated onto the glenoid baseplate. Personal Fit(®) system is based on reconstructing the shoulder joint bones in three dimensions using CT scan data, placing a landmark on the scapula and locating points on the glenoid and humerus. That will be used as a reference for the patient-specific templates. We study the glenoid position planned with Personal Fit(®) software relative to native glenoid position in 30 cases. On average, the difference between the planned retroversion (or anteversion in one case) and native retroversion was 8.6°.
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Applications of 3D printing in the management of severe spinal conditions.
Provaggi, Elena; Leong, Julian J H; Kalaskar, Deepak M
2017-06-01
The latest and fastest-growing innovation in the medical field has been the advent of three-dimensional printing technologies, which have recently seen applications in the production of low-cost, patient-specific medical implants. While a wide range of three-dimensional printing systems has been explored in manufacturing anatomical models and devices for the medical setting, their applications are cutting-edge in the field of spinal surgery. This review aims to provide a comprehensive overview and classification of the current applications of three-dimensional printing technologies in spine care. Although three-dimensional printing technology has been widely used for the construction of patient-specific anatomical models of the spine and intraoperative guide templates to provide personalized surgical planning and increase pedicle screw placement accuracy, only few studies have been focused on the manufacturing of spinal implants. Therefore, three-dimensional printed custom-designed intervertebral fusion devices, artificial vertebral bodies and disc substitutes for total disc replacement, along with tissue engineering strategies focused on scaffold constructs for bone and cartilage regeneration, represent a set of promising applications towards the trend of individualized patient care.
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76 FR 61103 - Medicare Program; Comprehensive Primary Care Initiative
Federal Register 2010, 2011, 2012, 2013, 2014
2011-10-03
... interest by November 15, 2011 using the LOI template provided on the Innovation Center Web site at http://www.innovation.cms.gov /. Application Submission Deadline: Applications must be received through an... practice redesign in primary care through payment reform. The Center for Medicare & Medicaid Innovation...
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Consensus guidelines: improving the delivery of clinical preventive services.
Ayres, Cynthia G; Griffith, Hurdis M
2008-01-01
Medical directors from the largest competing health plans in the state came together in a noncompetitive way to collaborate on improving the delivery of clinical preventive service (CPS) among their provider base. They identified one consistent set of CPS guidelines based on U.S. Preventive Services Task Force recommendations, the health plan consensus guidelines (HPCG), that they could endorse as priority for guideline implementation. The purposes of this study were to assess clinicians' knowledge and use of CPS recommendations as a guide to delivering preventive care services to their patients and, most importantly, to test the effectiveness of providing the HPCG to clinicians in an effort to increase knowledge and use of CPS guidelines. Within-subjects repeated-measures design was used. We hypothesized an increase in clinician's knowledge and use of CPS after the provision of the HPCG. Survey methodology, including two surveys that assessed clinicians' knowledge and use of CPS in practice, was used. Health plan clinician databases were obtained from the health plans that participated in the development of the HPCG. Health plan clinicians directly involved in delivering preventive services were invited to participate in the study. Final sample included 163 clinicians. Spearman's rho correlation coefficients were determined to examine the relationships between clinician's knowledge and clinician's use of CPS guidelines. Differences between knowledge and use of CPS before and after HPCG were examined by t tests. No difference was found in the familiarity with U.S. Preventive Services Task Force guidelines before and after receipt of HPCG. However, clinician's use increased significantly. A consistent set of CPS guidelines provided by competing health plans can improve the delivery of CPS among contracted health plan clinicians. This approach provides a template for competing health plans nationwide to come to consensus on guidelines that support clinicians in the delivery of CPS ().
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Mallen, Christian D; Nicholl, Barbara I; Lewis, Martyn; Bartlam, Bernadette; Green, Daniel; Jowett, Sue; Kigozi, Jesse; Belcher, John; Clarkson, Kris; Lingard, Zoe; Pope, Christopher; Chew-Graham, Carolyn A; Croft, Peter; Hay, Elaine M; Peat, George
2017-04-01
This study aimed to evaluate whether prompting general practitioners (GPs) to routinely assess and manage anxiety and depression in patients consulting with osteoarthritis (OA) improves pain outcomes. We conducted a cluster randomised controlled trial involving 45 English general practices. In intervention practices, patients aged ≥45 y consulting with OA received point-of-care anxiety and depression screening by the GP, prompted by an automated electronic template comprising five questions (a two-item Patient Health Questionnaire-2 for depression, a two-item Generalized Anxiety Disorder-2 questionnaire for anxiety, and a question about current pain intensity [0-10 numerical rating scale]). The template signposted GPs to follow National Institute for Health and Care Excellence clinical guidelines for anxiety, depression, and OA and was supported by a brief training package. The template in control practices prompted GPs to ask the pain intensity question only. The primary outcome was patient-reported current pain intensity post-consultation and at 3-, 6-, and 12-mo follow-up. Secondary outcomes included pain-related disability, anxiety, depression, and general health. During the trial period, 7,279 patients aged ≥45 y consulted with a relevant OA-related code, and 4,240 patients were deemed potentially eligible by participating GPs. Templates were completed for 2,042 patients (1,339 [31.6%] in the control arm and 703 [23.1%] in the intervention arm). Of these 2,042 patients, 1,412 returned questionnaires (501 [71.3%] from 20 intervention practices, 911 [68.0%] from 24 control practices). Follow-up rates were similar in both arms, totalling 1,093 (77.4%) at 3 mo, 1,064 (75.4%) at 6 mo, and 1,017 (72.0%) at 12 mo. For the primary endpoint, multilevel modelling yielded significantly higher average pain intensity across follow-up to 12 mo in the intervention group than the control group (adjusted mean difference 0.31; 95% CI 0.04, 0.59). Secondary outcomes were consistent with the primary outcome measure in reflecting better outcomes as a whole for the control group than the intervention group. Anxiety and depression scores did not reduce following the intervention. The main limitations of this study are two potential sources of bias: an imbalance in cluster size (mean practice size 7,397 [intervention] versus 5,850 [control]) and a difference in the proportion of patients for whom the GP deactivated the template (33.6% [intervention] versus 27.8% [control]). In this study, we observed no beneficial effect on pain outcomes of prompting GPs to routinely screen for and manage comorbid anxiety and depression in patients presenting with symptoms due to OA, with those in the intervention group reporting statistically significantly higher average pain scores over the four follow-up time points than those in the control group. ISRCTN registry ISRCTN40721988.
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Kaneyama, Shuichi; Sugawara, Taku; Sumi, Masatoshi
2015-03-15
Clinical trial for midcervical pedicle screw insertion using a novel patient-specific intraoperative screw guiding device. To evaluate the availability of the "Screw Guide Template" (SGT) system for insertion of midcervical pedicle screws. Despite many efforts for accurate midcervical pedicle screw insertion, there still remain unacceptable rate of screw malpositioning that might cause neurovascular injuries. We developed patient-specific SGT system for safe and accurate intraoperative screw navigation tool and have reported its availability for the screw insertion to C2 vertebra and thoracic spine. Preoperatively, the bone image on computed tomography was analyzed and the trajectories of the screws were designed in 3-dimensional format. Three types of templates were created for each lamina: location template, drill guide template, and screw guide template. During the operations, after engaging the templates directly with the laminae, drilling, tapping, and screwing were performed with each template. We placed 80 midcervical pedicle screws for 20 patients. The accuracy and safety of the screw insertion by SGT system were evaluated using postoperative computed tomographic scan by calculation of screw deviation from the preplanned trajectory and evaluation of screw breach of pedicle wall. All templates fitted the laminae and screw navigation procedures proceeded uneventfully. All screws were inserted accurately with the mean screw deviation from planned trajectory of 0.29 ± 0.31 mm and no neurovascular complication was experienced. We demonstrated that our SGT system could support the precise screw insertion in midcervical pedicle. SGT prescribes the safe screw trajectory in a 3-dimensional manner and the templates fit and lock directly to the target laminae, which prevents screwing error along with the change of spinal alignment during the surgery. These advantages of the SGT system guarantee the high accuracy in screw insertion, which allowed surgeons to insert cervical pedicle screws safely. 3.
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Norton & Elaine Sarnoff Center for Jewish Genetics
... to register! QuestionPro provides free survey templates for Customer Satisfaction, Human Resources, Marketing, Health Care, Customer Service, Academic Evaluation, and Community surveys. Contact Us ...
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Multidisciplinary disease management in rheumatology.
Oliver, Susan
2003-11-01
With an increasingly ageing population, the number of patients with osteoarthritis and rheumatoid arthritis is expected to rise. High-quality patient education and self-management are essential in these chronic debilitating conditions. A multidisciplinary team has produced a template to guide the assessment, treatment and holistic care of patients in primary care.
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MRI-alone radiation therapy planning for prostate cancer: Automatic fiducial marker detection
DOE Office of Scientific and Technical Information (OSTI.GOV)
Ghose, Soumya, E-mail: soumya.ghose@case.edu; Mitra, Jhimli; Rivest-Hénault, David
Purpose: The feasibility of radiation therapy treatment planning using substitute computed tomography (sCT) generated from magnetic resonance images (MRIs) has been demonstrated by a number of research groups. One challenge with an MRI-alone workflow is the accurate identification of intraprostatic gold fiducial markers, which are frequently used for prostate localization prior to each dose delivery fraction. This paper investigates a template-matching approach for the detection of these seeds in MRI. Methods: Two different gradient echo T1 and T2* weighted MRI sequences were acquired from fifteen prostate cancer patients and evaluated for seed detection. For training, seed templates from manual contoursmore » were selected in a spectral clustering manifold learning framework. This aids in clustering “similar” gold fiducial markers together. The marker with the minimum distance to a cluster centroid was selected as the representative template of that cluster during training. During testing, Gaussian mixture modeling followed by a Markovian model was used in automatic detection of the probable candidates. The probable candidates were rigidly registered to the templates identified from spectral clustering, and a similarity metric is computed for ranking and detection. Results: A fiducial detection accuracy of 95% was obtained compared to manual observations. Expert radiation therapist observers were able to correctly identify all three implanted seeds on 11 of the 15 scans (the proposed method correctly identified all seeds on 10 of the 15). Conclusions: An novel automatic framework for gold fiducial marker detection in MRI is proposed and evaluated with detection accuracies comparable to manual detection. When radiation therapists are unable to determine the seed location in MRI, they refer back to the planning CT (only available in the existing clinical framework); similarly, an automatic quality control is built into the automatic software to ensure that all gold seeds are either correctly detected or a warning is raised for further manual intervention.« less
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MRI-alone radiation therapy planning for prostate cancer: Automatic fiducial marker detection.
Ghose, Soumya; Mitra, Jhimli; Rivest-Hénault, David; Fazlollahi, Amir; Stanwell, Peter; Pichler, Peter; Sun, Jidi; Fripp, Jurgen; Greer, Peter B; Dowling, Jason A
2016-05-01
The feasibility of radiation therapy treatment planning using substitute computed tomography (sCT) generated from magnetic resonance images (MRIs) has been demonstrated by a number of research groups. One challenge with an MRI-alone workflow is the accurate identification of intraprostatic gold fiducial markers, which are frequently used for prostate localization prior to each dose delivery fraction. This paper investigates a template-matching approach for the detection of these seeds in MRI. Two different gradient echo T1 and T2* weighted MRI sequences were acquired from fifteen prostate cancer patients and evaluated for seed detection. For training, seed templates from manual contours were selected in a spectral clustering manifold learning framework. This aids in clustering "similar" gold fiducial markers together. The marker with the minimum distance to a cluster centroid was selected as the representative template of that cluster during training. During testing, Gaussian mixture modeling followed by a Markovian model was used in automatic detection of the probable candidates. The probable candidates were rigidly registered to the templates identified from spectral clustering, and a similarity metric is computed for ranking and detection. A fiducial detection accuracy of 95% was obtained compared to manual observations. Expert radiation therapist observers were able to correctly identify all three implanted seeds on 11 of the 15 scans (the proposed method correctly identified all seeds on 10 of the 15). An novel automatic framework for gold fiducial marker detection in MRI is proposed and evaluated with detection accuracies comparable to manual detection. When radiation therapists are unable to determine the seed location in MRI, they refer back to the planning CT (only available in the existing clinical framework); similarly, an automatic quality control is built into the automatic software to ensure that all gold seeds are either correctly detected or a warning is raised for further manual intervention.
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Vasak, Christoph; Watzak, Georg; Gahleitner, André; Strbac, Georg; Schemper, Michael; Zechner, Werner
2011-10-01
This prospective study was intended to evaluate the overall deviation in a clinical treatment setting to provide for quantification of the potential impairment of treatment safety and reliability with computer-assisted, template-guided transgingival implantation. The patient population enrolled (male/female=10/8) presented with partially dentate and edentulous maxillae and mandibles. Overall, 86 implants were placed by two experienced dental surgeons strictly following the NobelGuide™ protocol for template-guided implantation. All patients had a postoperative computed tomography (CT) with identical settings to the preoperative examination. Using the triple scan technique, pre- and postoperative CT data were merged in the Procera planning software, a newly developed procedure - initially presented in 2007 allowing measurement of the deviations at implant shoulder and apex. The deviations measured were an average of 0.43 mm (bucco-lingual), 0.46 mm (mesio-distal) and 0.53 mm (depth) at the level of the implant shoulder and slightly higher at the implant apex with an average of 0.7 mm (bucco-lingual), 0.63 mm (mesio-distal) and 0.52 mm (depth). The maximum deviation of 2.02 mm was encountered in the corono-apical direction. Significantly lower deviations were seen for implants in the anterior region vs. the posterior tooth region (P<0.01, 0.31 vs. 0.5 mm), and deviations were also significantly lower in the mandible than in the maxilla (P=0.04, 0.36 vs. 0.45 mm) in the mesio-distal direction. Moreover, a significant correlation between deviation and mucosal thickness was seen and a learning effect was found over the time period of performance of the surgical procedures. Template-guided implantation will ensure reliable transfer of preoperative computer-assisted planning into surgical practice. With regard to the required verification of treatment reliability of an implantation system with flapless access, all maximum deviations measured in this clinical study were within the safety margins recommended by the planning software. © 2011 John Wiley & Sons A/S.
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ERIC Educational Resources Information Center
Brodzik, Michael C.
2012-01-01
This Executive Position Paper is a one-to-one laptop implementation plan for Pittsgrove Township Schools that can be used as a template for other districts with similar interests. Each of the three chapters fulfills a major purpose. In Chapter One the paper is designed to substantiate the need for the Pittsgrove Township School District to…
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Designing Services and Programs for High-Ability Learners. A Guidebook for Gifted Education
ERIC Educational Resources Information Center
Purcell, Jeanne H., Ed.; Eckert, Rebecca D., Ed.
2005-01-01
This book will help the reader every step of the way with detailed guidelines, practical tips, templates, action plans, and suggestions for strategic planning teams as well as for the sole practitioner. Consolidating the sage advice and up-to-date research of 29 leaders in the field, this comprehensive and highly practical guide takes the…
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3-Dimensional printing guide template assisted percutaneous vertebroplasty: Technical note.
Li, Jian; Lin, JiSheng; Yang, Yong; Xu, JunChuan; Fei, Qi
2018-06-01
Percutaneous vertebroplasty (PVP) is currently considered as an effective treatment for pain caused by acute osteoporotic vertebral compression fracture. Recently, puncture-related complications are increasingly reported. It's important to find a precise technique to reduce the puncture-related complications. We report a case and discussed the novel surgical technique with step-by-step operating procedures, to introduce the precise PVP assisted by a 3-dimensional printing guide template. Based on the preoperative CT scan and infrared scan data, a well-designed individual guide template could be established in a 3-dimensional reconstruction software and printed out by a 3-dimensional printer. In real operation, by matching the guide template to patient's back skin, cement needles' insertion orientation and depth were easily established. Only 14 times C-arm fluoroscopy with HDF mode (total exposure dose was 4.5 mSv) were required during the procedure. The operation took only 17 min. Cement distribution in the vertebral body was very good without any puncture-related complications. Pain was significantly relieved after surgery. In conclusion, the novel precise 3-dimensional printing guide template system may allow (1) comprehensive visualization of the fractured vertebral body and the individual surgical planning, (2) the perfect fitting between skin and guide template to ensure the puncture stability and accuracy, and (3) increased puncture precision and decreased puncture-related complications, surgical time and radiation exposure. Copyright © 2018 Elsevier Ltd. All rights reserved.
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Generation and evaluation of an ultra-high-field atlas with applications in DBS planning
NASA Astrophysics Data System (ADS)
Wang, Brian T.; Poirier, Stefan; Guo, Ting; Parrent, Andrew G.; Peters, Terry M.; Khan, Ali R.
2016-03-01
Purpose Deep brain stimulation (DBS) is a common treatment for Parkinson's disease (PD) and involves the use of brain atlases or intrinsic landmarks to estimate the location of target deep brain structures, such as the subthalamic nucleus (STN) and the globus pallidus pars interna (GPi). However, these structures can be difficult to localize with conventional clinical magnetic resonance imaging (MRI), and thus targeting can be prone to error. Ultra-high-field imaging at 7T has the ability to clearly resolve these structures and thus atlases built with these data have the potential to improve targeting accuracy. Methods T1 and T2-weighted images of 12 healthy control subjects were acquired using a 7T MR scanner. These images were then used with groupwise registration to generate an unbiased average template with T1w and T2w contrast. Deep brain structures were manually labelled in each subject by two raters and rater reliability was assessed. We compared the use of this unbiased atlas with two other methods of atlas-based segmentation (single-template and multi-template) for subthalamic nucleus (STN) segmentation on 7T MRI data. We also applied this atlas to clinical DBS data acquired at 1.5T to evaluate its efficacy for DBS target localization as compared to using a standard atlas. Results The unbiased templates provide superb detail of subcortical structures. Through one-way ANOVA tests, the unbiased template is significantly (p <0.05) more accurate than a single-template in atlas-based segmentation and DBS target localization tasks. Conclusion The generated unbiased averaged templates provide better visualization of deep brain nuclei and an increase in accuracy over single-template and lower field strength atlases.
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Lin, Yen-Kun; Yau, Hong-Tzong; Wang, I-Chung; Zheng, Cheng; Chung, Kwok-Hung
2015-06-01
Stereoscopic visualization concept combined with head-mounted displays may increase the accuracy of computer-aided implant surgery. The aim of this study was to develop an augmented reality-based dental implant placement system and evaluate the accuracy of the virtually planned versus the actual prepared implant site created in vitro. Four fully edentulous mandibular and four partially edentulous maxillary duplicated casts were used. Six implants were planned in the mandibular and four in the maxillary casts. A total of 40 osteotomy sites were prepared in the casts using stereolithographic template integrated with augmented reality-based surgical simulation. During the surgery, the dentist could be guided accurately through a head-mounted display by superimposing the virtual auxiliary line and the drill stop. The deviation between planned and prepared positions of the implants was measured via postoperative computer tomography generated scan images. Mean and standard deviation of the discrepancy between planned and prepared sites at the entry point, apex, angle, depth, and lateral locations were 0.50 ± 0.33 mm, 0.96 ± 0.36 mm, 2.70 ± 1.55°, 0.33 ± 0.27 mm, and 0.86 ± 0.34 mm, respectively, for the fully edentulous mandible, and 0.46 ± 0.20 mm, 1.23 ± 0.42 mm, 3.33 ± 1.42°, 0.48 ± 0.37 mm, and 1.1 ± 0.39 mm, respectively, for the partially edentulous maxilla. There was a statistically significant difference in the apical deviation between maxilla and mandible in this surgical simulation (p < .05). Deviation of implant placement from planned position was significantly reduced by integrating surgical template and augmented reality technology. © 2013 Wiley Periodicals, Inc.
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CLINICAL APPLICATION OF A DRILL GUIDE TEMPLATE FOR PEDICLE SCREW PLACEMENT IN SEVERE SCOLIOSIS.
Li, Xin; Zhang, Yaoshen; Zhang, Qiang; Zhao, Changsong; Liu, Kun
2017-01-01
To evaluate the accuracy and the effect of drill guide template for pedicle screw placement in severe scoliosis. Eight patients with rigid scoliosis were enrolled, five males and three females, ranging from nine to 23 years old. A three-dimensional CT scan of the spine was performed and saved as a DICOM file type. The multi-level template was designed by Mimics software and manufactured according to the part of the most severe deformity. The drill template was placed on the corresponding vertebral surface. Pedicle screws were carefully inserted across the trajectory of the template. Postoperatively, the positions of the pedicle screws were evaluated by CT scan and graded for validation. No spinal cord injury or nerve damage occurred. All patients had satisfactory outcomes. The abnormalities and the measures observed during operation were the same as those found in the preoperative period. The position of the pedicle screws was accurate, according to the postoperative X-ray and CT scan. The rate of scoliosis correction was 60%. Compared with controls, surgery time, blood loss and radiation were significantly lower. With the application of multi-level template, the placement of pedicle screws shows high accuracy in scoliosis with shorter surgical time, less blood loss and less radiation exposure. Level of Evidence III, Retrospective Comparative Study.
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MO-B-BRB-01: Optimize Treatment Planning Process in Clinical Environment
DOE Office of Scientific and Technical Information (OSTI.GOV)
Feng, W.
The radiotherapy treatment planning process has evolved over the years with innovations in treatment planning, treatment delivery and imaging systems. Treatment modality and simulation technologies are also rapidly improving and affecting the planning process. For example, Image-guided-radiation-therapy has been widely adopted for patient setup, leading to margin reduction and isocenter repositioning after simulation. Stereotactic Body radiation therapy (SBRT) and Radiosurgery (SRS) have gradually become the standard of care for many treatment sites, which demand a higher throughput for the treatment plans even if the number of treatments per day remains the same. Finally, simulation, planning and treatment are traditionally sequentialmore » events. However, with emerging adaptive radiotherapy, they are becoming more tightly intertwined, leading to iterative processes. Enhanced efficiency of planning is therefore becoming more critical and poses serious challenge to the treatment planning process; Lean Six Sigma approaches are being utilized increasingly to balance the competing needs for speed and quality. In this symposium we will discuss the treatment planning process and illustrate effective techniques for managing workflow. Topics will include: Planning techniques: (a) beam placement, (b) dose optimization, (c) plan evaluation (d) export to RVS. Planning workflow: (a) import images, (b) Image fusion, (c) contouring, (d) plan approval (e) plan check (f) chart check, (g) sequential and iterative process Influence of upstream and downstream operations: (a) simulation, (b) immobilization, (c) motion management, (d) QA, (e) IGRT, (f) Treatment delivery, (g) SBRT/SRS (h) adaptive planning Reduction of delay between planning steps with Lean systems due to (a) communication, (b) limited resource, (b) contour, (c) plan approval, (d) treatment. Optimizing planning processes: (a) contour validation (b) consistent planning protocol, (c) protocol/template sharing, (d) semi-automatic plan evaluation, (e) quality checklist for error prevention, (f) iterative process, (g) balance of speed and quality Learning Objectives: Gain familiarity with the workflow of modern treatment planning process. Understand the scope and challenges of managing modern treatment planning processes. Gain familiarity with Lean Six Sigma approaches and their implementation in the treatment planning workflow.« less
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MO-B-BRB-00: Optimizing the Treatment Planning Process
DOE Office of Scientific and Technical Information (OSTI.GOV)
NONE
The radiotherapy treatment planning process has evolved over the years with innovations in treatment planning, treatment delivery and imaging systems. Treatment modality and simulation technologies are also rapidly improving and affecting the planning process. For example, Image-guided-radiation-therapy has been widely adopted for patient setup, leading to margin reduction and isocenter repositioning after simulation. Stereotactic Body radiation therapy (SBRT) and Radiosurgery (SRS) have gradually become the standard of care for many treatment sites, which demand a higher throughput for the treatment plans even if the number of treatments per day remains the same. Finally, simulation, planning and treatment are traditionally sequentialmore » events. However, with emerging adaptive radiotherapy, they are becoming more tightly intertwined, leading to iterative processes. Enhanced efficiency of planning is therefore becoming more critical and poses serious challenge to the treatment planning process; Lean Six Sigma approaches are being utilized increasingly to balance the competing needs for speed and quality. In this symposium we will discuss the treatment planning process and illustrate effective techniques for managing workflow. Topics will include: Planning techniques: (a) beam placement, (b) dose optimization, (c) plan evaluation (d) export to RVS. Planning workflow: (a) import images, (b) Image fusion, (c) contouring, (d) plan approval (e) plan check (f) chart check, (g) sequential and iterative process Influence of upstream and downstream operations: (a) simulation, (b) immobilization, (c) motion management, (d) QA, (e) IGRT, (f) Treatment delivery, (g) SBRT/SRS (h) adaptive planning Reduction of delay between planning steps with Lean systems due to (a) communication, (b) limited resource, (b) contour, (c) plan approval, (d) treatment. Optimizing planning processes: (a) contour validation (b) consistent planning protocol, (c) protocol/template sharing, (d) semi-automatic plan evaluation, (e) quality checklist for error prevention, (f) iterative process, (g) balance of speed and quality Learning Objectives: Gain familiarity with the workflow of modern treatment planning process. Understand the scope and challenges of managing modern treatment planning processes. Gain familiarity with Lean Six Sigma approaches and their implementation in the treatment planning workflow.« less
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Kapur, A.
The radiotherapy treatment planning process has evolved over the years with innovations in treatment planning, treatment delivery and imaging systems. Treatment modality and simulation technologies are also rapidly improving and affecting the planning process. For example, Image-guided-radiation-therapy has been widely adopted for patient setup, leading to margin reduction and isocenter repositioning after simulation. Stereotactic Body radiation therapy (SBRT) and Radiosurgery (SRS) have gradually become the standard of care for many treatment sites, which demand a higher throughput for the treatment plans even if the number of treatments per day remains the same. Finally, simulation, planning and treatment are traditionally sequentialmore » events. However, with emerging adaptive radiotherapy, they are becoming more tightly intertwined, leading to iterative processes. Enhanced efficiency of planning is therefore becoming more critical and poses serious challenge to the treatment planning process; Lean Six Sigma approaches are being utilized increasingly to balance the competing needs for speed and quality. In this symposium we will discuss the treatment planning process and illustrate effective techniques for managing workflow. Topics will include: Planning techniques: (a) beam placement, (b) dose optimization, (c) plan evaluation (d) export to RVS. Planning workflow: (a) import images, (b) Image fusion, (c) contouring, (d) plan approval (e) plan check (f) chart check, (g) sequential and iterative process Influence of upstream and downstream operations: (a) simulation, (b) immobilization, (c) motion management, (d) QA, (e) IGRT, (f) Treatment delivery, (g) SBRT/SRS (h) adaptive planning Reduction of delay between planning steps with Lean systems due to (a) communication, (b) limited resource, (b) contour, (c) plan approval, (d) treatment. Optimizing planning processes: (a) contour validation (b) consistent planning protocol, (c) protocol/template sharing, (d) semi-automatic plan evaluation, (e) quality checklist for error prevention, (f) iterative process, (g) balance of speed and quality Learning Objectives: Gain familiarity with the workflow of modern treatment planning process. Understand the scope and challenges of managing modern treatment planning processes. Gain familiarity with Lean Six Sigma approaches and their implementation in the treatment planning workflow.« less
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MO-B-BRB-02: Maintain the Quality of Treatment Planning for Time-Constraint Cases
DOE Office of Scientific and Technical Information (OSTI.GOV)
Chang, J.
The radiotherapy treatment planning process has evolved over the years with innovations in treatment planning, treatment delivery and imaging systems. Treatment modality and simulation technologies are also rapidly improving and affecting the planning process. For example, Image-guided-radiation-therapy has been widely adopted for patient setup, leading to margin reduction and isocenter repositioning after simulation. Stereotactic Body radiation therapy (SBRT) and Radiosurgery (SRS) have gradually become the standard of care for many treatment sites, which demand a higher throughput for the treatment plans even if the number of treatments per day remains the same. Finally, simulation, planning and treatment are traditionally sequentialmore » events. However, with emerging adaptive radiotherapy, they are becoming more tightly intertwined, leading to iterative processes. Enhanced efficiency of planning is therefore becoming more critical and poses serious challenge to the treatment planning process; Lean Six Sigma approaches are being utilized increasingly to balance the competing needs for speed and quality. In this symposium we will discuss the treatment planning process and illustrate effective techniques for managing workflow. Topics will include: Planning techniques: (a) beam placement, (b) dose optimization, (c) plan evaluation (d) export to RVS. Planning workflow: (a) import images, (b) Image fusion, (c) contouring, (d) plan approval (e) plan check (f) chart check, (g) sequential and iterative process Influence of upstream and downstream operations: (a) simulation, (b) immobilization, (c) motion management, (d) QA, (e) IGRT, (f) Treatment delivery, (g) SBRT/SRS (h) adaptive planning Reduction of delay between planning steps with Lean systems due to (a) communication, (b) limited resource, (b) contour, (c) plan approval, (d) treatment. Optimizing planning processes: (a) contour validation (b) consistent planning protocol, (c) protocol/template sharing, (d) semi-automatic plan evaluation, (e) quality checklist for error prevention, (f) iterative process, (g) balance of speed and quality Learning Objectives: Gain familiarity with the workflow of modern treatment planning process. Understand the scope and challenges of managing modern treatment planning processes. Gain familiarity with Lean Six Sigma approaches and their implementation in the treatment planning workflow.« less
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Toward an interim standard for patient-centered knowledge-access.
Tuttle, M. S.; Sherertz, D. D.; Fagan, L. M.; Carlson, R. W.; Cole, W. G.; Schipma, P. B.; Nelson, S. J.
1993-01-01
Most care-giver "knowledge" needs arise at the point of care and are "patient-centered." Many of these knowledge needs can be met using existing on-line knowledge sources, but the process is too time-consuming, currently, for even the computer-proficient. We are developing a set of public domain standards aimed at bringing potentially relevant knowledge to the point of care in a straight-forward and timely fashion. The standards will a) make use of selected items from a Computer-based Patient Record (CPR), e.g., a diagnosis and measure of severity, b) anticipate certain care-giver knowledge needs, e.g., "therapy," "protocols," "complications," and c) try to satisfy those needs from available knowledge sources, e.g., knowledge-bases, citation databases, practice guidelines, and on-line textbooks. The standards will use templates, i.e., fill-in-the-blank structures, to anticipate knowledge needs and UMLS Metathesaurus enhancements to represent the content of knowledge sources. Together, the standards will form the specification for a "Knowledge-Server" (KS) designed to be accessed from any CPR system. Plans are in place to test an interim version of this specification in the context of medical oncology. We are accumulating anecdotal evidence that a KS operating in conjunction with a CPR is much more compelling to users than either a CPR or a KS operating alone. PMID:8130537
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Mainard, D; Barbier, O; Knafo, Y; Belleville, R; Mainard-Simard, L; Gross, J-B
2017-06-01
In total hip arthroplasty (THA), the acetabular cup and femoral stem must be correctly sized and positioned to avoid intraoperative and postoperative complications, achieve good functional outcomes and ensure long-term survival. Current two-dimensional (2D) techniques do not provide sufficient accuracy, while low-dose biplanar X-rays (EOS) had not been assessed in this indication. Therefore, we performed a case-control study to : (1) evaluate the prediction of stem and cup size for a new 3D planning technique (stereoradiographic imaging plus 3D modeling) in comparison to 2D templating on film radiographs and (2) evaluate the accuracy and reproducibility of this 3D technique for preoperative THA planning. Accuracy and reproducibility are better with the 3D vs. 2D method. Stem and cup sizes were retrospectively determined by two senior surgeons, twice, for a total of 31 unilateral primary THA patients in this pilot study, using 3D preplanning software on low-dose biplanar X-rays and with 2D templating on conventional anteroposterior (AP) film radiographs. Patients with a modular neck or dual-mobility prosthesis were excluded. All patients but one had primary osteoarthritis; one following trauma did not have a cup implanted. The retrospectively planned sizes were compared to the sizes selected during surgery, and intraclass coefficients (ICC) calculated. 3D planning predicted stem size more accurately than 2D templating: stem sizes were planned within one size in 26/31 (84%) of cases in 3D versus 21/31 (68%) in 2D (P=0.04). 3D and 2D planning accuracies were not significantly different for cup size: cup sizes were planned within one size in 28/30 (92%) of cases in 3D versus 26/30 (87%) in 2D (P=0.30). ICC for stem size were 0.88 vs. 0.91 for 3D and 2D, respectively. Inter-operator ICCs for cup size were 0.84 vs. 0.71, respectively. Repetitions of the 3D planning were within one size (except one stem), with the majority predicting the same size. Increased accuracy in 3D may be due to the use of actual size (non-magnified) images, and judging fit on AP and lateral images simultaneously. Results for other implant components may differ from those presented. Size selection may improve further with planning experience, based on a feedback loop between planning and surgical execution. Level III. Retrospective case-control study. Copyright © 2017 Elsevier Masson SAS. All rights reserved.
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Superfund Removal Guidance for Preparing Action Memoranda
Dated September 2009, this updates and replaces previous documents. An Action Memo (AM) should substantiate need for removal action based upon criteria in the National Oil and Hazardous Substances Pollution Contingency Plan (NCP). Includes AM template.
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Nano-textured fluidic biochip as biological filter for selective survival of neuronal cells.
Han, Hsieh-Cheng; Lo, Hung-Chun; Wu, Chia-Yu; Chen, Kuei-Hsien; Chen, Li-Chyong; Ou, Keng-Liang; Hosseinkhani, Hossein
2015-06-01
This is an innovative study to engineer biological filter to evaluate the effect of template surface structure and physiochemical properties that can be used for wide variety of applications in biological, health care as well as environmental protection. Specifically, planar silicon (Si) wafer and arrayed Si nano-tips (SiNT) templates were fabricated and coated with gold for various lengths of time to study the effect of surface charge, surface roughness, and hydrophilicity on biological activity of rat pheochromocytoma cell lines PC12. The initial growth and proliferation of PC12 cells on Si and SiNT templates showed an antipathy for the ultra-sharp SiNTs templates. In contrast, the same cells demonstrated a preferable adherence to and proliferation on planar Si templates, resulting in higher cell densities by three orders of magnitude than those on SiNT templates. It is hypothesized that SiNTs array does generate nano-fluidic effect such that the effective contact region for aqueous solution on SiNTs is lower than that on planar Si templates, thus decreasing adsorbable area for cell viability and survival. Moreover, the effect of the gold coating on cell number density was analyzed in terms of the surface roughness, zeta potential and wetting properties of the templates. It was determined that surface charge, as measured by the zeta potential, strongly correlated with the trend observed in the surface cell density, whereas no such correlation was observed for surface roughness or wetting properties in the ranges of our experiment conditions. © 2014 Wiley Periodicals, Inc.
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Integrating disease management and wound care critical pathways in home care.
Barr, J E
1999-10-01
This article discusses the need for an integration of the concepts of disease management and critical pathways as a foundation of a healthcare delivery system. The steps in the process for development, implementation, and evaluation of a wound care critical pathway are reviewed and variance classifications are defined. Co-pathways and algorithms are presented as methodologies for dealing with variances. A template of a wound care critical pathway that has been developed for use in the home care setting is included.
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SU-F-T-231: Improving the Efficiency of a Radiotherapy Peer-Review System for Quality Assurance
DOE Office of Scientific and Technical Information (OSTI.GOV)
Hsu, S; Basavatia, A; Garg, M
Purpose: To improve the efficiency of a radiotherapy peer-review system using a commercially available software application for plan quality evaluation and documentation. Methods: A commercial application, FullAccess (Radialogica LLC, Version 1.4.4), was implemented in a Citrix platform for peer-review process and patient documentation. This application can display images, isodose lines, and dose-volume histograms and create plan reports for peer-review process. Dose metrics in the report can also be benchmarked for plan quality evaluation. Site-specific templates were generated based on departmental treatment planning policies and procedures for each disease site, which generally follow RTOG protocols as well as published prospective clinicalmore » trial data, including both conventional fractionation and hypo-fractionation schema. Once a plan is ready for review, the planner exports the plan to FullAccess, applies the site-specific template, and presents the report for plan review. The plan is still reviewed in the treatment planning system, as that is the legal record. Upon physician’s approval of a plan, the plan is packaged for peer review with the plan report and dose metrics are saved to the database. Results: The reports show dose metrics of PTVs and critical organs for the plans and also indicate whether or not the metrics are within tolerance. Graphical results with green, yellow, and red lights are displayed of whether planning objectives have been met. In addition, benchmarking statistics are collected to see where the current plan falls compared to all historical plans on each metric. All physicians in peer review can easily verify constraints by these reports. Conclusion: We have demonstrated the improvement in a radiotherapy peer-review system, which allows physicians to easily verify planning constraints for different disease sites and fractionation schema, allows for standardization in the clinic to ensure that departmental policies are maintained, and builds a comprehensive database for potential clinical outcome evaluation.« less
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Lightning Protection System for HE Facilities at LLNL - Certification Template
DOE Office of Scientific and Technical Information (OSTI.GOV)
Clancy, T J; Ong, M M; Brown, C G
2005-12-08
This document is meant as a template to assist in the development of your own lighting certification process. Aside from this introduction and the mock representative name of the building (Building A), this document is nearly identical to a lightning certification report issued by the Engineering Directorate at Lawrence Livermore National Laboratory. At the date of this release, we have certified over 70 HE processing and storage cells at our Site 300 facilities. In Chapters 1 and 2 respectively, we address the need and methods of lightning certification for HE processing and storage facilities at LLNL. We present the preferredmore » method of lightning protection in Chapter 3, as well as the likely building modifications that are needed to comply with this method. In Chapter 4, we present the threat assessment and resulting safe work areas within a cell. After certification, there may be changes to operations during a lightning alert, and this is discussed in Chapter 5. Chapter 6 lists the maintenance requirements for the continuation of lighting certification status. Appendices of this document are meant as an aid in developing your own certification process, and they include a bonding list, an inventory of measurement equipment, surge suppressors in use at LLNL, an Integrated Work and Safety form (IWS), and a template certification sign-off sheet. The lightning certification process involves more that what is spelled out in this document. The first steps involve considerable planning, the securing of funds, and management and explosives safety buy-in. Permits must be obtained, measurement equipment must be assembled and tested, and engineers and technicians must be trained in their use. Cursory building inspections are also recommended, and surge suppression for power systems must be addressed. Upon completion of a certification report and its sign-off by management, additional work is required. Training will be needed in order to educate workers and facility managers of the requirements of lightning certification. Operating procedures will need to be generated and/or modified with additional controls. Engineering controls may also be implemented requiring the modification of cells. Careful planning should bring most of these issues to light, making it clear where this document is helpful and were additional assistance may be necessary.« less
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Mueller, Stephanie K; Giannelli, Kyla; Boxer, Robert; Schnipper, Jeffrey L
2015-07-01
Low health literacy is common, leading to patient vulnerability during hospital discharge, when patients rely on written health instructions. We aimed to examine the impact of the use of electronic, patient-friendly, templated discharge instructions on the readability of discharge instructions provided to patients at discharge. We performed a retrospective cohort study of 233 patients discharged from a large tertiary care hospital to their homes following the implementation of a web-based "discharge module," which included the optional use of diagnosis-specific templated discharge instructions. We compared the readability of discharge instructions, as measured by the Flesch Reading Ease Level test (FREL, on a 0-100 scale, with higher scores indicating greater readability) and the Flesch-Kincaid Grade Level test (FKGL, measured in grade levels), between discharges that used templated instructions (with or without modification) versus discharges that used clinician-generated instructions (with or without available templated instructions for the specific discharge diagnosis). Templated discharge instructions were provided to patients in 45% of discharges. Of the 55% of patients that received clinician-generated discharge instructions, the majority (78.1%) had no available templated instruction for the specific discharge diagnosis. Templated discharge instructions had higher FREL scores (71 vs. 57, P < .001) and lower FKGL scores (5.6 vs. 7.6, P < .001), compared to clinician-generated discharge instructions. The use of electronically available templated discharge instructions was associated with better readability (a higher FREL score and a lower FKGL score) than the use of clinician-generated discharge instructions. The main reason for clinicians to create discharge instructions was the lack of available templates for the patient's specific discharge diagnosis. Use of electronically available templated discharge instructions may be a viable option to improve the readability of written material provided to patients at discharge, although the library of available templates requires expansion. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
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Proactive cancer care in primary care: a mixed-methods study.
Kendall, Marilyn; Mason, Bruce; Momen, Natalie; Barclay, Stephen; Munday, Dan; Lovick, Roberta; Macpherson, Stella; Paterson, Euan; Baughan, Paul; Cormie, Paul; Kiehlmann, Peter; Free, Amanda; Murray, Scott A
2013-06-01
Current models of post-treatment cancer care are based on traditional practices and clinician preference rather than evidence of benefit. To assess the feasibility of using a structured template to provide holistic follow-up of patients in primary care from cancer diagnosis onwards. A two-phase mixed methods action research project. An electronic cancer ongoing review document (CORD) was first developed with patients and general practitioners, and used with patients with a new diagnosis of cancer. This was evaluated through documentary analysis of the CORDs, qualitative interviews with patients, family carers and health professionals and record reviews. The records of 107 patients from 13 primary care teams were examined and 45 interviews conducted. The document was started in 54% of people with newly diagnosed cancer, and prompted clear documentation of multidimension needs and understanding. General practitioners found using the document helped to structure consultations and cover psychosocial areas, but they reported it needed to be better integrated in their medical records with computerized prompts in place. Few clinicians discussed the review openly with patients, and the template was often completed afterwards. Anticipatory cancer care from diagnosis to cure or death, 'in primary care', is feasible in the U.K. and acceptable to patients, although there are barriers. The process promoted continuity of care and holism. A reliable system for proactive cancer care in general practice supported by hospital specialists may allow more survivorship care to be delivered in primary care, as in other long-term conditions.
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Template-guided vs. non-guided drilling in site preparation of dental implants.
Scherer, Uta; Stoetzer, Marcus; Ruecker, Martin; Gellrich, Nils-Claudius; von See, Constantin
2015-07-01
Clinical success of oral implants is related to primary stability and osseointegration. These parameters are associated with delicate surgical techniques. We herein studied whether template-guided drilling has a significant influence on drillholes diameter and accuracy in an in vitro model. Fresh cadaveric porcine mandibles were used for drilling experiments of four experimental groups. Each group consisted of three operators, comparing guide templates for drilling with free-handed procedure. Operators without surgical knowledge were grouped together, contrasting highly experienced oral surgeons in other groups. A total of 180 drilling actions were performed, and diameters were recorded at multiple depth levels, with a precision measuring instrument. Template-guided drilling procedure improved accuracy on a very significant level in comparison with free-handed drilling operation (p ≤ 0.001). Inaccuracy of free-handed drilling became more significant in relation to measurement depth. High homogenic uniformity of template-guided drillholes was significantly stronger than unguided drilling operations by highly experienced oral surgeons (p ≤ 0.001). Template-guided drilling procedure leads to significantly enhanced accuracy. Significant results compared to free-handed drilling actions were achieved, irrespective of the clinical experience level of the operator. Template-guided drilling procedures lead to a more predictable clinical diameter. It shows that any set of instruments has to be carefully chosen to match the specific implant system. The current in vitro study is implicating an improvement of implant bed preparation but needs to be confirmed in clinical studies.
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[Role of the technician in a brachytherapy department].
Bélot-Cheval, V; Lemoine, L; Cuisinier, C; Gensse, M-C; Lasbareilles, O
2013-04-01
The role of the technician in a brachytherapy department is essential for the cohesion of the treatment team made up of the radiation oncologist, the physicist, and the technician. He/she collaborates in the different treatment steps such as taking care of the patients, training of the professionals and research studies in collaboration with the team. He participates in all steps of the treatment such as preparation, technician's consultation, catheters/templates and radioactives sources implant, dose distribution analysis and treatment. He looks after the management of planning, radioactive sources and chemist's equipments. He takes part in the training of the junior technician, and support doctors and physicists in different studies. The procedure writing and the presentation of professional practices are also part of the technician task. Copyright © 2013 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.
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International developments in openEHR archetypes and templates.
Leslie, Heather
Electronic Health Records (EHRs) are a complex knowledge domain. The ability to design EHRs to cope with the changing nature of health knowledge, and to be shareable, has been elusive. A recent pilot study1 tested the applicability of the CEN 13606 as an electronic health record standard. Using openEHR archetypes and tools2, 650 clinical content specifi cations (archetypes) were created (e.g. for blood pressure) and re-used across all clinical specialties and contexts. Groups of archetypes were aggregated in templates to support clinical information gathering or viewing (e.g. 80 separate archetypes make up the routine antenatal visit record). Over 60 templates were created for use in the emergency department, antenatal care and delivery of an infant, and paediatric hearing loss assessment. The primary goal is to define a logical clinical record architecture for the NHS but potentially, with archetypes as the keystone, shareable EHRs will also be attainable. Archetype and template development work is ongoing, with associated evaluation occurring in parallel.
