Labor Market Work and Home Care's Unpaid Caregivers: A Systematic Review of Labor Force Participation Rates, Predictors of Labor Market Withdrawal, and Hours of Work

PubMed Central

Lilly, Meredith B; Laporte, Audrey; Coyte, Peter C

2007-01-01

As people continue to age and receive complex health care services at home, concern has arisen about the availability of family caregivers and their ability to combine employment with caregiving. This article evaluates the international research on unpaid caregivers and their labor market choices, highlighting three conclusions: first, caregivers in general are equally as likely to be in the labor force as noncaregivers; second, caregivers are more likely to work fewer hours in the labor market than noncaregivers, particularly if their caring commitments are heavy; and finally, only those heavily involved in caregiving are significantly more likely to withdraw from the labor market than noncaregivers. Policy recommendations are targeting greater access to formal care for “intensive” caregivers and developing workplace policies for employed caregivers. PMID:18070333

Infants in Italy: An Evaluation of Other Than Mother Care.

ERIC Educational Resources Information Center

Ross, Helen Warren

As more and more women return to the work force while their children are but infants, care other than by the mothers and outside the families' own homes has become an issue of major importance in the United States. In Europe, however, most governments subsidize infant care for mothers working outside the home. One country, Italy, has provided…

CHILD CARE ARRANGEMENTS OF THE NATION'S WORKING MOTHERS, 1965, A PRELIMINARY REPORT.

ERIC Educational Resources Information Center

BRITTAIN, CLAY; LOW, SETH

THE BUREAU OF CENSUS, USING ITS NATIONAL SAMPLE OF HOUSEHOLDS, SURVEYED CHILD CARE ARRANGEMENTS OF MOTHERS WHO HAD WORKED 27 WEEKS OR MORE DURING 1964 AND HAD AT LEAST ONE CHILD UNDER 14 YEARS OLD LIVING AT HOME. ONE-EIGHTH OF THE NATIONAL WORK FORCE WAS COMPOSED OF WORKING MOTHERS WITH CHILDREN UNDER 18. ONE-THIRD OF THE MOTHERS WITH CHILDREN…

Immigrant workers in the United States: recent trends, vulnerable populations, and challenges for occupational health.

PubMed

McCauley, Linda A

2005-07-01

Immigrant workers are a rapidly growing segment of the U.S. work force, and these increasing numbers have resulted in a different ethnic mix in the work force than in previous decades. Immigrant workers are not a homogenous group, but are over-represented in low-paying occupations. Their diversity and vulnerability present distinct challenges for occupational health nurses. High-risk occupations in which a large proportion of immigrant workers are hired include agriculture, sweatshops, day laborers, and construction. Initiatives needed to improve the working conditions of this vulnerable population include improved surveillance and research, culturally competent care providers, improved health care access, advocacy, and changes in immigration and health policy.

Women in medicine: a four-nation comparison.

PubMed

McMurray, Julia E; Cohen, May; Angus, Graham; Harding, John; Gavel, Paul; Horvath, John; Paice, Elisabeth; Schmittdiel, Julie; Grumbach, Kevin

2002-01-01

to determine the impact of increasing numbers of women in medicine on the physician work force in Australia, Canada, England, and the United States. We collected data on physician work force issues from professional organizations and government agencies in each of the 4 nations. Women now make up nearly half of all medical students in all 4 countries and 20% to 30% of all practicing physicians. Most are concentrated in primary care specialties and obstetrics/gynecology and are underrepresented in surgical training programs. Women physicians practice largely in urban settings and work 7 to 11 fewer hours per week than men do, for lower pay. Twenty percent to 50% of women primary care physicians are in part-time practice. Work force planners should anticipate larger decreases in physician full-time equivalencies than previously expected because of the increased number of women in practice and their tendency to work fewer hours and to be in part-time practice, especially in primary care. Responses to these changes vary among the 4 countries. Canada has developed a detailed database of work/family issues; England has pioneered flexible training schemes and reentry training programs; and Australia has joined consumers, physicians, and educators in improving training opportunities and the work climate for women. Improved access to surgical and subspecialty fields, training and practice settings that provide balance for work/family issues, and improved recruitment and retention of women physicians in rural areas will increase the contributions of women physicians.

Work and Elder Care: Facts for Caregivers and Their Employers. Facts on Working Women No. 98-1.

ERIC Educational Resources Information Center

Women's Bureau (DOL), Washington, DC.

As the elderly population continues to grow, more elderly persons are requiring assistance with activities of daily living. Women are the traditional caregivers to the elderly, and the many women who also participate in the paid labor force must face the challenges of meeting both work and family obligations. Types of elder care assistance not…

Employment barriers for persons with psychiatric disabilities: update of a report for the President's Commission.

PubMed

Cook, Judith A

2006-10-01

A major public policy problem is the extremely low labor force participation of people with severe mental illness coupled with their overrepresentation on the public disability rolls. This situation is especially troubling given the existence of evidence-based practices designed to return them to the labor force. This article reviews research from the fields of disability, economics, health care, and labor studies to describe the nature of barriers to paid work and economic security for people with disabling mental disorders. These barriers include low educational attainment, unfavorable labor market dynamics, low productivity, lack of appropriate vocational and clinical services, labor force discrimination, failure of protective legislation, work disincentives caused by state and federal policies, poverty-level income, linkage of health care access to disability beneficiary status, and ineffective work incentive programs. The article concludes with a discussion of current policy initiatives in health care, mental health, and disability. Recommendations for a comprehensive system of services and supports to address multiple barriers are presented. These include access to affordable health care, including mental health treatment and prescription drug coverage; integrated clinical and vocational services; safe and stable housing that is not threatened by changes in earned income; remedial and postsecondary education and vocational training; benefits counseling and financial literacy education; economic security through asset development; legal aid for dealing with employment discrimination; peer support and self-help to enhance vocational self-image and encourage labor force attachment; and active involvement of U.S. business and employer communities.

Major Aspects of Day Care: Statements and Articles.

ERIC Educational Resources Information Center

Hutchinson, Shauneen, Comp.

Published material concerned with various types of day care are provided. The material has been separated into four different sections: (1) General, which describes underlying policy, trends, and the present status of day care in the United States; (2) Working Mothers, covering day care arrangements made by women in the labor force; (3) Foreign,…

Labour Force Inclusion of Parents Caring for Children with Disabilities.

ERIC Educational Resources Information Center

Roeher Inst., North York (Ontario).

This report discusses the outcomes of a study that sought to identify the particular problems Canadian parents caring for children with disabilities face in trying to make the transition to work in terms of their child care arrangements and employment-related factors, and best practices in child care arrangements and employment accommodations.…

Corporate Caretaking.

ERIC Educational Resources Information Center

Butruille, Susan G.

1990-01-01

Reviews the changes in labor force composition and worker values that are impelling companies to create family support policies such as child care, elder care, and flexible schedules. Assesses the status of working women in the workplace and the home. (SK)

Overcoming parochialism: interdisciplinary training of the generalist team.

PubMed

Benson, J A

1997-01-01

The work force that will staff most health care systems of the future will include a complex array of professionals working together in teams. The traditional inpatient model of patient care has been only multidisciplinary--nurses, medical social workers, dietitians, pharmacists, and physicians, all interested in each patient, but with divided responsibilities, training formats, and faculties--whereas interdisciplinary teams openly share decision making, expectations for care, goals for the team, and mutual respect.

Assistance Received by Employed Caregivers and Their Care Recipients: Who Helps Care Recipients when Caregivers Work Full Time?

ERIC Educational Resources Information Center

Scharlach, Andrew E.; Gustavson, Kristen; Dal Santo, Teresa S.

2007-01-01

Purpose: This study examined the association among caregiver labor force participation, employees' caregiving activities, and the amount and quality of care received by care recipients. Design and Methods: Telephone interviews were conducted with 478 adults who were employed full time and 705 nonemployed adults who provided care to a family member…

African Immigrants in Low-Wage Direct Health Care: Motivations, Job Satisfaction, and Occupational Mobility.

PubMed

Covington-Ward, Yolanda

2017-06-01

This study explores motivations, job satisfaction, and overall perceived occupational mobility for African immigrants working in low-wage direct health care occupations. The study uses qualitative semi-structured interviews with a sample of thirty African immigrant workers in the greater Pittsburgh metropolitan area. Results show that four major themes captured the motivations of interviewees for doing direct care work: passion for care work, quick money, easily obtained employment, and direct care work as a pathway to other health occupations. The majority of the interviewees were satisfied with their jobs, yet almost all of them saw their occupations as temporary or transitional employment. Most of the interviewees also saw their jobs as lacking occupational mobility. In light of the increased national demand for direct care workers, the growing numbers of immigrants in the direct care labor force, and the high turnover and low retention rates of direct care workers overall, the study suggests that more must be done to make direct care work attractive and rewarding for African immigrant workers.

Developing Professionalism in the Child Care Industry. An Instructional Program Guide for Child Care Workers.

ERIC Educational Resources Information Center

Johnson, Ann; And Others

This program guide documents a child care job family curriculum that develops competence in generic work force education skills through two minicourses: Basic Issues in Child Care and Child Development Associate. An annotated table of contents lists a brief description of the questions answered in each section. An introduction presents a program…

Care work versus career work: sibling conflict over getting priorities right.

PubMed

Lashewicz, Bonnie

2011-01-01

As the average age of the Canadian population continues to increase, and providing care at home to frail older adults becomes ever more prevalent, support for family and friend caregivers remains a key social policy issue. Economic support is an important consideration given the impact of caregiving on labour force participation. Yet the caregiving/paid work relationship is not always straightforward. While caregiving often restricts employment, limited attachment to employment may also influence the decision to provide care. Isabel's story, collected as part of a study of sibling views of fairness in sharing parent care as well as parent assets, provides a case study in how siblings give different priority to care work versus career work and what support needs arise including those related to sibling conflict over differing priorities. Isabel claims she sacrificed her career to care for her ailing mother while her siblings argue that through caregiving, Isabel was sheltered from the paid workforce.

Liminal and invisible long-term care labour: Precarity in the face of austerity.

PubMed

Daly, Tamara; Armstrong, Pat

2016-09-01

Using feminist political economy, this article argues that companions hired privately by families to care for residents in publicly funded long-term care facilities (nursing homes) are a liminal and invisible labour force. A care gap, created by public sector austerity, has resulted in insufficient staff to meet residents' health and social care needs. Families pay to fill this care gap in public funding with companion care, which limits demands on the state to collectively bear the costs of care for older adults. We assess companions' work in light of Vosko's (2015) and Rodgers and Rodgers' (1989) dimensions for precariousness. We discuss how to classify paid care work that overlaps with paid formal and unpaid informal care. Our findings illuminate how companions' labour is simultaneously autonomous and precarious; it fills a care gap and creates one, and can be relational compared with staffs' task-oriented work.

Liminal and invisible long-term care labour: Precarity in the face of austerity

PubMed Central

Daly, Tamara; Armstrong, Pat

2016-01-01

Using feminist political economy, this article argues that companions hired privately by families to care for residents in publicly funded long-term care facilities (nursing homes) are a liminal and invisible labour force. A care gap, created by public sector austerity, has resulted in insufficient staff to meet residents’ health and social care needs. Families pay to fill this care gap in public funding with companion care, which limits demands on the state to collectively bear the costs of care for older adults. We assess companions’ work in light of Vosko’s (2015) and Rodgers and Rodgers’ (1989) dimensions for precariousness. We discuss how to classify paid care work that overlaps with paid formal and unpaid informal care. Our findings illuminate how companions’ labour is simultaneously autonomous and precarious; it fills a care gap and creates one, and can be relational compared with staffs’ task-oriented work. PMID:27840453

The Accreditation Council for Graduate Medical Education resident duty hour new standards: history, changes, and impact on staffing of intensive care units.

PubMed

Pastores, Stephen M; O'Connor, Michael F; Kleinpell, Ruth M; Napolitano, Lena; Ward, Nicholas; Bailey, Heatherlee; Mollenkopf, Fred P; Coopersmith, Craig M

2011-11-01

The Accreditation Council for Graduate Medical Education recently released new standards for supervision and duty hours for residency programs. These new standards, which will affect over 100,000 residents, take effect in July 2011. In response to these new guidelines, the Society of Critical Care Medicine convened a task force to develop a white paper on the impact of changes in resident duty hours on the critical care workforce and staffing of intensive care units. A multidisciplinary group of professionals with expertise in critical care education and clinical practice. Relevant medical literature was accessed through a systematic MEDLINE search and by requesting references from all task force members. Material published by the Accreditation Council for Graduate Medical Education and other specialty organizations was also reviewed. Collaboratively and iteratively, the task force corresponded by electronic mail and held several conference calls to finalize this report. The new rules mandate that all first-year residents work no more than 16 hrs continuously, preserving the 80-hr limit on the resident workweek and 10-hr period between duty periods. More senior trainees may work a maximum of 24 hrs continuously, with an additional 4 hrs permitted for handoffs. Strategic napping is strongly suggested for trainees working longer shifts. Compliance with the new Accreditation Council for Graduate Medical Education duty-hour standards will compel workflow restructuring in intensive care units, which depend on residents to provide a substantial portion of care. Potential solutions include expanded utilization of nurse practitioners and physician assistants, telemedicine, offering critical care training positions to emergency medicine residents, and partnerships with hospitalists. Additional research will be necessary to evaluate the impact of the new standards on patient safety, continuity of care, resident learning, and staffing in the intensive care unit.

Attitudes toward working mothers: accommodating the needs of mothers in the work force.

PubMed

Albright, A

1992-10-01

More women, including mothers, are part of the work force than ever before. In the workplace, barriers often exist that restrict promotion and advancement of mothers. Mothers often are penalized in attempting to meet the demands of parent and worker roles. Parenting practices have been considered primarily the domain of mothers. However, nurturing may be done effectively by fathers or other motivated adults. Policies of employers must change to accommodate needs of families. Examples of supportive practices may include flexible working hours, parental leave, and on-site child care.

Child Care and the Labor Supply of Married Women: Reduced Form Evidence.

ERIC Educational Resources Information Center

Ribar, David C.

1992-01-01

With data from the Survey of Income Program Participation, a three-equation, reduced-form econometric model is used to generate estimates revealing that the cost of market child care decreases the labor force participation of married women. High wages increase likelihood of working and use of paid child care. (SK)

Employers and Child Care: Development of a New Employee Benefit. A BNA Special Report.

ERIC Educational Resources Information Center

Bureau of National Affairs, Inc., Washington, DC.

Written primarily from the employer's perspective, this report examines the issues involved in providing child care assistance as an employee benefit. Chapter 1 summarizes rapid changes in the work force that have produced employer involvement in child care arrangements. The major findings of the report are highlighted in Chapter 2, including the…

Children and Society Policy Review: Health Policy Affecting Children and Young People

ERIC Educational Resources Information Center

Simkiss, Doug

2013-01-01

The Health and Social Care Act comes into force in April 2013. It changes the organisation of the health service and accelerates the integration of health and social care. New relationships between primary and secondary healthcare will develop and the culture of clinical and cost effectiveness will expand into social care; work on children in…

Caring for people with dementia disease (DD) and working in a private not-for-profit residential care facility for people with DD.

PubMed

Ericson-Lidman, Eva; Larsson, Lise-Lotte Franklin; Norberg, Astrid

2014-06-01

Caring for people with dementia and working in dementia care is described as having both rewarding and unpleasant aspects and has been studied to a minor extent. This study aims to explore care providers' narrated experiences of caring for people with dementia disease (DD) and working in a private not-for-profit residential care facility for people with DD. Nine care providers were interviewed about their experiences, the interviews were recorded, transcribed and analysed using thematic analysis. The analysis revealed that participants were struggling to perform person-centred care, which meant trying to see the person behind the disease, dealing with troublesome situations in the daily care, a two-edged interaction with relatives, feelings of shortcomings and troubled conscience, and the need for improvements in dementia care. The analysis also revealed an ambiguous work situation, which meant a challenging value base, the differently judged work environment, feelings of job satisfaction and the need for a functional leadership and management. The results illuminate participants' positive as well as negative experiences and have identified areas requiring improvements. It seems of great importance to strive for a supportive and attendant leadership, a leadership which aims to empower care providers in their difficult work. Using conscience as a driving force together in the work group may benefit care providers' health. © 2013 Nordic College of Caring Science.

Workplace relationships impact self-rated health: A survey of Swedish municipal health care employees.

PubMed

Persson, Sophie Schön; Lindström, Petra Nilsson; Pettersson, Pär; Andersson, Ingemar

2018-05-22

The impact of positive social relationships on the health of municipal employees in the elder care sector in Sweden needs further examination. To explore the association between health and relationships among elderly care employees using a salutogenic perspective. Survey of all employees (n = 997) in special housing, home care and Disabled Support and Services in a Swedish municipality. The questionnaire, which had a salutogenic perspective, included information on self-rated health from the previously validated SHIS (Salutogenic Health Indicator Scale), psychosocial work environment and experiences, social climate, and health-promoting workplace relationships. The response rate was 69% . Results of a multivariable linear regression model showed four significant predictors of health: general work experiences, colleague belongingness and positive relationships with managers and care recipients. In another model, colleague belongingness was significantly related to satisfaction with care recipients, work, length of employment as well as general work experiences and relationships with managers. Strengthening of positive work relationships, not only between workmates but also with managers and care recipients, seems to be an essential area for employee health promotion. Colleague belongingness may be deepened by development of a positive work climate, including satisfactory work experiences, positive manager relationships and a stable work force.

Effects of a performance and quality improvement intervention on the work environment in HIV-related care: a quasi-experimental evaluation in Zambia.

PubMed

Bazant, Eva; Sarkar, Supriya; Banda, Joseph; Kanjipite, Webby; Reinhardt, Stephanie; Shasulwe, Hildah; Mulilo, Joyce Monica Chongo; Kim, Young Mi

2014-12-20

Human resource shortages and reforms in HIV-related care make it challenging for frontline health care providers in southern Africa to deliver high-quality services. At health facilities of the Zambian Defence Forces, a performance and quality improvement approach was implemented to improve HIV-related care and was evaluated in 2010/2011. Changes in providers' work environment and perceived quality of HIV-related care were assessed to complement data of provider performance. The intervention involved on-site training, supportive supervision, and action planning focusing on detailed service delivery standards. The quasi-experimental evaluation collected pre- and post-intervention data from eight intervention and comparison facilities matched on defence force branch and baseline client volume. Overall, 101 providers responded to a 24-item questionnaire on the work environment, covering topics of drugs, supplies, and equipment; training, feedback, and supervision; compensation; staffing; safety; fulfilment; and HIV services quality. In bivariate analysis and multivariate analyses, we assessed changes within each study group and between the two groups. In the bivariate analysis, the intervention group providers reported improvements in the work environment on adequacy of equipment, feeling safe from harm, confidence in clinical skills, and reduced isolation, while the comparison group reported worsening of the work environment on supplies, training, safety, and departmental morale.In the multivariate analysis, the intervention group's improvement and the comparison group's decline were significant on perceived adequacy of drugs, supplies, and equipment; constructive feedback received from supervisor and co-workers; and feeling safe from physical harm (all P <0.01, except P <0.04 for equipment). Further, the item "provider lacks confidence in some clinical skills" declined in the intervention group but increased in the comparison group (P = -0.005). In multivariate analysis, changes in perceived quality of HIV care did not differ between study groups. Provider perceptions were congruent with observations of preparing drugs, supplies, equipment, and in service delivery of prevention of mother-to-child transmission of HIV and antiretroviral therapy follow-up care. The performance and quality improvement intervention implemented at Zambian Defence Forces' health facilities was associated with improvements in providers' perceptions of work environment consistent with the intervention's focus on commodities, skills acquisition, and receipt of constructive feedback.

New Evidence on Employment Effects of Informal Care Provision in Europe.

PubMed

Kolodziej, Ingo W K; Reichert, Arndt R; Schmitz, Hendrik

2018-02-22

To estimate how labor force participation is affected when adult children provide informal care to their parents. Survey of Health, Ageing and Retirement in Europe from 2004 to 2013. To offset the problem of endogeneity, we exploit the availability of other potential caregivers within the family as predictors of the probability to provide care for a dependent parent. Contrary to most previous studies, the dataset covers the whole working-age population in the majority of European countries. Individuals explicitly had to opt for or against the provision of care to their care-dependent parents, which allows us to more precisely estimate the effect of caregiving on labor force participation. Results reveal a negative causal effect that indicates that informal care provision reduces labor force participation by 14.0 percentage points (95 percent CI: -0.307, 0.026). Point estimates suggest that the effect is larger for men; however, this gender difference is not significantly different from zero at conventional levels. Results apply to individuals whose consideration in long-term care policy is highly relevant, that is, children whose willingness to provide informal care to their parents is altered by available alternatives of family caregivers. © Health Research and Educational Trust.

Behavioral health in the Department of Defense Patient-Centered Medical Home: history, finance, policy, work force development, and evaluation.

PubMed

Hunter, Christopher L; Goodie, Jeffrey L

2012-09-01

Integrating behavioral health services into the patient-centered medical home (PCMH) is an important component for meeting the goals of easy access, whole person, coordinated, and integrated care. Unlike most PCMH initiatives, the Department of Defense's (DoD) Military Health System (MHS) launched its PCMH initiative with integrated behavioral health services. This integration facilitates the MHS's goal to meet its strategic imperatives under the "Quadruple Aim" of (1) maximizing readiness, (2) improving the health of the population, (3) enhancing the patient experience of care (including quality, access, and reliability), and (4) responsibly managing per capita cost of care. The MHS experience serves as a guide to other organizations. We discuss the historical underpinnings, funding, policy, and work force development strategies that contributed to integrated behavioral healthcare being a mandated component of the MHS's PCMH.

Beyond the Simple Model of Child Care Facilities: Support Spaces for Quality

ERIC Educational Resources Information Center

Greenman, Jim

2006-01-01

The age of child care building on a wide scale really began in the 1970s. Before that, there had been a history of day nurseries going back to the turn of the century and Lanham Act centers during World War II to provide care for "Rosie the Riveter" mothers in the work force. The "purpose built" child care center was an economical box with almost…

Integration a la population active des parents s'occupant d'enfants ayant des incapacites (Labour Force Inclusion of Parents Caring for Children with Disabilities).

ERIC Educational Resources Information Center

Roeher Inst., North York (Ontario).

This report discusses the outcomes of a study that sought to identify the particular problems Canadian parents caring for children with disabilities face in trying to make the transition to work in terms of their child care arrangements and employment-related factors, and best practices in child care arrangements and employment accommodations.…

The Child Care Industry: Supporting Jobs and Economic Development in Minneapolis. Report and Recommendations.

ERIC Educational Resources Information Center

Miels, Gayle, Ed.

Once generally perceived as a service for working parents, child care is now recognized as an early education setting where children learn skills and behaviors for life. The child care and early education industry is also a powerful economic force that experienced significant growth in the past three decades in response to family, economic, and…

Forced sex: a critical factor in the sleep difficulties of young Australian women.

PubMed

Astbury, Jill; Bruck, Dorothy; Loxton, Deborah

2011-01-01

The prevalence of forced sex and its contribution to sleep difficulties among young Australian women aged 24-30 years (n=9,061) was examined using data from the 2003 Australian Longitudinal Study of Women's Health. The lifetime prevalence of reported forced sex was 8.7%. Significantly higher levels of recurrent sleep difficulties, prescription sleep medication, clinical depression, anxiety disorder, self-harm, and substance use, as well as lower socioeconomic status (SES) indicators, were reported by the forced sex group compared to the no forced sex group. Hierarchical logistic regression revealed the high odds (OR=1.95, CI=1.66-2.26) of recurrent sleep difficulty in such women becomes partially attenuated, but remains statistically significant, after adjusting for key psychological, SES, and behavioral variables. Clinical implications for primary care providers and sleep specialists are discussed. Sleep difficulties are highly prevalent and affect more than 30% of those seeking primary health care (Kushida et al., 2005). They negatively impact on the way a person feels and functions (Dinges et al., 1997) and make a significant contribution to accidents, health care costs, and problems at work (Roth, 2005).

Investment in Learning: An Assessment of the Economic Return.

ERIC Educational Resources Information Center

Rasell, M. Edith; Appelbaum, Eileen

Past investments in the U.S. work force--early childhood interventions, formal education, and training--have improved productivity and made important contributions both to the wages of individuals and to the growth of the economy. Excellent, comprehensive prenatal care, good nutrition, medical care, and intensive early childhood education programs…

The effect of informal care on work and wages.

PubMed

Van Houtven, Courtney Harold; Coe, Norma B; Skira, Meghan M

2013-01-01

Cross-sectional evidence in the United States finds that informal caregivers have less attachment to the labor force. The causal mechanism is unclear: do children who work less become informal caregivers, or are children who become caregivers working less? Using longitudinal data from the Health and Retirement Study, we identify the relationship between informal care and work in the United States, both on the intensive and extensive margins, and examine wage effects. We control for time-invariant individual heterogeneity; rule out or control for endogeneity; examine effects for men and women separately; and analyze heterogeneous effects by task and intensity. We find modest decreases-2.4 percentage points-in the likelihood of working for male caregivers providing personal care. Female chore caregivers, meanwhile, are more likely to be retired. For female care providers who remain working, we find evidence that they decrease work by 3-10hours per week and face a 3 percent lower wage than non-caregivers. We find little effect of caregiving on working men's hours or wages. These estimates suggest that the opportunity costs to informal care providers are important to consider when making policy recommendations about the design and funding of public long-term care programs. Published by Elsevier B.V.

Female labor force participation: an international perspective.

PubMed

Psacharopoulos, G; Tzannatos, Z

1989-07-01

This article gives an international perspective in regard to female participation in the labor force. In most countries women contribute less than men toward the value of recorded production. Social environment, statistical inconsistencies and methods of recording labor all contribute to this inequity. In Britain for instance, women caring for the household duties are in some studies considered to be part of the labor force and in other studies they are not. Further, internationally, women often find themselves in casual, temporary, or seasonal work that goes unrecorded. Defining what "labor force participation" constitutes is a key starting point to any survey. At what age is one considered employable? What constitutes a person "actively seeking" employment? Economists often try to explain labor force participation rate by age, sex, race and income groups and use this information to cite trends. The income-leisure model theorizes that choice of work or non-work by women is based primarily upon wages for work vs. wages for non-work. This theory sees non-labor income exerting a negative influence. Empirical evidence, however, suggests that women will choose work if wages are good regardless of any non-work benefits. Because most men are permanently in the labor force, estimates of labor reserves and projections of supply focus mostly on women. International generalizations are often misleading since trends vary widely among countries. During the last 20 years the global female participation rate has remained almost constant, but this is misleading. The percentage of working women in industrial countries increased 10%; developing countries showed a decrease of 7%. Female rates are often tied closely to shifts in the overall economy, (e.g., a transition from an agricultural to an industrial economy often sees a drop in female labor because subsistence jobs are lost). Of course the ability of women to bear children and the social expectations regarding child care often play a role. It is common in western industrialized countries to see drops in female participation during childbearing years. Countries with the lowest female participation rates are those with strong religious views about women in society, (e.g., Catholic and Muslim countries).

The effect of normative social forces on managed care organizations: implications for strategic management.

PubMed

Kirby, E G; Sebastian, J G

1998-01-01

Drawing on institutional theory, this study examines how adherence to a number of "institutional" and "technical" environmental forces can influence the business success of managed care organizations (MCOs). The standards studied include: (1) institutional forces: socially accepted procedures for delivering care (access to quality care, availability of information, and delivery of care in a personal manner); and (2) technical forces: industry standards for cost control and efficient use of financial and medical resources. The most significant finding is that successful MCOs must conform to both institutional and technical forces to be successful. MCOs that conform to either one or the other type of standard were no more successful than those that conformed to neither. These findings have several important implications for MCO strategy. First, to be successful, MCO executives must understand the external environment in which they operate. They must anticipate and respond to shifts in that environment. Second, this understanding of the external environment must place equal emphasis on societal demands (e.g., for accessible care and information) and on technical demands (e.g., for cost-efficient care). These findings may well reflect that once managed care penetration reaches relatively high levels, marketshare can no longer be gained through cost-efficiency alone; rather, enrollee satisfaction based on societal demands becomes a key factor in maintaining and gaining marketshare. Institutional theory provides' some strategies for accomplishing these goals. Cost-containment strategies include implementing policies for cutting costs in areas that do not affect the quality of care, such as using generic drugs and reducing administrative excesses and redundancies. At the same time, MCOs must implement strategies aimed at improving conformity to prevailing societal perceptions of appropriate care, including providing patients more freedom to choose their physicians and encouraging and rewarding care providers for being friendly and personable. An MCO should work to inform the public of the organization's efforts to provide high-quality, low-cost medical care in a friendly, convenient manner.

Three Methods of Assessing Values for Advance Care Planning

PubMed Central

Karel, Michele J.; Moye, Jennifer; Bank, Adam; Azar, Armin R.

2016-01-01

Advance care planning ideally includes communication about values between patients, family members, and care providers. This study examined the utility of health care values assessment tools for older adults with and without dementia. Adults aged 60 and older, with and without dementia, completed three values assessment tools—open-ended, forced-choice, and rating scale questions—and named a preferred surrogate decision maker. Responses to forced-choice items were examined at 9-month retest. Adults with and without dementia appeared equally able to respond meaningfully to questions about values regarding quality of life and health care decisions. People with dementia were generally as able as controls to respond consistently after 9 months. Although values assessment methods show promise, further item and scale development work is needed. Older adults with dementia should be included in clarifying values for advance care planning to the extent that they desire and are able. PMID:17215205

Sick child care options: what do working mothers prefer?

PubMed

Landis, S E; Earp, J A

1987-01-01

More than half of all mothers with children under age 6 are in the labor force. Working mothers must take off anywhere from 5.6 days to 28.8 days per employee per year to care for their sick children. In a survey of 134 working mothers with children in day care centers, 70% expressed an interest in sick child care options outside the home, especially a sick room at the child's regular day care center or an infirmary at the parent's workplace. Mothers who chose "out-of home care" were more likely to: be minority (p less than 0.01); be single parents (p = 0.06); earn less than $10,000 annually (p = 0.03); want their children with temperatures of 100-100.9 F to remain in school until the end of the day (p less than 0.01). Communities and day care centers serving especially lower income, minority or single-parent working mothers should consider investigating these out-of-home sick child care options; the savings to employers could be $2 to $12 billion per year, not to speak of the personal savings to the mothers themselves.

The contribution of organization theory to nursing health services research.

PubMed

Mick, Stephen S; Mark, Barbara A

2005-01-01

We review nursing and health services research on health care organizations over the period 1950 through 2004 to reveal the contribution of nursing to this field. Notwithstanding this rich tradition and the unique perspective of nursing researchers grounded in patient care production processes, the following gaps in nursing research remain: (1) the lack of theoretical frameworks about organizational factors relating to internal work processes; (2) the need for sophisticated methodologies to guide empirical investigations; (3) the difficulty in understanding how organizations adapt models for patient care delivery in response to market forces; (4) the paucity of attention to the impact of new technologies on the organization of patient care work processes. Given nurses' deep understanding of the inner workings of health care facilities, we hope to see an increasing number of research programs that tackle these deficiencies.

Investing in Child Care Jobs in Low-Income Communities: A Special Report from the National Center for the Early Childhood Work Force.

ERIC Educational Resources Information Center

National Center for the Early Childhood Work Force, Washington, DC.

Child care is a prevalent service need among parents of young children and a major employment option for women. Low compensation for child care teachers/providers contributes to the cycle of poverty because poor women have little access to training, education, and other avenues of career advancement. Mandatory employment for welfare recipients…

Health Workforce: Ensuring Adequate Supply and Distribution Remains Challenging. Testimony before the Subcommittee on Health, Committee on Energy and Commerce, House of Representatives.

ERIC Educational Resources Information Center

Heinrich, Janet

The General Accounting Office's (GAO's) director of health care-public health issues testified before Congress regarding growing concerns about the adequacy of the health care work force and lessons learned from the experience of the National Health Service Corps (NHSC) in addressing the maldistribution of health care professionals. The following…

Herself: Elle-Meme. Report of the Nova Scotia Task Force on the Status of Women.

ERIC Educational Resources Information Center

Nova Scotia Task Force on the Status of Women, Halifax.

This report to the Canadian Government from the Nova Scotia Women's Task Force examines the social issues and problems pertaining to the women's movement in that province. Discussions are provided on the situations and attitudes toward homemakers, working women, marriage, divorce, child care, education, health, and political participation.…

For the Health-Care Work Force, a Critical Prognosis

ERIC Educational Resources Information Center

Rahn, Daniel W.; Wartman, Steven A.

2007-01-01

The United States faces a looming shortage of many types of health-care professionals, including nurses, physicians, dentists, pharmacists, and allied-health and public-health workers. There may also be a shortage of faculty members in the health sciences. The results will be felt acutely within the next 10 years. Colleges and health-science…

"Every Experience Is a Moving Force": Identity and Growth through Mentoring

ERIC Educational Resources Information Center

Johnson, Kimberly A.

2003-01-01

This narrative of the experience of a native English speaking (NES) cooperating teacher working with a nonnative English speaking (NNES) student teacher in an MA Teaching English as a Second Language practicum begins with a discussion of teacher identity, then outlines the significance of caring in teacher-student relations Noddings (Caring: A…

Satisfaction with civilian family medicine residency training: Perspectives from serving general duty medical officers in the Canadian Armed Forces.

PubMed

Wolfrom, Brent; Hodgetts, Geoff; Kotecha, Jyoti; Pollock, Emily; Martin, Mary; Han, Han; Morissette, Pierre

2016-09-01

To evaluate satisfaction with civilian residency training programs among serving general duty medical officers within the Canadian Armed Forces. A 23-item, cross-sectional survey face-validated by the office of the Surgeon General of the Canadian Armed Forces. Canada. General duty medical officers serving in the Canadian Armed Forces as of February 2014 identified through the Directorate of Health Services Personnel of the Canadian Forces Health Services Group Headquarters. Satisfaction with and time spent in 7 domains of training: trauma, critical care, emergency medicine, psychiatry, occupational health, sports medicine, and base clinic training. Overall preparedness for leading a health care team, caring for a military population, working in isolated and challenging environments, and being deployed were evaluated on a 5-point Likert scale. Among the survey respondents (n = 135, response rate 54%), 77% agreed or strongly agreed that their family medicine residency training was relevant to their role as a general duty medical officer. Most respondents were either satisfied or very satisfied with their emergency medicine training (77%) and psychiatry training (63%), while fewer were satisfied or very satisfied with their sports medicine (47%), base clinic (41%), and critical care (43%) training. Even fewer respondents were satisfied or very satisfied with their trauma (26%) and occupational health (12%) training. Regarding overall preparedness, 57% believed that they were adequately prepared to care for a military patient population, and 52% of respondents believed they were prepared for their first posting. Fewer respondents (38%) believed they were prepared to work in isolated, austere, or challenging environments, and even fewer (32%) believed that residency training prepared them to lead a health care team. General duty medical officers were satisfied with many aspects of their family medicine residency training; however, military-specific areas for improvement were identified. Many of these areas might be addressed within the context of a 2-year residency program without risking the generalist nature of family medicine training. These findings provide valuable data for residency programs that accept military trainees across the country. Copyright© the College of Family Physicians of Canada.

Epidemiology and prevention of substance use disorders in the military.

PubMed

Sirratt, Deborah; Ozanian, Alfred; Traenkner, Barbara

2012-08-01

U.S. military service members have been in active combat for more than 10 years. Research reveals that combat exposure increases the risk of substance use disorders, post-traumatic stress disorder, major depression, and tobacco use. The Services and the field of addiction medicine are working hard to find a common definition for prescription drug misuse, which is a growing concern in both the general U.S. population and the force. Meanwhile, leaders at all levels of Department of Defense are diligently working to address barriers to care, particularly stigma related to substance abuse care, by seeking a balance between improving service member privacy in order to encourage self-referral for medical care and a commander's need to know the status of the unit and its combat readiness. The treatment and management of substance abuse disorders are a complex force health issue that requires the use of evidence-based medical interventions and policies that are consistent with them.

On the other side of the battle: Russian nurses in the Crimean War.

PubMed

Benson, E R

1992-01-01

One redeeming feature that emerged from the horrors of the Crimean War was the skilled and compassionate nursing care provided by women. The work of Florence Nightingale and her nurses with the British forces is a familiar story. What is less well-known is that the fighting forces on the other side of the battle lines also had their contingent of nurses who helped to alleviate the suffering of their sick and wounded. This paper discusses the events leading up to the organization of Russia's volunteer nurses who provided care on their side of the battle.

Infusing Integrated Behavioral Health in an MSW Program: Curricula, Field, and Interprofessional Educational Activities

ERIC Educational Resources Information Center

Zerden, Lisa de Saxe; Jones, Anne; Brigham, Rebecca; Kanfer, Meryl; Zomorodi, Margaret

2017-01-01

An essential aspect of integrated care is the coordination of medical and behavioral health needs concurrently. This has sparked renewed emphasis on interprofessional (IP) education and practice. The impetus for IP efforts was crystalized in large part because of health care reforms, and federal funding to expand the behavioral health work force.…

The Changing Workforce. Comparison of Federal and Nonfederal Work/Family Programs and Approaches.

ERIC Educational Resources Information Center

General Accounting Office, Washington, DC. General Government Div.

The tremendous growth in the number of women in the labor force has dramatically changed the world of work. Traditional human resources policies were not designed for this new workforce. Federal regulations prohibit federal workers from using any of their sick leave to care for a child or a parent. To learn about nonfederal work/family efforts,…

Report on Financing the New Model of Family Medicine

PubMed Central

Spann, Stephen J.

2004-01-01

PURPOSE To foster redesigning the work and workplaces of family physicians, this Future of Family Medicine task force was created to formulate and recommend a financial model that sustains and promotes a thriving New Model of care by focusing on practice reimbursement and health care finances. The goals of the task force were to develop a financial model that assesses the impact of the New Model on practice finances, and to recommend health care financial policies that, if implemented, would be expected to promote the New Model and the primary medical care function in the United States for the next few decades. METHODS The members of the task force reflected a wide range of professional backgrounds and expertise. The group met in person on 2 occasions and communicated by e-mail and conference calls to achieve consensus. A marketing study was carried out using focus groups to test the concept of the New Model with consumers. External consultants with expertise in health economics, health care finance, health policy, and practice management were engaged to assist the task force with developing the microeconomic (practice level) and macroeconomic (societal level) financial models necessary to achieve its goals. Model assumptions were derived from the published medical literature, existing practice management databases, and discussions with experienced physicians and other content experts. The results of the financial modeling exercise are included in this report. The initial draft report of the findings and recommendations was shared with a reactor panel representing a broad spectrum of constituencies. Feedback from these individuals was reviewed and incorporated, as appropriate, into the final report. RESULTS The practice-level financial model suggests that full implementation of the New Model of care within the current fee-for-service system of reimbursement would result in a 26% increase in compensation (from $167,457 to $210,288 total annual compensation) for prototypical family physicians who maintain their current number of work hours. Alternatively, physicians could choose to decrease their work hours by 12% and maintain their current compensation. This result is sensitive to physician practice group size. The societal level financial model shows that modifications in the current reimbursement system could lead to further improvements in compensation for family physicians practicing the New Model of care. Reimbursement for e-visits and chronic disease management could further increase total annual compensation to $229,849 for prototypical family physicians maintaining their current number of work hours. The widespread introduction of quality-based physician incentive bonus payments similar to some current programs that have been implemented on a limited basis could further increase total annual compensation up to $254,500. The adoption of a mixed reimbursement model, which would add an annual per-patient fee, a chronic care bonus, and an overall performance bonus to the current reimbursement system, could increase total annual compensation for the prototypical family physician continuing the current number of hours worked to as much as $277,800, a 66% increase above current compensation levels. The cost of transition to the New Model is estimated to range from $23,442 to $90,650 per physician, depending on the assumed magnitude of productivity loss associated with implementing an electronic health record. The financial impact of enhanced use of primary care on the costs of health care in the United States was estimated. If every American used a primary care physician as their usual source of care, health care costs would likely decrease by 5.6%, resulting in national savings of $67 billion dollars per year, with an improvement in the quality of the health care provided. CONCLUSIONS Family physicians could use New Model efficiency to increase compensation or to reduce work time. There are alternative reimbursement methodologies compatible with the New Model that would allow family physicians to share in the health care cost savings achieved as a result of effective and efficient delivery of care. The New Model of care should enhance health care while propelling the US system toward improved performance and results that are satisfying to patients, health care professionals, purchasers, and payers. The New Model needs to be implemented now. Given the recognized need for improvements in the US health care system in the areas of quality, safety, access and costs, there is no reason to delay. PMID:15654084

Report on financing the new model of family medicine.

PubMed

Spann, Stephen J

2004-12-02

To foster redesigning the work and workplaces of family physicians, this Future of Family Medicine task force was created to formulate and recommend a financial model that sustains and promotes a thriving New Model of care by focusing on practice reimbursement and health care finances. The goals of the task force were to develop a financial model that assesses the impact of the New Model on practice finances, and to recommend health care financial policies that, if implemented, would be expected to promote the New Model and the primary medical care function in the United States for the next few decades. The members of the task force reflected a wide range of professional backgrounds and expertise. The group met in person on 2 occasions and communicated by e-mail and conference calls to achieve consensus. A marketing study was carried out using focus groups to test the concept of the New Model with consumers. External consultants with expertise in health economics, health care finance, health policy, and practice management were engaged to assist the task force with developing the microeconomic (practice level) and macroeconomic (societal level) financial models necessary to achieve its goals. Model assumptions were derived from the published medical literature, existing practice management databases, and discussions with experienced physicians and other content experts. The results of the financial modeling exercise are included in this report. The initial draft report of the findings and recommendations was shared with a reactor panel representing a broad spectrum of constituencies. Feedback from these individuals was reviewed and incorporated, as appropriate, into the final report. The practice-level financial model suggests that full implementation of the New Model of care within the current fee-for-service system of reimbursement would result in a 26% increase in compensation (from 167,457 dollars to 210,288 dollars total annual compensation) for prototypical family physicians who maintain their current number of work hours. Alternatively, physicians could choose to decrease their work hours by 12% and maintain their current compensation. This result is sensitive to physician practice group size. The societal level financial model shows that modifications in the current reimbursement system could lead to further improvements in compensation for family physicians practicing the New Model of care. Reimbursement for e-visits and chronic disease management could further increase total annual compensation to 229,849 dollars for prototypical family physicians maintaining their current number of work hours. The widespread introduction of quality-based physician incentive bonus payments similar to some current programs that have been implemented on a limited basis could further increase total annual compensation up to 254,500 dollars. The adoption of a mixed reimbursement model, which would add an annual per-patient fee, a chronic care bonus, and an overall performance bonus to the current reimbursement system, could increase total annual compensation for the prototypical family physician continuing the current number of hours worked to as much as 277,800 dollars, a 66% increase above current compensation levels. The cost of transition to the New Model is estimated to range from 23,442 dollars to 90,650 dollars per physician, depending on the assumed magnitude of productivity loss associated with implementing an electronic health record. The financial impact of enhanced use of primary care on the costs of health care in the United States was estimated. If every American used a primary care physician as their usual source of care, health care costs would likely decrease by 5.6%, resulting in national savings of 67 billion dollars per year, with an improvement in the quality of the health care provided. Family physicians could use New Model efficiency to increase compensation or to reduce work time. There are alternative reimbursement methodologies compatible with the New Model that would allow family physicians to share in the health care cost savings achieved as a result of effective and efficient delivery of care. The New Model of care should enhance health care while propelling the US system toward improved performance and results that are satisfying to patients, health care professionals, purchasers, and payers. The New Model needs to be implemented now. Given the recognized need for improvements in the US health care system in the areas of quality, safety, access and costs, there is no reason to delay.

An initiative to improve the management of clinically significant test results in a large health care network.

PubMed

Roy, Christopher L; Rothschild, Jeffrey M; Dighe, Anand S; Schiff, Gordon D; Graydon-Baker, Erin; Lenoci-Edwards, Jennifer; Dwyer, Cheryl; Khorasani, Ramin; Gandhi, Tejal K

2013-11-01

The failure of providers to communicate and follow up clinically significant test results (CSTR) is an important threat to patient safety. The Massachusetts Coalition for the Prevention of Medical Errors has endorsed the creation of systems to ensure that results can be received and acknowledged. In 2008 a task force was convened that represented clinicians, laboratories, radiology, patient safety, risk management, and information systems in a large health care network with the goals of providing recommendations and a road map for improvement in the management of CSTR and of implementing this improvement plan during the sub-force sequent five years. In drafting its charter, the task broadened the scope from "critical" results to "clinically significant" ones; clinically significant was defined as any result that requires further clinical action to avoid morbidity or mortality, regardless of the urgency of that action. The task force recommended four key areas for improvement--(1) standardization of policies and definitions, (2) robust identification of the patient's care team, (3) enhanced results management/tracking systems, and (4) centralized quality reporting and metrics. The task force faced many challenges in implementing these recommendations, including disagreements on definitions of CSTR and on who should have responsibility for CSTR, changes to established work flows, limitations of resources and of existing information systems, and definition of metrics. This large-scale effort to improve the communication and follow-up of CSTR in a health care network continues with ongoing work to address implementation challenges, refine policies, prepare for a new clinical information system platform, and identify new ways to measure the extent of this important safety problem.

Informal Care and Labor Market Outcomes: Evidence From Chinese Married Women.

PubMed

Chen, Lu; Zhao, Na; Fan, Hongli; Coyte, Peter C

2015-10-16

Data were used from the 1991-2009 China Health and Nutrition Survey to examine the influence of informal care on labor market outcomes for married women of working aged, with emphasis on caregiving intensity. After accounting for potential endogeneity between caregiving and labor force participation (LFP) through simultaneous equations modeling, caregivers who provided more than 15 or 20 hr of caregiving per week were 4.5-7.7% less likely to be LFPs. Intensive caregivers who remained working had significantly lower (4.97-7.20) weekly hours of work. The significant positive effect of informal care on LFP only existed in the rural sample, and these women also had much lower hours of work than their urban counterparts. Opportunities exist for policy interventions that target intensive caregivers in order to allow them to balance both work and caregiving. © The Author(s) 2015.

The retailing of health care.

PubMed

Paul, T; Wong, J

1984-01-01

A number of striking parallels between recent developments in health care marketing and changes in the retailing industry exist. The authors have compared retailing paradigms to the area on health care marketing so strategists in hospitals and other health care institutions can gain insight from these parallels. Many of the same economic, demographic, technological and lifestyle forces may be at work in both the health care and retail markets. While the services or products offered in health care are radically different from those of conventional retail markets, the manner in which the products and services are positioned, priced or distributed is surprisingly similar.

Prerequisites and driving forces behind an extended working life among older workers.

PubMed

Hovbrandt, Pia; Håkansson, Carita; Albin, Maria; Carlsson, Gunilla; Nilsson, Kerstin

2017-11-28

Reforms are changing pension systems in many European countries, in order to both restrict early retirement and force people to extend their working life. From occupational therapy and occupational science perspectives, studies focusing on aspects of working life that motivate the older worker is urgent. The aim was to describe incentives behind an extended working life among people over age 65. Focus group methodology was used, with participants ages 66-71, from varying work fields: construction and technical companies and the municipal elderly care sector. Work was considered important and valuable to the degree of how challenging work was, the possibilities for inclusion in a team of colleagues and the chances for better personal finances. Amongst all, the participants expressed a feeling of a strengthened identity by being challenged and having the opportunity to manage working tasks. The finding showed the actual reasons behind an extended working life among older workers. However, a risk of rising social inequity may appear with increased working life if older people are forced to extend their working life due to a difficult financial situation as a pensioner. A variety of retirement options and initiatives in order to support older workers are justified.

Developing primary care in Hong Kong: evidence into practice and the development of reference frameworks.

PubMed

Griffiths, Sian M; Lee, Jeff P M

2012-10-01

Enhancing primary care is one of the proposals put forward in the Healthcare Reform Consultation Document "Your Health, Your Life" issued in March 2008. In 2009, the Working Group on Primary Care, chaired by the Secretary for Food and Health, recommended the development of age-group and disease-specific primary care conceptual models and reference frameworks. Drawing on international experience and best evidence, the Task Force on Conceptual Model and Preventive Protocols of the Working Group on Primary Care has developed two reference frameworks for the management of two common chronic diseases in Hong Kong, namely diabetes and hypertension, in primary care settings. Adopting a population approach for the prevention and control of diabetes and hypertension across the life course, the reference frameworks aim to provide evidence-based and appropriate recommendations for the provision of continuing and comprehensive care for patients with chronic diseases in the community.

Work ability of Dutch employees with rheumatoid arthritis.

PubMed

de Croon, E M; Sluiter, J K; Nijssen, T F; Kammeijer, M; Dijkmans, B A C; Lankhorst, G J; Frings-Dresen, M H W

2005-01-01

To (i) examine the association between fatigue, psychosocial work characteristics (job control, support, participation in decision making, psychological job demands), and physical work requirements on the one hand and work ability of employees with rheumatoid arthritis (RA) on the other, and (ii) determine the advice that health care professionals give to employees with RA on how to maintain their work ability. Data were gathered from 78 employees with early RA (response = 99%) by telephone interviews and self-report questionnaires. Fatigue, lack of autonomy, low coworker/supervisor support, low participation in decision making, and high physical work requirements (i.e. using manual force) predicted low work ability. High psychological job demands, however, did not predict low work ability. The rheumatologist, occupational physician, occupational therapist, physiotherapist, and psychologist gave advice on how to cope with RA at work to 36, 30, 27, 26, and 17% of the employees, respectively. Advice was directed mainly at factors intrinsic to the employee. Employees expressed a positive attitude towards this advice. Fatigue, lack of support, lack of autonomy, lack of participation in decision making, and using manual force at work (e.g. pushing and pulling) threaten the work ability of employees with RA. According to the employees with RA, involvement of health care professionals from different disciplines and the implementation of organizational and technical interventions would help them to tackle these threats.

Nursing Faculty Roles in Teaching Racially and Ethnically Diverse Nursing Students in a Registered Nurse Program

ERIC Educational Resources Information Center

Beard, Kenya V.

2009-01-01

Racial and ethnic health care disparities continue to plague the United States, placing a tremendous personal and societal burden on individuals. A culturally diverse nursing work force can help eliminate these disparities and improve the quality of health care that is delivered. However, the nursing profession does not reflect the nation's…

Child Care Programs Help Parents Find and Keep Jobs: Funding Shortfalls Leave Many Families Without Assistance

ERIC Educational Resources Information Center

Mezey, Jennifer

2004-01-01

Child care subsidies help low-income families work and leave welfare, but funding shortfalls are forcing states to enact restrictive policies that are hurting poor families and efforts to promote their employment and earnings. The Administration?s recently proposed FY 2005 budget would make this situation even worse, causing 447,000 children…

[How is the implementation of the new legal framework for health care affecting HIV-infected immigrants in an irregular situation in Spain?].

PubMed

Pérez-Molina, José A; Pulido, Federico

2015-01-01

The entry into force of Royal Decree (RD) 16/2012 in Spain in September 2012 led to the exclusion of the group of irregular immigrants from the National Healthcare System. With this work, GESIDA attempts to measure the impact of the entry into force of the RD in relation to its application by the Autonomous Communities (CCAA), and how it has affected the health care of irregular immigrants infected with HIV. Information was requested from the 17 CCAA of the existence of measures to ensure the care and treatment of people with HIV infection that were left unprotected because of the implementation of the RD. Likewise, a survey was conducted on health professionals and NGOs involved in the care of these people, to find out how it has affected the implementation of the RD to their daily healthcare work and the availability of information on regulations to implement it. The response of the CCAA was variable, hardly contributing, in some cases, to mitigate the negative effect of the RD. To this is added a complex bureaucracy to access the benefits offered by some regions, often inaccessible to the most vulnerable subjects. Lack of information for health-care professionals and NGOs involved in the care of immigrants, hinders access of this population to health care and the establishment of control measures for diseases with an impact on the public health. The RD 16/2012 has had a negative impact on daily healthcare working, generating the appearance of deep inequities throughout the country. Copyright © 2014 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Do work and family care histories predict health in older women?

PubMed

Benson, Rebecca; Glaser, Karen; Corna, Laurie M; Platts, Loretta G; Di Gessa, Giorgio; Worts, Diana; Price, Debora; McDonough, Peggy; Sacker, Amanda

2017-12-01

Social and policy changes in the last several decades have increased women's options for combining paid work with family care. We explored whether specific combinations of work and family care over the lifecourse are associated with variations in women's later life health. We used sequence analysis to group women in the English Longitudinal Study of Ageing according to their work histories and fertility. Using logistic regression, we tested for group differences in later life disability, depressive symptomology and mortality, while controlling for childhood health and socioeconomic position and a range of adult socio-economic circumstances and health behaviours. Women who transitioned from family care to either part-time work after a short break from the labour force, or to full-time work, reported lower odds of having a disability compared with the reference group of women with children who were mostly employed full-time throughout. Women who shifted from family care to part-time work after a long career break had lower odds of mortality than the reference group. Depressive symptoms were not associated with women's work and family care histories. Women's work histories are predictive of their later life disability and mortality. This relationship may be useful in targeting interventions aimed at improving later life health. Further research is necessary to explore the mechanisms linking certain work histories to poorer later life health and to design interventions for those affected. © The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association.

Do work and family care histories predict health in older women?

PubMed Central

Benson, Rebecca; Glaser, Karen; Corna, Laurie M.; Platts, Loretta G.; Di Gessa, Giorgio; Worts, Diana; Price, Debora; McDonough, Peggy; Sacker, Amanda

2017-01-01

Abstract Background Social and policy changes in the last several decades have increased women’s options for combining paid work with family care. We explored whether specific combinations of work and family care over the lifecourse are associated with variations in women’s later life health. Methods We used sequence analysis to group women in the English Longitudinal Study of Ageing according to their work histories and fertility. Using logistic regression, we tested for group differences in later life disability, depressive symptomology and mortality, while controlling for childhood health and socioeconomic position and a range of adult socio-economic circumstances and health behaviours. Results Women who transitioned from family care to either part-time work after a short break from the labour force, or to full-time work, reported lower odds of having a disability compared with the reference group of women with children who were mostly employed full-time throughout. Women who shifted from family care to part-time work after a long career break had lower odds of mortality than the reference group. Depressive symptoms were not associated with women’s work and family care histories. Conclusion Women’s work histories are predictive of their later life disability and mortality. This relationship may be useful in targeting interventions aimed at improving later life health. Further research is necessary to explore the mechanisms linking certain work histories to poorer later life health and to design interventions for those affected. PMID:29036311

Juggling Jobs and Babies: America's Child Care Challenge. Population Trends and Public Policy, Number 12.

ERIC Educational Resources Information Center

O'Connell, Martin; Bloom, David E.

The most remarkable trend in the U.S. labor force over the past 3 decades has been the entrance of more and more mothers of young children. In 1985, a total of 54 percent of the women with children under 6 years of age were working--four times the 1950 level. This report summarizes recent trends in labor force participation and outlines some of…

The nursing shortage: an update for occupational health nurses.

PubMed

Palmer, Carol

2003-12-01

Nursing is about to realize the worst shortage in history at the same time the first baby boomers are increasing the need for health care. A large component of the current and projected nursing shortage is the aging of the RN work force. Several factors contribute to the aging of the work force, including overall decline in nursing as a chosen profession, the increasing age of nursing graduates, and the aging of the existing RN work force. Job dissatisfaction has been a key issue contributing to the crisis related to recruitment and retention of nurses. Inadequate staffing, heavy workloads, flat salaries, and increased use of mandatory overtime are primary issues related to job dissatisfaction. Job dissatisfaction issues are key components of retention of nursing personnel. Occupational health nurses are experts in dealing with issues of ergonomic challenges, workplace violence, mandatory overtime, stress related injuries, and high stress associated with nursing.

Police referrals to a psychiatric hospital: experiences of nurses caring for police-referred admissions.

PubMed

Maharaj, Reshin; O'Brien, Louise; Gillies, Donna; Andrew, Sharon

2013-08-01

Police are a major source of referral to psychiatric hospitals in industrialized countries with mental health legislation. However, little attention has been paid to nurses' experience of caring for police-referred patients to psychiatric hospitals. This study utilized a Heideggerian phenomenological framework to explore the experiences of nine nurses caring for patients referred by the police, through semistructured interviews. Two major themes emerged from the hermeneutic analyses of interviews conducted with nurse participants: (i) 'expecting "the worst" '; and (ii) 'balancing therapeutic care and forced treatment'. Expecting 'the worst' related to the perceptions nurse participants had about patients referred by the police. This included two sub-themes: (i) 'we are here to care for whoever they bring in'; and (ii) 'but who deserves care?' The second theme balancing therapeutic care and forced treatment included the sub-themes: (i) 'taking control, taking care'; and (ii) 'managing power'. The study raises ethical and skill challenges for nursing including struggling with the notion of who deserves care, and balancing the imperatives of legislation with the need to work within a therapeutic framework. © 2012 The Authors; International Journal of Mental Health Nursing © 2012 Australian College of Mental Health Nurses Inc.

Translations on People’s Republic of China, Number 379

DTIC Science & Technology

1977-05-03

TECHNOLOGICAL Family Planning, Birth Control Linked to Learning- From-Ta-chai (Various sources, various dates) 18 Family Planning Work Well Done in...Nan-kung-hsien Female Labor Force Liberated Through Birth Control Two Counties Hailed for Good Family Planning Work Careful Records Kept on Women...CSO: 4006 17 SCIENTIFIC AND TECHNOLOGICAL FAMILY PLANNING, BIRTH CONTROL LINKED TO LEARNING-FROM-TA-CHAI Family Planning Work Well Done in Nan-kung

[Day care and female employment in Mexico: descriptive evidence and policy considerations].

PubMed

Knaul, F; Parker, S

1996-01-01

"This paper analyzes the supply and organization of public day care in Mexico and presents a series of considerations as to the formulation of future policy. The research concentrates on the evolution of public policies to provide day care to working women in the formal sector through the Mexican Social Security Institute (IMSS). Data on the evolution of female labor force participation, changes in family structure, the supply of day care and patterns of child care arrangements, suggest that access to formal facilities falls short of demand.... Innovative policies for the reorganization and expansion of the provision of day care are presently under consideration." (EXCERPT)

'We have to be satisfied with the scraps': South African nurses' experiences of care on adult psychiatric intellectual disability inpatient wards.

PubMed

Capri, Charlotte; Buckle, Chanellé

2015-05-01

Migrating nursing labour inadvertently reinforces South Africa's care drain, contributes to a global care crisis and forces us to reconsider migration motivation. This paper highlights issues that complicate psychiatric intellectual disability nursing care and identifies loci for change in an attempt to redress this care challenge. An exploratory descriptive-interpretivist method investigated nurses' experiences of psychiatric intellectual disability work. Sixteen free association narrative interviews were collected in 2013. Thematic analysis allowed findings to emerge from the data. Findings reflect a number of themes: 'relational interaction', 'care burden', 'system fatigue', 'infantilising dynamic of care' and 'resources for coping'. System fatigue contributes more to negative experiences of providing care than direct patient work, and nurses experience more relational reciprocity from patients than from institutional management. Organizations should meet nurses' needs for burnout prevention, afford them impact in implementing institutional controls, and engage in a non-exploitative and non-exclusionary way. © 2014 John Wiley & Sons Ltd.

Gaining Control of Occupational Injury and Illness in the U.S. Navy Civilian Work Force

DTIC Science & Technology

1990-01-16

caring for the back. Also monitored by the supervisor is a work -hardening program developed by the clinic physical therapist and physician that... development of a work -hardening program for the returning injured employee to ensure a safe re-entry to the workplace. e. "Green Table" and Medical...physical therapist work closely in developing effective programs for the treatment of occupational injuries. Having an onsite physical therapist available

Hydrophilic-coated catheters for intermittent catheterisation reduce urethral micro trauma: a prospective, randomised, participant-blinded, crossover study of three different types of catheters.

PubMed

Stensballe, J; Looms, D; Nielsen, P N; Tvede, M

2005-12-01

To compare two hydrophilic-coated (SpeediCath and LoFric and one uncoated gel-lubricated catheter (InCare Advance Plus) concerning withdrawal friction force and urethral micro trauma. 49 healthy male volunteers participated in this prospective, randomised, blinded, crossover study of three different bladder catheters. The withdrawal friction force was measured, and urine analysis of blood, nitrite and leucocytes, microbiological analysis of urine cultures and subjective evaluation of the catheters were performed. 40 participants completed the study and were included in the analysis. SpeediCath exerted a significantly lower mean withdrawal friction force and work than the gel-lubricated uncoated catheter, whereas LoFric exerted a significantly higher mean friction force than both of the other catheters. The hydrophilic catheters caused less microscopic haematuria and less pain than the gel-lubricated uncoated catheter. Furthermore, 93% of the participants preferred the hydrophilic catheters. Hydrophilic-coated catheters perform better than uncoated catheters with regard to haematuria and preference. SpeediCath, but not LoFric, exerts less withdrawal friction force than InCare Advance Plus.

Adding Value to Air Force Management Through Building Partnerships Assessment

DTIC Science & Technology

2010-01-01

information on reprint and linking permissions, please see RAND Permissions. Skip all front matter: Jump to Page 16 The RAND Corporation is a nonprofit...public service of the RAND Corporation . CHILDREN AND FAMILIES EDUCATION AND THE ARTS ENERGY AND ENVIRONMENT HEALTH AND HEALTH CARE INFRASTRUCTURE AND...5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) Rand Corporation ,Project Air Force,PO Box 2138,Santa Monica,CA,90407-2138

Labor-Force Participation, Policies & Practices in an Aging America: Adaptation Essential for a Healthy & Resilient Population.

