Sample records for development medical facility

  1. Examining Regionalization Efforts to Develop Lessons Learned and Consideration for Department of Defense Medical Facilities

    DTIC Science & Technology

    2017-03-23

    Consideration for Department of Defense Medical Facilities Erik B. Schuh Follow this and additional works at: https://scholar.afit.edu/etd Part of the...Citation Schuh, Erik B., "Examining Regionalization Efforts to Develop Lessons Learned and Consideration for Department of Defense Medical Facilities...Consideration for Department of Defense Medical Facilities THESIS Erik B. Schuh, 2Lt, USAF AFIT-ENS-MS-17-M-156 DEPARTMENT OF THE AIR FORCE AIR UNIVERSITY AIR

  2. [The development of the system of medical rehabilitation based at the Russian health resort facilities: investment prospects].

    PubMed

    Povazhnaya, E L; Gusakova, E V; Moiseenko, S V

    2018-05-21

    The present work is devoted to the prospects for attracting investments for the maintenance and development of the medical rehabilitation practices based at the Russian health resort facilities. The article describes the prerequisites for the enhancement of the investment attractiveness of the development of the system of medical rehabilitation in the said institutions including the formulation and strengthening of the legal and regulatory framework, the capacity for the organization of the second and third stages of medical rehabilitation in the existing spa and health resort facilities, the attraction of the funds of compulsory medical insurance as an additional source of the financial support. The main legal documents regulating the organization and provision of medical rehabilitation based at the spa and health resort facilities are presented. The results of the implementation of the investment concept of the development of medical rehabilitation in the framework of the system of health resort treatment as exemplified by the experience of JSC «The group of companies «Medsi» are discussed. It is shown that the development of medical rehabilitation based at the spa and health resort facilities greatly contributes to the significant expansion of the potential customer base and promotes the further growth of business scale.

  3. 10 CFR 50.21 - Class 104 licenses; for medical therapy and research and development facilities.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 10 Energy 1 2010-01-01 2010-01-01 false Class 104 licenses; for medical therapy and research and...; for medical therapy and research and development facilities. A class 104 license will be issued, to an... Administration entered into under the Cooperative Power Reactor Demonstration Program, except as otherwise...

  4. Difference between Japanese Secondary and Tertiary Medical Facilities Regarding Changes in the Hospitalization of Children for Pneumonia after the Introduction of the Pneumococcal Conjugate Vaccine.

    PubMed

    Haro, Kaoru; Ogawa, Masato; Hoshina, Takayuki; Kojiro, Masumi; Kusuhara, Koichi

    2017-05-24

    This study aimed to compare hospitalization of children for pneumonia between secondary and tertiary medical facilities, which hospitalize many children without and with underlying diseases, respectively, after the introduction of the pneumococcal conjugate vaccine (PCV). Our retrospective study included children admitted to the Department of Pediatrics at Kitakyushu General Hospital, a secondary medical facility, and the Hospital of the University of Occupational and Environment Health, Japan, a tertiary medical facility, from 2009 to 2013 for pneumonia. We compared the change in the rate of hospitalization for pneumonia after the introduction of the 7-valent PCV between the secondary and tertiary medical facilities. Hospitalization of patients with pneumonia declined by 28.8% in our secondary medical facility. In particular, hospitalization for pneumonia other than confirmed mycoplasmal or viral pneumonia was significantly reduced by 49.2%. In contrast, hospitalization of patients with pneumonia did not decline in our tertiary medical facility. After the introduction of PCV, hospitalization of children for pneumonia was not reduced at the tertiary medical facility. Various other pathogens besides pneumococcus may be associated with the development of pneumonia in children with underlying diseases.

  5. Design for Medical Education. The Development and Planning of a Medical College and Care Center.

    ERIC Educational Resources Information Center

    Peery, Thomas M.; Green, Alan C.

    Planning and design procedures which one medical education center employed in translating its educational objectives, philosophy and techniques into laboratory, classroom and clinic facilities are described. Basic planning considerations included--(1) determination of the curriculum, (2) facility utilization rate, (3) housing of research…

  6. Developing a national role description for medical directors in long-term care

    PubMed Central

    Rahim-Jamal, Sherin; Quail, Patrick; Bhaloo, Tajudaullah

    2010-01-01

    OBJECTIVE To develop a national role description for medical directors in long-term care (LTC) based on role functions drawn from the literature and the LTC industry. DESIGN A questionnaire about the role functions identified from the literature was mailed or e-mailed to randomly selected medical directors, directors of care or nursing (DOCs), and administrators in LTC facilities. SETTING Long-term care facilities in Canada randomly selected from regional clusters. PARTICIPANTS Medical directors, DOCs, and administrators in LTC facilities; a national advisory group of medical directors from the Long Term Care Medical Directors Association of Canada; and a volunteer group of medical directors. MAIN OUTCOME MEASURES Respondents were asked to indicate, from the list of identified functions, 1) whether medical directors spent any time on each activity; 2) whether medical directors should spend time on each activity; and 3) if medical directors should spend time on an activity, whether the activity was “essential” or “desirable.” RESULTS An overall response rate of 37% was obtained. At least 80% of the respondents from all 3 groups (medical directors, DOCs, and administrators) highlighted 24 functions they deemed to be “essential” or “desirable,” which were then included in the role description. In addition, the advisory group expanded the role description to include 5 additional responsibilities from the remaining 18 functions originally identified. A volunteer group of medical directors confirmed the resulting role description. CONCLUSION The role description developed as a result of this study brings clarity to the medical director’s role in Canadian LTC facilities; the functions outlined are considered important for medical directors to undertake. The role description could be a useful tool in negotiations pertaining to time commitment and expectations of a medical director and fair compensation for services rendered. PMID:20090058

  7. Developing a national role description for medical directors in long-term care: survey-based approach.

    PubMed

    Rahim-Jamal, Sherin; Quail, Patrick; Bhaloo, Tajudaullah

    2010-01-01

    To develop a national role description for medical directors in long-term care (LTC) based on role functions drawn from the literature and the LTC industry. A questionnaire about the role functions identified from the literature was mailed or e-mailed to randomly selected medical directors, directors of care or nursing (DOCs), and administrators in LTC facilities. Long-term care facilities in Canada randomly selected from regional clusters. Medical directors, DOCs, and administrators in LTC facilities; a national advisory group of medical directors from the Long Term Care Medical Directors Association of Canada; and a volunteer group of medical directors. Respondents were asked to indicate, from the list of identified functions, 1) whether medical directors spent any time on each activity; 2) whether medical directors should spend time on each activity; and 3) if medical directors should spend time on an activity, whether the activity was "essential" or "desirable." An overall response rate of 37% was obtained. At least 80% of the respondents from all 3 groups (medical directors, DOCs, and administrators) highlighted 24 functions they deemed to be "essential" or "desirable," which were then included in the role description. In addition, the advisory group expanded the role description to include 5 additional responsibilities from the remaining 18 functions originally identified. A volunteer group of medical directors confirmed the resulting role description. The role description developed as a result of this study brings clarity to the medical director's role in Canadian LTC facilities; the functions outlined are considered important for medical directors to undertake. The role description could be a useful tool in negotiations pertaining to time commitment and expectations of a medical director and fair compensation for services rendered.

  8. Medical Applications of Non-Medical Research: Applications Derived from BES-Supported Research and Research at BES Facilities

    DOE R&D Accomplishments Database

    1998-07-01

    This publication contains stories that illustrate how the Office of Basic Energy Sciences (BES) research and major user facilities have impacted the medical sciences in the selected topical areas of disease diagnosis, treatment (including drug development, radiation therapy, and surgery), understanding, and prevention.

  9. A Medical Decision Support System for the Space Station Health Maintenance Facility

    PubMed Central

    Ostler, David V.; Gardner, Reed M.; Logan, James S.

    1988-01-01

    NASA is developing a Health Maintenance Facility (HMF) to provide the equipment and supplies necessary to deliver medical care in the Space Station. An essential part of the Health Maintenance Facility is a computerized Medical Decision Support System (MDSS) that will enhance the ability of the medical officer (“paramedic” or “physician”) to maintain the crew's health, and to provide emergency medical care. The computer system has four major functions: 1) collect and integrate medical information into an electronic medical record from Space Station medical officers, HMF instrumentation, and exercise equipment; 2) provide an integrated medical record and medical reference information management system; 3) manage inventory for logistical support of supplies and secure pharmaceuticals; 4) supply audio and electronic mail communications between the medical officer and ground based flight surgeons. ImagesFigure 1

  10. Understanding health care provider barriers to hospital affiliated medical fitness center facility referral: a questionnaire survey and semi structured interviews.

    PubMed

    Smock, Carissa; Alemagno, Sonia

    2017-08-03

    The purpose of this study is to understand health care provider barriers to referring patients to Medical Fitness Center Facilities within an affiliated teaching hospital system using referral of diabetic services as an example. The aims of this study include: (1) to assess health care providers' awareness and use of facilities, (2) to determine barriers to referring patients to facilities, (3) identify current and needed resources and/or changes to increase referral to facilities. A 20-item electronic survey and requests for semi-structured interviews were administered to hospital system directors and managers (n = 51). Directors and managers instructed physicians and staff to complete the survey and interviews as applicable. Perceived barriers, knowledge, utilization, and referral of patients to Medical Fitness Center Facilities were collected and examined. Descriptive statistics were generated regarding practice characteristics, provider characteristics, and referral. Of the health care providers surveyed and interviewed (n = 25) 40% indicated verbally suggesting use of facilities, 24% provided a flyer about the facilities. No respondents indicated that they directly referred patients to the facilities. However, 16% referred patients to other locations for physical activity - including their own department's management and prevention services. 20% do not refer to Medical Fitness Center Facilities or any other lifestyle programs/locations. Lack of time (92%) and lack of standard guidelines and operating procedures (88%) are barriers to referral. All respondents indicated a strong ability to refer patients to Medical Fitness Center Facilities if given education about referral programs available as well as standard clinical guidelines and protocol for delivery. The results of this study indicate that, although few healthcare providers are currently referring patients to Medical Fitness Center Facilities, health care providers with an affiliated Medical Fitness Center Facility not only want clinical standard guidelines, protocol, and training to refer patients to Medical Fitness Center Facilities, but believe they have the ability to increase referral if given these tools. The Medical Fitness Association has a unique opportunity to bridge health care providers to Medical Fitness Center Facilities by developing clinical practice guidelines in cooperation with the American Diabetes Association.

  11. Barriers to providing palliative care in long-term care facilities

    PubMed Central

    Brazil, Kevin; Bédard, Michel; Krueger, Paul; Taniguchi, Alan; Kelley, Mary Lou; McAiney, Carrie; Justice, Christopher

    2006-01-01

    OBJECTIVE To assess challenges in providing palliative care in long-term care (LTC) facilities from the perspective of medical directors. DESIGN Cross-sectional mailed survey. A questionnaire was developed, reviewed, pilot-tested, and sent to 450 medical directors representing 531 LTC facilities. Responses were rated on 2 different 5-point scales. Descriptive analyses were conducted on all responses. SETTING All licensed LTC facilities in Ontario with designated medical directors. PARTICIPANTS Medical directors in the facilities. MAIN OUTCOME MEASURES Demographic and practice characteristics of physicians and facilities, importance of potential barriers to providing palliative care, strategies that could be helpful in providing palliative care, and the kind of training in palliative care respondents had received. RESULTS Two hundred seventy-five medical directors (61%) representing 302 LTC facilities (57%) responded to the survey. Potential barriers to providing palliative care were clustered into 3 groups: facility staff’s capacity to provide palliative care, education and support, and the need for external resources. Two thirds of respondents (67.1%) reported that inadequate staffing in their facilities was an important barrier to providing palliative care. Other barriers included inadequate financial reimbursement from the Ontario Health Insurance Program (58.5%), the heavy time commitment required (47.3%), and the lack of equipment in facilities (42.5%). No statistically significant relationship was found between geographic location or profit status of facilities and barriers to providing palliative care. Strategies respondents would use to improve provision of palliative care included continuing medical education (80.0%), protocols for assessing and monitoring pain (77.7%), finding ways to increase financial reimbursement for managing palliative care residents (72.1%), providing educational material for facility staff (70.7%), and providing practice guidelines related to assessing and managing palliative care patients (67.8%). CONCLUSION Medical directors in our study reported that their LTC facilities were inadequately staffed and lacked equipment. The study also highlighted the specialized role of medical directors, who identified continuing medical education as a key strategy for improving provision of palliative care. PMID:17327890

  12. Barriers to providing palliative care in long-term care facilities.

    PubMed

    Brazil, Kevin; Bédard, Michel; Krueger, Paul; Taniguchi, Alan; Kelley, Mary Lou; McAiney, Carrie; Justice, Christopher

    2006-04-01

    To assess challenges in providing palliative care in long-term care (LTC) facilities from the perspective of medical directors. Cross-sectional mailed survey. A questionnaire was developed, reviewed, pilot-tested, and sent to 450 medical directors representing 531 LTC facilities. Responses were rated on 2 different 5-point scales. Descriptive analyses were conducted on all responses. All licensed LTC facilities in Ontario with designated medical directors. Medical directors in the facilities. Demographic and practice characteristics of physicians and facilities, importance of potential barriers to providing palliative care, strategies that could be helpful in providing palliative care, and the kind of training in palliative care respondents had received. Two hundred seventy-five medical directors (61%) representing 302 LTC facilities (57%) responded to the survey. Potential barriers to providing palliative care were clustered into 3 groups: facility staff's capacity to provide palliative care, education and support, and the need for external resources. Two thirds of respondents (67.1%) reported that inadequate staffing in their facilities was an important barrier to providing palliative care. Other barriers included inadequate financial reimbursement from the Ontario Health Insurance Program (58.5%), the heavy time commitment required (47.3%), and the lack of equipment in facilities (42.5%). No statistically significant relationship was found between geographic location or profit status of facilities and barriers to providing palliative care. Strategies respondents would use to improve provision of palliative care included continuing medical education (80.0%), protocols for assessing and monitoring pain (77.7%), finding ways to increase financial reimbursement for managing palliative care residents (72.1%), providing educational material for facility staff (70.7%), and providing practice guidelines related to assessing and managing palliative care patients (67.8%). Medical directors in our study reported that their LTC facilities were inadequately staffed and lacked equipment. The study also highlighted the specialized role of medical directors, who identified continuing medical education as a key strategy for improving provision of palliative care.

  13. 42 CFR 124.707 - Waiver of recovery where facility is sold or transferred to a proprietary entity.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... OF HEALTH AND HUMAN SERVICES HEALTH RESOURCES DEVELOPMENT MEDICAL FACILITY CONSTRUCTION AND... deficits will be adjusted by the percent change in the National Consumer Price Index for Medical Care... adjusted by the percent change in the National Consumer Price Index for Medical Care between that year and...

  14. 42 CFR 124.707 - Waiver of recovery where facility is sold or transferred to a proprietary entity.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... OF HEALTH AND HUMAN SERVICES HEALTH RESOURCES DEVELOPMENT MEDICAL FACILITY CONSTRUCTION AND... deficits will be adjusted by the percent change in the National Consumer Price Index for Medical Care... adjusted by the percent change in the National Consumer Price Index for Medical Care between that year and...

  15. Development of a Knowledge-Based System Approach for Decision Making in Construction Projects

    DTIC Science & Technology

    1992-05-01

    a generic model for an administrative facility and medical facility with predefined fixed building systems based on Air Force criteria and past...MAINTENANCE HANGAR (MEDIUM BAY) CORROSION CONTROL HANGAR (HIGH BAY) FUEL SYSTEM MAINTENANCE HANGAR (MEDIUM BAY) MEDICAL MODEL 82 Table 5-1--continued...BUILDING SUPPORT MEDICAL LOGISTICS MEDICAL TOTAL 85 Table 5-2--continued MISSILE ASSEMBLY AND MAINTENANCE BUILDING TOTAL MISSILE LOADING AND UNLOADING

  16. Development and perceived effects of an educational programme on quality and safety in medication handling in residential facilities.

    PubMed

    Mygind, Anna; El-Souri, Mira; Rossing, Charlotte; Thomsen, Linda Aagaard

    2018-04-01

    To develop and test an educational programme on quality and safety in medication handling for staff in residential facilities for the disabled. The continuing pharmacy education instructional design model was used to develop the programme with 22 learning objectives on disease and medicines, quality and safety, communication and coordination. The programme was a flexible, modular seven + two days' course addressing quality and safety in medication handling, disease and medicines, and medication supervision and reconciliation. The programme was tested in five Danish municipalities. Municipalities were selected based on their application for participation; each independently selected a facility for residents with mental and intellectual disabilities, and a facility for residents with severe mental illnesses. Perceived effects were measured based on a questionnaire completed by participants before and after the programme. Effects on motivation and confidence as well as perceived effects on knowledge, skills and competences related to medication handling, patient empowerment, communication, role clarification and safety culture were analysed conducting bivariate, stratified analyses and test for independence. Of the 114 participants completing the programme, 75 participants returned both questionnaires (response rate = 66%). Motivation and confidence regarding quality and safety in medication handling significantly improved, as did perceived knowledge, skills and competences on 20 learning objectives on role clarification, safety culture, medication handling, patient empowerment and communication. The programme improved staffs' motivation and confidence and their perceived ability to handle residents' medication safely through improved role clarification, safety culture, medication handling and patient empowerment and communication skills. © 2017 Royal Pharmaceutical Society.

  17. 42 CFR 124.514 - Compliance alternative for facilities with small annual obligations.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... HUMAN SERVICES HEALTH RESOURCES DEVELOPMENT MEDICAL FACILITY CONSTRUCTION AND MODERNIZATION Reasonable... recent year for which a published index is available. (ii) Title XVI-assisted facilities. (A) For the...

  18. 42 CFR 124.514 - Compliance alternative for facilities with small annual obligations.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... HUMAN SERVICES HEALTH RESOURCES DEVELOPMENT MEDICAL FACILITY CONSTRUCTION AND MODERNIZATION Reasonable... recent year for which a published index is available. (ii) Title XVI-assisted facilities. (A) For the...

  19. 42 CFR 124.2 - Definitions.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 1 2011-10-01 2011-10-01 false Definitions. 124.2 Section 124.2 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH RESOURCES DEVELOPMENT MEDICAL FACILITY CONSTRUCTION AND MODERNIZATION Project Grants for Public Medical Facility Construction and Modernization § 124.2 Definitions. As used in this...

  20. 42 CFR 124.2 - Definitions.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 1 2014-10-01 2014-10-01 false Definitions. 124.2 Section 124.2 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH RESOURCES DEVELOPMENT MEDICAL FACILITY CONSTRUCTION AND MODERNIZATION Project Grants for Public Medical Facility Construction and Modernization § 124.2 Definitions. As used in this...

  1. 42 CFR 124.2 - Definitions.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 1 2012-10-01 2012-10-01 false Definitions. 124.2 Section 124.2 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH RESOURCES DEVELOPMENT MEDICAL FACILITY CONSTRUCTION AND MODERNIZATION Project Grants for Public Medical Facility Construction and Modernization § 124.2 Definitions. As used in this...

  2. 42 CFR 124.2 - Definitions.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Definitions. 124.2 Section 124.2 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH RESOURCES DEVELOPMENT MEDICAL FACILITY CONSTRUCTION AND MODERNIZATION Project Grants for Public Medical Facility Construction and Modernization § 124.2 Definitions. As used in this...

  3. 42 CFR 124.2 - Definitions.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 1 2013-10-01 2013-10-01 false Definitions. 124.2 Section 124.2 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH RESOURCES DEVELOPMENT MEDICAL FACILITY CONSTRUCTION AND MODERNIZATION Project Grants for Public Medical Facility Construction and Modernization § 124.2 Definitions. As used in this...

  4. Development of a Medical Cyclotron Production Facility

    NASA Astrophysics Data System (ADS)

    Allen, Danny R.

    2003-08-01

    Development of a Cyclotron manufacturing facility begins with a business plan. Geographics, the size and activity of the medical community, the growth potential of the modality being served, and other business connections are all considered. This business used the customer base established by NuTech, Inc., an independent centralized nuclear pharmacy founded by Danny Allen. With two pharmacies in operation in Tyler and College Station and a customer base of 47 hospitals and clinics the existing delivery system and pharmacist staff is used for the cyclotron facility. We then added cyclotron products to contracts with these customers to guarantee a supply. We partnered with a company in the process of developing PET imaging centers. We then built an independent imaging center attached to the cyclotron facility to allow for the use of short-lived isotopes.

  5. Medical Terminology of the Musculoskeletal System. Medical Records. Instructional Unit for the Medical Transcriber.

    ERIC Educational Resources Information Center

    Gosman, Minna L.

    Following an analysis of the task of transcribing as practiced in a health facility, this study guide was developed to teach the knowledge and skills required of a medical transcriber. The medical record department was identified as a major occupational area, and a task inventory for medical records was developed and used as a basis for a…

  6. 42 CFR 124.516 - Charitable facility compliance alternative.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Charitable facility compliance alternative. 124.516... RESOURCES DEVELOPMENT MEDICAL FACILITY CONSTRUCTION AND MODERNIZATION Reasonable Volume of Uncompensated Services to Persons Unable To Pay § 124.516 Charitable facility compliance alternative. (a) Effect of...

  7. Real-time Stack Monitoring at the BaTek Medical Isotope Production Facility

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

    McIntyre, Justin I.; Agusbudiman, A.; Cameron, Ian M.

    2016-04-01

    Radioxenon emissions from radiopharmaceutical production are a major source of background concentrations affecting the radioxenon detection systems of the International Monitoring System (IMS). Collection of real-time emissions data from production facilities makes it possible to screen out some medical isotope signatures from the IMS radioxenon data sets. This paper describes an effort to obtain and analyze real-time stack emissions data with the design, construction and installation of a small stack monitoring system developed by a joint CTBTO-IDC, BATAN, and PNNL team at the BaTek medical isotope production facility near Jakarta, Indonesia.

  8. Medical Terminology of the Circulatory System. Medical Records. Instructional Unit for the Medical Transcriber.

    ERIC Educational Resources Information Center

    Gosman, Minna L.

    Developed as a result of an analysis of the task of transcribing as practiced in a health facility, this study guide was designed to teach the knowledge and skills required of a medical transcriber. The medical record department was identified as a major occupational area, and a task inventory for medical records was developed and used as a basis…

  9. 42 CFR 124.517 - Unrestricted availability compliance alternative for Title VI-assisted facilities.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... for Title VI-assisted facilities. 124.517 Section 124.517 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH RESOURCES DEVELOPMENT MEDICAL FACILITY CONSTRUCTION AND... availability compliance alternative for Title VI-assisted facilities. (a) Effect of certification. The...

  10. Development of a Medical Cyclotron Production Facility

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

    Allen, Danny R.

    Development of a Cyclotron manufacturing facility begins with a business plan. Geographics, the size and activity of the medical community, the growth potential of the modality being served, and other business connections are all considered. This business used the customer base established by NuTech, Inc., an independent centralized nuclear pharmacy founded by Danny Allen. With two pharmacies in operation in Tyler and College Station and a customer base of 47 hospitals and clinics the existing delivery system and pharmacist staff is used for the cyclotron facility. We then added cyclotron products to contracts with these customers to guarantee a supply.more » We partnered with a company in the process of developing PET imaging centers. We then built an independent imaging center attached to the cyclotron facility to allow for the use of short-lived isotopes.« less

  11. Medications Associated with Geriatric Syndromes (MAGS) and their Prevalence in Older Hospitalized Adults Discharged to Skilled Nursing Facilities

    PubMed Central

    Saraf, Avantika A.; Peterson, Alec W.; Simmons, Sandra F.; Schnelle, John F.; Bell, Susan P.; Kripalani, Sunil; Myers, Amy P.; Mixon, Amanda S.; Long, Emily A.; Jacobsen, J. Mary Lou; Vasilevskis, Eduard E.

    2016-01-01

    Background More than half of the hospitalized older adults discharged to skilled nursing facilities (SNFs) have more than three geriatric syndromes. Pharmacotherapy may be contributing to geriatric syndromes in this population. Objectives Develop a list of medications associated with geriatric syndromes and describe their prevalence in patients discharged from acute care to skilled nursing facilities (SNFs) Design Literature review and multidisciplinary expert panel discussion, followed by cross-sectional analysis. Setting Academic Medical Center in the United States Participants 154 hospitalized Medicare beneficiaries discharged to SNFs Measurements Development of a list of medications that are associated with six geriatric syndromes. Prevalence of the medications associated with geriatric syndromes was examined in the hospital discharge sample. Results A list of 513 medications was developed as potentially contributing to 6 geriatric syndromes: cognitive impairment, delirium, falls, reduced appetite or weight loss, urinary incontinence, and depression. Medications included 18 categories. Antiepileptics were associated with all syndromes while antipsychotics, antidepressants, antiparkinsonism and opioid agonists were associated with 5 geriatric syndromes. In the prevalence sample, patients were discharged to SNFs with an overall average of 14.0 (±4.7) medications, including an average of 5.9 (±2.2) medications that could contribute to geriatric syndromes, with falls having the most associated medications at discharge, 5.5 (±2.2). Conclusions Many commonly prescribed medications are associated with geriatric syndromes. Over 40% of all medications ordered upon discharge to SNFs were associated with geriatric syndromes and could be contributing to the high prevalence of geriatric syndromes experienced by this population. PMID:27255830

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

    PubMed

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

    2015-01-01

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

  13. High-tech rural clinics and hospitals in Japan: a comparison to the Japanese average.

    PubMed

    Matsumoto, Masatoshi; Okayama, Masanobu; Inoue, Kazuo; Kajii, Eiji

    2004-10-01

    Japanese medical facilities are noted for being heavily equipped with high-tech equipment compared to other industrialised countries. Rural facilities are anecdotally said to be better equipped than facilities in other areas due to egalitarian health resource diffusion policies by public sectors whose goal is to secure fair access to modern medical technologies among the entire population. To show the technology status of rural practice and compare it to the national level. Nationwide postal survey. Questionnaires were sent to the directors of 1362 public hospitals and clinics (of the 1723 municipalities defined as 'rural' by four national laws). Information was collected about the technologies they possessed. The data were compared with figures from a national census of all hospitals and clinics. A total of 766 facilities responded (an effective response rate of 56%). Rural facilities showed higher possession rates in most comparable technologies than the national level. It is noted that almost all rural hospitals had gastroscopes and colonoscopes and their possession rates of bronchoscopes and dialysis equipment were twice as high as the national level. The discrepancy in possession rates between rural and national was even more remarkable in clinics than in hospitals. Rural clinics owned twice as many abdominal ultrasonographs, and three times as many gastroscopes, colonoscopes, defibrillators and computed tomography scanners as the national level. Rural facilities are equipped with more technology than urban ones. Government-led, tax based, technology diffusion in the entire country seems to have attained its goal. What is already known on this subject: As a general tendency in both developing and developed countries, rural medical facilities are technologically less equipped than their urban counterparts. What does this paper add?: In Japan, rural medical facilities are technologically better equipped than urban facilities.

  14. Community pharmacists as educators in Danish residential facilities: a qualitative study.

    PubMed

    Mygind, Anna; El-Souri, Mira; Pultz, Kirsten; Rossing, Charlotte; Thomsen, Linda A

    2017-08-01

    To explore experiences with engaging community pharmacists in educational programmes on quality and safety in medication handling in residential facilities for the disabled. A secondary analysis of data from two Danish intervention studies where community pharmacists were engaged in educational programmes. Data included 10 semi-structured interviews with staff, five semi-structured interviews and three open-ended questionnaires with residential facility managers, and five open-ended questionnaires to community pharmacists. Data were thematically coded to identify key points pertaining to the themes 'pharmacists as educators' and 'perceived effects of engaging pharmacists in competence development'. As educators, pharmacists were successful as medicines experts. Some pharmacists experienced pedagogical challenges. Previous teaching experience and obtained knowledge of the local residential facility before teaching often provided sufficient pedagogical skills and tailored teaching to local needs. Effects of engaging community pharmacists included in most instances improved cooperation between residential facilities and community pharmacies through a trustful relationship and improved dialogue about the residents' medication. Other effects included a perception of improved patient safety, teaching skills and branding of the pharmacy. Community pharmacists provide a resource to engage in educational programmes on medication handling in residential facilities, which may facilitate improved cooperation between community pharmacies and residential facilities. However, development of pedagogical competences and understandings of local settings are prerequisites for facilities and pharmacists to experience the programmes as successful. © 2016 Royal Pharmaceutical Society.

  15. 42 CFR 124.708 - Waiver of recovery-good cause for other use of facility.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... facility. 124.708 Section 124.708 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH RESOURCES DEVELOPMENT MEDICAL FACILITY CONSTRUCTION AND MODERNIZATION Recovery of Grant Funds § 124.708 Waiver of recovery—good cause for other use of facility. The Secretary may for good...

  16. Non-acute care facility ownership: if not you, who?

    PubMed

    Davis, J Michael

    2007-01-01

    Physician groups now face a dynamic medical real estate market that can provide an attractive alternative to self-owned and self-financed outpatient facilities and medical office buildings. The ownership and financing options available to physicians and physician groups considering the development of new medical projects have expanded greatly over the past few years and are likely to continue to evolve in the foreseeable future. This changing environment, driven by new sources of institutional capital and the emergence of qualified developers, has led to a more competitive market for physicians and groups seeking real estate capital partners, and physicians are starting to take advantage of it. Physicians and groups have embraced third-party ownership and management of real estate, because it can preserve capital resources and minimizes risk. These groups are using third parties to develop and own new medical real estate projects. This article describes medical real estate project development alternatives, the attributes and concerns of developers, typical transaction terms, and a recommended process for physicians and groups to select the best real estate development partner.

  17. Complicating causality: patient and professional perspectives on obstetric fistula in Nigeria.

    PubMed

    Phillips, Beth S; Ononokpono, Dorothy N; Udofia, Nsikanabasi W

    2016-09-01

    Obstetric fistula, a preventable maternal morbidity characterised by chronic bladder and/or bowel incontinence, is widespread in Nigeria. This qualitative, multi-site study examined the competing narratives on obstetric fistula causality in Nigeria. Research methods were participant observation and in-depth interviews with 86 fistula patients and 43 healthcare professionals. The study found that both patient and professional narratives identified limited access to medical facilities as a major factor leading to obstetric fistula. Patients and professionals beliefs regarding the access problem, however, differed significantly. The majority of fistula patients reported either delivering or attempting to deliver in medical facilities and most patients attributed fistula to a lack of trained medical staff and mismanagement at medical facilities. Conversely, a majority of health professionals believed that women developed obstetric fistula because they chose to deliver at home due to women's traditional beliefs about womanhood and childbirth. Both groups described financial constraints and inadequate transport to medical facilities during complicated labour as related to obstetric fistula onset. Programmatic insights derived from these findings should inform fistula prevention interventions both with healthcare professionals and with Nigerian women.

  18. Anatomy Education in Namibia: Balancing Facility Design and Curriculum Development

    ERIC Educational Resources Information Center

    Wessels, Quenton; Vorster, Willie; Jacobson, Christian

    2012-01-01

    The anatomy curriculum at Namibia's first, and currently only, medical school is clinically oriented, outcome-based, and includes all of the components of modern anatomical sciences i.e., histology, embryology, neuroanatomy, gross, and clinical anatomy. The design of the facilities and the equipment incorporated into these facilities were directed…

  19. [Health care units image development on the market of medical services].

    PubMed

    Kemicer-Chmielewska, Ewa; Karakiewicz, Beata

    2010-01-01

    The cause for this document is to present a deliberation on public health facility image development on the medical services market. Marketization of the health service, growing awareness of Polish citizens and their expectation of high service quality as well as increased competition in the healthcare system market is the reason why health unit managers need to put a lot of strength and effort in sustaining or improving the image of the facility they run. Such action gives a chance for obtaining a competitive advantage.

  20. Medical Terminology of the Respiratory System. Medical Records. Instructional Unit for the Medical Transcriptionist.

    ERIC Educational Resources Information Center

    Gosman, Minna L.

    Following an analysis of the task of transcribing as practiced in a health facility, this study guide was designed to teach the knowledge and skills required of a medical transcriber. The medical record department was identified as a major occupational area, and a task inventory for medical records was developed and used as a basis for…

  1. [Structure of pain management facilities in Germany : Classification of medical and psychological pain treatment services-Consensus of the Joint Commission of the Professional Societies and Organizations for Quality in Pain Medicine].

    PubMed

    Müller-Schwefe, G H H; Nadstawek, J; Tölle, T; Nilges, P; Überall, M A; Laubenthal, H J; Bock, F; Arnold, B; Casser, H R; Cegla, T H; Emrich, O M D; Graf-Baumann, T; Henning, J; Horlemann, J; Kayser, H; Kletzko, H; Koppert, W; Längler, K H; Locher, H; Ludwig, J; Maurer, S; Pfingsten, M; Schäfer, M; Schenk, M; Willweber-Strumpf, A

    2016-06-01

    On behalf of the Medical/Psychological Pain Associations, Pain Patients Alliance and the Professional Association of Pain Physicians and Psychologists, the Joint Commission of Professional Societies and Organizations for Quality in Pain Medicine, working in close collaboration with the respective presidents, has developed verifiable structural and process-related criteria for the classification of medical and psychological pain treatment facilities in Germany. Based on the established system of graded care in Germany and on existing qualifications, these criteria also argue for the introduction of a basic qualification in pain medicine. In addition to the first-ever comprehensive description of psychological pain facilities, the criteria presented can be used to classify five different levels of pain facilities, from basic pain management facilities, to specialized institutions, to the Centre for Interdisciplinary Pain Medicine. The recommendations offer binding and verifiable criteria for quality assurance in pain medicine and improved pain treatment.

  2. Use of information systems in Air Force medical treatment facilities in strategic planning and decision-making.

    PubMed

    Yap, Glenn A; Platonova, Elena A; Musa, Philip F

    2006-02-01

    An exploratory study used Ansoff's strategic planning model as a framework to assess perceived effectiveness of information systems in supporting strategic business plan development at Air Force medical treatment facilities (MTFs). Results showed information systems were most effective in supporting historical trend analysis, strategic business plans appeared to be a balance of operational and strategic plans, and facilities perceived a greater need for new clinical, vice administrative, information systems to support strategic planning processes. Administrators believed information systems should not be developed at the local level and perceived information systems have the greatest impact on improving clinical quality outcomes, followed by ability to deliver cost effective care and finally, ability to increase market share.

  3. [Marketing in the system of military-medical facilities].

    PubMed

    Kostiuchenko, O M; Sviridova, T B

    2014-02-01

    Military medical facilities of the Ministry of Defence of the Russian, have received the right to provide additional services and have been involved in the sphere of market relations. The strong influence of market relations - an objective reality that must be used for the development of military medical institutions and improving quality of care.Effective commercial activity can improve capabilities of the military medical institutions. This requires constant study of market mechanisms to implement and develop their competitive advantage. The paper substantiates the need for the participation of military medical institutions in the provision of health services to the public on the terms of compensation incurred by financial institutions costs (paid medical services, medical assistance program of compulsory and voluntary health insurance). Taking into account the specifics of military medical institutions set out basic principles and recommendations have been implementing marketing approach in their management, the practical application of which will not only increase efficiency, but also create conditions to improve the financial and economic indicators. This knowledge will help the mechanism of functioning health care market and the rules of interaction of market counterparties.

  4. New irradiation facilities for development of production methods of medical radionuclides at cyclotrons at Forschungszentrum Jülich

    NASA Astrophysics Data System (ADS)

    Spellerberg, S.; Scholten, B.; Spahn, I.; Felden, O.; Gebel, R.; Qaim, S. M.; Bai, M.; Neumaier, B.

    2017-05-01

    An essential basis for research and development work on radiopharmaceuticals is the efficient production of radionuclides of high quality. In this process research-oriented studies aiming for elucidation of biochemical processes require novel products. The radionuclide development at INM-5 entails basic research, e.g. the determination of nuclear reaction data, as well as technical aspects of practical production, such as high-current targetry, chemical separation, formulation and quality control. In this work developments, adaptation and optimization of irradiation facilities at the BC 1710, JULIC as Injector of COSY and COSY itself are summarized, which shall allow the extension of radionuclide production possibilities, aiming at innovations in medical applications.

  5. Application of nuclear physics in medical physics and nuclear medicine

    NASA Astrophysics Data System (ADS)

    Hoehr, Cornelia

    2016-09-01

    Nuclear physics has a long history of influencing and advancing medical fields. At TRIUMF we use the applications of nuclear physics to diagnose several diseases via medical isotopes and treat cancer by using proton beams. The Life Science division has a long history of producing Positron Emission Tomography (PET) isotopes but we are also investigating the production of SPECT and PET isotopes with a potential shortage for clinical operation or otherwise limited access to chemists, biologists and medical researchers. New targets are being developed, aided by a simulation platform investigating the processes inside a target under proton irradiation - nuclear, thermodynamic, and chemical. Simulations also aid in the development of new beam-shaping devices for TRIUMF's Proton Therapy facility, Canada's only proton therapy facility, as well as new treatment testing systems. Both promise improved treatment delivery for cancer patients.

  6. A pilot survey of the U.S. medical waste industry to determine training needs for safely handling highly infectious waste.

    PubMed

    Le, Aurora B; Hoboy, Selin; Germain, Anne; Miller, Hal; Thompson, Richard; Herstein, Jocelyn J; Jelden, Katelyn C; Beam, Elizabeth L; Gibbs, Shawn G; Lowe, John J

    2018-02-01

    The recent Ebola outbreak led to the development of Ebola virus disease (EVD) best practices in clinical settings. However, after the care of EVD patients, proper medical waste management and disposal was identified as a crucial component to containing the virus. Category A waste-contaminated with EVD and other highly infectious pathogens-is strictly regulated by governmental agencies, and led to only several facilities willing to accept the waste. A pilot survey was administered to determine if U.S. medical waste facilities are prepared to handle or transport category A waste, and to determine waste workers' current extent of training to handle highly infectious waste. Sixty-eight percent of survey respondents indicated they had not determined if their facility would accept category A waste. Of those that had acquired a special permit, 67% had yet to modify their permit since the EVD outbreak. This pilot survey underscores gaps in the medical waste industry to handle and respond to category A waste. Furthermore, this study affirms reports a limited number of processing facilities are capable or willing to accept category A waste. Developing the proper management of infectious disease materials is essential to close the gaps identified so that states and governmental entities can act accordingly based on the regulations and guidance developed, and to ensure public safety. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  7. Prioritizing interventions to manage polypharmacy in Australian aged care facilities.

    PubMed

    Jokanovic, Natali; Wang, Kate N; Dooley, Michael J; Lalic, Samanta; Tan, Edwin Ck; Kirkpatrick, Carl M; Bell, J Simon

    Polypharmacy is highly prevalent in residential aged care facilities (RACFs). Although polypharmacy is sometimes unavoidable, polypharmacy has been associated with increased morbidity and mortality. To identify and prioritize a range of potential interventions to manage polypharmacy in RACFs from the perspectives of health care professionals, health policy and consumer representatives. Two nominal group technique (NGT) sessions were convened in August 2015. A purposive sample (n = 19) of clinicians, researchers, managers and representatives of consumer, professional and health policy organizations were asked to nominate interventions to address the prevalence and appropriateness of medication use. Participants were then asked to prioritize five interventions suitable for possible implementation at the system level. Six of 16 potential interventions were prioritized highest for possible implementation in clinical practice, with two interventions prioritized as second highest. The top interventions in rank order were 'implementation of a pharmacist-led medication reconciliation service for new residents,' 'conduct facility-level audits and feedback to staff and health care professionals,' 'develop deprescribing scripts to assist clinician-resident discussion,' 'develop or revise prescribing guidelines specific to older people with multimorbidity in RACFs,' 'implement electronic medication charts and records' and 'better support Medication Advisory Committees (MACs) to address medication appropriateness.' This study prioritized a range of potential interventions that may be used to assist clinicians and policy makers develop a comprehensive strategy to manage polypharmacy in RACFs. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. A national survey of clubs medical personnel, facilities and protocols in Irish Rugby Union.

    PubMed

    Coughlan, G F; Fullen, B M; McCarthy, C

    2014-03-01

    Rugby Union is one of the most popular sports in Ireland. Participation in all sports carries risk, and there is an onus on governing bodies and those involved in sport to minimise this risk using injury prevention and management programmes. The aim of this study was to evaluate the current status of medical personnel, facilities and equipment in Rugby Union clubs in Ireland. A nationwide cross sectional survey of affiliated clubs in Ireland was undertaken at the beginning of the 2011-2012. Clubs were surveyed on a range of variables including their medical personnel, facilities, equipment, policies and concussion. 47.7 % of those surveyed responded. The majority reported involvement of appropriate medically qualified personnel, having a dedicated medical area/room, a first aid kit and defibrillator, and a demand for first aid courses. This survey provided key information on the current medical status of clubs in Ireland to the governing body. Many clubs have adequate medical resources in place, however a large number do not have medical professionals working with them or own basic medical equipment. The results of this study have lead to the development and implementation of a rugby specific injury prevention and management programme for medical and non-medical personnel at all levels of the game in Ireland.

  9. Assessment of primary health care facilities' service readiness in Nigeria.

    PubMed

    Oyekale, Abayomi Samuel

    2017-03-01

    Effective delivery of healthcare services requires availability of adequate infrastructure, diagnostic medical equipment, drugs and well-trained medical personnel. In Nigeria, poor funding and mismanagement often characterize healthcare service delivery thereby affecting coverage and quality of healthcare services. Therefore, the state of service delivery in Nigeria's health sector has come under some persistent criticisms. This paper analyzed service readiness of Primary Health Care (PHC) facilities in Nigeria with focus on availability of some essential drugs and medical equipment. Service Delivery Indicator (SDI) data for PHC in Nigeria were used. The data were collected from 2480 healthcare facilities from 12 states in the Nigeria's 6 geopolitical zones between 2013 and 2014. Data were analyzed with descriptive statistics, Principal Component Analysis (PCA) and Ordinary Least Square regression. Medical disposables such as hand gloves and male condoms were reported to be available in 77.18 and 44.03% of all the healthcare facilities respectively, while immunization services were provided by 86.57%. Functional stethoscopes were reported by 77.22% of the healthcare facilities, while only 68.10% had sphygmomanometers. In the combined healthcare facilities, availability of some basic drugs such as Azithromycin, Nifedipine, Dexamethasone and Misoprostol was low with 10.48, 25.20, 21.94 and 17.06%, respectively, while paracetamol and folic acid both had high availability with 74.31%. Regression results showed that indices of drug and medical equipment availability increased significantly (p < 0.05) among states in southern Nigeria and with presence of some power sources (electricity, generators, batteries and solar), but decreased among dispensaries/health posts. Travel time to headquarters and rural facilities significantly reduced indices of equipment availability (p < 0.05). It was concluded that for Nigeria to ensure better equity in access to healthcare facilities, which would facilitate achievement of some health-related sustainable development goals (SDGs), quality of services at its healthcare facilities should be improved. Given some differences between availability of basic medical equipment and their functionality, and lack of some basic drugs, proper inventory of medical services should be taken with effort put in place to increase funding and ensure proper management of healthcare resources.

  10. The Papua New Guinea medical supply system - documenting opportunities and challenges to meet the Millennium Development Goals

    PubMed Central

    2014-01-01

    Objectives Limited human resources are widely recognised as an impediment to achieving the health-related Millennium Development Goals in Pacific Island Countries, with the availability of medical supplies and suitably trained health personnel crucial to ensuring a well-functioning medical supply chain. This paper presents our findings as we seek to answer the research question ‘What factors influence the availability of medical supplies within the health facilities of Papua New Guinea?’ Methods We used a qualitative, triangulated strategy using semi-structured interviews, workplace observation and semi-structured focus groups. The parallel use of the interview tool and workplace observation tool allowed identification of ‘know-do’ gaps between what the interviewee said they did in their work practices, and the actual evidence of these practices. Focus groups provided further opportunities for raising and elaborating issues. Results During 2 weeks of data collection we conducted 17 interviews and 15 observational workplace surveys in 15 facilities. Sixteen health personnel participated in 3 focus groups across 2 provinces and one district. An array of medical supply issues across all levels of the medical supply chain were revealed, including standard operating procedures, facilities, transport, emergency medical kits, the cold chain and record keeping. The influence of health worker training and competency was found to be common across all of these issues. Conclusion The factors influencing the availability of medical supplies in PNG consist of a range of interrelating issues, consisting of both simple and complex problems involving the different levels and cadres of workers within the medical supply chain. Health systems sustainability theory suggests that a coordinated approach which addresses the inter-related nature of these issues, led by the PNG government and supported by suitable development partners, will be required for sustainable health systems change to occur. These changes are necessary for PNG to meet the health-related Millennium Development Goals. PMID:25848545

  11. The Papua New Guinea medical supply system - documenting opportunities and challenges to meet the Millennium Development Goals.

    PubMed

    Brown, Andrew N; Gilbert, Ben

    2014-01-01

    Limited human resources are widely recognised as an impediment to achieving the health-related Millennium Development Goals in Pacific Island Countries, with the availability of medical supplies and suitably trained health personnel crucial to ensuring a well-functioning medical supply chain. This paper presents our findings as we seek to answer the research question 'What factors influence the availability of medical supplies within the health facilities of Papua New Guinea?' We used a qualitative, triangulated strategy using semi-structured interviews, workplace observation and semi-structured focus groups. The parallel use of the interview tool and workplace observation tool allowed identification of 'know-do' gaps between what the interviewee said they did in their work practices, and the actual evidence of these practices. Focus groups provided further opportunities for raising and elaborating issues. During 2 weeks of data collection we conducted 17 interviews and 15 observational workplace surveys in 15 facilities. Sixteen health personnel participated in 3 focus groups across 2 provinces and one district. An array of medical supply issues across all levels of the medical supply chain were revealed, including standard operating procedures, facilities, transport, emergency medical kits, the cold chain and record keeping. The influence of health worker training and competency was found to be common across all of these issues. The factors influencing the availability of medical supplies in PNG consist of a range of interrelating issues, consisting of both simple and complex problems involving the different levels and cadres of workers within the medical supply chain. Health systems sustainability theory suggests that a coordinated approach which addresses the inter-related nature of these issues, led by the PNG government and supported by suitable development partners, will be required for sustainable health systems change to occur. These changes are necessary for PNG to meet the health-related Millennium Development Goals.

  12. 42 CFR 124.502 - Definitions.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH RESOURCES DEVELOPMENT MEDICAL... Consumer Price Index for medical care. (e) Facility means an entity that received assistance under title VI... (42 U.S.C. 2641, et seq.); the Public Works and Economic Development Act of 1965 (42 U.S.C. 3121, et...

  13. Medical Isotope Production Analyses In KIPT Neutron Source Facility

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

    Talamo, Alberto; Gohar, Yousry

    Medical isotope production analyses in Kharkov Institute of Physics and Technology (KIPT) neutron source facility were performed to include the details of the irradiation cassette and the self-shielding effect. An updated detailed model of the facility was used for the analyses. The facility consists of an accelerator-driven system (ADS), which has a subcritical assembly using low-enriched uranium fuel elements with a beryllium-graphite reflector. The beryllium assemblies of the reflector have the same outer geometry as the fuel elements, which permits loading the subcritical assembly with different number of fuel elements without impacting the reflector performance. The subcritical assembly is drivenmore » by an external neutron source generated from the interaction of 100-kW electron beam with a tungsten target. The facility construction was completed at the end of 2015, and it is planned to start the operation during the year of 2016. It is the first ADS in the world, which has a coolant system for removing the generated fission power. Argonne National Laboratory has developed the design concept and performed extensive design analyses for the facility including its utilization for the production of different radioactive medical isotopes. 99Mo is the parent isotope of 99mTc, which is the most commonly used medical radioactive isotope. Detailed analyses were performed to define the optimal sample irradiation location and the generated activity, for several radioactive medical isotopes, as a function of the irradiation time.« less

  14. The operating room of the future: white paper summation.

    PubMed

    Moses, Gerald R; Farr, James O

    2003-01-01

    On November 8 and 9, 2001, leading experts in patient safety, medical informatics, advanced surgical devices, telesurgery, and surgical facilities met to formulate strategic directions for the "OR of the Future" in both military and civilian healthcare. The meeting was co-hosted by the Telemedicine and Advanced Technology Research Center (TATRC) part of the U.S. Army Medical Research and Materiel Command at Fort Detrick, and the University of Maryland Medical Center. Researchers, surgeons, and experts in the field of operating room (OR) technology addressed the current state of research and technological developments. Experts in (1) patient safety, (2) medical informatics, (3) advanced surgical devices, (4) telesurgery, and (5) surgical facilities met in focused work groups to develop a proposed research agenda for each content area. Afterwards, each focused group agreed to develop a 'White Paper' on each specific area, addressing the current and future prospectus. In addition, they attempted to provide a recommended research roadmap for the 'OR of the Future.'

  15. Decontamination Workshop for Emergency Responding Personnel How Clean is Clean Enough 12-14 September 2007

    DTIC Science & Technology

    2008-09-01

    refers to a Medical Treatment Facility (MTF), can we assume that disrobing is sufficient? Is it possible to develop specific site clearance criteria ...o First responders , medical personnel, and the HAZMAT team o Incident Commanders o Public information officials o Hospitals and hospital networks ...clean personnel (both victims and first responders ) need to be when they are released from the incident site (or treatment facility for those that make

  16. An object-oriented class library for medical software development.

    PubMed

    O'Kane, K C; McColligan, E E

    1996-12-01

    The objective of this research is the development of a Medical Object Library (MOL) consisting of reusable, inheritable, portable, extendable C++ classes that facilitate rapid development of medical software at reduced cost and increased functionality. The result of this research is a library of class objects that range in function from string and hierarchical file handling entities to high level, procedural agents that perform increasingly complex, integrated tasks. A system built upon these classes is compatible with any other system similarly constructed with respect to data definitions, semantics, data organization and storage. As new objects are built, they can be added to the class library for subsequent use. The MOL is a toolkit of software objects intended to support a common file access methodology, a unified medical record structure, consistent message processing, standard graphical display facilities and uniform data collection procedures. This work emphasizes the relationship that potentially exists between the structure of a hierarchical medical record and procedural language components by means of a hierarchical class library and tree structured file access facility. In doing so, it attempts to establish interest in and demonstrate the practicality of the hierarchical medical record model in the modern context of object oriented programming.

  17. 46 CFR 4.03-5 - Medical facility.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 1 2012-10-01 2012-10-01 false Medical facility. 4.03-5 Section 4.03-5 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Definitions § 4.03-5 Medical facility. The term medical facility means an American hospital...

  18. 46 CFR 4.03-5 - Medical facility.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 1 2013-10-01 2013-10-01 false Medical facility. 4.03-5 Section 4.03-5 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Definitions § 4.03-5 Medical facility. The term medical facility means an American hospital...

  19. 46 CFR 4.03-5 - Medical facility.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 1 2014-10-01 2014-10-01 false Medical facility. 4.03-5 Section 4.03-5 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Definitions § 4.03-5 Medical facility. The term medical facility means an American hospital...

  20. 46 CFR 4.03-5 - Medical facility.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 1 2010-10-01 2010-10-01 false Medical facility. 4.03-5 Section 4.03-5 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Definitions § 4.03-5 Medical facility. The term medical facility means an American hospital...

  1. 46 CFR 4.03-5 - Medical facility.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 1 2011-10-01 2011-10-01 false Medical facility. 4.03-5 Section 4.03-5 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC MARINE CASUALTIES AND INVESTIGATIONS Definitions § 4.03-5 Medical facility. The term medical facility means an American hospital...

  2. A perspective on 10-years HTS experience at the Walter and Eliza Hall Institute of Medical Research - eighteen million assays and counting.

    PubMed

    Lackovic, Kurt; Lessene, Guillaume; Falk, Hendrik; Leuchowius, Karl-Johan; Baell, Jonathan; Street, Ian

    2014-03-01

    The Walter and Eliza Hall Institute of Medical Research (WEHI) is Australia's longest serving medical research institute. WEHI's High Throughput Screening (HTS) Facility was established in 2003 with $5 million of infrastructure funds invested by WEHI, and the Victorian State Government's Strategic Technology Initiative through Bio21 Australia Ltd. The Facility was Australia's first truly academic HTS facility and was one of only a handful operating in publicly funded institutions worldwide at that time. The objectives were to provide access to enabling HTS technologies, such as assay design, liquid handling automation, compound libraries and expertise to promote translation of basic research in a national setting that has a relatively young biotech sector and does not have a big Pharma research presence. Ten years on and the WEHI HTS Facility has participated in over 92 collaborative projects, generated over 18 million data points, and most importantly, projects that began in the Facility have been commercialized successfully (due to strong ties with Business Development and emphasis on intellectual property management) and now have molecules progressing in clinical trials.

  3. 77 FR 6915 - Medical Diagnostic Equipment Accessibility Standards

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-09

    ... Israel Deaconess Medical Center (October 22, 2009) accessible facilities and accessible medical equipment... of types of accessible medical equipment required in different types of health care facilities. If... facilities, accessible medical equipment, and auxiliary aids and services; University of Southern California...

  4. Exploring Factors Affecting Emergency Medical Services Staffs' Decision about Transporting Medical Patients to Medical Facilities.

    PubMed

    Ebrahimian, Abbasali; Seyedin, Hesam; Jamshidi-Orak, Roohangiz; Masoumi, Gholamreza

    2014-01-01

    Transfer of patients in medical emergency situations is one of the most important missions of emergency medical service (EMS) staffs. So this study was performed to explore affecting factors in EMS staffs' decision during transporting of patients in medical situations to medical facilities. The participants in this qualitative study consisted of 18 EMS staffs working in prehospital care facilities in Tehran, Iran. Data were gathered through semistructured interviews. The data were analyzed using a content analysis approach. The data analysis revealed the following theme: "degree of perceived risk in EMS staffs and their patients." This theme consisted of two main categories: (1) patient's condition' and (2) the context of the EMS mission'. The patent's condition category emerged from "physical health statuses," "socioeconomic statuses," and "cultural background" subcategories. The context of the EMS mission also emerged from two subcategories of "characteristics of the mission" and EMS staffs characteristics'. EMS system managers can consider adequate technical, informational, financial, educational, and emotional supports to facilitate the decision making of their staffs. Also, development of an effective and user-friendly checklist and scoring system was recommended for quick and easy recognition of patients' needs for transportation in a prehospital situation.

  5. The Development of a Quality Management Framework for Evaluating Medical Device Reprocessing Practice in Healthcare Facilities.

    PubMed

    Lorv, Bailey; Horodyski, Robin; Welton, Cynthia; Vail, John; Simonetto, Luca; Jokanovic, Danilo; Sharma, Richa; Mahoney, Angela Rea; Savoy-Bird, Shay; Bains, Shalu

    2017-01-01

    There is increasing awareness of the importance of medical device reprocessing (MDR) for the provision of safe patient care. Although industry service standards are available to guide MDR practices, there remains a lack of published key performance indicators (KPIs) and targets that are necessary to evaluate MDR quality for feedback and improvement. This article outlines the development of an initial framework that builds on established guidelines and includes service standards, KPIs and targets for evaluating MDR operations. This framework can support healthcare facilities in strengthening existing practices and enables a platform for collaboration towards better MDR performance management.

  6. A prototype Crew Medical Restraint System (CMRS) for Space Station Freedom

    NASA Technical Reports Server (NTRS)

    Johnston, S. L.; Eichstadt, F. T.; Billica, R. D.

    1992-01-01

    The Crew Medical Restrain System (CMRS) is a prototype system designed and developed for use as a universally deployable medical restraint/workstation on Space Station Freedom (SSF), the Shuttle Transportation System (STS), and the Assured Crew Rescue Vehicle (ACRV) for support of an ill or injured crewmember requiring stabilization and transportation to Earth. The CMRS will support all medical capabilities of the Health Maintenance Facility (HMF) by providing a restraint/interface system for all equipment (advance life support packs, defibrillator, ventilator, portable oxygen supply, IV pump, transport monitor, transport aspirator, and intervenous fluids delivery system) and personnel (patient and crew medical officers). It must be functional within the STS, ACRV, and all SSF habitable volumes. The CMRS will allow for medical capabilities within CPR, ACLS and ATLS standards of care. This must all be accomplished for a worst case transport time scenario of 24 hours from SSF to a definitive medical care facility on Earth. A presentation of the above design prototype with its subsequent one year SSF/HMF and STS/ACRV high fidelity mock-up ground based simulation testing will be given. Also, parabolic flight and underwater Weightless Test Facility evaluations will be demonstrated for various medical contingencies. The final design configuration to date will be discussed with future space program impact considerations.

  7. The Vanuatu medical supply system – documenting opportunities and challenges to meet the Millennium Development Goals

    PubMed Central

    Brown, Andrew; Gilbert, Ben

    2012-01-01

    Objectives: Limited human resources are widely recognised as a barrier to achieve health-related Millennium Development Goals. Availability of medical supplies and suitably trained health personnel are crucial to ensuring a well-functioning medical supply system. The objective of this paper is to identify the factors which influence the availability of medical supplies within the health facilities of Vanuatu. Methods: A qualitative triangulated strategy using semi-structured interviews, observational workplace surveys and semi-structured focus groups was developed. This research was approved by the Human Ethics Committee of the University of Canberra and was funded through a direct grant from the United Nations Population Fund Suva, Pacific sub regional office. Results: During two weeks of data collection, 21 interviews were conducted, observational workplace surveys were completed in 19 facilities and 22 personnel participated in three focus groups across three provinces. The interviewees had a wide range of primary professional groupings and were representative of the Vanuatu health workforce. A complex array of medical supply issues are described from within the three tiered structure of the medical supply system. Conclusion: The results of this research have further informed our understanding of the competencies required by healthcare personnel to conduct medical supply management activities effectively in Pacific Island countries. As a result of this research, a platform is provided for the government of Vanuatu to engage development partners to work toward a sustainable medical supply system. PMID:23093895

  8. Why do women choose private over public facilities for family planning services? A qualitative study of post-partum women in an informal urban settlement in Kenya.

    PubMed

    Keesara, Sirina R; Juma, Pamela A; Harper, Cynthia C

    2015-08-20

    Nearly 40% of women in developing countries seek contraceptives services from the private sector. However, the reasons that contraceptive clients choose private or public providers are not well studied. We conducted six focus groups discussions and 51 in-depth interviews with postpartum women (n = 61) to explore decision-making about contraceptive use after delivery, including facility choice. When seeking contraceptive services, women in this study preferred private over public facilities due to convenience and timeliness of services. Women avoided public facilities due to long waits and disrespectful providers. Study participants reported, however, that they felt more confident about the technical medical quality in public facilities than in private, and believed that private providers prioritized profit over safe medical practice. Women reported that public facilities offered comprehensive counseling and chose these facilities when they needed contraceptive decision-support. Provision of comprehensive counseling and screening, including side effects counseling and management, determined perception of quality. Women believed private providers offered the advantages of convenience, efficiency and privacy, though they did not consistently offer high-quality care. Quality-improvement of contraceptive care at private facilities could include technical standardization and accreditation. Development of support and training for side effect management may be an important intervention to improve perceived quality of care.

  9. 42 CFR 124.514 - Compliance alternative for facilities with small annual obligations.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... annual obligations. 124.514 Section 124.514 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH RESOURCES DEVELOPMENT MEDICAL FACILITY CONSTRUCTION AND MODERNIZATION Reasonable... qualify threrefor under a program of discounted health services. A “program of discounted health services...

  10. 42 CFR 124.514 - Compliance alternative for facilities with small annual obligations.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... annual obligations. 124.514 Section 124.514 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH RESOURCES DEVELOPMENT MEDICAL FACILITY CONSTRUCTION AND MODERNIZATION Reasonable... qualify threrefor under a program of discounted health services. A “program of discounted health services...

  11. 42 CFR 124.514 - Compliance alternative for facilities with small annual obligations.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... annual obligations. 124.514 Section 124.514 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH RESOURCES DEVELOPMENT MEDICAL FACILITY CONSTRUCTION AND MODERNIZATION Reasonable... qualify threrefor under a program of discounted health services. A “program of discounted health services...

  12. Medical evaluations on the KC-135 1991 flight report summary

    NASA Technical Reports Server (NTRS)

    Lloyd, Charles W.