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Dick, W F; Baskett, P J; Grande, C; Delooz, H; Kloeck, W; Lackner, C; Lipp, M; Mauritz, W; Nerlich, M; Nicholl, J; Nolan, J; Oakley, P; Parr, M; Seekamp, A; Soreide, E; Steen, P A; van Camp, L; Wolcke, B; Yates, D
2000-01-01
Basic and advanced care of trauma patients has always been an important aspect of prehospital and immediate in-hospital emergency medicine, involving a broad spectrum of disciplines, specialties and skills delivered through Emergency Medical Services Systems which, however, may differ significantly in structure, resources and operation. This complex background has, at least in part, hindered the development of a uniform pattern or set of criteria and definitions. This in turn has hitherto rendered data incompatible, with the consequence that such differing systems or protocols of care cannot be readily evaluated or compared with acceptable validity. Guided by previous consensus processes evolved by the ERC, the AHA and other International Organizations--represented in ILCOR--on 'Uniform reporting of data following out-of-hospital and in-hospital cardiac arrest--the Utstein style' an international working group of ITACCS has drafted a document, 'Recommendations for uniform reporting of data following major trauma--the Utstein style'. The reporting system is based on the following considerations: A structured reporting system based on an "Utstein style template" which would permit the compilation of data and statistics on major trauma care, facilitating and validating independent or comparative audit of performance and quality of care (and enable groups to challenge performance statistics which did not take account of all relevant information). The recommendations and template should encompass both out-of-hospital and in-hospital trauma care. The recommendations and template should further permit intra- and inter-system evaluation to improve the quality of delivered care and identification of the relative benefits of different systems and innovative initiatives. The template should facilitate studies setting out to improve epidemiological understanding of trauma; for example such studies might focus on the factors that determine survival. The document is structured along the lines of the original Utstein Style Guidelines publication on 'prehospital cardiac arrest'. It includes a glossary of terms used in the prehospital and early hospital phase and definitions, time points and intervals. The document uses an almost identical scheme for illustrating the different process time clocks--one for the patient, one for the dispatch centre, one for the ambulance and, finally, one for the hospital. For clarity, data should be reported as core data (i.e. always obtained) and optional data (obtained under specific circumstances). In contrast to the graphic approach used for the Utstein template for pre- or in-hospital cardiac arrest, respectively, the present template introduces, for the time being, at least, a number of terms and definitions and a semantic rather than a graphic report form. The document includes the following sections: The Section Introduction and background The Section on Trauma Data Structure Development: presents a general outline of the development of structured data using object-orientated modelling (which will be discussed in due course) and includes a set of explanatory illustrations. The Section on Terms and Definitions: outlines terms and definitions in trauma care, describing different types of trauma (blunt, penetrating, long bone, major/combined, multiple/polytrauma and predominant trauma). The Section on Factors relating to the circumstances of the injury describes the following items: cause of injury (e.g. type of injury (blunt or penetrating), burns, cold, crush, laceration, amputation, radiation, multiple, etc. Severity of Injury e.g. prehospital basic abbreviated injury score developed by the working group. The score contains anatomical and physiological disability data, with the anatomical scale ranging ordinally from 1. Head to 9. External; the physiological disability scale ranging ordinally from 0--unsurvivable. Mechanism of injury recording for transportation incidents etc. e.g. the type of impact, po
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Proactive cancer care in primary care: a mixed-methods study
Murray, Scott A
2013-01-01
Background. Current models of post-treatment cancer care are based on traditional practices and clinician preference rather than evidence of benefit. Objectives. To assess the feasibility of using a structured template to provide holistic follow-up of patients in primary care from cancer diagnosis onwards. Methods. A two-phase mixed methods action research project. An electronic Cancer Ongoing Review Document (CORD) was first developed with patients and general practitioners, and used with patients with a new diagnosis of cancer. This was evaluated through documentary analysis of the CORDs, qualitative interviews with patients, family carers and health professionals and record reviews. Results. The records of 107 patients from 13 primary care teams were examined and 45 interviews conducted. The document was started in 54% of people with newly diagnosed cancer, and prompted clear documentation of multidimension needs and understanding. General practitioners found using the document helped to structure consultations and cover psychosocial areas, but they reported it needed to be better integrated in their medical records with computerized prompts in place. Few clinicians discussed the review openly with patients, and the template was often completed afterwards. Conclusions. Anticipatory cancer care from diagnosis to cure or death, ‘in primary care’, is feasible in the UK and acceptable to patients, although there are barriers. The process promoted continuity of care and holism. A reliable system for proactive cancer care in general practice supported by hospital specialists may allow more survivorship care to be delivered in primary care, as in other long-term conditions. PMID:23382502
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Phelan, Elizabeth A; Aerts, Sally; Dowler, David; Eckstrom, Elizabeth; Casey, Colleen M
2016-01-01
A multifactorial approach to assess and manage modifiable risk factors is recommended for older adults with a history of falls. Limited research suggests that this approach does not routinely occur in clinical practice, but most related studies are based on provider self-report, with the last chart audit of United States practice published over a decade ago. We conducted a retrospective chart review to assess the extent to which patients aged 65+ years with a history of repeated falls or fall-related health-care use received multifactorial risk assessment and interventions. The setting was an academic primary care clinic in the Pacific Northwest. Among the 116 patients meeting our inclusion criteria, 48% had some type of documented assessment. Their mean age was 79 ± 8 years; 68% were female, and 10% were non-white. They averaged six primary care visits over a 12-month period subsequent to their index fall. Frequency of assessment of fall-risk factors varied from 24% (for home safety) to 78% (for vitamin D). An evidence-based intervention was recommended for identified risk factors 73% of the time, on average. Two risk factors were addressed infrequently: medications (21%) and home safety (24%). Use of a structured visit note template independently predicted assessment of fall-risk factors (p = 0.003). Geriatrics specialists were more likely to use a structured note template (p = 0.04) and perform more fall-risk factor assessments (4.6 vs. 3.6, p = 0.007) than general internists. These results suggest opportunities for improving multifactorial fall-risk assessment and management of older adults at high fall risk in primary care. A structured visit note template facilitates assessment. Given that high-risk medications have been found to be independent risk factors for falls, increasing attention to medications should become a key focus of both public health educational efforts and fall prevention in primary care practice.
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Phelan, Elizabeth A.; Aerts, Sally; Dowler, David; Eckstrom, Elizabeth; Casey, Colleen M.
2016-01-01
A multifactorial approach to assess and manage modifiable risk factors is recommended for older adults with a history of falls. Limited research suggests that this approach does not routinely occur in clinical practice, but most related studies are based on provider self-report, with the last chart audit of United States practice published over a decade ago. We conducted a retrospective chart review to assess the extent to which patients aged 65+ years with a history of repeated falls or fall-related health-care use received multifactorial risk assessment and interventions. The setting was an academic primary care clinic in the Pacific Northwest. Among the 116 patients meeting our inclusion criteria, 48% had some type of documented assessment. Their mean age was 79 ± 8 years; 68% were female, and 10% were non-white. They averaged six primary care visits over a 12-month period subsequent to their index fall. Frequency of assessment of fall-risk factors varied from 24% (for home safety) to 78% (for vitamin D). An evidence-based intervention was recommended for identified risk factors 73% of the time, on average. Two risk factors were addressed infrequently: medications (21%) and home safety (24%). Use of a structured visit note template independently predicted assessment of fall-risk factors (p = 0.003). Geriatrics specialists were more likely to use a structured note template (p = 0.04) and perform more fall-risk factor assessments (4.6 vs. 3.6, p = 0.007) than general internists. These results suggest opportunities for improving multifactorial fall-risk assessment and management of older adults at high fall risk in primary care. A structured visit note template facilitates assessment. Given that high-risk medications have been found to be independent risk factors for falls, increasing attention to medications should become a key focus of both public health educational efforts and fall prevention in primary care practice. PMID:27660753
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Titanium template for scaphoid reconstruction.
Haefeli, M; Schaefer, D J; Schumacher, R; Müller-Gerbl, M; Honigmann, P
2015-06-01
Reconstruction of a non-united scaphoid with a humpback deformity involves resection of the non-union followed by bone grafting and fixation of the fragments. Intraoperative control of the reconstruction is difficult owing to the complex three-dimensional shape of the scaphoid and the other carpal bones overlying the scaphoid on lateral radiographs. We developed a titanium template that fits exactly to the surfaces of the proximal and distal scaphoid poles to define their position relative to each other after resection of the non-union. The templates were designed on three-dimensional computed tomography reconstructions and manufactured using selective laser melting technology. Ten conserved human wrists were used to simulate the reconstruction. The achieved precision measured as the deviation of the surface of the reconstructed scaphoid from its virtual counterpart was good in five cases (maximal difference 1.5 mm), moderate in one case (maximal difference 3 mm) and inadequate in four cases (difference more than 3 mm). The main problems were attributed to the template design and can be avoided by improved pre-operative planning, as shown in a clinical case. © The Author(s) 2014.
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Marshall, Deborah A; Douglas, Patrick R; Drummond, Michael F; Torrance, George W; Macleod, Stuart; Manti, Orlando; Cheruvu, Lokanadha; Corvari, Ron
2008-01-01
Until now, there has been no standardized method of performing and presenting budget impact analyses (BIAs) in Canada. Nevertheless, most drug plan managers have been requiring this economic data to inform drug reimbursement decisions. This paper describes the process used to develop the Canadian BIA Guidelines; describes the Guidelines themselves, including the model template; and compares this guidance with other guidance on BIAs. The intended audience includes those who develop, submit or use BIA models, and drug plan managers who evaluate BIA submissions. The Patented Medicine Prices Review Board (PMPRB) initiated the development of the Canadian BIA Guidelines on behalf of the National Prescription Drug Utilisation Information System (NPDUIS). The findings and recommendations from a needs assessment with respect to BIA submissions were reviewed to inform guideline development. In addition, a literature review was performed to identify existing BIA guidance. The detailed guidance was developed on this basis, and with the input of the NPDUIS Advisory Committee, including drug plan managers from multiple provinces in Canada and a representative from the Canadian Agency for Drugs and Technologies in Health. A Microsoft Excel-based interactive model template was designed to support BIA model development. Input regarding the guidelines and model template was sought from each NPDUIS Advisory Committee member to ensure compatibility with existing drug plan needs. Decisions were made by consensus through multiple rounds of review and discussion. Finally, BIA guidance in Canadian provinces and other countries were compared on the basis of multiple criteria. The BIA guidelines consist of three major sections: Analytic Framework, Inputs and Data Sources, and Reporting Format. The Analytic Framework section contains a discussion of nine general issues surrounding BIAs (model design, analytic perspective, time horizon, target population, costing, scenarios to be compared, the characterisation of uncertainty, discounting, and validation methods). The Inputs and Data Sources section addresses methods for market size estimation, comparator selection, scenario forecasting and drug price estimation. The Reporting Format section describes methods for BIA reporting. The new Canadian BIA Guidelines represent a significant departure from the limited guidance that was previously available from some of the provinces, because they include specific details of the methods of performing BIAs. The Canadian BIA Guidelines differ from the Principles of Good Research Practice for BIAs developed by the International Society for Pharmacoeconomic and Outcomes Research (ISPOR), which provide more general guidance. The Canadian BIA Guidelines and template build upon existing guidance to address the specific requirements of each of the participating drug plans in Canada. Both have been endorsed by the NPDUIS Steering Committee and the PMPRB for the standardization of BIA submissions.
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Do knowledge translation (KT) plans help to structure KT practices?
Tchameni Ngamo, Salomon; Souffez, Karine; Lord, Catherine; Dagenais, Christian
2016-06-17
A knowledge translation (KT) planning template is a roadmap laying out the core elements to be considered when structuring the implementation of KT activities by researchers and practitioners. Since 2010, the Institut national de santé publique du Québec (INSPQ; Québec Public Health Institute) has provided tools and guidance to in-house project teams to help them develop KT plans. This study sought to identify the dimensions included in those plans and which ones were integrated and how. The results will be of interest to funding agencies and scientific organizations that provide frameworks for KT planning. The operationalization of KT planning dimensions was assessed in a mixed methods case study of 14 projects developed at the INSPQ between 2010 and 2013. All plans were assessed (rated) using an analytical tool developed for this study and data from interviews with the planning coordinators. The analytical tool and interview guide were based on eight core KT dimensions identified in the literature. Analysis of the plans and interviews revealed that the dimensions best integrated into the KT plans were 'analysis of the context (barriers and facilitators) and of users' needs', 'knowledge to be translated', 'KT partners', 'KT strategies' and, to a lesser extent, 'overall KT approach'. The least well integrated dimensions were 'knowledge about knowledge users', 'KT process evaluation' and 'resources'. While the planning coordinators asserted that a plan did not need to include all the dimensions to ensure its quality and success, nevertheless the dimensions that received less attention might have been better incorporated if they had been supported with more instruments related to those dimensions and sustained methodological guidance. Overall, KT planning templates appear to be an appreciated mechanism for supporting KT reflexive practices. Based on this study and our experience, we recommend using KT plans cautiously when assessing project efficacy and funding.
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48 CFR 302.7100 - HHS standard templates and formats.
Code of Federal Regulations, 2010 CFR
2010-10-01
...). Acquisition Strategy 307.104-70. Annual Acquisition Plan 307.104(a)(5). Competition Advocate Report 306.502(b... Request for Information 315.201(e)(4). FedBizOpps Small Business Sources Sought Notice 319.202-2(a)(3...
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Berkeley Lab - Materials Sciences Division
MSD Support Human Resources Facilities & Space Planning Procurement and Property Proposals & ; Finance Templates Travel One-Stop Acknowledging MSD Support Human Resources Facilities & Space Operations For information regarding Human Resources, procedures for acknowledging MSD support, division
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Plan recommendation for traffic sign management.
DOT National Transportation Integrated Search
2012-12-01
This report template reflects the Guidelines for Preparing UDOT Research Reports, revised April 2012. It may be used for preparation of UDOT research reports. Include a brief summary of the report here in 200-250 words. The Federal Highway Admi...
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Chemical synthesis of water-soluble, chiral conducting-polymer complexes
Wang, Hsing-Lin; McCarthy, Patrick A.; Yang, Sze Cheng
2003-01-01
The template-guided synthesis of water-soluble, chiral conducting polymer complexes is described. Synthesis of water-soluble polyaniline complexes is achieved by carefully controlling the experimental parameters such as; acid concentration, ionic strength, monomer/template ratio, total reagent concentration, and order of reagent addition. Chiral (helical) polyaniline complexes can be synthesized by addition of a chiral inducing agent (chiral acid) prior to polymerization, and the polyaniline helix can be controlled by the addition of the (+) or (-) form of the chiral acid. Moreover the quantity of chiral acid and the salt content has a significant impact on the degree of chirality in the final polymer complexes. The polyaniline and the template have been found to be mixed at the molecular level which results in chiral complexes that are robust through repeated doping and dedoping cycles.
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Social marketing and student documentation of asthma care: a quasi-randomized controlled trial.
Gimbel, Ronald W; Olsen, Cara H; Williams, Pamela M; Stephens, Mark B
2012-02-01
The study's objective was to determine the effectiveness of a social marketing intervention in influencing use of a targeted electronic medical record (EMR) template to document a standard asthma encounter. This quasi-randomized controlled trial used intervention groups exposed to an educational workshop on EMR documentation with embedded social marketing messages aimed at persuading behavior. Conducted in July 2009 to June 2010, participants in the study included third-year medical students. The primary outcome was the number of participants using a target EMR template. (Clinicaltrials.gov identifier: NCT01043113). A total of 155 participants randomized across eight clusters. Following the workshop, intervention groups were more likely to use the target asthma template than the control group (PR 3.97, 95% CI=1.34--11.79). At slightly over 30 days following the workshop, the intervention group continued to use the asthma template more often than the control group (PR 2.40, 95% CI=1.10--5.21). Stratifying by gender, intervention group females used the asthma template more after the interventions than control group females (PR 10.79, 95% CI=1.18--64.27). In follow-up at slightly over 30 days after the intervention, intervention group female participant asthma template use continued to be used more than control group females (PR 2.82, 95% CI=1.58--5.02). There were no significant differences in group use of asthma template use by intervention group males immediately after the intervention compared to control group males (PR 2.55, 95% CI=0.80--8.14) or similarly at slightly over 30 day follow-up (PR 2.18, 95% CI=0.74-6.42). Social marketing can effectively influence medical student use of EMR templates for clinical documentation in a controlled setting.
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Elliott, Lydia; DeCristofaro, Claire; Carpenter, Alesia
2012-09-01
This article describes the development and implementation of integrated use of personal handheld devices (personal digital assistants, PDAs) and high-fidelity simulation in an advanced health assessment course in a graduate family nurse practitioner (NP) program. A teaching tool was developed that can be utilized as a template for clinical case scenarios blending these separate technologies. Review of the evidence-based literature, including peer-reviewed articles and reviews. Blending the technologies of high-fidelity simulation and handheld devices (PDAs) provided a positive learning experience for graduate NP students in a teaching laboratory setting. Combining both technologies in clinical case scenarios offered a more real-world learning experience, with a focus on point-of-care service and integration of interview and physical assessment skills with existing standards of care and external clinical resources. Faculty modeling and advance training with PDA technology was crucial to success. Faculty developed a general template tool and systems-based clinical scenarios integrating PDA and high-fidelity simulation. Faculty observations, the general template tool, and one scenario example are included in this article. ©2012 The Author(s) Journal compilation ©2012 American Academy of Nurse Practitioners.
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A review of integrated heart failure care.
MacInnes, Julie; Williams, Liz
2018-06-18
AimThe aim of this integrative review is to determine the effectiveness of integrated heart failure (HF) care in terms of patient-, service- and resource-related outcomes, and to determine what model or characteristics of integrated care work best, for whom and in what contexts. Integration of health and social care services is a significant driver in the development of better and more cost-effective health and social care systems in Europe and developed countries. As high users of health and social care services, considerable attention has been paid to the care of people with long-term conditions. HF is a progressive, prevalent and disabling condition, requiring complex management involving multiple health and social care agencies. An integrative review was conducted according to a framework by Whittemore and Knafl (2005). A literature search was undertaken using the databases: Medline, CINAHL, Embase, PsychINFO and the Cochrane Library, using key words of 'heart failure' OR 'cardiac failure' AND 'integrated' OR 'multidisciplinary' OR 'interdisciplinary' OR 'multiprofessional' OR 'interprofessional' OR 'collaborative care'. Application of the inclusion and exclusion criteria resulted in 17 articles being included in the review. Articles were screened and coded for methodological quality according to a two-point criteria. Data were extracted using a template and analysed thematically.FindingsIntegrated HF care results in enhanced quality of life (QoL), and improved symptom control and self-management. Reduced admission rates, reduced length of hospital stay, improved prescribing practices and better care co-ordination are also reported. There is more limited evidence for improved efficiency although overall costs may be reduced. Although findings are highly context dependent, key features of integrated HF models are: liaison between primary and secondary care services to facilitate planned discharge, early and medium term follow-up, multidisciplinary patient education and team working including shared professional education, and the development and implementation of comprehensive care pathways.
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2012-01-01
Background Health economics is increasingly used to inform resource allocation decision-making, however, there is comparatively little evidence relevant to minority groups. In part, this is due to lack of cost and effectiveness data specific to these groups upon which economic evaluations can be based. Consequently, resource allocation decisions often rely on mainstream evidence which may not be representative, resulting in inequitable funding decisions. This paper describes a method to overcome this deficiency for Australia’s Indigenous population. A template has been developed which can adapt mainstream health intervention data to the Indigenous setting. Methods The ‘Indigenous Health Service Delivery Template’ has been constructed using mixed methods, which include literature review, stakeholder discussions and key informant interviews. The template quantifies the differences in intervention delivery between best practice primary health care for the Indigenous population via Aboriginal Community Controlled Health Services (ACCHSs), and mainstream general practitioner (GP) practices. Differences in costs and outcomes have been identified, measured and valued. This template can then be used to adapt mainstream health intervention data to allow its economic evaluation as if delivered from an ACCHS. Results The template indicates that more resources are required in the delivery of health interventions via ACCHSs, due to their comprehensive nature. As a result, the costs of such interventions are greater, however this is accompanied by greater benefits due to improved health service access. In the example case of the polypill intervention, 58% more costs were involved in delivery via ACCHSs, with 50% more benefits. Cost-effectiveness ratios were also altered accordingly. Conclusions The Indigenous Health Service Delivery Template reveals significant differences in the way health interventions are delivered from ACCHSs compared to mainstream GP practices. It is important that these differences are included in the conduct of economic evaluations to ensure results are relevant to Indigenous Australians. Similar techniques would be generalisable to other disadvantaged minority populations. This will allow resource allocation decision-makers access to economic evidence that more accurately represents the needs and context of disadvantaged groups, which is particularly important if addressing health inequities is a stated goal. PMID:22954136
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Holtrop, Jodi Summers; Potworowski, Georges; Fitzpatrick, Laurie; Kowalk, Amy; Green, Lee A
2015-08-21
Care management in primary care can be effective in helping patients with chronic disease improve their health status. Primary care practices, however, are often challenged with its implementation. Incorporating care management involves more than a simple physical process redesign to existing clinical care routines. It involves changes to who is working with patients, and consequently such things as who is making decisions, who is sharing patient information, and how. Studying the range of such changes in "knowledge work" during implementation requires a perspective and tools designed to do so. We used the macrocognition perspective, which is designed to understand how individuals think in dynamic, messy real-world environments such as care management implementation. To do so, we used cognitive task analysis to understand implementation in terms of such thinking as decision making, knowledge, and communication. Data collection involved semi-structured interviews and observations at baseline and at approximately 9 months into implementation at five practices in one physician-owned administratively connected group of practices in the state of Michigan, USA. Practices were intervention participants in a larger trial of chronic care model implementation. Data were transcribed, qualitatively coded and analyzed, initially using an editing approach and then a template approach with macrocognition as a guiding framework. Seventy-four interviews and five observations were completed. There were differences in implementation success across the practices, and these differences in implementation success were well explained by macrocognition. Practices that used more macrocognition functions and used them more often were also more successful in care management implementation. Although care management can introduce many new changes into the delivery of primary care clinical practice, implementing it successfully as a new complex intervention is possible. Macrocognition is a useful perspective for illuminating the elements that facilitate new complex interventions with a view to addressing them during implementation planning.
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Washington, Karla T; Guo, Yuqi; Albright, David L; Lewis, Alexandria; Parker Oliver, Debra; Demiris, George
2017-07-01
Interprofessional collaboration is the foundation of hospice service delivery. In the United States, hospice agencies are required to regularly convene interprofessional meetings during which teams review plans of care for the patients and families they serve. A small body of research suggests that team functioning could be significantly enhanced in hospice interprofessional meetings; however, systematic investigation of this possibility has been limited to date. The purpose of this qualitative study was to better understand the experiences and perspectives of hospice providers who regularly participate in interprofessional meetings as a first step toward improving teamwork in this setting. We interviewed 24 hospice providers and conducted a template analysis of qualitative data to identify barriers and facilitators to effective team functioning in interprofessional meetings. Participants recognised the ways meetings supported high-quality, holistic patient and family care but voiced frustrations over meeting inefficiencies, particularly in light of caseloads they perceived as overly demanding. Time constraints were often viewed as prohibiting the inclusion of interprofessional content and full participation of all team members. Findings suggest that modifications to interprofessional meetings such as standardising processes may enhance meeting efficiency and team functioning.
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Bhat, Somanath; McLaughlin, Jacob L H; Emslie, Kerry R
2011-02-21
Digital polymerase chain reaction (dPCR) has the potential to enable accurate quantification of target DNA copy number provided that all target DNA molecules are successfully amplified. Following duplex dPCR analysis from a linear DNA target sequence that contains single copies of two independent template sequences, we have observed that amplification of both templates in a single partition does not always occur. To investigate this finding, we heated the target DNA solution to 95 °C for increasing time intervals and then immediately chilled on ice prior to preparing the dPCR mix. We observed an exponential decline in estimated copy number (R(2)≥ 0.98) of the two template sequences when amplified from either a linearized plasmid or a 388 base pair (bp) amplicon containing the same two template sequences. The distribution of amplifiable templates and the final concentration (copies per µL) were both affected by heat treatment of the samples at 95 °C from 0 s to 30 min. The proportion of target sequences from which only one of the two templates was amplified in a single partition (either 1507 or hmg only) increased over time, while the proportion of target sequences where both templates were amplified (1507 and hmg) in each individual partition declined rapidly from 94% to 52% (plasmid) and 88% to 31% (388 bp amplicon) suggesting an increase in number of targets from which both templates no longer amplify. A 10 min incubation at 95 °C reduced the initial amplifiable template concentration of the plasmid and the 388 bp amplicon by 59% and 91%, respectively. To determine if a similar decrease in amplifiable target occurs during the default pre-activation step of typical PCR amplification protocol, we used mastermixes with a 20 s or 10 min hot-start. The choice of mastermix and consequent pre-activation time did not affect the estimated plasmid concentration. Therefore, we conclude that prolonged exposure of this DNA template to elevated temperatures could lead to significant bias in dPCR measurements. However, care must be taken when designing PCR and non-PCR based experiments by reducing exposure of the DNA template to sustained elevated temperatures in order to improve accuracy in copy number estimation and concentration determination.
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Scherer, Michael D; Kattadiyil, Mathew T; Parciak, Ewa; Puri, Shweta
2014-01-01
Three-dimensional radiographic imaging for dental implant treatment planning is gaining widespread interest and popularity. However, application of the data from 30 imaging can be a complex and daunting process initially. The purpose of this article is to describe features of three software packages and the respective computerized guided surgical templates (GST) fabricated from them. A step-by-step method of interpreting and ordering a GST to simplify the process of the surgical planning and implant placement is discussed.
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Organizational structure for addressing the attributes of the ideal healthcare delivery system.
Cowen, Mark; Halasyamani, Lakshmi K; McMurtrie, Daniel; Hoffman, Denise; Polley, Theodore; Alexander, Jeffrey A
2008-01-01
The Institute of Medicine's (IOM) report Crossing the Quality Chasm described the aims, characteristics, and components of the ideal healthcare system but did not provide the templates of organizational structures needed to achieve this vision. In this article, we review three principles of effective organizations to inform the design of a facilitative clinical care structure: a focus on the patient and caregiving team, the use of information, and connectivity with executive and operational leadership. These concepts can be realized in an organizational chart that is inverted to place patients and their care providers on top, flat with few degrees of separation between patients and executive leadership, and webbed to reflect connections to the professional and ancillary departments. An example of a recently implemented clinical care infrastructure follows this discussion. This model divides the patient population into nonexclusive subgroups, each with an interdisciplinary collaborative practice team that oversees and advocates the subgroup's clinical care activities. The organization's interdisciplinary practice council, in conjunction with its physician and nursing practice councils, backs these teams, providing a second layer of support. The council layer is connected to the health system board through the clinical oversight group, whose core membership consists of council chairs, the chief executive officer, and the chief medical and nursing officers. Clinical information for planning and evaluation is available at all levels. This model provides a framework for identifying the individuals and processes necessary to achieve IOM's vision.
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Holtrop, Jodi Summers; Potworowski, Georges; Fitzpatrick, Laurie; Kowalk, Amy; Green, Lee A
2016-08-15
Care management in primary care can be effective in helping patients with chronic disease improve their health status, however, primary care practices are often challenged with implementation. Further, there are different ways to structure care management that may make implementation more or less successful. Normalization process theory (NPT) provides a means of understanding how a new complex intervention can become routine (normalized) in practice. In this study, we used NPT to understand how care management structure affected how well care management became routine in practice. Data collection involved semi-structured interviews and observations conducted at 25 practices in five physician organizations in Michigan, USA. Practices were selected to reflect variation in physician organizations, type of care management program, and degree of normalization. Data were transcribed, qualitatively coded and analyzed, initially using an editing approach and then a template approach with NPT as a guiding framework. Seventy interviews and 25 observations were completed. Two key structures for care management organization emerged: practice-based care management where the care managers were embedded in the practice as part of the practice team; and centralized care management where the care managers worked independently of the practice work flow and was located outside the practice. There were differences in normalization of care management across practices. Practice-based care management was generally better normalized as compared to centralized care management. Differences in normalization were well explained by the NPT, and in particular the collective action construct. When care managers had multiple and flexible opportunities for communication (interactional workability), had the requisite knowledge, skills, and personal characteristics (skill set workability), and the organizational support and resources (contextual integration), a trusting professional relationship (relational integration) developed between practice providers and staff and the care manager. When any of these elements were missing, care management implementation appeared to be affected negatively. Although care management can introduce many new changes into delivery of clinical practice, implementing it successfully as a new complex intervention is possible. NPT can be helpful in explaining differences in implementing a new care management program with a view to addressing them during implementation planning.
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ERIC Educational Resources Information Center
Day, C. William; Parsley, James
1996-01-01
Describes how school boards and administrators can use a facility-planning symposium, which brings together educators, students, parents, business leaders, and others, to establish an educational program and to design a template representative of the community. Examines ways to construct a shared vision and looks at design issues. (RJM)
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Using movies in family medicine teaching: A reference to EURACT Educational Agenda
Švab, Igor
2017-01-01
Abstract Introduction Cinemeducation is a teaching method where popular movies or movie clips are used. We aimed to determine whether family physicians’ competencies as listed in the Educational Agenda produced by the European Academy of Teachers in General Practice/Family Medicine (EURACT) can be found in movies, and to propose a template for teaching by these movies. Methods A group of family medicine teachers provided a list of movies that they would use in cinemeducation. The movies were categorised according to the key family medicine competencies, thus creating a framework of competences, covered by different movies. These key competencies are Primary care management, Personcentred care, Specific problem-solving skills, Comprehensive approach, Community orientation, and Holistic approach. Results The list consisted of 17 movies. Nine covered primary care management. Person-centred care was covered in 13 movies. Eight movies covered specific problem-solving skills. Comprehensive approach was covered in five movies. Five movies covered community orientation. Holistic approach was covered in five movies. Conclusions All key family medicine competencies listed in the Educational Agenda can be taught using movies. Our results can serve as a template for teachers on how to use any appropriate movies in family medicine education. PMID:28289469
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Using movies in family medicine teaching: A reference to EURACT Educational Agenda.
Klemenc Ketiš, Zalika; Švab, Igor
2017-06-01
Cinemeducation is a teaching method where popular movies or movie clips are used. We aimed to determine whether family physicians' competencies as listed in the Educational Agenda produced by the European Academy of Teachers in General Practice/Family Medicine (EURACT) can be found in movies, and to propose a template for teaching by these movies. A group of family medicine teachers provided a list of movies that they would use in cinemeducation. The movies were categorised according to the key family medicine competencies, thus creating a framework of competences, covered by different movies. These key competencies are Primary care management, Personcentred care, Specific problem-solving skills, Comprehensive approach, Community orientation, and Holistic approach. The list consisted of 17 movies. Nine covered primary care management. Person-centred care was covered in 13 movies. Eight movies covered specific problem-solving skills. Comprehensive approach was covered in five movies. Five movies covered community orientation. Holistic approach was covered in five movies. All key family medicine competencies listed in the Educational Agenda can be taught using movies. Our results can serve as a template for teachers on how to use any appropriate movies in family medicine education.
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A public health hazard mitigation planning process.
Griffith, Jennifer M; Kay Carpender, S; Crouch, Jill Artzberger; Quiram, Barbara J
2014-01-01
The Texas A&M Health Science Center School of Rural Public Health, a member of the Training and Education Collaborative System Preparedness and Emergency Response Learning Center (TECS-PERLC), has long-standing partnerships with 2 Health Service Regions (Regions) in Texas. TECS-PERLC was contracted by these Regions to address 2 challenges identified in meeting requirements outlined by the Risk-Based Funding Project. First, within Metropolitan Statistical Areas, there is not a formal authoritative structure. Second, preexisting tools and processes did not adequately satisfy requirements to assess public health, medical, and mental health needs and link mitigation strategies to the Public Health Preparedness Capabilities, which provide guidance to prepare for, respond to, and recover from public health incidents. TECS-PERLC, with its partners, developed a framework to interpret and apply results from the Texas Public Health Risk Assessment Tool (TxPHRAT). The 3-phase community engagement-based TxPHRAT Mitigation Planning Process (Mitigation Planning Process) and associated tools facilitated the development of mitigation plans. Tools included (1) profiles interpreting TxPHRAT results and identifying, ranking, and prioritizing hazards and capability gaps; (2) a catalog of intervention strategies and activities linked to hazards and capabilities; and (3) a template to plan, evaluate, and report mitigation planning efforts. The Mitigation Planning Process provided a framework for Regions to successfully address all funding requirements. TECS-PERLC developed more than 60 profiles, cataloged and linked 195 intervention strategies, and developed a template resulting in 20 submitted mitigation plans. A public health-focused, community engagement-based mitigation planning process was developed by TECS-PERLC and successfully implemented by the Regions. The outcomes met all requirements and reinforce the effectiveness of academic practice partnerships and importance of community engagement in mitigation planning. Additional funding has been approved to expand the Mitigation Planning Process to all counties in Texas with local health departments.
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Cristache, Corina Marilena; Gurbanescu, Silviu
2017-01-01
of this study was to evaluate the accuracy of a stereolithographic template, with sleeve structure incorporated into the design, for computer-guided dental implant insertion in partially edentulous patients. Sixty-five implants were placed in twenty-five consecutive patients with a stereolithographic surgical template. After surgery, digital impression was taken and 3D inaccuracy of implants position at entry point, apex, and angle deviation was measured using an inspection tool software. Mann-Whitney U test was used to compare accuracy between maxillary and mandibular surgical guides. A p value < .05 was considered significant. Mean (and standard deviation) of 3D error at the entry point was 0.798 mm (±0.52), at the implant apex it was 1.17 mm (±0.63), and mean angular deviation was 2.34 (±0.85). A statistically significant reduced 3D error was observed at entry point p = .037, at implant apex p = .008, and also in angular deviation p = .030 in mandible when comparing to maxilla. The surgical template used has proved high accuracy for implant insertion. Within the limitations of the present study, the protocol for comparing a digital file (treatment plan) with postinsertion digital impression may be considered a useful procedure for assessing surgical template accuracy, avoiding radiation exposure, during postoperative CBCT scanning.
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Chen, Jinyang; Ji, Xinghu; Tinnefeld, Philip; He, Zhike
2016-01-27
In this work, a multifunctional template for selective formation of fluorescent silver nanoclusters (AgNCs) or copper nanoparticles (CuNPs) is put forward. This dumbbell-shaped (DS) DNA template is made up of two cytosine hairpin loops and an adenine-thymine-rich double-helical stem which is closed by the loops. The cytosine loops act as specific regions for the growth of AgNCs, and the double-helical stem serves as template for the CuNPs formation. By carefully investigating the sequence and length of DS DNA, we present the optimal design of the template. Benefiting from the smart design and facile synthesis, a simple, label-free, and ultrasensitive fluorescence strategy for adenosine triphosphate (ATP) detection is proposed. Through the systematic comparison, it is found that the strategy based on CuNPs formation is more sensitive for ATP assay than that based on AgNCs synthesis, and the detection limitation was found to be 81 pM. What's more, the CuNPs formation-based method is successfully applied in the detection of ATP in human serum as well as the determination of cellular ATP. In addition to small target molecule, the sensing strategy was also extended to the detection of biomacromolecule (DNA), which illustrates the generality of this biosensor.
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Luites, J W H; Wymenga, A B; Blankevoort, L; Kooloos, J M G; Verdonschot, N
2011-01-01
Femoral graft placement is an important factor in the success of anterior cruciate ligament (ACL) reconstruction. In addition to improving the accuracy of femoral tunnel placement, Computer Assisted Surgery (CAS) can be used to determine the anatomic location. This is achieved by using a 3D femoral template which indicates the position of the anatomical ACL center based on endoscopically measurable landmarks. This study describes the development and application of this method. The template is generated through statistical shape analysis of the ACL insertion, with respect to the anteromedial (AM) and posterolateral (PL) bundles. The ligament insertion data, together with the osteocartilage edge on the lateral notch, were mapped onto a cylinder fitted to the intercondylar notch surface (n = 33). Anatomic variation, in terms of standard variation of the positions of the ligament centers in the template, was within 2.2 mm. The resulting template was programmed in a computer-assisted navigation system for ACL replacement and its accuracy and precision were determined on 31 femora. It was found that with the navigation system the AM and PL tunnels could be positioned with an accuracy of 2.5 mm relative to the anatomic insertion centers; the precision was 2.4 mm. This system consists of a template that can easily be implemented in 3D computer navigation software. Requiring no preoperative images and planning, the system provides adequate accuracy and precision to position the entrance of the femoral tunnels for anatomical single- or double-bundle ACL reconstruction.
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Pinto, A; Raffone, C
2017-01-01
The aim of the present study was to describe a postextraction, computer-guided protocol for implant-prosthetic rehabilitations in partially edentate patients with metal restorations. A 60-year-old man with a loose FDP (fixed dental prosthesis) in the first quadrant was selected for a postextraction computer guided implantology according with the 2-piece radiographic template protocol. A two components radiographic template was produced, with the teeth setup portion based on the wax-up. CBCT (cone beam computed tomography) scans of the patient, wearing the base portion of the radiographic template and of the assembled radiographic template alone, were accomplished. The CBCT volume were imported in a dedicated software (NobelClinician, Nobel-Biocare, Kloten, Switzerland) and a surgical template was produced from the digital planning. The surgery was performed with a flap approach, as a bone regeneration procedure was carried out. A delayed loading protocol was chosen to allow a healing free of masticatory stress. A mobile partial denture was delivered to the patient to grant function and social life until the delivery of the definitive FDP. The surgery was performed rapidly and free of obstacles. A good primary stability of the implants was achieved. The patient referred an acceptable postoperative pain and swelling. The 2-piece radiographic template protocol was evaluated as smooth, complication-free and suitable for patients who want to maintain their teeth until the day of implant surgery. A good command of the computer-guided software as well as a comprehensive learning curve in computer-guided implantology is necessary to obtain predictable results.
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Effects of using structured templates for recalling chemistry experiments.
Willoughby, Cerys; Logothetis, Thomas A; Frey, Jeremy G
2016-01-01
The way that we recall information is dependent upon both the knowledge in our memories and the conditions under which we recall the information. Electronic Laboratory Notebooks can provide a structured interface for the capture of experiment records through the use of forms and templates. These templates can be useful by providing cues to help researchers to remember to record particular aspects of their experiment, but they may also constrain the information that is recorded by encouraging them to record only what is asked for. It is therefore unknown whether using structured templates for capturing experiment records will have positive or negative effects on the quality and usefulness of the records for assessment and future use. In this paper we report on the results of a set of studies investigating the effects of different template designs on the recording of experiments by undergraduate students and academic researchers. The results indicate that using structured templates to write up experiments does make a significant difference to the information that is recalled and recorded. These differences have both positive and negative effects, with templates prompting the capture of specific information that is otherwise forgotten, but also apparently losing some of the personal elements of the experiment experience such as observations and explanations. Other unexpected effects were seen with templates that can change the information that is captured, but also interfere with the way an experiment is conducted. Our results showed that using structured templates can improve the completeness of the experiment context information captured but can also cause a loss of personal elements of the experiment experience when compared with allowing the researcher to structure their own record. The results suggest that interfaces for recording information about chemistry experiments, whether paper-based questionnaires or templates in Electronic Laboratory Notebooks, can be an effective way to improve the quality of experiment write-ups, but that care needs to be taken to ensure that the correct cues are provided.Graphical abstractScientists have traditionally recorded their research in paper notebooks, a format that provides great flexibility for capturing information. In contrast, Electronic Laboratory Notebooks frequently make use of forms or structured templates for capturing experiment records. Structured templates can provide cues that can improve record quality by increasing the amount of information captured and encouraging consistency. However, using the wrong cues can lead to a loss of personal elements of the experiment experience and frustrate users. This image shows two participants from one of our studies recording their experiment using a computer-based template.
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Rapid prototyping of microchannels with surface patterns for fabrication of polymer fibers
Goodrich, Payton J.; Sharifi, Farrokh; Hashemi, Nastaran
2015-08-14
Microfluidic technology has provided innovative solutions to numerous problems, but the cost of designing and fabricating microfluidic channels is impeding its expansion. In this study, Shrinky-Dink thermoplastic sheets are used to create multilayered complex templates for microfluidic channels. We also used inkjet and laserjet printers to raise a predetermined microchannel geometry by depositing several layers of ink for each feature consecutively. We achieved feature heights over 100 μm, which were measured and compared with surface profilometry. Templates closest to the target geometry were then used to create microfluidic devices from soft-lithography with the molds as a template. These microfluidic devicesmore » were, futhermore used to fabricate polymer microfibers using the microfluidic focusing approach to demonstrate the potential that this process has for microfluidic applications. Finally, an economic analysis was conducted to compare the price of common microfluidic template manufacturing methods. We showed that multilayer microchannels can be created significantly quicker and cheaper than current methods for design prototyping and point-of-care applications in the biomedical area.« less
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Planning surgical reconstruction in Treacher-Collins syndrome using virtual simulation.
Nikkhah, Dariush; Ponniah, Allan; Ruff, Cliff; Dunaway, David
2013-11-01
Treacher-Collins syndrome is a rare autosomal dominant condition of varying phenotypic expression. The surgical correction in this syndrome is difficult, and the approach varies between craniofacial departments worldwide. The authors aimed to design standardized tools for planning orbitozygomatic and mandibular reconstruction in Treacher-Collins syndrome using geometric morphometrics. The Great Ormond Street Hospital database was retrospectively identified for patients with Treacher-Collins syndrome. Thirteen children (aged 2 to 15 years) who had suitable preoperative three-dimensional computed tomographic head scans were included. Six Treacher-Collins syndrome three-dimensional computed tomographic head scans were quantitatively compared using a template of 96 anatomically defined landmarks to 26 age-matched normal dry skulls. Thin-plate spline videos illustrated the characteristic deformities of retromicrognathia and maxillary and orbitozygomatic hypoplasia in the Treacher-Collins syndrome population. Geometric morphometrics was used in the virtual reconstruction of the orbitozygomatic and mandibular region in Treacher-Collins syndrome patients. Intrarater and interrater reliability of the landmarks was acceptable and within a standard deviation of less than 1 mm on 97 percent and 100 percent of 10 repeated scans, respectively. Virtual normalization of the Treacher-Collins syndrome skull effectively describes characteristic skeletal deformities and provides a useful guide to surgical reconstruction. Size-matched stereolithographic templates derived from thin-plate spline warps can provide effective intraoperative templates for zygomatic and mandibular reconstruction in the Treacher-Collins syndrome patient. Diagnostic, V.
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Liu, Kun; Zhang, Qiang; Li, Xin; Zhao, Changsong; Quan, Xuemin; Zhao, Rugang; Chen, Zongfeng; Li, Yansheng
2017-06-01
Accurate implantation of pedicle screw in spinal deformity correction surgeries is always challenging. We have developed a method of pedicle screw placement in severe and rigid scoliosis with a multi-level 3D printing drill guide template. From November 2011 to March 2015, ten patients (4 males and 6 females) with severe and rigid scoliosis (Cobb angle >70° and flexibility <30%)were included. Multi-level template was designed and manufactured according to the part (two or three levels) of the most severe deformity. The drill template was then placed on the corresponding vertebral surface. Then, pedicle screws were carefully inserted along the trajectories. The other screws were placed in free hand. After surgery, the positions of the pedicle screws were evaluated by CT scan and graded for validation. 48 screws were implanted using templates, other 104 screws in free hand, and the accuracies were 93.8 and 78.8%, respectively, with significant difference. The deformity correction ratio was 67.1 and 41.2% in coronal and sagittal plane post-operatively, respectively. The average operation time was 234.0 ± 34.1 min, and average blood loss was 557 ± 67.4 ml. With the application of multi-level template, the incidence of cortex perforation in severe and rigid scoliosis decreased and this technology is, therefore, potentially applicable in clinical practice.
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Dean, Shannon M; Gilmore-Bykovskyi, Andrea; Buchanan, Joel; Ehlenfeldt, Brad; Kind, Amy JH
2016-01-01
Background The hospital discharge summary is the primary method used to communicate a patient's plan of care to the next provider(s). Despite the existence of regulations and guidelines outlining the optimal content for the discharge summary and its importance in facilitating an effective transition to post-hospital care, incomplete discharge summaries remain a common problem that may contribute to poor post-hospital outcomes. Electronic health records (EHRs) are regularly used as a platform upon which standardization of content and format can be implemented. Objective We describe here the design and hospital-wide implementation of a standardized discharge summary using an EHR. Methods We employed the evidence-based Replicating Effective Programs implementation strategy to guide the development and implementation during this large-scale project. Results Within 18 months, 90% of all hospital discharge summaries were written using the standardized format. Hospital providers found the template helpful and easy to use, and recipient providers perceived an improvement in the quality of discharge summaries compared to those sent from our hospital previously. Conclusions Discharge summaries can be standardized and implemented hospital-wide with both author and recipient provider satisfaction, especially if evidence-based implementation strategies are employed. The use of EHR tools to guide clinicians in writing comprehensive discharge summaries holds promise in improving the existing deficits in communication at transitions of care. PMID:28334559
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X-Gliders: Exploring Flight Research with Experimental Gliders. Educational Brief.
ERIC Educational Resources Information Center
National Aeronautics and Space Administration, Washington, DC.
This brief discusses X-gliders and flight research with experimental gliders. In this activity, designed for grades K-4, students will learn how to change the flight characteristics of a glider using scientific inquiry methods. Glider plans and a template are included. (MVL)
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Not single brain areas but a network is involved in language: Applications in presurgical planning.
Alemi, Razieh; Batouli, Seyed Amir Hossein; Behzad, Ebrahim; Ebrahimpoor, Mitra; Oghabian, Mohammad Ali
2018-02-01
Language is an important human function, and is a determinant of the quality of life. In conditions such as brain lesions, disruption of the language function may occur, and lesion resection is a solution for that. Presurgical planning to determine the language-related brain areas would enhance the chances of language preservation after the operation; however, availability of a normative language template is essential. In this study, using data from 60 young individuals who were meticulously checked for mental and physical health, and using fMRI and robust imaging and data analysis methods, functional brain maps for the language production, perception and semantic were produced. The obtained templates showed that the language function should be considered as the product of the collaboration of a network of brain regions, instead of considering only few brain areas to be involved in that. This study has important clinical applications, and extends our knowledge on the neuroanatomy of the language function. Copyright © 2018 Elsevier B.V. All rights reserved.
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De Santis, Daniele; Canton, Luciano Claudio; Cucchi, Alessandro; Zanotti, Guglielmo; Pistoia, Enrico; Nocini, Pier Francesco
2010-01-01
Computer-assisted surgery is based on computerized tomography (CT) scan technology to plan the placement of dental implants and a computer-aided design/computer-aided manufacturing (CAD-CAM) technology to create a custom surgical template. It provides guidance for insertion implants after analysis of existing alveolar bone and planning of implant position, which can be immediately loaded, therefore achieving esthetic and functional results in a surgical stage. The absence of guidelines to treat dentulous areas is often due to a lack of computer-assisted surgery. The authors have attempted to use this surgical methodology to replace residual teeth with an immediate implantoprosthetic restoration. The aim of this case report is to show the possibility of treating a dentulous patient by applying a computer-assisted surgical protocol associated with the use of a double surgical template: one before extraction and a second one after extraction of selected teeth.
