A retrospective population based cohort study of access to specialist palliative care in the last year of life: who is still missing out a decade on?

PubMed

Rosenwax, Lorna; Spilsbury, Katrina; McNamara, Beverley A; Semmens, James B

2016-05-10

Historically, specialist palliative care has been accessed by a greater proportion of people dying with cancer compared to people with other life-limiting conditions. More recently, a variety of measures to improve access to palliative care for people dying from non-cancer conditions have been implemented. There are few rigorous population-based studies that document changes in palliative care service delivery relative to the number of patients who could benefit from such services. A retrospective cohort study of the last year of life of persons with an underlying cause of death in 2009-10 from cancer, heart failure, renal failure, liver failure, chronic obstructive pulmonary disease, Alzheimer's disease, motor neurone disease, Parkinson's disease, Huntington's disease and/or HIV/AIDS. The proportion of decedents receiving specialist palliative care was compared to a 2000-02 cohort. Logistic regression models were used identify social and demographic factors associated with accessing specialist palliative care. There were 12,817 deaths included into the cohort; 7166 (56 %) from cancer, 527 (4 %) from both cancer and non-cancer conditions and 5124 (40 %) from non-cancer conditions. Overall, 46.3 % of decedents received community and/or hospital based specialist palliative care; a 3.5 % (95 % CI 2.3-4.7) increase on specialist palliative care access reported ten years earlier. The majority (69 %; n = 4928) of decedents with cancer accessed palliative care during the last year of life. Only 14 % (n = 729) of decedents with non-cancer conditions accessed specialist palliative care, however, this represented a 6.1 % (95 % CI 4.9-7.3) increase on the specialist palliative care access reported for the same decedent group ten years earlier. Compared to decedents with heart failure, increased odds of palliative care access was observed for decedents with cancer (OR 10.5; 95 % CI 9.1-12.2), renal failure (OR 1.5; 95 % CI 1.3-1.9), liver failure (OR 2.3; 95 % CI 1.7-3.3) or motor neurone disease (OR 4.5; 95 % CI 3.1-6.6). Living in major cities, being female, having a partner and living in a private residence was associated with increased odds of access to specialist palliative care. There is small but significant increase in access to specialist palliative care services in Western Australia, specifically in patients dying with non-cancer conditions.

Few older people in New Zealand who commit suicide receive specialist psychogeriatric services.

PubMed

Cheung, Gary; Casey, Jane

2014-08-01

Suicide in older people is a growing public health concern in many parts of the world. The literature on this issue is lacking in New Zealand. The aim of this study is to ascertain whether this group is accessing specialist psychogeriatric services. A retrospective case series study of completed suicides in older people (≥65 years) during a three-year period from January 2010 to December 2012 was performed. An online survey detailing demographic and clinical information was completed by psychiatrists in 15 of the 20 District Health Boards in New Zealand. Only about 15% of older people who committed suicide were accessing specialist psychogeriatric services and the group with the highest suicide rate (men≥85 years) did not feature in specialist services. Depression (61%) was the most common diagnosis and nearly half (35%) had had contact with specialist services within three days prior to the suicide. Over half (52%) had a history of past suicide attempt(s). Older people who complete suicide are infrequently accessing specialist services. In those that do, there are questions to be answered regarding suicide prediction and prevention for this high-risk group of vulnerable individuals. More research is required targeting those not accessing specialist services, in particular the high risk group of older men. The role of general practitioner, community care, the assessment and management of depression and whether there is any access issue to specialist psychogeriatric services require elucidation. © The Royal Australian and New Zealand College of Psychiatrists 2014.

Specialist clinics in remote Australian Aboriginal communities: where rock art meets rocket science.

PubMed

Gruen, Russell; Bailie, Ross

2004-10-01

People in remote Aboriginal communities in the Northern Territory have greater morbidity and mortality than other Australians, but face considerable barriers when accessing hospital-based specialist services. The Specialist Outreach Service, which began in 1997, was a novel policy initiative to improve access by providing a regular multidisciplinary visiting specialist services to remote communities. It led to two interesting juxtapositions: that of 'state of the art' specialist services alongside under-resourced primary care in remote and relatively traditional Aboriginal communities; and that of attempts to develop an evidence base for the effectiveness of outreach, while meeting the short-term evaluative requirements of policy-makers. In this essay, first we describe the development of the service in the Northern Territory and its initial process evaluation. Through a Cochrane systematic review we then summarise the published research on the effectiveness of specialist outreach in improving access to tertiary and hospital-based care. Finally we describe the findings of an observational population-based study of the use of specialist services and the impact of outreach to three remote communities over 11 years. Specialist outreach improves access to specialist care and may lessen the demand for both outpatient and inpatient hospital care. Specialist outreach is, however, dependent on well-functioning primary care. According to the way in which outreach is conducted and the service is organised, it can either support primary care or it can hinder primary care and, as a result, reduce its own effectiveness.

Association of State Access Standards With Accessibility to Specialists for Medicaid Managed Care Enrollees.

PubMed

Ndumele, Chima D; Cohen, Michael S; Cleary, Paul D

2017-10-01

Medicaid recipients have consistently reported less timely access to specialists than patients with other types of coverage. By 2018, state Medicaid agencies will be required by the Center for Medicare and Medicaid Services (CMS) to enact time and distance standards for managed care organizations to ensure an adequate supply of specialist physicians for enrollees; however, there have been no published studies of whether these policies have significant effects on access to specialty care. To compare ratings of access to specialists for adult Medicaid and commercial enrollees before and after the implementation of specialty access standards. We used Consumer Assessment of Healthcare Providers and Systems survey data to conduct a quasiexperimental difference-in-differences (DID) analysis of 20 163 nonelderly adult Medicaid managed care (MMC) enrollees and 54 465 commercially insured enrollees in 5 states adopting access standards, and 37 290 MMC enrollees in 5 matched states that previously adopted access standards. Reported access to specialty care in the previous 6 months. Seven thousand six hundred ninety-eight (69%) Medicaid enrollees and 28 423 (75%) commercial enrollees reported that it was always or usually easy to get an appointment with a specialist before the policy implementation (or at baseline) compared with 11 889 (67%) of Medicaid enrollees in states that had previously implemented access standards. Overall, there was no significant improvement in timely access to specialty services for MMC enrollees in the period following implementation of standard(s) (adjusted difference-in-differences, -1.2 percentage points; 95% CI, -2.7 to 0.1), nor was there any impact of access standards on insurance-based disparities in access (0.6 percentage points; 95% CI, -4.3 to 5.4). There was heterogeneity across states, with 1 state that implemented both time and distance standards demonstrating significant improvements in access and reductions in disparities. Specialty access standards did not lead to widespread improvements in access to specialist physicians. Meaningful improvements in access to specialty care for Medicaid recipients may require additional interventions.

Barriers to access to education for young people with epilepsy in Northern Tanzania: A qualitative interview and focus group study involving teachers, parents and young people with epilepsy.

PubMed

Quereshi, Charlotte; Standing, Holly C; Swai, Amina; Hunter, Ewan; Walker, Richard; Owens, Stephen

2017-07-01

Educational outcomes for young people with epilepsy (YPE) in Hai District, Tanzania, are poor, as is commonly observed elsewhere in Sub-Saharan Africa. The reasons for this finding are not well understood, though stigma arising from supernatural concepts of epilepsy is frequently cited as a barrier to YPE accessing education. In this study, we aimed to explore the reasons why many YPE in Tanzania experience poor access to education, and elicit ways in which education could be improved for YPE according to teachers, parents and YPE. Ten focus group discussions with teachers were organized in Hai schools between March and May 2016. The themes arising from these discussions were identified, coded, analyzed and tested in semi-structured interviews with 19 YPE and 17 parents identified from a prevalent cohort of YPE identified in 2009. Behavioral problems and learning difficulties were cited as the main barriers to education for YPE. Other barriers included parental stigmatization, teachers' inadequate seizure management, and limited access to specialist schools. Teachers perceived that parents and YPE believe in spiritual etiology and traditional management for epilepsy. However, the majority of teachers, parents, and YPE cited biological etiology and management options, although understanding of epilepsy etiology and management could be improved amongst all groups. A multidimensional approach is needed to improve educational access, and hence outcomes, for YPE. Widespread community education is needed to improve knowledge of epilepsy etiology and management. Teachers require seizure management training, and parents need help to recognize YPE's right to education. Educational needs assessments would help to identify YPE requiring specialist schooling, and access to this could be improved. These interventions will likely reduce stigma, ensure appropriate academic and pastoral care at school, and thus enable YPE to attend, and succeed, in education. Copyright © 2017 Elsevier Inc. All rights reserved.

Out & Online; effectiveness of a tailored online multi-symptom mental health and wellbeing program for same-sex attracted young adults: study protocol for a randomised controlled trial.

PubMed

Abbott, Jo-Anne M; Klein, Britt; McLaren, Suzanne; Austin, David W; Molloy, Mari; Meyer, Denny; McLeod, Bronte

2014-12-23

Same-sex attracted young adults have been found to experience higher rates of mental health problems and greater difficulties in accessing specialist mental health care services compared to their heterosexual peers. Internet-based mental health interventions have the potential to be more engaging and accessible to young adults compared to those delivered face-to-face. However, they are rarely inclusive of lesbian women and gay men. Thus, the current study aims to evaluate the effectiveness of an online mental health and wellbeing program, Out & Online (http://www.outandonline.org.au), in comparison to a wait-list control group, for reducing anxiety and depressive symptoms in same-sex attracted young adults aged between 18 and 25 years. We are recruiting, through media and community organisations, 200 same-sex attracted young adults with anxiety and/or depressive symptoms and mild to moderate psychological distress (Kessler-10 score between 16 to 21). Participants will be randomly allocated to the intervention (the online program) or the wait-list control group based on a permuted blocked randomisation method to allow for stratification by gender. Participants in the intervention group will receive a tailored program for up to three types of mental health difficulties simultaneously. The primary outcome of anxiety and/or depressive symptoms, and secondary outcomes related to psychological distress, wellbeing and health behaviour will be measured at pre-intervention (0 week), post-intervention (8 weeks) and at a 3-month follow-up (20 weeks). This online mental health and wellbeing program will be one of the first online interventions to be designed specifically to be relevant for same-sex attracted individuals. If the program is found to be effective it will improve access to specialist same-sex attracted-relevant mental health services for young adults and will facilitate wellbeing outcomes for these individuals. This program will also be a significant development in the delivery of tailored interventions that target multiple types of mental health conditions simultaneously. Australian New Zealand Clinical Trials Registry: ACTRN12611000700932. Date registered: 7 July 2011.

The Expanding Role of Managed Care in the Medicaid Program

PubMed Central

Caswell, Kyle J.; Long, Sharon K.

2015-01-01

States increasingly use managed care for Medicaid enrollees, yet evidence of its impact on health care outcomes is mixed. This research studies county-level Medicaid managed care (MMC) penetration and health care outcomes among nonelderly disabled and nondisabled enrollees. Results for nondisabled adults show that increased penetration is associated with increased probability of an emergency department visit, difficulty seeing a specialist, and unmet need for prescription drugs, and is not associated with reduced expenditures. We find no association between penetration and health care outcomes for disabled adults. This suggests that the primary gains from MMC may be administrative simplicity and budget predictability for states rather than reduced expenditures or improved access for individuals. PMID:25882616

Improving access to specialists in remote communities: a cross-sectional study and cost analysis of the use of eConsult in Nunavut.

PubMed

Liddy, Clare; McKellips, Fanny; Armstrong, Catherine Deri; Afkham, Amir; Fraser-Roberts, Leigh; Keely, Erin

2017-01-01

Residents of remote communities face inequities in access to specialists, excessive wait times, and poorly coordinated care. The Champlain BASE TM (Building Access to Specialists through eConsultation) service facilitates asynchronous communication between primary care providers (PCP) and specialists. The service was extended to several PCPs in Nunavut in 2014. To (1) describe the use of eConsult services in Nunavut, and (2) conduct a costing evaluation. A cross-sectional study and cost analysis of all eConsult cases submitted between August 2014 and April 2016. PCPs from Nunavut submitted 165 eConsult cases. The most popular specialties were dermatology (16%), cardiology (8%), endocrinology (7%), otolaryngology (7%), and obstetrics/gynaecology (7%). Specialists provided a response in a median of 0.9 days (IQR=0.3-3.0, range=0.01-15.02). In 35% of cases, PCPs were able to avoid the face-to-face specialist visits they had originally planned for their patients. Total savings associated with eConsult in Nunavut are estimated at $180,552.73 or $1,100.93 per eConsult. The eConsult service provided patients in Nunavut's remote communities with prompt access to specialist advice. The service's chief advantage in Canada's northern communities is its ability to offer electronic access to a breadth of specialties far greater than could be supported locally. Our findings suggest that a territory-wide adoption of eConsult would generate enormous savings.

Persisting Barriers to Employment for Recently Housed Adults with Mental Illness Who Were Homeless.

PubMed

Poremski, Daniel; Woodhall-Melnik, Julia; Lemieux, Ashley J; Stergiopoulos, Vicky

2016-02-01

Adults with mental illness who are homeless experience multiple barriers to employment, contributing to difficulties securing and maintaining housing. Housing First programs provide quick, low-barrier access to housing and support services for this population, but their success in improving employment outcomes has been limited. Supported employment interventions may augment Housing First programs and address barriers to employment for homeless adults with mental illness. The present paper presents data from qualitative interviews to shed light on the persisting barriers to employment among people formerly homeless. Once housed, barriers to employment persisted, including the following: (1) worries about disclosing sensitive information, (2) fluctuating motivation, (3) continued substance use, and (4) fears about re-experiencing homelessness-related trauma. Nevertheless, participants reported that their experiences of homelessness helped them develop interpersonal strength and resilience. Discussing barriers with an employment specialist helps participants develop strategies to overcome them, but employment specialists must be sensitive to specific homelessness-related experiences that may not be immediately evident. Supported housing was insufficient to help people return to employment. Supported employment may help people return to work by addressing persisting barriers.

Accessibility of general practitioners and selected specialist physicians by car and by public transport in a rural region of Germany.

PubMed

Stentzel, Ulrike; Piegsa, Jens; Fredrich, Daniel; Hoffmann, Wolfgang; van den Berg, Neeltje

2016-10-19

The accessibility of medical care facilities in sparsely populated rural regions is relevant especially for elderly people which often represent a large segment of the population in such regions. Elderly people have higher morbidity risks and a higher demand for medical care. Although travelling with private cars is the dominating traffic mode in rural regions, accessibility by public transport is increasingly important especially because of limited mobility of elderly people. The aim of this study was to determine accessibility both by car and public transport to general practitioners (GP) and selected specialist physicians for a whole region and to detect areas with poor to no access in the county Vorpommern-Greifswald, which is a rural and sparsely populated region in the very northeast of Germany. Accessibility of medical care facilities by car was calculated on the basis of a network analysis within a geographic information system (GIS) with routable street data. Accessibility by public transport was calculated using GIS and a network analysis based on the implementation of Dijkstra's algorithm. The travelling time to general practitioners (GP) by car in the study region ranges from 0.1 to 22.9 min. This is a significant difference compared to other physician groups. Traveling times to specialist physicians are 0.4 to 42.9 min. A minority of 80 % of the inhabitants reach the specialist physicians within 20 min. The accessibility of specialist physicians by public transport is poor. The travel time (round trip) to GPs averages 99.3 min, to internists 143.0, to ophthalmologists 129.3 and to urologists 159.9 min. These differences were significant. Assumed was a one hour appointment on a Tuesday at 11 am. 8,973 inhabitants (3.8 %) have no connection to a GP by public transport. 15,455 inhabitants (6.5 %) have no connection to specialist internists. Good accessibility by public transport is not a question of distance but of transport connections. GIS analyses can detect areas with imminent or manifest deficits in the accessibility of health care providers. Accessibility analyses should be established instruments in planning issues.

Diagnostic and Prescriptive Skills of Teachers and Related Specialists.

ERIC Educational Resources Information Center

Banks, Karen Vlahos; Nolen, Patricia

In light of criticisms that teacher preparation programs do not adequately prepare prospective reading teachers and specialists for actual classroom problems, a study was conducted to determine the accuracy of teacher diagnoses and planning for reading difficulties and to examine differences in coursework preparation and classroom experience.…

PROFESSIONAL INTEGRATION AND CLINICAL RESEARCH.

ERIC Educational Resources Information Center

WARD, TED W.

THE RATIONALE OF A CLINICAL APPROACH TO RESEARCH ON TEACHER BEHAVIOR IS SET FORTH TOGETHER WITH INDICATION OF DIFFICULTIES. IN ONE CLINICAL STUDY, RECORDS OF FOCUSED OBSERVATIONS OF TEACHER BEHAVIOR WERE REVIEWED BY A SPECIALIST IN LEARNING AND A SPECIALIST IN SOCIAL PSYCHOLOGY IN RELATION TO RESEARCH FROM THESE FIELDS. TEACHER DECISIONS PROVED…

Geographic Variation in Health Service Use and Perceived Access Barriers for Australian Adults with Chronic Non-Cancer Pain Receiving Opioid Therapy.

PubMed

Peacock, Amy; Nielsen, Suzanne; Bruno, Raimondo; Campbell, Gabrielle; Larance, Briony; Degenhardt, Louisa

2016-11-01

Rates of chronic non-cancer pain are increasing worldwide, with concerns regarding poorer access to specialist treatment services in remote areas. The current study comprised the first in-depth examination of use and barriers to access of health services in Australia according to remoteness. A cohort of Australian adults prescribed pharmaceutical opioids for chronic non-cancer pain (n = 1,235) were interviewed between August 2012 and April 2014, and grouped into 'major city' (49%), 'inner regional' (37%), and 'outer regional/remote' (14%) according to the Australian Standard Geographical Classification based on postcode. Multinomial logistic regression analyses were conducted to determine geographical differences in socio-demographic and clinical characteristics, health service use, and perceived barriers to health service access. The 'inner regional group' and 'outer regional/remote group' were more likely to be male (relative risk ratio (RRR)=1.38,95%CI 1.08-1.77 and RRR = 1.60, 95%CI 1.14-2.24) and have no private health insurance (RRR = 1.53, 95%CI 1.19-1.97 and RRR = 1.65, 95%CI 1.16-2.37) than the 'major city group' (49%). However, the 'inner regional group' reported lower pain severity and better mental health relative to the 'major city group' = 0.92, 95%CI 0.86-0.98 and RRR = 1.02, 95%CI 1.01-1.03, respectively). Although rates of health service access were generally similar, the 'outer regional/remote group' were more likely to report client-practitioner communication problems (RRR = 1.57, 95%CI 1.03-2.37), difficulties accessing specialists (RRR = 1.56, 95%CI 1.01-2.39), and perception of practitioner lack of confidence in prescribing pain medication (RRR = 1.73, 1.14-2.62), relative to both groups. Perceived communication, access, and financial barriers to healthcare indicate the need for increased efforts to address geographic inequality in pain treatment. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Effects of a Malpractice Crisis on Specialist Supply and Patient Access to Care

PubMed Central

Mello, Michelle M.; Studdert, David M.; DesRoches, Catherine M.; Peugh, Jordon; Zapert, Kinga; Brennan, Troyen A.; Sage, William M.

2005-01-01

Objective: To investigate specialist physicians' practice decisions in response to liability concerns and their perceptions of the impact of the malpractice environment on patient access to care. Summary Background Data: A perennial concern during “malpractice crises” is that liability costs will drive physicians in high-risk specialties out of practice, creating specialist shortages and access-to-care problems. Methods: Mail survey of 824 Pennsylvania physicians in general surgery, neurosurgery, orthopedic surgery, obstetrics/gynecology, emergency medicine, and radiology eliciting information on practice decisions made in response to rising liability costs. Results: Strong majorities of specialists reported increases over the last 3 years in patients' driving distances (58%) and waiting times (83%) for specialist care or surgery, waiting times for emergency department care (82%), and the number of patients forced to switch physicians (89%). Professional liability costs and managed care were both considered important contributing factors. Small proportions of specialists reported that they would definitely retire (7%) or relocate their practice out of state (4%) within the next 2 years; another third (32% and 29%, respectively) said they would likely do so. Forty-two percent of specialists have reduced or eliminated high-risk aspects of their practice, and 50% are likely to do so over the next 2 years. Conclusions: Our data suggest that claims of a “physician exodus” from Pennsylvania due to rising liability costs are overstated, but the malpractice situation is having demonstrable effects on the supply of specialist physicians in affected areas and their scope of practice, which likely impinges upon patients' access to care. PMID:16244532

Specialist outreach clinics in primary care and rural hospital settings.

PubMed

Gruen, R L; Weeramanthri, T S; Knight, S E; Bailie, R S

2004-01-01

Specialist medical practitioners have conducted clinics in primary care and rural hospital settings for a variety of reasons in many different countries. Such clinics have been regarded as an important policy option for increasing the accessibility and effectiveness of specialist services and their integration with primary care services. To undertake a descriptive overview of studies of specialist outreach clinics and to assess the effectiveness of specialist outreach clinics on access, quality, health outcomes, patient satisfaction, use of services, and costs. We searched the Cochrane Effective Practice and Organisation of Care (EPOC) specialised register (March 2002), the Cochrane Controlled Trials Register (CCTR) (Cochrane Library Issue 1, 2002), MEDLINE (including HealthStar) (1966 to May 2002), EMBASE (1988 to March 2002), CINAHL (1982 to March 2002), the Primary-Secondary Care Database previously maintained by the Centre for Primary Care Research in the Department of General Practice at the University of Manchester, a collection of studies from the UK collated in "Specialist Outreach Clinics in General Practice" (Roland 1998), and the reference lists of all retrieved articles. Randomised trials, controlled before and after studies and interrupted time series analyses of visiting specialist outreach clinics in primary care or rural hospital settings, either providing simple consultations or as part of complex multifaceted interventions. The participants were patients, specialists, and primary care providers. The outcomes included objective measures of access, quality, health outcomes, satisfaction, service use, and cost. Four reviewers working in pairs independently extracted data and assessed study quality. 73 outreach interventions were identified covering many specialties, countries and settings. Nine studies met the inclusion criteria. Most comparative studies came from urban non-disadvantaged populations in developed countries. Simple 'shifted outpatients' styles of specialist outreach were shown to improve access, but there was no evidence of impact on health outcomes. Specialist outreach as part of more complex multifaceted interventions involving collaboration with primary care, education or other services was associated with improved health outcomes, more efficient and guideline-consistent care, and less use of inpatient services. The additional costs of outreach may be balanced by improved health outcomes. This review supports the hypothesis that specialist outreach can improve access, outcomes and service use, especially when delivered as part of a multifaceted intervention. The benefits of simple outreach models in urban non-disadvantaged settings seem small. There is a need for good comparative studies of outreach in rural and disadvantaged settings where outreach may confer most benefit to access and health outcomes.

Library Media Specialists: Premier Information Specialists for the Information Age

ERIC Educational Resources Information Center

Neuman, Delia

2011-01-01

The information age has given library media specialists an unprecedented opportunity to play a leading role in helping teachers, administrators, and especially students access and use information intelligently. As the school's premier information specialist; the library media specialist has a unique role to play in helping everyone in the school…

Factors influencing specialist outreach and support services to rural populations in the Eden and Central Karoo districts of the Western Cape.

PubMed

Schoevers, Johan; Jenkins, Louis

2015-04-21

Access to health care often depends on where one lives. Rural populations have significantly poorer health outcomes than their urban counterparts. Specialist outreach to rural communities is one way of improving access to care. A multifaceted style of outreach improves access and health outcomes, whilst a shifted outpatients style only improves access. In principle, stakeholders agree that specialist outreach and support (O&S) to rural populations is necessary. In practice, however, factors influence whether or not O&S reaches its goals, affecting sustainability.Aim and setting: Our aim was to better understand factors associated with the success or failure of specialist O&S to rural populations in the Eden and Central Karoo districts in the Western Cape. An anonymous parallel three-stage Delphi process was followed to obtain consensus in a specialist and district hospital panel. Twenty eight specialist and 31 district hospital experts were invited, with response rates of 60.7%-71.4% and 58.1%-74.2% respectively across the three rounds. Relationships, communication and planning were found to be factors feeding into a service delivery versus capacity building tension, which affects the efficiency of O&S. The success of the O&S programme is dependent on a site-specific model that is acceptable to both the outreaching specialists and the hosting district hospital. Good communication, constructive feedback and improved planning may improve relationships and efficiency, which might lead to a more sustainable and mutually beneficial O&S system.

Impact of specialist palliative care on coping with Parkinson's disease: patients and carers.

PubMed

Badger, Nathan J; Frizelle, Dorothy; Adams, Debi; Johnson, Miriam J

2018-06-01

UK guidelines recommend palliative care access for people with Parkinson's disease; however, this remains sporadic, and it is unknown whether specialist palliative care helps patients and carers cope with this distressing condition. This study aimed to explore whether, and how, access to specialist palliative care services affected patients' and carers' coping with Parkinson's disease. Semistructured interviews were conducted, audio-recorded and verbatim transcribed. Data were analysed using interpretative phenomenological analysis. Participants were patients with advanced idiopathic Parkinson's disease (n=3), and carers of people with Parkinson's disease (n=5, however, one diagnosis was reviewed) receiving care from an integrated specialist palliative care and Parkinson's disease service in North East England. Access to specialist palliative care helped participants cope with some aspects of advanced Parkinson's disease. Three superordinate themes were developed:' managing uncertainty', 'impacts on the self' and 'specialist palliative care maintaining a positive outlook'. Specialist palliative care helped patients and carers cope with advanced Parkinson's disease. Specialist palliative care is a complex intervention that acknowledges the complex and holistic nature of Parkinson's disease, enabling health in some domains despite continued presence of pathology. These exploratory findings support the utility of this approach for people living with Parkinson's disease. © 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.

No longer 'flying blind': how access has changed emergency mental health care in rural and remote emergency departments, a qualitative study.

PubMed

Saurman, Emily; Kirby, Sue E; Lyle, David

2015-04-14

Mental health presentations are considered to be a difficult aspect of emergency care. Although emergency department (ED) staff is qualified to provide emergency mental health care, for some, such presentations pose a challenge to their training, confidence, and time. Providing access to relevant and responsive specialist mental health care can influence care and management for these patients. The Mental Health Emergency Care-Rural Access Program (MHEC-RAP) is a telepsychiatry program that was established to improve access to specialist emergency mental health care across rural and remote western NSW, Australia. This study uses interviews with ED providers to understand their experience of managing emergency mental health patients and their use of MHEC-RAP. The lens of access was applied to assess program impact and inform continuing program development. With MHEC-RAP, these ED providers are no longer 'flying blind'. They are also more confident to manage and care for emergency mental health patients locally. For these providers, access to specialists who are able to conduct assessments and provide relevant and responsive advice for emergency mental health presentations was valued. Assessing the fit between the consumer and service as a requirement for the development, evaluation, and ongoing management of the service should result in decisions about design and delivery that achieve improved access to care and meet the needs of their consumers. The experience of these providers prior to MHEC-RAP is consistent with that reported in other rural and remote populations suggesting that MHEC-RAP could address limitations in access to specialist care and change the provision of emergency mental health care elsewhere. MHEC-RAP has not only provided access to specialist mental health care for local ED providers, but it has changed their practice and perspective. MHEC-RAP could be adapted for implementation elsewhere. Provider experience confirms that the program is accessible and offers insights to those considering how to establish an emergency telepyschiatry service in other settings.

Pediatrician identification of Latino children at risk for autism spectrum disorder.

PubMed

Zuckerman, Katharine E; Mattox, Kimber; Donelan, Karen; Batbayar, Oyundari; Baghaee, Anita; Bethell, Christina

2013-09-01

Latino-white disparities in age at autism spectrum disorder (ASD) diagnosis may be modified by primary care pediatrician (PCP) practices and beliefs. The objectives of this study were to assess ASD and developmental screening practices, attitudes toward ASD identification in Latino children, and barriers to ASD identification for Latino children, in a sample of 267 California PCPs. In mail-based PCP survey, we assessed rates of bilingual general developmental and ASD screening, perceptions of parent ASD knowledge in Latino and white families, reports of difficulty assessing for ASDs in Latino and white children, and perceptions of barriers to early ASD identification for Latinos. Although 81% of PCPs offered some form of developmental screening, 29% of PCPs offered Spanish ASD screening per American Academy of Pediatrics guidelines, and only 10% offered both Spanish general developmental and Spanish ASD screening per American Academy of Pediatrics guidelines. Most PCPs thought that Latino (English and Spanish primary family language) parents were less knowledgeable about ASDs than white parents. PCPs had more difficulty assessing ASD risk for Latino children with Spanish primary family language than for white children, even when the PCP conducted recommended ASD screening or had >25% Latino patients. The most frequent barrier to ASD identification in Latinos was access to developmental specialists. Multiple factors in the primary care setting may contribute to delayed ASD identification for Latinos. Promoting language-appropriate screening, disseminating culturally appropriate ASD materials to Latino families, improving the specialist workforce, and providing PCP support in screening and referral of Latino children may be important ways to reduce racial and ethnic differences in care.

Epilepsy services in Ireland: 'A survey of people with epilepsy in relation to satisfaction, preferences and information provision'.

PubMed

Bennett, Louise; Bergin, Michael; Gooney, Martina; Doherty, Colin P; Synnott, Cara; Wells, John S G

2015-07-01

A challenge facing modern health care systems is to develop and implement new models of service that deliver increased capacity while providing a higher-quality, more cost-effective service within resource constraints. Incorporating the experience of people with epilepsy must be seen as central to the effectiveness of service design and delivery. This paper, therefore, reports the views of people with epilepsy with regards to health service delivery in Ireland. A cross-sectional descriptive survey design involving both quantitative and qualitative items was administered to a convenience sample of one hundred and two people with epilepsy (n=102) attending an epilepsy specialist centre. Despite high levels of satisfaction with hospital and primary care, participants offered several suggestions to improve healthcare delivery, such as: less delay in accessing specialist care and hospital appointments; better communication; and easier access to investigatory services. Findings demonstrate that for people with epilepsy the burden of the disorder is substantial and complex encompassing social, psychological and structural difficulties. Poor information provision particularly among women is reported. Furthermore, a lack of empowerment in people with epilepsy is highlighted. This study has implications for the reform and development of epilepsy services in relation to practice, education and research. It provides a basis for an evaluation of current practice and identifies opportunities for future service reorganization to improve the quality and efficiency of healthcare provision. Copyright © 2015 Elsevier B.V. All rights reserved.

An Observational Study of the Relationship between Diagnosis and Remediation in Reading. Research Series No. 72.

ERIC Educational Resources Information Center

Weinshank, Annette B.

A study was conducted to determine whether reading specialists' diagnoses lead directly to remedial recommendations. Eight experienced reading specialists were observed during 24 sessions as they performed a series of tasks using three simulated cases of reading difficulty, two of which were thinly disguised versions of the same reading problem.…

Meeting the Challenges of Literacy Difficulties: Developing a Qualification for Specialist Literacy Teachers.

ERIC Educational Resources Information Center

Limbrick, Libby; Parkhill, Faye; Smith, John

In 2001, the New Zealand Ministry of Education awarded a contract to a consortium of three colleges of education to provide a training program that would lead to a new national literacy qualification for a newly developed specialist literacy teaching position--Resource Teacher: Literacy. Resource Teachers of Literacy are skilled and experienced…

The visiting specialist model of rural health care delivery: a survey in Massachusetts.

PubMed

Drew, Jacob; Cashman, Suzanne B; Savageau, Judith A; Stenger, Joseph

2006-01-01

Hospitals in rural communities may seek to increase specialty care access by establishing clinics staffed by visiting specialists. To examine the visiting specialist care delivery model in Massachusetts, including reasons specialists develop secondary rural practices and distances they travel, as well as their degree of satisfaction and intention to continue the visiting arrangement. Visiting specialists at 11 rural hospitals were asked to complete a mailed survey. Visiting specialists were almost evenly split between the medical (54%) and surgical (46%) specialties, with ophthalmology, nephrology, and obstetrics/gynecology the most common specialties reported. A higher proportion of visiting specialists than specialists statewide were male (P = .001). Supplementing their patient base and income were the most important reasons visiting specialists reported for having initiated an ancillary clinic. There was a significant negative correlation between a hospital's number of staffed beds and the total number of visiting specialists it hosted (r =-0.573, P = .032); study hospitals ranged in bed size from 15 to 129. The goal of matching supply of health care services with demand has been elusive. Visiting specialist clinics may represent an element of a market structure that expands access to needed services in rural areas. They should be included in any enumeration of physician availability.

Exploring challenges to telehealth communication by specialists in poison information.

PubMed

Rothwell, Erin; Ellington, Lee; Planalp, Sally; Crouch, Barbara

2012-01-01

The use of the telephone for providing health care is growing. A significant amount of social meaning is derived from visual information, and the absence of visual stimuli provides unique barriers to communication and increases the risks for misunderstandings and distractions. Understanding challenges to telephone communication can provide insight into training opportunities for overcoming these difficulties and improving patient care. The purpose of this research was to explore through focus groups the challenges of phone communication perceived by specialists in poison information. General types of challenges to effective phone communication included developing new communication skills to compensate for lack of visual information, difficulty assessing caller understanding, difficulty managing caller misunderstandings, maintaining distinctive assessments for routine calls, and managing the multifaceted aspects of job stress. The desire for training to enhance telehealth and cultural competency skills was also mentioned, and these findings might provide guidance for the development of training opportunities for telehealth professionals.

The Visiting Specialist Model of Rural Health Care Delivery: A Survey in Massachusetts

ERIC Educational Resources Information Center

Drew, Jacob; Cashman, Suzanne B.; Savageau, Judith A.; Stenger, Joseph

2006-01-01

Context: Hospitals in rural communities may seek to increase specialty care access by establishing clinics staffed by visiting specialists. Purpose: To examine the visiting specialist care delivery model in Massachusetts, including reasons specialists develop secondary rural practices and distances they travel, as well as their degree of…

Extending specialist palliative care to all?

PubMed

Field, D; Addington-Hall, J

1999-05-01

How to extend palliative care services to all patients needing them is an issue currently exercising a range of bodies in contemporary Britain. This paper first considers the evidence regarding the needs of dying patients with long term conditions other than cancer and concludes that there is evidence to support their presumed need for palliative care. It then considers five potential barriers to extending specialist palliative care services to non-cancer patients in Britain. These are the skill base of current specialists in palliative care, difficulties in identifying candidates for specialist palliative care, the views of potential users of these services, resource implications and vested interests in present health service arrangements.

People with Intellectual Disabilities at the End of Their Lives: The Case for Specialist Care?