    1993-01-01

    The medical investigations completed on the KC-135 during FY 1991 in support of the development of the Health Maintenance Facility and Medical Operations are presented. The experiments consisted of medical and engineering evaluations of medical hardware and procedures and were conducted by medical and engineering personnel. The hardware evaluated included prototypes of a crew medical restraint system and advanced life support pack, a shuttle orbiter medical system, an airway medical accessory kit, a supplementary extended duration orbiter medical kit, and a surgical overhead canopy. The evaluations will be used to design flight hardware and identify hardware-specific training requirements. The following procedures were evaluated: transport of an ill or injured crewmember at man-tended capability, surgical technique in microgravity, transfer of liquids in microgravity, advanced cardiac life support using man-tended capability Health Maintenance Facility hardware, medical transport using a model of the assured crew return vehicle, and evaluation of delivery mechanisms for aerosolized medications in microgravity. The results of these evaluation flights allow for a better understanding of the types of procedures that can be performed in a microgravity environment.

  13. Medical technology advances from space research

    NASA Technical Reports Server (NTRS)

    Pool, S. L.

    1972-01-01

    Details of medical research and development programs, particularly an integrated medical laboratory, as derived from space technology are given. The program covers digital biotelemetry systems, automatic visual field mapping equipment, sponge electrode caps for clinical electroencephalograms, and advanced respiratory analysis equipment. The possibility of using the medical laboratory in ground based remote areas and regional health care facilities, as well as long duration space missions is discussed.

  14. Development of an integrated medical supply information system

    NASA Astrophysics Data System (ADS)

    Xu, Eric; Wermus, Marek; Blythe Bauman, Deborah

    2011-08-01

    The integrated medical supply inventory control system introduced in this study is a hybrid system that is shaped by the nature of medical supply, usage and storage capacity limitations of health care facilities. The system links demand, service provided at the clinic, health care service provider's information, inventory storage data and decision support tools into an integrated information system. ABC analysis method, economic order quantity model, two-bin method and safety stock concept are applied as decision support models to tackle inventory management issues at health care facilities. In the decision support module, each medical item and storage location has been scrutinised to determine the best-fit inventory control policy. The pilot case study demonstrates that the integrated medical supply information system holds several advantages for inventory managers, since it entails benefits of deploying enterprise information systems to manage medical supply and better patient services.

  15. Health care for all: effective, community supported, healthcare with innovative use of telemedicine technology.

    PubMed

    Shah, Tariq Kazim; Tariq, Tasneem; Phillips, Roger; Davison, Steve; Hoare, Adam; Hasan, Syed Shahzad; Babar, Zaheer-Ud-Din

    2018-01-01

    Almost half of the world's total population reside in rural and remote areas and a large number of these people remain deprived of most basic facilities like healthcare and education. It is deemed impossible for government with scarce resources in developing countries to open and run a health facility in every remote community using conventional means. One increasingly popular unconventional mean is the use of existing technology to improve exchange of medical information for the purpose of improving health of underprivileged communities. Telemedicine implies the use of information and communication technology to provide health care remotely from a distance. With the induction of telemedicine, patients who live in rural and remote areas can have increased access to medical services. In many developing countries, use of telemedicine however has been limited mainly to teleconferencing between primary and secondary/tertiary care facilities for diagnosis and management of patients. This system still requires patients from remote communities to travel, often long and arduous journeys to the centre where telecom and medical facilities are available. Health Care 4 All International, a not for profit registered charity is providing primary care to patients by taking telemedicine into their homes in remote communities, thus obviating the need and hardships of travel for patient.

  16. 42 CFR 431.105 - Consultation to medical facilities.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false Consultation to medical facilities. 431.105 Section... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STATE ORGANIZATION AND GENERAL ADMINISTRATION Administrative Requirements: Provider Relations § 431.105 Consultation to medical facilities. (a) Basis and...

  17. 42 CFR 431.105 - Consultation to medical facilities.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Consultation to medical facilities. 431.105 Section... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STATE ORGANIZATION AND GENERAL ADMINISTRATION Administrative Requirements: Provider Relations § 431.105 Consultation to medical facilities. (a) Basis and...

  18. 42 CFR 431.105 - Consultation to medical facilities.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 4 2012-10-01 2012-10-01 false Consultation to medical facilities. 431.105 Section... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STATE ORGANIZATION AND GENERAL ADMINISTRATION Administrative Requirements: Provider Relations § 431.105 Consultation to medical facilities. (a) Basis and...

  19. 42 CFR 431.105 - Consultation to medical facilities.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Consultation to medical facilities. 431.105 Section... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STATE ORGANIZATION AND GENERAL ADMINISTRATION Administrative Requirements: Provider Relations § 431.105 Consultation to medical facilities. (a) Basis and...

  20. Supply-side barriers to maternity-care in India: a facility-based analysis.

    PubMed

    Kumar, Santosh; Dansereau, Emily

    2014-01-01

    Health facilities in many low- and middle-income countries face several types of barriers in delivering quality health services. Availability of resources at the facility may significantly affect the volume and quality of services provided. This study investigates the effect of supply-side determinants of maternity-care provision in India. Health facility data from the District-Level Household Survey collected in 2007-2008 were analyzed to explore the effects of supply-side factors on the volume of delivery care provided at Indian health facilities. A negative binomial regression model was applied to the data due to the count and over-dispersion property of the outcome variable (number of deliveries performed at the facility). Availability of a labor room (Incidence Rate Ratio [IRR]: 1.81; 95% Confidence Interval [CI]: 1.68-1.95) and facility opening hours (IRR: 1.43; CI: 1.35-1.51) were the most significant predictors of the volume of delivery care at the health facilities. Medical and paramedical staff were found to be positively associated with institutional deliveries. The volume of deliveries was also higher if adequate beds, essential obstetric drugs, medical equipment, electricity, and communication infrastructures were available at the facility. Findings were robust to the inclusion of facility's catchment area population and district-level education, health insurance coverage, religion, wealth, and fertility. Separate analyses were performed for facilities with and without a labor room and results were qualitatively similar across these two types of facilities. Our study highlights the importance of supply-side barriers to maternity-care India. To meet Millennium Development Goals 4 and 5, policymakers should make additional investments in improving the availability of medical drugs and equipment at primary health centers (PHCs) in India.

  1. Supply-Side Barriers to Maternity-Care in India: A Facility-Based Analysis

    PubMed Central

    Kumar, Santosh; Dansereau, Emily

    2014-01-01

    Background Health facilities in many low- and middle-income countries face several types of barriers in delivering quality health services. Availability of resources at the facility may significantly affect the volume and quality of services provided. This study investigates the effect of supply-side determinants of maternity-care provision in India. Methods Health facility data from the District-Level Household Survey collected in 2007–2008 were analyzed to explore the effects of supply-side factors on the volume of delivery care provided at Indian health facilities. A negative binomial regression model was applied to the data due to the count and over-dispersion property of the outcome variable (number of deliveries performed at the facility). Results Availability of a labor room (Incidence Rate Ratio [IRR]: 1.81; 95% Confidence Interval [CI]: 1.68–1.95) and facility opening hours (IRR: 1.43; CI: 1.35–1.51) were the most significant predictors of the volume of delivery care at the health facilities. Medical and paramedical staff were found to be positively associated with institutional deliveries. The volume of deliveries was also higher if adequate beds, essential obstetric drugs, medical equipment, electricity, and communication infrastructures were available at the facility. Findings were robust to the inclusion of facility's catchment area population and district-level education, health insurance coverage, religion, wealth, and fertility. Separate analyses were performed for facilities with and without a labor room and results were qualitatively similar across these two types of facilities. Conclusions Our study highlights the importance of supply-side barriers to maternity-care India. To meet Millennium Development Goals 4 and 5, policymakers should make additional investments in improving the availability of medical drugs and equipment at primary health centers (PHCs) in India. PMID:25093729

  2. 42 CFR 124.704 - Notification of sale, transfer, or change of use.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... HEALTH RESOURCES DEVELOPMENT MEDICAL FACILITY CONSTRUCTION AND MODERNIZATION Recovery of Grant Funds...” when an entity that is not a public or other non-profit corporation or association assumes management... management agreement contains both of the following provisions: The Board of Directors of the facility...

  3. Achieving Medical Currency via Selected Staff Integration in Civilian and Veterans Administration Medical Facilities

    DTIC Science & Technology

    2012-10-01

    medical license as long as care is delivered in a military facility.26 Hurdles—Liability Medical malpractice also presents a formidable challenge. In...AIR UNIVERSITY AIR WAR COLLEGE Achieving Medical Currency via Selected Staff Integration in Civilian and Veterans Administration... Medical Facilities THOMAS W. HARRELL Colonel, USAF, MC, SFS Air War College Maxwell Paper No. 68 Maxwell Air Force Base, Alabama

  4. Medical Ultrasound Technology Research and Development at the University of Washington Center for Industrial and Medical Ultrasound

    DTIC Science & Technology

    2003-10-02

    provide a world-class, advanced research center for bioengineering development and graduate education in high-intensity, focused ultrasound ( HIFU ). This...convenient, and robust. These technological enhancements have enabled the development of HIFU arrays and image-guided ultrasound systems for greater... Ultrasound (CIMU). The many disparate facilities and technical capabilities available to CIMU staff and students were integrated and enhanced to

  5. 32 CFR 728.1 - Mission of Navy Medical Department facilities.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES General § 728.1... is to provide medical and dental care for members of the Navy and Marine Corps and for members of the... facilities may provide medical and dental care to dependents of military personnel, to members not on active...

  6. 32 CFR 728.1 - Mission of Navy Medical Department facilities.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES General § 728.1... is to provide medical and dental care for members of the Navy and Marine Corps and for members of the... facilities may provide medical and dental care to dependents of military personnel, to members not on active...

  7. 32 CFR 728.1 - Mission of Navy Medical Department facilities.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES General § 728.1... is to provide medical and dental care for members of the Navy and Marine Corps and for members of the... facilities may provide medical and dental care to dependents of military personnel, to members not on active...

  8. 32 CFR 728.1 - Mission of Navy Medical Department facilities.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES General § 728.1... is to provide medical and dental care for members of the Navy and Marine Corps and for members of the... facilities may provide medical and dental care to dependents of military personnel, to members not on active...

  9. Medical evaluations on the KC-135 1990 flight report summary

    NASA Technical Reports Server (NTRS)

    Lloyd, Charles W.; Guess, Terrell M.; Whiting, Charles W.; Doarn, Charles R.

    1991-01-01

    The medical investigations completed on the KC-135 during FY 1990 in support of the development of the Health Maintenance Facility and Medical Operations are discussed. The experiments are comprised of engineering evaluations of medical hardware and medical procedures. The investigating teams are made up of both medical and engineering personnel responsible for the development of medical hardware and medical operations. The hardware evaluated includes dental equipment, a coagulation analyzer, selected pharmaceutical aerosol devices, a prototype air/fluid separator, a prototype packaging and stowage system for medical supplies, a microliter metering system, and a workstation for minor surgical procedures. The results of these engineering evaluations will be used in the design of fleet hardware as well as to identify hardware specific training requirements.

  10. Decommissioning ALARA programs Cintichem decommissioning experience

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

    Adler, J.J.; LaGuardia, T.S.

    1995-03-01

    The Cintichem facility, originally the Union Carbide Nuclear Company (UCNC) Research Center, consisted primarily of a 5MW pool type reactor linked via a four-foot-wide by twelve-foot-deep water-filled canal to a bank of five adjacent hot cells. Shortly after going into operations in the early 1960s, the facility`s operations expanded to provide various reactor-based products and services to a multitude of research, production, medical, and education groups. From 1968 through 1972, the facility developed a process of separating isotopes from mixed fission products generated by irradiating enriched Uranium target capsules. By the late 1970s, 20 to 30 capsules were being processedmore » weekly, with about 200,000 curies being produced per week. Several isotopes such as Mo{sup 99}, I{sup 131}, and Xe{sup 133} were being extracted for medical use.« less

  11. [Research on the hospital construction and structure in Daehan empire and colonial modern period].

    PubMed

    Han, Dong Gwan; Ryu, Chang Ug; Ko, Sang Kyun; Jung, Jae Kook; Moon, Jong Youn; Park, Yoon Hyung

    2011-12-31

    It was the late Chosun Dynasty and Daehan Empire era that Western Medicine has firstly been introduced to Korea, previously operating on a basis of Korean traditional medicine. Western Medicine has been introduced by American missionary and Japanese Imperialism. An introduction of Western Medicine made it feasible to proceed new type medical care including operation, leading to require a new form of medical facilities. In the beginning, new facilities were constructed by Japanese Imperialism. Other hand many of facilities including Severance Hospital were established by missionaries. First of all, Daehan Empire established and managed a modern type of medical facility named "Jejoongwon" in 1885 as a government institution hospital. The Red Cross Hospital built in 1889. Afterwards, Jejoongwon and the Red Cross Hospital were taken over to missionary hospital and Japanese Imperialism, respectively. Japanese Imperialists firstly have protected their nationals residing in Chosun but have proceeded care a few Chosun people to exploit medical treatment as a mean to advertise superiority of the Empire of Japan. The facility that has firstly been established and managed was Jeseang Hospital in Busan in 1877, leading to establish in Wonju, Wonsan, and Mokpo. Afterwards, Japan has organized "Donginhoi" as a civil invasion organization, leading for "Donginhoi" to established "Dongin Hospital" in Pyeongyang, Daegu, and Seoul. Since 1909, governmental leading medical facility named Jahye Hospital was established according to an imperial order, leading to establish 32 hospitals all over the nation. American missionaries have established and managed 28 hospitals started from Severance Hospital built in 1904. However, Chosun doctors started to having educated and opening up their own hospital since 1920, leading for many of medical facilities to be established, but most of them have taken different roles followed by 6.25 War and economic development period. However, some of them are currently under protection as cultural assets, and some of them are now preserved. Buildings have originally been structured of wood as a single story in the beginning, but bricks started to be steadily used, leading to build two story building. Each of clinic department started to be separated since 1920, establishing operation room and treatment room. Now, a change of perception as to buildings that need to be preserved and an attention from government and doctors are required since modern medical facilities keep disappearing.

  12. Science on the International Space Station: Stepping Stones for Exploration

    NASA Technical Reports Server (NTRS)

    Robinson, Julie A.

    2007-01-01

    This viewgraph presentation reviews the state of science research on the International Space Station (ISS). The shuttle and other missions that have delivered science research facilities to the ISS are shown. The different research facilities provided by both NASA and partner organizations available for use and future facilities are reviewed. The science that has been already completed is discussed. The research facilitates the Vision for Space Exploration, in Human Life Sciences, Biological Sciences, Materials Science, Fluids Science, Combustion Science, and all other sciences. The ISS Focus for NASA involves: Astronaut health and countermeasure, development to protect crews from the space environment during long duration voyages, Testing research and technology developments for future exploration missions, Developing and validating operational procedures for long-duration space missions. The ISS Medical Project (ISSMP) address both space systems and human systems. ISSMP has been developed to maximize the utilization of ISS to obtain solutions to the human health and performance problems and the associated mission risks of exploration class missions. Including complete programmatic review with medical operations (space medicine/flight surgeons) to identify: (1) evidence base on risks (2) gap analysis.

  13. APPLICATION OF INFORMATION AND COMMUNICATION TECHNOLOGIES IN MEDICAL EDUCATION

    PubMed Central

    Al-Tamimi, Dalal M.

    2003-01-01

    The recognition that information and communication technologies should play an increasingly important role in medical education is a key to educating physicians in the 21st century. Computer use in medical education includes, Internet hypermedia/multimedia technologies, medical informatics, distance learning and telemedicine. Adaptation to the use of these technologies should ideally start from the elementary school level. Medical schools must introduce medical informatics courses very early in the medical curriculum. Teachers will need regular CME courses to prepare and update themselves with the changing circumstances. Our infrastructure must be prepared for the new developments with computer labs, basic skill labs, close circuit television facilities, virtual class rooms, smart class rooms, simulated teaching facilities, and distance teaching by tele-techniques. Our existing manpower including, doctors, nurses, technicians, librarians, and administration personal require hands-on training, while new recruitment will have to emphasize compulsory knowledge of and familiarity with information technology. This paper highlights these subjects in detail as a means to prepare us to meet the challenges of the 21st century. PMID:23011983

  14. Navy Research, Development, and Acquisition Management Guide

    DTIC Science & Technology

    1993-02-01

    the Coast Guard. Not to be medicine, special or preventive medicine, used by Navy or Marine Corps activities. dentistry , and medical equipment and...development facilities. D-4 D4.2 Each center gathers information in its Crew Systems Ergonomics Information specialized area of interest; reviews, analyzes...ocean facilities and to enhance the Marine Corps population, and on problems of fleet Seabees and the Marine Corps operational and field dentistry

  15. US Army Medical Department Journal, October-December 2008

    DTIC Science & Technology

    2008-12-01

    various aspects of EMR development and implementation, as well as the pros and cons of the systems that AMEDD professionals have used in delivering...Systems Detainee Healthcare System Primary & Dental Care Systems Veterinary Care Systems Pro -MEET, Cooperative Medical Engagements Trauma & Chronic...need for professional filler system* general medical officers ( GMOs ) in level I and II facilities results in a several specialists and

  16. Ambulatory anesthesia for cosmetic surgery in Brazil.

    PubMed

    May, Diego Marcelo

    2016-08-01

    Outpatient plastic surgery is growing around the world. This industry faces unique challenges in terms of patient selection and standards of practice to ensure safety and cost-effectiveness. This review will highlight information about anesthesia practice for outpatient cosmetic surgery in Brazil, especially regarding regulation, legislation, and medical tourism. Medical tourism is growing worldwide, with a flow of patients traveling from developed to developing countries where procedures can be done at a fraction of the cost as in the patient's home country. Though generally well tolerated, there are concerns about incomplete data on outcomes of office-based surgeries and lack of safety standards. Brazil is one of the world's leaders in cosmetic surgery. Strong legislation governing outpatient facilities and continued development of accrediting standards for healthcare facilities are indications of a commitment to patient safety and high quality of care. Although the market for medical tourism in this country is high, there are still barriers to overcome before Brazil reaches its full potential in this industry.

  17. The incidence of abortion and unintended pregnancy in India, 2015

    PubMed Central

    Singh, Susheela; Shekhar, Chander; Acharya, Rajib; Moore, Ann M; Stillman, Melissa; Pradhan, Manas R; Frost, Jennifer J; Sahoo, Harihar; Alagarajan, Manoj; Hussain, Rubina; Sundaram, Aparna; Vlassoff, Michael; Kalyanwala, Shveta; Browne, Alyssa

    2018-01-01

    Summary Background Reliable information on the incidence of induced abortion in India is lacking. Official statistics and national surveys provide incomplete coverage. Since the early 2000s, medication abortion has become increasingly available, improving the way women obtain abortions. The aim of this study was to estimate the national incidence of abortion and unintended pregnancy for 2015. Methods National abortion incidence was estimated through three separate components: abortions (medication and surgical) in facilities (including private sector, public sector, and non-governmental organisations [NGOs]); medication abortions outside facilities; and abortions outside of facilities and with methods other than medication abortion. Facility-based abortions were estimated from the 2015 Health Facilities Survey of 4001 public and private health facilities in six Indian states (Assam, Bihar, Gujarat, Madhya Pradesh, Tamil Nadu, and Uttar Pradesh) and from NGO clinic data. National medication abortion drug sales and distribution data were obtained from IMS Health and six principal NGOs (DKT International, Marie Stopes International, Population Services International, World Health Partners, Parivar Seva Santha, and Janani). We estimated the total number of abortions that are not medication abortions and are not obtained in a health facility setting through an indirect technique based on findings from community-based study findings in two states in 2009, with adjustments to account for the rapid increase in use of medication abortion since 2009. The total number of women of reproductive age and livebirth data were obtained from UN population data, and the proportion of births from unplanned pregnancies and data on contraceptive use and need were obtained from the 2015–16 National Family Health Survey-4. Findings We estimate that 15·6 million abortions (14·1 million–17·3 million) occurred in India in 2015. The abortion rate was 47·0 abortions (42·2–52·1) per 1000 women aged 15–49 years. 3·4 million abortions (22%) were obtained in health facilities, 11·5 million (73%) abortions were medication abortions done outside of health facilities, and 0·8 million (5%) abortions were done outside of health facilities using methods other than medication abortion. Overall, 12·7 million (81%) abortions were medication abortions, 2·2 million (14%) abortions were surgical, and 0·8 million (5%) abortions were done through other methods that were probably unsafe. We estimated 48·1 million pregnancies, a rate of 144·7 pregnancies per 1000 women aged 15–49 years, and a rate of 70·1 unintended pregnancies per 1000 women aged 15–49 years. Abortions accounted for one third of all pregnancies, and nearly half of pregnancies were unintended. Interpretation Health facilities can have a greater role in abortion service provision and provide quality care, including post-abortion contraception. Interventions are needed to expand access to abortion services through better equipping existing facilities, ensuring adequate and continuous supplies of medication abortion drugs, and by increasing the number of trained providers. In view of how many women rely on self-administration of medication abortion drugs, interventions are needed to provide women with accurate information on these drugs and follow-up care when needed. Research is needed to test interventions that improve knowledge and practice in providing medication abortion, and the Indian Government at the national and state level needs to prioritise improving policies and practice to increase access to comprehensive abortion care and quality contraceptive services that prevent unintended pregnancy. Funding Government of UK Department for International Development (until 2015), the David and Lucile Packard Foundation, the John D. and Catherine T. MacArthur Foundation, and the Ford Foundation. PMID:29241602

  18. A Guide for Planning Facilities for Occupational Preparation Programs for Dental Laboratory Technicians. Research Series No. 34.

    ERIC Educational Resources Information Center

    Macconnell, James D., And Others

    The twelfth in a series also including guides for facilities for medical x-ray technologist, medical assistant, and medical secretary programs, the document is intended for use in the preparation of educational specifications for facilities for dental laboratory technician programs. Designed for use by those responsible for planning facilities,…

  19. Caregiver involvement in a large clinical systems project.

    PubMed Central

    Sales, S.; Mathews, P.; Gamblin, D.; Gee, S.

    1994-01-01

    The Kaiser Permanente Northern California Region (KPNCR) CareGiver Workstation (CGW) Project's mission is to develop and implement a clinical workstation system that will enhance each caregiver-member interaction and aid in the decision-making processes of direct patient care in the inpatient and outpatient settings. The requirements analysis approach for CareGiver Workstation (CGW) is based on the belief that extensive caregiver involvement will provide a better understanding of the diverse needs of Kaiser Permanente Northern California Region (KPNCR). In order to involve as many caregivers as reasonably possible, CGW included a 16 member caregiver core team and 6 different Medical Centers in the requirements definition process. The Medical Centers are referred to as "focus facilities". A "focus group" (caregiver team) at each selected focus facility consisted of a site coordinator and a 24-30 person multidisciplinary team involving physicians, nurses, therapists and other caregivers. The Medical Center selection process identified facilities that provided the best cross-sectional representation of KPNCR. The Lead Focus Facility participated in the initial round of requirements definition activities. These sessions assisted in the design of a simulation that was used at five additional Medical Centers to validate requirements. The five additional Focus Facilities participated in simulation review sessions. Feedback from these sessions was used to revise the simulation and update the requirements document. Caregivers from all six focus facilities and other identified groups participated in a requirements survey to assist CGW with identification of high priority features. Caregiver commitment and continuing involvement are essential for the success of CGW.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7949953

  20. [The development of the medical information system for the improvement of the quality of work of the Crimean spa and health resorts].

    PubMed

    Ezhov, V V; Grigor'ev, P E; Mizin, V I; Andriiashek, Iu I; Gol'dberg, D L; Olenchuk, A V

    2016-01-01

    The Crimea has the enormous potential for the health promotion activities. However, neither the profile of these activities nor the demand for the socio-medical services is clearly defined for the majority of the local spa and health resort facilities. The possibilities of modern information technology are not used in the full measure either. The objective of the present work was to elaborate the new medical information system and demonstrate its effectiveness. In addition, the article describes the main advantages of the system for the optimization of healthcare in the Crimean spa and health resort facilities. We reviewed and analyzed various literature publications, legal framework, standards, regulations, guidelines, and questionnaire survey data obtain at 50 spa and health resort facilities of the Crimea. The results of the assessment indicate the necessity of the systematic approach to the analysis of the quality of medical care and the process of its further development. Statistical and mathematical methods were used to elaborate the medical information system for the optimization of the activities of the Crimean spa and health resorts. The distinctive features of the proposed information system are modularity and the possibility of flexible adjustment to the conditions of individual settings, one-step data loading with the subsequent multiple application for the formulation of documents, automated filling of records in compliance with the medical standards, and taking into consideration the possible changes in or amendments to the form of the documents. The data obtained in the course of project implementation were used for the first time in the Republic of Crimea to design, substantiate, and recommend for the practical application the algorithm for the comprehensive estimation of the results of treatment of the patients based at the spa and health resort facilities with due regard for the specific regional conditions.

  1. Restructuring opens new doors. Business ventures redirect deflected revenue.

    PubMed

    Moore, R F

    1989-01-01

    To fulfill its mission of caring for the sick and the poor while remaining competitive, St. Vincent's Medical Center, Jacksonville, FL, underwent corporate restructuring in 1983. Three existing entities--the medical center, a skilled nursing facility, and a fund-raising foundation--incorporated under St. Vincent dePaul Community Stewardship Services, Inc. One of the goals was to make optimal use of existing facilities and expertise while also creating channels to redirect deflected revenue to the corporate mission of service to the poor. Among its projects St. Vincent's established 12 ambulatory care facilities; offered use of its laboratory to physicians' offices, nursing homes, and other entities needing fast, high-quality service; developed a mobile magnetic resonance imaging service; created a nurse staffing business; and entered into services-oriented, price-competitive, for-profit operations. By assuming some of the broad-based responsibilities for planning, financing, marketing, and providing administrative and legal support, the parent company has freed the entities under it to concentrate on the jobs they do best: the delivery of healthcare products and services and the generation of referrals to the medical staff and, in turn, to the medical center.

  2. Application countermeasures of non-incineration technologies for medical waste treatment in China.

    PubMed

    Chen, Yang; Ding, Qiong; Yang, Xiaoling; Peng, Zhengyou; Xu, Diandou; Feng, Qinzhong

    2013-12-01

    By the end of 2012, there were 272 modern, high-standard, centralized medical waste disposal facilities operating in various cities in China. Among these facilities nearly 50% are non-incineration treatment facilities, including the technologies of high temperature steam, chemical disinfection and microwave. Each of the non-incineration technologies has its advantages and disadvantages, and any single technology cannot offer a panacea because of the complexity of medical waste disposal. Although non-incineration treatment of medical waste can avoid the release of polychlorinated dibenzo-p-dioxins/dibenzofurans, it is still necessary to decide how to best meet the local waste management needs while minimizing the impact on the environment and public health. There is still a long way to go to establish the sustainable application and management mode of non-incineration technologies. Based on the analysis of typical non-incineration process, pollutant release, and the current tendency for technology application and development at home and abroad, this article recommends the application countermeasures of non-incineration technologies as the best available techniques and best environmental practices in China.

  3. Medication management policy, practice and research in Australian residential aged care: Current and future directions.

    PubMed

    Sluggett, Janet K; Ilomäki, Jenni; Seaman, Karla L; Corlis, Megan; Bell, J Simon

    2017-02-01

    Eight percent of Australians aged 65 years and over receive residential aged care each year. Residents are increasingly older, frailer and have complex care needs on entry to residential aged care. Up to 63% of Australian residents of aged care facilities take nine or more medications regularly. Together, these factors place residents at high risk of adverse drug events. This paper reviews medication-related policies, practices and research in Australian residential aged care. Complex processes underpin prescribing, supply and administration of medications in aged care facilities. A broad range of policies and resources are available to assist health professionals, aged care facilities and residents to optimise medication management. These include national guiding principles, a standardised national medication chart, clinical medication reviews and facility accreditation standards. Recent Australian interventions have improved medication use in residential aged care facilities. Generating evidence for prescribing and deprescribing that is specific to residential aged care, health workforce reform, medication-related quality indicators and inter-professional education in aged care are important steps toward optimising medication use in this setting. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. [Training of medical physicists in radiation therapy at the International Educational Center of the Association of Medical Physicists in Russia].

    PubMed

    Kostylev, V A; Lysenko, M N; Zhgutov, A V; Ulanov, D V; Kislyakova, M V; Kazantsev, P V; Kostylev, D V; Narkevich, B Y

    2015-01-01

    The efficiency of radiotherapy treatment for cancer patients and use of the state-of-the-art accelerator facilities, in the first place, depends on the qualification and number of medical physicists. The need for the training and continuing professional development (CPD) of medical radiation physicists in Russia and CIS countries has dramatically increased today. The article considers the system of refresher training which should provide the continuing professional development and advance training of medical radiation physicists. The authors analyze the experience of the International Educational Center of the Association of Medical Physicists in Russia involved in the CPD of medical physicists under the IAEA TC projects, RMAPO and N.N. Blokhin RCRC joint educational programs.

  5. Move to outpatient settings may boost medical hotels.

    PubMed

    Burns, J

    1992-06-08

    The shift of surgeries to outpatient settings could be healthy for medical hotels, those amenity-equipped facilities originally developed to ease patients out of costly acute-care beds. Because fewer hospitals have a pressing need to use such alternative lodging, some medical hotels are hoping to hitch their fortunes to the outpatient trade, keeping patients overnight after surgeries that don't require hospital admission.

  6. Medical directors of long-term care facilities: preventing another physician shortage?

    PubMed

    Frank, C; Seguin, R; Haber, Shelly; Godwin, Marshall; Stewart, G I

    2006-06-01

    The long-term care (LTC) sector in Canada is expanding, but little attention has been given to medical human resources in this area. Our objective was to seek LTC medical directors' opinions about medical services in LTC and about strategies for recruitment and retention. Mailed survey. Long-term care facilities and nursing homes. Seven hundred five medical directors of LTC facilities across Canada were identified from the Canadian Healthcare Association database. Responses to open- and closed-ended questions and to Likert-type scales. The response rate was 55%. The average age of medical directors was 54 years. Most had started work in LTC because of a vacant position, as opposed to self-perceived skills or training. Most (75.3%) reported satisfaction with their role as medical directors, but 82.7% believed that there was a significant shortage of physicians working in LTC, and 42% had seriously considered leaving their positions. Major sources of satisfaction identified were clinical, especially working with older patients and improving care. Important sources of dissatisfaction were remuneration for LTC work, on-call coverage, and excessive paperwork. Directors suggested increases to fee schedules as the main recruitment and retention strategy, and many believed that increasing exposure to LTC during residency would increase recruitment. Development of larger on-call groups for coverage and alternative methods of remuneration were not cited as important factors. Most did not believe that working in a teaching nursing home would increase their satisfaction. Directors did not think the use of nurse practitioners would alleviate concerns about shortages of physicians. Medical directors of LTC facilities are aging, and many are considering leaving their work in LTC. Without an increase in the number of physicians willing to work in LTC institutions, the current shortage of LTC physicians could increase in the near future. Medical directors' responses to questions could help guide strategies to recruit and retain physicians. Future areas of research should include the perspectives of physicians who are not medical directors and of family medicine residents.

  7. Implementation of an integrated computerized prescriber order-entry system for chemotherapy in a multisite safety-net health system.

    PubMed

    Chung, Clement; Patel, Shital; Lee, Rosetta; Fu, Lily; Reilly, Sean; Ho, Tuyet; Lionetti, Jason; George, Michael D; Taylor, Pam

    2018-03-15

    The development of a computerized prescriber order-entry (CPOE) system for chemotherapy in a multisite safety-net health system and the challenges to its successful implementation are described. Before CPOE for chemotherapy was first implemented and embedded in the electronic medical record system of Harris Health System (HHS), pharmacy personnel relied on regimen-specific preprinted order sets. However, due to differences in practice styles and workflow logistics, the paper orders across the 3 facilities were mostly site specific, with varying clinical content. Many of these order sets had not been approved by the oncology subcommittee. In addition, disparities in clinical knowledge and lack of communication contributed to inconsistencies in order set development. Led by medical directors from medical oncology departments at the 3 facilities, pharmacy administrators, and information technology representatives, HHS committed resources to supporting the adoption and use of a CPOE system for chemotherapy. Five practical lessons of broad applicability have been learned: engagement of interprofessional stakeholders, optimization of workflow before CPOE implementation, requirement of verification tool for CPOE, consolidation of protocols, and commitment to ongoing training and support. Evaluation of the CPOE system demonstrated a systemwide reduction in medication errors by 75% ( p < 0.05). Satisfaction with the CPOE system varied among sites and was unchanged institutionwide 6 months after the CPOE implementation. The development and implementation of CPOE for chemotherapy at a multisite safety-net health system created opportunities to optimize patient care and reduce variations through interprofessional collaborations. Initial evaluation suggested that CPOE reduced the medication-order error rate and improved user satisfaction in 1 of 3 facilities. Copyright © 2018 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  8. Are residents of aged care facilities willing to have their medications deprescribed?

    PubMed

    Kalogianis, Mona J; Wimmer, Barbara C; Turner, Justin P; Tan, Edwin C K; Emery, Tina; Robson, Leonie; Reeve, Emily; Hilmer, Sarah N; Bell, J Simon

    2016-01-01

    There has been recent interest in deprescribing, particularly among older people. No previous studies have assessed whether residents of aged care facilities are willing to have their medications deprescribed. Understanding residents' attitudes toward deprescribing is important for developing deprescribing interventions. To investigate residents' willingness to have their medications deprescribed. This was a cross-sectional survey of 232 residents aged ≥65 years from six residential aged care facilities (RACFs) across metropolitan and regional South Australia. Overall, 163 of the 232 residents (70.3%) took ≥9 regular medications. All participants completed the 10-item Patients' Attitudes Towards Deprescribing (PATD) questionnaire. Overall, 40.5% of residents reported a desire to stop taking one or more of their medications. If their doctor said it was possible, 78.9% of residents were willing to have one or more of their medications deprescribed. Residents taking ≥9 medications were more likely to feel that they were taking a large number of medications compared to residents taking <9 medications (50.3% vs 14.5%, P < 0.01), and were more likely to believe one or more of their medications was causing side effects (14.7% vs 10.1%, P = 0.02). However, residents taking ≥9 regular medications were not significantly more likely to want to reduce their number of medications than residents taking <9 medications. Deprescribing interventions are likely to be acceptable to residents' of RACFs, with a high willingness to discontinue medicines if doctors say it is possible. This highlights the importance of the proactive involvement of health care professionals in an individualized deprescribing process. Copyright © 2015 Elsevier Inc. All rights reserved.

  9. Evaluation of the antipsychotic medication review process at four long-term facilities in Alberta.

    PubMed

    Birney, Arden; Charland, Paola; Cole, Mollie; Aslam Arain, Mubashir

    2016-01-01

    The goal of this evaluation was to understand how four long-term care (LTC) facilities in Alberta have implemented medication reviews for the Appropriate Use of Antipsychotics (AUA) initiative. We aimed to determine how interprofessional (IP) collaboration was incorporated in the antipsychotic medication reviews and how the reviews had been sustained. Four LTC facilities in Alberta participated in this evaluation. We conducted semistructured interviews with 18 facility staff and observed one antipsychotic medication review at each facility. We analyzed data according to the following key components that we identified as relevant to the antipsychotic medication reviews: the structure of the reviews, IP interactions between the staff members, and strategies for sustaining the reviews. The duration of antipsychotic medication reviews ranged from 1 to 1.5 hours. The number of professions in attendance ranged from 3 to 9; a pharmacist led the review at two sites, while a registered nurse led the review at one site and a nurse practitioner at the remaining site. The number of residents discussed during the review ranged from 6 to 20. The process at some facilities was highly IP, demonstrating each of the six IP competencies. Other facilities conducted the review in a less IP manner due to challenges of physician involvement and staff workload, particularly of health care aides. Facilities that had an nurse practitioner on site were more efficient with the process of implementing recommendations resulting from the medication reviews. The LTC facilities were successful in implementing the medication review process and the process seemed to be sustainable. A few challenges were observed in the implementation process at two facilities. IP practice moved forward the goals of the AUA initiative to reduce the inappropriate use of antipsychotics.

  10. Target development for diversified irradiations at a medical cyclotron.

    PubMed

    Spellerberg, S; Scholten, B; Spahn, I; Bolten, W; Holzgreve, M; Coenen, H H; Qaim, S M

    2015-10-01

    The irradiation facility at an old medical cyclotron (Ep=17 MeV; Ed=10 MeV) was upgraded by extending the beam line and incorporation of solid state targetry. Tests performed to check the quality of the available beam are outlined. Results on nuclear data measurements and improvement of radiochemical separations are described. Using solid targets, with the proton beam falling at a slanting angle of 20°, a few radionuclides, e.g. (75)Se, (120)I, (124)I, etc. were produced with medium currents (up to 20 µA) in no-carrier-added form in quantities sufficient for local use. The extended irradiation facility has considerably enhanced the utility of the medical cyclotron. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. Navy nurse anesthetists at Fleet Hospital Five: the Desert Shield/Storm experience.

    PubMed

    Hrezo, Richard J

    2003-06-01

    In 1990, the United States Navy deployed its first operational fleet hospital: "Fleet Hospital Five" in support of Operation Desert Shield/Storm. Within 2 weeks of notification, the 900 medical providers assigned to this medical facility, which was capable of providing major trauma surgery and critical care, were on their way to Al Jabayl, Saudi Arabia. This article discusses the unique characteristics of this facility and introduces the crucial role that nurse anesthetists play. The article also introduces several innovative ideas that were developed and tested to expand the capabilities of the hospital.

  12. An emergency medical planning guide for commercial spaceflight events.

    PubMed

    Law, Jennifer; Vanderploeg, James

    2012-09-01

    Commercial spaceflight events transporting paying passengers into space will begin to take place at various spaceports around the country within the next few years. Many spaceports are located in remote areas that are far from major hospitals and trauma centers. Spaceport medical directors should develop emergency medical plans (EMPs) to prepare for potential medical contingencies that may occur during commercial spaceflight events. The aim of this article is to guide spaceport medical directors in emergency medical planning for commercial spaceflight events. This guide is based on our experience and a recently developed EMP for Spaceport America which incorporated a literature review of mass gathering medicine, existing planning guides for mass gathering events, and EMPs for analogous aerospace events. We propose a multipronged approach to emergency medical planning, consisting of event planning, medical reconnaissance, medical personnel, protocols, physical facility and hardware, and documentation. Medical directors should use this guide to develop an emergency medical plan tailored to the resources and constraints specific to their events.

  13. LWAs computational platform for e-consultation using mobile devices: cases from developing nations.

    PubMed

    Olajubu, Emmanuel Ajayi; Odukoya, Oluwatoyin Helen; Akinboro, Solomon Adegbenro

    2014-01-01

    Mobile devices have been impacting on human standard of living by providing timely and accurate information anywhere and anytime through wireless media in developing nations. Shortage of experts in medical fields is very obvious throughout the whole world but more pronounced in developing nations. Thus, this study proposes a telemedicine platform for the vulnerable areas of developing nations. The vulnerable area are the interior with little or no medical facilities, hence the dwellers are very susceptible to sicknesses and diseases. The framework uses mobile devices that can run LightWeight Agents (LWAs) to send consultation requests to a remote medical expert in urban city from the vulnerable interiors. The feedback is conveyed to the requester through the same medium. The system architecture which contained AgenRoller, LWAs, The front-end (mobile devices) and back-end (the medical server) is presented. The algorithm for the software component of the architecture (AgenRoller) is also presented. The system is modeled as M/M/1/c queuing system, and simulated using Simevents from MATLAB Simulink environment. The simulation result presented show the average queue length, the number of entities in the queue and the number of entities departure from the system. These together present the rate of information processing in the system. A full scale development of this system with proper implementation will help extend the few medical facilities available in the urban cities in developing nations to the interiors thereby reducing the number of casualties in the vulnerable areas of the developing world especially in Sub Saharan Africa.

  14. Medical waste management in Ibadan, Nigeria: Obstacles and prospects

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

    Coker, Akinwale; School of Engineering and the Built Environment, University of Wolverhampton, Wolverhampton WV1 1SB; Sangodoyin, Abimbola

    Quantification and characterization of medical waste generated in healthcare facilities (HCFs) in a developing African nation has been conducted to provide insights into existing waste collection and disposal approaches, so as to provide sustainable avenues for institutional policy improvement. The study, in Ibadan city, Nigeria, entailed a representative classification of nearly 400 healthcare facilities, from 11 local government areas (LGA) of Ibadan, into tertiary, secondary, primary, and diagnostic HCFs, of which, 52 HCFs were strategically selected. Primary data sources included field measurements, waste sampling and analysis and a questionnaire, while secondary information sources included public and private records from hospitalsmore » and government ministries. Results indicate secondary HCFs generate the greatest amounts of medical waste (mean of 10,238 kg/day per facility) followed by tertiary, primary and diagnostic HCFs, respectively. Characterised waste revealed that only {approx}3% was deemed infectious and highlights opportunities for composting, reuse and recycling. Furthermore, the management practices in most facilities expose patients, staff, waste handlers and the populace to unnecessary health risks. This study proffers recommendations to include (i) a need for sustained cooperation among all key actors (government, hospitals and waste managers) in implementing a safe and reliable medical waste management strategy, not only in legislation and policy formation but also particularly in its monitoring and enforcement and (ii) an obligation for each HCF to ensure a safe and hygienic system of medical waste handling, segregation, collection, storage, transportation, treatment and disposal, with minimal risk to handlers, public health and the environment.« less

  15. Impact of medical director certification on nursing home quality of care.

    PubMed

    Rowland, Frederick N; Cowles, Mick; Dickstein, Craig; Katz, Paul R

    2009-07-01

    This study tests the research hypothesis that certified medical directors are able to use their training, education, and knowledge to positively influence quality of care in US nursing homes. F-tag numbers were identified within the State Operations Manual that reflect dimensions of quality thought to be impacted by the medical director. A weighting system was developed based on the "scope and severity" level at which the nursing homes were cited for these specific tag numbers. Then homes led by certified medical directors were compared with homes led by medical directors not known to be certified. DATA/PARTICIPANTS: Data were obtained from the Centers for Medicare & Medicaid Services' Online Survey Certification and Reporting database for nursing homes. Homes with a certified medical director (547) were identified from the database of the American Medical Directors Association. The national survey database was used to compute a "standardized quality score" (zero representing best possible score and 1.0 representing average score) for each home, and the homes with certified medical directors compared with the other homes in the database. Regression analysis was then used to attempt to identify the most important contributors to measured quality score differences between the homes. The standardized quality score of facilities with certified medical directors (n=547) was 0.8958 versus 1.0037 for facilities without certified medical directors (n=15,230) (lower number represents higher quality). When nursing facility characteristics were added to the regression equation, the presence of a certified medical director accounted for up to 15% improvement in quality. The presence of certified medical directors is an independent predictor of quality in US nursing homes.

  16. Medical Waste Management Implications for Small Medical Facilities.

    ERIC Educational Resources Information Center

    Byrns, George; Burke, Thomas

    1992-01-01

    Discusses the implications of the Medical Waste Management Act of 1988 for small medical facilities, public health, and the environment. Reviews health and environmental risks associated with medical waste, current regulatory approaches, and classifications. Concludes that the health risk of medical wastes has been overestimated; makes…

  17. [The challenges of sustainable development in healthcare facilities].

    PubMed

    Mourgues, François; Muret, Jane; Pauchard, Jean-Claude

    2018-03-01

    Healthcare and medical-social facilities have a major responsibility within society, that of the quality of care, but also that of developing a system of sustainable and socially-responsible health. This system must meet the three pillars which constitute such an approach: economic, social and environmental sustainability. Innovation remains central to the sustainable evolution of practices and the first results are now visible. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

  18. Impact of a function-based payment model on the financial performance of acute inpatient medical rehabilitation providers: a simulation analysis.

    PubMed

    Sutton, J P; DeJong, G; Song, H; Wilkerson, D

    1997-12-01

    To operationalize research findings about a medical rehabilitation classification and payment model by building a prototype of a prospective payment system, and to determine whether this prototype model promotes payment equity. This latter objective is accomplished by identifying whether any facility or payment model characteristics are systematically associated with financial performance. This study was conducted in two phases. In Phase 1 the components of a diagnosis-related group (DRG)-like payment system, including a base rate, function-related group (FRG) weights, and adjusters, were identified and estimated using hospital cost functions. Phase 2 consisted of a simulation analysis in which each facility's financial performance was modeled, based on its 1990-1991 case mix. A multivariate regression equation was conducted to assess the extent to which characteristics of 42 rehabilitation facilities contribute toward determining financial performance under the present Medicare payment system as well as under the hypothetical model developed. Phase 1 (model development) included 61 rehabilitation hospitals. Approximately 59% were rehabilitation units within a general hospital and 48% were teaching facilities. The number of rehabilitation beds averaged 52. Phase 2 of the stimulation analysis included 42 rehabilitation facilities, subscribers to UDS in 1990-1991. Of these, 69% were rehabilitation units and 52% were teaching facilities. The number of rehabilitation beds averaged 48. Financial performance, as measured by the ratio of reimbursement to average costs. Case-mix index is the primary determinant of financial performance under the present Medicare payment system. None of the facility characteristics included in this analysis were associated with financial performance under the hypothetical FRG payment model. The most notable impact of an FRG-based payment model would be to create a stronger link between resource intensity and level of reimbursement, resulting in greater equity in the reimbursement of inpatient medical rehabilitation hospitals.

  19. Education and Professional Training of Undergraduate Medical Students Abroad

    ERIC Educational Resources Information Center

    Farrukh, A.; Mayberry, J. F.

    2014-01-01

    During the last twenty years there has been a significant growth in the training of overseas students especially within the European Union. This development has been paralleled by the emergence of off-shore medical schools in the American hemisphere. These facilities are to be found in both traditional established universities as well as less…

  20. 78 FR 55244 - Notice of Availability of Record of Decision for Medical Facilities Development and University...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-10

    ... AGENCY: Department of the Navy, DoD. ACTION: Notice. SUMMARY: The United States Department of the Navy... alternative for the University Expansion will provide adequate education and research space to meet Military Health System commitments to deliver training and post-graduate level education to the military medical...

  1. 32 CFR 732.18 - Notification of illness or injury.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... NONNAVAL MEDICAL AND DENTAL CARE Medical and Dental Care From Nonnaval Sources § 732.18 Notification of... medical or dental attention in a non-Federal facility. The member will also assure (request the facility... or dental facility rendering treatment. (iii) Date(s) of such treatment. (iv) Nature and extent of...

  2. 32 CFR 732.18 - Notification of illness or injury.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... NONNAVAL MEDICAL AND DENTAL CARE Medical and Dental Care From Nonnaval Sources § 732.18 Notification of... medical or dental attention in a non-Federal facility. The member will also assure (request the facility... or dental facility rendering treatment. (iii) Date(s) of such treatment. (iv) Nature and extent of...

  3. 32 CFR 732.18 - Notification of illness or injury.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... NONNAVAL MEDICAL AND DENTAL CARE Medical and Dental Care From Nonnaval Sources § 732.18 Notification of... medical or dental attention in a non-Federal facility. The member will also assure (request the facility... or dental facility rendering treatment. (iii) Date(s) of such treatment. (iv) Nature and extent of...

  4. 32 CFR 732.18 - Notification of illness or injury.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... NONNAVAL MEDICAL AND DENTAL CARE Medical and Dental Care From Nonnaval Sources § 732.18 Notification of... medical or dental attention in a non-Federal facility. The member will also assure (request the facility... or dental facility rendering treatment. (iii) Date(s) of such treatment. (iv) Nature and extent of...

  5. 32 CFR 732.18 - Notification of illness or injury.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... NONNAVAL MEDICAL AND DENTAL CARE Medical and Dental Care From Nonnaval Sources § 732.18 Notification of... medical or dental attention in a non-Federal facility. The member will also assure (request the facility... or dental facility rendering treatment. (iii) Date(s) of such treatment. (iv) Nature and extent of...

  6. VIEW OF BUILDING 122 WHICH HOUSES THE ONSITE MEDICAL FACILITIES ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    VIEW OF BUILDING 122 WHICH HOUSES THE ON-SITE MEDICAL FACILITIES OF THE ROCKY FLATS PLANT AND THE OCCUPATIONAL HEALTH AND INTERNAL DOSIMETRY ORGANIZATIONS. EMERGENCY MEDICAL SERVICES, DIAGNOSIS, DECONTAMINATION, FIRST AID, X-RAY, MINOR SURGICAL TREATMENT, AND AMBULATORY ACTIVITIES ARE CARRIED OUT IN THIS BUILDING. (1/98) - Rocky Flats Plant, Emergency Medical Services Facility, Southwest corner of Central & Third Avenues, Golden, Jefferson County, CO

  7. Non-health care facility anticonvulsant medication errors in the United States.

    PubMed

    DeDonato, Emily A; Spiller, Henry A; Casavant, Marcel J; Chounthirath, Thitphalak; Hodges, Nichole L; Smith, Gary A

    2018-06-01

    This study provides an epidemiological description of non-health care facility medication errors involving anticonvulsant drugs. A retrospective analysis of National Poison Data System data was conducted on non-health care facility medication errors involving anticonvulsant drugs reported to US Poison Control Centers from 2000 through 2012. During the study period, 108,446 non-health care facility medication errors involving anticonvulsant pharmaceuticals were reported to US Poison Control Centers, averaging 8342 exposures annually. The annual frequency and rate of errors increased significantly over the study period, by 96.6 and 76.7%, respectively. The rate of exposures resulting in health care facility use increased by 83.3% and the rate of exposures resulting in serious medical outcomes increased by 62.3%. In 2012, newer anticonvulsants, including felbamate, gabapentin, lamotrigine, levetiracetam, other anticonvulsants (excluding barbiturates), other types of gamma aminobutyric acid, oxcarbazepine, topiramate, and zonisamide, accounted for 67.1% of all exposures. The rate of non-health care facility anticonvulsant medication errors reported to Poison Control Centers increased during 2000-2012, resulting in more frequent health care facility use and serious medical outcomes. Newer anticonvulsants, although often considered safer and more easily tolerated, were responsible for much of this trend and should still be administered with caution.

  8. Genetic counseling services and development of training programs in Malaysia.

    PubMed

    Lee, Juliana Mei-Har; Thong, Meow-Keong

    2013-12-01

    Genetic counseling service is urgently required in developing countries. In Malaysia, the first medical genetic service was introduced in 1994 at one of the main teaching hospitals in Kuala Lumpur. Two decades later, the medical genetic services have improved with the availability of genetic counseling, genetic testing and diagnosis, for both paediatric conditions and adult-onset inherited conditions, at four main centers of medical genetic services in Malaysia. Prenatal diagnosis services and assisted reproductive technologies are available at tertiary centres and private medical facilities. Positive developments include governmental recognition of Clinical Genetics as a subspecialty, increased funding for genetics services, development of medical ethics guidelines, and establishment of support groups. However, the country lacked qualified genetic counselors. Proposals were presented to policy-makers to develop genetic counseling courses. Challenges encountered included limited resources and public awareness, ethical dilemmas such as religious and social issues and inadequate genetic health professionals especially genetic counselors.

  9. Medical RI development plan of KOMAC

    NASA Astrophysics Data System (ADS)

    Kim, Kye-Ryung; Jung, Myung-Hwan; Yoon, Sang-Pil; Min, Yi-Sub; Cho, Yong-Sub

    2017-12-01

    Many kinds of radioisotopes (RIs) produced by the high energy (100 200 MeV) proton accelerators are developed by the foreign R&D institutes and the worldwide demands are being increased continuously. The RI production using high energy proton beam higher than 50 MeV was not considerable because of the limit of the proton beam energy from existing proton accelerator facilities in Korea before 2013. The available maximum proton energy was 50 MeV from MC-50 cyclotron of Korea Institute of Radiological and Medical Sciences (KIRAMS) at that time. After the construction of a 100 MeV high-current and high-energy proton accelerator and a new irradiation facility for the RI production in 2013 and 2016 by the Korea Multi-purpose Accelerator Complex (KOMAC) at Korea Atomic Energy Research Institute (KAERI), we can make a plan for the new RI production of Cu-67, Sr-82 and so on. In the medical application fields, the worldwide demand of Sr-82 is being increased rapidly during last several years and the domestic demand of Cu-67 is also expected to be increased in near future. And alpha-emitters, such as Ac-225 and Ra-223, are becoming attractive to the users in the medical science fields in the future. The RI development plan of KOMAC was specified recently reflecting the recent environment changes and requirements from the users. In this paper, the results and present status of RI production and R&D facilities, calculation results related to the RI production yields, and future plans is presented.

  10. A proton medical accelerator by the SBIR route — an example of technology transfer

    NASA Astrophysics Data System (ADS)

    Martin, R. L.

    1989-04-01

    Medical facilities for radiation treatment of cancer with protons have been established in many laboratories throughout the world. Essentially all of these have been designed as physics facilities, however, because of the requirement for protons up to 250 MeV. Most of the experience in this branch of accelerator technology lies in the national laboratories and a few large universities. A major issue is the transfer of this technology to the commercial sector to provide hospitals with simple, reliable and relatively inexpensive accelerators for this application. The author has chosen the SBIR route to accomplish this goal. ACCTEK Associates has received grants from the National Cancer Institute for development of the medical accelerator and beam delivery systems. Considerable encouragement and help has been received from Argonne National Laboratory and the Department of Energy. The experiences to date and the pros and cons on this approach to commercializing medical accelerators are described.

  11. The DE-PHARM Project: A Pharmacist-Driven Deprescribing Initiative in a Nursing Facility.

    PubMed

    Pruskowski, Jennifer; Handler, Steven M

    2017-08-01

    Many residents with life-limiting illnesses are being prescribed and taking potentially inappropriate medications (PIMs) and questionably beneficial medications either near or at the end of life. These medications can contribute to adverse drug reactions, increase morbidity, and increase unnecessary burden and cost. It is crucial that the process of deprescribing be incorporated into the care of these residents. After developing a clinical pharmacist-driven deprescribing initiative in the nursing facility, the objective of this project was to reduce the number of PIMs via accepted recommendations from the clinical pharmacist to the primary team. The Discussion to Ensure the Patient-centered, Health-focused, prognosis-Appropriate, and Rational Medication regimen (DE-PHARM) quality improvement-approved project was conducted in an urban, academic nursing facility in Pittsburgh, Pennsylvania. The pilot phase occurred between October 2015 and April 2016. To be included in this study, participants had to be a custodial resident of the nursing facility with a previously documented comfort-focused treatment plan. All medications used for the management of chronic comorbid diseases were eligible for review. Forty-seven residents managed by eight different primary teams met inclusion criteria. Thirty-nine recommendations for 23 residents were made by the clinical pharmacist, with an average of 0.82 and range of 0-5 recommendations per resident, respectively. Of those, only 10 (26%) were accepted, 1 (3%) was modified, 3 (7%) were rejected, and 25 (64%) had no response within the 120-day response period. Additionally, two residents died during the project, and one resident was readmitted to the hospital for a prolonged period of time. The pilot phase of the DE-PHARM project, a clinical pharmacist-driven deprescribing initiative, was designed and assessed. This project demonstrated the feasibility of such an initiative. Because of the complexity of such a process, special attention must be paid to eligible residents and medications, the need for interprofessional collaboration, and the operational process. This project is ongoing in other nursing facilities in Western Pennsylvania.

  12. The association of change in medication regimen and use of inappropriate medication based on beers criteria with adverse outcomes in Japanese long-term care facilities.

    PubMed

    Ishii, Shinya; Kojima, Taro; Ezawa, Kazuhiko; Higashi, Kentaro; Ikebata, Yukihiko; Takehisa, Yozo; Akishita, Masahiro

    2017-04-01

    To describe medication use including potentially inappropriate medication (PIM) and examine the association between adverse outcomes and patient factors including PIM use in Japanese elderly patients in long-term care facilities. This was a retrospective cohort study of 470 patients in 53 Geriatric Health Service Facilities and 44 Sanatorium Type Medical Care Facilities for the Elderly Requiring Long Term Care. Standardized forms were used to collect information including oral and parenteral medication use on admission, and 1 month and 3 months after admission. PIMs were determined by the 2003 or 2012 Beers criteria. Adverse outcomes were any medical events leading to emergency department transfer, hospitalization to acute care hospitals or death. A total of 2,227 oral medications and 197 parenteral medications were prescribed for 470 patients on admission. PIM exposure based on the 2003 and 2012 Beers criteria was observed in 11.9% and 37.5%, respectively. Adverse outcomes within 3 months after admission were observed in 8.9% of the entire cohort, and were associated with age, sex, facility type and number of parenteral medications on admission. Adverse outcomes between one and three months after admission were associated with age, sex, number of parenteral medications at one month, and a change in the number of oral and parenteral medications within one month after admission. PIM exposure was not associated with adverse outcomes in any models. Use of PIM was prevalent in long-term care facilities. Our findings support the importance of comprehensive assessment of medication regimens including parenteral medication. Geriatr Gerontol Int 2017; 17: 591-597. © 2016 Japan Geriatrics Society.

  13. Mental health issues in Australian nursing homes.

    PubMed

    Lie, David

    2003-07-01

    Mental illness is common, under detected and often poorly managed in residential aged care facilities. These concerns have achieved greater prominence as the worldwide population ages. Over 80% of people in nursing home care fulfill criteria for one or more psychiatric disorders in an environment that often presents significant difficulties for assessment and treatment. This article aims to provide an overview of the important mental health issues involved in providing medical care for patients with behavioural and psychological problems in residential aged care facilities. Recent developments in education and training, service development and assessment and treatment strategies show some promise of improving the outcome for aged care residents with mental health problems. This is of especial relevance for primary care physicians who continue to provide the bulk of medical care for this population.

  14. Peculiarities of organizing the construction of nuclear medicine facilities and the transportation of radionuclide

    NASA Astrophysics Data System (ADS)

    Telichenko, Valeriy; Malykha, Galina; Dorogan, Igor

    2017-10-01

    The article is devoted to the organization of construction of nuclear medicine facilities in Russia. The article describes the main methods of nuclear medical diagnostics, as well as the peculiarities of nuclear medicine facilities that determine the need for application of specific methods for organizing and managing the construction, methods of requirements management in the organization of construction of nuclear medicine facilities. Sustainable development of the transport of radioactive isotopes from the place of production to places of consumption is very important for the safety of the population. The requirements management system is an important and necessary component in organizing the construction of complex facilities, such as nuclear medicine facilities. The author developed and proposed a requirements management system for the design, construction and operation of a nuclear medicine facility, which provides for a cyclic sequence of actions. This system allows reducing the consumption of resources including material and energy during construction and operation of complex objects.

  15. 38 CFR 1.301 - Definitions.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ..., including any necessary buildings and structures, garage or parking facility. (e) Parking facilities... whom the Secretary is authorized to furnish medical examination or treatment. (c) Garage means a structure or part of a structure in which vehicles may be parked. (d) Medical facility means any facility or...

  16. 38 CFR 1.301 - Definitions.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ..., including any necessary buildings and structures, garage or parking facility. (e) Parking facilities... whom the Secretary is authorized to furnish medical examination or treatment. (c) Garage means a structure or part of a structure in which vehicles may be parked. (d) Medical facility means any facility or...

  17. 38 CFR 1.301 - Definitions.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ..., including any necessary buildings and structures, garage or parking facility. (e) Parking facilities... whom the Secretary is authorized to furnish medical examination or treatment. (c) Garage means a structure or part of a structure in which vehicles may be parked. (d) Medical facility means any facility or...

  18. 38 CFR 1.301 - Definitions.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ..., including any necessary buildings and structures, garage or parking facility. (e) Parking facilities... whom the Secretary is authorized to furnish medical examination or treatment. (c) Garage means a structure or part of a structure in which vehicles may be parked. (d) Medical facility means any facility or...

  19. 38 CFR 1.301 - Definitions.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ..., including any necessary buildings and structures, garage or parking facility. (e) Parking facilities... whom the Secretary is authorized to furnish medical examination or treatment. (c) Garage means a structure or part of a structure in which vehicles may be parked. (d) Medical facility means any facility or...