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[Development of a portfolio for competency-based assessment in a clinical clerkship curriculum].
Roh, HyeRin; Lee, Jong-Tae; Yoon, Yoo Sang; Rhee, Byoung Doo
2015-12-01
The purpose of this report was to describe our experience in planning and developing a portfolio for a clinical clerkship curriculum. We have developed a portfolio for assessing student competency since 2007. During an annual workshop on clinical clerkship curricula, clerkship directors from five Paik hospitals of Inje University met to improve the assessment of the portfolio. We generated templates for students to record their activities and reflection and receive feedback. We uploaded these templates to our school's website for students to download freely. Annually, we have held a faculty development seminar and a workshop for portfolio assessment and feedback. Also, we established an orientation program on how to construct a learning portfolio for students. Future actions include creating a ubiquitous portfolio system, extending the portfolio to the entire curriculum, setting up an advisor system, and managing the quality of the portfolio. This study could be helpful for medical schools that plan to improve their portfolio assessment with an outcome-based approach.
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Care plans and care planning in long-term conditions: a conceptual model.
Burt, Jenni; Rick, Jo; Blakeman, Thomas; Protheroe, Joanne; Roland, Martin; Bower, Pete
2014-10-01
The prevalence and impact of long-term conditions continues to rise. Care planning for people with long-term conditions has been a policy priority for chronic disease management in a number of health-care systems. However, patients and providers appear unclear about the formulation and implementation of care planning. Further work in this area is therefore required to inform the development, implementation and evaluation of future care planning initiatives. We distinguish between 'care planning' (the process by which health-care professionals and patients discuss, agree and review an action plan to achieve the goals or behaviour change of most relevance and concern to the patient) and a 'care plan' (a written document recording the outcome of a care planning process). We propose a typology of care planning and care plans with three core dimensions: perspective (patient or professional), scope (a focus on goals or on behaviours) and networks (confined to the professional-patient dyad or extending to the entire care network). In addition, we draw on psychological models of mediation and moderation to outline potential mechanisms through which care planning and care plans may lead to improved outcomes for both patients and the wider health-care system. The proposed typology of care planning and care plans offered here, along with the model of the process by which care planning may influence outcomes, provide a useful framework for future policy developments and evaluations. Empirical work is required to explore the degree to which current care planning approaches and care plans can be described according to these dimensions, and the factors that determine which types of patients and professionals use which type of care plans.
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Web-Based Intervention for Transitioning Smokers From Inpatient to Outpatient Care: An RCT.
Kathleen F, Harrington; Young-Il, Kim; Meifang, Chen; Rekha, Ramachandran; Maria, Pisu; Rajani S, Sadasivam; Thomas K, Houston; William C, Bailey
2016-10-01
Smoking-cessation follow-up care after hospitalization is known to be effective. Cost-effective and disseminable interventions adoptable by hospitals are needed. RCT. Fourteen hundred eighty-eight current smokers recruited during a tertiary care hospital stay were randomly assigned to Usual Care (UC) or Usual Care plus Web-Based Intervention (WI). Data were collected in 2011-2013 and analyzed in 2014-2015. UC provided brief bedside advice to quit, a quit plan template, and quitline contact information. WI included access to a website with asynchronous e-message communication with a tobacco counselor, use of interactive self-assessments, helpful cessation information, and access to additional web resources, as well as automated e-mail messages tailored for health concern and readiness to quit. Self-reported 30-day abstinence at 6 months was the primary outcome; a subset was verified by saliva cotinine. Six-month follow-up was completed by 83% of participants. No difference was found between study arms for self-reported abstinence rates in intent-to-treat (25.4% WI vs 26.8% UC) and complete case (31.3% WI vs 31.4% UC) analyses. Reduced smoking was reported by 45.5% (WI, n=276) and 47% (UC, n=296) of non-abstinent responders (p=0.59). Using a 10-ng/mL cotinine cut off, abstinence was verified in 52.1% of WI and 62.5% of UC (p=0.11). Significant covariates associated with abstinence at 6 months were being male, not smoking during hospitalization, being very confident in quitting, planning to quit/stay quit, smoking fewer days in the past 30 days, fewer years of smoking, and having cerebrovascular or connective tissue rheumatic disease as primary hospital diagnosis. Lack of difference between treatment arms suggests a strong effect for UC, WI was not effective, or both. Low intervention engagement may be partially responsible. Self-reported abstinence rates were relatively high in both arms, although the biochemically verified rates indicate over-reporting of abstinence. These findings suggest brief bedside counseling for all hospitalized smokers is beneficial. This study is registered at www.clinicaltrials.gov NCT01277250. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
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Multiple template-based fluoroscopic tracking of lung tumor mass without implanted fiducial markers
NASA Astrophysics Data System (ADS)
Cui, Ying; Dy, Jennifer G.; Sharp, Gregory C.; Alexander, Brian; Jiang, Steve B.
2007-10-01
Precise lung tumor localization in real time is particularly important for some motion management techniques, such as respiratory gating or beam tracking with a dynamic multi-leaf collimator, due to the reduced clinical tumor volume (CTV) to planning target volume (PTV) margin and/or the escalated dose. There might be large uncertainties in deriving tumor position from external respiratory surrogates. While tracking implanted fiducial markers has sufficient accuracy, this procedure may not be widely accepted due to the risk of pneumothorax. Previously, we have developed a technique to generate gating signals from fluoroscopic images without implanted fiducial markers using a template matching method (Berbeco et al 2005 Phys. Med. Biol. 50 4481-90, Cui et al 2007 Phys. Med. Biol. 52 741-55). In this paper, we present an extension of this method to multiple-template matching for directly tracking the lung tumor mass in fluoroscopy video. The basic idea is as follows: (i) during the patient setup session, a pair of orthogonal fluoroscopic image sequences are taken and processed off-line to generate a set of reference templates that correspond to different breathing phases and tumor positions; (ii) during treatment delivery, fluoroscopic images are continuously acquired and processed; (iii) the similarity between each reference template and the processed incoming image is calculated; (iv) the tumor position in the incoming image is then estimated by combining the tumor centroid coordinates in reference templates with proper weights based on the measured similarities. With different handling of image processing and similarity calculation, two such multiple-template tracking techniques have been developed: one based on motion-enhanced templates and Pearson's correlation score while the other based on eigen templates and mean-squared error. The developed techniques have been tested on six sequences of fluoroscopic images from six lung cancer patients against the reference tumor positions manually determined by a radiation oncologist. The tumor centroid coordinates automatically detected using both methods agree well with the manually marked reference locations. The eigenspace tracking method performs slightly better than the motion-enhanced method, with average localization errors less than 2 pixels (1 mm) and the error at a 95% confidence level of about 2-4 pixels (1-2 mm). This work demonstrates the feasibility of direct tracking of a lung tumor mass in fluoroscopic images without implanted fiducial markers using multiple reference templates.
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Trotman, Judith; Trinh, Jimmy; Kwan, Yiu Lam; Estell, Jane A; Fletcher, Julie; Archer, Kate; Lee, Kenneth; Foo, Kerwin; Curnow, Jennifer; Bianchi, Alessandra; Wignall, Lynda; Verner, Emma; Gasiorowski, Robin; Siedlecka, Elizabeth; Cunningham, Ilona
2017-05-01
Multidisciplinary team (MDT) meetings aimed at facilitating peer review have become standard practice in oncology. However, there is scant literature on the optimal structure and conduct of such meetings. To develop a process for formal peer review of patients with haematological malignancies and to audit any resulting changes made to the management recommendations of the treating physician. A standard operating procedure (SOP) for MDT meetings was developed essentially to integrate clinical peer review with weekly pathology and radiology meetings. The centrepiece is the electronic submission of a patient-specific proforma (Microsoft InfoPath) prior to the meeting. It serves as the template for presentation, discussion and recording of recommendations and conclusions. The final verified document is stored in the electronic patient record, and a copy is sent to the general practitioner. The proposed management plans were compared to the consensus recommendations of the meeting for the first 4 years since inception. Both SOP and proforma underwent continual improvements. These provided the framework for the conduct of a robust weekly MDT meeting for peer review of the management of patients with haematological malignancies. On 20% of occasions, patient management plans were altered to optimise patient care as a direct consequence on peer review at the MDT. Our streamlined process, in its ultimate format, has provided a mature and efficient forum for formal peer review in a genuine multidisciplinary environment. Both initial data and informal feedback support its ongoing activity as an integral component of delivering quality patient care. © 2016 Royal Australasian College of Physicians.
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Auditing Practice Style Variation in Pediatric Inpatient Asthma Care.
Silber, Jeffrey H; Rosenbaum, Paul R; Wang, Wei; Ludwig, Justin M; Calhoun, Shawna; Guevara, James P; Zorc, Joseph J; Zeigler, Ashley; Even-Shoshan, Orit
2016-09-01
Asthma is the most prevalent chronic illness among children, remaining a leading cause of pediatric hospitalizations and representing a major financial burden to many health care systems. To implement a new auditing process examining whether differences in hospital practice style may be associated with potential resource savings or inefficiencies in treating pediatric asthma admissions. A retrospective matched-cohort design study, matched for asthma severity, compared practice patterns for patients admitted to Children's Hospital Association hospitals contributing data to the Pediatric Hospital Information System (PHIS) database. With 3 years of PHIS data on 48 887 children, an asthma template was constructed consisting of representative children hospitalized for asthma between April 1, 2011, and March 31, 2014. The template was matched with either a 1:1, 2:1, or 3:1 ratio at each of 37 tertiary care children's hospitals, depending on available sample size. Treatment at each PHIS hospital. Cost, length of stay, and intensive care unit (ICU) utilization. After matching patients (n = 9100; mean [SD] age, 7.1 [3.6] years; 3418 [37.6%] females) to the template (n = 100, mean [SD] age, 7.2 [3.7] years; 37 [37.0%] females), there was no significant difference in observable patient characteristics at the 37 hospitals meeting the matching criteria. Despite similar characteristics of the patients, we observed large and significant variation in use of the ICUs as well as in length of stay and cost. For the same template-matched populations, comparing utilization between the 12.5th percentile (lower eighth) and 87.5th percentile (upper eighth) of hospitals, median cost varied by 87% ($3157 vs $5912 per patient; P < .001); total hospital length of stay varied by 47% (1.5 vs 2.2 days; P < .001); and ICU utilization was 254% higher (6.5% vs 23.0%; P < .001). Furthermore, the patterns of resource utilization by patient risk differed significantly across hospitals. For example, as patient risk increased one hospital displayed significantly increasing costs compared with their matched controls (comparative cost difference: lowest risk, -34.21%; highest risk, 53.27%; P < .001). In contrast, another hospital displayed significantly decreasing costs relative to their matched controls as patient risk increased (comparative cost difference: lowest risk, -10.12%; highest risk, -16.85%; P = .01). For children with asthma who had similar characteristics, we observed different hospital resource utilization; some values differed greatly, with important differences by initial patient risk. Through the template matching audit, hospitals and stakeholders can better understand where this excess variation occurs and can help to pinpoint practice styles that should be emulated or avoided.
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Care plans and care planning in long term conditions: a conceptual model
Burt, J; Rick, J; Blakeman, T; Protheroe, J; Roland, M; Bower, P
2013-01-01
The prevalence and impact of long term conditions continues to rise. Care planning for people with long term conditions has been a policy priority for chronic disease management in a number of health care systems. However, patients and providers appear unclear about the formulation and implementation of care planning. Further work in this area is therefore required to inform the development, implementation and evaluation of future care planning initiatives. We distinguish between ‘care planning’ (the process by which health care professionals and patients discuss, agree and review an action plan to achieve the goals or behaviour change of most relevance and concern to the patient) and a ‘care plan’ (a written document recording the outcome of a care planning process). We propose a typology of care planning and care plans with three core dimensions: perspective (patient or professional), scope (a focus on goals or on behaviours) and networks (confined to the professional-patient dyad or extending to the entire care network). In addition, we draw on psychological models of mediation and moderation to outline potential mechanisms through which care planning and care plans may lead to improved outcomes for both patients and the wider health care system. The proposed typology of care planning and care plans offered here, along with the model of the process by which care planning may influence outcomes, provide a useful framework for future policy developments and evaluations. Empirical work is required to explore the degree to which current care planning approaches and care plans can be described according to these dimensions, and the factors that determine which types of patients and professionals use which type of care plans. PMID:23883621
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Advances in nanosized zeolites
NASA Astrophysics Data System (ADS)
Mintova, Svetlana; Gilson, Jean-Pierre; Valtchev, Valentin
2013-07-01
This review highlights recent developments in the synthesis of nanosized zeolites. The strategies available for their preparation (organic-template assisted, organic-template free, and alternative procedures) are discussed. Major breakthroughs achieved by the so-called zeolite crystal engineering and encompass items such as mastering and using the physicochemical properties of the precursor synthesis gel/suspension, optimizing the use of silicon and aluminium precursor sources, the rational use of organic templates and structure-directing inorganic cations, and careful adjustment of synthesis conditions (temperature, pressure, time, heating processes from conventional to microwave and sonication) are addressed. An on-going broad and deep fundamental understanding of the crystallization process, explaining the influence of all variables of this complex set of reactions, underpins an even more rational design of nanosized zeolites with exceptional properties. Finally, the advantages and limitations of these methods are addressed with particular attention to their industrial prospects and utilization in existing and advanced applications.
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Implant-Related Gingival Recession: Pilot Case Series Presents Novel Technique and Scoring Template.
El Askary, Abd El Salam; Ghallab, Noha A; Tan, Shuh-Chern; Rosen, Paul S; Shawkat, Ahmad
2016-07-01
This article introduces a novel protocol for the predictable treatment of Class II division 2 implantrelated gingival recession and presents an innovative acrylic template for scoring the peri-implant soft-tissue gain, used before and after treatment. Ten patients with Class II division 2 single-implant-related gingival recession received combined double-papillary flap approximation and rotated subepithelial connective tissue grafting from the palate, along with any preferred optimal grafting technique that suits the type of preexisting defect. Clinical gingival recession was recorded using a scoring template at 4, 6, and 9 months postoperatively. At the end of the 9-month follow-up period, 80% of the cases showed improved soft-tissue coverage; two patients showed significant wound complications that were related to poor home-care measures. The scoring method used can be considered a diagnostic and prognostic tool for better understanding of implant-related gingival recession.
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NASA Technical Reports Server (NTRS)
Plante, Jeannete
2010-01-01
GEIA-STD-0005-1 defines the objectives of, and requirements for, documenting processes that assure customers and regulatory agencies that AHP electronic systems containing lead-free solder, piece parts, and boards will satisfy the applicable requirements for performance, reliability, airworthiness, safety, and certify-ability throughout the specified life of performance. It communicates requirements for a Lead-Free Control Plan (LFCP) to assist suppliers in the development of their own Plans. The Plan documents the Plan Owner's (supplier's) processes, that assure their customer, and all other stakeholders that the Plan owner's products will continue to meet their requirements. The presentation reviews quality assurance requirements traceability and LFCP template instructions.
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The 10 building blocks of high-performing primary care.
Bodenheimer, Thomas; Ghorob, Amireh; Willard-Grace, Rachel; Grumbach, Kevin
2014-01-01
Our experiences studying exemplar primary care practices, and our work assisting other practices to become more patient centered, led to a formulation of the essential elements of primary care, which we call the 10 building blocks of high-performing primary care. The building blocks include 4 foundational elements-engaged leadership, data-driven improvement, empanelment, and team-based care-that assist the implementation of the other 6 building blocks-patient-team partnership, population management, continuity of care, prompt access to care, comprehensiveness and care coordination, and a template of the future. The building blocks, which represent a synthesis of the innovative thinking that is transforming primary care in the United States, are both a description of existing high-performing practices and a model for improvement.
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The center for expanded data annotation and retrieval
Bean, Carol A; Cheung, Kei-Hoi; Dumontier, Michel; Durante, Kim A; Gevaert, Olivier; Gonzalez-Beltran, Alejandra; Khatri, Purvesh; Kleinstein, Steven H; O’Connor, Martin J; Pouliot, Yannick; Rocca-Serra, Philippe; Sansone, Susanna-Assunta; Wiser, Jeffrey A
2015-01-01
The Center for Expanded Data Annotation and Retrieval is studying the creation of comprehensive and expressive metadata for biomedical datasets to facilitate data discovery, data interpretation, and data reuse. We take advantage of emerging community-based standard templates for describing different kinds of biomedical datasets, and we investigate the use of computational techniques to help investigators to assemble templates and to fill in their values. We are creating a repository of metadata from which we plan to identify metadata patterns that will drive predictive data entry when filling in metadata templates. The metadata repository not only will capture annotations specified when experimental datasets are initially created, but also will incorporate links to the published literature, including secondary analyses and possible refinements or retractions of experimental interpretations. By working initially with the Human Immunology Project Consortium and the developers of the ImmPort data repository, we are developing and evaluating an end-to-end solution to the problems of metadata authoring and management that will generalize to other data-management environments. PMID:26112029
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Christensen, Signe; Horowitz, Scott; Bardwell, James C.A.; Olsen, Johan G.; Willemoës, Martin; Lindorff-Larsen, Kresten; Ferkinghoff-Borg, Jesper; Hamelryck, Thomas; Winther, Jakob R.
2017-01-01
Despite the development of powerful computational tools, the full-sequence design of proteins still remains a challenging task. To investigate the limits and capabilities of computational tools, we conducted a study of the ability of the program Rosetta to predict sequences that recreate the authentic fold of thioredoxin. Focusing on the influence of conformational details in the template structures, we based our study on 8 experimentally determined template structures and generated 120 designs from each. For experimental evaluation, we chose six sequences from each of the eight templates by objective criteria. The 48 selected sequences were evaluated based on their progressive ability to (1) produce soluble protein in Escherichia coli and (2) yield stable monomeric protein, and (3) on the ability of the stable, soluble proteins to adopt the target fold. Of the 48 designs, we were able to synthesize 32, 20 of which resulted in soluble protein. Of these, only two were sufficiently stable to be purified. An X-ray crystal structure was solved for one of the designs, revealing a close resemblance to the target structure. We found a significant difference among the eight template structures to realize the above three criteria despite their high structural similarity. Thus, in order to improve the success rate of computational full-sequence design methods, we recommend that multiple template structures are used. Furthermore, this study shows that special care should be taken when optimizing the geometry of a structure prior to computational design when using a method that is based on rigid conformations. PMID:27659562
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Johansson, Kristoffer E; Tidemand Johansen, Nicolai; Christensen, Signe; Horowitz, Scott; Bardwell, James C A; Olsen, Johan G; Willemoës, Martin; Lindorff-Larsen, Kresten; Ferkinghoff-Borg, Jesper; Hamelryck, Thomas; Winther, Jakob R
2016-10-23
Despite the development of powerful computational tools, the full-sequence design of proteins still remains a challenging task. To investigate the limits and capabilities of computational tools, we conducted a study of the ability of the program Rosetta to predict sequences that recreate the authentic fold of thioredoxin. Focusing on the influence of conformational details in the template structures, we based our study on 8 experimentally determined template structures and generated 120 designs from each. For experimental evaluation, we chose six sequences from each of the eight templates by objective criteria. The 48 selected sequences were evaluated based on their progressive ability to (1) produce soluble protein in Escherichia coli and (2) yield stable monomeric protein, and (3) on the ability of the stable, soluble proteins to adopt the target fold. Of the 48 designs, we were able to synthesize 32, 20 of which resulted in soluble protein. Of these, only two were sufficiently stable to be purified. An X-ray crystal structure was solved for one of the designs, revealing a close resemblance to the target structure. We found a significant difference among the eight template structures to realize the above three criteria despite their high structural similarity. Thus, in order to improve the success rate of computational full-sequence design methods, we recommend that multiple template structures are used. Furthermore, this study shows that special care should be taken when optimizing the geometry of a structure prior to computational design when using a method that is based on rigid conformations. Copyright © 2016 Elsevier Ltd. All rights reserved.
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NASA Astrophysics Data System (ADS)
Wang, Han; Jin, Tingting; Zheng, Xing; Jiang, Bo; Zhu, Chaosheng; Yuan, Xiangdong; Zheng, Jingtang; Wu, Mingbo
2016-11-01
Hollow cadmium sulfide (CdS) nanospheres of about 260 nm average diameters and about 30 nm shell thickness can be easily synthesized via a sonochemical process, in which polystyrene (PS) nanoparticles were employed as templates. In order to remove the PS templates, both etching and calcination were applied in this paper. The influence of the two different template removal methods on the surface micromorphology, crystal structure, and photocatalytic activity of hollow CdS nanospheres was carefully performed a comparative study. Results of X-ray diffraction, scanning electron microscopy, transmission electron microscopy, energy dispersive X-ray, FT-IR, thermogravimetric analysis, Brunauer-Emmett-Teller, diffused reflectance spectra, and decolorization experiments showed that the different template removal methods exhibited a significant influence on the surface micromorphology, crystal structure, and photocatalytic activity of hollow CdS nanospheres. The CdS hollow nanospheres as-prepared by etching had pure cubic sphalerite structure, higher -OH content, less defects and exhibited good photocatalytic activity for rhodamine-B, Methylene Blue and methyl orange under UV-vis light irradiation. However, CdS hollow nanospheres obtained by calcination with a hexagonal crystal structure, less -OH content, more defects have shown worse photocatalytic activity. This indicated that surface micromorphology and crystalline phase were mainly factors influencing photocatalytic activity of hollow CdS nanospheres.
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Solid waste management complex site development plan
DOE Office of Scientific and Technical Information (OSTI.GOV)
Greager, T.M.
1994-09-30
The main purpose of this Solid Waste Management Complex Site Development Plan is to optimize the location of future solid waste treatment and storage facilities and the infrastructure required to support them. An overall site plan is recommended. Further, a series of layouts are included that depict site conditions as facilities are constructed at the SWMC site. In this respect the report serves not only as the siting basis for future projects, but provides siting guidance for Project W-112, as well. The plan is intended to function as a template for expected growth of the site over the next 30more » years so that future facilities and infrastructure will be properly integrated.« less
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LoPresti, Melissa; Daniels, Bradley; Buchanan, Edward P; Monson, Laura; Lam, Sandi
2017-04-01
Repeat surgery for restenosis after initial nonsyndromic craniosynostosis intervention is sometimes needed. Calvarial vault reconstruction through a healed surgical bed adds a level of intraoperative complexity and may benefit from preoperative and intraoperative definitions of biometric and aesthetic norms. Computer-assisted design and manufacturing using 3D imaging allows the precise formulation of operative plans in anticipation of surgical intervention. 3D printing turns virtual plans into anatomical replicas, templates, or customized implants by using a variety of materials. The authors present a technical note illustrating the use of this technology: a repeat calvarial vault reconstruction that was planned and executed using computer-assisted design and 3D printed intraoperative guides.
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How to evaluate a potential merger or acquisition.
Horowitz, Richard E; Provizer, Harold; Barry, Michael J
2013-12-01
Economic imperatives in health care financing are compelling a variety of mergers, acquisitions, integrations, and other forms of amalgamation. As hospitals merge, their pathology practices are merging. Physicians are forming clinically integrated groups, both with and without hospitals. Universities, commercial laboratories, and even insurance companies are acquiring laboratories and pathology practices. There are few standards or guidelines to help the practicing pathologist respond to such new undertakings. In the present study, we present a "how-to" guide or template to assist pathologists in evaluating proposals to amalgamate and in managing the alliance. The procedure begins with an articulation of the cons and pros, followed by a series of assessments of the cultures, the market, the organization, and operations, as well as a legal and financial assessment and human resources appraisal of each of the entities. We then outline the method for developing an organizational and operational model for the new merged entity and for performing the feasibility analysis, making a final decision, drafting a contract, and developing the business plan for the new venture.
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76 FR 57744 - Agency Information Collection Activities: Submission for OMB Review; Comment Request
Federal Register 2010, 2011, 2012, 2013, 2014
2011-09-16
... of forms necessary to conduct ongoing business with State partners in the implementation of Medicaid... reporting templates. The development of streamlined submission forms is critical for States to implement... requests for State plan amendments, waivers, and demonstration, as well as ongoing reporting.; Form Number...
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A Mindfulness-Based Cognitive Psychoeducational Group Manual for Problem Gambling
ERIC Educational Resources Information Center
Cormier, Abigail; McBride, Dawn Lorraine
2012-01-01
This project provides a comprehensive overview of the research literature on problem gambling in adults and includes a detailed mindfulness-based psychoeducational group manual for problem gambling, complete with an extensive group counselling consent form, assessment and screening protocols, 10 user-friendly lesson plans, templates for a…
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Nottingham Health Science Biobank: a sustainable bioresource.
Matharoo-Ball, Balwir; Thomson, Brian J
2014-10-01
Nottingham Health Science Biobank (NHSB) was established in 2011 by a 3-year "pump priming" grant from the United Kingdom National Institute of Health Research. Before biobanking operations began, NHSB commissioned a financial report on the full costs of biobanking and worked with key stakeholders and external consultants to develop a business plan with the aim of achieving financial and operational sustainability. The plan included: scanning published information, telephone interviews with commercial companies, Freedom of Information Requests, dialogue with prospective customers, and a market analysis of global trends in the use of human tissue samples in research. Our financial report provided a comprehensive and structured costing template for biobanking and confirmed the absolute requirement to ensure cost-efficient processes, careful staff utilization, and maximization of sample turnover. Together with our external consultants, we developed a business model responsive to global interest in healthcare founded on i) identification of key therapeutic areas that mapped to the strengths of the NHSB; ii) a systematic approach to identifying companies operating in these therapy areas; iii) engagement with noncommercial stakeholders to agree strategically aligned sample collection with the aim of ensuring the value of our tissue resource. By adopting this systematic approach to business modelling, the NHSB has achieved sustainability after less than 3 years of operation.
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2012-07-13
completed through SAP -standard templates that are then used for gap analysis as compared to the commercial-off-the-shelf “To-Be” process. The Navy ERP ...13F25-04 4800 Mark Center Drive Alexandria, VA 22350-1500 Acronyms and Abbreviations BPR CMO DAI DCMO DEAMS DLA EBS EC ERP FIAR GAO...overall objective was to evaluate six Enterprise Resource Planning ( ERP ) systems that we identified as necessary for DoD to produce auditable
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The 10 Building Blocks of High-Performing Primary Care
Bodenheimer, Thomas; Ghorob, Amireh; Willard-Grace, Rachel; Grumbach, Kevin
2014-01-01
Our experiences studying exemplar primary care practices, and our work assisting other practices to become more patient centered, led to a formulation of the essential elements of primary care, which we call the 10 building blocks of high-performing primary care. The building blocks include 4 foundational elements—engaged leadership, data-driven improvement, empanelment, and team-based care—that assist the implementation of the other 6 building blocks—patient-team partnership, population management, continuity of care, prompt access to care, comprehensiveness and care coordination, and a template of the future. The building blocks, which represent a synthesis of the innovative thinking that is transforming primary care in the United States, are both a description of existing high-performing practices and a model for improvement. PMID:24615313
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Kritchevsky, S. B.; Braun, B. I.; Wong, E. S.; Solomon, S. L.; Steele, L.; Richards, C.; Simmons, B. P.
2001-01-01
The Evaluation of Processes and Indicators in Infection Control (EPIC) study assesses the relationship between hospital care and rates of central venous catheter-associated primary bacteremia in 54 intensive-care units (ICUs) in the United States and 14 other countries. Using ICU rather than the patient as the primary unit of statistical analysis permits evaluation of factors that vary at the ICU level. The design of EPIC can serve as a template for studies investigating the relationship between process and event rates across health-care institutions. PMID:11294704
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Collins, Sarah A.; Gazarian, Priscilla; Stade, Diana; McNally, Kelly; Morrison, Conny; Ohashi, Kumiko; Lehmann, Lisa; Dalal, Anuj; Bates, David W.; Dykes, Patricia C.
2014-01-01
Patient- and Family-Centered Care (PFCC) is essential for high quality care in the critical and acute-specialty care hospital setting. Effective PFCC requires clinicians to form an integrated interprofessional team to collaboratively engage with the patient/family and contribute to a shared patient-centered plan of care. We conducted observations on a critical care and specialty unit to understand the plan of care activities and workflow documentation requirements for nurses and physicians to inform the development of a shared patient-centered plan of care to support patient engagement. We identified siloed plan of care documentation, with workflow opportunities to converge the nurses plan of care with the physician planned To-do lists and quality and safety checklists. Integration of nurses and physicians plan of care activities into a shared plan of care is a feasible and valuable step toward interprofessional teams that effectively engage patients in plan of care activities. PMID:25954345
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Barone, Sandro; Paoli, Alessandro; Razionale, Armando Viviano
2015-07-01
In the field of orthodontic planning, the creation of a complete digital dental model to simulate and predict treatments is of utmost importance. Nowadays, orthodontists use panoramic radiographs (PAN) and dental crown representations obtained by optical scanning. However, these data do not contain any 3D information regarding tooth root geometries. A reliable orthodontic treatment should instead take into account entire geometrical models of dental shapes in order to better predict tooth movements. This paper presents a methodology to create complete 3D patient dental anatomies by combining digital mouth models and panoramic radiographs. The modeling process is based on using crown surfaces, reconstructed by optical scanning, and root geometries, obtained by adapting anatomical CAD templates over patient specific information extracted from radiographic data. The radiographic process is virtually replicated on crown digital geometries through the Discrete Radon Transform (DRT). The resulting virtual PAN image is used to integrate the actual radiographic data and the digital mouth model. This procedure provides the root references on the 3D digital crown models, which guide a shape adjustment of the dental CAD templates. The entire geometrical models are finally created by merging dental crowns, captured by optical scanning, and root geometries, obtained from the CAD templates. Copyright © 2015 Elsevier Ltd. All rights reserved.
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Hu, Ying Kai; Xie, Qian Yang; Yang, Chi; Xu, Guang Zhou
2017-01-01
Abstract The aim of this study was to introduce a novel method of mesiodens extraction using a vascularized pedicled bone flap by piezosurgery and to compare the differences between a computer-aided design surgical guide template and free-hand operation. A total of 8 patients with mesiodens, 4 with a surgical guide (group I), and 4 without it (group II) were included in the study. The surgical design was to construct a trapdoor pedicle on the superior mucoperiosteal attachment with application of piezosurgery. The bone lid was repositioned after mesiodens extraction. Group I patients underwent surgeries based on the preoperative planning with surgical guide templates, while group II patients underwent free-hand operation. The outcome variables were success rate, intraoperative time, anterior nasal spine (ANS) position, changes of nasolabial angle (NLA), and major complications. Data from the 2 groups were compared by SPSS 17.0, using Wilcoxon test. The operative time was significantly shorter in group I patients. All the mesiodentes were extracted successfully and no obvious differences of preoperative and postoperative ANS position and NLA value were found in both groups. The patients were all recovered uneventfully. Surgical guide templates can enhance clinical accuracy and reduce operative time by facilitating accurate osteotomies. PMID:28658139
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A Cost-Effective, In-House, Positioning and Cutting Guide System for Orthognathic Surgery.
McAllister, Peter; Watson, Melanie; Burke, Ezra
2018-03-01
Technological advances in 3D printing can dramatically improve orthognathic surgical planning workflow. Custom positioning and cutting guides enable intraoperative reproduction of pre-planned osteotomy cuts and can result in greater surgical accuracy and patient safety. This short paper describes the use of freeware (some with open-source) combined with in-house 3D printing facilities to produce reliable, affordable osteotomy cutting guides. Open-source software (3D Slicer) is used to visualise and segment three-dimensional planning models from imported conventional computed tomography (CT) scans. Freeware (Autodesk Meshmixer ©) allows digital manipulation of maxillary and mandibular components to plan precise osteotomy cuts. Bespoke cutting guides allow exact intraoperative positioning. These are printed in polylactic acid (PLA) using a fused-filament fabrication 3D printer. Fixation of the osteotomised segments is achieved using plating templates and four pre-adapted plates with planned screw holes over the thickest bone. We print maxilla/ mandible models with desired movements incorporated to use as a plating template. A 3D printer capable of reproducing a complete skull can be procured for £1000, with material costs in the region of £10 per case. Our production of models and guides typically takes less than 24 hours of total print time. The entire production process is frequently less than three days. Externally sourced models and guides cost significantly more, frequently encountering costs totalling £1500-£2000 for models and guides for a bimaxillary osteotomy. Three-dimensional guided surgical planning utilising custom cutting guides enables the surgeon to determine optimal orientation of osteotomy cuts and better predict the skeletal maxilla/mandible relationship following surgery. The learning curve to develop proficiency using planning software and printer settings is offset by increased surgical predictability and reduced theatre time, making this form of planning a worthy investment.
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Interdisciplinary Care Planning and the Written Care Plan in Nursing Homes: A Critical Review
ERIC Educational Resources Information Center
Dellefield, Mary Ellen
2006-01-01
Purpose: This article is a critical review of the history, research evidence, and state-of-the-art technology in interdisciplinary care planning and the written plan of care in American nursing homes. Design and Methods: We reviewed educational and empirical literature. Results: Interdisciplinary care planning and the written care plan are…
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42 CFR 456.180 - Individual written plan of care.
Code of Federal Regulations, 2011 CFR
2011-10-01
... 42 Public Health 4 2011-10-01 2011-10-01 false Individual written plan of care. 456.180 Section... Plan of Care § 456.180 Individual written plan of care. (a) Before admission to a mental hospital or... plan of care for each applicant or recipient. (b) The plan of care must include— (1) Diagnoses...
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Schnutenhaus, Sigmar; Edelmann, Cornelia; Rudolph, Heike; Dreyhaupt, Jens; Luthardt, Ralph G
2018-01-22
The aim of this study was to investigate differences between the virtually planned and clinically achieved implant positions in completely template-guided implantations as a function of the type of edentulous space, the residual natural dentition, and the surgical implementation. Fifty-six patient cases with a total of 122 implants were evaluated retrospectively. The implantations were completely template-based. The data of the planned implant positions were overlaid with the actual clinical implant positions, followed by measurements of the 3D deviations in terms of coronal (x c ) and apical distance, height (x h ), and angulation (ang) and statistical analysis. The mean x c was 1.2 mm (SD 0.7 mm); the mean x a was 1.8 mm (SD 0.9 mm), the mean x h was 0.8 mm (SD 0.7 mm); and the mean ang was 4.8° (SD 3.1). The type of edentulous space and the jaw (maxilla/mandible) had no significant effect on the results in terms of implant positions. The presence of an adjacent natural tooth at the time of implantation had a significant influence on x h (p = 0.04) and ang (p = 0.05). No significant differences were found regarding the surgical approach for any of the parameters examined. The results of our study are in the same range as those of other studies. Template-guided implantation offers a high degree of accuracy even in the presence of different configurations of the residual dentition or different surgical approaches. A clinical benefit is therefore present, especially from a prosthetic point of view. The clinically achievable accuracy can be described as sufficient for further prosthetic treatment, given the intrinsic and methodological tolerances, making prosthetic rehabilitation safe and predictable.
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Patel, Samir
2015-03-01
Health care is in a state of transition, shifting from volume-based success to value-based success. Hospital executives and referring physicians often do not understand the total value a radiology group provides. A template for easy, cost-effective implementation in clinical practice for most radiology groups to demonstrate the value they provide to their clients (patients, physicians, health care executives) has not been well described. A value management program was developed to document all of the value-added activities performed by on-site radiologists, quantify them in terms of time spent on each activity (investment), and present the benefits to internal and external stakeholders (outcomes). The radiology value-added matrix is the platform from which value-added activities are categorized and synthesized into a template for defining investments and outcomes. The value management program was first implemented systemwide in 2013. Across all serviced locations, 9,931.75 hours were invested. An annual executive summary report template demonstrating outcomes is given to clients. The mean and median individual value-added hours per radiologist were 134.52 and 113.33, respectively. If this program were extrapolated to the entire field of radiology, approximately 30,000 radiologists, this would have resulted in 10,641,161 uncompensated value-added hours documented in 2013, with an estimated economic value of $2.21 billion. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.
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Moving survivorship care plans forward: focus on care coordination.
Salz, Talya; Baxi, Shrujal
2016-07-01
After completing treatment for cancer, the coordination of oncology and primary care presents a challenge for cancer survivors. Many survivors need continued oncology follow-up, and all survivors require primary care. Coordinating the shared care of a cancer survivor, or facilitating an informed handoff from oncology to primary care, is essential for cancer survivors. Survivorship care plans are personalized documents that summarize cancer treatment and outline a plan of recommended ongoing care, with the goal of facilitating the coordination of post-treatment care. Despite their face validity, five trials have failed to demonstrate the effectiveness of survivorship care plans. We posit that these existing trials have critical shortcomings and do not adequately address whether survivorship care plans improve care coordination. Moving forward, we propose four criteria for future trials of survivorship care plans: focusing on high-needs survivor populations, tailoring the survivorship care plan to the care setting, facilitating implementation of the survivorship care plan in clinical practice, and selecting appropriate trial outcomes to assess care coordination. When trials meet these criteria, we can finally assess whether survivorship care plans help cancer survivors receive optimal oncology and primary care. © 2016 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
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Virtual estimates of fastening strength for pedicle screw implantation procedures
NASA Astrophysics Data System (ADS)
Linte, Cristian A.; Camp, Jon J.; Augustine, Kurt E.; Huddleston, Paul M.; Robb, Richard A.; Holmes, David R.
2014-03-01
Traditional 2D images provide limited use for accurate planning of spine interventions, mainly due to the complex 3D anatomy of the spine and close proximity of nerve bundles and vascular structures that must be avoided during the procedure. Our previously developed clinician-friendly platform for spine surgery planning takes advantage of 3D pre-operative images, to enable oblique reformatting and 3D rendering of individual or multiple vertebrae, interactive templating, and placement of virtual pedicle implants. Here we extend the capabilities of the planning platform and demonstrate how the virtual templating approach not only assists with the selection of the optimal implant size and trajectory, but can also be augmented to provide surrogate estimates of the fastening strength of the implanted pedicle screws based on implant dimension and bone mineral density of the displaced bone substrate. According to the failure theories, each screw withstands a maximum holding power that is directly proportional to the screw diameter (D), the length of the in-bone segm,ent of the screw (L), and the density (i.e., bone mineral density) of the pedicle body. In this application, voxel intensity is used as a surrogate measure of the bone mineral density (BMD) of the pedicle body segment displaced by the screw. We conducted an initial assessment of the developed platform using retrospective pre- and post-operative clinical 3D CT data from four patients who underwent spine surgery, consisting of a total of 26 pedicle screws implanted in the lumbar spine. The Fastening Strength of the planned implants was directly assessed by estimating the intensity - area product across the pedicle volume displaced by the virtually implanted screw. For post-operative assessment, each vertebra was registered to its homologous counterpart in the pre-operative image using an intensity-based rigid registration followed by manual adjustment. Following registration, the Fastening Strength was computed for each displaced bone segment. According to our preliminary clinical study, a comparison between Fastening Strength, displaced bone volume and mean voxel intensity showed similar results (p < 0.1) between the virtually templated plans and the post-operative outcome following the traditional clinical approach. This study has demonstrated the feasibility of the platform in providing estimates the pedicle screw fastening strength via virtual implantation, given the intrinsic vertebral geometry and bone mineral density, enabling the selection of the optimal implant dimension adn trajectory for improved strength.
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Ugalde, Anna; O'Callaghan, Clare; Byard, Clem; Brean, Samantha; MacKay, Jenelle; Boltong, Anna; Davoren, Sondra; Lawson, Deborah; Parente, Phillip; Michael, Natasha; Livingston, Patricia
2018-05-11
While advance care planning holds promise, uptake is variable and it is unclear how well people engage with or comprehend advance care planning. The objective of this study was to explore how people with cancer comprehended advance care plans and examine how accurately advance care planning documentation represented patient wishes. This study used a qualitative descriptive design. Data collection comprised interviews and an examination of participants' existing advance care planning documentation. Participants included those who had any diagnosis of cancer with an advance care plan recorded: Refusal of Treatment Certificate, Statement of Choices, and/or Enduring Power of Attorney (Medical Treatment) at one cancer treatment centre. Fourteen participants were involved in the study. Twelve participants were female (86%). The mean age was 77 (range: 61-91), and participants had completed their advance care planning documentation between 8 and 72 weeks prior to the interview (mean 33 weeks). Three themes were evident from the data: incomplete advance care planning understanding and confidence, limited congruence for attitude and documentation, advance care planning can enable peace of mind. Complete advance care planning understanding was unusual; most participants demonstrated partial comprehension of their own advance care plan, and some indicated very limited understanding. Participants' attitudes and their written document congruence were limited, but advance care planning was seen as helpful. This study highlighted advance care planning was not a completely accurate representation of patient wishes. There is opportunity to improve how patients comprehend their own advance care planning documentation.
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Bourdeaux, Christopher P; Davies, Keith J; Thomas, Matthew J C; Bewley, Jeremy S; Gould, Timothy H
2014-05-01
Computerised order sets have the potential to reduce clinical variation and improve patient safety but the effect is variable. We sought to evaluate the impact of changes to the design of an order set on the delivery of chlorhexidine mouthwash and hydroxyethyl starch (HES) to patients in the intensive care unit. The study was conducted at University Hospitals Bristol NHS Foundation Trust, UK. Our intensive care unit uses a clinical information system (CIS). All drugs and fluids are prescribed with the CIS and drug and fluid charts are stored within a database. Chlorhexidine mouthwash was added as a default prescription to the prescribing template in January 2010. HES was removed from the prescribing template in April 2009. Both interventions were available to prescribe manually throughout the study period. We conducted a database review of all patients eligible for each intervention before and after changes to the configuration of choices within the prescribing system. 2231 ventilated patients were identified as appropriate for treatment with chlorhexidine, 591 before the intervention and 1640 after. 55.3% were prescribed chlorhexidine before the change and 90.4% after (p<0.001). 6199 patients were considered in the HES intervention, 2177 before the intervention and 4022 after. The mean volume of HES infused per patient fell from 630 mL to 20 mL after the change (p<0.001) and the percentage of patients receiving HES fell from 54.1% to 3.1% (p<0.001). These results were well sustained with time. The presentation of choices within an electronic prescribing system influenced the delivery of evidence-based interventions in a predictable way and the effect was well sustained. This approach has the potential to enhance the effectiveness of computerised order sets.
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Stiel, Stephanie; Heckel, Maria; Christensen, Britta; Ostgathe, Christoph; Klein, Carsten
2016-01-01
Numerous (inter-)national guidelines and frameworks have been developed to provide recommendations for the application of palliative sedation (PS). However, they are still not widely known, and large variations in PS clinical practice can be found. This study aims to collect and describe contents from documents used in clinical practice and to compare to what extent they match the European Association for Palliative Care (EAPC) framework recommendations. In a national survey on PS in Germany 2012, participants were asked to upload their in-service templates, assessment tools, specific protocols, and in-service statements for the application and documentation of PS. These documents are analyzed by using systematic structured content analysis. Three hundred seven content units of 52 provided documents were coded. The analyzed templates are very heterogeneous and also contain items not mentioned in the EAPC framework. Among 11 scales for the evaluation of sedation level, the Ramsey Sedation Score (n = 5) and the Richmond-Agitation-Sedation-Scale (n = 2) were found most often. For symptom assessment, three different scales were provided one time respectively. In all six PS statements, the common core elements were possible indications for PS, instructions on dose titration, patient monitoring, and care. Wide congruency exists for physical and psychological indications. Most documents coincide on midazolam as a preferred drug and basic monitoring in regular intervals. Aspects such as pre-emptive discussion of the potential role of sedation, informational needs of relatives, and care for the medical professionals are mentioned rarely. The analyzed templates do neglect some points of the EAPC recommendations. However, they expand the ten-point scheme of the framework in some details. The findings may facilitate the development of standardized consensus documentation and monitoring draft as an operational statement.
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Figueiredo, L; Erny, G L; Santos, L; Alves, A
2016-01-01
Personal-care products (PCPs) involve a variety of chemicals whose persistency along with their constant release into the environment raised concern to their potential impact on wildlife and humans health. Regarded as emergent contaminants, PCPs demonstrated estrogenic activity leading to the need of new methodologies to detect and remove those compounds from the environment. Molecular imprinting starts with a complex between a template molecule and a functional monomer, which is then polymerized in the presence of a cross-linker. After template removal, the polymer will contain specific cavities. Based on a good selectivity towards the template, molecularly imprinted polymers (MIPs) have been investigated as efficient materials for the analysis and extraction of the so called emergent pollutants contaminants. Rather than lowering the limit of detections, the key theoretical advantage of MIP over existing methodologies is the potential to target specific chemicals. This unique feature, sometime named specificity (as synonym to very high selectivity) allows to use cheap, simple and/or rapid quantitative techniques such as fast separation with ultra-violet (UV) detection, sensors or even spectrometric techniques. When a high degree of selectivity is achieved, samples extracted with MIPs can be directly analyzed without the need of a separation step. However, while some papers clearly demonstrated the specificity of their MIP toward the targeted PCP, such prove is often lacking, especially with real matrices, making it difficult to assess the success of the different approaches. This review paper focusses on the latest development of MIPs for the analysis of personal care products in the environment, with particular emphasis on design, preparation and practical applications of MIPs. Copyright © 2015 Elsevier B.V. All rights reserved.
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ERIC Educational Resources Information Center
Patchner, Michael A.; Balgopal, Pallassana R.
Three studies were undertaken to examine topics of care planning, personnel management, and quality assurance in long-term care facilities. The first study examined the formulation and implementation processes of care planning for nursing home residents. The exemplary homes' care planning included the existence of strong care planning leadership,…
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42 CFR 456.380 - Individual written plan of care.
Code of Federal Regulations, 2012 CFR
2012-10-01
... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care Facilities Plan of Care § 456.380 Individual written plan of care. (a) Before admission to an ICF or before... designed to meet the objectives of the plan of care; (5) Plans for continuing care, including review and...
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42 CFR 456.380 - Individual written plan of care.