PubMed

Berkman, Lisa F; Börsch-Supan, Axel; Avendano, Mauricio

2015-01-01

Population aging in the United States poses challenges to societal institutions while simultaneously creating opportunities to build a more resilient, successful, and cohesive society. Work organization and labor-force participation are central to both the opportunities and challenges posed by our aging society. We argue that expectations about old age have not sufficiently adapted to the reality of aging today. Our institutions need more adaptation in order to successfully face the consequences of demographic change. Although this adaptation needs to focus especially on work patterns among the "younger elderly," our society has to change its general attitudes toward work organization and labor-force participation, which will have implications for education and health care. We also show that work's beneficial effects on well-being in older ages are often neglected, while the idea that older workers displace younger workers is a misconception emerging from the "lump of labor" fallacy. We conclude, therefore, that working at older ages can lead to better quality of life for older people and to a more productive and resilient society overall.

Report of a Consultation on the Employment of Women with Family Responsibilities (February 17, 1965).

ERIC Educational Resources Information Center

Department of Labour, Ottawa (Ontario). Women's Bureau.

Fifty-four participants met to consider counseling and training for women who were entering or re-entering the labor force after varying periods of time devoted to their families, and the need for day care services and facilities for children of working mothers, provision for maternity leave, and part-time work. Presentations were: (1) "Women…

The Competitiveness and Productivity of Tomorrow's Work Force: Compelling Reasons for Investing in Healthy Children.

ERIC Educational Resources Information Center

National Center for Education in Maternal and Child Health, Washington, DC.

This fact sheet outlines some demographic trends that are influencing the cost and availability of health care for children and making it increasingly necessary to take action to improve the health of the nation's children. In recent years children, as a group, are more likely to be poor, lack health insurance, have working mothers, receive…

Casualisation of the nursing workforce in Australia: driving forces and implications.

PubMed

Creegan, Reta; Duffield, Christine; Forrester, Kim

2003-01-01

This article provides an overview of the extent of casualisation of the nursing workforce in Australia, focusing on the impact for those managing the system. The implications for nurse managers in particular are considerable in an industry where service demand is difficult to control and where individual nurses are thought to be increasingly choosing to work casually. While little is known of the reasons behind nurses exercising their preference for casual work arrangements, some reasons postulated include visa status (overseas trained nurses on holiday/working visas); permanent employees taking on additional shifts to increase their income levels; and those who elect to work under casual contracts for lifestyle reasons. Unknown is the demography of the casual nursing workforce, how these groups are distributed within the workforce, and how many contracts of employment they have across the health service--either through privately managed nursing agencies or hospital managed casual pools. A more detailed knowledge of the forces driving the decisions of this group is essential if health care organisations are to equip themselves to manage this changing workforce and maintain a standard of patient care that is acceptable to the community.

International confederation for cleft lip and palate and related craniofacial anomalies task force report: beyond eurocleft.

PubMed

Semb, Gunvor

2014-11-01

The assigned objective for the Task Force Beyond Eurocleft was "to make recommendations for initiations of local and/or participation in multi-national cleft outcome studies and consist of individuals from the European experience with cleft outcome studies (Scandcleft, Eurocleft) and those who have initiated, or intend to initiate, similar studies in other geographical areas." By May 2013 the Task Force (TF) consisted of 183 members from 59 countries. It was agreed that this initiative should be truly global and include all cleft specialties as well as representatives from cleft support groups in recognition of the huge commitment for improving cleft care worldwide. The vision for this group is to build a dynamic, well-functioning TF that will work globally and be multidisciplinary with inclusive and respectful behavior to improve care for all individuals born with cleft lip and/or palate. As there is a large diversity in needs and interest in the group a range of parallel approaches would be required depending on the experience, resources, and challenges of regions, teams, and individuals. Important ideas for future work were: (1) Work on a global survey of access, existing outcome studies, current collaborations, and lessons learned. (2) Work towards the creation of a lasting, living resource for newcomers to intercenter collaboration that is kept fresh with new reports, copies of relevant publications, model grant applications, and a list of volunteers with the right experience to provide support and guidance for new initiatives. (3) Develop simple online training modules to provide information about the benefits and principles of multidisciplinary care, collaborative data collection and auditing short and longer-term outcomes. (4) Establish subgroups that will work within all regions of the world with regional and national leaders identified. An evaluation of current standards of care should be undertaken and country/region specific remedies to optimize treatment outcome suggested. (5) Reach agreement on minimum standards of care, minimum record collection, and reach consensus on simple outcome measures in all disciplines. This should include all cleft types and all ages. These standards could be used to encourage governments to fund multidisciplinary care. (6) Teams will be encouraged to start and continue recordkeeping using simple and agreed protocols, according to agreed standards of minimum records and later share their data with other teams and then, embark on outcome studies. (7) Teams already active in research should: Create a register for cleft professionals and teams to reach agreement of contemporary and comprehensive multidisciplinary outcome measures, explore the possibilities using modern technology and plan large multi-national studies. A patient/parent centered data collection should always be included. These studies need funding. One task could also be exploring whether health care at a distance could be initiated using new technology.

The impact of labor policies on the health of young children in the context of economic globalization.

PubMed

Heymann, Jody; Earle, Alison; McNeill, Kristen

2013-01-01

Globalization has transformed the workplace at the same time that increasing numbers of children live in families in which all adults work for pay outside the home. Extensive research evidence demonstrates the importance of parental involvement in the early years of a child's life. Yet, parents caring for young children may face challenges in fulfilling both work and family responsibilities under current labor force conditions. In this article, we review the evidence on the importance of parental care for meeting young children's routine care needs, preventive health care needs, and curative medical treatment requirements. We examine the evidence regarding the impact of four policies in particular on young children's health and development: parental leave, breastfeeding breaks, early childhood care and education, and leave for children's health needs. Last, we examine the availability of these policies worldwide and discuss the potential economic implications.

Regulation of health information processing in an outsourcing environment.

PubMed

2004-06-01

Policy makers must consider the work force, technology, cost, and legal implications of their legislative proposals. AHIMA, AAMT, CHIA, and MTIA urge lawmakers to craft regulatory solutions that enforce HIPAA and support advancements in modern health information processing practices that improve the quality and cost of healthcare. We also urge increased investment in health information work force development and implementation of new technologies to advance critical healthcare outcomes--timely, accurate, accessible, and secure information to support patient care. It is essential that state legislatures reinforce the importance of improving information processing solutions for healthcare and not take actions that will produce unintended and detrimental consequences.

Job satisfaction of primary health-care providers (public sector) in urban setting.

PubMed

Kumar, Pawan; Khan, Abdul Majeed; Inder, Deep; Sharma, Nandini

2013-07-01

Job satisfaction is determined by a discrepancy between what one wants in a job and what one has in a job. The core components of information necessary for what satisfies and motivates the health work force in our country are missing at policy level. Therefore present study will help us to know the factors for job satisfaction among primary health care providers in public sector. Present study is descriptive in nature conducted in public sector dispensaries/primary urban health centers in Delhi among health care providers. Pretested structured questionnaire was administered to 227 health care providers. Data was analyzed using SPSS and relevant statistical test were applied. Analysis of study reveals that ANMs are more satisfied than MOs, Pharmacist and Lab assistants/Lab technicians; and the difference is significant (P < 0.01). Age and education level of health care providers don't show any significant difference in job satisfaction. All the health care providers are dissatisfied from the training policies and practices, salaries and opportunities for career growth in the organization. Majority of variables studied for job satisfaction have low scores. Five factor were identified concerned with job satisfaction in factor analysis. Job satisfaction is poor for all the four groups of health care providers in dispensaries/primary urban health centers and it is not possible to assign a single factor as a sole determinant of dissatisfaction in the job. Therefore it is recommended that appropriate changes are required at the policy as well as at the dispensary/PUHC level to keep the health work force motivated under public sector in Delhi.

Business Planning for Parenthood.

ERIC Educational Resources Information Center

Spruell, Geraldine

1986-01-01

With more mothers than ever in the labor force, companies are realizing they must help workers deal with multiple roles. Employer-sponsored programs include day care centers, vouchers, and referrals; flextime; job sharing; extended leave, flexible benefits, and work-at-home plans; and support groups. (CH)

The influence of institutional discourses on the work of informal carers: an institutional ethnography from the perspective of informal carers.

PubMed

Øydgard, Guro Wisth

2017-09-07

The growing numbers of seniors worldwide and the need for support and services that follow from a higher standard of living have led to an increased focus on scarce benefits and limited human resources. At the same time, many western countries have had to make welfare cuts to balance budgets. This has brought the contributions of informal carers to the fore. Thus far, the focus has generally been on the need for the informal carers to receive information and support; to enable them to contribute. The study is designed as an institutional ethnography. The article describes the social processes of informal caregiving and how it interacts with formal caregiving, from the perspective of informal carers. The research question for the study is How do institutional discourses on the work of informal carers influence informal carework? Data for the article comes from qualitative semi-structured interviews with 26 informal carers caring for persons with dementia in Norway, and with 7 administrators working in the allocation divisions of five different municipalities. The results demonstrate how three institutional discourses of informal carers' work influence the allocation divisions' practices and the work of informal carers in caring for their next of kin. The three discourses are categorised as moral and family obligation, shared care and task specificity. The informal carers want to contribute, as they feel a family and moral obligation to their next of kin. In the interaction with the allocation division, they find that the expectation that they will share in the carework and perform specific tasks forces them to perform care within a framework set by the public services. The findings suggest that further research should challenge how services are distributed and allocated rather than focus on how to enable informal carers to fulfil their role better. Because of their moral and family obligation, the informal carers do not have to be forced to perform certain tasks or parts of the shared care. To maintain the informal carers' carework and to fully utilise their contributions, public services would benefit from collaborating with the informal carers to fulfil the total care need of the person with dementia.

Forces between permanent magnets: experiments and model

NASA Astrophysics Data System (ADS)

González, Manuel I.

2017-03-01

This work describes a very simple, low-cost experimental setup designed for measuring the force between permanent magnets. The experiment consists of placing one of the magnets on a balance, attaching the other magnet to a vertical height gauge, aligning carefully both magnets and measuring the load on the balance as a function of the gauge reading. A theoretical model is proposed to compute the force, assuming uniform magnetisation and based on laws and techniques accessible to undergraduate students. A comparison between the model and the experimental results is made, and good agreement is found at all distances investigated. In particular, it is also found that the force behaves as r -4 at large distances, as expected.

Effect of two contrasting interventions on upper limb chronic pain and disability: a randomized controlled trial.

PubMed

Sundstrup, Emil; Jakobsen, Markus D; Andersen, Christoffer H; Jay, Kenneth; Persson, Roger; Aagaard, Per; Andersen, Lars L

2014-01-01

Chronic pain and disability of the arm, shoulder, and hand severely affect labor market participation. Ergonomic training and education is the default strategy to reduce physical exposure and thereby prevent aggravation of pain. An alternative strategy could be to increase physical capacity of the worker by physical conditioning. To investigate the effect of 2 contrasting interventions, conventional ergonomic training (usual care) versus resistance training, on pain and disability in individuals with upper limb chronic pain exposed to highly repetitive and forceful manual work. Examiner-blinded, parallel-group randomized controlled trial with allocation concealment. Slaughterhouses located in Denmark, Europe. Sixty-six adults with chronic pain in the shoulder, elbow/forearm, or hand/wrist and work disability were randomly allocated to 10 weeks of specific resistance training for the shoulder, arm, and hand muscles for 3 x 10 minutes per week, or ergonomic training and education (usual care control group). Pain intensity (average of shoulder, arm, and hand, scale 0 - 10) was the primary outcome, and disability (Work module of DASH questionnaire) as well as isometric shoulder and wrist muscle strength were secondary outcomes. Pain intensity, disability, and muscle strength improved more following resistance training than usual care (P < 0.001, P = 0.05, P <0.0001, respectively [corrected]). Pain intensity decreased by 1.5 points (95% confidence interval -2.0 to -0.9) following resistance training compared with usual care, corresponding to an effect size of 0.91 (Cohen's d). Blinding of participants is not possible in behavioral interventions. However, at baseline outcome expectations of the 2 interventions were similar. Resistance training at the workplace results in clinical relevant improvements in pain, disability, and muscle strength in adults with upper limb chronic pain exposed to highly repetitive and forceful manual work. NCT01671267.

The wicked question answered: positive deviance delivers patient-centered care.

PubMed

Gary, Jodie C

2014-01-01

How nurses respond when faced with the dilemma of providing patient-centered care in the absence of patient-centered practice guidelines remains relatively unreported. Standards may not be available to guide nurses or may not be realistic for implementation at the point of care. Nurses may be forced to react creatively to meet the needs of their patients. The purpose was to understand nursing care when standard practice guidelines did not meet patient-specific care needs and to develop various viewpoints related to the use of positive deviance in providing patient-centered care. Complexity theory and the framework of a wicked question were used to guide a 3-round online national Delphi study from November 2011 to February 2012. The panel was accessed through the American Association of Critical Care Nurses to expose the care provided when standard practice guidelines were lacking. Findings support the presence of positive deviance and expose care provided by nurses when standard practice guidelines lacked the ability to provide patient-centered care. Dominant themes of positive deviance are recommended as priorities for future research. Better guidelines are needed that work for nurses, instead of against them, that would not force a nurse into actions that are not patient centered. Guidelines should guide practice and assist in allowing nurses to provide care that is centered on the best needs of the patient in the specific care situation.

Peace making/peace keeping missions: role of the U.S. Army nurse.

PubMed

Yoder, Linda H; Brunken, Sandra L

2003-06-01

Somewhere in the world every month expert military critical care/trauma providers are working side-by-side with host nations to help them develop their trauma and disaster management systems. This article discusses the Air Force Medical System's (AFMS) mission to provide humanitarian and civic assistance, disaster response, and care of wartime injured. Within the context of this tripartite mission, the article introduces the AFMS's flagship international course, "Leadership Course in Regional Disaster Response and Trauma System Management," and highlights the that military critical care nurses play in this international effort.

Nursing leadership and management effects work environments.

PubMed

Tomey, Ann Marriner

2009-01-01

The aim of this literature search was to identify recent research related to nursing leadership and management effects on work environment using the 14 forces of magnetism. This article gives some historical perspective from the original 1983 American Academy of Nursing study through to the 2002 McClure and Hinshaw update to 2009 publications. Research publications were given a priority for references. The 14 forces of magnetism as identified by Unden and Monarch were: '1. Quality of leadership..., 2. Organizational structure..., 3. Management style..., 4. Personnel policies and programs..., 5. Professional models of care..., 6. Quality of care..., 7 Quality improvement..., 8. Consultation and resources..., 9. Autonomy..., 10. Community and the hospital..., 11. Nurse as teacher..., 12. Image of nursing..., 13. Interdisciplinary relationships... and 14. Professional development....'. Correlations have been found among positive workplace management initiatives, style of transformational leadership and participative management; patient-to-nurse ratios; education levels of nurses; quality of patient care, patient satisfaction, employee health and well-being programmes; nurse satisfaction and retention of nurses; healthy workplace environments and healthy patients and personnel. This article identifies some of the research that provides evidence for evidence-based nursing management and leadership practice.

Employer supports for parents with young children.

PubMed

Friedman, D E

2001-01-01

The competing interests of employers, working parents, and very young children collide in decisions over work schedules, child care arrangements, promotions, children's sicknesses, and overtime hours. With the rising number of women in the labor force, more and more employers are concerned about how their workers balance work and family priorities. This article examines the supports that employers provide to help parents with young children juggle demands on their time and attention. It reviews the availability of traditional benefits, such as vacation and health insurance, and describes family-friendly initiatives. Exciting progress is being made in this arena by leading employers, but coverage remains uneven: Employers say they provide family-friendly policies and programs to improve staff recruitment and retention, reduce absenteeism, and increase job satisfaction and company loyalty. Evaluations demonstrate positive impacts on each of these valued outcomes. Employee benefits and work/family supports seldom reach all layers of the work force, and low-income workers who need assistance the most are the least likely to receive or take advantage of it. Understandably, employer policies seek to maximize productive work time. However, it is often in the best interests of children for a parent to be able to set work aside to address urgent family concerns. The author concludes that concrete work/family supports like on-site child care, paid leave, and flextime are important innovations. Ultimately, the most valuable aid to employees would be a family-friendly workplace culture, with supportive supervision and management practices.

Labor-Force Participation, Policies & Practices in an Aging America: Adaptation Essential for a Healthy & Resilient Population

PubMed Central

Berkman, Lisa F.; Börsch-Supan, Axel; Avendano, Mauricio

2016-01-01

Population aging in the United States poses challenges to societal institutions while simultaneously creating opportunities to build a more resilient, successful, and cohesive society. Work organization and labor-force participation are central to both the opportunities and challenges posed by our aging society. We argue that expectations about old age have not sufficiently adapted to the reality of aging today. Our institutions need more adaptation in order to successfully face the consequences of demographic change. Although this adaptation needs to focus especially on work patterns among the “younger elderly,” our society has to change its general attitudes toward work organization and labor-force participation, which will have implications for education and health care. We also show that work’s beneficial effects on well-being in older ages are often neglected, while the idea that older workers displace younger workers is a misconception emerging from the “lump of labor” fallacy. We conclude, therefore, that working at older ages can lead to better quality of life for older people and to a more productive and resilient society overall. PMID:28042166

Parenting work and autism trajectories of care.

PubMed

Singh, Jennifer S

2016-09-01

This study investigates the work and care associated with raising a child with disabilities in the United States. Based on in-depth interviews with parents who have a child with autism, it develops the notion of parenting work and trajectories of care to investigate how parents navigate and coordinate the challenges of getting an autism diagnosis, obtaining educational services, and re-contextualising the possibilities for the future. I argue that parents embody a complex mix of love, hope, and responsibility in parenting work and trajectories of care that expands temporal and social elements of illness work and trajectories initially developed by Anselm Strauss and colleagues. This type of parenting work changes over time and is influenced by social structural forces and relationships in which the care takes place. The re-articulation of these analytic tools also begins to untangle the intricate mix of both medical and social models of disability that parents embrace and continuously negotiate. This study demonstrates how parents accept the medical model of disability by seeking and pushing for a clinical autism diagnosis and subsequent treatments, while at the same time challenge the limits placed on their children by providing them with opportunities, possible futures, and a sense of personhood. A Virtual Abstract of this paper can be accessed at: https://www.youtube.com/watch?v=x0UmGvpcjeQ. © 2016 Foundation for the Sociology of Health & Illness.

Recent trends in workload, input costs, and expenditures in the Air Force Medical Service Direct Care System.

PubMed

Robbins, Anthony S; Moilanen, Dale A; Fonseca, Vincent P; Chao, Susan Y

2002-04-01

A study was conducted to examine the relationship between two types of trends in the Air Force Medical Service Direct Care System (AFMS/DCS): trends in expenditures, total and by categories; and trends in medical workload, defined as the sum of inpatient admissions and outpatient clinic visits. Expenditure and medical workload data were extracted from the Medical Expense and Performance Reporting System Executive Query System. Medical inflation data were obtained from the Bureau of Labor Statistics Producer Price Index series. Between fiscal years 1995 and 1999, the AFMS/DCS experienced a 21.2% decrease in medical workload, but total (nominal) expenditures declined only 3.6%. Of all expenditure categories, only inpatient medical care, outpatient medical care, and military-funded private sector care for active duty personnel (supplemental care) have any direct relationship with AFMS/DCS medical workload. Real expenditures for the three categories above decreased by 20.3% during the 5-year period. Accounting for inflation and considering only expenditures related to medical workload, these results suggest that the AFMS/DCS is spending approximately 20% less money to do approximately 20% less work.

Evaluating a nursing care delivery model using a quality improvement design.

PubMed

Nardone, P L; Markie, J W; Tolle, S

1995-10-01

The goal to develop and implement a new model of nursing care delivery grew out of administrative and shared governance initiatives to improve the quality of nursing care. This evaluative study used both quantitative and qualitative methods. Seven principles related to quality were identified and became the driving force behind the changes. Aspects of these changes in care delivery were piloted on a neurological unit and included implementation of collaborative rounds, a modular structure, role changes, and work redesign. Frequency distribution, questionnaire, focus group, and financial data indicated that there had been improvement in the delivery of care in addition to financial benefits. A considerable amount of the data provided evidence that supported continuing the changes.

[Mobilization of obese patients : Increasing demands on personnel and equipment].

PubMed

Klarmann, S; Klocke, J

2017-02-01

The number of overweight people in Germany is constantly increasing, thus, forcing nurses and therapists to adjust to new challenges in patient care. Therefore, it is necessary to redefine the methods and goals in treating obese people. Working in an interprofessional team, using state of the art techniques, seems to be of crucial importance in facing the complex treatment that is associated with these patients. The occupational safety and health of personnel is of utmost importance.In this article, the problems associated with patient care and consequences for medical staff are considered. Finally, possibilities to facilitate work in treating obese patients are discussed.

A scoping review of the nurse practitioner workforce in oncology.

PubMed

Coombs, Lorinda A; Hunt, Lauren; Cataldo, Janine

2016-08-01

The quality of cancer care may be compromised in the near future because of work force issues. Several factors will impact the oncology health provider work force: an aging population, an increase in the number of cancer survivors, and expansion of health care coverage for the previously uninsured. Between October 2014 and March 2015, an electronic literature search of English language articles was conducted using PubMed(®) , the Cumulative Index to Nursing and Allied Health Sciences (CINAHL(®) ), Web of Science, Journal Storage (JSTOR(®) ), Google Scholar, and SCOPUS(®) . Using the scoping review criteria, the research question was identified "How much care in oncology is provided by nurse practitioners (NPs)?" Key search terms were kept broad and included: "NP" AND "oncology" AND "workforce". The literature was searched between 2005 and 2015, using the inclusion and exclusion criteria, 29 studies were identified, further review resulted in 10 relevant studies that met all criteria. Results demonstrated that NPs are utilized in both inpatient and outpatient settings, across all malignancy types and in a variety of roles. Academic institutions were strongly represented in all relevant studies, a finding that may reflect the Accreditation Council for Graduate Medical Education (ACGME) duty work hour limitations. There was no pattern associated with state scope of practice and NP representation in this scoping review. Many of the studies reviewed relied on subjective information, or represented a very small number of NPs. There is an obvious need for an objective analysis of the amount of care provided by oncology NPs. © 2016 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

The Economics of Air Force Medical Service Readiness

PubMed Central

Graser, John C.; Blum, Daniel; Brancato, Kevin; Burks, James J.; Chan, Edward W.; Nicosia, Nancy; Neumann, Michael J.; Ritschard, Hans V.; Mundell, Benjamin F.

2012-01-01

Abstract The prime mission of the Air Force Medical Service (AFMS), like those of the medical departments of its sister services, is to provide medical care during wartime. AFMS currently runs three successful in-theater hospitals that treat severely injured or wounded U.S. personnel from all four services. But this wartime mission depends on capabilities built at home, as critical-care specialists maintain their technical proficiency, as much as peacetime opportunities allow, by meeting health-care needs of Department of Defense beneficiaries at home. These patients have ranged from young, healthy active-duty personnel to aging retirees, historically presenting a broad range of injuries and illnesses for treatment. However, between the demands of deployments creating gaps in staff at home and changes in care plans, some beneficiaries now seek care in the civilian sector. In addition, several AFMS hospitals stateside have been closed, converted to clinics, or combined with those of other services for various reasons. All is problematic for two reasons: First, inpatient workloads in particular represent the best opportunities for critical care providers to prepare for their wartime missions. AFMS will need to increase these opportunities, perhaps working with other services, the Department of Veterans Affairs, or civilian hospitals. Second, AFMS's funding depends, in part, on the workload performed, but current measurement methods do not necessarily do a good job of accounting for the work AFMS practitioners accomplish outside their home stations. Some imminent changes may help resolve this situation, but AFMS should pursue opportunities to create additional workload for its medical personnel and to increase its budgets. PMID:28083242

The Economics of Air Force Medical Service Readiness.

PubMed

Graser, John C; Blum, Daniel; Brancato, Kevin; Burks, James J; Chan, Edward W; Nicosia, Nancy; Neumann, Michael J; Ritschard, Hans V; Mundell, Benjamin F

2012-01-01

The prime mission of the Air Force Medical Service (AFMS), like those of the medical departments of its sister services, is to provide medical care during wartime. AFMS currently runs three successful in-theater hospitals that treat severely injured or wounded U.S. personnel from all four services. But this wartime mission depends on capabilities built at home, as critical-care specialists maintain their technical proficiency, as much as peacetime opportunities allow, by meeting health-care needs of Department of Defense beneficiaries at home. These patients have ranged from young, healthy active-duty personnel to aging retirees, historically presenting a broad range of injuries and illnesses for treatment. However, between the demands of deployments creating gaps in staff at home and changes in care plans, some beneficiaries now seek care in the civilian sector. In addition, several AFMS hospitals stateside have been closed, converted to clinics, or combined with those of other services for various reasons. All is problematic for two reasons: First, inpatient workloads in particular represent the best opportunities for critical care providers to prepare for their wartime missions. AFMS will need to increase these opportunities, perhaps working with other services, the Department of Veterans Affairs, or civilian hospitals. Second, AFMS's funding depends, in part, on the workload performed, but current measurement methods do not necessarily do a good job of accounting for the work AFMS practitioners accomplish outside their home stations. Some imminent changes may help resolve this situation, but AFMS should pursue opportunities to create additional workload for its medical personnel and to increase its budgets.

Air Force Shift Worker Fatigue Survey

DTIC Science & Technology

2005-08-01

ensuring that health care and counseling services are available to employees who work non-traditional schedules. "* " Employees may consider various ways for...responded: Shift workers 1stSgt/CC Environmental (noise, lighting, temp., etc.): 35% 35% Family: 15% 14% Health factors (diet, stress, insomnia): 8% 14...fatigue and equity problems reported by the shift workers . 14. An automated shift work scheduling tool is needed’°. Sleep Hygiene and Health Issues

The DISAM Journal of International Security Assistance Management. Volume 32, Number 1, July 2010

DTIC Science & Technology

2010-07-01

Brasilia for the signing ceremony. However, the venue was rescheduled because Jobim is accompanying Brazilian President Luiz Inácio Lula da Silva to...heath care providers, midwives, pharmacists, and nurses . They worked closely with MBLT-3 to make today happen, said a U.S. Army Special Forces Medic...More medical professionals are arriving, and all are highly motivated. We had critical care nurses show up; and after they signed in, they put

Accounting for charity care on a systemwide basis.

PubMed

Peck, T

1988-06-01

The Daughters of Charity National Health System (DCNHS), St. Louis, has developed a systemwide model which formally sets a policy statement, goals, and procedures that enable the 42 DCNHS health-care ministries to effectively serve the poor in their communities on a daily basis, while addressing the long-term challenges of providing charity care for the sick poor. One of the first steps was forming a task force known as the Working Group on Care of the Poor. Its goal was to set the stage for the expansion and accountability of charity care at every level within the new national system. The group outlined these objectives: To identify and recommend several advocacy models. To recommend test models of healthcare delivery for the poor. To recommend strategies for involving the private sector. To develop a method of documenting charity care. To recommend linkage models to jointly provide charity care with related organizations. To gain a firm knowledge of charity care actually provided by the Daughters of Charity After hours of discussions and research, the task force developed a cohesive, workable set of goals and policies that today is helping individual health-care ministries nationwide meet local needs for care of the sick poor. By identifying specific programs and determining how to report charity care in terms of money and services, individual health-care institutions gain insights into their annual operational planning and reporting for the present and the future. This approach ensures that charity care remains in the forefront at every level of planning.

Taking 'women's work' 'like a man': husbands' experiences of care work.

PubMed

Calasanti, Toni; King, Neal

2007-08-01

We adopted a feminist, structural approach to husbands' experiences of caring for wives with Alzheimer's disease. This framework posited that men and women draw upon gender repertoires-situational ideals of behavior based upon their respective structural locations-that create gendered experiences of stress and coping strategies. We used a qualitative, constructivist approach to analyze in-depth interviews with 22 spousal caregivers and observations within support groups. Our analysis focused on the nine husbands, the strategies these men reported using to deal with problems that arose in their care work, and the extent to which these are congruent with the masculinities of White men in the United States. We found that these husbands' approaches to caregiving and their strategies for dealing with the work and feelings involved were rooted in their sense of selves as men. We outline their overall approaches to caregiving, identify six strategies husbands used to deal with problems stemming from care work-exerting force, focusing on tasks, blocking emotions, minimizing disruption, distracting attention, and self-medicating-and tie these to their structural positions as working-, middle-, and professional-class men. Theories of gender differences in the performance or quality of care work should tie these to structural arrangements. Unless the gendered bases upon which different styles or experiences are removed (i.e., structural inequality), designers of interventions cannot and should not expect to use the experience of one group to inform appropriate strategies for the other.

Job Satisfaction of Primary Health-Care Providers (Public Sector) in Urban Setting

PubMed Central

Kumar, Pawan; Khan, Abdul Majeed; Inder, Deep; Sharma, Nandini

2013-01-01

Introduction: Job satisfaction is determined by a discrepancy between what one wants in a job and what one has in a job. The core components of information necessary for what satisfies and motivates the health work force in our country are missing at policy level. Therefore present study will help us to know the factors for job satisfaction among primary health care providers in public sector. Materials and Methods: Present study is descriptive in nature conducted in public sector dispensaries/primary urban health centers in Delhi among health care providers. Pretested structured questionnaire was administered to 227 health care providers. Data was analyzed using SPSS and relevant statistical test were applied. Results: Analysis of study reveals that ANMs are more satisfied than MOs, Pharmacist and Lab assistants/Lab technicians; and the difference is significant (P < 0.01). Age and education level of health care providers don’t show any significant difference in job satisfaction. All the health care providers are dissatisfied from the training policies and practices, salaries and opportunities for career growth in the organization. Majority of variables studied for job satisfaction have low scores. Five factor were identified concerned with job satisfaction in factor analysis. Conclusion: Job satisfaction is poor for all the four groups of health care providers in dispensaries/primary urban health centers and it is not possible to assign a single factor as a sole determinant of dissatisfaction in the job. Therefore it is recommended that appropriate changes are required at the policy as well as at the dispensary/PUHC level to keep the health work force motivated under public sector in Delhi. PMID:24479088

A flexible nursing workforce: realities and fallouts.

PubMed

Grinspun, Doris

2002-01-01

While policy-makers are increasingly concerned about a looming nursing shortage, almost half of Canada's nursing workforce is currently employed on a part-time or casual basis. Why are so many nurses not working full-time and providing the nursing care that would help to alleviate such shortages in our healthcare organizations? Do nurses want to work part-time, or are they driven into this by labour market forces, life demands, poor working conditions and policy decisions external to them? The answers to these questions are critical to ensure that care will be there for all of us. This article presents a brief analysis of flexible employment arrangements in nursing, particularly part-time and casual work, and the impact on nurses, patients and the healthcare system as a whole. Given the sharp increases in these work arrangements in Canada during the last decade, the limited discussion of these trends in the literature is both surprising and troublesome.

What does it mean to be an oncology nurse? Reexamining the life cycle concepts.

PubMed

Cohen, Marlene Z; Ferrell, Betty R; Vrabel, Mark; Visovsky, Constance; Schaefer, Brandi

2010-09-01

To summarize the current research pertaining to the concepts initially examined by the Oncology Nursing Society Life Cycle of the Oncology Nurse Task Force and related projects completed in 1994. Published articles on the 21 concepts from the Oncology Nursing Society Life Cycle of the Oncology Nurse Task Force work. Research published in English from 1995-2009 was obtained from PubMed, CINAHL(R), PsycINFO, ISI Science, and EBSCO Health Source(R): Nursing/Academic Edition databases. Most of the concepts identified from the Oncology Nursing Society Life Cycle of the Oncology Nurse Task Force have been examined in the literature. Relationships and witnessing suffering were common concepts among studies of the meaning of oncology nursing. Nurses provide holistic care, and not surprisingly, holistic interventions have been found useful to support nurses. Interventions included storytelling, clinical support of nurses, workshops to find balance in lives, and dream work. Additional support comes from mentoring. The research identified was primarily descriptive, with very few interventions reported. Findings have been consistent over time in diverse countries. This review indicates that although the healthcare system has changed significantly in 15 years, nurses' experiences of providing care to patients with cancer have remained consistent. The need for interventions to support nurses remains.

Analysis of injury patterns and roles of care in US and Israel militaries during recent conflicts: Two are better than one.

PubMed

Antebi, Ben; Benov, Avi; Mann-Salinas, Elizabeth A; Le, Tuan D; Cancio, Leopoldo C; Wenke, Joseph C; Paran, Haim; Yitzhak, Avraham; Tarif, Bader; Gross, Kirby R; Dagan, David; Glassberg, Elon

2016-11-01

As new conflicts emerge and enemies evolve, military medical organizations worldwide must adopt the "lessons learned." In this study, we describe roles of care (ROCs) deployed and injuries sustained by both US and Israeli militaries during recent conflicts. The purpose of this collaborative work is facilitate exchange of medical data among allied forces in order to advance military medicine and facilitate strategic readiness for future military engagements that may involve less predictable situations of evacuation and care, such as prolonged field care. This retrospective study was conducted for the periods of 2003 to 2014 from data retrieved from the Department of Defense Trauma Registry and the Israel Defense Force (IDF) Trauma Registry. Comparative analyses included ROC capabilities, casualties who died of wounds, as well as mechanism of injury, anatomical wound distribution, and Injury Severity Score of US and IDF casualties during recent conflicts. Although concept of ROCs was similar among militaries, the IDF supports increased capabilities at point of injury and Role 1 including the presence of physicians, but with limited deployment of other ROCs; conversely, the US maintains fewer capabilities at Role 1 but utilized the entire spectrum of care, including extensive deployment of Roles 2/2+, during recent conflicts. Casualties from US forces (n = 19,005) and IDF (n = 2,637) exhibited significant differences in patterns of injury with higher proportions of casualties who died of wounds in the US forces (4%) compared with the IDF (0.6%). As these data suggest deployed ROCs and injury patterns of US and Israeli militaries were both conflict and system specific. We envision that identification of discordant factors and common medical strategies of the two militaries will enable strategic readiness for future conflicts as well as foster further collaboration among allied forces with the overarching universal goal of eliminating preventable death on the battlefield.

Assuming Multiple Roles: The Time Crunch.

ERIC Educational Resources Information Center

McKitric, Eloise J.

Women's increased labor force participation and continued responsibility for most household work and child care have resulted in "time crunch." This strain results from assuming multiple roles within a fixed time period. The existence of an egalitarian family has been assumed by family researchers and writers but has never been verified. Time…

Royal Naval nursing: 'testing but worth it'.

PubMed

Moore, Alison

2014-08-19

Inga Kennedy is the most senior nurse in the Royal Navy. She enjoys the commitment and discipline required by a career in the armed forces and says the work offers great opportunities for nurses. Her career highlights have included checking that injured personnel in Afghanistan were receiving the best care possible.

Workforce Issues Facing HRD. [Concurrent Symposium Session at AHRD Annual Conference, 1997.

ERIC Educational Resources Information Center

1997

This document contains three papers from a symposium on work force issues facing human resource development (HRD). "Diversity Management in Nonprofit Women's Health Care Settings: A Qualitative Study of Race, Class, and Gender Influences" (Camille A. Cordak) demonstrates which organizational activities support diversity and how an…

Making Assets out of Tomorrow's Elderly.

ERIC Educational Resources Information Center

Chen, Yung-Ping

1987-01-01

Uses concept of equivalent retirement ages to explain old age dependency ratio. Asserts that a future larger, able aging population could continue to work, compensating for the smaller, younger labor force. Economic growth as the foundation of economic security is emphasized as a means of lessening cost of caring for society's dependents.…

What Americans Build and Why

USDA-ARS?s Scientific Manuscript database

The purpose of What Americans Build and Why is to foster understanding of the “forces that have shaped our built landscape” in five facets of American life in which facilities play a key role: housing, health care, schools, work, and retail. The book is written from the point of view of an environme...

Power Plays: Proven Methods of Professional Learning Pack a Force

ERIC Educational Resources Information Center

Easton, Lois Brown

2005-01-01

Powerful professional learning is more than a one-shot workshop. It involves educators working collegially on a matter they care about with content arising directly from their classroom experiences. Educators know which strategies offer more powerful learning. Choosing the appropriate strategy requires answering just three questions.

Curriculum Model for Optometry: Outcomes of the Process.

ERIC Educational Resources Information Center

Berman, Morris S.

1994-01-01

A national conference of colleges of optometry focused on planning for optometric curricular reform and faculty development. Issues addressed included changes needed to meet entry-level professional needs, available resources, changes in optometry practice, and optometry's role in health care reform. Task forces worked together to develop a…

Federal Nursing Service Award. Impact of TriCare/managed care on total force readiness.

PubMed

Ray, M A; Turkel, M C

2001-04-01

Mission readiness is dependent on a healthy total force and the response of military medical and nursing services. Managed care has become the norm in U.S. health care, including the Department of Defense Military Health System. Cost management, health maintenance organizations, and other health plans are defined as "managed care," an aggressive cost-control effort by health care purchasers and insurers to limit health care spending and services and advance a market-oriented, profit-driven system. The impact of managed care on mission readiness and retention of active and reserve personnel is and will continue to be profound. The purpose of this research was to conduct a qualitative, phenomenological study (life experiences) of TriCare/managed care to explore the impact and the meaning of the experience on total force mission readiness of the U.S. Air Force and how managed care has changed nursing practice. The results reveal the significance of the impact of TriCare/managed care on total force readiness by identifying, through themes, meta-themes, and a representative model, the negative effect that economics is having on active duty and reserve force health and well-being.

Juggling work and elder caregiving: work-life balance for aging American workers.

PubMed

Pitsenberger, D Jeanne

2006-04-01

As the American work force ages, the demands of caring for aging relatives increase. Family caregiving often interferes with workplace responsibilities, creating physical, emotional, and financial stress for caregivers. Employers must address the productivity losses created by absenteeism of workers who struggle with work-life issues created by caregiving roles. Occupational health nurses must understand the factors that affect workers in their caregiving roles and make appropriate nursing interventions. They are in key positions to help aging employees and their employers face the increased demands on work-life balance created by elder caregiving.

Stabilizing and destabilizing forces in the nursing work environment: a qualitative study on turnover intention.

PubMed

Choi, Sandy Pin-Pin; Pang, Samantha Mei-Che; Cheung, Kin; Wong, Thomas Kwok-Shing

2011-10-01

The nursing work environment, which provides the context of care delivery, has been gaining increasing attention in recent years. A growing body of evidence points to an inseparable link between attributes of the nursing work environment and nurse and patient outcomes. While most studies have adopted a survey design to examine the workforce and work environment issues, this study employed a phenomenological approach to provide empirical evidence regarding nurses' perceptions of their work and work environment. The aim of this study was to advance our understanding of the phenomenon of increasing nurse turnover through exploring frontline registered nurses' lived experiences of working in Hong Kong public hospitals. A modified version of Van Kaam's controlled explication method was adopted. Individual semi-structured interviews were conducted with 26 frontline nurses recruited from ten acute regional, district and non-acute public hospitals in Hong Kong. Their perspectives in regard to their work and work environment, such as workload, manpower demand and professional values, were extensively examined, and a hypothetical description relating the nursing work environment with nurses' turnover intention was posited. Contemplation of nurses' experiences revealed the vulnerable aspects of nursing work and six essential constituents of the nursing work environment, namely staffing level, work responsibility, management, co-worker relationships, job, and professional incentives. These essential constituents have contributed to two sets of forces, stabilizing and destabilizing forces, which originate from the attributes of the nursing work environment. Nurses viewed harmonious co-worker relationships, recognition and professional development as the crucial retaining factors. However, nurses working in an unfavorable environment were overwhelmed by destabilizing forces; they expressed frustration and demonstrated an intention to leave their work environment. The nursing work environment is a complex entity comprising multiple constituents; its attributes affect nurses' perceptions of their work and work environment, which warrant special attention in addressing the phenomenon of increasing nurse turnover. Copyright © 2011 Elsevier Ltd. All rights reserved.

External Hand Forces Exerted by Long-Term Care Staff to Push Floor-Based Lifts: Effects of Flooring System and Resident Weight.

PubMed

Lachance, Chantelle C; Korall, Alexandra M B; Russell, Colin M; Feldman, Fabio; Robinovitch, Stephen N; Mackey, Dawn C

2016-09-01

The aim of this study was to investigate the effects of flooring type and resident weight on external hand forces required to push floor-based lifts in long-term care (LTC). Novel compliant flooring is designed to reduce fall-related injuries among LTC residents but may increase forces required for staff to perform pushing tasks. A motorized lift may offset the effect of flooring on push forces. Fourteen female LTC staff performed straight-line pushes with two floor-based lifts (conventional, motor driven) loaded with passengers of average and 90th-percentile resident weights over four flooring systems (concrete+vinyl, compliant+vinyl, concrete+carpet, compliant+carpet). Initial and sustained push forces were measured by a handlebar-mounted triaxial load cell and compared to participant-specific tolerance limits. Participants rated pushing difficulty. Novel compliant flooring increased initial and sustained push forces and subjective ratings compared to concrete flooring. Compared to the conventional lift, the motor-driven lift substantially reduced initial and sustained push forces and perceived difficulty of pushing for all four floors and both resident weights. Participants exerted forces above published tolerance limits only when using the conventional lift on the carpet conditions (concrete+carpet, compliant+carpet). With the motor-driven lift only, resident weight did not affect push forces. Novel compliant flooring increased linear push forces generated by LTC staff using floor-based lifts, but forces did not exceed tolerance limits when pushing over compliant+vinyl. The motor-driven lift substantially reduced push forces compared to the conventional lift. Results may help to address risk of work-related musculoskeletal injury, especially in locations with novel compliant flooring. © 2016, Human Factors and Ergonomics Society.

Ulnar neuropathy and ulnar neuropathy-like symptoms in relation to biomechanical exposures assessed by a job exposure matrix: a triple case-referent study.

PubMed

Svendsen, Susanne Wulff; Johnsen, Birger; Fuglsang-Frederiksen, Anders; Frost, Poul

2012-11-01

We aimed to evaluate relations between occupational biomechanical exposures and (1) ulnar neuropathy confirmed by electroneurography (ENG) and (2) ulnar neuropathy-like symptoms with normal ENG. In this triple case-referent study, we identified all patients aged 18-65 years, examined with ENG at a neurophysiological department on suspicion of ulnar neuropathy, 2001-2007. We mailed a questionnaire to 546 patients with ulnar neuropathy, 633 patients with ulnar neuropathy-like symptoms and two separate groups of community referents, matched on sex, age and primary care centre (risk set sampling). The two patient groups were also compared to each other directly. We constructed a Job Exposure Matrix to provide estimates of exposure to non-neutral postures, repetitive movements, hand-arm vibrations and forceful work. Conditional and unconditional logistic regressions were used. The proportion who responded was 59%. Ulnar neuropathy was related to forceful work with an exposure-response pattern reaching an OR of 3.85 (95% CI 2.04 to 7.24); non-neutral postures strengthened effects of forceful work. No relation was observed with repetitive movements. Ulnar neuropathy-like symptoms were related to repetitive movements with an OR of 1.89 (95% CI 1.01 to 3.52) in the highest-exposure category (≥2.5 h/day); forceful work was unrelated to the outcome. Ulnar neuropathy and ulnar neuropathy-like symptoms differed with respect to associations with occupational biomechanical exposures. Findings suggested specific effects of forceful work on the ulnar nerve. Thus, results corroborated the importance of an electrophysiological diagnosis when evaluating risk factors for ulnar neuropathy. Preventive effects may be achieved by reducing biomechanical exposures at work.

Finance issue brief: health care claims payment: prompt payment: year end report-2003.

PubMed

MacEachern, Lillian

2003-12-31

Since the mid 1990's state legislators and regulators have worked to resolve the complex issue of timely payment of health care claims. They have been challenged with bridging the communication gap between provider and payor and forced to address such base problems as what determines a correctly billed service. As time has progressed it is ever apparent that the completion of payment for services is dependent on many variables, not just simply timely processing of a claim.

Development of entrepreneurial activity in nurse education.

PubMed

Roberts, Paula; Bridgwood, Bernadeta; Jester, Rebecca

The provision of health care and healthcare education in the UK is undergoing rapid change and development, and is subject to intense market forces. A reduction in the amount of money being spent on nurses' education and training, together with changes in working practices in health care, are affecting the provision of healthcare education significantly. This article gives an overview of the changes influencing providers of pre and post-registration healthcare education, and describes how education providers are generating income through enterprise activity.

The introduction of new critical care equipment into the aeromedical evacuation service of the Royal Air Force.

PubMed

Lamb, Di

2003-04-01

Changing world events over recent years and an increasingly complex patient casemix have led to a review of the equipment used by the Aeromedical Evacuation Squadron of the Royal Air Force. The initial special purpose aeromedical equipment (SPAME) project was completed in 2001 with the new equipment being brought into service in August of the same year. The project incorporated long term planning for replacing the equipment along with its rapidly developing technology, especially with that used for the care of the critically ill. An intensive training programme was simultaneously introduced to support the deployment of this new technology. Critical care teams comprise a consultant anaesthetist, a critical care nurse, a flight nurse attendant (paramedic) and a technician, all of whom attend courses designed specifically to accommodate their role within the team.A considerable amount of work has been undertaken by a dedicated team to ensure this project became a reality and which has resulted in the provision of care to meet the needs of any casualty, anywhere in the world, being achieved using the latest technology proportionate to any hospital-based ICU.

Health reform: setting the agenda for long term care.

PubMed

Hatch, O G; Wofford, H; Willging, P R; Pomeroy, E

1993-06-01

The White House Task Force on National Health Care Reform, headed by First Lady Hillary Rodham Clinton, is expected to release its prescription for health care reform this month. From the outset, Clinton's mandate was clear: to provide universal coverage while reining in costs for delivering quality health care. Before President Clinton was even sworn into office, he had outlined the major principles that would shape the health reform debate. Global budgeting would establish limits on all health care expenditures, thereby containing health costs. Under a system of managed competition, employers would form health alliances for consumers to negotiate for cost-effective health care at the community level. So far, a basic approach to health care reform has emerged. A key element is universal coverage--with an emphasis on acute, preventive, and mental health care. Other likely pieces are employer-employee contributions to health care plans, laws that guarantee continued coverage if an individual changes jobs or becomes ill, and health insurance alliances that would help assure individual access to low-cost health care. What still is not clear is the extent to which long term care will be included in the basic benefits package. A confidential report circulated by the task force last month includes four options for long term care: incremental Medicaid reform; a new federal/state program to replace Medicaid; a social insurance program for home and community-based services; or full social insurance for long term care. Some work group members have identified an additional option: prefunded long term care insurance.(ABSTRACT TRUNCATED AT 250 WORDS)

[Childrearing environment and fertility in contemporary Japan (author's transl)].

PubMed

Horosima, K

1981-04-01

This study focused on the decrease in the marital fertility rate and attempted to clarify some traits in childrearing behavior which are responsible for the low fertility. Regarding the increase in difficulties in childrearing, the author pointed out the necessity and possibility of fertility study from the viewpoint of childrearing. The author proposed to regard childbearing behavior as a part of childrearing behavior and to explain childbearing behavior by childrearing environment which surrounds the couple's childrearing behavior and childrearing consciousness. Childrearing environment is composed of family formation in the household, labor force status of the mother, housing conditions, nursery facilities, and physical environment in the community; these components are all closely allied. Data obtained from 2375 mothers with preschool children were studied. There were great differences in the degree of mother's participation in the labor foce but there was a large ratio of mothers who did not live with their parents and who wanted to work outside the home if nursery facilities could be affored. Clearly the desire of women of reproductive age to work is very strong and the differences in the labor force participation rate are the result of insufficient socialized child care. The authors found a stratum of women who were strongly orientated towards working but who had chosen to live with the parents as a solution to their child care problem. We could only find small differences in fertility by family formation in the household and by work history of mother when observed. However, when the 2 were combined, there were relatively large differences (1.94-2.65 after 10 years of marriage) which has rarely been observed in social analyses of fertility thus far. The lowest fertility by work history was observed among women who had worked since before their marriages, and the largest differences in fertility between 2 family formation types was found among these women (1.94:2.24). This difference in fertility can be supposed to reflect the difference in child care conditions by family formation in household. As to the reasons for limiting births, differences were not found between these 2 family formation types. Working mothers who relied upon their parents for child care expressed relatively greater anxiety about their child's development status than those mothers in nuclear families where child care was supplied by the nursery schools. It is likely that the trend of working mothers will not diminish, and we must thus anticipate the limit of the mechanism of maintaining the fertility by child care supplied by cohabiting parents. Physical environment in the community was found to be a factor in limiting childbirth and the effect was most conspicuous among women who had continued to work in the nuclear family.

Caring for the Underserved: Exemplars in Teaching

PubMed Central

Shane-McWhorter, Laura; Scott, Doneka R.; Chen, Judy T.; Seaba, Hazel H.

2009-01-01

The objective was to identify exemplars in teaching pharmacy students awareness, knowledge, and the skills needed to provide care and services to the underserved. A call for exemplars was sent out in spring 2007. A subcommittee of the AACP Task Force on Caring for the Underserved reviewed all applications received. The 3 best exemplars for teaching pharmacy students the awareness, attitudes, knowledge, and skills needed to care for the underserved were selected and are described in this manuscript. Included are 1 didactic, 1 experiential, and 1 international experience. These exemplars in educating students on working with the underserved provide schools with models which could be adapted to fit individual programmatic curricular needs. PMID:19513156

3 CFR 8800 - Proclamation 8800 of April 17, 2012. National Equal Pay Day, 2012

Code of Federal Regulations, 2013 CFR

2013-01-01

... combat equal pay violations. The Task Force has helped women recover millions in lost wages, built... Proclamation Working women power America’s economy and sustain our middle class. For millions of families across our country, women’s wages mean food on the table, decent medical care, and timely mortgage...

On Jorge Becoming a Boy: A Counselor's Perspective

ERIC Educational Resources Information Center

Wright, Travis

2007-01-01

In this portrait, Travis Wright, writing as a psychology counselor in training, brings the reader into one morning's events in his clinical work with Jorge, a three-year-old boy whose family is experiencing difficult times. Throughout the morning at Jorge's day-care center, Wright encounters scenarios that force him to ask questions about child…

Toward Communal Child Rearing

ERIC Educational Resources Information Center

Sands, Rosalind M.

1973-01-01

Social work's preoccupation with the preservation of the nuclear family has blinded it to the necessity of finding new ways to care for children. This myopia has impeded recognition of the forces in American life that are bringing social change and new forms of child rearing. This article describes some of these phenomena and concludes that…

Community Engagement to End Child Early Forced Marriage--Experiences in Selected South Asian Countries

ERIC Educational Resources Information Center

Ferreira, Frances J.; Kamal, Mostafa Azad

2017-01-01

Sustainable Development Goal (SDG) 5, "achieve gender equality and empower all women and girls", emphasises the need for "providing women and girls with equal access to education, health care, decent work, and representation in political and economic decision-making processes [which] will fuel sustainable economies and benefit…

Women in Military Aircrews: Possible Outlooks for the French Air Force

DTIC Science & Technology

1989-05-01

carefully implemented, because the current all-male environment is likely to be phychologically hostile. However, the system works very well in the... phychological barrier might be as much on the female side (for parochialistic reasons) as on the male side (who would perceive it as "downgrading" to join a

Hunger and Population. Facts for Action #7.

ERIC Educational Resources Information Center

Phillips, James

The relationship between world hunger and world population is explored in this document for high school global education classes. Reasons for the high birth rates in developing nations are suggested, e.g., a poor family has many children because children are an inexpensive work force, provide extra income, and care for parents in old age. The…

The Effects of an Adversarial Process on Adoption Decisions.

ERIC Educational Resources Information Center

Ryburn, Murray

1993-01-01

Examines the legal and social work process in contested adoption proceedings, and argues that there are moral grounds for repealing provisions in British legislation on forced adoption. Considers the adversarial process that characterizes adoption hearings, the role of poverty in the lives of families whose children are admitted to foster care,…

77 FR 68744 - Department of Defense Task Force on the Care, Management, and Transition of Recovering Wounded...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-16

... DEPARTMENT OF DEFENSE Office of the Secretary Department of Defense Task Force on the Care, Management, and Transition of Recovering Wounded, Ill, and Injured Members of the Armed Forces; Federal... Committee meeting of the Department of Defense Task Force on the Care, Management, and Transition of...

A comparison of three methods for estimating the requirements for medical specialists: the case of otolaryngologists.

PubMed Central

Anderson, G F; Han, K C; Miller, R H; Johns, M E

1997-01-01

OBJECTIVE: To compare three methods of computing the national requirements for otolaryngologists in 1994 and 2010. DATA SOURCES: Three large HMOs, a Delphi panel, the Bureau of Health Professions (BHPr), and published sources. STUDY DESIGN: Three established methods of computing requirements for otolaryngologists were compared: managed care, demand-utilization, and adjusted needs assessment. Under the managed care model, a published method based on reviewing staffing patterns in HMOs was modified to estimate the number of otolaryngologists. We obtained from BHPr estimates of work force projections from their demand model. To estimate the adjusted needs model, we convened a Delphi panel of otolaryngologists using the methodology developed by the Graduate Medical Education National Advisory Committee (GMENAC). DATA COLLECTION/EXTRACTION METHODS: Not applicable. PRINCIPAL FINDINGS: Wide variation in the estimated number of otolaryngologists required occurred across the three methods. Within each model it was possible to alter the requirements for otolaryngologists significantly by changing one or more of the key assumptions. The managed care model has a potential to obtain the most reliable estimates because it reflects actual staffing patterns in institutions that are attempting to use physicians efficiently. CONCLUSIONS: Estimates of work force requirements can vary considerably if one or more assumptions are changed. In order for the managed care approach to be useful for actual decision making concerning the appropriate number of otolaryngologists required, additional research on the methodology used to extrapolate the results to the general population is necessary. PMID:9180613

Translating evidence into practice: Hong Kong Reference Framework for Preventive Care for Children in Primary Care Settings.

PubMed

Siu, Natalie P Y; Too, L C; Tsang, Caroline S H; Young, Betty W Y

2015-06-01

There is increasing evidence that supports the close relationship between childhood and adult health. Fostering healthy growth and development of children deserves attention and effort. The Reference Framework for Preventive Care for Children in Primary Care Settings has been published by the Task Force on Conceptual Model and Preventive Protocols under the direction of the Working Group on Primary Care. It aims to promote health and prevent disease in children and is based on the latest research, and contributions of the Clinical Advisory Group that comprises primary care physicians, paediatricians, allied health professionals, and patient groups. This article highlights the comprehensive, continuing, and patient-centred preventive care for children and discusses how primary care physicians can incorporate the evidence-based recommendations into clinical practice. It is anticipated that the adoption of this framework will contribute to improved health and wellbeing of children.

Note: Effect of the parasitic forced vibration in an atom gravimeter

NASA Astrophysics Data System (ADS)

Chen, Le-Le; Luo, Qin; Zhang, Heng; Duan, Xiao-Chun; Zhou, Min-Kang; Hu, Zhong-Kun

2018-06-01

The vibration isolator usually plays an important role in atom interferometry gravimeters to improve their sensitivity. We show that the parasitic forced vibration of the Raman mirror, which is induced by external forces acting on the vibration isolator, can cause a bias in atom gravimeters. The mechanism of how this effect induces an additional phase shift in our interferometer is analyzed. Moreover, modulation experiments are performed to measure the dominant part of this effect, which is caused by the magnetic force between the passive vibration isolator and the coil of the magneto-optic trap. In our current apparatus, this forced vibration contributes a systematic error of -2.3(2) × 10-7 m/s2 when the vibration isolator works in the passive isolation mode. Even suppressed with an active vibration isolator, this effect can still contribute -6(1) × 10-8 m/s2; thus, it should be carefully considered in precision atom gravimeters.

The impact of welfare reform on parents' ability to care for their children's health.

PubMed Central

Heymann, S J; Earle, A

1999-01-01

OBJECTIVES: Most of the national policy debate regarding welfare assumed that if middle-income mothers could balance work while caring for their children's health and development, mothers leaving welfare for work should be able to do so as well. Yet, previous research has not examined the conditions faced by mothers leaving welfare for work. METHODS: Using data from the National Longitudinal Survey of Youth, this study examined the availability of benefits that working parents commonly use to meet the health and developmental needs of their children; paid sick leave, vacation leave, and flexible hours. RESULTS: In comparison with mothers who had never received welfare, mothers who had been on Aid to Families with Dependent Children were more likely to be caring for at least 1 child with a chronic condition (37% vs 21%, respectively). Yet, they were more likely to lack sick leave for the entire time they worked (36% vs 20%) and less likely to receive other paid leave or flexibility. CONCLUSIONS: If current welfare recipients face similar conditions when they return to work, many will face working conditions that make it difficult or impossible to succeed in the labor force at the same time as meeting their children's health and developmental needs. PMID:10191791

Family medical leave. An employee benefit for working caregivers of elderly family members.

PubMed

Carruth, A K; Booth, D

1991-09-01

Future trends include a decrease in the number of adult children, an increase in the number of individuals over age 65, single parent families, working women, and individuals with no health care insurance. As more women with multiple roles and responsibilities enter and continue as part of the work force, employers recognize the need for support of family issues. Currently many employers lack initiative to make these needed changes. The occupational health nurses' role in relation to future policy for working caregivers includes assessment of how employment and caregiving impact work performance, job satisfaction, and health; and participation in defining public policy issues.

United States Air Force Child Care Center Infant Care Guide.

ERIC Educational Resources Information Center

Craig, Ardyn; And Others

Intended to guide Air Force infant caregivers in providing high quality group care for infants 6 weeks to 6 months of age, this infant care guide must be used in conjunction with other Air Force regulations on day care, such as AFR 215-1, Volume VI (to be renumbered AFR 215-27). After a brief introductory chapter (Chapter I), Chapter II indicates…

32 CFR 728.25 - Army and Air Force National Guard personnel.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 32 National Defense 5 2013-07-01 2013-07-01 false Army and Air Force National Guard personnel. 728... Guard Personnel § 728.25 Army and Air Force National Guard personnel. (a) Medical and dental care. Upon... Care) and AFR 168-6 (Persons Authorized Medical Care) to members of the Army and Air Force National...

78 FR 7415 - Department of Defense Task Force on the Care, Management, and Transition of Recovering Wounded...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-01

... DEPARTMENT OF DEFENSE Office of the Secretary Department of Defense Task Force on the Care, Management, and Transition of Recovering Wounded, Ill, and Injured Members of the Armed Forces; Notice of... Committee meeting of the Department of Defense Task Force on the Care, Management, and Transition of...

32 CFR 728.25 - Army and Air Force National Guard personnel.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 32 National Defense 5 2012-07-01 2012-07-01 false Army and Air Force National Guard personnel. 728... Guard Personnel § 728.25 Army and Air Force National Guard personnel. (a) Medical and dental care. Upon... Care) and AFR 168-6 (Persons Authorized Medical Care) to members of the Army and Air Force National...

78 FR 66902 - Department of Defense Task Force on the Care, Management, and Transition of Recovering Wounded...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-07

... DEPARTMENT OF DEFENSE Office of the Secretary Department of Defense Task Force on the Care, Management, and Transition of Recovering Wounded, Ill, and Injured Members of the Armed Forces; Notice of... Federal Advisory Committee meeting of the Department of Defense Task Force on the Care, Management, and...

77 FR 31337 - Department of Defense Task Force on the Care, Management, and Transition of Recovering Wounded...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-25

... DEPARTMENT OF DEFENSE Office of the Secretary Department of Defense Task Force on the Care, Management, and Transition of Recovering Wounded, Ill, and Injured Members of the Armed Forces; Notice of... Department of Defense Task Force on the Care, Management, and Transition of Recovering Wounded, Ill, and...

32 CFR 728.25 - Army and Air Force National Guard personnel.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 32 National Defense 5 2010-07-01 2010-07-01 false Army and Air Force National Guard personnel. 728... Guard Personnel § 728.25 Army and Air Force National Guard personnel. (a) Medical and dental care. Upon... Care) and AFR 168-6 (Persons Authorized Medical Care) to members of the Army and Air Force National...

32 CFR 728.25 - Army and Air Force National Guard personnel.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 5 2011-07-01 2011-07-01 false Army and Air Force National Guard personnel. 728... Guard Personnel § 728.25 Army and Air Force National Guard personnel. (a) Medical and dental care. Upon... Care) and AFR 168-6 (Persons Authorized Medical Care) to members of the Army and Air Force National...

78 FR 38015 - Department of Defense Task Force on the Care, Management, and Transition of Recovering Wounded...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-25

... DEPARTMENT OF DEFENSE Office of the Secretary Department of Defense Task Force on the Care, Management, and Transition of Recovering Wounded, Ill, and Injured Members of the Armed Forces; Notice of... of the Department of Defense Task Force on the Care, Management, and Transition of Recovering Wounded...

Pregnant at work: time for prenatal care providers to act.