  20. Proceedings of the Space Station Freedom Clinical Experts Seminar

    NASA Technical Reports Server (NTRS)

    Billica, Roger P. (Editor); Lloyd, Charles W. (Editor); Doarn, Charles R. (Editor)

    1991-01-01

    These are the proceedings of the Space Station Freedom Health Maintenance Facility 1990 Clinical Experts Seminar held August 27-29, 1990, at the Nassau Bay Hilton, Houston, Texas. Contained within are the agenda, list of medical consultants, executive summary, individual presentations, and the comments generated from the working groups. Issues include the adequacy of current Health Maintenance Facility for Space Station Freedom; impact of having, or not having, an ACRV or physician on board Space Station Freedom; new and developing technologies, techniques, and medications and their impact on the evolving Space Station Freedom, considerations surrounding x-ray, ultrasound, lab, decontamination, blood transfusion, nutrition, safe-haven, computer/telemedicine; suggestions as to how to train the Crew Medical Officer; and, how the consultant network will interface over the next several years.

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

    PubMed

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

    2014-01-01

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

  2. "Best care on home ground" versus "elitist healthcare": concerns and competing expectations for medical tourism development in Barbados.

    PubMed

    Johnston, Rory; Adams, Krystyna; Bishop, Lisa; Crooks, Valorie A; Snyder, Jeremy

    2015-02-03

    Many countries have demonstrated interest in expanding their medical tourism sectors because of its potential economic and health system benefits. However, medical tourism poses challenges to the equitable distribution of health resources between international and local patients and private and public medical facilities. Currently, very little is known about how medical tourism is perceived among front line workers and users of health systems in medical tourism 'destinations'. Barbados is one such country currently seeking to expand its medical tourism sector. Barbadian nurses and health care users were consulted about the challenges and benefits posed by ongoing medical tourism development there. Focus groups were held with two stakeholder groups in May, 2013. Nine (n = 9) citizens who use the public health system participated in the first focus group and seven (n = 7) nurses participated in the second. Each focus group ran for 1.5 hours and was digitally recorded. Following transcription, thematic analysis of the digitally coded focus group data was conducted to identify cross-cutting themes and issues. Three core concerns regarding medical tourism's health equity impacts were raised; its potential to 1) incentivize migration of health workers from public to private facilities, 2) burden Barbados' lone tertiary health care centre, and 3) produce different tiers of quality of care within the same health system. These concerns were informed and tempered by the existing a) health system structure that incorporates both universal public healthcare and a significant private medical sector, b) international mobility among patients and health workers, and c) Barbados' large recreational tourism sector, which served as the main reference in discussions about medical tourism's impacts. Incorporating these concerns and contextual influences, participants' shared their expectations of how medical tourism should locally develop and operate. By engaging with local health workers and users, we begin to unpack how potential health equity impacts of medical tourism in an emerging destination are understood by local stakeholders who are not directing sector development. This further outlines how these groups employ knowledge from their home context to ground and reconcile their hopes and concerns for the impacts posed by medical tourism.

  3. Application of federal indicators in nursing-home drug-regimen review.

    PubMed

    Shannon, R C; De Muth, J E

    1984-05-01

    Numbers of medications per patient and rate of drug administration errors were compared in Wisconsin long-term care facilities that used federal indicators in conducting drug-regimen review versus facilities that did not use the indicators. Data were collected from 1132 charts in 24 facilities randomly selected from a state survey schedule for June-October 1982. Both prescription and nonprescription drugs that patients received during the 30-day period preceding the survey were counted. Medication use was compared by facility type--skilled-nursing facility (SNF), intermediate-care facility (ICF), or ICF for the mentally retarded. The federal indicators were used in 10 facilities. Mean number of medications used per patient where indicators were applied (5.4 versus 6.6 for SNFs and 3.4 versus 5.8 for ICFs ) was not significantly different. In SNFs using the indicators, patients received 5.6 medications where the consultant pharmacist was also the provider and 5.2 where the consultant was not the provider. Medication use was not significantly different by facility type. The number of drug administration irregularities per 100 residents was significantly greater where indicators were not applied. Further study is needed to determine whether use of federal indicators encourages more efficient and appropriate drug therapy for patients in long-term care facilities.

  4. Managing Disruptive Behavior by Patients and Physicians: A Responsibility of the Dialysis Facility Medical Director.

    PubMed

    Jones, Edward R; Goldman, Richard S

    2015-08-07

    The Centers for Medicare & Medicaid Services' Conditions for Coverage make the medical director of an ESRD facility responsible for all aspects of care, including high-quality health care delivery (e.g., safe, effective, timely, efficient, and patient centered). Because of the high-pressure environment of the dialysis facility, conflicts are common. Conflict frequently occurs when aberrant behaviors disrupt the dialysis facility. Patients, family members, friends, and, less commonly appreciated, nephrology clinicians (i.e., nephrologists and advanced care practitioners) may manifest disruptive behavior. Disruptive behavior in the dialysis facility impairs the ability to deliver high-quality care. Furthermore, disruptive behavior is the leading cause for involuntary discharge (IVD) or involuntary transfer (IVT) of a patient from a facility. IVD usually results in loss of continuity of care, increased emergency department visits, and increased unscheduled, acute dialysis treatments. A sufficient number of IVDs and IVTs also trigger an extensive review of the facility by the regional ESRD Networks, exposing the facility to possible Medicare-imposed sanctions. Medical directors must be equipped to recognize and correct disruptive behavior. Nephrology-based literature and tools exist to help dialysis facility medical directors successfully address and resolve disruptive behavior before medical directors must involuntarily discharge a patient or terminate an attending clinician. Copyright © 2015 by the American Society of Nephrology.

  5. A Guide for Planning Facilities for Occupational Preparation Programs for Medical X-Ray Technicians. Research 31.

    ERIC Educational Resources Information Center

    Macconnell, James D.; And Others

    The major purpose of this guide is to develop the necessary information for the writing of educational specifications to house medical x-ray technician programs. The guide is also designed to: (1) assist planners in the formation of creative housing solutions for desired educational programs, (2) prevent important considerations from being…

  6. Military Retirement: Background and Recent Developments

    DTIC Science & Technology

    2017-01-06

    nonmonetary benefits including exchange and commissary privileges, medical care through TRICARE, and access to Morale , Welfare and Recreation (MWR...include exchange and commissary privileges, medical care through TRICARE, and access to Morale , Welfare and Recreation facilities and programs...over the past decade. Congress grapples with constituent concerns as well as budgetary constraints in considering military retirement issues . In the

  7. The Ambulatory Care Workload Management System for Nursing Reference Manual

    DTIC Science & Technology

    1991-05-31

    MEDICAL DATA SERVICES CENTER BETHESDA, MARYLAND 2088Q-506. 91-03029 SECuRItY CLASSIFICATION OF THIS PAGEr REPORT DOCUMENTATION PAGE Ia. REPORT SECURITY...ORGANIZATION 6b OFFICE SYMBOL 7a. NAME OF MONITORING ORGANIZATION Naval Medical Data Servics (If applicable) Center 6c. ADDRESS (City, State, and ZIPCode) 7b...staffing methodology developed for emergency and ambulatory care departments in naval medical treatment facilities . The staffing model translates varying

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

    Cozzi, A.; Johnson, F.

    Production of Mo-99 for medical isotope use is being investigated using dissolved low enriched uranium (LEU) fissioned using an accelerator driven process. With the production and separation of Mo-99, a low level waste stream will be generated. Since the production facility is a commercial endeavor, waste disposition paths normally available for federally generated radioactive waste may not be available. Disposal sites for commercially generated low level waste are available, and consideration to the waste acceptance criteria (WAC) of the disposal site should be integral in flowsheet development for the Mo-99 production. Pending implementation of the “Uranium Lease and Take-Back Programmore » for Irradiation for Production of Molybdenum-99 for Medical Use” as directed by the American Medical Isotopes Production Act of 2012, there are limited options for disposing of the waste generated by the production of Mo-99 using an accelerator. The commission of a trade study to assist in the determination of the most favorable balance of production throughput and waste management should be undertaken. The use of a waste broker during initial operations of a facility has several benefits that can offset the cost associated with using a subcontractor. As the facility matures, the development of in-house capabilities can be expanded to incrementally reduce the dependence on a subcontractor.« less

  9. The component-based architecture of the HELIOS medical software engineering environment.

    PubMed

    Degoulet, P; Jean, F C; Engelmann, U; Meinzer, H P; Baud, R; Sandblad, B; Wigertz, O; Le Meur, R; Jagermann, C

    1994-12-01

    The constitution of highly integrated health information networks and the growth of multimedia technologies raise new challenges for the development of medical applications. We describe in this paper the general architecture of the HELIOS medical software engineering environment devoted to the development and maintenance of multimedia distributed medical applications. HELIOS is made of a set of software components, federated by a communication channel called the HELIOS Unification Bus. The HELIOS kernel includes three main components, the Analysis-Design and Environment, the Object Information System and the Interface Manager. HELIOS services consist in a collection of toolkits providing the necessary facilities to medical application developers. They include Image Related services, a Natural Language Processor, a Decision Support System and Connection services. The project gives special attention to both object-oriented approaches and software re-usability that are considered crucial steps towards the development of more reliable, coherent and integrated applications.

  10. Re-modelled CT unit quickly up to speed.

    PubMed

    2011-06-01

    Medical turnkey pre-installation specialist Canute International Medical Services (CIMS) recently supported provider of managed equipment services Asteral in a project to re-model the Rowan Bentall wing of Surrey's Kingston Hospital. The new CT scanning facility was developed by Asteral via an MES agreement, elements of which included two new CT scanners, major refurbishment of the existing building, and ongoing maintenance and finance. As HEJ editor Jonathan Baillie reports, despite a tight two-month schedule, the project team's expertise, and meticulous co-ordination and planning, enabled the delivery of a significantly enhanced facility on time and on budget with minimal disruption and without a single day's scanning being lost.

  11. Time to rehabilitation in the burn population: incidence of zero onset days in the UDSMR national dataset.

    PubMed

    Schneider, Jeffrey C; Tan, Wei-Han; Goldstein, Richard; Mix, Jacqueline M; Niewczyk, Paulette; Divita, Margaret A; Ryan, Colleen M; Gerrard, Paul B; Kowalske, Karen; Zafonte, Ross

    2013-01-01

    A preliminary investigation of the burn rehabilitation population found a large variability of zero onset day frequency between facilities. Onset days is defined as the time from injury to inpatient rehabilitation admission; this variable has not been investigated in burn patients previously. This study explored if this finding was a facility-based phenomena or characteristic of burn inpatient rehabilitation patients. This study was a secondary analysis of Uniform Data System for Medical Rehabilitation (UDSmr) data from 2002 to 2007 examining inpatient rehabilitation characteristics among patients with burn injuries. Exclusion criteria were age less than 18 years and discharge against medical advice. Comparisons of demographic, medical and functional data were made between facilities with a high frequency of zero onset days versus facilities with a low frequency of zero onset days. A total of 4738 patients from 455 inpatient rehabilitation facilities were included. Twenty-three percent of the population exhibited zero onset days (n = 1103). Sixteen facilities contained zero onset patients; two facilities accounted for 97% of the zero onset subgroup. Facilities with a high frequency of zero onset day patients demonstrated significant differences in demographic, medical, and functional variables compared to the remainder of the study population. There were significantly more zero onset day admissions among burn patients (23%) than other diagnostic groups (0.5- 3.6%) in the Uniform Data System for Medical Rehabilitation database, but the majority (97%) came from two inpatient rehabilitation facilities. It is unexpected for patients with significant burn injury to be admitted to a rehabilitation facility on the day of injury. Future studies investigating burn rehabilitation outcomes using the Uniform Data System for Medical Rehabilitation database should exclude facilities with a high percentage of zero onset days, which are not representative of the burn inpatient rehabilitation population.

  12. Medical status of adolescents at time of admission to a juvenile detention center.

    PubMed

    Feinstein, R A; Lampkin, A; Lorish, C D; Klerman, L V; Maisiak, R; Oh, M K

    1998-03-01

    To examine the medical status and history of health care utilization of adolescents at the time of their admission to a juvenile detention facility. Data were collected over an 18-month period on all detainees admitted for the first time to a juvenile detention facility in a major southeastern city in the United States. Information was gathered through a private, confidential interview completed by a medical social worker and a physical examination by a physician. Information was obtained regarding past medical history, complaints at the time of admission, health care utilization, and physical examination. Approximately 10% of teenagers admitted to a detention facility have a significant medical problem (excluding drug/alcohol abuse, or uncomplicated sexually transmitted diseases) that requires medical follow-up. The majority of these conditions were known to the adolescent at the time of admission. Only a third of adolescents admitted to the detention facility reported a regular source of medical care, and only about 20% reported having a private physician. A majority of all the detainees had already fallen behind in or dropped out of school. More than half of the families of the adolescents with a medical problem appeared to be unable or unwilling to assist in ensuring proper medical follow-up. A significant percentage of adolescents entering a detention facility have a medical problem requiring health care services. Detention facilities offer an opportunity to deliver and coordinate medical care to high-risk adolescents. Programs linking public and private health care providers with the correctional care system may provide juveniles with an acceptable option for obtaining needed health care services.

  13. Case-Mix Adjustment of the Bereaved Family Survey.

    PubMed

    Kutney-Lee, Ann; Carpenter, Joan; Smith, Dawn; Thorpe, Joshua; Tudose, Alina; Ersek, Mary

    2018-01-01

    Surveys of bereaved family members are increasingly being used to evaluate end-of-life (EOL) care and to measure organizational performance in EOL care quality. The Bereaved Family Survey (BFS) is used to monitor EOL care quality and benchmark performance in the Veterans Affairs (VA) health-care system. The objective of this study was to develop a case-mix adjustment model for the BFS and to examine changes in facility-level scores following adjustment, in order to provide fair comparisons across facilities. We conducted a cross-sectional secondary analysis of medical record and survey data from veterans and their family members across 146 VA medical centers. Following adjustment using model-based propensity weighting, the mean change in the BFS-Performance Measure score across facilities was -0.6 with a range of -2.6 to 0.6. Fifty-five (38%) facilities changed within ±0.5 percentage points of their unadjusted score. On average, facilities that benefited most from adjustment cared for patients with greater comorbidity burden and were located in urban areas in the Northwest and Midwestern regions of the country. Case-mix adjustment results in minor changes to facility-level BFS scores but allows for fairer comparisons of EOL care quality. Case-mix adjustment of the BFS positions this National Quality Forum-endorsed measure for use in public reporting and internal quality dashboards for VA leadership and may inform the development and refinement of case-mix adjustment models for other surveys of bereaved family members.

  14. Infection prevention and control in deployed military medical treatment facilities.

    PubMed

    Hospenthal, Duane R; Green, Andrew D; Crouch, Helen K; English, Judith F; Pool, Jane; Yun, Heather C; Murray, Clinton K

    2011-08-01

    Infections have complicated the care of combat casualties throughout history and were at one time considered part of the natural history of combat trauma. Personnel who survived to reach medical care were expected to develop and possibly succumb to infections during their care in military hospitals. Initial care of war wounds continues to focus on rapid surgical care with debridement and irrigation, aimed at preventing local infection and sepsis with bacteria from the environment (e.g., clostridial gangrene) or the casualty's own flora. Over the past 150 years, with the revelation that pathogens can be spread from patient to patient and from healthcare providers to patients (including via unwashed hands of healthcare workers, the hospital environment and fomites), a focus on infection prevention and control aimed at decreasing transmission of pathogens and prevention of these infections has developed. Infections associated with combat-related injuries in the recent operations in Iraq and Afghanistan have predominantly been secondary to multidrug-resistant pathogens, likely acquired within the military healthcare system. These healthcare-associated infections seem to originate throughout the system, from deployed medical treatment facilities through the chain of care outside of the combat zone. Emphasis on infection prevention and control, including hand hygiene, isolation, cohorting, and antibiotic control measures, in deployed medical treatment facilities is essential to reducing these healthcare-associated infections. This review was produced to support the Guidelines for the Prevention of Infections Associated With Combat-Related Injuries: 2011 Update contained in this supplement of Journal of Trauma.

  15. Registered nurses' medication management of the elderly in aged care facilities.

    PubMed

    Lim, L M; Chiu, L H; Dohrmann, J; Tan, K-L

    2010-03-01

    Data on adverse drug reactions (ADRs) showed a rising trend in the elderly over 65 years using multiple medications. To identify registered nurses' (RNs) knowledge of medication management and ADRs in the elderly in aged care facilities; evaluate an education programme to increase pharmacology knowledge and prevent ADRs in the elderly; and develop a learning programme with a view to extending provision, if successful. This exploratory study used a non-randomized pre- and post-test one group quasi-experimental design without comparators. It comprised a 23-item knowledge-based test questionnaire, one-hour teaching session and a self-directed learning package. The volunteer sample was RNs from residential aged care facilities, involved in medication management. Participants sat a pre-test immediately before the education, and post-test 4 weeks later (same questionnaire). Participants' perceptions obtained. Pre-test sample n = 58, post-test n = 40, attrition rate of 31%. Using Microsoft Excel 2000, descriptive statistical data analysis of overall pre- and post-test incorrect responses showed: pre-test proportion of incorrect responses = 0.40; post-test proportion of incorrect responses = 0.27; Z-test comparing pre- and post-tests scores of incorrect responses = 6.55 and one-sided P-value = 2.8E-11 (P < 0.001). Pre-test showed knowledge deficits in medication management and ADRs in the elderly; post-test showed statistically significant improvement in RNs' knowledge. It highlighted a need for continuing professional education. Further studies are required on a larger sample of RNs in other aged care facilities, and on the clinical impact of education by investigating nursing practice and elderly residents' outcomes.

  16. Medical tourism today: what is the state of existing knowledge?

    PubMed

    Hopkins, Laura; Labonté, Ronald; Runnels, Vivien; Packer, Corinne

    2010-07-01

    One manifestation of globalization is medical tourism. As its implications remain largely unknown, we reviewed claimed benefits and risks. Driven by high health-care costs, long waiting periods, or lack of access to new therapies in developed countries, most medical tourists (largely from the United States, Canada, and Western Europe) seek care in Asia and Latin America. Although individual patient risks may be offset by credentialing and sophistication in (some) destination country facilities, lack of benefits to poorer citizens in developing countries offering medical tourism remains a generic equity issue. Data collection, measures, and studies of medical tourism all need to be greatly improved if countries are to assess better both the magnitude and potential health implications of this trade.

  17. Simple solution to the medical instrumentation software problem

    NASA Astrophysics Data System (ADS)

    Leif, Robert C.; Leif, Suzanne B.; Leif, Stephanie H.; Bingue, E.

    1995-04-01

    Medical devices now include a substantial software component, which is both difficult and expensive to produce and maintain. Medical software must be developed according to `Good Manufacturing Practices', GMP. Good Manufacturing Practices as specified by the FDA and ISO requires the definition and compliance to a software processes which ensures quality products by specifying a detailed method of software construction. The software process should be based on accepted standards. US Department of Defense software standards and technology can both facilitate the development and improve the quality of medical systems. We describe the advantages of employing Mil-Std-498, Software Development and Documentation, and the Ada programming language. Ada provides the very broad range of functionalities, from embedded real-time to management information systems required by many medical devices. It also includes advanced facilities for object oriented programming and software engineering.

  18. Student perception about working in rural Nepal after graduation: a study among first- and second-year medical students.

    PubMed

    Shankar, P Ravi; Thapa, Trilok P

    2012-08-31

    The Federal Democratic Republic of Nepal is a developing country in South Asia with a population of 29.8 million. In September 2011, there were 18 medical schools with 14 being in the private sector. KIST Medical College is a private school in Lalitpur district. The present study was conducted to obtain information on student perceptions about working in rural Nepal after graduation. The study was conducted among first- and second-year undergraduate medical students using a semi-structured questionnaire developed by the authors using inputs from the literature and their experiences of teaching medical students. Year of study, gender, method of financing of medical education, place of family residence and occupation of parents were noted. Participant responses were analysed, grouped together and the number of respondents stating a particular response was noted. Of the 200 students, 185 (92.5%) participated with 95 being from the first year and 90 from the second. Most students were self-financing and from urban areas. Regarding the question of working in rural Nepal after graduation, 134 (72.4%) said they will work after their undergraduate course. Students preferred to work in the government or nongovernmental sector. Student felt doctors are reluctant to serve in rural Nepal due to inadequate facilities, low salary, less security, problems with their professional development, less equipment in health centres, decreased contact with family and difficulties in communicating with an illiterate, rural population. About 43% of respondents felt medical education does not adequately prepare them for rural service. Repeated rural exposure, postings in rural hospitals and health centres, and training students to diagnose and treat illness with less technology were suggested. The median monthly salary expected was 60 000 Nepalese rupees (US$ 820) and was significantly higher among first-year students. The majority of respondents were in favour of working in rural Nepal after graduation. They wanted facilities in rural areas and health centres to be improved. Changes in the education system were suggested. Providing relatively better facilities for rural doctors compared with urban doctors and reorienting medical education for producing doctors for rural Nepal can be considered. Further studies are required in other private medical schools.

  19. Medical directors of long-term care facilities

    PubMed Central

    Frank, C.; Seguin, R.; Haber, Shelly; Godwin, Marshall; Stewart, G.I.

    2006-01-01

    OBJECTIVE The long-term care (LTC) sector in Canada is expanding, but little attention has been given to medical human resources in this area. Our objective was to seek LTC medical directors’ opinions about medical services in LTC and about strategies for recruitment and retention. DESIGN Mailed survey. SETTING Long-term care facilities and nursing homes. PARTICIPANTS Seven hundred five medical directors of LTC facilities across Canada were identified from the Canadian Healthcare Association database. MAIN OUTCOME MEASURES Responses to open- and closed-ended questions and to Likert-type scales. RESULTS The response rate was 55%. The average age of medical directors was 54 years. Most had started work in LTC because of a vacant position, as opposed to self-perceived skills or training. Most (75.3%) reported satisfaction with their role as medical directors, but 82.7% believed that there was a significant shortage of physicians working in LTC, and 42% had seriously considered leaving their positions. Major sources of satisfaction identified were clinical, especially working with older patients and improving care. Important sources of dissatisfaction were remuneration for LTC work, on-call coverage, and excessive paperwork. Directors suggested increases to fee schedules as the main recruitment and retention strategy, and many believed that increasing exposure to LTC during residency would increase recruitment. Development of larger on-call groups for coverage and alternative methods of remuneration were not cited as important factors. Most did not believe that working in a teaching nursing home would increase their satisfaction. Directors did not think the use of nurse practitioners would alleviate concerns about shortages of physicians. CONCLUSION Medical directors of LTC facilities are aging, and many are considering leaving their work in LTC. Without an increase in the number of physicians willing to work in LTC institutions, the current shortage of LTC physicians could increase in the near future. Medical directors’ responses to questions could help guide strategies to recruit and retain physicians. Future areas of research should include the perspectives of physicians who are not medical directors and of family medicine residents. PMID:17273484

  20. Hazardous medical waste generation in Greece: case studies from medical facilities in Attica and from a small insular hospital.

    PubMed

    Komilis, Dimitrios; Katsafaros, Nikolaos; Vassilopoulos, Panagiotis

    2011-08-01

    The accurate calculation of the unit generation rates and composition of medical waste generated from medical facilities is necessary in order to design medical waste treatment systems. In this work, the unit medical waste generation rates of 95 public and private medical facilities in the Attica region were calculated based on daily weight records from a central medical waste incineration facility. The calculated medical waste generation rates (in kg bed(-1) day( -1)) varied widely with average values at 0.27 ± 113% and 0.24 ± 121%, for public and private medical facilities, respectively. The hazardous medical waste generation was measured, at the source, in the 40 bed hospital of the island of Ikaria for a period of 42 days during a 6 month period. The average hazardous medical waste generation rate was 1.204 kg occupied bed(-1) day(-1) or 0.33 kg (official) bed( -1) day(-1). From the above amounts, 54% resulted from the patients' room (solid and liquid wastes combined), 24% from the emergency department (solid waste), 17% from the clinical pathology lab and 6% from the X-ray lab. In average, 17% of the total hazardous medical waste was solely infectious. Conclusively, no correlation among the number of beds and the unit medical waste generation rate could be established. Each hospital should be studied separately, since medical waste generation and composition depends on the number and type of departments/laboratories at each hospital, number of external patients and number of occupied beds.

  1. Economic evaluation of pharmacist-led medication reviews in residential aged care facilities.

    PubMed

    Hasan, Syed Shahzad; Thiruchelvam, Kaeshaelya; Kow, Chia Siang; Ghori, Muhammad Usman; Babar, Zaheer-Ud-Din

    2017-10-01

    Medication reviews is a widely accepted approach known to have a substantial impact on patients' pharmacotherapy and safety. Numerous options to optimise pharmacotherapy in older people have been reported in literature and they include medication reviews, computerised decision support systems, management teams, and educational approaches. Pharmacist-led medication reviews are increasingly being conducted, aimed at attaining patient safety and medication optimisation. Cost effectiveness is an essential aspect of a medication review evaluation. Areas covered: A systematic searching of articles that examined the cost-effectiveness of medication reviews conducted in aged care facilities was performed using the relevant databases. Pharmacist-led medication reviews confer many benefits such as attainment of biomarker targets for improved clinical outcomes, and other clinical parameters, as well as depict concrete financial advantages in terms of decrement in total medication costs and associated cost savings. Expert commentary: The cost-effectiveness of medication reviews are more consequential than ever before. A critical evaluation of pharmacist-led medication reviews in residential aged care facilities from an economical aspect is crucial in determining if the time, effort, and direct and indirect costs involved in the review rationalise the significance of conducting medication reviews for older people in aged care facilities.

  2. 76 FR 67736 - Implementation of Section 2695 (42 U.S.C. 300ff-131) of Public Law 111-87: Infectious Diseases...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-02

    ... Treatment Extension Act of 2009 (Pub. L. 111-87) addresses notification procedures for medical facilities... describing the manner in which medical facilities should make determinations about exposures. On December 13... Which Medical Facilities Should Make Determinations for Purposes of Section 2695B(d) [42 U.S.C. 300ff...

  3. [Osaka Medical Laboratory ISO15189 Study Group: History and Future Prospects of the Group].

    PubMed

    Iguchi, Ken

    2016-02-01

    The IS015189 "Medical laboratories: Specific requirements regarding quality and competence" is an international standard issued by the International Organization for Standardization (ISO) in February 2003. In October 2004, pilot surveys were initiated in Japan prior to accreditation surveys scheduled to be started in 2005. In September 2005, the first ever ISO15189-accredited facility was established in Japan. With the background of limited information about and few opportunities to study ISO15189 in 2004, we established the Osaka Medical Laboratory ISO15189 Study Group as a unique association that anyone interested in the ISO is able to join. Approximately 900 people have participated in group meetings, which have been held a total of 11 times. Thus, our group has played a major role in ISO development in Japan. To date, approximately 100 facilities have been ISO15189-accredited in Japan, suggesting the need to take new steps regarding its accreditation. As our group has achieved our initial objective, we are planning to work towards taking new steps, such as interaction with accredited facilities.

  4. Providing emergency medical care to offshore oil and gas platforms in the Gulf of Mexico using telemedicine

    NASA Astrophysics Data System (ADS)

    Bouabene, Anis

    2002-08-01

    UTMB is developing with industrial partners the "24/7 telemedicine triage project" to provide emergency medical care to offshore oil and gas rigs and platforms in the Gulf of Mexico. The oil and gas industry is second only to the US department of defense in the number of employees stationed in remote areas. Providing medical care to such populations is logistically complex and expensive. In addition, emergency evacuation is often time-consuming and poses risks for both patients and medical crews. By utilizing high-resolution videoconferencing technology, through a satellite communication, patient visits will be conducted in real time and will provide more informed decisions about the need for more extensive treatment, thereby reducing unnecessary evacuations. In addition, patients who require evacuation will receive a higher standard of care while waiting for transport to a medical facility. UTMB physicians report that 39% of all patients from offshore facilities treated in the emergency department, could have been successfully treated through telemedicine without being evacuated to a hospital. The telemedicine project will employ standard procedures for medical triage, in which patients are directed to appropriate medical experts based on their symptoms or type of injury.

  5. Target development for 67Cu, 82Sr radionuclide production at the RIC-80 facility

    NASA Astrophysics Data System (ADS)

    Panteleev, V. N.; Barzakh, A. E.; Batist, L. Kh.; Fedorov, D. V.; Ivanov, V. S.; Krotov, S. A.; Molkanov, P. L.; Moroz, F. V.; Orlov, S. Yu.; Volkov, Yu. M.

    2018-01-01

    A high-current cyclotron C-80 capable of producing 40-80 MeV proton beams with a current of up to 200 μA has been constructed and commissioned at PNPI (Petersburg Nuclear Physics Institute). One of the main goals of cyclotron C-80 is the production of a wide spectrum of medical radionuclides for diagnostics and therapy. To date, the project development of a radioisotope facility RIC-80 (radioisotopes at cyclotron C-80) has been completed. The feature of the project is the use of a mass-separator combined with the ion-target device for obtaining ion beams of radioisotopes with a high purity of separation that is especially important for medical applications. The first results of a new high-temperature method for extracting 82Sr and 67Cu radioisotopes from irradiated targets have been presented.

  6. [Marketing macroenvironment of a sanatorium and spa facility as a study object and a factor of strategic decision making].

    PubMed

    Babaskin, D V

    2009-01-01

    Analysis of marketing macroenvironment is an important stage in the formulation of the strategy for the development and operation of a therapeutic and preventive healthcare facility making possible rapid adjustment to sharply changing marketing conditions. The possibility of using expert evaluation for the analysis of the marketing macroenvironment of a sanatorium and spa facility and a concrete medical care service provided (peloidotherapy) is illustrated. The study covers five aspects of marketing macroenvironment, viz. socio-demographic, technological, economic, political and ecological.

  7. The Optimizing Patient Transfers, Impacting Medical Quality, andImproving Symptoms:Transforming Institutional Care approach: preliminary data from the implementation of a Centers for Medicare and Medicaid Services nursing facility demonstration project.

    PubMed

    Unroe, Kathleen T; Nazir, Arif; Holtz, Laura R; Maurer, Helen; Miller, Ellen; Hickman, Susan E; La Mantia, Michael A; Bennett, Merih; Arling, Greg; Sachs, Greg A

    2015-01-01

    The Optimizing Patient Transfers, Impacting Medical Quality, and Improving Symptoms: Transforming Institutional Care (OPTIMISTIC) project aims to reduce avoidable hospitalizations of long-stay residents enrolled in 19 central Indiana nursing facilities. This clinical demonstration project, funded by the Centers for Medicare and Medicaid Services Innovations Center, places a registered nurse in each nursing facility to implement an evidence-based quality improvement program with clinical support from nurse practitioners. A description of the model is presented, and early implementation experiences during the first year of the project are reported. Important elements include better medical care through implementation of Interventions to Reduce Acute Care Transfers tools and chronic care management, enhanced transitional care, and better palliative care with a focus on systematic advance care planning. There were 4,035 long-stay residents in 19 facilities enrolled in OPTIMISTIC between February 2013 and January 2014. Root-cause analyses were performed for all 910 acute transfers of these long stay residents. Of these transfers, the project RN evaluated 29% as avoidable (57% were not avoidable and 15% were missing), and opportunities for quality improvement were identified in 54% of transfers. Lessons learned in early implementation included defining new clinical roles, integrating into nursing facility culture, managing competing facility priorities, communicating with multiple stakeholders, and developing a system for collecting and managing data. The success of the overall initiative will be measured primarily according to reduction in avoidable hospitalizations of long-stay nursing facility residents. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

  8. A Unique BSL-3 Cryo-Electron Microscopy Laboratory at UTMB

    PubMed Central

    Sherman, Michael B.; Freiberg, Alexander N.; Razmus, Dennis; Yazuka, Shintaro; Koht, Craig; Hilser, Vincent J.; Lemon, Stanley M.; Brocard, Anne-Sophie; Zimmerman, Dee; Chiu, Wah; Watowich, Stanley J.; Weaver, Scott C.

    2010-01-01

    This article describes a unique cryo-electron microscopy (CryoEM) facility to study the three-dimensional organization of viruses at biological safety level 3 (BSL-3). This facility, the W. M. Keck Center for Virus Imaging, has successfully operated for more than a year without incident and was cleared for select agent studies by the Centers for Disease Control and Prevention (CDC). Standard operating procedures for the laboratory were developed and implemented to ensure its safe and efficient operation. This facility at the University of Texas Medical Branch (Galveston, TX) is the only such BSL-3 CryoEM facility approved for select agent research. PMID:21852942

  9. Accelerator Production of Isotopes for Medical Use

    NASA Astrophysics Data System (ADS)

    Lapi, Suzanne

    2014-03-01

    The increase in use of radioisotopes for medical imaging and therapy has led to the development of novel routes of isotope production. For example, the production and purification of longer-lived position emitting radiometals has been explored to allow for nuclear imaging agents based on peptides, antibodies and nanoparticles. These isotopes (64Cu, 89Zr, 86Y) are typically produced via irradiation of solid targets on smaller medical cyclotrons at dedicated facilities. Recently, isotope harvesting from heavy ion accelerator facilities has also been suggested. The Facility for Rare Isotope Beams (FRIB) will be a new national user facility for nuclear science to be completed in 2020. Radioisotopes could be produced by dedicated runs by primary users or may be collected synergistically from the water in cooling-loops for the primary beam dump that cycle the water at flow rates in excess of hundreds of gallons per minute. A liquid water target system for harvesting radioisotopes at the National Superconducting Cyclotron Laboratory (NSCL) was designed and constructed as the initial step in proof-of-principle experiments to harvest useful radioisotopes in this manner. This talk will provide an overview of isotope production using both dedicated machines and harvesting from larger accelerators typically used for nuclear physics. Funding from Department of Energy under DESC0007352 and DESC0006862.

  10. 38 CFR 17.52 - Hospital care and medical services in non-VA facilities.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... the life or health of a veteran receiving hospital care or medical services in a facility over which... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Hospital care and medical... VETERANS AFFAIRS MEDICAL Use of Public Or Private Hospitals § 17.52 Hospital care and medical services in...

  11. 38 CFR 17.52 - Hospital care and medical services in non-VA facilities.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... the life or health of a veteran receiving hospital care or medical services in a facility over which... 38 Pensions, Bonuses, and Veterans' Relief 1 2012-07-01 2012-07-01 false Hospital care and medical... VETERANS AFFAIRS MEDICAL Use of Public Or Private Hospitals § 17.52 Hospital care and medical services in...

  12. Floor vibration evaluations for medical facilities

    NASA Astrophysics Data System (ADS)

    Himmel, Chad N.

    2003-10-01

    The structural floor design for new medical facilities is often selected early in the design phase and in renovation projects, the floor structure already exists. Because the floor structure can often have an influence on the location of vibration sensitive medical equipment and facilities, it is becoming necessary to identify the best locations for equipment and facilities early in the design process. Even though specific criteria for vibration-sensitive uses and equipment may not always be available early in the design phase, it should be possible to determine compatible floor structures for planned vibration-sensitive uses by comparing conceptual layouts with generic floor vibration criteria. Relatively simple evaluations of planned uses and generic criteria, combined with on-site vibration and noise measurements early in design phase, can significantly reduce future design problems and expense. Concepts of evaluation procedures and analyses will be presented in this paper. Generic floor vibration criteria and appropriate parameters to control resonant floor vibration and noise will be discussed for typical medical facilities and medical research facilities. Physical, economic, and logistical limitations that affect implementation will be discussed through case studies.

  13. [Organization of medical equipment and stock supply of military medical facilities and groups of Disaster Medicine Service of the Russian Defense Ministry in emergency situations].

    PubMed

    Korniushko, I G; Iakovlev, S V; Krasavin, K D; Lemeshkin, R N

    2011-10-01

    The article outlined the modern concept of medical equipment and stock supply of medical facilities and groups of Disaster Medicine Service of the Russian Defense Ministry involved into the remedial of the medical actions of emergency situations. The structure of the units of medical supplies in these conditions is presented.

  14. Medical surveillance and programs on industrial hygiene at RCRA facilities

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

    Murphy, T.E.

    1994-12-31

    Some special areas where much progress in industrial hygiene and safety has been made in the past few years are; training, personal protective equipment, uniforms, personal monitoring, area monitoring, and medical surveillance. Before one can begin to construct programs for worker protection, some knowledge of potential exposures must be gained. The best place to start is the Waste Analysis Plan, and the list of wastes that a particular site is authorized to receive. Waste Codes are listed within a facility`s Part A and Part B permits. Actual facility receipt of wastes are well documented within Load Records and other documentation.more » A facility`s training program forms the heart of a health and safety program. Every TSD facility should have developed a matrix of job titles and required training. Every facility must also make a commitment to providing a wide range of personal protective equipment, including a wide array of disposables. Some facilities will benefit from the occasional use of the newer respirator quantitative fit-testing devices. All facilities are urged to rent or borrow this type of equipment periodically. Quantitative respirator fit-testers are capable of revealing important deficiencies in a respirator program. Providing uniforms is a newer means of protecting workers. The use of uniforms is an effective means for addressing the idea of carry-home-waste. The use of disposables including boots, must be integrated into a Uniform Program if the program is to be effective. In addition, employees must strictly understand that uniforms must not leave the facility at any time, including lunch time.« less

  15. Clinical Practice Guideline Implementation Strategy Patterns in Veterans Affairs Primary Care Clinics

    PubMed Central

    Hysong, Sylvia J; Best, Richard G; Pugh, Jacqueline A

    2007-01-01

    Background The Department of Veterans Affairs (VA) mandated the system-wide implementation of clinical practice guidelines (CPGs) in the mid-1990s, arming all facilities with basic resources to facilitate implementation; despite this resource allocation, significant variability still exists across VA facilities in implementation success. Objective This study compares CPG implementation strategy patterns used by high and low performing primary care clinics in the VA. Research Design Descriptive, cross-sectional study of a purposeful sample of six Veterans Affairs Medical Centers (VAMCs) with high and low performance on six CPGs. Subjects One hundred and two employees (management, quality improvement, clinic personnel) involved with guideline implementation at each VAMC primary care clinic. Measures Participants reported specific strategies used by their facility to implement guidelines in 1-hour semi-structured interviews. Facilities were classified as high or low performers based on their guideline adherence scores calculated through independently conducted chart reviews. Findings High performing facilities (HPFs) (a) invested significantly in the implementation of the electronic medical record and locally adapting it to provider needs, (b) invested dedicated resources to guideline-related initiatives, and (c) exhibited a clear direction in their strategy choices. Low performing facilities exhibited (a) earlier stages of development for their electronic medical record, (b) reliance on preexisting resources for guideline implementation, with little local adaptation, and (c) no clear direction in their strategy choices. Conclusion A multifaceted, yet targeted, strategic approach to guideline implementation emphasizing dedicated resources and local adaptation may result in more successful implementation and higher guideline adherence than relying on standardized resources and taxing preexisting channels. PMID:17355583

  16. The ASCENT (Allocation System Changes for Equity in Kidney Transplantation) Study: a Randomized Effectiveness-Implementation Study to Improve Kidney Transplant Waitlisting and Reduce Racial Disparity.

    PubMed

    Patzer, Rachel E; Smith, Kayla; Basu, Mohua; Gander, Jennifer; Mohan, Sumit; Escoffery, Cam; Plantinga, Laura; Melanson, Taylor; Kalloo, Sean; Green, Gary; Berlin, Alex; Renville, Gary; Browne, Teri; Turgeon, Nicole; Caponi, Susan; Zhang, Rebecca; Pastan, Stephen

    2017-05-01

    The United Network for Organ Sharing (UNOS) implemented a new Kidney Allocation System (KAS) in December 2014 that is expected to substantially reduce racial disparities in kidney transplantation among waitlisted patients. However, not all dialysis facility clinical providers and end stage renal disease (ESRD) patients are aware of how the policy change could improve access to transplant. We describe the ASCENT (Allocation System Changes for Equity in KidNey Transplantation) study, a randomized controlled effectiveness-implementation study designed to test the effectiveness of a multicomponent intervention to improve access to the early steps of kidney transplantation among dialysis facilities across the United States. The multicomponent intervention consists of an educational webinar for dialysis medical directors, an educational video for patients and an educational video for dialysis staff, and a dialysis-facility specific transplant performance feedback report. Materials will be developed by a multidisciplinary dissemination advisory board and will undergo formative testing in dialysis facilities across the United States. This study is estimated to enroll ~600 U.S. dialysis facilities with low waitlisting in all 18 ESRD Networks. The co-primary outcomes include change in waitlisting, and waitlist disparity at 1 year; secondary outcomes include changes in facility medical director knowledge about KAS, staff training regarding KAS, patient education regarding transplant, and a medical director's intent to refer patients for transplant evaluation. The results from the ASCENT study will demonstrate the feasibility and effectiveness of a multicomponent intervention designed to increase access to the deceased-donor kidney waitlist and reduce racial disparities in waitlisting.

  17. Pilot statewide study of pediatric emergency department alignment with national guidelines.

    PubMed

    Costich, Julia F; Fallat, Mary E; Scaggs, C Morgan; Bartlett, Richard

    2013-07-01

    The American Academy of Pediatrics, American College of Emergency Physicians, and Emergency Nursing Association have developed consensus guidelines for pediatric emergency department policies, procedures, supplies, and equipment. Kentucky received funding from the Health Resources and Services Administration through the Emergency Medical Services for Children program to pilot test the guidelines with the state's hospitals. In addition to providing baseline data regarding institutional alignment with the guidelines, the survey supported development of grant funding to procure missing items. Survey administration was undertaken by staff and members of the Kentucky Board of Emergency Medical Services Emergency Medical Services for Children work group and faculty and staff of the University of Kentucky College of Public Health and the University of Louisville School of Medicine. Responses were solicited primarily online with repeated reminders and offers of assistance. Seventy respondents completed the survey section on supplies and equipment either online or by fax. Results identified items unavailable at 20% or more of responding facilities, primarily the smallest sizes of equipment. The survey section addressing policy and procedure received only 16 responses. Kentucky facilities were reasonably well equipped by national standards, but rural facilities and small hospitals did not stock the smallest equipment sizes because of low reported volume of pediatric emergency department cases. Thus, a centralized procurement process that gives them access to an adequate range of pediatric supplies and equipment would support capacity building for the care of children across the entire state. Grant proposals were received from 28 facilities in the first 3 months of funding availability.

  18. Medical Director Responsibilities to the ESRD Network

    PubMed Central

    DeOreo, Peter B.

    2015-01-01

    The 18 regional ESRD Networks are established in legislation and contract with the Centers for Medicare and Medicaid Services to improve the quality and safety of dialysis, maximize patient rehabilitation, encourage collaboration among and between providers toward common quality goals, and improve the reliability and the use of data in pursuit of quality improvement. The Networks are funded by a $0.50 per treatment fee deducted from the reimbursement to dialysis providers, and their deliverables are determined by a statement of work, which is updated in a new contract every 3 years. The Conditions for Coverage require dialysis providers to participate in Network activities, and failure to do so can be the basis for sanctions against the provider. However, the Networks attempt to foster a collegial relationship with dialysis facilities by offering tools, educational activities, and other resources to assist the facilities in meeting the evolving requirements by the Centers for Medicare and Medicaid Services on the basis of national aims and domains for quality improvement in health care that transcend the ESRD program. Because of his/her responsibility for implementing the quality assessment and performance improvement activities in the facility, the medical director has much to gain by actively participating in Network activities, especially those focused on quality, safety, patient grievance, patient engagement, and coordination of care. Membership on Network committees can also foster the professional growth of the medical director through participation in quality improvement activity development and implementation, authorship of articles in peer-reviewed journals, creation of educational tools and presentations, and application of Network-sponsored materials to improve patient outcomes, engagement, and satisfaction in the medical director’s facility. The improvement of care of patients on dialysis will be beneficial to the facility in achieving its goals of quality, safety, and financial viability. PMID:25255911

  19. Developments and potential of radiation processing in the Philippines

    NASA Astrophysics Data System (ADS)

    Singson, C.; Carmona, C.

    This paper describes the research and development activities in three areas of radiation processing, namely: food irradiation, medical product sterilization and wood plastic combination. Plans and efforts exerted to acquire a larger gamma source to augment our present 5,000 curie source are discussed. Cost estimates for a radiation facility is presented on the basis of the market potential of food irradiation and medical product sterilization. Existing local industries that can benefit from the adaptation of irradiation technology in their processing requirements is described.

  20. Multi-Service Doctrine for Chemical, Biological, Radiological, and Nuclear Operations

    DTIC Science & Technology

    2011-07-01

    currently valid OMB control number. 1. REPORT DATE JUL 2011 2. REPORT TYPE 3. DATES COVERED 00-00-2011 to 00-00-2011 4. TITLE AND SUBTITLE Multi...research reactors, research and development facilities, laboratories, production facilities, radioisotope thermoelectric generators, pharmaceutical...requests from the U.S. armed forces for emergency, up-to- date medical intelligence assessments. It is the nation’s premier producer and coordinator of

  1. Water immersion facility general description, spacecraft design division, crew station branch

    NASA Technical Reports Server (NTRS)

    1978-01-01

    The Water Immersion Facility provides an accurate, safe, neutral buoyancy simulation of zero gravity conditions for development of equipment and procedures, and the training of crews. A detailed description is given of some of the following systems: (1) water tank and support equipment; (2) communications systems; (3) environmental control and liquid cooled garment system (EcS/LCG); (4) closed circuit television system; and (5) medical support system.

  2. Evaluation of PACS in a multihospital environment

    NASA Astrophysics Data System (ADS)

    Siegel, Eliot L.; Reiner, Bruce I.; Protopapas, Zenon

    1998-07-01

    Although a number of authors have described the challenges and benefits of filmless operation using a hospital-wide Picture Archival and Communication System (PACS), there have been few descriptions of a multi-hospital wide area PACS. The purpose of this paper is to describe our two and a half year experience with PACS in an integrated multi-facility health care environment, the Veterans Affairs Maryland Health Care System (VAMHCS). On June 17, 1995 the Radiology and Nuclear Medicine services became integrated for four medical centers forming the VA Maryland Health Care System creating a single multi-facility imaging department. The facilities consisted of the Baltimore VA (acute and outpatient care, tertiary referral center), Ft. Howard (primarily long term care), Perry Point (primarily psychiatric care), and the Baltimore Rehabilitation and extended care facility (nursing home). The combined number of studies at all four sites is slightly more than 80,000 examinations per year. In addition to residents and fellows, the number of radiologists at Baltimore was approximately seven, with two at Perry Point, one at Ft. Howard, and no radiologists at the Rehabilitation and Extended Care facility. A single HIS/RIS, which is located physically at the Baltimore VAMC is utilized for all four medical centers. The multi- facility image management and communication system utilizes two separate PAC Systems that are physically located at the Baltimore VA Medical Center (BVAMC). The commercial system (GE Medical Systems) has been in place in Baltimore for more than 41/2 years and is utilized primarily in the acquisition, storage, distribution and display of radiology and nuclear medicine studies. The second PACS is the VISTA Imaging System, which has been developed as a module of the VA's HIS/RIS by and for the Department of Veterans Affairs. All of the radiology images obtained on the commercial PACS are requested by the VISTA Imaging System using DICOM query/retrieve commands and are stored on a separate server and optical jukebox. Additionally, the VISTA system is used to store all images obtained by all specialties in the medical center including pathology, dermatology, GI medicine, surgery, podiatry, ophthalmology, etc. Using this two PAC system approach, the hospital is able to achieve redundancy with regard to image storage, retrieval, and display of radiology images. The transition to a 'virtual' multi-facility imaging department was accomplished over a period of two years. Initially, Perry Point and Ft. Howard replaced their general radiographic film processors with Computed Radiography (CR) units. The CR units and subsequently, the CT and Ultrasound systems at Perry Point were interfaced (DeJarnette Research Systems) with the commercial PACS located in Baltimore. A HIS/RIS to modality interface was developed (DeJarnette and Fuji Medical Systems) between the computed radiography and CT units and VISTA Information System at Baltimore. A digital dictation system was recently implemented across the multi- facility network. The integration of the three radiology departments into a single virtual imaging department serving four medical centers has resulted in a number of benefits. Economically, there has been the elimination via attrition of one and a half radiologist FTE's (full time equivalents) and an administrative position resulting in an annual savings of more than $375,000 per year. Additionally, the expenditures for moonlighter coverage for vacation, meeting, and sick leave have been eliminated. There is now subspecialty coverage for primary or secondary interpretation and for peer review.

  3. The Cost-efficiency and Care Effectiveness of Probiotic Administration with Antibiotics to Prevent Hospital-Acquired Clostridium difficile Infection.

    PubMed

    Starn, Emily S; Hampe, Holly; Cline, Thomas

    Health care facility-acquired Clostridium difficile infections (HCFA-CDI) have increased over the last several decades despite facilities developing protocols for prescribing probiotics with antibiotics to prevent HCFA-CDI. The literature does not consistently support this. A retrospective medical record review evaluated the care effectiveness of this practice. Care effectiveness was not found; patients receiving probiotics with antibiotics were twice as likely to develop HCFA-CDI (P = .004). Except with glycopeptides, patients were 1.88 times less likely to experience HCFA-CDI (P = .05).

  4. Unpredictable, unpreventable and impersonal medicine: global disaster response in the 21st century.

    PubMed

    Andrews, Russell J; Quintana, Leonidas M

    2015-01-01

    The United Nations has recognized the devastating consequences of "unpredictable, unpreventable and impersonal" disasters-at least US $2 trillion in economic damage and more than 1.3 million lives lost from natural disasters in the last two decades alone. In many disasters (both natural and man-made) hundreds-and in major earthquakes, thousands-of lives are lost in the first days following the event because of the lack of medical/surgical facilities to treat those with potentially survivable injuries. Disasters disrupt and destroy not only medical facilities in the disaster zone but also infrastructure (roads, airports, electricity) and potentially local healthcare personnel as well. To minimize morbidity and mortality from disasters, medical treatment must begin immediately, within minutes ideally, but certainly within 24 h (not the days to weeks currently seen in medical response to disasters). This requires that all resources-medical equipment and support, and healthcare personnel-be portable and readily available; transport to the disaster site will usually require helicopters, as military medical response teams in developed countries have demonstrated. Some of the resources available and in development for immediate medical response for disasters-from portable CT scanners to telesurgical capabilities-are described. For immediate deployment, these resources-medical equipment and personnel-must be ready for deployment on a moment's notice and not require administrative approvals or bureaucratic authorizations from numerous national and international agencies, as is presently the case. Following the "trauma center/stroke center" model, disaster response incorporating "disaster response centers" would be seamlessly integrated into the ongoing daily healthcare delivery systems worldwide, from medical education and specialty training (resident/registrar) to acute and subacute intensive care to long-term rehabilitation. The benefits of such a global disaster response network extend far beyond the lives saved: universal standards for medical education and healthcare delivery, as well as the global development of medical equipment and infrastructure, would follow. Capitalizing on the humanitarian nature of disaster response-with its suspension of the cultural, socioeconomic and political barriers that often paralyze international cooperation and development-disaster response can be predictable, loss of life can be preventable and benefits can be both personal and societal.

  5. Motivation and Retention of Physicians in Primary Healthcare Facilities: A Qualitative Study From Abbottabad, Pakistan.

    PubMed

    Shah, Sayed Masoom; Zaidi, Shehla; Ahmed, Jamil; Rehman, Shafiq Ur

    2016-04-09

    Workforce motivation and retention is important for the functionality and quality of service delivery in health systems of developing countries. Despite huge primary healthcare (PHC) infrastructure, Pakistan's health indicators are not impressive; mainly because of under-utilization of facilities and low patient satisfaction. One of the major underlying issues is staff absenteeism. The study aimed to identify factors affecting retention and motivation of doctors working in PHC facilities of Pakistan. An exploratory study was conducted in a rural district in Khyber Puktunkhwa (KP) province, in Pakistan. A conceptual framework was developed comprising of three organizational, individual, and external environmental factors. Qualitative research methods comprising of semi-structured interviews with doctors working in basic health units (BHUs) and in-depth interviews with district and provincial government health managers were used. Document review of postings, rules of business and policy actions was also conducted. Triangulation of findings was carried out to arrive at the final synthesis. Inadequate remuneration, unreasonable facilities at residence, poor work environment, political interference, inadequate supplies and medical facilities contributed to lack of motivation among both male and female doctors. The physicians accepted government jobs in BHUs with a belief that these jobs were more secure, with convenient working hours. Male physicians seemed to be more motivated because they faced less challenges than their female counterparts in BHUs especially during relocations. Overall, the organizational factors emerged as the most significant whereby human resource policy, career growth structure, performance appraisal and monetary benefits played an important role. Gender and marital status of female doctors was regarded as most important individual factor affecting retention and motivation of female doctors in BHUs. Inadequate remuneration, unreasonable facilities at residence, poor work environment, political interference, inadequate supplies, and medical facilities contributed to lack of motivation in physicians in our study. Our study advocates that by addressing the retention and motivation challenges, service delivery can be made more responsive to the patients and communities in Pakistan and other similar settings. © 2016 by Kerman University of Medical Sciences

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

    PubMed

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

    2009-05-09

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

  7. A telemedicine health care delivery system

    NASA Technical Reports Server (NTRS)

    Sanders, Jay H.

    1991-01-01

    The Interactive Telemedicine Systems (ITS) system was specifically developed to address the ever widening gap between our medical care expertise and our medical care delivery system. The frustrating reality is that as our knowledge of how to diagnose and treat medical conditions has continued to advance, the system to deliver that care has remained in an embryonic stage. This has resulted in millions of people being denied their most basic health care needs. Telemedicine utilizes an interactive video system integrated with biomedical telemetry that allows a physician at a base station specialty medical complex or teaching hospital to examine and treat a patient at multiple satellite locations, such as rural hospitals, ambulatory health centers, correctional institutions, facilities caring for the elderly, community hospital emergency departments, or international health facilities. Based on the interactive nature of the system design, the consulting physician at the base station can do a complete history and physical examination, as if the patient at the satellite site was sitting in the physician's office. This system is described.

  8. MLA Certification: Its Present Problems and Future Development *

    PubMed Central

    Proctor, Vilma

    1967-01-01

    The certification program is reviewed and questions as to the validity of the existing three grades of certification are raised. Large institutions which employ many medical librarians do not officially recognize the certificates. The three types of certificates should be replaced with one certificate or diploma. Problems of meaningful examinations, lack of training facilities, and revision of the curriculum require attention. A program is proposed for the improvement of education for medical librarianship. Public identification of medical librarianship is presently difficult. PMID:6016375

  9. Nursing delegation and medication administration in assisted living.

    PubMed

    Mitty, Ethel; Resnick, Barbara; Allen, Josh; Bakerjian, Debra; Hertz, Judith; Gardner, Wendi; Rapp, Mary Pat; Reinhard, Susan; Young, Heather; Mezey, Mathy

    2010-01-01

    Assisted living (AL) residences are residential long-term care settings that provide housing, 24-hour oversight, personal care services, health-related services, or a combination of these on an as-needed basis. Most residents require some assistance with activities of daily living and instrumental activities of daily living, such as medication management. A resident plan of care (ie, service agreement) is developed to address the health and psychosocial needs of the resident. The amount and type of care provided, and the individual who provides that care, vary on the basis of state regulations and what services are provided within the facility. Some states require that an RN hold a leadership position to oversee medication management and other aspects of care within the facility. A licensed practical nurse/licensed vocational nurse can supervise the day-to-day direct care within the facility. The majority of direct care in AL settings is provided by direct care workers (DCWs), including certified nursing assistants or unlicensed providers. The scope of practice of a DCW varies by state and the legal structure within that state. In some states, the DCW is exempt from the nurse practice act, and in some states, the DCW may practice within a specific scope such as being a medication aide. In most states, however, the DCW scope of practice is conscribed, in part, by the delegation of responsibilities (such as medication administration) by a supervising RN. The issue of RN delegation has become the subject of ongoing discussion for AL residents, facilities, and regulators and for the nursing profession. The purpose of this article is to review delegation in AL and to provide recommendations for future practice and research in this area.

  10. Department of the Defense Agency Financial Report for Fiscal Year 2009

    DTIC Science & Technology

    2009-11-16

    healthcare was provided for 9.3 million eligible beneficiaries in 59 inpatient medical facilities, more than 800 medical and dental clinics, as well as...The Department is working with the Reserves and National Guard to address challenges in force readiness, particularly in the area of dental ...mess facilities. There are over 80 airports, 59 inpatient facilities (hospitals), 378 medical clinics, and 285 dental clinics. These structures are in

  11. Estimates of Radioxenon Released from Southern Hemisphere Medical isotope Production Facilities Using Measured Air Concentrations and Atmospheric Transport Modeling

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

    Eslinger, Paul W.; Friese, Judah I.; Lowrey, Justin D.

    2014-09-01

    Abstract The International Monitoring System (IMS) of the Comprehensive-Nuclear-Test-Ban-Treaty monitors the atmosphere for radioactive xenon leaking from underground nuclear explosions. Emissions from medical isotope production represent a challenging background signal when determining whether measured radioxenon in the atmosphere is associated with a nuclear explosion prohibited by the treaty. The Australian Nuclear Science and Technology Organisation (ANSTO) operates a reactor and medical isotope production facility in Lucas Heights, Australia. This study uses two years of release data from the ANSTO medical isotope production facility and Xe-133 data from three IMS sampling locations to estimate the annual releases of Xe-133 from medicalmore » isotope production facilities in Argentina, South Africa, and Indonesia. Atmospheric dilution factors derived from a global atmospheric transport model were used in an optimization scheme to estimate annual release values by facility. The annual releases of about 6.8×1014 Bq from the ANSTO medical isotope production facility are in good agreement with the sampled concentrations at these three IMS sampling locations. Annual release estimates for the facility in South Africa vary from 1.2×1016 to 2.5×1016 Bq and estimates for the facility in Indonesia vary from 6.1×1013 to 3.6×1014 Bq. Although some releases from the facility in Argentina may reach these IMS sampling locations, the solution to the objective function is insensitive to the magnitude of those releases.« less

  12. 76 FR 51957 - Notice of Intent To Prepare an Environmental Impact Statement for the Medical Facilities...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-19

    ...: NSA Bethesda is a 243-acre health care, medical education and research installation located in... tertiary medical services to NNMC and its transformation to WRNMMCB, the facility will become the premier... training and post-graduate level education to the military medical community and serve as a critical...

  13. Use of information technology for medication management in residential care facilities: correlates of facility characteristics.

    PubMed

    Bhuyan, Soumitra S; Chandak, Aastha; Powell, M Paige; Kim, Jungyoon; Shiyanbola, Olayinka; Zhu, He; Shiyanbola, Oyewale

    2015-06-01

    The effectiveness of information technology in resolving medication problems has been well documented. Long-term care settings such as residential care facilities (RCFs) may see the benefits of using such technologies in addressing the problem of medication errors among their resident population, who are usually older and have numerous chronic conditions. The aim of this study was two-fold: to examine the extent of use of Electronic Medication Management (EMM) in RCFs and to analyze the organizational factors associated with the use of EMM functionalities in RCFs. Data on RCFs were obtained from the 2010 National Survey of Residential Care Facilities. The association between facility, director and staff, and resident characteristics of RCFs and adoption of four EMM functionalities was assessed through multivariate logistic regression. The four EMM functionalities included were maintaining lists of medications, ordering for prescriptions, maintaining active medication allergy lists, and warning of drug interactions or contraindications. About 12% of the RCFs adopted all four EMM functionalities. Additionally, maintaining lists of medications had the highest adoption rate (34.5%), followed by maintaining active medication allergy lists (31.6%), ordering for prescriptions (19.7%), and warning of drug interactions or contraindications (17.9%). Facility size and ownership status were significantly associated with adoption of all four EMM functionalities. Medicaid certification status, facility director's age, education and license status, and the use of personal care aides in the RCF were significantly associated with the adoption of some of the EMM functionalities. EMM is expected to improve the quality of care and patient safety in long-term care facilities including RCFs. The extent of adoption of the four EMM functionalities is relatively low in RCFs. Some RCFs may strategize to use these functionalities to cater to the increasing demands from the market and also to provide better quality of care.