ERIC Educational Resources Information Center

Forrester-Jones, Rachel; Beecham, Jennifer K.; Barnoux, Magali; Oliver, David; Couch, Elyse; Bates, Claire

2017-01-01

Background: People with intellectual disabilities have a shorter life expectancy, but healthcare improvements mean that they are beginning to live longer, with associated health difficulties. This means that there is an urgent need to focus research on ageing as well as end-of-life care. This study aimed to explore a specialist intellectual…

Coordination of cancer care between family physicians and cancer specialists

PubMed Central

Easley, Julie; Miedema, Baukje; Carroll, June C.; Manca, Donna P.; O’Brien, Mary Ann; Webster, Fiona; Grunfeld, Eva

2016-01-01

Abstract Objective To explore health care provider (HCP) perspectives on the coordination of cancer care between FPs and cancer specialists. Design Qualitative study using semistructured telephone interviews. Setting Canada. Participants A total of 58 HCPs, comprising 21 FPs, 15 surgeons, 12 medical oncologists, 6 radiation oncologists, and 4 GPs in oncology. Methods This qualitative study is nested within a larger mixed-methods program of research, CanIMPACT (Canadian Team to Improve Community-Based Cancer Care along the Continuum), focused on improving the coordination of cancer care between FPs and cancer specialists. Using a constructivist grounded theory approach, telephone interviews were conducted with HCPs involved in cancer care. Invitations to participate were sent to a purposive sample of HCPs based on medical specialty, sex, province or territory, and geographic location (urban or rural). A coding schema was developed by 4 team members; subsequently, 1 team member coded the remaining transcripts. The resulting themes were reviewed by the entire team and a summary of results was mailed to participants for review. Main findings Communication challenges emerged as the most prominent theme. Five key related subthemes were identified around this core concept that occurred at both system and individual levels. System-level issues included delays in medical transcription, difficulties accessing patient information, and physicians not being copied on all reports. Individual-level issues included the lack of rapport between FPs and cancer specialists, and the lack of clearly defined and broadly communicated roles. Conclusion Effective and timely communication of medical information, as well as clearly defined roles for each provider, are essential to good coordination of care along the cancer care trajectory, particularly during transitions of care between cancer specialist and FP care. Despite advances in technology, substantial communication challenges still exist. This can lead to serious consequences that affect clinical decision making. PMID:27737996

Coordination of cancer care between family physicians and cancer specialists: Importance of communication.

PubMed

Easley, Julie; Miedema, Baukje; Carroll, June C; Manca, Donna P; O'Brien, Mary Ann; Webster, Fiona; Grunfeld, Eva

2016-10-01

To explore health care provider (HCP) perspectives on the coordination of cancer care between FPs and cancer specialists. Qualitative study using semistructured telephone interviews. Canada. A total of 58 HCPs, comprising 21 FPs, 15 surgeons, 12 medical oncologists, 6 radiation oncologists, and 4 GPs in oncology. This qualitative study is nested within a larger mixed-methods program of research, CanIMPACT (Canadian Team to Improve Community-Based Cancer Care along the Continuum), focused on improving the coordination of cancer care between FPs and cancer specialists. Using a constructivist grounded theory approach, telephone interviews were conducted with HCPs involved in cancer care. Invitations to participate were sent to a purposive sample of HCPs based on medical specialty, sex, province or territory, and geographic location (urban or rural). A coding schema was developed by 4 team members; subsequently, 1 team member coded the remaining transcripts. The resulting themes were reviewed by the entire team and a summary of results was mailed to participants for review. Communication challenges emerged as the most prominent theme. Five key related subthemes were identified around this core concept that occurred at both system and individual levels. System-level issues included delays in medical transcription, difficulties accessing patient information, and physicians not being copied on all reports. Individual-level issues included the lack of rapport between FPs and cancer specialists, and the lack of clearly defined and broadly communicated roles. Effective and timely communication of medical information, as well as clearly defined roles for each provider, are essential to good coordination of care along the cancer care trajectory, particularly during transitions of care between cancer specialist and FP care. Despite advances in technology, substantial communication challenges still exist. This can lead to serious consequences that affect clinical decision making. Copyright© the College of Family Physicians of Canada.

The impact of electronic consultation on a Canadian tertiary care pediatric specialty referral system: A prospective single-center observational study.

PubMed

Lai, Lillian; Liddy, Clare; Keely, Erin; Afkham, Amir; Kurzawa, Julia; Abdeen, Nishard; Audcent, Tobey; Bromwich, Matthew; Brophy, Jason; Carsen, Sasha; Fournier, Annick; Fraser-Roberts, Leigh; Gandy, Hazen; Hui, Charles; Johnston, Donna; Keely, Kathryn; Kontio, Ken; Lamontagne, Christine; Major, Nathalie; O'Connor, Michael; Radhakrishnan, Dhenuka; Reisman, Joe; Robb, Marjorie; Samson, Lindy; Sell, Erick; Splinter, William; van Stralen, Judy; Venkateswaran, Sunita; Murto, Kimmo

2018-01-01

Champlain BASE™ (Building Access to Specialists through eConsultation) is a web-based asynchronous electronic communication service that allows primary-care- practitioners (PCPs) to submit "elective" clinical questions to a specialist. For adults, PCPs have reported improved access and timeliness to specialist advice, averted face-to-face specialist referrals in up to 40% of cases and high provider satisfaction. To determine whether the expansion of eConsult to a pediatric setting would result in similar measures of improved healthcare system process and high provider acceptance reported in adults. Prospective observational cohort study. Single Canadian tertiary-care academic pediatric hospital (June 2014-16) servicing 1.2 million people. 1. PCPs already using eConsult. 2.Volunteer pediatric specialists provided services in addition to their regular workload. 3.Pediatric patients (< 18 years-old) referred for none-acute care conditions. Specialty service utilization and access, impact on PCP course-of-action and referral-patterns and survey-based provider satisfaction data were collected. 1064 eConsult requests from 367 PCPs were answered by 23 pediatric specialists representing 14 specialty-services. The top three specialties represented were: General Pediatrics 393 cases (36.9%), Orthopedics 162 (15.2%) and Psychiatry 123 (11.6%). Median specialist response time was 0.9 days (range <1 hour-27 days), most consults (63.2%) required <10minutes to complete and 21/21(100%) specialist survey-respondents reported minimal workload burden. For 515/1064(48.4%) referrals, PCPs received advice for a new or additional course of action; 391/1064(36.7%) referrals resulted in an averted face-to-face specialist visit. In 9 specialties with complete data, the median wait-time was significantly less (p<0.001) for an eConsult (1 day, 95%CI:0.9-1.2) compared with a face-to-face referral (132 days; 95%CI:127-136). The majority (>93.3%) of PCPs rated eConsult as very good/excellent value for both patients and themselves. All specialist survey-respondents indicated eConsult should be a continued service. Similar to adults, eConsult improves PCP access and timeliness to elective pediatric specialist advice and influences their care decisions, while reporting high end-user satisfaction. Further study is warranted to assess impact on resource utilization and clinical outcomes.

Adolescents and mothers value referral to a specialist service for chronic fatigue syndrome or myalgic encephalopathy (CFS/ME).

PubMed

Beasant, Lucy; Mills, Nicola; Crawley, Esther

2014-04-01

Paediatric chronic fatigue syndrome or myalgic encephalopathy (CFS/ME) is relatively common and disabling. Current guidance recommends referral to specialist services, although some general practitioners believe the label of CFS/ME is harmful and many are not confident about diagnosing CFS/ME. Aim Explore whether or not adolescents and their mothers value referral to a specialist service for young people with CFS/ME. A qualitative study nested within a feasibility study of interventions for CFS/ME [Specialist Medical Intervention and Lightning Evaluation (SMILE)]. In-depth interviews were undertaken with 13 mothers and 12 adolescents participating in the SMILE study. Transcripts were systematically assigned codes using the qualitative data organisation package NVivo and analysed thematically using techniques of constant comparison. Gaining access to the specialist service was difficult and took a long time. Mothers felt that they needed to be proactive and persistent, partly because of a lack of knowledge in primary and secondary care. Having gained access, mothers felt the CFS/ME service was useful because it recognised and acknowledged their child's condition and opened channels of dialogue between health-care professionals and education providers. Adolescents reported that specialist medical care resulted in better symptom management, although some adolescents did not like the fact that the treatment approach limited activity. Adolescents and their mothers value receiving a diagnosis from a specialist service and making progress in managing CFS/ME. General practitioners should support adolescents with CFS/ME in accessing CFS/ME specialist services, consistent with current guidance.

Common Femoral Artery Access on YouTube: What Practices are Being Shown and Who is Delivering the Message?

PubMed

Pitcher, Grayson S; Newton, Daniel H; Amendola, Michael F

Novice learners are increasingly turning to YouTube as a learning resource for surgical procedures. One example of such a procedure is common femoral artery puncture and sheath placement. Practitioners in several specialties perform this procedure to access the arterial system for angiography and intervention. We set forth to compare the techniques demonstrated on YouTube by the various specialists, as well as compare each specialty׳s prevalence on this website. YouTube (www.youtube.com) was accessed in December 2015 at multiple time points with a cleared-cache web browser for the keyword search categories: "femoral artery access," "femoral access," and "angiography access." The top 500 videos from each of these keyword searches were analyzed. Videos were categorized by practitioner specialty, technique, duration of video, age of video, and total views. Videos with clear demonstration of femoral artery access were included in the analysis. All industry videos were excluded from the analysis. Categorical variables were compared using Fisher׳s exact test, and continuous variables were compared with the Student׳s t-test. A total of 2460, 4680 and 1800 videos were found for each keyword search, respectively. Of these, 33 videos clearly demonstrated femoral artery access technique. Vascular specialists, compared to interventional cardiology and radiology, had fewer videos (n = 4 vs. 14) and older videos (3.5 ± 2.1y vs. 2.25 ± 0.5y, p < 0.05). The vascular specialists demonstrated ultrasound-guided access, while interventional cardiology predominantly demonstrated landmark-guided access (p < 0.05). Although YouTube and other online resources are being used by novice learners, vascular specialists are underrepresented for femoral artery access, a foundational vascular procedure. Other practitioners demonstrate videos with landmark-guided access and rarely demonstrate ultrasound use. As recognized vascular experts, vascular surgeons should improve their visibility in online learning resources. Copyright © 2017 Association of Program Directors in Surgery. All rights reserved.

The diagnosis and lived experience of polycystic ovary syndrome: A qualitative study.

PubMed

Tomlinson, Julie; Pinkney, Jonathan; Adams, Linda; Stenhouse, Elizabeth; Bendall, Alison; Corrigan, Oonagh; Letherby, Gayle

2017-10-01

To explore the impact of the diagnosis of polycystic ovary syndrome on health/ill health identity, how women experience this diagnosis and their health beliefs. Polycystic ovary syndrome is a common and heterogeneous condition, giving rise to a wide range of different health concerns. Previous research on polycystic ovary syndrome has been dominated by the medical perspective and less is known about the experiences and needs of women. A qualitative study of 32 premenopausal adult women with polycystic ovary syndrome (diagnosis confirmed by Rotterdam criteria), aged between 18 and 45 years, recruited from a primary and secondary care setting. Thematic analysis of transcripts from 11 focus groups conducted between 2013-2015. Women identified a range of concerns affecting personal and reproductive identity, health knowledge and beliefs: (1) delays and barriers to diagnosis; (2) general lack of empathy by the medical profession; (3) difficulty in accessing specialist referral; (4) lack of information from professionals; (5) inconsistent and sometimes unsatisfactory experiences with medications; (6) insufficient help and advice regarding in/fertility; (7) relative lack of awareness or concern about longer term risks such as diabetes; and (8) significant discrepancies between the beliefs of women with polycystic ovary syndrome and how they experienced the attitudes of healthcare professionals. There appears to be a divergence between women's experience and attitudes of healthcare professionals. The diagnosis, support and lived experience of women with polycystic ovary syndrome could be enhanced by better professional recognition of these concerns, improved knowledge and communication about polycystic ovary syndrome and better access to support and specialist advice. © 2017 John Wiley & Sons Ltd.

[Spontaneous speech prosody and discourse analysis in schizophrenia and Fronto Temporal Dementia (FTD) patients].

PubMed

Martínez, Angela; Felizzola Donado, Carlos Alberto; Matallana Eslava, Diana Lucía

2015-01-01

Patients with schizophrenia and Frontotemporal Dementia (FTD) in their linguistic variants share some language characteristics such as the lexical access difficulties, disordered speech with disruptions, many pauses, interruptions and reformulations. For the schizophrenia patients it reflects a difficulty of affect expression, while for the FTD patients it reflects a linguistic issue. This study, through an analysis of a series of cases assessed Clinic both in memory and on the Mental Health Unit of HUSI-PUJ (Hospital Universitario San Ignacio), with additional language assessment (analysis speech and acoustic analysis), present distinctive features of the DFT in its linguistic variants and schizophrenia that will guide the specialist in finding early markers of a differential diagnosis. In patients with FTD language variants, in 100% of cases there is a difficulty understanding linguistic structure of complex type; and important speech fluency problems. In patients with schizophrenia, there are significant alterations in the expression of the suprasegmental elements of speech, as well as disruptions in discourse. We present how depth language assessment allows to reassess some of the rules for the speech and prosody analysis of patients with dementia and schizophrenia; we suggest how elements of speech are useful in guiding the diagnosis and correlate functional compromise in everyday psychiatrist's practice. Copyright © 2014 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

The 'price signal' for health care is loud and clear: A cross-sectional study of self-reported access to health care by disadvantaged Australians.

PubMed

Paul, Christine; Bonevski, Billie; Twyman, Laura; D'Este, Catherine; Siahpush, Mohammad; Guillaumier, Ashleigh; Bryant, Jamie; Fradgley, Elizabeth; Palazzi, Kerrin

2016-04-01

To describe self-reported inability to access health care and factors associated with lack of access among a socioeconomically disadvantaged group. A cross-sectional survey with 906 adult clients of a large community welfare agency in New South Wales. Clients attending the service for emergency assistance completed a touchscreen survey. Inability to access health care in the prior year was reported by more than one-third of the sample (38%), compared to the 5% found for the general population. Dentists (47%), specialists (43%) or GPs (29%) were the least accessible types of health care. The main reason for inability to access health care was cost, accounting for 60% of responses. Almost half (47%) the sample reported delayed or non-use of medicines due to cost. Increasing financial stress was associated with increased inability to access GP or specialist care, medicines and imaging. Higher anxiety scores were associated with inability to access health care, and with cost-related inability to access medicines and imaging. For disadvantaged groups, cost-related barriers to accessing care are prominent and are disproportionately high - particularly regarding dentistry, specialist and GP care. Improvements in health outcomes for disadvantaged groups are likely to require strategies to reduce cost-related barriers to health care. © 2015 Public Health Association of Australia.

[Osteoarthritis, disability, travel and recreational activities: comments from physicians and travel specialists].

PubMed

Solignac, Marie

2004-05-22

IMPACT OF DISABILITY: A survey of general practitioners, rheumatology specialists, and tourism specialists conducted by NEGMA-LERADS Laboratories demonstrated that subjects with osteoarthritis avoid vacation trips more readily than recreational activities. VACATION TRIPS ARE STILL POSSIBLE: Certain tourism organisms have nevertheless developed specialized services for disabled persons. Special emphasis is placed on adequate preparation before the vacation trip. PROBLEMS WITH WALKING: Many persons disabled by osteoarthritis do not require a wheel chair, yet have difficulty walking long distances. It is important to recognize the specific disabilities related to osteoarthritis and their effects on grip force and/or ambulation.

Australasian haematologist referral patterns to palliative care: lack of consensus on when and why.

PubMed

Auret, K; Bulsara, C; Joske, D

2003-12-01

Patients with haematological malignancies are not referred to palliative care services as frequently as those with solid cancers (non-haematological malignancies). The present study surveyed haematologists in Australia and New Zealand. We aimed to record theoretical referral times, identify problems with referral to palliative care and clarify elements used to decide whether a patient was "terminally ill". A questionnaire based on the case-histories of three patients (with acute leukaemia, lymphoma or multiple myeloma) was distributed at the Haematology Society of Australia and New Zealand Congress 2000, Perth, Australia. Each case was divided into stages by transitional points in the illness to include issues or prognostic variables that may stimulate referral to palliative care. Questions were asked about: (i) referral-triggers, (ii) problems previously experienced, (iii) definition of when the patient was "terminally ill", (iv) prognostication difficulties and (v) communication about prognosis. The response rate was 11%, which may represent up to 32% of Australian specialists. Eighty per cent had access to all types of palliative care services and refer for symptom control, regardless of illness stage. Twenty-nine per cent had experienced difficulties in referring. There was a variation as to exactly when referral would occur and when each case was considered "terminally ill". Reasons for early or later referral were explored. Prognostication difficulties were common. In theory there is a willingness to refer to palliative care, however this has yet to be translated to day-to-day practice. This may be due to prognostication difficulties, logistical factors and medical concerns. Models of referral are suggested for further study.

Evaluation of an Innovative Programme for Training Teachers of Children with Learning and Behavioural Difficulties in New Zealand

ERIC Educational Resources Information Center

Pilgrim, Marcia; Hornby, Garry; Everatt, John; Macfarlane, Angus

2017-01-01

This article reports the views of recent graduates of a competency based, blended learning teacher education programme for specialist resource teachers of children with learning and behaviour difficulties in New Zealand. Identifying and developing the competencies needed by teachers in the field of special needs education is important in ensuring…

Developing and Sustaining Provision for Children with Motor Skills Difficulties in Schools: The Role of Educational Psychologists

ERIC Educational Resources Information Center

Bond, Caroline; Cole, Marilyn; Fletcher, Judy; Noble, Jennifer; O'Connell, Maria

2011-01-01

The current paper outlines a three-year action research project with 39 schools in one inner city local authority. A local need to improve provision for children with motor skills difficulties resulted in a team of educational psychologists (EPs) and specialist teachers developing the Manchester Motor Skills Intervention (MMSI), which is a…

Los Angeles Safety-Net Program eConsult System Was Rapidly Adopted And Decreased Wait Times To See Specialists.

PubMed

Barnett, Michael L; Yee, Hal F; Mehrotra, Ateev; Giboney, Paul

2017-03-01

Lack of timely access to specialty care is a significant problem among disadvantaged populations, such as those served by the Los Angeles County Department of Health Services. In 2012 the department implemented an electronic system for the provision of specialty care called the eConsult system, in which all requests from primary care providers for specialty assistance were reviewed by specialists. In many cases, the specialist can address the primary care provider's question via an electronic dialogue, thereby eliminating the need for the patient to see a specialist in person. We observed rapid growth in the use of eConsult: By 2015 the system was in use by over 3,000 primary care providers, and 12,082 consultations were taking place per month, compared to 86 in the third quarter of 2012. The median time to an electronic response from a specialist was one day, and 25 percent of eConsults were resolved without a specialist visit. Three to four years after implementation, the median time to a specialist appointment decreased significantly, while the volume of visits remained stable. eConsult systems are a promising and sustainable intervention that could improve access to specialist care for underserved patients. Project HOPE—The People-to-People Health Foundation, Inc.

The impact of electronic consultation on a Canadian tertiary care pediatric specialty referral system: A prospective single-center observational study

PubMed Central

Liddy, Clare; Keely, Erin; Afkham, Amir; Kurzawa, Julia; Abdeen, Nishard; Audcent, Tobey; Bromwich, Matthew; Brophy, Jason; Carsen, Sasha; Fournier, Annick; Fraser-Roberts, Leigh; Gandy, Hazen; Hui, Charles; Johnston, Donna; Keely, Kathryn; Kontio, Ken; Lamontagne, Christine; Major, Nathalie; O’Connor, Michael; Radhakrishnan, Dhenuka; Reisman, Joe; Robb, Marjorie; Samson, Lindy; Sell, Erick; Splinter, William; van Stralen, Judy; Venkateswaran, Sunita; Murto, Kimmo

2018-01-01

Background Champlain BASE™ (Building Access to Specialists through eConsultation) is a web-based asynchronous electronic communication service that allows primary-care- practitioners (PCPs) to submit “elective” clinical questions to a specialist. For adults, PCPs have reported improved access and timeliness to specialist advice, averted face-to-face specialist referrals in up to 40% of cases and high provider satisfaction. Objective To determine whether the expansion of eConsult to a pediatric setting would result in similar measures of improved healthcare system process and high provider acceptance reported in adults. Design Prospective observational cohort study. Setting Single Canadian tertiary-care academic pediatric hospital (June 2014–16) servicing 1.2 million people. Participants 1. PCPs already using eConsult. 2.Volunteer pediatric specialists provided services in addition to their regular workload. 3.Pediatric patients (< 18 years-old) referred for none-acute care conditions. Main outcomes and measures Specialty service utilization and access, impact on PCP course-of-action and referral-patterns and survey-based provider satisfaction data were collected. Results 1064 eConsult requests from 367 PCPs were answered by 23 pediatric specialists representing 14 specialty-services. The top three specialties represented were: General Pediatrics 393 cases (36.9%), Orthopedics 162 (15.2%) and Psychiatry 123 (11.6%). Median specialist response time was 0.9 days (range <1 hour-27 days), most consults (63.2%) required <10minutes to complete and 21/21(100%) specialist survey-respondents reported minimal workload burden. For 515/1064(48.4%) referrals, PCPs received advice for a new or additional course of action; 391/1064(36.7%) referrals resulted in an averted face-to-face specialist visit. In 9 specialties with complete data, the median wait-time was significantly less (p<0.001) for an eConsult (1 day, 95%CI:0.9–1.2) compared with a face-to-face referral (132 days; 95%CI:127–136). The majority (>93.3%) of PCPs rated eConsult as very good/excellent value for both patients and themselves. All specialist survey-respondents indicated eConsult should be a continued service. Conclusions and relevance Similar to adults, eConsult improves PCP access and timeliness to elective pediatric specialist advice and influences their care decisions, while reporting high end-user satisfaction. Further study is warranted to assess impact on resource utilization and clinical outcomes. PMID:29320539

Reorganization of secondary medical care in the Israeli Defense Forces Medical Corps: A cost-effect analysis.

PubMed

Yagil, Yael; Arnon, Ronen; Ezra, Vered; Ashkenazi, Isaac

2006-12-01

To increase accessibility and availability of secondary medical care, 10 secondary unit specialist clinics were established side-by-side with five existing regional specialist centers, thus achieving decentralization. The purpose was to analyze the impact of this reorganization on overall consumption of secondary medical care and expenditures. Consumption of secondary medical care was analyzed by using computerized clinic and Medical Corps databases. Functional efficiency and budgetary expenditures were evaluated in four representative unit specialist clinics. The reorganization resulted in an 8% increase in total secondary care consumption over 2.5 years. The establishment of unit specialist clinics did not achieve increased accessibility or availability for military personnel. Functional analysis of representative unit specialist clinics showed diversity in efficiency, differences in physicians' performance, and excess expenditures. The decentralizing reorganization of secondary medical care generated an increase in medical care consumption, possibly because of supply-induced demand. The uniform inefficiency of the unit specialist clinics might have been related to incorrect planning and management. The decentralization of secondary medical care within the Israeli Defense Forces has not proved to be cost-efficient.

Specialist Endoscopists Are Associated with a Decreased Risk of Incomplete Polyp Resection During Endoscopic Mucosal Resection in the Colon.

PubMed

Tavakkoli, Anna; Law, Ryan J; Bedi, Aarti O; Prabhu, Anoop; Hiatt, Tadd; Anderson, Michelle A; Wamsteker, Erik J; Elmunzer, B Joseph; Piraka, Cyrus R; Scheiman, James M; Elta, Grace H; Kwon, Richard S

2017-09-01

Endoscopic experience is known to correlate with outcomes of endoscopic mucosal resection (EMR), particularly complete resection of the polyp tissue. Whether specialist endoscopists can protect against incomplete polypectomy in the setting of known risk factors for incomplete resection (IR) is unknown. We aimed to characterize how specialist endoscopists may help to mitigate the risk of IR of large sessile polyps. This is a retrospective cohort study of patients who underwent EMR at the University of Michigan from January 1, 2006, to November 15, 2015. The primary outcome was endoscopist-reported polyp tissue remaining at the end of the initial EMR attempt. Specialist endoscopists were defined as endoscopists who receive tertiary referrals for difficult colonoscopy cases and completed at least 20 EMR colonic polyp resections over the study period. A total of 257 patients with 269 polyps were included in the study. IR occurred in 40 (16%) cases. IR was associated with polyp size ≥ 40 mm [adjusted odds ratio (aOR) 3.31, 95% confidence interval (CI) 1.38-7.93], flat/laterally spreading polyps (aOR 2.61, 95% CI 1.24-5.48), and difficulty lifting the polyp (aOR 11.0, 95% CI 2.66-45.3). A specialist endoscopist performing the initial EMR was protective against IR, even in the setting of risk factors for IR (aOR 0.13, 95% CI 0.04-0.41). IR is associated with polyp size ≥ 40 mm, flat and/or laterally spreading polyps, and difficulty lifting the polyp. A specialist endoscopist initiating the EMR was protective of IR.

Re-shaping NHS orthodontic provision - the North Wales experience.

PubMed

Lewis, B R K; Plunkett, D J; Hickman, J; Sandham, J S

2017-05-26

The orthodontic service provision within North Wales, in common with many areas of the United Kingdom, was experiencing increasing waiting times for assessment and treatment. Reasons for this included an increasing population, patient demand and fixed NHS contracted orthodontic provision. In addition to these universal challenges, the geography of North Wales contributed to difficulties in accessing care. It was felt that with a reshaping of the orthodontic services there was potential to enhance the quality of orthodontic care available to patients and deliver prudent NHS orthodontic services. Three distinct, but inter-related steps, were identified to progress the reshaping of the service with the intended outcome of achieving an improved co-ordinated service. Initially, this involved the re-commissioning of the primary care specialist service through a formal retendering process. Following this, a standardised orthodontic referral form was developed, to be used for all orthodontic referrals regardless of whether their destination was a primary or secondary care provider. Finally, a formal accreditation process for all non-specialist dentists who were undertaking NHS orthodontic treatment was developed and implemented. The successful outcome of this process was only possible because of the close working partnership between the North Wales Orthodontic Managed Clinical Network (OMCN) and Betsi Cadwaladr University Health Board.

Opportunity Costs in Paediatric Training: The Specialist Registrars Experience.

PubMed

O'Neill, M B; Nabialek, T; Kandamany, N

2017-08-08

In the training process, there is a tension between the work life and home life of trainees. This study explored both the personal impact and the opportunity costs of training from the Specialist Paediatric Registrar (SPR) perspective. The survey explored 1) career progression, 2) perceived functional effectiveness at work, 3) psychological impact of hospital based training, and 4) the personal and social cost of training. Fifty-three (71%) SPRs responded of whom 47 (89%)were married or in long term relationships. Seventy-five percent of trainees had a definite career plan with 86% intending to undertake fellowship training. Seventy percent believed they were efficient time managers but 53% had difficulty in making time for academic pursuits and fifty percent experienced negative feelings, which lingered after work and interfered with their relationships at home. Seventy-four percent stated training was undertaken at significant personal cost with only 21% achieving a very satisfactory work/life balance. To address these difficulties trainee wellbeing should be addressed at the Basic Specialist Training (BST) level and the career path clearly explained outlining the challenges that are likely to be encountered.

What Is a Pediatric Infectious Diseases Specialist?

MedlinePlus

... mode Turn off more accessible mode Skip Ribbon Commands Skip to main content Turn off Animations Turn ... through the teen years. What Kind of Training Do Pediatric Infectious Diseases Specialists Have? Pediatric infectious diseases ...

What Is a Pediatric Critical Care Specialist?

MedlinePlus

... mode Turn off more accessible mode Skip Ribbon Commands Skip to main content Turn off Animations Turn ... offered in the PICU. What Kind of Training Do Pediatric Critical Care Specialists Have? Pediatric critical care ...

eCONSULTS TO ENDOCRINOLOGISTS IMPROVE ACCESS AND CHANGE PRIMARY CARE PROVIDER BEHAVIOR.

PubMed

Tran, Christopher S; Liddy, Clare E; Liu, Dora M; Afkham, Amir; Keely, Erin J

2016-10-01

To describe the impact of an eConsult service on access to endocrinologists along with its influence on changing primary care provider (PCP) course of action and referral behaviors. Established in 2011, the Champlain BASE (Building Access to Specialist Care via eConsult) service allows PCPs to access specialist care in lieu of traditional face-to-face referrals. We conducted a cross-sectional study of eConsult cases submitted to endocrinologists by PCPs between April 15, 2011 and January 31, 2015. Usage data and PCP responses to a mandatory closeout survey were analyzed to determine eConsult response times, PCP practice behavior, referral outcomes, and provider satisfaction. Each eConsult was coded according to clinical topic and question type based on established taxonomies. A total of 180 PCPs submitted 464 eConsults to endocrinology during the study period. Specialist median response time was 7 hours, with 90% of responses occurring within 3 days. PCPs received a new or additional course of action in 62% of submitted cases. An unnecessary face-to-face referral was avoided in 44% of all eConsults and in 67% of cases where the PCP initially contemplated requesting a referral. Over 95% of cases were rated at least 4 out of 5 in value for PCPs and their patients. The use of eConsult improves access to endocrinologists by providing timely, highly rated practice-changing clinical advice while reducing the need for patients to attend face-to-face office visits. BASE = Building Access to Specialist Advice through eConsult PCP = primary care physician UCSF = University of California San Francisco.

Development of a Clinical Data Warehouse for Hospital Infection Control

PubMed Central

Wisniewski, Mary F.; Kieszkowski, Piotr; Zagorski, Brandon M.; Trick, William E.; Sommers, Michael; Weinstein, Robert A.

2003-01-01

Existing data stored in a hospital's transactional servers have enormous potential to improve performance measurement and health care quality. Accessing, organizing, and using these data to support research and quality improvement projects are evolving challenges for hospital systems. The authors report development of a clinical data warehouse that they created by importing data from the information systems of three affiliated public hospitals. They describe their methodology; difficulties encountered; responses from administrators, computer specialists, and clinicians; and the steps taken to capture and store patient-level data. The authors provide examples of their use of the clinical data warehouse to monitor antimicrobial resistance, to measure antimicrobial use, to detect hospital-acquired bloodstream infections, to measure the cost of infections, and to detect antimicrobial prescribing errors. In addition, they estimate the amount of time and money saved and the increased precision achieved through the practical application of the data warehouse. PMID:12807807

Managed care and the delivery of primary care to the elderly and the chronically ill.

PubMed Central

Wholey, D R; Burns, L R; Lavizzo-Mourey, R

1998-01-01

OBJECTIVE: To analyze primary care staffing in HMOs and to review the literature on primary care organization and performance in managed care organizations, with an emphasis on the delivery of primary care to the elderly and chronically ill. DATA SOURCES/STUDY SETTING: Analysis of primary care staffing: InterStudy HMO census data on primary care (n = 1,956) and specialist (n = 1,777) physician staffing levels from 1991 through 1995. Primary care organization and performance for the chronically ill and elderly were analyzed using a review of published research. STUDY DESIGN: For the staffing-level models, the number of primary care and specialist physicians per 100,000 enrollees was regressed on HMO characteristics (HMO type [group, staff, network, mixed], HMO enrollment, federal qualification, profit status, national affiliation) and community characteristics (per capita income, population density, service area size, HMO competition). For the review of organization and performance, literature published was summarized in a tabular format. PRINCIPAL FINDINGS: The analysis of physician staffing shows that group and staff HMOs have fewer primary care and specialist physicians per 100,000 enrollees than do network and mixed HMOs, which have fewer than IPAs. Larger HMOs use fewer physicians per 100,000 enrollees than smaller HMOs. Federally qualified HMOs have fewer primary care and specialist physicians per 100,000 enrollees. For-profit, nationally affiliated, and Blue Cross HMOs have more primary care and specialist physicians than do local HMOs. HMOs in areas with high per capita income have more PCPs per 100,000 and a greater proportion of PCPs in the panel. HMO penetration decreases the use of specialists, but the number of HMOs increases the use of primary care and specialist physicians in highly competitive markets. Under very competitive conditions, HMOs appear to compete by increasing access to both PCPs and specialists, with a greater emphasis on access to specialists. The review of research on HMO performance suggests that access to PCPs is better in MCOs. But access to specialists and hospitals is lower and more difficult in MCOs than FFS. Data do not suggest that processes of care, given access, are different in MCOs and FFS. MCO enrollees are more satisfied with financial aspects of a health plan and less satisfied with other aspects of health plan organization. There are potential problems with outcomes, with some studies finding greater declines among the chronically ill in MCOs than FFS. We found a variety of innovative care programs for the elderly, based on two fundamentally different approaches: organization around primary care or organizing around specialty care. Differences between the performance of the two approaches cannot be evaluated because of the small amount of research done. It is difficult to say how well particular programs perform and if they can be replicated. The innovative programs described in the literature tend to be benchmark programs developed by HMOs with a strong positive reputation. PMID:9618674

Managed care and the delivery of primary care to the elderly and the chronically ill.

PubMed

Wholey, D R; Burns, L R; Lavizzo-Mourey, R

1998-06-01

To analyze primary care staffing in HMOs and to review the literature on primary care organization and performance in managed care organizations, with an emphasis on the delivery of primary care to the elderly and chronically ill. Analysis of primary care staffing: InterStudy HMO census data on primary care (n = 1,956) and specialist (n = 1,777) physician staffing levels from 1991 through 1995. Primary care organization and performance for the chronically ill and elderly were analyzed using a review of published research. For the staffing-level models, the number of primary care and specialist physicians per 100,000 enrollees was regressed on HMO characteristics (HMO type [group, staff, network, mixed], HMO enrollment, federal qualification, profit status, national affiliation) and community characteristics (per capita income, population density, service area size, HMO competition). For the review of organization and performance, literature published was summarized in a tabular format. The analysis of physician staffing shows that group and staff HMOs have fewer primary care and specialist physicians per 100,000 enrollees than do network and mixed HMOs, which have fewer than IPAs. Larger HMOs use fewer physicians per 100,000 enrollees than smaller HMOs. Federally qualified HMOs have fewer primary care and specialist physicians per 100,000 enrollees. For-profit, nationally affiliated, and Blue Cross HMOs have more primary care and specialist physicians than do local HMOs. HMOs in areas with high per capita income have more PCPs per 100,000 and a greater proportion of PCPs in the panel. HMO penetration decreases the use of specialists, but the number of HMOs increases the use of primary care and specialist physicians in highly competitive markets. Under very competitive conditions, HMOs appear to compete by increasing access to both PCPs and specialists, with a greater emphasis on access to specialists. The review of research on HMO performance suggests that access to PCPs is better in MCOs. But access to specialists and hospitals is lower and more difficult in MCOs than FFS. Data do not suggest that processes of care, given access, are different in MCOs and FFS. MCO enrollees are more satisfied with financial aspects of a health plan and less satisfied with other aspects of health plan organization. There are potential problems with outcomes, with some studies finding greater declines among the chronically ill in MCOs than FFS. We found a variety of innovative care programs for the elderly, based on two fundamentally different approaches: organization around primary care or organizing around specialty care. Differences between the performance of the two approaches cannot be evaluated because of the small amount of research done. It is difficult to say how well particular programs perform and if they can be replicated. The innovative programs described in the literature tend to be benchmark programs developed by HMOs with a strong positive reputation.

A qualitative exploration of psychosocial specialists' experiences of providing support in UK burn care services.

PubMed

Guest, Ella; Griffiths, Catrin; Harcourt, Diana

2018-01-01

A burn can have a significant and long-lasting psychosocial impact on a patient and their family. The National Burn Care Standards (2013) recommend psychosocial support should be available in all UK burn services; however, little is known about how it is provided. The current study aimed to explore experiences of psychosocial specialists working in UK burn care, with a focus on the challenges they experience in their role. Semi-structured telephone interviews with eight psychosocial specialists (two psychotherapists and six clinical psychologists) who worked within UK burn care explored their experiences of providing support to patients and their families. Thematic analysis revealed two main themes: burn service-related experiences and challenges reflected health professionals having little time and resources to support all patients; reduced patient attendance due to them living large distances from service; psychosocial appointments being prioritised below wound-related treatments; and difficulties detecting patient needs with current outcome measures. Therapy-related experiences and challenges outlined the sociocultural and familial factors affecting engagement with support, difficulties treating patients with pre-existing mental health conditions within the burn service and individual differences in the stage at which patients are amenable to support. Findings provide an insight into the experiences of psychosocial specialists working in UK burn care and suggest a number of ways in which psychosocial provision in the NHS burn service could be developed.