PubMed

Karkowsky, Chavi Eve; Morris, Liz

2016-09-01

Fifty years ago, when a woman became pregnant, she was expected to stop working. Today, however, most women who work are the primary, sole, or co-breadwinner for their families, and their earnings during pregnancy are often essential to their families' economic well-being. Medical data about working during pregnancy are sparse but generally show that both low-risk and high-risk women can tolerate work-related duties well, although some work accommodations (eg, providing a chair for sitting, allowing snacks, or modifying the work schedule) may be necessary. However, some employers refuse to accommodate pregnant women who need adjustments. This can result in a woman being forced to make the choice between working without accommodations and losing her income and health insurance or even her job. Prenatal care providers can play an important role by implementing changes in their own practice, shaping public policy, and conducting research to increase protections for pregnant women and to ensure that they receive medically recommended accommodations while continuing to earn income for their growing families. Copyright © 2016 Elsevier Inc. All rights reserved.

Managing change in the nursing handover from traditional to bedside handover – a case study from Mauritius

PubMed Central

Kassean, Hemant K; Jagoo, Zaheda B

2005-01-01

Background The shift handover forms an important part of the communication process that takes place twice within the nurses' working day in the gynaecological ward. This paper addresses the topic of implementing a new system of bedside handover, which puts patients central to the whole process of managing care and also addresses some of the shortcomings of the traditional handover system. Methods A force field analysis in terms of the driving forces had shown that there was dissatisfaction with the traditional method of handover which had led to an increase in the number of critical incidents and complaints from patients, relatives and doctors. The restraining forces identified were a fear of accountability, lack of confidence and that this change would lead to more work. A 3 – step planned change model consisting of unfreezing, moving and refreezing was used to guide us through the change process. Resistance to change was managed by creating a climate of open communication where stakeholders were allowed to voice opinions, share concerns, insights, and ideas thereby actively participating in decision making. Results An evaluation had shown that this process was successfully implemented to the satisfaction of patients, and staff in general. Conclusion This successful change should encourage other nurses to become more proactive in identifying areas for change management in order to improve our health care system. PMID:15676078

Building the Future: Summary of Four Studies to Develop the Private Sector, Education, Health Care, and Data for Decisionmaking for the Kurdistan Region - Iraq (with Arabic-language version).

PubMed

Anthony, C Ross; Hansen, Michael L; Kumar, Krishna B; Shatz, Howard J; Vernez, Georges

2013-01-01

In 2010, the Kurdistan Regional Government (KRG) asked the RAND Corporation to undertake four studies aimed at improving the economic and social development of the Kurdistan Region of Iraq. RAND's work was intended to help the KRG expand access to high-quality education and health care, increase private-sector development and employment for the expanding labor force, and design a data-collection system to support high-priority policies. The studies were carried out over the year beginning February 2010. The RAND teams worked closely with the Ministries of Planning, Education, and Health to develop targeted solutions to the critical issues faced by the KRG. This article summarizes the health care study. It is intended to provide a high-level overview of the approaches, followed by the studies, key findings, and major recommendations.

75 FR 52958 - Solicitation for Nominations for Members of the U.S. Preventive Services Task Force (USPSTF)

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-30

... on specific topics or methods. A diversity of perspectives is valuable to the work of the USPSTF. To... of research published in peer reviewed literature and in the methods of evidence review; 2... primary health care clinical experience may be selected based on their expertise in methodological issues...

Critical Thinking and Clinical Judgment in Novice Registered Nurses

ERIC Educational Resources Information Center

Tyne, Sheila L.

2018-01-01

The health care field has become increasingly more complex, requiring new nurses to be prepared upon graduation to respond to a variety of complex situations. Unfortunately, many graduates from associate degree nursing (ADN) programs are not able to think critically upon entering the work force. This presents a major problem for the nurse and for…

Families of Working Wives Spending More on Services and Nondurables.

ERIC Educational Resources Information Center

Jacobs, Eva; And Others

1989-01-01

Data from the 1984-86 Consumer Expenditure Survey were used to examine effects of a wife's labor force participation on family income and expenditures. Findings indicate that families with employed wives spend significantly more on food away from home, child care, women's apparel, and gasoline than do families in which the wife stays at home. (CH)

Men as Workers in Childcare Services. A Discussion Paper.

ERIC Educational Resources Information Center

Jensen, Jytte Juul

For some years, the European Commission on Childcare and Other Measures to Reconcile Employment and Family Responsibilities has given priority to the role of men as caregivers. Work in child care services remains one of the most gender-segregated occupations in the entire labor force, and this discussion paper adopts a clear position that more men…

Day Care and Maternal Employment in 1990's Introductory Psychology Textbooks.

ERIC Educational Resources Information Center

Etaugh, Claire; Cohen, Joseph; Hill, Myra

One of the most striking societal changes in recent years is the increasing participation of mothers in the labor force. Since college-educated mothers are especially likely to work, a potentially important source of information about the effects of maternal employment is the introductory psychology course. To study the features of mothers in the…

More Colleges Tighten Benefit Programs to Meet Big Rise in Health-Insurance Costs.

ERIC Educational Resources Information Center

Magner, Denise K.

1992-01-01

Increases in costs to colleges and universities for employee health insurance have risen as much as 20 to 30 percent annually, requiring adjustments to control costs, a new philosophy of sharing costs with employees, increased proportions of payroll (now 6.1 percent) going for health care costs, and reductions in work force size. (DB)

Seize the Day

ERIC Educational Resources Information Center

Milne, Sarah

2008-01-01

When the health of her son deteriorated, the author was forced to give up a good job and work part-time from home. She had no choice but to become more creative, grasping the opportunity to revive her passion for writing. In this article, the author describes her experience in taking care of her son and how it gives her the opportunity to realize…

Task Force on Workplace Violence: Part I. The assessment.

PubMed

Carroll, V

1997-06-01

Prevention is key in dealing with workplace violence. Assessment, open communication within the workplace, well-designed policies, and adequate staff training form the framework for an effective violence reduction plan. Nurses offer invaluable resources to each other, their patients. and their workplace. Through effective planning and problem-solving, we can collaborate with other disciplines to enhance the future of health care and provide for a safer workplace. Just as we are advocates for safe and quality health care for our patients, we must also be champions for creating a safe work environment for ourselves.

Assessment of the U.S. Department of Defense Efforts to Develop an Effective Medical Logistics System within the Afghan National Security Forces

DTIC Science & Technology

2011-06-14

aggressively to strengthen measures aimed at ensuring a successful ANSF transition. Ongoing actions include: • Working with CURE International and the ANSF...sustainability include the following ongoing actions: • Working with CURE International and the MoD and MoI to complete, promulgate and implement Standards of Care...approximately June-August 2011. In addition, NTM-A/CSTC-A previously awarded an approximately $1.57M contract with the NGO CURE International to

Occupational medicine practice in the United States since the industrial revolution.

PubMed

Gochfeld, Michael

2005-02-01

Occupational medicine lies at the interface between work and health. Not only do workplace hazards impact health, but our state of health influences our ability to get to work, to perform work, to tolerate work, and to gain a measure of satisfaction from the work we do. Comprehensive occupational medicine requires familiarity with the work that patients do; knowledge of the workplace itself and its hazards; appreciation of the social forces that shape work; and understanding of how chemical, physical, biologic, mechanical, and psychosocial agents influence health. Many practitioners who treat injured workers or provide disability assessments have no more formal training in occupational medicine than primary care physicians in general, which limits the quality, or at least the scope, of the care they give to workers. This history has been compiled from books, journals, letters and recollections. A subset of journal issues from each decade after 1910 has been systematically reviewed, making no attempt to read through every issue. Industrial medicine as we recognize it began in the late-1800s, grew rapidly in the early and mid-1900s, and peaked toward the end of the 20th century, when American corporations began to outsource medical services, supporting the rise of free-standing industrial medicine facilities, chains of which now operate profitably throughout the country. Many of these facilities emphasize injury treatment, work hardening, and physical therapy rather than disease recognition and prevention. Occupational medicine is one of the very few medical specialties to be underserved. Board-certified specialists are relatively few, and when supply falls short of demand, the demand has tended to lower its sights. Occupational medicine has always been influenced by economics, politics, and changing patterns of employment, and today these forces include managed care, weakened unions, outsourcing and contract labor, and a generally growing political and social conservatism, not to mention multinational corporations. The globalization of manufacture and economics facilitated by rapid population growth in poor nations assures an unending supply of cheap labor, allowing limited attention to hazard control, thereby impeding progress in occupational health and safety. Some corporations are meeting the challenge of protecting their international workforce. Many, probably most, have not yet achieved this.

Work disability in adults with cystic fibrosis.

PubMed

Gillen, M; Lallas, D; Brown, C; Yelin, E; Blanc, P

1995-07-01

Greater numbers of persons with cystic fibrosis (CF) reach adulthood and, therefore, actively participate in the labor force. In this study, we estimated labor force participation rates and determined risk factors for work disability among persons with CF. We recruited 49 (73%) of 67 adults followed at one of two hospital-based CF centers. We ascertained employment history and CF-attributed work disability by structured questionnaire. Independently, we reviewed medical records for demographics and illness severity indicators. We analyzed potential risk factors for work disability by logistic regression analysis. All of those studied reported past or present labor force participation, consistent with high work motivation. Complete cessation of work attributed to CF was reported by 17 (35%; 95% CI, 21 to 49%). Although 23 (47%; 95% CI, 32 to 60%) of those surveyed stated that CF had affected career choice, only nine respondents had ever received career counselling and 16 had ever discussed job choice with their physicians. After adjusting for standard measures of disease severity by multiple logistic regression, age, adult diagnosis of CF, female gender, and single marital status, analyzed as a group, provided significant additional explanatory power to a predictive model of disability risk (model chi square [4 d.f.] = 11.5, p < 0.05). Health care professionals who design interventions targeted at work disability among persons with CF should address demographic factors as well as illness severity and should assess the vocational needs of persons with CF and the potential benefit of career counselling.

Stress analysis of mandibular implant overdenture with locator and bar/clip attachment: Comparative study with differences in the denture base length.

PubMed

Yoo, Jin Suk; Kwon, Kung-Rock; Noh, Kwantae; Lee, Hyeonjong; Paek, Janghyun

2017-06-01

The design of the attachment must provide an optimum stress distribution around the implant. In this study, for implant overdentures with a bar/clip attachment or a locator attachment, the stress transmitted to the implant in accordance with the change in the denture base length and the vertical pressure was measured and analyzed. Test model was created with epoxy resin. The strain gauges made a tight contact with implant surfaces. A universal testing machine was used to exert a vertical pressure on the mandibular implant overdenture and the strain rate of the implants was measured. Means and standard deviations of the maximum micro-deformation rates were determined. 1) Locator attachment: The implants on the working side generally showed higher strain than those on the non-working side. Tensile force was observed on the mesial surface of the implant on the working side, and the compressive force was applied to the buccal surface and on the surfaces of the implant on the non-working side. 2) Bar/clip attachment: The implants on the both non-working and working sides showed high strain; all surfaces except the mesial surface of the implant on the non-working side showed a compressive force. To minimize the strain on implants in mandibular implant overdentures, the attachment of the implant should be carefully selected and the denture base should be extended as much as possible.

Optical trapping gold nanoparticles by a pulse laser

NASA Astrophysics Data System (ADS)

Liu, XiaoYu; Wang, Feng

2010-11-01

Gold nanoparticles are widely employed in nanomaterials, nanobiotechnology and health care, but generally they are considered difficult to trap stably. Compared with the continuous laser which is popular to the optical trapping, pulse laser has a relatively larger power in its work pulse, which is useful for trap particles. So this paper comprehensively analyzes the forces (the radiation forces, the gravitation, and the Brownian motion) on the gold nanoparticles in the optical tweezers formed by a pulse laser, through building up a mathematical model. Finally gets the dependence relation between the characteristics of the pulse laser and that of the gold nanoparticles.

Physical Profiling Performance of Air Force Primary Care Providers

DTIC Science & Technology

2017-08-09

AFRL-SA-WP-TR-2017-0014 Physical Profiling Performance of Air Force Primary Care Providers Anthony P. Tvaryanas1; William P...COVERED (From – To) September 2016 – January 2017 4. TITLE AND SUBTITLE Physical Profiling Performance of Air Force Primary Care Providers...encounter with their primary care team. An independent medical standards subject matter expert (SME) reviewed encounters in the electronic health record

[Intensive care within the context of military long-distance transport].

PubMed

Hossfeld, B; Rohowsky, B; Rödig, E; Lampl, L

2004-05-01

Due to the changed task spectrum of the German Federal Armed Forces with participation in international deployments for UN and NATO the concept of Aeromedical Evacuation (MedEvac) gained a new quality for the Air Force as well as for the Medical Corps. The transport of mostly severely injured or critically ill patients requires both, medical equipment which has to be permanently adapted to the national standard, and qualified intensive-care-personnel. At present, the aircrafts used for such deployments are four C-160 Transall, one CL-601 Challenger and two Airbus A310, which, if necessary, can be equipped with one or more intensive-care "patient transportation units" (PTU). Contrary to the two other aircrafts, the CL-601 Challenger is only equipped for the intensive-care transport of one individual patient. The PTU corresponds to the technical equipment of the intensive care unit of a level-1-trauma centre and ensures an intensive-care therapy on highest level also during longer transportation. The work with this equipment, the characteristics of the long-distance air transport and the special situation of the military deployment causes special demands on the qualifications of the assigned personnel. Primarily planned for the repatriation of injured or ill soldiers, in the mean time, this concept is also essential for the medevac of civilian victims after mass casualties worldwide.

The American Organization of Nurse Executives System CNE task force: a work in progress.

PubMed

Rudisill, Pamela T; Thompson, Pamela A

2012-01-01

Health care is a complex industry, consequently requiring a diverse group of health care executives leading initiatives for efficiency and effectiveness in patient care delivery. Value-based purchasing and pay for performance are at the top of the list for indicators of success, and many hospitals are merging into health care systems. The role of the system chief nurse executive is an evolving role to lead health care systems in clinical, operational, patient safety, and patient satisfaction processes and outcomes. The American Organization of Nurse Executives, being the voice for nursing leadership, convened a group of system chief nurse executives to address the role, function, and competencies needed for this significant and emerging role in health care. This article describes the role statement and system chief nurse executive competencies needed for success in the role. In addition, the next steps for addressing the needs of this group will be outlined in this article.

Private duty home care: what it means to real people across the nation.

PubMed

2011-04-01

Private duty home care is growing rapidly to accommodate the needs of more and more seniors, disabled persons, and those with chronic conditions as these populations themselves are fast expanding and projected to continue to do so in the coming years and decades. The services that private duty/privately paid home care providers deliver each day to individuals across the United States can be absolutely essential to allowing them to remain in their own homes and communities leading as active and healthy lives as possible and continuing to contribute in the work force and to society as they are able. Requirements vary from state to state, and while most private duty agencies provide nonmedical companionship, homemaker, and personal care services--often described as assistance with activities of daily living--some incorporate licensed medical care as well.

Bridging the accountability gap.

PubMed

Johnson, J E

1991-01-01

Accountability for patient care is a responsibility shared by nursing and hospital administration. Inherent in professional nursing is the responsibility for the achievement of patient outcomes, while administrators assume more indirect responsibilities related to managerial functions, strategic planning and legal obligations. Historically, the poor communication and conflict between these groups have been a barrier to achieving true institutional accountability for patient care. Collaboration rather than conflict can be promoted in health care institutions by making organizational changes that promote communication and clarify ambiguities in job responsibilities. Such changes include redefining the nurse's job to reflect its scope and purpose; integrating nursing into the hospital environment via regular forums for information exchange and participation in hospital committees; considering that the delegation of patient care is implicit in nursing practice and patient-care management; and strengthening the nursing work force by improving compensation and benefits packages for nurses.

Interdisciplinary shared governance: a partnership model for high performance in a managed care environment.

PubMed

Anderson, D A; Bankston, K; Stindt, J L; Weybright, D W

2000-09-01

Today's managed care environment is forcing hospitals to seek new and innovative ways to deliver a seamless continuum of high-quality care and services to defined populations at lower costs. Many are striving to achieve this goal through the implementation of shared governance models that support point-of-service decision making, interdisciplinary partnerships, and the integration of work across clinical settings and along the service delivery continuum. The authors describe the key processes and strategies used to facilitate the design and successful implementation of an interdisciplinary shared governance model at The University Hospital, Cincinnati, Ohio. Implementation costs and initial benefits obtained over a 2-year period also are identified.

Aligning career development with organizational goals: working towards the development of a strong and sustainable workforce.

PubMed

Saxe-Braithwaite, Marcy; Carlton, Sandra; Bass, Brenda

2009-01-01

The rapidly changing world of healthcare is faced with many challenges, not the least of which is a diminishing workforce. Healthcare organizations must develop multiple strategies, not only to attract and retain employees, but also to ensure that workers are prepared for continuous change in the workplace, are working at their full scope of practice and are committed to, and accountable for, the provision of high-quality care. There is evidence that by creating a healthier workplace, improved patient care will follow. Aligning Healthy Workplace Initiatives with an organization's strategic goals, corporate culture and vision reinforces their importance within the organization. In this paper, we describe an innovative pilot to assess a career development program, one of multiple Healthy Workplace Initiatives taking place at Providence Care in Kingston, Ontario in support of our three strategic goals. The results of the pilot were very encouraging; subsequent success in obtaining funding from HealthForceOntario has allowed the implementation of a sustainable program of career development within the organization. More work is required to evaluate its long-term effectiveness.

A Core Course on Veterans' Health in an Online RN to BSN Program: Preparing Nurses to Work with Veterans

ERIC Educational Resources Information Center

Keavney, Elaine C.

2015-01-01

The Joining Forces Initiative challenges nursing programs throughout the country to develop curriculum that addresses the unique healthcare issues facing veterans. It is imperative that Bachelor of Science in Nursing (BSN) students acquire the knowledge that will help them to care for veterans in all areas of nursing practice. This article…

Sensor design for outdoor racing bicycle field testing for human vibration comfort evaluation

NASA Astrophysics Data System (ADS)

Vanwalleghem, Joachim; De Baere, Ives; Loccufier, Mia; Van Paepegem, Wim

2013-09-01

This paper is concerned with the vibrational comfort evaluation of the cyclist when cycling a rough surface. Outdoor comfort tests have so far only been done through instrumenting the bicycle with accelerometers. This work instruments a racing bicycle with custom-made contact force sensors and velocity sensors to acquire human comfort through the absorbed power method. Comfort evaluation is assessed at the hand-arm and seat interface of the cyclist with the bicycle. By means of careful finite-element analysis for designing the force gauges at the handlebar and the seat combined with precise calibration of both force and velocity sensors, all sensors have proven to work properly. Initial field tests are focused on the proper functioning of the designed sensors and their suitability for vibration comfort measurements. Tests on a cobblestone road reveal that the outcome of the absorbed power values is within the same range as those from laboratory tests found in the literature. This sensor design approach for outdoor testing with racing bicycles may give a new interpretation on evaluating the cyclist's comfort since the vibrational load is not only quantified in terms of acceleration but also in terms of force and velocity at the bicycle-cyclist contact points.

Commentary: on the transformation of the moral economy of care.

PubMed

Hopper, K

2001-12-01

The documentation amassed in these provisional assessments of the changing terms and conditions of psychiatric work amounts to a reconfiguring of the moral economy of care--those root value-laden assumptions about what constitutes proper conduct in a service or treatment context. Such a transformation appears to have been in the works for some time, but the acuity with which it afflicts the consciousness of present-day actors suggests that a threshold has been crossed. The loss of "slippage" in everyday clinical work, limited recourse of those who would resist the trend, deep "persuasive" impact on non-believers of being forced to "go through the motions," all argue that the ethos of psychiatric work has been thoroughly infiltrated by efficiency, with costs yet to be reckoned. Anthropology may have been slow to take cognizance of such trends, but its improvisational methods and flexible tools should be of use in mapping such costs, direct and indirect, and any countervailing benefits.

Nursing and health care reform: implications for curriculum development.

PubMed

Bowen, M; Lyons, K J; Young, B E

2000-01-01

The health care system is undergoing profound changes. Cost containment efforts and restructuring have resulted in cutbacks in registered nurse (RN) positions. These changes are often related to the increased market penetration by managed care companies. To determine how RN graduates perceive these changes and their impact on the delivery of patient care, Healthcare Environment Surveys were mailed to graduates of the classes of 1986 and 1991. Using the Survey's 5-point Likert Scale, we measured the graduates' satisfaction with their salary, quality of supervision they received, opportunities for advancement, recognition for their job, working conditions, the overall job and the changes in their careers over the previous five year period. Our study suggests that the changes in the health care system are having an impact on how health care is being delivered and the way nurses view their jobs. Respondents reported that insurance companies are exerting increased control over patient care and perceive that the quality of patient care is declining. Increased workloads and an increase in the amount of paperwork were reported. Participants perceived that there were fewer jobs available and that job security was decreasing. The percentage of nurses who see job satisfaction as remaining the same or increasing are a majority. However, the relatively high percent of nurses who see job satisfaction as declining should provide a note of warning. The major implications of this study are that the professional nursing curriculum must be modified to include content on communication, organization, legislative/policy skills, and leadership. The nation's health care system is undergoing profound changes. There are numerous forces at work that are effecting the delivery of care and, consequently, the work of health professionals. These forces include significant efforts at cost containment, restructuring and downsizing of hospitals, and the movement of health care delivery out of acute care centers and into the community. Even though cutbacks in registered nurse (RN) positions appear to have leveled off in sections of the country that have gone through restructuring and reengineering of the work place, there still remains a heavy emphasis on lowering costs by decreasing employee benefits and increasing productivity through the substitution of part-time RNs for full-time RNs and the substitution of unlicensed assistive personnel (UAP) for RNs. These changes are often related to the increased market penetration by managed care companies, which are not expected to abate any time soon. It is important to determine what impact these changes are having on the delivery of patient care since there is some evidence to suggest that reduction in nursing staff below certain levels is related to poor patient outcomes (Fridken et al, 1996). It is also important to assess the effect of system changes on the satisfaction level health professionals have in their jobs. This is particularly important since some researchers suggest that job dissatisfaction, over a period of time, can result in burnout and eventually, turnover (Cameron, Horsburgh, & Armstrong-Stassen, 1994; Cotterman, 1991). Finally, understanding the impact of these health care delivery system changes has significant implications for baccalaureate nursing education and the preparation needed by future nurses to help them adjust to the changed environment.

Modeling good research practices--overview: a report of the ISPOR-SMDM Modeling Good Research Practices Task Force-1.

PubMed

Caro, J Jaime; Briggs, Andrew H; Siebert, Uwe; Kuntz, Karen M

2012-01-01

Models-mathematical frameworks that facilitate estimation of the consequences of health care decisions-have become essential tools for health technology assessment. Evolution of the methods since the first ISPOR modeling task force reported in 2003 has led to a new task force, jointly convened with the Society for Medical Decision Making, and this series of seven papers presents the updated recommendations for best practices in conceptualizing models; implementing state-transition approaches, discrete event simulations, or dynamic transmission models; dealing with uncertainty; and validating and reporting models transparently. This overview introduces the work of the task force, provides all the recommendations, and discusses some quandaries that require further elucidation. The audience for these papers includes those who build models, stakeholders who utilize their results, and, indeed, anyone concerned with the use of models to support decision making.

75 FR 76422 - Meeting of the Department of Defense Task Force on the Care, Management, and Transition of...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-08

... DEPARTMENT OF DEFENSE Office of the Secretary Meeting of the Department of Defense Task Force on... Forces (Subsequently Referred to as the Task Force) AGENCY: Department of Defense. ACTION: Notice... forthcoming meeting of the Department of Defense Task Force on the Care, Management, and Transition of...

Dealing with labor shortages in long-term care: a marketing problem.

PubMed

Moore, S T

1990-01-01

A recent analysis of data from the Bureau of Labor statistics raise serious implications for the long-term care industry. The human resource problems faced by managers in long-term care will escalate into a fullblown crisis by the end of this century. This will result from a decrease in the number of young workers available to work in unskilled and semiskilled occupations. The effect of this shortage will be exaggerated by an expansion of other sectors of the service industry. Long-term care facilities will be forced to compete with the fast food and retail industry as well as other sectors of the health industry for scarce workers. This article briefly examines the causes, consequences of this problem and suggests several strategies to mitigate the effect of the coming labor shortage.

Do stigma and other perceived barriers to mental health care differ across Armed Forces?

PubMed Central

Gould, Matthew; Adler, Amy; Zamorski, Mark; Castro, Carl; Hanily, Natalie; Steele, Nicole; Kearney, Steve; Greenberg, Neil

2010-01-01

Summary Objectives Military organizations are keen to address barriers to mental health care yet stigma and barriers to care remain little understood, especially potential cultural differences between Armed Forces. The aim of this study was to compare data collected by the US, UK, Australian, New Zealand and Canadian militaries using Hoge et al.'s perceived stigma and barriers to care measure (Combat duty in Iraq and Afghanistan, mental health problems and barriers to care. New Engl J Med 2004;351:13–22). Design Each member country identified data sources that had enquired about Hoge et al.'s perceived stigma and perceived barriers to care items in the re-deployment or immediate post-deployment period. Five relevant statements were included in the study. Setting US, UK Australian, New Zealand and Canadian Armed Forces. Results Concerns about stigma and barriers to care tended to be more prominent among personnel who met criteria for a mental health problem. The pattern of reported stigma and barriers to care was similar across the Armed Forces of all five nations. Conclusions Barriers to care continue to be a major issue for service personnel within Western military forces. Although there are policy, procedural and cultural differences between Armed Forces, the nations studied appear to share some similarities in terms of perceived stigma and barriers to psychological care. Further research to understand patterns of reporting and subgroup differences is required. PMID:20382906

Medical Student Teaching and Recruiting: 50 Years of Balancing Two Educational Aims.

PubMed

Schneider, Benjamin N; Chessman, Alexander; Toffler, William; Handler, Lara; Steiner, Beat; Biagioli, Frances Emily

2017-04-01

Family medicine (FM) undergraduate medical educators have had two distinct missions, to increase the knowledge, skills, and attitudes of all students while also striving to attract students to the field of family medicine. A five decade literature search was conducted gathering FM curricular innovations and the parallel trends in FM medical student interest. Student interest in FM had a rapid first-decade rise to 14%, a second 1990's surge, followed by a drop to the current plateau of 8-9%. This falls far short of the 30-50% generalist benchmark needed to fill the country's health care needs. Curricular innovations fall into three periods: Charismatic Leaders & Clinical Exposures (1965-1978), Creation of Clerkships of FM (1979-1998) and Curricular Innovations (1998-present). There is good evidence that having a required third-year clerkship positively impacts student interest in the field, however there is little research regarding the recruitment impact of specific clerkship curricula. Other tools associated with student interest include programming geared towards primary care or rural training and extracurricular opportunities such as FM Interest Groups. Strategic plans to improve the primary care work force should focus funding and legislative efforts on effective methods such as: establishing and maintaining FM clerkships, admitting students with rural and underserved backgrounds or primary care interest, developing longitudinal primary care tracks, and supporting extracurricular FM activities. Rigorous research is needed to assess how best to utilize limited educational resources to ensure that all students graduate with a core set of FM competence as well as an increased FM matriculation. Strategic plans to improve the primary care work force should focus funding and legislative efforts on effective methods such as: establishing and maintaining FM clerkships, admitting students with rural and underserved backgrounds or primary care interest, developing longitudinal primary care tracks, and supporting extracurricular FM activities. Rigorous research is needed to assess how best to utilize limited educational resources to ensure that all students graduate with a core set of FM competence as well as an increased FM matriculation. st in FM had a rapid first-decade rise to 14%, a second 1990's surge, followed by a drop to the current plateau of 8-9%. This falls far short of the 30-50% generalist benchmark needed to fill the country's healthcare needs. Curricular innovations fall into three periods: Charismatic Leaders & Clinical Exposures (1965-1978), Creation of Clerkships of FM (1979-1998) and Curricular Innovations (1998 - present). There is good evidence that having a required third-year clerkship positively impacts student interest in the field, however there is little research regarding the recruitment impact of specific clerkship curricula. Other tools associated with student interest include programming geared towards primary care or rural training and extracurricular opportunities such as FM Interest Groups. Strategic plans to improve the primary care work force should focus funding and legislative efforts on effective methods such as: establishing and maintaining FM clerkships, admitting students with rural and underserved backgrounds or primary care interest, developing longitudinal primary care tracks, and supporting extracurricular FM activities. Rigorous research is needed to assess how best to utilize limited educational resources to ensure that all students graduate with a core set of FM competence as well as an increased FM matriculation.

Compression force on the upper jaw during neonatal intubation: mannequin study.

PubMed

Doreswamy, Srinivasa Murthy; Almannaei, Khaled; Fusch, Chris; Shivananda, Sandesh

2015-03-01

Neonatal intubation is a technically challenging procedure, and pressure-related injuries to surrounding structures have been reported. The primary objective of this study was to determine the pressure exerted on the upper jaw during tracheal intubation using a neonatal mannequin. Multidisciplinary care providers working at a neonatal intensive care unit were requested to intubate a neonatal mannequin using the standard laryngoscope and 3.0-mm (internal diameter) endotracheal tube. Compression force exerted was measured by using pressure-sensitive film taped on the upper jaw before every intubation attempt. Pressure, area under pressure and time taken to intubate were compared between the different types of health-care professionals. Thirty care providers intubated the mannequin three times each. Pressure impressions were observed on the developer film after every intubation attempt (n = 90). The mean pressure exerted during intubation across all health-care providers was 568 kPa (SD 78). The mean area placed under pressure was 142 mm(2) (SD 45), and the mean time taken for intubation was 14.7 s (SD 4.3). There was no difference in pressure exerted on the upper jaw between frequent and less frequent intubators. It was found that pressure greater than 400 kPa was inadvertently applied on the upper jaw during neonatal intubation, far exceeding the 250 kPa shown to cause tissue injury in animal models. The upper jaw is exposed to a significant compression force during intubation. Although such exposure is brief, it has the potential to cause tissue injury. Contact of the laryngoscope blade with the upper jaw occurred in all intubation attempts with the currently used design of laryngoscope. © 2014 The Authors. Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

The Influence of Altering Push Force Effectiveness on Upper Extremity Demand during Wheelchair Propulsion

PubMed Central

Rankin, Jeffery W.; Kwarciak, Andrew M.; Richter, W. Mark; Neptune, Richard R.

2010-01-01

Manual wheelchair propulsion has been linked to a high incidence of overuse injury and pain in the upper extremity, which may be caused by the high load requirements and low mechanical efficiency of the task. Previous studies have suggested that poor mechanical efficiency may be due to a low effective handrim force (i.e. applied force that is not directed tangential to the handrim). As a result, studies attempting to reduce upper extremity demand have used various measures of force effectiveness (e.g. fraction effective force, FEF) as a guide for modifying propulsion technique, developing rehabilitation programs and configuring wheelchairs. However, the relationship between FEF and upper extremity demand is not well understood. The purpose of this study was to use forward dynamics simulations of wheelchair propulsion to determine the influence of FEF on upper extremity demand by quantifying individual muscle stress, work and handrim force contributions at different values of FEF. Simulations maximizing and minimizing FEF resulted in higher average muscle stresses (23% and 112%) and total muscle work (28% and 71%) compared to a nominal FEF simulation. The maximal FEF simulation also shifted muscle use from muscles crossing the elbow to those at the shoulder (e.g. rotator cuff muscles), placing greater demand on shoulder muscles during propulsion. The optimal FEF value appears to represent a balance between increasing push force effectiveness to increase mechanical efficiency and minimizing upper extremity demand. Thus, care should be taken in using force effectiveness as a metric to reduce upper extremity demand. PMID:20674921

The impact of gender, culture, and sexuality on Mauritian nursing: Nursing as a non-gendered occupational identity or masculine field? Qualitative study.

PubMed

Hollup, Oddvar

2014-05-01

International studies have generally defined nursing as a female-dominated occupation. The almost absence of male nurses seems universal, except as a privileged minority occupying positions within nursing specialties ('islands of masculinity'). Nursing is associated with relatively low status owing to gender and income, and is also influenced by cultural perceptions of social status, the nature of the work and sexuality. This study aims to describe and analyse how gender and cultural perceptions influenced the development of nursing in Mauritius. This paper examines why nursing in Mauritius became gendered in different ways due to the impact of gender equivalence in the work force, the gendered segregation in clinical practice and the absence of caring feminisation in nursing. This qualitative study is based on in-depth, semi-structured interviews and convenience sampling. The sample includes nurses working at five hospitals. They all come from the central and southern part of Mauritius. The data were collected over a five-month period during 2006. Individual qualitative interviews were conducted with 47 nurses, both men (27) and women (20), of different grades, ages, religions and ethnic backgrounds. Nursing practice is gender segregated, influenced and supported by cultural traditions and perceptions of gender relations, sexuality and touch in nursing. However, the professional identity and role is considered non-gendered, implied by the title of 'nursing officer' and the presence of male nurses who constitute almost 50 percent of the work force. Male nurses do not face similar barriers deterring them from entering nursing profession. Nursing did not develop the image of women's work and a low status job in Mauritius. The nursing profession in Mauritius has been shaped by a different 'history of origin', social, cultural and societal conditions on the basis of the absence of gender imbalance in the work force and caring feminisation in nursing. Moreover, the increase of men's presence in nursing influenced its name, status and perception, shifting nursing into a masculine sphere with advantageous impacts on nursing. Copyright © 2013 Elsevier Ltd. All rights reserved.

Motivations for entry into sex work and HIV risk among mobile female sex workers in India.

PubMed

Saggurti, Niranjan; Verma, Ravi K; Halli, Shiva S; Swain, Suvakanta N; Singh, Rajendra; Modugu, Hanimi Reddy; Ramarao, Saumya; Mahapatra, Bidhubhusan; Jain, Anrudh K

2011-09-01

This paper assesses the reasons for entry into sex work and its association with HIV risk behaviours among mobile female sex workers (FSWs) in India. Data were collected from a cross-sectional survey conducted in 22 districts across four high HIV prevalence states in India during 2007-2008. Analyses were limited to 5498 eligible mobile FSWs. The reasons given by FSWs for entering sex work and associations with socio-demographic characteristics were assessed. Reported reasons for entering sex work include poor or deprived economic conditions; negative social circumstances in life; own choice; force by an external person; and family tradition. The results from multivariate analyses indicate that those FSWs who entered sex work due to poor economic conditions or negative social circumstances in life or force demonstrated elevated levels of current inconsistent condom use as well as in the past in comparison with those FSWs who reported entering sex work by choice or family tradition. This finding indicates the need for a careful assessment of the pre-entry contexts among HIV prevention interventions since these factors may continue to hinder the effectiveness of efforts to reduce the spread of HIV/AIDS in India and elsewhere.

[Working conditions of community nurses].

PubMed

Kułagowska, Ewa; Kosińska, Maria

2010-01-01

To ensure the most efficient workplace health promotion it is essential to identify and monitor health conditions of employees and all components of the work process, as well as to recognize their cause-effect relationships. Community nurses form an occupational group with a specific type of workplace that is usually located in the patient's place of residence and thus not inspected in terms of safety and hygiene. The aim of the study was to identify working conditions of community nurses with special reference to occupational hazards. An anonymous questionnaire was used as a major tool of this survey. It contained 33 questions, concerning the work process, working conditions, work loads and arduousness, hazards and work-related complaints. The questionnaire was completed by 86 community nurses working in the Upper Silesia region. Community nurses generally assessed their work as hard. A more thorough analysis revealed that nursing and curative care, nursing and hygienic care and rehabilitation were regarded by community nurses as hard, whereas social diagnostics and curative diagnostics were assessed as much easier tasks. Excessive physical load, forced position at work, aggressive patients, patients' aggressive family members, dangerous domestic animals, low quality of technical devices in patients' homes were reported as the greatest hazards. The obtained results reveal that working conditions of community nurses do not ensure their safety at work.

Core Competencies in Integrative Pain Care for Entry-Level Primary Care Physicians.

PubMed

Tick, Heather; Chauvin, Sheila W; Brown, Michael; Haramati, Aviad

2015-11-01

The objective was to develop a set of core competencies for graduating primary care physicians in integrative pain care (IPC), using the Accreditation Council for Graduate Medical Education (ACGME) domains. These competencies build on previous work in competencies for integrative medicine, interprofessional education, and pain medicine and are proposed for inclusion in residency training. A task force was formed to include representation from various professionals who are involved in education, research, and the practice of IPC and who represent broad areas of expertise. The task force convened during a 1.5-day face-to-face meeting, followed by a series of surveys and other vetting processes involving diverse interprofessional groups, which led to the consensus of a final set of competencies. The proposed competencies focus on interprofessional knowledge, skills, and attitudes (KSAs) and are in line with recommendations by the Institute of Medicine, military medicine, and professional pain societies advocating the need for coordination and integration of services for effective pain care with reduced risk and cost and improved outcomes. These ACGME domain compatible competencies for physicians reflect the contributions of several disciplines that will need to be included in evolving interprofessional settings and underscore the need for collaborative care. These core competencies can guide the incorporation of KSAs within curricula. The learning experiences should enable medical educators and graduating primary care physicians to focus more on integrative approaches, interprofessional team-based, patient-centered care that use evidence-based, traditional and complementary disciplines and therapeutics to provide safe and effective treatments for people in pain. Wiley Periodicals, Inc.

3D printed microfluidic mixer for point-of-care diagnosis of anemia.

PubMed

Plevniak, Kimberly; Campbell, Matthew; Mei He

2016-08-01

3D printing has been an emerging fabrication tool in prototyping and manufacturing. We demonstrated a 3D microfluidic simulation guided computer design and 3D printer prototyping for quick turnaround development of microfluidic 3D mixers, which allows fast self-mixing of reagents with blood through capillary force. Combined with smartphone, the point-of-care diagnosis of anemia from finger-prick blood has been successfully implemented and showed consistent results with clinical measurements. Capable of 3D fabrication flexibility and smartphone compatibility, this work presents a novel diagnostic strategy for advancing personalized medicine and mobile healthcare.

Job-sharing: an innovative approach for administration.

PubMed

Foster, D; Wilcox, C; Gibson, H

1992-01-01

A job-sharing arrangement for the Assistant Directors of Physiotherapy at the Royal Jubilee Hospital proved to be an innovative and successful experience demonstrating the feasibility of job-sharing at administrative levels in rehabilitation. Physiotherapy is traditionally a female dominated profession. By the time therapists are most highly skilled and clinically experienced, they have arrived at prime marriage and child-bearing years. Many valuable members are lost to the profession each year as therapists leave the work force to take care of their families, continue their education and participate in recreational activities. Alternative employment opportunities are needed to retain and return therapists to the work force. Convenience of work time is often important. Financial expectations may become a secondary consideration. A search of the literature revealed that while job-sharing has much to recommend it, it is not yet generally accepted in most health professional situations. A few anecdotal references described job-sharing in nursing. An industry-wide literature search revealed few references to the application of job-sharing at administrative levels.

Managing respiratory care services.

PubMed

Thalman, Janice J

2004-06-01

Managing in a health care environment is not for the frail of heart or weak of spirit. Health care is a system in crisis that is exacerbated because it got there by doing what once made it successful. From 1900 to 2004, focus of health care has shifted from controlling infectious diseases to episodic care and to present-day chronic and perspective care. The system has moved from issues of mortality, to morbidity, to mobility, to quality of life, to feeling good and, finally, to looking good. Managing the delivery of health care, if you choose to accept it, is not an impossible mission, but it will be a challenging job. Obviously, the focus of managers is how the system can be designed to innovate and improve care. Organizations and professions must change not only structures and processes, but national priorities for improvement with better methods of disseminating and applying knowledge. Managers of respiratory care departments must foster the use of information technology in clinical care, must create payment policies that encourage innovation and tested performance, and must enhance education programs to strengthen and retain the health care work forces.

Santa Monica College Child Care Task Force Report.

ERIC Educational Resources Information Center

Feiger, Helen Tina; And Others

In 1983, Santa Monica College (SMC) created a task force to assess the college's need for child care services and to devise possible service models for consideration. Subcommittees were formed to address student and staff child care needs; ways of funding child care services; criteria for possible child care facilities and sites which met these…

Breastfeeding policies and breastfeeding support programs in the mother's workplace.

PubMed

Bettinelli, Maria Enrica

2012-10-01

Women should never be forced to make a choice between mother-work and other work. Many women mistakenly think they cannot breastfeed if they plan to return to work, and thus they may not talk with their employers about their intention to breastfeed or how breastfeeding might be supported at their workplace. All breastfeeding policies and strategies underline the importance of providing support for lactating mothers and highlight the need to promote specific interventions in the workplace. Possible strategies for working mothers include having the mother keep the baby with her while she works, allowing the mother to go to the baby to breastfeed during the workday, telecommuting, offering flexible work schedules, maintaining part-time work schedules, and using on-site or nearby child care centres.

Being female in a health care hierarchy. On the social construction of gender and leader identity in a work organization having a predominance of women.

PubMed

Sebrant, U

1999-01-01

The aim of this paper is to illuminate the situation of women working in hierarchical organizations--patriarchal systems where male values and characteristics are normative--especially when the majority of employees in the organization are female. Do organizations where women make up the majority of the work force offer specific opportunities for women? How does the predominance of women affect the social construction of gender and leader identity? These questions are examined from a feminist perspective. Two concepts, gender system and the logic of personal relationships, provide the point of departure. Empirical support is drawn from studies, primarily of health care institutions, one of them an ongoing study by the author. The conclusion is that the hierarchical system seems to be self-generating among both women and men. A more flexible and anti-authoritarian work organization gives greater opportunities for women to develop in their work and to accept leading positions. The benefits of certain female characteristics, summarized in the concept of responsible rationality, in organizational life are discussed.

Modulation of post-movement beta rebound by contraction force and rate of force development.

PubMed

Fry, Adam; Mullinger, Karen J; O'Neill, George C; Barratt, Eleanor L; Morris, Peter G; Bauer, Markus; Folland, Jonathan P; Brookes, Matthew J

2016-07-01

Movement induced modulation of the beta rhythm is one of the most robust neural oscillatory phenomena in the brain. In the preparation and execution phases of movement, a loss in beta amplitude is observed [movement related beta decrease (MRBD)]. This is followed by a rebound above baseline on movement cessation [post movement beta rebound (PMBR)]. These effects have been measured widely, and recent work suggests that they may have significant importance. Specifically, they have potential to form the basis of biomarkers for disease, and have been used in neuroscience applications ranging from brain computer interfaces to markers of neural plasticity. However, despite the robust nature of both MRBD and PMBR, the phenomena themselves are poorly understood. In this study, we characterise MRBD and PMBR during a carefully controlled isometric wrist flexion paradigm, isolating two fundamental movement parameters; force output, and the rate of force development (RFD). Our results show that neither altered force output nor RFD has a significant effect on MRBD. In contrast, PMBR was altered by both parameters. Higher force output results in greater PMBR amplitude, and greater RFD results in a PMBR which is higher in amplitude and shorter in duration. These findings demonstrate that careful control of movement parameters can systematically change PMBR. Further, for temporally protracted movements, the PMBR can be over 7 s in duration. This means accurate control of movement and judicious selection of paradigm parameters are critical in future clinical and basic neuroscientific studies of sensorimotor beta oscillations. Hum Brain Mapp 37:2493-2511, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Constructing a positive identity: A qualitative study of the driving forces of peer workers in mental health-care systems.

PubMed

Vandewalle, Joeri; Debyser, Bart; Beeckman, Dimitri; Vandecasteele, Tina; Deproost, Eddy; Van Hecke, Ann; Verhaeghe, Sofie

2018-02-01

There is growing recognition in mental health for the perspective of individuals with lived experience of mental health problems and mental health service use. As peer workers, these individuals can use their specific experience to benefit and support peers and professional caregivers, and to participate at all levels of mental health-care systems. The aim of the present study was to develop a conceptual framework representing the driving forces of peer workers to fullfil their position in mental health-care systems. A qualitative interview approach was employed using principles of grounded theory. Over a period of 5 months in 2014-2015, semistructured interviews were conducted with 14 peer workers in residential and community mental health-care systems. The emerged conceptual framework reveals that peer workers strive towards constructing a positive identity. This process is powered by driving forces reflecting a desire for normalization and an urge for self-preservation. Peer workers realize a meaningful employment by using their lived experience perspective as an asset, liberating themselves out of restrictive role patterns, and by breaking down stigma and taboo. As a precondition to engage in these normalization processes, peer workers perceive they need to secure their self-preservation by balancing the emergence of adverse emotional fluctuations. The conceptual framework can inform the development of work contexts in which peer workers have an authentic and meaningful contribution, while being offered sufficient support and learning opportunities to manage their well-being. © 2017 Australian College of Mental Health Nurses Inc.

Meeting the needs of people with AIDS: local initiatives and Federal support.

PubMed Central

Sundwall, D N; Bailey, D

1988-01-01

The Health Resources and Services Administration (HRSA), one of the seven agencies of the Public Health Service, is working to meet some of the resource and patient service needs engendered by the epidemic of acquired immune deficiency syndrome (AIDS). Those actions derived from, and support the continuation, expansion, and replication of, initiatives at the community and State levels. HRSA is carrying out many of the recommendations of the Intragovernmental Task Force on AIDS Health Care Delivery by enhancing the AIDS training of health care personnel in prevention, diagnosis, and care and by counseling and encouraging the expansion of facilities outside hospitals to care for AIDS patients. The agency, through its pediatric AIDS demonstration projects, is working on models for the care of children with HIV infections. The needs of AIDS patients are being addressed through a drug therapy reimbursement program; demonstration grants to 13 projects to promote coordinated, integrated systems of care in the community; and grants for the development of intermediate and long-term care facilities for patients. Ten regional education and training centers, funded in 1987 and 1988, will increase the supply of health care providers prepared to diagnose and treat persons with HIV infections. Programs will be conducted for several thousand providers over the next 3 years, using such modalities as televised programs and train-the-trainer courses. The centers will also offer support and referral services for providers. PMID:3131821

Accountable Care Organizations in California: Market Forces at Work?

PubMed

Whaley, Christopher; Frech, H E; Scheffler, Richard M

2015-08-01

Accountable care organizations (ACOs), one of the most recent and promising health care delivery innovations, encourage care coordination among providers. While ACOs hold promise for decreasing costs by reducing unnecessary procedures, improving resource use as a result of economies of scale and scope, ACOs also raise concerns about provider market power. This study examines the market-level competition factors that are associated with ACO participation and the number of ACOs. Using data from California, we find that higher levels of preexisting managed care leads to higher ACO entry and enrollment growth, while hospital concentration leads to fewer ACOs and lower enrollment. We find interesting results for physician market power - markets with concentrated physician markets have a smaller share of individuals in commercial ACOs but a larger number of commercial ACO organizations. This finding implies smaller ACOs in these markets. Copyright © 2015 by Duke University Press.

Nurses' willingness to take care of people living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)--does a teaching intervention make a difference?

PubMed

Mockiene, Vida; Suominen, Tarja; Välimäki, Maritta; Razbadauskas, Arturas; Caplinskas, Saulius; Martinkenas, Arvydas

2011-08-01

The aim of this study is to describe the impact of an education intervention programme on nurses' willingness to care for HIV-positive people in Lithuania. The study utilizes a randomized controlled trial design (RCT). The total sample comprises 185 nurses working in medical, surgical and gynaecological units, and primary health care centres from the same hospital areas in three Lithuanian hospitals. The data were analyzed using SPSS 12.0 and descriptive statistics. Our educational intervention did not have an impact on the nurses' willingness to take care of people living with HIV (PLHIV), as their level of willingness was high already before the education intervention. Further research on this issue is needed to try to understand the forces acting on our nursing staff in order to ensure appropriate care for PLHIV. Copyright © 2010 Elsevier Ltd. All rights reserved.

Forces and Factors Likely to Influence Vocational Education: The Aging Population.

ERIC Educational Resources Information Center

Lewis, Morgan V.; Norton, Lee

The aging of the population is one of the major influences on the environment in which vocational education operates. The number of people 65 and older will increase more slowly in next 25 years than in the past. Improvements in working conditions, health care, and pension plans since World War II have made those who will be 65 by the end of the…

Changing Demographics and the Impact on Air Force Officer Retention

DTIC Science & Technology

2000-04-01

arrangements such as part-time, telecommuting , job-shares, and variable work schedules. Hewlett-Packard also provides a variety of dependent care...100 Best” companies. These companies understand the power of flexibility by offering flextime and other alternatives such as telecommuting and job...them over $7 million in reduced absenteeism and turnover. CIGNA, another insurance giant, reported its new lactation program reduced the time away from

A Novel Use of Peer Coaching to Teach Primary Palliative Care Skills: Coaching Consultation.

PubMed

Jacobsen, Juliet; Alexander Cole, Corinne; Daubman, Bethany-Rose; Banerji, Debjani; Greer, Joseph A; O'Brien, Karen; Doyle, Kathleen; Jackson, Vicki A

2017-10-01

We aim to address palliative care workforce shortages by teaching clinicians how to provide primary palliative care through peer coaching. We offered peer coaching to internal medicine residents and hospitalists (attendings, nurse practioners, and physician assistants). An audit of peer coaching encounters and coachee feedback to better understand the applicability of peer coaching in the inpatient setting to teach primary palliative care. Residents and hospitalist attendings participated in peer coaching for a broad range of palliative care-related questions about pain and symptom management (44%), communication (34%), and hospice (22%). Clinicians billed for 68% of encounters using a time-based billing model. Content analysis of coachee feedback identified that the most useful elements of coaching are easy access to expertise, tailored teaching, and being in partnership. Peer coaching can be provided in the inpatient setting to teach primary palliative care and potentially extend the palliative care work force. Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

78 FR 28580 - Department of Defense Task Force on the Care, Management, and Transition of Recovering Wounded...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-15

... DEPARTMENT OF DEFENSE Office of the Secretary Department of Defense Task Force on the Care, Management, and Transition of Recovering Wounded, Ill, and Injured Members of the Armed Forces AGENCY: Office... Defense announces the following Federal Advisory Committee meeting of the Department of Defense Task Force...

75 FR 59698 - Federal Advisory Committee; Department of Defense Task Force on the Care, Management, and...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-28

.... SUPPLEMENTARY INFORMATION: The Task Force is a non-discretionary Federal advisory committee established to (a... for wounded, ill, and injured members of the Armed Forces; ii. Medical case management; iii. Non... Task Force on the Care, Management, and Transition of Recovering Wounded, Ill, and Injured Member of...

Effect of Pore Topology and Accessibility on Gas Adsorption Capacity in Zeolitic-Imidazolate Frameworks: Bringing Molecular Simulation Close to Experiment

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

Babarao, Ravichandar; Dai, Sheng; Jiang, Deen

2011-01-01

When all cages are assumed to be accessible, popular force fields such as universal force field (UFF) and DREIDING dramatically overpredicted gas adsorption capacity in two widely studied zeolitic-imidazolate frameworks (ZIFs), ZIF-68 and -69. Instead of adjusting the force-field parameters to match the experiments, herein we show that when the pore topology and accessibility are correctly taken into account, simulations with the standard force fields agree very well with the experiments. Careful inspection shows that ZIF-68 and -69 have two one-dimensional channels, which are not interaccessible to gases. The small channel consists of alternating small (HPR) and medium (GME) cages,more » while the large channel comprises the large (KNO) cages. Our analysis indicates that the small channel is not accessible to gases such as CO{sub 2}. So when the cages in the small channel are intentionally blocked in our simulation, the predicted adsorption capacities of CO{sub 2}, CH{sub 4} and N{sub 2} at room temperature from standard force-field parameters for the framework show excellent agreement with the experimental results. In the case of H{sub 2}, all cages are accessible, so simulation results without cage-blocking show excellent agreement with experiment. Due to the promising potential of ZIFs in gas storage and separation, our work here shows that pore topology and accessibility should be carefully examined to understand how gases adsorb in ZIFs.« less

The core of love when caring for patients suffering from addiction.

PubMed

Thorkildsen, Kari M; Eriksson, Katie; Råholm, Maj-Britt

2015-06-01

Drug addiction is a serious health problem. The aim of this study was to gain an understanding of the core of love when caring for patients suffering from addiction. The study had a hermeneutical approach. Four nurses working at a detoxification unit were interviewed. Data were interpreted using a hermeneutical text interpretation based on Gadamer's hermeneutics. The results revealed the core of love in four dimensions: love as an inner driving force, searching for the human being behind the addiction, faith in the inner power of human beings and love as a movement of giving and receiving. The hermeneutical interpretation revealed the core of love as sacrifice, showing that sacrifice is an ethical dimension and that sacrifice involves searching for the patient's ontological suffering. Sacrifice is connected to faith, and faith in love is decisive for a life without drugs. Sacrifice involves being mutual gifts to one another, a self-reinforcing motion of sacrifice that energizes the nurses to go on with their work. © 2014 Nordic College of Caring Science.

Retirement timing of women and the role of care responsibilities for grandchildren.

PubMed

Lumsdaine, Robin L; Vermeer, Stephanie J C

2015-04-01

This article considers the potential relationship between providing care for grandchildren and retirement, among women nearing retirement age. Using 47,444 person-wave observations from the Health and Retirement Study (HRS), we find that the arrival of a new grandchild is associated with more than an 8 % increase in the retirement hazard despite little overall evidence of a care/retirement interaction. We document that although family characteristics seem to be the most important factors driving the care decision, they are also important determinants of retirement. In contrast, although financial incentives such as pensions and retiree health insurance have the largest influence on retirement, the opportunity cost associated with outside income seems to have little effect on whether a grandmother provides care. There is little evidence of substitution between caring for grandchildren versus providing care for elderly parents or engaging in volunteer activities; grandchild care is instead taken on as an additional responsibility. Our findings suggest that policies aimed at prolonging work life may need to consider grandchild care responsibilities as a countervailing factor, while those policies focused on grandchild care may also affect elderly labor force participation.

Mental Illness-Related Stigma in Canadian Military and Civilian Populations: A Comparison Using Population Health Survey Data.

PubMed

Weeks, Murray; Zamorski, Mark A; Rusu, Corneliu; Colman, Ian

2017-07-01

This study sought to compare the prevalence and impacts of mental illness-related stigma among Canadian Armed Forces personnel and Canadian civilians. Data were from two highly comparable, population-based, cross-sectional surveys of Canadian military personnel and Canadian civilians: the 2013 Canadian Forces Mental Health Survey (N=6,696) and the 2012 Canadian Community Health Survey-Mental Health (N=25,113), respectively. Perceived stigma was assessed among those who reported care seeking for a mental health problem in the past 12 months. Follow-up questions assessed the impact of stigma in various domains. Modified Poisson regression and linear regression were used to examine population differences (military versus civilian) in terms of care seeking, stigma, and stigma impact, with adjustments for sociodemographic characteristics and the need for care. Military personnel were significantly more likely than civilians to have perceived stigma (adjusted prevalence ratio [PR]=1.70, 95% confidence interval [CI]=1.11-2.60). Stigma had a greater impact on military personnel, particularly in terms of work or school life (b=1.01, CI=.57-1.47). However, military personnel were also significantly more likely than civilians to have sought care (PR=1.86, CI=1.53-2.25). Military personnel reported a disproportionate amount of mental illness-related stigma, compared with Canadian civilians, and a greater impact of stigma. Nevertheless, military personnel were more likely to seek care, pointing to a complex relationship between stigma and care seeking in the military.

Diabetes mellitus in older people: position statement on behalf of the International Association of Gerontology and Geriatrics (IAGG), the European Diabetes Working Party for Older People (EDWPOP), and the International Task Force of Experts in Diabetes.

PubMed

Sinclair, Alan; Morley, John E; Rodriguez-Mañas, Leo; Paolisso, Giuseppe; Bayer, Tony; Zeyfang, Andrej; Bourdel-Marchasson, Isabelle; Vischer, Ulrich; Woo, Jean; Chapman, Ian; Dunning, Trisha; Meneilly, Graydon; Rodriguez-Saldana, Joel; Gutierrez Robledo, Luis Miguel; Cukierman-Yaffe, Tali; Gadsby, Roger; Schernthaner, Guntram; Lorig, Kate

2012-07-01

Diabetes mellitus is a highly prevalent metabolic condition in ageing societies associated with high levels of morbidity, multiple therapies, and functional deterioration that challenges even the best of health care systems to deliver high-quality, individualized care. Most international clinical guidelines have ignored the often-unique issues of frailty, functional limitation, changes in mental health, and increasing dependency that characterize many aged patients with diabetes. A collaborative Expert Group of the IAGG and EDWPOP and an International Task Force have explored the key issues that affect diabetes in older people using a robust method comprising a Delphi process and an evidence-based review of the literature. Eight domains of interest were initially agreed and discussed: hypoglycemia, therapy, care home diabetes, influence of comorbidities, glucose targets, family/carer perspectives, diabetes education, and patient safety. A set of "consensus" statements was produced in each domain of interest. These form a foundation for future policy development in this area and should influence the clinical behavior and approach of all health professionals engaged in delivering diabetes care to older people. Copyright © 2012 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.

Job embeddedness factors and retention of nurses with 1 to 3 years of experience.

PubMed

Halfer, Diana

2011-10-01

An aging work force, predictions of job growth in health care, and an eventual economic recovery suggest that the current reprieve from the national nursing shortage is temporary. New graduate nurses are an important part of the work force and are needed to replace nurses who will retire in the next decade. Organizational leaders can address the forecasted work force demand by proactively investing in programs for workplace development and retention. Recent literature reports an increased focus on understanding the work experience and career support needed for new graduate nurses. Several studies report improvements in job satisfaction and retention after implementation of structured mentoring programs for new graduate nurses. However, despite successful transition programs, turnover for these same nurses after 1 to 3 years of organizational tenure remains high. Studying factors that contribute to retention and supporting careers beyond the first year of practice may have a significant effect on improving retention and will contribute new knowledge to the nursing literature. This study, undertaken at a Midwestern pediatric academic medical center, examined job factors and career development support that lead to retention of nurses with 1 to 3 years of experience. Understanding these issues may guide nursing leaders and staff development educators in investing in focused retention and career development plans during an economic recession. Copyright 2011, SLACK Incorporated.

Who joins the network? Physicians' resistance to take budgetary co-responsibility.

PubMed

Rischatsch, Maurus

2015-03-01

Managed Care (MC) is expected to provide health care at a lower cost than conventional provision. Therefore, Switzerland intends to promote MC by forcing health insurers to write MC contracts and introducing budgetary co-responsibility for ambulatory care physicians. A discrete choice experiment conducted in 2011 including 872 physicians reveals a strong preference heterogeneity with respect to network participation and alternative remuneration schemes. The number of physicians working in networks is unlikely to rise on a voluntary basis, while general practitioners are more likely to join networks than specialists with surgical activities. For physicians considering joining networks, cost savings are predicted to be higher than the estimated willingness-to-accept payments. Copyright © 2014 Elsevier B.V. All rights reserved.

Air Force Aerospace Medicine Enterprise Ambulatory Medical Care Survey

DTIC Science & Technology

2014-03-01

aerospace medicine • utilization • health care • Air Force Introduction The planning and management of health care delivery is becoming increasingly...preferences and to adhere to the prescribed regimen. In the broader context of heath care systems, managers and policy makers influence budget and...providers, managers , policy makers, and researchers on the effectiveness of health care organization, patterns of service use, quality of care, health

The mapping competences of the nurse Case/Care Manager in the context of Intensive Care.

PubMed

Alfieri, Emanuela; Ferrini, Anna Chiara; Gianfrancesco, Francesca; Lise, Gianluca; Messana, Giovanni; Tirelli, Lorenzo; Lorenzo, Ana; Sarli, Leopoldo

2017-03-15

Since the recent introduction of the Case/Care Manager's professional figure, it is quite difficult to identify properly his/her own particular features, which could be mainly be found revising mainly in American studies. Therefore, the present study intended to identify the Case/Care Manager's skills and professional profile in an Intensive Care Unit experience, taking into consideration the staff's activities, perception and expectations towards the Case/Care Manager. In particular, it has been compared the experience of an Intensive Care Units where the Case/Care Manager's profile is operational to a different Unit where a Case/Care Manager is not yet in force. a Levati's model was used to map the Case/Care Manager's skills, involving each unit whole working staff, executives and caregivers through semi-structured interviews. It has been taken into consideration the Anaesthesia Unit and Emergency Unit of Cesena's healthcare organisation (AUSL of Romagna) and a Cardiology Intensive Care Unit of Piacenza's healthcare organisation, where the Case/Care Manager's profile has not been experimented yet. Firstly, it a data collection in each healthcare organization has been organised. Subsequently, semi-structured interviews to doctors, unit nurses, caregivers, nurses' coordinators and medical staff have been used to compare each healthcare system. The interviewees' described their expectations in relation to the Case/Care Manager working in a critical area. Then, every data collected during interviews has been organised to map a Case/Care Manager's essential professional profile to work in a critical area together with medical staff. Piacenza's O.U. critical area experience reported a major demand for patients' and patient's families' assistance. On the other hand, the very same aspects seem to have been better achieved in Cesena's O.U., where a Case/Care Manager's recent introduction has actually helped to overcome the void in organising systems. a Case/Care Manager's profile has been drafted on the basis of the comparative analysis conducted. It has been noted how the Case/Care Manager's professional profile can really improve relationships and communications between medical staff and patients, promoting a major unity among the working team. According to the present research, the Case/Care Manager's profile has been proved helpful in positively influencing the team activity and to elicit major satisfaction both in patients and their family.