Code of Federal Regulations, 2014 CFR
2014-10-01
... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care Facilities Plan of Care § 456.380 Individual written plan of care. (a) Before admission to an ICF or before... designed to meet the objectives of the plan of care; (5) Plans for continuing care, including review and...
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42 CFR 456.380 - Individual written plan of care.
Code of Federal Regulations, 2013 CFR
2013-10-01
... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care Facilities Plan of Care § 456.380 Individual written plan of care. (a) Before admission to an ICF or before... designed to meet the objectives of the plan of care; (5) Plans for continuing care, including review and...
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78 FR 39305 - 30-Day Notice of Proposed Information Collection: OSHC Progress Report Template
Federal Register 2010, 2011, 2012, 2013, 2014
2013-07-01
... Building, Washington, DC 20503; fax: 202-395-5806. Email: [email protected] . FOR FURTHER... proposed use: The Appropriations Act, provided a total of $100,000,000 to HUD for a Sustainable Communities... Sustainable Communities Regional Planning Grant Program, and $30,000,000 is available for the Community...
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76 FR 29249 - Agency Information Collection Activities: Submission for OMB Review; Comment Request
Federal Register 2010, 2011, 2012, 2013, 2014
2011-05-20
... collection; Title of Information Collection: State Plan Template to Implement Section 6062 of the Deficit Reduction Act; Form No.: CMS-10232 (OMB : 0938-1045); Use: The Deficit Reduction Act (DRA) provides States..., 2011. OMB, Office of Information and Regulatory Affairs, Attention: CMS Desk Officer, Fax Number: (202...
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Building a Model PE Curriculum: Education Reform in Action
ERIC Educational Resources Information Center
Moore, John
2012-01-01
The blueprint to build a model physical education (PE) curriculum begins by establishing a sound curricular foundation based on a lesson plan template that incorporates clear and concise program goals, the alignment of lessons to state or national content standards, and the collection, analysis and use of objective assessment data that informs…
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The MIMIC Code Repository: enabling reproducibility in critical care research.
Johnson, Alistair Ew; Stone, David J; Celi, Leo A; Pollard, Tom J
2018-01-01
Lack of reproducibility in medical studies is a barrier to the generation of a robust knowledge base to support clinical decision-making. In this paper we outline the Medical Information Mart for Intensive Care (MIMIC) Code Repository, a centralized code base for generating reproducible studies on an openly available critical care dataset. Code is provided to load the data into a relational structure, create extractions of the data, and reproduce entire analysis plans including research studies. Concepts extracted include severity of illness scores, comorbid status, administrative definitions of sepsis, physiologic criteria for sepsis, organ failure scores, treatment administration, and more. Executable documents are used for tutorials and reproduce published studies end-to-end, providing a template for future researchers to replicate. The repository's issue tracker enables community discussion about the data and concepts, allowing users to collaboratively improve the resource. The centralized repository provides a platform for users of the data to interact directly with the data generators, facilitating greater understanding of the data. It also provides a location for the community to collaborate on necessary concepts for research progress and share them with a larger audience. Consistent application of the same code for underlying concepts is a key step in ensuring that research studies on the MIMIC database are comparable and reproducible. By providing open source code alongside the freely accessible MIMIC-III database, we enable end-to-end reproducible analysis of electronic health records. © The Author 2017. Published by Oxford University Press on behalf of the American Medical Informatics Association.
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Social workers' involvement in advance care planning: a systematic narrative review.
Wang, Chong-Wen; Chan, Cecilia L W; Chow, Amy Y M
2017-07-10
Advance care planning is a process of discussion that enables competent adults to express their wishes about end-of-life care through periods of decisional incapacity. Although a number of studies have documented social workers' attitudes toward, knowledge about, and involvement in advance care planning, the information is fragmented. The purpose of this review was to provide a narrative synthesis of evidence on social workers' perspectives and experiences regarding implementation of advance care planning. Six databases were searched for peer-reviewed research papers from their respective inception through December 2016. All of the resulting studies relevant to both advance care planning and social worker were examined. The findings of relevant studies were synthesized thematically. Thirty-one articles met the eligibility criteria. Six research themes were identified: social workers' attitudes toward advance care planning; social workers' knowledge, education and training regarding advance care planning; social workers' involvement in advance care planning; social workers' perceptions of their roles; ethical issues relevant to advance care planning; and the effect of social work intervention on advance care planning engagement. The findings suggest that there is a consensus among social workers that advance care planning is their duty and responsibility and that social workers play an important role in promoting and implementing advance care planning through an array of activities. This study provides useful knowledge for implementing advance care planning through illustrating social workers' perspectives and experiences. Further studies are warranted to understand the complexity inherent in social workers' involvement in advance care planning for different life-limiting illnesses or within different socio-cultural contexts.
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Population based MRI and DTI templates of the adult ferret brain and tools for voxelwise analysis.
Hutchinson, E B; Schwerin, S C; Radomski, K L; Sadeghi, N; Jenkins, J; Komlosh, M E; Irfanoglu, M O; Juliano, S L; Pierpaoli, C
2017-05-15
Non-invasive imaging has the potential to play a crucial role in the characterization and translation of experimental animal models to investigate human brain development and disorders, especially when employed to study animal models that more accurately represent features of human neuroanatomy. The purpose of this study was to build and make available MRI and DTI templates and analysis tools for the ferret brain as the ferret is a well-suited species for pre-clinical MRI studies with folded cortical surface, relatively high white matter volume and body dimensions that allow imaging with pre-clinical MRI scanners. Four ferret brain templates were built in this study - in-vivo MRI and DTI and ex-vivo MRI and DTI - using brain images across many ferrets and region of interest (ROI) masks corresponding to established ferret neuroanatomy were generated by semi-automatic and manual segmentation. The templates and ROI masks were used to create a web-based ferret brain viewing software for browsing the MRI and DTI volumes with annotations based on the ROI masks. A second objective of this study was to provide a careful description of the imaging methods used for acquisition, processing, registration and template building and to demonstrate several voxelwise analysis methods including Jacobian analysis of morphometry differences between the female and male brain and bias-free identification of DTI abnormalities in an injured ferret brain. The templates, tools and methodological optimization presented in this study are intended to advance non-invasive imaging approaches for human-similar animal species that will enable the use of pre-clinical MRI studies for understanding and treating brain disorders. Published by Elsevier Inc.
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Advance Care Planning for Serious Illness
ADVANCE CARE PLANNING FOR SERIOUS ILLNESS Making plans for the health care you want during a serious illness is called “advance care planning.” Planning involves learning about your illness, understanding choices ...
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Educational Utilization of Microsoft Powerpoint for Oral and Maxillofacial Cancer Presentations.
Carvalho, Francisco Samuel Rodrigues; Chaves, Filipe Nobre; Soares, Eduardo Costa Studart; Pereira, Karuza Maria Alves; Ribeiro, Thyciana Rodrigues; Fonteles, Cristiane Sa Roriz; Costa, Fabio Wildson Gurgel
2016-01-01
Electronic presentations have become useful tools for surgeons, other clinicians and patients, facilitating medical and legal support and scientific research. Microsoft® PowerPoint is by far and away the most commonly used computer-based presentation package. Setting up surgical clinical cases with PowerPoint makes it easy to register and follow patients for the purpose of discussion of treatment plan or scientific presentations. It facilitates communication between professionals, supervising clinical cases and teaching. It is often useful to create a template to standardize the presentation, offered by the software through the slide master. The purpose of this paper was to show a simple and practical method for creating a Microsoft® PowerPoint template for use in presentations concerning oral and maxillofacial cancer.
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Jiang, Guoqian; Evans, Julie; Endle, Cory M; Solbrig, Harold R; Chute, Christopher G
2016-01-01
The Biomedical Research Integrated Domain Group (BRIDG) model is a formal domain analysis model for protocol-driven biomedical research, and serves as a semantic foundation for application and message development in the standards developing organizations (SDOs). The increasing sophistication and complexity of the BRIDG model requires new approaches to the management and utilization of the underlying semantics to harmonize domain-specific standards. The objective of this study is to develop and evaluate a Semantic Web-based approach that integrates the BRIDG model with ISO 21090 data types to generate domain-specific templates to support clinical study metadata standards development. We developed a template generation and visualization system based on an open source Resource Description Framework (RDF) store backend, a SmartGWT-based web user interface, and a "mind map" based tool for the visualization of generated domain-specific templates. We also developed a RESTful Web Service informed by the Clinical Information Modeling Initiative (CIMI) reference model for access to the generated domain-specific templates. A preliminary usability study is performed and all reviewers (n = 3) had very positive responses for the evaluation questions in terms of the usability and the capability of meeting the system requirements (with the average score of 4.6). Semantic Web technologies provide a scalable infrastructure and have great potential to enable computable semantic interoperability of models in the intersection of health care and clinical research.
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Exploring the knowledge, attitudes and needs of advance care planning in older Chinese Australians.
Yap, Sok Shin; Chen, Karren; Detering, Karen M; Fraser, Scott A
2017-05-23
To identify factors that influence the engagement of Chinese Australians with advance care planning. Despite the benefits of advance care planning, there is a low prevalence of advance care planning in the Chinese Australian community. Reasons for this are often cited as cultural considerations and taboos surrounding future medical planning and death; however, other logistical factors may also be important. This qualitative study used a thematic analysis grounded theory approach to explore facilitators and barriers to engagement in advance care planning. Semistructured interviews were conducted in-language (Mandarin or Cantonese) exploring the views of a purposive sample of 30 community-dwelling older Chinese Australians within Victoria, Australia. Three key themes were identified: knowledge of, attitudes towards and needs for undertaking advance care planning amongst the Chinese Australians. There was a low awareness of advance care planning amongst the participants and some confusion regarding the concept. Most participants reported positive attitudes towards advance care planning but acknowledged that others may be uncomfortable discussing death-related topics. Participants would want to know the true status of their health and plan ahead in consultation with family members to reduce the burden on the family and suffering for themselves. Language was identified as the largest barrier to overcome to increase advance care planning awareness. In-language materials and key support networks including GPs, family and Chinese community groups were identified as ideal forums for the promotion of advance care planning. The participants of this study were open to conversations regarding future medical planning and end-of-life care, suggesting the low uptake of advance care planning amongst Chinese Australians is not culturally motivated but may be due a lack of knowledge relating to advance care planning. The results highlight the need to provide access to appropriate in-language advance care planning resources and promotion of advance care planning across the Chinese community. © 2017 John Wiley & Sons Ltd.
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Validation of a Novel Electronic Health Record Patient Portal Advance Care Planning Delivery System.
Bose-Brill, Seuli; Feeney, Michelle; Prater, Laura; Miles, Laura; Corbett, Angela; Koesters, Stephen
2018-06-26
Advance care planning allows patients to articulate their future care preferences should they no longer be able to make decisions on their own. Early advance care planning in outpatient settings provides benefits such as less aggressive care and fewer hospitalizations, yet it is underutilized due to barriers such as provider time constraints and communication complexity. Novel methods, such as patient portals, provide a unique opportunity to conduct advance care planning previsit planning for outpatient care. This follow-up to our pilot study aimed to conduct pragmatic testing of a novel electronic health record-tethered framework and its effects on advance care planning delivery in a real-world primary care setting. Our intervention tested a previsit advance care planning workflow centered around a framework sent via secure electronic health record-linked patient portal in a real-world clinical setting. The primary objective of this study was to determine its impact on frequency and quality of advance care planning documentation. We conducted a pragmatic trial including 2 sister clinical sites, one site implementing the intervention and the other continuing standard care. A total of 419 patients aged between 50 and 93 years with active portal accounts received intervention (n=200) or standard care (n=219). Chart review analyzed the presence of advance care planning and its quality and was graded with previously established scoring criteria based on advance care planning best practice guidelines from multiple nations. A total of 19.5% (39/200) of patients who received previsit planning responded to the framework. We found that the intervention site had statistically significant improvement in new advance care planning documentation rates (P<.01) and quality (P<.01) among all eligible patients. Advance care planning documentation rates increased by 105% (19/39 to 39/39) and quality improved among all patients who engaged in the previsit planning framework (n=39). Among eligible patients aged between 50 and 60 years at the intervention site, advance care planning documentation rates increased by 37% (27/96 to 37/96). Advance care planning documentation rates increased 34% among high users (27/67 to 36/67). Advance care planning previsit planning using a secure electronic health record-supported patient portal framework yielded improvement in the presence of advance care planning documentation, with highest improvement in active patient portal users and patients aged between 50 and 60 years. Targeted previsit patient portal advance care planning delivery in these populations can potentially improve the quality of care in these populations. ©Seuli Bose-Brill, Michelle Feeney, Laura Prater, Laura Miles, Angela Corbett, Stephen Koesters. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 26.06.2018.
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Donohue, SarahMaria; Sesto, Mary E.; Hahn, David L.; Buhr, Kevin A.; Jacobs, Elizabeth A.; Sosman, James M.; Andreason, Molly J.; Wiegmann, Douglas A.; Tevaarwerk, Amye J.
2015-01-01
Purpose: Survivorship care plans for cancer survivors may facilitate provider-to-provider communication. Primary care provider (PCP) perspectives on care plan provision and use are limited, especially when care plans are generated by an electronic health record (EHR) system. We sought to examine PCPs' perspectives regarding EHR-generated care plans. Methods: PCPs (N = 160) who were members of the Wisconsin Research and Education Network listserv received a sample 10-page plan (WREN cohort). PCPs (n = 81) who had or were currently seeing survivors enrolled onto one of our survivorship clinical trials received a copy of the survivor's personalized care plan (University of Wisconsin [UW] cohort). Both cohorts received a survey after reviewing the plan. All plans were generated within an EHR. Results: Forty-six and 26 PCPs participated in the WREN and UW cohorts, respectively. PCPs regarded EHR-generated plans as useful in coordinating care (88%), understanding treatments (94%), understanding treatment adverse effects (89%), and supporting clinical decisions (82%). Few felt using EHR-generated plans would disrupt clinic workflow (14%) or take too much time (11%). Most (89%) preferred receiving the plan via EHR. PCPs reported consistent provision (81%) and standard location in the medical record (89%) as key factors facilitating their use of survivorship care plans. Important facilitators of care plan use included a more abbreviated plan, ideally one to three pages (32%), and/or a plan specifically tailored to PCP use (57%). Conclusion: Plans were viewed as useful for coordinating care and making clinical decisions. However, PCPs desired shorter, clinician-oriented plans, accessible within an EHR and delivered and located in a standardized manner. PMID:25804989
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Developing and Implementing a Citywide Asthma Action Plan: A Community Collaborative Partnership.
Staudt, Amanda Marie; Alamgir, Hasanat; Long, Debra Lynn; Inscore, Stephen Curtis; Wood, Pamela Runge
2015-12-01
Asthma affects 1 in 10 children in the United States, with higher prevalence among children living in poverty. Organizations in San Antonio, Texas, partnered to design and implement a uniform, citywide asthma action plan to improve asthma management capacity in schools. The asthma action plan template was modified from that of the Global Initiative for Asthma. School personnel were trained in symptom recognition, actions to take, and use of equipment before the asthma action plan implementation. The annual Asthma Action Plan Summit was organized as a forum for school nurses, healthcare providers, and members of the community to exchange ideas and strategies on implementation, as well as to revise the plan. The asthma action plan was implemented in all 16 local school districts. Feedback received from school nurses suggests that the citywide asthma action plan resulted in improved asthma management and student health at schools. The evidence in this study suggests that community organizations can successfully collaborate to implement a citywide health initiative similar to the asthma action plan.
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Template for updating regulations in QA manuals
DOE Office of Scientific and Technical Information (OSTI.GOV)
White, M.G.; Banerjee, B.
1992-01-01
Recently, the U.S. Department of Energy (DOE) issued new quality assurance (QA) orders to reflect current policies for conduct and operation of DOE-authorized programs and facilities. Establishing traceability to new QA criteria and requirements from former multidraft orders, QA manuals, and guidance documentation for DOE-funded work can be confusing. Identified critical considerations still must be addressed. Most of the newly stated QA criteria can be cross referenced, where applicable, to former QA plans and manuals. Where additional criteria occur, new procedures may be required, together with revisions in QA plans and manuals.
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Brigl, B; Ammenwerth, E; Dujat, C; Gräber, S; Grosse, A; Häber, A; Jostes, C; Winter, A
2005-01-01
Systematic information management in hospitals demands for a strategic information management plan (SIM plan). As preparing a SIM plan is a considerable challenge we provide a practical guideline that is directly applicable when a SIM plan is going to be prepared. The guideline recommends a detailed structure of a SIM plan and gives advice about its content and the preparation process. It may be used as template, which can be adapted to the individual demands of any hospital. The guideline was used in several hospitals preparing a SIM plan. Experiences showed that the SIM plans could be prepared very efficiently and timely using the guideline, that the proposed SIM plan structure suited well, that the guideline offers enough flexibility to meet the requirements of the individual hospitals and that the specific recommendations of the guideline were very helpful. Nevertheless, we must strive for a more comprehensive theory of strategic information management planning which -- in the sense of enterprise architecture planning -- represents the intrinsic correlations of the different parts of a SIM plan to a greater extent.
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NASA Astrophysics Data System (ADS)
Rau, Thomas S.; Lexow, G. Jakob; Blume, Denise; Kluge, Marcel; Lenarz, Thomas; Majdani, Omid
2017-03-01
A new method for template-guided cochlear implantation surgery is proposed which has been developed to create a minimally invasive access to the inner ear. A first design of the surgical template was drafted, built, and finally tested regarding its accuracy. For individual finalization of the micro-stereotactic frame bone cement is utilized as this well-known and well-established material suggests ease of use as well as high clinical acceptance and enables both sterile and rapid handling. The new concept includes an alignment device, based on a passive hexapod with manually adjustable legs for temporary fixation of the separate parts in the patient-specific pose until the bone cement is spread and finally cured. Additionally, a corresponding evaluation method was developed to determine the accuracy of the microstereotactic frame in some initial experiments. In total 18 samples of the surgical template were fabricated based on previously planned trajectories. The mean positioning error at the target point was 0.30 mm with a standard deviation of 0.25 mm.
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Transition and closeout of the Fernald Closure Project
DOE Office of Scientific and Technical Information (OSTI.GOV)
Bilson, H.E.; Terry, T.; Reising, J.
The U.S. Department of Energy (DOE) and Fluor Fernald have completed the majority of the cleanup of the Fernald Site. The over 1,000 acre complex for processing uranium has been demolished and soil contamination has been remediated. With acres of wetlands and prairies replacing the buildings and waste pits. At the end of the project the focus shifted to developing demonstrating the completion of the project and the contract, as well as ensuring a smooth transition of the facility from the DOE's Environmental Management (EM) Program to the DOE's Legacy Management (LM) Program. Working with the DOE, each portion ofmore » the closure contract was examined for specific closure definition. From this negotiation effort the Comprehensive Exit and Transition Plan (CE/T Plan) was written. The CE/T Plan is intended to assist DOE in the analysis that the site is ready for transfer into long-term stewardship (LTS) (also referred to as legacy management) and that Fluor Fernald, Inc. has satisfactorily completed the closure contract statement of work elements. Following the Lessons Learned from the closure of the Rocky Flats Site, the DOE's Legacy Management Program created a matrix of Transition Elements required to ensure adequate information was in place to allow the new prime contractor to perform the Legacy Management scope of work. The transition plan included over 1,000 elements broken down into functional areas and relied on specific Fernald Responsibility Transition Packages (RTPs) for detailed transition actions. The template for Closure and Transition Planning used at the Fernald Site was developed using the best Lessons Learned from across the DOE Complex. The template could be used for other sites, and lessons learned from this closure and transition will be appropriate for all closure projects. (authors)« less
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Miller, Virginia M; Kararigas, Georgios; Seeland, Ute; Regitz-Zagrosek, Vera; Kublickiene, Karolina; Einstein, Gillian; Casanova, Robert; Legato, Marianne J
2016-01-01
In the era of individualized medicine, training future scientists and health-care providers in the principles of sex- and gender-based differences in health and disease is critical in order to optimize patient care. International successes to incorporate these concepts into medical curricula can provide a template for others to follow. Methodologies and resources are provided that can be adopted and adapted to specific needs of other institutions and learning situations.
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Is it time for a comprehensive approach in older home care clients' care planning in Finland?
Turjamaa, Riitta; Hartikainen, Sirpa; Kangasniemi, Mari; Pietilä, Anna-Maija
2015-06-01
Home-care services require access to high quality information. Apart from the provision of right-time organised planning of care and to document information about clients' needs, in home care, the care planning is intended to facilitate continuity and individual nursing through nursing documentation of the assessment of the client. The aim was to describe the contents of older (+75 years) home-care clients' electronic care and service plans and to evaluate how the clients' resources have been taken into account. The data were collected from the care and service plans (n = 437) of home-care services during July 2010. The data were analysed by quantitative methods and by thematic content analysis. Based on the analysis, medication was the most reported component in all plans (92.7%); other commonly reported components were self-care (85.4%) and coping (78.0%). Components within respiratory, follow-up treatment, life cycle and health behaviour were forgotten. Most of the care and service plans were designed from the home-care professionals' point of view but the plans lacked the perspective of older clients. To be able to promote older home clients' ability to live at home, home-care planning needs to be individually designed and must take into account clients' needs and their perspectives regarding meaningful activities and social relationships. In addition, there is a need to develop a more comprehensive care planning system, based on the clients' individual needs and standards of care planning. © 2014 Nordic College of Caring Science.
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Krastl, Gabriel; Zehnder, Marc S; Connert, Thomas; Weiger, Roland; Kühl, Sebastian
2016-06-01
To present a new treatment approach for teeth with pulp canal calcification (PCC) which require root canal treatment. A 15-year-old male patient presented with pain of his upper right central incisor. The tooth showed signs of apical periodontitis. Due to PCC, location of the root canal was judged to be difficult and associated with a high risk of perforation. A cone beam computed tomography (CBCT) and an intra-oral surface scan were performed and matched using software for virtual implant planning. After planning the position of the drill for root canal location, a virtual template was designed, and the data were exported as an STL file and sent to a 3D printer for template fabrication. The template was positioned on the anterior maxillary teeth. A specific drill was used to penetrate through the obliterated part of the root canal and obtain minimally invasive access to the apical part. The root canal was accessible at 9 mm distance from the apex. Further root canal preparation was carried out using an endodontic rotary instrumentation system. After an interappointment dressing for 4 weeks, the root canal was filled with vertically condensed gutta-percha using an epoxy sealer. The access cavity was restored with a composite material. After 15 months, the patient was clinically asymptomatic with no pain on percussion. The radiograph showed no apical pathology. The presented guided endodontic approach seems to be a safe, clinically feasible method to locate root canals and prevent root perforation in teeth with PCC. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
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NASA Astrophysics Data System (ADS)
Fryirs, K.
2016-12-01
In an `era of river repair' fluvial geomorphology has emerged as a key science in river management practice. Geomorphologists are ideally placed to use their science in an applied manner to provide guidance on the impact of floods and droughts, landuse and climate change, and water use on river forms, processes and evolution. Increasingly, fluvial geomorphologists are also asked to make forecasts about how systems might adjust in the future, and to work with managers to implement strategies on-the-ground. Using case study material from Eastern Australia (Bega, Hunter, Wollombi and Lockyer catchments) I will focus on how process-based understanding of rivers has developed and evolved to provide a coherent physical template for effective and proactive, river management practice. I will focus on four key principles and demonstrate how geomorphology has been, and should continue to be, used in process-based, recovery enhancement approaches to river management. How understanding the difference between river behaviour and river change is used to determine how a river is `expected' to function, and how to identify anomalous processes requiring a treatment response. How understanding evolutionary trajectory is used to make future forecasts on river condition and recovery potential, and how working with processes can enhance river recovery. How geomorphic information can be used as a physical template atop which to analyse a range of biotic processes and habitat outcomes. How geomorphic information is used to effectively prioritise and plan river conservation and rehabilitation activities as part of catchment and region-scale action plans.
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Refinement of protein termini in template-based modeling using conformational space annealing.
Park, Hahnbeom; Ko, Junsu; Joo, Keehyoung; Lee, Julian; Seok, Chaok; Lee, Jooyoung
2011-09-01
The rapid increase in the number of experimentally determined protein structures in recent years enables us to obtain more reliable protein tertiary structure models than ever by template-based modeling. However, refinement of template-based models beyond the limit available from the best templates is still needed for understanding protein function in atomic detail. In this work, we develop a new method for protein terminus modeling that can be applied to refinement of models with unreliable terminus structures. The energy function for terminus modeling consists of both physics-based and knowledge-based potential terms with carefully optimized relative weights. Effective sampling of both the framework and terminus is performed using the conformational space annealing technique. This method has been tested on a set of termini derived from a nonredundant structure database and two sets of termini from the CASP8 targets. The performance of the terminus modeling method is significantly improved over our previous method that does not employ terminus refinement. It is also comparable or superior to the best server methods tested in CASP8. The success of the current approach suggests that similar strategy may be applied to other types of refinement problems such as loop modeling or secondary structure rearrangement. Copyright © 2011 Wiley-Liss, Inc.
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Summer Reading Camp Self-Study Guide. REL 2015-070
ERIC Educational Resources Information Center
Smith, Kevin G.; Foorman, Barbara R.
2015-01-01
This guide is designed to facilitate self-studies of planning and implementation of state-required summer reading camp programs for grade 3 students who scored at the lowest level on the state reading assessment. It provides a template for data collection and guiding questions for discussion that may improve instruction and increase the number of…
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ERIC Educational Resources Information Center
Strobridge, Michele
This practicum was designed to provide speech and language therapy to children identified as speech and language impaired, in a Head Start classroom with typically developing peers. The practicum involved amending Head Start component plans, discussing inclusion issues at four education component meetings, conducting an interagency meeting with…
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Zhou, You; Kang, Xiaopeng; Li, Chuan; Xu, Xiaoshan; Li, Rong; Wang, Jun; Li, Wei; Luo, Haotian; Lu, Sheng
2016-12-01
The aim of the present study was to describe the application of 3D printed templates for intraoperative navigation and simulation of periacetabular osteotomies (PAOs) in a cadaveric model.Five cadaveric specimens (10 sides) underwent thin-slice computed tomographic scans of the ala of ilium downwards to the proximal end of femoral shaft. Bernese PAO was performed. Using Mimics v10.1 software (Materialise, Leuven, Belgium), 3D computed tomographic reconstructions were created and the 4 standard PAO bone cuts-ischial, pubic, anterior, and posterior aspects of the ilium-as well as rotation of the dislocated acetabular bone blocks were simulated for each specimen. Using these data, custom 3D printed bone-drilling templates of the pelvis were manufactured, to guide surgical placement of the PAO bone cuts. An angle fix wedge was designed and printed, to help accurately achieve the predetermined rotation angle of the acetabular bone block. Each specimen underwent a conventional PAO. Preoperative, postsimulation, and postoperative lateral center-edge angles, acetabular indices, extrusion indices, and femoral head coverage were measured and compared; P and t values were calculated for above-mentioned measurements while comparing preoperative and postoperative data, and also in postsimulation and postoperative data comparison.All 10 PAO osteotomies were successfully completed using the 3D printed bone-drilling template and angle fix wedge. No osteotomy entered the hip joint and a single posterior column fracture was observed. Comparison of preoperative and postoperative measurements of the 10 sides showed statistically significant changes, whereas no statistically significant differences between postsimulation and postoperative values were noted, demonstrating the accuracy and utility of the 3D printed templates.The application of patient-specific 3D printed bone-drilling and rotation templates in PAO is feasible and may facilitate improved clinical outcomes, through the use of precise presurgical planning and reduced surgical complications with the precisely guided bone drilling.
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Ampe, Sophie; Sevenants, Aline; Smets, Tinne; Declercq, Anja; Van Audenhove, Chantal
2017-01-01
(1) To pilot 'we DECide' in terms of influence on advance care planning policy and practice in nursing home dementia care units. (2) To investigate barriers and facilitators for implementing 'we DECide'. This was a pre-test-post-test study in 18 nursing homes. Measurements included: compliance with best practice of advance care planning policy (ACP-audit); advance care planning practice (ACP criteria: degree to which advance care planning was discussed, and OPTION scale: degree of involvement of residents and families in conversations). Advance care planning policy was significantly more compliant with best practice after 'we DECide'; policy in the control group was not. Advance care planning was not discussed more frequently, nor were residents and families involved to a higher degree in conversations after 'we DECide'. Barriers to realizing advance care planning included staff's limited responsibilities; facilitators included support by management staff, and involvement of the whole organization. 'We DECide' had a positive influence on advance care planning policy. Daily practice, however, did not change. Future studies should pay more attention to long-term implementation strategies. Long-term implementation of advance care planning requires involvement of the whole organization and a continuing support system for health care professionals. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
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Your cancer survivorship care plan
... ency/patientinstructions/000822.htm Your cancer survivorship care plan To use the sharing features on this page, ... get one. What Is a Cancer Survivorship Care Plan? A cancer survivorship care plan is a document ...
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Life care planning after traumatic brain injury.
Zasler, Nathan D; Ameis, Arthur; Riddick-Grisham, Susan N
2013-08-01
A life care plan is a detailed and comprehensive analysis of impairments, realistic needs, and associated costs relevant to providing a lifetime of care to patients. Physicians have a central role in advising life care planners. Within an expertly prepared life care plan, issues must correspond directly with proposed goods and services. A life care plan must clearly cite all relevant caregiver sources and rely on scientific evidence. The central tenets of a life care plan and the ethical and professional roles that physicians may play in the context of traumatic brain injury and a life care plan are reviewed in this article. Copyright © 2013 Elsevier Inc. All rights reserved.
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Y2K compliance readiness and contingency planning.
Stahl, S; Cohan, D
1999-09-01
As the millennium approaches, discussion of "Y2K compliance" will shift to discussion of "Y2K readiness." While "compliance" focuses on the technological functioning of one's own computers, "readiness" focuses on the operational planning required in a world of interdependence, in which the functionality of one's own computers is only part of the story. "Readiness" includes the ability to cope with potential Y2K failures of vendors, suppliers, staff, banks, utility companies, and others. Administrators must apply their traditional skills of analysis, inquiry and diligence to the manifold imaginable challenges which Y2K will thrust upon their facilities. The SPICE template can be used as a systematic tool to guide planning for this historic event.
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Chi, Donald L.
2013-01-01
Objectives To test the hypotheses that youth with special health care needs (YSHCN) with a medical care transition plan are more likely to use dental care during the transition from adolescence to young adulthood and that different factors are associated with dental utilization for YSHCN with and YSHCN without functional limitations. Methods National Survey of CSHCN (2001) and Survey of Adult Transition and Health (2007) data were analyzed (N=1,746). The main predictor variable was having a medical care transition plan, defined as having discussed with a doctor how health care needs might change with age and having developed a transition plan. The outcome variable was dental care use in 2001 (adolescence) and 2007 (young adulthood). Multiple variable Poisson regression models with robust standard errors were used to estimate covariate-adjusted relative risks (RR). Results About 63% of YSHCN had a medical care transition plan and 73.5% utilized dental care. YSHCN with a medical care transition plan had a 9% greater relative risk (RR) of utilizing dental care than YSHCN without a medical care transition plan (RR:1.09; 95% CI:1.03–1.16). In the models stratified by functional limitation status, having a medical care transition plan was significantly associated with dental care use, but only for YSHCN without functional limitations (RR:1.11; 95% CI:1.04–1.18). Conclusions Having a medical care transition plan is significantly associated with dental care use, but only for YSHCN with no functional limitation. Dental care should be an integral part of the comprehensive health care transition planning process for all YSHCN. PMID:23812799
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Larsson, Lena Gunvor; Bäck-Pettersson, Siv; Kylén, Sven; Marklund, Bertil; Carlström, Eric
2017-01-01
The aim of this study was to investigate primary care managers' perceptions of their capability in providing care planning to patients with complex needs. Care planning is defined as a process where the patient, family and health professionals engage in dialogue about the patient's care needs and plan care interventions together. Semi-structured interviews with 18 primary care managers in western Sweden were conducted using Westrin's theoretical cooperation model. Data were analysed using a qualitative deductive method. Results reveal that the managers' approach to care planning was dominated by non-cooperation and separation. The managers were permeated by uncertainty about the meaning of the task of care planning as such. They did not seem to be familiar with the national legislation stipulating that every healthcare provider must meet patients' need for care interventions and participate in the care planning. To accomplish care planning, the process needs to cross - and overcome - both professional and organisational boundaries. There is also a need for incentives to develop working methods that promote local cooperation in order to facilitate optimal care for patients with complex needs. Copyright © 2016. Published by Elsevier Ireland Ltd.
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Association Between Health Plan Exit From Medicaid Managed Care and Quality of Care, 2006-2014
Schpero, William L.; Schlesinger, Mark J.; Trivedi, Amal N.
2017-01-01
Importance State Medicaid programs have increasingly contracted with insurers to provide medical care services for enrollees (Medicaid managed care plans). Insurers that provide these plans can exit Medicaid programs each year, with unclear effects on quality of care and health care experiences. Objective To determine the frequency and interstate variation of health plan exit from Medicaid managed care and evaluate the relationship between health plan exit and market-level quality. Design, Setting, and Participants Retrospective cohort of all comprehensive Medicaid managed care plans (N = 390) during the interval 2006-2014. Exposures Plan exit, defined as the withdrawal of a managed care plan from a state’s Medicaid program. Main Outcomes and Measures Eight measures from the Healthcare Effectiveness Data and Information Set were used to construct 3 composite indicators of quality (preventive care, chronic disease care management, and maternity care). Four measures from the Consumer Assessment of Healthcare Providers and Systems were combined into a composite indicator of patient experience, reflecting the proportion of beneficiaries rating experiences as 8 or above on a 0-to-10–point scale. Outcome data were available for 248 plans (68% of plans operating prior to 2014, representing 78% of beneficiaries). Results Of the 366 comprehensive Medicaid managed care plans operating prior to 2014, 106 exited Medicaid. These exiting plans enrolled 4 848 310 Medicaid beneficiaries, with a mean of 606 039 beneficiaries affected by plan exits annually. Six states had a mean of greater than 10% of Medicaid managed care recipients enrolled in plans that exited, whereas 10 states experienced no plan exits. Plans that exited from a state’s Medicaid market performed significantly worse prior to exiting than those that remained in terms of preventive care (57.5% vs 60.4%; difference, 2.9% [95% CI, 0.3% to 5.5%]), maternity care (69.7% vs 73.6%; difference, 3.8% [95% CI, 1.7% to 6.0%]), and patient experience (73.5% vs 74.8%; difference, 1.3% [95% CI, 0.6% to 1.9%]). There was no significant difference between exiting and nonexiting plans for the quality of chronic disease care management (76.2% vs 77.1%; difference, 1.0% [95% CI, −2.1% to 4.0%]). There was also no significant change in overall market performance before and after the exit of a plan: 0.7–percentage point improvement in preventive care quality (95% CI, −4.9 to 6.3); 0.2–percentage point improvement in chronic disease care management quality (95% CI, −5.8 to 6.2); 0.7–percentage point decrease in maternity care quality (95% CI, −6.4 to 5.0]); and a 0.6–percentage point improvement in patient experience ratings (95% CI, −3.9 to 5.1). Medicaid beneficiaries enrolled in exiting plans had access to coverage for a higher-quality plan, with 78% of plans in the same county having higher quality for preventive care, 71.1% for chronic disease management, 65.5% for maternity care, and 80.8% for patient experience. Conclusions and Relevance Between 2006 and 2014, health plan exit from the US Medicaid program was frequent. Plans that exited generally had lower quality ratings than those that remained, and the exits were not associated with significant overall changes in quality or patient experience in the plans in the Medicaid market. PMID:28655014
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Association Between Health Plan Exit From Medicaid Managed Care and Quality of Care, 2006-2014.
Ndumele, Chima D; Schpero, William L; Schlesinger, Mark J; Trivedi, Amal N
2017-06-27
State Medicaid programs have increasingly contracted with insurers to provide medical care services for enrollees (Medicaid managed care plans). Insurers that provide these plans can exit Medicaid programs each year, with unclear effects on quality of care and health care experiences. To determine the frequency and interstate variation of health plan exit from Medicaid managed care and evaluate the relationship between health plan exit and market-level quality. Retrospective cohort of all comprehensive Medicaid managed care plans (N = 390) during the interval 2006-2014. Plan exit, defined as the withdrawal of a managed care plan from a state's Medicaid program. Eight measures from the Healthcare Effectiveness Data and Information Set were used to construct 3 composite indicators of quality (preventive care, chronic disease care management, and maternity care). Four measures from the Consumer Assessment of Healthcare Providers and Systems were combined into a composite indicator of patient experience, reflecting the proportion of beneficiaries rating experiences as 8 or above on a 0-to-10-point scale. Outcome data were available for 248 plans (68% of plans operating prior to 2014, representing 78% of beneficiaries). Of the 366 comprehensive Medicaid managed care plans operating prior to 2014, 106 exited Medicaid. These exiting plans enrolled 4 848 310 Medicaid beneficiaries, with a mean of 606 039 beneficiaries affected by plan exits annually. Six states had a mean of greater than 10% of Medicaid managed care recipients enrolled in plans that exited, whereas 10 states experienced no plan exits. Plans that exited from a state's Medicaid market performed significantly worse prior to exiting than those that remained in terms of preventive care (57.5% vs 60.4%; difference, 2.9% [95% CI, 0.3% to 5.5%]), maternity care (69.7% vs 73.6%; difference, 3.8% [95% CI, 1.7% to 6.0%]), and patient experience (73.5% vs 74.8%; difference, 1.3% [95% CI, 0.6% to 1.9%]). There was no significant difference between exiting and nonexiting plans for the quality of chronic disease care management (76.2% vs 77.1%; difference, 1.0% [95% CI, -2.1% to 4.0%]). There was also no significant change in overall market performance before and after the exit of a plan: 0.7-percentage point improvement in preventive care quality (95% CI, -4.9 to 6.3); 0.2-percentage point improvement in chronic disease care management quality (95% CI, -5.8 to 6.2); 0.7-percentage point decrease in maternity care quality (95% CI, -6.4 to 5.0]); and a 0.6-percentage point improvement in patient experience ratings (95% CI, -3.9 to 5.1). Medicaid beneficiaries enrolled in exiting plans had access to coverage for a higher-quality plan, with 78% of plans in the same county having higher quality for preventive care, 71.1% for chronic disease management, 65.5% for maternity care, and 80.8% for patient experience. Between 2006 and 2014, health plan exit from the US Medicaid program was frequent. Plans that exited generally had lower quality ratings than those that remained, and the exits were not associated with significant overall changes in quality or patient experience in the plans in the Medicaid market.
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Hallett, Nutmeg; Huber, Jörg W; Sixsmith, Judith; Dickens, Geoffrey L
2016-12-01
This paper describes an audit of prevention and management of violence and aggression care plans and incident reporting forms which aimed to: (i) report the compliance rate of completion of care plans; (ii) identify the extent to which patients contribute to and agree with their care plan; (iii) describe de-escalation methods documented in care plans; and (iv) ascertain the extent to which the de-escalation methods described in the care plan are recorded as having been attempted in the event of an incident. Care plans and incident report forms were examined for all patients in men's and women's mental health care pathways who were involved in aggressive incidents between May and October 2012. In total, 539 incidents were examined, involving 147 patients and 121 care plans. There was no care plan in place at the time of 151 incidents giving a compliance rate of 72%. It was documented that 40% of patients had contributed to their care plans. Thematic analysis of de-escalation methods documented in the care plans revealed five de-escalation themes: staff interventions, interactions, space/quiet, activities and patient strategies/skills. A sixth category, coercive strategies, was also documented. Evidence of adherence to de-escalation elements of the care plan was documented in 58% of incidents. The reasons for the low compliance rate and very low documentation of patient involvement need further investigation. The inclusion of coercive strategies within de-escalation documentation suggests that some staff fundamentally misunderstand de-escalation. © 2016 Australian College of Mental Health Nurses Inc.
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Advance care planning for nursing home residents with dementia: policy vs. practice.
Ampe, Sophie; Sevenants, Aline; Smets, Tinne; Declercq, Anja; Van Audenhove, Chantal
2016-03-01
The aims of this study were: to evaluate the advance care planning policy for people with dementia in nursing homes; to gain insight in the involvement of residents with dementia and their families in advance care planning, and in the relationship between the policy and the actual practice of advance care planning. Through advance care planning, nursing home residents with dementia are involved in care decisions, anticipating their reduced decision-making capacity. However, advance care planning is rarely realized for this group. Prevalence and outcomes have been researched, but hardly any research has focused on the involvement of residents/families in advance care planning. Observational cross-sectional study in 20 nursing homes. The ACP audit assessed the views of the nursing homes' staff on the advance care planning policy. In addition, individual conversations were analysed with 'ACP criteria' (realization of advance care planning) and the 'OPTION' instrument (involvement of residents/families). June 2013-September 2013. Nursing homes generally met three quarters of the pre-defined criteria for advance care planning policy. In almost half of the conversations, advance care planning was explained and discussed substantively. Generally, healthcare professionals only managed to involve residents/families on a baseline skill level. There were no statistically significant correlations between policy and practice. The evaluations of the policy were promising, but the actual practice needs improvement. Future assessment of both policy and practice is recommended. Further research should focus on communication interventions for implementing advance care planning in the daily practice. © 2015 John Wiley & Sons Ltd.
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An introduction to the Emergency Department Adult Clinical Escalation protocol: ED-ACE.
Coughlan, Eoin; Geary, Una; Wakai, Abel; O'Sullivan, Ronan; Browne, John; McAuliffe, Eilish; Ward, Marie; McDaid, Fiona; Deasy, Conor
2017-09-01
This study demonstrates how a participatory action research approach was used to address the challenge of the early and effective detection of the deteriorating patient in the ED setting. The approach enabled a systematic approach to patient monitoring and escalation of care to be developed to address the wide-ranging spectrum of undifferentiated presentations and the phases of ED care from triage to patient admission. This paper presents a longitudinal patient monitoring system, which aims to provide monitoring and escalation of care, where necessary, of adult patients from triage to admission to hospital in a manner that is feasible in the unique ED environment. An action research approach was taken to designing a longitudinal patient monitoring system appropriate for the ED. While the first draft protocol for post-triage monitoring and escalation was designed by a core research group, six clinical sites were included in iterative cycles of planning, action, reviewing and further planning. Reasons for refining the system at each site were collated and the protocol was adjusted accordingly before commencing the process at the next site. The ED Adult Clinical Escalation longitudinal patient monitoring system (ED-ACE) evolved through iterative cycles of design and testing to include: (1) a monitoring chart for adult patients; (2) a standardised approach to the monitoring and reassessment of patients after triage until they are assessed by a clinician; (3) the ISBAR (I=Identify, S=Situation, B=Background, A=Assessment, R=Recommendation) tool for interprofessional communication relating to clinical escalation; (4) a template for prescribing a patient-specific monitoring plan to be used by treating clinicians to guide patient monitoring from the time the patient is assessed until when they leave the ED and (5) a protocol for clinical escalation prompted by single physiological triggers and clinical concern. This tool offers a link in the 'Chain of Prevention' between the Manchester Triage System and ward-based early warning scores taking account of the importance of standardisation, while being sufficiently adaptable for the unique working environment and patient population in the ED. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
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Ozan, Oguz; Seker, Emre; Kurtulmus-Yilmaz, Sevcan; Ersoy, Ahmet Ersan
2012-10-01
The success of implant-supported restorations depends on the treatment planning and the transfer of planning through the surgical field. Recently, new computer-aided design and manufacturing (CAD/CAM) techniques, such as stereolithographic (SLA) rapid prototyping, have been developed to fabricate surgical guides to improve the precision of implant placement. The objective of the present case is to introduce a recently developed SLA surgical guide system into the rehabilitation of a 62-year-old male patient with mandibular edentulism. After obtaining a cone-beam computerized tomography (CBCT) scan of the mandible with a radiographic template, the images were transferred into a 3-dimensional (3D) image-based software for implant planning. The StentCad Beyond SLA surgical guide system, which is a combination of a currently used surgical template with pilot hollows and a surgical handpiece guidance apparatus, was designed to transfer a preoperatively defined implant position onto the surgical site without any drill-surgical guide contact. For the fabrication of this system, a surgical handpiece was scanned by a laser optical scanner and a mucosa-supported surgical guide was designed according to the patient's 3D model, which was attained from the CBCT images. Four dental implants were inserted through the SLA surgical guide system by a torque-controlled surgical handpiece to the interforaminal region via a flapless surgical procedure. Implants were assessed 3 months after surgery, and an implant-retained mandibular overdenture was fabricated. The present case emphasizes that CAD/CAM SLA surgical guides, along with CBCT images and scanning data, may help clinicians plan and place dental implants.
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Advance care planning in a community setting.
Connolly, Josaleen; Milligan, Stuart; Stevens, Elaine; Jackson, Susan; Rooney, Kevin
2015-02-10
To evaluate the effects of implementing an advance care planning process within pilot sites in North Ayrshire in 2010, focusing on people with palliative care needs. Data were collected from participants in advance care planning training using a questionnaire. Semi-structured interviews were conducted and an audit of documentation was undertaken. Thirty nine questionnaires were returned, a response rate of 16%. Twenty four out of 25 (96%) participants rated the training as having improved their understanding of the advance care planning process. The general consensus in interviews was that advance care planning is a worthwhile process. Participants reported patients achieving their preferred place of end of life care and greater consultation regarding hospitalisation. Within the pilot sites, advance care planning training enhanced the ability of professionals to implement the advance care planning process and record the wishes of patients and residents.