  14. Health systems challenges in cervical cancer prevention program in Malawi.

    PubMed

    Maseko, Fresier C; Chirwa, Maureen L; Muula, Adamson S

    2015-01-01

    Cervical cancer remains the leading cause of cancer death among women in sub-Saharan Africa. In Malawi, very few women have undergone screening and the incidence of cervical cancer is on the increase as is the case in most developing countries. We aimed at exploring and documenting health system gaps responsible for the poor performance of the cervical cancer prevention program in Malawi. The study was carried out in 14 randomly selected districts of the 29 districts of Malawi. All cervical cancer service providers in these districts were invited to participate. Two semi-structured questionnaires were used, one for the district cervical cancer coordinators and the other for the service providers. The themes of both questionnaires were based on World Health Organization (WHO) health system frameworks. A checklist was also developed to audit medical supplies and equipment in the cervical cancer screening facilities. The two questionnaires together with the medical supplies and equipment checklist were piloted in Chikwawa district before being used as data collection tools in the study. Quantitative data were analyzed using STATA and qualitative in NVIVO. Forty-one service providers from 21 health facilities and 9 district coordinators participated in the study. Our findings show numerous health system challenges mainly in areas of health workforce and essential medical products and technologies. Seven out of the 21 health facilities provided both screening and treatment. RESULTS showed challenges in the management of the cervical cancer program at district level; inadequate service providers who are poorly supervised; lack of basic equipment and stock-outs of basic medical supplies in some health facilities; and inadequate funding of the program. In most of the health facilities, services providers were not aware of the policy which govern their work and that they did not have standards and guidelines for cervical cancer screening and treatment. Numerous health system challenges are prevailing in the cervical cancer prevention program in Malawi. These challenges need to be addressed if the health system is to improve on the coverage of cervical cancer screening and treatment.

  15. 32 CFR 728.74 - Applicants for appointment in the regular Navy or Marine Corps and reserve components, including...

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... NAVY PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Other... and Marine Corps facilities or MEPS may be furnished emergency medical and dental care, including...

  16. 32 CFR 728.74 - Applicants for appointment in the regular Navy or Marine Corps and reserve components, including...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... NAVY PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Other... and Marine Corps facilities or MEPS may be furnished emergency medical and dental care, including...

  17. 32 CFR 728.74 - Applicants for appointment in the regular Navy or Marine Corps and reserve components, including...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... NAVY PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Other... and Marine Corps facilities or MEPS may be furnished emergency medical and dental care, including...

  18. 32 CFR 728.74 - Applicants for appointment in the regular Navy or Marine Corps and reserve components, including...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... NAVY PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Other... and Marine Corps facilities or MEPS may be furnished emergency medical and dental care, including...

  19. Infection prevention and control standards in assisted living facilities: are residents' needs being met?

    PubMed

    Kossover, Rachel A; Chi, Carolyn J; Wise, Matthew E; Tran, Alvin H; Chande, Neha D; Perz, Joseph F

    2014-01-01

    Assisted living facilities (ALFs) provide housing and care to persons unable to live independently, and who often have increasing medical needs. Disease outbreaks illustrate challenges of maintaining adequate resident protections in these facilities. Describe current state laws on assisted living admissions criteria, medical oversight, medication administration, vaccination requirements, and standards for infection control training. We abstracted laws and regulations governing assisted living facilities for the 50 states using a structured abstraction tool. Selected characteristics were compared according to the time period in which the regulation took effect. Selected state health departments were queried regarding outbreaks identified in assisted living facilities. Of the 50 states, 84% specify health-based admissions criteria to assisted living facilities; 60% require licensed health care professionals to oversee medical care; 88% specifically allow subcontracting with outside entities to provide routine medical services onsite; 64% address medication administration by assisted living facility staff; 54% specify requirements for some form of initial infection control training for all staff; 50% require reporting of disease outbreaks to the health department; 18% specify requirements to offer or require vaccines to staff; 30% specify requirements to offer or require vaccines to residents. Twelve states identified approximately 1600 outbreaks from 2010 to 2013, with influenza or norovirus infections predominating. There is wide variation in how assisted living facilities are regulated in the United States. States may wish to consider regulatory changes that ensure safe health care delivery, and minimize risks of infections, outbreaks of disease, and other forms of harm among assisted living residents. Published by Elsevier Inc.

  20. Occupational Medical Trends in the 70's from Industrial View

    NASA Technical Reports Server (NTRS)

    Williamson, S. M.

    1970-01-01

    Industrial health measures to ensure worker productivity constitute physical examinations as well as environmental control systems. Considered are automatic record keeping facilities for case histories, preventive medical and mental counselling, development of safety standards, and health insurance and disability benefit plans. Cooperation of industry health programs with community health aspects is required to eliminate the loss of manpower capability through alcoholism or mental disease.

  1. RD and A Management Guide, 12th Edition (Revision)

    DTIC Science & Technology

    1993-02-01

    systems, types of aircraft; and astronautic publication and printing matters. vehicles. 6000 Series-Medicine and Dentistry . Medical 16000 Series-Coast...medicine, used by Navy or Marine Corps activities. dentistry , and medical equipment and supplies. 7000 Series-Financial Management. Financial C9.2...decisions development facilities. D-4 D4.2 Each center gathers information in its Crew Systems Ergonomics Information specialized area of interest

  2. Development by a Large Integrated Health Care System of an Objective Methodology for Evaluation of Medical Oncology Service Sites.

    PubMed

    Bjegovich-Weidman, Marija; Kahabka, Jill; Bock, Amy; Frick, Jacob; Kowalski, Helga; Mirro, Joseph

    2012-03-01

    Aurora Health Care (AHC) is the largest health care system in Wisconsin, with 14 acute care hospitals. In early 2010, a group of 18 medical oncologists became affiliated with AHC. This affiliation added 13 medical oncology infusion clinics to our existing 12 sites. In the era of health care reform and declining reimbursement, we need an objective method and criteria to evaluate our 25 outpatient medical oncology sites. We developed financial, clinical, and strategic tools for the evaluation and management of our cancer subservice lines and outpatient sites. The key to our success has been the direct involvement of stakeholders with a vested interest in the services in the selection of the criteria and evaluation process. We developed our objective metrics for evaluation based on strategic, financial, operational, and patient experience criteria. Strategic criteria included: population trends, full-time equivalent (FTE) medical oncologists/primary care physicians, FTE radiation oncologists, FTE oncologic surgeons, new annual cases of patients with cancer, and market share trends. Financial criteria per site included: physician work relative value units, staff FTE by type, staff salaries, and profit and loss. Operational criteria included: facility by type (clinic v hospital based), hours of operation, and facility detail (eg, No. of chairs, No. of procedure and examination rooms, square footage). Patient experience criteria included: nursing model primary/nurse navigators, multidisciplinary support at site, Press Ganey (South Bend, IN; health care performance improvement company) results, and employee engagement score. The outcome of our data analysis has resulted in the development of recommendations for AHC senior leadership and geographic market leadership to consider the consolidation of four sites (phase one, four sites; phase two, two sites) and priority strategic sites to address capacity issues that limit growth. The recommendations if implemented would result in significant cost savings, currently being quantified as a result of consolidation and improved efficiency. A reinvestment of these cost savings would be required to address facility expansion and program enhancement to maximize patient-centered expert care consistently across all of our remaining sites of service.

  3. [Medical safety management in the setting of a clinical reference laboratory--risk management efforts in clinical testing].

    PubMed

    Seki, Akira; Miya, Tetsumasa

    2011-03-01

    As a result of recurring medical accidents, risk management in the medical setting has been given much attention. The announcement in August, 2000 by the Ministry of Health committee for formulating a standard manual for risk management, of a "Risk management manual formulation guideline" has since been accompanied by the efforts of numerous medical testing facilities to develop such documents. In 2008, ISO/TS 22367:2008 on "Medical laboratories-Reduction of error through risk management and continual improvement" was published. However, at present, risk management within a medical testing facility stresses the implementation of provisional actions in response to a problem after it has occurred. Risk management is basically a planned process and includes "corrective actions" as well as "preventive actions." A corrective action is defined as identifying the root cause of the problem and removing it, and is conducted to prevent the problem from recurring. A preventive action is defined as identifying of the any potential problem and removing it, and is conducted to prevent a problem before it occurs. Presently, I shall report on the experiences of our laboratory regarding corrective and preventive actions taken in response to accidents and incidents, respectively.

  4. ARCADIA: a system for the integration of angiocardiographic data and images by an object-oriented DBMS.

    PubMed

    Pinciroli, F; Combi, C; Pozzi, G

    1995-02-01

    Use of data base techniques to store medical records has been going on for more than 40 years. Some aspects still remain unresolved, e.g., the management of textual data and image data within a single system. Object-orientation techniques applied to a database management system (DBMS) allow the definition of suitable data structures (e.g., to store digital images): some facilities allow the use of predefined structures when defining new ones. Currently available object-oriented DBMS, however, still need improvements both in the schema update and in the query facilities. This paper describes a prototype of a medical record that includes some multimedia features, managing both textual and image data. The prototype here described considers data from the medical records of patients subjected to percutaneous transluminal coronary artery angioplasty. We developed it on a Sun workstation with a Unix operating system and ONTOS as an object-oriented DBMS.

  5. MUNICIPAL WASTE COMBUSTION ASSESSMENT: MEDICAL WASTE COMBUSTION PRACTICES AT MUNICIPAL WASTE COMBUSTION FACILITIES

    EPA Science Inventory

    The report defines and characterizes types of medical waste, discusses the impacts of burning medical waste on combustor emissions, and outlines important handling and operating considerations. Facility-specific design, handling, and operating practiced are also discussed for mun...

  6. 77 FR 59087 - Fisher House and Other Temporary Lodging

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-26

    ... 60 prior to this revision, versus the phrase ``VA medical facility.'' The public therefore should be...'' and ``VA medical facility'' in the proposed rule indicates that the public did not understand these... care facility'' when describing substantive criteria to the public. Therefore, consistent use of the...

  7. 76 FR 80865 - Approval and Promulgation of State Plans for Designated Facilities and Pollutants; State of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-27

    ... Promulgation of State Plans for Designated Facilities and Pollutants; State of Florida; Control of Hospital/ Medical/Infectious Waste Incinerator (HMIWI) Emissions From Existing Facilities AGENCY: Environmental... Guidelines (EGs) applicable to existing Hospital/Medical/Infectious Waste Incinerators (HMIWIs). These EGs...

  8. Ambulatory Resource Analysis Project Synopsis of Major Project Tasks,

    DTIC Science & Technology

    1992-01-02

    January of 1992. These weights, developed by William Hsiao, PhD, at Harvard University School of Public Health, 1 t Medicare Program; Fee Schedule for...professional services fees and not facility costs. Without the facility cost data, the study focuses on the statistical properties of the group data and...and ambulatory surgery centers. There are three types of APG: (1) procedure, (2) ancillary service , and (3) medical. A key attribute of APGs is that

  9. Space medicine - Answering the challenge

    NASA Technical Reports Server (NTRS)

    Lloyd, Charles W.

    1991-01-01

    The development of Space Station Freedom (SSF) Health Maintenance Facility (HMF) is discussed. Attention is given to HMF subsystems; the diagnostic radiological imaging system; the physician instruments; the pharmacy and central supply; the Fluid Therapy Subsystem; the restraints to be used for medical procedures; and the Safe Haven mode, which is a mode of station operation in which it is assumed that the HMF has been lost and the medical needs must be provided by the emergency medical equipment and supplies located in the Portable Emergency Provisions. Special attention is given to the pharmaceutical issues involved, including such as the product selection, oral medications, injectable medications, the effect of exposing medications to high vacuum, and the product shelf life.

  10. NASA Johnson Space Center Biomedical Research Resources

    NASA Technical Reports Server (NTRS)

    Paloski, W. H.

    1999-01-01

    Johnson Space Center (JSC) medical sciences laboratories constitute a national resource for support of medical operations and life sciences research enabling a human presence in space. They play a critical role in evaluating, defining, and mitigation the untoward effect of human adaption to space flight. Over the years they have developed the unique facilities and expertise required to perform: biomedical sample analysis and physiological performance tests supporting medical evaluations of space flight crew members and scientific investigations of the operationally relevant medical, physiological, cellular, and biochemical issues associated with human space flight. A general overview of these laboratories is presented in viewgraph form.

  11. Competency-based medical education and continuing professional development: A conceptualization for change.

    PubMed

    Lockyer, Jocelyn; Bursey, Ford; Richardson, Denyse; Frank, Jason R; Snell, Linda; Campbell, Craig

    2017-06-01

    Competency-based medical education (CBME) is as important in continuing professional development (CPD) as at any other stage of a physician's career. Principles of CBME have the potential to revolutionize CPD. Transitioning to CBME-based CPD will require a cultural change to gain commitment from physicians, their employers and institutions, CPD providers, professional organizations, and medical regulators. It will require learning to be aligned with professional and workplace standards. Practitioners will need to develop the expertise to systematically examine their own clinical performance data, identify performance improvement opportunities and possibilities, and develop a plan to address areas of concern. Health care facilities and systems will need to produce data on a regular basis and to develop and train CPD educators who can work with physician groups. Stakeholders, such as medical regulatory authorities who are responsible for licensing physicians and other standard-setting bodies that credential and develop maintenance-of-certification systems, will need to change their paradigm of competency enhancement through CPD.

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

    PubMed

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

    2016-02-19

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

  13. Notes from a field hospital south of Mosul.

    PubMed

    Quinn V, John M; Amouri, Omar F; Reed, Pete

    2018-03-06

    This short letter from the field is offered as a rapid communiqué of the emergency medical situation in Mosul and surrounding areas on the eve of the final onslaught to liberate the city. This letter is based on emergency medical work at two World Health Organization (WHO) and Ministry of Health (MoH) Iraq lead Role II+ Field Hospital facilities south of Mosul City from April to June 2017; these facilities are currently and temporarily managed and administered by private medical industry until full handover to MoH Iraq, with WHO support and expert facilitation. The prominence of non-state actors in the conflict, using hybrid warfare tactics that maximize casualties, makes health security a particular challenge for the global community. This challenge requires health leaders and other actors in the region to set clear strategic goals that support public health of the many millions displaced, maimed and affected by the war. Whether in clinical medicine, development, peace and stability operations, or global health diplomacy, the shared values and conviction to best serve vulnerable communities and mitigate morbidity must embrace the lessons of evidenced based practice derived from military medical experience. WHO is leading the charge in disaster response for the conflict in Iraq, and many challenges remain. This might also include developing a new process in emergency medical response that utilizes private contracting to improve efficiency in delivery and overall sustainability.

  14. Distant Operational Care Centre: Design Project Report

    NASA Technical Reports Server (NTRS)

    1996-01-01

    The goal of this project is to outline the design of the Distant Operational Care Centre (DOCC), a modular medical facility to maintain human health and performance in space, that is adaptable to a range of remote human habitats. The purpose of this project is to outline a design, not to go into a complete technical specification of a medical facility for space. This project involves a process to produce a concise set of requirements, addressing the fundamental problems and issues regarding all aspects of a space medical facility for the future. The ideas presented here are at a high level, based on existing, researched, and hypothetical technologies. Given the long development times for space exploration, the outlined concepts from this project embodies a collection of identified problems, and corresponding proposed solutions and ideas, ready to contribute to future space exploration efforts. In order to provide a solid extrapolation and speculation in the context of the future of space medicine, the extent of this project's vision is roughly within the next two decades. The Distant Operational Care Centre (DOCC) is a modular medical facility for space. That is, its function is to maintain human health and performance in space environments, through prevention, diagnosis, and treatment. Furthermore, the DOCC must be adaptable to meet the environmental requirements of different remote human habitats, and support a high quality of human performance. To meet a diverse range of remote human habitats, the DOCC concentrates on a core medical capability that can then be adapted. Adaptation would make use of the DOCC's functional modularity, providing the ability to replace, add, and modify core functions of the DOCC by updating hardware, operations, and procedures. Some of the challenges to be addressed by this project include what constitutes the core medical capability in terms of hardware, operations, and procedures, and how DOCC can be adapted to different remote habitats.

  15. Health care delivery system for long duration manned space operations

    NASA Technical Reports Server (NTRS)

    Logan, J. S.; Shulman, E. L.; Johnson, P. C.

    1983-01-01

    Specific requirements for medical support of a long-duration manned facility in a low earth orbit derive from inflight medical experience, projected medical scenarios, mission related spacecraft and environmental hazards, health maintenance, and preventive medicine. A sequential buildup of medical capabilities tailored to increasing mission complexity is proposed. The space station health maintenance facility must provide preventive, diagnostic, and therapeutic medical support as immediate rescue capability may not exist.

  16. 50 Years of the Radiological Research Accelerator Facility (RARAF)

    PubMed Central

    Marino, Stephen A.

    2017-01-01

    The Radiological Research Accelerator Facility (RARAF) is in its 50th year of operation. It was commissioned on April 1, 1967 as a collaboration between the Radiological Research Laboratory (RRL) of Columbia University, and members of the Medical Research Center of Brookhaven National Laboratory (BNL). It was initially funded as a user facility for radiobiology and radiological physics, concentrating on monoenergetic neutrons. Facilities for irradiation with MeV light charged particles were developed in the mid-1970s. In 1980 the facility was relocated to the Nevis Laboratories of Columbia University. RARAF now has seven beam lines, each having a dedicated irradiation facility: monoenergetic neutrons, charged particle track segments, two charged particle microbeams (one electrostatically focused to <1 μm, one magnetically focused), a 4.5 keV soft X-ray microbeam, a neutron microbeam, and a facility that produces a neutron spectrum similar to that of the atomic bomb dropped at Hiroshima. Biology facilities are available on site within close proximity to the irradiation facilities, making the RARAF very user friendly. PMID:28140790

  17. Clinic-level introduction of medical abortion in Vietnam.

    PubMed

    Raghavan, Sheila; Ngoc, Nguyen thi Nhu; Shochet, Tara; Winikoff, Beverly

    2012-10-01

    To assess the efficacy of medical abortion and patient satisfaction in the clinic setting, in addition to determining healthcare providers' views. From 2006 to 2008, 2400 women were enrolled at 10 Vietnam Family Planning Association (VINAFPA) clinics in an operations research project. Participants took 200mg of oral mifepristone in the clinic and 400 μg of oral misoprostol 2 days later at home or in the clinic. Abortion status was assessed at follow-up. Furthermore, in 2006, 900 clinicians at 45 health facilities answered a knowledge, attitudes, and practices survey to capture providers' views. In total, 93.8% of participants had successful medical abortions. The majority (84.5%) administered misoprostol at home. Adverse effects included bleeding, pain/cramps, and nausea. Most women (92.6%) were satisfied/very satisfied with the method. Most providers who took the survey (85.6%) recommended that medical abortion be introduced at VINAFPA clinics. The operations research data demonstrate the safety, efficacy, and acceptability of medical abortion at VINAFPA clinics. The majority of surveyed providers endorsed adding medical abortion at their own facilities. Developing national guidelines for providing medical abortion at the clinic level is an important step in expanding access to services in Vietnam. Copyright © 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  18. Universities and medical schools: reflections on a half-century of Canadian medical education.

    PubMed Central

    Naimark, A

    1993-01-01

    After 50 years of accelerated development, universities and medical schools have entered a period of uncertainty and instability. The Flexnerian paradigm of medical education, rooted in biomedical science and conducted under the aegis of a university, reached its apotheosis by the late 1960s and the early 1970s. Fuelled by the introduction of comprehensive, government-sponsored health care insurance and advances in technology, the demand for health care professionals and for access to facilities increased sharply. Medical education, research and advanced clinical services expanded dramatically aided by the emergence of academic health sciences centres and accompanied by a wave of medical curriculum reform. Now medical schools must strike a dynamic balance in responding to the continued expansion of knowledge and technology, the demand for social equity and the exigencies of prolonged fiscal constraint. They must also balance the biological and sociological approaches to medicine in establishing the foundations for the future development of Canadian medical education. PMID:8477376

  19. Electronic Medical Record and Quality Ratings of Long Term Care Facilities Long-Term Care Facility Characteristics and Reasons and Barriers for Adoption of Electronic Medical Record

    ERIC Educational Resources Information Center

    Daniels, Cheryl Andrea

    2013-01-01

    With the growing elderly population, compounded by the retirement of the babyboomers, the need for long-term care (LTC) facilities is expected to grow. An area of great concern for those that are seeking a home for their family member is the quality of care provided by the nursing home to the residents. Electronic medical records (EMR) are often…

  20. For support of USAMRMC Biological Weapons Convention, treaty and statement implementation activities. Final report, 1 March 1996-28 February 1997

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

    Fox, J.

    Program of work to provide support to the Biological Arms Control Treaty Office (BACTO) of the U.S. Army Medical Research and Material Command (USAMRMC), in the development of Army and U.S. Government negotiation, implementation and compliance policies and preparations regarding potential verification and confidence measures for the 1975 Biological Weapons Convention (BWC) and related biological weapons agreements. Support services provided included the preparation of Army installations and commands for implementation of visits pursuant to the U.S./UK/Russian Trilateral Statement on BW. Support included site assistance visit, development of required facility documentation and briefings, identification of additional facilities potentially subject to access,more » and support to DOD development of guidelines, procedures, documentation, and other materials for the conduct of visits. Specific tasks under this contract included: identification and delineation of `Military Biological Facilities` and related activities at Army installations; development of visit implementation documentation for the Army; assessment of potentially at-risk equities and sensitivities at relevant facilities; facility staff training and preparation; and review and modification of facility inputs to annual BWC Confidence Building Measure Declarations. Also supported the provision of timely and critical technical support to the Joint Staff and OSD in the development of DoD negotiation biological arms control positions.« less

  1. An Outbreak of Acute Hepatitis in a Medical Facility of Bangladesh

    PubMed Central

    Mohammad Fazle Akbar, Sheikh; chandra Podder, Dulal; Kumar Saha, Paban; Jahan, Munira; Begum, Lovely; Afrose, Tanjina; chowdhury, Farzana; Rahman, Salimur

    2014-01-01

    ABSTRACT A total of 45 patients with acute hepatitis were detected in a medical facility of Bangladesh over a period of 6 months. All of them were physicians, nurses, students or employees of the hospital. About 50% of these patients suffered from acute hepatitis within a period of 2 months. All of them had clinical and biochemical evidences of acute hepatitis. All of them shared common working places as well as common dining and cooking facilities. Although the disease was supposed to be caused by hepatitis viruses, none of them were expressing IgM type antibody to hepatitis B core antigen (IgM anti-HBc) or hepatitis C virus (IgM anti-HCV). IgM type antibody to hepatitis A virus (IgM HAV) was detected in one patient and IgM type antibody to hepatitis E virus (anti-HEV IgM) were found in 14 patients. In conclusion, diagnosis of etiological agent of viral acute hepatitis constitutes a formidable challenge to the existing health care delivery system in developing countries as available serological and routine screening fails to find the proper etiological agent. How to cite this article: Mahtab MA, Akbar SMF, Podder DC, Saha PK, Jahan M, Begum L, Afrose T, Chowdhury F, Rahman S. An Outbreak of Acute Hepatitis in a Medical Facility of Bangladesh. Euroasian J Hepato-Gastroenterol 2014;4(1):66-67. PMID:29264325

  2. An Outbreak of Acute Hepatitis in a Medical Facility of Bangladesh.

    PubMed

    Al Mahtab, Mamun; Mohammad Fazle Akbar, Sheikh; Chandra Podder, Dulal; Kumar Saha, Paban; Jahan, Munira; Begum, Lovely; Afrose, Tanjina; Chowdhury, Farzana; Rahman, Salimur

    2014-01-01

    A total of 45 patients with acute hepatitis were detected in a medical facility of Bangladesh over a period of 6 months. All of them were physicians, nurses, students or employees of the hospital. About 50% of these patients suffered from acute hepatitis within a period of 2 months. All of them had clinical and biochemical evidences of acute hepatitis. All of them shared common working places as well as common dining and cooking facilities. Although the disease was supposed to be caused by hepatitis viruses, none of them were expressing IgM type antibody to hepatitis B core antigen (IgM anti-HBc) or hepatitis C virus (IgM anti-HCV). IgM type antibody to hepatitis A virus (IgM HAV) was detected in one patient and IgM type antibody to hepatitis E virus (anti-HEV IgM) were found in 14 patients. In conclusion, diagnosis of etiological agent of viral acute hepatitis constitutes a formidable challenge to the existing health care delivery system in developing countries as available serological and routine screening fails to find the proper etiological agent. How to cite this article: Mahtab MA, Akbar SMF, Podder DC, Saha PK, Jahan M, Begum L, Afrose T, Chowdhury F, Rahman S. An Outbreak of Acute Hepatitis in a Medical Facility of Bangladesh. Euroasian J Hepato-Gastroenterol 2014;4(1):66-67.

  3. [CERN-MEDICIS (Medical Isotopes Collected from ISOLDE): a new facility].

    PubMed

    Viertl, David; Buchegger, Franz; Prior, John O; Forni, Michel; Morel, Philippe; Ratib, Osman; Bühler Léo H; Stora, Thierry

    2015-06-17

    CERN-MEDICIS is a facility dedicated to research and development in life science and medical applications. The research platform was inaugurated in October 2014 and will produce an increasing range of innovative isotopes using the proton beam of ISOLDE for fundamental studies in cancer research, for new imaging and therapy protocols in cell and animal models and for preclinical trials, possibly extended to specific early phase clinical studies (phase 0) up to phase I trials. CERN, the University Hospital of Geneva (HUG), the University Hospital of Lausanne (CHUV), the Swiss Institute for Experimental Cancer (ISREC) at Swiss Federal Institutes of Technology (EPFL) that currently support the project will benefit of the initial production that will then be extended to other centers.

  4. 21 CFR 803.33 - If I am a user facility, what must I include when I submit an annual report?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES MEDICAL DEVICE REPORTING User Facility... medical device reports, or the number assigned by us for reporting purposes in accordance with § 803.3; (2...) Date of the annual report and report numbers identifying the range of medical device reports that you...

  5. 21 CFR 803.33 - If I am a user facility, what must I include when I submit an annual report?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES MEDICAL DEVICE REPORTING User Facility... medical device reports, or the number assigned by us for reporting purposes in accordance with § 803.3; (2...) Date of the annual report and report numbers identifying the range of medical device reports that you...

  6. Managing data quality in an existing medical data warehouse using business intelligence technologies.

    PubMed

    Eaton, Scott; Ostrander, Michael; Santangelo, Jennifer; Kamal, Jyoti

    2008-11-06

    The Ohio State University Medical Center (OSUMC) Information Warehouse (IW) is a comprehensive data warehousing facility that provides providing data integration, management, mining, training, and development services to a diversity of customers across the clinical, education, and research sectors of the OSUMC. Providing accurate and complete data is a must for these purposes. In order to monitor the data quality of targeted data sets, an online scorecard has been developed to allow visualization of the critical measures of data quality in the Information Warehouse.

  7. The impact of nonreferral outpatient co-payment on medical care utilization and expenditures in Taiwan.

    PubMed

    Chen, Li-Chia; Schafheutle, Ellen I; Noyce, Peter R

    2009-09-01

    Taiwan's National Health Insurance's (NHI) generous coverage and patients' freedom to access different tiers of medical facilities have resulted in accelerating outpatient care utilization and costs. To deter nonessential visits and encourage initial contact in primary care (physician clinics), a differential co-payment was introduced on 15th July 2005. Under this, patients pay more for outpatient consultations at "higher tiers" of medical facilities (local community hospitals, regional hospitals, medical centers), particularly if accessed without referral. This study explored the impact of this policy on outpatient medical activities and expenditures, different co-payment groups, and tiers of medical facilities. A segmented time-series analysis on regional weekly outpatient medical claims (January 2004 to July 2006) was conducted. Outcome variables (number of visits, number of outpatients, total cost of outpatient care) and variables for cost structure were stratified by tiers of medical facilities and co-payment groups. Analysis used the auto-regressive integrated moving-average model in STATA 9.0. The overall number of outpatient visits significantly decreased after policy implementation due to a reduction in the number of patients using outpatient facilities, but total costs of care remained unchanged. The policy had its greatest impact on the number of visits to regional and local community hospitals but had no influence on those to the medical centers. Medical utilization in physician clinics decreased due to an audit of reimbursement declarations. Overall, the policy failed to encourage referrals from primary care to higher tiers because there was no obvious shifting of medical utilization and costs reversely. Differential co-payment policy decreased total medication utilization but not costs to NHI. The results suggest that the increased level of co-payment charge and the strategy of a single cost-sharing policy are not sufficient to promote referrals within the system. To achieve an effective co-payment policy, further research is needed to explore how patients' out-of-pocket payment affects medical utilization and which forces (not susceptible to co-payment) act in tertiary facilities.

  8. New electron beam facility for R&D and production at acsion industries

    NASA Astrophysics Data System (ADS)

    Lopata, V. J.; Barnard, J. W.; Saunders, C. B.; Stepanik, T. M.

    2003-08-01

    Since its incorporation in 1998, Acsion Industries Inc. has been working with clients to develop industrial uses of electron processing for improving products and manufacturing processes. Acsion has promoted this technology for sterilizing medical devices and pharmaceuticals, for treating wood pulp in the viscose/rayon process, for reducing pathogens in food and animal feed, and for curing advanced composites for the aerospace industry. As a result of significant developments in its composite curing programs, Acsion has recently made major modifications to its facility to increase its production and R&D capabilities. These modifications are described in this paper.

  9. Special Analysis: 2016-001 Analysis of the Potential Under-Reporting of Am-241 Inventory for Nitrate Salt Waste at Area G

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

    Chu, Shaoping; Stauffer, Philip H.; Birdsell, Kay Hanson

    The Los Alamos National Laboratory (LANL) generates radioactive waste as a result of various activities. Operational waste is generated from a wide variety of research and development activities including nuclear weapons development, energy production, and medical research. Environmental restoration (ER), and decontamination and decommissioning (D&D) waste is generated as contaminated sites and facilities at LANL undergo cleanup or remediation. The majority of this waste is low-level radioactive waste (LLW) and is disposed of at the Technical Area 54 (TA-54), Area G disposal facility.

  10. Field evaluations of the VD max approach for substantiation of a 25 kGy sterilization dose and its application to other preselected doses

    NASA Astrophysics Data System (ADS)

    Kowalski, John B.; Herring, Craig; Baryschpolec, Lisa; Reger, John; Patel, Jay; Feeney, Mary; Tallentire, Alan

    2002-08-01

    The International and European standards for radiation sterilization require evidence of the effectiveness of a minimum sterilization dose of 25 kGy but do not provide detailed guidance on how this evidence can be generated. An approach, designated VD max, has recently been described and computer evaluated to provide safe and unambiguous substantiation of a 25 kGy sterilization dose. The approach has been further developed into a practical method, which has been subjected to field evaluations at three manufacturing facilities which produce different types of medical devices. The three facilities each used a different overall evaluation strategy: Facility A used VD max for quarterly dose audits; Facility B compared VD max and Method 1 in side-by-side parallel experiments; and Facility C, a new facility at start-up, used VD max for initial substantiation of 25 kGy and subsequent quarterly dose audits. A common element at all three facilities was the use of 10 product units for irradiation in the verification dose experiment. The field evaluations of the VD max method were successful at all three facilities; they included many different types of medical devices/product families with a wide range of average bioburden and sample item portion values used in the verification dose experiments. Overall, around 500 verification dose experiments were performed and no failures were observed. In the side-by-side parallel experiments, the outcomes of the VD max experiments were consistent with the outcomes observed with Method 1. The VD max approach has been extended to sterilization doses >25 and <25 kGy; verification doses have been derived for sterilization doses of 15, 20, 30, and 35 kGy. Widespread application of the VD max method for doses other than 25 kGy must await controlled field evaluations and the development of appropriate specifications/standards.

  11. Collaborating across services to advance evidence-based nursing practice.

    PubMed

    Kenny, Deborah J; Richard, Maggie L; Ceniceros, Xochitl; Blaize, Kelli

    2010-01-01

    Military medical treatment facilities offer a unique environment in which to develop a culture of evidence-based practice (EBP). Distinctive issues arise in the context of changed patient care demographics because of a war-injured population. These issues offer an opportunity to enhance the quality of care through the use and adaptation of research findings in this special nursing environment. In addition, the colocation of two military medical centers offers the prospect of collaborative efforts to create a regional culture for nursing EBP. The purposes of this study were to describe the processes of a collaborative project to train nurses in EBP and to share resources in developing and implementing evidence-based clinical nursing guidelines in two large military medical centers in the Northeastern United States and to discuss the collective efforts of nurse researchers, leadership, advanced practice nurses, and staff nurses in each hospital to facilitate the EBP process. A description of the organizational structure and the climate for EBP of each facility is provided followed by discussion of training efforts and the inculcation of an organizational culture for EBP. Contextual barriers and facilitators were encountered throughout the project. The two nurse researchers leading the projects were able to overcome the barriers and capitalize on opportunities to promote EBP. Three evidence-based clinical practice guidelines were developed at each facility and are currently in various stages of implementation. Despite the barriers, EBP continues to be at the forefront of military nursing practice in the U.S. National Capital Region. Clear communication and regular meetings were essential to the success of the collaborative project within and between the two military hospitals. Military-specific barriers to EBP included high team attrition and turnover because of the war mission and the usual high staff turnover at military hospitals. Military facilitators included a common mission of providing high-quality care for war-injured service members. Lessons learned from this project can be generalized to civilian facilities.

  12. Design and implementation of an affordable, public sector electronic medical record in rural Nepal.

    PubMed

    Raut, Anant; Yarbrough, Chase; Singh, Vivek; Gauchan, Bikash; Citrin, David; Verma, Varun; Hawley, Jessica; Schwarz, Dan; Harsha Bangura, Alex; Shrestha, Biplav; Schwarz, Ryan; Adhikari, Mukesh; Maru, Duncan

    2017-06-23

    Globally, electronic medical records are central to the infrastructure of modern healthcare systems. Yet the vast majority of electronic medical records have been designed for resource-rich environments and are not feasible in settings of poverty. Here we describe the design and implementation of an electronic medical record at a public sector district hospital in rural Nepal, and its subsequent expansion to an additional public sector facility.DevelopmentThe electronic medical record was designed to solve for the following elements of public sector healthcare delivery: 1) integration of the systems across inpatient, surgical, outpatient, emergency, laboratory, radiology, and pharmacy sites of care; 2) effective data extraction for impact evaluation and government regulation; 3) optimization for longitudinal care provision and patient tracking; and 4) effectiveness for quality improvement initiatives. For these purposes, we adapted Bahmni, a product built with open-source components for patient tracking, clinical protocols, pharmacy, laboratory, imaging, financial management, and supply logistics. In close partnership with government officials, we deployed the system in February of 2015, added on additional functionality, and iteratively improved the system over the following year. This experience enabled us then to deploy the system at an additional district-level hospital in a different part of the country in under four weeks. We discuss the implementation challenges and the strategies we pursued to build an electronic medical record for the public sector in rural Nepal.DiscussionOver the course of 18 months, we were able to develop, deploy and iterate upon the electronic medical record, and then deploy the refined product at an additional facility within only four weeks. Our experience suggests the feasibility of an integrated electronic medical record for public sector care delivery even in settings of rural poverty.

  13. Design and implementation of an affordable, public sector electronic medical record in rural Nepal

    PubMed Central

    Raut, Anant; Yarbrough, Chase; Singh, Vivek; Gauchan, Bikash; Citrin, David; Verma, Varun; Hawley, Jessica; Schwarz, Dan; Harsha, Alex; Shrestha, Biplav; Schwarz, Ryan; Adhikari, Mukesh; Maru, Duncan

    2018-01-01

    Introduction Globally, electronic medical records are central to the infrastructure of modern healthcare systems. Yet the vast majority of electronic medical records have been designed for resource-rich environments and are not feasible in settings of poverty. Here we describe the design and implementation of an electronic medical record at a public sector district hospital in rural Nepal, and its subsequent expansion to an additional public sector facility. Development The electronic medical record was designed to solve for the following elements of public sector healthcare delivery: 1) integration of the systems across inpatient, surgical, outpatient, emergency, laboratory, radiology, and pharmacy sites of care; 2) effective data extraction for impact evaluation and government regulation; 3) optimization for longitudinal care provision and patient tracking; and 4) effectiveness for quality improvement initiatives. Application For these purposes, we adapted Bahmni, a product built with open-source components for patient tracking, clinical protocols, pharmacy, laboratory, imaging, financial management, and supply logistics. In close partnership with government officials, we deployed the system in February of 2015, added on additional functionality, and iteratively improved the system over the following year. This experience enabled us then to deploy the system at an additional district-level hospital in a different part of the country in under four weeks. We discuss the implementation challenges and the strategies we pursued to build an electronic medical record for the public sector in rural Nepal. Discussion Over the course of 18 months, we were able to develop, deploy and iterate upon the electronic medical record, and then deploy the refined product at an additional facility within only four weeks. Our experience suggests the feasibility of an integrated electronic medical record for public sector care delivery even in settings of rural poverty. PMID:28749321

  14. Development and Assessment of a Medication Safety Measurement Program in a Long-Term Care Pharmacy.

    PubMed

    Hertig, John B; Hultgren, Kyle E; Parks, Scott; Rondinelli, Rick

    2016-02-01

    Medication errors continue to be a major issue in the health care system, including in long-term care facilities. While many hospitals and health systems have developed methods to identify, track, and prevent these errors, long-term care facilities historically have not invested in these error-prevention strategies. The objective of this study was two-fold: 1) to develop a set of medication-safety process measures for dispensing in a long-term care pharmacy, and 2) to analyze the data from those measures to determine the relative safety of the process. The study was conducted at In Touch Pharmaceuticals in Valparaiso, Indiana. To assess the safety of the medication-use system, each step was documented using a comprehensive flowchart (process flow map) tool. Once completed and validated, the flowchart was used to complete a "failure modes and effects analysis" (FMEA) identifying ways a process may fail. Operational gaps found during FMEA were used to identify points of measurement. The research identified a set of eight measures as potential areas of failure; data were then collected on each one of these. More than 133,000 medication doses (opportunities for errors) were included in the study during the research time frame (April 1, 2014, and ended on June 4, 2014). Overall, there was an approximate order-entry error rate of 15.26%, with intravenous errors at 0.37%. A total of 21 errors migrated through the entire medication-use system. These 21 errors in 133,000 opportunities resulted in a final check error rate of 0.015%. A comprehensive medication-safety measurement program was designed and assessed. This study demonstrated the ability to detect medication errors in a long-term pharmacy setting, thereby making process improvements measureable. Future, larger, multi-site studies should be completed to test this measurement program.

  15. [Current Situation Survey of the Measures to Prevent Medication Errors in the Operating Room: Report of the Japan Society of Anesthesiologists Safety Commission Working Group for Consideration of Recommendations for Color Coding of Prepared Syringe Labels for Prevention of Medication Errors].

    PubMed

    Shida, Kyoko; Suzuki, Toshiyasu; Sugahara, Kazuhiro; Sobue, Kazuya

    2016-05-01

    In the case of medication errors which are among the more frequent adverse events that occur in the hospital, there is a need for effective measures to prevent incidence. According to the Japan Society of Anesthesiologists study "Drug incident investigation 2005-2007 years", "Error of a syringe at the selection stage" was the most frequent (44.2%). The status of current measures and best practices implemented in Japanese hospitals was the focus of a subsequent investigation. Representative specialists in anesthesiology certified hospitals across the country were surveyed via a questionnaire sampling that lasted 46 days. Investigation method was via the Web with survey responses anonymous. With respect to preventive measures implemented to mitigate risk of medication errors in perioperative settings, responses included: incident and accident report (215 facilities, 70.3%), use of pre-filled syringes (180 facilities, 58.8%), devised the arrangement of dangerous drugs (154 facilities, 50.3%), use of the product with improper connection preventing mechanism (123 facilities, 40.2%), double-check (116 facilities, 37.9%), use of color barreled syringe (115 facilities, 37.6%), use of color label or color tape (89 facilities, 29.1%), presentation of medication such as placing the ampoule or syringe on a tray by dividing color code for drug class on a tray (54 facilities, 17.6%), the discontinuance of handwritten labels (23 facilities, 7.5%), use of a drug verification system that uses bar code (20 facilities, 6.5%), and facilities that have not implemented any means (11 facilities, 3.6%), others not mentioned (10 facilities, 3.3%), and use of carts that count/account the agents by drug type and record selection and number picked automatically (6 facilities, 2.0%). Drug name identification affixed to the syringe via perforated label torn from the ampoule/vial, etc. (245 facilities, 28.1%), handwriting directly to the syringe (208 facilities, 23.8%), use of the attached label (like that comes with the product) (187 facilities, 21.4%), handwriting on the plain tape (87 facilities, 10.0%), printing labels (62 facilities, 7.1%), printed color labels (44 facilities, 5.0%), handwriting on the color tape (27 facilities, 3.1%), machinery for printing the drug name by scanning bar code of the ampoule, etc.(10 facilities, 1.1%), others (3 facilities, 0.3%), no description on the prepared drug (0 facilities, 0%). The awareness of international standard color code, such as by the International Organization for Standardization (ISO), was only 18.6%. Targeting anesthesiology certified hospitals recognized by the Japan Society of Anesthesiologists, the result of the survey on the measures to prevent medication errors during perioperative procedures indicated that various measures were documented in use. However, many facilities still use hand written labels (a common cause for errors). Confirmation of the need for improved drug name and drug recognition on syringe was documented.

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

    PubMed Central

    Razzak, Junaid A.; Kellermann, Arthur L.

    2002-01-01

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

  17. Report on the International Conference on Emergency Health Care Development.

    PubMed Central

    Dines, G B

    1990-01-01

    Emergency medical services (EMS) provide rescue, field stabilization, transportation to medical facilities, and definitive care for persons experiencing medical emergencies. In order to advance worldwide development and refinement of EMS systems, and their integration with emergency preparedness and response programs, the International Conference on Emergency Health Care Development was held in Crystal City, Arlington, VA, August 15-19, 1989. The conference was supported by the Department of Health and Human Services and its Health Resources and Services Administration; the Department of Transportation and its National Highway Traffic and Safety Administration; and the Pan American Health Organization. Objectives of the conference were to clarify linkages between various levels of emergency response, to present methods for developing or improving EMS systems within societies with different resources, to demonstrate processes by which EMS systems have been developed, and to propose international emergency health care development goals. Topics included development of services in developing nations, case studies of underdeveloped countries' responses to natural disasters, and a method for updating disaster response through use of available medical resources. PMID:1968669

  18. A Clinical Decision Support Engine Based on a National Medication Repository for the Detection of Potential Duplicate Medications: Design and Evaluation

    PubMed Central

    Yang, Cheng-Yi; Lo, Yu-Sheng; Chen, Ray-Jade

    2018-01-01

    Background A computerized physician order entry (CPOE) system combined with a clinical decision support system can reduce duplication of medications and thus adverse drug reactions. However, without infrastructure that supports patients’ integrated medication history across health care facilities nationwide, duplication of medication can still occur. In Taiwan, the National Health Insurance Administration has implemented a national medication repository and Web-based query system known as the PharmaCloud, which allows physicians to access their patients’ medication records prescribed by different health care facilities across Taiwan. Objective This study aimed to develop a scalable, flexible, and thematic design-based clinical decision support (CDS) engine, which integrates a national medication repository to support CPOE systems in the detection of potential duplication of medication across health care facilities, as well as to analyze its impact on clinical encounters. Methods A CDS engine was developed that can download patients’ up-to-date medication history from the PharmaCloud and support a CPOE system in the detection of potential duplicate medications. When prescribing a medication order using the CPOE system, a physician receives an alert if there is a potential duplicate medication. To investigate the impact of the CDS engine on clinical encounters in outpatient services, a clinical encounter log was created to collect information about time, prescribed drugs, and physicians’ responses to handling the alerts for each encounter. Results The CDS engine was installed in a teaching affiliate hospital, and the clinical encounter log collected information for 3 months, during which a total of 178,300 prescriptions were prescribed in the outpatient departments. In all, 43,844/178,300 (24.59%) patients signed the PharmaCloud consent form allowing their physicians to access their medication history in the PharmaCloud. The rate of duplicate medication was 5.83% (1843/31,614) of prescriptions. When prescribing using the CDS engine, the median encounter time was 4.3 (IQR 2.3-7.3) min, longer than that without using the CDS engine (median 3.6, IQR 2.0-6.3 min). From the physicians’ responses, we found that 42.06% (1908/4536) of the potential duplicate medications were recognized by the physicians and the medication orders were canceled. Conclusions The CDS engine could easily extend functions for detection of adverse drug reactions when more and more electronic health record systems are adopted. Moreover, the CDS engine can retrieve more updated and completed medication histories in the PharmaCloud, so it can have better performance for detection of duplicate medications. Although our CDS engine approach could enhance medication safety, it would make for a longer encounter time. This problem can be mitigated by careful evaluation of adopted solutions for implementation of the CDS engine. The successful key component of a CDS engine is the completeness of the patient’s medication history, thus further research to assess the factors in increasing the PharmaCloud consent rate is required. PMID:29351893

  19. Using a decade of data on medical student computer literacy for strategic planning

    PubMed Central

    Seago, Brenda L.; Schlesinger, Jeanne B.; Hampton, Carol L.

    2002-01-01

    Purpose: From 1991 through 2000, incoming medical students (M-Is) at the School of Medicine at Virginia Commonwealth University have been surveyed with a written questionnaire on their computer literacy. The survey's purpose is to learn the students' levels of knowledge, skill, and experience with computer technology to guide instructional services and facilities. Methodology: The questionnaire was administered during M-I orientation or mailed to students' homes after matriculation. It evolved from sixteen questions in 1991 to twenty-three questions in 2000, with fifteen questions common to all. Results: The average survey response rate was 81% from an average of 177 students. Six major changes were introduced based on information collected from the surveys and advances in technology: production of CD-ROMs distributed to students containing required computer-based instructional programs, delivery of evaluation instruments to students via the Internet, modification of the lab to a mostly PC-based environment, development of an electronic curriculum Website, development of computerized examinations for medical students to prepare them for the computerized national board examinations, and initiation of a personal digital assistant (PDA) project for students to evaluate PDAs' usefulness in clinical settings. Conclusion: The computer literacy survey provides a snapshot of students' past and present use of technology and guidance for the development of services and facilities. PMID:11999178

  20. Using a decade of data on medical student computer literacy for strategic planning.

    PubMed

    Seago, Brenda L; Schlesinger, Jeanne B; Hampton, Carol L

    2002-04-01

    From 1991 through 2000, incoming medical students (M-Is) at the School of Medicine at Virginia Commonwealth University have been surveyed with a written questionnaire on their computer literacy. The survey's purpose is to learn the students' levels of knowledge, skill, and experience with computer technology to guide instructional services and facilities. The questionnaire was administered during M-I orientation or mailed to students' homes after matriculation. It evolved from sixteen questions in 1991 to twenty-three questions in 2000, with fifteen questions common to all. The average survey response rate was 81% from an average of 177 students. Six major changes were introduced based on information collected from the surveys and advances in technology: production of CD-ROMs distributed to students containing required computer-based instructional programs, delivery of evaluation instruments to students via the Internet, modification of the lab to a mostly PC-based environment, development of an electronic curriculum Website, development of computerized examinations for medical students to prepare them for the computerized national board examinations, and initiation of a personal digital assistant (PDA) project for students to evaluate PDAs' usefulness in clinical settings. The computer literacy survey provides a snapshot of students' past and present use of technology and guidance for the development of services and facilities.

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

    PubMed Central

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

    2016-01-01

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

  2. The Chinese community patient’s life satisfaction, assessment of community medical service, and trust in community health delivery system

    PubMed Central

    2013-01-01

    Background Although the Chinese government put a lot of effort into promoting the community patient’s life satisfaction, there still lacked the holistic and systematic approaches to promote the community patient’s life satisfaction in various regions of China. On the basis of the literature, it was found that both the community patient’s assessment of community medical service and trust in community health delivery system were important considerations when the community patient comprehensively evaluated community medical service to generate life satisfaction. So this study was set up to test whether and to what extent the community patient’s assessments of various major aspects of community medical service/various major aspects of the community patient’s trust in community health delivery system influenced life satisfaction in whole China/in various regions of China. Methods In order to explore the situation of China’s community health delivery system before 2009 and provide a reference for China’s community health delivery system reform, the data that could comprehensively and accurately reflect the community patient’s life satisfaction, assessment of community medical service, and trust in community health delivery system in various regions of China was needed, so this study collaborated with the National Bureau of Statistics of China to carry out a large-scale 2008 national community resident household survey (N = 3,306) for the first time in China. And the specified ordered probit models were established to analyze the dataset from this household survey. Results Among major aspects of community medical service, the medical cost (particularly in developed regions), the doctor-patient communication (particularly in developed regions), the medical facility and hospital environment (particularly in developed regions), and the medical treatment process (particularly in underdeveloped regions) were all key considerations (p<0.05 for t statistics) in generating the community patient’s life satisfaction. Among major aspects of the community patient’s trust in community health delivery system, trust in doctor (particularly in underdeveloped regions), trust in prescription (particularly in underdeveloped regions), and trust in recommended medical examination (particularly in underdeveloped regions) were all important considerations (p<0.10 for t statistics) in generating the community patient’s life satisfaction. Conclusion The reduction of medical cost (particularly in developed regions), the improvement of doctor-patient communication (particularly in developed regions), the promotion of medical facility and hospital environment (particularly in developed regions), the improvement of medical treatment process (particularly in underdeveloped regions), the promotion of trust in doctor (particularly in underdeveloped regions), the promotion of trust in prescription (particularly in underdeveloped regions), and the promotion of trust in recommended medical examination (particularly in underdeveloped regions) could help promote the community patient’s life satisfaction. PMID:23406216

  3. Design and Evaluation of a Medication Adherence Application with Communication for Seniors in Independent Living Communities.

    PubMed

    Dasgupta, Dipanwita; Johnson, Reid A; Chaudhry, Beenish; Reeves, Kimberly G; Willaert, Patty; Chawla, Nitesh V

    2016-01-01

    Medication non-adherence is a pressing concern among seniors, leading to a lower quality of life and higher healthcare costs. While mobile applications provide a viable medium for medication management, their utility can be limited without tackling the specific needs of seniors and facilitating the active involvement of care providers. To address these limitations, we are developing a tablet-based application designed specifically for seniors to track their medications and a web portal for their care providers to track medication adherence. In collaboration with a local Aging in Place program, we conducted a three-month study with sixteen participants from an independent living facility. Our study found that the application helped participants to effectively track their medications and improved their sense of wellbeing. Our findings highlight the importance of catering to the needs of seniors and of involving care providers in this process, with specific recommendations for the development of future medication management applications.

  4. "Byoin" in Modern Japan: Focusing on the Terminological Introduction of "Hospital" and the Complex Formation of Its Concept.

    PubMed

    Kim, Youngsoo

    2017-04-01

    This paper aims to clarify when the term of Byoin (hospital) was introduced and how its concept was developed in modern Japan. The word "Byoin" was introduced in Japan in 1787 for the first time, but it had not been in use until early 1860s. Instead, various medical institutions performing the functions of modern medical facilities, such as Yojosho (A place for preserving health), Shijuku (private school), called by traditional names as ever. Japanese intellectuals already adopted the word Byoin and the concept of western hospital in early 1860s when their national delegates were dispatched to Europe to revise the treaties forged with western powers. Japanese translations of hospital appeared in English-Japanese/Japanese-English dictionaries published in the 1860s. For instance, the word Byoin (hospital in Japanese) was first published in a dictionary published in 1867 and unclearly connected to the words, hospital, infirmary. This paper will argue that the concept of Byoin was sophisticated through Meiji government's efforts to implement reforms distinguishing medical facilities based on their capacity of inpatients and quality. The first medical law (Isei) proclaimed by the Meiji government in 1874 articulated regulations for a hospital in eight different articles. The government established hospitals in various parts of the country, following its newly established modern medical care policies. However, in this process, Iin (hospital/clinic), another term for "hospital" appeared. Regional differences and financial issues made standardizing the concept of a hospital even more difficult. In response to the widely embedded confusion, the Japanese government made an effort to clarify the concept of a hospital, setting up provisions regarding the size of medical facilities. As a result, the word Byoin finally came to be used for a hospital with more than ten beds, while a clinic with beds below ten was called Shinryojo (clinic). On the other hand, Iin meant a medical facility less qualified than a hospital since 1933 when Japanese government made a harder restriction on the usage of Byoin.

  5. Improving medication information transfer between hospitals, skilled-nursing facilities, and long-term-care pharmacies for hospital discharge transitions of care: A targeted needs assessment using the Intervention Mapping framework.

    PubMed

    Kerstenetzky, Luiza; Birschbach, Matthew J; Beach, Katherine F; Hager, David R; Kennelty, Korey A

    2018-02-01

    Patients transitioning from the hospital to a skilled nursing home (SNF) are susceptible to medication-related errors resulting from fragmented communication between facilities. Through continuous process improvement efforts at the hospital, a targeted needs assessment was performed to understand the extent of medication-related issues when patients transition from the hospital into a SNF, and the gaps between the hospital's discharge process, and the needs of the SNF and long-term care (LTC) pharmacy. We report on the development of a logic model that will be used to explore methods for minimizing patient care medication delays and errors while further improving handoff communication to SNF and LTC pharmacy staff. Applying the Intervention Mapping (IM) framework, a targeted needs assessment was performed using quantitative and qualitative methods. Using the hospital discharge medication list as reference, medication discrepancies in the SNF and LTC pharmacy lists were identified. SNF and LTC pharmacy staffs were also interviewed regarding the continuity of medication information post-discharge from the hospital. At least one medication discrepancy was discovered in 77.6% (n = 45/58) of SNF and 76.0% (n = 19/25) of LTC pharmacy medication lists. A total of 191 medication discrepancies were identified across all SNF and LTC pharmacy records. Of the 69 SNF staff interviewed, 20.3% (n = 14) reported patient care delays due to omitted documents during the hospital-to-SNF transition. During interviews, communication between the SNF/LTC pharmacy and the discharging hospital was described by facility staff as unidirectional with little opportunity for feedback on patient care concerns. The targeted needs assessment guided by the IM framework has lent to several planned process improvements initiatives to help reduce medication discrepancies during the hospital-to-SNF transition as well as improve communication between healthcare entities. Opening lines of communication along with aligning healthcare entity goals may help prevent medication-related errors. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Implementing technology to improve medication safety in healthcare facilities: a literature review.

    PubMed

    Hidle, Unn

    Medication errors remain one of the most common causes of patient injuries in the United States, with detrimental outcomes including adverse reactions and even death. By developing a better understanding of why and how medication errors occur, preventative measures may be implemented including technological advances. In this literature review, potential methods of reducing medication errors were explored. Furthermore, technology tools available for medication orders and administration are described, including advantages and disadvantages of each system. It was found that technology can be an excellent aid in improving safety of medication administration. However, computer technology cannot replace human intellect and intuition. Nurses should be involved when implementing any new computerized system in order to obtain the most appropriate and user-friendly structure.

  7. Quality Improvement in Skilled Nursing Facilities for Residents With Alzheimer's Disease.

    PubMed

    Farlow, Martin R; Borson, Soo; Connor, Stephen R; Grossberg, George T; Mittelman, Mary S

    2016-03-01

    This report describes a quality improvement continuing medical education activity designed to enhance the recognition and treatment of residents with Alzheimer's disease (AD) or other dementias in skilled-nursing facilities (SNFs). Charts were compared in 6 areas prior to and following (stages A and C) a live, faculty-led workshop (stage B). Four SNFs completed stages A (n = 67 residents) and B, and 3 SNFs completed stage C (n = 52 residents). All charts came from residents with AD or a diagnosis of dementia or dementia-like symptoms. The SNFs had >95% baseline performance in both the frequency of cognitive assessments and documented medication reviews. The percentage of residents who received a quality-of-life assessment and those who had a mental health care plan in place represent areas for improvement. As part of this activity, a toolkit was developed to help guide facilities and clinicians in instituting care improvements for residents with AD/dementia. © The Author(s) 2015.

  8. The marketing mix and development of medical tourism in shiraz.

    PubMed

    Jabbari, Alireza; Rahimi Zarchi, Mohammad Kazem; Kavosi, Zahra; Shafaghat, Tahere; Keshtkaran, Ali

    2013-01-01

    In recent years, medical tourism market has been raised as one of the income-earning and competitive industries in the world and is considered as a modern field of advanced tourism. Therefore, a great number of countries are seeking to develop this type of tourism and one of the strategies for developing this industry is using the marketing mix elements. This study was a descriptive-analytic and cross sectional one. The research community included all the public and private hospitals of Shiraz among which, 7 public and 9 private hospitals were studied. The study data were collected through a researcher-made check list whose face and content validity was confirmed by the experts. Then, the data were entered into the SPSS statistical software. According to the objectives of the study, the descriptive results were presented in frequency tables and Chi-square test was used for data analysis. In addition, P<0.05 was considered as statistically significant. According to the results, both public and private hospitals of Shiraz were in the best condition regarding staff and physician mix and in the worst condition concerning promoting and facilities mixes. No significant difference was found between public and private hospitals regarding the mixes. From marketing mix elements view, paying more attention to media advertisements and providing more facilities can improve the status of the hospitals which, consequently, results in attracting more medical tourists and developing this industry in Shiraz.

  9. Understanding the impact of supervision on reducing medication risks: an interview study in long-term elderly care.

    PubMed

    Vermeulen, J A; Kleefstra, S M; Zijp, E M; Kool, R B

    2017-07-06

    In 2009, the Dutch Health Care Inspectorate (IGZ) observed several serious risks to safety involving medication within elderly care facilities. However, by 2011, high risks had been reduced in almost all the organisations we visited. And yet the IGZ analysed too the alarming increase in the number of incidents arising in the self-reported national indicator of medication safety between 2009 and 2010. The aim of this study was to understand the factors that can explain this contradiction between the increase in self-reported medication incidents and the observation of the IGZ in reducing the risks to medication safety through supervision. We interviewed health care professionals of ten care facilities, visited by the IGZ, who were involved in, or responsible for, the improvement of medication safety in their institutions. As outcome measures we used the rate of medication safety risk per facility; the perceptions of the participant with regard to the reports of medication incidents; the level of medication safety of the facility; the measures used to improve medication safety; and the supervision of medication safety. This was a mixed methods study, qualitative in that we used semi-structured interviews, and quantitative, by calculating risks for the different organisations we visited. The findings from both study methods resulted in a comprehensive view and an in-depth understanding of this contradiction. The contradiction between the increase in self-reported medication incidents and the observation of reduced risks was explained by three themes: activities designed to improve medication safety, the reporting of medication incidents, and, lastly, the impact of supervision. The focus of the IGZ on issues of medication safety stimulated most elderly care facilities to reduce medication risks. Also, a change in the culture of reporting incidents caused an increase in the number of reported incidents. Supervision contributed to an improvement in actions geared towards reducing the risks associated with the safety of medication. It also increased a willingness to report such incidents. The more incidents reported are therefore not necessarily a sign of an increase in the risks, but can also be considered as a sign of a safer culture.

  10. Access to Medication Abortion Among California's Public University Students.

    PubMed

    Upadhyay, Ushma D; Cartwright, Alice F; Johns, Nicole E

    2018-06-09

    A proposed California law will require student health centers at public universities to provide medication abortion. To understand its potential impact, we sought to describe current travel time, costs, and wait times to access care at the nearest abortion facilities. We projected total medication abortion use based on campus enrollment figures and age- and state-adjusted abortion rates. We calculated distance and public transit time from campuses to the nearest abortion facility. We contacted existing abortion-providing facilities to determine costs, insurance acceptance, and wait times. We estimate 322 to 519 California public university students seek medication abortions each month. As many as 62% of students at these universities were more than 30 minutes from the closest abortion facility via public transportation. Average cost of medication abortion was $604, and average wait time to the first available appointment was one week. College students face cost, scheduling, and travel barriers to abortion care. Offering medication abortion on campus could reduce these barriers. Copyright © 2018 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  11. Psychotropic medication patterns among youth in juvenile justice.