Development of electromagnetic welding facility of flat plates for nuclear industry

NASA Astrophysics Data System (ADS)

Kumar, Rajesh; Sahoo, Subhanarayan; Sarkar, Biswanath; Shyam, Anurag

2017-04-01

Electromagnetic pulse welding (EMPW) process, one of high speed welding process uses electromagnetic force from discharged current through working coil, which develops a repulsive force between the induced current flowing parallel and in opposite direction. For achieving the successful weldment using this process the design of working coil is the most important factor due to high magnetic field on surface of work piece. In case of high quality flat plate welding factors such as impact velocity, angle of impact standoff distance, thickness of flyer and overlap length have to be chosen carefully. EMPW has wide applications in nuclear industry, automotive industry, aerospace, electrical industries. However formability and weldability still remain major issues. Due to ease in controlling the magnetic field enveloped inside tubes, the EMPW has been widely used for tube welding. In case of flat components control of magnetic field is difficult. Hence the application of EMPW gets restricted. The present work attempts to make a novel contribution by investigating the effect of process parameters on welding quality of flat plates. The work emphasizes the approaches and engineering calculations required to effectively use of actuator in EMPW of flat components.

An official American Thoracic Society/American Association of Critical-Care Nurses/American College of Chest Physicians/Society of Critical Care Medicine policy statement: the Choosing Wisely® Top 5 list in Critical Care Medicine.

PubMed

Halpern, Scott D; Becker, Deborah; Curtis, J Randall; Fowler, Robert; Hyzy, Robert; Kaplan, Lewis J; Rawat, Nishi; Sessler, Curtis N; Wunsch, Hannah; Kahn, Jeremy M

2014-10-01

The high costs of health care in the United States and other developed nations are attributable, in part, to overuse of tests, treatments, and procedures that provide little to no benefit for patients. To improve the quality of care while also combating this problem of cost, the American Board of Internal Medicine Foundation developed the Choosing Wisely Campaign, tasking professional societies to develop lists of the top five medical services that patients and physicians should question. To present the Critical Care Societies Collaborative's Top 5 list in Critical Care Medicine and describe its development. Each professional society in the Collaborative nominated members to the Choosing Wisely task force, which established explicit criteria for evaluating candidate items, generated lists of items, performed literature reviews on each, and sought external input from content experts. Task force members narrowed the list to the Top 5 items using a standardized scoring system based on each item's likely overall impact and merits on the five explicit criteria. From an initial list of 58 unique recommendations, the task force proposed a Top 5 list that was ultimately endorsed by each Society within the Collaborative. The five recommendations are: (1) do not order diagnostic tests at regular intervals (such as every day), but rather in response to specific clinical questions; (2) do not transfuse red blood cells in hemodynamically stable, nonbleeding ICU patients with an Hb concentration greater than 7 g/dl; (3) do not use parenteral nutrition in adequately nourished critically ill patients within the first 7 days of an ICU stay; (4) do not deeply sedate mechanically ventilated patients without a specific indication and without daily attempts to lighten sedation; and (5) do not continue life support for patients at high risk for death or severely impaired functional recovery without offering patients and their families the alternative of care focused entirely on comfort. These five recommendations provide a starting point for clinicians and patients to make decisions leading to higher-quality, lower-cost care. Future work is needed to promote adherence to these recommendations and to develop additional ways for intensive care clinicians to take leadership in reining in health-care costs.

Intensive care unit quality improvement: a "how-to" guide for the interdisciplinary team.

PubMed

Curtis, J Randall; Cook, Deborah J; Wall, Richard J; Angus, Derek C; Bion, Julian; Kacmarek, Robert; Kane-Gill, Sandra L; Kirchhoff, Karin T; Levy, Mitchell; Mitchell, Pamela H; Moreno, Rui; Pronovost, Peter; Puntillo, Kathleen

2006-01-01

Quality improvement is an important activity for all members of the interdisciplinary critical care team. Although an increasing number of resources are available to guide clinicians, quality improvement activities can be overwhelming. Therefore, the Society of Critical Care Medicine charged this Outcomes Task Force with creating a "how-to" guide that focuses on critical care, summarizes key concepts, and outlines a practical approach to the development, implementation, evaluation, and maintenance of an interdisciplinary quality improvement program in the intensive care unit. The task force met in person twice and by conference call twice to write this document. We also conducted a literature search on "quality improvement" and "critical care or intensive care" and searched online for additional resources. DATA SYNTHESIS AND OVERVIEW: We present an overview of quality improvement in the intensive care unit setting and then describe the following steps for initiating or improving an interdisciplinary critical care quality improvement program: a) identify local motivation, support teamwork, and develop strong leadership; b) prioritize potential projects and choose the first target; c) operationalize the measures, build support for the project, and develop a business plan; d) perform an environmental scan to better understand the problem, potential barriers, opportunities, and resources for the project; e) create a data collection system that accurately measures baseline performance and future improvements; f) create a data reporting system that allows clinicians and others to understand the problem; g) introduce effective strategies to change clinician behavior. In addition, we identify four steps for evaluating and maintaining this program: a) determine whether the target is changing with periodic data collection; b) modify behavior change strategies to improve or sustain improvements; c) focus on interdisciplinary collaboration; and d) develop and sustain support from the hospital leadership. We also identify a number of online resources to complement this overview. This Society of Critical Care Medicine Task Force report provides an overview for clinicians interested in developing or improving a quality improvement program using a step-wise approach. Success depends not only on committed interdisciplinary work that is incremental and continuous but also on strong leadership. Further research is needed to refine the methods and identify the most cost-effective means of improving the quality of health care received by critically ill patients and their families.

32 CFR 644.368 - Procedures and responsibilities for care, custody, accountability, and maintenance.

Code of Federal Regulations, 2010 CFR

2010-07-01

... their jurisdiction until final disposition is effected. (c) Department of the Air Force property. Pursuant to AFR 87-4, the Department of the Air Force is responsible for care and custody of excess Air Force real property. However, upon request by the Air Force DEs may assume custody if no costs are...

32 CFR 644.368 - Procedures and responsibilities for care, custody, accountability, and maintenance.

Code of Federal Regulations, 2013 CFR

2013-07-01

... property under their jurisdiction until final disposition is effected. (c) Department of the Air Force property. Pursuant to AFR 87-4, the Department of the Air Force is responsible for care and custody of excess Air Force real property. However, upon request by the Air Force DEs may assume custody if no costs...

32 CFR 644.368 - Procedures and responsibilities for care, custody, accountability, and maintenance.

Code of Federal Regulations, 2011 CFR

2011-07-01

... property under their jurisdiction until final disposition is effected. (c) Department of the Air Force property. Pursuant to AFR 87-4, the Department of the Air Force is responsible for care and custody of excess Air Force real property. However, upon request by the Air Force DEs may assume custody if no costs...

Women's caregiving and paid work: causal relationships in late midlife.

PubMed

Pavalko, E K; Artis, J E

1997-07-01

Care of an ill or disabled family member or friend is disproportionately done by women and typically is done in late midlife. Because this is-also a time in the life course when women's labor force participation peaks, many women faced with caregiving demands have to decide how to balance them with their employment. In this study we use the National Longitudinal Survey (NLS) of Mature Women to examine the causal relationship between employment and caring for an ill or disabled friend or relative over a three-year period. We find that employment does not affect whether or not women start caregiving, but that women who do start are more likely to reduce employment hours or stop work. Thus, the causal relationship between employment and caregiving in late midlife is largely unidirectional, with women reducing hours to meet caregiving demands.

Our Families, Our Children: The Lesbian and Gay Child Care Task Force Report on Quality Child Care.

ERIC Educational Resources Information Center

Dispenza, Mary

The Lesbian and Gay Child Care Task Force documented anecdotal evidence of homophobia in child care and school age communities, including: (1) refusal to accept children from lesbian, gay, bisexual, and transgender (LGBT) families into child care; (2) biased attitudes expressed to children when they speak about their families; and (3) demonstrated…

Trends in dental and allied dental education.

PubMed

Neumann, Laura M

2004-09-01

Educational programs play an important role in preparing a qualified dental work force. This article reviews the current status and trends in dental, advanced dental and allied dental education programs in the United States and examines their impact on the dental work force. This analysis focuses on survey data collected by the American Dental Association during the past 10 to 15 years and compares recent patterns in applications, enrollment and graduation with previous trends. The numbers of educational programs, applicants, enrollees and graduates have increased in dentistry, dental hygiene and dental assisting, while dental laboratory technology has declined in all measures. The proportion of women in dentistry has increased, while the ethnic profile of dental and allied personnel has shown little change. Both the cost of dental education and student debt continue to increase. Despite increases in the number of educational programs and overall numbers of graduates from dental and allied dental education programs, the proportion of underrepresented groups still lags behind their representation in the overall population, and the number of allied personnel falls short of practice needs. Patterns in applications, enrollment and graduation are important determinants of the dental and allied dental work force. The cost and funding of education significantly affect the attractiveness of dental careers and the sustainability of educational programs and should be monitored carefully by the profession.

Oncology nursing: Finding the balance in a changing health care system.

PubMed

Bakker, Debra; Fitch, Margaret I; Green, Esther; Butler, Lorna; Olson, Karin

2006-01-01

Health care restructuring has resulted in significant changes in the workload and work environment for oncology nurses. While recent studies describe the impact of these changes on the general nursing workforce in several countries, there have been no published studies that have focused on worklife issues of Canadian oncology nurses. Therefore, a qualitative study was conducted to gain insight about how oncology nursing has changed over the past decade and how Canadian oncology nurses are managing these changes. Analysis of telephone interviews with 51 practising oncology nurses employed across Canada revealed three major themes. The first theme, "health care milieu", portrayed a picture of the cancer care environment and patient and professional changes that occurred over the past decade. The second theme, "conflicting demands", reflects how the elements of change and social forces have challenged professional oncology nursing practice. The third theme, "finding the way", describes the patterns of behaviour that nurses used to manage the changing health care environment and make meaning out of nurses' work in cancer care. Overall, the findings portray a picture of Canadian oncology nurses in "survival mode". They face many workplace challenges, but are able to keep going "for now" because they find ways to balance their responsibilities on a daily basis and because they know and believe that their specialized nursing knowledge and skills make a difference in patient care.

Patient or customer?

PubMed

Parker, J M

1999-01-01

This paper investigates caring in practice within the context of the global imperative of increasing rationalisation of care based on an economic ethic. The notion of the global marketplace has spread to the domain of health services, so that 'health' has come to be seen as a commodity, with the body as its site, and the 'patient' a customer; clinicians work to construct standard pathways through the healthcare supermarket. The challenge for nurses is to work within but also to challenge and resist the reductionist impetus of economically based and commercially driven approaches to health care. They must retain the sense of the value of the wholeness of the person, the deeply personal and profoundly significant professional-recipient relationship, and find ways of demonstrating their capacity to deliver high-quality care in a cost-effective way. Proper and appropriate accountability is a key strategy to maintaining quality nursing as a significant aspect of care. The expansion of the role of the advanced practice nurse is very useful in providing holistic and cost-effective care, though there are currently limitations to scope of practice that need to be removed. The metaphor of the marketplace, underpinned by powerful global economic forces, can draw us into unthinking compliance with its imperatives--but other metaphors are available. Metaphor and creativity are linked, and we need to consider how the creative use of language can facilitate the emergence of new ways of understanding in health care.

An interprofessional educational approach to oral health care in the geriatric population.

PubMed

Bonwell, Patricia Brown; Parsons, Pamela L; Best, Al M; Hise, Sabrina

2014-01-01

An interprofessional educational approach was used to provide five in-service training sessions for all direct health care providers in a long-term care facility, and one half-day seminar/live webinar for community-licensed health care professionals. Content included presentations by five disciplines: (a) periodontist: oral-systemic relationship, (b) oral pathologist: oral pathology, (c) pharmacist: oral health-pharmacological link, (d) dietitian: oral health-dietary link, and (e) occupational therapist: providing and practicing proper oral hygiene. Significant improvement in posttest scores for the five in-service training sessions and the half-day seminar/live webinar was revealed in t-test results, representing an increase in knowledge gained. Approximately 80% of the 145 participants indicated that they would make a change in patient care. Findings indicate that the in-service training sessions and half-day seminar/live webinar supported development of the geriatric work force by utilizing an interprofessional educational approach which will assist in meeting the oral health care needs of the geriatric population.

Baby Boomers and Generation X: strategies to bridge the gap.

PubMed

Bertholf, L; Loveless, S

2001-09-01

Health care staffing challenges for the next few years necessitate the need to develop strategies to integrate the Generation Xer into a predominantly Baby Boomer work force. Strategies to assist Baby Boomers and Generation Xers to engage one another in constructive relationships are discussed. Misunderstanding and stereotyping create barriers that focus on differences and perceived limitations rather than identification of common thinking and focusing on strengths of each generation.

[Addictions: Motivated or forced care].

PubMed

Cottencin, Olivier; Bence, Camille

2016-12-01

Patients presenting with addictions are often obliged to consult. This constraint can be explicit (partner, children, parents, doctor, police, justice) or can be implicit (for their children, for their families, or for their health). Thus, beyond the fact that the caregiver faces the paradox of caring for subjects who do not ask treatment, he faces as well a double bind considered to be supporter of the social order or helper of patients. The transtheoretical model of change is complex showing us that it was neither fixed in time, nor perpetual for a given individual. This model includes ambivalence, resistance and even relapse, but it still considers constraint as a brake than an effective tool. Therapist must have adequate communication tools to enable everyone (forced or not) understand that involvement in care will enable him/her to regain his free will, even though it took to go through coercion. We propose in this article to detail the first steps with the patient presenting with addiction looking for constraint (implicit or explicit), how to work with constraint, avoid making resistances ourselves and make of constraint a powerful motivator for change. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Electrokinetic Analysis of Cell Translocation in Low-Cost Microfluidic Cytometry for Tumor Cell Detection and Enumeration.

PubMed

Guo, Jinhong; Pui, Tze Sian; Ban, Yong-Ling; Rahman, Abdur Rub Abdur; Kang, Yuejun

2013-12-01

Conventional Coulter counters have been introduced as an important tool in biological cell assays since several decades ago. Recently, the emerging portable Coulter counter has demonstrated its merits in point of care diagnostics, such as on chip detection and enumeration of circulating tumor cells (CTC). The working principle is based on the cell translocation time and amplitude of electrical current change that the cell induces. In this paper, we provide an analysis of a Coulter counter that evaluates the hydrodynamic and electrokinetic properties of polystyrene microparticles in a microfluidic channel. The hydrodynamic force and electrokinetic force are concurrently analyzed to determine the translocation time and the electrical current pulses induced by the particles. Finally, we characterize the chip performance for CTC detection. The experimental results validate the numerical analysis of the microfluidic chip. The presented model can provide critical insight and guidance for developing micro-Coulter counter for point of care prognosis.

Toward creating family-friendly work environments in pediatrics: baseline data from pediatric department chairs and pediatric program directors.

PubMed

McPhillips, Heather A; Burke, Ann E; Sheppard, Kate; Pallant, Adam; Stapleton, F Bruder; Stanton, Bonita

2007-03-01

The objective was to determine baseline characteristics of pediatric residency training programs and academic departments in regard to family-friendly work environments as outlined in the Report of the Task Force on Women in Pediatrics. We conducted Web-based anonymous surveys of 147 pediatric department chairs and 203 pediatric program directors. The chair's questionnaire asked about child care, lactation facilities, family leave policies, work-life balance, and tenure and promotion policies. The program director's questionnaire asked about family leave, parenting, work-life balance, and perceptions of "family-friendliness." The response rate was 52% for program directors and 51% for chairs. Nearly 60% of chairs reported some access to child care or provided assistance locating child care; however, in half of these departments, demand almost always exceeded supply. Lactation facilities were available to breastfeeding faculty in 74% of departments, although only 57% provided access to breast pumps. A total of 78% of chairs and 90% of program directors reported written maternity leave policies with slightly fewer reporting paternity leave policies. The majority (83%) of chairs reported availability of part-time employment, whereas only 27% of program directors offered part-time residency options. Most departments offered some flexibility in promotion and tenure. Although progress has been made, change still is needed in many areas in pediatric departments and training programs, including better accessibility to quality child care; improved lactation facilities for breastfeeding mothers; clear, written parental leave policies; and flexible work schedules to accommodate changing demands of family life.

New hope for the health care field.

PubMed

Mabbett, P

1993-03-01

Creativity is required for solving many of the problems that face the health care system. As a group, caregivers tend to underestimate their own creativity and its potential impact on the systems in which they work. This article reviews common misconceptions about creativity and describes forces that erode its expression. Suggestions are made for how creativity can be increased within traditional-practice settings. Steps in a creative process are reviewed as well as internal and external factors that support the occurrence of creative moments. The benefits to be gained from increased creativity range from practical improvements within the system to personal gratification for individual caregivers.

The case for reassessment of health care technology. Once is not enough.

PubMed

Banta, H D; Thacker, S B

1990-07-11

Assessment of health care technologies should be an iterative process, not a single event. In the United States there are an increasing number of organized attempts at reassessment of technologies by the health industry, professional societies, and national government agencies, such as the Medical Necessity Project of Blue Cross/Blue Shield, the Clinical Efficacy Assessment Project of the American College of Physicians, and the work of the US Preventive Services Task Force. We examine four clinical practices--electronic fetal monitoring, episiotomy, electroencephalography, and hysterectomy--to illustrate the need to continuously reassess existing technologies and to challenge our current inertia in this critical arena of health practice.

A study of characteristics of Michigan workers with work-related asthma exposed to welding.

PubMed

Banga, Amit; Reilly, Mary Jo; Rosenman, Kenneth D

2011-04-01

To describe the characteristics of subjects with work-related asthma (WRA) secondary to welding exposure. As part of statewide surveillance, WRA reports were received from health care professionals. These reports were followed up with a telephonic interview using a standardized questionnaire; lung function tests were reviewed, and final assessment regarding the diagnosis was made. Welding exposure was the fifth leading cause of WRA (n = 142; age, 43.3 ± 11.4 years; male to female ratio, 94:48). Several workers (n = 72) were nonwelders but all worked around welding fumes. More than a third had predicted forced expiratory volume in one second less than 80% (38 of 106, 35.8%). Most had sought medical treatment (95.8%) and had emergency room visits (n = 86, 60.6%), and several had required hospitalization (n = 50, 36.7%). Welding exposure is a common cause of WRA. It is seen in workers from different industries engaged in diverse jobs. Spirometry changes are common. Work-related asthma is associated with high morbidity and health care costs.

Modulation of post‐movement beta rebound by contraction force and rate of force development

PubMed Central

Fry, Adam; Mullinger, Karen J.; O'Neill, George C.; Barratt, Eleanor L.; Morris, Peter G.; Bauer, Markus; Folland, Jonathan P.

2016-01-01

Abstract Movement induced modulation of the beta rhythm is one of the most robust neural oscillatory phenomena in the brain. In the preparation and execution phases of movement, a loss in beta amplitude is observed [movement related beta decrease (MRBD)]. This is followed by a rebound above baseline on movement cessation [post movement beta rebound (PMBR)]. These effects have been measured widely, and recent work suggests that they may have significant importance. Specifically, they have potential to form the basis of biomarkers for disease, and have been used in neuroscience applications ranging from brain computer interfaces to markers of neural plasticity. However, despite the robust nature of both MRBD and PMBR, the phenomena themselves are poorly understood. In this study, we characterise MRBD and PMBR during a carefully controlled isometric wrist flexion paradigm, isolating two fundamental movement parameters; force output, and the rate of force development (RFD). Our results show that neither altered force output nor RFD has a significant effect on MRBD. In contrast, PMBR was altered by both parameters. Higher force output results in greater PMBR amplitude, and greater RFD results in a PMBR which is higher in amplitude and shorter in duration. These findings demonstrate that careful control of movement parameters can systematically change PMBR. Further, for temporally protracted movements, the PMBR can be over 7 s in duration. This means accurate control of movement and judicious selection of paradigm parameters are critical in future clinical and basic neuroscientific studies of sensorimotor beta oscillations. Hum Brain Mapp 37:2493–2511, 2016. © 2016 The Authors Human Brain Mapping Published by Wiley Periodicals, Inc PMID:27061243

Women and changes in the Chilean economy: some questions.

PubMed

Smiaroski, M S

1996-10-01

The author argues that a new development model that encourages greater participation of women in the work force in domestic piecework, temporary work, and subcontracting may further lead to the exploitation of women in Chile. The importance of women in economic development in Chile should be based on building skills, providing support child care services, reorienting women's education, and tax incentives. Chile over the past decade has achieved relatively stable economic growth and increased employment of women. During 1990-93 the growth of women in the work force increased at a rate of 16.8%, while men's presence increased by only 9.8%. The Chilean economy is based on a sophisticated modern sector and a labor-intensive informal sector. The Chilean model of development relies on cheap, flexible labor and a government approval of this model. Increased participation of women in the labor force is usually perceived as increased economic empowerment. A 1994 Oxfam study found that women were being forced into the labor market due to declines in family income and low wages. 46% of men and women received wages that did not cover basic necessities. The Chilean labor market is gender-stratified. Men are paid better than women for the same work. Men are in more permanent positions. Labor laws are either inadequate or violated, particularly for hours of work and overtime pay and conditions of employment and benefits. Traditional female jobs are those that rely on women's natural attributes. These unskilled attributes are rewarded with low wages. Little opportunity is provided for upgrading skills or acquiring new skills. Some women turn down advancement because of a lack of role models. Women have little opportunity to develop their self-image as workers. Poor self-images affect women's work attitudes and motivation. Some firms use competition between women to boost production. Chilean women remain in subordinate roles.

When high pressure, system constraints, and a social justice mission collide: A socio-structural analysis of emergency department social work services.

PubMed

Moore, Megan; Cristofalo, Margaret; Dotolo, Danae; Torres, Nicole; Lahdya, Alexandra; Ho, Leyna; Vogel, Mia; Forrester, Mollie; Conley, Bonnie; Fouts, Susan

2017-04-01

The emergency department (ED) can be a critical intervention point for many patients with multifaceted needs. Social workers have long been part of interdisciplinary ED teams. This study aimed to contribute to the limited understanding of social worker-patient interactions and factors influencing social work services in this setting. This paper reports a qualitative content analysis of social work medical record notes (N = 1509) of services provided to trauma patients in an urban, public, level 1 trauma center and an in-depth analysis of semi-structured interviews with ED social workers (N = 10). Eight major social work roles were identified: investigator, gatekeeper, resource broker, care coordinator, problem solver, crisis manager, advocate, discharge planner. Analyses revealed a complex interplay between ED social work services and multi-layered contexts. Using a social-ecological framework, we identified the interactions between micro or individual level factors, mezzo or local system level factors and macro environmental and systemic factors that play a role in ED interactions and patient services. Macro-level contextual influences were socio-structural forces including socioeconomic barriers to health, social hierarchies that reflected power differentials between providers and patients, and distrust or bias. Mezzo-level forces were limited resources, lack of healthcare system coordination, a challenging hierarchy within the medical model and the pressure to discharge patients quickly. Micro-level factors included characteristics of patients and social workers, complexity of patient stressors, empathic strain, lack of closure and compassion. All of these forces were at play in patient-social worker interactions and impacted service provision. Social workers were at times able to successfully navigate these forces, yet at other times these challenges were insurmountable. A conceptual model of ED social work and the influences on the patient-social worker interactions was developed to assist in guiding innovative research and practice models to improve services and outcomes in the complex, fast-paced ED. Copyright © 2017 Elsevier Ltd. All rights reserved.

When high pressure, system constraints, and a social justice mission collide: a socio-structural analysis of emergency department social work services

PubMed Central

Cristofalo, Margaret; Dotolo, Danae; Torres, Nicole; Lahdya, Alexandra; Ho, Leyna; Vogel, Mia; Forrester, Mollie; Conley, Bonnie; Fouts, Susan

2017-01-01

The emergency department (ED) can be a critical intervention point for many patients with multifaceted needs. Social workers have long been part of interdisciplinary ED teams. This study aimed to contribute to the limited understanding of social worker-patient interactions and factors influencing social work services in this setting. This paper reports a qualitative content analysis of social work medical record notes (N=1,509) of services provided to trauma patients in an urban, public, level 1 trauma center and an in-depth analysis of semi-structured interviews with ED social workers (N=10). Eight major social work roles were identified: investigator, gatekeeper, resource broker, care coordinator, problem solver, crisis manager, advocate, discharge planner. Analyses revealed a complex interplay between ED social work services and multi-layered contexts. Using a social-ecological framework, we identified the interactions between micro or individual level factors, mezzo or local system level factors and macro environmental and systemic factors that play a role in ED interactions and patient services. Macro-level contextual influences were socio-structural forces including socioeconomic barriers to health, social hierarchies that reflected power differentials between providers and patients, and distrust or bias. Mezzo-level forces were limited resources, lack of healthcare system coordination, a challenging hierarchy within the medical model and the pressure to discharge patients quickly. Micro-level factors included characteristics of patients and social workers, complexity of patient stressors, empathic strain, lack of closure and compassion. All of these forces were at play in patient-social worker interactions and impacted service provision. Social workers were at times able to successfully navigate these forces, yet at other times these challenges were insurmountable. A conceptual model of ED social work and the influences on the patient-social worker interactions was developed to assist in guiding innovative research and practice models to improve services and outcomes in the complex, fast-paced ED. PMID:28214722

Bullying at work, personality and subjective well-being.

PubMed

Plopa, Mieczysław; Plopa, Wojciech; Skuzińska, Anna

2017-01-01

The present study examines the role of personality in the relationship between bullying at work and the subjective well-being of employees. The study was conducted with 359 participating employees of administrative bodies, the police force, and the health care sector. Four selected groups of persons with various personality profiles based on the 5-factor model underwent analysis. The obtained results attest to a protective role of a configuration of low neuroticism, high agreeableness, and high conscientiousness and a configuration of low neuroticism, high extraversion, and high openness to experience. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Modeling good research practices--overview: a report of the ISPOR-SMDM Modeling Good Research Practices Task Force--1.

PubMed

Caro, J Jaime; Briggs, Andrew H; Siebert, Uwe; Kuntz, Karen M

2012-01-01

Models--mathematical frameworks that facilitate estimation of the consequences of health care decisions--have become essential tools for health technology assessment. Evolution of the methods since the first ISPOR Modeling Task Force reported in 2003 has led to a new Task Force, jointly convened with the Society for Medical Decision Making, and this series of seven articles presents the updated recommendations for best practices in conceptualizing models; implementing state-transition approaches, discrete event simulations, or dynamic transmission models; and dealing with uncertainty and validating and reporting models transparently. This overview article introduces the work of the Task Force, provides all the recommendations, and discusses some quandaries that require further elucidation. The audience for these articles includes those who build models, stakeholders who utilize their results, and, indeed, anyone concerned with the use of models to support decision making. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Hospitalist time usage and cyclicality: opportunities to improve efficiency.

PubMed

Kim, Christopher S; Lovejoy, William; Paulsen, Michael; Chang, Robert; Flanders, Scott A

2010-01-01

Academic medical centers (AMCs) have a constrained resident work force. Many AMCs have increased the use of nonresident service hospitalists to manage continued growth in clinical volume. To optimize their time in the hospital, it is important to understand hospitalists' work flow. We performed a time-motion study of hospitalists carrying the admission pager throughout the 3 types of shifts we have at our hospital (day shift, swing shift, and night shift). Tertiary academic medical center in the Midwest. Hospitalists spend about 15% of their time on direct patient care, and two-thirds of their time on indirect patient care. Of the indirect activities, communication and documentation dominate. Travel demands make up over 7% of a hospitalists' time. There are spikes in indirect patient care, followed closely by spikes in direct patient care, at shift changes. At our AMC, indirect patient care activities accounted for the majority of the admitting hospitalists' time spent in the hospital, with documentation and communication dominating this time. Travel takes a significant fraction of hospitalists' time. There is also a cyclical nature to activities performed throughout the day, which can cause patient delays and impose variability on support services. There is a need for both service-specific and systemic improvements for AMCs to efficiently manage further growth in their inpatient volume. (c) 2010 Society of Hospital Medicine.

Medically unexplained physical symptoms (MUPS) among adults in Canada: Comorbidity, health care use and employment.

PubMed

Park, Jungwee; Gilmour, Heather

2017-03-15

Based on data from the 2014 Canadian Community Health Survey and the 2012 Canadian Community Health Survey-Mental Health, this study provides estimates of the prevalence of medically unexplained physical symptoms (MUPS) in the household population aged 25 or older. MUPS are examined in relation to sociodemographic characteristics, physical and mental comorbidity, health care use and unmet needs, labour force participation and productivity. In 2014, 5.5% of Canadian adults-an estimated 1.3 million - reported having chronic fatigue syndrome (1.6%), fibromyalgia (2.0%) and/or multiple chemical sensitivity (2.7%). Half (51%) of people with MUPS reported other chronic physical conditions, compared with 8% of those without MUPS. Similarly, mental comorbidities were more prevalent among those with MUPS. Higher health care use was observed among people with MUPS, but 25% of them reported unmet health care needs, compared with 11% of those without MUPS. People with MUPS were more likely than those without MUPS to be permanently unable to work or to not have a job; fewer than half (45%) were employed. Among those who were employed, 18% had missed work because of a chronic condition, compared with 5% of workers without MUPS.

Treating work-injured patients in Europe. The Italian experience.

PubMed

Giannini, Sandro; Ceccarelli, Francesco

2002-06-01

According with to International Labor Office, the European Union gave the directions to improve the life of workers not only by regulating care, but also safety and return to work. Each European country is conforming to this. In Italy, INAIL, an independent body under the control of the Department of Labor and the Ministry of Health, covers the workers for occupational accidents and is funded by an insurance premium, obligatory paid by the employer. INAIL has the medicolegal task of assessment of injuries, supply of prostheses, physical therapy, and various compensation according to the degree of disability and the type of work. The specific treatment of the injured workers is carried out by the SSN, which is in charge of the outpatient treatment and hospitalization; however, INAIL contributes to the costs according to agreements made with each region. Although on one hand the injured worker is fully protected by the regulations, on the other hand, he or she is obliged to abide to the laws of security and to undergo treatment offered. In returning to work, certain factors are taken into account, such as percentage of disability, type of work, and discomfort that disability produces in carrying out work. Should the type or severity of the disability not allow complete return to work, support is given to assess and integrate the reduced working ability of the injured worker with regards to the workplace, even by adapting the latter to solve structural and environmental problems. INAIL, in accordance with the European Council, is committed to the total care of the worker and not only worker meaning "work force." In fact, health care and economic aid are integrated with the safety and rehabilitation of the worker and his or her return to family, social, and working life.

ACOG Committee Opinion No. 729: Importance of Social Determinants of Health and Cultural Awareness in the Delivery of Reproductive Health Care.

PubMed

2018-01-01

Awareness of the broader contexts that influence health supports respectful, patient-centered care that incorporates lived experiences, optimizes health outcomes, improves communication, and can help reduce health and health care inequities. Although there is little doubt that genetics and lifestyle play an important role in shaping the overall health of individuals, interdisciplinary researchers have demonstrated how the conditions in the environment in which people are born, live, work, and age, play equally as important a role in shaping health outcomes. These factors, referred to as social determinants of health, are shaped by historical, social, political, and economic forces and help explain the relationship between environmental conditions and individual health. Recognizing the importance of social determinants of health can help obstetrician-gynecologists and other health care providers better understand patients, effectively communicate about health-related conditions and behavior, and improve health outcomes.

Integrating information on substance use disorders into electronic health record systems.

PubMed

Tai, Betty; McLellan, A Thomas

2012-07-01

For reasons of safety and effectiveness, many forces in health care, especially the Affordable Care Act of 2010, are pressing for improved identification and management of substance use disorders within mainstream health care. Thus, standard information about patient substance use will have to be collected and used by providers within electronic health record systems (EHRS). Although there are many important technical, legal, and patient confidentiality issues that must be dealt with to achieve integration, this article focuses upon efforts by the National Institute on Drug Abuse and other federal agencies to develop a common set of core questions to screen, diagnose, and initiate treatment for substance use disorders as part of national EHRS. This article discusses the background and rationale for these efforts and presents the work to date to identify the questions and to promote information sharing among health care providers. Published by Elsevier Inc.

The Mangle of Interprofessional Health Care Teams

PubMed Central

2015-01-01

The aim of this study was to explore dimensions of relational work in interprofessional health care teams. Practitioners from a variety of disciplines came together to examine teamwork and cocreate knowledge about interprofessionalism using forum theater. Interviews held prior to the workshop to explore teamwork were foundational to structuring the workshop. The forum theater processes offered participants the opportunity to enact and challenge behaviors and attitudes they experienced in health care teams. Throughout the workshop, aspects of professional identity, power, trust, communication, system structures, and motivation were explored. The activities of the workshop were analyzed using Pickering’s theory, identifying three mangle strands found in being a team: organizational influences, accomplishing tasks, and an orientation to care. Performativity was identified as having a bearing on how teams perform and how teamwork is enacted. Practice components were seen as strands within a mangling of human and nonhuman forces that shape team performativity. PMID:28462298

Vying for time. Work and family.

PubMed

Martinez, M N; Overman, S; Thornburg, L

1990-08-01

Time--there is never enough of it. There are never enough hours in the day to do everything at work and at home. Today's employees, forced to choose between work obligations and family responsibilities, often feel frazzled and guilty. Some employers recognize these conflicts and are finding ways to lighten the work/family load. They are offering a sophisticated combination of dependent-care options, flexible work hours and family-related benefits tailored to meet the needs of the employees within their specific industries. HRMagazine looks at leaders in six major industries--manufacturing, health, communications/technology, financial management, government and retail. No one can give employees that 25-hour day that everyone feels they need to juggle all their work and family obligations. But these industry leaders have provided a nurturing environment where employees can successfully balance those obligations.

The economic role of the Emergency Department in the health care continuum: applying Michael Porter's five forces model to Emergency Medicine.

PubMed

Pines, Jesse M

2006-05-01

Emergency Medicine plays a vital role in the health care continuum in the United States. Michael Porters' five forces model of industry analysis provides an insight into the economics of emergency care by showing how the forces of supplier power, buyer power, threat of substitution, barriers to entry, and internal rivalry affect Emergency Medicine. Illustrating these relationships provides a view into the complexities of the emergency care industry and offers opportunities for Emergency Departments, groups of physicians, and the individual emergency physician to maximize the relationship with other market players.

Vorticity dipoles and a theoretical model of a finite force at the moving contact line singularity

NASA Astrophysics Data System (ADS)

Zhang, Peter; Devoria, Adam; Mohseni, Kamran

2017-11-01

In the well known works of Moffatt (1964) and Huh & Scriven (1971), an infinite force was reported at the moving contact line (MCL) and attributed to a non-integrable stress along the fluid-solid boundary. In our recent investigation of the boundary driven wedge, a model of the MCL, we find that the classical solution theoretically predicts a finite force at the contact line if the forces applied by the two boundaries that make up the corner are taken into consideration. Mathematically, this force can be obtained by the complex contour integral of the holomorphic vorticity-pressure function given by G = μω + ip . Alternatively, this force can also be found using a carefully defined real integral that incorporates the two boundaries. Motivated by this discovery, we have found that the rate of change in circulation, viscous energy dissipation, and viscous energy flux is also finite per unit contact line length. The analysis presented demonstrates that despite a singular stress and a relatively simple geometry, the no-slip semi-infinite wedge is capable of capturing some physical quantities of interest. Furthermore, this result provides a foundation for other challenging topics such as dynamic contact angle.

Local Viscoelastic Properties of Live Cells Investigated Using Dynamic and Quasi-Static Atomic Force Microscopy Methods

PubMed Central

Cartagena, Alexander; Raman, Arvind

2014-01-01

The measurement of viscoelasticity of cells in physiological environments with high spatio-temporal resolution is a key goal in cell mechanobiology. Traditionally only the elastic properties have been measured from quasi-static force-distance curves using the atomic force microscope (AFM). Recently, dynamic AFM-based methods have been proposed to map the local in vitro viscoelastic properties of living cells with nanoscale resolution. However, the differences in viscoelastic properties estimated from such dynamic and traditional quasi-static techniques are poorly understood. In this work we quantitatively reconstruct the local force and dissipation gradients (viscoelasticity) on live fibroblast cells in buffer solutions using Lorentz force excited cantilevers and present a careful comparison between mechanical properties (local stiffness and damping) extracted using dynamic and quasi-static force spectroscopy methods. The results highlight the dependence of measured viscoelastic properties on both the frequency at which the chosen technique operates as well as the interactions with subcellular components beyond certain indentation depth, both of which are responsible for differences between the viscoelasticity property maps acquired using the dynamic AFM method against the quasi-static measurements. PMID:24606928

Nursing unit teams matter: Impact of unit-level nurse practice environment, nurse work characteristics, and burnout on nurse reported job outcomes, and quality of care, and patient adverse events--a cross-sectional survey.

PubMed

Van Bogaert, Peter; Timmermans, Olaf; Weeks, Susan Mace; van Heusden, Danny; Wouters, Kristien; Franck, Erik

2014-08-01

To investigate the impact of nurse practice environment factors, nurse work characteristics, and burnout on nurse reported job outcomes, quality of care, and patient adverse events variables at the nursing unit level. Nurse practice environment studies show growing insights and knowledge about determining factors for nurse workforce stability, quality of care, and patient safety. Until now, international studies have primarily focused on variability at the hospital level; however, insights at the nursing unit level can reveal key factors in the nurse practice environment. A cross-sectional design with a survey. In a cross-sectional survey, a sample of 1108 nurses assigned to 96 nursing units completed a structured questionnaire composed of various validated instruments measuring nurse practice environment factors, nurse work characteristics, burnout, nurse reported job outcomes, quality of care, and patient adverse events. Associations between the variables were examined using multilevel modelling techniques. Various unit-level associations (simple models) were identified between nurse practice environment factors, nurse work characteristics, burnout dimensions, and nurse reported outcome variables. Multiple multilevel models showed various independent variables such as nursing management at the unit level, social capital, emotional exhaustion, and depersonalization as important predictors of nurse reported outcome variables such job satisfaction, turnover intentions, quality of care (at the unit, the last shift, and in the hospital within the last year), patient and family complaints, patient and family verbal abuse, patient falls, nosocomial infections, and medications errors. Results suggested a stable nurse work force, with the capability to achieve superior quality and patient safety outcomes, is associated with unit-level favourable perceptions of nurse work environment factors, workload, decision latitude, and social capital, as well low levels of burnout. Nurses, physicians, nursing leaders, and executives share responsibility to create an environment supportive of interdisciplinary team development. Copyright © 2013 Elsevier Ltd. All rights reserved.

The labor force of the future.

PubMed

Norwood, J L

1987-07-01

In the decades ahead, the US labor force will reflect changes in the industrial structure, with declines in some manufacturing industries and expansion in service industries. The services sector is so diverse that the jobs within it cannot be categorized as either high wage or low wage. The service-producing sector employs 85% of professional specialty workers in the US. In general, information on compensation trends indicates that greater increases in compensation have occurred for workers in service-producing as opposed to goods-producing industries. The increase in service sector jobs has created opportunities for women to enter the labor force and, at present, 5 out of 6 women work in this sector compared to fewer than 2 out of 3 men. Productivity growth rates in the service-producing industries vary substantially and are strongly affected by the business cycle. Central to employment opportunities in the years ahead will be the effect of new technology. To date, the aggregate effect of new technology has been increased employment and higher living standards. Although retraining programs should be in place, the scenario of a huge technology-created labor surplus seems unlikely. In fact, a more likely problem is a shortage of labor resulting from earlier labor force withdrawal and demographic aging of the population. Those in the 25-54-year age group will represent a larger share of the labor force in the years ahead. In addition, blacks are expected to account for 20% of the labor force growth in the next decade. Finally, given increasing labor force participation rates among mothers, employers may have to provide more flexible work schedules, assistance with day care, and more attractive benefits packages.

Report of the Special Task Force to Study Not-for-Profit Hospitals and Unsponsored Charity Care.

PubMed

Anderson, R J; Milburn, L T

1990-04-01

Texas not-for-profit hospitals recently received intense scrutiny regarding their involvement in charity-related contributions when Texas Attorney General Jim Mattox formed the Task Force to Study Not-for-Profit Hospitals and Unsponsored Charity Care. This article details the task force's recommendations concerning charity care obligations of Texas not-for-profit hospitals. Setting the stage for these recommendations was a broad definition of charitable services that included costs for delivering services to indigents and for providing community services to fulfill the hospital's charitable, religious, educational, research, or eleemosynary purposes. The task force unanimously agreed that a mandated level of charity care was incongruent with the hospitals' individual missions and specific community needs, but they supported the formation of standard accounting procedures for charitable services and the voluntary submission of their mission statements to the attorney general of Texas. While the hospitals' role in providing charitable services is very important, the task force emphasized that the overall need for adequate financing and reimbursement of health care is a societal problem that needs specific state and federal actions.

Multidisciplinary workshops: learning to work together.

PubMed

Fatchett, Anita; Taylor, Dawn

2013-03-01

Health and social care professional practice needs to move with the times and to respond to the ever-changing combination of health needs, economic realities and health-policy imperatives. A clear understanding of the variety of forces at play and the ability to marshal these to good effect by working in partnership with multidisciplinary colleagues and children/families is a must, not least in this time of economic austerity and ever-rising health inequalities, when vulnerable children's lives and complex family relationships and behaviours so easily become increasingly strained and challenged. This sad reality calls out for relevant joined-up solutions by all participants--an agenda so often called into question by court judgement after court judgement. The multidisciplinary workshops to be discussed have developed and changed over the past decade and provide a safe but realistic learning environment for students from health and social care backgrounds to experience the difficulties and barriers to good multidisciplinary working, to better understand others' perspectives and activities and consider and develop new and better practical strategies for working with multidisciplinary professional colleagues, children and families. All of the workshops are underpinned by specific discipline-focused theoretical work.

Health care for children in Indian Armed Forces.

PubMed

Kanitkar, Madhuri

2017-10-01

Children of Armed Forces personnel constitute 33% of the clientele dependant on our healthcare. Various child health indicators and immunization coverage of Indian Armed Forces children is better than the national figures. With improved patient care, it has been observed that the morbidity and mortality pattern of diseases affecting the children of Armed Forces personnel has shown a change from infectious diseases in the past to more of chronic complex disorders at present. Hospital admissions of children in military hospitals due to nutritional and infectious diseases have reduced and constitute only around 21% of all paediatric hospital admissions. Various factors responsible for this shift are preventive health measures (antenatal care, immunization), Active promotion of health (baby friendly hospital concept, Well baby clinic) curative health services (outpatient services, in-patient care, specialty care, supportive Care) and supportive care-reaching beyond like ASHA schools. Presently, we need to handle, life style diseases like obesity, mental stress, teach coping mechanisms for common stressors such as parental separation, family reunification, parental loss, behavioral problems, diseases other than infectious diseases requiring super specialty care. The challenge lies in planning the road ahead for these children and adolescents ensuring a life-course approach.

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

PubMed

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

2014-01-01

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

Shaping the future of practice through political activity: how nurses can influence health care policy.

PubMed

Ennen, K A

2001-12-01

1. The scope of professional nursing practice obligates the individual nurse to make participation in public policy formulation part of their professional work. Helping to shape the health and welfare of our communities and the nation fulfills part of nursing's contract with America's citizens. 2. Nurses have valuable, special knowledge and skills which "fit" very well with political involvement and policy making activities. 3. Occupational and environmental health nurses have a special responsibility to influence public policies that affect America's work force by using the five Cs of political action to enable effective involvement. 4. Nursing's professional associations act as advocates for nursing's unique interests and causes. Nurses who join and become active in associations such as AAOHN and ANA are instrumental in protecting the profession of nursing and ensuring that health care issues are at the top of the political agenda at all government levels.

Marine Corps Leadership: Empowering or Limiting the Strategic Corporal?

DTIC Science & Technology

2008-03-01

burner. Finally, day care and nannies enabled both boomer parents to enter the work force. 5 "Generation X did not receive the attention heaped on the...but instead attempt to restore, rebuild, repair, replace and renovate institutions or invent new institutions that will promote the common good.,,9...Millennial Generation’s parents have been dubbed helicopter parents because of their incessant hovering over their children. 12 Finally, the Millennial’s

Can outcome-based continuing medical education improve performance of immigrant physicians?

PubMed

Castel, Orit Cohen; Ezra, Vered; Alperin, Mordechai; Nave, Rachel; Porat, Tamar; Golan, Avivit Cohen; Vinker, Shlomo; Karkabi, Khaled

2011-01-01

Immigrant physicians are a valued resource for physician workforces in many countries. Few studies have explored the education and training needs of immigrant physicians and ways to facilitate their integration into the health care system in which they work. Using an educational program developed for immigrant civilian physicians working in military primary care clinics at the Israel Defence Force, we illustrate how an outcome-based CME program can address practicing physicians' needs for military-specific primary care education and improve patient care. Following an extensive needs assessment, a 3-year curriculum was developed. The curriculum was delivered by a multidisciplinary educational team. Pre/post multiple-choice examinations, objective structured clinical examinations (OSCE), and end-of-program evaluations were administered for curriculum evaluation. To evaluate change in learners' performance, data from the 2003 (before-program) and 2006 (after-program) work-based assessments were retrieved retrospectively. Change in the performance of program participants was compared with that of immigrant physicians who did not participate in the program. Out of 28 learners, 23 (82%) completed the program. Learners did significantly better in the annual post-tests compared with the pretests (p <.01) and improved their OSCE scores (p <.001). Most program graduates (90%) rated overall satisfaction as very good or excellent. In comparison with nonparticipants, program graduates performed better on work-based assessments (Cohen's d =.63). Our intensive, outcome-based, longitudinal CME program has yielded encouraging results. Other medical educators, facing the challenge of integrating immigrant physicians to fit their health care system, may consider adapting our approach. Copyright © 2011 The Alliance for Continuing Medical Education, the Society for Academic Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education.

Magnetohydrodynamic actuation of droplets for millimetric planar fluidic systems

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

Ahmadi, A., E-mail: ali.ahmadi@ubc.ca; McDermid, C. M.; Markley, L.

2016-01-04

In this work, a magnetohydrodynamic method is proposed for the actuation of droplets in small-scale planar fluidic systems, providing an alternative to commonly used methods such as electrowetting-on-dielectric. Elementary droplet-based operations, including transport, merging, and mixing, are demonstrated. The forces acting on millimetric droplets are carefully investigated, with a primary focus on the magnetic actuation force and on the unbalanced capillary forces that arise due to hysteresis. A super-hydrophobic channel is 3D printed to guide the droplets, with thin wires installed as contact electrodes and permanent magnets providing a static magnetic field. It is shown that droplet motion is enhancedmore » by increasing the droplet size and minimizing the electrode contact surface. The effects of channel geometry on threshold voltage and minimum moveable droplet volume are characterized. Finally, the presence of electrolysis is investigated and mitigating strategies are discussed.« less

Labor force participation and human capital increases in an aging population and implications for U.S. research investment.

PubMed

Manton, Kenneth G; Lowrimore, Gene R; Ullian, Arthur D; Gu, Xiliang; Tolley, H Dennis

2007-06-26

The proportion of the United States labor force >/=65 years of age is projected to increase between 2004 and 2014 by the passing of age 65 of the large post-World War II baby boom cohorts starting in 2010 and their greater longevity, income, education, and health [Toossi M (2005) Mon Labor Rev 128(11):25-44]. The aging of the U.S. labor force will continue to at least 2034, when the largest of the baby boom cohorts reaches age 70. Thus, the average health and functional capacity of persons age 65+ must improve for sufficient numbers of elderly persons to be physically and cognitively capable of work. This will require greater investments in research, public health, and health care. We examine how disability declines and improved health may increase human capital at later ages and stimulate the growth of gross domestic product and national wealth.

Current ethical and other problems in the practice of African traditional medicine.

PubMed

Omonzejele, Peter

2003-01-01

Medicine in Africa is regarded as possessing its own "life force", not just using a system of prescribing. This is because health problems are not only attributed to pathological explanations alone, but also to other "forces". Hence, traditional healers utter incantations to take care of negative forces which militate against achieving cure. Treatment in African traditional medicine (ATM) is holistic. It seeks to strike a balance between the patients' body, soul and spirit. The problems arise from the infiltration of charlatans into the field, the practice of using mystical explanations for ill-health, and inadequate knowledge of the properties and clinical use of herbal remedies. Despite its problems, ATM can work in parallel with orthodox medicine using its strengths rather than its weaknesses. ATM has to be applied within a uniform ethical system. Practitioners of ATM must follow the principles of autonomy and confidentiality.

Hand forces exerted by long-term care staff when pushing wheelchairs on compliant and non-compliant flooring.

PubMed

Lachance, Chantelle C; Korall, Alexandra M B; Russell, Colin M; Feldman, Fabio; Robinovitch, Stephen N; Mackey, Dawn C

2018-09-01

Purpose-designed compliant flooring and carpeting have been promoted as a means for reducing fall-related injuries in high-risk environments, such as long-term care. However, it is not known whether these surfaces influence the forces that long-term care staff exert when pushing residents in wheelchairs. We studied 14 direct-care staff who pushed a loaded wheelchair instrumented with a triaxial load cell to test the effects on hand force of flooring overlay (vinyl versus carpet) and flooring subfloor (concrete versus compliant rubber [brand: SmartCells]). During straight-line pushing, carpet overlay increased initial and sustained hand forces compared to vinyl overlay by 22-49% over a concrete subfloor and by 8-20% over a compliant subfloor. Compliant subflooring increased initial and sustained hand forces compared to concrete subflooring by 18-31% when under a vinyl overlay. In contrast, compliant flooring caused no change in initial or sustained hand forces compared to concrete subflooring when under a carpet overlay. Copyright © 2018 Elsevier Ltd. All rights reserved.

Using Kiosks for Patient Self-Service Check-in as a Technology Portal to Health Forces throughout a Health Care Network

DTIC Science & Technology

2004-09-01

AD Award Number: MIPR 4EBAVM4068 TITLE: Using Kiosks for Patient Self-service Check-in as a Technology Portal to Health Forces throughout a Health ... Patient Self-service Check-in as a Technology Portal to HealtheForces Throughout a Health Care Network Funds MIPRed: $300,000 1. Project...study measures were as follows: Hypothesis: Deployment of MICK throughout the DeWitt Health Care Network will: improve measures of patient satisfaction

Ethical issues in pediatric emergency mass critical care.

PubMed

Antommaria, Armand H Matheny; Powell, Tia; Miller, Jennifer E; Christian, Michael D

2011-11-01

As a result of recent events, including natural disasters and pandemics, mass critical care planning has become a priority. In general, planning involves limiting the scope of disasters, increasing the supply of medical resources, and allocating scarce resources. Entities at varying levels have articulated ethical frameworks to inform policy development. In spite of this increased focus, children have received limited attention. Children require special attention because of their unique vulnerabilities and needs. In May 2008, the Task Force for Mass Critical Care published guidance on provision of mass critical care to adults. Acknowledging that the critical care needs of children during disasters were unaddressed by this effort, a 17-member Steering Committee, assembled by the Oak Ridge Institute for Science and Education with guidance from members of the American Academy of Pediatrics, convened in April 2009 to determine priority topic areas for pediatric emergency mass critical care recommendations.Steering Committee members established subgroups by topic area and performed literature reviews of MEDLINE and Ovid databases. Draft documents were subsequently developed and revised based on the feedback from the Task Force. The Pediatric Emergency Mass Critical Care Task Force, composed of 36 experts from diverse public health, medical, and disaster response fields, convened in Atlanta, GA, on March 29-30, 2010. This document reflects expert input from the Task Force in addition to the most current medical literature. The Ethics Subcommittee recommends that surge planning seek to provide resources for children in proportion to their percentage of the population or preferably, if data are available, the percentage of those affected by the disaster. Generally, scarce resources should be allocated on the basis of need, benefit, and the conservation of resources. Estimates of need, benefit, and resource utilization may be more subjective or objective. While the Subcommittee favors more objective methods, pediatrics lacks a simple, validated scoring system to predict benefit or resource utilization. The Subcommittee hesitantly recommends relying on expert opinion while pediatric triage tools are developed. If resources remain inadequate, they should then be allocated based on queuing or lottery. Choosing between these methods is based on ethical, psychological, and practical considerations upon which the Subcommittee could not reach consensus. The Subcommittee unanimously believes the proposal to favor individuals between 15 and 40 yrs of age is inappropriate. Other age-based criteria and criteria based on social role remain controversial. The Subcommittee recommends continued work to engage all stakeholders, especially the public, in deliberation about these issues.

Reengineering health care materials management.

PubMed

Connor, L R

1998-01-01

Health care executives across the country, faced with intense competition, are being forced to consider drastic cost cutting measures as a matter of survival. The entire health care industry is under siege from boards of directors, management and others who encourage health care systems to take actions ranging from strategic acquisitions and mergers to simple "downsizing" or "rightsizing," to improve their perceived competitive positions in terms of costs, revenues and market share. In some cases, management is poorly prepared to work within this new competitive paradigm and turns to consultants who promise that following their methodologies can result in competitive advantage. One favored methodology is reengineering. Frequently, cost cutting attention is focused on the materials management budget because it is relatively large and is viewed as being comprised mostly of controllable expenses. Also, materials management is seldom considered a core competency for the health care system and the organization performing these activities does not occupy a strongly defensible position. This paper focuses on the application of a reengineering methodology to healthcare materials management.

The initial regime of drop coalescence

NASA Astrophysics Data System (ADS)

Anthony, Christopher; Harris, Michael; Basaran, Osman

2017-11-01

Drop coalescence plays a key role in both industry and nature. Consequently, study of the phenomenon has been the focus of numerous experimental, computational and theoretical works to date. In coalescence, two drops come into contact and a liquid bridge forms between them. As time advances, this bridge grows from microscopic to macroscopic scales. Despite the large volume of work dedicated to this problem, currently experiment, theory, and computation are not in perfect agreement with respect to the earliest times following the initial contact of the drops. Experiments report an initial regime where the radius of the connecting bridge grows linearly in time before a transition to either a Stokes regime or an inertial regime where either viscous or inertial forces balance capillary force. In the initial linear regime, referred to as the inertially-limited viscous regime, all three forces are thought to be important. This is in contrast to theory which predicts that all coalescence events begin in the Stokes regime. We use high accuracy numerical simulation to show that the existing discrepancy in the literature can be resolved by paying careful attention to the initial conditions that set the shape and size of the bridge connecting the two drops.

Stigma and barriers to accessing mental health services perceived by Air Force nursing personnel.

PubMed

Hernandez, Stephen H A; Bedrick, Edward J; Parshall, Mark B

2014-11-01

We investigated perceptions of stigma and barriers associated with accessing mental health services among active component U.S. Air Force officer and enlisted nursing personnel (N = 211). The Britt and Hoge et al Stigma scale and Hoge et al Barriers to Care scale were administered via an anonymous, online survey. Stigma items pertained to concerns that might affect decisions to seek mental health treatment. Most of the sample agreed with the items "Members of my unit might have less confidence in me" and "My unit leadership might treat me differently." Approximately 20% to 46% agreed with the other four stigma items. Officer nursing personnel were significantly more likely than enlisted to agree that accessing mental health services would be embarrassing, harm their career, or cause leaders to blame them for the problem (p ≤ 0.03 for each comparison). Getting time off from work for treatment and scheduling appointments were perceived as barriers by 41% and 21% of respondents, respectively. We conclude that proportions of Air Force nursing personnel reporting concerns about potential stigmatizing consequences of seeking mental health care are substantial and similar to ranges previously reported by military service members screening positive for mental health problems after deployment. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

Task Force 1. Report of the Task Force on Patient Expectations, Core Values, Reintegration, and the New Model of Family Medicine

PubMed Central

Green, Larry A.; Graham, Robert; Bagley, Bruce; Kilo, Charles M.; Spann, Stephen J.; Bogdewic, Stephen P.; Swanson, John

2004-01-01

BACKGROUND To lay the groundwork for the development of a comprehensive strategy to transform and renew the specialty of family medicine, this Future of Family Medicine task force was charged with identifying the core values of family medicine, developing proposals to reform family medicine to meet consumer expectations, and determining systems of care to be delivered by family medicine in the future. METHODS A diverse, multidisciplinary task force representing a broad spectrum of perspectives and expertise analyzed and discussed published literature; findings from surveys, interviews, and focus groups compiled by research firms contracted to the Future of Family Medicine project; and analyses from The Robert Graham Center, professional societies in the United States and abroad, and others. Through meetings, conference calls, and writing, and revision of a series of subcommittee reports, the entire task force reached consensus on its conclusions and recommendations. These were reviewed by an external panel of experts and revisions were made accordingly. MAJOR FINDINGS After delivering on its promise to reverse the decline of general practice in the United States, family medicine and the nation face additional challenges to assure all people receive care that is safe, effective, patient-centered, timely, efficient, and equitable. Challenges the discipline needs to address to improve family physicians’ ability to make important further contributions include developing a broader, more accurate understanding of the specialty among the public and other health professionals, addressing the wide scope and variance in practice types within family medicine, winning respect for the specialty in academic circles, making family medicine a more attractive career option, and dealing with the perception that family medicine is not solidly grounded in science and technology. The task force set forth a proposed identity statement for family medicine, a basket of services that should be reliably provided in family medicine practices, and an itemization of key attributes and core values that define the specialty. It also proposed and described a New Model of family medicine for people of all ages and both genders that emphasizes patient-centered, evidence-based, whole-person care provided through a multidisciplinary team approach in settings that reduce barriers to access and use advanced information systems and other new technologies. The task force recommended a time of active experimentation to redesign the work and workplace of family physicians; the development of revised financial models for family medicine, and a national resource to provide assistance to individual practices moving to New Model practice; and cooperation with others pursuing the transformation of frontline medicine to better serve the public. CONCLUSIONS Unless there are changes in the broader health care system and within the specialty, the position of family medicine in the United States will be untenable in a 10- to 20-year time frame. Even within the constraints of today’s flawed health care system, there are major opportunities for family physicians to realize improved results for patients and economic success. A period of aggressive experimentation and redevelopment of family medicine is needed now. The future success of the discipline and its impact on public well-being depends in large measure on family medicine’s ability to rearticulate its vision and competencies in a fashion that has greater resonance with the public while substantially revising the organization and processes by which care is delivered. When accomplished, family physicians will achieve more fully the aspirations articulated by the specialty’s core values and contribute to the solution of the nation’s serious health care problems.

Assistance received by employed caregivers and their care recipients: who helps care recipients when caregivers work full time?

PubMed

Scharlach, Andrew E; Gustavson, Kristen; Dal Santo, Teresa S

2007-12-01

This study examined the association among caregiver labor force participation, employees' caregiving activities, and the amount and quality of care received by care recipients. Telephone interviews were conducted with 478 adults who were employed full time and 705 nonemployed adults who provided care to a family member or friend aged 50 or older, identified through random sampling of California households. We assessed care recipient impairment and service problems; the amounts and types of assistance received from caregivers, family and friends, and paid providers; and caregiver utilization of support services. Care recipients of caregivers employed full time were less likely to receive large amounts of care from their caregivers, more likely to receive personal care from paid care providers, more likely to use community services, and more likely to experience service problems than were care recipients of nonemployed caregivers. Employed caregivers were more likely to use caregiver support services than were nonemployed caregivers. Accommodation to caregiver full-time employment involves selective supplementation by caregivers and their care recipients, reflecting increased reliance on formal support services as well as increased vulnerability to service problems and unmet care recipient needs. These findings suggest the need for greater attention to the well-being of disabled elders whose caregivers are employed full time.

Care challenges for informal caregivers of chronically ill lung patients: results from a questionnaire survey.

PubMed

Gautun, Heidi; Werner, Anne; Lurås, Hilde

2012-02-01

The article aims to answer who the informal caregivers of patients with chronic obstructive pulmonary disease (COPD) are, what kind of help they provide, and how they experience providing help to the patient. Data from a questionnaire survey to next of kin of COPD patients carried through in Norway in December 2009 and January 2010 is explored. About 70% of the patients have one or more informal caregivers, and a majority of the caregivers is the patient's spouse, most often a wife. The help provided is, to a large extent, practical help like housework, garden work, and shopping. Another important support is to accompany the patient to health care. About 45% of the caregivers are part of the work force. Rather few of the respondents experience the caregiving as so demanding that they have chosen to work part-time or quit working. The most demanding part of being an informal caregiver is an overall worrying for the patient. Paid sick leaves for caregivers that are employed, and hospital-at-home programmes that provide education and surveillance to the patient and his/her family through different phases of the illness, are policy means that both can help the informal caregivers to manage daily life and reduce the pressure on the formal healthcare and long-term care services in the future.

The impact of chronic conditions of care recipients on the labour force participation of informal carers in Australia: which conditions are associated with higher rates of non-participation in the labour force?

PubMed Central

2014-01-01

Background Little is known about the effects of personal and other characteristics of care recipients on the behaviour of carers. The aim of this study is to examine the association between the main chronic (disabling) condition of care recipients and the likelihood of their (matched) primary carers aged 15–64 years being out of the labour force. Methods We conducted a retrospective analysis of cross-sectional data from the Australian Bureau of Statistics 2009 Survey of Disability, Ageing and Carers (SDAC) for people aged 15–64 years. We estimated the rates of exit from the labour force for primary carers and non-carers; rates of chronic disease occurrence for care recipients living with their main carers; odds ratios of primary carers being out of the labour force associated with the main chronic condition of their care recipient who lives with them. Results From the 2009 SDAC, we identified 1,268 out of 37,186 eligible participants who were primary carers of a care recipient who lived with them. Of these, 628 (49.5%) were out of the labour force. Most common diseases of care recipients were: back problems (12%); arthritis and related disorders (10%); diseases of the nervous system (such as multiple sclerosis, epilepsy, cerebral palsy) (7.4%); and conditions originating in the perinatal period or congenital malformations, deformations and chromosomal abnormalities (5.1%). When adjusted for age, sex, education and whether have a long term chronic condition of informal carers, the five conditions of care recipients associated with the highest odds of their carers being out of the labour force were: head injury/acquired brain damage; neoplasms, blood diseases, disorders of the immune system; leg/knee/foot/hip damage from injury/accident; dementia, Parkinson’s disease, Alzheimer’s disease; and diseases of the musculoskeletal system and connective tissue (osteoporosis). Conclusions This study identifies the type of conditions that have the greatest impact on the labour force participation of informal carers – previously unavailable information for Australia. Australia, like most developed countries, is facing several skills shortages and an ageing population. These governments will need to adopt novel and more wholistic approaches to increase the labour force participation of diverse groups. Informal carers are one such group. PMID:24898043

Perspective: limiting resident work hours is a moral concern.