Crown and crown-root fractures: an evaluation of the treatment plans for management proposed by 154 specialists in restorative dentistry.

PubMed

de Castro, Mara Antonio Monteiro; Poi, Wilson Roberto; de Castro, José Carlos Monteiro; Panzarini, Sônia Regina; Sonoda, Celso Koogi; Trevisan, Carolina Lunardelli; Luvizuto, Eloá Rodrigues

2010-06-01

Traumatic tooth injuries involve function and aesthetics and cause damage that range from minimal enamel loss to complex fractures involving the pulp tissue and even loss of the tooth crown. Technical knowledge and clinical experience are essential to establish an accurate diagnosis and provide a rational treatment. The purpose of this study was to evaluate the knowledge of Restorative Dentistry specialists about the management of crown and crown-root fractures based on treatment plans proposed by these professionals for these cases. A descriptive questionnaire was mailed to 245 Restorative Dentistry specialists with questions referring to their professional profile and the treatment plans they would propose for the management of crown and crow-root fractures resulting from dental trauma. One hundred and fifty-four questionnaires were returned properly filled. The data were subjected to descriptive statistics and the chi-square test was used to determine the frequency and the level of the significance among the variables. The analysis of data showed that in spite of having a specialist title, all interviewees had great difficulty in planning the treatments. As much as 42.8% of the participants were unable to treat all types of dental trauma. Complicated and uncomplicated crown-root fractures posed the greatest difficulties for the dentists to establish adequate treatment plans because these fractures require multidisciplinary knowledge and approach for a correct case planning and prognosis.

Parental help-seeking in primary care for child and adolescent mental health concerns: qualitative study.

PubMed

Sayal, Kapil; Tischler, Victoria; Coope, Caroline; Robotham, Sarah; Ashworth, Mark; Day, Crispin; Tylee, Andre; Simonoff, Emily

2010-12-01

Child and adolescent mental health problems are common in primary care. However, few parents of children with mental health problems express concerns about these problems during consultations. To explore the factors influencing parental help-seeking for children with emotional or behavioural difficulties. Focus group discussions with 34 parents from non-specialist community settings who had concerns about their child's mental health. All groups were followed by validation groups or semi-structured interviews. Most children had clinically significant mental health symptoms or associated impairment in function. Appointment systems were a key barrier, as many parents felt that short appointments did not allow sufficient time to address their child's difficulties. Continuity of care and trusting relationships with general practitioners (GPs) who validated their concerns were perceived to facilitate help-seeking. Parents valued GPs who showed an interest in their child and family situation. Barriers to seeking help included embarrassment, stigma of mental health problems, and concerns about being labelled or receiving a diagnosis. Some parents were concerned about being judged a poor parent and their child being removed from the family should they seek help. Primary healthcare is a key resource for children and young people with emotional and behavioural difficulties and their families. Primary care services should be able to provide ready access to health professionals with an interest in children and families and appointments of sufficient length so that parents feel able to discuss their mental health concerns.

STS-61B Astronaut Ross During ACCESS Extravehicular Activity

NASA Technical Reports Server (NTRS)

1985-01-01

The crew assigned to the STS-61B mission included Bryan D. O'Conner, pilot; Brewster H. Shaw, commander; Charles D. Walker, payload specialist; mission specialists Jerry L. Ross, Mary L. Cleave, and Sherwood C. Spring; and Rodolpho Neri Vela, payload specialist. Launched aboard the Space Shuttle Atlantis November 28, 1985 at 7:29:00 pm (EST), the STS-61B mission's primary payload included three communications satellites: MORELOS-B (Mexico); AUSSAT-2 (Australia); and SATCOM KU-2 (RCA Americom). Two experiments were conducted to test assembling erectable structures in space: EASE (Experimental Assembly of Structures in Extravehicular Activity), and ACCESS (Assembly Concept for Construction of Erectable Space Structure). In a joint venture between NASA/Langley Research Center in Hampton, VA and the Marshall Space Flight Center (MSFC), ACCESS and EASE were developed and demonstrated at MSFC's Neutral Buoyancy Simulator (NBS). In this STS-61B onboard photo, astronaut Ross was working on the ACCESS experiment during an Extravehicular Activity (EVA). The primary objective of this experiment was to test the ACCESS structural assembly concept for suitability as the framework for larger space structures and to identify ways to improve the productivity of space construction.

A spatial analysis of variations in health access: linking geography, socio-economic status and access perceptions

PubMed Central

2011-01-01

Background This paper analyses the relationship between public perceptions of access to general practitioners (GPs) surgeries and hospitals against health status, car ownership and geographic distance. In so doing it explores the different dimensions associated with facility access and accessibility. Methods Data on difficulties experienced in accessing health services, respondent health status and car ownership were collected through an attitudes survey. Road distances to the nearest service were calculated for each respondent using a GIS. Difficulty was related to geographic distance, health status and car ownership using logistic generalized linear models. A Geographically Weighted Regression (GWR) was used to explore the spatial non-stationarity in the results. Results Respondent long term illness, reported bad health and non-car ownership were found to be significant predictors of difficulty in accessing GPs and hospitals. Geographic distance was not a significant predictor of difficulty in accessing hospitals but was for GPs. GWR identified the spatial (local) variation in these global relationships indicating locations where the predictive strength of the independent variables was higher or lower than the global trend. The impacts of bad health and non-car ownership on the difficulties experienced in accessing health services varied spatially across the study area, whilst the impacts of geographic distance did not. Conclusions Difficulty in accessing different health facilities was found to be significantly related to health status and car ownership, whilst the impact of geographic distance depends on the service in question. GWR showed how these relationships were varied across the study area. This study demonstrates that the notion of access is a multi-dimensional concept, whose composition varies with location, according to the facility being considered and the health and socio-economic status of the individual concerned. PMID:21787394

Healthcare personnel's experiences using video consultation in primary healthcare in rural areas.

PubMed

Johansson, Annette M; Lindberg, Inger; Söderberg, Siv

2017-01-01

Patients living in rural areas often need to travel long distances for access to specialist care. To increase access to specialist care, video consultation between patients in primary healthcare and specialist care has been used. In order for this new method to be developed and used to the fullest, it is important to understand healthcare personnel's experiences with this intervention. The aim of this study was to describe healthcare personnel's experiences using video consultation in their work in primary healthcare. A mixed methods design was used, and the data were analysed using qualitative and quantitative analysis methods. Interviews were conducted with eight general practitioners and one district nurse, all of whom had conducted a video consultation with a patient and a specialist physician or a cardiac specialist nurse. After each video consultation, the participants completed a consultation report/questionnaire. Healthcare personnel considered video consultation to provide quicker access to specialist care for the patient, and greater security when the video consultation encounter was conducted at their own primary healthcare centre. They considered video consultation an opportunity to provide education and for the patients to ask questions. Video consultation is a satisfactory tool for healthcare personnel, and the technology is a new, useful method, especially for the district nurses. Further, video consultation is an opportunity for healthcare personnel to learn. However, for it to work as an accepted method, the technology must function well and be user friendly. It must also be clear that it is beneficial for the patients and the healthcare personnel.

Equity of access to specialist chronic fatigue syndrome (CFS/ME) services in England (2008–2010): a national survey and cross-sectional study

PubMed Central

Collin, Simon M; Sterne, Jonathan A C; Hollingworth, William; May, Margaret T; Crawley, Esther

2012-01-01

Objectives Provision of National Health Service (NHS) specialist chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) services in England has been deemed patchy and inconsistent. Our objective was to explore variation in the provision of NHS specialist CFS/ME services and to investigate whether access is related to measures of deprivation and inequality. Design Survey of all CFS/ME clinical teams in England, plus cross-sectional data from a subset of teams. Setting Secondary care. Outcome measures We used clinic activity data from CFS/ME clinical teams in England to describe provision of specialist CFS/ME services (referral, assessment and diagnosis rates per 1000 adults per year) during 2008–2011 according to Primary Care Trust (PCT) population estimates, and to investigate whether use of services was related to PCT-level measures of deprivation and inequality. We used postcode data from seven services to investigate variation in provision by deprivation. Results Clinic activity data were obtained from 93.9% (46/49) of clinical teams in England which between them received referrals from 84.9% (129/152) of PCTs. 12 PCTs, covering a population of 2.08 million adults, provided no specialist CFS/ME service. There was a six-fold variation in referral and assessment rates between services which could not be explained by PCT-level measures of deprivation and inequality. The median assessment rate in 2010 was 0.25 (IQR 0.17, 0.35) per 1000 adults per year. 91.9% (IQR 76.5%, 100.0%) of adults assessed were diagnosed with CFS/ME. Postcode data from seven clinical teams showed that assessment rates were equal across deprivation quartiles for four teams but were 40–50% lower in the most deprived compared with the most affluent areas for three teams. Conclusions Two million adults in England do not have access to a specialist CFS/ME service. In some areas which do have a specialist service, access is inequitable. This inequity may worsen with the impending fragmentation of NHS commissioning across England. PMID:22899647

Equity of access to specialist chronic fatigue syndrome (CFS/ME) services in England (2008-2010): a national survey and cross-sectional study.

PubMed

Collin, Simon M; Sterne, Jonathan A C; Hollingworth, William; May, Margaret T; Crawley, Esther

2012-01-01

Provision of National Health Service (NHS) specialist chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) services in England has been deemed patchy and inconsistent. Our objective was to explore variation in the provision of NHS specialist CFS/ME services and to investigate whether access is related to measures of deprivation and inequality. Survey of all CFS/ME clinical teams in England, plus cross-sectional data from a subset of teams. Secondary care. We used clinic activity data from CFS/ME clinical teams in England to describe provision of specialist CFS/ME services (referral, assessment and diagnosis rates per 1000 adults per year) during 2008-2011 according to Primary Care Trust (PCT) population estimates, and to investigate whether use of services was related to PCT-level measures of deprivation and inequality. We used postcode data from seven services to investigate variation in provision by deprivation. Clinic activity data were obtained from 93.9% (46/49) of clinical teams in England which between them received referrals from 84.9% (129/152) of PCTs. 12 PCTs, covering a population of 2.08 million adults, provided no specialist CFS/ME service. There was a six-fold variation in referral and assessment rates between services which could not be explained by PCT-level measures of deprivation and inequality. The median assessment rate in 2010 was 0.25 (IQR 0.17, 0.35) per 1000 adults per year. 91.9% (IQR 76.5%, 100.0%) of adults assessed were diagnosed with CFS/ME. Postcode data from seven clinical teams showed that assessment rates were equal across deprivation quartiles for four teams but were 40-50% lower in the most deprived compared with the most affluent areas for three teams. Two million adults in England do not have access to a specialist CFS/ME service. In some areas which do have a specialist service, access is inequitable. This inequity may worsen with the impending fragmentation of NHS commissioning across England.

Integrating HCI Specialists into Open Source Software Development Projects

NASA Astrophysics Data System (ADS)

Hedberg, Henrik; Iivari, Netta

Typical open source software (OSS) development projects are organized around technically talented developers, whose communication is based on technical aspects and source code. Decision-making power is gained through proven competence and activity in the project, and non-technical end-user opinions are too many times neglected. In addition, also human-computer interaction (HCI) specialists have encountered difficulties in trying to participate in OSS projects, because there seems to be no clear authority and responsibility for them. In this paper, based on HCI and OSS literature, we introduce an extended OSS development project organization model that adds a new level of communication and roles for attending human aspects of software. The proposed model makes the existence of HCI specialists visible in the projects, and promotes interaction between developers and the HCI specialists in the course of a project.

Ask the eConsultant: Improving access to haematology expertise using an asynchronous eConsult system.

PubMed

Fogel, Adam; Khamisa, Karima; Afkham, Amir; Liddy, Clare; Keely, Erin

2017-04-01

Introduction The Champlain BASE (Building Access to Specialists through eConsultation) eConsultation service was designed to address the limited access to specialist care in Canada, which can lead to long waiting times and, subsequently, negative patient outcomes. Our primary objective was to perform an in-depth analysis of the use, content, and perceived value of haematology electronic consults (eConsults) submitted by primary care providers (PCPs) to the eConsult service. Methods We conducted a cross-sectional study using descriptive statistics to examine post-eConsult surveys for PCPs and other collected data including PCP designation, time for specialist to complete the eConsult, specialist response time, perceived value of the eConsult by the PCP, and the need for a face-to-face referral following the eConsult. A medically-trained author reviewed all haematology eConsults from April 2011 to January 2015, and categorized them by clinical topic and question type using validated taxonomies. Results Haematology accounted for 436 out of 5601 (7.8%) total eConsults, making it the third most popular service utilized. In 66% of haematology eConsults, a face-to-face consultation was not needed. Anaemia, neutropenia, and hyperferritinemia were the most common clinical queries. Most eConsult question types concerned the management of haematological disorders or the interpretation of laboratory tests. Most eConsults were answered within three days, using less than 15 minutes of the specialists' time. PCPs highly valued the service. Discussion This initiative increases access to haematology care and has the potential to reduce the long waiting times for non-urgent traditional consultation, along with the benefit of cost savings to the healthcare system.

The non specialist paediatric training registrar in the healthcare system.

PubMed

O'Neill, M B; Kumar, A

2012-01-01

This study evaluated the experiences of non Specialist Paediatric Training Registrars (nonSPTR) in the Irish Healthcare system. The survey explored their adaptation to the healthcare system, skill development, perceptions of training and career development inclusive of working conditions. Thirty nine (53%) doctors responded. The time spent in Paediatrics ranged from 3 to 19 years with a mean of 8.9 years. Nineteen (49%) had only worked in non regional hospitals and for 20 (51%) the mean time spent in regional hospitals was 2.6 years. The very positives experiences (likert scores 5/6) included journal appraisal for 19 (49%), clinical skill development for 17 (44%) and consultant feedback for 11 (28%).The very negative experiences were difficulty obtaining desired clinical posts for 16 (43%) doctors and only 5 (13%) were happy with their career progression. Thirty one (79.5%) cited specific barriers to career progression, with only 10 (25%) making an application to the Specialist Paediatrics Registrar (SPR) training programme. Solutions for the non SPTR difficulties include the expansion of the SPR programme and the utilization of a criterion based portfolio system to integrate the nonSPTR into formal training.

What is the current NHS service provision for patients severely affected by chronic fatigue syndrome/myalgic encephalomyelitis? A national scoping exercise

PubMed Central

McDermott, Clare; Al Haddabi, Atheer; Akagi, Hiroko; Selby, Michelle; Cox, Diane; Lewith, George

2014-01-01

Background Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME), in its most severe clinical presentation, can result in patients becoming housebound and bedbound so unable to access most available specialist services. This presents particular clinical risks and treatment needs for which the National Institute for Health and Care Excellence (NICE) advises specialist medical care and monitoring. The extent of National Health Service (NHS) specialist provision in England for severe CFS/ME is currently unknown. Objectives To establish the current NHS provision for patients with severe CFS/ME in England. Setting and participants All 49 English NHS specialist CFS/ME adult services in England, in 2013. Method Cross-sectional survey by email questionnaire. Primary outcome measures Adherence to NICE guidelines for severe CFS/ME. Results All 49 services replied (100%). 33% (16/49) of specialist CFS/ME services provided no service for housebound patients. 55% (27/49) services did treat patients with severe CFS/ME and their interventions followed the NICE guidelines. The remaining services (12%, 6/49) offered occasional or minimal support where funding allowed. There was one NHS unit providing specialist inpatient CFS/ME provision in England. Conclusions Study findings highlight substantial variation in access to specialist care for patients with severe presentation of CFS/ME. Where treatment was provided, this appeared to comply with NICE recommendations for this patient group. PMID:24984956

Self-Reported Barriers to Healthcare Access for Rheumatoid Arthritis Patients in Rural and Northern Saskatchewan: A Mixed Methods Study.

PubMed

Nair, B V; Schuler, R; Stewart, S; Taylor-Gjevre, R M

2016-12-01

The aim of the present study was to identify potential barriers for access to medical and allied health services from the perspective of rural and Northern Saskatchewan rheumatoid arthritis (RA) patients. A total of 100 adults with established RA, residing in rural and Northern Saskatchewan, were recruited from two rheumatology practices. Structured interviews with standardized scripts solicited patient perspectives on appointment waiting times, travel required to access medical services and satisfaction with healthcare provision. Thematic analysis was employed for qualitative data. Patients-reported concerns regarding waiting time for their first rheumatology appointment. There was reduced access to allied health professionals, with only 53% of the participants having seen a physiotherapist (PT), and only 26% an occupational therapist (OT). Patients had similar driving distances to their family physician, PT, pharmacy and laboratory services but commuted significantly further for rheumatologist and OT services. There were high levels of satisfaction with their rheumatologist and family physician appointments (8.96 and 8.04 on a ten-point scale). Patients with longer travel times had higher satisfaction with their health care appointments: Patients who travelled one, two and more than two hours had satisfaction scores of 0.93, 0.88 and 1.32 points higher on a ten-point scale (p < 0.03). Access to medical services is a concern for this population. Patients were dissatisfied with the waiting time for their first specialist appointment and with decreased access to allied health professionals. Patients travelling longer distances were more satisfied with their health care provider's care, suggesting that good patient-care giver relationships helped to ameliorate the difficulties of travelling to their appointments. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Accessing and Selecting Word Meaning in Autism Spectrum Disorder

ERIC Educational Resources Information Center

Henderson, L. M.; Clarke, P. J.; Snowling, M. J.

2011-01-01

Background: Comprehension difficulties are commonly reported in autism spectrum disorder (ASD) but the causes of these difficulties are poorly understood. This study investigates how children with ASD access and select meanings of ambiguous words to test four hypotheses regarding the nature of their comprehension difficulties: semantic deficit,…

Content Validity and Psychometric Characteristics of the "Knowledge about Older Patients Quiz" for Nurses Using Item Response Theory.

PubMed

Dikken, Jeroen; Hoogerduijn, Jita G; Kruitwagen, Cas; Schuurmans, Marieke J

2016-11-01

To assess the content validity and psychometric characteristics of the Knowledge about Older Patients Quiz (KOP-Q), which measures nurses' knowledge regarding older hospitalized adults and their certainty regarding this knowledge. Cross-sectional. Content validity: general hospitals. Psychometric characteristics: nursing school and general hospitals in the Netherlands. Content validity: 12 nurse specialists in geriatrics. Psychometric characteristics: 107 first-year and 78 final-year bachelor of nursing students, 148 registered nurses, and 20 nurse specialists in geriatrics. Content validity: The nurse specialists rated each item of the initial KOP-Q (52 items) on relevance. Ratings were used to calculate Item-Content Validity Index and average Scale-Content Validity Index (S-CVI/ave) scores. Items with insufficient content validity were removed. Psychometric characteristics: Ratings of students, nurses, and nurse specialists were used to test for different item functioning (DIF) and unidimensionality before item characteristics (discrimination and difficulty) were examined using Item Response Theory. Finally, norm references were calculated and nomological validity was assessed. Content validity: Forty-three items remained after assessing content validity (S-CVI/ave = 0.90). Psychometric characteristics: Of the 43 items, two demonstrating ceiling effects and 11 distorting ability estimates (DIF) were subsequently excluded. Item characteristics were assessed for the remaining 30 items, all of which demonstrated good discrimination and difficulty parameters. Knowledge was positively correlated with certainty about this knowledge. The final 30-item KOP-Q is a valid, psychometrically sound, comprehensive instrument that can be used to assess the knowledge of nursing students, hospital nurses, and nurse specialists in geriatrics regarding older hospitalized adults. It can identify knowledge and certainty deficits for research purposes or serve as a tool in educational or quality improvement programs. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

An exploratory trial of the effectiveness of an enhanced consultative approach to delivering speech and language intervention in schools.

PubMed

Mecrow, Carol; Beckwith, Jennie; Klee, Thomas

2010-01-01

Increased demand for access to specialist services for providing support to children with speech, language and communication needs prompted a local service review of how best to allocate limited resources. This study arose as a consequence of a wish to evaluate the effectiveness of an enhanced consultative approach to delivering speech and language intervention in local schools. The purpose was to evaluate an intensive speech and language intervention for children in mainstream schools delivered by specialist teaching assistants. A within-subjects, quasi-experimental exploratory trial was conducted, with each child serving as his or her own control with respect to the primary outcome measure. Thirty-five children between the ages of 4;2 and 6;10 (years; months) received speech and/or language intervention for an average of four 1-hour sessions per week over 10 weeks. The primary outcome measure consisted of change between pre- and post-intervention scores on probe tasks of treated and untreated behaviours summed across the group of children, and maintenance probes of treated behaviours. Secondary outcome measures included standardized tests (Clinical Evaluation of Language Fundamentals - Preschool(UK) (CELF-P(UK)); Diagnostic Evaluation of Articulation and Phonology (DEAP)) and questionnaires completed by parents/carers and school staff before and after the intervention period. The primary outcome measure showed improvement over the intervention period, with target behaviours showing a significantly larger increase than control behaviours. The gains made on the target behaviours as a result of intervention were sustained when reassessed 3-12 months later. These findings were replicated on a second set of targets and controls. Significant gains were also observed on CELF-Preschool(UK) receptive and expressive language standard scores from pre- to post-intervention. However, DEAP standard scores of speech ability did not increase over the intervention period, although improvements in raw scores were observed. Questionnaires completed before and after intervention showed some significant differences relating to how much the child's speech and language difficulties affected him/her at home and at school. This exploratory study demonstrates the benefit of an intensive therapy delivered by specialist teaching assistants for remediating speech and language difficulties experienced by young children in mainstream schools. The service delivery model was perceived by professionals as offering an inclusive and effective practice and provides empirical support for using both direct and indirect intervention in the school setting.

Clinical nurse specialists as entrepreneurs: constrained or liberated.

PubMed

Austin, Lynn; Luker, Karen; Roland, Martin; Ronald, Martin

2006-12-01

This qualitative study explored the experiences of two groups of clinical nurse specialists--continence advisors and tissue viability nurses--working in primary care in the UK. In particular, the study focused on how clinical nurse specialists' relationships with other health-care professionals had an impact on their role. Clinical nurse specialists are recognized worldwide as having expertise in a given field, which they use to develop the practice of others. Additionally, clinical nurse specialists share many of the characteristics of entrepreneurs, which they use to develop services related to their speciality. However, little research has been conducted in relation to clinical nurse specialists' experiences as they attempt to diversify nursing practice. An ethnographic approach was adopted comprising many elements of Glaserian grounded theory. Data were collected via participant observation and face-to-face interviews with 22 clinical nurse specialists. Services provided by clinical nurse specialists were not static, clinical nurse specialists being the main drivers for service developments. However, clinical nurse specialists encountered difficulties when introducing new ideas. Given their role as advisors, clinical nurse specialists lacked authority to bring about change and were dependent on a number of mechanisms to bring about change, including 'cultivating relationships' with more powerful others, most notably the speciality consultant. The UK government has pledged to 'liberate the talents of nurses' so that their skills can be used to progress patient services. This study highlights the fact that a lack of collaborative working practices between health-care professionals led to clinical nurse specialists being constrained. Health-care organizations need to provide an environment in which the entrepreneurial skills of clinical nurse specialists may be capitalized on. In the absence of an outlet for their ideas regarding service developments, clinical nurse specialists may remain dependent on the mechanisms witnessed in this study for some time.

[The situation of pediatric patients' rights in the Transylvanian healthcare].

PubMed

Albert-Lőrincz, Csanád

2018-03-01

This study summarizes the results of the author's PhD thesis presenting the research process and the most important findings regarding the situation of Transylvanian healthcare. Our data are based on the knowledge and compliance of pediatric patients' rights as they are seen by healthcare specialists, parents and children. A number of 751 persons were involved in the research: 200 healthcare specialists, 200 parents, 200 children aged from 7 to 17 years who have been experiencing health services at least three times over the past year and a control group of 151 children who did not have this kind of experience. Based on our data, it was possible to highlight the major problems encountered in children's healthcare. We found that children are treated by obsolete principles of medical practice despite the fact that the rights of pediatric patients are well known to doctors. Neither the parents nor the children themselves are sufficiently aware of their rights. Healthcare professionals are not prepared to overcome communication difficulties due to the age-specific characteristics of children, so the fundamental rights of children are just partially enforced: children are usually heard, but not properly informed, their medical decisions are usually not taken into account violating the right to self-determination. The chances to access adequate health services are lower for vulnerable children living in poverty. Orv Hetil. 2018; 159(11): 423-429.

The research component of specialist registration--a question of alligators and swamps? A personal view.

PubMed

Aldous, C M; Adhikari, M; Rout, C C

2015-01-01

The recent implementation of the research requirement for specialist registration presents difficulties with regard to the provision of research supervision, particularly in those medical schools that previously followed the path of qualification via the Colleges of Medicine of South Africa examinations. The differences between the requirements for research supervision as stated in the Health Professions Council of South Africa memorandum and those of the Committee for Higher Education are causing disparities between medical schools similar to those that led to the memorandum in the first place. While the research component of specialist training can only improve the quality of both patient care and academic endeavour, it requires an enormous investment of time on the part of both the specialist trainees and their supervisors. In order to deal with this, specific issues outlined in the article need to be addressed.

Using technology to improve access to specialist care in amyotrophic lateral sclerosis: A systematic review.

PubMed

Hobson, Esther V; Baird, Wendy O; Cooper, Cindy L; Mawson, Sue; Shaw, Pamela J; Mcdermott, Christopher J

2016-01-01

Our objective was to review the evidence for using technology to improve access to specialist care for patients with amyotrophic lateral sclerosis (ALS) and their carers. Medline, Google Scholar and the Cochrane library were searched for articles describing technology that enabled clinical care of patients with ALS or their carers where the patient/carer and clinician were not in the same location. Two applications were identified: telemedicine to facilitate video conferencing as an alternative to outpatient consultations and telehealth monitoring for patients with respiratory failure. One randomized controlled trial using telehealth in patients with respiratory failure including 22 patients with ALS was identified. While rates of hospitalization were reduced, overall mortality was unchanged and there were too few patients with ALS in the study to detect significant benefit. In conclusion, there is limited evidence to support the use of telemedicine or telehealth in the care of patients with ALS. Future research needs to develop an understanding of the key beneficial aspects of the traditional specialist ALS service and how these factors could be delivered using technology. Successful evaluation and implementation of technologies to facilitate access to specialist care will only be possible if all the relevant impacts of an intervention are understood and measured.

[The influence of the type of insurance access on health and of education on health services utilization patterns].

PubMed

Rodríguez, Marisol; Stoyanova, Alexandrina

2004-05-01

This study analyses the utilisation of health services by gender, type of insurance access and the level of education. Descriptive and logistic regression analysis of the National Health Interview Survey, 1997, confirms that women go more often to the doctor than men. Differences are greater in the case of general practitioners (versus specialists) and public doctors (versus private). However, there are hardly any differences in hospitalisations and emergency visits. Having private access has no impact on hospitalisations, emergency visits or the probability of a visit (except for women), but it increases the probability of visits to specialists (mainly among women) and to private doctors (especially among men), confirming the existence of gender differences in the impact of this variable. In fact, the utilisation patterns by men and women with only public access resemble each other more than those of men and women with only private or dual coverage. Education is to a certain extent inversely related to the probability of a medical visit, visits to a GP and hospitalisations, but directly related to the utilisation of specialists and private doctors. Here, there are also gender disparities: differences in utilisation by educational level are more prominent among men.

Astronaut Ross Approaches Assembly Concept for Construction of Erectable Space Structure (ACCESS)

NASA Technical Reports Server (NTRS)

1999-01-01

The crew assigned to the STS-61B mission included Bryan D. O'Conner, pilot; Brewster H. Shaw, commander; Charles D. Walker, payload specialist; mission specialists Jerry L. Ross, Mary L. Cleave, and Sherwood C. Spring; and Rodolpho Neri Vela, payload specialist. Launched aboard the Space Shuttle Atlantis November 28, 1985 at 7:29:00 pm (EST), the STS-61B mission's primary payload included three communications satellites: MORELOS-B (Mexico); AUSSAT-2 (Australia); and SATCOM KU-2 (RCA Americom). Two experiments were conducted to test assembling erectable structures in space: EASE (Experimental Assembly of Structures in Extravehicular Activity), and ACCESS (Assembly Concept for Construction of Erectable Space Structure). In a joint venture between NASA/Langley Research Center in Hampton, Virginia, and the Marshall Space Flight Center (MSFC), EASE and ACCESS were developed and demonstrated at MSFC's Neutral Buoyancy Simulator (NBS). In this STS-61B onboard photo, astronaut Ross, perched on the Manipulator Foot Restraint (MFR) approaches the erected ACCESS. The primary objective of these experiments was to test the structural assembly concepts for suitability as the framework for larger space structures and to identify ways to improve the productivity of space construction.

Ross Works on the Assembly Concept for Construction of Erectable Space Structure (ACCESS) During

NASA Technical Reports Server (NTRS)

1985-01-01

The crew assigned to the STS-61B mission included Bryan D. O'Conner, pilot; Brewster H. Shaw, commander; Charles D. Walker, payload specialist; mission specialists Jerry L. Ross, Mary L. Cleave, and Sherwood C. Spring; and Rodolpho Neri Vela, payload specialist. Launched aboard the Space Shuttle Atlantis November 28, 1985 at 7:29:00 pm (EST), the STS-61B mission's primary payload included three communications satellites: MORELOS-B (Mexico); AUSSAT-2 (Australia); and SATCOM KU-2 (RCA Americom). Two experiments were conducted to test assembling erectable structures in space: EASE (Experimental Assembly of Structures in Extravehicular Activity), and ACCESS (Assembly Concept for Construction of Erectable Space Structure). In a joint venture between NASA/Langley Research Center in Hampton, Virginia, and the Marshall Space Flight Center (MSFC), EASE and ACCESS were developed and demonstrated at MSFC's Neutral Buoyancy Simulator (NBS). In this STS-61B onboard photo, astronaut Ross works on ACCESS high above the orbiter. The primary objective of these experiments was to test the structural assembly concepts for suitability as the framework for larger space structures and to identify ways to improve the productivity of space construction.

STS-61B Astronaut Ross During ACCESS Extravehicular Activity

NASA Technical Reports Server (NTRS)

1985-01-01

The crew assigned to the STS-61B mission included Bryan D. O'Conner, pilot; Brewster H. Shaw, commander; Charles D. Walker, payload specialist; mission specialists Jerry L. Ross, Mary L. Cleave, and Sherwood C. Spring; and Rodolpho Neri Vela, payload specialist. Launched aboard the Space Shuttle Atlantis November 28, 1985 at 7:29:00 pm (EST), the STS-61B mission's primary payload included three communications satellites: MORELOS-B (Mexico); AUSSAT-2 (Australia); and SATCOM KU-2 (RCA Americom). Two experiments were conducted to test assembling erectable structures in space: EASE (Experimental Assembly of Structures in Extravehicular Activity), and ACCESS (Assembly Concept for Construction of Erectable Space Structure). In a joint venture between NASA/Langley Research Center in Hampton, Virginia and the Marshall Space Flight Center (MSFC), EASE and ACCESS were developed and demonstrated at MSFC's Neutral Buoyancy Simulator (NBS). The primary objective of this experiment was to test the structural assembly concepts for suitability as the framework for larger space structures and to identify ways to improve the productivity of space construction. In this STS-61B onboard photo, astronaut Ross was working on the ACCESS experiment during an Extravehicular Activity (EVA).

Service distribution and models of rural outreach by specialist doctors in Australia: a national cross-sectional study.

PubMed

O'Sullivan, Belinda G; McGrail, Matthew R; Joyce, Catherine M; Stoelwinder, Johannes

2016-06-01

Objective This paper describes the service distribution and models of rural outreach by specialist doctors living in metropolitan or rural locations. Methods The present study was a national cross-sectional study of 902 specialist doctors providing 1401 rural outreach services in the Medicine in Australia: Balancing Employment and Life study, 2008. Five mutually exclusive models of rural outreach were studied. Results Nearly half of the outreach services (585/1401; 42%) were provided to outer regional or remote locations, most (58%) by metropolitan specialists. The most common model of outreach was drive-in, drive-out (379/902; 42%). In comparison, metropolitan-based specialists were less likely to provide hub-and-spoke models of service (odd ratio (OR) 0.31; 95% confidence interval (CI) 0.21-0.46) and more likely to provide fly-in, fly-out models of service (OR 4.15; 95% CI 2.32-7.42). The distance travelled by metropolitan specialists was not affected by working in the public or private sector. However, rural-based specialists were more likely to provide services to nearby towns if they worked privately. Conclusions Service distribution and models of outreach vary according to where specialists live as well as the practice sector of rural specialists. Multilevel policy and planning is needed to manage the risks and benefits of different service patterns by metropolitan and rural specialists so as to promote integrated and accessible services. What is known about this topic? There are numerous case studies describing outreach by specialist doctors. However, there is no systematic evidence describing the distribution of rural outreach services and models of outreach by specialists living in different locations and the broad-level factors that affect this. What does this paper add? The present study provides the first description of outreach service distribution and models of rural outreach by specialist doctors living in rural versus metropolitan areas. It shows that metropolitan and rural-based specialists have different levels of service reach and provide outreach through different models. Further, the paper highlights that practice sector has no effect on metropolitan specialists, but private rural specialists limit their travel distance. What are the implications for practitioners? The complexity of these patterns highlights the need for multilevel policy and planning approaches to promote integrated and accessible outreach in rural and remote Australia.

Evaluation of ultrasound-guided vascular access in dogs.

PubMed

Chamberlin, Scott C; Sullivan, Lauren A; Morley, Paul S; Boscan, Pedro

2013-01-01

To describe the technique and determine the feasibility, success rate, perceived difficulty, and time to vascular access using ultrasound guidance for jugular vein catheterization in a cardiac arrest dog model. Prospective descriptive study. University teaching hospital. Nine Walker hounds. A total of 27 jugular catheterizations were performed postcardiac arrest using ultrasound guidance. Catheterizations were recorded based on the order in which they were performed and presence/absence of a hematoma around the vein. Time (minutes) until successful vascular access and perceived difficulty in achieving vascular access (scale of 1 = easy to 10 = difficult) were recorded for each catheterization. Mean time to vascular access was 1.9 minutes (95% confidence interval, 1.1-3.4 min) for catheterizations without hematoma, versus 4.3 minutes (1.8-10.1 min) for catheterizations with hematoma (P = 0.1). Median perceived difficulty was 2 of 10 (range 1-7) for catheterizations without hematoma, versus 2 of 10 (range 1-8) for catheterizations with hematoma (P = 0.3). A learning curve was evaluated by comparing mean time to vascular access and perceived difficulty in initial versus subsequent catheterizations. Mean time to vascular access was 2.5 minutes (1.0-6.4 min) in the initial 13 catheterizations versus 3.3 minutes (1.5-7.5 min) in the subsequent 14 catheterizations (P = 0.6). Median perceived difficulty in the first 13 catheterizations (3, range 1-8) was significantly greater (P = 0.049) than median perceived difficulty in the subsequent 14 catheterizations (2, range 1-6). Ultrasound-guided jugular catheterization is associated with a learning curve but is successful in obtaining rapid vascular access in dogs. Further prospective studies are warranted to confirm the utility of this technique in a clinical setting. © Veterinary Emergency and Critical Care Society 2013.