    PubMed

    Lyons, Camilla L; Wasserman, Gail A; Olfson, Mark; McReynolds, Larkin S; Musabegovic, Hana; Keating, Joseph M

    2013-03-01

    This paper aims to determine the prevalence, patterns, and demographic and diagnostic correlates of psychotropic medication use in a sample of youth in one state's post-adjudicatory secure facilities. The health records database of the facilities was the source of linked demographic, diagnostic and pharmacy information for the 1-year period ending June 30, 2008. Age, gender, race, offense, prior petitions and diagnoses were examined across groups, and concomitant psychotropic pharmacotherapy patterns were identified. Period prevalence was 10.2% for youth ranging in age from 12 through 22 years who had any psychotropic drug prescribed during the first 30 days after intake to the facility. Among medicated youths, almost half received concomitant therapy. Medicated youth were significantly less likely to be Hispanic and more likely to endorse one or more diagnoses. Antidepressants, antipsychotics and antihistamines were the most commonly dispensed agents. Our findings revealed that the rate of psychotropic medication use was low, concomitant medication use was common, and ethnic/race differences in psychopharmacologic treatment were present in this sample of youths in post-adjudicatory secure facilities.

  12. Biomedical waste management: incineration vs. environmental safety.

    PubMed

    Gautam, V; Thapar, R; Sharma, M

    2010-01-01

    Public concerns about incinerator emissions, as well as the creation of federal regulations for medical waste incinerators, are causing many health care facilities to rethink their choices in medical waste treatment. As stated by Health Care Without Harm, non-incineration treatment technologies are a growing and developing field. Most medical waste is incinerated, a practice that is short-lived because of environmental considerations. The burning of solid and regulated medical waste generated by health care creates many problems. Medical waste incinerators emit toxic air pollutants and toxic ash residues that are the major source of dioxins in the environment. International Agency for Research on Cancer, an arm of WHO, acknowledged dioxins cancer causing potential and classified it as human carcinogen. Development of waste management policies, careful waste segregation and training programs, as well as attention to materials purchased, are essential in minimizing the environmental and health impacts of any technology.

  13. Developing an active emergency medical service system based on WiMAX technology.

    PubMed

    Li, Shing-Han; Cheng, Kai-An; Lu, Wen-Hui; Lin, Te-Chang

    2012-10-01

    The population structure has changed with the aging of population. In the present, elders account for 10.63% of the domestic population and the percentage is still gradually climbing. In other words, the demand for emergency services among elders in home environment is expected to grow in the future. In order to improve the efficiency and quality of emergency care, information technology should be effectively utilized to integrate medical systems and facilities, strengthen human-centered operation designs, and maximize the overall performance. The improvement in the quality and survival rate of emergency care is an important basis for better life and health of all people. Through integrated application of medical information systems and information communication technology, this study proposes a WiMAX-based emergency care system addressing the public demands for convenience, speed, safety, and human-centered operation of emergency care. This system consists of a healthcare service center, emergency medical service hospitals, and emergency ambulances. Using the wireless transmission capability of WiMAX, patients' physiological data can be transmitted from medical measurement facilities to the emergency room and emergency room doctors can provide immediate online instructions on emergency treatment via video and audio transmission. WiMAX technology enables the establishment of active emergency medical services.

  14. Rapid assessment of infrastructure of primary health care facilities - a relevant instrument for health care systems management.

    PubMed

    Scholz, Stefan; Ngoli, Baltazar; Flessa, Steffen

    2015-05-01

    Health care infrastructure constitutes a major component of the structural quality of a health system. Infrastructural deficiencies of health services are reported in literature and research. A number of instruments exist for the assessment of infrastructure. However, no easy-to-use instruments to assess health facility infrastructure in developing countries are available. Present tools are not applicable for a rapid assessment by health facility staff. Therefore, health information systems lack data on facility infrastructure. A rapid assessment tool for the infrastructure of primary health care facilities was developed by the authors and pilot-tested in Tanzania. The tool measures the quality of all infrastructural components comprehensively and with high standardization. Ratings use a 2-1-0 scheme which is frequently used in Tanzanian health care services. Infrastructural indicators and indices are obtained from the assessment and serve for reporting and tracing of interventions. The tool was pilot-tested in Tanga Region (Tanzania). The pilot test covered seven primary care facilities in the range between dispensary and district hospital. The assessment encompassed the facilities as entities as well as 42 facility buildings and 80 pieces of technical medical equipment. A full assessment of facility infrastructure was undertaken by health care professionals while the rapid assessment was performed by facility staff. Serious infrastructural deficiencies were revealed. The rapid assessment tool proved a reliable instrument of routine data collection by health facility staff. The authors recommend integrating the rapid assessment tool in the health information systems of developing countries. Health authorities in a decentralized health system are thus enabled to detect infrastructural deficiencies and trace the effects of interventions. The tool can lay the data foundation for district facility infrastructure management.

  15. Evolution of robotics in surgery and implementing a perioperative robotics nurse specialist role.

    PubMed

    Francis, Paula

    2006-03-01

    Use of robotics is expanding rapidly in the medical arena. Not only are a growing number of facilities purchasing robotic systems, but the number of surgeons using them also is increasing, which creates many challenges (eg, cost, training, safety). The evolution of robotics in surgery is presented within the context of virtual reality, telepresence, telemanipulation, and passive (ie, master-slave) robotic surgical systems. A new perioperative nursing role, the robotics nurse specialist, was developed and implemented at one facility. The need for a robotics nurse specialist and how this role can help the entire surgical team promote positive patient and facility outcomes also is discussed.

  16. [Internal audit--the foundation of healthcare quality management in health care].

    PubMed

    Smiianov, V A

    2014-01-01

    The paper proved the need for internal audit as the basis for quality control of medical care in a health facility, developed the project milestones and explains what needs to be taken into account at every stage during its implementation.

  17. Vocabulary for Healthcare Personnel.

    ERIC Educational Resources Information Center

    Falagrady, Teresa

    Developed by educators from the Emily Griffith Opportunity School, this teacher's guide presents a course in health care vocabulary for secretaries, medical records personnel, laboratory assistants, shipping personnel, and patient relations personnel in health care facilities. The course, which should require 10-14 hours of instruction, contains…

  18. 42 CFR 124.510 - Record maintenance requirements.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 1 2012-10-01 2012-10-01 false Record maintenance requirements. 124.510 Section 124.510 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH RESOURCES DEVELOPMENT MEDICAL FACILITY CONSTRUCTION AND MODERNIZATION Reasonable Volume of Uncompensated Services to...

  19. 42 CFR 124.509 - Reporting requirements.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 1 2010-10-01 2010-10-01 false Reporting requirements. 124.509 Section 124.509 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH RESOURCES DEVELOPMENT MEDICAL FACILITY CONSTRUCTION AND MODERNIZATION Reasonable Volume of Uncompensated Services to Persons...

  20. 42 CFR 124.510 - Record maintenance requirements.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 1 2013-10-01 2013-10-01 false Record maintenance requirements. 124.510 Section 124.510 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH RESOURCES DEVELOPMENT MEDICAL FACILITY CONSTRUCTION AND MODERNIZATION Reasonable Volume of Uncompensated Services to...

  1. 42 CFR 124.510 - Record maintenance requirements.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 1 2014-10-01 2014-10-01 false Record maintenance requirements. 124.510 Section 124.510 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH RESOURCES DEVELOPMENT MEDICAL FACILITY CONSTRUCTION AND MODERNIZATION Reasonable Volume of Uncompensated Services to...

  2. 7 CFR 1703.123 - Nonapproved purposes for grants.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ..., DEPARTMENT OF AGRICULTURE RURAL DEVELOPMENT Distance Learning and Telemedicine Grant Program § 1703.123...) To pay for medical equipment not having telemedicine as its essential function; (3) To pay salaries... the applicant. (6) To duplicate facilities providing distance learning or telemedicine services in...

  3. 7 CFR 1703.123 - Nonapproved purposes for grants.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ..., DEPARTMENT OF AGRICULTURE RURAL DEVELOPMENT Distance Learning and Telemedicine Grant Program § 1703.123...) To pay for medical equipment not having telemedicine as its essential function; (3) To pay salaries... the applicant. (6) To duplicate facilities providing distance learning or telemedicine services in...

  4. 7 CFR 1703.123 - Nonapproved purposes for grants.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ..., DEPARTMENT OF AGRICULTURE RURAL DEVELOPMENT Distance Learning and Telemedicine Grant Program § 1703.123...) To pay for medical equipment not having telemedicine as its essential function; (3) To pay salaries... the applicant. (6) To duplicate facilities providing distance learning or telemedicine services in...

  5. 7 CFR 1703.123 - Nonapproved purposes for grants.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ..., DEPARTMENT OF AGRICULTURE RURAL DEVELOPMENT Distance Learning and Telemedicine Grant Program § 1703.123...) To pay for medical equipment not having telemedicine as its essential function; (3) To pay salaries... the applicant. (6) To duplicate facilities providing distance learning or telemedicine services in...

  6. Medical Director Responsibilities to the ESRD Network.

    PubMed

    DeOreo, Peter B; Wish, Jay B

    2015-10-07

    The 18 regional ESRD Networks are established in legislation and contract with the Centers for Medicare and Medicaid Services to improve the quality and safety of dialysis, maximize patient rehabilitation, encourage collaboration among and between providers toward common quality goals, and improve the reliability and the use of data in pursuit of quality improvement. The Networks are funded by a $0.50 per treatment fee deducted from the reimbursement to dialysis providers, and their deliverables are determined by a statement of work, which is updated in a new contract every 3 years. The Conditions for Coverage require dialysis providers to participate in Network activities, and failure to do so can be the basis for sanctions against the provider. However, the Networks attempt to foster a collegial relationship with dialysis facilities by offering tools, educational activities, and other resources to assist the facilities in meeting the evolving requirements by the Centers for Medicare and Medicaid Services on the basis of national aims and domains for quality improvement in health care that transcend the ESRD program. Because of his/her responsibility for implementing the quality assessment and performance improvement activities in the facility, the medical director has much to gain by actively participating in Network activities, especially those focused on quality, safety, patient grievance, patient engagement, and coordination of care. Membership on Network committees can also foster the professional growth of the medical director through participation in quality improvement activity development and implementation, authorship of articles in peer-reviewed journals, creation of educational tools and presentations, and application of Network-sponsored materials to improve patient outcomes, engagement, and satisfaction in the medical director's facility. The improvement of care of patients on dialysis will be beneficial to the facility in achieving its goals of quality, safety, and financial viability. Copyright © 2015 by the American Society of Nephrology.

  7. Medication Review and Transitions of Care: A Case Report of a Decade-Old Medication Error.

    PubMed

    Comer, Rachel; Lizer, Mitsi

    2017-10-01

    A 69-year-old Caucasian male with a 25-year history of paranoid schizophrenia was brought to the emergency department because of violence toward the staff in his nursing facility. He was diagnosed with a urinary tract infection and was admitted to the behavioral health unit for medication stabilization. History included a five-year state psychiatric hospital admission and nursing facility placement. Because of poor cognitive function, the patient was unable to corroborate medication history, so the pharmacy student on rotation performed an in-depth chart review. The review revealed a transcription error in 2003 deleting amantadine 100 mg twice daily and adding amiodarone 100 mg twice daily. Subsequent hospitalization resulted in another transcription error increasing the amiodarone to 200 mg twice daily. All electrocardiograms conducted were negative for atrial fibrillation. Once detected, the consulted cardiologist discontinued the amiodarone, and the primary care provider was notified via letter and discharge papers. An admission four months later revealed that the nursing facility restarted the amiodarone. Amiodarone was discontinued and the facility was again notified. This case reviews how a 10-year-old medication error went undetected in the electronic medical records through numerous medication reconciliations, but was uncovered when a single comprehensive medication review was conducted.

  8. Design and Weighting Methods for a Nationally Representative Sample of HIV-infected Adults Receiving Medical Care in the United States-Medical Monitoring Project

    PubMed Central

    Iachan, Ronaldo; H. Johnson, Christopher; L. Harding, Richard; Kyle, Tonja; Saavedra, Pedro; L. Frazier, Emma; Beer, Linda; L. Mattson, Christine; Skarbinski, Jacek

    2016-01-01

    Background: Health surveys of the general US population are inadequate for monitoring human immunodeficiency virus (HIV) infection because the relatively low prevalence of the disease (<0.5%) leads to small subpopulation sample sizes. Objective: To collect a nationally and locally representative probability sample of HIV-infected adults receiving medical care to monitor clinical and behavioral outcomes, supplementing the data in the National HIV Surveillance System. This paper describes the sample design and weighting methods for the Medical Monitoring Project (MMP) and provides estimates of the size and characteristics of this population. Methods: To develop a method for obtaining valid, representative estimates of the in-care population, we implemented a cross-sectional, three-stage design that sampled 23 jurisdictions, then 691 facilities, then 9,344 HIV patients receiving medical care, using probability-proportional-to-size methods. The data weighting process followed standard methods, accounting for the probabilities of selection at each stage and adjusting for nonresponse and multiplicity. Nonresponse adjustments accounted for differing response at both facility and patient levels. Multiplicity adjustments accounted for visits to more than one HIV care facility. Results: MMP used a multistage stratified probability sampling design that was approximately self-weighting in each of the 23 project areas and nationally. The probability sample represents the estimated 421,186 HIV-infected adults receiving medical care during January through April 2009. Methods were efficient (i.e., induced small, unequal weighting effects and small standard errors for a range of weighted estimates). Conclusion: The information collected through MMP allows monitoring trends in clinical and behavioral outcomes and informs resource allocation for treatment and prevention activities. PMID:27651851

  9. US Army Medical Bioengineering Research and Development Laboratory Annual Progress Report for FY 84. Volume 1

    DTIC Science & Technology

    1984-10-01

    develop pollution abatement procedures for Army munition plants and military installations.n, t ftr Laboratory is also actively engaged in the...FACILITIES The physical plant provides over 100,000 square feet for research, development, testing, and administrative activities . Space is...protection of industrial workers and thq surrounding community at Army-controlled, industry-operated munition plants . G Environmental Quality program

  10. MUNICIPAL WASTE COMBUSTION ASSESSMENT ...

    EPA Pesticide Factsheets

    The report defines and characterizes types of medical waste, discusses the impacts of burning medical waste on combustor emissions, and outlines important handling and operating considerations. Facility-specific design, handling, and operating practiced are also discussed for municipal waste combustors (MWCs) that reportedly accept medical waste in the U.S., Europe, and Canada. nly very limited data are available on the emission impacts associated with the combustion of medical waste in MWGs. Especially lacking is information needed to fully evaluate the impacts on acid gas, dioxin, and metals emissions, as well as the design and operating requirements for complete destruction of solvents, cytotoxic chemicals, and pathogens. The EPA's Office of Air Quatity Planning and Standards is developing emission standards and guidelines for new and existing MWCs under Sections 111(b) and 111(d) of the Clean Air Act. In support of these regulatory development efforts, the Air and Energy Engineering Research Laboratory in EPA's Office of Research and Development has conducted an assessment to examine the incineration of medical waste in MWGs from an emission standpoint. Potential worker safety and health problems associated with handling of medical wastes and residues were also identified. information

  11. Task Force 62 Medical Brigade combat healthcare support system in the mature Iraq theater of operations.

    PubMed

    Sargent, Patrick D

    2008-01-01

    Leading a deployed combat healthcare system is a very complex task and requires a command and control structure that is a unique blend of technical and tactical expertise to efficaciously deliver world-class medical care to America's sons and daughters. The medical task force in Iraq has successfully managed the transformation of the medical footprint from a tactically arrayed set of disparate medical units to a nascent integrated healthcare system with many features similar to the best healthcare systems in the United States. The American public demands, and Soldiers, Marines, Sailors, Airmen, and Coast Guardsmen deserve US quality medical care, whether they are being treated at a military medical center in the US, or a US medical facility in Iraq. This article presents an overview of the 62nd Medical Brigade's development of the combat healthcare support system during its tenure leading the US medical task force in Iraq.

  12. Committee on Veterinary Medicine at the Society for Medical Education: Skills Labs in Veterinary Medicine - a brief overview.

    PubMed

    Dilly, Marc; Gruber, Christian

    2016-01-01

    Since 2012, skills labs have been set up to teach practical skills at veterinary training facilities in the German-speaking world. In addition to didactic considerations, ethical points of view in terms of animal protection form the basis of the increasing significance of skills labs in veterinary medicine. Not least because of the quality standards in veterinary medicine training which apply across Europe, the link between veterinary medicine training facilities is particularly significant when it comes to the setting up and development of skills labs. The Committee on Veterinary Medicine is therefore not only interested in exchange and cooperation within veterinary medicine, but also sees an opportunity for mutual gain in the link with the Society for Medical Education Committee "Practical Skills".

  13. MYRRHA: A multipurpose nuclear research facility

    NASA Astrophysics Data System (ADS)

    Baeten, P.; Schyns, M.; Fernandez, Rafaël; De Bruyn, Didier; Van den Eynde, Gert

    2014-12-01

    MYRRHA (Multi-purpose hYbrid Research Reactor for High-tech Applications) is a multipurpose research facility currently being developed at SCK•CEN. MYRRHA is based on the ADS (Accelerator Driven System) concept where a proton accelerator, a spallation target and a subcritical reactor are coupled. MYRRHA will demonstrate the ADS full concept by coupling these three components at a reasonable power level to allow operation feedback. As a flexible irradiation facility, the MYRRHA research facility will be able to work in both critical as subcritical modes. In this way, MYRRHA will allow fuel developments for innovative reactor systems, material developments for GEN IV and fusion reactors, and radioisotope production for medical and industrial applications. MYRRHA will be cooled by lead-bismuth eutectic and will play an important role in the development of the Pb-alloys technology needed for the LFR (Lead Fast Reactor) GEN IV concept. MYRRHA will also contribute to the study of partitioning and transmutation of high-level waste. Transmutation of minor actinides (MA) can be completed in an efficient way in fast neutron spectrum facilities, so both critical reactors and subcritical ADS are potential candidates as dedicated transmutation systems. However critical reactors heavily loaded with fuel containing large amounts of MA pose reactivity control problems, and thus safety problems. A subcritical ADS operates in a flexible and safe manner, even with a core loading containing a high amount of MA leading to a high transmutation rate. In this paper, the most recent developments in the design of the MYRRHA facility are presented.

  14. Prevalence of inappropriate medication use in residential long-term care facilities for the elderly: A systematic review.

    PubMed

    Storms, Hannelore; Marquet, Kristel; Aertgeerts, Bert; Claes, Neree

    2017-12-01

    Multi-morbidity and polypharmacy of the elderly population enhances the probability of elderly in residential long-term care facilities experiencing inappropriate medication use. The aim is to systematically review literature to assess the prevalence of inappropriate medication use in residential long-term care facilities for the elderly. Databases (MEDLINE, EMBASE) were searched for literature from 2004 to 2016 to identify studies examining inappropriate medication use in residential long-term care facilities for the elderly. Studies were eligible when relying on Beers criteria, STOPP, START, PRISCUS list, ACOVE, BEDNURS or MAI instruments. Inappropriate medication use was defined by the criteria of these seven instruments. Twenty-one studies met inclusion criteria. Seventeen studies relied on a version of Beers criteria with prevalence ranging between 18.5% and 82.6% (median 46.5%) residents experiencing inappropriate medication use. A smaller range, from 21.3% to 63.0% (median 35.1%), was reported when considering solely the 10 studies that used Beers criteria updated in 2003. Prevalence varied from 23.7% to 79.8% (median 61.1%) in seven studies relying on STOPP. START and ACOVE were relied on in respectively four (prevalence: 30.5-74.0%) and two studies (prevalence: 28.9-58.0%); PRISCUS, BEDNURS and MAI were all used in one study each. Beers criteria of 2003 and STOPP were most frequently used to determine inappropriate medication use in residential long-term care facilities. Prevalence of inappropriate medication use strongly varied, despite similarities in research design and assessment with identical instrument(s).

  15. Prevalence of inappropriate medication use in residential long-term care facilities for the elderly: A systematic review

    PubMed Central

    Storms, Hannelore; Marquet, Kristel; Aertgeerts, Bert; Claes, Neree

    2017-01-01

    Abstract Background: Multi-morbidity and polypharmacy of the elderly population enhances the probability of elderly in residential long-term care facilities experiencing inappropriate medication use. Objectives: The aim is to systematically review literature to assess the prevalence of inappropriate medication use in residential long-term care facilities for the elderly. Methods: Databases (MEDLINE, EMBASE) were searched for literature from 2004 to 2016 to identify studies examining inappropriate medication use in residential long-term care facilities for the elderly. Studies were eligible when relying on Beers criteria, STOPP, START, PRISCUS list, ACOVE, BEDNURS or MAI instruments. Inappropriate medication use was defined by the criteria of these seven instruments. Results: Twenty-one studies met inclusion criteria. Seventeen studies relied on a version of Beers criteria with prevalence ranging between 18.5% and 82.6% (median 46.5%) residents experiencing inappropriate medication use. A smaller range, from 21.3% to 63.0% (median 35.1%), was reported when considering solely the 10 studies that used Beers criteria updated in 2003. Prevalence varied from 23.7% to 79.8% (median 61.1%) in seven studies relying on STOPP. START and ACOVE were relied on in respectively four (prevalence: 30.5–74.0%) and two studies (prevalence: 28.9–58.0%); PRISCUS, BEDNURS and MAI were all used in one study each. Conclusions: Beers criteria of 2003 and STOPP were most frequently used to determine inappropriate medication use in residential long-term care facilities. Prevalence of inappropriate medication use strongly varied, despite similarities in research design and assessment with identical instrument(s). PMID:28271916

  16. Glossary of Health Care Terminology

    DTIC Science & Technology

    1989-03-01

    surgery, readmission rate following discharge, nosocomial infection rate, and wound evisceration or dehiscence rate. OUTLIERS. Atypical cases which have an...center. INFECTION CONTROL PROGRAM. Policies and procedures followed by a medical or dental treatment facility to minimize the risk of infection to...patients and staff. INFECTION CONTROL COMMITTEE. Medical treatment facility committee composed of medical, dental, nursing, laboratory, and

  17. Guide to Facilities, Capabilities, and Programs of Medical Schools in the United States.

    ERIC Educational Resources Information Center

    Mayeda, Tadashi A.

    The information in this document was gathered to aid analysts and designers of the proposed Biomedical Communications Network (BCN) of the National Library of Medicine. The current capabilities and facilities of medical schools in areas of activity impinging on the concept and role of BCN are summarized. Medical schools are listed geographically…

  18. Are healthcare aides underused in long-term care? A cross-sectional study on continuing care facilities in Canada.

    PubMed

    Arain, Mubashir A; Deutschlander, Siegrid; Charland, Paola

    2017-05-17

    Over the last 10 years, appropriate workforce utilisation has been an important discussion among healthcare practitioners and policy-makers. The role of healthcare aides (HCAs) has also expanded to improve their utilisation. This evolving role of HCAs in Canada has prompted calls for standardised training, education and scope of practice for HCAs. The purpose of this research was to examine the differences in HCAs training and utilisation in continuing care facilities. From June 2014 to July 2015, we conducted a mixed-method study on HCA utilisation in continuing care. This paper presents findings gathered solely from the prospective cross-sectional survey of continuing care facilities (long-term care (LTC) and supportive living (SL)) on HCA utilisation. We conducted this study in a Western Canadian province. The managers of the continuing care facilities (SL and LTC) were eligible to participate in the survey. The pattern of HCAs involvement in medication assistance and other care activities in SL and LTC facilities. We received 130 completed surveys (LTC=64 and SL=52). Our findings showed that approximately 81% of HCAs were fully certified. We found variations in how HCAs were used in SL and LTC facilities. Overall, HCAs in SL were more likely to be involved in medication management such as assisting with inhaled medication and oral medication delivery. A significantly larger proportion of survey respondents from SL facilities reported that medication assistance training was mandatory for their HCAs (86%) compared with the LTC facilities (50%) (p value <0.01). The utilisation of HCAs varies widely between SL and LTC facilities. HCAs in SL facilities may be considered better used according to their required educational training and competencies. Expanding the role of HCAs in LTC facilities may lead to a cost-effective and more efficient utilisation of workforce in continuing care facilities. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  19. Medical and radiological aspects of emergency preparedness and response at SevRAO facilities.

    PubMed

    Savkin, M N; Sneve, M K; Grachev, M I; Frolov, G P; Shinkarev, S M; Jaworska, A

    2008-12-01

    Regulatory cooperation between the Norwegian Radiation Protection Authority and the Federal Medical Biological Agency (FMBA) of the Russian Federation has the overall goal of promoting improvements in radiation protection in Northwest Russia. One of the projects in this programme has the objectives to review and improve the existing medical emergency preparedness capabilities at the sites for temporary storage of spent nuclear fuel and radioactive waste. These are operated by SevRAO at Andreeva Bay and in Gremikha village on the Kola Peninsula. The work is also intended to provide a better basis for regulation of emergency response and medical emergency preparedness at similar facilities elsewhere in Russia. The purpose of this paper is to present the main results of that project, implemented by the Burnasyan Federal Medical Biophysical Centre. The first task was an analysis of the regulatory requirements and the current state of preparedness for medical emergency response at the SevRAO facilities. Although Russian regulatory documents are mostly consistent with international recommendations, some distinctions lead to numerical differences in operational intervention criteria under otherwise similar conditions. Radiological threats relating to possible accidents, and related gaps in the regulation of SevRAO facilities, were also identified. As part of the project, a special exercise on emergency medical response on-site at Andreeva Bay was prepared and carried out, and recommendations were proposed after the exercise. Following fruitful dialogue among regulators, designers and operators, special regulatory guidance has been issued by FMBA to account for the specific and unusual features of the SevRAO facilities. Detailed sections relate to the prevention of accidents, and emergency preparedness and response, supplementing the basic Russian regulatory requirements. Overall it is concluded that (a) the provision of medical and sanitary components of emergency response at SevRAO facilities is a priority task within the general system of emergency preparedness; (b) there is an effective and improving interaction between SevRAO and the local medical institutions of FMBA and other territorial medical units; (c) the infrastructure of emergency response at SevRAO facilities has been created and operates within the framework of Russian legal and normative requirements. Further proposals have been made aimed at increasing the effectiveness of the available system of emergency preparedness and response, and to promote interagency cooperation.

  20. On-site or off-site treatment of medical waste: a challenge

    PubMed Central

    2014-01-01

    Treating hazardous-infectious medical waste can be carried out on-site or off-site of health-care establishments. Nevertheless, the selection between on-site and off-site locations for treating medical waste sometimes is a controversial subject. Currently in Iran, due to policies of Health Ministry, the hospitals have selected on-site-treating method as the preferred treatment. The objectives of this study were to assess the current condition of on-site medical waste treatment facilities, compare on-site medical waste treatment facilities with off-site systems and find the best location of medical waste treatment. To assess the current on-site facilities, four provinces (and 40 active hospitals) were selected to participate in the survey. For comparison of on-site and off-site facilities (due to non availability of an installed off-site facility) Analytical Hierarchy Process (AHP) was employed. The result indicated that most on-site medical waste treating systems have problems in financing, planning, determining capacity of installations, operation and maintenance. AHP synthesis (with inconsistency ratio of 0.01 < 0.1) revealed that, in total, the off-site treatment of medical waste was in much higher priority than the on-site treatment (64.1% versus 35.9%). According to the results of study it was concluded that the off-site central treatment can be considered as an alternative. An amendment could be made to Iran’s current medical waste regulations to have infectious-hazardous waste sent to a central off-site installation for treatment. To begin and test this plan and also receive the official approval, a central off-site can be put into practice, at least as a pilot in one province. Next, if it was practically successful, it could be expanded to other provinces and cities. PMID:24739145

  1. Medical Image Analysis Facility

    NASA Technical Reports Server (NTRS)

    1978-01-01

    To improve the quality of photos sent to Earth by unmanned spacecraft. NASA's Jet Propulsion Laboratory (JPL) developed a computerized image enhancement process that brings out detail not visible in the basic photo. JPL is now applying this technology to biomedical research in its Medical lrnage Analysis Facility, which employs computer enhancement techniques to analyze x-ray films of internal organs, such as the heart and lung. A major objective is study of the effects of I stress on persons with heart disease. In animal tests, computerized image processing is being used to study coronary artery lesions and the degree to which they reduce arterial blood flow when stress is applied. The photos illustrate the enhancement process. The upper picture is an x-ray photo in which the artery (dotted line) is barely discernible; in the post-enhancement photo at right, the whole artery and the lesions along its wall are clearly visible. The Medical lrnage Analysis Facility offers a faster means of studying the effects of complex coronary lesions in humans, and the research now being conducted on animals is expected to have important application to diagnosis and treatment of human coronary disease. Other uses of the facility's image processing capability include analysis of muscle biopsy and pap smear specimens, and study of the microscopic structure of fibroprotein in the human lung. Working with JPL on experiments are NASA's Ames Research Center, the University of Southern California School of Medicine, and Rancho Los Amigos Hospital, Downey, California.

  2. The Value of Electronic Medical Record Implementation in Mental Health Care: A Case Study

    PubMed Central

    Fischler, Ilan; Stuckey, Melanie I; Klassen, Philip E; Chen, John

    2017-01-01

    Background Electronic medical records (EMR) have been implemented in many organizations to improve the quality of care. Evidence supporting the value added to a recovery-oriented mental health facility is lacking. Objective The goal of this project was to implement and customize a fully integrated EMR system in a specialized, recovery-oriented mental health care facility. This evaluation examined the outcomes of quality improvement initiatives driven by the EMR to determine the value that the EMR brought to the organization. Methods The setting was a tertiary-level mental health facility in Ontario, Canada. Clinical informatics and decision support worked closely with point-of-care staff to develop workflows and documentation tools in the EMR. The primary initiatives were implementation of modules for closed loop medication administration, collaborative plan of care, clinical practice guidelines for schizophrenia, restraint minimization, the infection prevention and control surveillance status board, drug of abuse screening, and business intelligence. Results Medication and patient scan rates have been greater than 95% since April 2014, mitigating the adverse effects of medication errors. Specifically, between April 2014 and March 2015, only 1 moderately severe and 0 severe adverse drug events occurred. The number of restraint incidents decreased 19.7%, which resulted in cost savings of more than Can $1.4 million (US $1.0 million) over 2 years. Implementation of clinical practice guidelines for schizophrenia increased adherence to evidence-based practices, standardizing care across the facility. Improved infection prevention and control surveillance reduced the number of outbreak days from 47 in the year preceding implementation of the status board to 7 days in the year following. Decision support to encourage preferential use of the cost-effective drug of abuse screen when clinically indicated resulted in organizational cost savings. Conclusions EMR implementation allowed Ontario Shores Centre for Mental Health Sciences to use data analytics to identify and select appropriate quality improvement initiatives, supporting patient-centered, recovery-oriented practices and providing value at the clinical, organizational, and societal levels. PMID:28057607

  3. Development of a novel Global Trauma System Evaluation Tool and initial results of implementation in the Republic of South Sudan.

    PubMed

    Remick, Kyle N; Wong, Evan G; Chuot Chep, Chep; Morton, Richard T; Monsour, Abdullah; Fisher, Dane; Oh, John S; Wilson, Ramey; Malone, Debra L; Branas, Charles; Elster, Eric; Gross, Kirby R; Kushner, Adam L

    2014-11-01

    Trauma remains a leading cause of death and disability in the world, and trauma systems decrease mortality from trauma. We developed the Global Trauma System Evaluation Tool (G-TSET) specifically for use in low- and middle-income countries (LMICs). The Sudan People's Liberation Army (SPLA) in the Republic of South Sudan (RSS) desires a military trauma system (MTS) which allowed us to pilot the G-TSET. The G-TSET was developed by modifying key components of a trauma system applicable to LMICs. We partnered with the SPLA Medical Corps using clinical collaboration, direct observation, and discussion groups. Benchmarks and indicators were scored with 5 indicating "full capability" and 1 meaning "not present" and were used to develop a SPLA MTS plan. The overall MTS score was 1.15 indicating an urgent need for system development. The assessment highlighted the need for SPLA Command support. Battlefield care, transport to a trauma facility, and inter-facility communication were identified for improvement. After essential battlefield care, consisting primarily of bandaging and splinting, transport times for injured SPLA soldiers were 12h to 3 days by truck. Based on our findings, we collaborated with SPLA medical leadership to develop a plan to develop a formal MTS. We piloted a novel trauma system assessment tool for the MTS in the RSS. Qualitatively, we identified gaps in the MTS and provided the medical leadership with a plan for improvement. We anticipate a short-term follow-up to quantify improvement, and we seek to validate this tool for use in other countries. Published by Elsevier Ltd.

  4. Proton Radiation Therapy in the Hospital Environment: Conception, Development, and Operation of the Initial Hospital-Based Facility

    NASA Astrophysics Data System (ADS)

    Slater, James M.; Slater, Jerry D.; Wroe, Andrew J.

    The world's first hospital-based proton treatment center opened at Loma Linda University Medical Center in 1990, following two decades of development. Patients' needs were the driving force behind its conception, development, and execution; the primary needs were delivery of effective conformal doses of ionizing radiation and avoidance of normal tissue to the maximum extent possible. The facility includes a proton synchrotron and delivery system developed in collaboration with physicists and engineers at Fermi National Accelerator Laboratory and from other high-energy-physics laboratories worldwide. The system, operated and maintained by Loma Linda personnel, was designed to be safe, reliable, flexible in utilization, efficient in use, and upgradeable to meet demands of changing patient needs and advances in technology. Since the facility opened, nearly 14,000 adults and children have been treated for a wide range of cancers and other diseases. Ongoing research is expanding the applications of proton therapy, while reducing costs.

  5. The Medical Gopher — A Microcomputer Based Physician Work Station

    PubMed Central

    McDonald, Clement J.

    1984-01-01

    We've developed a microcomputer medical work station intended to reduce the physician's “gopher” work of fetching, reviewing, organizing and writing that consumes his day. The system requires extensive physician interaction; so we have developed a fast and consistent menu-oriented user interface. It provides facilities for entering prescriptions, orders, problems and other medical record information and for generating flowsheets, executing reminder rules, providing ad hoc retrievals and reporting facts about drugs, tests and differential diagnoses. Each work station is connected to a central server (currently a VAX 117/80) in a network configuration, but carries all of its own programs, tables and medical records for a few hundred patients, locally. This system is tested but not yet tried. Questions remain about physician's acceptance and the true usefullness of such a work station.

  6. Web-based system for surgical planning and simulation

    NASA Astrophysics Data System (ADS)

    Eldeib, Ayman M.; Ahmed, Mohamed N.; Farag, Aly A.; Sites, C. B.

    1998-10-01

    The growing scientific knowledge and rapid progress in medical imaging techniques has led to an increasing demand for better and more efficient methods of remote access to high-performance computer facilities. This paper introduces a web-based telemedicine project that provides interactive tools for surgical simulation and planning. The presented approach makes use of client-server architecture based on new internet technology where clients use an ordinary web browser to view, send, receive and manipulate patients' medical records while the server uses the supercomputer facility to generate online semi-automatic segmentation, 3D visualization, surgical simulation/planning and neuroendoscopic procedures navigation. The supercomputer (SGI ONYX 1000) is located at the Computer Vision and Image Processing Lab, University of Louisville, Kentucky. This system is under development in cooperation with the Department of Neurological Surgery, Alliant Health Systems, Louisville, Kentucky. The server is connected via a network to the Picture Archiving and Communication System at Alliant Health Systems through a DICOM standard interface that enables authorized clients to access patients' images from different medical modalities.

  7. Discharge disposition of adolescents admitted to medical hospitals after attempting suicide.

    PubMed

    Levine, Leonard J; Schwarz, Donald F; Argon, Jesse; Mandell, David S; Feudtner, Chris

    2005-09-01

    To test the hypothesis that discharge disposition for adolescents admitted to medical hospitals after attempting suicide varies as a function of hospital type and geographic region. Retrospective cohort analysis. The nationally representative Kids' Inpatient Database for 2000. Patients aged 10 to 19 years with a diagnosis of suicide attempt or self-inflicted injury.Main Outcome Measure Likelihood of transfer to another facility vs discharge to home. Care for 32 655 adolescents who attempted suicide was provided in adult hospitals (83% of hospitalizations), children's units in general hospitals (10%), and children's hospitals (4%). More than half (66%) of medical hospitalizations ended with discharge to home, 21% with transfer to a psychiatric, rehabilitation, or chronic care (P/R/C) facility, 10% with transfer to a skilled nursing facility, intermediate care facility, or short-term acute care hospital facility, and 2% with death or departure against medical advice. After adjustment for individual patient characteristics, children's units were 44% more likely than adult hospitals to transfer adolescent patients to a P/R/C facility (odds ratio [OR], 1.44; 95% confidence interval [CI], 1.07-1.94). Patients cared for outside the Northeast were significantly less likely to be transferred to a P/R/C facility (South: OR, 0.79; 95% CI, 0.65-0.97; Midwest: OR, 0.63; 95% CI, 0.49-0.80; West: OR, 0.29; 95% CI, 0.22-0.38). Most adolescents admitted to a medical hospital after a suicide attempt are discharged to home, and the likelihood of transfer to another facility appears to be influenced by the geographic location of the admitting hospital and whether it caters to children.

  8. Non-physician communities in Japan: are they still disadvantaged?

    PubMed

    Kashima, S; Inoue, K; Matsumoto, M; Takeuchi, K

    2014-01-01

    Non-physician community' (NPC) is a policy term that indicates a medically underserved area in Japan. Designated NPCs are politically targeted as the foci of medical resource allocation. NPC is defined as a specified district where 50 or more persons dwell within a geographic diameter of 4 km and medical care is not easily accessible. The definition of NPC was first introduced in 1960 and has been unchanged for more than half a century despite radical social changes in rural Japan. This study examines whether designated NPCs are still more disadvantaged in terms of geographical access to healthcare in comparison to other communities. Hiroshima prefecture, which has the largest number of NPCs in terms of tertiary healthcare areas of Japan, was used as the study area. Targeted communities were all the NPCs in the prefecture, and, as controls, two community groups were selected: non-NPC adjacent to NPC, and municipal center. We measured driving time from NPCs and control communities to the nearest healthcare facilities, which were classified into the following two types: primary or secondary care facilities (n=2636) and tertiary care facilities (equal to tertiary emergency care centers; n=6). We further calculated the driving time to the nearest facilities for secondary emergency care (n=246) extracted from the 2636 primary or secondary care facilities. The median driving times to the nearest primary or secondary healthcare facility for NPC, non-NPC, and municipal center were 11 minutes, 11 minutes, and 1 minute, respectively; the times to a tertiary healthcare facility (equal to an accident and emergency care center) were 80 minutes, 84 minutes, and 68 minutes, respectively; and the times to a secondary emergency care facility were 24 minutes, 18 minutes, and 15 minutes, respectively. Although a municipal center was significantly more advantageous in driving time compared to a primary or secondary care facility, the disadvantage of a NPC in access was no more obvious than an adjacent non-NPC for any type of healthcare facility. NPCs had a disadvantage in access time to primary, secondary and tertiary medical care compared with a municipal center. NPCs, however, did not have a greater access disadvantage in comparison to adjacent rural communities for any type of medical facility. As such, future resource allocation policies in Japan need to redefine medically underserved communities.

  9. Compact solar autoclave based on steam generation using broadband light-harvesting nanoparticles.

    PubMed

    Neumann, Oara; Feronti, Curtis; Neumann, Albert D; Dong, Anjie; Schell, Kevin; Lu, Benjamin; Kim, Eric; Quinn, Mary; Thompson, Shea; Grady, Nathaniel; Nordlander, Peter; Oden, Maria; Halas, Naomi J

    2013-07-16

    The lack of readily available sterilization processes for medicine and dentistry practices in the developing world is a major risk factor for the propagation of disease. Modern medical facilities in the developed world often use autoclave systems to sterilize medical instruments and equipment and process waste that could contain harmful contagions. Here, we show the use of broadband light-absorbing nanoparticles as solar photothermal heaters, which generate high-temperature steam for a standalone, efficient solar autoclave useful for sanitation of instruments or materials in resource-limited, remote locations. Sterilization was verified using a standard Geobacillus stearothermophilus-based biological indicator.

  10. Self-efficacy, social support and service integration at medical cannabis facilities in the San Francisco Bay area of California.

    PubMed

    Reiman, Amanda E

    2008-01-01

    In an effort to examine and possibly utilise the community-based, bottom-up service design of medical cannabis facilities in the San Francisco Bay area of California, 130 adults who had received medical cannabis recommendations from a physician were surveyed at seven facilities to describe the social service aspects of these unique, community-based programmes. This study used an unselected consecutive sample and cross-sectional survey design that included primary data collection at the medical cannabis facilities themselves. In this exploratory study, individual level data were collected on patient demographics and reported patient satisfaction as gathered by the Patient Satisfaction Questionnaire III. Surveys were filled out on site. In the case of a refusal, the next person was asked. The refusal rate varied depending on the study site and ranged between 25% and 60%, depending on the facility and the day of sampling. Organisational-level data, such as operating characteristics and products offered, created a backdrop for further examination into the social services offered by these facilities and the attempts made by this largely unregulated healthcare system to create a community-based environment of social support for chronically ill people. Informal assessment suggests that chronic pain is the most common malady for which medical cannabis is used. Descriptive statistics were generated to examine sample- and site-related differences. Results show that medical cannabis patients have created a system of dispensing medical cannabis that also includes services such as counselling, entertainment and support groups - all important components of coping with chronic illness. Furthermore, patients tend to be male, over 35, identify with more than one ethnicity, and earn less than US$20 000 annually. Levels of satisfaction with facility care were fairly high, and higher than nationally reported satisfaction with health care in the USA. Facilities tended to follow a social model of cannabis care, including allowing patients to use medicine on site and offering social services. This approach has implications for the creation and maintenance of a continuum of care among bottom-up social and health services agencies.

  11. Evaluation of a hybrid paper-electronic medication management system at a residential aged care facility.

    PubMed

    Elliott, Rohan A; Lee, Cik Yin; Hussainy, Safeera Y

    2016-06-01

    Objectives The aims of the study were to investigate discrepancies between general practitioners' paper medication orders and pharmacy-prepared electronic medication administration charts, back-up paper charts and dose-administration aids, as well as delays between prescribing, charting and administration, at a 90-bed residential aged care facility that used a hybrid paper-electronic medication management system. Methods A cross-sectional audit of medication orders, medication charts and dose-administration aids was performed to identify discrepancies. In addition, a retrospective audit was performed of delays between prescribing and availability of an updated electronic medication administration chart. Medication administration records were reviewed retrospectively to determine whether discrepancies and delays led to medication administration errors. Results Medication records for 88 residents (mean age 86 years) were audited. Residents were prescribed a median of eight regular medicines (interquartile range 5-12). One hundred and twenty-five discrepancies were identified. Forty-seven discrepancies, affecting 21 (24%) residents, led to a medication administration error. The most common discrepancies were medicine omission (44.0%) and extra medicine (19.2%). Delays from when medicines were prescribed to when they appeared on the electronic medication administration chart ranged from 18min to 98h. On nine occasions (for 10% of residents) the delay contributed to missed doses, usually antibiotics. Conclusion Medication discrepancies and delays were common. Improved systems for managing medication orders and charts are needed. What is known about the topic? Hybrid paper-electronic medication management systems, in which prescribers' orders are transcribed into an electronic system by pharmacy technicians and pharmacists to create medication administration charts, are increasingly replacing paper-based medication management systems in Australian residential aged care facilities. The accuracy and safety of these systems has not been studied. What does this paper add? The present study identified discrepancies between general practitioners' orders and pharmacy-prepared electronic medication administration charts, back-up paper medication charts and dose-administration aids, as well as delays between ordering, charting and administering medicines. Discrepancies and delays sometimes led to medication administration errors. What are the implications for practitioners? Facilities that use hybrid systems need to implement robust systems for communicating medication changes to their pharmacy and reconciling prescribers' orders against pharmacy-generated medication charts and dose-administration aids. Fully integrated, paperless medication management systems, in which prescribers' electronic medication orders directly populate an electronic medication administration chart and are automatically communicated to the facility's pharmacy, could improve patient safety.

  12. [Building Process and Architectural Planning Characteristics of Daehan Hospital Main Building].

    PubMed

    Lee, Geauchul

    2016-04-01

    This paper explores the introduction process of Daehan Hospital from Japan as the modern medical facility in Korea, and the architectural planning characteristics as a medical facility through the detailed building process of Daehan Hospital main building. The most noticeable characteristic of Daehan Hospital is that it was designed and constructed not by Korean engineers but by Japanese engineers. Therefore, Daehan Hospital was influenced by Japanese early modern medical facility, and Japanese engineers modeled Daehan Hospital main building on Tokyo Medical School main building which was constructed in 1876 as the first national medical school and hospital. The architectural type of Tokyo Medical School main building was a typical school architecture in early Japanese modern period which had a middle corridor and a pseudo Western-style tower, but Tokyo Medical School main building became the model of a medical facility as the symbol of the medical department in Tokyo Imperial University. This was the introduction and transplantation process of Japanese modern 'model' like as other modern systems and technologies during the Korean modern transition period. However, unlike Tokyo Medical School main building, Daehan Hospital main building was constructed not as a wooden building but as a masonry building. Comparing with the function of Daehan Hospital main building, its architectural form and construction costs was excessive scale, which was because Japanese Resident-General of Korea had the intention of ostentation that Japanese modernity was superior to Korean Empire.

  13. [Reality of Inter-Professional Cooperation in Medical Day Care Facilities - What is Visible from the Level of Inter-Professional Cooperation].

    PubMed

    Ugai, Chizuru; Hata, Kiyomi

    2015-12-01

    In order to improve the quality of life of patients with moderate to severe symptoms who are highly dependent on medical care and to reduce the physical and psychological burden on family members, at medical day care facilities, care and services, such as functional training, is provided to improve daily life for patients in need of significant care who have intractable diseases under the Long-Term Care Insurance Act; home care patients, such as those in the final stages of cancer; and severely mentally and physically handicapped children under the Child Welfare Act. This study conducted semi-structured interviews with 15 nurses working in medical day care facilities with the objective of clarifying the reality of inter-professional cooperation of nurses working in these facilities and contributing to delivery of high-quality care. The results of the study revealed that the level of inter-professional cooperation of nurses at medical day care facilities was high and that professions that are involved in cooperation include visiting nurses, doctors, medical staff, such as physical therapists, caregivers, and welfare professions, such as care managers. The study also showed that the contents of cooperation include information exchange, information sharing, continuation of care, implementation of care that respects the intentions of the patient, care proposals, and guidance and control regarding care.

  14. Promoting medical tourism to India: messages, images, and the marketing of international patient travel.

    PubMed

    Crooks, Valorie A; Turner, Leigh; Snyder, Jeremy; Johnston, Rory; Kingsbury, Paul

    2011-03-01

    The practice of medical tourism depends on successfully informing potential patients about procedure options, treatment facilities, tourism opportunities, travel arrangements, and destination countries. The promotion of medical tourism includes a wide range of marketing materials such as flyers, booklets, and websites. Yet, there is a paucity of knowledge about the dissemination, content, and reception of these promotional materials. Drawing on a thematic content analysis of the promotional print material distributed at the first medical tourism trade show in Canada in 2009, the main purpose of this article is to identify and understand the messages and images that companies use to market India as a global destination. While researchers and news media frequently cite low cost procedures as a key determinant for international patient travel, particularly to developing nations, our analysis reveals few low cost-related images or messages in the promotional materials distributed at the trade show. To help explain this surprising disjuncture, we consider four related issues: (1) promotional materials may be designed to be circulated amongst potential patients' concerned family and friends who privilege knowing about things such as the use of advanced technologies; (2) developing nations need to portray safe and advanced treatment facilities in order to dispel potential patients' suspicions that their medical care is inferior; (3) companies may avoid making cost saving claims that cannot be fulfilled for all of their international patients, especially those traveling from developing nations; and (4) messages of low cost may detract from and even undermine messages about quality. We conclude by identifying numerous avenues for future research by social and health scientists, and by considering the implications of our findings for existing knowledge gaps and debates within health geography specifically. Copyright © 2011 Elsevier Ltd. All rights reserved.

  15. Treatment of yellow scorpion (Leiurus quinquestriatus) sting: a case report.

    PubMed

    Shalita, Eric A; Wells, Ryan D

    2007-01-01

    To report the treatment given to a 26-year-old Air Force medic who was stung twice by a yellow scorpion (Leiurus quinquestriatus) while stationed in Iraq and to describe the problems and issues related to the use of the scorpion antivenin. The patient presented 2 hours after envenomation to the local military treatment facility, where she was minimally symptomatic initially. Shortness of breath and anxiety developed, and the patient was sedated, intubated, and evacuated to a large Air Force medical facility for more advanced care. Vasopressor support was required during flight. At the medical facility, antivenin was administered, and the patient's cardiac condition was stabilized with norepinephrine drip, mild hydration, and vasopressor support. A second dose of antivenin diluted in sodium chloride and further pressor support were required. ST-segment depression eventually resolved, and the patient was gradually taken off norepinephrine and extubated. She recovered fully within 2 weeks and returned to active duty. Because the antivenin used is not licensed by the Food and Drug Administration, informed consent was needed; however, it could not be obtained because the patient was unconscious, intubated, and in a life-or-death situation. Antivenin selection is based on the species of scorpion and symptom severity; therefore, the scorpion should be, with great care, killed for identification. In the military setting, inventory control, storage, and accountability are vital issues surrounding antivenin use, and these are discussed in this article. Immediate action and effective communication, along with timely antivenin administration and well-equipped intensive care facilities, were integral in saving the life of this victim of a yellow scorpion envenomation. All level 3 facilities in Southwest Asia must be familiar with ordering, administering, and documenting this antivenin because it is difficult to obtain and infrequently available.

  16. [The medical and sanitary passport of chemically hazardous facility and the surrounding area as the register of indicators of sanitary and epidemiologic safety of a state of health and habitat areas].

    PubMed

    Kombarova, M Yu; Radilov, A S; Romanov, V V; Oleynikova, E V; Ovchinikova, N S; Gulyaev, D V; Ivanova, I O

    2013-01-01

    Basic provisions of the medical and sanitary passport of chemically dangerous object and the territory adjoining to it are presented in article. Need of development of the medical and sanitary passport for systematization of sanitary and epidemiologic data with the purpose of a complex assessment of health of the population and the personnel working at chemically dangerous objects, harmful factors production and environment taking into account emissions of polluting substances of chemically dangerous objects is shown.

  17. A Clinical Decision Support Engine Based on a National Medication Repository for the Detection of Potential Duplicate Medications: Design and Evaluation.

    PubMed

    Yang, Cheng-Yi; Lo, Yu-Sheng; Chen, Ray-Jade; Liu, Chien-Tsai

    2018-01-19

    A computerized physician order entry (CPOE) system combined with a clinical decision support system can reduce duplication of medications and thus adverse drug reactions. However, without infrastructure that supports patients' integrated medication history across health care facilities nationwide, duplication of medication can still occur. In Taiwan, the National Health Insurance Administration has implemented a national medication repository and Web-based query system known as the PharmaCloud, which allows physicians to access their patients' medication records prescribed by different health care facilities across Taiwan. This study aimed to develop a scalable, flexible, and thematic design-based clinical decision support (CDS) engine, which integrates a national medication repository to support CPOE systems in the detection of potential duplication of medication across health care facilities, as well as to analyze its impact on clinical encounters. A CDS engine was developed that can download patients' up-to-date medication history from the PharmaCloud and support a CPOE system in the detection of potential duplicate medications. When prescribing a medication order using the CPOE system, a physician receives an alert if there is a potential duplicate medication. To investigate the impact of the CDS engine on clinical encounters in outpatient services, a clinical encounter log was created to collect information about time, prescribed drugs, and physicians' responses to handling the alerts for each encounter. The CDS engine was installed in a teaching affiliate hospital, and the clinical encounter log collected information for 3 months, during which a total of 178,300 prescriptions were prescribed in the outpatient departments. In all, 43,844/178,300 (24.59%) patients signed the PharmaCloud consent form allowing their physicians to access their medication history in the PharmaCloud. The rate of duplicate medication was 5.83% (1843/31,614) of prescriptions. When prescribing using the CDS engine, the median encounter time was 4.3 (IQR 2.3-7.3) min, longer than that without using the CDS engine (median 3.6, IQR 2.0-6.3 min). From the physicians' responses, we found that 42.06% (1908/4536) of the potential duplicate medications were recognized by the physicians and the medication orders were canceled. The CDS engine could easily extend functions for detection of adverse drug reactions when more and more electronic health record systems are adopted. Moreover, the CDS engine can retrieve more updated and completed medication histories in the PharmaCloud, so it can have better performance for detection of duplicate medications. Although our CDS engine approach could enhance medication safety, it would make for a longer encounter time. This problem can be mitigated by careful evaluation of adopted solutions for implementation of the CDS engine. The successful key component of a CDS engine is the completeness of the patient's medication history, thus further research to assess the factors in increasing the PharmaCloud consent rate is required. ©Cheng-Yi Yang, Yu-Sheng Lo, Ray-Jade Chen, Chien-Tsai Liu. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 19.01.2018.

  18. Guidelines for Management Information Systems in Canadian Health Care Facilities

    PubMed Central

    Thompson, Larry E.

    1987-01-01

    The MIS Guidelines are a comprehensive set of standards for health care facilities for the recording of staffing, financial, workload, patient care and other management information. The Guidelines enable health care facilities to develop management information systems which identify resources, costs and products to more effectively forecast and control costs and utilize resources to their maximum potential as well as provide improved comparability of operations. The MIS Guidelines were produced by the Management Information Systems (MIS) Project, a cooperative effort of the federal and provincial governments, provincial hospital/health associations, under the authority of the Canadian Federal/Provincial Advisory Committee on Institutional and Medical Services. The Guidelines are currently being implemented on a “test” basis in ten health care facilities across Canada and portions integrated in government reporting as finalized.

  19. Validation of Medical Tourism Service Quality Questionnaire (MTSQQ) for Iranian Hospitals.

    PubMed

    Qolipour, Mohammad; Torabipour, Amin; Khiavi, Farzad Faraji; Malehi, Amal Saki

    2017-03-01

    Assessing service quality is one of the basic requirements to develop the medical tourism industry. There is no valid and reliable tool to measure service quality of medical tourism. This study aimed to determine the reliability and validity of a Persian version of medical tourism service quality questionnaire for Iranian hospitals. To validate the medical tourism service quality questionnaire (MTSQQ), a cross-sectional study was conducted on 250 Iraqi patients referred to hospitals in Ahvaz (Iran) from 2015. To design a questionnaire and determine its content validity, the Delphi Technique (3 rounds) with the participation of 20 medical tourism experts was used. Construct validity of the questionnaire was assessed through exploratory and confirmatory factor analysis. Reliability was assessed using Cronbach's alpha coefficient. Data were analyzed by Excel 2007, SPSS version18, and Lisrel l8.0 software. The content validity of the questionnaire with CVI=0.775 was confirmed. According to exploratory factor analysis, the MTSQQ included 31 items and 8 dimensions (tangibility, reliability, responsiveness, assurance, empathy, exchange and travel facilities, technical and infrastructure facilities and safety and security). Construct validity of the questionnaire was confirmed, based on the goodness of fit quantities of model (RMSEA=0.032, CFI= 0.98, GFI=0.88). Cronbach's alpha coefficient was 0.837 and 0.919 for expectation and perception questionnaire. The results of the study showed that the medical tourism SERVQUAL questionnaire with 31 items and 8 dimensions was a valid and reliable tool to measure service quality of medical tourism in Iranian hospitals.

  20. [Medical Service Information Seeking Behaviors in Rural and Urban Patients in Sichuan Province].

    PubMed

    Zhang, Wen-Jie; Xue, Li; Chen, Rao; Duan, Zhan-Qi; Liu, Dan-Ping

    2018-03-01

    To understand how rural and urban patients seek medical service information in Sichuan province. A self-designed questionnaire was distributed randomly to patients who visited primary,secondary and tertiary health facilities in Chengdu,Yibin and Suining,collecting data in relation to their sources of medical service information,as well as the contents and credibility of the information. The major sources of medical service information came from friends,past experiences and television programs,which were consistent with the most desirable access channels. The urban patients were more likely to trust (5.3%) and use (10.6%) the Internet to obtain medical service information compared with their rural counterparts (3.4% and 5.5%,respectively, P <0.05). The most sought after information concerned about medical staff,reputation and price. The rural patients were more likely to be concerned about price (26.7%) than their urban counterparts (20.3%, P <0.05). The choices of patients were likely to be influenced by advices from family members,relatives and friends,and doctors and nurses. The patients had a higher level of trust in doctors and nurses than their relatives and friends,but lower than their family members. Patient choices are shaped by their medical service information seeking behaviors and advices from others. Targeted marketing strategies for urban and rural patients should be developed to channel patients to appropriate health facilities. Copyright© by Editorial Board of Journal of Sichuan University (Medical Science Edition).

  1. Pain treatment facilities: do we need quantity or quality?

    PubMed

    de Meij, Nelleke; Köke, Albère; van der Weijden, Trudy; van Kleef, Maarten; Patijn, Jacob

    2014-10-01

    Chronic pain patients referred to a pain treatment facility have no guarantee that they will receive a proper diagnostic procedure or treatment. To obtain information about organizational aspects of pain treatment facilities and the content of their daily pain practice, we performed a questionnaire survey. The aim of the study was to evaluate the amount of pain treatment facilities, the content of organized specialized pain care and adherence to the criteria of the internationally accepted guidelines for pain treatment services. The University Pain Centre Maastricht in the Department of Anaesthesiology and Pain Management at Maastricht University Medical Centre developed a questionnaire survey based on the Recommendations for Pain Treatment Services of the International Association for the Study of Pain (IASP). The questionnaire was sent to the medical boards of all hospitals in the Netherlands (n=94). The response rate was 86% (n=81). Of all hospitals, 88.9% (n=72) reported the provision of organized specialized pain care, which was provided by a pain management team in 86.1% (n=62) and by an individual specialist in 13.9% (n=10). Insight was obtained from pain treatment facilities in five different domains: the organizational structure of pain management, composition of the pain team, pain team practice, patient characteristics, and research and education facilities. Although 88.9% of all hospitals stated that organized specialized pain care was provided, only a few hospitals could adhere to the criteria for pain treatment services of the IASP. The outcome of the questionnaire survey may help to define quality improvement standards for pain treatment facilities. © 2014 John Wiley & Sons, Ltd.

  2. Basrah Children’s Hospital, Basrah, Iraq

    DTIC Science & Technology

    2009-07-28

    that 97% of urban and 79% of rural populations had access to health care, which included public health programs for malaria and tuberculosis control...construct the medical logistics warehouses landscaping install kitchen and laundry equipment medical equipment (medical waste autoclave, oxygen...addition, the SOW required the construction of supporting facilities to include the following: cafeteria and associated facilities (i.e. kitchen

  3. Military Medical Care: Questions and Answers

    DTIC Science & Technology

    2013-07-24

    services through either Department of Defense (DOD) medical facilities, known as “military treatment facilities” or “MTFs” as space is available, or...Chiefs of Staff, CAE /PEO =Component Acquisition Executive/Program Executive Officer, DHA OGC = Defense Health Agency Office of General Counsel, NCR...funding for all fixed medical treatment facilities/activities, including such costs as real property maintenance, environmental compliance, minor

  4. The Value of Electronic Medical Record Implementation in Mental Health Care: A Case Study.

    PubMed

    Riahi, Sanaz; Fischler, Ilan; Stuckey, Melanie I; Klassen, Philip E; Chen, John

    2017-01-05

    Electronic medical records (EMR) have been implemented in many organizations to improve the quality of care. Evidence supporting the value added to a recovery-oriented mental health facility is lacking. The goal of this project was to implement and customize a fully integrated EMR system in a specialized, recovery-oriented mental health care facility. This evaluation examined the outcomes of quality improvement initiatives driven by the EMR to determine the value that the EMR brought to the organization. The setting was a tertiary-level mental health facility in Ontario, Canada. Clinical informatics and decision support worked closely with point-of-care staff to develop workflows and documentation tools in the EMR. The primary initiatives were implementation of modules for closed loop medication administration, collaborative plan of care, clinical practice guidelines for schizophrenia, restraint minimization, the infection prevention and control surveillance status board, drug of abuse screening, and business intelligence. Medication and patient scan rates have been greater than 95% since April 2014, mitigating the adverse effects of medication errors. Specifically, between April 2014 and March 2015, only 1 moderately severe and 0 severe adverse drug events occurred. The number of restraint incidents decreased 19.7%, which resulted in cost savings of more than Can $1.4 million (US $1.0 million) over 2 years. Implementation of clinical practice guidelines for schizophrenia increased adherence to evidence-based practices, standardizing care across the facility. Improved infection prevention and control surveillance reduced the number of outbreak days from 47 in the year preceding implementation of the status board to 7 days in the year following. Decision support to encourage preferential use of the cost-effective drug of abuse screen when clinically indicated resulted in organizational cost savings. EMR implementation allowed Ontario Shores Centre for Mental Health Sciences to use data analytics to identify and select appropriate quality improvement initiatives, supporting patient-centered, recovery-oriented practices and providing value at the clinical, organizational, and societal levels. ©Sanaz Riahi, Ilan Fischler, Melanie I Stuckey, Philip E Klassen, John Chen. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 05.01.2017.