PubMed

Higginson, Jason D

2009-03-01

The author outlines the cross-cultural and widespread expectation that the moral character of physicians is built on dual possession of skill and compassion. The details of the moral makeup of physicians are often hotly debated in the biomedical literature. Despite a lack of consensus regarding the required aspects of character, the author demonstrates that little debate exists that at a minimum physicians should possess not only knowledge but also a willingness to care for and comfort patients. The primacy of the patient in the physician's life is reflected in the panoply of oaths taken by new physicians despite great variability in other aspects of these oaths. The author details recent worrisome reports demonstrating the erosion of medical trainees' empathy and compassion by long work hours. Further, the continued linkage of these attitude changes and fatigue to poor medical outcomes is a call to action. Changes enacted by the Accreditation Council for Graduate Medical Education to reduce resident work hours are insufficient to achieve the goal of improved patient care while promoting moral development among resident physicians. The debate regarding resident work hours is often framed as an idealistic discussion of placing patients first. However, residents are used as an inexpensive labor force, and efforts to curtail this usage would have a significant economic impact. Economic concerns play a larger part in decision making than is generally discussed. The author calls for further alterations of resident work schedules to improve patient care and ensure the preservation of the moral ethos of medicine.

77 FR 4787 - Department of Defense Task Force on the Care, Management, and Transition of Recovering Wounded...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-31

..., Management, and Transition of Recovering Wounded, Ill, and Injured Members of the Armed Forces; Amended... of the Department of Defense Task Force on the Care, Management, and Transition of Recovering Wounded... edition of the Federal Register (77 FR 3454) is amended to reflect changes in the meeting times and agenda...

Ergonomic evaluation of slide boards used by home care aides to assist client transfers.

PubMed

Sun, Chuan; Buchholz, Bryan; Quinn, Margaret; Punnett, Laura; Galligan, Catherine; Gore, Rebecca

2018-07-01

Home care aides risk musculoskeletal injury because they lift and move clients; the body weight of most adults exceeds the NIOSH recommended limit for lifting. Methods to reduce manual patient lifting in institutional settings are often technically or economically infeasible in home care. Our goal was to identify suitable, safe, low-technology transfer devices for home care use. Sixteen experienced home care aides performed client transfers from wheelchair to bed (upward) and bed to wheelchair (downward) in a simulated home care environment (laboratory), using four different slide boards and by hand without a device. Aides' hand forces were measured during client transfers; aides also evaluated usability of each board. Hand forces exerted while using slide boards were mostly lower than in manual transfer, and forces were lower in downward versus upward transfers. Aides judged a board with a sliding mechanism easier to use than boards without a sliding mechanism. Practitioner Summary: This paper provides quantitative biomechanical measurements showing that slide boards reduced the hand forces needed by home care aides to transfer clients from bed to wheel chair and vice versa, compared to manual lifting. Using a semi-quantitative usability survey, aides identified boards with a sliding mechanism easiest to use.

Using the ecological framework to identify barriers and enablers to implementing Namaste Care in Canada's long-term care system.

PubMed

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.

The modulation of upper extremity musculoskeletal disorders for a knowledge worker with chiropractic care and applied ergonomics: a case study

PubMed Central

Sherrod, Charles W.; Casey, George; Dubro, Robert E.; Johnson, Dale F.

2013-01-01

Objective This report describes the case management of musculoskeletal disorders for an employee in a college work environment using both chiropractic care and applied ergonomics. Clinical Findings A 54-year-old male office worker presented with decreased motor function in both wrists; intermittent moderate-to-severe headaches; and pain or discomfort in the neck, both shoulders, left hand and wrist, and lumbosacral region resulting from injuries sustained during recreational soccer and from excessive forces and awkward postures when interacting with his home and office computer workstations. Intervention and Results Ergonomic training, surveillance, retrofitted equipment with new furniture, and an emphasis on adopting healthy work-style behaviors were applied in combination with regular chiropractic care. Baseline ergonomic job task analysis identified risk factors and delineated appropriate control measures to improve the subject's interface with his office workstation. Serial reevaluations at 3-month, 1-year, and 2-year periods recorded changes to the participant's pain, discomfort, and work-style behaviors. At end of study and relative to baseline, pain scale improved from 4/10 to 2/10; general disability improved from 4 to 0; and hand grip strength (pounds) increased from 20 to 105 (left) and 45 to 100 (right). Healthy work habits and postures adopted in the 3-month to 1-year period regressed to baseline exposures for 3 of 6 risk priorities identified in the ergonomic job task analysis. Conclusion The patient responded positively to the intervention of chiropractic care and applied ergonomics. PMID:23997724

A standards-based approach to quality improvement for HIV services at Zambia Defence Force facilities: results and lessons learned.

PubMed

Kols, Adrienne; Kim, Young-Mi; Bazant, Eva; Necochea, Edgar; Banda, Joseph; Stender, Stacie

2015-07-01

The Zambia Defence Force adopted the Standards-Based Management and Recognition approach to improve the quality of the HIV-related services at its health facilities. This quality improvement intervention relies on comprehensive, detailed assessment tools to communicate and verify adherence to national standards of care, and to test and implement changes to improve performance. A quasi-experimental evaluation of the intervention was conducted at eight Zambia Defence Force primary health facilities (four facilities implemented the intervention and four did not). Data from three previous analyses are combined to assess the effect of Standards-Based Management and Recognition on three domains: facility readiness to provide services; observed provider performance during antiretroviral therapy (ART) and antenatal care consultations; and provider perceptions of the work environment. Facility readiness scores for ART improved on four of the eight standards at intervention sites, and one standard at comparison sites. Facility readiness scores for prevention of mother-to-child transmission (PMTCT) of HIV increased by 15 percentage points at intervention sites and 7 percentage points at comparison sites. Provider performance improved significantly at intervention sites for both ART services (from 58 to 84%; P < 0.01) and PMTCT services (from 58 to 73%; P = 0.003); there was no significant change at comparison sites. Providers' perceptions of the work environment generally improved at intervention sites and declined at comparison sites; differences in trends between study groups were significant for eight items. A standards-based approach to quality improvement proved effective in supporting healthcare managers and providers to deliver ART and PMTCT services in accordance with evidence-based standards in a health system suffering from staff shortages.

The doctor's dilemma.

PubMed

Irvine, D H; Donaldson, L J

1995-10-01

The close relationship between expenditure on health care and the countless individual judgements made by doctors for their patients means that any discussion about rationing must involve the process of clinical decision-making. Increasingly, doctors are being drawn into rationing by two powerful forces. Firstly, through the corporate responsibilities of those working within a managed health care system in which organisational objectives and budgetary constraints are agreed and specified in a much more explicit way than ever before. Secondly, by the professionally-led movement towards more clinically effective practice. These, in combination, are leading towards a fundamental review of the nature and ethical basis of clinical practice in which the duty of doctors to individual patients must be balanced against the wider considerations.

Determinants and predictors of the cost of COPD in primary care: A Spanish perspective

PubMed Central

de Miguel Diez, Javier; Garrido, Pilar Carrasco; Carballo, Marta García; de Miguel, Angel Gil; Gutierrez, Javier Rejas; Cano, José M Bellón; Barrera, Valentín Hernández; García, Rodrigo Jimenez

2008-01-01

Objectives 1) To estimate the annual cost of patients with stable chronic obstructive pulmonary disease (COPD) followed in primary care in Spain; 2) To analyze the possible cost predictor variables. Patients and methods A multicenter, epidemiological, observational, descriptive study. Sociodemographic data, severity of disease, associated comorbidity, treatment followed by patients, quality of life (SF-12 questionnaire), health care resource utilization in the previous 12 months and duration of working disability due to COPD were collected. Results A total of 10,711 patients (75.6% men; 24.4% women) with a mean age of 67.1 ± 9.66 years were evaluated. The mean forced expiratory volume in one second (FEV1) value was 57.4 ± 13.4%. The total cost per patient per year was €1,922.60 ± 2,306.44. The largest component of this cost was hospitalization (€788.72 ± 1,766.65), followed by cost of drugs (€492.87 ± 412.15) and visits to emergency rooms (€134.32 ± 195.44). Linear regression analysis found associated heart disease, FEV1, physical component of quality of life, number of medical visits (primary care physician, pneumologist and emergency room), hospital admissions (frequency and duration of stay) and duration of working disability to be significant predictors of the total annual cost. Conclusions The total annual cost of a COPD patient followed in primary care in Spain was considered high in this study. The presence of associated heart disease, severity of airflow obstruction, physical component of quality of life, health care resource utilization and duration of work disability were found to be predictor of cost. PMID:19281084

The Oklahoma Attorney General's Task Force report on the State of End-of-Life Health Care, 2005.

PubMed

Edmondson, W A Drew

2005-05-01

This article includes the recommendations submitted by the 15 members of the Oklahoma Attorney General's Task Force in their Report on the State of End-of-Life Health Care. The task force was created on April 21, 2004, and their report was accepted by Attorney General W.A. Drew Edmondson at a press conference April 11, 2005. It has been forwarded to members of the Oklahoma Legislature, relevant state agencies and organizations with an invitation to join with members of the task force to continue efforts to improve end-of-life care for Oklahomans. Copies of the report are available upon request to the Office of Attorney General.

Health Professionals Special Pays Study: Report to Congress on Armed Forces Health Professionals Special Pays -- Other Health Care Providers

DTIC Science & Technology

1988-12-01

of its force in those years, while others were able to maintain their size fairly well. Various factors have contributed to the relative health of each...specialized health care providers. These factors have particular significance for health care in the Military Health Services System (MHSS). The Military...system. Many factors interrelate to cause major changes in health care delivery since the early 1970s. And health care is continuing to evolve as a result

Musculoskeletal health and work ability in physically demanding occupations: study protocol for a prospective field study on construction and health care workers.

PubMed

Lunde, Lars-Kristian; Koch, Markus; Knardahl, Stein; Wærsted, Morten; Mathiassen, Svend Erik; Forsman, Mikael; Holtermann, Andreas; Veiersted, Kaj Bo

2014-10-16

Musculoskeletal disorders have a profound impact on individual health, sickness absence and early retirement, particularly in physically demanding occupations. Demographics are changing in the developed countries, towards increasing proportions of senior workers. These senior workers may have particular difficulties coping with physically demanding occupations while maintaining good health. Previous studies investigating the relationship between physical work demands and musculoskeletal disorders are mainly based on self-reported exposures and lack a prospective design. The aim of this paper is to describe the background and methods and discuss challenges for a field study examining physical demands in construction and health care work and their prospective associations with musculoskeletal disorders, work ability and sickness absence. This protocol describes a prospective cohort study on 1200 construction and health care workers. Participants will answer a baseline questionnaire concerning musculoskeletal complaints, general health, psychosocial and organizational factors at work, work demands, work ability and physical activity during leisure. A shorter questionnaire will be answered every 6th months for a total of two years, together with continuous sickness absence monitoring during this period. Analysis will prospectively consider associations between self-reported physical demands and musculoskeletal disorders, work ability and sickness absence. To obtain objective data on physical exposures, technical measurements will be collected from two subgroups of N = 300 (Group A) and N = 160 (Group B) during work and leisure. Both group A and B will be given a physical health examination, be tested for physical capacity and physical activity will be measured for four days. Additionally, muscle activity, ground reaction force, body positions and physical activity will be examined during one workday for Group B. Analysis of associations between objectively measured exposure data and the outcomes described above will be done separately for these subpopulations. The field study will at baseline produce objectively measured data on physical demands in the construction and health care occupations. In combination with clinical measurements and questionnaire data during follow-up, this will provide a solid foundation to prospectively investigate relationships between physical demands at work and development of musculoskeletal disorders, work ability and sickness absence.

Job strain and older workers: Can a reduction in job strain help to eliminate the social security drain?

PubMed

Cahalin, Lawrence P

2009-01-01

Job strain is the psychological and physiological response to a lack of control or support in the work environment. It appears to be an important risk factor for continued employment throughout the lifespan. Reducing job strain earlier in a workers life has the potential to have substantial beneficial health effects throughout a workers life. Early screening for job strain should be implemented in known high risk or high strain jobs. This is particularly important since there a fewer younger workers entering the labor force and there will be a growing need for older workers to remain in the workforce. Furthermore, healthier workers will require less medical care and are likely to work longer if they are willing and able. Healthier older workers who are willing and able to work longer will defer receipt of retirement benefits while continuing to pay into the Social Security System. Further investigation of older individuals (1) willingness and motivation to work past the normal retirement age, (2) career and employment security, skills development, and reconciliation of working and non-working life, and (3) job strain and effects of reducing job strain is needed. The current job strain literature has been expanded to the Social Security System arena and suggests that reducing job strain has the potential to help eliminate the Social Security drain by increasing older worker labor force retention.

The Role of Institutions and Health in European Patterns of Work and Retirement

PubMed Central

Börsch-Supan, Axel; Brugiavini, Agar; Croda, Enrica

2010-01-01

This paper uses the Survey of Health, Ageing and Retirement in Europe (SHARE) to investigate the role of pension and social security institutions in shaping the European patterns of work and retirement. The key novelty of our paper is a careful account of the health status of the respondents. We provide new evidence on the extent of health-adjusted “unused capacity” in the labour force, on the institutional determinants of the pathways to retirement, and on the relationship between actual health status and disability-benefit recipiency. We find that institutional differences between countries explain much of the cross-national differences in work and retirement, while differences in health and demographics play only a minor role. PMID:20428466

[Care of the chronically ill: strategic challenge, macro-management and health policies].

PubMed

Gómez-Picard, Patricia; Fuster-Culebras, Juli

2014-01-01

The prevalence of chronic diseases is increasing, with the patients who suffer from them having greater need for healthcare. This fact forces a redirection in the health system, currently focused on the acute diseases, to achieve an efficient care. For this reason, it is necessary to work at all levels, starting with political decisions. These decisions should be based on the technical and scientific evidence available. Health planning is essential to establish care strategies, defining the actions to ensure the coordination and continuity of care, and also the redefinition of professional roles, where primary care nurses assume more competencies, becoming key professionals in the care of the chronic patient. The new model should include the professionalization of the management of health services. Information and communication technologies will play an important role in the development of strategies, but considering them as the tools that they are, allowing for the patient to be the focus of attention, and ensuring the privacy and the confidentiality. Copyright © 2013 Elsevier España, S.L. All rights reserved.

Comparison of the 1996 and 2001 census data for Aboriginal and non-Aboriginal workers in health care occupations.

PubMed

Lecompte, Emily; Baril, Mireille

2008-01-01

To meet the unique health needs of Aboriginal peoples (First Nations, Inuit and Métis), it is important to increase and encourage Aboriginal representation in health care. One Federal initiative, the Aboriginal Health Human Resource Initiative (AHHRI) at Health Canada, focuses on: (1) increasing the number of Aboriginal people working in health careers; (2) adapting health care educational curricula to support the development of cultural competencies; and (3) improving the retention of health care workers in Aboriginal communities. A health care system that focuses on understanding the unique challenges, concerns, and needs of Aboriginal people can better respond to this specific population, which suffers disproportionately from ill health in comparison to their non-Aboriginal counterparts. This report examines the supply of Aboriginal health care providers in Canada, based on geographic region, area of residence, Aboriginal identity, and occupation. Findings are drawn from the 1996 and 2001 censuses from Statistics Canada. Quantitative results provide a greater understanding of labour force characteristics of First Nation, Inuit, Métis, and non-Aboriginal health providers.

Evaluation of the overweight/obese child--practical tips for the primary health care provider: recommendations from the Childhood Obesity Task Force of the European Association for the Study of Obesity.

PubMed

Baker, Jennifer L; Farpour-Lambert, Nathalie J; Nowicka, Paulina; Pietrobelli, Angelo; Weiss, Ram

2010-01-01

The prevalence of obesity among children and adolescents is on the rise. The majority of overweight or obese children are treated by primary health care providers including paediatricians, family practitioners, dieticians, nurses, and school health services - and not by specialists. The majority of obese children have no underlying medical disorder causing their obesity yet a significant proportion might suffer from obesity-related co-morbidities. This text is aimed at providing simple and practical tools for the identification and management of children with or at risk of overweight and obesity in the primary care setting. The tips and tools provided are based on data from the recent body of work that has been published in this field, official statements of several scientific societies along with expert opinion provided by the members of the Childhood Obesity Task Force (COTF) of the European Association for the Study of Obesity (EASO). We have attempted to use an evidence-based approach while allowing flexibility for the practicing clinician in domains where evidence is currently lacking and ensuring that treating the obese child involves the entire family as well. Copyright 2010 S. Karger AG, Basel.

Modeling using discrete event simulation: a report of the ISPOR-SMDM Modeling Good Research Practices Task Force--4.

PubMed

Karnon, Jonathan; Stahl, James; Brennan, Alan; Caro, J Jaime; Mar, Javier; Möller, Jörgen

2012-01-01

Discrete event simulation (DES) is a form of computer-based modeling that provides an intuitive and flexible approach to representing complex systems. It has been used in a wide range of health care applications. Most early applications involved analyses of systems with constrained resources, where the general aim was to improve the organization of delivered services. More recently, DES has increasingly been applied to evaluate specific technologies in the context of health technology assessment. The aim of this article was to provide consensus-based guidelines on the application of DES in a health care setting, covering the range of issues to which DES can be applied. The article works through the different stages of the modeling process: structural development, parameter estimation, model implementation, model analysis, and representation and reporting. For each stage, a brief description is provided, followed by consideration of issues that are of particular relevance to the application of DES in a health care setting. Each section contains a number of best practice recommendations that were iterated among the authors, as well as among the wider modeling task force. Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Operational Stress and Correlates of Mental Health Among Joint Task Force Guantanamo Bay Military Personnel.

PubMed

Webb-Murphy, Jennifer A; De La Rosa, Gabriel M; Schmitz, Kimberly J; Vishnyak, Elizabeth J; Raducha, Stephanie C; Roesch, Scott C; Johnston, Scott L

2015-12-01

Military personnel deployed to Joint Task Force Guantanamo Bay (JTF-GTMO) faced numerous occupational stressors. As part of a program evaluation, personnel working at JTF-GTMO completed several validated self-report measures. Personnel were at the beginning, middle, or end of their deployment phase. This study presents data regarding symptoms of posttraumatic stress disorder, alcohol abuse, depression, and resilience among 498 U.S. military personnel deployed to JTF-GTMO in 2009. We also investigated individual and organizational correlates of mental health among these personnel. Findings indicated that tenure at JTF-GTMO was positively related to adverse mental health outcomes. Regression models including these variables had R2 values ranging from .02 to .11. Occupation at JTF-GTMO also related to mental health such that guards reported poorer mental health than medical staff. Reluctance to seek out mental health care was also related to mental health outcomes. Those who reported being most reluctant to seek out care tended to report poorer mental health than those who were more willing to seek out care. Results suggested that the JTF-GTMO deployment was associated with significant psychological stress, and that both job-related and attitude-related variables were important to understanding mental health symptoms in this sample. Copyright © 2015 International Society for Traumatic Stress Studies.

Understanding Primary Care Behavioral Health Across Military Settings: A Preliminary Comparison Between Deployed and In-Garrison Care.

PubMed

Landoll, Ryan R; Nielsen, Matthew K; Waggoner, Kathryn K

2017-03-01

Integrated primary care behavioral health (PCBH) is a growing trend in health care delivery, particularly in the Department of Defense and the Department of Veterans Affairs. This consultative model has been applied within the U.S. Air Force for over 15 years and has demonstrated positive health impacts and patient satisfaction. With extended conflicts and engagements, including Operation Enduring Freedom and Operation Iraqi Freedom, deployment behavioral health care has expanded and positively received, but there is less empirical support of particular models of care in a deployed environment. Brief, solution-focused strategies commonly utilized in PCBH are likely to be particularly good candidates for the deployed environment. One key feature the Air Force's PCBH program is the collaborative team-based approach to care centered around a patient and driven by a primary care manager. This study expands the evaluation of the Air Force's PCBH program to include its novel application in a combat setting. A retrospective review of 516 archival patient satisfaction surveys across Air Force military treatment facilities utilizing a PCBH program compared patient satisfaction surveys collected in a deployed environment at a large combat support hospital to noncombat facilities. Results indicated that patient satisfaction in theater was comparable to satisfaction at Air Force military treatment facilities in noncombat environments, with one exception; patients seen in garrison rated higher satisfaction with the treatment plan than those seen in a deployed setting, F(509) = 5.36, p < 0.01, consistent with limited resources available in theater. Given patient satisfaction across settings was found to be relatively equivalent, results suggests that the PCBH consultation model may be an appropriate model of care to meet a majority of the population's needs for a deployed environment. This pilot study has implications not only for military combat environments, but other austere settings, including civilian rural mental health settings. These findings inform provision of care in a deployed environment by demonstrating the benefits of the primary care behavioral model. Additionally, the Department of Veterans Affairs and other federal health care agencies will benefit from reviewing the structured and standardized PCBH model employed by the U.S. Air Force for nearly two decades as they expand care in rural mental health settings across the country. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

Three-body correlations and conditional forces in suspensions of active hard disks

NASA Astrophysics Data System (ADS)

Härtel, Andreas; Richard, David; Speck, Thomas

2018-01-01

Self-propelled Brownian particles show rich out-of-equilibrium physics, for instance, the motility-induced phase separation (MIPS). While decades of studying the structure of liquids have established a deep understanding of passive systems, not much is known about correlations in active suspensions. In this work we derive an approximate analytic theory for three-body correlations and forces in systems of active Brownian disks starting from the many-body Smoluchowski equation. We use our theory to predict the conditional forces that act on a tagged particle and their dependence on the propulsion speed of self-propelled disks. We identify preferred directions of these forces in relation to the direction of propulsion and the positions of the surrounding particles. We further relate our theory to the effective swimming speed of the active disks, which is relevant for the physics of MIPS. To test and validate our theory, we additionally run particle-resolved computer simulations, for which we explicitly calculate the three-body forces. In this context, we discuss the modeling of active Brownian swimmers with nearly hard interaction potentials. We find very good agreement between our simulations and numerical solutions of our theory, especially for the nonequilibrium pair-distribution function. For our analytical results, we carefully discuss their range of validity in the context of the different levels of approximation we applied. This discussion allows us to study the individual contribution of particles to three-body forces and to the emerging structure. Thus, our work sheds light on the collective behavior, provides the basis for further studies of correlations in active suspensions, and makes a step towards an emerging liquid state theory.

Algorithms for the diagnosis and treatment of restless legs syndrome in primary care

PubMed Central

2011-01-01

Background Restless legs syndrome (RLS) is a neurological disorder with a lifetime prevalence of 3-10%. in European studies. However, the diagnosis of RLS in primary care remains low and mistreatment is common. Methods The current article reports on the considerations of RLS diagnosis and management that were made during a European Restless Legs Syndrome Study Group (EURLSSG)-sponsored task force consisting of experts and primary care practioners. The task force sought to develop a better understanding of barriers to diagnosis in primary care practice and overcome these barriers with diagnostic and treatment algorithms. Results The barriers to diagnosis identified by the task force include the presentation of symptoms, the language used to describe them, the actual term "restless legs syndrome" and difficulties in the differential diagnosis of RLS. Conclusion The EURLSSG task force reached a consensus and agreed on the diagnostic and treatment algorithms published here. PMID:21352569

How Cuba's Latin American School of Medicine challenges the ethics of physician migration.

PubMed

Huish, Robert

2009-08-01

This paper demonstrates a working alternative to the accepted ethics of physician migration. A dominant cosmopolitan ethics encourages upward mobility of physicians in a globalized labour force, and this ultimately advances the position of individuals rather than improving public health-care service for vulnerable communities in the global South. Cuba's Escuela Latinoamericana de Medicina (ELAM) challenges this trend as its institutional ethics furnishes graduates with appropriate skills, knowledge and service ethics to deliver quality care in marginalized areas. This paper provides an analysis of how ELAM trains physicians in community-oriented service for marginalized areas in the global South. The principle finding of this analysis is that ELAM exhibits a working alternative to the accepted ethics of physician migration, as it encourages graduates to practice in marginalized communities rather than feed the migration pipeline into the North. Arguably, ELAM serves as an important case study in how a medical school's ethics can work to bring graduates closer to the communities that are in desperate need of their skills and of their compassion.

Public health and nursing: a natural partnership.

PubMed

Savage, Christine; Kub, Joan

2009-11-01

The health of individuals occurs within the context of their environment and the other individuals they interact with in the communities they live in, work in and visit. Promoting the health of the public requires multiple strategies aimed at improving the environment, the health knowledge of groups and individuals, maintaining adequate food and water, and reducing the spread of disease. Many disciplines are needed to meet these goals, but the largest segment of the professional health work force required to meet these needs is nursing. Historically, nursing leaders in public health such as Florence Nightingale and Lillian Wald made significant inroads related to serious health issues because they were nurses. Today across the globe, nurses provide the key components of public health interventions including well baby care, health education, screening and immunization clinics, disaster management and emergency preparedness. With the growing nursing shortage in acute care settings, the brain drain of nurses from certain areas of the world, the shrinking public dollars for preventive health care, the nursing workforce needed to continue to provide these essential health care services is threatened. It is essential to put the spot light on nursing's role in public health with the hopes of attracting more public funds and more nurses to provide these essential services.

[Demography and labor shortage. Future challenges of labor market policy].

PubMed

Fuchs, J

2013-03-01

For demographic reasons, the German labor force will decrease dramatically and it will be much older on average. However, labor demand, especially for qualified workers, is expected to remain high. This paper focuses on the possibilities of expanding the labor force by increasing the participation rates of women and older persons. Herein, the change in the labor force is decomposed with respect to population and labor participation and, moreover, the effects of higher participation rates are simulated. The decomposition and simulation scenarios are based on data published by the Institute for Employment Research. The analysis clearly reveals that the effect of a considerably higher labor participation of women and older workers will disappear over time when the working-age population shrinks more and more. In addition, individuals who are currently unemployed or out of the labor force are not skilled enough. Since it seems difficult to get more qualified workers in the short and even in the medium term, improving the conditions for women and older people to take up jobs should be tackled soon. This includes investments in education and health care.

Holistic Health Care for the Medically Uninsured: The Church Health Center of Memphis.

PubMed

Morris, G Scott

2015-11-05

The Church Health Center (CHC) in Memphis was founded in 1987 to provide quality, affordable health care for working, uninsured people and their families. With numerous, dedicated financial supporters and health care volunteers, CHC has become the largest faith-based health care organization of its type nationally, serving >61,000 patients. CHC embraces a holistic approach to health by promoting wellness in every dimension of life. It offers on-site services including medical care, dentistry, optometry, counseling, social work, and nutrition and fitness education, to promote wellness in every dimension of life. A 2012 economic analysis estimated that a $1 contribution to the CHC provided roughly $8 in health services. The CHC has trained >1200 Congregational Health Promoters to be health leaders and is conducting research on the effectiveness of faith community nurses partnering with congregations to assist in home care for patients recently discharged from Memphis hospitals. The MEMPHIS Plan, CHC's employer-sponsored health care plan for small business and the self-employed, offers uninsured people in lower-wage jobs access to quality, affordable health care. The CHC also conducts replications workshops several times a year to share their model with leaders in other communities. The Institute for Healthcare Improvement (IHI) recently completed a case study that concluded: "The CHC is one of a very few organizations successfully embodying all three components of the IHI Triple Aim by improving population health outcomes, enhancing the individual's health care experience, and controlling costs. All three have been part of the Center's DNA since its inception, and as a transforming force in the community, the model is well worth national attention."

The future of surgery: autonomy or employment?

PubMed

Liepert, Amy; Babu, Maya; Leichtle, Stefan

2011-08-01

History has shown that the professions of medicine and surgery have been in constant evolution. Physicians, including the historical barber surgeons, often remained focused only on medical practice and patient care. As a result, the medical profession had a reactionary response to the financial and political circumstances that developed over time. Subsequently, physicians have worked in environments designed by nonphysicians lacking the benefit of medical insight. The most poignant example of this in the U.S. was the rapid development of private insurance and Medicare. Due to the surrounding financial and political forces, these programs rapidly changed the practice environment of medicine. Physicians found that they needed to participate in these programs to remain financially solvent. Various countries around the world have faced similar challenges of increasing health care cost. As populations expand, the need for care increases, but is limited by available resources. These global experiences can lend insight into the effects of different models and how variations may or may not work within the U.S. The effects of those systems demonstrate the importance of physician input into the development of new models. A long-standing unwritten rule in medicine has taught generations of physicians to avoid discussing reimbursement and health care politics. Yet, in order to recruit the brightest minds with a compassionate bedside manner, excellent judgment, and high vigilance toward patient care, medical professionals need to discuss topics related to reimbursement. The government, insurance company administrations, and other lobby interest groups freely express their interests in these issues. Physicians must engage in health care politics to ensure an adequate physician pool in the future to take care of patients. By influencing the structure of the health care system, including physician reimbursement, all patient care can be positively influenced.

Level of functioning, perceived work ability, and work status among psychiatric patients with major mental disorders.

PubMed

Karpov, B; Joffe, G; Aaltonen, K; Suvisaari, J; Baryshnikov, I; Näätänen, P; Koivisto, M; Melartin, T; Oksanen, J; Suominen, K; Heikkinen, M; Isometsä, E

2017-07-01

Major mental disorders are highly disabling conditions that result in substantial socioeconomic burden. Subjective and objective measures of functioning or ability to work, their concordance, or risk factors for them may differ between disorders. Self-reported level of functioning, perceived work ability, and current work status were evaluated among psychiatric care patients with schizophrenia or schizoaffective disorder (SSA, n=113), bipolar disorder (BD, n=99), or depressive disorder (DD, n=188) within the Helsinki University Psychiatric Consortium Study. Correlates of functional impairment, subjective work disability, and occupational status were investigated using regression analysis. DD patients reported the highest and SSA patients the lowest perceived functional impairment. Depressive symptoms in all diagnostic groups and anxiety in SSA and BD groups were significantly associated with disability. Only 5.3% of SSA patients versus 29.3% or 33.0% of BD or DD patients, respectively, were currently working. About half of all patients reported subjective work disability. Objective work status and perceived disability correlated strongly among BD and DD patients, but not among SSA patients. Work status was associated with number of hospitalizations, and perceived work disability with current depressive symptoms. Psychiatric care patients commonly end up outside the labour force. However, while among patients with mood disorders objective and subjective indicators of ability to work are largely concordant, among those with schizophrenia or schizoaffective disorder they are commonly contradictory. Among all groups, perceived functional impairment and work disability are coloured by current depressive symptoms, but objective work status reflects illness course, particularly preceding psychiatric hospitalizations. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Junior doctors' working hours: perspectives on the reforms.

PubMed

Wilkinson, Carol

2008-06-01

The European Working Time Directive for junior doctors came into force in Britain in August 2004. The reforms themselves have been a long time in development and implementation since the inception and debates regarding the New Deal, to the current formations under health and safety legislation. This study, undertaken within a hospital trust setting in England, provides an insight into the perspectives of doctors, nurses and human resources managers in relation to the European Working Time Directive. Critical consideration is given to the impact of the reforms upon the National Health Service and more specifically to daily working relationships at the point of implementation. The results demonstrate some ambivalence towards the reforms because of the major shift in culture for the professions per se, but also for the future of health-care delivery where there are considerable tensions.

Factors influencing nurses' perceptions of occupational safety.

PubMed

Samur, Menevse; Intepeler, Seyda Seren

2017-01-02

To determine nurses' perceptions of occupational safety and their work environment and examine the sociodemographic traits and job characteristics that influence their occupational safety, we studied a sample of 278 nurses. According to the nurses, the quality of their work environment is average, and occupational safety is insufficient. In the subdimensions of the work environment scale, it was determined that the nurses think "labor force and other resources" are insufficient. In the occupational safety subdimensions "occupational illnesses and complaints" and "administrative support and approaches," they considered occupational safety to be insufficient. "Doctor-nurse-colleague relationships," "exposure to violence," and "work unit" (eg, internal medicine, surgical, intensive care) are the main factors that affect occupational safety. This study determined that hospital administrations should develop and immediately implement plans to ameliorate communication and clinical precautions and to reduce exposure to violence.

Forced sterilization of women as discrimination.

PubMed

Patel, Priti

2017-01-01

There has been a long history of subjecting marginalized women to forced and coerced sterilization. In recent years, the practice has been documented in countries in North and South America, Europe, Asia, and Africa. It has targeted women who are ethnic and racial minorities, women with disabilities, women living with HIV, and poor women. A handful of courts have issued decisions on the recent forced sterilization of marginalized women finding that such actions violate the women's rights. However, they have all failed to address the women's claims of discrimination. The failure to acknowledge that forced sterilization is at its core a violation of the prohibition of discrimination undermines efforts to eradicate the practice. It further fails to recognize that coerced and forced sterilization fundamentally seeks to deny women deemed as "unworthy" the ability to procreate. Four key principles outlined in the human rights in patient care framework highlight the importance of a finding that the prohibition of discrimination was violated in cases of forced sterilization: the need to highlight the vulnerability of marginalized populations to discrimination in health care settings; the importance of the rights of medical providers; the role of the state in addressing systemic human rights violations in health care settings; and the application of human rights to patient care. Based on these principles, it is clear that finding a violation of the prohibition of discrimination in forced sterilization cases is critical in addressing the systemic nature of the practice, acknowledging the marginalization of specific groups and effectively ending forced sterilization through addressing the underlying purpose of the practice. If litigators, non-governmental organizations and judicial officers are mindful of these principles when dealing with cases of forced sterilization, it is likely that they will be better able to eradicate forced sterilization.

Longitudinal associations of experiences of adversity and socioeconomic disadvantage during childhood with labour force participation and exit in later adulthood.

PubMed

Fahy, A E; Stansfeld, S A; Smuk, M; Lain, D; van der Horst, M; Vickerstaff, S; Clark, C

2017-06-01

The Extending Working Lives (EWL) agenda seeks to sustain employment up to and beyond traditional retirement ages. This study examined the potential role of childhood factors in shaping labour force participation and exit among older adults, with a view to informing proactive interventions early in the life-course to enhance individuals' future capacity for extending their working lives. Childhood adversity and socioeconomic disadvantage have previously been linked to ill-health across the life-span and sickness benefit in early adulthood. This study builds upon previous research by examining associations between childhood adversity and self-reported labour force participation among older adults (aged 55). Data was from the National Child Development Study - a prospective cohort of all English, Scottish, & Welsh births in one week in 1958. There was evidence for associations between childhood adversity and increased risk of permanent sickness at 55 years - which were largely sustained after adjustment for educational disengagement and adulthood factors (mental/physical health, qualifications, socioeconomic disadvantage). Specifically, children who were abused or neglected were more likely to be permanently sick at 55 years. In addition, among males, those in care, those experiencing illness in the home, and those experiencing two or more childhood adversities were more likely to be permanently sick at 55 years. Childhood factors were also associated with part-time employment and retirement at 55 years. Severe childhood adversities may represent important distal predictors of labour force exit at 55 years, particularly via permanent sickness. Notably, some adversities show associations among males only, which may inform interventions designed to extend working lives. Copyright © 2017 Elsevier Ltd. All rights reserved.

Perceptions of Ambulatory Workflow Changes in an Academic Primary Care Setting.

PubMed

Hanak, Michael A; McDevitt, Colleen; Dunham, Daniel P

As health care moves to a value-based system, the need for team-based models of care becomes increasingly important to adequately address the growing number of clinical quality metrics required of health care providers. Finding ways to better engage certified medical assistants (CMAs) in the process allows providers to focus on more complex tasks while improving the efficiency of each office visit. Although the roles and responsibilities for CMAs across the specialties can vary widely, standardizing the work can be a helpful step in scaling best practices across an institution. This article presents the results of a survey that evaluated various components of a CMA workflow in adult primary care practices within an academic medical center. Although the survey identified improved engagement and satisfaction with standardized changes overall, it also showed time constraints and provider discretion forcing unplanned modifications. Reviewing and reconciling medications seemed to be the most challenging for CMA staff, leading us to reconsider their involvement in this aspect of each visit. It will be important to continue innovating and testing team-based care models to keep up with the demands of a quality-based health care system.

Design Principles for Nickel/Hydrogen Cells and Batteries

NASA Technical Reports Server (NTRS)

Thaller, Lawrence H.; Manzo, Michelle A.; Gonzalez-Sanabria, Olga D.

1987-01-01

Individual-pressure-vessel (IPV) nickel/hydrogen cells and bipolar batteries developed for use as energy-storage subsystems for satelite applications. Design principles applied draw upon extensive background in separator technology, alkaline-fuel-cell technology and several alkaline-cell technology areas. Principals are rather straightforward applications of capillary-force formalisms, coupled with slowly developing data base resulting from careful post-test analyses. Based on preconceived assumptions relative to how devices work and how to be designed so they display longer cycle lives at deep discharge.

The Contributions of the American Military Working Dog in Vietnam.

DTIC Science & Technology

1998-06-05

program. Due to limited resources, the ARVN forces could not and would not provide a nutritious diet to the dogs and many suffered and even died of...Vietnam War the U.S. would continue to support the ARVN dog program. Due to inadequate diet and medical care the dogs suffered a high mortality rate...would become instructors when the U.S. Army established its own training school in the U.S.. The British- Malaysian -American agreement was to expire in

The occupational health status of African-American women health care workers.

PubMed

Arnold, C W

1996-01-01

Race, ethnicity, and gender are significant indicators of occupational status, general health status, and thus, occupational health status. Although African-American women constitute only 6.8% of the total U.S. labor force, they hold 20% of the jobs in the health care industry and are disproportionately represented in those jobs that have the highest levels of workplace exposure to hazards. As a result, they are therefore more likely to be at greater exposure and risk to the spectrum of occupational health problems. In order to gain insight into the effects of race and gender on the occupational health status of African-American women health care workers, this article uses three data sources that provide different but complementary sources of information on the demographic characteristics of workers, location of categories of occupations, working conditions of jobs, and other job and worker characteristics. Given the concentration of African-American women in health care positions where there exists a greater likelihood of being exposed to occupational hazards, it is therefore both logical and appropriate for primary care physicians, especially those engaged in office-based practices, to identify this target population for special services and to be more aware of the type of health issues with which these patients are more likely to present and to experience during their working lives. Health care providers have a responsibility to assess occupational factors related to a patient's health problems and to incorporate this information into their treatment protocols and into the design and explanation of each patient's care plan.

Physician-centered management guidelines.

PubMed

Pulde, M F

1999-01-01

The "Fortune 500 Most Admired" companies fully understand the irreverent premise "the customer comes second" and that there is a direct correlation between a satisfied work force and productivity, service quality, and, ultimately, organizational success. If health care organizations hope to recruit and retain the quality workforce upon which their core competency depends, they must develop a vision strategic plan, organizational structure, and managerial style that acknowledges the vital and central role of physicians in the delivery of care. This article outlines a conceptual framework for effective physician management, a "critical pathway," that will enable health care organizations to add their name to the list of "most admired." The nine principles described in this article are based on a more respectful and solicitous treatment of physicians and their more central directing role in organizational change. They would permit the transformation of health care into a system that both preserves the virtues of the physician-patient relationship and meets the demand for quality and cost-effectiveness.

The socioeconomic aspects of information technology for health care with emphasis on radiology.

PubMed

Sistrom, Chris

2005-04-01

Information technology is the key to cost effective and error free medical care in the United States and the only problem is that there is not enough of it yet. During the past 15 years, billions of dollars have been spent on information technology for health care with very little benefit but significant adverse effects on patients, physicians, and nurses. The truth about health care information technology (HIT) probably lies somewhere between these extreme statements, representing technophile and skeptical views, respectively. There is no doubt that computer and communication hardware has reached a state of sophistication and availability in which any and all necessary information can be generated, stored, and distributed to health care workers in support of their patient care tasks. The barriers to rapid and widespread development and diffusion of cost effective and practically useful HIT are exclusively related to human factors. This article explores some of the organizational, cultural, cognitive, and economic forces that interact to influence success of HIT initiatives in health care organizations. A key point to be recognized is that the intrinsically handcrafted nature of health care work combined with high degrees of complexity and contingency make it impossible to "computerize" with the same ease and completeness of other industries. The major thrust of the argument is that designers of information systems and health care informatics managers must meet needs of patients and care providers. The software they create and implement should promote, support, and enhance the existing processes of health care rather than seeking to dictate how direct care providers should do their work. Instead of looking for "buy in" from physicians and nurses, the informatics community must return the authority over functional specification of patient care information systems to them--where it belonged in the first place. This same lesson about computer technology and organizational politics is also being learned in the business community, where executives are reclaiming responsibility for mission critical informatics decisions.

Eldercare work, migrant care workers, affective care and subjective proximity.

PubMed

Lovelock, Kirsten; Martin, Greg

2016-08-01

To document and explore the experience of migrant care workers providing health and social care to the elderly in institutional care settings and in the homes of the elderly in the community in New Zealand with a particular focus on the affective components of care work. This qualitative study involved conducting face-to-face, open-ended, semi-structured interviews with 29 migrant care workers in the eldercare sector in the cities of Auckland and Wellington, New Zealand. Participants were recruited through various agencies focusing on aged care and engaged with migrant eldercare workers and snowballing through participant referral. Sample size was determined when saturation was reached. The interviews were audio recorded, transcribed verbatim, themes were identified and then analysed drawing on a body of theoretical work in the fields of emotional anthropology and moral geography and the international empirical literature addressing migrant eldercare workers. As with the international research in this field we found that these workers were vulnerable to exploitation, the workforce is largely feminised and stereotypical understandings of racial groups and national characteristics informed recruitment and the workplace experience. Here attributing gradients of affect to particular migrant groups in the workforce was the main mechanism employed to establish worker worth and difference. Identifying with these gradients of affect enabled these eldercare workers to demonstrate that they met the moral and ethical requirements of permanent residency and ultimately citizenship. Eldercare workers in the home were vulnerable to 'blurred emotional boundaries' and care recipient demand for greater emotional commitment. The migrant eldercare workers in this study all shared vulnerable residential status and many feared they would never obtain permanent residency or citizenship. All had family who remained in the Philippines and towards whom they had an obligation to substitute care support. Central to understanding how this labour force issue is experienced by both caregivers and the elderly is the notion of subjective proximity and how emotional and moral trajectories serve to mediate the connection between the eldercare worker and workplace, the Filipino migrant eldercare relationship with employers, agencies and institutions; and, the transnational nature of this mobility and social and actual citizenship.

Adolescent health in South America.

PubMed

Gaete, Veronica

2016-08-01

Since the 1950s, a significant amount of work has been done on behalf of the comprehensive health of young people in South America. This article focuses on the regional process of training health professionals to work with this age group. There are countries in which the growth of adolescent health training has been significant, others that have made progress but still have a narrower offer of teaching activities, and a few where only very basic and limited training is available. Latin American professional associations, scientific societies, and international organizations have also contributed to the education of the adolescent health work force. Although the training in the region has advanced in some countries to the point that there is specialization in adolescent medicine, much remains to be done. Certain regional conditions have contributed to the education of providers in adolescent care. The most important has been the existence of professionals who have been highly motivated to improve the health of young people. They have worked very hard and with great commitment to achieve this goal. There have also been important obstacles to educating professionals in adolescent care. Aside from the usual lack of funding, barriers have existed in the health care system and its providers, as well as the training entities and because of certain South American conditions. Finally, this article describes the regional adolescent medicine programs and the status of recognition of this specialty, and addresses the opportunities and challenges for adolescent health training.

PVO profile: CARE.

PubMed

Bhatt, P

1994-01-01

CARE was founded when 22 American humanitarian organizations joined forces to help European survivors of World War II. CARE is now a confederation of eleven national CAREs working together to address poverty and respond to emergencies in 53 countries in Africa, Asia, Latin America, and eastern Europe. The organization supports processes which create competence and become self-sustaining over time, through the provision of technical assistance, training, management skills, and material resources. AIDS become a priority for CARE in the late 1980s and projects now exist in almost 20 countries. They focus upon HIV awareness and prevention involving information, education, communication, and condom distribution targeted to youth, commercial sex workers, transporters, migrants, and health professionals. CARE also has a development wing which focuses upon reducing household and community vulnerability to external pressures such as drought, war, and disease. AIDS may be considered within the purview of CARE's development mandate as a slow-onset emergency which may eventually threaten the very ability of families and communities to survive. CARE is therefore developing a framework to assess cross-cultural development strategies accounting for the vulnerability for communities as a result of increases in HIV prevalence. This effort is being made in the attempt to prepare communities to cope with the potential future devastation of AIDS and will take CARE beyond its more traditional prevention scope of involvement.

Adding Value to Total Joint Arthroplasty Care in an Academic Environment: The Utah Experience.

PubMed

Pelt, Christopher E; Anderson, Mike B; Erickson, Jill A; Gililland, Jeremy M; Peters, Christopher L

2018-06-01

Adding value in a university-based academic health care system provides unique challenges when compared to other health care delivery models. Herein, we describe our experience in adding value to joint arthroplasty care at the University of Utah, where the concept of value-based health care reform has become an embraced and driving force. To improve the value, new resources were needed for care redesign, physician leadership, and engagement in alternative payment models. The changes that occurred at our institution are described. Real-time data and knowledgeable personnel working behind the scenes, while physicians provide clinical care, help move clinical pathway redesigns. Engaged physicians are essential to the successful implementation of value creation and care pathway redesign that can lead to improvements in value. An investment of money and resources toward added infrastructure and personnel is often needed to realize large-scale improvements. Alignment of providers, payers, and hospital administration, including by means of gainsharing programs, can lead to improvements. Although significant care pathway redesign efforts may realize substantial initial cost savings, savings may be asymptotic in nature, which calls into question the likely sustainability of programs that incentivize or penalize payments based on historical targets. Copyright © 2018 Elsevier Inc. All rights reserved.

[The 175th anniversary of the District Military Clinical Hospital of the Leningrad Military District].

PubMed

Liutov, V V

2010-09-01

For 175 years a hospital made a great contribution to the development of national health care, gaining a wealth experience in high quality health care for the soldiers. Especially the biggest merit was made by the hospital during the Great Patriotic War of 1941-1945, when 82% of the wounded soldiers ware returned for further service. The hospital was glorified by famous medical scientists of XIX-XX-centuries, such as: V. Bekhterev, R. Wreden, N. Sklifosovsky, P. Kupriyanov, N. Petrov and others. Currently, the hospital takes a worthy place among the best military medical agencies of Russian Armed Forces. The hospital is equipped with modern medical equipment. There work highly qualified personnel: 17 distinguished doctors of the Russian Federation, 2 doctors and 27 candidates of medical sciences. In practice the hospital successfully uses achievements of the leading Russian military medical facilities. The staff treat with care historical traditions of the hospital.

Raising the "glass ceiling" for ethnic minority women in health care management.

PubMed

Kumar, R; Johnston, G

1999-01-01

Ethnic minority women are well represented in the work force and in the health care system in general, but do not have a similar level of representation in the management sector. This paper explores three strategies for schools of health administration to consider to lessen the effect of a "glass ceiling" that may be encountered by ethnic minority women aspiring to positions of leadership in health services agencies. These strategies are advancing affirmative action, valuing ethnic women in health administration education, and investigating diversity management. Inherent in each of the three strategies is the need for acknowledgment and more open discussion of the "glass ceiling." Problem-solving in relation to the potential for systemic discrimination adversely affecting ethnic minority women in senior health care management positions, and greater study of the three strategies using both qualitative and quantitative methodologies is also needed.

Task Force Report on Care for Victims of Sexual Assault

DTIC Science & Technology

2004-04-01

National Violence Against Women Survey. Research in Brief. U.S. Department of Justice, National Institute of Justice. Washington, D.C. Tjaden, P...Readiness, Ms. Elaine Donnelly The American Prosecutors’ Research Institute The Miles Foundation Rape, Abuse, and Incest National Network ii DoD Care...respect, provided proper medical and psychological care, and that the perpetrators of such assaults be held accountable. Task Force Charter On

Health care market deviations from the ideal market.

PubMed

Mwachofi, Ari; Al-Assaf, Assaf F

2011-08-01

A common argument in the health policy debate is that market forces allocate resources efficiently in health care, and that government intervention distorts such allocation. Rarely do those making such claims state explicitly that the market they refer to is an ideal in economic theory which can only exist under very strict conditions. This paper explores the strict conditions necessary for that ideal market in the context of health care as a means of examining the claim that market forces do allocate resources efficiently in health care.

Financial impact of tertiary care in an academic medical center.

PubMed

Huber, T S; Carlton, L M; O'Hern, D G; Hardt, N S; Keith Ozaki, C; Flynn, T C; Seeger, J M

2000-06-01

To analyze the financial impact of three complex vascular surgical procedures to both an academic hospital and a department of surgery and to examine the potential impact of decreased reimbursements. The cost of providing tertiary care has been implicated as one potential cause of the financial difficulties affecting academic medical centers. Patients undergoing revascularization for chronic mesenteric ischemia, elective thoracoabdominal aortic aneurysm repair, and treatment of infected aortic grafts at the University of Florida were compared with those undergoing elective infrarenal aortic reconstruction and carotid endarterectomy. Hospital costs and profit summaries were obtained from the Clinical Resource Management Office. Departmental costs and profit summary were estimated based on the procedural relative value units (RVUs), the average clinical cost per RVU ($33.12), surgeon charges, and the collection rate for the vascular surgery division (30.2%) obtained from the Faculty Group Practice. Surgeon work effort was analyzed using the procedural work RVUs and the estimated total care time. The analyses were performed for all payors and the subset of Medicare patients, and the potential impact of a 15% reduction in hospital and physician reimbursement was analyzed. Net hospital income was positive for all but one of the tertiary care procedures, but net losses were sustained by the hospital for the mesenteric ischemia and infected aortic graft groups among the Medicare patients. In contrast, the estimated reimbursement to the department of surgery for all payors was insufficient to offset the clinical cost of providing the RVUs for all procedures, and the estimated losses were greater for the Medicare patients alone. The surgeon work effort was dramatically higher for the tertiary care procedures, whereas the reimbursement per work effort was lower. A 15% reduction in reimbursement would result in an estimated net loss to the hospital for each of the tertiary care procedures and would exacerbate the estimated losses to the department. Caring for complex surgical problems is currently profitable to an academic hospital but is associated with marginal losses for a department of surgery. Economic forces resulting from further decreases in hospital and physician reimbursement may limit access to academic medical centers and surgeons for patients with complex surgical problems and may compromise the overall academic mission.

The role of the US Army Veterinary Corps in military family pet health.

PubMed

Vincent-Johnson, Nancy A

2013-01-01

Even though privately-owned pet care is a lower priority mission than military working dog care, food inspection,and the public health mission, it is still very important,and the one that many Veterinary Corps officers, civil-ian veterinarians, and technicians enjoy the most. The vast majority of veterinarians and technicians went into veterinary medicine because of a love for animals. It is fulfilling to offer guidance to a client with a new puppy or kitten, see a sick pet improve after treatment, and interact with dozens of animals and clients in a day. The services provided by the Army Veterinary Corps in car-ing for pets has expanded over the years and the standard of care has improved as well. It is truly a privilege to serve those who dedicate themselves to the protection of our Nation. The Army Veterinary Corps is indeed proud to provide care to the pets of Warfighters of the Army,Navy, Marine Corps, Air Force, and Coast Guard; their family members; and our military retirees.

Health and labor-power: a theoretical investigation.

PubMed

Schatzkin, A

1978-01-01

In this historical materialist analysis of health and medical care, health is defined as a component of labor-power (capacity to work). Investment in health, including provision of medical services, represents part of the cost of maintaining the labor force. The primary determined of the level of health and medical care under capitalism is the tendency toward maximization of the rate of exploitation. The absolute level of health and medical care tends to decline as unemployment rises and individual workers become more "replaceable." Health differentials by socioeconomic status are similarly explained by the easier replacement of lesser-skilled workers. Medical care services in the context of the capitalist system constitute a drain on surplus-value. In periods of economic decline, attempts are made to conserve surplus-value through reductions in medical services ("social wages"). Institutional and ideological racism yields additional surplus-value savings and weakness public resistance to medical care retrenchment. The profits of health-related industries are shown to be merely partially recouped surplus-value losses. The social epidemiology of capitalism has been characterized as social murder. "Public health" measures appropriate to this systemic pathology are suggested.

Light at the end of the tunnel: a vision for an empowered nursing profession across the continuum of care.

PubMed

Dingel-Stewart, Sylvia; LaCoste, Janice

2004-01-01

Lacking political stewardship, healthcare in America is shaped primarily by rapidly changing market forces seeking to stem the tide of rising healthcare costs. However, nursing's voice in this process is fragmented and unfocused. Staff nurses' focus and commitment are to quality care rendered at the bedside and in interactions with the patient. With this narrow focus, staff nurses are paralyzed by the constant change and unable to move to a broader, more integrative view of healthcare-one that encompasses quality care, policymaking, and healthcare finance. Using the theory of transformative learning, nurse administrators and managers can influence nurses' frames of reference and expand their view to be more inclusive. Nurses who are successful in this transformation process will emerge with a new view of self-visible and empowered. These newly transformed nurses see themselves more as healthcare engineers than as technicians coordinating care across the continuum, and creating fluid working relationships to prevent the dis-continuum of care of patients falling through the cracks of the current healthcare system.

America's Changing Work Force: Statistics in Brief.

ERIC Educational Resources Information Center

American Association of Retired Persons, Washington, DC.

This booklet provides information about the demographics of the changing work force. It offers an at-a-glance profile of workers age 45 and older and considers likely changes in the work force of the future. The document includes topics such as the composition of the work force of today and tomorrow by age and sex, labor force participation rates,…

Military duty: risk factor for preterm labor? A review.

PubMed

McNeary, A M; Lomenick, T S

2000-08-01

The female military population represents a high-risk group for preterm labor and other adverse pregnancy outcomes. As the number of women entering the armed forces continues to increase, concerns regarding the effects of military service on pregnancy must persist. Although active duty females have access to prenatal care and maintain consistent follow-up, previous research has noted a 5-fold increase in preterm labor compared with civilian working women. Hospitalization and loss of work attributable to pregnancy complications directly affect productivity and mission accomplishment; therefore, it is crucial to identify those at risk to institute measures that will prevent such occurrences and decrease time away from work. This article provides a review of the existing literature concerning preterm labor in military women, comparisons with the civilian population, and recommendations for future research.

[Family odysseys: the search for infant mental health care].

PubMed

Delfini, Patricia Santos de Souza; Bastos, Isabella Teixeira; Reis, Alberto Olavo Advincula

2017-12-18

The aim was to analyze the peregrination of families of children treated in a Center for Psychosocial Care for Children and Adolescents in their search for mental health care. The study included participant observations at the clinic and focus groups with the children's families. The qualitative study used institutional analysis as the theoretical and methodological reference, and the material was discussed in light of the approach to psychosocial care. The families' search in the face of the child's psychological distress is a prime indicator for assessing strengths and weaknesses in building the network of care, and for revealing the families' understanding of their children's mental health problems and treatments. The study found contradictory forces at play in daily care, demonstrating both the provider's transformative force and occasionally the user's crystallization and maintenance. In this sense, the hegemonic model - disease-centered, fragmenting patients and their care - has been challenged by the instituting force that proposes to reposition the patient and incorporate psychological distress as part of overall health, linking services and actions in a model of care. Despite the tangled maze that families face in their peregrination for care, strides have been made in psychosocial care, while highlighting challenges. Such progress has been anchored in relational technologies (shelter, bonding, trust, and accountability) with the various actors involved in the care.

From slavery to incarceration: social forces affecting the epidemiology of sexually transmitted diseases in the rural South.

PubMed

Thomas, James C

2006-07-01

The high rates of sexually transmitted diseases (STDs) in the southeastern United States have been shaped by historic and contemporary social forces. More than other regions of the country, the South was defined by slavery, an extremely hierarchical relationship between whites and blacks. Emancipation left much of the racial hierarchy intact with whites as farm owners and blacks as hired workers or sharecroppers. Agricultural policies that favored mechanization caused blacks to leave farm work and move into segregated towns, leading to the advent of the rural ghetto. Post-World War II mass migration, mostly by young men, to the industrial north altered the sex ratio and social capital of the southern towns left behind. The cocaine epidemic of the 1990s, followed by the high incarceration rates of the "War on Drugs," disproportionately affected low-income blacks. Each of these forces led to sexual and care-seeking behaviors that favor transmission of STDs.

Antimicrobial resistance surveillance in the AFHSC-GEIS network

PubMed Central

2011-01-01

International infectious disease surveillance has been conducted by the United States (U.S.) Department of Defense (DoD) for many years and has been consolidated within the Armed Forces Health Surveillance Center, Division of Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) since 1998. This includes activities that monitor the presence of antimicrobial resistance among pathogens. AFHSC-GEIS partners work within DoD military treatment facilities and collaborate with host-nation civilian and military clinics, hospitals and university systems. The goals of these activities are to foster military force health protection and medical diplomacy. Surveillance activities include both community-acquired and health care-associated infections and have promoted the development of surveillance networks, centers of excellence and referral laboratories. Information technology applications have been utilized increasingly to aid in DoD-wide global surveillance for diseases significant to force health protection and global public health. This section documents the accomplishments and activities of the network through AFHSC-GEIS partners in 2009. PMID:21388568

Antimicrobial resistance surveillance in the AFHSC-GEIS network.

PubMed

Meyer, William G; Pavlin, Julie A; Hospenthal, Duane; Murray, Clinton K; Jerke, Kurt; Hawksworth, Anthony; Metzgar, David; Myers, Todd; Walsh, Douglas; Wu, Max; Ergas, Rosa; Chukwuma, Uzo; Tobias, Steven; Klena, John; Nakhla, Isabelle; Talaat, Maha; Maves, Ryan; Ellis, Michael; Wortmann, Glenn; Blazes, David L; Lindler, Luther

2011-03-04

International infectious disease surveillance has been conducted by the United States (U.S.) Department of Defense (DoD) for many years and has been consolidated within the Armed Forces Health Surveillance Center, Division of Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) since 1998. This includes activities that monitor the presence of antimicrobial resistance among pathogens. AFHSC-GEIS partners work within DoD military treatment facilities and collaborate with host-nation civilian and military clinics, hospitals and university systems. The goals of these activities are to foster military force health protection and medical diplomacy. Surveillance activities include both community-acquired and health care-associated infections and have promoted the development of surveillance networks, centers of excellence and referral laboratories. Information technology applications have been utilized increasingly to aid in DoD-wide global surveillance for diseases significant to force health protection and global public health. This section documents the accomplishments and activities of the network through AFHSC-GEIS partners in 2009.

How electronic health records can unmask the hidden value of PAs.

PubMed

Ogunfiditimi, Folusho; Sherry, Scott P; Foote, Monica; Christie, Sarah L; Shock, Lisa P; Cawley, James; Browne, Aaron

2017-06-01

The Fee for Value (FFV) Task Force, a subgroup of the American Academy of PAs' Research and Strategic Initiatives Commission, has examined tools and mechanisms aimed at better clarifying the volume and value of PA work and how that work contributes to improving access to high-quality care. Establishing the value of PAs has been a challenging task for many healthcare providers. Often, PA value has been defined by their clinical productivity, without any clear direction as to what constitutes value versus productivity. The objective of this article is to unmask the value of PAs through the role of electronic health records and highlight PAs' ability to produce services that are value-oriented and quantifiably productive.

Bacterial adhesion forces to Ag-impregnated contact lens cases and transmission to contact lenses.

PubMed

Qu, Wenwen; Busscher, Henk J; van der Mei, Henny C; Hooymans, Johanna M M

2013-03-01

To measure adhesion forces of Pseudomonas aeruginosa, Staphylococcus aureus, and Serratia marcescens to a rigid contact lens (CL), standard polypropylene, and Ag-impregnated lens cases using atomic force microscopy and determine bacterial transmission from lens case to CL. Adhesion forces of bacterial strains to Ag-impregnated and polypropylene lens cases and a rigid CL were measured using atomic force microscopy. Adhesion forces were used to calculate Weibull distributions, from which transmission probabilities from lens case to CL were derived. Transmission probabilities were compared with actual transmission of viable bacteria from a lens case to the CL in 0.9% NaCl and in an antimicrobial lens care solution. Bacterial transmission probabilities from polypropylene lens cases based on force analysis coincided well for all strains with actual transmission in 0.9% NaCl. Bacterial adhesion forces on Ag-impregnated lens cases were much smaller than that on polypropylene and CLs, yielding a high probability of transmission. Comparison with actual bacterial transmission indicated bacterial killing due to Ag ions during colony-forming unit transmission from an Ag-impregnated lens case, especially for P. aeruginosa. Transmission of viable bacteria from Ag-impregnated lens cases could be further decreased by use of an antimicrobial lens care solution instead of 0.9% NaCl. Bacterial transmission probabilities are higher from Ag-impregnated lens cases than from polypropylene lens cases because of small adhesion forces, but this is compensated for by enhanced bacterial killing due to Ag impregnation, especially when in combination with an antimicrobial lens care solution. This calls for a balanced combination of antimicrobial lens care solutions and surface properties of a lens case and CL.