Electronic Reference Service: A Teen's Eye View.

ERIC Educational Resources Information Center

Farmer, Lesley S.

2003-01-01

Discusses electronic reference service from a teen's point of view and from the school library media specialist's view. Considers traits that attract teens, including anonymity, speed, and convenience; and explains concerns of media specialists, including quality of electronic resources, how to provide access, library instruction options, and…

Cost-effectiveness of Access to Critical Cerebral Emergency Support Services (ACCESS): a neuro-emergent telemedicine consultation program.

PubMed

Whetten, Justin; van der Goes, David N; Tran, Huy; Moffett, Maurice; Semper, Colin; Yonas, Howard

2018-04-01

Access to Critical Cerebral Emergency Support Services (ACCESS) was developed as a low-cost solution to providing neuro-emergent consultations to rural hospitals in New Mexico that do not offer comprehensive stroke care. ACCESS is a two-way audio-visual program linking remote emergency department physicians and their patients to stroke specialists. ACCESS also has an education component in which hospitals receive training from stroke specialists on the triage and treatment of patients. This study assessed the clinical and economic outcomes of the ACCESS program in providing services to rural New Mexico from a healthcare payer perspective. A decision tree model was constructed using findings from the ACCESS program and existing literature, the likelihood that a patient will receive a tissue plasminogen activator (tPA), cost of care, and resulting quality adjusted life years (QALYs). Data from the ACCESS program includes emergency room patients in rural New Mexico from May 2015 to August 2016. Outcomes and costs have been estimated for patients who were taken to a hospital providing neurological telecare and patients who were not. The use of ACCESS decreased neuro-emergent stroke patient transfers from rural hospitals to urban settings from 85% to 5% (no tPA) and 90% to 23% (tPA), while stroke specialist reading of patient CT/MRI imaging within 3 h of onset of stroke symptoms increased from 2% to 22%. Results indicate that use of ACCESS has the potential to save $4,241 ($3,952-$4,438) per patient and increase QALYs by 0.20 (0.14-0.22). This increase in QALYs equates to ∼73 more days of life at full health. The cost savings and QALYs are expected to increase when moving from a 90-day model to a lifetime model. The analysis demonstrates potential savings and improved quality-of-life associated with the use of ACCESS for patients presenting to rural hospitals with acute ischemic stroke (AIS).

Understanding the internet-based distance learning preferences of European respiratory specialists.

PubMed

Roberts, C M; Milon, S; Kurosinski, P

2006-08-01

We studied the learning preferences of 160 respiratory specialists from four European countries who participated in ten internet-based learning modules and answered linked survey questions. Specialists were enthusiastic for internet learning amongst all national groups and particularly wanted to access material for teaching others. The value of social interactive learning was acknowledged but British and German subjects appeared more reluctant to participate. Internet delivered distance learning is well perceived amongst respiratory specialists. There is potential for both individual and group learning that could be realized by developing Europe-wide continuing professional development communities.

Clinical nurse specialists: essential resource for an effective NHS.

PubMed

Vidall, Cheryl; Barlow, Helen; Crowe, Maggie; Harrison, Isabel; Young, Annie

Despite emerging evidence for the clinical and financial efficacy of the clinical nurse specialist (CNS), the provision of this role is patchy across the country. There is also a risk that incumbent CNS' may be redirected to less specialist work in trusts that do not appreciate the full value of the service that these nurses provide. Optimal and equitable patient access to CNS care will require the development of a strong evidence base showing that specialist nurses not only deliver patient-focused care, but that they can also help to meet healthcare managers' objectives of streamlined, cost-effective clinical services.

Accessing disability services by people from culturally and linguistically diverse backgrounds in Australia.

PubMed

Zhou, Qingsheng

2016-01-01

To examine whether differences in access to specialist disability services by people from culturally and linguistically diverse (CALD) backgrounds when compared with those born in Australia represent a service gap or the healthy migrant effect. To use the latest disability statistics to measure the different rates of people with disability, and the rates of people with profound and severe disability, of people born in Australia and those born abroad; to compare the difference between those who mainly speak English with those who primarily speak a language other than English at home (LOTE); and examine the age-specific and standardised disability rates of these subgroups. The rate of access of specialist disability services by people with disability who were from CALD backgrounds is highly disproportionate to their presence in the community. As a whole, people from CALD backgrounds have a similar level of disability as Australia-born people. They have a greater rate of profound and severe disability and a higher level of need for assistance in undertaking core activities. For younger age cohorts targeted by specialist disability services, there is little difference in the level of need for assistance between people from CALD backgrounds and the rest of community. Those people who mainly speak LOTE at home have a relatively higher level of need for assistance than those who speak mainly English at home. The paper reveals a substantial gap in specialist disability services between people from CALD and the broader community. This cannot be explained by the difference in the level of need for assistance between Australia-born and overseas-born populations, therefore raises some policy questions as to the barriers to the use of such services and how to effectively narrow the service access gap and improve utilisation rates. The paper reveals a substantial accessibility gap in specialist disability services between people from culturally and linguistically diverse (CALD) backgrounds and the broader community in Australia. Rehabilitation is a large component of disability services. Therefore, understanding the gap, promoting the awareness of the services, developing appropriate and effective services to respond the need of people with disability from CALD backgrounds, are critically important to rehabilitation services and related research.

Effect of an imaging-based streamlined electronic healthcare process on quality and costs.

PubMed

Bui, Alex A T; Taira, Ricky K; Goldman, Dana; Dionisio, John David N; Aberle, Denise R; El-Saden, Suzie; Sayre, James; Rice, Thomas; Kangarloo, Hooshang

2004-01-01

A streamlined process of care supported by technology and imaging may be effective in managing the overall healthcare process and costs. This study examined the effect of an imaging-based electronic process of care on costs and rates of hospitalization, emergency room (ER) visits, specialist diagnostic referrals, and patient satisfaction. A healthcare process was implemented for an employer group, highlighting improved patient access to primary care plus routine use of imaging and teleconsultation with diagnostic specialists. An electronic infrastructure supported patient access to physicians and communication among healthcare providers. The employer group, a self-insured company, manages a healthcare plan for its employees and their dependents: 4,072 employees were enrolled in the test group, and 7,639 in the control group. Outcome measures for expenses and frequency of hospitalizations, ER visits, traditional specialist referrals, primary care visits, and imaging utilization rates were measured using claims data over 1 year. Homogeneity tests of proportions were performed with a chi-square statistic, mean differences were tested by two-sample t-tests. Patient satisfaction with access to healthcare was gauged using results from an independent firm. Overall per member/per month costs post-implementation were lower in the enrolled population (126 dollars vs 160 dollars), even though occurrence of chronic/expensive diseases was higher in the enrolled group (18.8% vs 12.2%). Lower per member/per month costs were seen for inpatient (33.29 dollars vs 35.59 dollars); specialist referrals (21.36 dollars vs 26.84 dollars); and ER visits (3.68 dollars vs 5.22 dollars). Moreover, the utilization rate for hospital admissions, ER visits, and traditional specialist referrals were significantly lower in the enrolled group, although primary care and imaging utilization were higher. Comparison to similar employer groups showed that the company's costs were lower than national averages (119.24 dollars vs 146.32 dollars), indicating that the observed result was not attributable to normalization effects. Patient satisfaction with access to healthcare ranked in the top 21st percentile. A streamlined healthcare process supported by technology resulted in higher patient satisfaction and cost savings despite improved access to primary care and higher utilization of imaging.

A survey on the perception of allergy specialists about the reimbursed grass pollen tablets for seasonal allergic rhinitis in Italy.

PubMed

Massaro, Ilaria; Rossi, Oliviero; Incorvaia, Cristoforo; Lombardi, Carlo

2017-01-01

Sublingual immunotherapy (SLIT) is a feasible option to classical subcutaneous immunotherapy to treat respiratory allergy and is increasingly prescribed in Europe. However, the lack of reimbursement may limit its prescription. In 2015, the 5-grass pollen tablets was authorized by the European Medicine Agency to treat grass-pollen induced rhinitis and was approved in Italy for full reimbursement. We evaluated the opinions of allergy specialists after the availability of the reimbursed 5-grass pollen tablets. A multiple choice questionnaire composed by six questions was used to assess the specialists opinion. The questionnaire was uploaded on the free access online platform SurveyMonkey. The link to access the platform was sent to all members of the Società Italiana di Asma, Allergologia e Immunologia Clinica (SIAAIC). The access to the questionnaire was anonymous. At survey ending, the access was closed and data were downloaded directly from SurveyMonkey website. The questionnaire was filled by 70 allergists. The majority of allergists felt as most important the concept of SLIT as a drug, the content of allergen extract mirroring the natural exposure, the pre-coseasonal schedule as the most patient's oriented, the very good profile of tolerability and safety, the importance of the build-up phase, and the importance of checking the patient after starting immunotherapy. The opinions of the Italian allergy specialists about the reimbursed 5-grass-pollen tablets are very positive and make likely an appropriate prescription of SLIT for grass-pollen induced rhinitis in the next years.

Is the named nurse a reality in accident and emergency?

PubMed

Pryce, C

1994-07-01

Previous articles have looked at particular aspects of the named nurse concept, but few have addressed the perceived difficulties in the speciality of Accident and Emergency (A & E) nursing. This paper seeks to promote discussion with other specialist areas/departments/units.

The Future of Generalists.

ERIC Educational Resources Information Center

Rosson, Jay

1980-01-01

Liberal arts majors are having difficulty finding jobs in a specialist-oriented world. Career counseling must have more creative solutions for those who need diversity in their lives, including variable time schedules or jobs such as small business franchises that allow for high levels of diversification. (JAC)

Prevalence and predictors of difficulty accessing the mouths of intubated critically ill adults to deliver oral care: An observational study.

PubMed

Dale, Craig M; Smith, Orla; Burry, Lisa; Rose, Louise

2018-04-01

Oral care of intubated patients is essential to the prevention of infection and patient discomfort. However, barriers to oral access and delivery of oral care have received little attention. To determine prevalence and predictors of oral access difficulty. A prospective, observational, multi-center study. Four intensive care units in Toronto, Canada. Adult patients orally intubated for ≥48 h. We screened consecutive admissions once a week to identify eligible participants. We observed each patient and asked the patient's nurse about presence or absence of difficulty accessing the mouth to deliver oral care across three categories: (1) visualizing inside the mouth; (2) obtaining patient cooperation, or (3) inserting instruments for delivery of oral care. We asked nurses to identify presence of patient behaviors contributing to oral access difficulty and perceived level of difficulty on a Likert response scale. We examined patient and treatment characteristics associated with extreme difficulty (i.e., difficulty in all 3 categories) using a generalized estimating equation regression model. A total of 428 patients were observed, 58% admitted with a medical diagnosis. More than half (57%) had ≥2 oral devices up to maximum of 4. Oral care difficulty was identified in 83% of patients and rated as moderate to high for 217 (51%). Difficulty concerned visibility (74%), patient cooperation (55%), and space to insert instruments (53%). Patient behaviors contributing difficulty included coughing/gagging (60%), mouth closing (49%), biting (45%) and localizing (27%) during care. Variables associated with extreme difficulty included neurological (OR 1.92, 95% CI 1.42-2.60) or trauma admission (OR 1.83, 95% CI 1.16-2.89), lack of pain assessment or treatment in the 4 h prior to oral care (OR 1.43, 95% CI 1.14-1.80), more oral devices (OR 1.40, 95% CI 1.05-1.87), and duration of intubation (OR 1.05, 95% CI 1.01-1.10). Absence of documented agitation in the 4 h prior to oral care was associated with less difficulty (OR 0.68, 95% CI 0.54-0.86). Oral care is complex and difficulties are experienced in a vast majority of intubated patients. Some difficulties are amenable to correction such as pain management. Copyright © 2017 Elsevier Ltd. All rights reserved.

Barriers to Employment Among Social Security Disability Insurance Beneficiaries in the Mental Health Treatment Study.

PubMed

Milfort, Roline; Bond, Gary R; McGurk, Susan R; Drake, Robert E

2015-12-01

This study examined barriers to employment among Social Security Disability Insurance (SSDI) beneficiaries who received comprehensive vocational and mental health services but were not successful in returning to work. This study examined barriers to employment among 430 SSDI beneficiaries with mental disorders who received evidence-based vocational and mental health services for two years but worked less than one month or not at all. Comprehensive care teams, which included employment specialists, made consensus judgments for each participant, identifying the top three barriers to employment from a checklist of 14 common barriers. Teams most frequently identified three barriers to employment: poorly controlled symptoms of mental illness (55%), nonengagement in supported employment (44%), and poorly controlled general medical problems (33%). Other factors were identified much less frequently. Some SSDI beneficiaries, despite having access to comprehensive services, continued to experience psychiatric impairments, difficulty engaging in vocational services, and general medical problems that limited their success in employment.

Space Shuttle Projects

NASA Image and Video Library

1985-11-30

The crew assigned to the STS-61B mission included Bryan D. O’Conner, pilot; Brewster H. Shaw, commander; Charles D. Walker, payload specialist; mission specialists Jerry L. Ross, Mary L. Cleave, and Sherwood C. Spring; and Rodolpho Neri Vela, payload specialist. Launched aboard the Space Shuttle Atlantis November 28, 1985 at 7:29:00 pm (EST), the STS-61B mission’s primary payload included three communications satellites: MORELOS-B (Mexico); AUSSAT-2 (Australia); and SATCOM KU-2 (RCA Americom). Two experiments were conducted to test assembling erectable structures in space: EASE (Experimental Assembly of Structures in Extravehicular Activity), and ACCESS (Assembly Concept for Construction of Erectable Space Structure). In a joint venture between NASA/Langley Research Center in Hampton, Virginia and the Marshall Space Flight Center (MSFC), EASE and ACCESS were developed and demonstrated at MSFC's Neutral Buoyancy Simulator (NBS). The primary objective of this experiment was to test the structural assembly concepts for suitability as the framework for larger space structures and to identify ways to improve the productivity of space construction. In this STS-61B onboard photo, astronaut Ross was working on the ACCESS experiment during an Extravehicular Activity (EVA).

Space Shuttle Projects

NASA Image and Video Library

1985-11-30

The crew assigned to the STS-61B mission included Bryan D. O’Conner, pilot; Brewster H. Shaw, commander; Charles D. Walker, payload specialist; mission specialists Jerry L. Ross, Mary L. Cleave, and Sherwood C. Spring; and Rodolpho Neri Vela, payload specialist. Launched aboard the Space Shuttle Atlantis November 28, 1985 at 7:29:00 pm (EST), the STS-61B mission’s primary payload included three communications satellites: MORELOS-B (Mexico); AUSSAT-2 (Australia); and SATCOM KU-2 (RCA Americom). Two experiments were conducted to test assembling erectable structures in space: EASE (Experimental Assembly of Structures in Extravehicular Activity), and ACCESS (Assembly Concept for Construction of Erectable Space Structure). In a joint venture between NASA/Langley Research Center in Hampton, Virginia, and the Marshall Space Flight Center (MSFC), EASE and ACCESS were developed and demonstrated at MSFC's Neutral Buoyancy Simulator (NBS). In this STS-61B onboard photo, astronaut Ross works on ACCESS high above the orbiter. The primary objective of these experiments was to test the structural assembly concepts for suitability as the framework for larger space structures and to identify ways to improve the productivity of space construction.

n/a

NASA Image and Video Library

1985-11-01

The crew assigned to the STS-61B mission included (kneeling left to right) Bryan D. O’conner, pilot; and Brewster H. Shaw, commander. On the back row, left to right, are Charles D. Walker, payload specialist; mission specialists Jerry L. Ross, Mary L. Cleave, and Sherwood C. Spring; and Rodolpho Neri Vela, payload specialist. Launched aboard the Space Shuttle Atlantis November 28, 1985 at 7:29:00 pm (EST), the STS-61B mission’s primary payload included three communications satellites: MORELOS-B (Mexico); AUSSAT-2 (Autralia); and SATCOM KU-2 (RCA Americom. Two experiments were conducted to test assembling erectable structures in space: EASE (Experimental Assembly of Structures in Extravehicular Activity), and ACCESS (Assembly Concept for Construction of Erectable Space Structure). In a joint venture between NASA/Langley Research Center in Hampton, VA and Marshall Space Flight Center (MSFC), the Assembly Concept for Construction of Erectable Space Structures (ACCESS) was developed and demonstrated at MSFC's Neutral Buoyancy Simulator (NBS). The primary objective of this experiment was to test the ACCESS structural assembly concept for suitability as the framework for larger space structures and to identify ways to improve the productivity of space construction.

Neuro-Ophthalmology: Transitioning From Old to New Models of Health Care Delivery.

PubMed

Frohman, Larry P

2017-06-01

In contradiction to fundamental laws of supply and demand, 2 decades of payment policies have led to some medical specialties experiencing declines in both manpower and reimbursement. This paradox has resulted in increasingly long wait times to see some specialists, some specialties becoming less attractive to potential trainees, and a dearth of new trainees entering these fields. Evolving models of health care delivery hold the promise of increasing patient access to most providers and may diminish costs and improve outcomes for most patients/conditions. However, patients who need care in understaffed fields may, in the future, be unable to quickly access a specialist with the requisite expertise. Impeding the sickest and most complex patients from seeing physicians with appropriate expertise may lead to increased costs and deleterious outcomes-consequences contrary to the goals of health care reform. To ensure appropriate access for these patients requires 2 conditions: 1. Compensation models that do not discourage trainees from pursuing nonprocedural specialties, and 2. A care delivery model that expediently identifies and routes these patients to the appropriate specialist.

STS-61B Crew Portrait

NASA Technical Reports Server (NTRS)

1985-01-01

The crew assigned to the STS-61B mission included (kneeling left to right) Bryan D. O'conner, pilot; and Brewster H. Shaw, commander. On the back row, left to right, are Charles D. Walker, payload specialist; mission specialists Jerry L. Ross, Mary L. Cleave, and Sherwood C. Spring; and Rodolpho Neri Vela, payload specialist. Launched aboard the Space Shuttle Atlantis November 28, 1985 at 7:29:00 pm (EST), the STS-61B mission's primary payload included three communications satellites: MORELOS-B (Mexico); AUSSAT-2 (Autralia); and SATCOM KU-2 (RCA Americom. Two experiments were conducted to test assembling erectable structures in space: EASE (Experimental Assembly of Structures in Extravehicular Activity), and ACCESS (Assembly Concept for Construction of Erectable Space Structure). In a joint venture between NASA/Langley Research Center in Hampton, VA and Marshall Space Flight Center (MSFC), the Assembly Concept for Construction of Erectable Space Structures (ACCESS) was developed and demonstrated at MSFC's Neutral Buoyancy Simulator (NBS). The primary objective of this experiment was to test the ACCESS structural assembly concept for suitability as the framework for larger space structures and to identify ways to improve the productivity of space construction.

Coordination and resource-related difficulties encountered by Quebec's public health specialists and infectious diseases/medical microbiologists in the management of A (H1N1)--a mixed-method, exploratory survey.

PubMed

Nhan, Charles; Laprise, Réjean; Douville-Fradet, Monique; Macdonald, Mary Ellen; Quach, Caroline

2012-02-10

In Quebec, the influenza A (H1N1) pandemic was managed using a top-down style that left many involved players with critical views and frustrations. We aimed to describe physicians' perceptions--infectious diseases specialists/medical microbiologists (IDMM) and public health/preventive medicine specialists (PHPMS)--in regards to issues encountered with the pandemics management at the physician level and highlight suggested improvements for future healthcare emergencies. In April 2010, Quebec IDMM and PHPMS physicians were invited to anonymously complete a web-based learning needs assessment. The survey included both open-ended and multiple-choice questions. Descriptive statistics were used to report on the frequency distribution of multiple choice responses whereas thematic content analysis was used to analyse qualitative data generated from the survey and help understand respondents' experience and perceptions with the pandemics. Of the 102 respondents, 85.3% reported difficulties or frustrations in their practice during the pandemic. The thematic analysis revealed two core themes describing the problems experienced in the pandemic management: coordination and resource-related difficulties. Coordination issues included communication, clinical practice guidelines, decision-making, roles and responsibilities, epidemiological investigation, and public health expert advisory committees. Resources issues included laboratory resources, patient management, and vaccination process. Together, the quantitative and qualitative data suggest a need for improved coordination, a better definition of roles and responsibilities, increased use of information technologies, merged communications, and transparency in the decisional process. Increased flexibility and less contradiction in clinical practice guidelines from different sources and increased laboratory/clinical capacity were felt critical to the proper management of infectious disease emergencies.

AquaUsers: Improving access to remotely sensed data for non-specialists

NASA Astrophysics Data System (ADS)

Clements, Oliver; Walker, Peter; Calton, Ben; Miller, Peter

2015-04-01

In recent years more and more complex remotely sensed data have been made available to the public by national and international agencies. These data are also reprocessed by different organisations to produce secondary products that are of specific need to a community. For instance the production of chlorophyll concentration maps from ocean colour data provided by NASA for the marine community. Providing access to such data has normally been focused on simply making the data available with appropriate metadata so that domain specialists can make use of it. One area that has seen significant investment, both of time and money, has been in the production of web based data portals. Primarily these have focused on spatial data. By providing a web map visualisation users are able to quickly assess both spatial coverage and data values. Data portal improvements have been possible thanks to advancements in back end data servers such as Thredds and ncWMS as well as improvements in front-end libraries for data visualisation including OpenLayers and D3. Data portals that make use of these technological advancements have aimed at improving the access and use of data by trained scientific domain specialists. There is now a push to improve access to these systems by non-scientific domain specialists through several European Commission funded projects, including OPEC and AquaUsers. These projects have improved upon an open source web GIS portal created by Plymouth Marine Laboratory [https://github.com/pmlrsg/GISportal]. We will present the latest version of our GIS portal, discuss the designs steps taken to achieve the latest build and share user stories as to how non-domain specialists are now able to utilise the system and get benefits from remotely sensed data. A first version was produced and disseminated to end users for feedback. At this stage the end users included government advisors, fish farmers and scientific groups with no specific GIS training or knowledge. This iteration produced some pretty harsh responses. The product looked good, it seemed to have a large volume of data available but it was too difficult to get any added value from without specific training in its functionality. The feedback we gathered lead to the involvement of a user experience specialist. This was a first for both our development team and the specialist. Through a focused iteration process we created a design that would reduce the steps necessary to get meaningful output from the portal, we minimised the amount of information shown initially by using a keyword system similar to online shopping. The interface for analysing the data was greatly simplified as well, allowing easier and quicker access to time series or subsetting of data.

STS-46 crewmembers participate in Fixed Base (FB) SMS training at JSC

NASA Technical Reports Server (NTRS)

1992-01-01

STS-46 Atlantis, Orbiter Vehicle (OV) 104, Mission Specialist (MS) and Payload Commander (PLC) Jeffrey A. Hoffman, standing at the interdeck access ladder, explains procedures to backup Italian Payload Specialist Umberto Guidoni (center) and Italian Payload Specialist Franco Malerba (right) on the middeck of JSC's fixed base (FB) shuttle mission simulator (SMS). Behind them, MS Marsha S. Ivins reviews a cheklist. Participants are wearing communications kit assembly lightweight headsets (HDSTs). FB-SMS is located in JSC's Mission Simulation and Training Facility Bldg 5.

A novel primary-specialist care collaborative demonstration project to improve the access and health care of medically complex patients.

PubMed

Siu, Henry Yu-Hin; Steward, Nicole; Peter, Jessica; Cooke, Laurel; Arnold, Donald M; Price, David

2017-09-01

Objective Medically complex patients experience fragmented health care compounded by long wait times. The MedREACH program was developed to improve access and overall system experience for medically complex patients. Program description MedREACH is a novel primary-tertiary care collaborative demonstration program that features community nursing outreach, community specialist outreach, and a multi-specialty consultation clinic. Methods All 179 patients, referring primary care clinicians, and specialists involved were eligible to participate. Patient and clinician feedback were elicited by feedback surveys. Process measures were evaluated by participant retrospective chart reviews. Community nursing outreach patients completed the Goal Attainment Scale. Results Forty-eight patients and 22 clinicians consented to the feedback survey. About 75% of patients were seen within 2 weeks of referral. Patients spent an average of 3, 1.63, and 1.2 visits with the nursing outreach, multi-specialty clinic, and specialist outreach, respectively. Patients indicated a better medical experience, health enablement, and goals attainment. Family physicians felt more supported in the community management of medically complex patients and, overall, physicians felt MedREACH could improve collaborative care for medically complex patients. Qualitative analysis of clinician responses identified the need for increased mental health services. Discussion MedREACH demonstrates a patient-centered link between primary and tertiary care that could improve health care access and overall experience.

How Do People Who Frequently Attend Emergency Departments for Alcohol-Related Reasons Use, View, and Experience Specialist Addiction Services?

PubMed

Parkman, Thomas; Neale, Joanne; Day, Ed; Drummond, Colin

2017-09-19

People who frequently attend emergency departments (EDs) for alcohol-related reasons, cost health systems greatly. Although specialist addiction services may be more appropriate for their needs, drinkers often experience barriers accessing specialist alcohol-related support. This study explores how people who frequently attend EDs for alcohol-related reasons use, view, and experience specialist addiction services. We conducted semi-structured interviews with 30 individuals recruited from six EDs across London, United Kingdom. Data relating to participants' socio-demographic characteristics and service use were systematically coded using qualitative software, and analyzed following the Framework. ED usage over the last 12 months was high, whereas current use of specialist addiction services was low. We found little evidence that structural barriers were preventing participants from attending specialist services; rather, participants seemed not to require help with their alcohol use. When asked what support they desired for their drinking, only 11/30 participants identified alcohol-specific treatment. More commonly, they wanted help relating to mental health problems; social contact; paid or voluntary work; housing-related issues; or gym access. Women were more likely to be receiving, and to have support from a specialist addiction service. Conclusions/Importance: People who frequently attended EDs for alcohol-related reasons expressed low levels of interest in, and motivation for, alcohol-specific treatment but desired broader psychosocial support. Case management and assertive outreach appear to be valuable models of service delivery for this population (particularly for men). However, further qualitative and quantitative research is now needed to verify these findings in different countries, regions, and health care systems.

Inequalities in Specialist Hand Surgeon Distribution across the United States.

PubMed

Rios-Diaz, Arturo J; Metcalfe, David; Singh, Mansher; Zogg, Cheryl K; Olufajo, Olubode A; Ramos, Margarita S; Caterson, Edward J; Talbot, Simon G

2016-05-01

Unequal access to hospital specialists for emergency care is an issue in the United States. The authors sought to describe the geographic distribution of specialist hand surgeons and associated factors in the United States. Geographic distributions of surgeons holding a Subspecialty Certificate in Surgery of the Hand and hand surgery fellowship positions were identified from the American Board of Medical Specialties Database and the literature (2013), respectively. State-level population and per capita income were ascertained using U.S. Census data. Variations in hand trauma admissions were determined using Healthcare Cost and Utilization Project national/state inpatient databases. Risk-adjusted generalized linear models were used to assess independent association between hand surgeon density and hand trauma admission density, fellowship position density, and per capita income. Among 2019 specialist hand surgeons identified, 72.1 percent were orthopedic surgeons, 18.3 percent were plastic surgeons, and 9.6 percent were general surgeons. There were 157 hand surgery fellowship positions nationwide. There were 149,295 annual hand trauma admissions. The national density of specialist hand surgeons and density of trauma admission were 0.6 and 47.6, respectively. The density of specialist hand surgeons varied significantly between states. State-level variations in density of surgeons were independent and significantly associated with median per capita income (p < 0.001) and with density of fellowships (p = 0.014). Specialist hand surgeons are distributed unevenly across the United States. State-level analyses suggest that states with lower per capita incomes may be particularly underserved, which may contribute to regional disparities in access to emergency hand trauma care.

Health Care Industry

DTIC Science & Technology

2007-01-01

variety of specialists including chiropractors, optometrists, speech therapists , and mental health specialists (IBISWorld, 2006). Registered nurses...correlation between increased health care costs and obesity. According to a 2005 CDC study, “ physical inactivity, overweight, and obesity were associated...previously discussed this problem. And, like cost and access issues, obesity is also not a strictly American problem. Globalization, reduced physical

Foursquare: A Health Education Specialist Checks-In--A Commentary

ERIC Educational Resources Information Center

Haithcox-Dennis, Melissa

2011-01-01

More and more, health education specialists are integrating technology into their work. Whereas most are familiar with social media sites like Facebook, Twitter and LinkedIn, one relatively new form of social media, location based services (LBS), may be less familiar. Developed in 2000, LBS are software applications that are accessible from a…

Information Needs 2000: Results of a Survey of Library Media Specialists.

ERIC Educational Resources Information Center

Ceperley, Patricia E.

School library media specialists in Kentucky, Tennessee, Virginia, and West Virginia were surveyed in April 1990 to determine their perceptions of their training needs as they are being called upon to use the latest information technologies to access, transfer, and store information. The 2,202 responses received represented a response rate of…

Influence of socio-economic status on access to different components of SCI management across Indian population.

PubMed

Chhabra, H S; Bhalla, A M

2015-11-01

To assess the influence of financial constraints on access to different components of spinal cord injury (SCI) management in various socio-economic strata of the Indian population. Indian Spinal Injuries Centre (ISIC). One hundred fifty SCI individuals who came for follow-up at ISIC between March 2009 and March 2013 with at least 1 year of community exposure after discharge were included in the study. Socio-economic classification was carried out according to the Kuppuswamy scale, a standard scale for the Indian population. A self-designed questionnaire was administered. No sample was available from the lower group. There was a statistically significant difference (P<0.05) for the levels of difficulty perceived by different socio-economic groups in accessing different components of SCI management. Aided upper lower group was dependent on welfare schemes for in-hospital treatment but could not access other components of management once discharged. Unaided upper lower group either faced severe difficulty or could not access management. Majority of lower middle group faced severe difficulty. Upper middle group was equally divided into facing severe, moderate or no difficulty. Most patients in the upper group faced no difficulty, whereas some faced moderate and a small number of severe difficulty. Financial constraints affected all components of SCI management in all except the upper group. The results of the survey suggest that a very large percentage of the Indian population would find it difficult to access comprehensive SCI management and advocate extension of essential medical coverage to unaided upper lower, lower middle and upper middle groups.

Wobbly Corner: Magnetism

ERIC Educational Resources Information Center

Corbett, Lisa; Maklad, Rania; Dunne, Mick; Grace, Pierre

2014-01-01

During a final seminar with BA year 4 science specialist trainee teachers, the authors posed a question about the difficulties associated with understanding magnetism. The ensuing discussion focused on a number of concerns commonly identified by students, which may also be of interest to classroom teachers teaching magnetism. Issues raised…

[Giving medico-legal opinions in cases with suspicion of medical mistake. part 2. Expert evidence in cases with suspicion of medical mistake - expectations, possibilities, threats…].

PubMed

Chowaniec, Czesław; Chowaniec, Małgorzata; Wilk, Mateusz

Problems of medical mistake and therapeutic failure are inextricably linked with realization of medical services. In recent years, mostly by the media and increasing demanding attitude, a rapid increase of initiated cases opened by judicial body in conjunction with medical mistake made by medical staff is observed. Making medico-legal opinions is not easy task and often face many difficulties. These consist of lacks in medical documentation, time rigor, formal tightening and need to create team that consist of both forensic medicine specialist and clinicians, who together shall write complex medico-legal opinion. This article touches the essence of the opinion-making problem in the aspect of medical mistake. It shows specifics of the role of forensic medicine specialist, his challenges and difficulties in creating opinions. The article confronts real possibilities of court experts with expectations of judicial body, outlining new challenges and dangers which court experts have to face.

Mental health problems in people living with HIV: changes in the last two decades: the London experience 1990–2014

PubMed Central

Adams, Catherine; Zacharia, Shilpa; Masters, Lisa; Coffey, Caroline; Catalan, Pepe

2016-01-01

ABSTRACT Mental health problems continue to be a significant comorbidity for people with HIV infection, even in the era of effective antiretroviral therapy. Here, we report on the changes in the mental health diagnoses based on clinical case reports amongst people with HIV referred to a specialist psychological medicine department over a 24-year period, which include the relative increase in depressive and anxiety disorders, often of a chronic nature, together with a decline in acute mental health syndromes, mania, and organic brain disorders. In addition, new challenges, like the presence of HIV and Hepatitis C co-infection, and the new problems created by recreational drugs, confirm the need for mental health services to be closely involved with the general medical services. A substantial proportion of people with HIV referred to specialist services suffer complex difficulties, which often require the collaboration of both psychiatrists and psychologists to deal effectively with their difficulties. PMID:26888472

Improving communication for interdisciplinary teams working on storage of digital information in DNA.

PubMed

Hesketh, Emily E; Sayir, Jossy; Goldman, Nick

2018-01-01

Close collaboration between specialists from diverse backgrounds and working in different scientific domains is an effective strategy to overcome challenges in areas that interface between biology, chemistry, physics and engineering. Communication in such collaborations can itself be challenging.  Even when projects are successfully concluded, resulting publications - necessarily multi-authored - have the potential to be disjointed. Few, both in the field and outside, may be able to fully understand the work as a whole. This needs to be addressed to facilitate efficient working, peer review, accessibility and impact to larger audiences. We are an interdisciplinary team working in a nascent scientific area, the repurposing of DNA as a storage medium for digital information. In this note, we highlight some of the difficulties that arise from such collaborations and outline our efforts to improve communication through a glossary and a controlled vocabulary and accessibility via short plain-language summaries. We hope to stimulate early discussion within this emerging field of how our community might improve the description and presentation of our work to facilitate clear communication within and between research groups and increase accessibility to those not familiar with our respective fields - be it molecular biology, computer science, information theory or others that might become relevant in future. To enable an open and inclusive discussion we have created a glossary and controlled vocabulary as a cloud-based shared document and we invite other scientists to critique our suggestions and contribute their own ideas.

Guiding People to Interpret Their Experienced Difficulty as Importance Highlights Their Academic Possibilities and Improves Their Academic Performance

PubMed Central

Oyserman, Daphna; Elmore, Kristen; Novin, Sheida; Fisher, Oliver; Smith, George C.