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

    PubMed

    Murashov, Vladimir; Howard, John

    2015-01-01

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

  6. Development of a novel controllable, multidirectional, reusable metallic port with a wide working space.

    PubMed

    Hosaka, Seiji; Ohdaira, Takeshi; Umemoto, Satoshi; Hashizume, Makoto; Kawamoto, Shunji

    2013-12-01

    Endoscopic surgery is currently a standard procedure in many countries. Furthermore, conventional four-port laparoscopic cholecystectomy is developing into a single-port procedure. However, in many developing countries, disposable medical products are expensive and adequate medical waste disposable facilities are absent. Advanced medical treatments such as laparoscopic or single-port surgeries are not readily available in many areas of developing countries, and there are often no other sterilization methods besides autoclaving. Moreover, existing reusable metallic ports are impractical and are thus not widely used. We developed a novel controllable, multidirectional single-port device that can be autoclaved, and with a wide working space, which was employed in five patients. In all patients, laparoscopic cholecystectomy was accomplished without complications. Our device facilitates single-port surgery in areas of the world with limited sterilization methods and offers a novel alternative to conventional tools for creating a smaller incision, decrease postoperative pain, and improve cosmesis. This novel device can also lower the cost of medical treatment and offers a promising tool for major surgeries requiring a wide working space.

  7. Medication Reconciliation and Therapy Management in Dialysis-Dependent Patients: Need for a Systematic Approach

    PubMed Central

    Cardone, Katie E.; Manley, Harold J.; St. Peter, Wendy L.; Shaffer, Rachel; Somers, Michael; Mehrotra, Rajnish

    2013-01-01

    Summary Patients with ESRD undergoing dialysis have highly complex medication regimens and disproportionately higher total cost of care compared with the general Medicare population. As shown by several studies, dialysis-dependent patients are at especially high risk for medication-related problems. Providing medication reconciliation and therapy management services is critically important to avoid costs associated with medication-related problems, such as adverse drug events and hospitalizations in the ESRD population. The Medicare Modernization Act of 2003 included an unfunded mandate stipulating that medication therapy management be offered to high-risk patients enrolled in Medicare Part D. Medication management services are distinct from the dispensing of medications and involve a complete medication review for all disease states. The dialysis facility is a logical coordination center for medication management services, like medication therapy management, and it is likely the first health care facility that a patient will present to after a care transition. A dedicated and adequately trained clinician, such as a pharmacist, is needed to provide consistent, high-quality medication management services. Medication reconciliation and medication management services that could consistently and systematically identify and resolve medication-related problems would be likely to improve ESRD patient outcomes and reduce total cost of care. Herein, this work provides a review of available evidence and recommendations for optimal delivery of medication management services to ESRD patients in a dialysis facility-centered model. PMID:23990162

  8. Ingham County Medical Care Facility solar energy project (Engineering Materials)

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

    Not Available

    A complete set of as-built drawings for the Ingham County Geriatric Medical Care Facility's solar water heating system is included. These drawings accompany report No. DOE/CS/32382-T1 and DOE/CS/32382-T2. (LS)

  9. 42 CFR 124.704 - Notification of sale, transfer, or change of use.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    .... 124.704 Section 124.704 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH RESOURCES DEVELOPMENT MEDICAL FACILITY CONSTRUCTION AND MODERNIZATION Recovery of Grant Funds... organization over patient admission, determination of what services will be provided, and charges for services...

  10. 24 CFR 242.44 - Construction standards.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 24 Housing and Urban Development 2 2012-04-01 2012-04-01 false Construction standards. 242.44... MORTGAGE INSURANCE FOR HOSPITALS Construction § 242.44 Construction standards. Work designed and performed... “Guidelines for Construction and Equipment of Hospital and Medical Facilities,” which is regularly updated and...

  11. 24 CFR 242.44 - Construction standards.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 24 Housing and Urban Development 2 2011-04-01 2011-04-01 false Construction standards. 242.44... MORTGAGE INSURANCE FOR HOSPITALS Construction § 242.44 Construction standards. Work designed and performed... “Guidelines for Construction and Equipment of Hospital and Medical Facilities,” which is regularly updated and...

  12. 24 CFR 242.44 - Construction standards.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 24 Housing and Urban Development 2 2014-04-01 2014-04-01 false Construction standards. 242.44... MORTGAGE INSURANCE FOR HOSPITALS Construction § 242.44 Construction standards. Work designed and performed... “Guidelines for Construction and Equipment of Hospital and Medical Facilities,” which is regularly updated and...

  13. Future Challenges in Managing Human Health and Performance Risks for Space Flight

    NASA Technical Reports Server (NTRS)

    Corbin, Barbara J.; Barratt, Michael

    2013-01-01

    The global economy forces many nations to consider their national investments and make difficult decisions regarding their investment in future exploration. To enable safe, reliable, and productive human space exploration, we must pool global resources to understand and mitigate human health & performance risks prior to embarking on human exploration of deep space destinations. Consensus on the largest risks to humans during exploration is required to develop an integrated approach to mitigating risks. International collaboration in human space flight research will focus research on characterizing the effects of spaceflight on humans and the development of countermeasures or systems. Sharing existing data internationally will facilitate high quality research and sufficient power to make sound recommendations. Efficient utilization of ISS and unique ground-based analog facilities allows greater progress. Finally, a means to share results of human research in time to influence decisions for follow-on research, system design, new countermeasures and medical practices should be developed. Although formidable barriers to overcome, International working groups are working to define the risks, establish international research opportunities, share data among partners, share flight hardware and unique analog facilities, and establish forums for timely exchange of results. Representatives from the ISS partnership research and medical communities developed a list of the top ten human health & performance risks and their impact on exploration missions. They also drafted a multilateral data sharing plan to establish guidelines and principles for sharing human spaceflight data. Other working groups are also developing methods to promote international research solicitations. Collaborative use of analog facilities and shared development of space flight research and medical hardware continues. Establishing a forum for exchange of results between researchers, aerospace physicians and program managers takes careful consideration of researcher concerns and decision maker needs. Active participation by researchers in the development of this forum is essential, and the benefit can be tremendous. The ability to rapidly respond to research results without compromising publication rights and intellectual property will facilitate timely reduction in human health and performance risks in support of international exploration missions.

  14. 42 CFR 442.1 - Basis and purpose.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...) MEDICAL ASSISTANCE PROGRAMS STANDARDS FOR PAYMENT TO NURSING FACILITIES AND INTERMEDIATE CARE FACILITIES... of services furnished by nursing facilities and intermediate care facilities for individuals with... agreements; Section 1902(a)(28), nursing facility standards; Section 1902(a)(33)(B), State survey agency...

  15. Association Between Facility-Level Utilization of Non-pharmacologic Chronic Pain Treatment and Subsequent Initiation of Long-Term Opioid Therapy.

    PubMed

    Carey, Evan P; Nolan, Charlotte; Kerns, Robert D; Ho, P Michael; Frank, Joseph W

    2018-05-01

    Expert guidelines recommend non-pharmacologic treatments and non-opioid medications for chronic pain and recommend against initiating long-term opioid therapy (LTOT). We examined whether veterans with incident chronic pain receiving care at facilities with greater utilization of non-pharmacologic treatments and non-opioid medications are less likely to initiate LTOT. Retrospective cohort study PARTICIPANTS: Veterans receiving primary care from a Veterans Health Administration facility with incident chronic pain between 1/1/2010 and 12/31/2015 based on either of 2 criteria: (1) persistent moderate-to-severe patient-reported pain and (2) diagnoses "likely to represent" chronic pain. The independent variable was facility-level utilization of pain-related treatment modalities (non-pharmacologic, non-opioid medications, LTOT) in the prior calendar year. The dependent variable was patient-level initiation of LTOT (≥ 90 days within 365 days) in the subsequent year, adjusting for patient characteristics. Among 1,094,569 veterans with incident chronic pain from 2010 to 2015, there was wide facility-level variation in utilization of 10 pain-related treatment modalities, including initiation of LTOT (median, 16%; range, 5-32%). Veterans receiving care at facilities with greater utilization of non-pharmacologic treatments were less likely to initiate LTOT in the year following incident chronic pain. Conversely, veterans receiving care at facilities with greater non-opioid and opioid medication utilization were more likely to initiate LTOT; this association was strongest for past year facility-level LTOT initiation (adjusted rate ratio, 2.10; 95% confidence interval, 2.06-2.15, top vs. bottom quartile of facility-level LTOT initiation in prior calendar year). Facility-level utilization patterns of non-pharmacologic, non-opioid, and opioid treatments for chronic pain are associated with subsequent patient-level initiation of LTOT among veterans with incident chronic pain. Further studies should seek to understand facility-level variation in chronic pain care and to identify facility-level utilization patterns that are associated with improved patient outcomes.

  16. Proton therapy detector studies under the experience gained at the CATANA facility

    NASA Astrophysics Data System (ADS)

    Cuttone, G.; Cirrone, G. A. P.; Di Rosa, F.; Lojacono, P. A.; Lo Nigro, S.; Marino, C.; Mongelli, V.; Patti, I. V.; Pittera, S.; Raffaele, L.; Russo, G.; Sabini, M. G.; Salamone, V.; Valastro, L. M.

    2007-10-01

    Proton therapy represents the most promising radiotherapy technique for external tumor treatments. At Laboratori Nazionali del Sud of the Istituto Nazionale di Fisica Nucleare (INFN-LNS), Catania (I), a proton therapy facility is active since March 2002 and 140 patients, mainly affected by choroidal and iris melanoma, have been successfully treated. Proton beams are characterized by higher dose gradients and linear energy transfer with respect to the conventional photon and electron beams, commonly used in medical centers for radiotherapy.In this paper, we report the experience gained in the characterization of different dosimetric systems, studied and/or developed during the last ten years in our proton therapy facility.

  17. Musculoskeletal trauma services in Serbia.

    PubMed

    Vukasinović, Zoran; Spasovski, Dusko; Zivković, Zorica

    2008-10-01

    Serbia, a middle-income country, is located in southeastern Europe, with territory of 88,361 km(2) and 9,400,000 inhabitants. Average month salary is US$542 and the registered unemployment rate is 22%. The country is administratively divided into 30 districts (193 municipalities). The healthcare system is territorially organized. In the state capital there are five clinical hospitals with musculoskeletal traumatology departments, as well as one in each of the four university centers. In addition, there are orthopaedic departments in 40 smaller hospitals throughout the country and in three military hospitals, along with several pediatric surgical departments involved in managing musculoskeletal trauma. There are 524 orthopaedic trauma surgeons (1:18,000 people), with a minor number of additionally trained general and pediatric surgeons who care for musculoskeletal problems. Bonesetters are neither recognized nor included in the healthcare system. Orthopaedic traumatology services are well organized, with variable accessibility depending on the distance between injury site and nearest medical facility. Preventive strategies are well developed and mainly consider agricultural, industrial, and traffic injuries. Distribution of medical institutions is satisfactory. Future activities should include continuing medical education of specialists, exclusion of inappropriate specialists, improvement of preventive strategies and medical transport facilities, as well as standardization of medical equipment, diagnostics, and treatment protocols.

  18. The Marketing Mix and Development of Medical Tourism in Shiraz

    PubMed Central

    Jabbari, Alireza; Rahimi Zarchi, Mohammad Kazem; Kavosi, Zahra; Shafaghat, Tahere; Keshtkaran, Ali

    2013-01-01

    Introduction: In recent years, medical tourism market has been raised as one of the income-earning and competitive industries in the world and is considered as a modern field of advanced tourism. Therefore, a great number of countries are seeking to develop this type of tourism and one of the strategies for developing this industry is using the marketing mix elements. Methods: This study was a descriptive-analytic and cross sectional one. The research community included all the public and private hospitals of Shiraz among which, 7 public and 9 private hospitals were studied. The study data were collected through a researcher-made check list whose face and content validity was confirmed by the experts. Then, the data were entered into the SPSS statistical software. According to the objectives of the study, the descriptive results were presented in frequency tables and Chi-square test was used for data analysis. In addition, P<0.05 was considered as statistically significant. Results: According to the results, both public and private hospitals of Shiraz were in the best condition regarding staff and physician mix and in the worst condition concerning promoting and facilities mixes. No significant difference was found between public and private hospitals regarding the mixes. Conclusion: From marketing mix elements view, paying more attention to media advertisements and providing more facilities can improve the status of the hospitals which, consequently, results in attracting more medical tourists and developing this industry in Shiraz. PMID:23678337

  19. 21 CFR 225.20 - Buildings.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... CURRENT GOOD MANUFACTURING PRACTICE FOR MEDICATED FEEDS Construction and Maintenance of Facilities and Equipment § 225.20 Buildings. (a) The location, design, construction, and physical size of the buildings and other production facilities are factors important to the manufacture of medicated feed. The features of...

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

    ERIC Educational Resources Information Center

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

    2009-01-01

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

  1. An Analysis of Medical Imaging Costs in Military Treatment Facilities

    DTIC Science & Technology

    2014-09-01

    authority to completely control the medical systems of each service, the DHA 7 was given management responsibility for specific shared services , functions...efficient health operations through enhanced enterprise-wide shared services . • Deliver more comprehensive primary care and integrated health...of shared services that will fall under central control: • facility planning • medical logistics • health information technology • Tricare health

  2. Management of radioactive material safety programs at medical facilities. Final report

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

    Camper, L.W.; Schlueter, J.; Woods, S.

    A Task Force, comprising eight US Nuclear Regulatory Commission and two Agreement State program staff members, developed the guidance contained in this report. This report describes a systematic approach for effectively managing radiation safety programs at medical facilities. This is accomplished by defining and emphasizing the roles of an institution`s executive management, radiation safety committee, and radiation safety officer. Various aspects of program management are discussed and guidance is offered on selecting the radiation safety officer, determining adequate resources for the program, using such contractual services as consultants and service companies, conducting audits, and establishing the roles of authorized usersmore » and supervised individuals; NRC`s reporting and notification requirements are discussed, and a general description is given of how NRC`s licensing, inspection and enforcement programs work.« less

  3. A Study to Develop a Methodology Determining the Feasibility of Establishing a Blood Collection Program in an Army Healthcare Facility

    DTIC Science & Technology

    1985-05-01

    minimal. The risk of acquiring syphilis through blood transfusions is so rare that American Association of Blood Bank Standards have dropped the...requirement to test for syphilis , although Federal regulations still require it. Malaria can be effectively screened out by excluding potential donors. 2 9 The...murmur or repair of a congenital defect medical director. Listed below are some does not necessarily disqualify a donor. drugs and medical conditions

  4. A Policy Analysis: Military Medical Treatment Facility Contingency Inpatient Expansion

    DTIC Science & Technology

    2005-06-06

    Immunology 3 71B Biochemistry 2 Nurse Corps 66H Medical Surgical Nurse 688 66E Operating Room Nurse 72 66C Psychiatry 30 66N Nurse Administration 18...To) 06-06-2005 Final Report I July 2005 to July 2005 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER A Policy Analysis: Military Medical Treatment Facility...Contingency Inpatient Expansion 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER Kalamaras, Peter Jr., Major, Medical

  5. Extracting Sexual Trauma Mentions from Electronic Medical Notes Using Natural Language Processing.

    PubMed

    Divita, Guy; Brignone, Emily; Carter, Marjorie E; Suo, Ying; Blais, Rebecca K; Samore, Matthew H; Fargo, Jamison D; Gundlapalli, Adi V

    2017-01-01

    Patient history of sexual trauma is of clinical relevance to healthcare providers as survivors face adverse health-related outcomes. This paper describes a method for identifying mentions of sexual trauma within the free text of electronic medical notes. A natural language processing pipeline for information extraction was developed and scaled to handle a large corpus of electronic medical notes used for this study from US Veterans Health Administration medical facilities. The tool was used to identify sexual trauma mentions and create snippets around every asserted mention based on a domain-specific lexicon developed for this purpose. All snippets were evaluated by trained human reviewers. An overall positive predictive value (PPV) of 0.90 for identifying sexual trauma mentions from the free text and a PPV of 0.71 at the patient level are reported. The metrics are superior for records from female patients.

  6. Manpower in Oklahoma: Health Occupations.

    ERIC Educational Resources Information Center

    DeSpain, Don

    In a survey of Oklahoma business designed to develop occupational data for the present and future, 300 occupations were selected and 11 schedules prepared to reflect various types of firms. The schedule concerning medical and other health services facilities was sent to nearly 200 firms and institutions and usable information was received from…

  7. 42 CFR 124.704 - Notification of sale, transfer, or change of use.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 1 2012-10-01 2012-10-01 false Notification of sale, transfer, or change of use. 124.704 Section 124.704 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH RESOURCES DEVELOPMENT MEDICAL FACILITY CONSTRUCTION AND MODERNIZATION Recovery of Grant Funds...

  8. 42 CFR 124.704 - Notification of sale, transfer, or change of use.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 1 2014-10-01 2014-10-01 false Notification of sale, transfer, or change of use. 124.704 Section 124.704 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH RESOURCES DEVELOPMENT MEDICAL FACILITY CONSTRUCTION AND MODERNIZATION Recovery of Grant Funds...

  9. 42 CFR 124.704 - Notification of sale, transfer, or change of use.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 1 2013-10-01 2013-10-01 false Notification of sale, transfer, or change of use. 124.704 Section 124.704 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH RESOURCES DEVELOPMENT MEDICAL FACILITY CONSTRUCTION AND MODERNIZATION Recovery of Grant Funds...

  10. Space Station Freedom CHeCS overview. [Crew Health Care System

    NASA Technical Reports Server (NTRS)

    Boyce, Joey B.

    1990-01-01

    The current status, progress, and future plans for development of the Crew Health Care System (CHeCS) for the International Space Station Freedom are presented. Essential operational biomedical support requirements for the astronauts, including medical care, environmental habitat monitoring, and countermeasures for the potentially maladaptive physiological effects of space flight will be provided by the CHeCS. Three integral parts will make up the system: a health maintenance facility, an environmental health system, and the exercise countermeasures facility. Details of each of the major systems and their subsystems are presented.

  11. Combining medically assisted treatment and Twelve-Step programming: a perspective and review.

    PubMed

    Galanter, Marc

    2018-01-01

    People with severe substance use disorders require long-term rehabilitative care after the initial treatment. There is, however, a deficit in the availability of such care. This may be due both to inadequate medical coverage and insufficient use of community-based Twelve-Step programs in many treatment facilities. In order to address this deficit, rehabilitative care for severe substance use disorders could be promoted through collaboration between practitioners of medically assisted treatment, employing medications, and Twelve-Step-oriented practitioners. To describe the limitations and benefits in applying biomedical approaches and Twelve-Step resources in the rehabilitation of persons with severe substance use disorders; and to assess how the two approaches can be employed together to improve clinical outcome. Empirical literature focusing on clinical and manpower issues is reviewed with regard (a) to limitations in available treatment options in ambulatory and residential addiction treatment facilities for persons with severe substance use disorders, (b) problems of long-term rehabilitation particular to opioid-dependent persons, associated with the limitations of pharmacologic approaches, (c) the relative effectiveness of biomedical and Twelve-Step approaches in the clinical context, and (d) the potential for enhanced use of these approaches, singly and in combination, to address perceived deficits. The biomedical and Twelve-Step-oriented approaches are based on differing theoretical and empirically grounded models. Research-based opportunities are reviewed for improving addiction rehabilitation resources with enhanced collaboration between practitioners of these two potentially complementary practice models. This can involve medications for both acute and chronic treatment for substances for which such medications are available, and Twelve-Step-based support for abstinence and long-term rehabilitation. Clinical and Scientific Significance: Criteria for developing evidence-based approaches for combined treatment should be developed, and research for evidence-based treatment on this basis can be undertaken in order to develop improved clinical outcome.

  12. Introducing medication abortion into public sector facilities in KwaZulu-Natal, South Africa: an operations research study.

    PubMed

    Blanchard, Kelly; Lince-Deroche, Naomi; Fetters, Tamara; Devjee, Jaymala; de Menezes, Ilundi Durão; Trueman, Karen; Sudhinaraset, May; Nkonko, Errol; Moodley, Jack

    2015-10-01

    Examine the feasibility of introducing mifepristone-misoprostol medication abortion into existing public sector surgical abortion services in KwaZulu-Natal, South Africa. Cohort study of women offered medication or surgical abortion in a larger medication abortion introduction study. The sample included 1167 women seeking first-trimester abortion at four public sector facilities; 923 women at ≤9 weeks' gestation were eligible for medication abortion. Women who chose medication abortion took 200 mg of mifepristone orally at the facility and 800 mcg of misoprostol buccally (or vaginally if they anticipated or experienced problems with buccal administration) 48 h later at home, based on international research and global safe abortion guidelines. Women who chose surgical abortion received 600 mg of misoprostol sublingually or vaginally on the day of their procedure followed by manual vacuum aspiration 4 h later. Main outcome measures included proportion of eligible women who chose each method, proportion with complete abortion and proportion reporting adverse events. Ninety-four percent of eligible women chose medication abortion. No adverse events were reported by women who chose surgical abortion; 3% of women in the medication abortion group reported adverse events and 0.4% reported a serious adverse event. Seventy-six percent of women received a family planning method at the facility where their received their abortion, with no difference based on procedure type. Medication abortion patients were significantly more likely to report they would choose this method again (94% vs. 78%, p<.001) and recommend the method to a friend (98% vs. 84%, p<.001). Medication abortion was successfully introduced with low and acceptable rates of adverse events; most women at study facilities chose this option. Mifepristone-misoprostol medication abortion was successfully integrated into public sector surgical abortion services in South Africa and was chosen by a large majority of women who were eligible and offered choice of early termination method; access to medication abortion should be expanded in South Africa and other similar settings. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Medical response of a physician and two nurses to the mass-casualty event resulting in the Phi Phi Islands from the tsunami.

    PubMed

    Ammartyothin, Surasak; Ashkenasi, Issac; Schwartz, Dagan; Leiba, Adi; Nakash, Guy; Pelts, Rami; Goldberg, Avishay; Bar-Dayan, Yaron

    2006-01-01

    The Phi Phi Islands are isolated islands located about one hour by ship from the mainland in Krabi province of Thailand. There is a small medical facility where the director is the one physician that provides care to residents and tourists. This small medical facility faced an enormous mass casualty incident due to the 2004 Tsunami. The hospital was damaged by the Tsunami wave and was not functional, one crew member died and another was injured. Medical care and evacuation posed a unique problem in the Phi Phi Islands due to remoteness, limited medical resources, lack of effective communication with the main land and the large number of victims. An alternative medical facility was located in a nearby hotel. The crew included the medical director, two nurses, two additional staff members, 10 local volunteers, and hotel staff members. The medical crew had to treat 600-700 casualties in 24 hours. Most of the victims were mildly injured, but approximately 100 (15%) of the victims could not walk due to their injuries. The medical director, made a conscious decision to initially treat only circulation ("C") problems, by controlling external hemorrhages. This decision was driven by the lack of equipment and personnel to deal with airway ("A") and breathing ("B") problems. In the post-disaster debriefing, the Phi Phi Island hospital physician noted five major lessons concerning disaster management in such extreme situation in a small facility located in a remote area: (1) effective resistant communication facilities must be ensured; (2) clear, simple "evacuation plans" should be made in advance; (3) plans should be made to ensure automatic reinforcement of remote areas with evacuation vehicles, medical equipment and medical personnel; (4) efficient cooperation with medical volunteers must be planned and drilled; and (5) every team member of such a hospital must participate in an educational program and periodic drills should be done to improve the disaster and emergency medicine capabilities. This case report is an example for caregivers all over the world, of an amazing lesson of leadership and courage.

  14. Reaching help on time in an emergency delivery.

    PubMed

    1991-01-01

    Many maternal deaths in developing countries occur because mothers with complicated pregnancies or deliveries cannot be transported at all or fast enough to a health facility. A pregnant woman hemorrhaging greatly had to wait for a taxi because an unauthorized person had the health center's vehicle in Tanzania. Since most physicians practice in cities, most maternal deaths involve rural women. Further the less educated, lower the socioeconomic status, and lower the family's income the more likely she is to die. 3 phases contributed to transport delays of pregnant women. The 1st phase includes the time it take for a woman and her family to decide if her condition is serious enough to require medical attention, and if so, can they afford to pay for transport. Sometimes the services scare her or she considers the services to be of poor quality. The next phase involves the availability of transport and the distance between the mother and the services. Indeed in Nigeria, 96% of mothers who do not use medical delivery services report that they do not do so because of distance. Once at the health facility, the waiting period between arrival and meeting the woman's medical needs make up the 3rd phase. Often health facilities have inadequate number of medical personnel. Moreover the family must buy needed medical supplies before treatment can even begin. Alarm and transport systems are needed. In 1 area of India, pigeons carry messages to a physician that a woman is experiencing labor difficulties. Prior to the civil war in Somalia, a distinct flag informed passing motorists that emergency transport was needed for a pregnant woman who was carried to the roadside on a stretcher or in a cart. High technology transport is not cost effective and should not be part of a primary health care system.

  15. Compact ECR ion source with permanent magnets for carbon therapy

    NASA Astrophysics Data System (ADS)

    Muramatsu, M.; Kitagawa, A.; Sakamoto, Y.; Sato, Y.; Yamada, S.; Ogawa, H.; Drentje, A. G.; Biri, S.; Yoshida, Y.

    2004-05-01

    Ion sources for the medical facilities should have the following characteristics of easy maintenance, low electric power, good stability, and long operation time without trouble (1 year or longer). For this, a 10 GHz compact electron cyclotron resonance ion source (ECRIS) with all permanent magnets was developed. The beam intensity and stability for C4+ were 280 e μA and better than 6% during 20 h with no adjustment of any source parameters. These results were acceptable for the medical requirements. Recently, many plans were proposed to construct the next generation cancer treatment facility. For such a facility we have designed an all permanent magnet ECRIS, in which a high magnetic field is chosen for increasing the beam intensity. The maximum mirror magnetic fields on the beam axis are 0.59 T at the extraction side and 0.87 T at the gas injection side, while the minimum B strength is 0.25 T. The source has a diameter of 32 cm and a length of 29.5 cm. Details of the design of this source and its background are described in this article.

  16. 42 CFR 431.105 - Consultation to medical facilities.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... State agencies furnish consultative services to hospitals, nursing homes, home health agencies, clinics... 42 Public Health 4 2010-10-01 2010-10-01 false Consultation to medical facilities. 431.105 Section 431.105 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN...

  17. 32 CFR 728.79 - Employees of Federal contractors and subcontractors.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Other Persons... nervous, mental, or contagious diseases or those requiring domiciliary care. Routine dental care, other than dental prosthesis and orthodontia, is authorized on a space available basis provided facilities...

  18. 32 CFR 728.79 - Employees of Federal contractors and subcontractors.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Other Persons... nervous, mental, or contagious diseases or those requiring domiciliary care. Routine dental care, other than dental prosthesis and orthodontia, is authorized on a space available basis provided facilities...

  19. 32 CFR 728.79 - Employees of Federal contractors and subcontractors.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Other Persons... nervous, mental, or contagious diseases or those requiring domiciliary care. Routine dental care, other than dental prosthesis and orthodontia, is authorized on a space available basis provided facilities...

  20. 32 CFR 728.79 - Employees of Federal contractors and subcontractors.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... PERSONNEL MEDICAL AND DENTAL CARE FOR ELIGIBLE PERSONS AT NAVY MEDICAL DEPARTMENT FACILITIES Other Persons... nervous, mental, or contagious diseases or those requiring domiciliary care. Routine dental care, other than dental prosthesis and orthodontia, is authorized on a space available basis provided facilities...

  1. 42 CFR 436.112 - Individuals who would be eligible for cash assistance except for increased OASDI under Pub. L. 92...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... were not in a medical institution or intermediate care facility, and the Medicaid plan covered this... assistance if he were not in a medical institution or intermediate care facility, and the Medicaid plan...

  2. 42 CFR 436.112 - Individuals who would be eligible for cash assistance except for increased OASDI under Pub. L. 92...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... were not in a medical institution or intermediate care facility, and the Medicaid plan covered this... assistance if he were not in a medical institution or intermediate care facility, and the Medicaid plan...

  3. 42 CFR 436.112 - Individuals who would be eligible for cash assistance except for increased OASDI under Pub. L. 92...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... were not in a medical institution or intermediate care facility, and the Medicaid plan covered this... assistance if he were not in a medical institution or intermediate care facility, and the Medicaid plan...

  4. 38 CFR 17.1006 - Decisionmakers.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... Reimbursement for Emergency Services for Nonservice-Connected Conditions in Non-Va Facilities § 17.1006 Decisionmakers. The Chief of the Health Administration Service or an equivalent official at the VA medical.... 1725, except that the Fee Service Review Physician or equivalent officer at the VA medical facility of...

  5. 38 CFR 17.1006 - Decisionmakers.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Reimbursement for Emergency Services for Nonservice-Connected Conditions in Non-Va Facilities § 17.1006 Decisionmakers. The Chief of the Health Administration Service or an equivalent official at the VA medical.... 1725, except that the Fee Service Review Physician or equivalent officer at the VA medical facility of...

  6. Establishing Medical Schools in Limited Resource Settings.

    PubMed

    Tsinuel, Girma; Tsedeke, Asaminew; Matthias, Siebeck; Fischer, Martin R; Jacobs, Fabian; Sebsibe, Desalegn; Yoseph, Mamo; Abraham, Haileamlak

    2016-05-01

    One urgent goal of countries in sub-Saharan Africa is to dynamically scale up the education and work force of medical doctors in the training institutions and health facilities, respectively. These countries face challenges related to the rapid scale up which is mostly done without proper strategic planning, without the basic elements of infrastructure development, educational as well as academic and administrative human resources. Medical education done in the context of limited resources is thus compromising the quality of graduates. In the future, a collaborative and need-based approach involving major stakeholders such as medical educators concerned, ministries, planners and policy makers is needed. This article identifies the challenges of establishing medical schools and sustaining the quality of education through rapid scale-up in Sub-Saharan Africa in the settings of limited resources. It also outlines the minimum requirements for establishing medical schools. A consensus building workshop was conducted in Bishoftu, Ethiopia, from Nov 8-12, 2013. Participants were professionals from 13 Ethiopian medical schools, and representatives of medical schools from South Sudan, Somaliland, Somalia, and Mozambique. Participants are listed in Appendix 1. The governments and stakeholders should jointly develop strategic plans and a roadmaps for opening or expanding medical schools to scale up educational resources. It is advisable that medical schools have autonomy regarding the number of student-intake, student selection, curriculum ownership, resource allocation including for infrastructure and staff development. Health science and medical curricula should be integrated within and harmonized nationally. An educational evaluation framework needs to be embedded in the curricula, and all medical schools should have Health Science Education Development Centers.

  7. Social work services in Army medical treatment facilities: are they reorganizing?

    PubMed

    Hamlin, E R; Pehrson, K L; Gemmill, R

    1996-01-01

    The end of the Cold War and the fall of Communism in Europe resulted in profound changes in U.S. defense policy. Those changes led to dramatic reductions in personnel and programs within the Army. The Army Medical Department (AMEDD) is also being reduced in size and reorganized. At the same time, the AMEDD is facing escalating health care costs associated with demand and access to medical care. Social work services in Army medical treatment facilities are being directly affected by these system changes. Therefore, the question is raised whether changes in the organization and delivery of social work services are being initiated or anticipated. To what extent are social work chiefs of service involved in these decisions at the medical treatment facility level, and what are the positive and negative effects of reorganization on social work staff and the clients they serve?

  8. Low Prevalence of Chronic Beryllium Disease among Workers at a Nuclear Weapons Research and Development Facility

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

    Arjomandi, M; Seward, J P; Gotway, M B

    2010-01-11

    To study the prevalence of beryllium sensitization (BeS) and chronic beryllium disease (CBD) in a cohort of workers from a nuclear weapons research and development facility. We evaluated 50 workers with BeS with medical and occupational histories, physical examination, chest imaging with HRCT (N=49), and pulmonary function testing. Forty of these workers also underwent bronchoscopy for bronchoalveolar lavage (BAL) and transbronchial biopsies. The mean duration of employment at the facility was 18 yrs and the mean latency (from first possible exposure) to time of evaluation was 32 yrs. Five of the workers had CBD at the time of evaluation (basedmore » on histology or HRCT); three others had evidence of probable CBD. These workers with BeS, characterized by a long duration of potential Be exposure and a long latency, had a low prevalence of CBD.« less

  9. Low Prevalence of Chronic Beryllium Disease Among Workers at aNuclearWeaponsResearchandDevelopmentFacility

    PubMed Central

    Arjomandi, Mehrdad; Seward, James; Gotway, Michael B.; Nishimura, Stephen; Fulton, George P.; Thundiyil, Josef; King, Talmadge E.; Harber, Philip; Balmes, John R.

    2012-01-01

    Objective To study the prevalence of beryllium sensitization (BeS) and chronic beryllium disease (CBD) in a cohort of workers from a nuclear weapons research and development facility. Methods We evaluated 50 workers with BeS with medical and occupational histories, physical examination, chest imaging with high-resolution computed tomography (N = 49), and pulmonary function testing. Forty of these workers also underwent bronchoscopy for bronchoalveolar lavage and transbronchial biopsies. Results The mean duration of employment at the facility was 18 years and the mean latency (from first possible exposure) to time of evaluation was 32 years. Five of the workers had CBD at the time of evaluation (based on histology or high-resolution computed tomography); three others had evidence of probable CBD. Conclusions These workers with BeS, characterized by a long duration of potential Be exposure and a long latency, had a low prevalence of CBD. PMID:20523233

  10. Smoke-Free Medical Facility Campus Legislation: Support, Resistance, Difficulties and Cost

    PubMed Central

    Sheffer, Christine; Stitzer, Maxine; Wheeler, J. Gary

    2009-01-01

    Although medical facilities restrict smoking inside, many people continue to smoke outside, creating problems with second-hand smoke, litter, fire risks, and negative role modeling. In 2005, Arkansas passed legislation prohibiting smoking on medical facility campuses. Hospital administrators (N=113) were surveyed pre- and post-implementation. Administrators reported more support and less difficulty than anticipated. Actual cost was 10–50% of anticipated cost. Few negative effects and numerous positive effects on employee performance and retention were reported. The results may be of interest to hospital administrators and demonstrate that state legislation can play a positive role in facilitating broad health-related policy change. PMID:19440281

  11. Compact solar autoclave based on steam generation using broadband light-harvesting nanoparticles

    PubMed Central

    Neumann, Oara; Feronti, Curtis; Neumann, Albert D.; Dong, Anjie; Schell, Kevin; Lu, Benjamin; Kim, Eric; Quinn, Mary; Thompson, Shea; Grady, Nathaniel; Nordlander, Peter; Oden, Maria; Halas, Naomi J.

    2013-01-01

    The lack of readily available sterilization processes for medicine and dentistry practices in the developing world is a major risk factor for the propagation of disease. Modern medical facilities in the developed world often use autoclave systems to sterilize medical instruments and equipment and process waste that could contain harmful contagions. Here, we show the use of broadband light-absorbing nanoparticles as solar photothermal heaters, which generate high-temperature steam for a standalone, efficient solar autoclave useful for sanitation of instruments or materials in resource-limited, remote locations. Sterilization was verified using a standard Geobacillus stearothermophilus-based biological indicator. PMID:23836642

  12. Expansion of Safe Abortion Services in Nepal Through Auxiliary Nurse‐Midwife Provision of Medical Abortion, 2011‐2013

    PubMed Central

    Basnett, Indira; Shrestha, Dirgha Raj; Shrestha, Meena Kumari; Shah, Mukta; Aryal, Shilu

    2016-01-01

    Introduction The termination of unwanted pregnancies up to 12 weeks’ gestation became legal in Nepal in 2002. Many interventions have taken place to expand access to comprehensive abortion care services. However, comprehensive abortion care services remain out of reach for women in rural and remote areas. This article describes a training and support strategy to train auxiliary nurse‐midwives (ANMs), already certified as skilled birth attendants, as medical abortion providers and expand geographic access to safe abortion care to the community level in Nepal. Methods This was a descriptive program evaluation. Sites and trainees were selected using standardized assessment tools to determine minimum facility requirements and willingness to provide medical abortion after training. Training was evaluated via posttests and observational checklists. Service statistics were collected through the government's facility logbook for safe abortion services (HMIS‐11). Results By the end of June 2014, medical abortion service had been expanded to 25 districts through 463 listed ANMs at 290 listed primary‐level facilities and served 25,187 women. Providers report a high level of confidence in their medical abortion skills and considerable clinical knowledge and capacity in medical abortion. Discussion The Nepali experience demonstrates that safe induced abortion care can be provided by ANMs, even in remote primary‐level health facilities. Post‐training support for providers is critical in helping ANMs handle potential barriers to medical abortion service provision and build lasting capacity in medical abortion. PMID:26860072

  13. SMS-Based Medical Diagnostic Telemetry Data Transmission Protocol for Medical Sensors

    PubMed Central

    Townsend, Ben; Abawajy, Jemal; Kim, Tai-Hoon

    2011-01-01

    People with special medical monitoring needs can, these days, be sent home and remotely monitored through the use of data logging medical sensors and a transmission base-station. While this can improve quality of life by allowing the patient to spend most of their time at home, most current technologies rely on hardwired landline technology or expensive mobile data transmissions to transmit data to a medical facility. The aim of this paper is to investigate and develop an approach to increase the freedom of a monitored patient and decrease costs by utilising mobile technologies and SMS messaging to transmit data from patient to medico. To this end, we evaluated the capabilities of SMS and propose a generic communications protocol which can work within the constraints of the SMS format, but provide the necessary redundancy and robustness to be used for the transmission of non-critical medical telemetry from data logging medical sensors. PMID:22163845

  14. Dialysis facility and patient characteristics associated with utilization of home dialysis.

    PubMed

    Walker, David R; Inglese, Gary W; Sloand, James A; Just, Paul M

    2010-09-01

    Nonmedical factors influencing utilization of home dialysis at the facility level are poorly quantified. Home dialysis is comparably effective and safe but less expensive to society and Medicare than in-center hemodialysis. Elimination of modifiable practice variation unrelated to medical factors could contribute to improvements in patient outcomes and use of scarce resources. Prevalent dialysis patient data by facility were collected from the 2007 ESRD Network's annual reports. Facility characteristic data were collected from Medicare's Dialysis Facility Compare file. A multivariate regression model was used to evaluate associations between the use of home dialysis and facility characteristics. The utilization of home dialysis was positively associated with facility size, percent patients employed full- or part-time, younger population, and years a facility was Medicare certified. Variables negatively associated include an increased number of hemodialysis patients per hemodialysis station, chain association, rural location, more densely populated zip code, a late dialysis work shift, and greater percent of black patients within a zip code. Improved understanding of factors affecting the frequency of use of home dialysis may help explain practice variations across the United States that result in an imbalanced use of medical resources within the ESRD population. In turn, this may improve the delivery of healthcare and extend the ability of an increasingly overburdened medical financing system to survive.

  15. How do patients respond to violation of their information privacy?

    PubMed

    Kuo, Kuang-Ming; Ma, Chen-Chung; Alexander, Judith W

    The introduction of electronic medical records (EMRs) can expose patients to the risk of infringement of their privacy. The purpose of this study was to explore the relationship between patients' concerns about information privacy and their protective responses. A questionnaire survey conducted in a Taiwanese hospital revealed that, regarding information privacy, patients' concerns about the collection of information about themselves, the secondary use of this information and the possibility of errors in the recorded information were associated with their information privacy-protective responses, while concern for unauthorised access to their information by other staff in the medical facility was not. Medical facilities should devote every effort to alleviate patients' concerns about the invasion of their information privacy to avoid eroding the reputation of medical facilities and impeding the promotion of EMRs.

  16. [Development in the National Hospice Care Service in Korea].

    PubMed

    Lee, S W; Lee, E O; Ahn, H S; Heo, D S; Kim, D S; Kim, H S; Lee, H J

    1997-01-01

    The urgent needs to establish hospice care systems in Korea arise from the following reasons: (1) a drastic increase in chronically ill patients with the increase of aged population: (2) rapid changes in living environment from the traditional habitation (e.g., Many Koreans living in apartment complexes, which is the most popular form of modern residence in recent years, prefer to die in the hospital.): the overall increase in patients with advanced cancer: (4) recent trends in early discharge of terminally ill patients from the limited hospital facilities to accommodate other medical insurance beneficiaries: (5) easy acceptance of euthanasia owing to the recent social atmosphere that belittles the dignity of human life: (6) medical and nursing care of AIDS patient in terminal stage: (7) and the problem associated with inhumane medical care system, overtreatment, and groundless fears against narcotics. Terminally ill patients were used to be treated in the hospital in the past. In these days, however, they are forced to have home cares with little assistance from the qualified medical personnel because of insufficient hospital facilities, which are even short for the need of emergency patients and provide priority cares to medical insurance beneficiaries with other acute problems. And yet, neither are there any administrative organizations nor systematic medical studies that deal with the level of terminally ill patient's need, their family's problems and resources of hospice care systems in Korea. Thus, most patients are not able to get appropriate medical care at the terminal stage of their lives. The objective of this study is to make comprehensive database for various hospice care organization currently in operation, link them through medical information system, and develop an easily accessible hospice care model that meets the need of most Korean people. Our survey results may be summarized as follows: Nationally there are 40 organizations that provide partial or full hospice care. However, these organizations are not linked to any formal medical service network. Furthermore, the objective of hospice care, care principles, personnel with appropriate training, educational programs, standard for care, costs, consulting service to patients' family members, the extent of medical care from professional staff members, status of hospice facility, and management of those institutions are neither clearly defined nor organized compared to the international hospice care standards. The surveys on patients of terminal stage, grouped in hospice and non-hospice care patients, reveal what they want visiting nursing care to help their pain control, psychological, social and spiritual demands. While the more than 90% of hospice care patients want to reduce their pains, the non-hospice care patients, in addition to their desire for pain control, demanded more psychological, social and spiritual helps as well. The results of this research could be utilized to (1) define the standard of hospice care, (2) provide the guidance for hospice medical care costs, (3) establish the database of hospice care systems, (4) develop softwares, (5) build communication network through Medinet, and (6) provide an organized visiting home nursing care system. These information should be a valuable resource to many medical staffs who are involved in cancer therapy, nursing care, and social welfare programs.

  17. Basic Military Justice Handbook. Revision

    DTIC Science & Technology

    1989-01-01

    copies. Note: The accused will be escorted to the local medical facility for a preconfinement physical. This is a function of your master-at-arms...5004 of ref (a). a. Retrieved dependent ID cards. b. If not surrendered, notify local medical facilities and military activities. c. A terminate DD 1172...dental records, and secure physical immediately before trial (or notify medical people of need). B. POST-TRIAL MATTERS 1. Assure confinement order is

  18. Area Handbook Series: Costa Rica, a Country Study.

    DTIC Science & Technology

    1983-11-01

    schools, and medical facilities without compensation. Citing the new con- tract as a precedent, the administration likewise more than dou- bled personal...sugar plantations has also been steady but has not paid nearly as well. Moreover, the housing, medical , and other facilities provided by the foreign...caused by illness in the early 1980s was comparatively low, and the availability of medical care and preventive measures was fairly widespread. Rates of

  19. [For the history of creation of central anatomicopathological facility of the Ministry of Defence].

    PubMed

    Chirskiĭ, V S; Sibirev, S A; Bushurov, S E

    2012-12-01

    The system of anatomicopathological facilities was created in 30s of XX century and first years of the Great Patriotic War. The goal of this system was to increase the effectiveness of Sanitary Corps of the Red Army. These anatomicopathological facilities analyzed causes of death of injured soldiers during all stages of the system of treatment-evacuative support of troops and mistakes made by medical specialists during first aid treatment. Organisational forms of anatomicopathological activity were changed and developed according to acquired battle experience. The main stage of formation of anatomicopathological service of the Red Army, and in fact the finished period in organisational formation of anatomicopathological service, was establishment of Central anatomicopathological facility - main methodological, organisational, coordinating and monioring center of anatomicopathological activity of the Armed Forces of the Russian Federation.

  20. Is psychotropic medication use related to organisational and treatment culture in residential care.

    PubMed

    Peri, Kathryn; Kerse, Ngaire; Moyes, Simon; Scahill, Shane; Chen, Charlotte; Hong, Jae Beom; Hughes, Carmel M

    2015-01-01

    The purpose of this paper is to establish the relationship between organisational culture and psychotropic medication use in residential care. Cross-sectional analyses of staff and resident's record survey in residential aged care facilities in Auckland, New Zealand (NZ). The competing values framework categorised organisational culture as clan, hierarchical, market driven or adhocracy and was completed by all staff. The treatment culture tool categorised facilities as having resident centred or traditional culture and was completed by registered nursing staff and general practitioners (GP). Functional and behavioural characteristics of residents were established by staff report and health characteristics and medications used were ascertained from the health record. Multiple regression was used to test for associations between measures of culture with psychotropic medication use (anxiolytics, sedatives, major tranquillisers). In total 199 staff, 27 GP and 527 residents participated from 14 facilities. On average 8.5 medications per resident were prescribed and 42 per cent of residents received psychotropic medication. Having a diagnosis of anxiety or depression (odds ratio (OR) 3.18, 95 per cent confidence interval (CI) 1.71, 5.91), followed by persistent wandering (OR 2.53, 95 per cent CI 1.59, 4.01) and being in a dementia unit (OR 2.45, 95 per cent CI 1.17, 5.12) were most strongly associated with psychotropic use. Controlling for resident- and facility-level factors, health care assistants' assignation of hierarchical organisational culture type was independently associated with psychotropic medication use, (OR 1.29, CI 1.08, 1.53) and a higher treatment culture score from the GP was associated with lower use of psychotropic medication (OR 0.95, CI 0.92, 0.98). Psychotropic medication use remains prevalent in residential care facilities in NZ. Interventions aimed at changing organisational culture towards a less hierarchical and more resident-centred culture may be another avenue to improve prescribing in residential aged care.

  1. Current status of collaborative relationships between dialysis facilities and dental facilities in Japan: results of a nationwide survey.

    PubMed

    Yoshioka, Masami; Shirayama, Yasuhiko; Imoto, Issei; Hinode, Daisuke; Yanagisawa, Shizuko; Takeuchi, Yuko

    2015-02-12

    Recent studies have reported an association between periodontal disease and mortality among dialysis patients. Therefore, preventive dental care should be considered very important for this population. In Japan, no systematic education has been undertaken regarding the importance of preventive dental care for hemodialysis patients--even though these individuals tend to have oral and dental problems. The aim of this study was to investigate the current state of collaborative relationships between hemodialysis facilities and dental services in Japan and also to identify strategies to encourage preventive dental visits among hemodialysis outpatients. A nationwide questionnaire on the collaborative relationship between dialysis facilities and dental facilities was sent by mail to all medical facilities in Japan offering outpatient hemodialysis treatment. Responses were obtained from 1414 of 4014 facilities (35.2%). Among the 1414 facilities, 272 (19.2%) had a dental service department. Approximately 100,000 dialysis outpatients were receiving treatment at these participating facilities, which amounts to one-third of all dialysis patients in Japan. Of those patients, 82.9% received hemodialysis at medical facilities without dental departments. Only 87 of 454 small clinics without in-house dental departments (19.2%) had collaborative registered dental clinics. Medical facilities with registered dental clinics demonstrated a significantly more proactive attitude to routine collaboration on dental matters than facilities lacking such clinics. Our nationwide survey revealed that most dialysis facilities in Japan have neither an in-house dental department nor a collaborative relationship with a registered dental clinic. Registration of dental clinics appears to promote collaboration with dental facilities on a routine basis, which would be beneficial for oral health management in hemodialysis patients.

  2. The Cost of Deploying a Role 2 Medical Asset to Afghanistan.

    PubMed

    Childers, Richard; Parker, Paul

    2015-11-01

    The costs of military assets, including medical resources, are necessary for military planners when determining their force make up. The monetary cost of operating a Role 3 unit, the most comprehensive medical asset in the combat theater, has been determined. The cost of operating a Role 2 (R2) facility-the less comprehensive but more common asset-has not been assessed. Here we estimate the cost of operating an R2 medical asset in Afghanistan. Personnel costs were assessed by combining the U.S. Department of Defense estimate for personnel cost with the replacement costs for deployed staff. Manning was for a U.S. Marine Corps Shock Trauma Platoon and Forward Resuscitative Surgical System. It costs $2,956,873 a month to operate an R2 medical facility in Afghanistan. It also takes the place of a rifle platoon and disrupts the domestic military health care mission. The costs of operating an R2 medical facility are significant and should be considered when the medical benefits of an R2 are unclear. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

  3. 2014 QuickCompass of TRICARE Child Beneficiaries: Utilization of Medicaid-Waivered Services. Tabulation of Responses

    DTIC Science & Technology

    2014-08-30

    management) Long term care (e.g., home health care, hospice, integrated personal care, intermediate care facilities for the mentally retarded, nurse ... aide training and testing, and nursing facilities) Medical equipment (e.g., medically necessary supplies, including oxygen, catheters, and reusable

  4. Cross-border issues in the development of medical tourism in Malaysia: legal challenges and opportunities.

    PubMed

    Nemie, Puteri; Kassim, Jahn

    2009-08-01

    Strategically located at the crossroads of Asia, Malaysia has become one of the key players in the fast-growing and lucrative market for health care services in Asia. Medical travel across international boundaries has been made possible through affordable airfares and the favourable exchange rates of the Malaysian ringgit has contributed to the rise of the "medical tourism phenomenon" where medical travel is combined with visiting popular tourist destinations in Malaysia. Further, competitive medical fees and modern medical facilities have also made Malaysia a popular destination for medical tourists. Nevertheless, the increased number of foreign patients has opened up possibilities of Malaysian health care providers being subjected to malpractice claims and triggering a myriad of cross-border legal issues. Presently, there is no internationally accepted legal framework to regulate medical tourism and issues of legal redress in relation to unsatisfactory provision of treatment across international boundaries. The economic benefits of medical tourism must be based upon a solid legal regulatory framework and strong ethical standards as well as upon high-quality medical and health care services. It is therefore important to assess the existing legal framework affecting the development of medical tourism in Malaysia in order to explore the gaps, deficiencies and possibilities for legal and regulatory reform.

  5. Medical devices made into weapons by prisoners: an unrecognized risk.

    PubMed

    Hayden, J W; Laney, C; Kellermann, A L

    1995-12-01

    The alteration of a knee immobilizer into a sharp weapon by a prisoner prompted us to survey neighboring penal institutions to determine the frequency of such events. We mailed a nine-item survey to all detention facilities in Tennessee, Arkansas, and Mississippi. A second survey was sent to nonresponding institutions 6 weeks after the initial mailing. The Regional Medical Center at Memphis, the designated facility for evaluation and treatment of prisoners from the county jail and state penitentiary. Survey respondents included 25 state penitentiaries, 31 county jails, 1 state minimum-security facility, 1 state maximum-security facility, 1 work-release center, 1 county detention center for drunken-driving offenders, and 1 federal penitentiary. Of the 81 institutions surveyed, 77% responded to one of the two mailings. Forty percent responded in the affirmative when asked whether stolen or unauthorized medical equipment from outside their institutions had been discovered among inmates. When respondents were questioned as to whether medical equipment, prescribed or not, had been used or altered in a criminal manner, 34% responded "yes." Medications and medical appliances were listed in the responses. A survey of 81 local and neighboring penal institutions in a three-state area revealed that the illicit use of medicine and medical devices by prisoners is a legitimate safety concern of prison personnel and health care workers when medical care for inmates must be sought outside the security of their institutions. The modification of medical equipment into weapons by incarcerated patients, although clearly recognized as a security and safety problem by police authorities, appears to be unappreciated by health care workers providing episodic care to inmates.

  6. Radiotherapy and Nuclear Medicine Project for an Integral Oncology Center at the Oaxaca High Specialization Regional Hospital

    NASA Astrophysics Data System (ADS)

    De Jesús, M.; Trujillo-Zamudio, F. E.

    2010-12-01

    A building project of Radiotherapy & Nuclear Medicine services (diagnostic and therapy), within an Integral Oncology Center (IOC), requires interdisciplinary participation of architects, biomedical engineers, radiation oncologists and medical physicists. This report focus on the medical physicist role in designing, building and commissioning stages, for the final clinical use of an IOC at the Oaxaca High Specialization Regional Hospital (HRAEO). As a first step, during design stage, the medical physicist participates in discussions about radiation safety and regulatory requirements for the National Regulatory Agency (called CNSNS in Mexico). Medical physicists propose solutions to clinical needs and take decisions about installing medical equipment, in order to fulfill technical and medical requirements. As a second step, during the construction stage, medical physicists keep an eye on building materials and structural specifications. Meanwhile, regulatory documentation must be sent to CNSNS. This documentation compiles information about medical equipment, radioactivity facility, radiation workers and nuclear material data, in order to obtain the license for the linear accelerator, brachytherapy and nuclear medicine facilities. As a final step, after equipment installation, the commissioning stage takes place. As the conclusion, we show that medical physicists are essentials in order to fulfill with Mexican regulatory requirements in medical facilities.

  7. Evaluation of Pharmacist-Initiated Discharge Medication Reconciliation and Patient Counseling Procedures.

    PubMed

    Choi, Sebastian; Babiak, Jaime

    2018-04-01

    To evaluate a recently implemented procedure of discharge medication reconciliation and patient counseling completed by pharmacists at a nursing facility. This is a 138-bed nursing facility that houses long-term care residents as well as patients for subacute rehabilitation. Discharge process involves the medical team (geriatrician, medical resident, medical students), social workers, and nurse coordinators. Pharmacists are incorporated in the discharge process by completing medication reconciliation, patient counseling, and telephone follow-up, to improve patient understanding and satisfaction. Medication discrepancies identified by pharmacists via medication reconciliation, number of patients who were counseled by pharmacist, and number of patients encountered for telephone follow-up. Fifty-four patients were discharged during the study period. A total of 200 discrepancies were identified after discharge medication reconciliation by the pharmacist. On average, we found that there were 4 discrepancies per patient (range 0 to 16). Most of the discrepancies that were found were medication additions and omissions. Forty-five patients (83.3%) agreed to counseling and were then counseled by a pharmacist. Patients were often not counseled because of last-minute discharge, and no encounter was made. Involving pharmacists in patient transitions of care may be beneficial as previous studies have demonstrated; however, additional studies in a nursing facility setting are needed to validate these benefits.

  8. Validation of Medical Tourism Service Quality Questionnaire (MTSQQ) for Iranian Hospitals

    PubMed Central

    Qolipour, Mohammad; Torabipour, Amin; Khiavi, Farzad Faraji; Malehi, Amal Saki

    2017-01-01

    Introduction Assessing service quality is one of the basic requirements to develop the medical tourism industry. There is no valid and reliable tool to measure service quality of medical tourism. This study aimed to determine the reliability and validity of a Persian version of medical tourism service quality questionnaire for Iranian hospitals. Methods To validate the medical tourism service quality questionnaire (MTSQQ), a cross-sectional study was conducted on 250 Iraqi patients referred to hospitals in Ahvaz (Iran) from 2015. To design a questionnaire and determine its content validity, the Delphi Technique (3 rounds) with the participation of 20 medical tourism experts was used. Construct validity of the questionnaire was assessed through exploratory and confirmatory factor analysis. Reliability was assessed using Cronbach’s alpha coefficient. Data were analyzed by Excel 2007, SPSS version18, and Lisrel l8.0 software. Results The content validity of the questionnaire with CVI=0.775 was confirmed. According to exploratory factor analysis, the MTSQQ included 31 items and 8 dimensions (tangibility, reliability, responsiveness, assurance, empathy, exchange and travel facilities, technical and infrastructure facilities and safety and security). Construct validity of the questionnaire was confirmed, based on the goodness of fit quantities of model (RMSEA=0.032, CFI= 0.98, GFI=0.88). Cronbach’s alpha coefficient was 0.837 and 0.919 for expectation and perception questionnaire. Conclusion The results of the study showed that the medical tourism SERVQUAL questionnaire with 31 items and 8 dimensions was a valid and reliable tool to measure service quality of medical tourism in Iranian hospitals. PMID:28461863

  9. Factors affecting the availability and use of hemodialysis facilities.

    PubMed

    Cleary, P D; Schlesinger, M; Blumenthal, D

    1991-01-01

    This article describes factors related to the geographic distribution of hemodialysis facilities and the relationship between availability and use. Such facilities tend to be concentrated in the same types of areas as other medical resources, and the number of medical specialists in an area is related to the rate of treatment for renal diseases. The proportion of treatment stations in an area owned by for-profit organizations is not related to the total treatment rate, but the market share of for-profit facilities is positively related to in-center treatment and negatively related to home treatment.

  10. Abatement of Xenon and Iodine Emissions from Medical Isotope Production Facilities

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

    Doll, Charles G.; Sorensen, Christina M.; Bowyer, Ted W.

    2014-04-01

    The capability of the International Monitoring System (IMS) to detect xenon from underground nuclear explosions is dependent on the radioactive xenon background. Adding to the background, medical isotope production (MIP) by fission releases several important xenon isotopes including xenon-133 and iodine-133 that decays to xenon-133. The amount of xenon released from these facilities may be equivalent to or exceed that released from an underground nuclear explosion. Thus the release of gaseous fission products within days of irradiation makes it difficult to distinguish MIP emissions from a nuclear explosion. In addition, recent shortages in molybdenum-99 have created interest and investment opportunitiesmore » to design and build new MIP facilities in the United States and throughout the world. Due to the potential increase in the number of MIP facilities, a discussion of abatement technologies provides insight into how the problem of emission control from MIP facilities can be tackled. A review of practices is provided to delineate methods useful for abatement of medical isotopes.« less

  11. The Effects of Antipsychotic Quality Reporting on Antipsychotic and Psychoactive Medication Use.

    PubMed

    Bowblis, John R; Lucas, Judith A; Brunt, Christopher S

    2015-08-01

    The objective of this study is to examine how nursing homes changed their use of antipsychotic and other psychoactive medications in response to Nursing Home Compare's initiation of publicly reporting antipsychotic use in July 2012. The study includes all state recertification surveys (n = 40,415) for facilities six quarters prior and post the initiation of public reporting. Using a difference-in-difference framework, the change in use of antipsychotics and other psychoactive medications is compared for facilities subject to public reporting and facilities not subject to reporting. The percentage of residents using antipsychotics, hypnotics, or any psychoactive medication is found to decline after public reporting. Facilities subject to reporting experienced an additional decline in antipsychotic use (-1.94 vs. -1.40 percentage points) but did not decline as much for hypnotics (-0.60 vs. -1.21 percentage points). Any psychoactive use did not vary with reporting status, and the use of antidepressants and anxiolytics did not change. Public reporting of an antipsychotic quality measure can be an effective policy tool for reducing the use of antipsychotic medications--though the effect many only exist in the short run. © Health Research and Educational Trust.

  12. Snakebite in bedroom kills a physician in Cameroon: a case report.

    PubMed

    Nkwescheu, Armand; Mbasso, Leopold Cyriaque Donfack; Pouth, Franky Baonga Ba; Dzudie, Anastase; Billong, Serge Clotaire; Ngouakam, Hermann; Diffo, Joseph Le Doux; Eyongorock, Hanny; Mbacham, Wilfred

    2016-01-01

    The World Health Organization (WHO) classifies snake bites as neglected public health problem affecting mostly tropical and subtropical countries. In Africa there are an estimated 1 million snake bites annually with about half needing a specific treatment. Women, children and farmers in poor rural communities in developing countries are the most affected. Case management of snake bites are not adequate in many health facilities in developing countries where personnel are not always abreast with the new developments in snake bite management and in addition, quite often the anti-venom serum is lacking. We report the case of a medical doctor bitten by a cobra in the rural area of Poli, Cameroon while asleep in his bedroom. Lack of facilities coupled with poor case management resulted in a fatal outcome.