Relationship of airflow limitation severity with work productivity reduction and sick leave in a Japanese working population.

PubMed

Onoue, Ayumi; Omori, Hisamitsu; Katoh, Takahiko; Kubota, Kenichi; Nonami, Yoshio; Ogata, Yasuhiro; Inoue, Hiromasa

2016-01-01

The aim of this study was to reveal the association between airflow limitation (AL) severity and reduction with work productivity as well as use of sick leave among Japanese workers. This cross-sectional study included 1,378 workers who underwent a lung function test during a health checkup at the Japanese Red Cross Kumamoto Health Care Center. AL was defined as forced expiratory volume in 1 second/forced vital capacity of <0.7. Workers completed a questionnaire on productivity loss at work and sick leave. The quality and quantity of productivity loss at work were measured on a ten-point scale indicating how much work was actually performed on the previous workday. Participants were asked how many days in the past 12 months they were unable to work because of health problems. Logistic regression analysis was used to assess the associations between AL severity and the quality and quantity of productivity loss at work as well as use of sick leave. Compared with workers without AL, workers with moderate-to-severe AL showed a significant productivity loss (quality: odds ratio [OR] =2.04, 95% confidence interval [CI]: 1.12-3.71, P=0.02 and quantity: OR =2.19, 95% CI: 1.20-4.00, P=0.011) and use of sick leave (OR =2.69, 95% CI: 1.33-5.44, P=0.006) after adjusting for sex, age, body mass index, smoking status, hypertension, hyperglycemia, dyslipidemia, sleep duration, work hours per day, and workplace smoking environment. AL severity was significantly associated with work productivity loss and use of sick leave. Our findings suggested that early intervention in the subjects with AL at the workforce might be beneficial for promoting work ability.

Families and elder care in the twenty-first century.

PubMed

Bookman, Ann; Kimbrel, Delia

2011-01-01

Although most Americans know that the U.S. population is aging, they are far less informed about the reality of providing elders with personal care, health care, and social support. Families-particularly women-have always been critical in providing elder care, but the entry of so many women into the paid labor force has made elder care increasingly difficult. Ann Bookman and Delia Kimbrel show how changes in both work and family life are complicating families' efforts to care for elderly relatives. Because almost 60 percent of elder caregivers today are employed, many forms of caregiving must now be "outsourced" to nonfamily members. And because elders are widely diverse by race and socioeconomic status, their families attach differing cultural meanings to care and have widely different resources with which to accomplish their care goals. Although the poorest elders have access to some subsidized services, and the wealthiest can pay for services, many middle-class families cannot afford services that allow elders to age in their homes and avoid even more costly institutional care. Six key groups--health care providers, nongovernmental community-based service providers, employers, government, families, and elders themselves--are engaged in elder care, but their efforts are often fragmented and uncoordinated. All six groups must be able to work in concert and to receive the resources they need. Both employer and government policies must be improved. Although large businesses have taken up the elder care challenge, most small and mid-sized firms still do not offer flexible work arrangements. Social Security and Medicare have provided critical support to families caring for elders, yet both face significant financial shortfalls. The Older American Act and the National Family Caregiver Support Program have broadened access to elder services, but need updating to address the needs of today's employed caregivers and elders who want to "age in place." And just over half of the nation's workforce is eligible for the unpaid leave benefits provided by the Family and Medical Leave Act. The authors close by reflecting on the need for a coordinated, cross-sector movement to create an "aging-friendly" society in the United States-a society that values well-being across the life span and supports citizens from diverse cultures and income levels as they age.

Competitive forces in the medical group industry: a stakeholder perspective.

PubMed

Blair, J D; Buesseler, J A

1998-01-01

Applying Porter's model of competitive forces to health care, stakeholder concepts are integrated to analyze the future of medical groups. Using both quantitative survey and qualitative observational data, competitors, physician suppliers, integrated systems new entrants, patient and managed care buyers, and hospitals substitutes are examined.

Health care and ICT, partnership is a must.

PubMed

Bakker, Albert R

2002-11-20

This article comments on the article 'Health Care in the Information Society; A Prognosis for the Year 2013' by Reinhold Haux et al. It is emphasised that besides the driving forces as identified in that article, the changes in the composition of the population will lead to a structural shortage of health professionals. So, despite the willingness of both individual patients and the society as a whole to pay more for health care no significant change will occur in the percentage of the gross domestic product spent on health care. By consequence we can not meet the challenges health care is facing by 'more of the same'. New forms of health care delivery have to be invented and implemented that lead to higher efficiency. The question is discussed whether health care is lagging behind other sectors of society in the application of ICT, the answer to that question is negative. It is explained why the percentage of the budget spent on ICT is no valuable yardstick. Comments are made to the quantitative expectations of Haux et al. Finally it is recommended that IMIA takes the initiative to organise in co-operation with international associations of health professionals a multidisciplinary working conference on the future role of ICT in health care.

2017 Annual Meeting of the American College of Radiology-Moreton Lecture: Forecasting the Futures of Radiology.

PubMed

Bauer, Jeffrey C

2017-12-01

The traditional forces of change in health care are no longer working as they did in the past. Political gridlock has destroyed Washington's ability to create sensible policy for reforming the medical marketplace, creating chaos for providers. Fortunately, chaos creates opportunity. The idea of creating one's future has never been more relevant and necessary. Predicting-the science of extrapolating future values from historical data-is not a valid method for looking ahead when causal relationships that explained change in the past are themselves being redefined (the current situation). Forecasting-the art of estimating probabilities of possibilities-is the appropriate method for anticipating futures when causality is being redefined. With its focus on identifying a range of possibilities, forecasting identifies many different outcomes that are simultaneously possible for radiology. Health care's new climate is being shaped by four defining trends: 1) revolution in biological science that is shifting caregivers' mission from acute care to disease management; 2) proliferation of information and communications technologies that are transforming the way care is delivered; 3) end of economic growth in the medical marketplace that is reshaping demand for care; and 4) political dysfunction that forces caregivers and their business partners to develop successful futures on their own. Radiology 3.0 is nicely aligned with the transformational trends. Staying focused on implementing Radiology 3.0 is supported as the optimal strategy for creating the profession's futures. Diagnostic convergence, establishing a unified diagnostic science with laboratory medicine, is proposed as a complementary initiative. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

The context of oncology nursing practice: an integrative review.

PubMed

Bakker, Debra; Strickland, Judith; Macdonald, Catherine; Butler, Lorna; Fitch, Margaret; Olson, Karin; Cummings, Greta

2013-01-01

In oncology, where the number of patients is increasing, there is a need to sustain a quality oncology nursing workforce. Knowledge of the context of oncology nursing can provide information about how to create practice environments that will attract and retain specialized oncology nurses. The aims of this review were to determine the extent and quality of the literature about the context of oncology nursing, explicate how "context" has been described as the environment where oncology nursing takes place, and delineate forces that shape the oncology practice environment. The integrative review involved identifying the problem, conducting a structured literature search, appraising the quality of data, extracting and analyzing data, and synthesizing and presenting the findings. Themes identified from 29 articles reflected the surroundings or background (structural environment, world of cancer care), and the conditions and circumstances (organizational climate, nature of oncology nurses' work, and interactions and relationships) of oncology nursing practice settings. The context of oncology nursing was similar yet different from other nursing contexts. The uniqueness was attributed to the dynamic and complex world of cancer control and the personal growth that is gained from the intense therapeutic relationships established with cancer patients and their families. The context of healthcare practice has been linked with patient, professional, or system outcomes. To achieve quality cancer care, decision makers need to understand the contextual features and forces that can be modified to improve the oncology work environment for nurses, other providers, and patients.

Identification of human trafficking victims in health care settings.

PubMed

Baldwin, Susie B; Eisenman, David P; Sayles, Jennifer N; Ryan, Gery; Chuang, Kenneth S

2011-07-14

An estimated 18,000 individuals are trafficked into the United States each year from all over the world, and are forced into hard labor or commercial sex work. Despite their invisibility, some victims are known to have received medical care while under traffickers' control. Our project aimed to characterize trafficking victims' encounters in US health care settings. The study consisted of semi-structured interviews with six Key Informants who work closely with trafficking victims (Phase I) and 12 female trafficking survivors (Phase II). All survivors were recruited through the Coalition to Abolish Slavery and Trafficking, an NGO in Los Angeles, and all were trafficked into Los Angeles. Interviews were conducted in English and six other languages, with the assistance of professional interpreters. Using a framework analysis approach that focused on victims' encounters in health care settings, we assessed interview transcript content and coded for themes. We used an exploratory pile-sorting technique to aggregate similar ideas and identify overarching domains. The survivors came from 10 countries. Eight had experienced domestic servitude, three had survived sex trafficking, and one had experienced both. Half the survivors reported that they had visited a physician while in their traffickers' control, and another worked in a health care facility. All Key Informants described other victims who had received medical care. For domestic servants, medical visits were triggered by injury and respiratory or systemic illness, while sex trafficking victims were seen by health professionals for sexually transmitted infections and abortion. Trafficking victims were prevented from disclosing their status to health care providers by fear, shame, language barriers, and limited interaction with medical personnel, among other obstacles. This exploration of survivors' experiences in health care settings supports anecdotal reports that US health care providers may unwittingly encounter human trafficking victims. Increasing awareness of human trafficking, and modifying practice to facilitate disclosure, could improve victim identification. Copyright © 2011 Baldwin, Eisenman, Sayles, Ryan, and Chuang. This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited.

Smarter elder care? A cost-effectiveness analysis of implementing technology in elder care.

PubMed

Aanesen, Margrethe; Lotherington, Ann Therese; Olsen, Frank

2011-09-01

Whereas in most sectors, technology has taken over trivial and labour consuming tasks, this transformation has been delayed in the healthcare sector. Although appropriate technology is available, there is general resistance to substituting 'warm' hands with 'cold' technology. In the future, this may change as the number of elderly people increases relative to the people in the work force. In combination with an increasing demand for healthcare services, there are calls for efforts to increase productivity in the sector. Based on experience data from previous studies on information and communication technology efforts in the healthcare sector, we quantitatively assess the use of smart house technology and video visits in home care. Having identified healthcare providers, hospitals and relatives as the main affected groups, we show that smart house technology is cost-effective, even if only relatives gain from it. Video visits, which have higher implementation costs, demand effects on both relatives and health care providers in order to be a cost-effective tool in home care. As the analysis is purely quantitative, these results need to be complemented with qualitative effects and with more thorough discussions of the ethical, medical and legal aspects of the use of technology in home care.

A taxonomy of nursing care organization models in hospitals

PubMed Central

2012-01-01

Background Over the last decades, converging forces in hospital care, including cost-containment policies, rising healthcare demands and nursing shortages, have driven the search for new operational models of nursing care delivery that maximize the use of available nursing resources while ensuring safe, high-quality care. Little is known, however, about the distinctive features of these emergent nursing care models. This article contributes to filling this gap by presenting a theoretically and empirically grounded taxonomy of nursing care organization models in the context of acute care units in Quebec and comparing their distinctive features. Methods This study was based on a survey of 22 medical units in 11 acute care facilities in Quebec. Data collection methods included questionnaire, interviews, focus groups and administrative data census. The analytical procedures consisted of first generating unit profiles based on qualitative and quantitative data collected at the unit level, then applying hierarchical cluster analysis to the units’ profile data. Results The study identified four models of nursing care organization: two professional models that draw mainly on registered nurses as professionals to deliver nursing services and reflect stronger support to nurses’ professional practice, and two functional models that draw more significantly on licensed practical nurses (LPNs) and assistive staff (orderlies) to deliver nursing services and are characterized by registered nurses’ perceptions that the practice environment is less supportive of their professional work. Conclusions This study showed that medical units in acute care hospitals exhibit diverse staff mixes, patterns of skill use, work environment design, and support for innovation. The four models reflect not only distinct approaches to dealing with the numerous constraints in the nursing care environment, but also different degrees of approximations to an “ideal” nursing professional practice model described by some leaders in the contemporary nursing literature. While the two professional models appear closer to this ideal, the two functional models are farther removed. PMID:22929127

The New Work Force. Trends and Issues Alerts.

ERIC Educational Resources Information Center

Imel, Susan

During the last years of this century, the work force will grow more slowly, becoming older, more female, and more disadvantaged. An increasing number of minority groups and immigrants will enter the work force. Despite public demands for reform, education lags behind in preparing youth for employment. The changing work force has many implications…

Holiness, virtue, and social justice: contrasting understandings of the moral life.

PubMed

Engelhardt, H Tristram

1997-03-01

Being a Christian involves metaphysical, epistemological, and social commitments that set Christians at variance with the dominant secular culture. Because Christianity is not syncretical, but proclaims the unique truth of its revelations, Christians will inevitably be placed in some degree of conflict with secular health care institutions. Because being Christian involves a life of holiness, not merely living justly or morally, Christians will also be in conflict with the ethos of many contemporary Christian health care institutions which have abandoned a commitment to Christian spirituality. In this regard, managed care raises the special question of how Christian institutions can act morally under financial constraints and maintain their character while under the control of secular managers. This question itself raises the further question as to why health care institutions need even pose this query when there are Christian physicians and nurses who could work for less, or Christian men and women who could become sisters and brothers and work for nothing. Contemporary challenges to Christians to maintain their integrity in a post-Christian world have much of their force because Christians have failed to maintain traditional Christian sprituality. In the face of that failure, Christian physicans and nurses will find themselves in greater conflict with health care institutions, because few will any longer understand the requirements of traditional Christianity. In its place, they will have put a generic spirituality, a value-neutral understanding of the role of the health professional, and an anonymous commitment to social justice.

Measuring physicians' productivity in a Veterans' Affairs Medical Center.

PubMed

Coleman, David L; Moran, Eileen; Serfilippi, Delchi; Mulinski, Paul; Rosenthal, Ronnie; Gordon, Bruce; Mogielnicki, R Peter

2003-07-01

The mission of the Department of Veterans Affairs includes patient care, education, research, and backup to the Department of Defense. Because the measurement of physicians' productivity must reflect both institutional goals and market forces, the authors designed a productivity model that uses measures of clinical workload and academic activities commensurate with the VA's investments in these activities. The productivity model evaluates four domains of physicians' activity: clinical work, education, research, and administration. Examples of the application of the productivity model in the evaluation of VA-paid physician-staff and in the composition of contracts for clinical services are provided. The proposed model is a relatively simple strategy for measuring a broad range of the work of academic physicians in VA medical centers. The model provides incentives for documentation of resident supervision and participation in administrative activities required for effective and efficient clinical care. In addition, the model can aid in determining resource distribution among clinical services and permits comparison with non-VA health care systems. A strategy for modifying the model to incorporate measures of quality of clinical care, research, education, and administration is proposed. The model has been a useful part of the process to ensure the optimum use of resources and to meet clinical and academic institutional goals. The activities and accomplishments used to define physician productivity will have a substantial influence on the character of the medical profession, the vitality of medical education and research, and the cost and quality of health care.

Barefoot and in a German kitchen: federal parental leave and benefit policy and the return to work after childbirth in Germany.

PubMed

Ondrich, J; Spiess, C K; Yang, Q

1996-01-01

"Since 1979 German federal maternity leave and benefit policy has given women incentives to stay at home and take care of their newborn and youngest children. In 1986 this leave and benefit policy was changed in several ways, turning it into a powerful instrument for delaying mothers' return to work after childbirth.... We estimate post childbirth return to work hazards for women during the federally protected leave protection period and immediately upon completion of this leave period. During the leave mothers are less likely to return to work the longer is the time left in the leave protection period; however, this result cannot be attributed generally to high levels of maternity benefits. When the leave protection period ends, mothers with strong labor force attachment who are still on leave return to their jobs." excerpt

Aircraft: United States Air Force Child Care Program Activity Guide.

ERIC Educational Resources Information Center

Boggs, Juanita; Brant, Linda

General information about United States' aircraft is provided in this program activity guide for teachers and caregivers in Air Force preschools and day care centers. The guide includes basic information for teachers and caregivers, basic understandings, suggested teaching methods and group activities, vocabulary, ideas for interest centers, and…

Evidence-Based Practice in Psychology

ERIC Educational Resources Information Center

American Psychologist, 2006

2006-01-01

The evidence-based practice movement has become an important feature of health care systems and health care policy. Within this context, the APA 2005 Presidential Task Force on Evidence-Based Practice defines and discusses evidence-based practice in psychology (EBPP). In an integration of science and practice, the Task Force's report describes…

Burn injury care for Special Forces and far-forward deployed troops.

PubMed

Brown, Tim La H; Skinner, Adrian M

2005-11-01

Special Forces are at risk of serious burn injury. We have suggested standard operating procedures for burn injury management in a constrained environment, with novel uses of operational kit components for trauma care. In addition, we propose instruction in basic skills of escharotomy for forward troops.

Joint Task Force-Bravo

Science.gov Websites

Air Base Squadron Joint Security Forces Medical Element (MEDEL) JSB / ARFOR En Español Noticias Hojas to provide medical care in Waspam Call to Duty - Senior Airman Nicholas Carssow Operations Support JTF-Bravo partners with Nicaragua to provide medical care in Waspam JTF-Bravo partners with Nicaragua

Health Care Market Deviations from the Ideal Market

PubMed Central

Mwachofi, Ari; Al-Assaf, Assaf F.

2011-01-01

A common argument in the health policy debate is that market forces allocate resources efficiently in health care, and that government intervention distorts such allocation. Rarely do those making such claims state explicitly that the market they refer to is an ideal in economic theory which can only exist under very strict conditions. This paper explores the strict conditions necessary for that ideal market in the context of health care as a means of examining the claim that market forces do allocate resources efficiently in health care. PMID:22087373

Chronic disease and labour force participation among older Australians.

PubMed

Schofield, Deborah J; Shrestha, Rupendra N; Passey, Megan E; Earnest, Arul; Fletcher, Susan L

2008-10-20

To examine the association between long-term health conditions and being out of the labour force among older Australians. Retrospective analysis of cross-sectional data from the Australian Bureau of Statistics 2003 Survey of Disability, Ageing and Carers for people aged 45-64 years. Rates of premature retirement associated with ill health; odds ratios of being out of the labour force associated with each long-term health condition and number of conditions; weighted population estimates; estimates of gross domestic product lost as a result. 9198 people surveyed were aged 45-64 years, 3010 of whom were not in the labour force. Of these, 1373 (45.6%) had retired because of a chronic health condition, most commonly a back problem (10.4%), or arthritis and related disorders (8.6%). When adjusted for age and sex, all conditions studied except diseases of the ear and mastoid process, other endocrine/nutritional and metabolic disorders, noise-induced deafness or hearing loss, and high cholesterol were significantly associated with being out of the labour force. Extrapolating from these results, an estimated 663 235 older Australians were not working because of ill health, reducing Australia's gross domestic product by around $14.7 billion per annum. Prevention of long-term health conditions may help older Australians remain in the labour force longer, thereby increasing revenue to fund health care for the ageing population.

Normal Forces at Solid-Liquid Interface

NASA Astrophysics Data System (ADS)

Das, Ratul

Adhesion can be defined as the tendency of dissimilar particles or surfaces to cling on to one another. Fields that require knowledge about adhesion interactions at the solid-liquid interface span over a wide spectrum from biotechnological issues such as liquid adhesion to skin tissues, insect feet adhesion to solids, or contact lenses to tear fluid adhesion; filtration issues such as membrane fouling and membrane affinity to different liquids; oil and gas extraction where one needs knowledge of the adhesion of the oil and brine to the rock; fuel cells in which droplets are formed on the electrodes and need to be considered in the system's design; classic chemical engineering industry such as drop adhesion to the mist eliminators in flash drums, or to heat exchangers; and classic surface science such as nano-structured surfaces, self cleaning surfaces, and general wetting phenomena. We execute the Young-Dupre (Y-P) gedanken experiment to establish unique values of work of adhesion rather than a work of adhesion range that the contact angle hysteresis results in. We use the Centrifugal Adhesion Balance (CAB) which allows independent manipulation of normal and lateral forces to induce an increase in the normal force which pulls on a liquid drop while keeping zero lateral force. This method mimics a drop that is subjected to a gravitational force that is gradually increasing. The values obtained for the work of adhesion are independent of drop size and are in agreement with the Y-P estimate. Cyclically varying the normal force, just to prevent the drop flying away from the surface will also enable us to study the Contact Angle Hysteresis for a pendant drop. With this set up, the work of adhesion is not only calculated from experimental normal force measurements, but the found results are also used to provide a venue for calculating the Young equilibrium contact angle, theta0. According to Shanahan and de Gennes, a liquid drop with a non-zero contact angle is associated with a deformation of the solid surface at the three phase contact line, causing the triple line to protrude up and form a rim, this is due to the unsatisfied normal component of the surface tension. Such rims were demonstrated by Care et al, and by Extrand, and the stresses associated with the rims facilitate reorientation of solid molecules at the interface, and therefore result in stronger solid liquid interaction at the rim. This stronger interaction gives rise to retention forces (due to adhesion). Recently, Xu et al, wrote a force equation based on this understanding, we test the validity of this approach and the Furmidge - Dussan model and other, more empirical, retention force approaches. A liquid drop that partially wets a solid surface will slide along the plane when a force beyond a critical value is applied to it. We study the sliding pattern of such a drop. Experiments for identifying the pattern of motion of liquid drops under influence of different normal forces are performed. We use a centrifugal adhesion balance (CAB) to study the pattern of drop motion under different effective gravities. A drop on a solid surface only slides after a certain critical force is applied to it, which is dependent on the drop volume, surface heterogeneities and other factors, even after the application of force the drop doesn't continue to move uniformly, which is the subject matter of this discussion.

The volunteer program in a Children's Hospice.

PubMed

Duggal, Shalu; Farah, Peggy; Straatman, Lynn Patricia; Freeman, Leanne; Dickson, Susan

2008-09-01

Canuck Place Children's Hospice (CPCH) is regarded as one of the leading pediatric palliative care systems in the world. Since 1995, it has been providing hospice care free of charge to children and their families living with life-threatening conditions. The pediatric palliative hospice is a relatively new practice in health care, in comparison to the longstanding adult model. As a result, development and implementation of volunteer programs in pediatric hospices is not currently represented in literature. With over 300 volunteers at present, CPCH has built a successful program that can serve as a model in pediatric volunteer services. To present the unique volunteer roles and experience at CPCH, and share ways volunteers work to support the efforts of the clinical team. Strategies to address current challenges in the volunteer program are also addressed. Descriptive design. A current CPCH volunteer discusses the volunteer program. Interviews were conducted with the founding volunteer director of CPCH and current volunteers. The volunteer program at CPCH fully embraces the life of each child and family. Volunteer selection is the groundwork for ensuring a cohesive work force, while training equips volunteers with the knowledge to carry out their role with confidence. Areas of improvement that have been recognized include offering effective feedback to volunteers and delivering adequate level of training for non-direct care roles. The talents of volunteers at CPCH are diverse, and CPCH aims to recognize and thank volunteers for their continuous contributions.

48 CFR 252.223-7004 - Drug-free work force.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 3 2013-10-01 2013-10-01 false Drug-free work force. 252... Provisions And Clauses 252.223-7004 Drug-free work force. As prescribed in 223.570-2, use the following clause: Drug-Free Work Force (SEP 1988) (a) Definitions. (1) Employee in a sensitive position, as used in...

48 CFR 252.223-7004 - Drug-free work force.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 3 2012-10-01 2012-10-01 false Drug-free work force. 252... Provisions And Clauses 252.223-7004 Drug-free work force. As prescribed in 223.570-2, use the following clause: Drug-Free Work Force (SEP 1988) (a) Definitions. (1) Employee in a sensitive position, as used in...

48 CFR 252.223-7004 - Drug-free work force.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 3 2011-10-01 2011-10-01 false Drug-free work force. 252... Provisions And Clauses 252.223-7004 Drug-free work force. As prescribed in 223.570-2, use the following clause: Drug-Free Work Force (SEP 1988) (a) Definitions. (1) Employee in a sensitive position, as used in...

48 CFR 252.223-7004 - Drug-free work force.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 3 2014-10-01 2014-10-01 false Drug-free work force. 252... Provisions And Clauses 252.223-7004 Drug-free work force. As prescribed in 223.570-2, use the following clause: Drug-Free Work Force (SEP 1988) (a) Definitions. (1) Employee in a sensitive position, as used in...

48 CFR 252.223-7004 - Drug-free work force.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Drug-free work force. 252... Provisions And Clauses 252.223-7004 Drug-free work force. As prescribed in 223.570-2, use the following clause: Drug-Free Work Force (SEP 1988) (a) Definitions. (1) Employee in a sensitive position, as used in...

40 CFR 35.936-14 - Force account work.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Force account work. 35.936-14 Section... Force account work. (a) A grantee must secure the project officer's prior written approval for use of the force account method for (1) any step 1 or step 2 work in excess of $10,000; (2) any sewer...

EurOOHnet-the European research network for out-of-hours primary health care.

PubMed

Huibers, Linda; Philips, Hilde; Giesen, Paul; Remmen, Roy; Christensen, Morten Bondo; Bondevik, Gunnar Tschudi

2014-09-01

European countries face similar challenges in the provision of health care. Demographic factors like ageing, population growth, changing patient behaviour, and lack of work force lead to increasing demands, costs, and overcrowding of out-of-hours (OOH) care (i.e. primary care services, emergency departments (EDs), and ambulance services). These developments strain services and imply safety risks. In the last few decades, countries have been re-organizing their OOH primary health care services. AIM AND SCOPE OF THE NETWORK: We established a European research network for out-of-hours primary health care (EurOOHnet), which aims to transfer knowledge, share experiences, and conduct research. Combining research competencies and integrating results can generate a profound information flow to European researchers and decision makers in health policy, contributing towards feasible and high-quality OOH care. It also contributes to a more comparable performance level within European regions. CONDUCTED RESEARCH PROJECTS: The European research network aims to conduct mutual research projects. At present, three projects have been accomplished, among others concerning the diagnostic scope in OOH primary care services and guideline adherence for diagnosis and treatment of cystitis in OOH primary care. Future areas of research will be organizational models for OOH care; appropriate use of the OOH services; quality of telephone triage; quality of medical care; patient safety issues; use of auxiliary personnel; collaboration with EDs and ambulance care; and the role of GPs in OOH care.

Continuity of care: an Italian clinical experience.

PubMed

Tarquini, Roberto; Coletta, Davide; Mazzoccoli, Gianluigi; Gensini, Gian Franco

2013-10-01

Recently, there is a growing interest in the concept of "continuity of care," since patients, being older and more complex, are increasingly seen by an array of providers in a wide variety of organizations and places. Different models of continuity of care have been proposed, yet no single model of care coordination has been proven to be universally applicable across patient (and disease) populations. In the present paper, we introduce a novel model of continuity of care, the Ospedale Santa Verdiana, in Castelfiorentino (Tuscany, Italy), and its first period (1 year) of implementation, since January 2010. There are two main cornerstones: (a) the clinical and urgent need to bridge the gap between primary care and hospital care; and (b) the development and implementation of a model of continuity and coordination of care, which target the so-called complex patient. It is not specific for a single disease but it works "across diseases." There are three driving forces: (a) "primary care" since one of the two Hospital Coordinators is a primary care physician; (b) "hospital care" since patients in the decompensated phase often require hospitalization; and (c) the "University of Florence", which is the "glue". The duties of the Hospital Coordinator, who is an assistant professor at University of Florence, are to guarantee an efficacious and dynamic communication between primary care physicians and hospitalists, and by creating a school for practitioners of the continuity and coordination of care, to make this model exportable.

Air Force Medical Service > Resources > Suicide Prevention

Science.gov Websites

Air Force Medical Service Air Force Medical Service Join the Air Force Home Your Healthcare Healthy Videos MHS Genesis AFMS Priorities Trusted Care Vision Air Force Medical Home Full Spectrum Medical ) Air Force EFMP Who is an EFM? Who must enroll? EFMP-Medical EFMP-M Objectives Family Criteria EFMP-M

Impacts of informal caregiver availability on long-term care expenditures in OECD countries.

PubMed

Yoo, Byung-Kwang; Bhattacharya, Jay; McDonald, Kathryn M; Garber, Alan M

2004-12-01

To quantify the effects of informal caregiver availability and public funding on formal long-term care (LTC) expenditures in developed countries. Secondary data were acquired for 15 Organization for Economic Cooperation and Development (OECD) countries from 1970 to 2000. Secondary data analysis, applying fixed- and random-effects models to time-series cross-sectional data. Outcome variables are inpatient or home heath LTC expenditures. Key explanatory variables are measures of the availability of informal caregivers, generosity in public funding for formal LTC, and the proportion of the elderly population in the total population. Aggregated macro data were obtained from OECD Health Data, United Nations Demographic Yearbooks, and U.S. Census Bureau International Data Base. Most of the 15 OECD countries experienced growth in LTC expenditures over the study period. The availability of a spouse caregiver, measured by male-to-female ratio among the elderly, is associated with a $28,840 (1995 U.S. dollars) annual reduction in formal LTC expenditure per additional elderly male. Availability of an adult child caregiver, measured by female labor force participation and full-time/part-time status shift, is associated with a reduction of $310 to $3,830 in LTC expenditures. These impacts on LTC expenditure vary across countries and across time within a country. The availability of an informal caregiver, particularly a spouse caregiver, is among the most important factors explaining variation in LTC expenditure growth. Long-term care policies should take into account behavioral responses: decreased public funding in LTC may lead working women to leave the labor force to provide more informal care.

Comparing the risk factors associated with serious versus and less serious work-related injuries in Ontario between 1991 and 2006.

PubMed

Smith, Peter; Hogg-Johnson, Sheilah; Mustard, Cameron; Chen, Cynthia; Tompa, Emile

2012-01-01

The objective of this study was to examine and compare the demographic and labor market risks for more serious and less serious work-related injuries and illnesses. Secondary analysis of accepted workers' compensation claims in Ontario, combined with labor force estimates for the period 1991 to 2006. Serious injuries and illnesses were claims resulting in wage replacement. Less serious injuries and illnesses were claims only requiring health care. Regression models examined the relationship between demographic and labor market characteristics (age, gender, industry, job tenure, and unemployment) and claim type. Relative risk estimates for serious and less serious claims were not concordant across age, gender and industry employment groups. For example, while the mining and utilities and the construction industry had an increased probability of reporting NLTCs, they had a decreased probability of reporting LTCs. The risk for serious and less serious work-related injury and illness claims differ by demographic and labor market groups. The use of composite measures that combine wage-replacement and health care only claims should be considered when using compensation data for surveillance and primary prevention targeting strategies. Copyright © 2011 Wiley Periodicals, Inc.

Fertility and work-force participation: The experience of Melbourne Wives.

PubMed

Ware, H

1976-11-01

Summary Current and retrospective data on the fertility control, work-force participation intentions and practice of Melbourne wives are combined in an examination of the causal link between work-force participation and reduced family size. Stress is laid on the analysis of the interaction between work-force participation and fertility over time, taking into account the proportion of married life spent in the work-force, rather than relying exclusively on a measure of current participation, the only option available in the analysis of census-type data. The wide range of information available makes it possible to study the effects of work-force participation on wives of unimpaired fertility, as well as the different consequences of planned and unplanned participation, and of working in a variety of occupations and for a number of distinct reasons. Examination of the future fertility intentions and current contraceptive practice of the younger wives shows that working wives are not, in these respects, markedly different from their house-wife peers. Overall, the balance of the evidence indicates that in the majority of cases fertility influences work-force participation rather than the converse.

Changing families, changing workplaces.

PubMed

Bianchi, Suzanne M

2011-01-01

American families and workplaces have both changed dramatically over the past half-century. Paid work by women has increased sharply, as has family instability. Education-related inequality in work hours and income has grown. These changes, says Suzanne Bianchi, pose differing work-life issues for parents at different points along the income distribution. Between 1975 and 2009, the labor force rate of mothers with children under age eighteen increased from 47.4 percent to 71.6 percent. Mothers today also return to work much sooner after the birth of a child than did mothers half a century ago. High divorce rates and a sharp rise in the share of births to unmarried mothers mean that more children are being raised by a single parent, usually their mother. Workplaces too have changed, observes Bianchi. Today's employees increasingly work nonstandard hours. The well-being of highly skilled workers and less-skilled workers has been diverging. For the former, work hours may be long, but income has soared. For lower-skill workers, the lack of "good jobs" disconnects fathers from family obligations. Men who cannot find work or have low earnings potential are much less likely to marry. For low-income women, many of whom are single parents, the work-family dilemma is how to care adequately for children and work enough hours to support them financially. Jobs for working-class and lower middle-class workers are relatively stable, except in economic downturns, but pay is low, and both parents must work full time to make ends meet. Family income is too high to qualify for government subsidized child care, but too low to afford high-quality care in the private market. These families struggle to have a reasonable family life and provide for their family's economic well-being. Bianchi concludes that the "work and family" problem has no one solution because it is not one problem. Some workers need more work and more money. Some need to take time off around the birth of a child without permanently derailing a fulfilling career. Others need short-term support to attend to a family health crisis. How best to meet this multiplicity of needs is the challenge of the coming decade.

A systematic approach to fabricate high aspect ratio silicon micro-needles for transdermal drug delivery

NASA Astrophysics Data System (ADS)

Ng, H. B.; Shearwood, C.

2007-12-01

The successful development of micro-needles can help transport drugs and vaccines both effectively and painlessly across the skin. However, not all micro-needles are strong enough to withstand the insertion forces and viscoelasticity of the skin. The work here focuses on the micro-fabrication of high aspect ratio needles with careful control of needle-profile using dry etching technologies. Silicon micro-needles, 150μm in length with base-diameters ranging from 90 to 240μm have been investigated in this study. A novel, multiple-sacrificial approach has been demonstrated as suited to the fabrication of long micro-needle bodies with positive profiles. The parameters that control the isotropic etching are adjusted to control the ratio of the needle-base diameter to needle length. By careful control of geometry, the needle profile can be engineered to give a suitable tip size for penetration, as well as a broad needle base to facilitate the creation of either single or multiple-through holes. This approach allows the mechanical properties of the otherwise brittle needles to be optimized. Finite element analysis indicates that the micro-needles will fracture prematurely due to buckling, with forces ranging from 10 to 30mN.

Social, economic, and political forces affecting the future of occupational health nursing.

PubMed

Miller, M A

1989-09-01

1. By monitoring the major social, economic, and political forces affecting health care, one can predict how these forces may impact the role of occupational health nurses. 2. Nursing can and must chart its own course in the midst of these social, economic, and political changes. 3. Changes which have major implications for occupational health nurses are: health care needs, cost containment, multi-hospital chains, alternative approaches to health care, the workplace, ethical concerns, biomedical technology, nursing shortage, and oversupply of physicians. 4. Nursing implications can also be drawn in the areas of autonomy, political skills, and education. Active involvement and a desire to shape professional change and the future of nursing are keys.

Integration of Stable Droplet Formation on a CD Microfluidic Device for Extreme Point of Care Applications

NASA Astrophysics Data System (ADS)

Ganesh, Shruthi Vatsyayani

With the advent of microfluidic technologies for molecular diagnostics, a lot of emphasis has been placed on developing diagnostic tools for resource poor regions in the form of Extreme Point of Care devices. To ensure commercial viability of such a device there is a need to develop an accurate sample to answer system, which is robust, portable, isolated yet highly sensitive and cost effective. This need has been a driving force for research involving integration of different microsystems like droplet microfluidics, Compact-disc (CD)microfluidics along with sample preparation and detection modules on a single platform. This work attempts to develop a proof of concept prototype of one such device using existing CD microfluidics tools to generate stable droplets used in point of care diagnostics (POC diagnostics). Apart from using a fairly newer technique for droplet generation and stabilization, the work aims to develop this method focused towards diagnostics for rural healthcare. The motivation for this work is first described with an emphasis on the current need for diagnostic testing in rural health-care and the general guidelines prescribed by WHO for such a sample to answer system. Furthermore, a background on CD and droplet microfluidics is presented to understand the merits and de-merits of each system and the need for integrating the two. This phase of the thesis also includes different methods employed/demonstrated to generate droplets on a spinning platform. An overview on the detection platforms is also presented to understand the challenges involved in building an extreme point of care device. In the third phase of the thesis, general manufacturing techniques and materials used to accomplish this work is presented. Lastly, design trials for droplet generation is presented. The shortcomings of these trials are solved by investigating mechanisms pertaining to design modification and use of agarose based droplet generation to ensure a more robust sample processing method. This method is further characterized and compared with non-agarose based system and the results are analyzed. In conclusion, future prospects of this work are discussed in relation to extreme POC applications.

Multisociety Task Force for Critical Care Research: key issues and recommendations.

PubMed

Deutschman, Clifford S; Ahrens, Tom; Cairns, Charles B; Sessler, Curtis N; Parsons, Polly E

2012-01-01

Research in critical care extends from the bench to the bedside, involving multiple departments, specialties, and funding organizations. Because of this diversity, it has been difficult for all stakeholders to collectively identify challenges and establish priorities. To define a comprehensive agenda for critical care research using input from a broad range of stakeholders to serve as a blueprint for future initiatives. The Critical Care Societies Collaborative (CCSC), consisting of the leadership of the American Association of Critical-Care Nurses (AACN), the American College of Chest Physicians (ACCP), the American Thoracic Society (ATS), and the Society of Critical Care Medicine (SCCM), joined the US Critical Illness and Injury Trials Group (USCIITG) in forming a task force to define a comprehensive critical care research agenda. This group of 25 identified experts was divided into subgroups to address basic, translational, clinical, implementation, and educational research. The subgroups met via conference calls, and the entire task force met in person for a 2-day session. The result was a detailed discussion of the research priorities that served as the basis for this report. The task force identified challenges, specific priority areas, and recommendations for process improvements to support critical care research. Additionally, four overarching themes emerged: 1) the traditional "silo-ed" approach to critical care research is counterproductive and should be modified; 2) an approach that more effectively links areas of research (i.e., basic and translational research, or clinical research and implementation) should be embraced; 3) future approaches to human research should account for disease complexity and patient heterogeneity; and 4) an enhanced infrastructure for critical care research is essential for future success. This document contains the themes/recommendations developed by a large, multiprofessional cross section of critical care scientists, clinicians, and educators. It provides a unique framework for future research in critical care medicine.

Multisociety task force for critical care research: key issues and recommendations.

PubMed

Deutschman, Clifford S; Ahrens, Tom; Cairns, Charles B; Sessler, Curtis N; Parsons, Polly E

2012-01-01

Research in critical care extends from the bench to the bedside, involving multiple departments, specialties, and funding organizations. Because of this diversity, it has been difficult for all stakeholders to collectively identify challenges and establish priorities. To define a comprehensive agenda for critical care research using input from a broad range of stakeholders to serve as a blueprint for future initiatives. The Critical Care Societies Collaborative (CCSC), consisting of the leadership of the American Association of Critical-Care Nurses (AACN), the American College of Chest Physicians (ACCP), the American Thoracic Society (ATS), and the Society of Critical Care Medicine (SCCM), joined the U.S. Critical Illness and Injury Trials Group (USCIITG) in forming a task force to define a comprehensive critical care research agenda. This group of 25 identified experts was divided into subgroups to address basic, translational, clinical, implementation, and educational research. The subgroups met via conference calls, and the entire task force met in person for a 2-day session. The result was a detailed discussion of the research priorities that served as the basis for this report. The task force identified challenges, specific priority areas, and recommendations for process improvements to support critical care research. Additionally, four overarching themes emerged: (1) the traditional "silo-ed" approach to critical care research is counterproductive and should be modified; (2) an approach that more effectively links areas of research (i.e., basic and translational research, or clinical research and implementation) should be embraced; (3) future approaches to human research should account for disease complexity and patient heterogeneity; and (4) an enhanced infrastructure for critical care research is essential for future success. This document contains the themes/recommendations developed by a large, multiprofessional cross-section of critical care scientists, clinicians, and educators. It provides a unique framework for future research in critical care medicine.

Multisociety task force for critical care research: key issues and recommendations.

PubMed

Deutschman, Clifford S; Ahrens, Tom; Cairns, Charles B; Sessler, Curtis N; Parsons, Polly E

2012-01-01

Research in critical care extends from the bench to the bedside, involving multiple departments, specialties, and funding organizations. Because of this diversity, it has been difficult for all stakeholders to collectively identify challenges and establish priorities. To define a comprehensive agenda for critical care research using input from a broad range of stakeholders to serve as a blueprint for future initiatives. The Critical Care Societies Collaborative (CCSC), consisting of the leadership of the American Association of Critical-Care Nurses (AACN), the American College of Chest Physicians (ACCP), the American Thoracic Society (ATS), and the Society of Critical Care Medicine (SCCM), joined the US Critical Illness and Injury Trials Group (USCIITG) in forming a task force to define a comprehensive critical care research agenda. This group of 25 identified experts was divided into subgroups to address basic, translational, clinical, implementation, and educational research. The subgroups met via conference calls, and the entire task force met in person for a 2-day session. The result was a detailed discussion of the research priorities that served as the basis for this report. The task force identified challenges, specific priority areas, and recommendations for process improvements to support critical care research. Additionally, four overarching themes emerged: 1) the traditional "silo-ed" approach to critical care research is counterproductive and should be modified; 2) an approach that more effectively links areas of research (ie, basic and translational research, or clinical research and implementation) should be embraced; 3) future approaches to human research should account for disease complexity and patient heterogeneity; and 4) an enhanced infrastructure for critical care research is essential for future success. This document contains the themes/recommendations developed by a large, multiprofessional cross section of critical care scientists, clinicians, and educators. It provides a unique framework for future research in critical care medicine.

Multisociety Task Force for Critical Care Research: Key Issues and Recommendations

PubMed Central

Deutschman, Clifford S.; Ahrens, Tom; Cairns, Charles B.; Sessler, Curtis N.; Parsons, Polly E.

2012-01-01

Background: Research in critical care extends from the bench to the bedside, involving multiple departments, specialties, and funding organizations. Because of this diversity, it has been difficult for all stakeholders to collectively identify challenges and establish priorities. Objective: To define a comprehensive agenda for critical care research using input from a broad range of stakeholders to serve as a blueprint for future initiatives. Methods: The Critical Care Societies Collaborative (CCSC), consisting of the leadership of the American Association of Critical-Care Nurses (AACN), the American College of Chest Physicians (ACCP), the American Thoracic Society (ATS), and the Society of Critical Care Medicine (SCCM), joined the U.S. Critical Illness and Injury Trials Group (USCIITG) in forming a task force to define a comprehensive critical care research agenda. This group of 25 identified experts was divided into subgroups to address basic, translational, clinical, implementation, and educational research. The subgroups met via conference calls, and the entire task force met in person for a 2-day session. The result was a detailed discussion of the research priorities that served as the basis for this report. Results: The task force identified challenges, specific priority areas, and recommendations for process improvements to support critical care research. Additionally, four overarching themes emerged: (1) the traditional “silo-ed” approach to critical care research is counterproductive and should be modified; (2) an approach that more effectively links areas of research (i.e., basic and translational research, or clinical research and implementation) should be embraced; (3) future approaches to human research should account for disease complexity and patient heterogeneity; and (4) an enhanced infrastructure for critical care research is essential for future success. Conclusions: This document contains the themes/recommendations developed by a large, multiprofessional cross-section of critical care scientists, clinicians, and educators. It provides a unique framework for future research in critical care medicine. PMID:22210788

Multisociety Task Force for Critical Care Research

PubMed Central

Deutschman, Clifford S.; Ahrens, Tom; Cairns, Charles B.; Sessler, Curtis N.

2012-01-01

Background: Research in critical care extends from the bench to the bedside, involving multiple departments, specialties, and funding organizations. Because of this diversity, it has been difficult for all stakeholders to collectively identify challenges and establish priorities. Objective: To define a comprehensive agenda for critical care research using input from a broad range of stakeholders to serve as a blueprint for future initiatives. Methods: The Critical Care Societies Collaborative (CCSC), consisting of the leadership of the American Association of Critical-Care Nurses (AACN), the American College of Chest Physicians (ACCP), the American Thoracic Society (ATS), and the Society of Critical Care Medicine (SCCM), joined the US Critical Illness and Injury Trials Group (USCIITG) in forming a task force to define a comprehensive critical care research agenda. This group of 25 identified experts was divided into subgroups to address basic, translational, clinical, implementation, and educational research. The subgroups met via conference calls, and the entire task force met in person for a 2-day session. The result was a detailed discussion of the research priorities that served as the basis for this report. Results: The task force identified challenges, specific priority areas, and recommendations for process improvements to support critical care research. Additionally, four overarching themes emerged: 1) the traditional “silo-ed” approach to critical care research is counterproductive and should be modified; 2) an approach that more effectively links areas of research (ie, basic and translational research, or clinical research and implementation) should be embraced; 3) future approaches to human research should account for disease complexity and patient heterogeneity; and 4) an enhanced infrastructure for critical care research is essential for future success. Conclusions: This document contains the themes/recommendations developed by a large, multiprofessional cross section of critical care scientists, clinicians, and educators. It provides a unique framework for future research in critical care medicine. PMID:22215828

Stochastic resonance whole-body vibration improves postural control in health care professionals: a worksite randomized controlled trial.

PubMed

Elfering, Achim; Schade, Volker; Stoecklin, Lukas; Baur, Simone; Burger, Christian; Radlinger, Lorenz

2014-05-01

Slip, trip, and fall injuries are frequent among health care workers. Stochastic resonance whole-body vibration training was tested to improve postural control. Participants included 124 employees of a Swiss university hospital. The randomized controlled trial included an experimental group given 8 weeks of training and a control group with no intervention. In both groups, postural control was assessed as mediolateral sway on a force plate before and after the 8-week trial. Mediolateral sway was significantly decreased by stochastic resonance whole-body vibration training in the experimental group but not in the control group that received no training (p < .05). Stochastic resonance whole-body vibration training is an option in the primary prevention of balance-related injury at work. Copyright 2014, SLACK Incorporated.

Work Force Information and Career-Technical Education. In Brief: Fast Facts for Policy and Practice No. 10.

ERIC Educational Resources Information Center

Sommers, Dixie

To prepare young people and adults for labor market success, career-technical education (CTE) practitioners must know how to find and use work force information. Recent federal legislation, including the Workforce Investment Act of 1998, underscores the importance of work force education. The nationwide work force information system makes data on…

A socioecological analysis of the determinants of national public health nutrition work force capacity: Australia as a case study.

PubMed

Hughes, Roger

2006-01-01

This article uses a socioecological analytical approach to assess the capacity of the public health nutrition work force in Australia as a prelude to work force development strategy planning. It demonstrates how the socioecological model can be used to assess and inform the development of the infrastructure required for effective public health nutrition effort. An interpretive case study method was used involving triangular analysis of quantitative and qualitative data from multiple sources including semistructured interviews with advanced-level practitioners, literature review, a cross-sectional national work force survey, and position description audit and consensus development using a Delphi study. The findings of this analysis indicate that the Australian public health nutrition work force's capacity to effectively address priority nutrition issues is limited by determinants that can be categorized as relating to human resource infrastructure, organizational and policy environments, intelligence access and use, practice improvement and learning systems, and work force preparation. This socioecological analysis supports an intelligence-based focus for work force development effort in Australia and a conceptual framework for work force capacity assessment with potential applications in other countries.

Critical Foundations: Protecting America’s Infrastructures. The Report of the President’s Commission on Critical Infrastructure Protection.

DTIC Science & Technology

1997-10-13

in Tokyo and bombings of the subway system in Paris, mass transit remains open and vulnerable to terrorist acts. Millions of miles of pipelines carry...Outside of "" C Risk Management Plan . Creates a Competitive Advantage , Not Considered Industry’s "• Protects Brand/ Franchise Responsibility- I ssue of...the out- set, the Commission considered expanding the scope of this sector to include food , health care and the nation’s work force as additional

Career Intent of Women VIS A VIS Men in the United States Air Force.

DTIC Science & Technology

1970-09-01

marry (O’Brien, 1973:41). It was not in accordance with her feminine image for a woman to actively pursue a career and seek fulfillment outside the home...If a woman went to work or to college, she was usually just biding her time until the right man came along to take care of her. Education and job ...training were considered insurance against failure in the unfortunate event that a girl did not get married (O’Brien, 1973:93). If a woman voluntarily

A technician carefully checks the thermal tiles on the underside of Space Shuttle Endeavour for nicks and dings following its landing at Edwards Air Force Base

NASA Image and Video Library

2008-12-02

A United Space Alliance technician carefully checks the thermal tiles on the underside of Space Shuttle Endeavour for nicks and dings following its landing at Edwards Air Force Base to conclude mission STS-126.

Forced Separations and Forced Reunions in the Foster Care System

ERIC Educational Resources Information Center

Lillas, Constance M.; Langer, Lester; Drinane, Monica

2005-01-01

The juvenile court system has undergone tremendous changes over the past century, but much still needs to change in order to fully meet the complex needs of very young children. This article examines the challenges that the juvenile court system faces in preserving and supporting continuity of children's care in physically safe and…

Maternal and Child Health Issues and Female Labor Force Participation.

ERIC Educational Resources Information Center

Howze, Dorothy C.; And Others

Reviewing health related "costs" of female labor force participation, this paper examines four highly salient maternal and child health issues. Discussion of acute illness in day care settings begins with an overview of studies on day care and illness and focuses on hepatitis A, appropriate sanitation, and indications of research on…

The Role of Market Forces in the Delivery of Health Care: Issues for Research.

ERIC Educational Resources Information Center

National Center for Health Services Research and Health Care Technology Assessment (DHHS/PHS), Rockville, MD.

This edition of the Role of Market Forces program note suggests empirical and descriptive analyses required to complement new areas of health policy emphasis and direction. Eight areas and related questions involving health economics are outlined: (1) rural health care; (2) medical malpractice and insurance; (3) supply, productivity, and…

Integrating Education and Patient Care. Observations from the GME Task Force.

ERIC Educational Resources Information Center

Association of American Medical Colleges, Washington, DC.

The American Association of Medical Colleges (AAMC) appointed a task force in November 1999 to examine how AAMC member institutions and others were developing, and could develop, new ways to integrate education and patient care. Mechanisms were identified that would aid in reorienting residency programs to education, rather than services. These…

Developing Clinical Leaders in Primary Care: The US Air Force Diabetes Champion Course

DTIC Science & Technology

2017-04-03

The US Air Force Diabetes Center of Excellence designed the Diabetes Champion Course (DCC), a semi-annual, 3-day course, to train primary care teams ...and patient flow in a team -based setting. Each team is tasked to identify local deficits and make a Plan of Action (POA) for implementation.

CWLA Best Practice Guidelines: Behavior Management.

ERIC Educational Resources Information Center

Child Welfare League of America, Inc., Washington, DC.

In the context of a national discussion regarding behavior management in child and youth care settings, and in an effort to address the need to care safely and appropriately for children and youth, the Child Welfare League of America (CWLA) formed the National Task Force on Behavior Management. The task force includes representatives of advocacy…

Target: Alcohol Abuse in the Hard-to-Reach Work Force. Ideas and Resources for Responding to Problems of the Hard-to-Reach Work Force.

ERIC Educational Resources Information Center

Informatics, Inc., Rockville, MD.

This guide is designed as a source of ideas and information for individuals and organizations interested in occupational alcoholism programs for the hard-to-reach work force. Following a brief overview of the problem and a report on progress in occupational alcoholism programming, a working definition of the hard-to-reach work force is offered;…

Cultural competency of health-care providers in a Swiss University Hospital: self-assessed cross-cultural skillfulness in a cross-sectional study.

PubMed

Casillas, Alejandra; Paroz, Sophie; Green, Alexander R; Wolff, Hans; Weber, Orest; Faucherre, Florence; Ninane, Françoise; Bodenmann, Patrick

2014-01-30

As the diversity of the European population evolves, measuring providers' skillfulness in cross-cultural care and understanding what contextual factors may influence this is increasingly necessary. Given limited information about differences in cultural competency by provider role, we compared cross-cultural skillfulness between physicians and nurses working at a Swiss university hospital. A survey on cross-cultural care was mailed in November 2010 to front-line providers in Lausanne, Switzerland. This questionnaire included some questions from the previously validated Cross-Cultural Care Survey. We compared physicians' and nurses' mean composite scores and proportion of "3-good/4-very good" responses, for nine perceived skillfulness items (4-point Likert-scale) using the validated tool. We used linear regression to examine how provider role (physician vs. nurse) was associated with composite skillfulness scores, adjusting for demographics (gender, non-French dominant language), workplace (time at institution, work-unit "sensitized" to cultural-care), reported cultural-competence training, and cross-cultural care problem-awareness. Of 885 questionnaires, 368 (41.2%) returned the survey: 124 (33.6%) physicians and 244 (66.4%) nurses, reflecting institutional distribution of providers. Physicians had better mean composite scores for perceived skillfulness than nurses (2.7 vs. 2.5, p < 0.005), and significantly higher proportion of "good/very good" responses for 4/9 items. After adjusting for explanatory variables, physicians remained more likely to have higher skillfulness (β = 0.13, p = 0.05). Among all, higher skillfulness was associated with perception/awareness of problems in the following areas: inadequate cross-cultural training (β = 0.14, p = 0.01) and lack of practical experience caring for diverse populations (β = 0.11, p = 0.04). In stratified analyses among physicians alone, having French as a dominant language (β = -0.34, p < 0.005) was negatively correlated with skillfulness. Overall, there is much room for cultural competency improvement among providers. These results support the need for cross-cultural skills training with an inter-professional focus on nurses, education that attunes provider awareness to the local issues in cross-cultural care, and increased diversity efforts in the work force, particularly among physicians.

Navigating role forces and the aesthetic|authentic caring dialectic: a novice urban science teacher's developmental trajectory

NASA Astrophysics Data System (ADS)

Rivera Maulucci, Maria S.

2010-09-01

Examining role forces and resources available to new teachers is crucial to understanding how teachers use and expand cultural, social, and symbolic resources and how they engage teaching for social justice and caring in urban science education. This critical narrative inquiry explores three levels of story. First, the narratives explore my role as a district science staff developer and my efforts to leverage district resources to improve students' opportunities to learn science. Second, the narratives explore the ways in which a novice science teacher, Tina, navigated role forces and the aesthetic|authentic caring dialectic in a high poverty, urban school. A third level of narrative draws on sociological theories of human interaction to explore role forces and how they shaped Tina's developmental trajectory. I describe how Tina expanded cultural, social, and symbolic resources to enact her teaching role.

Combined Diet and Physical Activity Promotion Programs for Prevention of Diabetes: Community Preventive Services Task Force Recommendation Statement.

PubMed

Pronk, Nicolaas P; Remington, Patrick L

2015-09-15

Community Preventive Services Task Force recommendation on the use of combined diet and physical activity promotion programs to reduce progression to type 2 diabetes in persons at increased risk. The Task Force commissioned an evidence review that assessed the benefits and harms of programs to promote and support individual improvements in diet, exercise, and weight and supervised a review on the economic efficiency of these programs in clinical trial, primary care, and primary care-referable settings. Adolescents and adults at increased risk for progression to type 2 diabetes. The Task Force recommends the use of combined diet and physical activity promotion programs by health care systems, communities, and other implementers to provide counseling and support to clients identified as being at increased risk for type 2 diabetes. Economic evidence indicates that these programs are cost-effective.

A critical analysis of the Australian Defence Force policy on maternal health care.

PubMed

Montalban, Maureen

2017-08-01

To critically analyse the Australian Defence Force (ADF) policy on maternal health care: Health Directive No 235 - Management of pregnant members in the Australian Defence Force. Bacchi's 'What's the problem represented to be' framework was used to analyse Health Directive No 235. This paper critically examines the representation of pregnancy and birth, the resulting effects and considers alternate representations. The ADF's policy on maternal healthcare considers pregnancy as a health issue that requires specialist intervention and care, also known as the medicalisation of birth. Current research emphasises women-centred care; a model of care not contained in the ADF policy. The problematisation of pregnancy in the ADF restricts women's choices regarding their maternal healthcare provider. This is contrary to the healthcare rights of Australians and likely contributes to health inequalities of ADF women. Implications for public health: A research gap regarding ADF women's knowledge and wishes regarding their maternal health care has been identified. Future research can inform any alterations to the ADF policy on maternal healthcare. © 2017 The Authors.

Exploring dual commitment among physician executives in managed care.

PubMed

Hoff, T J

2001-01-01

The growth of a medical management specialty is a significant event associated with managed care. Physician executives are lauded for their potential in bridging the clinical and managerial realms. They also serve as a countervailing force to help the medical profession and patients maintain a strong voice in healthcare decision making at the strategic level. However, little is known about their work loyalties. These attitudes are important to explore because they speak to whose interests physician executives consider and represent in their everyday management roles. If physician executives are to maximize their effectiveness in the healthcare workplace, both physicians and organizations must view them as credible sources of authority. This study examines organizational and professional commitment among a national sample of physician executives employed in managed care settings. Data used for the analysis come from a national survey conducted through the American College of Physician Executives in 1996. The findings support the notion that physician executives can and do express simultaneous loyalty to organizational and professional interests. This dual commitment is related to other work attitudes that contribute to success in the management role. In addition, it appears that situational factors increase the chances for dual commitment. These factors derive from a favorable work environment that includes both organizational and professional socialization in the management role. The results of the study are useful in specifying the training and socialization needs of physicians who wish to do management work. They also provide a rationale for collaboration between healthcare organizations and rank-and-file physicians aimed at cultivating physician executives who are credible leaders within the healthcare system.

Energetic costs of producing muscle work and force in a cyclical human bouncing task

PubMed Central

Kuo, Arthur D.

2011-01-01

Muscles expend energy to perform active work during locomotion, but they may also expend significant energy to produce force, for example when tendons perform much of the work passively. The relative contributions of work and force to overall energy expenditure are unknown. We therefore measured the mechanics and energetics of a cyclical bouncing task, designed to control for work and force. We hypothesized that near bouncing resonance, little work would be performed actively by muscle, but the cyclical production of force would cost substantial metabolic energy. Human subjects (n = 9) bounced vertically about the ankles at inversely proportional frequencies (1–4 Hz) and amplitudes (15–4 mm), such that the overall rate of work performed on the body remained approximately constant (0.30 ± 0.06 W/kg), but the forces varied considerably. We used parameter identification to estimate series elasticity of the triceps surae tendon, as well as the work performed actively by muscle and passively by tendon. Net metabolic energy expenditure for bouncing at 1 Hz was 1.15 ± 0.31 W/kg, attributable mainly to active muscle work with an efficiency of 24 ± 3%. But at 3 Hz (near resonance), most of the work was performed passively, so that active muscle work could account for only 40% of the net metabolic rate of 0.76 ± 0.28 W/kg. Near resonance, a cost for cyclical force that increased with both amplitude and frequency of force accounted for at least as much of the total energy expenditure as a cost for work. Series elasticity reduces the need for active work, but energy must still be expended for force production. PMID:21212245

Society for Neuroscience in Anesthesiology and Critical Care Expert consensus statement: anesthetic management of endovascular treatment for acute ischemic stroke*: endorsed by the Society of NeuroInterventional Surgery and the Neurocritical Care Society.

PubMed

Talke, Pekka O; Sharma, Deepak; Heyer, Eric J; Bergese, Sergio D; Blackham, Kristine A; Stevens, Robert D

2014-04-01

Literature on the anesthetic management of endovascular treatment of acute ischemic stroke (AIS) is limited. Anesthetic management during these procedures is still mostly dependent on individual or institutional preferences. Thus, the Society of Neuroscience in Anesthesiology and Critical Care (SNACC) created a task force to provide expert consensus recommendations on anesthetic management of endovascular treatment of AIS. The task force conducted a systematic literature review (up to August 2012). Because of the limited number of research articles relating to this subject, the task force solicited opinions from experts in this area. The task force created a draft consensus statement based on the available data. Classes of recommendations and levels of evidence were assigned to articles specifically addressing anesthetic management during endovascular treatment of stroke using the standard American Heart Association evidence rating scheme. The draft consensus statement was reviewed by the Task Force, SNACC Executive Committee and representatives of Society of NeuroInterventional Surgery (SNIS) and Neurocritical Care Society (NCS) reaching consensus on the final document. For this consensus statement the anesthetic management of endovascular treatment of AIS was subdivided into 12 topics. Each topic includes a summary of available data followed by recommendations. This consensus statement is intended for use by individuals involved in the care of patients with acute ischemic stroke, such as anesthesiologists, interventional neuroradiologists, neurologists, neurointensivists, and neurosurgeons.

Female labour force participation, fertility and public policy in Sweden.

PubMed

Sundstrom, M; Stafford, F P

1992-01-01

2nd only to Ireland in total fertility, Sweden has the highest total fertility (TFR) and female labor force participation rates (FLFPR) among European countries in the late 1980s and early 1990s. 1988 TFR and FLFPR were 1.96 and 80.1%, respectively. This paper considers the role of public policy in creating this unique trend, with particular focus on family leave policy. In 1974, Sweden became the 1st country to allow leave to both parents following childbirth. By 1990, leave duration had grown from an initial 6-month period to 15 months. In addition, subsidized day care, flexible working hours, and economic support to families with children is provided in the context of a family-supportive tax structure. While generous, benefits are related to work and income history. Labor income is replaced at 90% of gross earnings, while the unemployed receive only minimal taxable flat payments. Benefits overall are paid from general taxes. Given that benefits reflect job history and income, and income level tends to rise fastest in the initial stages of employment, women in Sweden postpone childbirth in order to realize wage increases and greater job standing over the short- to medium-terms. In sum, Sweden's policies stimulate both fertility and women's paid work by reducing the costs of having children while requiring parents to be employed to receive full benefits. This paper further reviews the development of parental leave and related policies and compares Swedish fertility, female labor force participation, and parental leave benefits to those of countries in the European Community.