2018-01-01

Does experiencing difficulty bolster or undermine future self-images, strategies to get there and actual performance? We build on four insights from prior research to predict that accessible interpretation-of-experienced-difficulty mindset shapes identity and performance. First, people have two different interpretation-of-experienced-difficulty mindsets available in memory; their difficulty-as-impossibility mindset focuses attention on difficulty as implying low odds and their difficulty-as-importance mindset focuses attention on difficulty as implying high value. Second, people are sensitive to contextual cues as to which mindset to apply to understand their experienced difficulty. Third, people apply the mindset that comes to mind unless they have reason to question why it is “on-the-mind.” Fourth, social class can be thought of as a chronic context influencing how much people endorse each interpretation-of-experienced-difficulty mindset. We used subtle primes to guide participants’ attention toward either a difficulty-as-importance or a difficulty-as-impossibility mindset (N = 591). Participants guided toward a difficulty-as-importance mindset performed better on difficult academic tasks (Studies 1, 2) than participants guided toward a difficulty-as-impossibility mindset; whether they had more school-focused possible identities and linked strategies depended on sample (Studies 3, 4). For college students, the effect of guided interpretation-of-experienced-difficulty mindset was not moderated by how much participants agreed with that mindset (Studies 1, 3, 4). College students mostly disagreed with a difficulty-as-impossibility mindset, but making that mindset accessible undermined their performance and sometimes their possible identities anyway. In contrast, middle school students (a younger and lower social class sample) were more likely to agree with a difficulty-as-impossibility mindset. In this sample (Study 2), we found an effect of mindset endorsement: agreeing that difficulty implies importance and disagreeing that difficulty implies impossibility improved performance. This study had a control group. Control group participants not guided to use a particular interpretation-of-experienced-difficulty mindset performed no differently than participants guided toward a difficulty-as-impossibility mindset. Results suggest that people may chronically act as if they are using a difficulty-as-impossibility mindset and may benefit from being guided to consider that experienced difficulty might imply task importance. Effect of accessible mindset on salience of academic possible selves was not stable, accessible mindset mattered in one university sample but not the other. PMID:29887819

Are gatekeepers to renal services referring patients equitably?

PubMed

Kee, Frank; Reaney, Elizabeth; Savage, Gerard; O'Reilly, Dermot; Patterson, Chris; Maxwell, Peter; Fogarty, Damian

2007-01-01

Patients with chronic kidney disease (CKD) benefit from specialist interventions to retard progression of renal failure and prevent cardiovascular events. Certain patient groups have poor access to specialist renal services when dialysis is required. This study used a population-based laboratory database to investigate access to and timeliness of referral to renal specialists relatively early in the course of the disease. All tests for serum creatinine and haemoglobin (Hb) A(1)c in Northern Ireland in a two-year period (2001 and 2002) were retrieved for 345,441 adults. Of these, 16,856 patients had at least one serum creatinine level above 150 micromol/L in 2001 not deemed to be due to acute renal failure (crude prevalence 1.42%). This cohort was followed until the end of 2002 and the differences in the time to referral to a specialist were assessed using Cox's proportional hazards regression. Diabetic patients, older patients and those living in deprived areas were significantly more likely to have serum creatinine testing, compared with non-diabetic, younger and those living in more affluent areas. Delays in referral to renal specialists for patients with raised serum creatinine levels were significantly shorter among diabetic patients, women, younger individuals, those living in rural areas, those living close to renal centres and those living in deprived areas. Overall, only 19% of diabetic patients and 6% of non-diabetic patients who had CKD had seen a renal specialist within 12 months of their index creatinine test. Contrary to other diseases, disadvantaged patients do not seem to be under-investigated for renal disease compared with their more affluent neighbours and are generally referred earlier for specialist assessment. However, the absolute rate of timely specialist assessment is low. Recent changes in referral criteria for CKD will result in more referrals and will have serious resource implications. Opportunities for health gain among patients with declining renal function are being missed, particularly among the old and those living furthest from specialist centres.

Keeping Current: The Digital Divide: Can School Library Media Specialists Help Build the Bridge?

ERIC Educational Resources Information Center

Barron, Daniel D.

2000-01-01

Discusses the growth of electronic commerce as well as electronic education and suggests ways that schools and public libraries can help overcome inequity of access. Highlights include access to the Internet and computers; educational levels; Blacks; race and ethnic origin; rural access; use of the Internet; and income. (LRW)

The Healthy Web--Access to Online Health Information for Individuals with Disabilities

ERIC Educational Resources Information Center

Geiger, Brian; Evans, R. R.; Cellitti, M. A.; Smith, K. Hogan; O'Neal, Marcia R.; Firsing, S. L., III; Chandan, P.

2011-01-01

Background: The Internet can be an invaluable resource for obtaining health information by people with disabilities. Although valid and reliable information is available, previous research revealed barriers to accessing health information online. Health education specialists have the responsibilities to insure that it is accessible to all users.…

Relieving the Confusion: Location and Access Made (Relatively) Easy

ERIC Educational Resources Information Center

Jansen, Barbara A.

2005-01-01

Students need much assistance if they are to successfully use the Location and Access procedure of problem-solving. Guidelines are presented on how classroom teachers and library media specialists can help elementary students manage this Big6 stage.

Stewart's maxims: eight "do's" for successfully communicating silviculture to policymakers

Treesearch

R. E. Stewart

1997-01-01

Technical specialists may experience difficulties in presenting information to non-technical policymakers and having that information used. Eight maxims are discussed that should help the silviculturist successfully provide technical information to non-technical audiences so that it will be considered in the formulation of policy.

Improving access to urologists through an electronic consultation service

PubMed Central

Witherspoon, Luke; Liddy, Clare; Afkham, Amir; Keely, Erin; Mahoney, John

2017-01-01

Introduction Access to specialist services is limited by wait times and geographic availability. Champlain Building Access to Specialist Advice (BASE) has been implemented in our service region to facilitate access to specialists by primary care providers (PCPs). Through a secure web-based system, PCPs are able to send eConsults instead of requesting a formal in-office consultation. Methods Urology eConsults completed through the Champlain BASE service from March 2013 to January 2015 were analyzed. Each consult was characterized in regard to the type of question asked by the referring physician and the clinical content of the referral. Using the mandatory close-out surveys, we analyzed rates of referral avoidance, physician satisfaction, and overall impact on patient care. Results Of 190 eConsultations, 70% were completed in less than 10 minutes. The most common clinical questions related to the interpretation of imaging reports (16%) and tests to choose for investigating a condition (15%). The most common diagnoses were hematuria (13%) and renal mass (8%). In 35% of cases, referral to a urologist had originally been contemplated and was avoided. In 8% of cases, a PCP did not believe a consultation was initially needed, but a referral was ultimately initiated after the eConsultation. Conclusions Our study shows that although certain clinical presentations still require a formal in-person urological consultation, eConsultations can potentially reduce unnecessary clinic visits while identifying patients who may benefit from early urological consultation. Through both these mechanisms, we may improve timely access to urologists. PMID:28798830

School Library Media Specialists and the Internet: Road Kill or Road Warriors?

ERIC Educational Resources Information Center

Barron, Daniel D.

1994-01-01

Discusses use of the Internet by school library media specialists and its importance in the development of the library profession. Highlights include how to access the Internet and resources about the Internet, including information about networks as well as three sources that provide introductions to the general concepts of the Internet. (LRW)

Caught in the Balance: An Organizational Analysis of Science Teaching in Schools with Elementary Science Specialists

ERIC Educational Resources Information Center

Marco-Bujosa, Lisa M.; Levy, Abigail Jurist

2016-01-01

Elementary schools are under increasing pressure to teach science and teach it well; yet, research documents that classroom teachers must overcome numerous personal and school-based challenges to teach science effectively at this level, such as access to materials and inadequate instructional time. The elementary science specialist model…

Content validation of the infant malnutrition and feeding checklist for congenital heart disease: a tool to identify risk of malnutrition and feeding difficulties in infants with congenital heart disease.

PubMed

St Pierre, Astrid; Khattra, Parveen; Johnson, Mandy; Cender, Laurie; Manzano, Sandra; Holsti, Liisa

2010-10-01

Infants with congenital heart disease (CHD) have a high prevalence of feeding difficulties and malnutrition. Early intervention decreases morbidity and long-term developmental deficits. The purpose of this study was to develop and establish the content validity of a screening checklist to identify infants with CHD at risk of feeding difficulties or inadequate nutritional intake for timely referral to a feeding specialist or dietitian. The Delphi method was used, and expert participants reached consensus on 24 risk indicators. This study is the first step in establishing the validity and reliability of a screening tool for early intervention of feeding difficulties and inadequate nutritional intake in infants with CHD. Copyright © 2010 Elsevier Inc. All rights reserved.

Institutional Change for Improving Accessibility in the Design and Delivery of Distance Learning--The Role of Faculty Accessibility Specialists at the Open University

ERIC Educational Resources Information Center

Slater, Rachel; Pearson, Victoria K.; Warren, James P.; Forbes, Tina

2015-01-01

The Open University (OU) has an established infrastructure for supporting disabled students. Historically, the thrust of this has focused on providing accessible adjustments post-production. In 2012, the OU implemented securing greater accessibility (SeGA) to raise awareness and bring about an institutional change to curriculum design so that the…

Experiences of gynecological cancer patients receiving care from specialist nurses: a qualitative systematic review.

PubMed

Cook, Olivia; McIntyre, Meredith; Recoche, Katrina; Lee, Susan

2017-08-01

The care needs of women with gynecological cancer are complex and change over the course of their cancer journey. Specialist nurses are well positioned to play a role in meeting the needs of women with gynecological cancer although their role and scope of practice have not been well defined. As patients are a key stakeholder, understanding their experience of care is an important step in better defining the role and scope of practice of specialist nurses in gynecological oncology in Australia and New Zealand. This review sought to consider gynecological cancer patients' experiences of specialist nursing care. Exploring the patient's experience of care by a specialist nurse is one step in the process of better defining the role and scope of practice of specialist gynecological-oncology nurses in Australia and New Zealand. This review included studies with a focus on women with gynecological cancer who had been cared for by a specialist nurse. Studies of women with gynecological cancer at any point on the continuum of care from pre-diagnosis to survivorship or end of life, including those with a recurrence of the disease, were included, with no limit to the duration of care received for inclusion in the review. Studies that explored how women with gynecological cancer experience the care and interventions of specialist nurses were included. Qualitative studies including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research were considered for review. This review also considered the qualitative components of mixed method studies. Research conducted in any country was considered for inclusion in this review providing that the study was reported in English. Studies conducted in any setting including, but not limited to, acute hospitals, outpatient/ambulatory clinics, chemotherapy or radiotherapy units, support groups, palliative care units or the patient's home were included. A three-step search strategy was utilized in this review. An initial limited search of MEDLINE and CINAHL was undertaken followed by a comprehensive search using all identified keywords and index terms across all included databases. The reference lists of all identified reports and articles were hand searched for additional studies. Each paper was independently assessed by two independent reviewers for methodological validity prior to inclusion in the review using the standardized critical appraisal instrument from the Joanna Briggs Institute the Qualitative Assessment and Review Instrument. When disagreement arose between the reviewers, the given paper was independently appraised by a third reviewer. Data were extracted from papers included in the review using the standardized data extraction tool from Joanna Briggs Institute the Qualitative Assessment and Review Instrument. Data extraction was completed independently by two reviewers. Extracted findings from seven included papers were grouped according to similarity in meaning from which 11 categories were developed. These categories were then subjected to a meta-synthesis that produced a set of three synthesized findings. Key findings were extracted from six included papers and classified as unequivocal (U) or credible (C). A total of 30 findings were extracted and aggregated into 11 categories based on similarity in meaning. From the 11 categories, three synthesized findings were developed: i) Tailored care: specialist nurses play a role in understanding and meeting the individual needs of women with gynecological cancer; ii) Accessible care: specialist nurses guide women with gynecological cancer along the continuum of care and are an easily accessed source of knowledge and support; iii) Dependable expertise: women with gynecological cancer express trust and reassurance in the experience and expertise of the specialist nurse. This systematic review synthesized the findings of seven studies that captured the experiences of women with gynecological cancer who received care from a specialist nurse. The specialist nurse offers tailored, accessible and expert care to women with gynecological cancer. From the synthesis it is recommended that women with gynecological cancer have access to the services of a specialist nurse at key points on the continuum of care, that specialist nurses provide information to patients on their disease and treatment in the form preferred by the patient and ensure that this information has been understood, and that specialist nurses are afforded time to spend with patients to enable greater exploration and identification of patient needs and the provision of personalized care. Further study that considers other key stakeholders in the specialist nurse role in gynecological oncology is recommended in order to gain a full understanding of specialist nurses' contribution to the care of women with gynecological cancer. Additionally, it is recommended that further studies be conducted to seek the perspectives of women with gynecological cancer from culturally and linguistically diverse backgrounds and Indigenous populations on specialist nursing care as they appear to be under-represented in current research.

Learning and Skills Formation in the New Economy: Evidence from Greece.

ERIC Educational Resources Information Center

Zambarloukos, Stella; Constantelou, Anastasia

2002-01-01

Interviews with 26 Greek companies involved in electronic activity revealed few major differences in recruiting information/communications technology (ICT) specialists and extensive use of outsourcing, especially by small firms. Those with recruiting difficulties thought ICT education was inadequate. Informal learning was important, but lack of…

Resolving Struggling Readers' Homework Difficulties: A Social Cognitive Perspective

ERIC Educational Resources Information Center

Margolis, Howard; Mccabe, Patrick

2004-01-01

Struggling readers often fail to complete homework or complete it in a slipshod, haphazard fashion. Often, this adversely affects grades, erodes motivation for academics, and causes conflict between readers, parents, and school personnel. To help teachers and educational consultants (e.g., reading specialists, school psychologists) help struggling…

Incorporating the Internet into the Marketing Classroom: Problems, Opportunities and Thoughts.

ERIC Educational Resources Information Center

Phillips, Melodie R.; Horton, Veronica

1998-01-01

Summarizes some of the opportunities and difficulties in integrating Internet-based activities in the traditional marketing classroom, and offers ideas for future applications and research. Marketing specialists are encouraged to examine both how, and when, the Internet can be used productively in the classroom. (Author/MSE)

A qualitative study of work-life balance amongst specialist orthodontists in the United Kingdom.

PubMed

Bateman, Lindsey E; Collins, Joanne M; Cunningham, Susan J

2016-12-01

To identify factors affecting work-life balance amongst male and female orthodontists in the UK. A qualitative interview-based study with a cross-sectional design. Specialist orthodontists working in specialist practice and the hospital service in the UK were selected by purposive sampling. In-depth semi-structured interviews were conducted with 18 orthodontic specialists. Interview transcripts were analyzed using Framework Analysis. Four main themes pertaining to work-life balance in orthodontics were identified: work factors affecting work-life balance, life factors affecting work-life balance, perception and effects of work-life balance and suggestions for managing work-life balance within the profession. There was substantial variation in the work-life balance of the orthodontists interviewed in this study; however the majority reported high levels of career satisfaction despite difficulties maintaining a good work-life balance. Whilst there were some clear distinctions in the factors affecting work-life balance between the hospital environment and specialist practice (including additional professional commitments and teaching/training-related issues), there were also a number of similarities. These included, the lack of flexibility in the working day, managing patient expectations, taking time off work at short notice and the ability to work part-time.

[Giving medico-legal opinions in cases with suspicion of medical mistake.part 1. between medicine and justice.

PubMed

Chowaniec, Czesław; Chowaniec, Małgorzata; Wilk, Mateusz

2017-01-01

Creating medico-legal opinion is a sophisticated investigative, analytical, decision-making and creative process. Forensic medicine specialist in cooperation with clinical medicine consultants, on the basis of evidence analysis, which was gathered during procedures and contained in the acts has to create an objective and essential opinion. This opinion is a vital, very important and irreplaceable proof in every case. Judicial body consults with forensic medicine specialist or specialists if there are circumstances for settlement of which there is a need of classified informations - art. 193 of Penalty Code. Forensic medicine specialists face many difficulties which may have effect on quality, positiveness of opinion, compliance with the deadline, increasing expectancy of judicial body or sides. It is very difficult to find clinical specialists which except their clinical knowledge have basic knowledge about law, the role and duties of an court expert. In this article we discuss creating-opinion problems, role and position of court expert in confrontation with expectations of judicial body and the Justice with particular emphasis on medical mistakes and assessment of medical proceedings. We show the complexity of creating of medical opinions, especially these institutional.

Population Estimates, Health Care Characteristics, and Material Hardship Experiences of U.S. Children With Parent-Reported Speech-Language Difficulties: Evidence From Three Nationally Representative Surveys.

PubMed

Sonik, Rajan A; Parish, Susan L; Akobirshoev, Ilhom; Son, Esther; Rosenthal, Eliana

2017-10-05

To provide estimates for the prevalence of parent-reported speech-language difficulties in U.S. children, and to describe the levels of health care access and material hardship in this population. We tabulated descriptive and bivariate statistics using cross-sectional data from the 2007 and 2011/2012 iterations of the National Survey of Children's Health, the 2005/2006 and 2009/2010 iterations of the National Survey of Children with Special Health Care Needs, and the 2004 and 2008 panels of the Survey of Income and Program Participation. Prevalence estimates ranged from 1.8% to 5.0%, with data from two of the three surveys preliminarily indicating increased prevalence in recent years. The largest health care challenge was in accessing care coordination, with 49%-56% of children with parent-reported speech-language difficulties lacking full access. Children with parent-reported speech-language difficulties were more likely than peers without any indications of speech-language difficulties to live in households experiencing each measured material hardship and participating in each measured public benefit program (e.g., 20%-22% experiencing food insecurity, compared to 11%-14% of their peers without any indications of speech-language difficulties). We found mixed preliminary evidence to suggest that the prevalence of parent-reported speech-language difficulties among children may be rising. These children face heightened levels of material hardship and barriers in accessing health care.

Bridging the gap: does a specialist eating disorder service, aimed at developing a continuum of community care, make a difference?

PubMed

Newton, John; Bosanac, Peter; Mancuso, Sam; Castle, David

2013-08-01

In 2010, the authors identified in a separate publication, Mind the evidence gap, the sparse evidence-base for the treatment of adult anorexia nervosa and barriers to accessing care. We report on the ensuing development, implementation and first 18-month results of a novel eating disorder service bridging the primary and specialist continuum of care in Victoria, Australia. Using literature review, stakeholder, and consumer and carer consultation, a model for a community eating disorder service was developed and then implemented. All patients entering the service were then assessed at intake and, if they gave consent, at 12 month follow-up. From December 2010 to July 2012, 208 patients accessed The Body Image Eating Disorders Treatment and Recovery Service (BETRS). Fifty-three per cent had a diagnosis of anorexia nervosa and the mean number of co-morbid psychiatric diagnoses was two. Twenty-three per cent attended a day patient programme and showed a significant improvement in their body mass index. Measures of depression, anxiety and eating disorder symptomatology showed a concomitant, significant decrease. The development of BETRS has led to markedly improved access and effectiveness of specialist services in the region.

Space Shuttle Projects

NASA Image and Video Library

1985-11-30

The crew assigned to the STS-61B mission included Bryan D. O’Conner, pilot; Brewster H. Shaw, commander; Charles D. Walker, payload specialist; mission specialists Jerry L. Ross, Mary L. Cleave, and Sherwood C. Spring; and Rodolpho Neri Vela, payload specialist. Launched aboard the Space Shuttle Atlantis November 28, 1985 at 7:29:00 pm (EST), the STS-61B mission’s primary payload included three communications satellites: MORELOS-B (Mexico); AUSSAT-2 (Australia); and SATCOM KU-2 (RCA Americom). Two experiments were conducted to test assembling erectable structures in space: EASE (Experimental Assembly of Structures in Extravehicular Activity), and ACCESS (Assembly Concept for Construction of Erectable Space Structure). In a joint venture between NASA/Langley Research Center in Hampton, Virginia and the Marshall Space Flight Center (MSFC), EASE and ACCESS were developed and demonstrated at MSFC's Neutral Buoyancy Simulator (NBS). In this STS-61B onboard photo astronaut Ross, located on the Manipulator Foot Restraint (MFR) over the cargo bay, erects ACCESS. The primary objective of this experiment was to test the structural assembly concepts for suitability as the framework for larger space structures and to identify ways to improve the productivity of space construction.

STS-61B Astronaut Ross Works on Assembly Concept for Construction of Erectable Space Structure

NASA Technical Reports Server (NTRS)

1985-01-01

The crew assigned to the STS-61B mission included Bryan D. O'Conner, pilot; Brewster H. Shaw, commander; Charles D. Walker, payload specialist; mission specialists Jerry L. Ross, Mary L. Cleave, and Sherwood C. Spring; and Rodolpho Neri Vela, payload specialist. Launched aboard the Space Shuttle Atlantis November 28, 1985 at 7:29:00 pm (EST), the STS-61B mission's primary payload included three communications satellites: MORELOS-B (Mexico); AUSSAT-2 (Australia); and SATCOM KU-2 (RCA Americom). Two experiments were conducted to test assembling erectable structures in space: EASE (Experimental Assembly of Structures in Extravehicular Activity), and ACCESS (Assembly Concept for Construction of Erectable Space Structure). In a joint venture between NASA/Langley Research Center in Hampton, Virginia and the Marshall Space Flight Center (MSFC), EASE and ACCESS were developed and demonstrated at MSFC's Neutral Buoyancy Simulator (NBS). In this STS-61B onboard photo astronaut Ross, located on the Manipulator Foot Restraint (MFR) over the cargo bay, erects ACCESS. The primary objective of this experiment was to test the structural assembly concepts for suitability as the framework for larger space structures and to identify ways to improve the productivity of space construction.

Influences on hospital admission for asthma in south Asian and white adults: qualitative interview study.

PubMed

Griffiths, C; Kaur, G; Gantley, M; Feder, G; Hillier, S; Goddard, J; Packe, G

2001-10-27

To explore reasons for increased risk of hospital admission among south Asian patients with asthma. Qualitative interview study using modified critical incident technique and framework analysis. Newham, east London, a deprived area with a large mixed south Asian population. 58 south Asian and white adults with asthma (49 admitted to hospital with asthma, 9 not admitted); 17 general practitioners; 5 accident and emergency doctors; 2 out of hours general practitioners; 1 asthma specialist nurse. Patients' and health professionals' views on influences on admission, events leading to admission, general practices' organisation and asthma strategies, doctor-patient relationship, and cultural attitudes to asthma. South Asian and white patients admitted to hospital coped differently with asthma. South Asians described less confidence in controlling their asthma, were unfamiliar with the concept of preventive medication, and often expressed less confidence in their general practitioner. South Asians managed asthma exacerbations with family advocacy, without systematic changes in prophylaxis, and without systemic corticosteroids. Patients describing difficulty accessing primary care during asthma exacerbations were registered with practices with weak strategies for asthma care and were often south Asian. Patients with easy access described care suggesting partnerships with their general practitioner, had better confidence to control asthma, and were registered with practices with well developed asthma strategies that included policies for avoiding hospital admission. The different ways of coping with asthma exacerbations and accessing care may partly explain the increased risk of hospital admission in south Asian patients. Interventions that increase confidence to control asthma, confidence in the general practitioner, understanding of preventive treatment, and use of systemic corticosteroids in exacerbations may reduce hospital admissions. Development of more sophisticated asthma strategies by practices with better access and partnerships with patients may also achieve this.

42 CFR 438.206 - Availability of services.

Code of Federal Regulations, 2010 CFR

2010-10-01

... female enrollees with direct access to a women's health specialist within the network for covered care... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS MANAGED CARE Quality Assessment and Performance Improvement Access... health care needs of specific Medicaid populations represented in the particular MCO, PIHP, and PAHP...

42 CFR 438.206 - Availability of services.

Code of Federal Regulations, 2014 CFR

2014-10-01

... female enrollees with direct access to a women's health specialist within the network for covered care... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS MANAGED CARE Quality Assessment and Performance Improvement Access... health care needs of specific Medicaid populations represented in the particular MCO, PIHP, and PAHP...

42 CFR 438.206 - Availability of services.

Code of Federal Regulations, 2012 CFR

2012-10-01

... female enrollees with direct access to a women's health specialist within the network for covered care... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS MANAGED CARE Quality Assessment and Performance Improvement Access... health care needs of specific Medicaid populations represented in the particular MCO, PIHP, and PAHP...

42 CFR 438.206 - Availability of services.

Code of Federal Regulations, 2011 CFR

2011-10-01

... female enrollees with direct access to a women's health specialist within the network for covered care... (CONTINUED) MEDICAL ASSISTANCE PROGRAMS MANAGED CARE Quality Assessment and Performance Improvement Access... health care needs of specific Medicaid populations represented in the particular MCO, PIHP, and PAHP...

Clinical Nurse Specialist Roles in Conducting Research: Changes Over 3 Years.

PubMed

Albert, Nancy M; Rice, Karen L; Waldo, Mary J; Bena, James F; Mayo, Ann M; Morrison, Shannon L; Westlake, Cheryl; Ellstrom, Kathleen; Powers, Jan; Foster, Jan

2016-01-01

The aim of this study is to describe clinical nurse specialists' characteristics, interest, confidence, motivators, and barriers in conducting research. This study was a descriptive, multicohort design. Clinical nurse specialists were recruited electronically through national and local organizations to complete anonymous surveys 3 times, over 3 years. Comparative analyses included χ and Kruskal-Wallis tests. Of 2052 responders (initial, n = 629; 18 months, n = 465; and 3 years, n = 958), mean (SD) participant age was 50.3 (9.3) years. Overall, 41.7% of participants were involved as principal or coinvestigators in research. Interest in conducting nursing research (on a 0-100 scale) was 61.1 (38.4) and was lowest among the 18-month time point participant group (score, 39.1 [32.2]) and highest at the 3-year time point (68.3, [30.7]; P < .001). Confidence in conducting research, discussion of statistics, and perceptions of motivators and barriers to conducting research did not differ across time period groups. Access to literature and mentors and research knowledge were the most prevalent barriers to conducting research. Less than 42% of clinical nurse specialists conducted research and the rate did not change between different time groups. Access and knowledge barriers to conducting research were prominent. Workplace leaders need to consider resources and support of academic educational opportunities to increase research conduct by clinical nurse specialists.

Facilities for investigating occupational asthma in UK non-specialist respiratory departments.

PubMed

Barber, Christopher M; Naylor, Steven; Bradshaw, Lisa; Francis, Mandy; Harris-Roberts, Joanne; Rawbone, Roger; Curran, Andrew; Fishwick, David

2008-01-01

The facilities which should be available to physicians offering specialist occupational asthma services have recently been agreed upon by a UK panel of experts. This study aimed to investigate whether these facilities are available in UK non-specialist secondary care respiratory departments and to document tertiary care referral patterns. A random sample of 100 UK respiratory units was selected, and the lead consultant invited to participate. Face-to-face interviews were conducted to document information on departmental facilities available for investigating cases of occupational asthma and utilization of tertiary referral centres. In total, 66% of consultants interviewed had seen a case of occupational asthma in the previous month, and 76% reported having ever referred a patient with suspected occupational asthma to a specialist centre for further investigation (referral distance range 1-111 miles). All the departments were able to perform the investigations previously deemed an absolute necessity in all patients. The availability of in-house facilities that were deemed as must be available varied between 3-100%. The results of this study demonstrate that while the majority of basic facilities are widely available, many respiratory departments do not have direct access to investigations routinely required to investigate occupational asthma. Access to specialist occupational respiratory centres varies within the UK, and in some parts of the country involves long travelling distances for patients.

Prescription Birth Control Access Among U.S. Women at Risk of Unintended Pregnancy.

PubMed

Grindlay, Kate; Grossman, Daniel

2016-03-01

Access to contraception is a vital component of preventing unintended pregnancies. This study was conducted to assess the prevalence of and factors associated with U.S. women's difficulty accessing prescription contraception (pill, patch, or ring). We performed a nationally representative survey of adult women at risk of unintended pregnancy (aged 18-44, not pregnant or seeking pregnancy, sexually active, not sterilized) using a probability-based web panel. In November to December 2011, 2046 women completed the survey. Weighted proportions were calculated and logistic regression was used to identify covariates associated with difficulty obtaining or refilling prescription contraception. A total of 1385 (68%) women had ever tried to get a prescription for hormonal contraception. Among this population, 29% reported ever having problems obtaining a prescription or refills. In multivariable regression, uninsured (vs. privately insured) and Spanish-speaking (vs. English-speaking) women were significantly more likely to report difficulties; women with a high school degree and those with some college (vs. a college degree or higher) were significantly less likely to report difficulty. Difficulties included cost barriers or lack of insurance (14%), challenges obtaining an appointment or getting to a clinic (13%), the clinician requiring a clinic visit, exam, or Pap smear (13%), not having a regular doctor/clinic (10%), difficulty accessing a pharmacy (4%), and other reasons (4%). One-third of adult U.S. women who have ever tried to obtain prescription contraception reported access barriers. While the Affordable Care Act may resolve some of these issues, these data indicate that additional factors may still need to be addressed.

Decision Model for Forecasting Projected Naval Enlisted Reserve Attainments

DTIC Science & Technology

2008-12-01

Command CM Construction Mechanic CS Culinary Specialist CTA Cryptologic Technician - Administrative CTI Cryptologic Technician - Interpretive...services are utilized to compile databases of active duty and reserve accession and loss Category Arts and Photography Journalist (JO) Photographer’s...MM) Mineman (MN) Torpedoman’s Mate (TM) Food, Restaurant, and Lodging Culinary Specialist (CS) Human Resources Navy Counselor (NC) Personnelman (PN

Specialty-care access for community health clinic patients: processes and barriers.

PubMed

Ezeonwu, Mabel C

2018-01-01

Community health clinics/centers (CHCs) comprise the US's core health-safety net and provide primary care to anyone who walks through their doors. However, access to specialty care for CHC patients is a big challenge. In this descriptive qualitative study, semistructured interviews of 37 referral coordinators of CHCs were used to describe their perspectives on processes and barriers to patients' access to specialty care. Analysis of data was done using content analysis. The process of coordinating care referrals for CHC patients is complex and begins with a provider's order for consultation and ends when the referring provider receives the specialist's note. Poverty, specialist and referral coordinator shortages, lack of insurance, insurance acceptability by providers, transport and clinic-location factors, lack of clinic-hospital affiliations, and poor communication between primary and specialty providers constitute critical barriers to specialty-care access for patients. Understanding the complexities of specialty-care coordination processes and access helps determine the need for comprehensive and uninterrupted access to quality health care for vulnerable populations. Guaranteed access to primary care at CHCs has not translated into improved access to specialty care. It is critical that effective policies be pursued to address the barriers and minimize interruptions in care, and to ensure continuity of care for all patients needing specialty care.

Can plant resistance to specialist herbivores be explained by plant chemistry or resource use strategy?

PubMed

Kirk, Heather; Vrieling, Klaas; Pelser, Pieter B; Schaffner, Urs

2012-04-01

At both a macro- and micro-evolutionary level, selection of and performance on host plants by specialist herbivores are thought to be governed partially by host plant chemistry. Thus far, there is little evidence to suggest that specialists can detect small structural differences in secondary metabolites of their hosts, or that such differences affect host choice or performance of specialists. We tested whether phytochemical differences between closely related plant species are correlated with specialist host choice. We conducted no-choice feeding trials using 17 plant species of three genera of tribe Senecioneae (Jacobaea, Packera, and Senecio; Asteraceae) and a more distantly related species (Cynoglossum officinale; Boraginaceae) containing pyrrolizidine alkaloids (PAs), and four PA-sequestering specialist herbivores of the genus Longitarsus (Chrysomelidae). We also assessed whether variation in feeding by specialist herbivores is attributable to different resource use strategies of the tested plant species. Plant resource use strategy was quantified by measuring leaf dry matter content, which is related to both plant nutritive value and to plant investment in quantitative defences. We found no evidence that intra-generic differences in PA profiles affect feeding by specialist herbivores. Instead, our results indicate that decisions to begin feeding are related to plant resource use strategy, while decisions to continue feeding are not based on any plant characteristics measured in this study. These findings imply that PA composition does not significantly affect host choice by these specialist herbivores. Leaf dry matter content is somewhat phylogenetically conserved, indicating that plants may have difficulty altering resource use strategy in response to selection pressure by herbivores and other environmental factors on an evolutionary time scale.

Sustainability of a Primary Care-Driven eConsult Service.

PubMed

Liddy, Clare; Moroz, Isabella; Afkham, Amir; Keely, Erin

2018-03-01

Excessive wait times for specialist appointments pose a serious barrier to patient care. To improve access to specialist care and reduce wait times, we launched the Champlain BASE (Building Access to Specialists through eConsultation) eConsult service in April 2011. The objective of this study is to report on the impact of our multiple specialty eConsult service during the first 5 years of use after implementation, with a focus on growth and sustainability. We conducted a cross-sectional study of all eConsult cases submitted between April 1, 2011 and April 30, 2016, and measured impact with system utilization data and mandatory close-out surveys completed at the end of each eConsult. Impact indicators included time interval to obtain specialist advice, effect of specialist advice on the primary care clinician's course of action, and rate of avoidance of face-to-face visits. A total of 14,105 eConsult cases were directed to 56 different medical specialty groups, completed with a median response time of 21 hours, and 65% of all eConsults were resolved without a specialist visit. We observed rapid growth in the use of eConsult during the study period: 5 years after implementation the system was in use by 1,020 primary care clinicians, with more than 700 consultations taking place per month. This study presents the first in-depth look at the growth and sustainability of the multispecialty eConsult service. The results show the positive impact of an eConsult service and can inform other regions interested in implementing similar systems. © 2018 Annals of Family Medicine, Inc.

Access to care for children with emotional/behavioral difficulties.

PubMed

Henning-Smith, Carrie; Alang, Sirry

2016-06-01

Emotional/behavioral difficulties (EBDs) are increasingly diagnosed in children, constituting some of the most common chronic childhood conditions. Left untreated, EBDs pose long-term individual and population-level consequences. There is a growing evidence of disparities in EBD prevalence by various demographic characteristics. This article builds on this research by examining disparities in access to medical care for children with EBD. From 2008 to 2011, using data from the US National Health Interview Survey (N = 31,631) on sample children aged 4-17, we investigate (1) whether having EBD affects access to care (modeled as delayed care due to cost and difficulty making an appointment) and (2) the role demographic characteristics, health insurance coverage, and frequency of service use play in access to care for children with EBD. Results indicate that children with EBD experience issues in accessing care at more than twice the rate of children without EBD, even though they are less likely to be uninsured than their counterparts without EBD. In multivariable models, children with EBD are still more likely to experience delayed care due to cost and difficulty making a timely appointment, even after adjusting for frequency of health service use, insurance coverage, and demographic characteristics. © The Author(s) 2015.

Access to care for children with emotional/behavioral difficulties

PubMed Central

Henning-Smith, Carrie; Alang, Sirry

2014-01-01

Emotional/behavioral difficulties (EBD) are increasingly diagnosed in children, constituting some of the most common chronic childhood conditions. Left untreated, EBD pose long-term individual and population-level consequences. There is growing evidence of disparities in EBD prevalence by various demographic characteristics. This paper builds on this research by examining disparities in access to medical care for children with EBD. Using data on sample children aged 4-17 from 2008-2011 of the United States National Health Interview Survey (n=29,493), we investigate: 1. Whether having EBD affects access to care (modeled as delayed care due to cost and difficulty making an appointment); and 2. The role demographic characteristics, health insurance coverage, and frequency of service use play in access to care for children with EBD. Results indicate that children with EBD experience issues in accessing care at more than twice the rate of children without EBD, even though they are less likely to be uninsured than their counterparts without EBD. In multivariable models, children with EBD are still more likely to experience delayed care due to cost and difficulty making a timely appointment, even after adjusting for frequency of health service use, insurance coverage, and demographic characteristics. PMID:25583944

Influence of cnicin, a sesquiterpene lactone ofCentaurea maculosa (Asteraceae), on specialist and generalist insect herbivores.