  13. 42 CFR 442.12 - Provider agreement: General requirements.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS STANDARDS FOR PAYMENT TO NURSING FACILITIES AND... nursing facility services nor make Medicaid payments to a facility for those services unless the Secretary...

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

    PubMed

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

    2018-05-21

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

  15. Contemporary Obstetric Triage.

    PubMed

    Sandy, Edward Allen; Kaminski, Robert; Simhan, Hygriv; Beigi, Richard

    2016-03-01

    The role of obstetric triage in the care of pregnant women has expanded significantly. Factors driving this change include the Emergency Medical Treatment and Active Labor Act, improved methods of testing for fetal well-being, increasing litigation risk, and changes in resident duty hour guidelines. The contemporary obstetric triage facility must have processes in place to provide a medical screening examination that complies with regulatory statues while considering both the facility's maternal level of care and available resources. This review examines the history of the development of obstetric triage, current considerations in a contemporary obstetric triage paradigm, and future areas for consideration. An example of a contemporary obstetric triage program at an academic medical center is presented. A successful contemporary obstetric triage paradigm is one that addresses the questions of "sick or not sick" and "labor or no labor," for every obstetric patient that presents for care. Failure to do so risks poor patient outcome, poor patient satisfaction, adverse litigation outcome, regulatory scrutiny, and exclusion from federal payment programs. Understanding the role of contemporary obstetric triage in the current health care environment is important for both providers and health care leadership. This study is for obstetricians and gynecologists as well as family physicians. After completing this activity, the learner should be better able to understand the scope of a medical screening examination within the context of contemporary obstetric triage; understand how a facility's level of maternal care influences clinical decision making in a contemporary obstetric triage setting; and understand the considerations necessary for the systematic evaluation of the 2 basic contemporary obstetric questions, "sick or not sick?" and "labor or no labor?"

  16. Commercial-scale biotherapeutics manufacturing facility for plant-made pharmaceuticals.

    PubMed

    Holtz, Barry R; Berquist, Brian R; Bennett, Lindsay D; Kommineni, Vally J M; Munigunti, Ranjith K; White, Earl L; Wilkerson, Don C; Wong, Kah-Yat I; Ly, Lan H; Marcel, Sylvain

    2015-10-01

    Rapid, large-scale manufacture of medical countermeasures can be uniquely met by the plant-made-pharmaceutical platform technology. As a participant in the Defense Advanced Research Projects Agency (DARPA) Blue Angel project, the Caliber Biotherapeutics facility was designed, constructed, commissioned and released a therapeutic target (H1N1 influenza subunit vaccine) in <18 months from groundbreaking. As of 2015, this facility was one of the world's largest plant-based manufacturing facilities, with the capacity to process over 3500 kg of plant biomass per week in an automated multilevel growing environment using proprietary LED lighting. The facility can commission additional plant grow rooms that are already built to double this capacity. In addition to the commercial-scale manufacturing facility, a pilot production facility was designed based on the large-scale manufacturing specifications as a way to integrate product development and technology transfer. The primary research, development and manufacturing system employs vacuum-infiltrated Nicotiana benthamiana plants grown in a fully contained, hydroponic system for transient expression of recombinant proteins. This expression platform has been linked to a downstream process system, analytical characterization, and assessment of biological activity. This integrated approach has demonstrated rapid, high-quality production of therapeutic monoclonal antibody targets, including a panel of rituximab biosimilar/biobetter molecules and antiviral antibodies against influenza and dengue fever. © 2015 Society for Experimental Biology, Association of Applied Biologists and John Wiley & Sons Ltd.

  17. Use of a Balanced Scorecard in strengthening health systems in developing countries: an analysis based on nationally representative Bangladesh Health Facility Survey.

    PubMed

    Khan, M Mahmud; Hotchkiss, David R; Dmytraczenko, Tania; Zunaid Ahsan, Karar

    2013-01-01

    This paper illustrates the importance of collecting facility-based data through regular surveys to supplement the administrative data, especially for developing countries of the world. In Bangladesh, measures based on facility survey indicate that only 70% of very basic medical instruments and 35% of essential drugs were available in health facilities. Less than 2% of officially designated obstetric care facilities actually had required drugs, injections and personnel on-site. Majority of (80%) referral hospitals at the district level were not ready to provide comprehensive emergency obstetric care. Even though the Management Information System reports availability of diagnostic machines in all district-level and sub-district-level facilities, it fails to indicate that 50% of these machines are not functional. In terms of human resources, both physicians and nurses are in short supply at all levels of the healthcare system. The physician-nurse ratio also remains lower than the desirable level of 3.0. Overall job satisfaction index was less than 50 for physicians and 66 for nurses. Patient satisfaction score, however, was high (86) despite the fact that process indicators of service quality were poor. Facility surveys can help strengthen not only the management decision-making process but also the quality of administrative data. Copyright © 2012 John Wiley & Sons, Ltd.

  18. Health care response to the tsunami in Taro District, Miyako City, Iwate Prefecture.

    PubMed

    Kuroda, Hitoshi

    2011-10-01

    IN THE TARO DISTRICT (POPULATION: 4434), the great tsunami of 11 March 2011 destroyed the central region including the clinic, the sole medical facility (one physician, 13 nurses and other staff) in the district, and many citizens were forced to live in evacuation centres. The Taro District experienced massive damage during the tsunamis of 1896 and 1933. Since then countermeasures to tsunamis have been implemented. The great tsunami on 11 March 2011 caused catastrophic damage to the low-lying areas where approximately 2500 people lived; 1609 buildings were completely destroyed, and approximately 200 people died or were missing across the district. The Taro National Health Insurance Clinic, the sole medical facility in the Taro District, was required to play a central role in a variety of activities to care for residents in severely affected areas. First of all, evacuees needed to move to neighbouring hospitals or safer evacuation centres because lifeline services were cut off to the first evacuation centre. Then, the clinic staff worked in a temporary clinic; they visited the evacuation centres to assess the public health and medical situation, cared for wounded residents, managed infection control and encouraged a normal lifestyle where possible. Additional medical, pharmaceutical and logistical support was received from outside the district. There was no noticeably severe damage to health, although there was manifestation of and deterioration in lifestyle-related diseases (e.g. diabetes, hypertension, obesity). Health care activities gradually returned to their pre-disaster levels. At the end of July 2011, the evacuation centres closed, and all evacuees moved to temporary accommodations. ISOLATED RURAL HEALTH PRACTITIONERS WERE REQUIRED TO BE INVOLVED IN A WIDE VARIETY OF ACTIVITIES RELATED TO THE DISASTER IN ADDITION TO THEIR ROUTINE WORK: e.g. preventive health (public health and safety activities), routine medical care, acute medical care, psychological care, post-mortems and recovery of medical facilities. Although the whole health care system returned to near-normal six months after the disaster, it is important to plan how to develop more resilient medical systems to respond to disasters, especially in rural areas. This article describes my experience and lessons learnt in responding to this disaster.

  19. Measuring the Efficient Utilization of Medical Personnel at Navy Military Treatment Facilities

    DTIC Science & Technology

    1990-06-01

    measures of effectiveness (MOE) for utilizing manpower at a medical treatment facility by analyzing data from Navy hospitals. The MOE will be able to...at Navy facili- ties will be used to compare alternative MOEs., The data resources are categorized into expenditures, Naval health-care statistics ...of years., At the Office of the Chief of Naval Operations, OP-801 maintains financial data of medical budgets, 2. NAVAL HEALTH-CARE STATISTICS The

  20. Medical Services Career Ladder (AFSC 902XO/A/B)

    DTIC Science & Technology

    1992-02-01

    the manner specified by the AFR 39-1 Specialty Description and may serve as a basis for considering changes to current utilization policies and...medical facility policies 59 F285 Apply tape or nonelastic bandages 59 E147 Answer patient telephone inquiries 58 H441 Maintain treatment room supplies 57...medical facility policies 55 A14 Establish performance standards for subordinates 55 B58 Initiate actions to correct substandard performance of

  1. Enhancing Military-Civilian Medical Synergies: The Role of Army Medical Practice in Civilian Facilities

    DTIC Science & Technology

    2016-01-01

    medical service (such as obstetric delivery), or a specific technology (such as robotic surgery apparatus), is not available at the MTF. All 13...operating theaters and lack of robotic surgery capabilities at WBAMC. We found three relevant agreements in the MEDCOM central repository...civilian facilities offer was superior to what was available (and justifiable) at the MTF—notably, robotic surgery capa- bility. Not only do these

  2. Evaluating technology service options.

    PubMed

    Blumberg, D F

    1997-05-01

    Four service and support options are available to healthcare organizations for maintaining their growth arsenals of medical and information technology. These options include maintaining and servicing all equipment using a facility-based biomedical engineering and MIS service department; using a combination of facility-based service and subcontracted service; expanding facility-based biomedical and MIS service departments to provide service to other healthcare organizations to achieve economies of scale; and outsourcing all maintenance, repair, and technical support services. Independent service companies and original equipment manufacturers (OEMs) are offering healthcare organizations a wider array of service and support capabilities than ever before. However, some health systems have successfully developed their own independent service organizations to take care of their own--and other healthcare organizations'--service and support needs.

  3. Predicting Urban Medical Services Demand in China: An Improved Grey Markov Chain Model by Taylor Approximation.

    PubMed

    Duan, Jinli; Jiao, Feng; Zhang, Qishan; Lin, Zhibin

    2017-08-06

    The sharp increase of the aging population has raised the pressure on the current limited medical resources in China. To better allocate resources, a more accurate prediction on medical service demand is very urgently needed. This study aims to improve the prediction on medical services demand in China. To achieve this aim, the study combines Taylor Approximation into the Grey Markov Chain model, and develops a new model named Taylor-Markov Chain GM (1,1) (T-MCGM (1,1)). The new model has been tested by adopting the historical data, which includes the medical service on treatment of diabetes, heart disease, and cerebrovascular disease from 1997 to 2015 in China. The model provides a predication on medical service demand of these three types of disease up to 2022. The results reveal an enormous growth of urban medical service demand in the future. The findings provide practical implications for the Health Administrative Department to allocate medical resources, and help hospitals to manage investments on medical facilities.

  4. Oxygen Assessments Ensure Safer Medical Devices

    NASA Technical Reports Server (NTRS)

    2013-01-01

    A team at White Sands Test Facility developed a test method to evaluate fire hazards in oxygen-enriched environments. Wendell Hull and Associates, located in Las Cruces, New Mexico, entered a Space Act Agreement with NASA and now provides services including fire and explosion investigations, oxygen testing and training, and accident reconstruction and forensic engineering.

  5. Defending A+: how to maintain a high credit rating during a facilities overhaul.

    PubMed

    Ollie, Ed; Kolb-Collier, Deborah; Clay, Scott

    2007-11-01

    To defend its strong credit rating, New Hanover Regional Medical Center: Demonstrated a clear and cohesive vision. Improved short-term financial performance. Developed robust financial projections. Avoided reliance on a "build it and they will come" strategy. Managed construction cost risks. Minimized construction disruption. Anticipated financial market concerns and questions

  6. [Pre-hospital management of adults with life-threatening emergencies].

    PubMed

    Wattel, Francis; Dubois, François

    2012-01-01

    In France, acute life-threatening situations are handled by the French Secours a Personne (assistance to persons) and emergency medical facilities. An unequivocal success, this early management of life-threatening emergency situations relies upon centralized call reception, medical dispatching, and immediate on-site emergency medical care. We describe the different emergency care providers and steps involved in the response to emergency situations. Each call centre (Samu, phone number 15; Sapeurs-Pompiers, 18) provides a response tailored to the nature of incoming calls for assistance. A check-list of grounds for an "automatic response" by the SDIS (Service Départemental d'Incendie et de Secours--the French fire brigade) is in use, ensuring that firefighters are often the first on the spot, while the knowledge and skills of the dispatching physician are essential to ascertain the patient's needs, to preserve life and vital functions, and to ensure the patient is sent to the appropriate emergency healthcare facility. In life-threatening emergency situations, patients must be brought straight to the appropriate reference emergency healthcare facility, as quickly as possible, without prior admittance to an emergency department. This is the procedure for extremely acute emergency situations in the following areas: trauma (multiple trauma and/or uncontrolled bleeding, spinal cord trauma), delivery bleeding, other life-threatening situations such as ischemic heart disease, cardiac arrest (sudden death), cerebrovascular stroke and ensuing brain damage, some acute respiratory situations such as anaphylactic shock, foreign-body inhalation, electrocution, drowning, drug overdose, certain forms of poisoning, and conditions requiring initial hyperbaric oxygen (diving accidents, acute carbon monoxide and smoke poisoning). The reasons for suboptimal emergency care in life-threatening situations are currently a major issue, with medical facilities being reduced in some areas, fewer voluntary firemen, hospital reorganization, tight funding, difficulties of medical dispatching, and the varying skills of "first-on-the-scene "emergency workers. Grievances include late emergency responses, inappropriate medical care, and dispatching to the wrong facility. This raises the question of equal opportunity for all in a country with widely varying geographic features and population density. Improvement in the system's efficiency will require a series of objectives to be met in varied and complementary--Enhanced functional coordination, by speeding up the deployment of the ANTARES digital radio-frequency transmission network (Adaptation Nationale des Transmissions Aux Risques Et aux Secours).--Implementation of a network of emergency services with varying degrees of emergency healthcare management related to the technical nature of the facilities. Three levels of emergency healthcare must be made available: level 1 is provided by local hospitals, level 2 includes support facilities available in general hospitals (not necessarily the nearest hospital), and level 3 provides specialized healthcare in large and/or training hospitals with specialized departments. Life-threatening emergency situations are to be handled by level 2 or 3 facilities. Specific facilities must be selected as reference centers. In France, the ARS (Agences Régionales de Santé) is in charge of this procedure, as it provide funding for healthcare continuity--Reducing inequalities in access to emergency care. This will involve improving the network of SDIS brigades, making local medical facilities more responsive, delegating more medical procedures, on-site telemedicine, providing more helicopters equipped with healthcare facilities, more automated external defibrillators, and more dedicated neuro-vascular units.--First aid training must be made widely available. The French National Academy of Medicine has approved ten recommendations regarding organization and facilities.

  7. 38 CFR 17.240 - Sharing specialized medical resources.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ..., public or private hospitals or other medical installations having hospital facilities or organ banks, blood banks, or similar institutions, or medical schools or clinics in a medical community with...

  8. Essential medicines for emergency care in Africa.

    PubMed

    Broccoli, Morgan C; Pigoga, Jennifer L; Nyirenda, Mulinda; Wallis, Lee; Calvello Hynes, Emilie J

    2018-04-07

    Essential medicines lists (EMLs) are efficient means to ensure access to safe and effective medications. The WHO has led this initiative, generating a biannual EML since 1977. Nearly all countries have implemented national EMLs based on the WHO EML. Although EMLs have given careful consideration to many public health priorities, they have yet to comprehensively address the importance of medicines for treating acute illness and injury. We undertook a multistep consensus process to establish an EML for emergency care in Africa. After a review of existing literature and international EMLs, we generated a candidate list for emergency care. This list was reviewed by expert clinicians who ranked the medicines for overall inclusion and strength of recommendation. These medications and recommendations were then evaluated by an expert group. Medications that reached consensus in both the online survey and expert review were included in a draft emergency care EML, which underwent a final inperson consensus process. The final emergency care EML included 213 medicines, 25 of which are not in the 2017 WHO EML, but were deemed essential for clinical practice by regional emergency providers. The final EML has associated recommendations of desirable or essential and is subdivided by facility level. Thirty-nine medicines were recommended for basic facilities, an additional 96 for intermediate facilities (eg, district hospitals) and an additional 78 for advanced facilities (eg, tertiary centres). The 25 novel medications not currently on the WHO EML should be considered by planners when making rational formularies for developing emergency care systems. It is our hope that these resource-stratified lists will allow for easier implementation and will be a useful tool for practical expansion of emergency care delivery in Africa. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  9. Development of a Medication Safety and Quality Survey for Small Rural Hospitals.

    PubMed

    Winterstein, Almut G; Johns, Thomas E; Campbell, Kyle N; Libby, Joel; Pannell, Bob

    2017-12-01

    We summarize the development and initial implementation of a survey tool to assess medication safety in small rural hospitals. As part of an ongoing rural hospital medication safety improvement program, we developed a survey tool in all 13 critical access hospitals (CAHs) in Florida. The survey was compiled from existing medication safety assessments and standards, clinical practice guidelines, and published literature. Survey items were selected based on considerations regarding practicality and relevance to the CAH setting.The final survey instrument included 134 items representing 17 medication safety domains. Overall hospital scores ranged from 41% to 95%, with a median of 59%. Most hospitals showed large variation in scores across domains, with 5 hospitals having at least 1 domain with scores less than 10%. Highest scores across all facilities were seen for safety procedures concerning high-alert or look-alike medications and the assembly of emergency carts. The lowest median scores included availability and consistent use of standardized order sets and the effective implementation of medication safety committees. Most hospitals used the survey results to identify and prioritize quality improvement activities. The survey can be used to conduct a short medication safety assessment specific to a limited number of areas and services in CAHs. It showed good ability to discriminate medication safety levels across participating sites and highlighted opportunities for improvement. It may need modification if case mix or services differ in other states or if the status quo of medication safety in CAHs or related standards advance. The described process of survey development might be helpful to support such modifications.

  10. Motivation and Retention of Physicians in Primary Healthcare Facilities: A Qualitative Study From Abbottabad, Pakistan

    PubMed Central

    Shah, Sayed Masoom; Zaidi, Shehla; Ahmed, Jamil; Rehman, Shafiq Ur

    2016-01-01

    Background: Workforce motivation and retention is important for the functionality and quality of service delivery in health systems of developing countries. Despite huge primary healthcare (PHC) infrastructure, Pakistan’s health indicators are not impressive; mainly because of under-utilization of facilities and low patient satisfaction. One of the major underlying issues is staff absenteeism. The study aimed to identify factors affecting retention and motivation of doctors working in PHC facilities of Pakistan. Methods: An exploratory study was conducted in a rural district in Khyber Puktunkhwa (KP) province, in Pakistan. A conceptual framework was developed comprising of three organizational, individual, and external environmental factors. Qualitative research methods comprising of semi-structured interviews with doctors working in basic health units (BHUs) and in-depth interviews with district and provincial government health managers were used. Document review of postings, rules of business and policy actions was also conducted. Triangulation of findings was carried out to arrive at the final synthesis. Results: Inadequate remuneration, unreasonable facilities at residence, poor work environment, political interference, inadequate supplies and medical facilities contributed to lack of motivation among both male and female doctors. The physicians accepted government jobs in BHUs with a belief that these jobs were more secure, with convenient working hours. Male physicians seemed to be more motivated because they faced less challenges than their female counterparts in BHUs especially during relocations. Overall, the organizational factors emerged as the most significant whereby human resource policy, career growth structure, performance appraisal and monetary benefits played an important role. Gender and marital status of female doctors was regarded as most important individual factor affecting retention and motivation of female doctors in BHUs. Conclusion: Inadequate remuneration, unreasonable facilities at residence, poor work environment, political interference, inadequate supplies, and medical facilities contributed to lack of motivation in physicians in our study. Our study advocates that by addressing the retention and motivation challenges, service delivery can be made more responsive to the patients and communities in Pakistan and other similar settings. PMID:27694660

  11. Design, Development and Operational Experience of Demonstration Facility for Cs-137 Source Pencil Production at Trombay - 13283

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

    Patil, S.B.; Srivastava, P.; Mishra, S.K.

    2013-07-01

    Radioactive waste management is a vital aspect of any nuclear program. The commercial feasibility of the nuclear program largely depends on the efficiency of the waste management techniques. One of such techniques is the separation of high yield radio-nuclides from the waste and making it suitable for medical and industrial applications. This will give societal benefit in addition to revenue generation. Co-60, the isotope presently being used for medical applications, needs frequent replacement because of its short half life. Cs-137, the major constituent of the nuclear waste, is a suitable substitute for Co-60 as a radioactive source because of itsmore » longer half life (28 years). Indian nuclear waste management program has given special emphasis on utilization of Cs-137 for such applications. In view of this a demonstration facility has been designed for vitrification of Cs-137 in borosilicate glass, cast in stainless steel pencils, to be used as source pencils of 300 Ci strength for blood irradiation. An induction heated metallic melter of suitable capacity has been custom designed for the application and employed for the Cs-137 pencil fabrication facility. This article describes various systems, design features, experiments and resulting modifications, observations and remote handling features necessary for the actual operation of such facility. The layout of the facility has been planned in such a way that the same can be adopted in a hot cell for commercial production of source pencils. (authors)« less

  12. Cost of Hospitalization for Foodborne Diarrhea: A Case Study from Vietnam.

    PubMed

    Hoang, Van Minh; Tran, Tuan Anh; Ha, Anh Duc; Nguyen, Viet Hung

    2015-11-01

    Vietnam is undergoing a rapid social and economic developments resulting in speedy urbanization, changes in methods for animal production, food marketing systems, and food consumption habits. These changes will have major impacts on human exposures to food poisoning. The present case study aimed to estimate hospitalization costs of foodborne diarrhea cases in selected health facilities in Vietnam. This is a facility-based cost-of-illness study conducted in seven health facilities in Northern Vietnam. All suspect cases of foodborne diarrhea, as diagnosed by doctors, who admitted to the studied health facilities during June-August, 2013 were selected. Costs associated with hospitalization for foodborne diseases were estimated from societal perspective using retrospective approach. We included direct and indirect costs of hospitalization of foodborne diarrhea cases. During the study period, 87 foodborne diarrhea cases were included. On average, the costs per treatment episode and per hospitalization day for foodborne diarrhea case were US$ 106.9 and US$ 33.6 respectively. Indirect cost (costs of times to patient, their relatives due to the patient's illness) made up the largest share (51.3%). Direct medical costs accounted for 33.8%; direct non-medical costs (patient and their relatives) represented 14.9%. Cost levels and compositions varied by level of health facilities. More attentions should be paid on prevention, control of foodborne diarrhea cases in Vietnam. Ensuring safety of food depends on efforts of everyone involved in food chain continuum, from production, processing, and transport to consumption.

  13. Perceptions of newly admitted undergraduate medical students on experiential training on community placements and working in rural areas of Uganda.

    PubMed

    Kaye, Dan K; Mwanika, Andrew; Sekimpi, Patrick; Tugumisirize, Joshua; Sewankambo, Nelson

    2010-06-23

    Uganda has an acute problem of inadequate human resources partly due to health professionals' unwillingness to work in a rural environment. One strategy to address this problem is to arrange health professional training in rural environments through community placements. Makerere University College of Health Sciences changed training of medical students from the traditional curriculum to a problem-based learning (PBL) curriculum in 2003. This curriculum is based on the SPICES model (student-centered, problem-based, integrated, community-based and services oriented). During their first academic year, students undergo orientation on key areas of community-based education, after which they are sent in interdisciplinary teams for community placements. The objective was to assess first year students' perceptions on experiential training through community placements and factors that might influence their willingness to work in rural health facilities after completion of their training. The survey was conducted among 107 newly admitted first year students on the medical, nursing, pharmacy and medical radiography program students, using in-depth interview and open-ended self-administered questionnaires on their first day at the college, from October 28-30, 2008. Data was collected on socio-demographic characteristics, motivation for choosing a medical career, prior exposure to rural health facilities, willingness to have part of their training in rural areas and factors that would influence the decision to work in rural areas. Over 75% completed their high school from urban areas. The majority had minimal exposure to rural health facilities, yet this is where most of them will eventually have to work. Over 75% of the newly admitted students were willing to have their training from a rural area. Perceived factors that might influence retention in rural areas include the local context of work environment, support from family and friends, availability of continuing professional training for career development and support of co-workers and the community. Many first year students at Makerere University have limited exposure to health facilities in rural areas and have concerns about eventually working there.

  14. The impact of correctional institutions on public health during a pandemic or emerging infection disaster.

    PubMed

    Schwartz, Rachel D

    2008-01-01

    With the growing threat of a naturally occurring or man-made global pandemic, many public, private, federal, state, and local institutions have begun to develop some form of preparedness and response plans. Among those in the front lines of preparedness are hospitals and medical professionals who will be among the first responders in the event of such a disaster. At the other end of the spectrum of preparedness is the Corrections community who have been working in a relative vacuum, in part because of lack of funding, but also because they have been largely left out of state, federal local planning processes. This isolation and lack of support is compounded by negative public perceptions of correctional facilities and their inmates, and a failure to understand the serious impact a jail or prison facility would have on public health in the event of a disaster. This article examines the unique issues faced by correctional facilities responding to disease disasters and emphasizes the importance of assisting them to develop workable and effective preparedness and response plans that will prevent them from becoming disease repositories spreading illness and infection throughout our communities. To succeed in such planning, it is crucial that the public health and medical community be involved in correctional disaster planning and that they should integrate correctional disaster response with their own. Failure to do so endangers the health of the entire nation.

  15. Evaluation of Human Research Facility Ultrasound With the ISS Video System

    NASA Technical Reports Server (NTRS)

    Melton, Shannon; Sargsyan, Ashot

    2003-01-01

    Most medical equipment on the International Space Station (ISS) is manifested as part of the U.S. or the Russian medical hardware systems. However, certain medical hardware is also available as part of the Human Research Facility. The HRF and the JSC Medical Operations Branch established a Memorandum of Agreement for joint use of certain medical hardware, including the HRF ultrasound system, the only diagnostic imaging device currently manifested to fly on ISS. The outcome of a medical contingency may be changed drastically, or an unnecessary evacuation may be prevented, if clinical decisions are supported by timely and objective diagnostic information. In many higher-probability medical scenarios, diagnostic ultrasound is a first-choice modality or provides significant diagnostic information. Accordingly, the Clinical Care Capability Development Project is evaluating the HRF ultrasound system for its utility in relevant clinical situations on board ISS. For effective management of these ultrasound-supported ISS medical scenarios, the resulting data should be available for viewing and interpretation on the ground, and bidirectional voice communication should be readily available to allow ground experts (sonographers, physicians) to provide guidance to the Crew Medical Officer. It may also be vitally important to have the capability of real-time guidance via video uplink to the CMO-operator during an exam to facilitate the diagnosis in a timely fashion. In this document, we strove to verify that the HRF ultrasound video output is compatible with the ISS video system, identify ISS video system field rates and resolutions that are acceptable for varying clinical scenaiios, and evaluate the HRF ultrasound video with a commercial, off-the-shelf video converter, and compare it with the ISS video system.

  16. [Estimation of cost-saving for reducing radioactive waste from nuclear medicine facilities by implementing decay in storage (DIS) in Japan].

    PubMed

    Kida, Tetsuo; Hiraki, Hitoshi; Yamaguchi, Ichirou; Fujibuchi, Toshioh; Watanabe, Hiroshi

    2012-01-01

    DIS has not yet been implemented in Japan as of 2011. Therefore, even if risk was negligible, medical institutions have to entrust radioactive temporal waste disposal to Japan Radio Isotopes Association (JRIA) in the current situation. To decide whether DIS should be implemented in Japan or not, cost-saving effect of DIS was estimated by comparing the cost that nuclear medical facilities pay. By implementing DIS, the total annual cost for all nuclear medical facilities in Japan is estimated to be decreased to 30 million yen or less from 710 million yen. DIS would save 680 million yen (96%) per year.

  17. Institutional deliveries weakly associated with improved neonatal survival in developing countries: evidence from 192 Demographic and Health Surveys.

    PubMed

    Fink, Günther; Ross, Rebecca; Hill, Kenneth

    2015-12-01

    Child and maternal mortality remain high in many developing countries. A principal strategy used in low- and middle-income countries is increasing the proportion of pregnancies delivered at facilities. Although this strategy is reasonable with high quality facilities, evidence for the protective effects of facility deliveries is mixed. We pooled 1.47 million birth records collected by the Demographic and Health Surveys to estimate the association between institutional deliveries and early neonatal mortality. Subsample analysis and instrumental variable estimation were used to assess and correct the extent to which mortality differentials are biased by an increased likelihood of facility attendance for high-risk deliveries. No associations between institutional deliveries and early neonatal mortality were found in the pooled sample [adjusted odds ratio (aOR) 0.995, 95% confidence interval (CI) 0.966-1.025)]. When stratified by facility type, protective effects were found for private facilities (aOR 0.876, 95% CI 0.840-0.914), but not for public hospitals or health centres. Significant protective effects were found when past behaviour was used to eliminate selection bias generated by short-term responses to medical need (aOR 0.884, 95% CI 0.814-0.961). At the community and country levels, strong positive associations were found between early neonatal mortality among facility deliveries and the prevalence of institutional deliveries. Facility deliveries have the potential to reduce early neonatal mortality in developing countries. The results presented suggest that the quality, utilization and protective effects of institutional deliveries vary widely across countries; major improvements in both utilization and quality of care will be needed to achieve further improvements in maternal and child health. © The Author 2015; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.

  18. Environmental Assessment for the NASA First Response Facility

    NASA Technical Reports Server (NTRS)

    Kennedy, Carolyn

    2003-01-01

    NASA intends to construct a First Response Facility for integrated emergency response and health management. This facility will consolidate the Stennis Space Center fire department, medical clinic, security operations, emergency operations and the energy management and control center. The alternative considered is the "No Action Alternative". The proposed action will correct existing operational weaknesses and enhance capabilities to respond to medical emergencies and mitigate any other possible threats. Environmental impacts include are emissions, wetlands disturbance, solid waste generation, and storm water control.

  19. [The urgency of the application of the medical sanitary passport in the system for chemical safety in the areas of location of high-risk chemical facilities in the Russian Federation].

    PubMed

    Kombarova, M Iu; Radilov, A S; Dulov, S A

    2012-01-01

    The main provisions concerning the need for a creation of medical and sanitary passport for territories in the protective measures zones (PMZ) of storage facilities and facilities for the destruction of chemical weapons (FDCW) are presented in the article. The assessment of results of certification of the territory of PMZ and FDCW in "Maradykovsky" in the Kirov region has been done.

  20. Delivering information: A descriptive study of Australian women’s information needs for decision-making about birth facility

    PubMed Central

    2012-01-01

    Background Little information is known about what information women want when choosing a birth facility. The objective of this study was to inform the development of a consumer decision support tool about birth facility by identifying the information needs of maternity care consumers in Queensland, Australia. Methods Participants were 146 women residing in both urban and rural areas of Queensland, Australia who were pregnant and/or had recently given birth. A cross-sectional survey was administered in which participants were asked to rate the importance of 42 information items to their decision-making about birth facility. Participants could also provide up to ten additional information items of interest in an open-ended question. Results On average, participants rated 30 of the 42 information items as important to decision-making about birth facility. While the majority of information items were valued by most participants, those related to policies about support people, other women’s recommendations about the facility, freedom to choose one’s preferred position during labour and birth, the aesthetic quality of the facility, and access to on-site neonatal intensive care were particularly widely valued. Additional items of interest frequently focused on postnatal care and support, policies related to medical intervention, and access to water immersion. Conclusions The women surveyed had significant and diverse information needs for decision-making about birth facility. These findings have immediate applications for the development of decision support tools about birth facility, and highlight the need for tools which provide a large volume of information in an accessible and user-friendly format. These findings may also be used to guide communication and information-sharing by care providers involved in counselling pregnant women and families about their options for birth facility or providing referrals to birth facilities. PMID:22708648

  1. Delivering information: a descriptive study of Australian women's information needs for decision-making about birth facility.

    PubMed

    Thompson, Rachel; Wojcieszek, Aleena M

    2012-06-18

    Little information is known about what information women want when choosing a birth facility. The objective of this study was to inform the development of a consumer decision support tool about birth facility by identifying the information needs of maternity care consumers in Queensland, Australia. Participants were 146 women residing in both urban and rural areas of Queensland, Australia who were pregnant and/or had recently given birth. A cross-sectional survey was administered in which participants were asked to rate the importance of 42 information items to their decision-making about birth facility. Participants could also provide up to ten additional information items of interest in an open-ended question. On average, participants rated 30 of the 42 information items as important to decision-making about birth facility. While the majority of information items were valued by most participants, those related to policies about support people, other women's recommendations about the facility, freedom to choose one's preferred position during labour and birth, the aesthetic quality of the facility, and access to on-site neonatal intensive care were particularly widely valued. Additional items of interest frequently focused on postnatal care and support, policies related to medical intervention, and access to water immersion. The women surveyed had significant and diverse information needs for decision-making about birth facility. These findings have immediate applications for the development of decision support tools about birth facility, and highlight the need for tools which provide a large volume of information in an accessible and user-friendly format. These findings may also be used to guide communication and information-sharing by care providers involved in counselling pregnant women and families about their options for birth facility or providing referrals to birth facilities.

  2. Positioning patient-perceived medical services to develop a marketing strategy.

    PubMed

    Jung, Minsoo; Hong, Myung-Sun

    2012-01-01

    In today's medical market, marketing philosophy is being rapidly transformed from customer searching to patient satisfaction and service improvement. The principal objective of this study was to contribute to the establishment of a desirable medical marketing strategy, through the factors of customer satisfaction and the positioning of patients' perceptions by marketing institutions. The data were collected from 282 students of the College of Public Health and Medicine in Seoul. The survey tools were developed using the SERVQUAL scale. Analysis in this study involved both statistical and network analysis. The former was used to verify the determinants of service satisfaction as perceived by respondents, via factor analysis and multiple regression analysis. The latter was obtained using a positioning map and 2-mode network analysis with the matrix data converted from raw data. The determining factors for patient satisfaction were identified as facilities, accessibility, process, physicians, and medical staff. The regression equation was significant (R = 0.606), and the most influential variable was the service quality of physicians (β = .569). According to multidimensional scaling, the positioning of medical institutions indicated that patients' perceptions were affected by hospital size and specialization. By recognizing and managing patient satisfaction, medical institutions are able to foster customer loyalty and, in turn, to enhance service quality. It is necessary to develop an adequate marketing mix to provide better medical services and to overcome medical competition among institutions.

  3. Virtual reality for health care: a survey.

    PubMed

    Moline, J

    1997-01-01

    This report surveys the state of the art in applications of virtual environments and related technologies for health care. Applications of these technologies are being developed for health care in the following areas: surgical procedures (remote surgery or telepresence, augmented or enhanced surgery, and planning and simulation of procedures before surgery); medical therapy; preventive medicine and patient education; medical education and training; visualization of massive medical databases; skill enhancement and rehabilitation; and architectural design for health-care facilities. To date, such applications have improved the quality of health care, and in the future they will result in substantial cost savings. Tools that respond to the needs of present virtual environment systems are being refined or developed. However, additional large-scale research is necessary in the following areas: user studies, use of robots for telepresence procedures, enhanced system reality, and improved system functionality.

  4. Dialysis Facility and Patient Characteristics Associated with Utilization of Home Dialysis

    PubMed Central

    Walker, David R.; Inglese, Gary W.; Sloand, James A.

    2010-01-01

    Background and objectives: Nonmedical factors influencing utilization of home dialysis at the facility level are poorly quantified. Home dialysis is comparably effective and safe but less expensive to society and Medicare than in-center hemodialysis. Elimination of modifiable practice variation unrelated to medical factors could contribute to improvements in patient outcomes and use of scarce resources. Design, setting, participants, & measurements: Prevalent dialysis patient data by facility were collected from the 2007 ESRD Network’s annual reports. Facility characteristic data were collected from Medicare’s Dialysis Facility Compare file. A multivariate regression model was used to evaluate associations between the use of home dialysis and facility characteristics. Results: The utilization of home dialysis was positively associated with facility size, percent patients employed full- or part-time, younger population, and years a facility was Medicare certified. Variables negatively associated include an increased number of hemodialysis patients per hemodialysis station, chain association, rural location, more densely populated zip code, a late dialysis work shift, and greater percent of black patients within a zip code. Conclusions: Improved understanding of factors affecting the frequency of use of home dialysis may help explain practice variations across the United States that result in an imbalanced use of medical resources within the ESRD population. In turn, this may improve the delivery of healthcare and extend the ability of an increasingly overburdened medical financing system to survive. PMID:20634324

  5. 20 CFR 416.414 - Amount of benefits; eligible individual or eligible couple in a medical treatment facility.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false Amount of benefits; eligible individual or eligible couple in a medical treatment facility. 416.414 Section 416.414 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Amount of Benefits...

  6. 20 CFR 416.414 - Amount of benefits; eligible individual or eligible couple in a medical treatment facility.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Amount of benefits; eligible individual or eligible couple in a medical treatment facility. 416.414 Section 416.414 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Amount of Benefits...

  7. 20 CFR 416.414 - Amount of benefits; eligible individual or eligible couple in a medical treatment facility.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Amount of benefits; eligible individual or eligible couple in a medical treatment facility. 416.414 Section 416.414 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Amount of Benefits...

  8. 20 CFR 416.414 - Amount of benefits; eligible individual or eligible couple in a medical treatment facility.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false Amount of benefits; eligible individual or eligible couple in a medical treatment facility. 416.414 Section 416.414 Employees' Benefits SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME FOR THE AGED, BLIND, AND DISABLED Amount of Benefits...

  9. Impact of service delivery model on health care access among HIV-positive women in New York City.

    PubMed

    Pillai, Nandini V; Kupprat, Sandra A; Halkitis, Perry N

    2009-01-01

    As the New York City HIV=AIDS epidemic began generalizing beyond traditionally high-risk groups in the early 1990s, AIDS Service Organizations (ASO) sought to increase access to medical care and broaden service offerings to incorporate the needs of low-income women and their families. Strategies to achieve entry into and retention in medical care included the development of integrated care facilities, case management, and a myriad of supportive service offerings. This study examines a nonrandom sample of 60 HIV-positive women receiving case management and supportive services at New York City ASOs. Over 55% of the women interviewed reported high access to care, 43% reported the ability to access urgent care all of the time and 94% reported high satisfaction with obstetrics=gynecology (OB=GYN) care. This held true across race=ethnicity, income level, medical coverage, and service delivery model.Women who accessed services at integrated care facilities offering onsite medical care and case management=supportive services perceived lower access to medical specialists as compared to those who received services at nonintegrated sites. Data from this analysis indicate that supportive services increase access to and satisfaction with both HIV and non-HIV-related health care. Additionally, women who received services at a medical model agency were more likely to report accessing non-HIV care at a clinic compared to those receiving services at a nonmedical model agencies, these women were more likely to report receiving non-HIV care at a hospital.

  10. Development of a lightweight portable ventilator for far-forward battlefield combat casualty support

    NASA Astrophysics Data System (ADS)

    Cutchis, Protagoras N.; Smith, Dexter G.; Ko, Harvey W.; Wiesmann, William P.; Pranger, L. Alex

    1999-07-01

    Immediate medical provision substantially reduces the number of fatalities sustained during military operations. However, the shift from large-scale regional conflicts to smaller peacekeeping and humanitarian missions has reduced the military medical support infrastructure. Civilian emergency medical services have long emphasized the 'golden hour' during which a patient must receive definitive medical attention. Without on-scene medical support, injured soldiers must be transported significant distances before receiving advanced medical care, and rapid transport to a medical facility is not always a viable option. Technological solutions enable military medics to deliver advanced medical care on the battlefield. We report here on the development of a small lightweight portable respirator for the treatment of far- forward battlefield casualties. The Far Forward Life Support System (FFLSS) utilizes a combination of COTS (commercial off the shelf) components and custom designed systems to provide ventilatory support to injured combatants. It also incorporates a small IV fluid pump and IV fluids for resuscitation. A microcompressor control system monitors both system performance and patient parameters for system control. Telemetry to a pager-like device worn by the front line medic alerts of any anomalies in ventilator or patient parameters, which will add greatly to triage decisions and resource management. Novel elements of the FLSS design include oxygen generation, low-pressure air generation, available patient suction, and the absence of any high pressure air cylinders. A prototype developed for animal testing will be described in detail as well as further design requirements for the human rated prototype.

  11. NASA personnel and facilities involved in Hurricane Katrina medical evacuation

    NASA Image and Video Library

    2005-09-02

    JSC2005-E-36144 (2 September 2005) --- NASA Johnson Space Center Aircraft Operations Hangar 990 at Ellington Field, Houston, has been used as a triage location this week for medical patients evacuated by air from New Orleans to pass through on their way to Houston-area medical facilities. Hundreds of patients have passed through the location so far, as the transfer operations, led by the Veterans Administration and supported by NASA and other agencies, continue.

  12. Military Personnel: Enhanced Collaboration and Process Improvements Needed for Determining Military Treatment Facility Medical Personnel Requirements

    DTIC Science & Technology

    2010-07-01

    Department of Defense (DOD) are in great demand due to projected nationwide medical personnel shortages over the next decade and are essential to...for the first year, in order to assist the services in addressing near- term personnel shortages . It also provides a consistent staffing standard...dentists, medical service corps, and veterinarians , to name a few, at the work center level across Army fixed military treatment facilities. The model uses

  13. Medical tourism in Iran: Issues and challenges.

    PubMed

    Jabbari, Alireza; Delgoshaei, Bahram; Mardani, Raja; Tabibi, Seid Jamaledin

    2012-01-01

    Medical tourism is rapidly becoming a worldwide, multibillion-dollar industry. Iran has a high potential for this industry. The purpose of this study was to examine the medical tourism cluster, using Diamond Analysis tool. This study is a descriptive, analytical and qualitative one. Thirty professionals and researchers in this field were interviewed and official documents belonging to the Health ministry as well as tourism organization and finally related literature were examined. The data was analyzed using content analysis method. Positive and negative parts of the medical tourism industry of Iran were determined according to diamond of advantage. The strategic issues were identified and a number of possible solutions for addressing them were recommended. More and effective public-private participations, aggressive marketing, improving infrastructures, and international accreditation of health care facilities and human resources development could improve medical tourism industry in the country.

  14. A Study to Develop an Implementation Plan for a Centralized Materiel Management System at the US Army Medical Department Activity, Ft. Sill, OK

    DTIC Science & Technology

    1986-08-01

    provide consumable medical and surgical supplies to patient care areas. In an environment of limited resources, the supply system uti - lized by the Fort... uti - lizing the Uniform Chart of Accounts in the Comptroller Division to get a list of cost centers, then cross-referencing this list 28 with the...ACTIVE-AISLE track can be utilized in the new facility, or, if ample space is available, the shelving could be uti - lized without the track with the

  15. Report of the CIRRPC Executive Committee regarding EPA NESHAP regulations on radionuclides for medical research institutions and radiopharmaceutical manufacturers

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

    NONE

    1990-06-01

    There appears to be no compelling public health protection reason for EPA`s promulgation of NESHAP regulations to control air emissions of radioactive materials from NRC-licensed facilities engaged in activities associated with the practice and development of nuclear medicine. The NRC`s existing regulations provide the necessary controls for protection and EPA`s regulations would only add burdensome reporting requirements at substantial cost to medical treatment and diagnosis. Availability of nuclear medicine practice could be impacted and advancements through research delayed.

  16. FDA publishes checklist of Y2K high-risk devices.

    PubMed

    1999-09-01

    Key points. The federal Food and Drug Administration (FDA) has developed a list of types of medical devices that have the potential for the most serious consequences for patients should they fail because of Y2K-related problems. This list of computer-controlled potentially high-risk devices can provide a guide to health care facilities regarding the types of devices that should receive priority in their assessment and remediation of medical devices. The list may change as the FDA receives comments on the types of devices included in the list.

  17. Peripheral phlebitis: a point-prevalence study.

    PubMed

    Washington, Georgita T; Barrett, Robin

    2012-01-01

    The purpose of this research study was to determine the factors influencing peripheral phlebitis in the adult medical-surgical population. The authors would then be able to use those data to determine whether a change in practice was warranted. Data collection and analysis of 188 intravenous sites revealed that females with higher doses of medications in intravenous sites of longer dwell times and suboptimal nutrition were at greater risk of developing peripheral phlebitis. The point prevalence was greater than the recommended 5%, which led the authors to review their facility's patient care and documentation practices.

  18. [Anesthesia practice in Catalan hospitals and other health care facilities].

    PubMed

    Villalonga, Antonio; Sabaté, Sergi; Campos, Juan Manuel; Fornaguera, Joan; Hernández, Carmen; Sistac, José María

    2006-05-24

    The aim of this arm of the ANESCAT study was to characterize anesthesia practice in the various types of health care facilities of Catalonia, Spain, in 2003. We analyzed data from the survey according to a) source of a facility's funding: public hospitals financed by the Catalan Public Health Authority (ICS), the network of subsidized hospitals for public use (XHUP), or private hospitals; b) size: facilities without hospital beds, hospitals with fewer than 250 beds, those with 251 to 500, and those with over 500; and c) training accreditation status: whether or not a facility gave medical resident training. A total of 131 facilities participated (11 under the ICS, 47 from the XHUP, and 73 private hospitals). Twenty-six clinics had no hospital beds, 78 facilities had fewer than 250, 21 had 251 to 500, and 6 had more than 500. Seventeen hospitals trained medical residents. XHUP hospitals performed 44.3% of all anesthetic procedures, private hospitals 36.7%, and ICS facilities 18.5%. Five percent of procedures were performed in clinics without beds, 42.9% in facilities with fewer than 250 beds, 35% in hospitals with 251 to 500, and 17.1% in hospitals with over 500. Anesthetists in teaching hospitals performed 35.5% of all procedures. The mean age of patients was lower in private hospitals, facilities with fewer than 250 beds, and hospitals that did not train medical residents. The physical status of patients was worse in ICS hospitals, in facilities with over 500 beds, and in teaching hospitals. It was noteworthy that 25% of anesthetic procedures were performed on an emergency basis in XHUP and ICS hospitals, in facilities with more than 250 beds, and in teaching hospitals. Anesthesia for outpatient procedures accounted for 40% of the total in private hospitals and 31% of the practice in ICS and XHUP hospitals. The duration of anesthesia and postanesthetic recovery was longer in ICS hospitals, in facilities with over 500 beds, and in those with medical resident training programs. The numbers of postoperative admissions to critical care units and of specialized analgesic techniques performed were higher in ICS hospitals, in facilities with over 500 beds, and in teaching hospitals. The complexity of both anesthesia and surgical practice and the severity of patient condition increased with hospital size and public funding status.

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

    PubMed

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

    2015-07-22

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

  20. Evaluation of multiple emission point facilities

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

    Miltenberger, R.P.; Hull, A.P.; Strachan, S.

    In 1970, the New York State Department of Environmental Conservation (NYSDEC) assumed responsibility for the environmental aspect of the state's regulatory program for by-product, source, and special nuclear material. The major objective of this study was to provide consultation to NYSDEC and the US NRC to assist NYSDEC in determining if broad-based licensed facilities with multiple emission points were in compliance with NYCRR Part 380. Under this contract, BNL would evaluate a multiple emission point facility, identified by NYSDEC, as a case study. The review would be a nonbinding evaluation of the facility to determine likely dispersion characteristics, compliance withmore » specified release limits, and implementation of the ALARA philosophy regarding effluent release practices. From the data collected, guidance as to areas of future investigation and the impact of new federal regulations were to be developed. Reported here is the case study for the University of Rochester, Strong Memorial Medical Center and Riverside Campus.« less

  1. [Implementation of quality management in medical rehabilitation--current challenges for rehabilitation facilities].

    PubMed

    Enge, M; Koch, A; Müller, T; Vorländer, T

    2010-12-01

    The legal responsibilities imposed upon rehabilitation facilities under section 20 (2a) SGB IX, necessitate fundamental decisions to be taken regarding the development of quality management systems over and above the existing framework. This article is intended to provide ideas and suggestions to assist rehabilitation facilities in implementing a quality management system, which is required in addition to participation in the quality assurance programmes stipulated by the rehabilitation carriers. In this context, the additional internal benefit a functioning quality management system can provide for ensuring a high level of quality and for maintaining the competitiveness of the rehabilitation facility should be taken into account. The core element of these observations, hence, is a list of requirements which enables assessment of the quality of consultants' performance in setting up a quality management system. © Georg Thieme Verlag KG Stuttgart · New York.

  2. [Similarities between disaster areas and developing countries in terms of the lack of facilities for clinical examinations].

    PubMed

    Suganami, Shigeru

    2012-03-01

    From the experience of more than 130 emergency medical relief missions in over 50 countries/areas, the AMDA would like to propose a system of mobile clinical examinations to prepare for possible natural disasters in Japan. Such a system will require the development of vehicles equipped with a full range of laboratory equipment, which I believe will become a public property in the world, and contribute to the enhancement of medical services in disaster areas as well as in areas with less developed medical technologies. AMDA's recent medical relief activities include the support of the victims of the earthquakes in Haiti (2010) and Turkey (2011), and the flood in Thailand (2012). In these countries, the AMDA faced the lack of a clinical examination system which resulted in a huge number of patients who could not receive proper treatment after injury, or those who suffered from infectious diseases. Domestically, when the AMDA sent medical teams to the affected areas of the Great East Japan Earthquake and tsunami (2011), their activities took place mainly in evacuation shelters, where survivors needed treatment for chronic diseases and preventive care. All of these experiences highlight the importance of clinical examination in disaster areas, as well as in developing countries/areas similarly lacking basic medical services. The Japanese Society of Laboratory Medicine will surely play an important role in the development of the proposed system of mobile clinical examinations. The AMDA would like to collaborate with the JSLM in emergency relief activities and medical aid projects in areas affected by disasters or lack basic medical services.

  3. Assessment of workplace air concentrations of formaldehyde during and before working hours in medical facilities.

    PubMed

    Higashikubo, Ichiro; Miyauchi, Hiroyuki; Yoshida, Satoru; Tanaka, Shinsuke; Matsuoka, Mitsunori; Arito, Heihachiro; Araki, Akihiro; Shimizu, Hidesuke; Sakurai, Haruhiko

    2017-04-07

    Workplace air concentrations of formaldehyde (FA) in medical facilities where FA and FA-treated organs were stored and handled were measured before and during working hours and assessed by the official method specified by Work Environment Measurement Law. Sixty-percent of the total facilities examined were judged as inappropriately controlled work environment. The concentrations of FA before working hours by spot sampling were found to exceed 0.1 ppm in some facilities, and tended to increase with increasing volume of containers storing FA and FA-treated materials. Regression analysis revealed that logarithmic concentrations of FA during working hours by the Law-specified analytical method were highly correlated with those before working hours by spot sampling, suggesting the importance for appropriate storing methods of FA and FA-treated materials. The concentrations of FA during working hours are considered to be lowered by effective ventilation of FA-contaminated workplace air and appropriate storage of FA and FA-treated materials in plastic containers in the medical facilities. In particular, such improvement by a local exhaust ventilation system and tightly-sealed containment of FA-treated material were urgently needed for the dissecting room where FA-treated cadavers were prepared and handled for a gross anatomy course in a medical school.

  4. 7 CFR 3565.206 - Ineligible uses of loan proceeds.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... transient residents; (d) Nursing homes, special care facilities and institutional type homes that require licensing as a medical care facility; (e) Operating capital for central dining facilities or for any items...

  5. 7 CFR 3565.206 - Ineligible uses of loan proceeds.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... transient residents; (d) Nursing homes, special care facilities and institutional type homes that require licensing as a medical care facility; (e) Operating capital for central dining facilities or for any items...

  6. 7 CFR 3565.206 - Ineligible uses of loan proceeds.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... transient residents; (d) Nursing homes, special care facilities and institutional type homes that require licensing as a medical care facility; (e) Operating capital for central dining facilities or for any items...

  7. 7 CFR 3565.206 - Ineligible uses of loan proceeds.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... transient residents; (d) Nursing homes, special care facilities and institutional type homes that require licensing as a medical care facility; (e) Operating capital for central dining facilities or for any items...

  8. 7 CFR 3565.206 - Ineligible uses of loan proceeds.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... transient residents; (d) Nursing homes, special care facilities and institutional type homes that require licensing as a medical care facility; (e) Operating capital for central dining facilities or for any items...

  9. [Evaluating the activity of the Italian Mental Health Services inpatient and residential facilities: the PRISM (Process Indicator System for Mental health) indicators].

    PubMed

    Picardi, Angelo; Tarolla, Emanuele; de Girolamo, Giovanni; Gigantesco, Antonella; Neri, Giovanni; Rossi, Elisabetta; Biondi, Massimo

    2014-01-01

    This article describes the activities of a project aimed at developing a system of process and process/outcome indicators suitable to monitor over time the quality of psychiatric care of Italian inpatient and residential psychiatric facilities. This system, named PRISM (Process Indicator System for Mental health), was developed by means of a standardized evaluation made by a panel of experts and a consecutive pilot study in 17 inpatient and 13 residential psychiatric facilities. A total of 28 indicators were selected from a set of 251 candidate indicators developed by the most relevant and qualified Italian and international authorities. These indicators are derived by data from medical records and information about characteristics of facilities, and they cover processes of care, operational equipment of facilities, staff training and working, relationships with external agencies, and sentinel events. The procedure followed for the development of the indicator system was reliable and innovative. The data collected from the pilot study suggested a favourable benefit-cost ratio between the workload associated with regular use of the indicators into the context of daily clinical activities and the advantages related to the information gathered through regular use of the indicators. CONCLUSIONS.:The PRISM system provides additional information about the healthcare processes with respect to the information gathered via routine information systems, and it might prove useful for both continuous quality improvement programs and health services research.

  10. An overview of the space medicine program and development of the Health Maintenance Facility for Space Station

    NASA Technical Reports Server (NTRS)

    Pool, Sam Lee

    1988-01-01

    Because the prolonged stay on board the Space Station will increase the risk of possible inflight medical problems from that on Skylab missions, the Health Maintenance Facility (HMF) planned for the Space Station is much more sophisticated than the small clinics of the Skylab missions. The development of the HMF is directed by the consideration of three primary factors: prevention, diagnosis, and treatment of injuries and illnesses that may occur in flight. The major components of the HMF include the clinical laboratory, pharmacy, imaging system, critical-care system, patient-restraint system, data-management system, exercise system, surgical system, electrophysiologic-monitoring system, introvenous-fluid system, dental system, and hyperbaric-treatment-support system.

  11. Perspectives on the state-of-the-science in rehabilitation medicine and its implications for Medicare postacute care policies.

    PubMed

    Gage, Barbara; Stineman, Margaret; Deutsch, Anne; Mallinson, Trudy; Heinemann, Allen; Bernard, Shulamit; Constantine, Roberta

    2007-12-01

    Better measurement of the case-mix complexity of patients receiving rehabilitation services is critical to understanding variations in the outcomes achieved by patients treated in different postacute care (PAC) settings. The Medicare program recognized this issue and is undertaking a major initiative to develop a new patient-assessment instrument that would standardize case-mix measurement in inpatient rehabilitation facilities, long-term care hospitals, skilled nursing facilities, and home health agencies. The new instrument, called the Continuity Assessment Record and Evaluation Tool, builds on the scientific advances in measurement to develop standard measures of medical acuity, functional status, cognitive impairment, and social support related to resource need, outcomes, and continuity of care for use in all PAC settings.

  12. A metropolitan airport disaster plan--coordination of a multihospital response to provide on-site resuscitation and stabilization before evacuation.

    PubMed

    Dove, D B; Del Guercio, L R; Stahl, W M; Star, L D; Abelson, L C

    1982-07-01

    At the John F. Kennedy International Airport in New York City, disaster planning has been an integral part of the airport operations for the past 20 years. The medical component of this disaster planning has focused around the Medical Office at JFK. Through this office, on-site emergency medical teams have been established and trained from all ranks of airport personnel. Following the crash of a Boeing 727 aircraft in 1975, a new concept was added to disaster planning for JFK, which involves bringing the hospital, its facilities, and its personnel to the scene. A new piece of equipment, known as Emergency Mobile Hospital, was developed with the cooperation of the airlines, the operating authority of the airport, and other interested parties. Two such vehicles are now in constant readiness at the airport, and together provide two operating rooms, 12 monitored ICU beds, a 16-bed burn unit, and 72 other beds to be used for on-site stabilization of critically ill patients, before transfer to a definitive care facility. Under the auspices of a single area medical school (New York Medical College) and its affiliated departments of surgery, trauma teams are made available to be airlifted to the scene within 30 minutes of notification. Additional medical teams from other medical school hospitals serve as backup support. The principle of bringing the hospital to the emergency, and of assembling trauma teams for the initial phase, remains the same for Kennedy Airport as for that of any other metropolitan airport.

  13. Use of medical technologies in rehabilitation medicine settings in Israel: results of the TECHNO-R 2005 survey.

    PubMed

    Ring, Haim; Keren, Ofer; Zwecker, Manuel; Dynia, Aida

    2007-10-01

    With the development of computer technology and the high-tech electronic industry over the past 30 years, the technological age is flourishing. New technologies are continually being introduced, and questions regarding the economic viability of these technologies need to be addressed. To identify the medical technologies currently in use in different rehabilitation medicine settings in Israel. The TECHNO-R 2005 survey was conducted in two phases. Beginning in 2004, the first survey used a questionnaire with open questions relating to the different technologies in clinical use, including questions on their purpose, who operates the device (technician, physiotherapist, occupational therapist, physician, etc.), and a description of the treated patients. This questionnaire was sent to 31 rehabilitation medicine facilities in Israel. Due to difficulties in comprehension of the term "technology," a second revised standardized questionnaire with closed-ended questions specifying diverse technologies was introduced in 2005. The responder had to mark from a list of 15 different medical technologies which were in use in his or her facility, as well as their purpose, who operates the device, and a description of the treated patients. Transcutaneous electrical nerve stimulation, the TILT bed, continuous passive movement, and therapeutic ultrasound were the most widely used technologies in rehabilitation medicine facilities. Monitoring of the sitting position in the wheelchair, at the bottom of the list, was found to be the least used technology (with 15.4% occurrence). Most of the technologies are used primarily for treatment purposes and to a lesser degree for diagnosis and research. Our study poses a fundamental semantic and conceptual question regarding what kind of technologies are or should be part of the standard equipment of any accredited rehabilitation medicine facility for assessment, treatment and/or research. For this purpose, additional data are needed.

  14. Conceptual design of BNCT facility based on the TRR medical room

    NASA Astrophysics Data System (ADS)

    Golshanian, M.; Rajabi, A. A.; Kasesaz, Y.

    2017-10-01

    This paper presents a conceptual design of the Boron Neutron Capture Therapy (BNCT) facility based on the medical room of Tehran Research Reactor (TRR). The medical room is located behind the east wall of the reactor pool. The designed beam line is an in-pool Beam Shaping Assembly (BSA) which is considered between the reactor core and the medical room wall. The final designed BSA can provide 2.96× 109 n/cm2ṡs epithermal neutron flux at the irradiation position with acceptable beam contamination to use as a clinical BNCT.

  15. 38 CFR 17.241 - Sharing medical information services.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2012-07-01 2012-07-01 false Sharing medical... AFFAIRS MEDICAL Sharing of Medical Facilities, Equipment, and Information § 17.241 Sharing medical... Under Secretary for Health shall prescribe, Directors of Department of Veterans Affairs medical centers...

  16. 75 FR 54627 - Best Management Practices for Unused Pharmaceuticals at Health Care Facilities

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-08

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

  17. VIEW OF BUILDING 122 EXAMINATION FACILITIES THAT SUPPORT ROUTINE EMPLOYEE ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    VIEW OF BUILDING 122 EXAMINATION FACILITIES THAT SUPPORT ROUTINE EMPLOYEE AND SUBCONTRACTOR PHYSICAL EXAMINATIONS. (10/85) - Rocky Flats Plant, Emergency Medical Services Facility, Southwest corner of Central & Third Avenues, Golden, Jefferson County, CO

  18. Report: Hospital waste management--awareness and practices: a study of three states in India.

    PubMed

    Rao, P Hanumantha

    2008-06-01

    The study was conducted in Andhra Pradesh, Maharashtra and Uttar Pradesh in India. Hospitals/nursing homes and private medical practitioners in urban as well as rural areas and those from the private as well as the government sector were covered. Information on (a) awareness of bio-medical waste management rules, (b) training undertaken and (c) practices with respect to segregation, use of colour coding, sharps management, access to common waste management facilities and disposal was collected. Awareness of Bio-medical Waste Management Rules was better among hospital staff in comparison with private medical practitioners and awareness was marginally higher among those in urban areas in comparison with those in rural areas. Training gained momentum only after the dead-line for compliance was over. Segregation and use of colour codes revealed gaps, which need correction. About 70% of the healthcare facilities used a needle cutter/destroyer for sharps management. Access to Common Waste Management facilities was low at about 35%. Dumping biomedical waste on the roads outside the hospital is still prevalent and access to Common Waste facilities is still limited. Surveillance, monitoring and penal machinery was found to be deficient and these require strengthening to improve compliance with the Bio-medical Waste Management Rules and to safeguard the health of employees, patients and communities.