Impact of primary care depression intervention on employment and workplace conflict outcomes: is value added?

PubMed

Smith, Jeffrey L; Rost, Kathryn M; Nutting, Paul A; Libby, Anne M; Elliott, Carl E; Pyne, Jeffrey M

2002-03-01

Depression causes significant functional impairment in sufferers and often leads to adverse employment outcomes for working individuals. Recovery from depression has been associated with better employment outcomes at one year. The study s goals were to assess a primary care depression intervention s impact on subsequent employment and workplace conflict outcomes in employed patients with depression. In 1996-1997, the study enrolled 262 employed patients with depression from twelve primary care practices located across ten U.S. states; 219 (84%) of the patients were followed at one year. Intent-to-treat analyses assessing intervention effects on subsequent employment and workplace conflict were conducted using logistic regression models controlling for individual clinical and sociodemographic characteristics, job classification and local employment conditions. To meet criteria for subsequent employment, persons working full-time at baseline had to report they were working full-time at follow-up and persons working part-time at baseline had to report working part-/full-time at follow-up. Workplace conflict was measured by asking patients employed at follow-up whether, in the past year, they had arguments or other difficulties with people at work . Findings showed that 92.1% of intervention patients met criteria for subsequent employment at one year, versus 82.0% of usual care patients (c2=4.42, p=.04). Intervention patients were less likely than usual care patients to report workplace conflict in the year following baseline (8.1% vs. 18.9%, respectively; c2=4.11; p=.04). The intervention s effect on subsequent employment was not mediated by its effect on workplace conflict. The intervention significantly improved employment outcomes and reduced workplace conflict in depressed, employed persons at one year. Economic implications for employers related to reduced turnover costs, for workers related to retained earnings, and for governments related to reduced unemployment expenditures and increased tax receipts may be considerable. Although similar primary care depression interventions have been shown to produce comparable effects on subsequent employment at one year, replications in larger samples of depressed, employed patients in different economic climates may be necessary to increase the generalizability and precision of estimates. Primary care interventions that enhance depression treatment and improve clinical outcomes can contribute meaningful added value to society by improving employment and workplace outcomes. Federal/state governments may realize economic benefits from reduced unemployment expenditures and increased tax receipts should primary care depression interventions that improve employment outcomes be broadly disseminated. Policy initiatives to increase the dissemination of such interventions may be an innovative approach for improving labor force participation by depressed individuals. Formal cost-benefit analyses are needed to explore whether economic benefits to societal stakeholders from these and other labor outcomes equal or exceed the incremental costs of disseminating similar primary care interventions nationally. Researchers in other nations may wish to consider investigating the impact primary care depression interventions might have on employment and workplace outcomes in their countries.

Inferring muscle functional roles of the ostrich pelvic limb during walking and running using computer optimization.

PubMed

Rankin, Jeffery W; Rubenson, Jonas; Hutchinson, John R

2016-05-01

Owing to their cursorial background, ostriches (Struthio camelus) walk and run with high metabolic economy, can reach very fast running speeds and quickly execute cutting manoeuvres. These capabilities are believed to be a result of their ability to coordinate muscles to take advantage of specialized passive limb structures. This study aimed to infer the functional roles of ostrich pelvic limb muscles during gait. Existing gait data were combined with a newly developed musculoskeletal model to generate simulations of ostrich walking and running that predict muscle excitations, force and mechanical work. Consistent with previous avian electromyography studies, predicted excitation patterns showed that individual muscles tended to be excited primarily during only stance or swing. Work and force estimates show that ostrich gaits are partially hip-driven with the bi-articular hip-knee muscles driving stance mechanics. Conversely, the knee extensors acted as brakes, absorbing energy. The digital extensors generated large amounts of both negative and positive mechanical work, with increased magnitudes during running, providing further evidence that ostriches make extensive use of tendinous elastic energy storage to improve economy. The simulations also highlight the need to carefully consider non-muscular soft tissues that may play a role in ostrich gait. © 2016 The Authors.

Soviet fertility, labor-force participation, and marital stability.

PubMed

Kuniansky, A

1983-06-01

A simultaneous-equations model of Soviet fertility and labor-force participation is estimated from a cross section of 72 oblast's of the Russian Republic (RSFSR) reported in the 1970 census. The construction of the model is based on the neoclassical theory of household behavior. Simulated changes capture effects of policy changes in the exogenous variables on Soviet fertility and the female labor supply. The exogenous variables investigated are child care facilities (CC), urbanization ratio (URB), male education (MALED), and female education (FEMED). It was found that an increase in FEMED affects labor force participation (LFP) directly and indirectly through impact on birth rate (BR). Increase in CC raise both LFP and BR; increases in FEMED causes womens withdrawal from the labor force and one would expect this to raise BR; however, FEMED raises the opportunity costs of fertility sufficiently to neutralize this effect. Increasing urbanization does not affect participation in a significant way, but it does retard fertility. This effect works through LFP's impact on BR and the indirect effect working through marital stability. A final set of simulations captured the impact of upward shocks of LFP, BR, and the ratio of divorces to marriages (DIV/MAR) on the endogenous variables. Such changes could occur through changes in abortion laws, tightening of divorce laws, or changes in labor legislation. Participation is reduced by the fertility shock, just as fertility is retarded by the LPF and marital stability shocks. Evidence of a backward-bending labor-supply curve was also found. The model is illustrated by tables and charts.

Assessing differences in hours worked between male and female dentists: an analysis of cross-sectional national survey data from 1979 through 1999.

PubMed

Walton, Surrey M; Byck, Gayle R; Cooksey, Judith A; Kaste, Linda M

2004-05-01

Women are increasingly entering the dental work force. This study examines the impact of sex, age and other demographic characteristics on dentists' work force participation and on hours worked from 1979 through 1999. The study drew on cross-sectional data on dentists (4,209 men and 354 women) from national population surveys conducted by the U.S. Bureau of Labor Statistics from 1979 through 1999. The authors used descriptive statistics and regression analyses to examine sex differences in work force participation and in hours worked across age, as well as other factors. Work force participation was high for both men and women. Men worked more hours and worked part time less frequently; they worked more than 42 hours per week more frequently. Older dentists worked fewer hours, with a larger impact of age seen among men. Having children had a significantly greater effect on the number of hours worked per week among female dentists than among male dentists. There were significant differences in dentists' hours worked by sex and by age. The consistency of the results with past studies suggests these differences will hold in the near future. Women's entry into the dental work force has been significant and has helped maintain the supply of dentists. Sex differences in the work force should be considered in evaluating the supply of dentists and related work force policy.

The thickness correction of sol-gel coating using ion-beam etching in the preparation of antireflection coating

NASA Astrophysics Data System (ADS)

Dong, Siyu; Xie, Lingyun; He, Tao; Jiao, Hongfei; Bao, Ganghua; Zhang, Jinlong; Wang, Zhanshan; Cheng, Xinbin

2017-09-01

For the sol-gel method, it is still challenging to achieve excellent spectral performance when preparing antireflection (AR) coating by this way. The difficulty lies in controlling the film thickness accurately. To correct the thickness error of sol-gel coating, a hybrid approach that combined conventional sol-gel process with ion-beam etching technology was proposed in this work. The etching rate was carefully adjusted and calibrated to a relatively low value for removing the redundant material. Using atomic force microscope (AFM), it has been demonstrated that film surface morphology will not be changed in this process. After correcting the thickness error, an AR coating working at 1064 nm was prepared with transmittance higher than 99.5%.

Correlation analysis between work-related musculoskeletal disorders and the nursing practice environment, quality of life, and social support in the nursing professionals

PubMed Central

Yan, Ping; Yang, Yi; Zhang, Li; Li, Fuye; Huang, Amei; Wang, Yanan; Dai, Yali; Yao, Hua

2018-01-01

Abstract We aim to analyze the correlated influential factors between work-related musculoskeletal disorders (WMSDs) and nursing practice environment and quality of life and social support. From January 2015 to October 2015, cluster sampling was performed on the nurses from 12 hospitals in the 6 areas in Xinjiang. The questionnaires including the modified Nordic Musculoskeletal Questionnaire, Practice Environment Scale (PES), the Mos 36-item Short Form Health Survey, and Social Support Rating Scale were used to investigate. Multivariate logistic regression analysis was used to explore the influential factors of WMSDs. The total prevalence of WMSDs was 79.52% in the nurses ever since the working occupation, which was mainly involved waist (64.83%), neck (61.83%), and shoulder (52.36%). Multivariate logistic regression analysis indicated age (≥26 years), working in the Department of Surgery, Department of Critical Care, Outpatient Department, and Department of Anesthesia, working duration of >40 hours per week were the risk factors of WMSDs in the nurses. The physiological function (PF), body pain, total healthy condition, adequate working force and financial support, and social support were the protective factors of WMSDs. The prevalence of WMSDs in the nurses in Xinjiang Autonomous Region was high. PF, bodily pain, total healthy condition, having adequate staff and support resources to provide quality patient care, and social support were the protective factors of WMSDs in the nurses. PMID:29489648

Correlation analysis between work-related musculoskeletal disorders and the nursing practice environment, quality of life, and social support in the nursing professionals.

PubMed

Yan, Ping; Yang, Yi; Zhang, Li; Li, Fuye; Huang, Amei; Wang, Yanan; Dai, Yali; Yao, Hua

2018-03-01

We aim to analyze the correlated influential factors between work-related musculoskeletal disorders (WMSDs) and nursing practice environment and quality of life and social support.From January 2015 to October 2015, cluster sampling was performed on the nurses from 12 hospitals in the 6 areas in Xinjiang. The questionnaires including the modified Nordic Musculoskeletal Questionnaire, Practice Environment Scale (PES), the Mos 36-item Short Form Health Survey, and Social Support Rating Scale were used to investigate. Multivariate logistic regression analysis was used to explore the influential factors of WMSDs.The total prevalence of WMSDs was 79.52% in the nurses ever since the working occupation, which was mainly involved waist (64.83%), neck (61.83%), and shoulder (52.36%). Multivariate logistic regression analysis indicated age (≥26 years), working in the Department of Surgery, Department of Critical Care, Outpatient Department, and Department of Anesthesia, working duration of >40 hours per week were the risk factors of WMSDs in the nurses. The physiological function (PF), body pain, total healthy condition, adequate working force and financial support, and social support were the protective factors of WMSDs.The prevalence of WMSDs in the nurses in Xinjiang Autonomous Region was high. PF, bodily pain, total healthy condition, having adequate staff and support resources to provide quality patient care, and social support were the protective factors of WMSDs in the nurses.

The livelihoods of Haitian health-care providers after the january 2010 earthquake: a pilot study of the economic and quality-of-life impact of emergency relief.

PubMed

Haar, Rohini J; Naderi, Sassan; Acerra, John R; Mathias, Maxwell; Alagappan, Kumar

2012-03-02

An effective international response to a disaster requires cooperation and coordination with the existing infrastructure. In some cases, however, international relief efforts can compete with the local work force and affect the balance of health-care systems already in place. This study seeks to evaluate the impact of the international humanitarian response to the 12 January 2010 earthquake on Haitian health-care providers (HHP). Fifty-nine HHPs were surveyed in August of 2010 using a modified World Health Organization Quality of Life-Brief questionnaire (WHOQoL-B) that included questions on respondents' workload before the earthquake, immediately after, and presently. The study population consisted of physicians, nurses, and technicians at public hospitals, non-governmental organization (NGO) clinics, and private offices in Port-au-Prince, Haiti. Following the earthquake, public hospital and NGO providers reported a significant increase in their workload (15 of 17 and 22 of 26 respondents, respectively). Conversely, 12 of 16 private providers reported a significant decrease in workload (p < 0.0001). Although all groups reported working a similar number of hours prior to the earthquake (average 40 h/week), they reported working significantly different amounts following the earthquake. Public hospital and NGO providers averaged more than 50 h/week, and private providers averaged just over 33 h/week of employment (p < 0.001).Health-care providers working at public hospitals and NGOs, however, had significantly lower scores on the WHOQoL-B when answering questions about their environment (p < 0.001), and in open-ended responses often commented about the lack of potable water and poor access to toilets. Providers from all groups expressed dissatisfaction with the scope and quality of care provided at public hospitals and NGO clinics, as well as disappointment with the reduction in patient volume at private practices. The emergency medical response to the January 2010 earthquake in Haiti had the unintended consequence of poorly distributing work among HHPs. To create a robust health-care system in the long term while meeting short-term needs, humanitarian responses should seek to better integrate existing systems and involve local providers in the design and implementation of an emergency program.

"I can't do this, it's too much": building social inclusion in cancer diagnosis and treatment experiences of Aboriginal people, their carers and health workers.

PubMed

Treloar, Carla; Gray, Rebecca; Brener, Loren; Jackson, Clair; Saunders, Veronica; Johnson, Priscilla; Harris, Magdalena; Butow, Phyllis; Newman, Christy

2014-04-01

Social inclusion theory has been used to understand how people at the margins of society engage with service provision. The aim of this paper was to explore the cancer care experiences of Aboriginal people in NSW using a social inclusion lens. Qualitative interviews were conducted with 22 Aboriginal people with cancer, 18 carers of Aboriginal people and 16 health care workers. Participants' narratives described experiences that could be considered to be situational factors in social inclusion such as difficulties in managing the practical and logistic aspects of accessing cancer care. Three factors were identified as processes of social inclusion that tied these experiences together including socio-economic security, trust (or mistrust arising from historic and current experience of discrimination), and difficulties in knowing the system of cancer treatment. These three factors may act as barriers to the social inclusion of Aboriginal people in cancer treatment. This challenges the cancer care system to work to acknowledge these forces and create practical and symbolic responses, in partnership with Aboriginal people, communities and health organisations.

Changing factors and changing needs in women's health care.

PubMed

Leslie, L A; Swider, S M

1986-03-01

The aforementioned social trends affecting women, including women in poverty, women in the labor force, and elderly women, are all ultimately related to problems of access to health care. In almost every age group, women use more health and medical services. Women are hospitalized more often, although their stays in hospitals tend to be shorter. Women also make more visits to health care providers for preventive health care, such as examinations and dental care. Access to care, however, is tied to ability to pay for the care. Medicaid payments for medical care are related to eligibility criteria in each state. Recent cuts in federal programs targeted eligibility for welfare and Medicaid. In 1982, 725,000 welfare recipients were declared ineligible. Given the earlier discussion of the predominance of women among those labeled poor in this country and the fact that two thirds of Medicaid recipients are women, these cutbacks have serious implications for women's health. Women are less likely to have medical insurance than men. Insurance coverage as a benefit is least likely to be offered in those areas where women work: part-time employment, small businesses, and manufacturing industries. Insurance eligibility is often dependent on a woman's marital status, despite the fact that 41.5 per cent of all American women are not spousal dependents. Insurance companies frequently adjust premiums for sex, age, income, race, and workforce characteristics, a policy which works against women. As the field of women's health expands and receives more emphasis, the data reflecting the experiences of large groups of women will have to be collected and analyzed ever more carefully. Information collected should include physiologic, psychosocial, and economic factors that together affect the health status of women. These data may then be used to guide health policy decision making, as well as provide a basis for health promotion and disease prevention interventions with individual clients.

Health professionals working with First Nations, Inuit, and Métis consensus guideline.

PubMed

Wilson, Don; de la Ronde, Sandra; Brascoupé, Simon; Apale, Alisha Nicole; Barney, Lucy; Guthrie, Bing; Harrold, Elizabeth; Horn, Ojistoh; Johnson, Robin; Rattray, Darrien; Robinson, Nicole; Alainga-Kango, Natsiq; Becker, Gisela; Senikas, Vyta; Aningmiuq, Annie; Bailey, Geri; Birch, Darlene; Cook, Katsi; Danforth, Jessica; Daoust, Mary; Kitty, Darlene; Koebel, Jaime; Kornelsen, Judith; Tsatsa Kotwas, Ndakaitedzva; Lawrence, Audrey; Mudry, Amanda; Senikas, Vyta; Turner, Gail Theresa; Van Wagner, Vicki; Vides, Eduardo; Wasekeesikaw, Fjola Hart; Wolfe, Sara

2013-06-01

Our aim is to provide health care professionals in Canada with the knowledge and tools to provide culturally safe care to First Nations, Inuit, and Métis women and through them, to their families, in order to improve the health of First Nations, Inuit, and Métis. Published literature was retrieved through searches of PubMed, CINAHL, Sociological Abstracts, and The Cochrane Library in 2011 using appropriate controlled vocabulary (e.g.,cultural competency, health services, indigenous, transcultural nursing) and key words (e.g., indigenous health services, transcultural health care, cultural safety). Targeted searches on subtopics (e.g., ceremonial rites and sexual coming of age) were also performed. The PubMed search was restricted to the years 2005 and later because of the large number of records retrieved on this topic. Searches were updated on a regular basis and incorporated in the guideline to May 2012. Grey (unpublished) literature was identified through searching the websites of selected related agencies (e.g., Campbell Collaboration, Social Care Online, Institute for Healthcare Improvement). The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task force on Preventive Health Care (Table).

The Joint Commission has provided a tool to change your work force: are you paying attention?

PubMed

Decker, P J; Strader, M K

1998-03-01

Most health care managers wonder how to change employee "attitudes" so that their staff will be more accountable for patient satisfaction, cost reduction, and quality of care. Employees were trained to function in an industry where the power players were the physician and the administrator and now it is exceedingly difficult to get them to switch their attention to the patient and the payer in a market-driven economy. For hospital managers, the answer may be right at their fingertips: The Joint Commission on Accreditation of Healthcare Organizations' standards demanding that employee competence be objectively measured, proven, tracked & trended, improved, and age specific. A comprehensive competence assessment system can save the health care manager enormous work in measuring fewer things, focusing performance assessment on the 20 percent of things that are true problems, and helping to specifically define certain competencies such as customer focus and cost consciousness so that coaching, training, and giving performance feedback is easier. Developing a comprehensive competence assessment system is a powerful tool to change the culture of organizations. Consequently, it is important that managers be aware of those possibilities before they embark on developing "competencies" or before their organizations get too carried away on redesigning systems to satisfy standards.

Between two roles - Experiences of newly trained nurse practitioners in surgical care in Sweden: A qualitative study using repeated interviews.

PubMed

Jangland, Eva; Yngman Uhlin, Pia; Arakelian, Erebouni

2016-11-01

The position of Nurse Practitioner is a new role in Nordic countries. The transition from a registered nurse to the Nurse Practitioner role has been reported to be a personal challenge. This study, guided by the Nordic theoretical model for use in the education of advanced practice nurses, represents a unique opportunity to describe this transition for newly graduated Nurse Practitioners in an interprofessional surgical care team in Sweden. The aim was to explore how the first Nurse Practitioners in surgical care experienced the transition into a new role and what competences they used in the team. Eight new Nurse Practitioners with parallel work in clinical practice were interviewed twice around the time of their graduation. The qualitative analyses show that the participants integrated several central competences, but the focus in this early stage in their new role was on direct clinical praxis, consultation, cooperation, case management, and coaching. Transition from the role of clinical nurse specialist to nurse practitioner was a challenging process in which the positive response from patients was a driving force for the new Nurse Practitioners. The participants felt prepared for and determined to solve the challenging situations they approached working in the interprofessional team. Copyright © 2016 Elsevier Ltd. All rights reserved.

3 CFR - White House Task Force on Middle-Class Working Families

Code of Federal Regulations, 2010 CFR

2010-01-01

... 3 The President 1 2010-01-01 2010-01-01 false White House Task Force on Middle-Class Working... Task Force on Middle-Class Working Families Memorandum for the Heads of Executive Departments and... times. To these ends, I hereby direct the following: Section 1. White House Task Force on Middle-Class...

Workplace Violence in Health Care-It's Not "Part of the Job".

PubMed

Wax, Joseph R; Pinette, Michael G; Cartin, Angelina

2016-08-01

While health care workers comprise just 13% of the US workforce, they experience 60% of all workplace assaults. This violence is the second leading cause of fatal occupational injury. Women comprise 45% of the US labor force but 80% of health care workers, the highest proportion of females in any industry. The purpose was to describe the prevalence, forms, and consequences of health care workplace violence (WPV). The role and components of prevention programs for avoiding or mitigating violence are discussed, including opportunities for participation by obstetrician-gynecologists. A search of PubMed from 1990 to February 1, 2016, identified relevant manuscripts. Additional studies were found by reviewing the manuscripts' references. Government Web sites were visited for relevant data, publications, and resources. Health care WPV continues to rise despite an overall decrease in US WPV. While workers are most likely to be assaulted by clients or patients, they are most frequently bullied and threatened by coworkers. All incidents are markedly underreported in the absence of physical injury or lost work time. Sequelae include physical and psychological trauma, adverse patient outcomes, and perceived lower quality of care. The human, societal, and economic costs of health care WPV are enormous and unacceptable. Comprehensive prevention, planning, and intervention offer the best means of mitigating risks. As women's health physicians and health care workers, obstetrician-gynecologists should be encouraged to participate in such efforts.

Working towards a national health information system in Australia.

PubMed

Bomba, B; Cooper, J; Miller, M

1995-01-01

One of the major administrative dilemmas facing the Australian national health care system is the need to reform practices associated with massive data-information overload. The current system is burdened with paper-based administrative forms, patient record files, referral notes and other manual methods of data organisation. An integrated computer-based information system may be perceived as an attractive solution to such burdens. However, computerisation must not be seen as a panacea with the possibility of exacerbating information overload and accentuating privacy concerns. Recent surveys in Australia [1] and the US [2] indicate a perceived causal link between computers and privacy invasion. Any moves toward a national health information system must counter this perception through macro-level education schemes of affected parties and micro-level mechanisms such as the establishment of hospital privacy officers. Such concerns may be viewed as a subset of the wider privacy debate, and information policy development should address such considerations to develop policies to prevent unauthorized access to personal information and to avoid the extraction and sale of sensitive health data. Conservative in nature and slow to change the health care sector may be forced to adopt more efficient work practices through the increasing proliferation of information technology (IT) in health care delivery and an escalating emphasis upon accountability and efficiency of the public health care dollar. The economic rationalist stance taken by governments in Australia and other nations generally will also force health care workers to adopt and develop more efficient information management practices, health indicators and best practice care methods than presently employed by this sector The benefits of a national health information system are far reaching, particularly in developing a more effective health care system through better identifying and understanding community health care trends and in applying IT to the efficient collection of data for the development of more appropriate performance measures and statistical indicators. A coherent and integrated approach is called for in the design of a national health information system which incorporates the necessary and requisite security features to meet privacy concerns. Protecting information privacy poses complex political, economic, technological, legal and social problems for systems developers and health care providers alike [2]. According to Brannigan [3] there are three components involved in the formulation and implementation of privacy: public policy (What level of privacy does society want?); legal structure (Does the law adequately provide for society's privacy requirements?); and technical (how much privacy can technical tools provide, at what cost, and with what effects on the system?). Examining technical tools alone, it is apparent that the necessary technologies are available in Australia to provide the security of medical records required by public policy. Such tools may include encryption, user and data authentication methods, authorisation schemes and mechanisms for the prevention of data inference. While none of these available measures are infallible, it is suitable for most applications where the encryption mechanism can provide protection for a given length of time. Australia needs to develop a coherent national health information infrastructure policy to ultimately avoid fragmented, duplicated and incompatible systems that rely on different standards and protocols. Such a policy will only work by addressing the key issue of patient privacy within a technological framework. The application of IT to health care systems is a sensitive social experiment affecting many professions including general practitioners, medical administrators, politicians, lawyers, computer specialists, privacy advocates and patients whose records will ultimately reside in the system. (abstract trun

Design of a Functional Training Prototype for Neonatal Resuscitation

PubMed Central

Rajaraman, Sivaramakrishnan; Ganesan, Sona; Jayapal, Kavitha; Kannan, Sadhani

2014-01-01

Birth Asphyxia is considered to be one of the leading causes of neonatal mortality around the world. Asphyxiated neonates require skilled resuscitation to survive the neonatal period. The project aims to train health professionals in a basic newborn care using a prototype with an ultimate objective to have one person at every delivery trained in neonatal resuscitation. This prototype will be a user-friendly device with which one can get trained in performing neonatal resuscitation in resource-limited settings. The prototype consists of a Force Sensing Resistor (FSR) that measures the pressure applied and is interfaced with Arduino® which controls the Liquid Crystal Display (LCD) and Light Emitting Diode (LED) indication for pressure and compression counts. With the increase in population and absence of proper medical care, the need for neonatal resuscitation program is not well addressed. The proposed work aims at offering a promising solution for training health care individuals on resuscitating newborn babies under low resource settings. PMID:27417489

HealthPartners adopts community business model to deepen focus on nonclinical factors of health outcomes.

PubMed

Isham, George J; Zimmerman, Donna J; Kindig, David A; Hornseth, Gary W

2013-08-01

Clinical care contributes only 20 percent to overall health outcomes, according to a population health model developed at the University of Wisconsin. Factors contributing to the remainder include lifestyle behaviors, the physical environment, and social and economic forces--all generally considered outside the realm of care. In 2010 Minnesota-based HealthPartners decided to target nonclinical community health factors as a formal part of its strategic business plan to improve public health in the Twin Cities area. The strategy included creating partnerships with businesses and institutions that are generally unaccustomed to working together or considering how their actions could help improve community health. This article describes efforts to promote healthy eating in schools, reduce the stigma of mental illness, improve end-of-life decision making, and strengthen an inner-city neighborhood. Although still in their early stages, the partnerships can serve as encouragement for organizations inside and outside health care that are considering undertaking similar efforts in their markets.

Scale-up of HIV treatment through PEPFAR: a historic public health achievement.

PubMed

El-Sadr, Wafaa M; Holmes, Charles B; Mugyenyi, Peter; Thirumurthy, Harsha; Ellerbrock, Tedd; Ferris, Robert; Sanne, Ian; Asiimwe, Anita; Hirnschall, Gottfried; Nkambule, Rejoice N; Stabinski, Lara; Affrunti, Megan; Teasdale, Chloe; Zulu, Isaac; Whiteside, Alan

2012-08-15

Since its inception in 2003, the US President's Emergency Plan for AIDS Relief (PEPFAR) has been an important driving force behind the global scale-up of HIV care and treatment services, particularly in expansion of access to antiretroviral therapy. Despite initial concerns about cost and feasibility, PEPFAR overcame challenges by leveraging and coordinating with other funders, by working in partnership with the most affected countries, by supporting local ownership, by using a public health approach, by supporting task-shifting strategies, and by paying attention to health systems strengthening. As of September 2011, PEPFAR directly supported initiation of antiretroviral therapy for 3.9 million people and provided care and support for nearly 13 million people. Benefits in terms of prevention of morbidity and mortality have been reaped by those receiving the services, with evidence of societal benefits beyond the anticipated clinical benefits. However, much remains to be accomplished to achieve universal access, to enhance the quality of programs, to ensure retention of patients in care, and to continue to strengthen health systems.

The Re-contextualization of the Patient: What Home Health Care Can Teach Us About Medical Decision-Making.

PubMed

Salter, Erica K

2015-06-01

This article examines the role of context in the development and deployment of standards of medical decision-making. First, it demonstrates that bioethics, and our dominant standards of medical decision-making, developed out of a specific historical and philosophical environment that prioritized technology over the person, standardization over particularity, individuality over relationship and rationality over other forms of knowing. These forces de-contextualize the patient and encourage decision-making that conforms to the unnatural and contrived environment of the hospital. The article then explores several important differences between the home health care and acute care settings. Finally, it argues that the personalized, embedded, relational and idiosyncratic nature of the home is actually a much more accurate reflection of the context in which real people make real decisions. Thus, we should work to "re-contextualize" patients, in order that they might be better equipped to make decisions that harmonize with their real lives.

Early exercise in critically ill patients enhances short-term functional recovery.

PubMed

Burtin, Chris; Clerckx, Beatrix; Robbeets, Christophe; Ferdinande, Patrick; Langer, Daniel; Troosters, Thierry; Hermans, Greet; Decramer, Marc; Gosselink, Rik

2009-09-01

: To investigate whether a daily exercise session, using a bedside cycle ergometer, is a safe and effective intervention in preventing or attenuating the decrease in functional exercise capacity, functional status, and quadriceps force that is associated with prolonged intensive care unit stay. A prolonged stay in the intensive care unit is associated with muscle dysfunction, which may contribute to an impaired functional status up to 1 yr after hospital discharge. No evidence is available concerning the effectiveness of an early exercise training intervention to prevent these detrimental complications. : Randomized controlled trial. : Medical and surgical intensive care unit at University Hospital Gasthuisberg. : Ninety critically ill patients were included as soon as their cardiorespiratory condition allowed bedside cycling exercise (starting from day 5), given they still had an expected prolonged intensive care unit stay of at least 7 more days. : Both groups received respiratory physiotherapy and a daily standardized passive or active motion session of upper and lower limbs. In addition, the treatment group performed a passive or active exercise training session for 20 mins/day, using a bedside ergometer. : All outcome data are reflective for survivors. Quadriceps force and functional status were assessed at intensive care unit discharge and hospital discharge. Six-minute walking distance was measured at hospital discharge. No adverse events were identified during and immediately after the exercise training. At intensive care unit discharge, quadriceps force and functional status were not different between groups. At hospital discharge, 6-min walking distance, isometric quadriceps force, and the subjective feeling of functional well-being (as measured with "Physical Functioning" item of the Short Form 36 Health Survey questionnaire) were significantly higher in the treatment group (p < .05). : Early exercise training in critically ill intensive care unit survivors enhanced recovery of functional exercise capacity, self-perceived functional status, and muscle force at hospital discharge.

Parental availability for the care of sick children.

PubMed

Heymann, S J; Earle, A; Egleston, B

1996-08-01

Parents have always played a critical role in the care of sick children. Although parents' roles remain crucial to children's health, parental availability has declined during the past half century. The percentage of women with preschool children who work has risen almost fivefold in 45 years from 12% in 1947 to 58% in 1992. The percentage of women in the paid work force with school-aged children has almost tripled in the same period, from 27.3% to 75.9%. Research has examined the effects of a variety of parental work conditions on children. However, past research has not examined how working conditions affect the ability of parents to care for their sick children. In this article, we examine how often the children of working parents get sick and whether parents receive enough paid leave to care for their sick children. This analysis makes use of two national surveys, which provide complementary information regarding the care of sick children. The National Longitudinal Survey of Youth is a longitudinal survey of a nationally representative probability sample of 12,686 men and women; the National Medical Expenditure Survey is a panel survey of 34,459 people. First, we estimated the family illness burden. Second, we looked in detail at the number of days of sick leave mothers had. Third, we examined whether mothers who had sick leave had it consistently during a 5-year period. Finally, we conducted a logistic regression to determine what factors were significant predictors of both lacking sick leave. More than one in three families faced a family illness burden of 2 weeks or more each year. Yet, 28% of mothers had sick leave none of the time they were employed between 1985 and 1990. Employed mothers of children with chronic conditions had less sick leave than other employed mothers. Thirty-six percent of mothers whose children had chronic conditions had sick leave none of the time they were employed. Although 20% of working parents who did not live in poverty lacked sick leave, 38% of parents who did live in poverty lacked sick leave. The problem is also more marked for nonwhite parents. Although 23% of working white parents lacked paid sick leave, 31% of nonwhite parents lacked sick leave. One in six families that lacked sick leave had to cover for more than 4 weeks of family illness during the year. In 1993, the US Congress passed the Family and Medical Leave Act (FMLA). However, by limiting the medical leave to the care of major illnesses, primarily those requiring hospitalization, the FMLA does not address the majority of children's sick care needs. For the common childhood illnesses that are not covered by the FMLA, employed parents often must rely on their sick leave if they are to care for their sick children themselves. Yet, we found that many employed parents lack sick leave. This is particularly true of parents of children with chronic conditions and poor and minority families.

Urologist Density and County-Level Urologic Cancer Mortality

PubMed Central

Odisho, Anobel Y.; Cooperberg, Matthew R.; Fradet, Vincent; Ahmad, Ardalan E.; Carroll, Peter R.

2010-01-01

Purpose The surgical work force distribution at the county level varies widely across the United States, and the impact of differential access on cancer outcomes is unclear. We used urologists as a test case because they are the first care providers for urologic cancers, can easily be identified from available data sources, and are unevenly distributed throughout the country. The goal of this study was to determine the effect of increasing urologist density on local prostate, bladder, and kidney cancer mortality. Patients and Methods Using county-level data from the Area Resource File, US Census, National Cancer Institute, and Centers for Disease Control, regression models were built for prostate, bladder, and kidney cancer mortality, controlling for categorized urologist density, county demographics, socioeconomic factors, and preexisting health care infrastructure. Results For each of the three cancers, there was a statistically significant cancer-specific mortality reduction associated with counties that had more than zero urologists (16% to 22% reduction for prostate cancer, 17% to 20% reduction for bladder cancer, and 8% to 14% reduction for kidney cancer with increasing urologist density) relative to zero urologists. However, increasing density greater than two urologists per 100,000 people had no statistically significant impact on mortality for any of the tumors studied. Conclusion The presence of a urologist is associated with lower mortality for urologic cancers in that county, but increasing urologist density does not yield further improvements. Therefore, a nuanced and geographically aware policy toward the size and distribution of the future work force is most likely to provide the greatest population-level improvement in cancer mortality outcomes. PMID:20406931

Purchasing oncology services. Kerr L. White Institute/American Cancer Society Task Force on Purchasing Oncology Services.

PubMed

Cangialose, C B; Blair, A E; Borchardt, J S; Ades, T B; Bennett, C L; Dickersin, K; Gesme, D H; Henderson, I C; McGinnis, L S; Mooney, K; Mortenson, L E; Sperduto, P; Winkenwerder, W; Ballard, D J

2000-06-15

A multidisciplinary panel representing various stakeholders in the health care delivery and oncology services marketplace was convened to develop specific criteria for healthcare purchasers to consider when evaluating the structures and processes of health plans. These rank ordered criteria also can be used by oncologic service providers and health plan designers as a yardstick for the services they offer. A multidisciplinary 31-member Task Force was assembled by the Kerr L. White Institute and the American Cancer Society in March 1997. Task Force members were selected for their ability to offer expert insight as purchasers, suppliers, policymakers, consumers, or stakeholders in the health care marketplace. A preference-weighted majority voting rule was used to identify the three most important recommendations of the 10 that were generated through a modified Delphi technique. To test the practicality of the top three recommendations, leaders of large managed care organizations (MCOs) were surveyed; the results of this survey then were compared with the results of the Task Force survey. The three most important recommendations from the Task Force were that health plans provide access to: 1) comprehensive cancer care, 2) preventive and screening services, and 3) second opinions and treatment options supported by scientific evidence. The difference between the responses of the Task Force and the MCOs was that MCOs placed the highest importance on evidence-based decision-making, with their next three rankings coinciding with those identified by the Task Force. The value of these summary recommendations will be realized through their use by both purchasers and suppliers to influence the structure and content of the delivery of oncologic services.

Grasp Assist Device with Automatic Mode Control Logic

NASA Technical Reports Server (NTRS)

Laske, Evan (Inventor); Davis, Donald R. (Inventor); Ihrke, Chris A. (Inventor)

2018-01-01

A system includes a glove, sensors, actuator assemblies, and controller. The sensors include load sensors which measure an actual grasping force and attitude sensors which determine a glove attitude. The actuator assembly provides a grasp assist force to the glove. Respective locations of work cells in the work environment and permitted work tasks for each work cell are programmed into the controller. The controller detects the glove location and attitude. A work task is selected by the controller for the location. The controller calculates a required grasp assist force using measured actual grasping forces from the load sensors. The required grasp assist force is applied via the glove using the actuator assembly to thereby assist the operator in performing the identified work task.

Post-Traumatic Stress Disorder among French Armed Forces Members in Afghanistan: A New Approach.

PubMed

Paul, Frédéric; Marimoutou, Catherine; Pommier de Santi, Vincent; Clervoy, Patrick

2016-01-01

During the 20th century, the management of war-related psychological trauma shifted from neurology to psychiatry. After September 11, 2001, the French forces participated in a multinational force deployed in Afghanistan to fight against terrorism. Post-traumatic stress disorder (PTSD) became a priority. We report the daily work of the psychiatrists involved in this mission and the organization developed to psychologically support wounded military personnel. The doctrine of early intervention psychiatrization and the technique of collective debriefing are the key points of this procedure. The psychiatrist is also responsible for the healthcare community, particularly vulnerable when confronted with severe ballistic injuries. One aim of this organization is also to screen PTSD in soldiers returning from Afghanistan. The military general practitioner is a pivotal point of this procedure built to detect PTSD, anxiety, depressive reaction and behavioral problems. The French health service has developed a genuine care strategy aimed at identifying patients, accompanying them in the formalities for recognition and compensation, and offering them treatment locally by arranging clinical psychology consultations near their home. © 2016 S. Karger AG, Basel.

Do inclusive work environments matter? Effects of community-integrated employment on quality of life for individuals with intellectual disabilities.

PubMed

Blick, Rachel N; Litz, Katherine S; Thornhill, Monica G; Goreczny, Anthony J

2016-01-01

More individuals with an intellectual disability now possess prerequisite skills and supports necessary for successful work force integration than did previous generations. The current study compared quality of life of community-integrated workers with those participating in sheltered vocational workshops and adult day care programs. We considered numerous indices of quality of life, including inclusion and community participation; satisfaction within professional services, home life, and day activities; dignity, rights, and respect received from others; fear; choice and control; and family satisfaction. Our data revealed several important differences in quality of life across daytime activities; participants involved in community-integrated employment tended to be younger, indicated a greater sense of community integration, and reported more financial autonomy than did those who participated in adult day care programs and sheltered workshops. However, individuals reported no differences in overall satisfaction across daytime activities. We discuss generational differences across employment status as well as possible explanations to account for high levels of satisfaction across daytime activities. Copyright © 2016 Elsevier Ltd. All rights reserved.

[Orthopedics and patients under national socialism dictatorship].

PubMed

Thomann, K D; Rauschmann, M

2001-10-01

The 12-year dictatorship of National Socialism represents a decisive event in the history of orthopedics in Germany. Treatment and care was limited to those patients whose prognosis promised their reintegration into the work force. Those orthopedic patients with mental and psychological handicaps no longer came under the care of orthopedists and were potential candidates for annihilation. Despite concerted efforts to the contrary, as can be gleaned from the lists of topics at the annual meetings, the prevailing political circumstances encumbered scientific activities. The almost total isolation from international contacts had a negative effect. Orthopedists were hindered in their work by the law on sterilization, which provided for sterilization in cases of severe physical deformity. Some orthopedists even considered the presence of hip dysplasia to be an indication. The roles played by Georg Hohmann, Hellmut Eckhardt, Lothar Kreuz, and other leading orthopedists are described in detail. It can be regarded as certain that Hohmann and Eckhardt were able to prevent dire consequences for their orthopedic patients and the profession by cautious tactics. The ethnical problems of involvement with National Socialism are thoroughly discussed.

State Workforce Policy Initiative.

ERIC Educational Resources Information Center

Public/Private Ventures, Philadelphia, PA.

Surging demand for workers, growing income inequality, and passage of welfare reforms have made work force development one of the United States' key national concerns. Public/Private Ventures has been working with various states to design work force development strategies that seek to address the concerns of many work force development specialists…

Consequences of caring for a child with a chronic disease: Employment and leisure time of parents.

PubMed

Hatzmann, Janneke; Peek, Niels; Heymans, Hugo; Maurice-Stam, Heleen; Grootenhuis, Martha

2014-12-01

Chronically ill children require several hours of additional care per day compared to healthy children. As parents provide most of this care, they have to incorporate it into their daily schedule, which implies a reduction in time for other activities. The study aimed to assess the effect of having a chronically ill child on parental employment and parental leisure activity time, and to explore the role of demographic, social, and disease-related variables in relation to employment and leisure activities. Outcomes of 576 parents of chronically ill children and 441 parents of healthy school children were analyzed with multivariate regression. Having a chronically ill child was negatively related with family employment, maternal labor force participation, and leisure activity time. Use of child care was positively related to family and maternal employment of the total group of parents. Within parents of chronically ill children, most important finding was the negative relation of dependency of the child on daily care and low parental educational level with family and maternal employment. In conclusion, parents of chronically ill children, mothers in particular, are disadvantaged in society probably due to the challenge of combining child care with work and leisure time. © The Author(s) 2013.

A COMPARISON OF STATIC AND DYNAMIC OPTIMIZATION MUSCLE FORCE PREDICTIONS DURING WHEELCHAIR PROPULSION

PubMed Central

Morrow, Melissa M.; Rankin, Jeffery W.; Neptune, Richard R.; Kaufman, Kenton R.

2014-01-01

The primary purpose of this study was to compare static and dynamic optimization muscle force and work predictions during the push phase of wheelchair propulsion. A secondary purpose was to compare the differences in predicted shoulder and elbow kinetics and kinematics and handrim forces. The forward dynamics simulation minimized differences between simulated and experimental data (obtained from 10 manual wheelchair users) and muscle co-contraction. For direct comparison between models, the shoulder and elbow muscle moment arms and net joint moments from the dynamic optimization were used as inputs into the static optimization routine. RMS errors between model predictions were calculated to quantify model agreement. There was a wide range of individual muscle force agreement that spanned from poor (26.4 % Fmax error in the middle deltoid) to good (6.4 % Fmax error in the anterior deltoid) in the prime movers of the shoulder. The predicted muscle forces from the static optimization were sufficient to create the appropriate motion and joint moments at the shoulder for the push phase of wheelchair propulsion, but showed deviations in the elbow moment, pronation-supination motion and hand rim forces. These results suggest the static approach does not produce results similar enough to be a replacement for forward dynamics simulations, and care should be taken in choosing the appropriate method for a specific task and set of constraints. Dynamic optimization modeling approaches may be required for motions that are greatly influenced by muscle activation dynamics or that require significant co-contraction. PMID:25282075

Task analysis of Air Force pharmacy practice.

PubMed

Bartholomew, A; Sawyer, W T; Coats, L

1995-01-15

The frequency with which United States Air Force pharmacists perform specific professional tasks and the pharmacists' views as to the importance of those tasks were studied. A questionnaire was prepared that asked recipients to rate each of 36 tasks selected as representing the spectrum of practice activities. There were four categories of tasks: managerial tasks, dispensing tasks, drug information tasks, and patient care tasks. Recipients rated the tasks with respect to frequency of performance and importance on separate 6-point scales. The questionnaire was mailed in May 1991 to the 225 pharmacists then serving in the Air Force worldwide. Of the 225 questionnaires, 150 usable questionnaires were returned (response rate, 67%). All the tasks in the survey were performed by at least one Air Force pharmacy officer, although the frequency of task performance varied. In particular, the frequency of many patient care tasks was low. All the tasks were perceived to have some importance, but drug information tasks were rated as being significantly more important than tasks in the other categories; patient care tasks were rated lowest in importance. The results varied with the respondents' demographic characteristics. Pharmacy officers with more years of service, more senior positions, higher rank, or an advanced degree in a field other than pharmacy tended to give responses that diverged from those of the population. A 1991 survey showed an awareness among Air Force pharmacists of the need to orient practice around patient care; however, they were not spending substantial time on patient care and tended to view it as less important than more traditional pharmacy tasks.

Innovations in primary care behavioral health: a pilot study across the U.S. Air Force.

PubMed

Landoll, Ryan R; Nielsen, Matthew K; Waggoner, Kathryn K; Najera, Elizabeth

2018-05-04

Integrated primary care services have grown in popularity in recent years and demonstrated significant benefits to the patient experience, patient health, and health care operations. However, broader systems-level factors for health care organizations, such as utilization, access, and cost, have been understudied. The current study reviews the results of quality improvement project conducted by the U.S. Air Force, which has practiced integrated primary care behavioral health for over 20 years. This study focuses on exploring how shifting the access point for behavioral from specialty mental health clinics to primary care, along with the use of technicians in patient care, can improve a range of health outcomes. Retrospective data analysis was conducted on an internal Air Force quality improvement project implemented at three military treatment facilities from October 2014 to September 2015. Positive preliminary support for these innovations was seen in the form of expanded patient populations, decreased time to first appointment, increased patient encounters, and decreased purchased community care compared with non-participating sites. Incorporation of behavioral health technicians further increased number of patient encounters while maintaining high levels of patient satisfaction across diverse clinical settings; in fact, patients preferred appointments with both technicians and behavioral health providers, compared with appointments with behavioral health providers only. These findings encourage further systematic review of systems-level factors in primary care behavioral health and adoption of the use of provider extenders in primary care behavioral health clinics.

Defense.gov - Special Report - Travels With Gates

Science.gov Websites

Force Base, Ala. Story» Warfighter Care at Center of 2010 Budget Considerations MAXWELL AIR FORCE BASE , Ala., April 15, 2009 – Defense Secretary Robert M. Gates met at Maxwell Air Force Base, Ala., with the U.S. Air Force Air War College on Maxwell Air Force Base, Ala., listen to Defense Secretary Robert

Part-time careers in academic internal medicine: a report from the association of specialty professors part-time careers task force on behalf of the alliance for academic internal medicine.

PubMed

Linzer, Mark; Warde, Carole; Alexander, R Wayne; Demarco, Deborah M; Haupt, Allison; Hicks, Leroi; Kutner, Jean; Mangione, Carol M; Mechaber, Hilit; Rentz, Meridith; Riley, Joanne; Schuster, Barbara; Solomon, Glen D; Volberding, Paul; Ibrahim, Tod

2009-10-01

To establish guidelines for more effectively incorporating part-time faculty into departments of internal medicine, a task force was convened in early 2007 by the Association of Specialty Professors. The task force used informal surveys, current literature, and consensus building among members of the Alliance for Academic Internal Medicine to produce a consensus statement and a series of recommendations. The task force agreed that part-time faculty could enrich a department of medicine, enhance workforce flexibility, and provide high-quality research, patient care, and education in a cost-effective manner. The task force provided a series of detailed steps for operationalizing part-time practice; to do so, key issues were addressed, such as fixed costs, malpractice insurance, space, cross-coverage, mentoring, career development, productivity targets, and flexible scheduling. Recommendations included (1) increasing respect for work-family balance, (2) allowing flexible time as well as part-time employment, (3) directly addressing negative perceptions about part-time faculty, (4) developing policies to allow flexibility in academic advancement, (5) considering part-time faculty as candidates for leadership positions, (6) encouraging granting agencies, including the National Institutes of Health and Veterans Administration, to consider part-time faculty as eligible for research career development awards, and (7) supporting future research in "best practices" for incorporating part-time faculty into academic departments of medicine.

Modern medical practice: a profession in transition.

PubMed

Merry, M D

1984-05-01

Modern medical practice is in a state of transition. The solo practitioner is slowly giving way to the large organized groups of health care providers. Driving this force of change is a change in payment for health care services from cost plus to preestablished pricing. For the first time, medical practice patterns are having a direct impact on the financial viability of the health care institution. To maintain quality of patient care and contain costs, more and more physicians are becoming involved in the administrative side of running a hospital. This article describes the forces of change, the change itself, and the future of medicine.

Cost-effectiveness of forced air warming during sedation in the cardiac catheterisation laboratory.

PubMed

Conway, Aaron; Duff, Jed; Sutherland, Joanna

2018-05-13

To determine the cost-effectiveness of forced air warming during sedation in a cardiac catheterisation laboratory. Forced air warming improves thermal comfort in comparison with standard care. It is not known whether the extra costs required for forced air warming are good value. Cost-effectiveness analysis alongside a randomised controlled trial conducted in 2016-2017. A cost-effectiveness analysis was undertaken using Monte Carlo simulations from input distributions to estimate costs and effects associated with using forced air warming to reduce risk of thermal discomfort for patients receiving sedation in a cardiac catheterisation laboratory. A range of willingness to pay threshold values were tested with results plotted on a cost-effectiveness acceptability curve. Costs were calculated in Australian currency ($AUD). Estimated total costs were $5.21 (SD 3.26) higher per patient for forced air warming in comparison to standard care. Estimated probability of success (rating of thermal comfort) was 0.16 (0.06) higher for forced air warming. Forced air warming becomes more likely to result in a net benefit than standard care at a willingness to pay threshold of $34. Forced air warming could be considered cost-effective for procedures performed with sedation in a cardiac catheterisation laboratory if the extra cost of an incremental gain in thermal comfort is less than the decision maker's willingness to pay for it. Therefore, those responsible for decision-making regarding use of forced air warming in the cardiac catheterisation laboratory can use results of our model to decide if it represents good value for their organisation. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

The impact of rheumatoid arthritis on work capacity in Chinese patients: a cross-sectional study.

PubMed

Zhang, Xiaoying; Mu, Rong; Wang, Xiuru; Xu, Chuanhui; Duan, Tianjiao; An, Yuan; Han, Shuling; Li, Xiaofeng; Wang, Lizhi; Wang, Caihong; Wang, Yongfu; Yang, Rong; Wang, Guochun; Lu, Xin; Zhu, Ping; Chen, Lina; Liu, Jinting; Jin, Hongtao; Liu, Xiangyuan; Sun, Lin; Wei, Ping; Wang, Junxiang; Chen, Haiying; Cui, Liufu; Shu, Rong; Liu, Bailu; Zhang, Zhuoli; Li, Guangtao; Li, Zhenbin; Yang, Jing; Li, Junfang; Jia, Bin; Zhang, Fengxiao; Tao, Jiemei; Lin, Jinying; Wei, Meiqiu; Liu, Xiaomin; Ke, Dan; Hu, Shaoxian; Ye, Cong; Yang, Xiuyan; Li, Hao; Huang, Cibo; Gao, Ming; Lai, Pei; Li, Xingfu; Song, Lijun; Wang, Yi; Wang, Xiaoyuan; Su, Yin; Li, Zhanguo

2015-08-01

To evaluate the impact of RA on work capacity and identify factors related to work capacity impairment in patients with RA. A cross-sectional multicentre study was performed in 21 tertiary care hospitals across China. A consecutive sample of 846 patients with RA was recruited, of which 589 patients of working age at disease onset constituted the study population. Information on the socio-demographic, clinical, working and financial conditions of the patients was collected. Logistic regression analyses were used to identify factors associated with work capacity impairment. The rate of work capacity impairment was 48.0% in RA patients with a mean disease duration of 60 months (interquartile range 14-134 months), including 11.7% leaving the labour force early, 33.6% working reduced hours and 2.7% changing job. Multivariable logistic regression analysis showed that reduced working hours was significantly related to current smoking [odds ratio (OR) 2.07 (95% CI 1.08, 3.97)], no insurance [OR 1.94 (95% CI 1.20, 3.12)], in manual labour [OR 2.66 (95% CI 1.68, 4.20)] and higher HAQ score [OR 2.22 (95% CI 1.36, 3.60)]. There was an association of current smoking [OR 3.75 (95% CI 1.54, 9.15)], in manual labour [OR 2.33 (95% CI 1.17, 4.64)], longer disease duration [OR 1.01 (95% CI 1.00, 1.01)] and lower BMI [OR 0.90 (95% CI 0.82, 0.99)] with leaving the labour force early. There is a substantial impact of RA on the work capacity of patients in China. Social-demographic, disease- and work-related factors are all associated with work capacity impairment. © The Author 2015. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Attitudes and beliefs regarding cardiovascular risk factors among Bangladeshi immigrants in the US.

PubMed

Patel, Mihir; Phillips-Caesar, Erica; Boutin-Foster, Carla

2014-10-01

The US has increasingly growing Bangladeshi population, a South Asian sub-ethnic group with a high prevalence of cardiovascular disease (CVD). We conducted a qualitative study using individual in-depth interviews to explore attitudes towards and difficulties with modifying CVD related behaviors among a Bangladeshi cohort. We interviewed 55 patients before reaching data saturation. Bangladeshis discussed the meaning of health and heart disease in the context of how disease can potentially impact their ability to care for their family. Behavioral and psychological factors were discussed as the causes of CVD. Internal forces and external forces were brought up to explain difficulties addressing the causes of CVD. Bangladeshi individuals in our study were aware of CVD, but felt unable to address behavioral risk factors. They cite a combination of internal and external factors as barriers to lifestyle modification. Interventions to address these barriers must simultaneously addressing self-efficacy and work-life balance.

Attitudes and Beliefs Regarding Cardiovascular Risk Factors Among Bangladeshi Immigrants in the US

PubMed Central

Phillips-Caesar, Erica; Boutin-Foster, Carla

2015-01-01

The US has increasingly growing Bangladeshi population, a South Asian sub-ethnic group with a high prevalence of cardiovascular disease (CVD). We conducted a qualitative study using individual in-depth interviews to explore attitudes towards and difficulties with modifying CVD related behaviors among a Bangladeshi cohort. We interviewed 55 patients before reaching data saturation. Bangladeshis discussed the meaning of health and heart disease in the context of how disease can potentially impact their ability to care for their family. Behavioral and psychological factors were discussed as the causes of CVD. Internal forces and external forces were brought up to explain difficulties addressing the causes of CVD. Bangladeshi individuals in our study were aware of CVD, but felt unable to address behavioral risk factors. They cite a combination of internal and external factors as barriers to lifestyle modification. Interventions to address these barriers must simultaneously addressing self-efficacy and work-life balance. PMID:23861069

“Catching Flies With Honey”: The Management of Conflict in Sexual Assault Response Teams

PubMed Central

Moylan, Carrie A.; Lindhorst, Taryn

2015-01-01

Sexual Assault Response Teams (SARTs) are models of service delivery characterized by coordination between rape crisis, health care, and criminal justice sectors. Expanding on research documenting the extent and nature of conflict in SARTs, this study qualitatively explores the strategies used to manage conflict and variations in the use of strategies between professions. Analysis of interviews with SART members (n = 24) revealed five types of strategies: (a) preventative strategies sought to prevent conflict and build capacity for resolving conflict, (b) problem-solving strategies identified and responded directly to conflicts, (c) forcing strategies involved one person attempting to force a perspective or solution on others, (d) unobtrusive strategies covertly worked toward change, and (e) resigned strategies limited direct responses to conflict to protect the coordination. Rape crisis advocates talked the most about conflict management strategies and were almost exclusively responsible for unobtrusive and resignation strategies. PMID:25246436

Joint Task Force on Undergraduate Physics Programs: Implications for physics programs and why you should care

NASA Astrophysics Data System (ADS)

Hodapp, Theodore

2016-03-01

The content of undergraduate physics programs has not changed appreciably in 50 years, however, the jobs our students take have changed dramatically. Preparing students for careers they are likely to encounter requires physics programs to rethink and in some cases retool to provide an education that will not only educate an individual in the habits of mind and keen sense of how to solve complex technical problems, but also what related skills they will need to be effective in those careers. Do you teach your student how to read or create a budget? How about dealing with a low-performing member of an R&D team? This talk will explore driving forces behind this report, potential implications for physics departments, and practical steps faculty members can take to continue to consider improvements in experiences for our students. This work is supported in part by the National Science Foundation (NSF-1540570).

Training Australian Defence Force Medical Officers to civilian general practice training standards--reflections on military medicine and its links to general practice education and training.

PubMed

Kitchener, Scott J; Rushbrook, Elizabeth; Brennan, Leonard; Davis, Stephen

2011-06-06

This article examines military medicine and its links to civilian general practice education and training, drawing attention to the variations and difficulties in, and successful approaches for, training Australian Defence Force (ADF) Medical Officers. Military medicine has been an area of change over the 10 years of the Australian General Practice Training (AGPT) program. Crisis situations like those in Timor Leste and Afghanistan have focused attention and recognition on the importance of primary health care in the work of the ADF. To train doctors in military medicine, there are several different models at different locations around Australia, as well as large variations in military course and experience recognition and approvals between AGPT regional training providers. At times, the lack of standardisation in training delays the progress of ADF registrars moving through the AGPT program and becoming independently deployable Medical Officers.

Multiple Criteria Decision Analysis for Health Care Decision Making--Emerging Good Practices: Report 2 of the ISPOR MCDA Emerging Good Practices Task Force.

PubMed

Marsh, Kevin; IJzerman, Maarten; Thokala, Praveen; Baltussen, Rob; Boysen, Meindert; Kaló, Zoltán; Lönngren, Thomas; Mussen, Filip; Peacock, Stuart; Watkins, John; Devlin, Nancy

2016-01-01

Health care decisions are complex and involve confronting trade-offs between multiple, often conflicting objectives. Using structured, explicit approaches to decisions involving multiple criteria can improve the quality of decision making. A set of techniques, known under the collective heading, multiple criteria decision analysis (MCDA), are useful for this purpose. In 2014, ISPOR established an Emerging Good Practices Task Force. The task force's first report defined MCDA, provided examples of its use in health care, described the key steps, and provided an overview of the principal methods of MCDA. This second task force report provides emerging good-practice guidance on the implementation of MCDA to support health care decisions. The report includes: a checklist to support the design, implementation and review of an MCDA; guidance to support the implementation of the checklist; the order in which the steps should be implemented; illustrates how to incorporate budget constraints into an MCDA; provides an overview of the skills and resources, including available software, required to implement MCDA; and future research directions. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Understanding multinational companies in public health systems, using a competitive advantage framework.

PubMed

Lethbridge, Jane

2011-07-01

This paper discusses the findings of a study which developed five case studies of five multinational health care companies involved in public health care systems. Strategies were analysed in terms of attitude to marketing, pricing and regulation. The company strategies have been subjected to an analysis using Porter's Five Forces, a business strategy framework, which is unusual in health policy studies. This paper shows how analysing company strategy using a business tool can contribute to understanding the strategies of global capital in national health systems. It shows how social science methodologies can draw from business methods to explain company strategies. The five companies considered in this paper demonstrate that their strategies have many dimensions, which fit into Porter's Five Forces of comparative advantage. More importantly the Five Forces can be used to identify factors that influence company entry into public health care systems. The process of examining the strategic objectives of five health care companies shows that a business tool can help to explain the actions and motives of health care companies towards public health care systems, and so contribute to a better understanding of the strategies of global capital in national health systems. Health service commissioners need to understand this dynamic process, which will evolve as the nature of public health care systems change.

Multiple Criteria Decision Analysis for Health Care Decision Making--An Introduction: Report 1 of the ISPOR MCDA Emerging Good Practices Task Force.

PubMed

Thokala, Praveen; Devlin, Nancy; Marsh, Kevin; Baltussen, Rob; Boysen, Meindert; Kalo, Zoltan; Longrenn, Thomas; Mussen, Filip; Peacock, Stuart; Watkins, John; Ijzerman, Maarten

2016-01-01

Health care decisions are complex and involve confronting trade-offs between multiple, often conflicting, objectives. Using structured, explicit approaches to decisions involving multiple criteria can improve the quality of decision making and a set of techniques, known under the collective heading multiple criteria decision analysis (MCDA), are useful for this purpose. MCDA methods are widely used in other sectors, and recently there has been an increase in health care applications. In 2014, ISPOR established an MCDA Emerging Good Practices Task Force. It was charged with establishing a common definition for MCDA in health care decision making and developing good practice guidelines for conducting MCDA to aid health care decision making. This initial ISPOR MCDA task force report provides an introduction to MCDA - it defines MCDA; provides examples of its use in different kinds of decision making in health care (including benefit risk analysis, health technology assessment, resource allocation, portfolio decision analysis, shared patient clinician decision making and prioritizing patients' access to services); provides an overview of the principal methods of MCDA; and describes the key steps involved. Upon reviewing this report, readers should have a solid overview of MCDA methods and their potential for supporting health care decision making. Copyright © 2016. Published by Elsevier Inc.

Teaming Up for Asthma Control: EPR-3 Compliant School Program in Missouri Is Effective and Cost-Efficient.

PubMed

Francisco, Benjamin; Rood, Tammy; Nevel, Rebekah; Foreman, Paul; Homan, Sherri

2017-05-25

Teaming Up for Asthma Control (TUAC) is a work force development intervention to improve asthma control among children by increasing the competency of school nurses and delivering guideline-based education. We hypothesized that the knowledge and skills of participating school nurses would improve and that this change would positively affect students' asthma health and reduce health care utilization cost. Asthma education for school nurses was provided online in a pretest/posttest format or in instructor-led groups. Students with persistent asthma were identified by using a checklist. Expert evaluators obtained student participants' preassessments/postassessments before and after the 3 asthma checkups by the school nurse, and the assessments were compared. Health care costs were assessed using Medicaid administrative claims data. A total of 54 school nurses and 178 students in Missouri participated in the TUAC evaluation from 2011 through 2014. Among school nurses who completed the online education (n = 42, 77.8%), knowledge scores significantly increased from pretest (49.1%) to posttest (90.7%, P < .001). Of school nurses who completed assessments on 3 children (n = 34), 91.2% met the ±6% equivalence for 1 or more assessments on forced expiratory volume in 1 second (FEV 1 ) compared with the expert evaluator. At enrollment, 69.7% of students had "not well-controlled" or "very poorly controlled" asthma. Postintervention, FEV 1 significantly improved (82.9% to 92.1% predicted), and self-reported impairment and tobacco smoke exposure significantly declined (P < .001). For TUAC students enrolled in Medicaid, there was an average 12-month health care cost difference (-$1,431) compared with controls. School nurses effectively assessed asthma status, students' outcomes improved, and health care utilization costs declined. This evaluation contributed to program improvements to further improve health outcomes among students with asthma.