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Nacul, L C; Stewart, A; Alberg, C; Chowdhury, S; Darlison, M W; Grollman, C; Hall, A; Modell, B; Moorthie, S; Sagoo, G S; Burton, H
2014-06-01
In 2010 the World Health Assembly called for action to improve the care and prevention of congenital disorders, noting that technical guidance would be required for this task, especially in low- and middle-income countries. Responding to this call, we have developed a freely available web-accessible Toolkit for assessing health needs for congenital disorders. Materials for the Toolkit website (http://toolkit.phgfoundation.org) were prepared by an iterative process of writing, discussion and modification by the project team, with advice from external experts. A customized database was developed using epidemiological, demographic, socio-economic and health-services data from a range of validated sources. Document-processing and data integration software combines data from the database with a template to generate topic- and country-specific Calculator documents for quantitative analysis. The Toolkit guides users through selection of topics (including both clinical conditions and relevant health services), assembly and evaluation of qualitative and quantitative information, assessment of the potential effects of selected interventions, and planning and prioritization of actions to reduce the risk or prevalence of congenital disorders. The Toolkit enables users without epidemiological or public health expertise to undertake health needs assessment as a prerequisite for strategic planning in relation to congenital disorders in their country or region. © The Author 2013. Published by Oxford University Press on behalf of Faculty of Public Health.
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MO-F-211-01: Methods for Completing Practice Quality Improvement (PQI).
Johnson, J; Brown, K; Ibbott, G; Pawlicki, T
2012-06-01
Practice Quality Improvement (PQI) is becoming an expected part of routine practice in healthcare as an approach to provide more efficient, effective and high quality care. Additionally, as part of the ABR's Maintenance of Certification (MOC) pathway, medical physicists are now expected to complete a PQI project. This session will describe the history behind and benefits of the ABR's MOC program, provide details of quality improvement methods and how to successfully complete a PQI project. PQI methods include various commonly used engineering and management tools. The Plan-Do-Study-Act (PDSA) cycle will be presented as one project planning and implementation tool. Other PQI analysis instruments such as flowcharts, Pareto charts, process control charts and fishbone diagrams will also be explained with examples. Cause analysis, solution development and implementation, and post-implementation measurement will be presented. Project identification and definition as well as appropriate measurement tool selection will be offered. Methods to choose key quality metrics (key quality indicators) will also be addressed. Several sample PQI projects and templates available through the AAPM and other organizations will be described. At least three examples of completed PQI projects will be shared. 1. Identify and define a PQI project 2. Identify and select measurement methods/techniques for use with the PQI project 3. Describe example(s) of completed projects. © 2012 American Association of Physicists in Medicine.
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Data Quality in Rare Diseases Registries.
Kodra, Yllka; Posada de la Paz, Manuel; Coi, Alessio; Santoro, Michele; Bianchi, Fabrizio; Ahmed, Faisal; Rubinstein, Yaffa R; Weinbach, Jérôme; Taruscio, Domenica
2017-01-01
In the field of rare diseases, registries are considered power tool to develop clinical research, to facilitate the planning of appropriate clinical trials, to improve patient care and healthcare planning. Therefore high quality data of rare diseases registries is considered to be one of the most important element in the establishment and maintenance of a registry. Data quality can be defined as the totality of features and characteristics of data set that bear on its ability to satisfy the needs that result from the intended use of the data. In the context of registries, the 'product' is data, and quality refers to data quality, meaning that the data coming into the registry have been validated, and ready for use for analysis and research. Determining the quality of data is possible through data assessment against a number of dimensions: completeness, validity; coherence and comparability; accessibility; usefulness; timeliness; prevention of duplicate records. Many others factors may influence the quality of a registry: development of standardized Case Report Form and security/safety controls of informatics infrastructure. With the growing number of rare diseases registries being established, there is a need to develop a quality validation process to evaluate the quality of each registry. A clear description of the registry is the first step when assessing data quality or the registry evaluation system. Here we report a template as a guide for helping registry owners to describe their registry.
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Tannenbaum, Cara
2018-01-01
Context: Interprofessional communication is an effective mechanism for reducing inappropriate prescriptions among older adults. Physicians’ views about which elements are essential for pharmacists to include in an evidence-based pharmaceutical opinion for deprescribing remain unknown. Objective: To develop a prototype for an evidence-based pharmaceutical opinion that promotes physician-pharmacist communication around deprescribing. Methods: A standardized template for an evidence-based pharmaceutical opinion was developed with input from a convenience sample of 32 primary care physicians and 61 primary care pharmacists, recruited from conferences and community settings in Montreal, Canada. Participants were asked to comment on the need for clarifying treatment goals, including personalized patient data and biomarkers, highlighting evidence about drug harms, listing the credibility and source of the recommendations, providing therapeutic alternatives and formalizing official documentation of decision making. The content and format of the prototype underwent revision by community physicians and pharmacists until consensus was reached on a final recommended template. Results: The majority of physicians (84%-97%) requested that the source of the deprescribing recommendations be cited, that alternative management options be provided and that the information be tailored to the patient. Sixteen percent of physicians expressed concern about the information in the opinions being too dense. Pharmacists also questioned the length of the opinion and asked that additional space be provided for the physician’s response. A statement was added making the opinion a valid prescription upon receipt of a signature from physicians. Compared to a nonstandardized opinion, the majority of pharmacists believed the template was easier to use, more evidence based, more time efficient and more likely to lead to deprescribing. Conclusion: Physicians and pharmacists endorsed a standardized template that promotes interprofessional communication for deprescribing (available at https://www.deprescribingnetwork.ca/pharmaceutical-opinions). The outcome of the D-Prescribe trial will determine the effectiveness of these evidence-based pharmaceutical opinions on deprescribing processes and outcomes. Can Pharm J (Ott) 2018;151:xx-xx. PMID:29531631
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Szarka, Jackie; McFarland, Lynne V.; Taylor, Janelle S.; Sudore, Rebecca L.; Trivedi, Ranak; Reinke, Lynn F.; Vig, Elizabeth K.
2016-01-01
Background and objectives There is growing interest in efforts to enhance advance care planning for patients with kidney disease. Our goal was to elicit the perspectives on advance care planning of multidisciplinary providers who care for patients with advanced kidney disease. Design, setting, participants, & measurements Between April and December of 2014, we conducted semistructured interviews at the Department of Veterans Affairs Puget Sound Health Care System with 26 providers from a range of disciplines and specialties who care for patients with advanced kidney disease. Participants were asked about their perspectives and experiences related to advance care planning in this population. Interviews were audiotaped, transcribed, and analyzed inductively using grounded theory. Results The comments of providers interviewed for this study spoke to significant system–level barriers to supporting the process of advance care planning for patients with advanced kidney disease. We identified four overlapping themes: (1) medical care for this population is complex and fragmented across settings and providers and over time; (2) lack of a shared understanding and vision of advance care planning and its relationship with other aspects of care, such as dialysis decision making; (3) unclear locus of responsibility and authority for advance care planning; and (4) lack of active collaboration and communication around advance care planning among different providers caring for the same patients. Conclusions The comments of providers who care for patients with advanced kidney disease spotlight both the need for and the challenges to interdisciplinary collaboration around advance care planning for this population. Systematic efforts at a variety of organizational levels will likely be needed to support teamwork around advance care planning among the different providers who care for patients with advanced kidney disease. PMID:27084877
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O'Hare, Ann M; Szarka, Jackie; McFarland, Lynne V; Taylor, Janelle S; Sudore, Rebecca L; Trivedi, Ranak; Reinke, Lynn F; Vig, Elizabeth K
2016-05-06
There is growing interest in efforts to enhance advance care planning for patients with kidney disease. Our goal was to elicit the perspectives on advance care planning of multidisciplinary providers who care for patients with advanced kidney disease. Between April and December of 2014, we conducted semistructured interviews at the Department of Veterans Affairs Puget Sound Health Care System with 26 providers from a range of disciplines and specialties who care for patients with advanced kidney disease. Participants were asked about their perspectives and experiences related to advance care planning in this population. Interviews were audiotaped, transcribed, and analyzed inductively using grounded theory. The comments of providers interviewed for this study spoke to significant system-level barriers to supporting the process of advance care planning for patients with advanced kidney disease. We identified four overlapping themes: (1) medical care for this population is complex and fragmented across settings and providers and over time; (2) lack of a shared understanding and vision of advance care planning and its relationship with other aspects of care, such as dialysis decision making; (3) unclear locus of responsibility and authority for advance care planning; and (4) lack of active collaboration and communication around advance care planning among different providers caring for the same patients. The comments of providers who care for patients with advanced kidney disease spotlight both the need for and the challenges to interdisciplinary collaboration around advance care planning for this population. Systematic efforts at a variety of organizational levels will likely be needed to support teamwork around advance care planning among the different providers who care for patients with advanced kidney disease. Copyright © 2016 by the American Society of Nephrology.
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Provider Tools for Advance Care Planning and Goals of Care Discussions: A Systematic Review.
Myers, Jeff; Cosby, Roxanne; Gzik, Danusia; Harle, Ingrid; Harrold, Deb; Incardona, Nadia; Walton, Tara
2018-01-01
Advance care planning and goals of care discussions involve the exploration of what is most important to a person, including their values and beliefs in preparation for health-care decision-making. Advance care planning conversations focus on planning for future health care, ensuring that an incapable person's wishes are known and can guide the person's substitute decision maker for future decision-making. Goals of care discussions focus on preparing for current decision-making by ensuring the person's goals guide this process. To provide evidence regarding tools and/or practices available for use by health-care providers to effectively facilitate advance care planning conversations and/or goals of care discussions. A systematic review was conducted focusing on guidelines, randomized trials, comparative studies, and noncomparative studies. Databases searched included MEDLINE, EMBASE, and the proceedings of the International Advance Care Planning Conference and the American Society of Clinical Oncology Palliative Care Symposium. Although several studies report positive findings, there is a lack of consistent patient outcome evidence to support any one clinical tool for use in advance care planning or goals of care discussions. Effective advance care planning conversations at both the population and the individual level require provider education and communication skill development, standardized and accessible documentation, quality improvement initiatives, and system-wide coordination to impact the population level. There is a need for research focused on goals of care discussions, to clarify the purpose and expected outcomes of these discussions, and to clearly differentiate goals of care from advance care planning.
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Wang, Chenglong; Chen, Ying; You, Yuanrong; Wang, Meng; Lv, Changsheng; Gui, Lai
2016-10-01
Mandibular distraction osteogenesis has become one of the most powerful reconstructive techniques for the treatment of mandibular deformities in young children. Damage to the tooth buds is often cited as a complication of it. The purpose of this study was to precisely design the osteotomy line and avoid the damage of tooth buds at the mandibular angle area with the help of surgical template. Six patients aged from 6 to 10 years were selected in this study. Three-dimensional computed tomography data was put into Mimics software for preoperative planning the osteotomy line and the accurate placement of the distractor based on the exact position of tooth follicle. And then the surgical template was manufactured by a three-dimensional printer with rapid prototyping technique. The surgeons were guided to perform the osteotomy aided with the prefabricated template through an intraoral approach. Distraction began 7 days postoperation with a rate of 1 mm/d and the distractor was removed after a 6 to 8 months consolidation period. The tooth buds were observed through radiographs that were performed at 5 time intervals: before distraction, at the end of latency, at the end of distraction, at the end of consolidation and 2 years of the postoperation to remove the distractor. The average follow-up time is 24 months. Facial appearance and occlusal plane of all the young patients were greatly improved without complications. From the radiological observation, the tooth buds was intact after the surgery and the second molar normally erupted after removing the distractor. The surgical template was considered to be helpful in improving the surgical accuracy and avoiding the tooth buds damage during mandibular distraction osteogenesis.
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NASA Astrophysics Data System (ADS)
Zeimer, Ute; Jeschke, Joerg; Mogilatenko, Anna; Knauer, Arne; Kueller, Viola; Hoffmann, Veit; Kuhn, Christian; Simoneit, Tino; Martens, Martin; Wernicke, Tim; Kneissl, Michael; Weyers, Markus
2015-11-01
The effects of the template on the optical and structural properties of Al0.75Ga0.25N/Al0.8Ga0.2N multiple quantum well (MQWs) laser active regions have been investigated. The laser structures for optical pumping were grown on planar c-plane AlN/sapphire as well as on thick epitaxially laterally overgrown (ELO) AlN layers on patterned AlN/sapphire. Two ELO AlN/sapphire templates were investigated, one with a miscut of the sapphire surface to the m-direction with an angle of 0.25°, the other with a miscut angle of 0.25° to the sapphire a-direction. The MQWs are studied by atomic force microscopy, plan-view cathodoluminescence (CL) at room temperature and 83 K as well as transmission electron microscopy using high-angle annular dark-field imaging and energy-dispersive x-ray spectroscopy. The results are compared to optical pumping measurements. It was found that the surface morphology of the templates determines the lateral wavelength distribution in the MQWs observed by spectral CL mappings. The lateral wavelength spread is largest for the laser structures grown on ELO AlN with miscut to sapphire a-direction caused by the local variation of the MQW thicknesses and the Ga incorporation at macrosteps on the ELO-AlN. A CL peak wavelength spread of up to 7 nm has been found. The MQWs grown on planar AlN/sapphire templates show a homogeneous wavelength distribution. However, due to the high threading dislocation density and the resulting strong nonradiative recombination, laser operation could not be achieved. The laser structures grown on ELO AlN/sapphire show optically pumped lasing with a record short wavelength of 237 nm.
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Wang, You-Yuan; Fan, Song; Zhang, Han-Qing; Lin, Zhao-Yu; Ye, Jian-Tao; Li, Jin-Song
2016-06-01
Reconstruction of maxillary and midfacial defects due to tumor ablation is challenging to conventional operation. The purposes of this study are to evaluate the precise 3-dimensional position of the fibular flap in reconstruction of maxillary defects assisted by virtual surgical planning and to assess the postoperative outcomes compared with conventional surgery. We retrospectively reviewed 18 consecutive patients who underwent maxillary reconstruction with a vascularized fibular flap assisted by virtual surgical planning after maxillary or midfacial tumor ablation. Conventional surgery was performed in another 15 patients. Proplan CMF surgical planning (Materialise, Leuven, Belgium) was performed preoperatively in the virtual planning group. Fibular flaps were harvested and underwent osteotomy assisted by prefabricated cutting guides, and the maxilla and midface were resected and reconstructed assisted by the prefabricated cutting guides and templates in the virtual planning group. The operative time and fibular flap positions were evaluated in the 2 groups. Postoperative fibular positions of the maxillary reconstruction were compared with virtual plans in the virtual planning group. The postoperative facial appearance and occlusal function were assessed. The operations were performed successfully without complications. The ischemia time and total operative time were shorter in the virtual planning group than those in the conventional surgery group (P < .05). High precision of the cutting guides and templates was found on both the fibula and maxilla in the virtual planning group. The positions of the fibular flaps, including the vertical and horizontal positions, were more accurate in the virtual planning group than those in the conventional surgery group (P < .05). Bone-to-bone contact between the maxilla and fibular segments was more precise in the virtual planning group (P < .05). Postoperative computed tomography scans showed excellent contour of the fibular flap segments in accordance with the virtual plans in the virtual planning group. All patients were alive with no evidence of disease. Functional mandibular range of motion, good occlusion, and an ideal facial appearance were observed in the virtual planning group. Virtual surgical planning appears to achieve precise maxillary reconstruction with a vascularized fibular flap after tumor ablation, as well as an ideal facial appearance and function after dental rehabilitation. The use of prefabricated cutting guides and plates eases fibular flap molding and placement, minimizes operating time, and improves clinical outcomes. Copyright © 2016 The American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.
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General method for the synthesis of hierarchical nanocrystal-based mesoporous materials.
Rauda, Iris E; Buonsanti, Raffaella; Saldarriaga-Lopez, Laura C; Benjauthrit, Kanokraj; Schelhas, Laura T; Stefik, Morgan; Augustyn, Veronica; Ko, Jesse; Dunn, Bruce; Wiesner, Ulrich; Milliron, Delia J; Tolbert, Sarah H
2012-07-24
Block copolymer templating of inorganic materials is a robust method for the production of nanoporous materials. The method is limited, however, by the fact that the molecular inorganic precursors commonly used generally form amorphous porous materials that often cannot be crystallized with retention of porosity. To overcome this issue, here we present a general method for the production of templated mesoporous materials from preformed nanocrystal building blocks. The work takes advantage of recent synthetic advances that allow organic ligands to be stripped off of the surface of nanocrystals to produce soluble, charge-stabilized colloids. Nanocrystals then undergo evaporation-induced co-assembly with amphiphilic diblock copolymers to form a nanostructured inorganic/organic composite. Thermal degradation of the polymer template results in nanocrystal-based mesoporous materials. Here, we show that this method can be applied to nanocrystals with a broad range of compositions and sizes, and that assembly of nanocrystals can be carried out using a broad family of polymer templates. The resultant materials show disordered but homogeneous mesoporosity that can be tuned through the choice of template. The materials also show significant microporosity, formed by the agglomerated nanocrystals, and this porosity can be tuned by the nanocrystal size. We demonstrate through careful selection of the synthetic components that specifically designed nanostructured materials can be constructed. Because of the combination of open and interconnected porosity, high surface area, and compositional tunability, these materials are likely to find uses in a broad range of applications. For example, enhanced charge storage kinetics in nanoporous Mn(3)O(4) is demonstrated here.
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Connection, regulation, and care plan innovation: a case study of four nursing homes.
Colón-Emeric, Cathleen S; Lekan-Rutledge, Deborah; Utley-Smith, Queen; Ammarell, Natalie; Bailey, Donald; Piven, Mary L; Corazzini, Kirsten; Anderson, Ruth A
2006-01-01
We describe how connections among nursing home staff impact the care planning process using a complexity science framework. We completed six-month case studies of four nursing homes. Field observations (n = 274), shadowing encounters (n = 69), and in-depth interviews (n = 122) of 390 staff at all levels were conducted. Qualitative analysis produced a conceptual/thematic description and complexity science concepts were used to produce conceptual insights. We observed that greater levels of staff connection were associated with higher care plan specificity and innovation. Connection of the frontline nursing staff was crucial for (1) implementation of the formal care plan and (2) spontaneous informal care planning responsive to changing resident needs. Although regulations could theoretically improve cognitive diversity and information flow in care planning, we observed instances of regulatory oversight resulting in less specific care plans and abandonment of an effective care planning process. Interventions which improve staff connectedness may improve resident outcomes.
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Leveraging standards to support patient-centric interdisciplinary plans of care.
Dykes, Patricia C; DaDamio, Rebecca R; Goldsmith, Denise; Kim, Hyeon-eui; Ohashi, Kumiko; Saba, Virginia K
2011-01-01
As health care systems and providers move towards meaningful use of electronic health records, the once distant vision of collaborative patient-centric, interdisciplinary plans of care, generated and updated across organizations and levels of care, may soon become a reality. Effective care planning is included in the proposed Stages 2-3 Meaningful Use quality measures. To facilitate interoperability, standardization of plan of care messaging, content, information and terminology models are needed. This degree of standardization requires local and national coordination. The purpose of this paper is to review some existing standards that may be leveraged to support development of interdisciplinary patient-centric plans of care. Standards are then applied to a use case to demonstrate one method for achieving patient-centric and interoperable interdisciplinary plan of care documentation. Our pilot work suggests that existing standards provide a foundation for adoption and implementation of patient-centric plans of care that are consistent with federal requirements.
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Planning and Decision Making for Care Transitions
Sörensen, Silvia; Mak, Wingyun; Pinquart, Martin
2015-01-01
The need to plan for future health care and residential adjustments increases with age, growing frailty, and restrictions in coverage of long-term care and will continue to grow with population aging. Older adults’ lack of financial preparation for health care costs, insufficient knowledge about available options, and inadequate communication about care-related values has become an increasing public health challenge. This chapter describes a model of Preparation for Future Care (PFC), which encompasses different levels and domains of planning. Research about the extent to which planning is helpful in navigating care transitions is reviewed, and barriers and facilitators of planning including individual, familial, cultural, and national long-term care policy factors are discussed. Planning in the context of dementia and practical approaches that can be taken to enhance PFC is addressed, as well as recommendations for future research in the area of planning and decision making in the context of care transitions. PMID:26207079
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Sugar, E Neubauer; Buzurovic, I; O’Farrell, D
2015-06-15
Purpose: To compare the dosimetry of a standard rectilinear and an adaptive technique used in I125 prostate seed implants. Methods: To achieve favorable dosimetry in prostate implants we used adaptive needle updates to match actual positions in real-time. The seed locations were optimized based on actual needle locations. The seeds were delivered automatically with a robotic device seedSelectron™ (Elekta Brachytherapy). In this study, we evaluated the former approach against the standard rectilinear technique in which the needles have a parallel distribution. The treatment plans for 10 patients were analyzed. For comparison, the actual treatment plans were revised so each needlemore » was repositioned to its original parallel location through the template. The analysis was performed by comparing the target coverage and dose to the organs at risk. The comparison was done using the following planning goals: the target D90> 90%, V100% > 90%, V50% <70% and V200% <30%; the urethra V125% < 1cm3 and V150%= 0cm3; and the Rectum V100%<1cm3 and V69% < 8cm3. The prescription dose to the target was 145Gy. Results: The average target volume and number of seeds were 44.39cm3(SD=11.14) and 74(SD=12), respectively. The D90 for adaptive and rectilinear plans was 159.9Gy(SD=2.99) and 155.53Gy(SD=4.04) resulting in a 2.74% difference for the average target coverage. A similar difference (1.75%) was noticed in the target V100[%]. No significant difference was noticed in the dose to the urethra and rectum. All planning goals were met with both the adaptive and rectilinear approach for each plan. Conclusion: The study reveals enhanced coverage of the target when using the adaptive needle adjustments as compared to the rectilinear approach for the analyzed cases. However, the differences in dosimetry did not translate to meaningful clinical outcomes.« less
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Nishiyama, Chika; Brown, Siobhan P; May, Susanne J; Iwami, Taku; Koster, Rudolph W.; Beesems, Stefanie G.; Kuisma, Markku; Salo, Ari; Jacobs, Ian; Finn, Judith; Sterz, Fritz; Nürnberger, Alexander; Smith, Karen; Morrison, Laurie; Olasveengen, Theresa M.; Callaway, Clifton W.; Shin, Sang Do; Gräsner, Jan-Thorsten; Daya, Mohamud; Ma, Matthew Huei-Ming; Herlitz, Johan; Strömsöe, Anneli; Aufderheide, Tom P.; Masterson, Siobhán; Wang, Henry; Christenson, Jim; Stiell, Ian; Davis, Dan; Huszti, Ella; Nichol, Graham
2014-01-01
Objectives Survival after out-of-hospital cardiac arrest (OHCA) varies between communities, due in part to variation in the methods of measurement. The Utstein template was disseminated to standardize comparisons of risk factors, quality of care and outcomes in patients with OHCA. We sought to assess whether OHCA registries are able to collate common data using the Utstein template. A subsequent study will assess whether the Utstein factors explain differences in survival between emergency medical services (EMS) systems. Study design Retrospective study. Setting This retrospective analysis of prospective cohorts included adults treated for OHCA, regardless of the etiology of arrest. Data describing the baseline characteristics of patients, and the process and outcome of their care were grouped by EMS system, de-identified then collated. Included were core Utstein variables and timed event data from each participating registry. This study was classified as exempt from human subjects’ research by a research ethics committee. Measurements and Main Results Twelve registries with 265 first-responding EMS agencies in 14 countries contributed data describing 125,840 cases of OHCA. Variation in inclusion criteria, definition, coding, and process of care variables were observed. Contributing registries collected 61.9% of recommended core variables and 42.9% of timed event variables. Among core variables, the proportion of missingness was mean 1.9 ± 2.2%. The proportion of unknown was mean 4.8 ± 6.4%. Among time variables, missingness was mean 9.0 ± 6.3%. Conclusions International differences in measurement of care after OHCA persist. Greater consistency would facilitate improved resuscitation care and comparison within and between communities. PMID:25010784
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Leadership for ethical policy and practice (LEPP): participatory action project.
Storch, Janet; Rodney, Patricia; Varcoe, Colleen; Pauly, Bernadette; Starzomski, Rosalie; Stevenson, Lynne; Best, Lynette; Mass, Heather; Fulton, Thomas Reilly; Mildon, Barbara; Bees, Fiona; Chisholm, Anne; MacDonald-Rencz, Sandra; McCutcheon, Amy Sanchez; Shamian, Judith; Thompson, Charlotte; Makaroff, Kara Schick; Newton, Lorelei
2009-01-01
Within Canada's fast-paced, ever-changing healthcare environment, providers are experiencing difficulty practising according to their professional ethical standards, leading many to experience moral or ethical distress. Limited attention has been paid to improvements in the ethical climate in healthcare settings in research focusing on nurses' workplaces. In this three-year study, we focused on how the ethical climate in healthcare delivery can be improved and how the use of participatory action research methods can lead to continued enhancements and lasting changes in services delivery. Together, we developed strategies for taking action, aimed at improving the quality of the work environment. This action involved both nurses in direct care and those in key leadership positions (CNOs or their equivalents). Through the active participation of those for whom the research-based change was intended, these strategies were tested in various sites across British Columbia and can be used as templates or designs for use in other settings. A key component of the success of the projects and action plans that were created was the integral involvement of nurse leaders through all phases.
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Multi-Objective Online Initialization of Spacecraft Formations
NASA Technical Reports Server (NTRS)
Jeffrey, Matthew; Breger, Louis; How, Jonathan P.
2007-01-01
This paper extends a previously developed method for finding spacecraft initial conditions (ICs) that minimize the drift resulting from J2 disturbances while also minimizing the fuel required to attain those ICs. It generalizes the single spacecraft optimization to a formation-wide optimization valid for an arbitrary number of vehicles. Additionally, the desired locations of the spacecraft, separate from the starting location, can be specified, either with respect to a reference orbit, or relative to the other spacecraft in the formation. The three objectives (minimize drift, minimize fuel, and maintain a geometric template) are expressed as competing costs in a linear optimization, and are traded against one another through the use of scalar weights. By carefully selecting these weights and re-initializing the formation at regular intervals, a closed-loop, formation-wide control system is created. This control system can be used to reconfigure the formations on the fly, and creates fuel-efficient plans by placing the spacecraft in semi-invariant orbits. The overall approach is demonstrated through nonlinear simulations for two formations a GEO orbit, and an elliptical orbit.
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NASA Astrophysics Data System (ADS)
Zahra, Noor e.; Sevindir, Hulya Kodal; Aslan, Zafer; Siddiqi, A. H.
2012-07-01
The aim of this study is to provide emerging applications of wavelet methods to medical signals and images, such as electrocardiogram, electroencephalogram, functional magnetic resonance imaging, computer tomography, X-ray and mammography. Interpretation of these signals and images are quite important. Nowadays wavelet methods have a significant impact on the science of medical imaging and the diagnosis of disease and screening protocols. Based on our initial investigations, future directions include neurosurgical planning and improved assessment of risk for individual patients, improved assessment and strategies for the treatment of chronic pain, improved seizure localization, and improved understanding of the physiology of neurological disorders. We look ahead to these and other emerging applications as the benefits of this technology become incorporated into current and future patient care. In this chapter by applying Fourier transform and wavelet transform, analysis and denoising of one of the important biomedical signals like EEG is carried out. The presence of rhythm, template matching, and correlation is discussed by various method. Energy of EEG signal is used to detect seizure in an epileptic patient. We have also performed denoising of EEG signals by SWT.
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Capacity planning for the future.
Johnson, A M
1997-01-01
Managed care is changing the way health care organizations plan for their futures. Traditional planning takes into account history and geography, while the new approach factors in the impact of managed care of future utilization. The new approach also incorporates strategic planning into an organization's broader strategic plan and budgeting process. The result is a more comprehensive planning method that is critical for health care organization's success.
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Developing nursing care plans.
Ballantyne, Helen
2016-02-24
This article aims to enhance nurses' understanding of nursing care plans, reflecting on the past, present and future use of care planning. This involves consideration of the central theories of nursing and discussion of nursing models and the nursing process. An explanation is provided of how theories of nursing may be applied to care planning, in combination with clinical assessment tools, to ensure that care plans are context specific and patient centred.
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Lotz, Julia Desiree; Daxer, Marion; Jox, Ralf J; Borasio, Gian Domenico; Führer, Monika
2017-09-01
Pediatric advance care planning is advocated by healthcare providers because it may increase the chance that patient and/or parent wishes are respected and thus improve end-of-life care. However, since end-of-life decisions for children are particularly difficult and charged with emotions, physicians are often afraid of addressing pediatric advance care planning. We aimed to investigate parents' views and needs regarding pediatric advance care planning. We performed a qualitative interview study with parents of children who had died from a severe illness. The interviews were analyzed by descriptive and evaluation coding according to Saldaña. We conducted semi-structured interviews with 11 parents of 9 children. Maximum variation was sought regarding the child's illness, age at death, care setting, and parent gender. Parents find it difficult to engage in pediatric advance care planning but consider it important. They argue for a sensitive, individualized, and gradual approach. Hope and quality of life issues are primary. Parents have many non-medical concerns that they want to discuss. Written advance directives are considered less important, but medical emergency plans are viewed as necessary in particular cases. Continuity of care and information should be improved through regular pediatric advance care planning meetings with the various care providers. Parents emphasize the importance of a continuous contact person to facilitate pediatric advance care planning. Despite a need for pediatric advance care planning, it is perceived as challenging. Needs-adjusted content and process and continuity of communication should be a main focus in pediatric advance care planning. Future research should focus on strategies that facilitate parent engagement in pediatric advance care planning to increase the benefit for the families.
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Hutchison, Lauren A; Raffin-Bouchal, Donna S; Syme, Charlotte A; Biondo, Patricia D; Simon, Jessica E
2017-09-01
Objectives Advance care planning is the process by which people reflect upon their wishes and values for healthcare, discuss their choices with family and friends and document their wishes. Readiness represents a key predictor of advance care planning participation; however, the evidence for addressing readiness is scarce within the renal failure context. Our objectives were to assess readiness for advance care planning and barriers and facilitators to advance care planning uptake in a renal context. Methods Twenty-five participants (nine patients, nine clinicians and seven family members) were recruited from the Southern Alberta Renal Program. Semi-structured interviews were recorded, transcribed and then analyzed using interpretive description. Results Readiness for advance care planning was driven by individual values perceived by a collaborative encounter between clinicians and patients/families. If advance care planning is not valued, then patients/families and clinicians are not ready to initiate the process. Patients and clinicians are delaying conversations until "illness burden necessitates," so there is little "advance" care planning, only care planning in-the-moment closer to the end of life. Discussion The value of advance care planning in collaboration with clinicians, patients and their surrogates needs reframing as an ongoing process early in the patient's illness trajectory, distinguished from end-of-life decision making.
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Employer health care plan design and its effect on plan costs.
Custer, W S
1991-01-01
This study uses claims data from employers in the Houston Area Health Care Coalition (HAHCC) for 1985 through the first half of 1987 to examine the effect of health care plan attributes on health care costs. Plan attributes affect the site of care and the costs of care. Utilization review clearly was effective in reducing the demand for inpatient services, but that reduction was in large measure matched by increases in care in the outpatient setting. Restrictions on mental health benefits also shifted the site of care. In contrast, neither premium sharing nor the plan's deductible had a significant impact on total plan charges. The study results demonstrate the need to have a comprehensive cost management strategy.
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Malhotra, Chetna; Sim, David Kheng Leng; Jaufeerally, Fazlur; Vikas, Nivedita Nadkarni; Sim, Genevieve Wong Cheng; Tan, Boon Cheng; Ng, Clarice Shu Hwa; Tho, Pei Leng; Lim, Jingfen; Chuang, Claire Ya-Ting; Fong, Florence Hui Mei; Liu, Joy; Finkelstein, Eric A
2016-06-10
Despite the promise and popularity of advance care planning, there is insufficient evidence that advance care planning helps patients to meet their end-of-life care preferences, especially in Asian settings. Thus, the proposed study aims to assess whether patients with advanced heart failure who are receiving advance care planning have a greater likelihood of receiving end-of-life care consistent with their preferences compared to patients receiving usual care. Secondary objectives are to compare differences in health care expenditures, quality of life, anxiety and depression, understanding of own illness, participation in decision-making and concordance with their caregiver's preferences for end-of-life care, between patients with advanced heart failure receiving advance care planning and usual care. This is a two-arm randomized controlled trial of advance care planning versus usual care (control) conducted at two institutions in Singapore. Two hundred and eighty-two patients with advanced heart failure (n = 94 in the advance care planning arm; n = 188 in the control arm receiving usual care) will be recruited from these centers and followed for 1 year or until they die, whichever is earlier. Additionally, the study will include up to one caregiver per patient enrolled. If advance care planning is proven to be effective, the results will help to promote its uptake among health care providers and patients both within Singapore and in other countries. NCT02299180 . Registered on 18 November 2014.
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Drummond, C; Simpson, A
2017-08-01
WHAT IS KNOWN ON THE SUBJECT?: A written plan is designed to improve communication and co-ordinate care between mental health inpatient wards and community settings. Reports of care plan quality issues and staff and service user dissatisfaction with healthcare bureaucracy have focused on working age mental health or general hospital settings. Little is known about mental health staff perspectives on the value of written care plans in supporting dementia care. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Competing demands on staff time and resources to meet administrative standards for care plans caused a tension with their own professional priorities for supporting care. Mental health staff face difficulties using electronic records alongside other systems of information sharing. Further exploration is needed of the gap between frontline staff values and those of the local organization and managers when supporting good dementia care. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Frontline staff should be involved in designing new information systems including care plans. Care plan documentation needs to be refocused to ensure it is effective in enabling staff to communicate amongst themselves and with others to support people with dementia. Practice-based mentors could be deployed to strengthen good practice in effective information sharing. Background Reports of increased healthcare bureaucracy and concerns over care plan quality have emerged from research and surveys into staff and service user experiences. Little is known of mental health staff perspectives on the value of written care plans in supporting dementia care. Aim To investigate the experiences and views of staff in relation to care planning in dementia services in one National Health Service (NHS) provider Trust in England. Method Grounded Theory methodology was used. A purposive sample of 11 multidisciplinary staff were interviewed across three sites in one NHS Trust. Interviews were transcribed, coded and analysed using the constant comparative method. Findings Five themes were identified and are explored in detail below: (1) Repetition; (2) the impact of electronic records on practice; (3) ambivalence about the value of paperwork; (4) time conflicts; and (5) alternative sources of information to plan care. Discussion Participants perceived that written care plans did not help staff with good practice in planning care or to support dementia care generally. Staff were frustrated by repetitive documentation, inflexible electronic records and conflicting demands on their time. Implications for practice Frontline staff should be involved in designing new information systems including care plans. © 2017 John Wiley & Sons Ltd.
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Palmquist, Moa; Brynhildsen, Jan; Falk, Gabriella
2015-06-01
OBJECTIVE To compare contraceptive services provided by family planning clinics in Linköping and Norrköping in Östergötland County, Sweden. The two cities are of similar size but have different socio-demographic profiles. The abortion rate in Linköping (15.3 per 1000) is substantially lower than in Norrköping (21.1 per 1000). METHODS The study was performed in two steps. First, the clinics providing contraceptive services in the two cities were studied using ten pre-defined quality indicators. Thereafter, 11 healthcare providers were interviewed: six in Linköping and five in Norrköping. The interviews were analysed using qualitative content analysis. RESULTS No differences were found in the organisation of contraceptive care in the two cities. Neither city met the criteria for five of the ten quality indicators. The analysis of the interviews generated four themes: 'Guidelines and electronic record template', 'Criteria for good contraceptive counselling', 'Availability of contraception', and 'Sexual health'. The interviews revealed that the clinical leadership in Norrköping was insufficient. CONCLUSION Clinics in the two cities are organised in the same way so that differences in abortion rates cannot be related to differences in organisation. The reasons for the differences in abortion rates in the two cities have yet to be determined.
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Results from a national survey on chronic care management by health plans.
Mattke, Soeren; Higgins, Aparna; Brook, Robert
2015-05-01
The growing burden of chronic disease necessitates innovative approaches to help patients and to ensure the sustainability of our healthcare system. Health plans have introduced chronic care management models, but systematic data on the type and prevalence of different approaches are lacking. Our goal was to conduct a systematic examination of chronic care management programs offered by health plans in the commercial market (ie, in products sold to employers and individuals. We undertook a national survey of a representative sample of health plans (70 plans, 36% response rate) and 6 case studies on health plans' programs to improve chronic care in the commercial market. The data underwent descriptive and bivariate analyses. All plans, regardless of size, location, and ownership, offer chronic care management programs, which identify eligible members from claims data and match them to interventions based on overall risk and specific care gaps. Plans then report information on care gaps to providers and offer self-management support to their members. While internal evaluations suggest that the interventions improve care and reduce cost, plans report difficulties in engaging members and providers. To overcome those obstacles, plans are integrating their programs into provider work flow, collaborating with providers on care redesign and leveraging patient support technologies. Our study shows that chronic care management programs have become a standard component of the overall approach used by health plans to manage the health of their members.
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The development and validation of the advance care planning questionnaire in Malaysia.
Lai, Pauline Siew Mei; Mohd Mudri, Salinah; Chinna, Karuthan; Othman, Sajaratulnisah
2016-10-18
Advance care planning is a voluntary process whereby individual preferences, values and beliefs are used to aid a person in planning for end-of-life care. Currently, there is no local instrument to assess an individual's awareness and attitude towards advance care planning. This study aimed to develop an Advance Care Planning Questionnaire and to determine its validity and reliability among older people in Malaysia. The Advance Care Planning Questionnaire was developed based on literature review. Face and content validity was verified by an expert panel, and piloted among 15 participants. Our study was conducted from October 2013 to February 2014, at an urban primary care clinic in Malaysia. Included were those aged >50 years, who could understand English. A retest was conducted 2 weeks after the first administration. Participants from the pilot study did not encounter any problems in answering the Advance Care Planning Questionnaire. Hence, no further modifications were made. Flesch reading ease was 71. The final version of the Advance Care Planning Questionnaire consists of 66 items: 30 items were measured on a nominal scale, whilst 36 items were measured on a Likert-like scale; of which we were only able to validate 22 items, as the remaining 14 items were descriptive in nature. A total of 245 eligible participants were approached; of which 230 agreed to participate (response rate = 93.9 %). Factor analysis on the 22 items measured on a Likert-scale revealed four domains: "feelings regarding advance care planning", "justifications for advance care planning", "justifications for not having advance care planning: fate and religion", and "justifications for not having advance care planning: avoid thinking about death". The Cronbach's alpha values for items each domain ranged from 0.637-0.915. In test-retest, kappa values ranged from 0.738-0.947. The final Advance Care Planning Questionnaire consisted of 63 items and 4 domains. It was found to be a valid and reliable instrument to assess the awareness and attitude of older people in Malaysia towards advance care planning.
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Adaptation of the CVT algorithm for catheter optimization in high dose rate brachytherapy
DOE Office of Scientific and Technical Information (OSTI.GOV)
Poulin, Eric; Fekete, Charles-Antoine Collins; Beaulieu, Luc
2013-11-15
Purpose: An innovative, simple, and fast method to optimize the number and position of catheters is presented for prostate and breast high dose rate (HDR) brachytherapy, both for arbitrary templates or template-free implants (such as robotic templates).Methods: Eight clinical cases were chosen randomly from a bank of patients, previously treated in our clinic to test our method. The 2D Centroidal Voronoi Tessellations (CVT) algorithm was adapted to distribute catheters uniformly in space, within the maximum external contour of the planning target volume. The catheters optimization procedure includes the inverse planning simulated annealing algorithm (IPSA). Complete treatment plans can then bemore » generated from the algorithm for different number of catheters. The best plan is chosen from different dosimetry criteria and will automatically provide the number of catheters and their positions. After the CVT algorithm parameters were optimized for speed and dosimetric results, it was validated against prostate clinical cases, using clinically relevant dose parameters. The robustness to implantation error was also evaluated. Finally, the efficiency of the method was tested in breast interstitial HDR brachytherapy cases.Results: The effect of the number and locations of the catheters on prostate cancer patients was studied. Treatment plans with a better or equivalent dose distributions could be obtained with fewer catheters. A better or equal prostate V100 was obtained down to 12 catheters. Plans with nine or less catheters would not be clinically acceptable in terms of prostate V100 and D90. Implantation errors up to 3 mm were acceptable since no statistical difference was found when compared to 0 mm error (p > 0.05). No significant difference in dosimetric indices was observed for the different combination of parameters within the CVT algorithm. A linear relation was found between the number of random points and the optimization time of the CVT algorithm. Because the computation time decrease with the number of points and that no effects were observed on the dosimetric indices when varying the number of sampling points and the number of iterations, they were respectively fixed to 2500 and to 100. The computation time to obtain ten complete treatments plans ranging from 9 to 18 catheters, with the corresponding dosimetric indices, was 90 s. However, 93% of the computation time is used by a research version of IPSA. For the breast, on average, the Radiation Therapy Oncology Group recommendations would be satisfied down to 12 catheters. Plans with nine or less catheters would not be clinically acceptable in terms of V100, dose homogeneity index, and D90.Conclusions: The authors have devised a simple, fast and efficient method to optimize the number and position of catheters in interstitial HDR brachytherapy. The method was shown to be robust for both prostate and breast HDR brachytherapy. More importantly, the computation time of the algorithm is acceptable for clinical use. Ultimately, this catheter optimization algorithm could be coupled with a 3D ultrasound system to allow real-time guidance and planning in HDR brachytherapy.« less
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Managed care quality of care and plan choice in New York SCHIP.
Liu, Hangsheng; Phelps, Charles E; Veazie, Peter J; Dick, Andrew W; Klein, Jonathan D; Shone, Laura P; Noyes, Katia; Szilagyi, Peter G
2009-06-01
To examine whether low-income parents of children enrolled in the New York State Children's Health Insurance Program (SCHIP) choose managed care plans with better quality of care. 2001 New York SCHIP evaluation data; 2001 New York State Managed Care Plan Performance Report; 2000 New York State Managed Care Enrollment Report. Each market was defined as a county. A final sample of 2,325 new enrollees was analyzed after excluding those in markets with only one SCHIP plan. Plan quality was measured using seven Consumer Assessment of Health Plans Survey (CAHPS) and three Health Plan Employer Data and Information Set (HEDIS) scores. A conditional logit model was applied with plan and individual/family characteristics as covariates. There were 30 plans in the 45 defined markets. The choice probability increased 2.5 percentage points for each unit increase in the average CAHPS score, and the association was significantly larger in children with special health care needs. However, HEDIS did not show any statistically significant association with plan choice. Low-income parents do choose managed care plans with higher CAHPS scores for their newly enrolled children, suggesting that overall quality could improve over time because of the dynamics of enrollment.
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NASA Astrophysics Data System (ADS)
Cordier, Y.; Azize, M.; Baron, N.; Chenot, S.; Tottereau, O.; Massies, J.
2007-11-01
In this work, we show that, by carefully designing the subsurface Fe doping profile in SI-GaN templates grown by MOVPE and by optimizing the MBE regrowth conditions, a highly resistive GaN buffer can be achieved on these epi-ready GaN-on-sapphire templates without any addition of acceptors during the regrowth. As a result, high-quality high electron mobility transistors can be fabricated. Furthermore, we report on the excellent properties of two-dimensional electron gas and device performances with electron mobility greater than 2000 cm 2/V s at room temperature and off-state buffer leakage currents as low as 5 μA/mm at 100 V.
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Busa, Csilla; Zeller, Judit; Csikós, Ágnes
2018-01-01
At the advanced stage of serious illness, end-of-life decisions need to be made. Advance care planning offers patients the right to decide on their own future care when independent decision-making is no longer possible. The most complex and effective advance care plans include patients' preferred or refused medical treatments, care-related wishes, and individual values as well. Advance care planning can improve end-of-life care and contribute to higher satisfaction. It can also reduce distress in relatives and the costs of care. Patients' preferences provide a guidance for professional care. A number of studies have identified the benefits of advance care planning, and it has been included in guidelines. Potential barriers to advance care planning could be as follows: taboo of talking about dying, negative attitudes of patients and relatives, poor knowledge of professional caregivers, lack of necessary circumstances to have the conversation. Advance care planning is almost unknown in Hungary, although it is possible to refuse certain types of treatments. Cooperation of professionals, development of gradual and postgraduate trainings, and improvement of social awareness are also needed so that advance care planning can be adapted in Hungary. Orv Hetil. 2018; 159(4): 131-140.