PubMed

Landau, I; Müller-Schärer, H; Ward, P I

1994-04-01

The sesquiterpene lactone cnicin was extracted fromCentaurea maculosa andCentaurea vallesiaca. We examined its effects on the ovipositional response and larval development of generalist and specialist insect herbivores associated withC. maculosa. For the oviposition trials, three plant species (C. maculosa, Achillea millefolium, andCichorium intybus), half of which were sprayed with 3% of cnicin, were exposed to the specialist mothsStenodes straminea, Agapeta zoegana, andPterolonche inspersa in field cages. All three species significantly preferredC. maculosa to other plants andP. inspersa significantly preferred cnicin-sprayed plants to untreated plants for oviposition. Tested over all species, cnicin significantly increased the number of eggs laid on a given plant. A larval diet test examined the toxicity of cnicin for larvae of the generalist noctuid mothSpodoptera littoralis. Cnicin concentrations of 3% and 6% were lethal and 1% and 0.5% seriously inhibited growth and development. The larvae of theC. maculosa specialistStenodes straminea survived at 6% cnicin, but none of the pupae hatched.Agapeta zoegana was able to survive at 1% and 3% cnicin. Both specialists had difficulties with the artificial diet, but weight increase and survival was not further reduced when cnicin was present compared with on the control diet. In conclusion, cnicin influenced host recognition by the specialist species, and larvae of the generalist did not survive on natural levels of cnicin. Growth and survival of the specialist were not influenced by cnicin but were considerably hampered on artificial diet.

KSC-98pc505

NASA Image and Video Library

1998-04-17

KENNEDY SPACE CENTER, FLA. -- The Space Shuttle Columbia soars from Launch Pad 39B at 2:19 p.m. EDT Apr. 17 to begin the nearly 17-day STS-90 Neurolab mission. The launch was delayed 24 hours due to difficulty with a network signal processor, which was replaced Apr. 16, on the orbiter. The crew members are Commander Richard Searfoss, Pilot Scott Altman, Mission Specialists Richard Linnehan, D.V.M., Dafydd (Dave) Williams, M.D., with the Canadian Space Agency, and Kathryn (Kay) Hire; and Payload Specialists Jay Buckey, M.D., and James Pawelczyk, Ph.D. Investigations during the Neurolab mission will focus on the effects of microgravity on the nervous system.

KSC-98PC501

NASA Image and Video Library

1998-04-17

Framed by native Floridian foliage, the Space Shuttle Columbia soars from Launch Pad 39B at 2:19 p.m. EDT Apr. 17 to begin the nearly 17-day STS-90 Neurolab mission. The launch was delayed 24 hours due to difficulty with a network signal processor, which was replaced Apr. 16, on the orbiter. The crew members are Commander Richard Searfoss, Pilot Scott Altman, Mission Specialists Richard Linnehan, D.V.M., Dafydd (Dave) Williams, M.D., with the Canadian Space Agency, and Kathryn (Kay) Hire; and Payload Specialists Jay Buckey, M.D., and James Pawelczyk, Ph.D. Investigations during the Neurolab mission will focus on the effects of microgravity on the nervous system

KSC-98dc496

NASA Image and Video Library

1998-04-17

The Space Shuttle Columbia soars from Launch Pad 39B at 2:19 p.m. EDT Apr. 17 to begin the nearly 17-day STS-90 Neurolab mission. The launch was delayed 24 hours due to difficulty with a network signal processor, which was replaced Apr. 16, on the orbiter. The crew members are Commander Richard Searfoss, Pilot Scott Altman, Mission Specialists Richard Linnehan, D.V.M., Dafydd (Dave) Williams, M.D., with the Canadian Space Agency, and Kathryn (Kay) Hire; and Payload Specialists Jay Buckey, M.D., and James Pawelczyk, Ph.D. Investigations during the Neurolab mission will focus on the effects of microgravity on the nervous system

KSC-98pc506

NASA Image and Video Library

1998-04-17

KENNEDY SPACE CENTER, FLA. -- The Space Shuttle Columbia lifts off from Launch Pad 39B at 2:19 p.m. EDT Apr. 17 to begin the nearly 17-day STS-90 Neurolab mission. The launch was delayed 24 hours due to difficulty with a network signal processor, which was replaced Apr. 16, on the orbiter. The crew members are Commander Richard Searfoss, Pilot Scott Altman, Mission Specialists Richard Linnehan, D.V.M., Dafydd (Dave) Williams, M.D., with the Canadian Space Agency, and Kathryn (Kay) Hire; and Payload Specialists Jay Buckey, M.D., and James Pawelczyk, Ph.D. Investigations during the Neurolab mission will focus on the effects of microgravity on the nervous system

KSC-98pc499

NASA Image and Video Library

1998-04-17

KENNEDY SPACE CENTER, FLA. -- The Space Shuttle Columbia soars from Launch Pad 39B at 2:19 p.m. EDT Apr. 17 to begin the STS-90 Neurolab mission. The launch was delayed 24 hours due to difficulty with a network signal processor, which was replaced Apr. 16, on the orbiter. The crew members are Commander Richard Searfoss, Pilot Scott Altman, Mission Specialists Richard Linnehan, D.V.M., Dafydd (Dave) Williams, M.D., with the Canadian Space Agency, and Kathryn (Kay) Hire; and Payload Specialists Jay Buckey, M.D., and James Pawelczyk, Ph.D. Investigations during the Neurolab mission will focus on the effects of microgravity on the nervous system

KSC-98pc516

NASA Image and Video Library

1998-04-17

KENNEDY SPACE CENTER, FLA. -- The Space Shuttle Columbia soars from Launch Pad 39B at 2:19 p.m. EDT Apr. 17 to begin the STS-90 Neurolab mission. The launch was delayed 24 hours due to difficulty with a network signal processor, which was replaced Apr. 16, on the orbiter. The crew members are Commander Richard Searfoss, Pilot Scott Altman, Mission Specialists Richard Linnehan, D.V.M., Dafydd (Dave) Williams, M.D., with the Canadian Space Agency, and Kathryn (Kay) Hire; and Payload Specialists Jay Buckey, M.D., and James Pawelczyk, Ph.D. Investigations during the Neurolab mission will focus on the effects of microgravity on the nervous system

KSC-98pc502

NASA Image and Video Library

1998-04-17

Framed by native Floridian foliage, the Space Shuttle Columbia soars from Launch Pad 39B at 2:19 p.m. EDT Apr. 17 to begin the nearly 17-day STS-90 Neurolab mission. The launch was delayed 24 hours due to difficulty with a network signal processor, which was replaced Apr. 16, on the orbiter. The crew members are Commander Richard Searfoss, Pilot Scott Altman, Mission Specialists Richard Linnehan, D.V.M., Dafydd (Dave) Williams, M.D., with the Canadian Space Agency, and Kathryn (Kay) Hire; and Payload Specialists Jay Buckey, M.D., and James Pawelczyk, Ph.D. Investigations during the Neurolab mission will focus on the effects of microgravity on the nervous system

KSC-98pc498

NASA Image and Video Library

1998-04-17

KENNEDY SPACE CENTER, FLA. -- The Space Shuttle Columbia soars from Launch Pad 39B at 2:19 p.m. EDT Apr. 17 to begin the nearly 17-day STS-90 Neurolab mission. The launch was delayed 24 hours due to difficulty with a network signal processor, which was replaced Apr. 16, on the orbiter. The crew members are Commander Richard Searfoss, Pilot Scott Altman, Mission Specialists Richard Linnehan, D.V.M., Dafydd (Dave) Williams, M.D., with the Canadian Space Agency, and Kathryn (Kay) Hire; and Payload Specialists Jay Buckey, M.D., and James Pawelczyk, Ph.D. Investigations during the Neurolab mission will focus on the effects of microgravity on the nervous system

KSC-98dc497

NASA Image and Video Library

1998-04-17

The Space Shuttle Columbia soars from Launch Pad 39B at 2:19 p.m. EDT Apr. 17 to begin the nearly 17-day STS-90 Neurolab mission. The launch was delayed 24 hours due to difficulty with a network signal processor, which was replaced Apr. 16, on the orbiter. The crew members are Commander Richard Searfoss, Pilot Scott Altman, Mission Specialists Richard Linnehan, D.V.M., Dafydd (Dave) Williams, M.D., with the Canadian Space Agency, and Kathryn (Kay) Hire; and Payload Specialists Jay Buckey, M.D., and James Pawelczyk, Ph.D. Investigations during the Neurolab mission will focus on the effects of microgravity on the nervous system

Variation in geographic access to specialist inpatient hospices in England and Wales.

PubMed

Gatrell, Anthony C; Wood, D Justin

2012-07-01

We seek to map and describe variation in geographic access to the set of 189 specialist adult inpatient hospices in England and Wales. Using almost 35,000 small Census areas (Local Super Output Areas: LSOAs) as our units of analysis, the locations of hospices, and estimated drive times from LSOAs to hospices we construct an accessibility 'score' for each LSOA, for England and Wales as a whole. Data on cancer mortality are used as a proxy for the 'demand' for hospice care and we then identify that subset of small areas in which accessibility (service supply) is relatively poor yet the potential 'demand' for hospice services is above average. That subset is then filtered according to the deprivation score for each LSOA, in order to identify those LSOAs which are also above average in terms of deprivation. While urban areas are relatively well served, large parts of England and Wales have poor access to hospices, and there is a risk that the needs of those living in relatively deprived areas may be unmet. Copyright © 2012 Elsevier Ltd. All rights reserved.

Accessing wound-care information on the Internet: the implications for patients.

PubMed

Bovill, E S; Hormbrey, E; Gillespie, P H; Banwell, P E

2001-02-01

The Internet and the World Wide Web have revolutionised communication and provide a unique forum for the exchange of information. It has been proposed that the Internet has given the public more access to medical information resources and improved patient education. This study assessed the impact of the Internet on the availability of information on wound care management. The search phrases 'wound care', 'wound healing' and 'wounds' were analysed using a powerful Metacrawler search engine (www.go2net.com). Web site access was classified according to the target audience (wound-care specialists, other health professionals, patients) and the author (societies, institutions or commercial companies). The largest proportion of web sites were commercially based (32%). Of the total number, 23% specifically targeted patients, mostly by advertising. Only 20% were aimed at wound specialists. Extensive surfing was required to obtain wound-care information, and objective information sites were under-represented. Regulated, easily accessible, objective information sites on wound-healing topics are needed for improved patient education and to balance the existing commercial bias.

Accessing FMS Functionality: The Impact of Design on Learning

NASA Technical Reports Server (NTRS)

Fennell, Karl; Sherry, Lance; Roberts, Ralph, Jr.

2004-01-01

In modern commercial and military aircraft, the Flight Management System (FMS) lies at the heart of the functionality of the airplane. The nature of the FMS has also caused great difficulties learning and accessing this functionality. This study examines actual Air Force pilots who were qualified on the newly introduced advanced FMS and shows that the design of the system itself is a primary source of difficulty learning the system. Twenty representative tasks were selected which the pilots could be expected to accomplish on an ' actual flight. These tasks were analyzed using the RAFIV stage model (Sherry, Polson, et al. 2002). This analysis demonstrates that a great burden is placed on remembering complex reformulation of the task to function mapping. 65% of the tasks required retaining one access steps in memory to accomplish the task, 20% required two memorized access steps, and 15% required zero memorized access steps. The probability that a participant would make an access error on the tasks was: two memorized access steps - 74%, one memorized access step - 13%, and zero memorized access steps - 6%. Other factors were analyzed as well, including experience with the system and frequency of use. This completed the picture of a system with many memorized steps causing difficulty with the new system, especially when trying to fine where to access the correct function.

Influences on hospital admission for asthma in south Asian and white adults: qualitative interview study

PubMed Central

Griffiths, Chris; Kaur, Gurmit; Gantley, Madeleine; Feder, Gene; Hillier, Sheila; Goddard, Jill; Packe, Geoff

2001-01-01

Objective To explore reasons for increased risk of hospital admission among south Asian patients with asthma. Design Qualitative interview study using modified critical incident technique and framework analysis. Setting Newham, east London, a deprived area with a large mixed south Asian population. Participants 58 south Asian and white adults with asthma (49 admitted to hospital with asthma, 9 not admitted); 17 general practitioners; 5 accident and emergency doctors; 2 out of hours general practitioners; 1 asthma specialist nurse. Main outcome measures Patients' and health professionals' views on influences on admission, events leading to admission, general practices' organisation and asthma strategies, doctor-patient relationship, and cultural attitudes to asthma. Results South Asian and white patients admitted to hospital coped differently with asthma. South Asians described less confidence in controlling their asthma, were unfamiliar with the concept of preventive medication, and often expressed less confidence in their general practitioner. South Asians managed asthma exacerbations with family advocacy, without systematic changes in prophylaxis, and without systemic corticosteroids. Patients describing difficulty accessing primary care during asthma exacerbations were registered with practices with weak strategies for asthma care and were often south Asian. Patients with easy access described care suggesting partnerships with their general practitioner, had better confidence to control asthma, and were registered with practices with well developed asthma strategies that included policies for avoiding hospital admission. Conclusions The different ways of coping with asthma exacerbations and accessing care may partly explain the increased risk of hospital admission in south Asian patients. Interventions that increase confidence to control asthma, confidence in the general practitioner, understanding of preventive treatment, and use of systemic corticosteroids in exacerbations may reduce hospital admissions. Development of more sophisticated asthma strategies by practices with better access and partnerships with patients may also achieve this. What is already known on this topicSouth Asian patients with asthma are at increased risk of hospital admission with asthma compared with white patientsNo consistent differences in severity or prevalence of asthma, prescribed drugs, or asthma education have been described, and interventions to reduce admission rates in Asian patients have met with variable successWhat this study addsCompared with white patients, south Asian patients admitted to hospital with asthma had less confidence to control asthma, were unfamiliar with the concept of preventive medication, and had less confidence in their general practitionersSouth Asian patients managed asthma attacks through family advocacy and without systematic changes in prophylaxis and without systemic corticosteroidsPatients reporting difficulty in accessing primary care during attacks were often south Asian PMID:11679384

Library Media Specialists and Assisted Technology

ERIC Educational Resources Information Center

Edwards-Johnson, Adriana

2009-01-01

Today many library resources are accessible 24/7. Students can be in the classroom, home, or at their favorite fast food place and do what once required a visit to the library. Electronic access to information has become a major part of the culture. No longer are students just watching a 16mm projected film in class; now they can access online…

Paediatric home care in the UK.

PubMed Central

Tatman, M A; Woodroffe, C

1993-01-01

Paediatric home care services in the UK were ascertained in 1991 and 1992. Respondents from 209 (97%) UK health districts and boards identified 62 general and 124 specialist paediatric home care services by January 1993, 15% having opened in the previous year. Of all UK children, 30% lived in a district with a general home care service. Five health regions had only specialist services. Districts differed widely in the availability of home care for different disorders. The home care services were small, general services employing a mean (SD) of 2.5 (1.6) whole time equivalent (WTE) nurses, and specialist services 1.3 (0.8) WTE nurses. Few services were available 24 hours a day. Funding arrangements were diverse and some services had difficulties in obtaining consumables and equipment for home use. Despite rapid growth there remains considerable scope for the development of paediatric home care throughout the UK. PMID:8285782

Influence of Men's Personality and Social Support on Treatment Decision-Making for Localized Prostate Cancer.

PubMed

Reamer, Elyse; Yang, Felix; Holmes-Rovner, Margaret; Liu, Joe; Xu, Jinping

2017-01-01

Optimal treatment for localized prostate cancer (LPC) is controversial. We assessed the effects of personality, specialists seen, and involvement of spouse, family, or friends on treatment decision/decision-making qualities. We surveyed a population-based sample of men ≤ 75 years with newly diagnosed LPC about treatment choice, reasons for the choice, decision-making difficulty, satisfaction, and regret. Of 160 men (71 black, 89 white), with a mean age of 61 (±7.3) years, 59% chose surgery, 31% chose radiation, and 10% chose active surveillance (AS)/watchful waiting (WW). Adjusting for age, race, comorbidity, tumor risk level, and treatment status, men who consulted friends during decision-making were more likely to choose curative treatment (radiation or surgery) than WW/AS (OR = 11.1, p < 0.01; 8.7, p < 0.01). Men who saw a radiation oncologist in addition to a urologist were more likely to choose radiation than surgery (OR = 6.0, p = 0.04). Men who consulted family or friends (OR = 2.6, p < 0.01; 3.7, p < 0.01) experienced greater decision-making difficulty. No personality traits (pessimism, optimism, or faith) were associated with treatment choice/decision-making quality measures. In addition to specialist seen, consulting friends increased men's likelihood of choosing curative treatment. Consulting family or friends increased decision-making difficulty.

Transition of Youth and Young Adults with Emotional or Behavioral Difficulties: An Evidence-Supported Handbook

ERIC Educational Resources Information Center

Clark, Hewitt B., Ed.; Unruh, Deanne K., Ed.

2009-01-01

This comprehensive professional handbook will help transition specialists, general and special educators, school psychologists, and administrators support youth and young adults in setting goals and achieving positive outcomes across employment, education, and community settings. Through up-to-date research and in-depth analyses of five successful…

Information Competence as a Means of Developing Leadership Qualities in Student-Teachers

ERIC Educational Resources Information Center

Sarzhanova, Galiya B.; Alimbekova, Anar A.; Slambekova, Tolkyn S.; Albytova, Nazymgul P.; Salykzhanova, Shynar B.

2016-01-01

Nowadays, the world requires skilled specialists in all spheres of life. In turn, the effectiveness of their education depends on both their will and the teacher's professionalism. This study investigates the advantages of the implementation of information technologies and the possible associated difficulties. It was found that in order to achieve…

Prevention of delayed referrals through the Champlain BASE eConsult service.

PubMed

Liddy, Clare; Drosinis, Paul; Fogel, Adam; Keely, Erin

2017-08-01

To identify the proportion and evaluate the content of eConsults (electronic consultations) in which the Champlain BASE (Building Access to Specialists through eConsultation) eConsult process prompted a referral to a specialist that was not originally contemplated by the primary care provider (PCP). Cross-sectional study of all eConsults submitted between April 15, 2011, and January 31, 2015. Champlain Local Health Integration Network, a large health region in eastern Ontario. Primary care providers registered to use the Champlain BASE eConsult service. Answers from a close-out survey-completed by PCPs at the conclusion of each eConsult-stating that specialist referral was not originally contemplated but that the eConsult process had prompted referral. The logs containing the communication exchanged between the PCPs and the specialists were reviewed, and each prompted referral case was categorized by the type of question asked, if pharmaceutical advice was given, if the referral was redirected to a different specialty group, and if the referral was urgent. A total of 188 (3.4%) of 5601 eConsults completed during the study period were cases in which PCPs stated that they had originally not contemplated referring the patient to a specialist but that the Champlain BASE eConsult process had prompted referral. Prompted referrals were most often directed to cardiologists (10.6%), dermatologists (10.6%), infectious disease specialists (9.0%), hematologists (9.0%), and urologists (8.5%). The most common questions were about diagnosis (34.0%), drug treatment (18.0%), and management (15.0%). Pharmaceutical advice was given in 28.0% of prompted referral cases, and in 26.0% of cases, the face-to-face referral was redirected to another specialty group. In 5.0% of cases, the specialist stated the referral was urgent. The median specialist response time was 0.96 days (interquartile range 0.17 to 3.80 days). By providing PCPs with increased access to specialists, the Champlain BASE eConsult service serves an important role in identifying and preventing the potential detrimental consequences of delayed medical referrals across specialty groups. Copyright© the College of Family Physicians of Canada.

Project ECHO: linking university specialists with rural and prison-based clinicians to improve care for people with chronic hepatitis C in New Mexico.

PubMed

Arora, Sanjeev; Thornton, Karla; Jenkusky, Steven M; Parish, Brooke; Scaletti, Joseph V

2007-01-01

Project Extension for Community Healthcare Outcomes (Project ECHO) is a telemedicine and distance-learning program designed to improve access to quality health care for New Mexicans with hepatitis C. Project ECHO links health-care providers from rural clinics, the Indian Health Service, and prisons with specialists at the University of New Mexico. At weekly clinics, partners present and discuss patients with hepatitis C with specialists. Partners can receive continuing education credits for participating. Since June 2003, 173 hepatitis C clinics have been conducted with 1,843 case presentations. Partners have received 390 hours of training and 2,997 hours of continuing education credits. And in 2006, the State Legislature approved $1.5 million in annual funding for the project. Project ECHO has increased access to state-of-the art hepatitis C virus care for patients living in rural areas or prisons. Because of its success with hepatitis C, this project is being expanded to other chronic medical conditions.

[Lack of neonatologists: vocational crisis or mistaken policies?].

PubMed

Justich, Pablo R

2012-10-01

In Argentina, the difficulty in covering neonatologist's positions represent an increasing problem. The absence of a coordinated and organized health system on one hand, and the lack of adaptation of the neonatologist's role to the current situation of the maternal and child care on the other, prevent the correct assistential coverage. The inadequate work conditions, the professional risks, the wide amount of time devoted to formation and studying, and the lack of knowledge of the professionals necessities and difficulties have a negative impact when it comes to incorporate new specialists. A global approach of the problem is essential to reach enduring answers.

Psychiatric service use and psychiatric disorders in adults with intellectual disability.

PubMed

Bhaumik, S; Tyrer, F C; McGrother, C; Ganghadaran, S K

2008-11-01

UK policies aim to facilitate access to general psychiatric services for adults with intellectual disability (ID). If this is to be achieved, it is important to have a clear idea of the characteristics and proportion of people with ID who currently access specialist psychiatric services and the nature and extent of psychiatric disorders in this population. A cross-sectional study was carried out on all adults with ID using specialist services in Leicestershire and Rutland, UK, between 2001 and 2006. Characteristics of individuals seen by psychiatric services and the nature and prevalence of psychiatric disorders were investigated. Of 2711 adults identified, 1244 (45.9%) accessed specialist psychiatric services at least once during the study period. Individuals attending psychiatric services were more likely to be older and to live in residential settings; they were less likely to be south Asian or to have mild/moderate ID. The prevalence of psychiatric disorders among the total study population was 33.8%; the most common disorders were behaviour disorder (19.8%) and autistic spectrum disorders (8.8%). Epilepsy was highly prevalent (60.8%) among those attending psychiatric services without a mental health diagnosis. Behaviour disorders and autistic spectrum disorders were more common in men and in adults with severe/profound ID, whereas schizophrenia and organic disorders were more common in women and in adults with mild/moderate ID. Depression was also more common in women with ID. Psychiatric disorders and specialist health problems are common among adults with ID and the profile of psychiatric disorders differs from that found in general psychiatry. Close collaboration between general and specialist service providers is needed if the current move towards use of general psychiatric services in this population is to be achieved. The measures should include a clear care pathway for people with ID and mental health problems to facilitate the smooth transfer of patients between specialist and generic mental health services and arrangements for joint working where input from both services is required. The commissioning framework for such processes should be in place with appropriate pooling of resources.

Integrated primary health care: Finnish solutions and experiences

PubMed Central

Kokko, Simo

2009-01-01

Background Finland has since 1972 had a primary health care system based on health centres run and funded by the local public authorities called ‘municipalities’. On the world map of primary health care systems, the Finnish solution claims to be the most health centre oriented and also the widest, both in terms of the numbers of staff and also of different professions employed. Offering integrated care through multi-professional health centres has been overshadowed by exceptional difficulties in guaranteeing a reasonable access to the population at times when they need primary medical or dental services. Solutions to the problems of access have been found, but they do not seem durable. Description of policy practice During the past 10 years, the health centres have become a ground of active development structural change, for which no end is in sight. Broader issues of municipal and public administration structures are being solved through rearranging primary health services. In these rearrangements, integration with specialist services and with social services together with mergers of health centres and municipalities are occurring at an accelerated pace. This leads into fundamental questions of the benefits of integration, especially if extensive integration leads into the threat of the loss of identity for primary health care. Discussion This article ends with some lessons to be learned from the situation in Finland for other countries. PMID:19590612

Choral singing therapy following stroke or Parkinson's disease: an exploration of participants' experiences.

PubMed

Fogg-Rogers, Laura; Buetow, Stephen; Talmage, Alison; McCann, Clare M; Leão, Sylvia H S; Tippett, Lynette; Leung, Joan; McPherson, Kathryn M; Purdy, Suzanne C

2016-01-01

People with stroke or Parkinson's disease (PD) live with reduced mood, social participation and quality of life (QOL). Communication difficulties affect 90% of people with PD (dysarthria) and over 33% of people with stroke (aphasia). These consequences are disabling in many ways. However, as singing is typically still possible, its therapeutic use is of increasing interest. This article explores the experiences of and factors influencing participation in choral singing therapy (CST) by people with stroke or PD and their significant others. Participants (eight people with stroke, six with PD) were recruited from a community music therapy choir running CST. Significant others (seven for stroke, two for PD) were also recruited. Supported communication methods were used as needed to undertake semi-structured interviews (total N = 23). Thematic analysis indicated participants had many unmet needs associated with their condition, which motivated them to explore self-management options. CST participation was described as an enjoyable social activity, and participation was perceived as improving mood, language, breathing and voice. Choral singing was perceived by people with stroke and PD to help them self-manage some of the consequences of their condition, including social isolation, low mood and communication difficulties. Choral singing therapy (CST) is sought out by people with stroke and PD to help self-manage symptoms of their condition. Participation is perceived as an enjoyable activity which improves mood, voice and language symptoms. CST may enable access to specialist music therapy and speech language therapy protocols within community frameworks.

Barriers to accessing biologic treatment for rheumatoid arthritis in Greece: the unseen impact of the fiscal crisis--the Health Outcomes Patient Environment (HOPE) study.

PubMed

Souliotis, Kyriakos; Papageorgiou, Manto; Politi, Anastasia; Ioakeimidis, Dimitrios; Sidiropoulos, Prodromos

2014-01-01

The latest regulatory change in the distribution system of biologic disease-modifying, antirheumatic drugs limited their sale only through the designated pharmacies of the National Organization for Healthcare Services Provision (EOPYY) or the National Health System (NHS) hospitals, adding to the complexity of access to effective treatment for rheumatoid arthritis (RA) in Greece. The aim of this paper was to assess the barriers to access RA treatment, by recording patients', rheumatologists' and EOPYY pharmacists' experiences. One twenty-three patients, 12 rheumatologists and 27 pharmacists from Athens and other urban areas in Greece participated in the study. Three types of standardized questionnaires were used to elicit information from each group of respondents using the method of personal interview for patients and the method of postal survey for doctors and pharmacists. During the last year, 26% of patients encountered problems in accessing their rheumatologist and 49% of patients experienced difficulties in accessing their medication. Ninety-two percent of rheumatologists and 96% of pharmacists confirmed that patients experience difficulties in accessing RA medication. The most commonly reported reasons for reduced access to medical treatment were travel difficulties and long distance from doctor's clinic, as well as delays in booking an appointment. The most frequently reported barriers to access pharmaceutical treatment were difficulties in the prescription process, distance from EOPYY pharmacies and medicine shortages in NHS hospitals. The study showed that RA patients are facing increased barriers to access timely and effective treatment. Redesign of the current system of distribution ensuring the operation of additional points of sale is deemed necessary.

"I just answer 'yes' to everything they say": access to health care for deaf people in Worcester, South Africa and the politics of exclusion.

PubMed

Kritzinger, Janis; Schneider, Marguerite; Swartz, Leslie; Braathen, Stine Hellum

2014-03-01

To explore whether there are other factors besides communication difficulties that hamper access to health care services for deaf patients. Qualitative methodology using semi-structured interviews with 16 deaf participants from the National Institute for the Deaf in Worcester and 3 Key informants from the Worcester area, South Africa. Communication difficulties were found to be a prominent barrier in accessing health care services. In addition to this interpersonal factors including lack of independent thought, overprotectedness, non-questioning attitude, and lack of familial communication interact with communication difficulties in a way that further hampers access to health care services. These interpersonal factors play a unique role in how open and accepting health services feel to deaf patients. Health care services need to take cognizance of the fact that providing sign language interpreters in the health care setting will not necessarily make access more equitable for deaf patients, as they have additional barriers besides communication to overcome before successfully accessing health care services. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Help-seeking amongst women survivors of domestic violence: a qualitative study of pathways towards formal and informal support.

PubMed

Evans, Maggie A; Feder, Gene S

2016-02-01

Informal and formal support for women experiencing domestic violence and abuse (DVA) can improve safety and health outcomes. There has been little qualitative work on the role of both pathways to support and women's experiences of disclosing their experience of DVA in different contexts. This qualitative study used repeat interviews with women survivors of DVA to explore their pathways to support and their experiences of barriers and facilitators to disclosure and help-seeking. Thirty-one women seeking help from specialist DVA agencies in the UK were interviewed twice over 5 months. Women recounted long journeys of ambivalence, often only disclosing abuse after leaving the perpetrator. Access to specialist support rarely came via general practitioners, despite high levels of consulting for anxious and depressed feelings, and was more often facilitated by police or housing agencies following a crisis such as assault. Informal disclosure only led to specialist help if the family member or friend themselves had experience or knowledge of DVA. Women experiencing DVA need earlier access to specialized DVA services. Many women needed an 'enabler' to facilitate access, but once this contact was made, disclosure to other professionals or to family and friends was legitimized in the eyes of the women. Safely accessible publicity about DVA services and an appropriate response from social and health-care professionals should be promoted, including support for women disclosing DVA to take action on the information they receive about services. © 2014 John Wiley & Sons Ltd.

Impact of a dedicated cancer-associated thrombosis service on clinical outcomes: a mixed-methods evaluation of a clinical improvement exercise

PubMed Central

Noble, Simon; Pease, Nikki; Sui, Jessica; Davies, James; Lewis, Sarah; Malik, Usman; Alikhan, Raza; Prout, Hayley; Nelson, Annmarie

2016-01-01

Objectives Cancer-associated thrombosis (CAT) complex condition, which may present to any healthcare professional and at any point during the cancer journey. As such, patients may be managed by a number of specialties, resulting in inconsistent practice and suboptimal care. We describe the development of a dedicated CAT service and its evaluation. Setting Specialist cancer centre, district general hospital and primary care. Participants Patients with CAT and their referring clinicians. Intervention A cross specialty team developed a dedicated CAT service , including clear referral pathways, consistent access to medicines, patient's information and a specialist clinic. Primary and secondary outcome measures The service was evaluated using a mixed-methods evaluation , including audits of clinical practice, clinical outcomes, staff surveys and qualitative interviewing of patients and healthcare professionals. Results Data from 457 consecutive referrals over an 18-month period were evaluated. The CAT service has led to an 88% increase in safe and consistent community prescribing of low-molecular-weight heparin, with improved access to specialist advice and information. Patients reported improved understanding of their condition, enabling better self-management as well as better access to support and information. Referring clinicians reported better care standards for their patients with improved access to expertise and appropriate management. Conclusions A dedicated CAT service improves overall standards of care and is viewed positively by patients and clinicians alike. Further health economic evaluation would enhance the case for establishing this as the standard model of care. PMID:27895068

Affective Support for Intellectual Access: Preventing Accidents on the On-Ramp.

ERIC Educational Resources Information Center

Havener, W. Michael; Latrobe, Kathy

1995-01-01

Discussion of how students can successfully enter the information highway focuses on the role of the school media specialist. Topics include information-seeking behavior; missions and goals of library media programs; affective access, including interpersonal communication, physical and affective ergonomics, and social interaction; and global…

A Multi-Level Approach to Caregiver Training Accessibility.

ERIC Educational Resources Information Center

Range, Diana

This brief paper discusses how in 10 year's time a system for providing caregiver training was developed in Texas. The training accessibility system consists of five dimensions: publications, free materials, resource rooms, child development specialists, Title XX training contracts and traveling resource vans. Tips for program continuity under…

Barriers and facilitators to parents seeking and accessing professional support for anxiety disorders in children: qualitative interview study.

PubMed

Reardon, Tessa; Harvey, Kate; Young, Bridget; O'Brien, Doireann; Creswell, Cathy

2018-01-25

Anxiety disorders are among the most common mental health disorders experienced by children, but only a minority of these children access professional help. Understanding the difficulties parents face seeking support for child anxiety disorders could inform targeted interventions to improve treatment access. The aims of the study were to identify barriers and facilitators to seeking and accessing professional support for child anxiety disorders, and ways to minimise these barriers. A qualitative interview study was conducted with parents of 16 children (aged 7-11 years) with anxiety disorders identified through screening in schools. Barriers and facilitators were identified in relation to four distinct stages in the help-seeking process: parents recognising the anxiety difficulty, parents recognising the need for professional support, parents contacting professionals, and families receiving professional support. Barriers and facilitators at each stage related to the child's difficulties, the role of the parent, and parent perceptions of professionals and services. Findings illustrate the need (1) for readily available tools to help parents and professionals identify clinically significant anxiety in children, (2) to ensure that families and professionals can easily access guidance on the help-seeking process and available support, and (3) to ensure existing services offer sufficient provision for less severe difficulties that incorporates direct support for parents.

Safe sleeping positions: practice and policy for babies with cleft palate.

PubMed

Davies, Karen; Bruce, Iain A; Bannister, Patricia; Callery, Peter

2017-05-01

Guidance recommends 'back to sleep' positioning for infants from birth in order to reduce the risk of sudden infant death. Exceptions have been made for babies with severe respiratory difficulties where lateral positioning may be recommended, although uncertainty exists for other conditions affecting the upper airway structures, such as cleft palate. This paper presents research of (i) current advice on sleep positioning provided to parents of infants with cleft palate in the UK; and (ii) decision making by clinical nurse specialists when advising parents of infants with cleft palate. A qualitative descriptive study used data from a national survey with clinical nurse specialists from 12 regional cleft centres in the UK to investigate current practice. Data were collected using semi-structured telephone interviews and analysed using content analysis. Over half the regional centres used lateral sleep positioning based on clinical judgement of the infants' respiratory effort and upper airway obstruction. Assessment relied upon clinical judgement augmented by a range of clinical indicators, such as measures of oxygen saturation, heart rate and respiration. Specialist practitioners face a clinical dilemma between adhering to standard 'back to sleep' guidance and responding to clinical assessment of respiratory effort for infants with cleft palate. In the absence of clear evidence, specialist centres rely on clinical judgement regarding respiratory problems to identify what they believe is the most appropriate sleeping position for infants with cleft palate. Further research is needed to determine the best sleep position for an infant with cleft palate. What is Known • Supine sleep positioning reduces the risk of sudden infant death in new born infants. • There is uncertainty about the benefits or risks of lateral sleep positioning for infants with upper airway restrictions arising from cleft palate. What is New • Variability exists in the information/advice provided to parents of infants with cleft palate regarding sleep positioning. • Over half the national specialist centres for cleft palate in the UK advise positioning infants with CP in the lateral position as a routine measure to reduce difficulties with respiration.

The prescribing practices of nurses who care for patients with skin conditions: a questionnaire survey.