Impacts of Informal Caregiver Availability on Long-term Care Expenditures in OECD Countries

PubMed Central

Yoo, Byung-Kwang; Bhattacharya, Jay; McDonald, Kathryn M; Garber, Alan M

2004-01-01

Objective To quantify the effects of informal caregiver availability and public funding on formal long-term care (LTC) expenditures in developed countries. Data Source/Study Setting Secondary data were acquired for 15 Organization for Economic Cooperation and Development (OECD) countries from 1970 to 2000. Study Design Secondary data analysis, applying fixed- and random-effects models to time-series cross-sectional data. Outcome variables are inpatient or home heath LTC expenditures. Key explanatory variables are measures of the availability of informal caregivers, generosity in public funding for formal LTC, and the proportion of the elderly population in the total population. Data Collection/Extraction Method Aggregated macro data were obtained from OECD Health Data, United Nations Demographic Yearbooks, and U.S. Census Bureau International Data Base. Principal Findings Most of the 15 OECD countries experienced growth in LTC expenditures over the study period. The availability of a spouse caregiver, measured by male-to-female ratio among the elderly, is associated with a $28,840 (1995 U.S. dollars) annual reduction in formal LTC expenditure per additional elderly male. Availability of an adult child caregiver, measured by female labor force participation and full-time/part-time status shift, is associated with a reduction of $310 to $3,830 in LTC expenditures. These impacts on LTC expenditure vary across countries and across time within a country. Conclusions The availability of an informal caregiver, particularly a spouse caregiver, is among the most important factors explaining variation in LTC expenditure growth. Long-term care policies should take into account behavioral responses: decreased public funding in LTC may lead working women to leave the labor force to provide more informal care. PMID:15544640

Women and the family of the future.

PubMed

Quimby, C H

1994-02-01

The complexities of current societal trends impose a daunting challenge to providers of maternal child health services. Demographers, anthropologists, sociologists, policy makers, and health care providers struggle to grasp the multiple issues in an effort to create useful strategies for the 21st century. The 1990s have been labeled the decade of women's health. Legislative and policy efforts have focused new and much-needed attention on women as recipients and providers of health care. The realities of mothers in the work force, the epidemic of adolescent pregnancy, the swelling ranks of women and children in poverty, the increasing number of women with acquired immune deficiency syndrome, the new advances in reproductive technology, and the effect of population and immigration trends greatly influence the childbearing client of the future and create enormous pressures for critical problem solving.

When health care workers experience mental ill health: institutional practices of silence.

PubMed

Moll, Sandra; Eakin, Joan M; Franche, Renée-Louise; Strike, Carol

2013-02-01

Based on findings from an institutional ethnography in a large mental health organization, we explore how institutional forces shape the experiences of health care workers with mental health issues. We interviewed 20 employees about their personal experiences with mental health issues and work and 12 workplace stakeholders about their interactions with workers who had mental health issues. We also reviewed organizational texts related to health, illness, and productivity. In analyzing transcripts and texts, silence emerged as a core underlying process characterizing individual and organizational responses to employees with mental health issues. Silence was an active practice that took many forms; it was pervasive, complex, and at times, paradoxical. It served many functions for workers and the organization. We discuss the theoretical and practical implications of the findings for workers with mental health issues.

Agricultural Work Force Households: How Much Do They Depend on Farming? Background for Agricultural Policy. Agriculture Information Bulletin Number 547.

ERIC Educational Resources Information Center

Cox, E. Jane; Oliveira, Victor J.

According to data from the 1985 Agricultural Work Force Survey, over 13.5 million of the 17.6 million agricultural work force household members (77 percent) lived in households headed by a farm worker. Some farm workers worked on the farm as their primary job, whereas others primarily worked off the farm. Farm work was an occasional form of…

Supplies and equipment for pediatric emergency mass critical care

PubMed Central

Bohn, Desmond; Kanter, Robert K.; Burns, Jeffrey; Barfield, Wanda D.; Kissoon, Niranjan

2015-01-01

Introduction Epidemics of acute respiratory disease, such as severe acute respiratory syndrome in 2003, and natural disasters, such as Hurricane Katrina in 2005, have prompted planning in hospitals that offer adult critical care to increase their capacity and equipment inventory for responding to a major demand surge. However, planning at a national, state, or local level to address the particular medical resource needs of children for mass critical care has yet to occur in any coordinated way. This paper presents the consensus opinion of the Task Force regarding supplies and equipment that would be required during a pediatric mass critical care crisis. Methods In May 2008, the Task Force for Mass Critical Care published guidance on provision of mass critical care to adults. Acknowledging that the critical care needs of children during disasters were unaddressed by this effort, a 17-member Steering Committee, assembled by the Oak Ridge Institute for Science and Education with guidance from members of the American Academy of Pediatrics, convened in April 2009 to determine priority topic areas for pediatric emergency mass critical care recommendations. Steering Committee members established subcommittees by topic area and performed literature reviews of MEDLINE and Ovid databases. The Steering Committee produced draft outlines through consensus-based study of the literature and convened October 6 –7, 2009, in New York, NY, to review and revise each outline. Eight draft documents were subsequently developed from the revised outlines as well as through searches of MEDLINE updated through March 2010. The Pediatric Emergency Mass Critical Care Task Force, composed of 36 experts from diverse public health, medical, and disaster response fields, convened in Atlanta, GA, on March 29 –30, 2010. Feedback on each manuscript was compiled and the Steering Committee revised each document to reflect expert input in addition to the most current medical literature. Task Force Recommendations The Task Force endorsed the view that supplies and equipment must be available for a tripling of capacity above the usual peak pediatric intensive care unit capacity for at least 10 days. The recommended size-specific pediatric mass critical care equipment stockpile for two types of patients is presented in terms of equipment needs per ten mass critical care beds, which would serve 26 patients over a 10-day period. Specific recommendations are made regarding ventilator capacity, including the potential use of high-frequency oscillatory ventilation and extracorporeal membrane oxygenation. Other recommendations include inventories for disposable medical equipment, medications, and staffing levels. PMID:22067920

Strategic alliance: adapting to the business environment in long-term care.

PubMed

Mara, Cynthia Massie; Ziegenfuss, James T

2002-01-01

This article is addressed to long-term-care administrators and planners as well as purchasers of long-term care. Believing the current and future business environment will force continued adaptation in long-term-care organizations, the authors utilize nine categories to map pressures for change: cultural, technological, educational, political, legal, natural resource, demographic, sociologic, and economic. Long-term-care organizations, especially those that are not-for-profit, are becoming members of alliances as one way of addressing these pressures. This article describes and presents a case example of a composite alliance to demonstrate the advantages of membership in a strategic alliance. We also present examples of ways in which alliance members use strategic partnerships to improve their ability to manage these forces.

Time allocation of disabled individuals.

PubMed

Pagán, Ricardo

2013-05-01

Although some studies have analysed the disability phenomenon and its effect on, for example, labour force participation, wages, job satisfaction, or the use of disability pension, the empirical evidence on how disability steals time (e.g. hours of work) from individuals is very scarce. This article examines how disabled individuals allocate their time to daily activities as compared to their non-disabled counterparts. Using time diary information from the Spanish Time Use Survey (last quarter of 2002 and the first three quarters of 2003), we estimate the determinants of time (minutes per day) spent on four aggregate categories (market work, household production, tertiary activities and leisure) for a sample of 27,687 non-disabled and 5250 disabled individuals and decompose the observed time differential by using the Oaxaca-Blinder methodology. The results show that disabled individuals devote less time to market work (especially females), and more time to household production (e.g. cooking, cleaning, child care), tertiary activities (e.g., sleeping, personal care, medical treatment) and leisure activities. We also find a significant effect of age on the time spent on daily activities and important differences by gender and disability status. The results are consistent with the hypothesis that disability steals time, and reiterate the fact that more public policies are needed to balance working life and health concerns among disabled individuals. Copyright © 2013 Elsevier Ltd. All rights reserved.

40 CFR 35.936-14 - Force account work.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 1 2011-07-01 2011-07-01 false Force account work. 35.936-14 Section... ASSISTANCE STATE AND LOCAL ASSISTANCE Grants for Construction of Treatment Works-Clean Water Act § 35.936-14 Force account work. (a) A grantee must secure the project officer's prior written approval for use of...

Diversity in the Work Force. The Highlight Zone: Research @ Work No. 4.

ERIC Educational Resources Information Center

Wentling, Rose Mary

A literature review was conducted to identify critical work force diversity issues in today's changing workplace and identify ways organizations and career and technical education (CTE) practitioners can increase work force diversity. A broad, all-inclusive definition of diversity was developed that focuses on how diversity affects individuals and…

The Changing Health Care Market: Implications for Nursing Education in the Coming Decade.

ERIC Educational Resources Information Center

Huston, Carol Jorgensen; Fox, Sherry

1998-01-01

Dominant trends in health care that will affect nursing education include the following: growth of the health care labor force, economics, movement away from acute-care hospitals, managed care, demographic change, information technology, and replacement of nurses with unlicensed assistants. (JOW)

Curriculum Recommendations of the AACP-PSSC Task Force on Caring for the Underserved

PubMed Central

Roche, Victoria F.; Assemi, Mitra; Conry, John M.; Shane-McWhorter, Laura; Sorensen, Todd D.

2008-01-01

A task force was convened by the American Association of Colleges of Pharmacy (AACP) and the Pharmaceutical Services Support Center (PSSC) and charged with the development of a curriculum framework to guide pharmacy programs in educating students on caring for the underserved. Utilizing a literature-based model, the task force constructed a framework that delineated evidence-based practice, clinical prevention and health promotion, health systems and policy, and community aspects of practice. Specific learning outcomes tailored to underserved populations were crafted and linked to resources readily available to the academy. The AACP-PSSC curriculum framework was shared with the academy in 2007. Schools and Colleges are urged to share experiences with implementation so that the impact of the tool can be evaluated. The task force recommends that the AACP Institutional Research Advisory Committee be involved in gathering assessment data. Implementation of the curriculum framework can help the academy fulfill the professional mandate to proactively provide the highest quality care to all, including underserved populations. PMID:18698398

New urgent care pilot program for Prime beneficiaries > U.S. Air Force >

Science.gov Websites

The Book Speeches Archive Former AF Top 3 Viewpoints and Speeches Air Force Warrior Games 2017 Events 2018 Air Force Strategic Documents Desert Storm 25th Anniversary Observances DoD Warrior Games

Extremity War Injuries XII: Homeland Defense as a Translation of War Lessons Learned.

PubMed

Stinner, Maj Daniel J; Schmidt, Andrew H

2018-06-12

The 12th Extremity War Injuries Symposium focused on issues related to the transitions in medical care that are occurring as the focus of the war on terror changes. The symposium highlighted the results of Department of Defense-funded research in musculoskeletal injury, the evolution of combat casualty care, and the readiness of the fighting force. Presentations and discussions focused on force readiness of both troops and their medical support as well as the maintenance of the combat care expertise that has been developed during the previous decade of conflict.

Evaluation of knee joint forces during kneeling work with different kneepads.

PubMed

Xu, Hang; Jampala, Sree; Bloswick, Donald; Zhao, Jie; Merryweather, Andrew

2017-01-01

The main purpose of this study is to determine knee joint forces resulting from kneeling work with and without kneepads to quantify how different kneepads redistribute force. Eleven healthy males simulated a tile setting task to different locations during six kneepad states (five different kneepad types and without kneepad). Peak and average forces on the anatomical landmarks of both knees were obtained by custom force sensors. The results revealed that kneepad design can significantly modify the forces on the knee joint through redistribution. The Professional Gel design was preferred among the five tested kneepads which was confirmed with both force measurements and participants' responses. The extreme reaching locations induced significantly higher joint forces on left knee or right knee depending on task. The conclusion of this study is that a properly selected kneepad for specific tasks and a more neutral working posture can modify the force distribution on the knees and likely decrease the risk of knee disorders from kneeling work. Copyright © 2016 Elsevier Ltd. All rights reserved.

Participatory ergonomic intervention versus strength training on chronic pain and work disability in slaughterhouse workers: study protocol for a single-blind, randomized controlled trial.

PubMed

Sundstrup, Emil; Jakobsen, Markus D; Andersen, Christoffer H; Jay, Kenneth; Persson, Roger; Aagaard, Per; Andersen, Lars L

2013-02-21

The prevalence of musculoskeletal pain in the shoulder, arm and hand is high among slaughterhouse workers, allegedly due to the highly repetitive and forceful exposure of these body regions during work. Work disability is a common consequence of these pains. Lowering the physical exposure through ergonomics intervention is the traditional strategy to reduce the workload. An alternative strategy could be to increase physical capacity of the worker through strength training. This study investigates the effect of two contrasting interventions, participatory ergonomics versus strength training on pain and work disability in slaughterhouse workers with chronic pain. 66 slaughterhouse workers were allocated to 10 weeks of (1) strength training of the shoulder, arm and hand muscles for 3 x 10 minutes per week, or (2) participatory ergonomics involving counseling on workstation adjustment and optimal use of work tools (~usual care control group). Inclusion criteria were (1) working at a slaughterhouse for at least 30 hours per week, (2) pain intensity in the shoulder, elbow/forearm, or hand/wrist of at least 3 on a 0-10 VAS scale during the last three months, (3) pain lasting for more than 3 months, (4) frequent pain (at least 3 days per week) (5) at least moderate work disability, (6) no strength training during the last year, (7) no ergonomics instruction during the last year.Perceived pain intensity (VAS scale 0-10) of the shoulder, elbow/forearm and hand/wrist (primary outcome) and Disability of the Arm, Shoulder and Hand (Work module, DASH questionnaire) were measured at baseline and 10-week follow-up. Further, total muscle tenderness score and muscle function were assessed during clinical examination at baseline and follow-up. This RCT study will provide experimental evidence of the effectiveness of contrasting work-site interventions aiming at reducing chronic pain and work disability among employees engaged in repetitive and forceful work. ClinicalTrials.gov:NCT01671267.

The productivity of physician assistants and nurse practitioners and health work force policy in the era of managed health care.

PubMed

Scheffler, R M; Waitzman, N J; Hillman, J M

1996-01-01

Managed care is spreading rapidly in the United States and creating incentives for physician practices to find the most efficient combination of health professionals to deliver care to an enrolled population. Given these trends, it is appropriate to reexamine the roles of physician assistants (PAs) and nurse practitioners (NPs) in the health care workforce. This paper briefly reviews the literature on PA and NP productivity, managed care plans' use of PAs and NPs, and the potential impact of PAs and NPs on the size and composition of the future physician workforce. In general, the literature supports the idea that PAs and NPs could have a major impact on the future health care workforce. Studies show significant opportunities for increased physician substitution and even conservative assumptions about physician task delegation imply a large increase in the number of PAs and NPs that can be effectively deployed. However, the current literature has certain limitations that make it difficult to quantify the future impact of PAs and NPs. Among these limitations is the fact that virtually all formal productivity studies were conducted in fee-for-service settings during the 1970s, rather than managed care settings. In addition, the vast majority of PA and NP productivity studies have viewed PAs and NPs as physician substitutes rather than as members of interdisciplinary health care teams, which may become the dominant health care delivery model over the next 10-20 years.

Perception, consequences, communication, and strategies for handling fatigue in persons with rheumatoid arthritis of working age--a focus group study.

PubMed

Feldthusen, Caroline; Björk, Mathilda; Forsblad-d'Elia, Helena; Mannerkorpi, Kaisa

2013-05-01

The aim of this study was to describe how persons with rheumatoid arthritis (RA) of working age experience and handle their fatigue in everyday life. Six focus group discussions were conducted focusing on experiences of fatigue in 25 persons with RA (19 women, 6 men), aged 20-60 years. The discussions were recorded, transcribed verbatim, and analyzed according to qualitative content analysis. The analyses resulted in four categories. (1) Perception of fatigue: Fatigue was experienced different from normal tiredness, unpredictable, and overwhelming. It was associated with negative emotions, changed self-image, and fears. Feelings of frustration and shame were central when the persons were forced to omit valued life activities. (2) Consequences due to fatigue: The fatigue caused changes in cognitive ability, ability to act, and overall activity pattern where the increased need for rest and sleep caused an imbalance in daily life. The participants struggled not to let the fatigue interfere with work. The fatigue also brought negative consequences for their significant others. (3) Communicating fatigue: Fatigue was difficult to gain understanding for, and the participants adjusted their communication accordingly; it was important to keep up appearances. During medical consultation, fatigue was perceived as a factor not given much consideration, and the participants expressed taking responsibility for managing their fatigue symptoms themselves. (4) Strategies to handle fatigue: Strategies comprised conscious self-care, mental strategies, planning, and prioritizing. Fatigue caused considerable health problems for persons with RA of working age: negative emotions, imbalance in daily life due to increased need for rest, and difficulties gaining understanding. This draws attention to the importance of developing new modes of care to address fatigue in RA. Person-centered care to improve balance in life may be one approach needing further investigations.

Hour-glass ceilings: Work-hour thresholds, gendered health inequities.

PubMed

Dinh, Huong; Strazdins, Lyndall; Welsh, Jennifer

2017-03-01

Long workhours erode health, which the setting of maximum weekly hours aims to avert. This 48-h limit, and the evidence base to support it, has evolved from a workforce that was largely male, whose time in the labour force was enabled by women's domestic work and care giving. The gender composition of the workforce has now changed, and many women (as well as some men) combine care-giving with paid work, a change viewed as fundamental for gender equality. However, it raises questions on the suitability of the work time limit and the extent it is protective of health. We estimate workhour-mental health thresholds, testing if they vary for men and women due to gendered workloads and constraints on and off the job. Using six waves of data from a nationally representative sample of Australian adults (24-65 years), surveyed in the Household Income Labour Dynamics of Australia Survey (N = 3828 men; 4062 women), our study uses a longitudinal, simultaneous equation approach to address endogeneity. Averaging over the sample, we find an overall threshold of 39 h per week beyond which mental health declines. Separate curves then estimate thresholds for men and women, by high or low care and domestic time constraints, using stratified and pooled samples. We find gendered workhour-health limits (43.5 for men, 38 for women) which widen further once differences in resources on and off the job are considered. Only when time is 'unencumbered' and similar time constraints and contexts are assumed, do gender gaps narrow and thresholds approximate the 48-h limit. Our study reveals limits to contemporary workhour regulation which may be systematically disadvantaging women's health. Copyright © 2017 Elsevier Ltd. All rights reserved.

The leadership journey.

PubMed

Schaeffer, Leonard D

2002-10-01

It isn't always easy to change leadership hats or to alter the way you assess a business problem. Under pressure, most executives fall back on the management style or approach that worked in the last crisis they faced. But old approaches rarely work in new and demanding situations. Just ask Leonard Schaeffer, chairman and CEO of WellPoint Health Networks, one of the country's largest and most successful managed-care companies. In this account, he describes how he consciously adopted three very different styles of leadership at critical points during his 30-year career, depending on the business challenges at hand. Schaeffer headed up the U.S. Health Care Finance Administration during the Carter years--and led the charge toward more efficient work practices at that agency. Then he transformed Blue Cross of California from a floundering bureaucracy losing close to $1 million each day into a strong public company, WellPoint. The dire circumstances at Blue Cross had dictated that Schaeffer initially be an autocratic leader, which he considers the managerial equivalent of being an emergency room surgeon--forced to do whatever it takes to save a patient's life. But as the company rebounded, the CEO shed that "any decision is better than no decision" style. He has become a participative, hands-off leader-setting strategies and goals from above but letting WellPoint's line managers and executives figure out how best to achieve those goals. Most recently, Schaeffer has turned into a reformer--a leader who works with one foot outside the company to spur changes in health care and society. There are pitfalls in switching leadership styles, Schaeffer admits, but this flexibility is necessary for realizing corporate- and personal-success.

Strategies of organization and service for the critical-care laboratory.

PubMed

Fleisher, M; Schwartz, M K

1990-08-01

Critical-care medicine requires rapidity of treatment decisions and clinical management. To meet the objectives of critical-care medicine, the critical-care laboratory must consider four major aspects of laboratory organization in addition to analytical responsibilities: specimen collection and delivery, training of technologists, selection of reliable instrumentation, and efficient data dissemination. One must also consider the advantages and disadvantages of centralization vs decentralization, the influence of such a laboratory on patient care and personnel needs, and the space required for optimal operation. Centralization may lead to workflow interruption and increased turnaround time (TAT); decentralization requires redundancy of instrumentation and staff but may shorten TAT. Minimal TAT is the hallmark of efficient laboratory service. We surveyed 55 laboratories in 33 hospitals and found that virtually all hospitals with 200 or more beds had a critical-care laboratory operating as a satellite of the main laboratory. We present data on actual TAT, although these were available in only eight of the 15 routine laboratories that provided emergency service and in eight of the 40 critical-care laboratories. In meeting the challenges of an increasing workload, a reduced clinical laboratory work force, and the need to reduce TAT, changes in traditional laboratory practice are mandatory. An increased reliance on whole-blood analysis, for example, should eliminate delays associated with sample preparation, reduce the potential hazards associated with centrifugation, and eliminate excess specimen handling.

Aligning for Heroes: Partnership for Veteran Care in New Hampshire.

PubMed

Fasoli, DiJon R

2015-01-01

A growing number of veterans and service members ("veterans" refers to both veterans and eligible service members) are returning home and may be living with mental health conditions related to their military service. For a variety of reasons, the majority of US veterans receive their health care outside the Veterans Administration or the military health system. Nurse leaders and citizen-soldiers were among a number of concerned government officials, health care professionals, service providers, and military leaders in New Hampshire (NH) who joined forces to explore NH veterans' mental health needs and manage provider service capacity. This article describes the formation and efforts of a permanent legislative commission, the NH Commission on PTSD and TBI (COPT), composed of interdisciplinary, multiorganizational, and cross-governmental leaders aligned to address the issues of stigma, military cultural awareness, and integration of care. Commission participants were asked to share their perspectives on the gaps and challenges to veterans' care, opportunities for collaboration, and measurable outcomes. Key challenges included interagency communication and care integration issues, veteran and provider knowledge gaps about needs and system problems. Favorable timing, available funding, and the collaborative environment of the commission were identified as potential opportunities. While still a work in progress, the COPT has begun making an impact. We identify early outcomes and lessons learned. The COPT is a model for leveraging interdisciplinary professional collaboration to improve access to care for veterans.

Factors associated with sex work involvement among transgender women in Jamaica: a cross-sectional study.

PubMed

Logie, Carmen H; Wang, Ying; Lacombe-Duncan, Ashley; Jones, Nicolette; Ahmed, Uzma; Levermore, Kandasi; Neil, Ava; Ellis, Tyrone; Bryan, Nicolette; Marshall, Annecka; Newman, Peter A

2017-04-06

Transgender women are disproportionately impacted by HIV. Transgender women involved in sex work may experience exacerbated violence, social exclusion, and HIV vulnerabilities, in comparison with non-sex work-involved transgender women. Scant research has investigated sex work among transgender women in the Caribbean, including Jamaica, where transgender women report pervasive violence. The study objective was to examine factors associated with sex work involvement among transgender women in Jamaica. In 2015, we implemented a cross-sectional survey using modified peer-driven recruitment with transgender women in Kingston and Ocho Rios, Jamaica, in collaboration with a local community-based AIDS service organization. We conducted multivariable logistic regression analyses to identify factors associated with paid sex and transactional sex. Exchanging oral, anal or vaginal sex for money only was categorized as paid sex. Exchanging sex for survival needs (food, accommodation, transportation), drugs or alcohol, or for money along with survival needs and/or drugs/alcohol, was categorized as transactional sex. Among 137 transgender women (mean age: 24.0 [SD: 4.5]), two-thirds reported living in the Kingston area. Overall, 25.2% reported being HIV-positive. Approximately half (n = 71; 51.82%) reported any sex work involvement, this included sex in exchange for: money (n = 64; 47.06%); survival needs (n = 27; 19.85%); and drugs/alcohol (n = 6; 4.41%). In multivariable analyses, paid sex and transactional sex were both associated with: intrapersonal (depression), interpersonal (lower social support, forced sex, childhood sexual abuse, intimate partner violence, multiple partners/polyamory), and structural (transgender stigma, unemployment) factors. Participants reporting transactional sex also reported increased odds of incarceration perceived to be due to transgender identity, forced sex, homelessness, and lower resilience, in comparison with participants reporting no sex work involvement. Findings reveal high HIV infection rates among transgender women in Jamaica. Sex work-involved participants experience social and structural drivers of HIV, including violence, stigma, and unemployment. Transgender women involved in transactional sex also experience high rates of incarceration, forced sex and homelessness in comparison with non-sex workers. Taken together, these findings suggest that social ecological factors elevate HIV exposure among sex work-involved transgender women in Jamaica. Findings can inform interventions to advance human rights and HIV prevention and care cascades with transgender women in Jamaica.

Factors associated with sex work involvement among transgender women in Jamaica: a cross-sectional study

PubMed Central

Logie, Carmen H; Wang, Ying; Lacombe-Duncan, Ashley; Jones, Nicolette; Ahmed, Uzma; Levermore, Kandasi; Neil, Ava; Ellis, Tyrone; Bryan, Nicolette; Marshall, Annecka; Newman, Peter A

2017-01-01

Abstract Introduction: Transgender women are disproportionately impacted by HIV. Transgender women involved in sex work may experience exacerbated violence, social exclusion, and HIV vulnerabilities, in comparison with non-sex work-involved transgender women. Scant research has investigated sex work among transgender women in the Caribbean, including Jamaica, where transgender women report pervasive violence. The study objective was to examine factors associated with sex work involvement among transgender women in Jamaica. Methods: In 2015, we implemented a cross-sectional survey using modified peer-driven recruitment with transgender women in Kingston and Ocho Rios, Jamaica, in collaboration with a local community-based AIDS service organization. We conducted multivariable logistic regression analyses to identify factors associated with paid sex and transactional sex. Exchanging oral, anal or vaginal sex for money only was categorized as paid sex. Exchanging sex for survival needs (food, accommodation, transportation), drugs or alcohol, or for money along with survival needs and/or drugs/alcohol, was categorized as transactional sex. Results: Among 137 transgender women (mean age: 24.0 [SD: 4.5]), two-thirds reported living in the Kingston area. Overall, 25.2% reported being HIV-positive. Approximately half (n = 71; 51.82%) reported any sex work involvement, this included sex in exchange for: money (n = 64; 47.06%); survival needs (n = 27; 19.85%); and drugs/alcohol (n = 6; 4.41%). In multivariable analyses, paid sex and transactional sex were both associated with: intrapersonal (depression), interpersonal (lower social support, forced sex, childhood sexual abuse, intimate partner violence, multiple partners/polyamory), and structural (transgender stigma, unemployment) factors. Participants reporting transactional sex also reported increased odds of incarceration perceived to be due to transgender identity, forced sex, homelessness, and lower resilience, in comparison with participants reporting no sex work involvement. Conclusions: Findings reveal high HIV infection rates among transgender women in Jamaica. Sex work-involved participants experience social and structural drivers of HIV, including violence, stigma, and unemployment. Transgender women involved in transactional sex also experience high rates of incarceration, forced sex and homelessness in comparison with non-sex workers. Taken together, these findings suggest that social ecological factors elevate HIV exposure among sex work-involved transgender women in Jamaica. Findings can inform interventions to advance human rights and HIV prevention and care cascades with transgender women in Jamaica. PMID:28406598

A future for primary care for the Greek population.

PubMed

Groenewegen, Peter P; Jurgutis, Arnoldas

2013-01-01

Greece is hit hard by the state debt crisis. This calls for comprehensive reforms to restore sustainable and balanced growth. Healthcare is one of the public sectors needing reform. The European Union (EU) Task Force for Greece asked the authors to assess the situation of primary care and to make recommendations for reform. Primary healthcare is especially relevant in that it might increase the efficiency of the healthcare system, and improve access to good quality healthcare. Assessment of the state of primary care in Greece was made on the basis of existing literature, site visits in primary care and consultations with stakeholders. The governance of primary care (and healthcare in general) is fragmented. There is no system of gatekeeping or patient lists. Private payments (formal and informal) are high. There are too many physicians, but too few general practitioners and nurses, and they are unevenly spread across the country. As a consequence, there are problems of access, continuity, co-ordination and comprehensiveness of primary care. The authors recommend the development of a clear vision and development strategy for strengthening primary care. Stepped access to secondary care should be realised through the introduction of mandatory referrals. Primary care should be accessible through the lowest possible out-of-pocket payments. The roles of purchaser and provider of care should be split. Quality of care should be improved through development of clinical guidelines and quality indicators. The education of health professionals should put more emphasis on primary care and medical specialists working in primary care should be (re-)trained to acquire the necessary competences to satisfy the job descriptions to be developed for primary care professionals. The advantages of strong primary care should be communicated to patients and the wider public.

"You must not rely upon the words that very kind and beautiful girls utter, because in that regard, no offence, they all - lie":venereal diseases as a motive of Fran Gundrum's (1856-1919) work on sexual hygiene.

PubMed

Kuhar, Martin; Fatović-Ferenčić, Stella

2013-01-01

Until the works of Fran Gundrum, there was no comprehensive analysis of sexuality in Croatia. In this article, we investigate the background of Gundrum's book Sexual Health Care, the first book on sexual hygiene in Croatia. We analyzed the motivational effect venereal diseases had on writing the book, as well as the metaphoric language he used to conceptualize them. Venereal diseases are presented in his work as a consequence of irresponsible sexual behavior, and are interpreted using the analogy of natural state of English political philosopher Thomas Hobbes. All aspects of his suggestions for suppression of venereal diseases were colored by giving priority to social over individual well-being. Tradition and modernity intermix in his work, shaping him as the pioneer of sexual hygiene on our territory in the times when questions about heredity and survival of the nation started to forcefully shape public health policies.

Occupational safety and health objectives of Healthy People 2010: a systematic approach for occupational health nurses--Part II.

PubMed

Olszewski, Kimberly; Parks, Carol; Chikotas, Noreen E

2007-03-01

Occupational safety and health objectives 20.6 through 20.11 focus on reducing work-related assaults, lead exposure, skin diseases and disorders, needlestick injuries, and work-related, noise-induced hearing loss and promoting worksite stress reduction programs. Using the intervention strategies provided, occupational health nurses can play a key role in reducing workplace-related injury, disease, disability, and death. variety of resources pertaining to occupational health and safety from the federal, national, health care, nursing, and environmental realms can assist occupational health nurses in developing and implementing programs appropriate for their workplaces. Through the Healthy People 2010 occupational health and safety objectives, occupational health nurses have the opportunity to develop and implement workplace policies and programs promoting not only a safe and healthy work environment but also improved health and disease prevention. Occupational health nurses can implement strategies to increase quality and years of life and eliminate health disparities in the American work force.

Physical training in children with osteogenesis imperfecta.

PubMed

Van Brussel, Marco; Takken, Tim; Uiterwaal, Cuno S P M; Pruijs, Hans J; Van der Net, Janjaap; Helders, Paul J M; Engelbert, Raoul H H

2008-01-01

To study the effects of a physical training program on exercise capacity, muscle force, and subjective fatigue levels in patients with mild to moderate forms of osteogenesis imperfecta (OI). Thirty-four children with OI type I or IV were randomly assigned to either a 12-week graded exercise program or care as usual for 3 months. Exercise capacity and muscle force were studied; subjective fatigue, perceived competence, and health-related quality of life were secondary outcomes. All outcomes were measured at baseline (T = 0), after intervention (T = 1), and after 6 and 9 months (T = 2 and T = 3, respectively). After intervention (T = 1), peak oxygen consumption (VO2peak), relative VO2peak (VO2peak/kg), maximal working capacity (Wmax), and muscle force were significantly improved (17%, 18%, 10%, and 12%, respectively) compared with control values. Subjective fatigue decreased borderline statistically significantly. Follow-up at T = 2 showed a significant decrease of the improvements measured at T = 1 of VO2peak, but VO2peak/kg, Wmax, and subjective fatigue showed no significant difference. At T = 3, we found a further decrease of the gained improvements. A supervised training program can improve aerobic capacity and muscle force and reduces levels of subjective fatigue in children with OI type I and IV in a safe and effective manner.

Building Bridges for Innovation in Ageing: Synergies between Action Groups of the EIP on AHA.

PubMed

Bousquet, J; Bewick, M; Cano, A; Eklund, P; Fico, G; Goswami, N; Guldemond, N A; Henderson, D; Hinkema, M J; Liotta, G; Mair, A; Molloy, W; Monaco, A; Monsonis-Paya, I; Nizinska, A; Papadopoulos, H; Pavlickova, A; Pecorelli, S; Prados-Torres, A; Roller-Wirnsberger, R E; Somekh, D; Vera-Muñoz, C; Visser, F; Farrell, J; Malva, J; Andersen Ranberg, K; Camuzat, T; Carriazo, A M; Crooks, G; Gutter, Z; Iaccarino, G; Manuel de Keenoy, E; Moda, G; Rodriguez-Mañas, L; Vontetsianos, T; Abreu, C; Alonso, J; Alonso-Bouzon, C; Ankri, J; Arredondo, M T; Avolio, F; Bedbrook, A; Białoszewski, A Z; Blain, H; Bourret, R; Cabrera-Umpierrez, M F; Catala, A; O'Caoimh, R; Cesari, M; Chavannes, N H; Correia-da-Sousa, J; Dedeu, T; Ferrando, M; Ferri, M; Fokkens, W J; Garcia-Lizana, F; Guérin, O; Hellings, P W; Haahtela, T; Illario, M; Inzerilli, M C; Lodrup Carlsen, K C; Kardas, P; Keil, T; Maggio, M; Mendez-Zorrilla, A; Menditto, E; Mercier, J; Michel, J P; Murray, R; Nogues, M; O'Byrne-Maguire, I; Pappa, D; Parent, A S; Pastorino, M; Robalo-Cordeiro, C; Samolinski, B; Siciliano, P; Teixeira, A M; Tsartara, S I; Valiulis, A; Vandenplas, O; Vasankari, T; Vellas, B; Vollenbroek-Hutten, M; Wickman, M; Yorgancioglu, A; Zuberbier, T; Barbagallo, M; Canonica, G W; Klimek, L; Maggi, S; Aberer, W; Akdis, C; Adcock, I M; Agache, I; Albera, C; Alonso-Trujillo, F; Angel Guarcia, M; Annesi-Maesano, I; Apostolo, J; Arshad, S H; Attalin, V; Avignon, A; Bachert, C; Baroni, I; Bel, E; Benson, M; Bescos, C; Blasi, F; Barbara, C; Bergmann, K C; Bernard, P L; Bonini, S; Bousquet, P J; Branchini, B; Brightling, C E; Bruguière, V; Bunu, C; Bush, A; Caimmi, D P; Calderon, M A; Canovas, G; Cardona, V; Carlsen, K H; Cesario, A; Chkhartishvili, E; Chiron, R; Chivato, T; Chung, K F; d'Angelantonio, M; De Carlo, G; Cholley, D; Chorin, F; Combe, B; Compas, B; Costa, D J; Costa, E; Coste, O; Coupet, A-L; Crepaldi, G; Custovic, A; Dahl, R; Dahlen, S E; Demoly, P; Devillier, P; Didier, A; Dinh-Xuan, A T; Djukanovic, R; Dokic, D; Du Toit, G; Dubakiene, R; Dupeyron, A; Emuzyte, R; Fiocchi, A; Wagner, A; Fletcher, M; Fonseca, J; Fougère, B; Gamkrelidze, A; Garces, G; Garcia-Aymeric, J; Garcia-Zapirain, B; Gemicioğlu, B; Gouder, C; Hellquist-Dahl, B; Hermosilla-Gimeno, I; Héve, D; Holland, C; Humbert, M; Hyland, M; Johnston, S L; Just, J; Jutel, M; Kaidashev, I P; Khaitov, M; Kalayci, O; Kalyoncu, A F; Keijser, W; Kerstjens, H; Knezović, J; Kowalski, M; Koppelman, G H; Kotska, T; Kovac, M; Kull, I; Kuna, P; Kvedariene, V; Lepore, V; MacNee, W; Maggio, M; Magnan, A; Majer, I; Manning, P; Marcucci, M; Marti, T; Masoli, M; Melen, E; Miculinic, N; Mihaltan, F; Milenkovic, B; Millot-Keurinck, J; Mlinarić, H; Momas, I; Montefort, S; Morais-Almeida, M; Moreno-Casbas, T; Mösges, R; Mullol, J; Nadif, R; Nalin, M; Navarro-Pardo, E; Nekam, K; Ninot, G; Paccard, D; Pais, S; Palummeri, E; Panzner, P; Papadopoulos, N K; Papanikolaou, C; Passalacqua, G; Pastor, E; Perrot, M; Plavec, D; Popov, T A; Postma, D S; Price, D; Raffort, N; Reuzeau, J C; Robine, J M; Rodenas, F; Robusto, F; Roche, N; Romano, A; Romano, V; Rosado-Pinto, J; Roubille, F; Ruiz, F; Ryan, D; Salcedo, T; Schmid-Grendelmeier, P; Schulz, H; Schunemann, H J; Serrano, E; Sheikh, A; Shields, M; Siafakas, N; Scichilone, N; Siciliano, P; Skrindo, I; Smit, H A; Sourdet, S; Sousa-Costa, E; Spranger, O; Sooronbaev, T; Sruk, V; Sterk, P J; Todo-Bom, A; Touchon, J; Tramontano, D; Triggiani, M; Tsartara, S I; Valero, A L; Valovirta, E; van Ganse, E; van Hage, M; van den Berge, M; Vandenplas, O; Ventura, M T; Vergara, I; Vezzani, G; Vidal, D; Viegi, G; Wagemann, M; Whalley, B; Wickman, M; Wilson, N; Yiallouros, P K; Žagar, M; Zaidi, A; Zidarn, M; Hoogerwerf, E J; Usero, J; Zuffada, R; Senn, A; de Oliveira-Alves, B

2017-01-01

The Strategic Implementation Plan of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA) proposed six Action Groups. After almost three years of activity, many achievements have been obtained through commitments or collaborative work of the Action Groups. However, they have often worked in silos and, consequently, synergies between Action Groups have been proposed to strengthen the triple win of the EIP on AHA. The paper presents the methodology and current status of the Task Force on EIP on AHA synergies. Synergies are in line with the Action Groups' new Renovated Action Plan (2016-2018) to ensure that their future objectives are coherent and fully connected. The outcomes and impact of synergies are using the Monitoring and Assessment Framework for the EIP on AHA (MAFEIP). Eight proposals for synergies have been approved by the Task Force: Five cross-cutting synergies which can be used for all current and future synergies as they consider overarching domains (appropriate polypharmacy, citizen empowerment, teaching and coaching on AHA, deployment of synergies to EU regions, Responsible Research and Innovation), and three cross-cutting synergies focussing on current Action Group activities (falls, frailty, integrated care and chronic respiratory diseases).

Health Equity and the Fallacy of Treating Causes of Population Health as if They Sum to 100.

PubMed

Krieger, Nancy

2017-04-01

Numerous examples exist in population health of work that erroneously forces the causes of health to sum to 100%. This is surprising. Clear refutations of this error extend back 80 years. Because public health analysis, action, and allocation of resources are ill served by faulty methods, I consider why this error persists. I first review several high-profile examples, including Doll and Peto's 1981 opus on the causes of cancer and its current interpretations; a 2015 high-publicity article in Science claiming that two thirds of cancer is attributable to chance; and the influential Web site "County Health Rankings & Roadmaps: Building a Culture of Health, County by County," whose model sums causes of health to equal 100%: physical environment (10%), social and economic factors (40%), clinical care (20%), and health behaviors (30%). Critical analysis of these works and earlier historical debates reveals that underlying the error of forcing causes of health to sum to 100% is the still dominant but deeply flawed view that causation can be parsed as nature versus nurture. Better approaches exist for tallying risk and monitoring efforts to reach health equity.

Health Equity and the Fallacy of Treating Causes of Population Health as if They Sum to 100%

PubMed Central

2017-01-01

Numerous examples exist in population health of work that erroneously forces the causes of health to sum to 100%. This is surprising. Clear refutations of this error extend back 80 years. Because public health analysis, action, and allocation of resources are ill served by faulty methods, I consider why this error persists. I first review several high-profile examples, including Doll and Peto’s 1981 opus on the causes of cancer and its current interpretations; a 2015 high-publicity article in Science claiming that two thirds of cancer is attributable to chance; and the influential Web site “County Health Rankings & Roadmaps: Building a Culture of Health, County by County,” whose model sums causes of health to equal 100%: physical environment (10%), social and economic factors (40%), clinical care (20%), and health behaviors (30%). Critical analysis of these works and earlier historical debates reveals that underlying the error of forcing causes of health to sum to 100% is the still dominant but deeply flawed view that causation can be parsed as nature versus nurture. Better approaches exist for tallying risk and monitoring efforts to reach health equity. PMID:28272952

The Work, the Workplace, and the Work Force of Tomorrow.

ERIC Educational Resources Information Center

Allen, Claudia

1995-01-01

Ann McLaughlin, a former secretary of labor, discusses her views on the future of the workplace. She feels that to solve the impending problem of educational deficits among the work force, employers will begin their own educational programs, improving both employee loyalty and work force mobility. Includes predictions for future growth fields.…

Report of the ASHP Task Force on Caring for Patients Served by Specialty Suppliers.

PubMed

Caselnova, Dominick; Donley, Kathy; Ehlers, Diane; Hyduk, Amy E; Koontz, Susannah E; Nowobilski-Vasilios, Anna; Pawlicki, Kathleen S; Poikonen, John C; Poremba, Art C; Sasser, Cathy L; Schell, Kenneth H; Schwab, Jay L; Swinarski, Dave; Chen, David; Kirschenbaum, Bonnie; Armitstead, John

2010-10-01

Task Force recommendations are discussed in more detail in eAppendix A (available at www.ajhp.org). What follows is a brief summary of those recommendations. In very abbreviated terms, the Task Force suggested that ASHP: 1. Consider creating and maintaining a Web resource center on ASHP's website to provide information about restricted drug distributions systems (RDDSs), risk evaluation and mitigation strategies (REMSs), risk assessment and minimization plans (RiskMAPs), and specialty suppliers and products. 2. Provide comprehensive education to members, other health professionals, regulators, third-party payers, patients, and other stakeholders about RDDSs, REMSs, RiskMAPs, and specialty suppliers and products. 3. Develop policies to advocate that a. Pharmacists serve as the institutional leaders in compliance and utilization challenges of safely managing externally supplied medications and related drug administration devices, b. Agencies, organizations, and associations that influence the distribution, sale, and dispensing of medications under these alternative distribution models address issues these models create in continuity of care, reimbursement, and patient safety, c. The Centers for Medicare and Medicaid Services and the Joint Commission develop standards and interpretations that accommodate hospital use of these products and devices when currently available technology (e.g., cold-chain storage, e-pedigree) is used to ensure patient safety, d. Group purchasing organizations negotiate contractual arrangements for specialty pharmaceuticals for both acquisition costs and distribution arrangements, and e. Information technology (IT) be used to resolve issues created by alternative distribution models and that ASHP work with IT vendors to ensure that programs are designed to meet the needs of these evolving models. 4. Quantify through research, perhaps in cooperation with entities such as the Agency for Healthcare Research and Quality, the Institute of Medicine, and the Institute for Safe Medication Practices, the impact of alternative distribution models on financial, safety, clinical, and humanistic patient outcomes. 5. Develop multidisciplinary tools and best practices that assist health care practitioners address the challenges created by alternative distribution models, from patient intake and referral to hospital discharge.

Transverse mode instabilities in burst operation of high-power fiber laser systems

NASA Astrophysics Data System (ADS)

Jauregui, Cesar; Stihler, Christoph; Tünnermann, Andreas; Limpert, Jens

2018-02-01

We propose, to the best of our knowledge, the first mitigation strategy for TMI based on controlling the phase shift between the thermally-induced index grating and the modal intensity pattern. In particular, in this work we present a study of transverse mode instabilities in burst operation in a high-power fiber laser system. It is shown that, with a careful choice of the parameters, this operation regime can potentially lead to the mitigation of TMI by forcing an energy transfer from the higher-order-modes into the fundamental mode during the burst.

Disabilities in the workplace: recruitment, accommodation, and retention.

PubMed

Davis, Linda

2005-07-01

Who has never had a need for accommodation to perform a job because of age-related changes, gender issues related to family care, religious practices, health status, or disability? Who has never had the benefit of universal accommodations designed to provide access for individuals with disabilities, such as using the handicap button to open a door when one's arms are loaded? All of society has had the benefit of inclusion of individuals with disabilities within the work force. Occupational health nurses are essential to accommodating new employees with disabilities, assisting ill or injured employees in returning to work, and changing attitudes toward disabled workers. Additionally, nurses have the skills and knowledge for leading and managing newly emerging disease management programs for workers with disabilities caused by chronic illness.

An Infrastructure to Advance the Scholarly Work of Staff Nurses

PubMed Central

Parkosewich, Janet A.

2013-01-01

The traditional role of the acute care staff nurse is changing. The new norm establishes an expectation that staff nurses base their practice on best evidence. When evidence is lacking, nurses are charged with using the research process to generate and disseminate new knowledge. This article describes the critical forces behind the transformation of this role and the organizational mission, culture, and capacity required to support practice that is based on science. The vital role of senior nursing leaders, the nurse researcher, and the nursing research committee within the context of a collaborative governance structure is highlighted. Several well-known, evidence-based practice models are presented. Finally, there is a discussion of the infrastructure created by Yale-New Haven Hospital to advance the scholarly work of the nursing staff. PMID:23482435

Office spirometry in primary care pediatrics: a pilot study.

PubMed

Zanconato, Stefania; Meneghelli, Giorgio; Braga, Raffaele; Zacchello, Franco; Baraldi, Eugenio

2005-12-01

The aim of this study was to investigate the validity of office spirometry in primary care pediatric practices. Ten primary care pediatricians undertook a spirometry training program that was led by 2 pediatric pulmonologists from the Pediatric Department of the University of Padova. After the pediatricians' training, children with asthma or persistent cough underwent a spirometric test in the pediatrician's office and at a pulmonary function (PF) laboratory, in the same day in random order. Both spirometric tests were performed with a portable turbine flow sensor spirometer. We assessed the quality of the spirometric tests and compared a range of PF parameters obtained in the pediatricians' offices and in the PF laboratory according to the Bland and Altman method. A total of 109 children (mean age: 10.4 years; range: 6-15) were included in the study. Eighty-five (78%) of the spirometric tests that were performed in the pediatricians' offices met all of the acceptability and reproducibility criteria. The 24 unacceptable test results were attributable largely to a slow start and failure to satisfy end-of-test criteria. Only the 85 acceptable spirometric tests were considered for analysis. The agreement between the spirometric tests that were performed in the pediatrician's office and in the PF laboratory was good for the key parameters (forced vital capacity, forced expiratory volume in 1 second, and forced expiratory flow between 25% and 75%). The repeatability coefficient was 0.26 L for forced expiratory volume in 1 second (83 of 85 values fall within this range), 0.30 L for forced vital capacity (81 values fall within this range), and 0.58 L/s for forced expiratory flow between 25% and 75% (82 values fall within this range). In 79% of cases, the primary care pediatricians interpreted the spirometric tests correctly. It seems justifiable to perform spirometry in pediatric primary care, but an integrated approach involving both the primary care pediatrician and certified pediatric respiratory medicine centers is recommended because effective training and quality assurance are vital prerequisites for successful spirometry.

Optimal resources for children's surgical care in the United States.

PubMed

2014-03-01

In summary, the Task Force does understand that change is difficult and, in the circumstance of the US health care environment, quite complex. Having acknowledged this, the Task Force firmly believes that if optimal resource standards are clear, providers will act in the best interests of their patients, infants, and children undergoing surgery in this circumstance. We intend to provide evidence to this point, to define optimal resources, and to facilitate this process. The hope and the underlying intent of these recommendations is to insure that every infant and child undergoing a surgical procedure in the United States will receive his or her care in an environment that offers all of the facilities, equipment, and, most especially, access to the professional providers who have the appropriate background and training to provide optimal care. This must be done while balancing the issues of access, staff, and the need to improve the value proposition. The Task Force is unanimous in its intent to advocate for this agenda.

Sexual violence against men and boys in conflict and forced displacement: implications for the health sector.

PubMed

Chynoweth, Sarah K; Freccero, Julie; Touquet, Heleen

2017-11-01

Sexual violence against men and boys is commonplace in many conflict-affected settings and may be frequent in relation to forced displacement as well. Adolescent boys, forming the majority of unaccompanied minors globally, are a particularly vulnerable group. Yet sensitised health services for adult and adolescent male sexual violence survivors are scarce, and barriers to accessing care remain high. We describe current challenges and gaps in the provision of health care for male survivors in settings affected by conflict and forced displacement, and provide suggestions on how to improve service provision and uptake.

Glove-related rhinopathy among hospital personnel.

PubMed

Kujala, V M; Reijula, K E

1996-08-01

Hypersensitivity to natural rubber latex (NRL) in health care personnel exposed to powdered latex gloves appears as conjunctivitis, rhinitis, nasal congestion, cough, dyspnea, or bronchial asthma in approximately 30% of all cases with latex allergy while most of the patients have contact urticaria. The purpose of the present study was to determine the prevalence of latex-induced allergic rhinitis in health care workers using NRL gloves on a daily basis. Clinical examination accompanied by skin prick test (SPT) with latex glove extracts and common aeroallergens, measurements of specific IgE to NRL, and lung function tests were performed in 25 symptomatic workers and 11 latex-exposed asymptomatic controls. Sensitization to NRL was detected using SPT in one (4%) of 25 symptomatic workers but not in any of the asymptomatic controls. Positive SPT to aeroallergens was demonstrated in 8/25 symptomatic workers and 6/11 controls. Measurements of forced vital capacity, forced expiratory volume in I sec, and bronchial methacholine challenge did not show any significant differences between the study groups. In conclusion, NRL-aeroallergen-induced occupational rhinitis may occur among physicians and nurses who have a frequent use of latex gloves on a daily basis at hospital work. However, a relatively low prevalence of NRL-induced occupational rhinitis is associated with profuse consumption of no-powder sterile gloves.

Older women: work and caregiving in conflict? A study of four countries.

PubMed

Muller, Charlotte; Volkov, Oleg

2009-01-01

Caregiving issues are important for industrialized societies that have been undergoing population aging. In this article we consider caregiving as a factor in the outlook for midlife and older women with respect to economic security and economic advancement. We use demographic and economic data from the United States, France, Sweden, and the United Kingdom, in particular to document the importance of continued labor force participation for older women to make ends meet in an era of high household costs of physician services, prescription drugs, and other health-related services, and uncertainties about pensions. Data on employment status, industry, and occupation of economically active women in comparison with men indicate the extent of both gender gaps and progress affecting women's resources. The research of Dr. Myrna Lewis was a stimulus to the present exploration. Our conclusion discusses the implications for women's welfare of policy initiatives relating to care of elderly disabled, including improving services to family caregivers, assuring social financing of formal care, raising local provisions to a national standard, and supporting women's return to the labor force after a period of caregiving. In the context of population aging and longevity, such initiatives are responsive to women's need for earned income to attain retirement security.

76 FR 38118 - Meeting of the Department of Defense Task Force on the Care, Management, and Transition of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-29

... DEPARTMENT OF DEFENSE Office of the Secretary Meeting of the Department of Defense Task Force on... Forces AGENCY: Department of Defense. ACTION: Meeting notice. SUMMARY: Under the provisions of the... that the following Federal Advisory Committee meeting of the Department of Defense Task Force on the...

Multisociety task force recommendations of competencies in Pulmonary and Critical Care Medicine.

PubMed

Buckley, John D; Addrizzo-Harris, Doreen J; Clay, Alison S; Curtis, J Randall; Kotloff, Robert M; Lorin, Scott M; Murin, Susan; Sessler, Curtis N; Rogers, Paul L; Rosen, Mark J; Spevetz, Antoinette; King, Talmadge E; Malhotra, Atul; Parsons, Polly E

2009-08-15

Numerous accrediting organizations are calling for competency-based medical education that would help define specific specialties and serve as a foundation for ongoing assessment throughout a practitioner's career. Pulmonary Medicine and Critical Care Medicine are two distinct subspecialties, yet many individual physicians have expertise in both because of overlapping content. Establishing specific competencies for these subspecialties identifies educational goals for trainees and guides practitioners through their lifelong learning. To define specific competencies for graduates of fellowships in Pulmonary Medicine and Internal Medicine-based Critical Care. A Task Force composed of representatives from key stakeholder societies convened to identify and define specific competencies for both disciplines. Beginning with a detailed list of existing competencies from diverse sources, the Task Force categorized each item into one of six core competency headings. Each individual item was reviewed by committee members individually, in group meetings, and conference calls. Nominal group methods were used for most items to retain the views and opinions of the minority perspective. Controversial items underwent additional whole group discussions with iterative modified-Delphi techniques. Consensus was ultimately determined by a simple majority vote. The Task Force identified and defined 327 specific competencies for Internal Medicine-based Critical Care and 276 for Pulmonary Medicine, each with a designation as either: (1) relevant, but competency is not essential or (2) competency essential to the specialty. Specific competencies in Pulmonary and Critical Care Medicine can be identified and defined using a multisociety collaborative approach. These recommendations serve as a starting point and set the stage for future modification to facilitate maximum quality of care as the specialties evolve.

Integrated primary care, the collaboration imperative inter-organizational cooperation in the integrated primary care field: a theoretical framework

PubMed Central

Valentijn, Pim P; Bruijnzeels, Marc A; de Leeuw, Rob J; Schrijvers, Guus J.P

2012-01-01

Purpose Capacity problems and political pressures have led to a rapid change in the organization of primary care from mono disciplinary small business to complex inter-organizational relationships. It is assumed that inter-organizational collaboration is the driving force to achieve integrated (primary) care. Despite the importance of collaboration and integration of services in primary care, there is no unambiguous definition for both concepts. The purpose of this study is to examine and link the conceptualisation and validation of the terms inter-organizational collaboration and integrated primary care using a theoretical framework. Theory The theoretical framework is based on the complex collaboration process of negotiation among multiple stakeholder groups in primary care. Methods A literature review of health sciences and business databases, and targeted grey literature sources. Based on the literature review we operationalized the constructs of inter-organizational collaboration and integrated primary care in a theoretical framework. The framework is being validated in an explorative study of 80 primary care projects in the Netherlands. Results and conclusions Integrated primary care is considered as a multidimensional construct based on a continuum of integration, extending from segregation to integration. The synthesis of the current theories and concepts of inter-organizational collaboration is insufficient to deal with the complexity of collaborative issues in primary care. One coherent and integrated theoretical framework was found that could make the complex collaboration process in primary care transparent. This study presented theoretical framework is a first step to understand the patterns of successful collaboration and integration in primary care services. These patterns can give insights in the organization forms needed to create a good working integrated (primary) care system that fits the local needs of a population. Preliminary data of the patterns of collaboration and integration will be presented.

First-line managers' experiences of alternative modes of funding in elderly care in Sweden.

PubMed

Antonsson, Helen; Korjonen, Susanne Eriksson; Rosengren, Kristina

2012-09-01

The aim of this study was to describe first-line managers' experiences of alternative modes of funding elderly care in two communities in western Sweden. A growing elderly population demands alternative modes of funding elderly care for better outcomes for patients and better efficiency as it is publicly funded through taxation. The study comprised a total of eight semi-structured interviews with first-line managers working within elderly care. The interviews were analysed using manifest qualitative content analysis. Respect for the individuals was a main concern in the study. One category, quality improvement, and four subcategories freedom of choice, organisational structure, quality awareness and market forces effects were identified to describe first-line managers' experiences of the operation of elderly care. Quality improvement was an important factor to deal with when elderly care was operated in different organisational perspectives, either private or public. The first-line manager is a key person for developing a learning organisation that encourages both staff, clients and their relatives to improve the organisation. Moreover, person-centred care strengthens the client's role in the organisation, which is in line with the government's goal for the quality improvement of elderly care. However, further research is needed on how quality improvement could be developed when different caregivers operate in the same market in order to improve care from the elderly perspective. This study highlights alternative modes of funding elderly care. The economical perspectives should not dominate without taking care of quality improvement when the operation of elderly care is planned and implemented. Strategies such as a learning organisational structure built on person-centred care could create quality improvement in elderly care. © 2012 Blackwell Publishing Ltd.

Practice guidelines for evaluating new fever in critically ill adult patients. Task Force of the Society of Critical Care Medicine and the Infectious Diseases Society of America.

PubMed

O'Grady, N P; Barie, P S; Bartlett, J G; Bleck, T; Garvey, G; Jacobi, J; Linden, P; Maki, D G; Nam, M; Pasculle, W; Pasquale, M D; Tribett, D L; Masur, H

1998-05-01

The development of practice guidelines for evaluating adult patients who develop new fever in the intensive care unit (ICU) for the purpose of guiding clinical practice. A task force of 13 experts in disciplines related to critical care medicine, infectious diseases, and surgery was convened from the membership of the Society of Critical Care Medicine and the Infectious Disease Society of America. The task force members provided personal experience and determined the published literature (articles retrieved with use of MEDLINE or textbooks) from which consensus would be sought. The published literature was reviewed and classified into one of four categories, according to study design and scientific value. The task force met several times in person and twice monthly by teleconference over a 1-year period to identify the pertinent literature and arrive at consensus recommendations. Consideration was given to the relationship between the weight of scientific evidence and the experts' opinions. Draft documents were composed and debated by the task force until consensus was reached by nominal group process. The panel concluded that because fever can have many infectious and noninfectious etiologies, a new fever in an adult patient in the ICU should trigger a careful clinical assessment rather than automatic orders for laboratory and radiological tests. A cost-conscious approach to obtaining diagnostic studies should be undertaken if they are indicated after a clinical evaluation. The goal of such an approach is to determine, in a directed manner, whether infection is present so that additional testing can be avoided and therapeutic options can be identified.

Utilizing data consortia to monitor safety and effectiveness of biosimilars and their innovator products.

PubMed

Baldziki, Mike; Brown, Jeff; Chan, Hungching; Cheetham, T Craig; Conn, Thomas; Daniel, Gregory W; Hendrickson, Mark; Hilbrich, Lutz; Johnson, Ayanna; Miller, Steven B; Moore, Tom; Motheral, Brenda; Priddy, Sarah A; Raebel, Marsha A; Randhawa, Gurvaneet; Surratt, Penny; Walraven, Cheryl; White, T Jeff; Bruns, Kevin; Carden, Mary Jo; Dragovich, Charlie; Eichelberger, Bernadette; Rosato, Edith; Sega, Todd

2015-01-01

The Biologics Price Competition and Innovation Act, introduced as part of the Affordable Care Act, directed the FDA to create an approval pathway for biologic products shown to be biosimilar or interchangeable with an FDA-approved innovator drug. These biosimilars will not be chemically identical to the reference agent. Investigational studies conducted with biosimilar agents will likely provide limited real-world evidence of their effectiveness and safety. How do we best monitor effectiveness and safety of biosimilar products once approved by the FDA and used more extensively by patients? To determine the feasibility of developing a distributed research network that will use health insurance plan and health delivery system data to detect biosimilar safety and effectiveness signals early and be able to answer important managed care pharmacy questions from both the government and managed care organizations. Twenty-one members of the AMCP Task Force on Biosimilar Collective Intelligence Systems met November 12, 2013, to discuss issues involved in designing this consortium and to explore next steps. The task force concluded that a managed care biosimilars research consortium would be of significant value. Task force members agreed that it is best to use a distributed research network structurally similar to existing DARTNet, HMO Research Network, and Mini-Sentinel consortia. However, for some surveillance projects that it undertakes, the task force recognizes it may need supplemental data from managed care and other sources (i.e., a "hybrid" structure model). The task force believes that AMCP is well positioned to lead the biosimilar-monitoring effort and that the next step to developing a biosimilar-innovator collective intelligence system is to convene an advisory council to address organizational governance.

48 CFR 223.570 - Drug-free work force.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Drug-free work force. 223.570 Section 223.570 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM... TECHNOLOGIES, OCCUPATIONAL SAFETY, AND DRUG-FREE WORKPLACE Drug-Free Workplace 223.570 Drug-free work force. ...

48 CFR 223.570 - Drug-free work force.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 3 2011-10-01 2011-10-01 false Drug-free work force. 223.570 Section 223.570 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM... TECHNOLOGIES, OCCUPATIONAL SAFETY, AND DRUG-FREE WORKPLACE Drug-Free Workplace 223.570 Drug-free work force. ...

48 CFR 223.570 - Drug-free work force.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 3 2013-10-01 2013-10-01 false Drug-free work force. 223.570 Section 223.570 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM... TECHNOLOGIES, OCCUPATIONAL SAFETY, AND DRUG-FREE WORKPLACE Drug-Free Workplace 223.570 Drug-free work force. ...

48 CFR 223.570 - Drug-free work force.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 3 2012-10-01 2012-10-01 false Drug-free work force. 223.570 Section 223.570 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM... TECHNOLOGIES, OCCUPATIONAL SAFETY, AND DRUG-FREE WORKPLACE Drug-Free Workplace 223.570 Drug-free work force. ...

48 CFR 223.570 - Drug-free work force.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 3 2014-10-01 2014-10-01 false Drug-free work force. 223.570 Section 223.570 Federal Acquisition Regulations System DEFENSE ACQUISITION REGULATIONS SYSTEM... TECHNOLOGIES, OCCUPATIONAL SAFETY, AND DRUG-FREE WORKPLACE Drug-Free Workplace 223.570 Drug-free work force. ...