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Wang, Ning; Yu, Ping; Hailey, David
2015-08-01
The nursing care plan plays an essential role in supporting care provision in Australian aged care. The implementation of electronic systems in aged care homes was anticipated to improve documentation quality. Standardized nursing terminologies, developed to improve communication and advance the nursing profession, are not required in aged care practice. The language used by nurses in the nursing care plan and the effect of the electronic system on documentation quality in residential aged care need to be investigated. To describe documentation practice for the nursing care plan in Australian residential aged care homes and to compare the quantity and quality of documentation in paper-based and electronic nursing care plans. A nursing documentation audit was conducted in seven residential aged care homes in Australia. One hundred and eleven paper-based and 194 electronic nursing care plans, conveniently selected, were reviewed. The quantity of documentation in a care plan was determined by the number of phrases describing a resident problem and the number of goals and interventions. The quality of documentation was measured using 16 relevant questions in an instrument developed for the study. There was a tendency to omit 'nursing problem' or 'nursing diagnosis' in the nursing process by changing these terms (used in the paper-based care plan) to 'observation' in the electronic version. The electronic nursing care plan documented more signs and symptoms of resident problems and evaluation of care than the paper-based format (48.30 vs. 47.34 out of 60, P<0.01), but had a lower total mean quality score. The electronic care plan contained fewer problem or diagnosis statements, contributing factors and resident outcomes than the paper-based system (P<0.01). Both types of nursing care plan were weak in documenting measurable and concrete resident outcomes. The overall quality of documentation content for the nursing process was no better in the electronic system than in the paper-based system. Omission of the nursing problem or diagnosis from the nursing process may reflect a range of factors behind the practice that need to be understood. Further work is also needed on qualitative aspects of the nurse care plan, nurses' attitudes towards standardized terminologies and the effect of different documentation practice on care quality and resident outcomes. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Lafata, K; Ren, L; Cai, J
2016-06-15
Purpose: To develop a methodology based on digitally-reconstructed-fluoroscopy (DRF) to quantitatively assess target localization accuracy of lung SBRT, and to evaluate using both a dynamic digital phantom and a patient dataset. Methods: For each treatment field, a 10-phase DRF is generated based on the planning 4DCT. Each frame is pre-processed with a morphological top-hat filter, and corresponding beam apertures are projected to each detector plane. A template-matching algorithm based on cross-correlation is used to detect the tumor location in each frame. Tumor motion relative beam aperture is extracted in the superior-inferior direction based on each frame’s impulse response to themore » template, and the mean tumor position (MTP) is calculated as the average tumor displacement. The DRF template coordinates are then transferred to the corresponding MV-cine dataset, which is retrospectively filtered as above. The treatment MTP is calculated within each field’s projection space, relative to the DRF-defined template. The field’s localization error is defined as the difference between the DRF-derived-MTP (planning) and the MV-cine-derived-MTP (delivery). A dynamic digital phantom was used to assess the algorithm’s ability to detect intra-fractional changes in patient alignment, by simulating different spatial variations in the MV-cine and calculating the corresponding change in MTP. Inter-and-intra-fractional variation, IGRT accuracy, and filtering effects were investigated on a patient dataset. Results: Phantom results demonstrated a high accuracy in detecting both translational and rotational variation. The lowest localization error of the patient dataset was achieved at each fraction’s first field (mean=0.38mm), with Fx3 demonstrating a particularly strong correlation between intra-fractional motion-caused localization error and treatment progress. Filtering significantly improved tracking visibility in both the DRF and MV-cine images. Conclusion: We have developed and evaluated a methodology to quantify lung SBRT target localization accuracy based on digitally-reconstructed-fluoroscopy. Our approach may be useful in potentially reducing treatment margins to optimize lung SBRT outcomes. R01-184173.« less
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El Fadly, AbdenNaji; Rance, Bastien; Lucas, Noël; Mead, Charles; Chatellier, Gilles; Lastic, Pierre-Yves; Jaulent, Marie-Christine; Daniel, Christel
2011-12-01
There are different approaches for repurposing clinical data collected in the Electronic Healthcare Record (EHR) for use in clinical research. Semantic integration of "siloed" applications across domain boundaries is the raison d'être of the standards-based profiles developed by the Integrating the Healthcare Enterprise (IHE) initiative - an initiative by healthcare professionals and industry promoting the coordinated use of established standards such as DICOM and HL7 to address specific clinical needs in support of optimal patient care. In particular, the combination of two IHE profiles - the integration profile "Retrieve Form for Data Capture" (RFD), and the IHE content profile "Clinical Research Document" (CRD) - offers a straightforward approach to repurposing EHR data by enabling the pre-population of the case report forms (eCRF) used for clinical research data capture by Clinical Data Management Systems (CDMS) with previously collected EHR data. Implement an alternative solution of the RFD-CRD integration profile centered around two approaches: (i) Use of the EHR as the single-source data-entry and persistence point in order to ensure that all the clinical data for a given patient could be found in a single source irrespective of the data collection context, i.e. patient care or clinical research; and (ii) Maximize the automatic pre-population process through the use of a semantic interoperability services that identify duplicate or semantically-equivalent eCRF/EHR data elements as they were collected in the EHR context. The RE-USE architecture and associated profiles are focused on defining a set of scalable, standards-based, IHE-compliant profiles that can enable single-source data collection/entry and cross-system data reuse through semantic integration. Specifically, data reuse is realized through the semantic mapping of data collection fields in electronic Case Report Forms (eCRFs) to data elements previously defined as part of patient care-centric templates in the EHR context. The approach was evaluated in the context of a multi-center clinical trial conducted in a large, multi-disciplinary hospital with an installed EHR. Data elements of seven eCRFs used in a multi-center clinical trial were mapped to data elements of patient care-centric templates in use in the EHR at the George Pompidou hospital. 13.4% of the data elements of the eCRFs were found to be represented in EHR templates and were therefore candidate for pre-population. During the execution phase of the clinical study, the semantic mapping architecture enabled data persisted in the EHR context as part of clinical care to be used to pre-populate eCRFS for use without secondary data entry. To ensure that the pre-populated data is viable for use in the clinical research context, all pre-populated eCRF data needs to be first approved by a trial investigator prior to being persisted in a research data store within a CDMS. Single-source data entry in the clinical care context for use in the clinical research context - a process enabled through the use of the EHR as single point of data entry, can - if demonstrated to be a viable strategy - not only significantly reduce data collection efforts while simultaneously increasing data collection accuracy secondary to elimination of transcription or double-entry errors between the two contexts but also ensure that all the clinical data for a given patient, irrespective of the data collection context, are available in the EHR for decision support and treatment planning. The RE-USE approach used mapping algorithms to identify semantic coherence between clinical care and clinical research data elements and pre-populate eCRFs. The RE-USE project utilized SNOMED International v.3.5 as its "pivot reference terminology" to support EHR-to-eCRF mapping, a decision that likely enhanced the "recall" of the mapping algorithms. The RE-USE results demonstrate the difficult challenges involved in semantic integration between the clinical care and clinical research contexts. Copyright © 2011 Elsevier Inc. All rights reserved.
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Brooks, Helen L; Lovell, Karina; Bee, Penny; Sanders, Caroline; Rogers, Anne
2018-06-01
It has been established that mental health-care planning does not adequately respond to the needs of those accessing services. Understanding the reasons for this and identifying whose needs care plans serve requires an exploration of the perspectives of service users, carers and professionals within the wider organizational context. To explore the current operationalization of care planning and perceptions of its function within mental health services from the perspectives of multiple stakeholders. Participants included 21 mental health professionals, 29 service users and 4 carers from seven Mental Health Trusts in England. All participants had experience of care planning processes within secondary mental health-care services. Fifty-four semi-structured interviews were conducted with participants and analysed utilizing a qualitative framework approach. Care plans and care planning were characterized by a failure to meet the complexity of mental health needs, and care planning processes were seen to prioritize organizational agendas and risk prevention which distanced care planning from the everyday lives of service users. Care planning is recognized, embedded and well established in the practices of mental health professionals and service users. However, it is considered too superficial and mainly irrelevant to users for managing mental health in their everyday lives. Those responsible for the planning and delivery of mental health services should consider ways to increase the relevance of care planning to the everyday lives of service users including separating risk from holistic needs assessment, using support aids and utilizing a peer workforce in this regard. © 2017 The Authors Health Expectations published by John Wiley & Sons Ltd.
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Bower, Peter; Roberts, Chris; O'Leary, Neil; Callaghan, Patrick; Bee, Penny; Fraser, Claire; Gibbons, Chris; Olleveant, Nicola; Rogers, Anne; Davies, Linda; Drake, Richard; Sanders, Caroline; Meade, Oonagh; Grundy, Andrew; Walker, Lauren; Cree, Lindsey; Berzins, Kathryn; Brooks, Helen; Beatty, Susan; Cahoon, Patrick; Rolfe, Anita; Lovell, Karina
2015-08-13
Involving service users in planning their care is at the centre of policy initiatives to improve mental health care quality in England. Whilst users value care planning and want to be more involved in their own care, there is substantial empirical evidence that the majority of users are not fully involved in the care planning process. Our aim is to evaluate the effectiveness and cost-effectiveness of training for mental health professionals in improving user involvement with the care planning processes. This is a cluster randomised controlled trial of community mental health teams in NHS Trusts in England allocated either to a training intervention to improve user and carer involvement in care planning or control (no training and care planning as usual). We will evaluate the effectiveness of the training intervention using a mixed design, including a 'cluster cohort' sample, a 'cluster cross-sectional' sample and process evaluation. Service users will be recruited from the caseloads of care co-ordinators. The primary outcome will be change in self-reported involvement in care planning as measured by the validated Health Care Climate Questionnaire. Secondary outcomes include involvement in care planning, satisfaction with services, medication side-effects, recovery and hope, mental health symptoms, alliance/engagement, well-being and quality of life. Cost- effectiveness will also be measured. A process evaluation informed by implementation theory will be undertaken to assess the extent to which the training was implemented and to gauge sustainability beyond the time-frame of the trial. It is hoped that the trial will generate data to inform mental health care policy and practice on care planning. ISRCTN16488358 (14 May 2014).
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Anssari Moin, David; Derksen, Wiebe; Waars, Hugo; Hassan, Bassam; Wismeijer, Daniel
2017-05-01
The aim of this study was to introduce a new concept for computer-assisted template-guided placement of a custom 3D-designed/3D-printed implant with congruent custom 3D-designed/3D-printed surgical tooling and to test the feasibility and accuracy of this method in-vitro. One partially edentulous human mandibular cadaver was scanned with a cone-beam computed tomography (CBCT) system and intra-oral scan system. The 3D data of this cadaver were imported in specialized software and used to analyse the region of a missing tooth. Based on the functional and anatomical parameters, an individual implant with congruent surgical tooling and surgical guided template was designed and 3D-printed. The guided osteotomy was performed, and the custom implant inserted. To evaluate the planned implant position in comparison with the placed implant position, the mandible with implant was scanned again with the CBCT system and software matching was applied to measure the accuracy of the procedure. The angular deflection with the planned implant position was 0.40°. When comparing the 3D positions of the shoulder, there is a deviation of 0.72 mm resulting in an apical deviation of 0.72 mm. With the use of currently available technology, it is very well feasible to create in a virtual simulation a custom implant with congruent custom surgical tooling and to transfer this to a clinical setting. However, further research on multiple levels is needed to explore this novel approach. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
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2017-01-01
Background Uterine myoma is the most common benign gynecologic tumor in reproductive-aged women. During myomectomy for women who want to preserve fertility, it is advisable to detect and remove all myomas to decrease the risk of additional surgery. However, finding myomas during surgery is often challenging, especially for deep-seated myomas. Therefore, three-dimensional (3D) preoperative localization of myomas can be helpful for the surgical planning for myomectomy. However, the previously reported manual 3D segmenting method takes too much time and effort for clinical use. The objective of this study was to propose a new method of rapid 3D visualization of uterine myoma using a uterine template. Methods Magnetic resonance images were listed according to the slide spacing on each plane of the multiplanar reconstruction, and images that were determined to be myomas were selected by simply scrolling the mouse down. By using the selected images, a 3D grid with a slide spacing interval was constructed and filled on its plane and finally registered to a uterine template. Results The location of multiple myomas in the uterus was visualized in 3D and this proposed method is over 95% faster than the existing manual-segmentation method. Not only the size and location of the myomas, but also the shortest distance between the uterine surface and the myomas, can be calculated. This technique also enables the surgeon to know the number of total, removed, and remaining myomas on the 3D image. Conclusion This proposed 3D reconstruction method with a uterine template enables faster 3D visualization of myomas. PMID:29215821
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Lowenstein, Margaret; Bamgbose, Olusinmi; Gleason, Nathaniel; Feldman, Mitchell D
2017-08-04
Mental health problems are commonly encountered in primary care, with primary care providers (PCPs) experiencing challenges referring patients to specialty mental health care. Electronic consultation (eConsult) is one model that has been shown to improve timely access to subspecialty care in a number of medical subspecialties. eConsults generally involve a PCP-initiated referral for specialty consultation for a clinical question that is outside their expertise but may not require an in-person evaluation. Our aim was to describe the implementation of eConsults for psychiatry in a large academic health system. We performed a content analysis of the first 50 eConsults to psychiatry after program implementation. For each question and response, we coded consults as pertaining to diagnosis and/or management as well as categories of medication choice, drug side effects or interactions, and queries about referrals and navigating the health care system. We also performed a chart review to evaluate the timeliness of psychiatrist responses and PCP implementation of recommendations. Depression was the most common consult template selected by PCPs (20/50, 40%), followed by the generic template (12/50, 24%) and anxiety (8/50, 16%). Most questions (49/50, 98%) pertained primarily to management, particularly for medications. Psychiatrists commented on both diagnosis (28/50, 56%) and management (50/50, 100%), responded in an average of 1.4 days, and recommended in-person consultation for 26% (13/50) of patients. PCPs implemented psychiatrist recommendations 76% (38/50) of the time. For the majority of patients, psychiatrists provided strategies for ongoing management in primary care without an in-person evaluation, and PCPs implemented most psychiatrist recommendations. eConsults show promise as one means of supporting PCPs to deliver mental health care to patients with common psychiatric disorders. ©Margaret Lowenstein, Olusinmi Bamgbose, Nathaniel Gleason, Mitchell D Feldman. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 04.08.2017.
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The evolving role and care management approaches of safety-net Medicaid managed care plans.
Gusmano, Michael K; Sparer, Michael S; Brown, Lawrence D; Rowe, Catherine; Gray, Bradford
2002-12-01
This article provides new empirical data about the viability and the care management activities of Medicaid managed-care plans sponsored by provider organizations that serve Medicaid and other low-income populations. Using survey and case study methods, we studied these "safety-net" health plans in 1998 and 2000. Although the number of safety-net plans declined over this period, the surviving plans were larger and enjoying greater financial success than the plans we surveyed in 1998. We also found that, based on a partnership with providers, safety-net plans are moving toward more sophisticated efforts to manage the care of their enrollees. Our study suggests that, with supportive state policies, safety-net plans are capable of remaining viable. Contracting with safety-net plans may not be an efficient mechanism for enabling Medicaid recipients to "enter the mainstream of American health care," but it may provide states with an effective way to manage and coordinate the care of Medicaid recipients, while helping to maintain the health care safety-net for the uninsured.
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Advance care planning in CKD/ESRD: an evolving process.
Holley, Jean L
2012-06-01
Advance care planning was historically considered to be simply the completion of a proxy (health care surrogate designation) or instruction (living will) directive that resulted from a conversation between a patient and his or her physician. We now know that advance care planning is a much more comprehensive and dynamic patient-centered process used by patients and families to strengthen relationships, achieve control over medical care, prepare for death, and clarify goals of care. Some advance directives, notably designated health care proxy documents, remain appropriate expressions of advance care planning. Moreover, although physician orders, such as do-not-resuscitate orders and Physician Orders for Life-Sustaining Treatment, may not be strictly defined as advance directives, their completion, when appropriate, is an integral component of advance care planning. The changing health circumstances and illness trajectory characteristic of ESRD mandate that advance care planning discussions adapt to a patient's situation and therefore must be readdressed at appropriate times and intervals. The options of withholding and withdrawing dialysis add ESRD-specific issues to advance care planning in this population and are events each nephrologist will at some time confront. Advance care planning is important throughout the spectrum of ESRD and is a part of nephrology practice that can be rewarding to nephrologists and beneficial to patients and their families.
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Mitchell, Geoffrey K; Brown, Robyn M; Erikssen, Lars; Tieman, Jennifer J
2008-01-01
Background Chronic disease management requires input from multiple health professionals, both specialist and primary care providers. This study sought to assess the impact of co-ordinated multidisciplinary care in primary care, represented by the delivery of formal care planning by primary care teams or shared across primary-secondary teams, on outcomes in stroke, relative to usual care. Methods A Systematic review of Medline, EMBASE, CINAHL (all 1990–2006), Cochrane Library (Issue 1 2006), and grey literature from web based searching of web sites listed in the CCOHA Health Technology Assessment List Analysis used narrative analysis of findings of randomised and non-randomised trials, and observational and qualitative studies of patients with completed stroke in the primary care setting where care planning was undertaken by 1) a multi-disciplinary primary care team or 2) through shared care by primary and secondary providers. Results One thousand and forty-five citations were retrieved. Eighteen papers were included for analysis. Most care planning took part in the context of multidisciplinary team care based in hospitals with outreach to community patients. Mortality rates are not impacted by multidisciplinary care planning. Functional outcomes of the studies were inconsistent. It is uncertain whether the active engagement of GPs and other primary care professionals in the multidisciplinary care planning contributed to the outcomes in the studies showing a positive effect. There may be process benefits from multidisciplinary care planning that includes primary care professionals and GPs. Few studies actually described the tasks and roles GPs fulfilled and whether this matched what was presumed to be provided. Conclusion While multidisciplinary care planning may not unequivocally improve the care of patients with completed stroke, there may be process benefits such as improved task allocation between providers. Further study on the impact of active GP involvement in multidisciplinary care planning is warranted. PMID:18681977
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Challenges in implementing an advance care planning programme in long-term care.
McGlade, Ciara; Daly, Edel; McCarthy, Joan; Cornally, Nicola; Weathers, Elizabeth; O'Caoimh, Rónán; Molloy, D William
2017-02-01
A high prevalence of cognitive impairment and frailty complicates the feasibility of advance care planning in the long-term-care population. Research aim: To identify challenges in implementing the 'Let Me Decide' advance care planning programme in long-term-care. This feasibility study had two phases: (1) staff education on advance care planning and (2) structured advance care planning by staff with residents and families. Participants and research context: long-term-care residents in two nursing homes and one community hospital. Ethical considerations: The local research ethics committee granted ethical approval. Following implementation, over 50% of all residents had completed some form of end-of-life care plan. Of the 70 residents who died in the post-implementation period, 14% had no care plan, 10% (with capacity) completed an advance care directive and lacking such capacity, 76% had an end-of-life care plan completed for them by the medical team, following discussions with the resident (if able) and family. The considerable logistical challenge of releasing staff for training triggered development of an e-learning programme to facilitate training. The challenges encountered were largely concerned with preserving resident's autonomy, avoiding harm and suboptimal or crisis decision-making, and ensuring residents were treated fairly through optimisation of finite resources. Although it may be too late for many long-term-care residents to complete their own advance care directive, the ' Let Me Decide' programme includes a feasible and acceptable option for structured end-of-life care planning for residents with variable capacity to complete an advance care directive, involving discussion with the resident (to the extent they were able) and their family. While end-of-life care planning was time-consuming to deliver, nursing staff were willing to overcome this and take ownership of the programme, once the benefits in improved communication and enhanced peace of mind among all parties involved became apparent in practice.
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Pistiner, Michael; Mattey, Beth
2017-09-01
Anaphylaxis is a life-threatening emergency. In the school setting, school nurses prepare plans to prevent an emergency, educating staff and students on life-threatening allergies. A critical component of any emergency plan is a plan of care in the event of accidental ingestion or exposure to an antigen to prevent the sequelae of untreated anaphylaxis. A universal anaphylaxis emergency care plan developed by the American Academy of Pediatrics and reviewed by NASN offers an opportunity for schools, family, and health care providers to use one standard plan and avoid confusion. The plan and benefits of use are described in this article.
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The Accuracy of Computer Image-Guided Template for Mandibular Angle Ostectomy.
Ye, Niansong; Long, Hu; Zhu, Songsong; Yang, Yunqiang; Lai, Wenli; Hu, Jing
2015-02-01
Mandibular angle ostectomy (MAO) is commonly used to correct prominent mandibular angles through an intraoral approach. However, limited vision in the operative site may lead to difficulties or complications during surgery. Therefore, it is necessary to develop an effective method for helping surgeons to perform MAO more precisely and safely. In this study, we report a novel method of a computer image-guided surgical template for navigation of MAO, and evaluate its accuracy and clinical outcomes. Nine patients with a prominent mandibular angle were enrolled in this study. A pair of stereolithographic templates was fabricated by computer-aided image design and 3D printing. In all cases, bilateral MAO was performed under the guide of these templates. Post-operative effects were evaluated by 3D curve functions and maximal shell-to-shell deviations. All patients were satisfied with their cosmetic outcomes. The mean and SD of ICC between R-Sim and R-Post were 0.958 ± 0.011; between L-Sim and L-Post, 0.965 ± 0.014; and between R-Post and L-Post, 0.964 ± 0.013. The maximal shell-to-shell deviations between the simulated mandibular contour and post-operative mandibular contour on the right and left sides were 2.02 ± 0.32 and 1.97 ± 0.41 mm, respectively. The results of this study suggest that this new technique could assist surgeons in making better pre-surgical plans and ensure more accurate and safer manipulation for completion of this procedure.
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Integrated Care Planning for Cancer Patients: A Scoping Review
Arthurs, Erin; Gradin, Sharon; MacKinnon, Marnie; Sussman, Jonathan; Kukreti, Vishal
2017-01-01
Introduction: There has been a growing emphasis on the use of integrated care plans to deliver cancer care. However little is known about how integrated care plans for cancer patients are developed including featured core activities, facilitators for uptake and indicators for assessing impact. Methods: Given limited consensus around what constitutes an integrated care plan for cancer patients, a scoping review was conducted to explore the components of integrated care plans and contextual factors that influence design and uptake. Results: Five types of integrated care plans based on the stage of cancer care: surgical, systemic, survivorship, palliative and comprehensive (involving a transition between stages) are described in current literature. Breast, esophageal and colorectal cancers were common disease sites. Multi-disciplinary teams, patient needs assessment and transitional planning emerged as key features. Provider buy-in and training alongside informational technology support served as important facilitators for plan uptake. Provider-level measurement was considerably less robust compared to patient and system-level indicators. Conclusions: Similarities in design features, components and facilitators across the various types of integrated care plans indicates opportunities to leverage shared features and enable a management lens that spans the trajectory of a patient’s journey rather than a phase-specific silo approach to care. PMID:29588638
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Catch a Glimpse of Me: The development of staff videos to promote person-centered care.
Gendron, Tracey L; King Seymour, Lindsay; Welleford, E Ayn
2016-09-01
Catch a Glimpse of Me is an ongoing project that uses video to help staff deliver more person-centered care for people with dementia living in long-term care. Focus groups consisting of residents, family and staff members were conducted to develop a template for the development of the videos. The five themes they identified as being important to include are: family; interests and hobbies; memories and moments; life space and getting personal. The article describes the process of developing the videos and discusses the ongoing potential of the Catch a Glimpse of Me project. © The Author(s) 2015.
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Ke, Li-Shan; Huang, Xiaoyan; O'Connor, Margaret; Lee, Susan
2015-08-01
To explore nurses' views regarding implementing advance care planning for older people. Advance care planning is recommended as a way for older people to discuss their future care with family members and health professionals. Nurses play key roles in the process of advance care planning, including ensuring that patients are informed of their rights and that decisions are known to, and respected by, the health care team. Thus, understanding of nurses' experiences and perspectives regarding implementing advance care planning for older people is a significant topic for review. Qualitative meta-synthesis. Four databases including CINAHL plus, Medline [EBSCOhost], EMBASE, and PsycINFO were searched, and 1844 articles were initially screened. Finally, 18 articles were critically appraised and a thematic synthesis was undertaken. Four themes were identified regarding implementation of advance care planning: perceived disadvantages and advantages of advance directives; nurses' responsibility and roles; facilitators and barriers; and nurses' needs and recommendations. Nurses felt that advance directives provided more advantages than disadvantages. Nurses generally believed that they were well positioned to engage in advance care planning conversations. Nurses perceived barriers relating to older people, families, environment, time, culture, cost, language and knowledge of health care teams with regard to advance care planning. In nurses' needs, education and support were highlighted. This study provides useful knowledge for implementing advance care planning through illustrating nurses' experiences and perspectives. The results showed that nurses were more concerned about barriers in relation to working environment, teamwork, time and knowledge of health care team members than older people's characteristics, when implementing advance care planning. The findings provide nurses and administrators with information to develop related policies and education. Additionally, the appointment of nurses to formal roles related to advance care planning is appropriate and warranted. © 2015 John Wiley & Sons Ltd.
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NASA Astrophysics Data System (ADS)
Agustin, R. R.; Liliasari, L.
2017-02-01
The purpose of this study was to attain an insight into pre-service science teachers’ technological pedagogical content knowledge (TPACK) as an integrative competency that is addressed by 21st century skills. The methods used in the study was descriptive. Nineteen pre-service science teachers (PSTs) of an educational university in Indonesia were involved in a semester long school science course. The course mainly develop students’ pedagogical content knowledge (PCK) by utilizing content representation (CoRe) template. Furthermore an infusion of technological knowledge (TK) analysis led to the study of their TPACK by extending the template with a question in line to TK. The extended CoRe and self-reported survey were employed as instruments. The analysis of data used were quantitative and qualitative technique to obtain the insight into PSTs’ PCK and TK. The results shows contrary value of PCK and TK identified by CoRe template to those measured by self-reported survey. However, the PSTs perceive their TPACK much higher, that, is 74.74%. Further investigation regarding PSTs ability to compose lesson plan was recommended for further research to capture more comprehensive insight into PSTs’ TPACK.
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What Kind of Doctor Do You Want to Be? Geriatric Medicine Podcast as a Career Planning Resource.
Byszewski, Anna; Bezzina, Kathryn; Latrous, Meriem
2017-01-01
For optimal direction in career paths and postgraduate training, students can benefit from information to guide them through options. Using geriatric medicine as a template, the goal was to develop a multimedia podcast resource that can give a clearer picture of what a specialty entails. The project included a survey of existing resources and needs assessment of medical students at the University of Ottawa, Canada. This survey assessed students' knowledge of geriatrics and interest in the field and explored what they foresee as being important to be informed on when considering application to programs. Based on this, interview questions and content were developed for a podcast which was then evaluated. Interviews were conducted with physicians and residents nationwide. Relevant resources and links were added to the podcast. Evaluation demonstrated improved student understanding and interest in geriatric medicine as a career. Point-by-point format for a template on how to develop similar podcasts was developed to assist other specialties looking to develop similar information. As no such framework currently exists, results of this project can serve as a template for other postgraduate programs in developing a multimedia resource for informing prospective trainees.
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Bee, Penny; Brooks, Helen; Fraser, Claire; Lovell, Karina
2015-12-01
Involving users/carers in mental health care-planning is central to international policy initiatives yet users frequently report feeling excluded from the care planning process. Rigorous explorations of mental health professionals' experiences of care planning are lacking, limiting our understanding of this important translational gap. To explore professional perceptions of delivering collaborative mental health care-planning and involving service users and carers in their care. Qualitative interviews and focus groups with data combined and subjected to framework analysis. UK secondary care mental health services. 51 multi-disciplinary professionals involved in care planning and recruited via study advertisements. Emergent themes identified care-planning as a meaningful platform for user/carer involvement but revealed philosophical tensions between user involvement and professional accountability. Professionals emphasised their individual, relational skills as a core facilitator of involvement, highlighting some important deficiencies in conventional staff training programmes. Although internationally accepted on philosophical grounds, user-involved care-planning is poorly defined and lacks effective implementation support. Its full realisation demands greater recognition of both the historical and contemporary contexts in which statutory mental healthcare occurs. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.
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Beck, Esther-Ruth; McIlfatrick, Sonja; Hasson, Felicity; Leavey, Gerry
2017-09-01
To examine nursing home managers' knowledge, attitudes, beliefs and current practice regarding advance care planning for people with dementia in long-term care settings informed by the theory of planned behaviour. Internationally, advance care planning is advocated for people with dementia. However, evidence suggests that discussions with people with dementia are rare, particularly in long-term care settings. Whilst nursing home managers can be considered central to implementation in this setting, there is a dearth of research that has examined their perspective. This study reports on their role with regard to advance care planning and the perceived factors which influence this. A cross-sectional postal survey was carried out as part of a larger scale sequential explanatory mixed-methods study between January-March 2015. Nursing home managers in a region in the UK (n = 178). A response rate of 66% (n = 116) was achieved. Nursing home managers demonstrated a lack of knowledge of advance care planning, with negative attitudes underpinned by concerns regarding the capacity and lack of perceived benefits to the person with dementia. Currently, they do not view advance care planning as part of their role, with lack of ownership impacting upon current practice behaviours. Whilst nursing home managers recognise the potential benefits of advance care planning, barriers and challenges create a reluctance to facilitate. Targeted training to address the knowledge deficit is required, with the wider components of advance care planning promoted. There is a need for greater role clarification to ensure nurses in long-term care settings identify with the process in the future. A gap between rhetoric and reality of implementation is evident; therefore, long-term care settings must critically examine system, organisational and individual factors for failure to implement advance care planning for people with dementia. Increased cognisance of the context in which advance care planning takes place is vital for improved implementation in this context. In addition strong nursing leadership is imperative to facilitate initiation, engagement and re-evaluation of the process of advance care planning. © 2016 John Wiley & Sons Ltd.
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Managed Care Quality of Care and Plan Choice in New York SCHIP
Liu, Hangsheng; Phelps, Charles E; Veazie, Peter J; Dick, Andrew W; Klein, Jonathan D; Shone, Laura P; Noyes, Katia; Szilagyi, Peter G
2009-01-01
Objective To examine whether low-income parents of children enrolled in the New York State Children's Health Insurance Program (SCHIP) choose managed care plans with better quality of care. Data Sources 2001 New York SCHIP evaluation data; 2001 New York State Managed Care Plan Performance Report; 2000 New York State Managed Care Enrollment Report. Study Design Each market was defined as a county. A final sample of 2,325 new enrollees was analyzed after excluding those in markets with only one SCHIP plan. Plan quality was measured using seven Consumer Assessment of Health Plans Survey (CAHPS) and three Health Plan Employer Data and Information Set (HEDIS) scores. A conditional logit model was applied with plan and individual/family characteristics as covariates. Principle Findings There were 30 plans in the 45 defined markets. The choice probability increased 2.5 percentage points for each unit increase in the average CAHPS score, and the association was significantly larger in children with special health care needs. However, HEDIS did not show any statistically significant association with plan choice. Conclusions Low-income parents do choose managed care plans with higher CAHPS scores for their newly enrolled children, suggesting that overall quality could improve over time because of the dynamics of enrollment. PMID:19208091
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42 CFR 456.80 - Individual written plan of care.
Code of Federal Regulations, 2010 CFR
2010-10-01
... 42 Public Health 4 2010-10-01 2010-10-01 false Individual written plan of care. 456.80 Section 456... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Hospitals Plan of Care § 456.80 Individual written plan of care. (a) Before admission to a hospital or before authorization for...
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Bjerkan, Jorunn; Vatne, Solfrid; Hollingen, Anne
2014-01-01
Background and objective The Individual Care Plan (ICP) was introduced in Norway to meet new statutory requirements for user participation in health care planning, incorporating multidisciplinary and cross-sector collaboration. A web-based solution (electronic ICP [e-ICP]) was used to support the planning and documentation. The aim of this study was to investigate how web-based collaboration challenged user and professional roles. Methods Data were obtained from 15 semistructured interviews with users and eight with care professionals, and from two focus-group interviews with eight care professionals in total. The data were analyzed using systematic text condensation in a stepwise analysis model. Results Users and care professionals took either a proactive or a reluctant role in e-ICP collaboration. Where both user and care professionals were proactive, the pairing helped to ensure that the planning worked well; so did pairings of proactive care professionals and reluctant users. Proactive users paired with reluctant care professionals also made care planning work, thanks to the availability of information and the users’ own capacity or willingness to conduct the planning. Where both parties were reluctant, no planning activities occurred. Conclusion Use of the e-ICP challenged the user–professional relationship. In some cases, a power transition took place in the care process, which led to patient empowerment. This knowledge might be used to develop a new understanding of how role function can be challenged when users and care professionals have equal access to health care documentation and planning tools. PMID:25525367
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The impact of concordant communication in outpatient care planning - nurses' perspective.
Olsson, Maivor; Larsson, Lena G; Flensner, Gullvi; Bäck-Pettersson, Siv
2012-09-01
To elucidate registered nurses' experiences of coordinated care planning in outpatient care. Coordinated care planning has been studied from the perspectives of both patients and nurses in inpatient care, but it is deficient in outpatient care. Qualitative content analysis of interviews with 10 registered nurses participating in two focus groups. An overall theme was identified: creating concordant communication in relation to patient and health-care providers. The result is based on four categories and nine subcategories. Nurses need extraordinary communication skills to reach concordance in outpatient care planning. In addition to involving and supporting the patients and next of kin in the decision-making process, the outcome of the nursing process must be understood by colleagues and members of other professions and health-care providers (non-nursing). An effective outpatient care-planning process requires that care managers understand the impact of communicating, transferring information and reaching consensus with other health-care providers, actively supporting employees in the outpatient care-planning process and contributing to the development of common goals and policy documents across organisational boundaries. © 2012 Blackwell Publishing Ltd.
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Advance Care Planning Meets Group Medical Visits: The Feasibility of Promoting Conversations
Lum, Hillary D.; Jones, Jacqueline; Matlock, Daniel D.; Glasgow, Russell E.; Lobo, Ingrid; Levy, Cari R.; Schwartz, Robert S.; Sudore, Rebecca L.; Kutner, Jean S.
2016-01-01
PURPOSE Primary care needs new models to facilitate advance care planning conversations. These conversations focus on preferences regarding serious illness and may involve patients, decision makers, and health care providers. We describe the feasibility of the first primary care–based group visit model focused on advance care planning. METHODS We conducted a pilot demonstration of an advance care planning group visit in a geriatrics clinic. Patients were aged at least 65 years. Groups of patients met in 2 sessions of 2 hours each facilitated by a geriatrician and a social worker. Activities included considering personal values, discussing advance care planning, choosing surrogate decision-makers, and completing advance directives. We used the RE-AIM framework to evaluate the project. RESULTS Ten of 11 clinicians referred patients for participation. Of 80 patients approached, 32 participated in 5 group visit cohorts (a 40% participation rate) and 27 participated in both sessions (an 84% retention rate). Mean age was 79 years; 59% of participants were female and 72% white. Most evaluated the group visit as better than usual clinic visits for discussing advance care planning. Patients reported increases in detailed advance care planning conversations after participating (19% to 41%, P = .02). Qualitative analysis found that older adults were willing to share personal values and challenges related to advance care planning and that they initiated discussions about a broad range of relevant topics. CONCLUSION A group visit to facilitate discussions about advance care planning and increase patient engagement is feasible. This model warrants further evaluation for effectiveness in improving advance care planning outcomes for patients, clinicians, and the system. PMID:26951587
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de Britto, Felipe A; Martins, Tatiana B; Landsberg, Gustavo A P
2015-01-01
To assess impact of a mobile health solution in the nursing care plan compliance of a home care service. A retrospective cohort study was performed with 3,036 patients. Compliance rates before and after the implementation were compared. After the implementation of a mobile health aplication, compliance with the nursing care plan increased from 53% to 94%. The system reduced IT spending, increased the nursing team efficiency and prevented planned hiring. The use of a mobile health solution with geolocating feature by a nursing home care team increased compliance to the care plan.
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van Abbema, Renske; Bielderman, Annemiek; De Greef, Mathieu; Hobbelen, Hans; Krijnen, Wim; van der Schans, Cees
2015-09-01
To develop and psychometrically test the Groningen Ageing Resilience Inventory. Ageing is a process that is often accompanied by functional limitation, disabilities and losses. Instead of focusing on these negative events of ageing, there are opportunities in focusing on adaptation mechanisms, like resilience, that are helpful to cope with those adversities. Cross-sectional study. The study was conducted from 2011-2012. First, a conceptual model of resilience during the ageing process was constructed. Next, items were formulated that made up a comprehensive template questionnaire reflecting the model. Finally, a cross-sectional study was performed to evaluate the construct validity and internal consistency of this template 16-item questionnaire. Participants (N = 229) with a mean age of 71·5 years, completed the template 16-item Groningen Ageing Resilience Inventory, and performance based tests and psychological questionnaires. Exploratory factor analysis resulted in a two factor solution of internal and external resources of resilience. Three items did not discriminate well between the two factors and were deleted, remaining a final 13-item questionnaire that shows evidence of good internal consistency. The direction and magnitude of the correlations with other measures support the construct validity. The Groningen Ageing Resilience Inventory is a useful instrument that can help nurses, other healthcare workers, researchers and providers of informal care to identify the internal and external resources of resilience in individuals and groups. In a multidisciplinary biopsychosocial approach this knowledge provides tools for empowering older patients in performing health promoting behaviors and self-care tasks. © 2015 John Wiley & Sons Ltd.
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Custis, Laura M; Hawkins, Shelley Y; Thomason, Tanna R
2017-03-01
Integrated information systems and wireless technology have been increasingly incorporated into health care organizations with the premise that information technology will promote safe, high-quality, cost-effective patient care. With the advancement of technology, the level of expertise necessary to assume health care information technology roles has escalated. The purpose of this article is to describe a clinical residency project whereby students in a graduate degree health care informatics program successfully fulfilled program competencies through a faculty-lead research project focused on the use of home telehealth with a group of heart failure patients. Through the use of Donabedian's framework of structure, process, and outcomes, the health care informatics students completed essential learning activities deemed essential for transition into the role of an informatics specialist. Health care informatics educational leaders are encouraged to adapt this template of applied learning into their practices.
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Outcome evaluation of a new model of critical care orientation.
Morris, Linda L; Pfeifer, Pamela; Catalano, Rene; Fortney, Robert; Nelson, Greta; Rabito, Robb; Harap, Rebecca
2009-05-01
The shortage of critical care nurses and the service expansion of 2 intensive care units provided a unique opportunity to create a new model of critical care orientation. The goal was to design a program that assessed critical thinking, validated competence, and provided learning pathways that accommodated diverse experience. To determine the effect of a new model of critical care orientation on satisfaction, retention, turnover, vacancy, preparedness to manage patient care assignment, length of orientation, and cost of orientation. A prospective, quasi-experimental design with both quantitative and qualitative methods. The new model improved satisfaction scores, retention rates, and recruitment of critical care nurses. Length of orientation was unchanged. Cost was increased, primarily because a full-time education consultant was added. A new model for nurse orientation that was focused on critical thinking and competence validation improved retention and satisfaction and serves as a template for orientation of nurses throughout the medical center.
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Blackford, Jeanine; Street, Annette
2012-09-01
This article reports a study to determine the feasibility of an advance care planning model developed with Australian community palliative care services. An effective advance care planning programme involves an organizational wide commitment and preparedness for health service reform to embed advance care planning into routine practice. Internationally, such programmes have been implemented predominantly in aged and acute care with more recent work in primary care. A multi-site action research was conducted over a 16-month period in 2007-2009 with three Victorian community palliative care services. Using mixed method data collection strategies to assess feasibility, we conducted a baseline audit of staff and clients; analysed relevant documents (client records, policies, procedures and quality improvement strategies) pre-implementation and post-implementation and conducted key informant interviews (n = 9). Three community palliative care services: one regional and two metropolitan services in Victoria, Australia. The services demonstrated that it was feasible to embed the Model into their organizational structures. Advance care planning conversations and involvement of family was an important outcome measure rather than completion rate of advance care planning documents in community settings. Services adapted and applied their own concept of community, which widened the impact of the model. Changes to quality audit processes were essential to consolidate the model into routine palliative care practice. An advance care planning model is feasible for community palliative care services. Quality audit processes are an essential component of the Model with documentation of advance care planning discussion established as an important outcome measure. © 2011 Blackwell Publishing Ltd.
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A qualitative evaluation of general practitioners’ views on protocol-driven eReferral in Scotland
2014-01-01
Background The ever increasing volume of referrals from primary care to specialist services is putting considerable pressure on resource-constrained health services while effective communication across fragmented services remains a substantial challenge. Previous studies have suggested that electronic referrals (eReferral) can bear important benefits for cross-organisational processes and patient care management. Methods We conducted 25 semi-structured interviews and 1 focus group with primary care providers to elucidate General Practitioners’ (GPs) perspectives on information management processes in the patient pathway in NHSScotland, 1 focus group with members of the Scottish Electronic Patient Record programme and one interview with a senior architect of the Scottish Care Information national eReferral System (SCI Gateway). Using Normalisation Process Theory, we performed a qualitative analysis to elucidate GPs’ perspectives on eReferral to identify the factors which they felt either facilitated or hindered referral processes. Results The majority of GPs interviewed felt that eReferral substantially streamlined communication processes, with the immediate transfer of referral documents and the availability of an electronic audit trail perceived as two substantial improvements over paper-based referrals. Most GPs felt that the SCI Gateway system was reasonably straightforward to use. Referral protocols and templates could be perceived as useful by some GPs while others considered them to be cumbersome at times. Conclusion Our study suggests that the deployment and adoption of eReferral across the NHS in Scotland has been achieved by a combination of factors: (i) a policy context – including national mandatory targets for eReferral – which all NHS health-boards were bound to operationalise through their Local Delivery Plans and also (ii) the fact that primary care doctors considered that the overall benefits brought by the deployment of eReferral throughout the patient pathway significantly outweigh any potential disbenefits. PMID:24712766
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The Feasibility of Using Computer and Internet in Teaching Family Education for the 8th Grade Class
ERIC Educational Resources Information Center
Alluhaydan, Nuwayyir Saleh F.
2016-01-01
This paper is just a sample template for the prospective authors of IISTE. Over the decades, the concepts of holons and holonic systems have been adopted in many research fields, but they are scarcely attempted on labour planning. A literature gap exists, thus motivating the author to come up with a holonic model that uses exponential smoothing to…
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Toward a Natural Speech Understanding System
1989-10-01
WALTER J. SENUS Technical Director Directorate of Intelligence & Reconnaissance FOR THE COMMANDER JAMES W. HYDE III V Directorate of Plans & Programs ...applicable) Human Resources Laboratory F30602-81-C-0193 8 . ADDRESS (City, State, and ZIP Code) 10. SOURCE OF FUNDING NUMBERS PROGRAM PROJECT TASK WORK...error rates for distinctive words produced in isolation by a single speaker, and their simple programming requirements. Template-matching systems rank
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ERIC Educational Resources Information Center
Seker, Burcu Sezginsoy; Erdem, Aliye
2017-01-01
Students learning a defined subject only perform by learning of thinking based on the concepts forming that subjects. Otherwise, students may move away from the scientific meaning of concepts and may fall into conceptual errors. Students' conceptual errors affect their following learning and cause them resist change. It is possible to prevent this…
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ERIC Educational Resources Information Center
Bureau of Indian Education, 2013
2013-01-01
The Bureau of Indian Education (BIE) funds schools located on 63 reservations in 23 states across the nation. Of the 183 schools, 59 are Bureau operated and 124 are tribally controlled. One-hundred and sixteen schools provide instructional programs, 55 provide instructional as well as boarding services and 12 peripheral dormitories provide only…
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Brazil, Kevin; Carter, Gillian; Cardwell, Chris; Clarke, Mike; Hudson, Peter; Froggatt, Katherine; McLaughlin, Dorry; Passmore, Peter; Kernohan, W George
2018-03-01
In dementia care, a large number of treatment decisions are made by family carers on behalf of their family member who lacks decisional capacity; advance care planning can support such carers in the decision-making of care goals. However, given the relative importance of advance care planning in dementia care, the prevalence of advance care planning in dementia care is poor. To evaluate the effectiveness of advance care planning with family carers in dementia care homes. Paired cluster randomized controlled trial. The intervention comprised a trained facilitator, family education, family meetings, documentation of advance care planning decisions and intervention orientation for general practitioners and nursing home staff. A total of 24 nursing homes with a dementia nursing category located in Northern Ireland, United Kingdom. Family carers of nursing home residents classified as having dementia and judged as not having decisional capacity to participate in advance care planning discussions. The primary outcome was family carer uncertainty in decision-making about the care of the resident (Decisional Conflict Scale). There was evidence of a reduction in total Decisional Conflict Scale score in the intervention group compared with the usual care group (-10.5, 95% confidence interval: -16.4 to -4.7; p < 0.001). Advance care planning was effective in reducing family carer uncertainty in decision-making concerning the care of their family member and improving perceptions of quality of care in nursing homes. Given the global significance of dementia, the implications for clinicians and policy makers include them recognizing the importance of family carer education and improving communication between family carers and formal care providers.
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Creating an advance-care-planning decision aid for high-risk surgery: a qualitative study
2014-01-01
Background High-risk surgery patients may lose decision-making capacity as a result of surgical complications. Advance care planning prior to surgery may be beneficial, but remains controversial and is hindered by a lack of appropriate decision aids. This study sought to examine stakeholders’ views on the appropriateness of using decision aids, in general, to support advance care planning among high-risk surgery populations and the design of such a decision aid. Methods Key informants were recruited through purposive and snowball sampling. Semi-structured interviews were conducted by phone until data collected reached theoretical saturation. Key informants were asked to discuss their thoughts about advance care planning and interventions to support advance care planning, particularly for this population. Researchers took de-identified notes that were analyzed for emerging concordant, discordant, and recurrent themes using interpretative phenomenological analysis. Results Key informants described the importance of initiating advance care planning preoperatively, despite potential challenges present in surgical settings. In general, decision aids were viewed as an appropriate approach to support advance care planning for this population. A recipe emerged from the data that outlines tools, ingredients, and tips for success that are needed to design an advance care planning decision aid for high-risk surgical settings. Conclusions Stakeholders supported incorporating advance care planning in high-risk surgical settings and endorsed the appropriateness of using decision aids to do so. Findings will inform the next stages of developing the first advance care planning decision aid for high-risk surgery patients. PMID:25067908
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Creating an advance-care-planning decision aid for high-risk surgery: a qualitative study.
Schuster, Anne Lr; Aslakson, Rebecca A; Bridges, John Fp
2014-01-01
High-risk surgery patients may lose decision-making capacity as a result of surgical complications. Advance care planning prior to surgery may be beneficial, but remains controversial and is hindered by a lack of appropriate decision aids. This study sought to examine stakeholders' views on the appropriateness of using decision aids, in general, to support advance care planning among high-risk surgery populations and the design of such a decision aid. Key informants were recruited through purposive and snowball sampling. Semi-structured interviews were conducted by phone until data collected reached theoretical saturation. Key informants were asked to discuss their thoughts about advance care planning and interventions to support advance care planning, particularly for this population. Researchers took de-identified notes that were analyzed for emerging concordant, discordant, and recurrent themes using interpretative phenomenological analysis. Key informants described the importance of initiating advance care planning preoperatively, despite potential challenges present in surgical settings. In general, decision aids were viewed as an appropriate approach to support advance care planning for this population. A recipe emerged from the data that outlines tools, ingredients, and tips for success that are needed to design an advance care planning decision aid for high-risk surgical settings. Stakeholders supported incorporating advance care planning in high-risk surgical settings and endorsed the appropriateness of using decision aids to do so. Findings will inform the next stages of developing the first advance care planning decision aid for high-risk surgery patients.
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Health care planning and education via gaming-simulation: a two-stage experiment.
Gagnon, J H; Greenblat, C S
1977-01-01
A two-stage process of gaming-simulation design was conducted: the first stage of design concerned national planning for hemophilia care; the second stage of design was for gaming-simulation concerning the problems of hemophilia patients and health care providers. The planning design was intended to be adaptable to large-scale planning for a variety of health care problems. The educational game was designed using data developed in designing the planning game. A broad range of policy-makers participated in the planning game.