  19. What Medical Directors Need to Know about Dialysis Facility Water Management.

    PubMed

    Kasparek, Ted; Rodriguez, Oscar E

    2015-06-05

    The medical directors of dialysis facilities have many operational clinic responsibilities, which on first glance, may seem outside the realm of excellence in patient care. However, a smoothly running clinic is integral to positive patient outcomes. Of the conditions for coverage outlined by the Centers for Medicare and Medicaid Services, one most critical to quality dialysis treatment is the provision of safe purified dialysis water, because there are many published instances where clinic failure in this regard has resulted in patient harm. As the clinical leader of the facility, the medical director is obliged to have knowledge of his/her facility's water treatment system to reliably ensure that the purified water used in dialysis will meet the standards for quality set by the Association for the Advancement of Medical Instrumentation and used by the Centers for Medicare and Medicaid Services for conditions for coverage. The methods used to both achieve and maintain these quality standards should be a part of quality assessment and performance improvement program meetings. The steps for water treatment, which include pretreatment, purification, and distribution, are largely the same, regardless of the system used. Each water treatment system component has a specific role in the process and requires individualized maintenance and monitoring. The medical director should provide leadership by being engaged with the process, knowing the facility's source water, and understanding water treatment system operation as well as the clinical significance of system failure. Successful provision of quality water will be achieved by those medical directors who learn, know, and embrace the requirements of dialysis water purification and system maintenance. Copyright © 2015 by the American Society of Nephrology.

  20. The medical director and quality requirements in the dialysis facility.

    PubMed

    Schiller, Brigitte

    2015-03-06

    Four decades after the successful implementation of the ESRD program currently providing life-saving dialysis therapy to >430,000 patients, the definitions of and demands for a high-quality program have evolved and increased at the same time. Through substantial technological advances ESRD care improved, with a predominant focus on the technical aspects of care and the introduction of medications such as erythropoiesis-stimulating agents and active vitamin D for anemia and bone disease management. Despite many advances, the size of the program and the increasingly older and multimorbid patient population have contributed to continuing challenges for providing consistently high-quality care. Medicare's Final Rule of the Conditions for Coverage (April 2008) define the medical director of the dialysis center as the leader of the interdisciplinary team and the person ultimately accountable for quality, safety, and care provided in the center. Knowledge and active leadership with a hands-on approach in the quality assessment and performance improvement process (QAPI) is essential for the achievement of high-quality outcomes in dialysis centers. A collaborative approach between the dialysis provider and medical director is required to optimize outcomes and deliver evidence-based quality care. In 2011 the Centers for Medicare & Medicaid Services introduced a pay-for-performance program-the ESRD quality incentive program (QIP)- with yearly varying quality metrics that result in payment reductions in subsequent years when targets are not achieved during the performance period. Success with the QIP requires a clear understanding of the structure, metrics, and scoring methods. Information on achievement and nonachievement is publicly available, both in facilities (through the facility performance score card) and on public websites (including Medicare's Dialysis Facility Compare). By assuming the leadership role in the quality program of dialysis facilities, the medical director is given an important opportunity to improve patients' lives and effect true change in a patient population dealing with a very challenging chronic disease. This article in the series on the role of the medical director summarizes the medical director's specific role in the quality improvement process in the dialysis facility and the associated requirements and programs, including QAPI and QIP. Copyright © 2015 by the American Society of Nephrology.

  1. A mobility program for an inpatient acute care medical unit.

    PubMed

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

    2014-10-01

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

  2. Security breaches: tips for assessing and limiting your risks.

    PubMed

    Coons, Leeanne R

    2011-01-01

    As part of their compliance planning, medical practices should undergo a risk assessment to determine any vulnerability within the practice relative to security breaches. Practices should also implement safeguards to limit their risks. Such safeguards include facility access controls, information and electronic media management, use of business associate agreements, and education and enforcement. Implementation of specific policies and procedures to address security incidents is another critical step that medical practices should take as part of their security incident prevention plan. Medical practices should not only develop policies and procedures to prevent, detect, contain, and correct security violations, but should make sure that such policies and procedures are actually implemented in their everyday operations.

  3. ALARA development in Mexico

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

    Lopez, M.A.M.

    1995-03-01

    Even though the ALARA philosophy was formally implemented in the early 1980`s, to some extent, ALARA considerations already had been incorporated into the design of most commercial equipment and facilities based on experience and engineering development. In Mexico, the design of medical and industrial facilities were based on international recommendations containing those considerations. With the construction of Laguna Verde Nuclear Power Station, formal ALARA groups were created to review some parts of its design, and to prepare the ALARA Program and related procedures necessary for its commercial operation. This paper begins with a brief historical description of ALARA development inmore » Mexico, and then goes on to discuss our regulatory frame in Radiation Protection, some aspects of the ALARA Program, efforts in controlling and reducing of sources of radiation, and finally, future perspectives in the ALARA field.« less

  4. VA Health Care: Further Action Needed to Address Weaknesses in Management and Oversight of Non-VA Medical Care

    DTIC Science & Technology

    2014-06-18

    medical centers. VA also provides care to veterans in VA-operated community-based outpatient clinics, community living centers ( nursing homes...facility or nursing home up to the point that the veteran can be safely returned to the VA facility following the emergency care treatment at the non-VA... nursing home care, compensation and pension exams, and most pharmacy expenses paid for through the Non-VA Medical Care Program. (See fig. 1.) 8VA

  5. Achieving World Class: An Independent Review of the Design Plans for the Walter Reed National Military Medical Center and the Fort Belvoir Community Hospital

    DTIC Science & Technology

    2009-05-01

    class medical facility. Based on a review of relevant reports and other literature, the HSAS’s collective experience and judgment, and extensive...analyses of the demand for PACU services and of the experience and skills of PACU staff relative to the skills needed to properly care for other...class medical facility. Based on a review of relevant reports and other literature, the Subcommittee’s collective experience and judgment, and

  6. Reducing length of stay provides key to improvement in Veterans Administration Medical Center.

    PubMed

    Huebler, L A; Christian, J A; Marcella, L W

    1980-02-01

    Concerted resolve and coordinated planning on the part of both administrative and patient care staff at the medical center made it possible to treat more patients in fewer beds than ever before and to improve the core staffing ratio at the same time. Staffing was enhanced and new programs were developed using available resources. Reduction of the average LOS for patients throughout the medical center was a primary factor in these achievements. In addition, formal quality assurance activities were strengthened; with careful planning and increased funding, the renovation of facilities and purchase of new equipment was also possible, thus making the improvement project comprehensive. These changes have had a major, beneficial impact on the delivery of health care a the Dublin Veterans Administration Medical Center.

  7. 32 CFR 204.8 - Benefits for which no fee shall be assessed.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ...-ray films of patients or former patients of military medical or dental facilities, when such... accredited medical facility, physician, or dentist, or requested by the patient, his or her next of kin, or..., “National Security Information,” and implemented by DoD 5200.1-R. Such services consist of the work...

  8. 42 CFR 410.170 - Payment for home health services, for medical and other health services furnished by a provider...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Payment for home health services, for medical and other health services furnished by a provider or an approved ESRD facility, and for comprehensive outpatient rehabilitation facility (CORF) services: Conditions. 410.170 Section 410.170 Public Health CENTERS...

  9. Drug Administration via Enteral Feeding Tube in Residential Care Facilities for Individuals with Intellectual Disability: A Focus Group Study on Guideline Implementation

    ERIC Educational Resources Information Center

    Joos, Elke; Van Tongelen, Inge; Wijnants, Karen; Mehuys, Els; Van Bocxlaer, Jan; Remon, Jean Paul; Grypdonck, Maria; Van Winckel, Myriam; Boussery, Koen

    2016-01-01

    People with profound intellectual disabilities often receive medication through enteral feeding tube (EFT). In a previous study, we found that current guidelines concerning medication preparation and administration through EFT are often not followed in residential care facilities (RCFs) for individuals with intellectual disabilities. The present…

  10. Assessment of Needs of Adults with Developmental Disabilities in Skilled Nursing and Intermediate Care Facilities in Illinois.

    ERIC Educational Resources Information Center

    Uehara, Edwina S.; And Others

    1991-01-01

    This study evaluated 2,815 adults with developmental disabilities in 328 Illinois intermediate care and skilled nursing facilities. Only 10 percent were determined to be appropriately placed in medical settings; 27 percent were enrolled in day training programs; and many individuals recommended for alternative residential settings had medical and…

  11. Fall Risk Assessment in Geriatric-Psychiatric Inpatients to Lower Events (FRAGILE).

    PubMed

    Nanda, Sudip; Dey, Tanujit; Gulstrand, Rudolph E; Cudnik, Daniel; Haller, Harold S

    2011-02-01

    The objectives of this retrospective case-control study were to identify risk factors of falls in geriatric-psychiatric inpatients and develop a screening tool to accurately predict falls. The study sample consisted of 225 geriatric-psychiatric inpatients at a Midwestern referral facility. The sample included 136 inpatients who fell and a random stratified sample of 89 inpatients who did not fall. Data collected included age, gender, activities of daily living, and nursing parameters such as bathing assistance, bed height, use of bed rails, one-on-one observation, fall warning system, Conley Scale fall risk assessment, medical diagnosis, and medications. History of falls, impaired judgment, impaired gait, dizziness, delusions, delirium, chronic use of sedative or antipsychotic agents, and anticholinergic urinary bladder medications significantly increased fall risk. Alzheimer's disease, acute use of sedative or anti-psychotic agents, and depression reduced fall risk. A falls risk tool, Fall Risk Assessment in Geriatric-psychiatric Inpatients to Lower Events (FRAGILE), was developed for assessment and risk stratification with new diagnoses or medications. Copyright 2011, SLACK Incorporated.

  12. Summary Statement: Appropriate Medical Care for the Secondary School-Aged Athlete

    PubMed Central

    Almquist, Jon; Valovich McLeod, Tamara C; Cavanna, Angela; Jenkinson, Dave; Lincoln, Andrew E; Loud, Keith; Peterson, Bart C; Portwood, Craig; Reynolds, John; Woods, Thomas S

    2008-01-01

    Objective: To present the recommendations made by the Appropriate Medical Care for Secondary School-Aged Athletes Task Force and to summarize the subsequent monograph developed around 11 consensus points. Data Sources: The MEDLINE, CINAHL, and SportDiscus databases were searched for relevant literature regarding secondary school-aged athletes; health care administration; preparticipation physical examination; facilities; athletic equipment; emergency action planning; environmental conditions; recognition, evaluation, and treatment of injuries; rehabilitation and reconditioning; psychosocial consultation; nutrition; and prevention strategies. Conclusions and Recommendations: Organizations that sponsor athletic programs for secondary school-aged athletes should establish an athletic health care team to ensure that appropriate medical care is provided to all participants. The 11 consensus points provide a framework—one that is supported by the medical literature and case law—for the development of an athletic health care team and for assigning responsibilities to the team, administrators, and staff members of institutions sponsoring secondary school and club-level athletic programs. PMID:18668175

  13. [Teaching practices and the position concerning medical education].

    PubMed

    Medina-Figueroa, Alda María; Espinosa-Alarcón, Patricia Atzimba; Viniegra-Velázquez, Leonardo

    2008-01-01

    Estimate the degree of development of a position concerning medical education, in a phisician population. We carried out a cross-sectional study at with 1580 physicians; we selected 395 participants by non-proportional stratified sampling of an IMSS health facility; 244 (62 %) was medical professors, included 15 physicians responsible for education. A previously validated instrument was applied to these participants. Three indicators were evaluated: agreement in general, most popular trend, and consequence. Group grading was done blindly. Kuder-Richardson test was utilized to calculate the value of internal instrument consistency and nonparametric statistics < 0.05. Answering tendency in agreement were similar among physicians; heads or managers were statistically significant. The most popular trend was participative. In terms of consequence in physicians, there were some without consequent sentences in pair. The most popular trend was participative, although it would appear that this has not been pondered, in that on exploring the indicator, that of consequence. Teaching practices do not have any significant influence on the development of a position concerning medical education.

  14. 42 CFR Appendix to Subpart G of... - Interim Procedures and Criteria for Review by Health Systems Agencies of Applications Under...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... RESOURCES DEVELOPMENT MEDICAL FACILITY CONSTRUCTION AND MODERNIZATION Community Service Pt. 124, Subpt. G... the area. 6. The availability of resources (including health manpower, management personnel, and funds... alternative uses of such resources for the provision of other health services. 7. The special needs and...

  15. 42 CFR Appendix to Subpart G of... - Interim Procedures and Criteria for Review by Health Systems Agencies of Applications Under...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... RESOURCES DEVELOPMENT MEDICAL FACILITY CONSTRUCTION AND MODERNIZATION Community Service Pt. 124, Subpt. G... the area. 6. The availability of resources (including health manpower, management personnel, and funds... alternative uses of such resources for the provision of other health services. 7. The special needs and...

  16. 42 CFR Appendix to Subpart G of... - Interim Procedures and Criteria for Review by Health Systems Agencies of Applications Under...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... RESOURCES DEVELOPMENT MEDICAL FACILITY CONSTRUCTION AND MODERNIZATION Community Service Pt. 124, Subpt. G... the area. 6. The availability of resources (including health manpower, management personnel, and funds... alternative uses of such resources for the provision of other health services. 7. The special needs and...

  17. Wound center facility billing: A retrospective analysis of time, wound size, and acuity scoring for determining facility level of service.

    PubMed

    Fife, Caroline E; Walker, David; Farrow, Wade; Otto, Gordon

    2007-01-01

    Outpatient wound center facility reimbursement for Medicare beneficiaries can be a challenge to determine and obtain. To compare methods of calculating facility service levels for outpatient wound centers and to demonstrate the advantages of an acuity-based billing system (one that incorporates components of facility work that is non-reimbursable by procedure codes and that represents an activity-based costing approach to medical billing), a retrospective study of 5,098 patient encounters contained in a wound care-specific electronic medical record database was conducted. Approximately 500 patient visits to the outpatient wound center of a Texas regional hospital between April 2003 and November 2004 were categorized by service level in documentation and facility management software. Visits previously billed using a time-based system were compared to the Centers for Medicare and Medicaid Services' proposed three-tiered wound size-based system. The time-based system also was compared to an acuity-based scoring system. The Pearson correlation coefficient between billed level of service by time and estimated level of service by acuity was 0.442 and the majority of follow-up visits were billed as Level 3 and above (on a time level of 1 to 5) , confirming that time is not a surrogate for actual work performed. Wound size also was found to be unrelated to service level (Pearson correlation = 0.017) and 97% of wound areas were < 100 cm2. The acuity-based scoring system produced a near-normal distribution of results, producing more mid-range billings than extremes; no other method produced this distribution. Hospital-based outpatient wound centers should develop, review, and refine acuity score-based models on which to determine billed level of service.

  18. 38 CFR 17.65 - Approvals and provisional approvals of community residential care facilities.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

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

  19. PACS: acceptance test, quality control, warranty, and maintenance continuum

    NASA Astrophysics Data System (ADS)

    Romlein, John R.; Norton, Gary S.; Lyche, David K.; Richardson, Ronald R., Jr.

    1999-07-01

    As PACS gain greater acceptance and use in medical facilities the question of life cycle management must be addressed in terms that relate to the common business practices for medical information system and medical devices. The issues in life cycle management of such a system are relatively new to the industry. Increased use of PACS within the medical community requires that standardized life cycle management practices by developed and implemented. This paper develops a new of life cycle issues as cyclic and related events that are not only manageable, but also predictable in terms, of, frequency, duration data content, data exchange, potential outcomes, staffing requirement, documentation, and staff interaction. This view is presented as a continuum that begins at the acceptance testing of a PACS and continues throughout its life cycle. The continuum incorporates the required relationship between quality control testing and maintenance actions during warranty period and the maintenance years. Interrelated cyclic events are described that bind these processes together and provide a basis for long-term proactive management of PACS in a medical environment.

  20. Intervening in the local health system to improve diabetes care: lessons from a health service experiment in a poor urban neighborhood in India.

    PubMed

    Bhojani, Upendra; Kolsteren, Patrick; Criel, Bart; De Henauw, Stefaan; Beerenahally, Thriveni S; Verstraeten, Roos; Devadasan, Narayanan

    2015-01-01

    Many efficacious health service interventions to improve diabetes care are known. However, there is little evidence on whether such interventions are effective while delivered in real-world resource-constrained settings. To evaluate an intervention aimed at improving diabetes care using the RE-AIM (reach, efficacy/effectiveness, adoption, implementation, and maintenance) framework. A quasi-experimental study was conducted in a poor urban neighborhood in South India. Four health facilities delivered the intervention (n=163 diabetes patients) and the four matched facilities served as control (n=154). The intervention included provision of culturally appropriate education to diabetes patients, use of generic medications, and standard treatment guidelines for diabetes management. Patients were surveyed before and after the 6-month intervention period. We did field observations and interviews with the doctors at the intervention facilities. Quantitative data were used to assess the reach of the intervention and its effectiveness on patients' knowledge, practice, healthcare expenditure, and glycemic control through a difference-in-differences analysis. Qualitative data were analyzed thematically to understand adoption, implementation, and maintenance of the intervention. Reach: Of those who visited intervention facilities, 52.3% were exposed to the education component and only 7.2% were prescribed generic medications. The doctors rarely used the standard treatment guidelines for diabetes management. The intervention did not have a statistically and clinically significant impact on the knowledge, healthcare expenditure, or glycemic control of the patients, with marginal reduction in their practice score. Adoption: All the facilities adopted the education component, while all but one facility adopted the prescription of generic medications. There was poor implementation of the intervention, particularly with regard to the use of generic medications and the standard treatment guidelines. Doctors' concerns about the efficacy, quality, availability, and acceptability by patients of generic medications explained limited prescriptions of generic medications. The patients' perception that ailments should be treated through medications limited the use of non-medical management by the doctors in early stages of diabetes. The other reason for the limited use of the standard treatment guidelines was that these doctors mainly provided follow-up care to patients who were previously put on a given treatment plan by specialists. Maintenance: The intervention facilities continued using posters and television monitors for health education after the intervention period. The use of generic medications and standard treatment guidelines for diabetes management remained very limited. Implementing efficacious health service intervention in a real-world resource-constrained setting is challenging and may not prove effective in improving patient outcomes. Interventions need to consider patients' and healthcare providers' experiences and perceptions and how macro-level policies translate into practice within local health systems.

  1. The UK Human Genome Mapping Project online computing service.

    PubMed

    Rysavy, F R; Bishop, M J; Gibbs, G P; Williams, G W

    1992-04-01

    This paper presents an overview of computing and networking facilities developed by the Medical Research Council to provide online computing support to the Human Genome Mapping Project (HGMP) in the UK. The facility is connected to a number of other computing facilities in various centres of genetics and molecular biology research excellence, either directly via high-speed links or through national and international wide-area networks. The paper describes the design and implementation of the current system, a 'client/server' network of Sun, IBM, DEC and Apple servers, gateways and workstations. A short outline of online computing services currently delivered by this system to the UK human genetics research community is also provided. More information about the services and their availability could be obtained by a direct approach to the UK HGMP-RC.

  2. Medical tourism in the Caribbean region: a call to consider environmental health equity.

    PubMed

    Johnston, R; Crooks, V A

    2013-03-01

    Medical tourism, which is the intentional travel by private-paying patients across international borders for medical treatment, is a sector that has been targeted for growth in many Caribbean countries. The international development of this industry has raised a core set of proposed health equity benefits and drawbacks for host countries. These benefits centre on the potential investment in health infrastructure and opportunities for health labour force development while drawbacks focus on the potential for reduced access to healthcare for locals and inefficient use of limited public resources to support the growth of the medical tourism industry. The development of the medical tourism sector in Caribbean countries raises additional health equity questions that have received little attention in existing international debates, specifically in regard to environmental health equity. In this viewpoint, we introduce questions of environmental health equity that clearly emerge in relation to the developing Caribbean medical tourism sector These questions acknowledge that the growth of this sector will have impacts on the social and physical environments, resources, and waste management infrastructure in countries. We contend that in addition to addressing the wider health equity concerns that have been consistently raised in existing debates surrounding the growth of medical tourism, planning for growth in this sector in the Caribbean must take environmental health equity into account in order to ensure that local populations, environments, and ecosystems are not harmed by facilities catering to international patients.

  3. Medical mall founders' satisfaction and integrated management requirements.

    PubMed

    Ito, Atsushi

    2017-10-01

    Medical malls help provide integrated medical services and the effective and efficient independent management of multiple clinics, pharmacies and other medical facilities. Primary care in an aging society is a key issue worldwide and the establishment of a new model for primary care in Japanese medical malls is needed. Understanding the requirements of integrated management that contribute to the improvement of medical mall founders' satisfaction levels will help provide better services. We conducted a questionnaire survey targeting 1840 medical facilities nationwide; 351 facilities responded (19.1%). We performed comparative analyses on founders' satisfaction levels according to years in business, department/area, founder's relationship, decision-making system and presence/absence of liaison role. A total of 70% of medical malls in Japan have adjacent relationships with no liaison role in most cases; however, 60% of founders are satisfied. Integrated management requirements involve establishing the mall with peers from the same medical office unit or hospital, and establishing a system in which all founders can participate in decision-making (council system) or one where each general practitioner (GP) independently runs a clinic without communicating with others. The council system can ensure the capability of general practitioners to treat many primary care patients in the future. © 2016 The Authors. The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd. © 2016 The Authors. The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd.

  4. Medical mall founders' satisfaction and integrated management requirements

    PubMed Central

    2016-01-01

    Summary Medical malls help provide integrated medical services and the effective and efficient independent management of multiple clinics, pharmacies and other medical facilities. Primary care in an aging society is a key issue worldwide and the establishment of a new model for primary care in Japanese medical malls is needed. Understanding the requirements of integrated management that contribute to the improvement of medical mall founders' satisfaction levels will help provide better services. We conducted a questionnaire survey targeting 1840 medical facilities nationwide; 351 facilities responded (19.1%). We performed comparative analyses on founders' satisfaction levels according to years in business, department/area, founder's relationship, decision‐making system and presence/absence of liaison role. A total of 70% of medical malls in Japan have adjacent relationships with no liaison role in most cases; however, 60% of founders are satisfied. Integrated management requirements involve establishing the mall with peers from the same medical office unit or hospital, and establishing a system in which all founders can participate in decision‐making (council system) or one where each general practitioner (GP) independently runs a clinic without communicating with others. The council system can ensure the capability of general practitioners to treat many primary care patients in the future. © 2016 The Authors. The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd PMID:27218206

  5. Medical Education in Decentralized Settings: How Medical Students Contribute to Health Care in 10 Sub-Saharan African Countries.

    PubMed

    Talib, Zohray; van Schalkwyk, Susan; Couper, Ian; Pattanaik, Swaha; Turay, Khadija; Sagay, Atiene S; Baingana, Rhona; Baird, Sarah; Gaede, Bernhard; Iputo, Jehu; Kibore, Minnie; Manongi, Rachel; Matsika, Antony; Mogodi, Mpho; Ramucesse, Jeremais; Ross, Heather; Simuyeba, Moses; Haile-Mariam, Damen

    2017-12-01

    African medical schools are expanding, straining resources at tertiary health facilities. Decentralizing clinical training can alleviate this tension. This study assessed the impact of decentralized training and contribution of undergraduate medical students at health facilities. Participants were from 11 Medical Education Partnership Initiative-funded medical schools in 10 African countries. Each school identified two clinical training sites-one rural and the other either peri-urban or urban. Qualitative and quantitative data collection tools were used to gather information about the sites, student activities, and staff perspectives between March 2015 and February 2016. Interviews with site staff were analyzed using a collaborative directed approach to content analysis, and frequencies were generated to describe site characteristics and student experiences. The clinical sites varied in level of care but were similar in scope of clinical services and types of clinical and nonclinical student activities. Staff indicated that students have a positive effect on job satisfaction and workload. Respondents reported that students improved the work environment, institutional reputation, and introduced evidence-based approaches. Students also contributed to perceived improvements in quality of care, patient experience, and community outreach. Staff highlighted the need for resources to support students. Students were seen as valuable resources for health facilities. They strengthened health care quality by supporting overburdened staff and by bringing rigor and accountability into the work environment. As medical schools expand, especially in low-resource settings, mobilizing new and existing resources for decentralized clinical training could transform health facilities into vibrant service and learning environments.

  6. Compliance to follow up and adherence to medication in hypertensive patients in an urban informal settlement in Kenya: comparison of three models of care.

    PubMed

    Kuria, Ng'endo; Reid, Anthony; Owiti, Philip; Tweya, Hannock; Kibet, Caleb Kipkurui; Mbau, Lilian; Manzi, Marcel; Murunga, Victor; Namusonge, Tecla; Kibachio, Joseph

    2018-05-19

    To determine and compare, among three models of care, compliance to scheduled clinic appointments and adherence to anti-hypertensive medication of patients in an informal settlement of Kibera, Kenya. Routinely collected patient data were used from three health facilities, six walkway clinics and one weekend/church clinic. Patients were eligible if they had received hypertension care for more than six months. Compliance with clinic appointments and self-reported adherence to medication were determined from clinic records and compared using the Chi-square test. Univariate and multivariate logistic regression models estimated the odds of overall adherence to medication. 785 patients received hypertension treatment eligible for analysis, of whom two-thirds were women. Between them, there were 5879 clinic visits with an overall compliance to appointments of 63%. Compliance was high in the health facilities and walkway clinics but men were more likely to attend the weekend/church clinics. Self-reported adherence to medication by those complying with scheduled clinic visits was 94%. Patients in the walkway clinics were two times more likely to adhere to anti-hypertensive medication than patients at the health facility (OR 1.97, 95%CI 1.25-3.10). Walkway clinics outperformed health facilities and weekend clinics. Use of multiple sites for the management of hypertensive patients led to good compliance with scheduled clinic visits and very good self-reported adherence to medication in a low-resource setting. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  7. Establishing a clinical pharmacy technician at a United States Army military treatment facility.

    PubMed

    Evans, Jennifer L; Gladd, Ellen M; Gonzalez, Alicia C; Tranam, Salman; Larrabee, Joni M; Lipphardt, Sarah E; Chen, Tina T; Ronn, Michael D; Spain, John

    2016-01-01

    To describe the creation of a clinical pharmacy technician position within the U.S. Army and to identify the personal skills and characteristics required to meet the demands of this role. An outpatient military treatment facility located in Maryland. The clinical pharmacy technician position was designed to support clinical pharmacy services within a patient-centered medical home. Funding and a position description were established to hire a clinical pharmacy technician. Expected duties included administrative (45%), patient education (30%), and dispensing (25%). Local policy, in accordance with federal law and U.S. Army regulations, was developed to define the expanded technician responsibility to deliver patient medication education. In the initial 3 months, the clinical pharmacy technician spent 24 hours per week on clinical activities, affording an additional 10-15 hours per week for clinical pharmacists to provide patient care. Completed consults increased from 41% to 56%, and patient-pharmacist encounters increased from 240 to 290 per month. The technician, acting as a clinical pharmacist extender, also completed an average of 90 patient encounters independently each month. As a result of these improvements, the decision was made to hire a second technician. Currently, the technicians spend 28-40 hours per week on clinical activities, offsetting an average of 26 hours per week for the clinical pharmacists. A patient-centered medical home clinical pharmacy technician can reduce the administrative workload for clinical pharmacists, improve their efficiency, and enhance the use of clinical pharmacy services. Several characteristics, particularly medication knowledge, make pharmacy technicians particularly suited for this role. The results from the implementation of a clinical pharmacy technician at this military treatment facility resulted in an Army-wide expansion of the position and suggested applicability in other practice sites, particularly in federal pharmacies. Published by Elsevier Inc.

  8. The state of the art of medical imaging technology: from creation to archive and back.

    PubMed

    Gao, Xiaohong W; Qian, Yu; Hui, Rui

    2011-01-01

    Medical imaging has learnt itself well into modern medicine and revolutionized medical industry in the last 30 years. Stemming from the discovery of X-ray by Nobel laureate Wilhelm Roentgen, radiology was born, leading to the creation of large quantities of digital images as opposed to film-based medium. While this rich supply of images provides immeasurable information that would otherwise not be possible to obtain, medical images pose great challenges in archiving them safe from corrupted, lost and misuse, retrievable from databases of huge sizes with varying forms of metadata, and reusable when new tools for data mining and new media for data storing become available. This paper provides a summative account on the creation of medical imaging tomography, the development of image archiving systems and the innovation from the existing acquired image data pools. The focus of this paper is on content-based image retrieval (CBIR), in particular, for 3D images, which is exemplified by our developed online e-learning system, MIRAGE, home to a repository of medical images with variety of domains and different dimensions. In terms of novelties, the facilities of CBIR for 3D images coupled with image annotation in a fully automatic fashion have been developed and implemented in the system, resonating with future versatile, flexible and sustainable medical image databases that can reap new innovations.

  9. The State of the Art of Medical Imaging Technology: from Creation to Archive and Back

    PubMed Central

    Gao, Xiaohong W; Qian, Yu; Hui, Rui

    2011-01-01

    Medical imaging has learnt itself well into modern medicine and revolutionized medical industry in the last 30 years. Stemming from the discovery of X-ray by Nobel laureate Wilhelm Roentgen, radiology was born, leading to the creation of large quantities of digital images as opposed to film-based medium. While this rich supply of images provides immeasurable information that would otherwise not be possible to obtain, medical images pose great challenges in archiving them safe from corrupted, lost and misuse, retrievable from databases of huge sizes with varying forms of metadata, and reusable when new tools for data mining and new media for data storing become available. This paper provides a summative account on the creation of medical imaging tomography, the development of image archiving systems and the innovation from the existing acquired image data pools. The focus of this paper is on content-based image retrieval (CBIR), in particular, for 3D images, which is exemplified by our developed online e-learning system, MIRAGE, home to a repository of medical images with variety of domains and different dimensions. In terms of novelties, the facilities of CBIR for 3D images coupled with image annotation in a fully automatic fashion have been developed and implemented in the system, resonating with future versatile, flexible and sustainable medical image databases that can reap new innovations. PMID:21915232

  10. Assessment of a quality improvement intervention to strengthen pharmaceutical human resources and improve availability and use of HIV medicines in Uganda.

    PubMed

    Byabagambi, John B; Broughton, Edward; Heltebeitel, Simon; Wuliji, Tana; Karamagi, Esther

    2017-01-01

    Inadequate medication dispensing and management by healthcare providers can contribute to poor outcomes among HIV-positive patients. Gaps in medication availability, often associated with pharmacy workforce shortages, are an important barrier to retention in HIV care in Uganda. An intervention to address pharmacy staffing constraints through strengthening pharmaceutical management, dispensing practices, and general competencies of facility clinical and pharmacy staff was implemented in 14 facilities in three districts in eastern Uganda. Teams of staff were organised in each facility and supported to apply quality improvement (QI) methods to address deficits in availability and rational use of HIV drugs. To evaluate the intervention, baseline and end line data were collected 24 months apart. Dispensing practices, clinical wellness and adherence to antiretrovirals improved by 45%, 28% and 20% from baseline to end line, respectively. All clients at end line received the medications prescribed, and medications were correctly, completely and legibly labelled more often. Clients better understood when, how much and for how long they were supposed to take their prescribed medicines at end line. Pharmaceutical management practices also improved from baseline in most categories by statistically significant margins. Facilities significantly improved on correctly recording stock information about antiretroviral drugs (53%vs100%, P<0.0001). Coinciding with existing staff taking on pharmaceutical roles, facilities improved management of unwanted and expired drugs, notably by optimising use of existing health workers and making pharmaceutical management processes more efficient. Implementation of this improvement intervention in the 14 facilities appeared to have a positive impact on client outcomes, pharmacy department management and providers' self-reported knowledge of QI methods. These results were achieved at a cost of about US$5.50 per client receiving HIV services at participating facilities.

  11. Acquisition and review of diagnostic images for use in medical research and medical testing examinations via the Internet

    NASA Astrophysics Data System (ADS)

    Pauley, Mark A.; Dalrymple, Glenn V.; Zhu, Quiming; Chu, Wei-Kom

    2000-12-01

    With the continued centralization of medical care into large, regional centers, there is a growing need for a flexible, inexpensive, and secure system to rapidly provide referring physicians in the field with the results of the sophisticated medical tests performed at these facilities. Furthermore, the medical community has long recognized the need for a system with similar characteristics to maintain and upgrade patient case sets for oral and written student examinations. With the move toward filmless radiographic instrumentation, the widespread and growing use of digital methods and the Internet, both of these processes can now be realized. This article describes the conceptual development and testing of a protocol that allow users to transmit, modify, remotely store and display the images and textual information of medical cases via the Internet. We also discuss some of the legal issues we encountered regarding the transmission of medical information; these issues have had a direct impact on the implementation of the results of this project.

  12. Utilization of health services in a resource-limited rural area in Kenya: Prevalence and associated household-level factors.

    PubMed

    Ngugi, Anthony K; Agoi, Felix; Mahoney, Megan R; Lakhani, Amyn; Mang'ong'o, David; Nderitu, Esther; Armstrong, Robert; Macfarlane, Sarah

    2017-01-01

    Knowledge of utilization of health services and associated factors is important in planning and delivery of interventions to improve health services coverage. We determined the prevalence and factors associated with health services utilization in a rural area of Kenya. Our findings inform the local health management in development of appropriately targeted interventions. We used a cluster sample survey design and interviewed household key informants on history of illness for household members and health services utilization in the preceding month. We estimated prevalence and performed random effects logistic regression to determine the influence of individual and household level factors on decisions to utilize health services. 1230/6,440 (19.1%, 95% CI: 18.3%-20.2%) household members reported an illness. Of these, 76.7% (95% CI: 74.2%-79.0%) sought healthcare in a health facility. The majority (94%) of the respondents visited dispensary-level facilities and only 60.1% attended facilities within the study sub-counties. Of those that did not seek health services, 43% self-medicated by buying non-prescription drugs, 20% thought health services were too costly, and 10% indicated that the sickness was not serious enough to necessitate visiting a health facility. In the multivariate analyses, relationship to head of household was associated with utilization of health services. Relatives other than the nuclear family of the head of household were five times less likely to seek medical help (Odds Ratio 0.21 (95% CI: 0.05-0.87)). Dispensary level health facilities are the most commonly used by members of this community, and relations at the level of the household influence utilization of health services during an illness. These data enrich the perspective of the local health management to better plan the allocation of healthcare resources according to need and demand. The findings will also contribute in the development of community-level health coverage interventions that target the disadvantaged household groups.

  13. Antidepressant and antipsychotic medication errors reported to United States poison control centers.

    PubMed

    Kamboj, Alisha; Spiller, Henry A; Casavant, Marcel J; Chounthirath, Thitphalak; Hodges, Nichole L; Smith, Gary A

    2018-05-08

    To investigate unintentional therapeutic medication errors associated with antidepressant and antipsychotic medications in the United States and expand current knowledge on the types of errors commonly associated with these medications. A retrospective analysis of non-health care facility unintentional therapeutic errors associated with antidepressant and antipsychotic medications was conducted using data from the National Poison Data System. From 2000 to 2012, poison control centers received 207 670 calls reporting unintentional therapeutic errors associated with antidepressant or antipsychotic medications that occurred outside of a health care facility, averaging 15 975 errors annually. The rate of antidepressant-related errors increased by 50.6% from 2000 to 2004, decreased by 6.5% from 2004 to 2006, and then increased 13.0% from 2006 to 2012. The rate of errors related to antipsychotic medications increased by 99.7% from 2000 to 2004 and then increased by 8.8% from 2004 to 2012. Overall, 70.1% of reported errors occurred among adults, and 59.3% were among females. The medications most frequently associated with errors were selective serotonin reuptake inhibitors (30.3%), atypical antipsychotics (24.1%), and other types of antidepressants (21.5%). Most medication errors took place when an individual inadvertently took or was given a medication twice (41.0%), inadvertently took someone else's medication (15.6%), or took the wrong medication (15.6%). This study provides a comprehensive overview of non-health care facility unintentional therapeutic errors associated with antidepressant and antipsychotic medications. The frequency and rate of these errors increased significantly from 2000 to 2012. Given that use of these medications is increasing in the US, this study provides important information about the epidemiology of the associated medication errors. Copyright © 2018 John Wiley & Sons, Ltd.

  14. What Are Nursing Facilities Doing to Reduce Potentially Avoidable Hospitalizations?

    PubMed

    Daras, Laura Coots; Wang, Joyce M; Ingber, Melvin J; Ormond, Catherine; Breg, Nathaniel W; Khatutsky, Galina; Feng, Zhanlian

    2017-05-01

    Hospitalizations among nursing facility residents are frequent and often potentially avoidable. A number of initiatives and interventions have been developed to reduce excessive hospitalizations; however, little is known about the specific approaches nursing facilities use to address this issue. The objective of this study is to better understand which types of interventions nursing facilities have introduced to reduce potentially avoidable hospitalizations of long-stay nursing facility residents. Cross-sectional survey. 236 nursing facilities from 7 states. Nursing facility administrators. Web-based survey to measure whether facilities introduced any policies or procedures designed specifically to reduce potentially avoidable hospitalizations of long-stay nursing facility residents between 2011 and 2015. We surveyed facilities about seven types of interventions and quality improvement activities related to reducing avoidable hospitalizations, including use of Interventions to Reduce Acute Care Transfers (INTERACT) and American Medical Directors Association tools. Ninety-five percent of responding nursing facilities reported having introduced at least one new policy or procedure to reduce nursing facility resident hospitalizations since January 2011. The most common practice reported was hospitalization rate tracking or review, followed by standardized communication tools, such as Situation, Background, Assessment, Recommendation (SBAR). We found some variation in the extent and types of these reported interventions. Nearly all facilities surveyed reported having introduced a variety of initiatives to reduce potentially avoidable hospitalizations, likely driven by federal, state, and corporate initiatives to decrease hospital admissions and readmissions. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. All rights reserved.

  15. Paediatric liver transplantation for children treated at public health facilities in South Africa: time for change.

    PubMed

    Lala, S G; Britz, R; Botha, J; Loveland, J

    2014-11-01

    Paediatric liver transplantation (PLT) is the only therapeutic option for many children with end-stage chronic liver disease or irreversible fulminant hepatic failure, and is routinely considered as a therapy by paediatric gastroenterologists and surgeons working in developed countries. In South Africa (SA), a PLT programme has been available at Red Cross War Memorial Children's Hospital in Cape Town since November 1991, and another has rapidly developed at the Wits Donald Gordon Medical Centre in Johannesburg over the past decade. However, for most children with progressive chronic liver disease who are reliant on the services provided at state facilities in SA, PLT is not an option because of a lack of resources in a mismanaged public health system. This article briefly outlines the services offered at Chris Hani Baragwanath Academic Hospital--which is typical of state facilities in SA--and proposes that resources be allocated to establish an innovative, nationally funded centre that would enable greater numbers of children access to a PLT programme.

  16. Contemporary social network sites: Relevance in anesthesiology teaching, training, and research

    PubMed Central

    Haldar, Rudrashish; Kaushal, Ashutosh; Samanta, Sukhen; Ambesh, Paurush; Srivastava, Shashi; Singh, Prabhat K.

    2016-01-01

    Objective: The phenomenal popularity of social networking sites has been used globally by medical professionals to boost professional associations and scientific developments. They have tremendous potential to forge professional liaisons, generate employment,upgrading skills and publicizing scientific achievements. We highlight the role of social networking mediums in influencing teaching, training and research in anaesthesiology. Background: The growth of social networking sites have been prompted by the limitations of previous facilities in terms of ease of data and interface sharing and the amalgamation of audio visual aids on common platforms in the newer facilities. Review: Contemporary social networking sites like Facebook, Twitter, Tumblr,Linkedn etc and their respective features based on anaesthesiology training or practice have been discussed. A host of advantages which these sites confer are also discussed. Likewise the potential pitfalls and drawbacks of these facilities have also been addressed. Conclusion: Social networking sites have immense potential for development of training and research in Anaesthesiology. However responsible and cautious utilization is advocated. PMID:27625491

  17. Contemporary social network sites: Relevance in anesthesiology teaching, training, and research.

    PubMed

    Haldar, Rudrashish; Kaushal, Ashutosh; Samanta, Sukhen; Ambesh, Paurush; Srivastava, Shashi; Singh, Prabhat K

    2016-01-01

    The phenomenal popularity of social networking sites has been used globally by medical professionals to boost professional associations and scientific developments. They have tremendous potential to forge professional liaisons, generate employment,upgrading skills and publicizing scientific achievements. We highlight the role of social networking mediums in influencing teaching, training and research in anaesthesiology. The growth of social networking sites have been prompted by the limitations of previous facilities in terms of ease of data and interface sharing and the amalgamation of audio visual aids on common platforms in the newer facilities. Contemporary social networking sites like Facebook, Twitter, Tumblr,Linkedn etc and their respective features based on anaesthesiology training or practice have been discussed. A host of advantages which these sites confer are also discussed. Likewise the potential pitfalls and drawbacks of these facilities have also been addressed. Social networking sites have immense potential for development of training and research in Anaesthesiology. However responsible and cautious utilization is advocated.

  18. Clinical audit of emergency unit before and after establishment of the emergency medicine department.

    PubMed

    Amini, Afshin; Dindoost, Payam; Moghimi, Mehrdad; Kariman, Hamid; Shahrami, Ali; Dolatabadi, Ali Arhami; Ali-Mohammadi, Hossein; Alavai-Moghaddam, Mostafa; Derakhshanfar, Hojjat; Hatamabadi, HamidReza; Heidari, Kamran; Alamdari, Shahram; Meibodi, Mohammad Kalantar; Shojaee, Majid; Foroozanfar, Mohammad Mehdi; Hashemi, Behrooz; Sabzeghaba, Anita; Kabir, Ali

    2012-02-01

    To assess the deficiencies and potential areas through a medical audit of the emergency departments, in six general hospitals affiliated to Shahid Beheshti University of Medical Sciences at Tehran, Iran, after preparing specific wards-based international standards. A checklist was completed for all hospitals which met our eligibility criteria mainly observation and interviews with head nurses and managers of the emergency medicine unit of the hospitals before (2003) and after (2008) the establishment of emergency departments there. Domains studied included staffing, education and continuing professional development (CPD), facility (design), equipment, ancillary services, medical records, manuals and references, research, administration, pre-hospital care, information systems, disaster planning, bench-marking and hospital accreditation. Education and CPD (p = 0.042), design and facility (p = 0.027), equipment (p = 0.028), and disaster (p = 0.026) had significantly improved after the establishment of emergency departments. Nearly all domains showed a positive change though it was non-significant in a few. In terms of observation, better improvement was seen in disaster, security, design, and research. According to the score for each domain compared to what it was in the earlier phase, better improvement was observed in hospital accreditation, information systems, security, disaster planning, and research. Security, disaster planning, research, design and facility had improved in hospitals that wave studied, while equipment, records, ancillary services, administration and bench-marking had the lowest improvement even after the establishment of emergency department, and, hence, needed specific attention.

  19. Financial impact of hand surgery programs on academic medical centers.

    PubMed

    Hasan, Jafar S; Chung, Kevin C; Storey, Amy F; Bolg, Mary L; Taheri, Paul A

    2007-02-01

    This study analyzes the financial performance of hand surgery in the Department of Surgery at the University of Michigan. This analysis can serve as a reference for other medical centers in the financial evaluation of a hand surgery program. Fiscal year 2004 billing records for all patients (n = 671) who underwent hand surgery procedures were examined. The financial data were separated into professional revenues and costs (relating to the hand surgery program in the Section of Plastic Surgery) and into facility revenues and costs (relating to the overall University of Michigan Health System). Professional net revenue was calculated by applying historical collection rates to procedural and clinic charges. Facility revenue was calculated by applying historical collection rates to the following charge categories: inpatient/operating room, clinic facility, neurology/electromyography, radiology facilities, and occupational therapy. Total professional costs were calculated by adding direct costs and allocated overhead costs. Facility costs were obtained from the hospital's cost accounting system. Professional and facility incomes were calculated by subtracting costs from revenues. The net professional revenue and total costs were 1,069,836 and 1,027,421 dollars, respectively. Professional operating income was 42,415 dollars, or 3.96 percent of net professional revenue. Net facility revenue and total costs were 5,500,606 and 4,592,534 dollars, respectively. Facility operating income was 908,071 dollars, or 16.51 percent of net facility revenues. While contributing to the academic mission of the institution, hand surgery is financially rewarding for the Department of Surgery. In addition, hand surgery activity contributes substantially to the financial well-being of the academic medical center.

  20. Older females are at higher risk for medical complications during 21 km road race running: a prospective study in 39 511 race starters--SAFER study III.

    PubMed

    Schwabe, Karen; Schwellnus, Martin P; Derman, Wayne; Swanevelder, Sonja; Jordaan, Esme

    2014-06-01

    The half-marathon (21 km) race is a very popular mass community-based distance running event. It is important to determine risk factors for medical complications during these events, so that prevention programmes can be developed. To determine risk factors associated with medical complications during 21 km road running events. Prospective study. Two Oceans half-marathon (21 km) races. 39 511 starters in the 21 km race. Medical complications (defined as any runner requiring assessment by a doctor at the race medical facility or a local hospital on race day) were recorded over a 4-year study period. Medical complications were subdivided according to the system affected and by final diagnosis. A Poisson regression model was used to determine risk factors for any medical complication and more common specific complications. Independent risk factors for medical complication during 21 km running were older female runners (women >50 vs  ≤50 years; p<0.0001) and year of observation (2008 vs 2011; p=0.0201: 2009 vs 2011: p=0.0019; 2010 vs 2011: p=0.0096). Independent risk factors for specific common medical complications were: postural hypotension (women, slow running pace), musculoskeletal complications (less running experience, slower running pace) and dermatological complications (women). Older female runners are at higher risk of developing medical complications during 21 km road running races. Environmental conditions in a particularly cold climate may also play a role. Less running experience and slower running pace are associated with specific medical complications. Medical staff can now plan appropriate care on race days, and interventions can be developed to reduce the risk of medical complications in 21 km races.

  1. Essential books for health workers in the Third World.

    PubMed

    Weitzel, R

    1992-01-01

    Some of the issues relating to access to medical reference information in developing countries is delineated: the selection of core collections, title selection, funding, and accommodation, supervision, and use of collections. Provision of medical textbooks has been ignored in the movement after Alma Ata to strengthen primary health care. Now that the infrastructures are partially in place there is need to improve the availability of medical information. In developing countries, information and communication systems outside cities are problematic. Library extension services in rural areas are limited and the needs are case related. Health care facilities need carefully selected textbooks and manuals: core collections. The experiences in Zimbabwe resulted in the selection of several core lists: 40 references and manuals for hospitals, and 13 textbooks for health center staff. There are economic constraints when a standard European or American medical textbook costs $85 and a nursing textbook $45 and the need, as in the case of Zimbabwe, requires collections for 1000 health care facilities. The source of supply in Zimbabwe and Malawi was the British Council's Educational Law-price Book Scheme, "Teaching Aids at Low Cost." Rural health manuals were available at low cost from the African Medical and Research Foundation. WHO also provides core materials on suitable topics at low prices and availability in several major languages. Other factors besides cost in the selection involve appropriateness to local disease patterns, geographical and environmental characteristics, and the composition and level of the health community. Journals should be included. In Zimbabwe a joint effort was made for core selection by Ministry of Health senior members in the Division of Health Manpower Development and Health Education, 3 medical librarians, a faculty members of the University of Zimbabwe, and advice from several district hospital physicians In Malawi, selection was made by the Ministry of Health and then distributed for comment. Government requires help in funding. Space needs to made available for free accessibility of materials. A staff member should be in charge of the use and intactness of the collection but staff should satisfy their own needs. Rural staff may need to be educated on the importance of use of reference materials.

  2. Prospects for Vascular Access Education in Developing Countries: Current Situation in Cambodia.

    PubMed

    Naganuma, Toshihide; Takemoto, Yoshiaki

    2017-01-01

    We report our activities training doctors on vascular access procedures at International University (IU) Hospital in Cambodia through a program facilitated by Ubiquitous Blood Purification International, a nonprofit organization that provides medical support to developing countries in the field of dialysis medicine. Six doctors from Japan have been involved in the education of medical personnel at IU, and we have collectively visited Cambodia about 15 times from 2010 to 2016. In these visits, we have performed many operations, including 42 for arteriovenous fistula, 1 arteriovenous graft, and 1 percutaneous transluminal angioplasty. Stable development and management of vascular access is increasingly required in Cambodia due to increased use of dialysis therapy, and training of doctors in this technique is urgently required. However, we have encountered several difficulties that need to be addressed, including (1) the situation of personnel receiving this training, (2) problems with facilities, including medical equipment and drugs, (3) financial limitations, and (4) problems with management of vascular access. © 2017 S. Karger AG, Basel.

  3. Slovenian national health insurance card: the next step.

    PubMed

    Kalin, T; Kandus, G; Trcek, D; Zupan, B

    1999-01-01

    The Slovenian national health insurance company started a full-scale deployment of the insurance smart card that is at the present used for insurance data and identification purpose only. There is ample capacity on the cards that were selected, to contain much more data than needed for the purely administrative and charging purposes. There are plans to include some basic medical information, donor information, etc. On the other hand, there are no firm plans to use the security infrastructure and the extensive network, connecting the insurance company with the more than 200 self service terminals positioned at the medical facilities through the country to build an integrated medical information system that would be very beneficial to the patients and the medical community. This paper is proposing some possible future developments and further discusses on the security issues involved with such countrywide medical information system.

  4. [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.

  5. Medical tourism in Iran: Issues and challenges

    PubMed Central

    Jabbari, Alireza; Delgoshaei, Bahram; Mardani, Raja; Tabibi, Seid Jamaledin

    2012-01-01

    Introduction: Medical tourism is rapidly becoming a worldwide, multibillion-dollar industry. Iran has a high potential for this industry. The purpose of this study was to examine the medical tourism cluster, using Diamond Analysis tool. Materials and Methods: This study is a descriptive, analytical and qualitative one. Thirty professionals and researchers in this field were interviewed and official documents belonging to the Health ministry as well as tourism organization and finally related literature were examined. The data was analyzed using content analysis method. Results: Positive and negative parts of the medical tourism industry of Iran were determined according to diamond of advantage. Conclusion: The strategic issues were identified and a number of possible solutions for addressing them were recommended. More and effective public-private participations, aggressive marketing, improving infrastructures, and international accreditation of health care facilities and human resources development could improve medical tourism industry in the country. PMID:23555142

  6. The Joint Military Medical Executive Skills initiative: an impressive response to changing human resource management rules of engagement.

    PubMed

    Kerr, Bernard J

    2007-01-01

    Confronted with a sudden and substantial change in the rules regarding who could command a military medical treatment facility (MTF), the Military Health System (MHS) responded to the challenge with an impressive human resource management solution-the Joint Medical Executive Skills Program. The history, emergence, and continuing role of this initiative exemplifies the MHS's capacity to fulfill the spirit and intent of an arduous Congressional mandate while enhancing professional development and sustaining the career opportunities of medical officers. The MHS response to the Congressional requirement that candidates for MTF command demonstrate professional administrative skills was decisive, creative, and consistent with the basic principles of human resource management. The Joint Medical Executive Skills Program is a management success story that demonstrates how strategic planning, well-defined skills requirements, and structured training can assure a ready supply of qualified commanders for the military's MTFs.

  7. TRICARE: the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); specialized treatment services (STS) program--DoD. Notice.

    PubMed

    1998-11-16

    This notice is to advise interested parties that Brooke Army Medical Center (BAMC) and Wilford Hall Medical Center (WHMC), hereinafter referred to as Destination San Antonio, have been designated the Regional Specialized Treatment Service facilities (STSFs) for DRGs 1, 3, 4, 49, 104-107, 110-111, 191, 209, 491, 286, and 357. The application for the STSF designation was submitted by the Lead Agency for TRICARE Region 6 and approved by the Assistant Secretary of Defense (Health Affairs). The Lead Agent will oversee that the STSFs maintain the quality and standards required for specialized treatment services. DoD beneficiaries residing within a 200-mile radius of Destination San Antonio facilities falling into the above patient category must be evaluated by Destination San Antonio staff before receiving care for these DRGs under direct military care or TRICARE/CHAMPUS cost sharing. Travel and lodging for the patient and, if stated to be medically necessary by a referring physician, for a nonmedical attendant, will be reimbursed by Destination San Antonio facility in accordance with the provisions of the Joint Federal Travel Regulation. Although evaluation in person is preferred, it is possible to conduct the evaluation telephonically if the patient is unable to travel to a Destination San Antonio facility. If the care for these DRGs cannot be performed at the Destination San Antonio facilities, the TRICARE Managed Care Support Contractor for Region 6 will provide a medical necessity review prior to issuance of an Inpatient Care Authorization or Non-availability Statement.

  8. The Innovation Hyperlab - Linking Student Innovation at University and Pre-College Levels

    NASA Astrophysics Data System (ADS)

    Tagg, Randall

    2012-02-01

    We have created a laboratory environment to support collaboration between university and pre-college students on innovation and entrepreneurship projects. Called the ``Innovation Hyperlab,'' this facility is located in a K-12 complex called VistaPEAK schools in Aurora, Colorado. The lab is supported by four elements: a research-grade technical infrastructure of supplies and equipment for technical prototyping, a developing curriculum of ``learning modules on demand'' for rapid assimilation of technical skills, mentors from universities / medical schools / industry, and innovation projects stimulated by connections with the regional community. A current focus of projects is on medical technology development, linking tenth graders with university undergraduate research students and coordinated with the University of Colorado Denver's medical school. The Innovation Hyperlab is a work in progress and we will describe challenges that arise in connecting such a collaboration with traditional curriculum at both the university and pre-college levels.

  9. Interdisciplinary group approach to occupational safety and health administration standard: reductions in cost and duplication of effort.

    PubMed

    Canola, T; Kirkis, E J; Meckes, P F; Pitts, S B

    1994-06-01

    After the December 1991 publication of the Occupational Safety and Health Administration standard, "Occupational Exposure to Bloodborne Pathogens; Final Rule," medical facilities in the United States were challenged to meet the mandates of this standard with massive training in a relatively short time. An interdisciplinary task force composed of representative members of a major health maintenance organization was charged with the task of developing a training plan for 11 Southern California medical centers and their 42 satellite medical offices. The task force ultimately developed, refined, and distributed a Trainer Guidebook that could be used by a variety of disciplines. This guidebook provided a method by which the information could be disseminated concisely, thoroughly, and promptly. The processes used in this project can be applied to other health care educational situations. The purpose of this article is to share these processes.

  10. 38 CFR 17.240 - Sharing specialized medical resources.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... medical resources. 17.240 Section 17.240 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Sharing of Medical Facilities, Equipment, and Information § 17.240 Sharing specialized medical resources. Subject to such terms and conditions as the Under Secretary for Health shall prescribe...

  11. 38 CFR 17.240 - Sharing specialized medical resources.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... medical resources. 17.240 Section 17.240 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Sharing of Medical Facilities, Equipment, and Information § 17.240 Sharing specialized medical resources. Subject to such terms and conditions as the Under Secretary for Health shall prescribe...

  12. The availability of essential medicines for mental healthcare in Sofala, Mozambique

    PubMed Central

    Wagenaar, Bradley H.; Stergachis, Andy; Rao, Deepa; Hoek, Roxanne; Cumbe, Vasco; Napúa, Manuel; Sherr, Kenneth

    2015-01-01

    Objective We assessed the availability of essential medicines for mental healthcare (MH) across levels of the public healthcare system to aid in future systems planning. Design Non-expired MH medications were assessed in 24 public health facilities and 13 district warehouses across Sofala Province, Mozambique, from July to August 2014. Medication categories included: antipsychotics, antidepressants, benzodiazepines, antiepileptics and mood stabilizers, and anticholinergics and antihistamines. Results Only 7 of 12 (58.3%) district warehouses, 11 of 24 (45.8%) of all health facilities, and 10 of 12 (83.3%) of facilities with trained MH staff had availability of at least one medication of each category. Thioridazine was the most commonly available antipsychotic across all facilities (9 of 24, 37.5%), while chlorpromazine and thioridazine were most common at facilities providing MH care (8 of 12, 66.7%). The atypical antipsychotic risperidone was not available at any facility or district warehouse. Amitriptyline was the most commonly available antidepressant (10 of 12 districts; 12 of 24 overall facilities; 9 or 12 MH facilities). Despite being on the national essential drug list, fluoxetine was only available at one quaternary-level facility and no district warehouses. Conclusions Essential psychotropic medicines are routinely unavailable at public health facilities. Current essential drug lists include six typical but no atypical antipsychotics, which is concerning given the side-effect profiles of typical antipsychotics. Ensuring consistent availability of at least one selective serotonin reuptake inhibitor should also be a priority, as they are essential for the treatment of individuals with underlying cardiovascular disease and/or suicidal ideation. Similar to successful task-sharing approaches used for HIV/AIDS, mid-level providers could be retrained and certified to prescribe and monitor first-line psychotropic regimens. PMID:26081970

  13. 49 CFR 33.20 - Definitions.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... warehousing, ports, services, equipment and facilities, such as transportation carrier shop and repair.... Health resources means drugs, biological products, medical devices, materials, facilities, health...

  14. 49 CFR 33.20 - Definitions.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... warehousing, ports, services, equipment and facilities, such as transportation carrier shop and repair.... Health resources means drugs, biological products, medical devices, materials, facilities, health...

  15. 49 CFR 33.20 - Definitions.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... warehousing, ports, services, equipment and facilities, such as transportation carrier shop and repair.... Health resources means drugs, biological products, medical devices, materials, facilities, health...

  16. Medical Services: Medical, Dental, and Veterinary Care

    DTIC Science & Technology

    2002-01-28

    requirements to fixed military treatment facility laboratories in Europe and Korea. Clarifies Joint Commission on the Accreditation of Healthcare ...which meets the requirements of the licensing and accrediting agencies (for example, FDA, AABB, Joint Commission on the Accreditation of Healthcare ...as officer in charge or equivalent status when no pharmacist is on duty at the facility. (2) Policies are established to ensure— (a) Rational

  17. 20 CFR 416.414 - Amount of benefits; eligible individual or eligible couple in a medical treatment facility.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... the cost of their care; and (3) Children under age 18 who reside for part of a month in a public... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Amount of benefits; eligible individual or eligible couple in a medical treatment facility. 416.414 Section 416.414 Employees' Benefits SOCIAL...

  18. 42 CFR 435.114 - Individuals who would be eligible for AFDC except for increased OASDI income under Pub. L. 92-336...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... in a medical institution or intermediate care facility, and the current Medicaid plan covers this...; or (3) He would have been eligible for AFDC if he were not in a medical institution or intermediate care facility, and the Medicaid plan covered this optional group. (b) The individual would currently be...

  19. 42 CFR 435.114 - Individuals who would be eligible for AFDC except for increased OASDI income under Pub. L. 92-336...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... in a medical institution or intermediate care facility, and the current Medicaid plan covers this...; or (3) He would have been eligible for AFDC if he were not in a medical institution or intermediate care facility, and the Medicaid plan covered this optional group. (b) The individual would currently be...

  20. 42 CFR 435.134 - Individuals who would be eligible except for the increase in OASDI benefits under Pub. L. 92-336...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... in a medical institution or intermediate care facility, and the Medicaid plan covered this optional... (2) Would meet all current SSI requirements if he were not in a medical institution or intermediate care facility, and the State's Medicaid plan covers this optional group. [43 FR 45204, Sept. 29, 1978...

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