PubMed

Carey, Nicola; Courtenay, Molly; Stenner, Karen

2013-07-01

To explore the practice of nurses who prescribe medication for patients with skin conditions. Nurses have lead roles in dermatology services. In the United Kingdom, nurses in primary care frequently prescribe medicines for skin conditions, but there are concerns about role preparation and access to continuing professional development. The prescribing practices of nurse independent supplementary prescribers who care for patients with skin conditions are under-researched. Cross-sectional survey. An online questionnaire was used to survey 186 nurses who prescribed for skin conditions from May-July 2010. Data were analysed using descriptive statistics and nonparametric tests. The majority worked in primary care (78%) and general practice (111, 59.7%). Twenty (10.8%) had specialist modules (at diploma, degree or master's level), 104 (55.9%) had dermatology training (e.g. study days), 44 (23.7%) had no training, and a further 18 (9.6%) did not respond. Oral antibiotics, topical antifungal and antibacterial drugs were frequently prescribed. Nurses with specialist dermatology training used their qualification in a greater number of ways, prescribed the broadest range of products and prescribed more items per week. Over 70% reporting on continuing professional development had been able to access it. A large number of nurses in primary care prescribe medicines for skin conditions and are involved in medicines management activities. Lack of specialist dermatology training is a concern and associated with lower prescribing-related activities. Access to dermatology training and continuing professional development are required to support nurse development in this area of practice and maximise benefits. Nurse prescribers' involvement in medicines management activities has important implications in terms of improving access to services, efficiency and cost savings. To maximise their contribution, improved provision of specialist dermatology training is required. This will be of interest to education providers and service planners in the UK and countries around the world. © 2013 John Wiley & Sons Ltd.

Paediatric rheumatology practice in the UK benchmarked against the British Society for Paediatric and Adolescent Rheumatology/Arthritis and Musculoskeletal Alliance Standards of Care for juvenile idiopathic arthritis.

PubMed

Kavirayani, Akhila; Foster, Helen E

2013-12-01

To describe current clinical practice against the BSPAR/ARMA Standards of Care (SOCs) for children and young people (CYP) with incident JIA. Ten UK paediatric rheumatology centres (including all current centres nationally accredited for paediatric rheumatology higher specialist training) participated in a retrospective case notes review using a pretested pro forma based on the SOC. Data collected per centre included clinical service configuration and the initial clinical care for a minimum of 30 consecutive new patients seen within the previous 2 years and followed up for at least 6 months. A total of 428 CYP with JIA (median age 11 years, range 1-21 years) were included, with complete data available for 73% (311/428). Against the key SOCs, 41% (175/428) were assessed ≤10 weeks from symptom onset, 60% (186/311) ≤4 weeks from referral, 26% (81/311) had eye screening at ≤6 weeks, 83% (282/341) had joint injections at ≤6 weeks, 59% (184/311) were assessed by a nurse specialist at ≤4 weeks and 45% (141/311) were assessed by a physiotherapist at ≤8 weeks. A median of 6% of patients per centre participated in clinical trials. All centres had access to eye screening and prescribed biologic therapies. All had access to a nurse specialist and physiotherapist. Most had access to an occupational therapist (8/10), psychologist (8/10), joint injection lists (general anaesthesia/inhaled analgesia) (9/10) and designated transitional care clinics (7/10). This first description of UK clinical practice in paediatric rheumatology benchmarked against the BSPAR/ARMA SOCs demonstrates variable clinical service delivery. Considerable delay in access to specialist care is evident and this needs to be addressed in order to improve clinical outcomes.

Providers' Access of Imaging Versus Only Reports: A System Log File Analysis.

PubMed

Jung, Hye-Young; Gichoya, Judy Wawira; Vest, Joshua R

2017-02-01

An increasing number of technologies allow providers to access the results of imaging studies. This study examined differences in access of radiology images compared with text-only reports through a health information exchange system by health care professionals. The study sample included 157,256 historical sessions from a health information exchange system that enabled 1,670 physicians and non-physicians to access text-based reports and imaging over the period 2013 to 2014. The primary outcome was an indicator of access of an imaging study instead of access of a text-only report. Multilevel mixed-effects regression models were used to estimate the association between provider and session characteristics and access of images compared with text-only reports. Compared with primary care physicians, specialists had an 18% higher probability of accessing actual images instead of text-only reports (β = 0.18; P < .001). Compared with primary care practice settings, the probability of accessing images was 4% higher for specialty care practices (P < .05) and 8% lower for emergency departments (P < .05). Radiologists, orthopedists, and neurologists accounted for 79% of all the sessions with actual images accessed. Orthopedists, radiologists, surgeons, and pulmonary disease specialists accessed imaging more often than text-based reports only. Consideration for differences in the need to access images compared with text-only reports based on the type of provider and setting of care are needed to maximize the benefits of image sharing for patient care. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Comparative Effectiveness of Web-Based vs. Educator-Delivered HIV Prevention for Adolescent Substance Users: A Randomized, Controlled Trial.

PubMed

Marsch, Lisa A; Guarino, Honoria; Grabinski, Michael J; Syckes, Cassandra; Dillingham, Elaine T; Xie, Haiyi; Crosier, Benjamin S

2015-12-01

Young people who engage in substance use are at risk for becoming infected with HIV and diseases with similar transmission dynamics. Effective disease prevention programs delivered by prevention specialists exist but are rarely provided in systems of care due to staffing/resource constraints and operational barriers-and are thus of limited reach. Web-based prevention interventions could possibly offer an effective alternative to prevention specialist-delivered interventions and may enable widespread, cost-effective access to evidence-based prevention programming. Previous research has shown the HIV/disease prevention program within the Web-based therapeutic education system (TES) to be an effective adjunct to a prevention specialist-delivered intervention. The present study was the first randomized, clinical trial to evaluate the comparative effectiveness of this Web-based intervention as a standalone intervention relative to a traditional, prevention specialist-delivered intervention. Adolescents entering outpatient treatment for substance use participated in this multi-site trial. Participants were randomly assigned to either a traditional intervention delivered by a prevention specialist (n=72) or the Web-delivered TES intervention (n=69). Intervention effectiveness was assessed by evaluating changes in participants' knowledge about HIV, hepatitis, and sexually transmitted infections, intentions to engage in safer sex, sex-related risk behavior, self-efficacy to use condoms, and condom use skills. Participants in the TES intervention achieved significant and comparable increases in HIV/disease-related knowledge, condom use self-efficacy, and condom use skills and comparable decreases in HIV risk behavior relative to participants who received the intervention delivered by a prevention specialist. Participants rated TES as easier to understand. This study indicates that TES is as effective as HIV/disease prevention delivered by a prevention specialist. Because technology-based interventions such as TES have high fidelity, are inexpensive and scalable, and can be implemented in a wide variety of settings, they have the potential to greatly increase access to effective prevention programming. Copyright © 2015 Elsevier Inc. All rights reserved.

JPRS Report, East Europe.

DTIC Science & Technology

1987-09-23

economic impact . Here, the cooperation of specialists from research institutes is required. c) Practice has shown that not...recording the national economic impact is the determination of the applicability area and the applicability volume. Here, in practice, repeated difficulties...68 68 Dascalescu Speech, by Constantin Dascalescu Olteanu Speech, by Constantin Olteanu Defense Minister’s Order of the Day, by Vasile Milea

Problematic Topics in First-Year Mathematics: Lecturer and Student Views

ERIC Educational Resources Information Center

Ní Shé, Caitríona; Mac an Bhaird, Ciarán; Ní Fhloinn, Eabhnat; O'Shea, Ann

2017-01-01

In this paper we report on the outcomes of two surveys carried out in higher education institutions of Ireland; one of students attending first-year undergraduate non-specialist mathematics modules and another of their lecturers. The surveys aimed to identify the topics that these students found difficult, whether they had most difficulty with the…

KSC-98pc504

NASA Image and Video Library

1998-04-17

KENNEDY SPACE CENTER, FLA. -- Framed by native Floridian foliage, the Space Shuttle Columbia soars from Launch Pad 39B at 2:19 p.m. EDT Apr. 17 to begin the nearly 17-day STS-90 Neurolab mission. The launch was delayed 24 hours due to difficulty with a network signal processor, which was replaced Apr. 16, on the orbiter. The crew members are Commander Richard Searfoss, Pilot Scott Altman, Mission Specialists Richard Linnehan, D.V.M., Dafydd (Dave) Williams, M.D., with the Canadian Space Agency, and Kathryn (Kay) Hire; and Payload Specialists Jay Buckey, M.D., and James Pawelczyk, Ph.D. Investigations during the Neurolab mission will focus on the effects of microgravity on the nervous system

KSC-98pc503

NASA Image and Video Library

1998-04-17

KENNEDY SPACE CENTER, FLA. -- The Space Shuttle Columbia surges skyward from Launch Pad 39B at 2:19 p.m. EDT Apr. 17 to begin the nearly 17-day STS-90 Neurolab mission. The launch was delayed 24 hours due to difficulty with a network signal processor, which was replaced Apr. 16, on the orbiter. The crew members on-board include Commander Richard Searfoss, Pilot Scott Altman, Mission Specialists Richard Linnehan, D.V.M., Dafydd (Dave) Williams, M.D., with the Canadian Space Agency, and Kathryn (Kay) Hire; and Payload Specialists Jay Buckey, M.D., and James Pawelczyk, Ph.D. Investigations during the Neurolab mission will focus on the effects of microgravity on the nervous system

Consumers’ experiences of back pain in rural Western Australia: access to information and services, and self-management behaviours

PubMed Central

2012-01-01

Background Coordinated, interdisciplinary services, supported by self-management underpin effective management for chronic low back pain (CLBP). However, a combination of system, provider and consumer-based barriers exist which limit the implementation of such models into practice, particularly in rural areas where unique access issues exist. In order to improve health service delivery for consumers with CLBP, policymakers and service providers require a more in depth understanding of these issues. The objective of this qualitative study was to explore barriers experienced by consumers in rural settings in Western Australia (WA) to accessing information and services and implementing effective self-management behaviours for CLBP. Methods Fourteen consumers with a history of CLBP from three rural sites in WA participated. Maximum variation sampling was employed to ensure a range of experiences were captured. An interviewer, blinded to quantitative pain history data, conducted semi-structured telephone interviews using a standardised schedule to explore individuals’ access to information and services for CLBP, and self-management behaviours. Interviews were digitally recorded and transcribed verbatim. Inductive analysis techniques were used to derive and refine key themes. Results Five key themes were identified that affected individuals’ experiences of managing CLBP in a rural setting, including: 1) poor access to information and services in rural settings; 2) inadequate knowledge and skills among local practitioners; 3) feelings of isolation and frustration; 4) psychological burden associated with CLBP; and 5) competing lifestyle demands hindering effective self-management for CLBP. Conclusions Consumers in rural WA experienced difficulties in knowing where to access relevant information for CLBP and expressed frustration with the lack of service delivery options to access interdisciplinary and specialist services for CLBP. Competing lifestyle demands such as work and family commitments were cited as key barriers to adopting regular self-management practices. Consumer expectations for improved health service coordination and a workforce skilled in pain management are relevant to future service planning, particularly in the contexts of workforce capacity, community health services, and enablers to effective service delivery in primary care. PMID:23057669

The accuracy of the Jamaican national physician register: a study of the status of physicians registered and their countries of training

PubMed Central

Knight-Madden, Jennifer; Gray, Robert

2008-01-01

Background The number of physicians per 10,000 population is a basic health indicator used to determine access to health care. Studies from the United States of America and Europe indicate that their physician registration databases may be flawed. Clinical research activities have suggested that the current records of physicians registered to practice in Jamaica may not be accurate. Our objective was to determine whether the Medical Council of Jamaica (MCJ) accurately records and reports the identities, number and specialty designation of physicians in Jamaica. An additional aim was to determine the countries in which these physicians were trained. Methods Data regarding physicians practicing in Jamaica in 2005 were obtained from multiple sources including the MCJ and the telephone directory. Intense efforts at tracing were undertaken in a sub-sample of physicians, internists and paediatricians to further improve the accuracy of the data. Data were analysed using SPSS, version 11.5. Results The MCJ listed 2667 registered physicians of which 118 (4.4%) were no longer practicing in Jamaica. Of the subset of 150 physicians who were more actively traced, an additional 11 were found to be no longer in practice. Thus at least 129 (4.8%) of the physicians on the MCJ list were not actively practising in Jamaica. Twenty-nine qualified physicians who were in practice, but not currently on the Jamaican register, were identified from other data sources. This yielded an estimate of 2567 physicians or 9.68 physicians per 10,000 persons. Seven hundred and twenty six specialists were identified, 118 from the MCJ list only, 452 from other sources, in particular medical associations, and 156 from both the MCJ list and other sources. Sixty-six percent of registered doctors completed medical school at the University of the West Indies (UWI). Conclusion These data suggest that the MCJ list includes some physicians no longer practicing in Jamaica while underestimating the number of specialists. Difficulty in accurately estimating the number of practicing physicians has been reported in studies done in other countries but the under-reporting of the number of specialists is uncommon. Additional consideration should be given to strategies to ensure compliance with the annual registration that is mandated by law and to changing the law to include registration of specialist qualifications. PMID:19077244

Enabling factors for specialist outreach in western KwaZulu-Natal

PubMed Central

2018-01-01

Background There exists a major disparity in access to specialist care between patients in urban and rural areas. Specialists are a scarce resource and are concentrated in urban areas. Specialist outreach attempts to fill the gap in service provision for patients situated remotely. While there is international evidence that multifaceted specialist outreach has achieved varying levels of success, factors that influence the effectiveness of outreach have not yet been fully elucidated in South Africa. Aim This study attempts to uncover some of the factors that enable good multifaceted specialist outreach. Setting The study was conducted in hospitals in western KwaZulu-Natal province. This health area is served by a tertiary hospital and 20 peripheral hospitals; three of these are regional level and the majority are district level hospitals. Specialist outreach emanates from the tertiary hospital. Methods Specialists providing outreach services from the tertiary hospital and medical officers at seven receiving hospitals were interviewed to explore perceptions regarding factors that might enable successful specialist outreach. Framework analysis on the transcribed interviews was carried out using NVivo version 11. Results A major positive finding concerns the relationships formed between outreach specialists and doctors at the recipient hospitals. The management of the programme with respect to structure, dependability, data management, transport provision, communication technology and public health systems was also seen as beneficial in specialist outreach. Conclusion Specialist outreach plays an essential role in providing equality in health care. To enable effectiveness, it is important to make full use of the multifaceted nature of this intervention. PMID:29781691

Big data, miniregistries: a rapid-turnaround solution to get quality improvement data into the hands of medical specialists.

PubMed

Herrinton, Lisa J; Liu, Liyan; Altschuler, Andrea; Dell, Richard; Rabrenovich, Violeta; Compton-Phillips, Amy L

2015-01-01

The cost to build and to maintain traditional registries for many dire, complex, low-frequency conditions is prohibitive. The authors used accessible technology to develop a platform that would generate miniregistries (small, routinely updated datasets) for surveillance, to identify patients who were missing elected utilization and to influence clinicians to change practices to improve care. The platform, tested in 5 medical specialty departments, enabled the specialists to rapidly and effectively communicate clinical questions, knowledge of disease, clinical workflows, and improve opportunities. Each miniregistry required 1 to 2 hours of collaboration by a specialist. Turnaround was 1 to 14 days.

Predictors of round window accessibility for adult cochlear implantation based on pre-operative CT scan: a prospective observational study.

PubMed

Park, Edward; Amoodi, Hosam; Kuthubutheen, Jafri; Chen, Joseph M; Nedzelski, Julian M; Lin, Vincent Y W

2015-05-28

Cochlear implantation has become a mainstream treatment option for patients with severe to profound sensorineural hearing loss. During cochlear implant, there are key surgical steps which are influenced by anatomical variations between each patient. The aim of this study is to determine if there are potential predictors of difficulties that may be encountered during the cortical mastoidectomy, facial recess approach and round window access in cochlear implant surgery based upon pre-operative temporal bone CT scan. Fifty seven patients undergoing unilateral cochlear implantation were analyzed. Difficulty with 1) cortical mastoidectomy, 2) facial recess approach, and 3) round window access were scored intra-operatively by the surgeon in a blinded fashion (1 = "easy", 2 = "moderate", 3 = "difficult"). Pre-operative temporal bone CT scans were analyzed for 1) degree of mastoid aeration; 2) location of the sigmoid sinus; 3) height of the tegmen; 4) the presence of air cells in the facial recess, and 5) degree of round window bony overhang. Poor mastoid aeration and lower tegmen position, but not the location of sigmoid sinus, are associated with greater difficulty with the cortical mastoidectomy. Presence of an air cell around the facial nerve was predictive of easier facial recess access. However, the degree of round window bony overhang was not predictive of difficulty associated with round window access. Certain parameters on the pre-operative temporal bone CT scan may be useful in predicting potential difficulties encountered during the key steps involved in cochlear implant surgery.

Big6 Stage 3 - Location and Access Treasure Hunting

ERIC Educational Resources Information Center

Darrow, Rob

2005-01-01

Locating sources and accessing the information they contain is part of the Big6 approach to information problem solving. In this stage of knowing where to look and how to find the required source, library media specialists train students in the use of the card catalog in the library media center.

An Accessible Approach to Understanding Entropy and Change

ERIC Educational Resources Information Center

Johnson, Philip

2018-01-01

This article challenges the notion that entropy is something to be avoided. A line of argument is presented that is accessible to those not having specialist knowledge and that offers a new perspective to those more familiar with the concept. It shows that temperature is better understood by addressing entropy. Entropy change diagrams are…

Hitch Your Wagon to a Mission Statement

ERIC Educational Resources Information Center

Zmuda, Allison

2007-01-01

Library media specialists typically are expected to collaborate with everyone. Because the teacher holds the proverbial key to the classroom door, he or she also has the access to the students. If there is no access to students, there is no opportunity to cause student learning. Real collaboration is, in contrast, based on a mutual understanding…

Beyond Search Technique and Strategy: Helping Students to Be Informed.

ERIC Educational Resources Information Center

Aversa, Elizabeth

1991-01-01

Suggests ways that the school library media specialist can help students become more successful as users of online information. Four types of barriers to becoming informed are described: (1) indicative access barriers (indexing systems and relevance); (2) physical access to documents identified in a search; (3) linguistic barriers; and (4)…

GuiaTreeKey, a multi-access electronic key to identify tree genera in French Guiana.

PubMed

Engel, Julien; Brousseau, Louise; Baraloto, Christopher

2016-01-01

The tropical rainforest of Amazonia is one of the most species-rich ecosystems on earth, with an estimated 16000 tree species. Due to this high diversity, botanical identification of trees in the Amazon is difficult, even to genus, often requiring the assistance of parataxonomists or taxonomic specialists. Advances in informatics tools offer a promising opportunity to develop user-friendly electronic keys to improve Amazonian tree identification. Here, we introduce an original multi-access electronic key for the identification of 389 tree genera occurring in French Guiana terra-firme forests, based on a set of 79 morphological characters related to vegetative, floral and fruit characters. Its purpose is to help Amazonian tree identification and to support the dissemination of botanical knowledge to non-specialists, including forest workers, students and researchers from other scientific disciplines. The electronic key is accessible with the free access software Xper ², and the database is publicly available on figshare: https://figshare.com/s/75d890b7d707e0ffc9bf (doi: 10.6084/m9.figshare.2682550).

Specialist Bibliographic Databases

PubMed Central

2016-01-01

Specialist bibliographic databases offer essential online tools for researchers and authors who work on specific subjects and perform comprehensive and systematic syntheses of evidence. This article presents examples of the established specialist databases, which may be of interest to those engaged in multidisciplinary science communication. Access to most specialist databases is through subscription schemes and membership in professional associations. Several aggregators of information and database vendors, such as EBSCOhost and ProQuest, facilitate advanced searches supported by specialist keyword thesauri. Searches of items through specialist databases are complementary to those through multidisciplinary research platforms, such as PubMed, Web of Science, and Google Scholar. Familiarizing with the functional characteristics of biomedical and nonbiomedical bibliographic search tools is mandatory for researchers, authors, editors, and publishers. The database users are offered updates of the indexed journal lists, abstracts, author profiles, and links to other metadata. Editors and publishers may find particularly useful source selection criteria and apply for coverage of their peer-reviewed journals and grey literature sources. These criteria are aimed at accepting relevant sources with established editorial policies and quality controls. PMID:27134485

Specialist Bibliographic Databases.

PubMed

Gasparyan, Armen Yuri; Yessirkepov, Marlen; Voronov, Alexander A; Trukhachev, Vladimir I; Kostyukova, Elena I; Gerasimov, Alexey N; Kitas, George D

2016-05-01

Specialist bibliographic databases offer essential online tools for researchers and authors who work on specific subjects and perform comprehensive and systematic syntheses of evidence. This article presents examples of the established specialist databases, which may be of interest to those engaged in multidisciplinary science communication. Access to most specialist databases is through subscription schemes and membership in professional associations. Several aggregators of information and database vendors, such as EBSCOhost and ProQuest, facilitate advanced searches supported by specialist keyword thesauri. Searches of items through specialist databases are complementary to those through multidisciplinary research platforms, such as PubMed, Web of Science, and Google Scholar. Familiarizing with the functional characteristics of biomedical and nonbiomedical bibliographic search tools is mandatory for researchers, authors, editors, and publishers. The database users are offered updates of the indexed journal lists, abstracts, author profiles, and links to other metadata. Editors and publishers may find particularly useful source selection criteria and apply for coverage of their peer-reviewed journals and grey literature sources. These criteria are aimed at accepting relevant sources with established editorial policies and quality controls.

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

PubMed

Astbury, Jill; Bruck, Dorothy; Loxton, Deborah

2011-01-01

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

The use of the BDA Case Mix Model to assess the need for referral of patients to specialist dental services.

PubMed

AlKindi, N A; Nunn, J

2016-04-22

Access to health services is a right for every individual. However, there is evidence that people with disabilities face barriers in accessing dental health. One of the reasons associated with this is the unclear referral pathway existing in the Irish dental health service. The appropriate assignment of patients to relevant services is an important issue to ensure better access to healthcare. This is all the more pertinent because there are only a few trained dental practitioners to provide dental treatment for people with disabilities, as well as even fewer qualified specialists in special care dentistry. The aim of this part of the study was to assess the use of the BDA Case Mix Model to determine the need for referral of patients to specialist dental services, and to determine any association between patient complexity and the need for adjunct measures, such as sedation and general anaesthesia for the management of people with disabilities and complex needs. A retrospective analysis of dental records using the BDA Case Mix Model.Results The results showed that patients with different levels of complexities were being referred to the special care dentistry clinic at the Dublin Dental University Hospital. The results also showed that the need for supportive adjunct measures such as sedation and general anaesthesia was not necessarily the main reason for referring patients to specialist services. The assessment with the BDA Case Mix Model was comprehensive as it looked at many factors contributing to the cases' complexity. Not all categories in the Case Mix Model had significant association with the need for an adjunct.Conclusion The BDA Case Mix Model can be used to measure the need for supportive adjunct measures, such as sedation and general anaesthesia.

Space Shuttle Projects

NASA Image and Video Library

1985-11-30

The crew assigned to the STS-61B mission included Bryan D. O’Conner, pilot; Brewster H. Shaw, commander; Charles D. Walker, payload specialist; mission specialists Jerry L. Ross, Mary L. Cleave, and Sherwood C. Spring; and Rodolpho Neri Vela, payload specialist. Launched aboard the Space Shuttle Atlantis November 28, 1985 at 7:29:00 pm (EST), the STS-61B mission’s primary payload included three communications satellites: MORELOS-B (Mexico); AUSSAT-2 (Australia); and SATCOM KU-2 (RCA Americom). Two experiments were conducted to test assembling erectable structures in space: EASE (Experimental Assembly of Structures in Extravehicular Activity), and ACCESS (Assembly Concept for Construction of Erectable Space Structure). In a joint venture between NASA/Langley Research Center in Hampton, Virginia, and the Marshall Space Flight Center (MSFC), the EASE and ACCESS were developed and demonstrated at MSFC's Neutral Buoyancy Simulator (NBS). In this STS-61B onboard photo, astronaut Spring was working on the EASE during an Extravehicular Activity (EVA). The primary objective of this experiment was to test the structural assembly concepts for suitability as the framework for larger space structures and to identify ways to improve the productivity of space construction.

[Nonattendance to medical specialists’ appointments and its relation to regional environmental and socioeconomic indicators in the Chilean public health system].

PubMed

Rebolledo, Elizabeth Angélica Salinas; Mesía, Rolando De la Cruz; Silva, Gabriel Bastías

2014-10-16

Medical care provided by medical specialists is one of the scarcest resources in the public system. It is costly and difficult to access for the general population. Availability and accessibility of specialized care is related to economic, social and cultural aspects that vary among geographical areas. An aggravating factor for this situation is patients’ failure to appear on the date of their appointment, which is defined as the nonattendance of patients to medical specialist appointments without notice. To measure and analyze the phenomenon of nonattendance of patients to medical appointments with specialists in the public healthcare system of Chile and its relationship with environmental and socioeconomic regional indicators. Ecological design study, using medical care records in the public system and environmental and socioeconomic regional indicators potentially related to the absence of patients, between the years 2005-2010. Poisson regression models with random components were used for assessing associations. There is 16.5% of nonattendance of patients, with a range between regions from 8.8 to 20.2%. Nonattendance is higher in the specialties of dermatology, geriatrics and nutrition (20.0%), in children (3.1% more than in adults), in areas with highest indigenous population (RR=1.3), in areas with low diversity of specialties (RR=1.1) and in the months of February, July, November and December (RR>1.1). In Chile, socioeconomic factors and the management of healthcare resources have greater influence on the nonattendance of patients to medical specialists’ appointments than environmental factors; therefore, this phenomenon may be avoidable.

Specialist participation in healthcare delivery transformation: influence of patient self-referral.

PubMed

Aliu, Oluseyi; Sun, Gordon; Burke, James; Chung, Kevin C; Davis, Matthew M

2014-01-01

Improving coordination of care and containing healthcare costs are prominent goals of healthcare reform. Specialist involvement in healthcare delivery transformation efforts like Accountable Care Organizations (ACOs) is necessary to achieve these goals. However, patients’ self-referrals to specialists may undermine care coordination and incur unnecessary costs if patients frequently receive care from specialists not engaged in such healthcare delivery transformation efforts. Additionally, frequent self-referrals may also diminish the incentive for specialist participation in reform endeavors like ACOs to get access to a referral base. To examine recent national trends in self-referred new visits to specialists. A descriptive cross-sectional study of new ambulatory visits to specialists from 2000 to 2009 using data from the National Ambulatory Medical Care Survey. We calculated nationally representative estimates of the proportion of new specialist visits through self-referrals among Medicare and private insurance beneficiaries. We also estimated the nationally representative absolute number of self-referred new specialist visits among both groups of beneficiaries. Among Medicare and private insurance beneficiaries, self-referred visits declined from 32.2% (95% confidence interval [CI], 24.0%-40.4%) to 19.6% (95% CI, 13.9%-23.3%) and from 32.4% (95% CI, 27.9%-36.8%) to 24.1% (95% CI,18.8%-29.4%), respectively. Hence, at least 1 in 5 and 1 in 4 new visits to specialists among Medicare and private insurance beneficiaries, respectively, are self-referred. The current considerable rate of self-referred new specialist visits among both Medicare and private insurance beneficiaries may have adverse implications for organizations attempting to transform healthcare delivery with improved care coordination.

Impact of a dedicated cancer-associated thrombosis service on clinical outcomes: a mixed-methods evaluation of a clinical improvement exercise.

PubMed

Noble, Simon; Pease, Nikki; Sui, Jessica; Davies, James; Lewis, Sarah; Malik, Usman; Alikhan, Raza; Prout, Hayley; Nelson, Annmarie

2016-11-28

Cancer-associated thrombosis (CAT) complex condition, which may present to any healthcare professional and at any point during the cancer journey. As such, patients may be managed by a number of specialties, resulting in inconsistent practice and suboptimal care. We describe the development of a dedicated CAT service and its evaluation. Specialist cancer centre, district general hospital and primary care. Patients with CAT and their referring clinicians. A cross specialty team developed a dedicated CAT service , including clear referral pathways, consistent access to medicines, patient's information and a specialist clinic. The service was evaluated using a mixed-methods evaluation , including audits of clinical practice, clinical outcomes, staff surveys and qualitative interviewing of patients and healthcare professionals. Data from 457 consecutive referrals over an 18-month period were evaluated. The CAT service has led to an 88% increase in safe and consistent community prescribing of low-molecular-weight heparin, with improved access to specialist advice and information. Patients reported improved understanding of their condition, enabling better self-management as well as better access to support and information. Referring clinicians reported better care standards for their patients with improved access to expertise and appropriate management. A dedicated CAT service improves overall standards of care and is viewed positively by patients and clinicians alike. Further health economic evaluation would enhance the case for establishing this as the standard model of care. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Internal medicine specialists' attitudes towards working part-time: a comparison between 1996 and 2004

PubMed Central

Lugtenberg, Marjolein; Heiligers, Phil JM; de Jong, Judith D; Hingstman, Lammert

2006-01-01

Background Although medical specialists traditionally hold negative views towards working part-time, the practice of medicine has evolved. Given the trend towards more part-time work and that there is no evidence that it compromises the quality of care, attitudes towards part-time work may have changed as well in recent years. The aim of this paper was to examine the possible changes in attitudes towards part-time work among specialists in internal medicine between 1996 and 2004. Moreover, we wanted to determine whether these attitudes were associated with individual characteristics (age, gender, investments in work) and whether attitudes of specialists within a partnership showed more resemblance than specialists' attitudes from different partnerships. Methods Two samples were used in this study: data of a survey conducted in 1996 and in 2004. After selecting internal medicine specialists working in general hospitals in The Netherlands, the sample consisted of 219 specialists in 1996 and 363 specialists in 2004. They were sent a questionnaire, including topics on the attitudes towards part-time work. Results Internal medicine specialists' attitudes towards working part-time became slightly more positive between 1996 and 2004. Full-time working specialists in 2004 still expressed concerns regarding the investments of part-timers in overhead tasks, the flexibility of task division, efficiency, communication and continuity of care. In 1996 gender was the only predictor of the attitude, in 2004 being a full- or a part-timer, age and the time invested in work were associated with this attitude. Furthermore, specialists' attitudes were not found to cluster much within partnerships. Conclusion In spite of the increasing number of specialists working or preferring to work part-time, part-time practice among internal medicine specialists seems not to be fully accepted. The results indicate that the attitudes are no longer gender based, but are associated with age and work aspects such as the number of hours worked. Though there is little evidence to support them, negative ideas about the consequences of part-time work for the quality of care still exist. Policy should be aimed at removing the organisational difficulties related to part-time work and create a system in which part-time practice is fully integrated and accepted. PMID:17026741

The Complex Learning Difficulties and Disabilities Research Project: Developing Meaningful Pathways to Personalised Learning. Executive Summary

ERIC Educational Resources Information Center

Schools Network, 2011

2011-01-01

The Specialist Schools and Academies Trust (SSAT) was commissioned by the Department for Education (DfE) to research ways to improve outcomes for children and young people with the most complex educational needs and disabilities through the development of evidence-based teaching and learning strategies. The programme of research brought together a…

Reports on the STARTER/101 Pilot Project in the Reading Center of the D.C. Public Schools.

ERIC Educational Resources Information Center

O'Keefe, Ruth Ann

Eight reading specialists and seven classroom teachers in Washington, D.C., taught the STARTER/101 reading program to 98 elementary school children in 1969-70. The children were chosen because they had experienced considerable difficulty in learning to read. The program, designed as a beginning reading program for urban children, consists of…

Chomsky: Selected Readings. Language and Language Learning Series, No. 31.

ERIC Educational Resources Information Center

Allen, J. P. B., Ed.; Van Buren, Paul, Ed.

The aim of this collection of Noam Chomsky's writings over the past 12 years is to present the main outlines of transformational theory, using as far as possible Chomsky's own words, but arranged in such a way that a non-specialist will have no difficulty in following the text. The topics covered include syntax, phonology, semantics, and language…

Does the Noun Phrase Accessibility Hierarchy Predict the Difficulty Order in the Acquisition of Japanese Relative Clauses?

ERIC Educational Resources Information Center

Ozeki, Hiromi; Shirai, Yasuhiro

2007-01-01

Although Keenan and Comrie's (1977) noun phrase accessibility hierarchy (NPAH) has been shown to predict the difficulty order of relative clauses (RCs) in SLA, most studies of the NPAH have been on European languages. This paper tests the prediction for Japanese. Study 1 analyzes RCs in an oral interview corpus from 90 learners of Japanese at four…

Plan characteristics and SSI enrollees' access to and quality of care in four TennCare MCOs.

PubMed

Hill, Steven C; Wooldridge, Judith

2002-10-01

To assess hypotheses about which managed care organization (MCO) characteristics affect access to care and quality of care--including access to specialists, providers' knowledge about disability, and coordination of care--for people with disabilities. Survey of blind/disabled Supplemental Security Income (SSI) enrollees in four MCOs serving TennCare, Tennessee's Medicaid managed care program, in Memphis, conducted from 1998 through spring 1999. We compared enrollee reports of access and quality across the four MCOs using regression methods, and we use case study methods to assess whether patterns both within and across MCOs are consistent with the hypotheses. We conducted computer-assisted telephone surveys and used regression analysis to compare access and quality controlling for enrollee characteristics. Although the four MCOs' characteristics varied, access to providers, coordination of care, and access to some services were generally similar across MCOs. Enrollees in one plan, the only MCO with a larger provider network and that paid physicians on a fee-for-service basis, reported their providers were more knowledgeable, and they had more secondary preventive care visits. Differences found in access to specialists and delays in approving care appear to be unrelated to characteristics reported by the MCOs, but instead may be related to how tightly utilization is reviewed. Plan networks, financial incentives, utilization management methods, and state requirements are important areas for further study, and, in the meantime, ongoing monitoring of SSI enrollees in each MCO may be important for detecting problems and successes.

Why are some medical specialists working part-time, while others work full-time?

PubMed

de Jong, Judith D; Heiligers, Phil; Groenewegen, Peter P; Hingstman, Lammert

2006-10-01

Although medical specialists primarily work full-time, part-time work is on the increase, a trend that can be found worldwide. This article seeks to answer the question why some medical specialists work part-time, while others do not although they are willing to work part-time. Two approaches are used. First, we studied reported reasons and as a second approach we used a theoretical model, based on goal-directed behavior and restrictions. A questionnaire was sent to all internists (N=817), surgeons (N=693) and radiologists (N=621) working in general hospitals in The Netherlands. Questions were asked about personal traits, characteristics of the work situation, and motives for working full-time or part-time. Frequencies were reported for the reasons given, and multilevel analysis was used to test the theoretical model. The results show that the reported reasons for working part-time and being willing to work part-time are the same: the importance of family and leisure pursuits. The second approach showed that medical specialists working part-time tend to be female, older, and have children below the age of five. Surgeons are least likely to work part-time. A willingness to work part-time is purely individual and not related to any of the explanatory variables. We conclude that working part-time is related to both professional and personal circumstances. Policy should be aimed at removing the organizational difficulties that obstruct the realization of part-time work. Alternatively, perhaps there should be a change in working hours for all medical specialists. As the majority of all full-time working medical specialists are willing to work part-time, this might indicate that most medical specialists actually prefer "normal" working hours.

Reduced food access due to a lack of money, inability to lift and lack of access to a car for food shopping: a multilevel study in Melbourne, Victoria.