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End-of-life care of oncology inpatients: Are we getting it right?
Batten, Monique; Nguyen, Bella; Burke, Brandon; Harryanto, Hilman; Mitchell, Imogen; Davis, Alison
2018-06-13
To examine the current patterns of end-of-life care of medical oncology patients dying in an Australian tertiary acute hospital setting in order to determine potential areas for improvement. A retrospective observational study was undertaken of 295 consecutive adult medical oncology inpatients dying between 2010 and 2015. Charts were reviewed for evidence of (1) resuscitation plans, (2) acute interventions in the 48-h period prior to death, (3) palliative care involvement and (4) recognition of the dying patient and comfort care plans. At the time of death, 98% of patients had a resuscitation plan, 71% of which were completed by the medical oncology team. Fifty-nine percent of medical emergency team reviews occurred in patients without a documented resuscitation plan. Within 48 h of death, active interventions were still being given to 64% of patients in the total patient population. Comfort care plans were documented in 86% of patients; however, 62% of these were only documented within 48 h of death and 20% of patients with a documented comfort care plan still received noncomfort measures. There was a high level of documented resuscitation plans, comfort care plans and recognition of dying. However, active interventions were common within 48 h of death, and comfort care plans and recognition of dying often occurred late. These data indicate a gap between documenting a resuscitation plan and providing timely and appropriate end-of-life care. Understanding the gaps in delivering appropriate care provides an opportunity for improving end-of-life care. © 2018 John Wiley & Sons Australia, Ltd.
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Advance Care Planning and the Quality of End-of-Life Care among Older Adults
Bischoff, Kara E.; Sudore, Rebecca; Miao, Yinghui; Boscardin, W. John; Smith, Alexander K.
2013-01-01
Background Advance care planning is increasingly common, but whether it influences end-of-life quality of care remains controversial. Design Medicare data and survey data from the Health and Retirement Study were combined to determine whether advance care planning was associated with quality metrics. Setting The nationally representative Health and Retirement Study. Participants 4394 decedent subjects (mean age 82.6 years at death, 55% women). Measurements Advance care planning was defined as having an advance directive, durable power of attorney or having discussed preferences for end-of-life care with a next-of-kin. Outcomes included previously reported quality metrics observed during the last month of life (rates of hospital admission, in-hospital death, >14 days in the hospital, intensive care unit admission, >1 emergency department visit, hospice admission, and length of hospice ≤3 days). Results Seventy-six percent of subjects engaged in advance care planning. Ninety-two percent of advance directives stated a preference to prioritize comfort. After adjustment, subjects who engaged in advance care planning were less likely to die in a hospital (adjusted RR 0.87, 95% CI 0.80-0.94), more likely to be enrolled in hospice (aRR 1.68, 1.43-1.97), and less likely to receive hospice for ≤3 days before death (aRR 0.88, 0.85-0.91). Having an advance directive, a durable-power-of-attorney or an advance care planning discussion were each independently associated with a significant increase in hospice use (p<0.01 for all). Conclusion Advance care planning was associated with improved quality of care at the end of life, including less in-hospital death and increased use of hospice. Having an advance directive, assigning a durable power of attorney and conducting advance care planning discussions are all important elements of advance care planning. PMID:23350921
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Pain assessment: the cornerstone to optimal pain management
2000-01-01
Pain assessment is critical to optimal pain management interventions. While pain is a highly subjective experience, its management necessitates objective standards of care. The WILDA approach to pain assessment—focusing on words to describe pain, intensity, location, duration, and aggravating or alleviating factors—offers a concise template for assessment in patients with acute and chronic pain. PMID:16389388
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Slomka, Jacquelyn; Prince-Paul, Maryjo; Webel, Allison; Daly, Barbara J
2016-01-01
People living with HIV (PLWH) who survive to older adulthood risk developing multiple chronic medical conditions. Health policymakers recognize the role of early palliative care and advance care planning in improving health quality for at-risk populations, but misperceptions about palliative care, hospice, and advance care planning are common. Before testing a program of early palliative care for PLWH and other chronic conditions, we conducted focus groups to elicit perceptions of palliative care, hospice, and advance care planning in our target population. Overall, participants were unfamiliar with the term palliative care, confused concepts of palliative care and hospice, and/or associated hospice care with dying. Participants misunderstood advance care planning, but valued communication about health care preferences. Accepting palliative care was contingent on distinguishing it from hospice and historical memories of HIV and dying. Provision of high-quality, comprehensive care will require changing public perceptions and individuals' views in this high-risk population. Copyright © 2016 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.
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Mitchell, Sarah; Dale, Jeremy
2015-04-01
The majority of children and young people who die in the United Kingdom have pre-existing life-limiting illness. Currently, most such deaths occur in hospital, most frequently within the intensive care environment. To explore the experiences of senior medical and nursing staff regarding the challenges associated with Advance Care Planning in relation to children and young people with life-limiting illnesses in the Paediatric Intensive Care Unit environment and opportunities for improvement. Qualitative one-to-one, semi-structured interviews were conducted with Paediatric Intensive Care Unit consultants and senior nurses, to gain rich, contextual data. Thematic content analysis was carried out. UK tertiary referral centre Paediatric Intensive Care Unit. Eight Paediatric Intensive Care Unit consultants and six senior nurses participated. Four main themes emerged: recognition of an illness as 'life-limiting'; Advance Care Planning as a multi-disciplinary, structured process; the value of Advance Care Planning and adverse consequences of inadequate Advance Care Planning. Potential benefits of Advance Care Planning include providing the opportunity to make decisions regarding end-of-life care in a timely fashion and in partnership with patients, where possible, and their families. Barriers to the process include the recognition of the life-limiting nature of an illness and gaining consensus of medical opinion. Organisational improvements towards earlier recognition of life-limiting illness and subsequent Advance Care Planning were recommended, including education and training, as well as the need for wider societal debate. Advance Care Planning for children and young people with life-limiting conditions has the potential to improve care for patients and their families, providing the opportunity to make decisions based on clear information at an appropriate time, and avoid potentially harmful intensive clinical interventions at the end of life. © The Author(s) 2015.
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Usage Analysis of a Shared Care Planning System
Warren, Jim; Gu, Yulong; Humphrey, Gayl
2012-01-01
We examined the content of electronically mediated communications in a trial of shared care planning (SCP) for long-term condition management. Software supports SCP by sharing patient records and care plans among members of the multidisciplinary care team (with patient access). Our analysis focuses on a three-month period with 73 enrolled patients, 149 provider-assigned tasks, 64 clinical notes and 48 care plans with 162 plan elements. Results show that content of notes entries is often related to task assignment and that nurses are the most active users. Directions for refinement of the SCP technology are indicated, including better integration of notes, tasks and care team notifications, as well as the central role of nurses for design use cases. Broader issues are raised about workforce roles and responsibilities for SCP, integrating patient-provider and provider-provider communications, and the centrality of care plans as the key entity in mediation of the care team. PMID:23304370
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Change in health care use after coordinated care planning: a quasi-experimental study.
Bielska, Iwona A; Cimek, Kelly; Guenter, Dale; O'Halloran, Kelly; Nyitray, Chloe; Hunter, Linda; Wodchis, Walter P
2018-05-31
We sought to determine whether patients with a coordinated care plan developed using the Health Links model of care in the Hamilton Niagara Haldimand Brant Local Health Integration Network differed in their use of health care (no. of emergency department visits, inpatient admissions, length of inpatient stay) when compared with a matched control group of patients with no care plans. We performed a propensity score-matched study of 12 months pre- and 12 months post-health care use. Patients who had a coordinated care plan that started between 2013 and 2015 were propensity score matched to patients in a control group. Patient information was obtained from Client Health and Related Information System, National Ambulatory Care Reporting System and Discharge Abstract Database. Differences in health care use pre- and post-index date were compared using the Wilcoxon signed-rank test. A negative binomial regression model was fit for each health care use outcome at 6 and 12 months post-index date. Six hundred coordinated care plan enrollees and 25 449 potential control patients were included in the matching algorithm, which resulted in 548 matched pairs (91.3%). Both groups showed decreases in health care use post-index date. Matched care plan enrollees had significantly fewer emergency department visits at 6 (incidence rate ratio [IRR] 0.81, 95% confidence interval [CI] 0.72-0.91, p < 0.01) and 12 months post-index date (IRR 0.88, 95% CI 0.79-0.99, p < 0.05) compared with the matched controls. Other use parameters were not significantly different between care plan enrollees and the control group. Care plan enrollees show a decrease in the number of times they visit emergency departments, which may be attributed to integrated and coordinated care planning. This association should be examined to see whether these reductions persist for more than 1 year. Copyright 2018, Joule Inc. or its licensors.
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District of Columbia Early Care and Education Strategic Plan.
ERIC Educational Resources Information Center
District of Columbia Univ., Washington, DC. Center for Applied Research and Urban Policy.
This report details the early care and education strategic plan for the District of Columbia. Following an executive summary, the report provides the rationale for developing an early care and education strategic plan and describes the process used to develop the plan. The top 10 early care and education issues in the district are then delineated…
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NASA Astrophysics Data System (ADS)
Papanikolaou, Dimitrios; Arvanitakis, Spyridon; Papanikolaou, , Ioannis; Lozios, Stylianos; Diakakis, Michalis; Deligiannakis, Georgios; Dimitropoulou, Margarita; Georgiou, Konstantinos
2013-04-01
Wildfires are a major hazard in Greece suffering on average 1,509 wildfires and 36,151 burned hectares of forestlands every year. Since 1998 the Greek Fire Service is responsible for wildfires suppression and response, while prevention and mitigation yearly directives are also being released by the General Secretariat of Civil Protection. The 3013/2002 Act introduced a major transfer of responsibilities from the national to local municipal and regional authorities, which are accompanied by supplementary financial support. Significant new features were established such as the operation of local coordination councils, the foundation of municipality civil protection offices, the establishment of the annually prevention planning for forest fires and the development of local action plans. The University of Athens has developed a Local Action Plan template for municipality administrative levels, integrating scientific techniques and technologies to public government management. The Local Action Plan for Forest Fire Prevention is the main handbook and primary tool of every municipality for reducing the risk of wildfires. Fire prevention and risk analysis are the principal aims of this Plan, which also emphasizes on the important role of the volunteer organizations on forest fire prevention. The 7 chapters of the Action Plan include the legal framework, the risk analysis parameters, the risk analysis using GIS, the prevention planning, the manpower and available equipment of services involved, along with operational planning and evaluation of the previous year's forest fire prevention actions. Multiple information layers, such as vegetation types, road network, power lines and landfills are combined in GIS environment and transformed into qualitative multiparameter as well as quantitative combinational fire hazard maps. These maps are essential in wildfire risk analysis as they display the areas that need the highest attention during the fire season. Moreover, the separate steps of operational planning and the reviewing of precaution, addressing and rehabilitation measures are analyzed. This action plan, risk analysis and maps are of decisive importance not only for prevention and operational planning purposes, but can also prove useful during the crisis and the rehabilitation processes as well. Additionally, we conducted a large questionnaire survey among the municipalities of Greece to assess the existing situation regarding forest fire prevention. Therefore, a network connecting civil protection departments of municipalities was developed, based on an Internet platform, which acted also as a communication tool. Overall, we had feedback either online or offline from 125 municipalities across the country (representing more than one/third of the total municipalities of Greece). 23% of the municipalities have not compiled an action plan yet despite the fact that the 3013/2002 Act of the Greek National Law requires one. Moreover, existing action plans are predominantly catalogues and tables of information regarding authorised personnel and equipment. They lack important information, present no spatial data and display no prevention measures. Indeed, 85% of the municipalities that have action plans do not use risk maps and spatial data, which are of decisive importance for compiling the plans. 74% of the municipalities do not keep a record of forest fires. The jurisdiction area has been modified after the new administrative plan of Kallikratis in 2010 in 74% of the municipalities, however, local action plans were not adapted accordingly in 61% of these. The daily Fire Risk Map of the General Secretariat of Civil Protection has a key role, since 77% of the municipalities take additional measures in case of increased fire risk. According to the civil protection officials, existing action plans suffer from several major problems which emerge due to the fact: that there is no assessment on the fire hazard 67%, there is lack of personnel training 65%, new technologies are not incorporated or used 57% and there is a lack of a template for compiling an action plan 53%. The partnership between the University of Athens with the support of the private sector and the Union of Municipalities of Attica was held under the LIFE+ project "Local Authorities Alliance for Forest Fire Prevention - LIFE08/ENV/GR/000553 " which is implemented with the contribution of the LIFE financial instrument of the European Community.
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Sustainability and transformation plans: translating the perspectives.
Thakrar, Sonali V; Bell, Diane
2017-10-02
Each local health economy has been tasked with producing a sustainability and transformation plan. A health economy is a system that controls and contributes to health-care resource and the effects of health services on its population. This includes commissioners, acute providers, primary care providers, community services, public health and the voluntary sector. Sustainability and transformation plans represent a shift in the way health care is planned for in England. The aim of each sustainability and transformation plan is to deliver care within existing resource limits by improving quality of care, developing new models of care and improving efficiency of care provision. The tight timescales for production of sustainability and transformation plans mean that in most cases there has been limited clinical engagement; as a result many clinicians have limited sight, understanding or ownership of the proposals within sustainability and transformation plans. As sustainability and transformation plans move into the implementation phase, this article explores the role of the clinician in the ongoing design and delivery of the local sustainability and transformation plans. By finding the common ground between the perspectives of the clinician, the commissioner and system leaders, the motivation of clinicians can be aligned with the ambitions of the sustainability and transformation plan. The common goal of a sustainability and transformation plan and the necessary collaboration required to make it successful is discussed. Ultimately, such translation is essential: clinicians are intelligent, adaptive and motivated individuals who must have a lead role in constructing and implementing plans that transform health and social care.
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Desai, Arti D; Jacob-Files, Elizabeth A; Wignall, Julia; Wang, Grace; Pratt, Wanda; Mangione-Smith, Rita; Britto, Maria T
2018-06-05
Shared care plans play an essential role in coordinating care across health care providers and settings for children with medical complexity (CMC). However, existing care plans often lack shared ownership, are out-of-date, and lack universal accessibility. In this study, we aimed to establish requirements for shared care plans to meet the information needs of caregivers and providers and to mitigate current information barriers when caring for CMC. We followed a user-centered design methodology and conducted in-depth semistructured interviews with caregivers and providers of CMC who receive care at a tertiary care children's hospital. We applied inductive, thematic analysis to identify salient themes. Analysis occurred concurrently with data collection; therefore, the interview guide was iteratively revised as new questions and themes emerged. Interviews were conducted with 17 caregivers and 22 providers. On the basis of participant perspectives, we identified 4 requirements for shared care plans that would help meet information needs and mitigate current information barriers when caring for CMC. These requirements included the following: (1) supporting the accessibility of care plans from multiple locations (eg, cloud-based) and from multiple devices, with alert and search features; (2) ensuring the organization is tailored to the specific user; (3) including collaborative functionality such as real-time, multiuser content management and secure messaging; and (4) storing care plans on a secure platform with caregiver-controlled permission settings. Although further studies are needed to understand the optimal design and implementation strategies, shared care plans that meet these specified requirements could mitigate perceived information barriers and improve care for CMC. Copyright © 2018 by the American Academy of Pediatrics.
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Simpson, Alan; Hannigan, Ben; Coffey, Michael; Jones, Aled; Barlow, Sally; Cohen, Rachel; Všetečková, Jitka; Faulkner, Alison; Haddad, Mark
2015-07-03
The collaborative care planning study (COCAPP) is a cross-national comparative study of care planning and coordination in community mental healthcare settings. The context and delivery of mental health care is diverging between the countries of England and Wales whilst retaining points of common interest, hence providing a rich geographical comparison for research. Across England the key vehicle for the provision of recovery-focused, personalised, collaborative mental health care is the care programme approach (CPA). The CPA is a form of case management introduced in England in 1991, then revised in 2008. In Wales the CPA was introduced in 2003 but has now been superseded by The Mental Health (Care Co-ordination and Care and Treatment Planning) (CTP) Regulations (Mental Health Measure), a new statutory framework. In both countries, the CPA/CTP requires providers to: comprehensively assess health/social care needs and risks; develop a written care plan (which may incorporate risk assessments, crisis and contingency plans, advanced directives, relapse prevention plans, etc.) in collaboration with the service user and carer(s); allocate a care coordinator; and regularly review care. The overarching aim of this study is to identify and describe the factors that ensure CPA/CTP care planning and coordination is personalised, recovery-focused and conducted collaboratively. COCAPP will employ a concurrent transformative mixed methods approach with embedded case studies. Phase 1 (Macro-level) will consider the national context through a meta-narrative mapping (MNM) review of national policies and the relevant research literature. Phase 2 (Meso-level and Micro-level) will include in-depth micro-level case studies of everyday 'frontline' practice and experience with detailed qualitative data from interviews and reviews of individual care plans. This will be nested within larger meso-level survey datasets, senior-level interviews and policy reviews in order to provide potential explanations and understanding. COCAPP will help identify the key components that support and hinder the provision of personalised, recovery-focused care planning and provide an informed rationale for a future planned intervention and evaluation.
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McDonnell, Diana D; Graham, Carrie L
2015-03-01
In 2011 California began transitioning approximately 340,000 seniors and people with disabilities from Medicaid fee-for-service (FFS) to Medicaid managed care plans. When beneficiaries did not actively choose a managed care plan, the state assigned them to one using an algorithm based on their previous FFS primary and specialty care use. When no clear link could be established, beneficiaries were assigned by default to a managed care plan based on weighted randomization. In this article we report the results of a telephone survey of 1,521 seniors and people with disabilities enrolled in Medi-Cal (California Medicaid) and who were recently transitioned to a managed care plan. We found that 48 percent chose their own plan, 11 percent were assigned to a plan by algorithm, and 41 percent were assigned to a plan by default. People in the latter two categories reported being similarly less positive about their experiences compared to beneficiaries who actively chose a plan. Many states in addition to California are implementing mandatory transitions of Medicaid-only beneficiaries to managed care plans. Our results highlight the importance of encouraging beneficiaries to actively choose their health plan; when beneficiaries do not choose, states should employ robust intelligent assignment algorithms. Project HOPE—The People-to-People Health Foundation, Inc.
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42 CFR 456.381 - Reports of evaluations and plans of care.
Code of Federal Regulations, 2011 CFR
2011-10-01
... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care... evaluation and plan of care must be entered in the applicant's or recipient's record— (a) At the time of... plan. Utilization Review (UR) Plan: General Requirement ...
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42 CFR 456.381 - Reports of evaluations and plans of care.
Code of Federal Regulations, 2010 CFR
2010-10-01
... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care... evaluation and plan of care must be entered in the applicant's or recipient's record— (a) At the time of... plan. Utilization Review (UR) Plan: General Requirement ...
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Chan, Kamfai; Wong, Pui-Yan; Parikh, Chaitanya; Wong, Season
2018-03-15
Traditionally, the majority of nucleic acid amplification-based molecular diagnostic tests are done in centralized settings. In recent years, point-of-care tests have been developed for use in low-resource settings away from central laboratories. While most experts agree that point-of-care molecular tests are greatly needed, their availability as cost-effective and easy-to-operate tests remains an unmet goal. In this article, we discuss our efforts to develop a recombinase polymerase amplification reaction-based test that will meet these criteria. First, we describe our efforts in repurposing a low-cost 3D printer as a platform that can carry out medium-throughput, rapid, and high-performing nucleic acid extraction. Next, we address how these purified templates can be rapidly amplified and analyzed using the 3D printer's heated bed or the deconstructed, low-cost thermal cycler we have developed. In both approaches, real-time isothermal amplification and detection of template DNA or RNA can be accomplished using a low-cost portable detector or smartphone camera. Last, we demonstrate the capability of our technologies using foodborne pathogens and the Zika virus. Our low-cost approach does not employ complicated and high-cost components, making it suitable for resource-limited settings. When integrated and commercialized, it will offer simple sample-to-answer molecular diagnostics. Copyright © 2018 Elsevier Inc. All rights reserved.
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Klingler, Corinna; in der Schmitten, Jürgen; Marckmann, Georg
2016-05-01
While there is increasing evidence that Advance Care Planning has the potential to strengthen patient autonomy and improve quality of care near the end of life, it remains unclear whether it could also reduce net costs of care. This study aims to describe the cost implications of Advance Care Planning programmes and discusses ethical conflicts arising in this context. We conducted a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. We systematically searched the databases PubMed, NHS EED, EURONHEED, Cochrane Library and EconLit. We included empirical studies (no limitation to study type) that investigated the cost implications of Advance Care Planning programmes involving professionally facilitated end-of-life discussions. Seven studies met our inclusion criteria. Four of them used a randomised controlled design, one used a before-after design and two were observational studies. Six studies found reductions in costs of care ranging from USD1041 to USD64,827 per patient, depending on the study period and the cost measurement. One study detected no differences in costs. Studies varied considerably regarding the Advance Care Planning intervention, patient selection and costs measured which may explain some of the variations in findings. Looking at the impact of Advance Care Planning on costs raises delicate ethical issues. Given the increasing pressure to reduce expenditures, there may be concerns that cost considerations could unduly influence the sensitive communication process, thus jeopardising patient autonomy. Safeguards are proposed to reduce these risks. The limited data indicate net cost savings may be realised with Advance Care Planning. Methodologically robust trials with clearly defined Advance Care Planning interventions are needed to make the costs and returns of Advance Care Planning transparent. © The Author(s) 2015.
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42 CFR 441.155 - Individual plan of care.
Code of Federal Regulations, 2014 CFR
2014-10-01
... 42 Public Health 4 2014-10-01 2014-10-01 false Individual plan of care. 441.155 Section 441.155 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Individual plan of care. (a) “Individual plan of care” means a written plan developed for each beneficiary in...
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42 CFR 441.155 - Individual plan of care.
Code of Federal Regulations, 2013 CFR
2013-10-01
... 42 Public Health 4 2013-10-01 2013-10-01 false Individual plan of care. 441.155 Section 441.155 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Individual plan of care. (a) “Individual plan of care” means a written plan developed for each beneficiary in...
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42 CFR 441.155 - Individual plan of care.
Code of Federal Regulations, 2012 CFR
2012-10-01
... 42 Public Health 4 2012-10-01 2012-10-01 false Individual plan of care. 441.155 Section 441.155 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Individual plan of care. (a) “Individual plan of care” means a written plan developed for each beneficiary in...
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42 CFR 441.155 - Individual plan of care.
Code of Federal Regulations, 2011 CFR
2011-10-01
... 42 Public Health 4 2011-10-01 2011-10-01 false Individual plan of care. 441.155 Section 441.155 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Individual plan of care. (a) “Individual plan of care” means a written plan developed for each recipient in...
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Accuracy of computer-guided implantation in a human cadaver model.
Yatzkair, Gustavo; Cheng, Alice; Brodie, Stan; Raviv, Eli; Boyan, Barbara D; Schwartz, Zvi
2015-10-01
To examine the accuracy of computer-guided implantation using a human cadaver model with reduced experimental variability. Twenty-eight (28) dental implants representing 12 clinical cases were placed in four cadaver heads using a static guided implantation template. All planning and surgeries were performed by one clinician. All radiographs and measurements were performed by two examiners. The distance of the implants from buccal and lingual bone and mesial implant or tooth was analyzed at the apical and coronal levels, and measurements were compared to the planned values. No significant differences were seen between planned and implanted measurements. Average deviation of an implant from its planning radiograph was 0.8 mm, which is within the range of variability expected from CT analysis. Guided implantation can be used safely with a margin of error of 1 mm. © 2014 The Authors. Clinical Oral Implants Research Published by John Wiley & Sons Ltd.
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International Space Station Payload Training Overview
NASA Technical Reports Server (NTRS)
Underwood, Deborah B.; Noneman, Steven R.; Sanchez, Julie N.
2001-01-01
This paper describes payload crew training-related activities performed by NASA and the U.S. Payload Developer (PD) community for the International Space Station (ISS) Program. It describes how payloads will be trained and the overall training planning and integration process. The overall concept, definition, and template for payload training are described. The roles and responsibilities of individuals, organizations, and groups involved are discussed. The facilities utilized during payload training and the primary processes and activities performed to plan, develop, implement, and administer payload training for ISS crews are briefly described. Areas of improvement to crew training processes that have been achieved or are currently being worked are identified.
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... Speech Pathology Occupational Therapy Art Therapy Recreational therapy Neuropsychology Home Care Options Advanced Care Planning Palliative Care ... Speech Pathology Occupational Therapy Art Therapy Recreational therapy Neuropsychology Home Care Options Advanced Care Planning Palliative Care ...
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Kilbourne, Amy M; Nord, Kristina M; Kyle, Julia; Van Poppelen, Celeste; Goodrich, David E; Kim, Hyungjin Myra; Eisenberg, Daniel; Un, Hyong; Bauer, Mark S
2014-01-01
Mood disorders represent the most expensive mental disorders for employer-based commercial health plans. Collaborative care models are effective in treating chronic physical and mental illnesses at little to no net healthcare cost, but to date have primarily been implemented by larger healthcare organizations in facility-based models. The majority of practices providing commercially insured care are far too small to implement such models. Health plan-level collaborative care treatment can address this unmet need. The goal of this study is to implement at the national commercial health plan level a collaborative care model to improve outcomes for persons with mood disorders. A randomized controlled trial of a collaborative care model versus usual care will be conducted among beneficiaries of a large national health plan from across the country seen by primary care or behavioral health practices. At discharge 344 patients identified by health plan claims as hospitalized for unipolar depression or bipolar disorder will be randomized to receive collaborative care (patient phone-based self-management support, care management, and guideline dissemination to practices delivered by a plan-level care manager) or usual care from their provider. Primary outcomes are changes in mood symptoms and mental health-related quality of life at 12 months. Secondary outcomes include rehospitalization, receipt of guideline-concordant care, and work productivity. This study will determine whether a collaborative care model for mood disorders delivered at the national health plan level improves outcomes compared to usual care, and will inform a business case for collaborative care models for these settings that can reach patients wherever they receive treatment. ClinicalTrials.gov Identifier: NCT02041962; registered January 3, 2014.
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Corporate buying of health care plans: a framework for marketing theory and practice.
Lindenmuth, L J; Burger, P C
1990-06-01
Much of the research in health care plan and provider selection has focused on the patient's selection process. The authors report on the increasing need to understand the corporation's decision process in selecting health care plans and providers. Managed care marketers need to understand this process in order to design and market such plans successfully.
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Administrative decision making: a stepwise method.
Oetjen, Reid M; Oetjen, Dawn M; Rotarius, Timothy
2008-01-01
Today's health care organizations face tremendous challenges and fierce competition. These pressures impact the decisions that managers must execute on any given day, not to mention the ever-present constraints of time, personnel, competencies, and finances. The importance of making quality and informed decisions cannot be underestimated. Traditional decision making methods are inadequate for today's larger, more complex health care organizations and the rapidly changing health care environment. As a result, today's health care managers and their teams need new approaches to making decisions for their organizations. This article examines the managerial decision making process and offers a model that can be used as a decision making template to help managers successfully navigate the choppy health care seas. The administrative decision making model will enable health care managers and other key decision makers to avoid the common pitfalls of poor decision making and guide their organizations to success.
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Farrell, Timothy W; Supiano, Katherine P; Wong, Bob; Luptak, Marilyn K; Luther, Brenda; Andersen, Troy C; Wilson, Rebecca; Wilby, Frances; Yang, Rumei; Pepper, Ginette A; Brunker, Cherie P
2018-05-01
Health professions trainees' performance in teams is rarely evaluated, but increasingly important as the healthcare delivery systems in which they will practice move towards team-based care. Effective management of care transitions is an important aspect of interprofessional teamwork. This mixed-methods study used a crossover design to randomise health professions trainees to work as individuals and as teams to formulate written care transition plans. Experienced external raters assessed the quality of the written care transition plans as well as both the quality of team process and overall team performance. Written care transition plan quality did not vary between individuals and teams (21.8 vs. 24.4, respectively, p = 0.42). The quality of team process did not correlate with the quality of the team-generated written care transition plans (r = -0.172, p = 0.659). However, there was a significant correlation between the quality of team process and overall team performance (r = 0.692, p = 0.039). Teams with highly engaged recorders, performing an internal team debrief, had higher-quality care transition plans. These results suggest that high-quality interprofessional care transition plans may require advance instruction as well as teamwork in finalising the plan.
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Patient-reported denials, appeals, and complaints: associations with overall plan ratings.
Quigley, Denise D; Haviland, Amelia M; Dembosky, Jacob W; Klein, David J; Elliott, Marc N
2018-03-01
To assess whether Medicare patients' reports of denied care, appeals/complaints, and satisfactory resolution were associated with ratings of their health plan or care. Retrospective analysis of 2010 Medicare Advantage Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data. Multivariate linear regression of data from 154,766 respondents (61.1% response rate) tested the association of beneficiary ratings of plan and care with beneficiary reports of denied care, appeals, complaints, and complaint resolution, adjusting for beneficiary demographics. Beneficiaries who reported being denied needed care rated their plans and care significantly less positively, by 17.2 points (on a 100-point scale) and 9.1 points, respectively. Filing an appeal was not statistically significantly associated with further lower ratings. Beneficiaries who filed a complaint that was satisfactorily resolved gave slightly lower ratings of plans (-3.4 points) and care (-2.5 points) than those not filing a complaint (P <.001 for all results). Lower ratings from patients reporting complaints and denied care may notably affect the overall 0-10 CAHPS ratings of Medicare Advantage plans. Our results suggest that beneficiaries may attribute the actions that lead to complaints or denials to plans more than to the care they received. Successful complaint resolution and utilization management review might eliminate most deficits associated with complaints and denied care, consistent with the service recovery paradox. High rates of complaints and denied care might identify areas that need improved utilization management review, customer service, and quality improvement. Among those reporting being denied care, filing an appeal was not associated with lower patient ratings of plan or care.
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Ampe, Sophie; Sevenants, Aline; Coppens, Evelien; Spruytte, Nele; Smets, Tinne; Declercq, Anja; van Audenhove, Chantal
2015-05-01
To evaluate the effects of 'we DECide', an educational intervention for nursing home staff on shared decision-making in the context of advance care planning for residents with dementia. Advance care planning (preparing care choices for when persons no longer have decision-making capacity) is of utmost importance for nursing home residents with dementia, but is mostly not realized for this group. Advance care planning consists of discussing care choices and making decisions and corresponds to shared decision-making (the involvement of persons and their families in care and treatment decisions). This quasi-experimental pre-test-post-test study is conducted in 19 nursing homes (Belgium). Participants are nursing home staff. 'We DECide' focuses on three crucial moments for discussing advance care planning: the time of admission, crisis situations and everyday conversations. The 'ACP-audit' assesses participants' views on the organization of advance care planning (organizational level), the 'OPTION scale' evaluates the degree of shared decision-making in individual conversations (clinical level) and the 'IFC-SDM Questionnaire' assesses participants' views on Importance, Frequency and Competence of realizing shared decision-making (clinical level). (Project funded: July 2010). The study hypothesis is that 'we DECide' results in a higher realization of shared decision-making in individual conversations on advance care planning. A better implementation of advance care planning will lead to a higher quality of end-of-life care and more person-centred care. We believe our study will be of interest to researchers and to professional nursing home caregivers and policy-makers. © 2014 John Wiley & Sons Ltd.
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Street, Maryann; Ottmann, Goetz; Johnstone, Megan-Jane; Considine, Julie; Livingston, Patricia M
2015-09-01
The purpose of this retrospective, cross-sectional study was to determine the prevalence of advance care planning (ACP) among older people presenting to an Emergency Department (ED) from the community or a residential aged care facility. The study sample comprised 300 older people (aged 65+ years) presenting to three Victorian EDs in 2011. A total of 150 patients transferred from residential aged care to ED were randomly selected and then matched to 150 people who lived in the community and attended the ED by age, gender, reason for ED attendance and triage category on arrival. Overall prevalence of ACP was 13.3% (n = 40/300); over one-quarter (26.6%, n = 40/150) of those presenting to the ED from residential aged care had a documented Advance Care Plan, compared to none (0%, n = 0/150) of the people from the community. There were no significant differences in the median ED length of stay, number of investigations and interventions undertaken in ED, time seen by a doctor or rate of hospital admission for those with an Advance Care Plan compared to those without. Those with a comorbidity of cerebrovascular disease or dementia and those assessed with impaired brain function were more likely to have a documented Advance Care Plan on arrival at ED. Length of hospital stay was shorter for those with an Advance Care Plan [median (IQR) = 3 days (2-6) vs. 6 days (2-10), P = 0.027] and readmission lower (0% vs. 13.7%). In conclusion, older people from the community transferred to ED were unlikely to have a documented Advance Care Plan. Those from residential aged care who were cognitively impaired more frequently had an Advance Care Plan. In the ED, decisions of care did not appear to be influenced by the presence or absence of Advance Care Plans, but length of hospital admission was shorter for those with an Advance Care Plan. © 2014 John Wiley & Sons Ltd.
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Small, Nicola; Brooks, Helen; Grundy, Andrew; Pedley, Rebecca; Gibbons, Chris; Lovell, Karina; Bee, Penny
2017-04-13
People with severe mental illness suffer more physical comorbidity than the general population, which can require a tailored approach to physical health care discussions within mental health care planning. Although evidence pertaining to service user and carer involvement in mental health care planning is accumulating, current understanding of how physical health is prioritised within this framework is limited. Understanding stakeholder experiences of physical health discussions within mental health care planning, and the key domains that underpin this phenomena is essential to improve quality of care. Our study aimed to explore service user, carer and professional experiences of and preferences for service user and carer involvement in physical health discussions within mental health care planning, and develop a conceptual framework of effective user-led involvement in this aspect of service provision. Six focus groups and four telephone interviews were carried out with twelve service users, nine carers, three service users with a dual service user and carer role, and ten mental health professionals recruited from one mental health Trust in the United Kingdom. Data was analysed utilising a thematic approach, analysed separately for each stakeholder group, and combined to aid comparisons. No service users or carers recalled being explicitly involved in physical health discussions within mental health care planning. Six prerequisites for effective service user and carer involvement in physical care planning were identified. Three themes confirmed general mental health care planning requirements: tailoring a collaborative working relationship, maintaining a trusting relationship with a professional, and having access to and being able to edit a living document. Three themes were novel to feeling involved in physical health care planning discussions: valuing physical health equally with mental health; experiencing coordination of care between physical-mental health professionals, and having a physical health discussion that is personalised. High quality physical health care discussions within the care planning process demands action at multiple levels. A conceptual framework is presented which provides an evidence-based foundation for service level improvement. Further work is necessary to develop a new patient reported outcome measure to enable meaningful quantification of health care quality and patient experience.
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Applications of patient-specific 3D printing in medicine.
Heller, Martin; Bauer, Heide-Katharina; Goetze, Elisabeth; Gielisch, Matthias; Roth, Klaus E; Drees, Philipp; Maier, Gerrit S; Dorweiler, Bernhard; Ghazy, Ahmed; Neufurth, Meik; Müller, Werner E G; Schröder, Heinz C; Wang, Xiaohong; Vahl, Christian-Friedrich; Al-Nawas, Bilal
Already three decades ago, the potential of medical 3D printing (3DP) or rapid prototyping for improved patient treatment began to be recognized. Since then, more and more medical indications in different surgical disciplines have been improved by using this new technique. Numerous examples have demonstrated the enormous benefit of 3DP in the medical care of patients by, for example, planning complex surgical interventions preoperatively, reducing implantation steps and anesthesia times, and helping with intraoperative orientation. At the beginning of every individual 3D model, patient-specific data on the basis of computed tomography (CT), magnetic resonance imaging (MRI), or ultrasound data is generated, which is then digitalized and processed using computer-aided design/computer-aided manufacturing (CAD/CAM) software. Finally, the resulting data sets are used to generate 3D-printed models or even implants. There are a variety of different application areas in the various medical fields, eg, drill or positioning templates, or surgical guides in maxillofacial surgery, or patient-specific implants in orthopedics. Furthermore, in vascular surgery it is possible to visualize pathologies such as aortic aneurysms so as to improve the planning of surgical treatment. Although rapid prototyping of individual models and implants is already applied very successfully in regenerative medicine, most of the materials used for 3DP are not yet suitable for implantation in the body. Therefore, it will be necessary in future to develop novel therapy approaches and design new materials in order to completely reconstruct natural tissue.
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Klie, T; Pfundstein, T
2010-04-01
In times of demographic and social change, it is increasingly important to ensure the availability of care services to cover the growing demand. With the implementation of the German long-term insurance act in 1994, the responsibility of states and municipalities was maintained; however, given the long-term care legislation's market orientation and competition neutrality, the classic instruments for demand planning and supervision of infrastructure developments were lost. This leads to new challenges for states and municipalities: their conventional objective-oriented planning lacks professional and juridical legitimization. Calculations of requirements must relate to methodology and professional expertise. In order to exercise their influence on infrastructure development, instruments of demand planning other than subsidization are required. Using the example of Rheinland-Pfalz (Rhineland-Palatinate) and the newly implemented care structure planning, the concept of care monitoring is introduced, and instruments to influence infrastructure development are outlined.
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Reid, Rebecca; Escott, Phil; Isobel, Sophie
2018-04-14
This qualitative study explores inpatient mental health consumer perceptions of how collaborative care planning with mental health nurses impacts personal recovery. Semi-structured interviews were conducted with consumers close to discharge from one unit in Sydney, Australia. The unit had been undertaking a collaborative care planning project which encouraged nurses to use care plan documentation to promote person-centred and goal-focussed interactions and the development of meaningful strategies to aid consumer recovery. The interviews explored consumer understandings of the collaborative care planning process, perceptions of the utility of the care plan document and the process of collaborating with the nurses, and their perception of the impact of collaboration on their recovery. Findings are presented under four organizing themes: the process of collaborating, the purpose of collaborating, the nurse as collaborator and the role of collaboration in wider care and recovery. Consumers highlighted the importance of the process of developing their care plan with a nurse as being as helpful for recovery as the goals and strategies themselves. The findings provide insights into consumers' experiences of care planning in an acute inpatient unit, the components of care that support recovery and highlight specific areas for mental health nursing practice improvement in collaboration. © 2018 Australian College of Mental Health Nurses Inc.
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Adversaries at the Bedside: Advance Care Plans and Future Welfare.
Kestigian, Aidan; London, Alex John
2016-10-01
Advance care planning refers to the process of determining how one wants to be cared for in the event that one is no longer competent to make one's own medical decisions. Some have argued that advance care plans often fail to be normatively binding on caretakers because those plans do not reflect the interests of patients once they enter an incompetent state. In this article, we argue that when the core medical ethical principles of respect for patient autonomy, honest and adequate disclosure of information, institutional transparency, and concern for patient welfare are upheld, a policy that would allow for the disregard of advance care plans is self-defeating. This is because when the four principles are upheld, a patient's willingness to undergo treatment depends critically on the willingness of her caretakers to honor the wishes she has outlined in her advance care plan. A patient who fears that her caretakers will not honor her wishes may choose to avoid medical care so as to limit the influence of her caretakers in the future, which may lead to worse medical outcomes than if she had undergone care. In order to avoid worse medical outcomes and uphold the four core principles, caregivers who are concerned about the future welfare of their patients should focus on improving advance care planning and commit to honoring their patients' advance care plans. © 2016 John Wiley & Sons Ltd.
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Development and implementation of an interdisciplinary plan of care.
Lewis, Cynthia; Hoffmann, Mary Lou; Gard, Angela; Coons, Jacqueline; Bichinich, Pat; Euclid, Jeff
2005-01-01
In January 2002 Aurora Health Care Metro Region chartered an interdisciplinary team to develop a process and structure for patient-centered interdisciplinary care planning. This unique endeavor created a process that includes the patient, family, and all clinical disciplines involved in planning and providing care to patients from system point of entry throughout the entire acute care episode. The interdisciplinary plan of care (IPOC) demonstrates the integration of prioritized problems, outcomes, and measurement toward goal attainment. This article focuses on the journey of this team to the successful implementation of an IPOC.
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Code of Federal Regulations, 2012 CFR
2012-10-01
... required for intermediate care facility services. 456.401 Section 456.401 Public Health CENTERS FOR...: General Requirement § 456.401 State plan UR requirements and options; UR plan required for intermediate care facility services. (a) The State plan must provide that— (1) UR is performed for each ICF that...
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Code of Federal Regulations, 2010 CFR
2010-10-01
... required for intermediate care facility services. 456.401 Section 456.401 Public Health CENTERS FOR...: General Requirement § 456.401 State plan UR requirements and options; UR plan required for intermediate care facility services. (a) The State plan must provide that— (1) UR is performed for each ICF that...
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Code of Federal Regulations, 2013 CFR
2013-10-01
... required for intermediate care facility services. 456.401 Section 456.401 Public Health CENTERS FOR...: General Requirement § 456.401 State plan UR requirements and options; UR plan required for intermediate care facility services. (a) The State plan must provide that— (1) UR is performed for each ICF that...
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The Con Edison Emergency Child Care Plan for Management Employees: Summary Plan Description.
ERIC Educational Resources Information Center
Consolidated Edison Co., Brooklyn, NY.
This summary plan description offers guidelines for participation in a pilot program that provides short-term emergency care for children of Con Edison managers who are under 13 years old. The plan offers professional, in-home child care that can be used when usual arrangements have collapsed. The summary plan description addresses the following…
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Delayed and forgone care for families with chronic conditions in high-deductible health plans.
Galbraith, Alison A; Soumerai, Stephen B; Ross-Degnan, Dennis; Rosenthal, Meredith B; Gay, Charlene; Lieu, Tracy A
2012-09-01
High-deductible health plans (HDHPs) are an increasingly common strategy to contain health care costs. Individuals with chronic conditions are at particular risk for increased out-of-pocket costs in HDHPs and resulting cost-related underuse of essential health care. To evaluate whether families with chronic conditions in HDHPs have higher rates of delayed or forgone care due to cost, compared with those in traditional health insurance plans. This mail and phone survey used multiple logistic regression to compare family-level rates of reporting delayed/forgone care in HDHPs vs. traditional plans. We selected families with children that had at least one member with a chronic condition. Families had employer-sponsored insurance in a Massachusetts health plan and >12 months of enrollment in an HDHP or a traditional plan. The primary outcome was report of any delayed or forgone care due to cost (acute care, emergency department visits, chronic care, checkups, or tests) for adults or children during the prior 12 months. Respondents included 208 families in HDHPs and 370 in traditional plans. Membership in an HDHP and lower income were each independently associated with higher probability of delayed/forgone care due to cost. For adult family members, the predicted probability of delayed/forgone care due to cost was higher in HDHPs than in traditional plans [40.0% vs 15.1% among families with incomes <400% of the federal poverty level (FPL) and 16.0% vs 4.8% among those with incomes ≥400% FPL]. Similar associations were observed for children. Among families with chronic conditions, reporting of delayed/forgone care due to cost is higher for both adults and children in HDHPs than in traditional plans. Families with lower incomes are also at higher risk for delayed/forgone care.
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Personalised Care Plan Management Utilizing Guideline-Driven Clinical Decision Support Systems.
Laleci Erturkmen, Gokce Banu; Yuksel, Mustafa; Sarigul, Bunyamin; Lilja, Mikael; Chen, Rong; Arvanitis, Theodoros N
2018-01-01
Older age is associated with an increased accumulation of multiple chronic conditions. The clinical management of patients suffering from multiple chronic conditions is very complex, disconnected and time-consuming with the traditional care settings. Integrated care is a means to address the growing demand for improved patient experience and health outcomes of multimorbid and long-term care patients. Care planning is a prevalent approach of integrated care, where the aim is to deliver more personalized and targeted care creating shared care plans by clearly articulating the role of each provider and patient in the care process. In this paper, we present a method and corresponding implementation of a semi-automatic care plan management tool, integrated with clinical decision support services which can seamlessly access and assess the electronic health records (EHRs) of the patient in comparison with evidence based clinical guidelines to suggest personalized recommendations for goals and interventions to be added to the individualized care plans.
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ERIC Educational Resources Information Center
Bureau of Indian Education, 2011
2011-01-01
The Bureau of Indian Education (BIE) funds schools located on 63 reservations in 23 states across the nation. Of the 183 schools, 59 are Bureau operated and 124 are tribally controlled. One-hundred and sixteen schools provide instructional programs, 55 provide instructional as well as boarding services and 12 peripheral dormitories provide only…
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ERIC Educational Resources Information Center
Morgan, Shona D.; Stewart, Alice C.
2017-01-01
The purpose of this brief is twofold. First, it describes a useful template for business instructors to improve teamwork assignment design and efficacy; and second, it provides an example of how to use data collected and analyzed from a Web-based tool, Comprehensive Assessment of Team Member Effectiveness (CATME). Though CATME has been the subject…
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ERIC Educational Resources Information Center
Bureau of Indian Education, 2012
2012-01-01
The Bureau of Indian Education (BIE) funds schools located on 63 reservations in 23 states across the nation. Of the 183 schools, 59 are Bureau operated and 124 are tribally controlled. One-hundred and sixteen schools provide instructional programs, 55 provide instructional as well as boarding services and 12 peripheral dormitories provide only…
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Sale, Joanna E M; Cameron, Cathy; Thielke, Stephen; Meadows, Lynn; Senior, Kevin
2017-06-01
Our objective was to ascertain whether the Theory of Planned Behaviour (TPB) explains patient intentions to use antiresorptive medication after a fracture. A qualitative study was conducted with English-speaking members of the Canadian Osteoporosis Patient Network (COPN) who had sustained a fragility fracture at 50+ years of age and were not taking antiresorptive medication at the time of that fracture. Questions during a 1-h telephone interview were guided by the domains of the TPB: they addressed the antecedent constructs regarding antiresorptive medication (attitudes, subjective norms, and perceived behavioural control) as well as intentions regarding antiresorptive medication use. We created a coding template a priori based on the TPB domains and applied this template to the interview data. Twenty-six eligible participants (24 females, 2 males) aged 51-89 completed an interview. The TPB appeared to be predictive of intentions in 19 (73%) participants. In the majority of participants where the TPB did not appear to be predictive (57%), a positive attitude toward antiresorptive medication was the most important antecedent variable in determining intentions. The TPB appeared to be predictive of intentions to use antiresorptive medication among individuals who had experienced a fragility fracture. Attitudes towards medication were especially important.
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Fehrenbacher, Lynne; McDevitt, Kimberly; Palmer, Matthew; Traynor, Laura; Boero, Joe; Crnich, Christopher
2017-01-01
Abstract Background One of the CDC core elements of antimicrobial stewardship in nursing homes emphasizes the promotion of clinical practice change and integration of the dispensing and consultant pharmacist to improve antibiotic use. An opportunity to support this element is via collaborative practice agreements (CPA). A CPA is a voluntary agreement between one or more prescribers and pharmacists which delegates physician authority under defined conditions and/or limitations toward a common goal. The Wisconsin Healthcare-Associated Infections (HAI) in Long-term Care (LTC) Coalition aims to reduce and eliminate HAIs among LTC residents. A coalition emphasis has been to educate caregivers about appropriate evaluation and treatment of suspected urinary tract infection (UTI). Given this focus, we targeted the same cohort for CPA design. Methods A literature review resulted in no report of CPAs being applied to LTC residents on antibiotics for UTI. Recognizing the dispensing and consultant pharmacist role varies by organization, we drafted a multi-layered CPA that can be customized by facility. The draft was reviewed by physicians, pharmacists, and nurses with expertise in infectious diseases, LTC, and CPAs. Through frequent meetings and collaborative editing, consensus was achieved. The final CPA includes antibiotic renal dose adjustment, discontinuation of antibiotics in asymptomatic patients with negative urinalysis or culture, and oral antibiotic modification based on organism susceptibility. Results The CPA template is supported by the WI HAI in LTC Coalition. It has been presented at the state level and is available for use by LTC facilities and pharmacists that may apply any/all level(s) of the CPA. An organization policy template and initial CPA competency for pharmacists have been designed to support implementation. Committed pilot sites have been identified. Conclusion A CPA is an innovative approach to expand the role of the dispensing and consultant pharmacist in antimicrobial stewardship initiatives in the LTC setting. Using an expert panel to develop templated resources that can be customized at the facility level may assist pharmacists and LTC providers in moving forward with this type of clinical practice change. Disclosures All authors: No reported disclosures.
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Applying the plan-do-study-act model to increase the use of kangaroo care.
Stikes, Reetta; Barbier, Denise
2013-01-01
To increase the rate of participation in kangaroo care within a level III neonatal intensive care unit. Preterm birth typically results in initial separation of mother and infant which may disrupt the bonding process. Nurses within the neonatal intensive care unit can introduce strategies that will assist parents in overcoming fears and developing relationships with their infants. Kangaroo care is a method of skin-to-skin holding that has been shown to enhance the mother-infant relationship while also improving infant outcomes. However, kangaroo care has been used inconsistently within neonatal intensive care unit settings. The Plan-Do-Study-Act Model was used as a framework for this project. Plan-Do-Study-Act Model uses four cyclical steps for continuous quality improvement. Based upon Plan-Do-Study-Act Model, education was planned, surveys were developed and strategies implemented to overcome barriers. Four months post-implementation, the use of kangaroo care increased by 31%. Staff surveys demonstrated a decrease in the perceived barriers to kangaroo care as well as an increase in kangaroo care. Application of Plan-Do-Study-Act Model was successful in meeting the goal of increasing the use of kangaroo care. The use of the Plan-Do-Study-Act Model framework encourages learning, reflection and validation throughout implementation. Plan-Do-Study-Act Model is a strategy that can promote the effective use of innovative practices in nursing. © 2013 Blackwell Publishing Ltd.
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Robotic Needle Guide for Prostate Brachytherapy: Clinical Testing of Feasibility and Performance
Song, Danny Y; Burdette, Everette C; Fiene, Jonathan; Armour, Elwood; Kronreif, Gernot; Deguet, Anton; Zhang, Zhe; Iordachita, Iulian; Fichtinger, Gabor; Kazanzides, Peter
2010-01-01
Purpose Optimization of prostate brachytherapy is constrained by tissue deflection of needles and fixed spacing of template holes. We developed and clinically tested a robotic guide towards the goal of allowing greater freedom of needle placement. Methods and Materials The robot consists of a small tubular needle guide attached to a robotically controlled arm. The apparatus is mounted and calibrated to operate in the same coordinate frame as a standard template. Translation in x and y directions over the perineum ±40mm are possible. Needle insertion is performed manually. Results Five patients were treated in an IRB-approved study. Confirmatory measurements of robotic movements for initial 3 patients using infrared tracking showed mean error of 0.489 mm (SD 0.328 mm). Fine adjustments in needle positioning were possible when tissue deflection was encountered; adjustments were performed in 54/179 (30.2%) needles placed, with 36/179 (20.1%) adjustments of > 2mm. Twenty-seven insertions were intentionally altered to positions between the standard template grid to improve the dosimetric plan or avoid structures such as pubic bone and blood vessels. Conclusions Robotic needle positioning provided a means of compensating for needle deflections as well as the ability to intentionally place needles into areas between the standard template holes. To our knowledge, these results represent the first clinical testing of such a system. Future work will be incorporation of direct control of the robot by the physician, adding software algorithms to help avoid robot collisions with the ultrasound, and testing the angulation capability in the clinical setting. PMID:20729152
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The economic evidence for advance care planning: Systematic review of evidence.
Dixon, Josie; Matosevic, Tihana; Knapp, Martin
2015-12-01
Advance care planning is a process of discussion and review concerning future care in the event of losing capacity. Aimed at improving the appropriateness and quality of care, it is also often considered a means of making better use of healthcare resources at the end of life. To review and summarise economic evidence on advance care planning. A systematic review of the academic literature. We searched for English language, peer-reviewed journal articles, 1990-2014, using relevant research databases: PubMed, ProQuest, CINAHL Plus with Full Text; EconLit, PsycINFO, SocINDEX with Full Text and International Bibliography of the Social Sciences. Empirical studies using statistical methods in which advance care planning and costs are variables were included. There are no published cost-effectiveness studies. Included studies focus on healthcare savings, usually associated with reduced demand for hospital care. Advance care planning appears to be associated with healthcare savings for some people in some circumstances, such as people living with dementia in the community, people in nursing homes or in areas with high end-of-life care spending. There is no evidence that advance care planning is likely to be more expensive. There is need for clearer articulation of the likely mechanisms by which advance care planning can lead to reduced care costs or improved cost-effectiveness, particularly for people who retain capacity. There is also a need to consider wider costs, including the costs of advance care planning facilitation or interventions and the costs of substitute health, social and informal care. Economic outcomes need to be considered in the context of quality benefits. © The Author(s) 2015.
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TEMPLATES: Targeting Extremely Magnified Panchromatic Lensed Arcs and Their Extended Star formation
NASA Astrophysics Data System (ADS)
Spilker, Justin; Rigby, Jane R.; Vieira, Joaquin D.; TEMPLATES Team
2018-06-01
TEMPLATES is a JWST Early Release Science program designed to produce high signal-to-noise imaging and IFU spectroscopic data cubes for four gravitationally lensed galaxies at high redshift. The program will spatially resolve the star formation in galaxies across the peak of cosmic star formation in an extinction-robust manner. Lensing magnification pushes JWST to the highest spatial resolutions possible at these redshifts, to map the key spectral diagnostics of star formation and dust extinction: H-alpha, Pa-alpha, and 3.3um PAH emission within individual distant galaxies. Our targets are among the brightest, best-characterized lensed systems known, and include both UV-bright 'normal' galaxies and heavily dust-obscured submillimeter galaxies, at a range of stellar masses and luminosities. I will describe the scientific motivation for this program, detail the targeted galaxies, and describe the planned data products to be delivered to the community in advance of JWST Cycle 2.
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Consider long-term care as service alternative.
Loria, L S
1987-04-01
The increasing demand for elderly care services, pressures on inpatient average length of stay and payment levels, and potential financial rewards from providing additional services, makes long-term care look attractive to hospitals. Long-term care, however, is not for every hospital. Before deciding to establish long-term care services, management should examine how the service fits within the hospital's strategic plan. The action plan below provides guidance in evaluating a decision to use hospital facilities for long-term care. Examine how long-term care services fit within the hospital's strategic plan. Study area demographics and competitors to assess the need and supply of long-term care services. Survey the medical staff, consumers and payers to determine attitudes, perceptions and interests regarding long-term care services. Develop a facility plan that identifies areas of excess capacity that can be most easily converted into long-term care with minimal effects on hospital operations. Prepare a financial feasibility analysis of the contribution margin and return on investment attributable to long-term care services. Include an impact analysis on hospital operations. Establish a management task force to develop a detailed implementation plan including assigned individual responsibilities and related timetable. Develop an effective marketing plan designed to generate increased patient market share.
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ERIC Educational Resources Information Center
Kontos, Pia C.; Miller, Karen-Lee; Mitchell, Gail J.
2010-01-01
Purpose: The Resident Assessment Instrument-Minimum Data Set (RAI/MDS) is an interdisciplinary standardized process that informs care plan development in nursing homes. This standardized process has failed to consistently result in individualized care planning, which may suggest problems with content and planning integrity. We examined the…
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Mittler, Jessica N; Landon, Bruce E; Zaslavsky, Alan M; Cleary, Paul D
2011-10-14
Medicare beneficiaries' awareness of Medicare managed care plans is critical for realizing the potential benefits of coverage choices. To assess the relationships of the number of Medicare risk plans, managed care penetration, and stability of plans in an area with traditional Medicare beneficiaries' awareness of the program. Cross-sectional analysis of Medicare Current Beneficiary Survey data about beneficiaries' awareness and knowledge of Medicare managed care plan availability. Logistic regression models used to assess the relationships between awareness and market characteristics. Traditional Medicare beneficiaries (n = 3,597) who had never been enrolled in Medicare managed care, but had at least one plan available in their area in 2002, and excluding beneficiaries under 65, receiving Medicaid, or with end stage renal disease. Traditional Medicare beneficiaries' knowledge of Medicare managed care plans in general and in their area. Having more Medicare risk plans available was significantly associated with greater awareness, and having an intermediate number of plans (2-4) was significantly associated with more accurate knowledge of Medicare risk plan availability than was having fewer or more plans. Medicare may have more success engaging consumers in choice and capturing the benefits of plan competition by more actively selecting and managing the plan choice set. Public Domain.
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Mittler, Jessica N.; Landon, Bruce E.; Zaslavsky, Alan M.; Cleary, Paul D.
2011-01-01
Background Medicare beneficiaries' awareness of Medicare managed care plans is critical for realizing the potential benefits of coverage choices. Objectives To assess the relationships of the number of Medicare risk plans, managed care penetration, and stability of plans in an area with traditional Medicare beneficiaries' awareness of the program. Research Design Cross-sectional analysis of Medicare Current Beneficiary Survey data about beneficiaries' awareness and knowledge of Medicare managed care plan availability. Logistic regression models used to assess the relationships between awareness and market characteristics. Subjects Traditional Medicare beneficiaries (n = 3,597) who had never been enrolled in Medicare managed care, but had at least one plan available in their area in 2002, and excluding beneficiaries under 65, receiving Medicaid, or with end stage renal disease. Measures Traditional Medicare beneficiaries' knowledge of Medicare managed care plans in general and in their area. Results Having more Medicare risk plans available was significantly associated with greater awareness, and having an intermediate number of plans (2-4) was significantly associated with more accurate knowledge of Medicare risk plan availability than was having fewer or more plans. Conclusions Medicare may have more success engaging consumers in choice and capturing the benefits of plan competition by more actively selecting and managing the plan choice set. PMID:22340776
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Zhang, Xiaoyan; Kim, Daeseung; Shen, Shunyao; Yuan, Peng; Liu, Siting; Tang, Zhen; Zhang, Guangming; Zhou, Xiaobo; Gateno, Jaime
2017-01-01
Accurate surgical planning and prediction of craniomaxillofacial surgery outcome requires simulation of soft tissue changes following osteotomy. This can only be achieved by using an anatomically detailed facial soft tissue model. The current state-of-the-art of model generation is not appropriate to clinical applications due to the time-intensive nature of manual segmentation and volumetric mesh generation. The conventional patient-specific finite element (FE) mesh generation methods are to deform a template FE mesh to match the shape of a patient based on registration. However, these methods commonly produce element distortion. Additionally, the mesh density for patients depends on that of the template model. It could not be adjusted to conduct mesh density sensitivity analysis. In this study, we propose a new framework of patient-specific facial soft tissue FE mesh generation. The goal of the developed method is to efficiently generate a high-quality patient-specific hexahedral FE mesh with adjustable mesh density while preserving the accuracy in anatomical structure correspondence. Our FE mesh is generated by eFace template deformation followed by volumetric parametrization. First, the patient-specific anatomically detailed facial soft tissue model (including skin, mucosa, and muscles) is generated by deforming an eFace template model. The adaptation of the eFace template model is achieved by using a hybrid landmark-based morphing and dense surface fitting approach followed by a thin-plate spline interpolation. Then, high-quality hexahedral mesh is constructed by using volumetric parameterization. The user can control the resolution of hexahedron mesh to best reflect clinicians’ need. Our approach was validated using 30 patient models and 4 visible human datasets. The generated patient-specific FE mesh showed high surface matching accuracy, element quality, and internal structure matching accuracy. They can be directly and effectively used for clinical simulation of facial soft tissue change. PMID:29027022
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WE-DE-201-08: Multi-Source Rotating Shield Brachytherapy Apparatus for Prostate Cancer
DOE Office of Scientific and Technical Information (OSTI.GOV)
Dadkhah, H; Wu, X; Kim, Y
Purpose: To introduce a novel multi-source rotating shield brachytherapy (RSBT) apparatus for the precise simultaneous angular and linear positioning of all partially-shielded 153Gd radiation sources in interstitial needles for treating prostate cancer. The mechanism is designed to lower the detrimental dose to healthy tissues, the urethra in particular, relative to conventional high-dose-rate brachytherapy (HDR-BT) techniques. Methods: Following needle implantation, the delivery system is docked to the patient template. Each needle is coupled to a multi-source afterloader catheter by a connector passing through a shaft. The shafts are rotated by translating a moving template between two stationary templates. Shaft walls asmore » well as moving template holes are threaded such that the resistive friction produced between the two parts exerts enough force on the shafts to bring about the rotation. Rotation of the shaft is then transmitted to the shielded source via several keys. Thus, shaft angular position is fully correlated with the position of the moving template. The catheter angles are simultaneously incremented throughout treatment as needed, and only a single 360° rotation of all catheters is needed for a full treatment. For each rotation angle, source depth in each needle is controlled by a multi-source afterloader, which is proposed as an array of belt-driven linear actuators, each of which drives a source wire. Results: Optimized treatment plans based on Monte Carlo dose calculations demonstrated RSBT with the proposed apparatus reduced urethral D{sub 1cc} below that of conventional HDR-BT by 35% for urethral dose gradient volume within 3 mm of the urethra surface. Treatment time to deliver 20 Gy with multi-source RSBT apparatus using nineteen 62.4 GBq {sup 153}Gd sources is 117 min. Conclusions: The proposed RSBT delivery apparatus in conjunction with multiple nitinol catheter-mounted platinum-shielded {sup 153}Gd sources enables a mechanically feasible urethra-sparing treatment technique for prostate cancer in a clinically reasonable timeframe.« less
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Zhang, Xiaoyan; Kim, Daeseung; Shen, Shunyao; Yuan, Peng; Liu, Siting; Tang, Zhen; Zhang, Guangming; Zhou, Xiaobo; Gateno, Jaime; Liebschner, Michael A K; Xia, James J
2018-04-01
Accurate surgical planning and prediction of craniomaxillofacial surgery outcome requires simulation of soft tissue changes following osteotomy. This can only be achieved by using an anatomically detailed facial soft tissue model. The current state-of-the-art of model generation is not appropriate to clinical applications due to the time-intensive nature of manual segmentation and volumetric mesh generation. The conventional patient-specific finite element (FE) mesh generation methods are to deform a template FE mesh to match the shape of a patient based on registration. However, these methods commonly produce element distortion. Additionally, the mesh density for patients depends on that of the template model. It could not be adjusted to conduct mesh density sensitivity analysis. In this study, we propose a new framework of patient-specific facial soft tissue FE mesh generation. The goal of the developed method is to efficiently generate a high-quality patient-specific hexahedral FE mesh with adjustable mesh density while preserving the accuracy in anatomical structure correspondence. Our FE mesh is generated by eFace template deformation followed by volumetric parametrization. First, the patient-specific anatomically detailed facial soft tissue model (including skin, mucosa, and muscles) is generated by deforming an eFace template model. The adaptation of the eFace template model is achieved by using a hybrid landmark-based morphing and dense surface fitting approach followed by a thin-plate spline interpolation. Then, high-quality hexahedral mesh is constructed by using volumetric parameterization. The user can control the resolution of hexahedron mesh to best reflect clinicians' need. Our approach was validated using 30 patient models and 4 visible human datasets. The generated patient-specific FE mesh showed high surface matching accuracy, element quality, and internal structure matching accuracy. They can be directly and effectively used for clinical simulation of facial soft tissue change.
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Managed care innovation and new product development.
Clark, C S; Schuster, T B
1994-01-01
This article explores recent innovative activity by managed care payor plans nationwide with particular emphasis on emerging, new relationships between the plans and their purchasers, enrollees, provider panels, and competitors. Because they already practice what advocates of health care reform are now preaching, many managed care plans are leading the charge to transform our health care delivery and financing systems.
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Child Care and Education: The Critical Connection. Action Plan [and] Policy Statement.
ERIC Educational Resources Information Center
Child Care Action Campaign, New York, NY.
This document presents the action plan of the Child Care Action Campaign (CCAC) for improving the quantity and quality of child care services. The document also provides a policy statement on linking education and child care efforts. The action plan describes CCAC's vision of a streamlined system providing child care to infants and toddlers,…
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Integration of health and social care: a case of learning and knowledge management.
Williams, Paul M
2012-09-01
This paper considers integration of health and social care as an exercise in learning and knowledge management (KM). Integration assembles diverse actors and organisations in a collective effort to design and deliver new service models underpinned by multidisciplinary working and generic practice. Learning and KM are integral to this process. A critical review of the literature is undertaken to identify theoretical insights and models in this field, albeit grounded mainly in a private sector context. The findings from a research study involving two integrated services are then used to explore the role of, and approach to, learning and KM. This case study research was qualitative in nature and involved an interrogation of relevant documentary material, together with 25 in-depth interviews with a cross-section of strategic managers and professionals undertaken between March and May 2011. The evidence emerging indicated no planned strategies for learning and KM, but rather, interventions and mechanisms at different levels to support integration processes. These included formal activities, particularly around training and appraisal, but also informal ones within communities of practice and networking. Although structural enablers such as a co-location of facilities and joint appointments were important, the value of trust and inter-personal relationships was highlighted especially for tacit knowledge exchange. The infrastructure for learning and KM was constructed around a collaborative culture characterised by a coherent strategic framework; clarity of purpose based on new models of service; a collaborative leadership approach that was facilitative and distributed; and, a focus on team working to exploit the potential of multidisciplinary practice, generic working and integrated management. The discussion and conclusion use Nonaka's knowledge conversation model to reflect on the research findings, to comment on the absence of an explicit approach to learning and KM, and to develop a template to assist policy-makers with the design of planned strategies. © 2012 Blackwell Publishing Ltd.
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42 CFR 456.180 - Individual written plan of care.
Code of Federal Regulations, 2010 CFR
2010-10-01
... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Mental Hospitals Plan of Care § 456.180 Individual written plan of care. (a) Before admission to a mental hospital or...
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Privacy-protected biometric templates: acoustic ear identification
NASA Astrophysics Data System (ADS)
Tuyls, Pim T.; Verbitskiy, Evgeny; Ignatenko, Tanya; Schobben, Daniel; Akkermans, Ton H.
2004-08-01
Unique Biometric Identifiers offer a very convenient way for human identification and authentication. In contrast to passwords they have hence the advantage that they can not be forgotten or lost. In order to set-up a biometric identification/authentication system, reference data have to be stored in a central database. As biometric identifiers are unique for a human being, the derived templates comprise unique, sensitive and therefore private information about a person. This is why many people are reluctant to accept a system based on biometric identification. Consequently, the stored templates have to be handled with care and protected against misuse [1, 2, 3, 4, 5, 6]. It is clear that techniques from cryptography can be used to achieve privacy. However, as biometric data are noisy, and cryptographic functions are by construction very sensitive to small changes in their input, and hence one can not apply those crypto techniques straightforwardly. In this paper we show the feasibility of the techniques developed in [5], [6] by applying them to experimental biometric data. As biometric identifier we have choosen the shape of the inner ear-canal, which is obtained by measuring the headphone-to-ear-canal Transfer Functions (HpTFs) which are known to be person dependent [7].
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A prototype of a beam steering assistant tool for accelerator operations
DOE Office of Scientific and Technical Information (OSTI.GOV)
M. Bickley; P. Chevtsov
2006-10-24
The CEBAF accelerator provides nuclear physics experiments at Jefferson Lab with high quality electron beams. Three experimental end stations can simultaneously receive the beams with different energies and intensities. For each operational mode, the accelerator setup procedures are complicated and require very careful checking of beam spot sizes and positions on multiple beam viewers. To simplify these procedures and make them reproducible, a beam steering assistant GUI tool has been created. The tool is implemented as a multi-window control screen. The screen has an interactive graphical object window, which is an overlay on top of a digitized live video imagemore » from a beam viewer. It allows a user to easily create and edit any graphical objects consisting of text, ellipses, and lines, right above the live beam viewer image and then save them in a file that is called a beam steering template. The template can show, for example, the area within which the beam must always be on the viewer. Later, this template can be loaded in the interactive graphical object window to help accelerator operators steer the beam to the specified area on the viewer.« less
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A facile and low-cost micro fabrication material: flash foam.
He, Yong; Xiao, Xiao; Wu, Yan; Fu, Jian-zhong
2015-08-28
Although many microfabrication methods have been reported, the preliminary replication templates used in most microfabrication still depend on the expensive and long-period photolithography. This paper explores an alternative replication templates based on a daily used material, flash foam (FF), and proposes a facile microfabrication method, flash foam stamp lithography (FFSL). When FF is exposed with a desired pattern mask, the negative of the pattern is transferred to its surface and micro structures are formed due to the shrinkage of the exposed area. As FF is commonly used in personal stamps, FFSL is very simple and cost-effective. In this paper, we demonstrated that FF is a good and low-cost template for many micro fabrication methods, such as micro casting and soft lithography. Thus, designing and fabricating micro structures at personal office immediately become possible with FFSL. Furthermore, we demonstrated that multi-scale micro structures can be easily fabricated by double exposure with FFSL. Skin textures is used as another case to demonstrate that FFSL can fabricate structures with different depth in a single exposure. As a result, FF shows a promising future in biology, and analytical chemistry, such as rapid fabrication of point of care diagnostics and microfluidic analytical devices with low cost.
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Adsorption of sugars on Al- and Ga-doped boron nitride surfaces: A computational study
NASA Astrophysics Data System (ADS)
Darwish, Ahmed A.; Fadlallah, Mohamed M.; Badawi, Ashraf; Maarouf, Ahmed A.
2016-07-01
Molecular adsorption on surfaces is a key element for many applications, including sensing and catalysis. Non-invasive sugar sensing has been an active area of research due to its importance to diabetes care. The adsorption of sugars on a template surface study is at the heart of matter. Here, we study doped hexagonal boron nitride sheets (h-BNNs) as adsorbing and sensing template for glucose and glucosamine. Using first principles calculations, we find that the adsorption of glucose and glucosamine on h-BNNs is significantly enhanced by the substitutional doping of the sheet with Al and Ga. Including long range van der Waals corrections gives adsorption energies of about 2 eV. In addition to the charge transfer occurring between glucose and the Al/Ga-doped BN sheets, the adsorption alters the size of the band gap, allowing for optical detection of adsorption. We also find that Al-doped boron nitride sheet is better than Ga-doped boron nitride sheet to enhance the adsorption energy of glucose and glucosamine. The results of our work can be potentially utilized when designing support templates for glucose and glucosamine.
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Zhou, Guiyun; Stoltzfus, Jill C; Houldin, Arlene D; Parks, Susan M; Swan, Beth Ann
2010-11-01
To establish initial reliability and validity of a Web-based survey focused on oncology advanced practice nurses' (APNs') knowledge, attitudes, and practice behaviors regarding advanced care planning, and to obtain preliminary understanding of APNs' knowledge, attitudes, and practice behaviors and perceived barriers to advanced care planning. Descriptive, cross-sectional, pilot survey study. The eastern United States. 300 oncology APNs. Guided by the Theory of Planned Behavior, a knowledge, attitudes, and practice behaviors survey was developed and reviewed for content validity. The survey was distributed to 300 APNs via e-mail and sent again to the 89 APNs who responded to the initial survey. Exploratory factor analysis was used to examine the construct validity and test-retest reliability of the survey's attitudinal and practice behavior portions. Respondents' demographics, knowledge, attitudes, practice behaviors, and perceived barriers to advanced care planning practice. Exploratory factor analysis yielded a five-factor solution from the survey's attitudes and practice behavior portions with internal consistency using Cronbach alpha. Respondents achieved an average of 67% correct answers in the 12-item knowledge section and scored positively in attitudes toward advanced care planning. Their practice behavior scores were marginally positive. The most common reported barriers were from patients' and families' as well as physicians' reluctance to discuss advanced care planning. The attitudinal and practice behaviors portions of the survey demonstrated preliminary construct validity and test-retest reliability. Regarding advanced care planning, respondents were moderately knowledgeable, but their advanced care planning practice was not routine. Validly assessing oncology APNs' knowledge, attitudes, and practice behaviors regarding advanced care planning will enable more tailored approaches to improve end-of-life care outcomes.
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42 CFR 456.380 - Individual written plan of care.
Code of Federal Regulations, 2010 CFR
2010-10-01
... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care Facilities Plan of Care § 456.380 Individual written plan of care. (a) Before admission to an ICF or before...) Activities; (v) Therapies; (vi) Social services; (vii) Diet; and (viii) Special procedures designed to meet...
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42 CFR 456.380 - Individual written plan of care.
Code of Federal Regulations, 2011 CFR
2011-10-01
... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Utilization Control: Intermediate Care Facilities Plan of Care § 456.380 Individual written plan of care. (a) Before admission to an ICF or before...) Activities; (v) Therapies; (vi) Social services; (vii) Diet; and (viii) Special procedures designed to meet...
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Managed care plan performance since 1980: another look at 2 literature reviews.
Sullivan, K
1999-01-01
OBJECTIVES: This article compares the quality of care provided by managed care plans (MCPs) and indemnity (or fee-for-service [FFS]) plans since 1980. METHODS: The 44 studies examined are the studies that Miller and Luft cited in their 1994 and 1997 reviews of the literature comparing MCPs with FFS plans. These studies are examined to determine how well they met Miller and Luft's selection criteria and, in addition, whether they controlled for differences in the breadth of insurance coverage. RESULTS: The 44 studies generated 57 observations. MCPs scored better than FFS plans on 10 of these, equally well on 25, and worse on 22. However, only 44 of these observations met the Miller-Luft criteria plus the coverage criterion. Four of these indicated that MCP care was better, 19 that MCP and FFS care were equivalent, and 21 that MCP care was worse. CONCLUSIONS: The small body of reliable studies comparing the quality of MCP care with that of FFS care indicates that the quality of care provided by MCPs tends to be equal or inferior to that provided by FFS plans. PMID:10394307
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Pediatric diabetes training for healthcare professionals in Europe: Time for change.
Kime, Nicky Helen; Waldron, Sheridan; Webster, Elizabeth; Lange, Karin; Zinken, Katarzyna; Danne, Thomas; Aschemeier, Bärbel; Sumnik, Zdenek; Cinek, Ondrej; Raposo, João Filipe; Vazeou, Andriani; Bratina, Natasa; Campbell, Fiona
2018-05-01
Training for healthcare professionals (HCPs) in Europe who care for children and young people (CYP) with type 1 diabetes and their families is variable depending on the country. Building on the work of SWEET (Better control in Pediatric and Adolescent diabeteS: Working to crEate CEnTers of Reference) and using the German Certified Diabetes Educators (CDEs) curriculum, a European collaboration of pediatric diabetes experts aimed to (1) establish current core elements that should be included in a pediatric diabetes education training course and (2) create a template for a European CDE's training curriculum. A qualitative methodology incorporating a survey questionnaire, focus group discussions, individual semi-structured interviews and workshops was employed to explore participants' experiences and opinions. HCPs-pediatric consultants, diabetes nurses, dietitians and psychologists, national and local diabetes leads, academic and education leads and children, and young people with diabetes and families took part in the study. The total number of participants equaled 186. A template for a European Certified Diabetes Educator Curriculum (EU-CDEC) was developed based on the themes that emerged from the participants' expertise and experiences. This provides a model for HCPs' pediatric diabetes training provision. There is a severe shortage of high quality, standardized training for HCPs across the majority of European countries. Lack of trained HCPs for CYP with diabetes will result in the delivery of suboptimal care and impact on health, wellbeing and clinical and psychological outcomes. The EU-CDEC template can be used to increase access to high quality training provision for all HCPs across Europe and worldwide. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
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Ke, Li-Shan; Huang, Xiaoyan; Hu, Wen-Yu; O'Connor, Margaret; Lee, Susan
2017-05-01
Studies have indicated that family members or health professionals may not know or predict their older relatives' or patients' health preferences. Although advance care planning is encouraged for older people to prepare end-of-life care, it is still challenging. To understand the experiences and perspectives of older people regarding advance care planning. A systematic review of qualitative studies and meta-synthesis was conducted. CINAHL, MEDLINE, EMBASE, and PsycINFO databases were searched. A total of 50 articles were critically appraised and a thematic synthesis was undertaken. Four themes were identified: life versus death, internal versus external, benefits versus burdens, and controlling versus being controlled. The view of life and death influenced older people's willingness to discuss their future. The characteristics, experiences, health status, family relationship, and available resources also affected their plans of advance care planning. Older people needed to balance the benefits and burdens of advance care planning, and then judge their own ability to make decisions about end-of-life care. Older people's perspectives and experiences of advance care planning were varied and often conflicted; cultural differences amplified variances among older people. Truthful information, available resources, and family support are needed to enable older people to maintain dignity at the end of life. The views of life and death for older people from different cultures should be compared to assist health professionals to understand older people's attitudes toward advance care planning, and thus to develop appropriate strategies to promote advance care planning in different cultures.
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White, Kari; Hopkins, Kristine; Grossman, Daniel; Potter, Joseph E
2017-10-20
To explore organizations' experiences providing family planning during the first year of an expanded primary care program in Texas. Between November 2014 and February 2015, in-depth interviews were conducted with program administrators at 30 organizations: 7 women's health organizations, 13 established primary care contractors (e.g., community health centers, public health departments), and 10 new primary care contractors. Interviews addressed organizational capacities to expand family planning and integrate services with primary care. Interview transcripts were analyzed using a theme-based approach. Themes were compared across the three types of organizations. Established and new primary care contractors identified several challenges expanding family planning services, which were uncommon among women's health organizations. Clinicians often lacked training to provide intrauterine devices and contraceptive implants. Organizations often recruited existing clients into family planning services, rather than expanding their patient base, and new contractors found family planning difficult to integrate because of clients' other health needs. Primary care contractors frequently described contraceptive provision protocols that were not evidence-based. Many primary care organizations in Texas initially lacked the capacity to provide evidence-based family planning services that women's health organizations already provided. © Health Research and Educational Trust.
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Brohard, Cheryl
2017-11-01
To test the efficacy of a novel intervention to facilitate advance care planning. . Exploratory, quasiexperimental pilot study with two independent groups. . A large hospice located in the southwestern United States. . A convenience sample of 50 participants with terminal cancer enrolled in hospice. . An autobiographical memory (ABM) intervention used the participants' experiences with cancer and end of life for the purpose of directing advance care planning. . Two domains of advance care planning, decision making and communication, were measured in relation to 11 variables. The ABM intervention was nonthreatening, short in duration, and easily completed with participants as they recalled, without hesitation, specific personal memories of family and friends who had died and their advance care plans. The Mann-Whitney nonparametric test revealed that participants in the experimental group had a higher average rank than those in the control group for communicating the decision about antibiotics, as well as exhibited a trend toward significance for five other advance care planning variables. . Findings showed that directive ABMs may be effective in influencing the decision making and communication of advance care planning for terminally ill patients with cancer. . The current level of understanding about using the ABM intervention suggests that nurses can initiate an advance care planning conversation using this approach.
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Menon, Sumytra; Kars, Marijke; Malhotra, Chetna; Campbell, Alastair V; van Delden, J J M
2018-05-15
Advance care planning has been shown to improve end-of-life care but it was developed in the USA and most research has been conducted in western communities. We aimed to study the attitudes and perceptions of patients with life-limiting illnesses, informal caregivers, doctors, nurses and medical social workers regarding advance care planning in a multi-cultural family-centric community. We conducted an explorative qualitative study, using focus groups and individual in-depth interviews. We used purposive sampling techniques to recruit 61 adults (15 doctors, 13 nurses, 5 medical social workers, 15 patients and 13 caregivers) from multiple healthcare settings across the country. The participants are genuinely anxious about the implementation of advance care planning. They had positive and negative expectations of advance care planning. Many were confused about the legal framework for healthcare decision-making and expected advance care planning to be of limited value because family members, rather than the patient, were usually the key decision-makers. A nuanced approach to advance care planning which considers the family network is required in multi-cultural family centric communities. Policies should be reconciled to create a more consistent message that respects patients, the family, and is legally coherent. Further research could focus on adaptations of advance care planning to promote its acceptance in such communities. Copyright © 2018. Published by Elsevier Inc.
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42 CFR 460.100 - Emergency care.
Code of Federal Regulations, 2014 CFR
2014-10-01
... 42 Public Health 4 2014-10-01 2014-10-01 false Emergency care. 460.100 Section 460.100 Public...) PACE Services § 460.100 Emergency care. (a) Written plan. A PACE organization must establish and maintain a written plan to handle emergency care. The plan must ensure that CMS, the State, and PACE...
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42 CFR 460.100 - Emergency care.
Code of Federal Regulations, 2013 CFR
2013-10-01
... 42 Public Health 4 2013-10-01 2013-10-01 false Emergency care. 460.100 Section 460.100 Public...) PACE Services § 460.100 Emergency care. (a) Written plan. A PACE organization must establish and maintain a written plan to handle emergency care. The plan must ensure that CMS, the State, and PACE...
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42 CFR 460.100 - Emergency care.
Code of Federal Regulations, 2012 CFR
2012-10-01
... 42 Public Health 4 2012-10-01 2012-10-01 false Emergency care. 460.100 Section 460.100 Public...) PACE Services § 460.100 Emergency care. (a) Written plan. A PACE organization must establish and maintain a written plan to handle emergency care. The plan must ensure that CMS, the State, and PACE...
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Health Instruction Packages: Nursing Care Plans.
ERIC Educational Resources Information Center
Kowalski, Dorcas S.; And Others
Text, illustrations, and exercises are provided in this set of learning modules to teach nurses and nursing students various patient care skills. The first module, "How to Write a Nursing Care Plan" by Dorcas S. Kowalski, discusses three tasks in developing patient care plans: identifying and prioritizing a patient's needs, gathering…
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Cryo-Milling and the Hydrogen Storage Properties of NaAlH4
NASA Astrophysics Data System (ADS)
Feller, Kevin; Dobbins, Tabbetha
2013-03-01
High energy ball milling of metal hydrides is a common way to both introduce catalysts (e.g. TiCl3) and to simultaneously increase the surface area. Both catalysis and increased surface area improve hydrogen storage capacity of the material. Nanostructuring of hydrides by depositing them into mesoporous templates (such as anodized alumina, MOFs, and SBA-15) has become a common way to increase surface area. However, the mesoporous template does not add hydrogen storage capacity--and thus, tends to decreased overall storage weight percent for the nanostructured hydride material. As with most materials, hydrides become brittle at low temperatures and will tend to fracture more readily. We will process Sodium Aluminum Hydride (NaAlH4) using cryogenic high energy ball milling using an in-house modified chamber SPEX Certiprep M8000 mixer/mill in order to gain a nanostructured hydride without mesoporous template material. Details of the modified mixer mill design will be presented. Ultimately, our planned future work is to study the resultant material using x-ray diffraction (Scherrer method for crystallite size), absorption/desorption temperature programmed desorption (TPD), and ultrasmall-angle x-ray scattering (USAXS) microstructural quantification to understand the role of cryomilling on enhancing the material's ability to store (and release) hydrogen.
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A continuum of sociotechnical requirements for patient-centered problem lists.
Collins, Sarah; Tsivkin, Kira; Hongsermeier, Tonya; Dubois, David; Nandigam, Hari Krishna; Rocha, Roberto A
2013-01-01
Specific requirements for patient-centered health information technology remain ill-defined. To create operational definitions of patient-centered problem lists, we propose a continuum of sociotechnical requirements with five stages: 1) Intradisciplinary Care Planning: Viewing and searching for problems by discipline; 2) Multi-disciplinary Care Planning: Categorizing problem states to meet discipline-specific needs; 3) Interdisciplinary Care Planning: Sharing and linking problems between disciplines; 4) Integrated and Coordinated Care Planning: Associating problems with assessments, tasks, interventions and outcomes across disciplines for coordination, knowledge development, and reporting; and 5) Patient-Centered Care Planning: Engaging patients in identification of problems and maintenance of their problem list.
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Geerts, Caroline C; van Dillen, Jeroen; Klomp, Trudy; Lagro-Janssen, Antoine L M; de Jonge, Ank
2017-07-14
The caregiver has an important influence on women's birth experiences. When transfer of care during labour is necessary, care is handed over from one caregiver to the other, and this might influence satisfaction with care. It is speculated that satisfaction with care is affected in particular for women who need to be transferred from home to hospital. We examined the level of satisfaction with the caregiver among women with planned home versus planned hospital birth in midwife-led care. We used data from the prospective multicentre DELIVER (Data EersteLIjns VERloskunde) cohort-study, conducted in 2009 and 2010 in the Netherlands. Women filled in a postpartum questionnaire which contained elements of the Consumer Quality index. This instrument measures 'general rate of satisfaction with the caregiver' (scale from 1 to 10, with cut-off of below 9) and 'quality of treatment by the caregiver' (containing 7 items on a 4 point Likert scale, with cut-off of mean of 4 or lower). Women who planned a home birth (n = 1372) significantly more often rated 'quality of treatment by caregiver' high than women who planned a hospital birth (n = 829). Primiparous women who planned a home birth significantly more often had a high rate (9 or 10) for 'general satisfaction with caregiver' (adj.OR 1.48; 95% CI 1.1, 2.0). Also, primiparous women who planned a home birth and had care transferred during labour (331/553; 60%) significantly more often had a high rate (9 or 10) for 'general satisfaction' compared to those who planned a hospital birth and who had care transferred (1.44; 1.0-2.1). Furthermore, they significantly more often rated 'quality of treatment by caregiver' high, than 276/414 (67%) primiparous women who planned a hospital birth and who had care transferred (1.65; 1.2-2.3). No differences were observed for multiparous women who had planned home or hospital birth and who had care transferred. Planning home birth is associated to a good experience of quality of care by the caregiver. Transferred planned home birth compared to a transferred planned hospital birth does not lead to a more negative experience of care received from the caregiver.
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Nonprice competition and quality of care in managed care: the New York SCHIP market.
Liu, Hangsheng; Phelps, Charles E
2008-06-01
To examine the effect of nonprice competition among managed care plans on the quality of care in the New York SCHIP market. U.S. Census 2000; 2002 New York State Managed Care Plan Performance Report; and 2001 New York State Managed Care Annual Enrollment Report. Each market is defined as a county, and competition is measured as the number of plans in a market. Quality of care is measured in percentages using three Consumer Assessment of Health Plans Survey and three Health Plan Employer Data and Information Set scores. Two-stage least squares is applied to address the endogeneity between competition and the quality of care, using population as an instrument. We find a negative association between competition and quality of care. An additional managed care plan is significantly associated with a decrease of 0.40-2.31 percentage points in four out of six quality measures. After adjusting for production cost, a positive correlation is observed between price and quality measures across different pricing regions. It seems likely that pricing policy is a constraint on quality production, although it may not be interpreted as a causal relationship and further study is needed.
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Mariner, W K
1996-06-01
As managed care organizations expand their programs of quality assurance and physician evaluation, more medical malpractice lawsuits may be brought against managed care organizations on the ground that, like hospitals, they are legally responsible for negligent corporate acts that injure patients. However, the federal Employee Retirement Income Security Act (ERISA) shields managed care organizations from liability when they are part of an employee group health plan governed by ERISA. Unlike patients with other types of insurance, patients in ERISA health plans do not have a malpractice remedy for a managed care organization's negligence. A few federal appeals courts recently recognized that ERISA plans can be vicariously liable for their physicians' medical malpractice, but only if the physician is the plan's employee or agent. Yet ERISA still prohibits negligence claims against ERISA health plans for injuries resulting from denial of plan benefits, failure to use qualified physicians, utilization review, or improper plan administration. Current managed care operations do not neatly distinguish between administering benefits and controlling quality of care. Neither should the law. ERISA should be amended to provide employees with the same remedies that patients in non-ERISA plans enjoy.
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Mariner, W K
1996-01-01
As managed care organizations expand their programs of quality assurance and physician evaluation, more medical malpractice lawsuits may be brought against managed care organizations on the ground that, like hospitals, they are legally responsible for negligent corporate acts that injure patients. However, the federal Employee Retirement Income Security Act (ERISA) shields managed care organizations from liability when they are part of an employee group health plan governed by ERISA. Unlike patients with other types of insurance, patients in ERISA health plans do not have a malpractice remedy for a managed care organization's negligence. A few federal appeals courts recently recognized that ERISA plans can be vicariously liable for their physicians' medical malpractice, but only if the physician is the plan's employee or agent. Yet ERISA still prohibits negligence claims against ERISA health plans for injuries resulting from denial of plan benefits, failure to use qualified physicians, utilization review, or improper plan administration. Current managed care operations do not neatly distinguish between administering benefits and controlling quality of care. Neither should the law. ERISA should be amended to provide employees with the same remedies that patients in non-ERISA plans enjoy. PMID:8659664
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Klingler, Corinna; in der Schmitten, Jürgen; Marckmann, Georg
2015-01-01
Background: While there is increasing evidence that Advance Care Planning has the potential to strengthen patient autonomy and improve quality of care near the end of life, it remains unclear whether it could also reduce net costs of care. Aim: This study aims to describe the cost implications of Advance Care Planning programmes and discusses ethical conflicts arising in this context. Design: We conducted a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data sources: We systematically searched the databases PubMed, NHS EED, EURONHEED, Cochrane Library and EconLit. We included empirical studies (no limitation to study type) that investigated the cost implications of Advance Care Planning programmes involving professionally facilitated end-of-life discussions. Results and discussion: Seven studies met our inclusion criteria. Four of them used a randomised controlled design, one used a before-after design and two were observational studies. Six studies found reductions in costs of care ranging from USD1041 to USD64,827 per patient, depending on the study period and the cost measurement. One study detected no differences in costs. Studies varied considerably regarding the Advance Care Planning intervention, patient selection and costs measured which may explain some of the variations in findings. Normative appraisal: Looking at the impact of Advance Care Planning on costs raises delicate ethical issues. Given the increasing pressure to reduce expenditures, there may be concerns that cost considerations could unduly influence the sensitive communication process, thus jeopardising patient autonomy. Safeguards are proposed to reduce these risks. Conclusion: The limited data indicate net cost savings may be realised with Advance Care Planning. Methodologically robust trials with clearly defined Advance Care Planning interventions are needed to make the costs and returns of Advance Care Planning transparent. PMID:26294218
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Systematic synthesis of barriers and facilitators to service user-led care planning.
Bee, Penny; Price, Owen; Baker, John; Lovell, Karina
2015-08-01
Service user (patient) involvement in care planning is a principle enshrined by mental health policy yet often attracts criticism from patients and carers in practice. To examine how user-involved care planning is operationalised within mental health services and to establish where, how and why challenges to service user involvement occur. Systematic evidence synthesis. Synthesis of data from 117 studies suggests that service user involvement fails because the patients' frame of reference diverges from that of providers. Service users and carers attributed highest value to the relational aspects of care planning. Health professionals inconsistently acknowledged the quality of the care planning process, tending instead to define service user involvement in terms of quantifiable service-led outcomes. Service user-involved care planning is typically operationalised as a series of practice-based activities compliant with auditor standards. Meaningful involvement demands new patient-centred definitions of care planning quality. New organisational initiatives should validate time spent with service users and display more tangible and flexible commitments to meeting their needs. © The Royal College of Psychiatrists 2015.
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Systematic synthesis of barriers and facilitators to service user-led care planning
Bee, Penny; Price, Owen; Baker, John; Lovell, Karina
2015-01-01
Background Service user (patient) involvement in care planning is a principle enshrined by mental health policy yet often attracts criticism from patients and carers in practice. Aims To examine how user-involved care planning is operationalised within mental health services and to establish where, how and why challenges to service user involvement occur. Method Systematic evidence synthesis. Results Synthesis of data from 117 studies suggests that service user involvement fails because the patients' frame of reference diverges from that of providers. Service users and carers attributed highest value to the relational aspects of care planning. Health professionals inconsistently acknowledged the quality of the care planning process, tending instead to define service user involvement in terms of quantifiable service-led outcomes. Conclusions Service user-involved care planning is typically operationalised as a series of practice-based activities compliant with auditor standards. Meaningful involvement demands new patient-centred definitions of care planning quality. New organisational initiatives should validate time spent with service users and display more tangible and flexible commitments to meeting their needs. PMID:26243762