PubMed

Burns, Cate; Bentley, Rebecca; Thornton, Lukar; Kavanagh, Anne

2011-06-01

To describe associations between demographic and individual and area-level socio-economic variables and restricted household food access due to lack of money, inability to lift groceries and lack of access to a car to do food shopping. Multilevel study of three measures of restricted food access, i.e. running out of money to buy food, inability to lift groceries and lack of access to a car for food shopping. Multilevel logistic regression was conducted to examine the risk of each of these outcomes according to demographic and socio-economic variables. Random selection of households from fifty small areas in Melbourne, Australia, in 2003. The main food shoppers in each household (n 2564). A lack of money was significantly more likely among the young and in households with single adults. Difficulty lifting was more likely among the elderly and those born overseas. The youngest and highest age groups both reported reduced car access, as did those born overseas and single-adult households. All three factors were most likely among those with a lower individual or household socio-economic position. Increased levels of area disadvantage were independently associated with difficulty lifting and reduced car access. In Melbourne, households with lower individual socio-economic position and area disadvantage have restricted access to food because of a lack of money and/or having physical limitations due difficulty lifting or lack of access to a car for food shopping. Further research is required to explore the relationship between physical restrictions and food access.

Psychiatric Service Use and Psychiatric Disorders in Adults with Intellectual Disability

ERIC Educational Resources Information Center

Bhaumik, S.; Tyrer, F. C.; McGrother, C.; Ganghadaran, S. K.

2008-01-01

Background: UK policies aim to facilitate access to general psychiatric services for adults with intellectual disability (ID). If this is to be achieved, it is important to have a clear idea of the characteristics and proportion of people with ID who currently access specialist psychiatric services and the nature and extent of psychiatric…

Insomnia patients' help-seeking experiences.

PubMed

Cheung, Janet M Y; Bartlett, Delwyn J; Armour, Carol L; Glozier, Nicholas; Saini, Bandana

2014-03-04

Timely access to appropriate treatment is important for optimizing insomnia management. To date, little is known about insomnia patients' treatment experiences or how they access and engage with the available health care resources. This study sought to capture the help-seeking experiences and behavioral patterns of patients with insomnia who are seeking or receiving specialist care. A purposive sample of 26 insomnia patients from specialist sleep and mental health clinics located in metropolitan New South Wales, Australia was recruited. Participants completed a brief questionnaire, followed by an in-depth, semi-structured interview. Interviews were digitally recorded, transcribed verbatim, and analyzed using framework analysis. Three key themes emerged from the data: patients' sleep beliefs, treatment beliefs, and accessing specialized care. The findings show that daytime symptoms arising from insomnia serve as important illness cues for patients to seek medical help. In addition, participants' treatment pathways highlight factors that prevent the widespread use of cognitive behavioral therapy for insomnia (CBT-I), including limited awareness about CBT-I, tentative referral mechanisms, limited service providers, and the high cost of CBT-I.

Exploring the leadership role of the clinical nurse specialist on an inpatient palliative care consulting team.

PubMed

Stilos, Kalli; Daines, Pat

2013-03-01

Demand for palliative care services in Canada will increase owing to an aging population and the evolving role of palliative care in non-malignant illness. Increasing healthcare demands continue to shape the clinical nurse specialist (CNS) role, especially in the area of palliative care. Clinical nurse specialists bring specialized knowledge, skills and leadership to the clinical setting to enhance patient and family care. This paper highlights the clinical leadership role of the CNS as triage leader for a hospital-based palliative care consulting team. Changes to the team's referral and triage processes are emphasized as key improvements to team efficiency and timely access to care for patients and families.

Accessing VA Healthcare During Large-Scale Natural Disasters.

PubMed

Der-Martirosian, Claudia; Pinnock, Laura; Dobalian, Aram

2017-01-01

Natural disasters can lead to the closure of medical facilities including the Veterans Affairs (VA), thus impacting access to healthcare for U.S. military veteran VA users. We examined the characteristics of VA patients who reported having difficulty accessing care if their usual source of VA care was closed because of natural disasters. A total of 2,264 veteran VA users living in the U.S. northeast region participated in a 2015 cross-sectional representative survey. The study used VA administrative data in a complex stratified survey design with a multimode approach. A total of 36% of veteran VA users reported having difficulty accessing care elsewhere, negatively impacting the functionally impaired and lower income VA patients.

Attention-deficit hyperactivity disorder medication use: factors involved in prescribing, safety aspects and outcomes.

PubMed

Martinez-Raga, Jose; Ferreros, Amparo; Knecht, Carlos; de Alvaro, Raquel; Carabal, Eloisa

2017-03-01

While treatment of patients with attention-deficit hyperactivity disorder (ADHD) is based on a multimodal approach that combines medication with specific psychological interventions, pharmacotherapy alone is generally considered an essential and cost-effective element. This paper aims to comprehensively and critically review factors involved in prescribing and medication use in individuals diagnosed with ADHD, focusing on the difficulties facing patients with ADHD seeking treatment, as well as the safety and tolerability aspects of ADHD pharmacotherapies, with particular attention on the cardiovascular adverse events and the potential risk of misuse or diversion of ADHD medications. A comprehensive and systematic literature search of PubMed/MEDLINE database was conducted to identify studies published in peer-reviewed journals until 1 August 2016. Children, adolescents and adults often encounter significant difficulties in the process of accessing specialist assessment and treatment for ADHD as a consequence of disparities in service organization and available treatment provision. Despite the well-established efficacy and overall safety profile, ADHD medications are not exempt from adverse events. The cardiovascular safety of pharmacotherapies used for treating individuals with ADHD has raised particular concerns; however there is little evidence of serious cardiovascular adverse events, including no serious corrected QT (QTc) abnormalities associated with stimulants, atomoxetine or α2-adrenergic receptor agonists. Although the abuse of prescription stimulant drugs, particularly, short-acting stimulants is a prevalent and growing problem, nonmedical use of prescription stimulants within the clinical context is very limited. In addition, nonstimulant ADHD medications lack any reinforcing effects and consequently any abuse potential.

Resource Allocation in a Repetitive Project Scheduling Using Genetic Algorithm

NASA Astrophysics Data System (ADS)

Samuel, Biju; Mathew, Jeeno

2018-03-01

Resource Allocation is procedure of doling out or allocating the accessible assets in a monetary way and productive way. Resource allocation is the scheduling of the accessible assets and accessible exercises or activities required while thinking about both the asset accessibility and the total project completion time. Asset provisioning and allocation takes care of that issue by permitting the specialist co-ops to deal with the assets for every individual demand of asset. A probabilistic selection procedure has been developed in order to ensure various selections of chromosomes

ANTS/PAM: Future Exploration of the Asteroid Belt

NASA Astrophysics Data System (ADS)

Clark, P. E.; Curtis, S. A.; Rilee, M. L.; Cheung, C. Y.

2004-05-01

The Autonomous Nano-Technology Swarm (ANTS) is applied to the Prospecting Asteroid Mission (PAM) concept, as part of a NASA RASC study. The ANTS architecture is inspired by success of social insect colonies, based on the division of labor within the colonies: 1) within their specialties, individual specialists generally outperform general-ists, and 2) with sufficiently efficient social interaction and coordination, the group of specialists generally outper-forms the group of generalists. ANTS as applied to PAM involves a thousand individual specialist `sciencecraft', one subswarm per target, in an environment where detection and tracking of irregular, infrequent targets is a major chal-lenge. Workers, carry and operate eight to nine different scientific instruments, including spectrometers, ranging and radio science devices, imagers. The remaining specialists, Messenger/Rulers, provide communication and coordina-tion. The non-expendable propulsion system is based on autonomously deployable and configurable solar sails, a system suitable to a low gravity environment. The design of the neural basis function requires a minimum of 4 or 5 specialists for collective decision making. Allowing for ten instrument specialist teams and compensating for antici-pated high attrition, we calculate an initial minimum of 100 per subswarm should allow characterization of hundreds of asteroids. The difficulty in observing irregular, rapidly moving, poorly illuminated objects is largely overcome by the ANT sciencecraft capability to optimize conditions for each instrument. Components are composed of carbon nanotubules reversibly deployable from NEMS nodes, allowing 100 times decrease in packaging volume. 1000 smart 10 centimeter, 1 kg cubic boxes create a 1000 kg 1 meter cube.

Corsair microcatheter for retrograde coronary chronic total occlusion recanalization: Early experience outside the realm of dedicated recanalization specialists

PubMed Central

Joseph, George; Thomson, Viji Samuel; Radhakrishnan, Shanmugasundaram

2012-01-01

Objective To determine the extent to which use of the Corsair microcatheter (CM, Asahi Intecc Co., Japan) improves procedural outcomes when an experienced operator who is not a dedicated recanalization specialist attempts retrograde chronic total occlusion (CTO) recanalization through collateral channels during percutaneous coronary intervention. Background The recently introduced CM has improved success rates of retrograde CTO recanalization to nearly 100% in the hands of dedicated coronary recanalization specialists; however, the impact the CM has on the results of non-specialist operators attempting retrograde CTO recanalization is not known. Methods A non-specialist operator attempted CM-assisted recanalization in seven consecutive CTO cases requiring retrograde recanalization. The results obtained were compared with those achieved by the same operator in eleven consecutive retrograde CTO recanalization procedures during the last 2 years before the CM became available. Results CM-assisted retrograde CTO recanalization was successful in 6 of 7 cases (86%), but failed in one case attempted through a tortuous epicardial collateral; there were no complications. In contrast, during the 2 years before the CM became available, retrograde CTO recanalization was successful in only 3 of 11 attempted cases (27%), and was associated with significant morbidity. Lesions in the two groups were comparable in terms of technical difficulty and procedural risk. Conclusions The non-specialist operator's retrograde CTO recanalization results improve significantly when using the CM. Given the effectiveness and safety of CM-assisted retrograde CTO recanalization, operators should be less aggressive with anterograde recanalization attempts, and should switch to the retrograde approach earlier and more often. PMID:22929822

Making the nursing curriculum more inclusive for students with specific learning difficulties (SpLD): embedding specialist study skills into a core module.

PubMed

Wray, Jane; Aspland, Jo; Taghzouit, Jayne; Pace, Kerry

2013-06-01

Wray et al. (2012) found that providing specialist 'add on' study skills sessions to students with SpLD increased the likelihood of progression and earlier identification. However, 48% of students identified as 'at risk' of having a SpLD did not pursue further assessment/support, which is of concern. OBJECTIVES/DESIGN/PARTICIPANTS/SETTINGS: The study aimed to explore the impact of embedding nine study skills sessions designed for students with SpLD into the mainstream curriculum on pre-registration nursing students in one HEI in the north of England. Two cohorts (September 2009 (n=257) and February 2010 (n=127)) took part; a total of 300 students completed a student feedback questionnaire (201 from September 2009, 99 from February 2010 (response rates of 87% and 80%)). The study used an outcome evaluation approach (Watson et al., 2008) to explore the impact of the sessions using a range of measures: (i) a student feedback questionnaire, (ii) length of time from registration to first contact with Disability Services, and (iii) progression data. Overall, the sessions were received very positively, especially those on essay writing, reflection and learning techniques. Students in the study cohorts made contact with Disability Services 4-6 weeks earlier than other cohorts; referrals were also higher. Equally, students with SpLD with access to study skills had higher rates of progression (e.g. 87% in 2009) than in years with no sessions (e.g. 62% in 2008); progression rates were comparable to their non-disabled peers. Mainstreaming what had previously been a reasonable adjustment made time- and resource-savings for the institution. Such approaches to embedding are important in encouraging and retaining talented and able students. Copyright © 2012 Elsevier Ltd. All rights reserved.

Rurality and determinants of hearing healthcare in adult hearing aid recipients.

PubMed

Chan, Stephen; Hixon, Brian; Adkins, Margaret; Shinn, Jennifer B; Bush, Matthew L

2017-10-01

The objective of this study was to compare the timing of hearing aid (HA) acquisition between adults in rural and urban communities. We hypothesized that time of acquisition of HA after onset of hearing loss is greater in rural adults compared with urban adults. Secondary objectives included assessment of socioeconomic/educational status and impact of hearing loss and hearing rehabilitation of urban and rural HA recipients. Cross-sectional questionnaire survey. We assessed demographics, timing of HA fitting from onset of hearing loss, and impact of hearing impairment in 336 adult HA recipients (273 urban, 63 rural) from a tertiary referral center. Amplification benefit was assessed using the International Outcome Inventory for Hearing Aids (IOI). The time to HA acquisition was greater for rural participants compared to urban participants (19.1 vs. 25.7 years, P = 0.024) for those with untreated hearing loss for at least 8 years. Age at hearing loss onset was correlated with time to HA acquisition (P = -0.54, P < 0.001). Rural HA participants experienced longer commutes to hearing specialists (68 vs. 32 minutes, P < 0.001), were less likely to achieve a degree beyond high school (P < 0.001), and were more likely to possess Medicaid coverage (P = 0.012) compared to urban participants. Hearing impairment caused job performance difficulty in 60% of all participants. Rural adults are at risk for delayed HA acquisition, which may be related to distance to hearing specialists. Further research is indicated to investigate barriers to care and expand access for vulnerable populations. 4. Laryngoscope, 127:2362-2367, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

Blood transfusions

MedlinePlus

... Updated December 29, 2016. Accessed September 29, 2017. Review Date 8/14/2017 Updated by: Todd Gersten, ... Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by ...

The integrated care pathway for post stroke patients (iCaPPS): a shared care approach between stakeholders in areas with limited access to specialist stroke care services.

PubMed

Abdul Aziz, Aznida Firzah; Mohd Nordin, Nor Azlin; Ali, Mohd Fairuz; Abd Aziz, Noor Azah; Sulong, Saperi; Aljunid, Syed Mohamed

2017-01-13

Lack of intersectoral collaboration within public health sectors compound efforts to promote effective multidisciplinary post stroke care after discharge following acute phase. A coordinated, primary care-led care pathway to manage post stroke patients residing at home in the community was designed by an expert panel of specialist stroke care providers to help overcome fragmented post stroke care in areas where access is limited or lacking. Expert panel discussions comprising Family Medicine Specialists, Neurologists, Rehabilitation Physicians and Therapists, and Nurse Managers from Ministry of Health and acadaemia were conducted. In Phase One, experts chartered current care processes in public healthcare facilities, from acute stroke till discharge and also patients who presented late with stroke symptoms to public primary care health centres. In Phase Two, modified Delphi technique was employed to obtain consensus on recommendations, based on current evidence and best care practices. Care algorithms were designed around existing work schedules at public health centres. Indication for patients eligible for monitoring by primary care at public health centres were identified. Gaps in transfer of care occurred either at post discharge from acute care or primary care patients diagnosed at or beyond subacute phase at health centres. Essential information required during transfer of care from tertiary care to primary care providers was identified. Care algorithms including appropriate tools were summarised to guide primary care teams to identify patients requiring further multidisciplinary interventions. Shared care approaches with Specialist Stroke care team were outlined. Components of the iCaPPS were developed simultaneously: (i) iCaPPS-Rehab© for rehabilitation of stroke patients at community level (ii) iCaPPS-Swallow© guided the primary care team to screen and manage stroke related swallowing problems. Coordinated post stroke care monitoring service for patients at community level is achievable using the iCaPPS and its components as a guide. The iCaPPS may be used for post stroke care monitoring of patients in similar fragmented healthcare delivery systems or areas with limited access to specialist stroke care services. No.: ACTRN12616001322426 (Registration Date: 21st September 2016).

Equity in specialist waiting times by socioeconomic groups: evidence from Spain.

PubMed

Abásolo, Ignacio; Negrín-Hernández, Miguel A; Pinilla, Jaime

2014-04-01

In countries with publicly financed health care systems, waiting time--rather than price--is the rationing mechanism for access to health care services. The normative statement underlying such a rationing device is that patients should wait according to need and irrespective of socioeconomic status or other non-need characteristics. The aim of this paper is to test empirically that waiting times for publicly funded specialist care do not depend on patients' socioeconomic status. Waiting times for specialist care can vary according to the type of medical specialty, type of consultation (review or diagnosis) and the region where patients' reside. In order to take into account such variability, we use Bayesian random parameter models to explain waiting times for specialist care in terms of need and non-need variables. We find that individuals with lower education and income levels wait significantly more time than their counterparts.

Integrating acute stroke telemedicine consultations into specialists' usual practice: a qualitative analysis comparing the experience of Australia and the United Kingdom.

PubMed

Bagot, Kathleen L; Cadilhac, Dominique A; Bladin, Christopher F; Watkins, Caroline L; Vu, Michelle; Donnan, Geoffrey A; Dewey, Helen M; Emsley, Hedley C A; Davies, D Paul; Day, Elaine; Ford, Gary A; Price, Christopher I; May, Carl R; McLoughlin, Alison S R; Gibson, Josephine M E; Lightbody, Catherine E

2017-11-21

Stroke telemedicine can reduce healthcare inequities by increasing access to specialists. Successful telemedicine networks require specialists adapting clinical practice to provide remote consultations. Variation in experiences of specialists between different countries is unknown. To support future implementation, we compared perceptions of Australian and United Kingdom specialists providing remote acute stroke consultations. Specialist participants were identified using purposive sampling from two new services: Australia's Victorian Stroke Telemedicine Program (n = 6; 2010-13) and the United Kingdom's Cumbria and Lancashire telestroke network (n = 5; 2010-2012). Semi-structured interviews were conducted pre- and post-implementation, recorded and transcribed verbatim. Deductive thematic and content analysis (NVivo) was undertaken by two independent coders using Normalisation Process Theory to explore integration of telemedicine into practice. Agreement between coders was M = 91%, SD = 9 and weighted average κ = 0.70. Cross-cultural similarities and differences were found. In both countries, specialists described old and new consulting practices, the purpose and value of telemedicine systems, and concerns regarding confidence in the assessment and diagnostic skills of unknown colleagues requesting telemedicine support. Australian specialists discussed how remote consultations impacted on usual roles and suggested future improvements, while United Kingdom specialists discussed system governance, policy and procedures. Australian and United Kingdom specialists reported telemedicine required changes in work practice and development of new skills. Both groups described potential for improvements in stroke telemedicine systems with Australian specialists more focused on role change and the United Kingdom on system governance issues. Future research should examine if cross-cultural variation reflects different models of care and extends to other networks.

Bleeding Hearts, Profiteers, or Both: Specialist Physician Fees in an Unregulated Market.

PubMed

Johar, Meliyanni; Mu, Chunzhou; Van Gool, Kees; Wong, Chun Yee

2017-04-01

This study shows that, in an unregulated fee-setting environment, specialist physicians practise price discrimination on the basis of their patients' income status. Our results are consistent with profit maximisation behaviour by specialists. These findings are based on a large population survey that is linked to administrative medical claims records. We find that, for an initial consultation, specialist physicians charge their high-income patients AU$26 more than their low-income patients. While this gap equates to a 19% lower fees for the poorest patients (bottom 25% of the household income distribution), it is unlikely to remove the substantial financial barriers they face in accessing specialist care. There are large variations across specialties, with neurologists exhibiting the largest fee gap between the high-income and low-income patients. Several possible channels for deducing the patient's income are examined. We find that patient characteristics such as age, health concession card status and private health insurance status are all used by specialists as proxies for income status. These characteristics are particularly important to further practise price discrimination among the low-income patients but are less relevant for the high-income patients. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Burns education for non-burn specialist clinicians in Western Australia.

PubMed

McWilliams, Tania; Hendricks, Joyce; Twigg, Di; Wood, Fiona

2015-03-01

Burn patients often receive their initial care by non-burn specialist clinicians, with increasingly collaborative burn models of care. The provision of relevant and accessible education for these clinicians is therefore vital for optimal patient care. A two phase design was used. A state-wide survey of multidisciplinary non-burn specialist clinicians throughout Western Australia identified learning needs related to paediatric burn care. A targeted education programme was developed and delivered live via videoconference. Pre-post-test analysis evaluated changes in knowledge as a result of attendance at each education session. Non-burn specialist clinicians identified numerous areas of burn care relevant to their practice. Statistically significant differences between perceived relevance of care and confidence in care provision were reported for aspects of acute burn care. Following attendance at the education sessions, statistically significant increases in knowledge were noted for most areas of acute burn care. Identification of learning needs facilitated the development of a targeted education programme for non-burn specialist clinicians. Increased non-burn specialist clinician knowledge following attendance at most education sessions supports the use of videoconferencing as an acceptable and effective method of delivering burns education in Western Australia. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

Attitudes regarding specialist referrals in periodontics.

PubMed

Sharpe, G; Durham, J A; Preshaw, P M

2007-02-24

To examine the attitudes of dental practitioners towards specialist periodontal referral in the North East of England. Semi-structured interviews were conducted with a purposive sample of 10 practitioners. Interviews continued until data saturation occurred. The data were organised using a framework and analysed by two researchers working independently. Perceptions of periodontal disease and treatment appear to be heavily influenced by the NHS remuneration system. Treatment in general practice was limited to simple scaling and there was an apparent reluctance to treat advanced periodontitis. Such cases were commonly referred to specialists, confirming the demand for a referral service in periodontics. The perceived potential for medico-legal consequences was a strong driver of referrals. Distance to the referral centre and the perceived costs of treatment were significant barriers to referral. Dentists valued the specialist's personal reputation and clinical skills more highly than academic status. Deficiencies in communication between primary and secondary care were highlighted. Increased resources are required to manage periodontal diseases within the NHS. There is a need for a periodontal referral service in the North East of England to improve accessibility to specialist care. This would appear to be most appropriately delivered by increased numbers of specialist practitioners.

Complication with Intraosseous Access: Scandinavian Users’ Experience

PubMed Central

Hallas, Peter; Brabrand, Mikkel; Folkestad, Lars

2013-01-01

Introduction: Intraosseous access (IO) is indicated if vascular access cannot be quickly established during resuscitation. Complication rates are estimated to be low, based on small patient series, model or cadaver studies, and case reports. However, user experience with IO use in real-life emergency situations might differ from the results in the controlled environment of model studies and small patient series. We performed a survey of IO use in real-life emergency situations to assess users’ experiences of complications. Methods: An online questionnaire was sent to Scandinavian emergency physicians, anesthesiologists and pediatricians. Results: 1,802 clinical cases of IO use was reported by n=386 responders. Commonly reported complications with establishing IO access were patient discomfort/pain (7.1%), difficulties with penetration of periosteum with IO needle (10.3%), difficulties with aspiration of bone marrow (12.3%), and bended/broken needle (4.0%). When using an established IO access the reported complications were difficulties with injection fluid and drugs after IO insertion (7.4%), slow infusion (despite use of pressure bag) (8.8%), displacement after insertion (8.5%), and extravasation (3.7%). Compartment syndrome and osteomyelitis occurred in 0.6% and 0.4% of cases respectively. Conclusion: In users’ recollection of real-life IO use, perceived complications were more frequent than usually reported from model studies. The perceived difficulties with using IO could affect the willingness of medical staff to use IO. Therefore, user experience should be addressed both in education of how to use, and research and development of IOs. PMID:24106537

STS-46 Italian Payload Specialist Malerba uses laptop PGSC on OV-104 middeck

NASA Technical Reports Server (NTRS)

1992-01-01

STS-46 Italian Payload Specialist Franco Malerba, wearing communications kit assembly headset (HDST), uses laptop payload and general support computer (PGSC) on the middeck of Atlantis, Orbiter Vehicle (OV) 104. Malerba is positioned in front of the airlock and surrounded by the interdeck access ladder (foreground), a cycle ergometer (directly behind him), the forward lockers (background), and the sleep station (at his left). Food, candy, hygiene kits, beverage containers, and film reels are attached to the forward lockers.

Restrictive Access to Books in School Library Media Centers in Georgia. Research Study.

ERIC Educational Resources Information Center

DuPree, Vi

This study sought to determine the extent of restrictive access to books in Georgia school library media centers and to discover by whose authority and for what reason these books might be placed on restrictive shelves. Questionnaires were completed and received from a stratified random sampling of 119 media specialists in high schools, middle or…

Forum Guide to Ensuring Equal Access to Education Websites: Introduction to Electronic Information Accessibility Standards. NFES 2011-807

ERIC Educational Resources Information Center

National Forum on Education Statistics, 2011

2011-01-01

This guide is designed for use by information technology administrators, data specialists, and program staff responsible for the "content" in data reports, as well as education leaders (e.g., administrators who prioritize tasks for technical and data staff), and other stakeholders who have an interest in seeing that schools, school…

Should the gap be filled between guidelines and actual practice for management of low back pain in primary care? The Quebec experience.

PubMed

Rossignol, M; Abenhaim, L; Bonvalot, Y; Gobeille, D; Shrier, I

1996-12-15

A prospective cohort study. To describe health services utilization for low back pain in the province of Quebec, Canada, and to compare it with North American guidelines. The Quebec Task Force and the Agency for Health Care Planning and Research (United States) published guidelines for the management of low back pain in 1987 and 1994, respectively. A cohort of 2147 adults with low back pain identified at the Quebec Worker's Compensation Board were selected randomly and observed over 2 years' time for their health care utilization profile. During the study period, 57.8% of the workers still under active care 7 weeks after their back injury had not yet been referred to a specialist. Specialized imaging techniques were obtained by 4.5% of the patients, with a delay of 7 weeks or more in 66% of them. Surgery was performed on 1.6% of the patients. The presence of an initial specific diagnosis and proximity to a university hospital significantly increased utilization rate and reduced the delays. Health services utilization for back pain in Quebec was equal or lower to what currently is practiced elsewhere, but access to specialists was not meeting the current recommendations. This would represent a 12% net increase in new specialist contacts and a quicker access in 39% who saw a specialist. Before such an effort can be considered, health care planners will need a better definition of the role of the specialist consultation in the guidelines and scientific evidence specifically addressing their benefit in primary care, especially in the absence of a specific diagnosis.

The association between question type and the outcomes of a Dermatology eConsult service.

PubMed

O'Toole, Ashley; Joo, Jiyeh; DesGroseilliers, Jean-Pierre; Liddy, Clare; Glassman, Steven; Afkham, Amir; Keely, Erin

2017-08-01

eConsult is a web based service that facilitates communication between primary care providers (PCPs) and specialists, which can reduce the need for face-to-face consultations with specialists. One example is the Champlain BASE (Building Access to Specialist through eConsultation) service with dermatology being the largest specialty consulted. Dermatology eConsults submitted from July 2011 to January 2015 were reviewed. Post eConsult surveys for PCPs were analyzed to determine the number of traditional consults avoided and perceived value of eConsults. The time it took the PCP to receive a reply and the amount of time reported by the specialist to answer eConsult were proactively recorded and analyzed. A subset of 154 most recent eConsults was categorized for dermatology content and question type (e.g. diagnosis or management) using a validated taxonomy. A total of 965 eConsults were directed to dermatology from 217 unique PCPs. The majority of eConsults (64%) took the specialist between 10 and 15 minutes to answer. The overall value of this service to the provider was rated as very good or excellent in 95% of cases. In 49%, traditional in-person assessments were avoided. In the subset of the most recent cases, diagnosis was the most common question type asked (65.2%) followed by management (29%) and drug treatment (10.6%). The top five subject areas (40%) were: Dermatitis, Infections, Neoplasm, Nevi, and Pruritus. eConsults was feasible and well received by PCPs, which improves access to dermatology care with a potential to reduce wait times for traditional consultation. © 2017 The International Society of Dermatology.

Differing Experiences with Pre-Exposure Prophylaxis in Boston Among Lesbian, Gay, Bisexual, and Transgender Specialists and Generalists in Primary Care: Implications for Scale-Up.

PubMed

Krakower, Douglas S; Ware, Norma C; Maloney, Kevin M; Wilson, Ira B; Wong, John B; Mayer, Kenneth H

2017-07-01

The Centers for Disease Control and Prevention estimates that one in four sexually active men who have sex with men (MSM) could decrease their HIV risk by using HIV pre-exposure prophylaxis (PrEP). Because many MSM access healthcare from primary care providers (PCPs), these clinicians could play an important role in providing access to PrEP. Semistructured qualitative interviews were conducted with 31 PCPs in Boston, MA, to explore how they approach decisions about prescribing PrEP to MSM and their experiences with PrEP provision. Purposive sampling included 12 PCPs from an urban community health center specializing in the care of lesbian, gay, bisexual, and transgender persons ("LGBT specialists") and 19 PCPs from a general academic medical center ("generalists"). Analyses utilized an inductive approach to identify emergent themes. Both groups of PCPs approached prescribing decisions about PrEP as a process of informed decision-making with patients. Providers would defer to patients' preferences if they were unsure about the appropriateness of PrEP. LGBT specialists and generalists were at vastly different stages of adopting PrEP into practice. For LGBT specialists, PrEP was a disruptive innovation that rapidly became normative in practice. Generalists had limited experience with PrEP; however, they desired succinct decision-support tools to help them achieve proficiency, because they considered preventive medicine to be central to their professional role. As generalists vastly outnumber LGBT specialists in the United States, interventions to support PrEP provision by generalists could accelerate the scale-up of PrEP for MSM nationally, which could in turn decrease HIV incidence for this priority population.

eConsultations to Infectious Disease Specialists: Questions Asked and Impact on Primary Care Providers' Behavior.

PubMed

Murthy, Ruchi; Rose, Gregory; Liddy, Clare; Afkham, Amir; Keely, Erin

2017-01-01

Since 2010, the Champlain BASE (Building Access to Specialist Advice through eConsultation) has allowed primary care providers (PCPs) to submit clinical questions to specialists through a secure web service. The study objectives are to describe questions asked to Infectious Diseases specialists through eConsultation and assess impact on physician behaviors. eConsults completed through the Champlain BASE service from April 15, 2013 to January 29, 2015 were characterized by the type of question asked and infectious disease content. Usage data and PCP responses to a closeout survey were analyzed to determine eConsult response time, change in referral plans, and change in planned course of action. Of the 224 infectious diseases eConsults, the most common question types were as follows: interpretation of a clinical test 18.0% (41), general management 16.5 % (37), and indications/goals of treating a particular condition 16.5% (37). The most frequently consulted infectious diseases were as follows: tuberculosis 14.3% (32), Lyme disease 14.3% (32), and parasitology 12.9% (29). Within 24 hours, 63% of cases responded to the questions, and 82% of cases took under 15 minutes to complete. In 32% of cases, a face-to-face referral was originally planned by the PCP but was no longer needed. In 8% of cases, the PCP referred the patient despite originally not planning to make a referral. In 55% of cases, the PCP either received new information or changed their course of action. An eConsult service provides PCPs with timely access to infectious disease specialists' advice that often results in a change in plans for a face-to-face referral. © The Author 2017. Published by Oxford University Press on behalf of Infectious Diseases Society of America.

How Loud Is Too Loud?

MedlinePlus Videos and Cool Tools

... of Organizations Free Publications Glossary Have a question? Information specialists can answer your questions in English or ... us on Contact Us Privacy Accessibility Freedom of Information Act Site Map Website Policies Free Publications Content ...

Chronic lymphocytic leukemia (CLL)

MedlinePlus

... Updated August 21, 2017. Accessed September 29, 2017. Review Date 8/14/2017 Updated by: Todd Gersten, ... Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by ...

Researching Learning Difficulties: A Guide for Practitioners

ERIC Educational Resources Information Center

Porter, Jill; Lacey, Penny

2005-01-01

The aim of this book is to provide a source for teachers and other professionals working with children and adults with learning difficulties and disabilities that will enable them to: (1) access selected recent and relevant research in the field of learning difficulties, drawn from a range of disciplines and groups of people; (2) reflect on…

Mechanisms Underlying Lexical Access in Native and Second Language Processing of Gender and Number Agreement

ERIC Educational Resources Information Center

Romanova, Natalia

2013-01-01

Despite considerable evidence suggesting that second language (L2) learners experience difficulties when processing morphosyntactic aspects of L2 in online tasks, the mechanisms underlying these difficulties remain unknown. The aim of this dissertation is to explore possible causes for the difficulties by comparing attentional mechanisms engaged…

The MUSOS (MUsic SOftware System) Toolkit: A computer-based, open source application for testing memory for melodies.

PubMed

Rainsford, M; Palmer, M A; Paine, G

2018-04-01

Despite numerous innovative studies, rates of replication in the field of music psychology are extremely low (Frieler et al., 2013). Two key methodological challenges affecting researchers wishing to administer and reproduce studies in music cognition are the difficulty of measuring musical responses, particularly when conducting free-recall studies, and access to a reliable set of novel stimuli unrestricted by copyright or licensing issues. In this article, we propose a solution for these challenges in computer-based administration. We present a computer-based application for testing memory for melodies. Created using the software Max/MSP (Cycling '74, 2014a), the MUSOS (Music Software System) Toolkit uses a simple modular framework configurable for testing common paradigms such as recall, old-new recognition, and stem completion. The program is accompanied by a stimulus set of 156 novel, copyright-free melodies, in audio and Max/MSP file formats. Two pilot tests were conducted to establish the properties of the accompanying stimulus set that are relevant to music cognition and general memory research. By using this software, a researcher without specialist musical training may administer and accurately measure responses from common paradigms used in the study of memory for music.

Staying Mobile

MedlinePlus

... representatives are factory-trained accessibility specialists in ramp design and installation and will provide a free evaluation and consultation to determine what ramp is best for your needs. Video Series Free From Falls Some MS symptoms and treatments ...

Patrick in Interdeck Access Hatch

NASA Image and Video Library

2010-02-09

S130-E-006314 (9 Feb. 2010) --- NASA astronaut Nicholas Patrick, STS-130 mission specialist, is pictured in the hatch which connects the flight deck and middeck of space shuttle Endeavour during flight day two activities.

Behnken in Interdeck Access Hatch

NASA Image and Video Library

2010-02-08

S130-E-005229 (8 Feb. 2010) --- NASA astronaut Robert Behnken, STS-130 mission specialist, is pictured in the hatch which connects the flight deck and middeck of space shuttle Endeavour during flight day one activities.

"How can I help?" Nurse call openings on a cancer helpline and implications for call progressivity.

PubMed

Leydon, Geraldine Marie; Ekberg, Katie; Drew, Paul

2013-07-01

Helplines are a key service used for information and support by people affected by cancer. Little is known about the process of delivering and seeking cancer related telephone help. Using conversation analysis 52 calls between callers and specialist nurses on a major UK cancer helpline are analysed; focusing on the openings of helpline calls by specialist nurses. The helpline involves a triage system from a frontline call-taker to a specialist nurse. The triage system introduces challenges to the interactions for nurses and callers. This paper demonstrates how calls commence, and outlines implications for how they progress. Four key elements to the nurse's initial opening of the call were identified, which together contribute to managing an effective transition from the frontline call-taker to the current call with the specialist cancer nurse. The smooth exchange of information and provision of support in a trusted call environment is a critical goal of the cancer helpline; an effective call opening in a triage environment may significantly optimise the possibility of this goal being realised. A simple strategy is recommended to avoid the difficulties identified, a script for how the triaged call openings may be optimally formulated. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

General medical training in gastroenterology: views from specialist trainees on the challenges of dual accreditation.

PubMed

Neale, James R; Basford, Peter J

2015-02-01

Higher specialist training in general internal medicine (GIM) and the medical specialties has been subject to many changes and increasing subspecialisation in recent years. The 'Shape of Training' review proposes 'broad-based specialty training', shortening of training by one year, and subspecialisation to be undertaken after the certificate of specialty training is obtained. All higher level gastroenterology trainees based in the UK were invited to complete an online survey between July and September 2012 to assess their experience of gastroenterology and GIM training. Overall, 72.7% of trainees expressed satisfaction with their training in gastroenterology but significantly fewer (43.5%) expressed satisfaction with their training in GIM. Satisfaction with gastroenterology training thus is good, but satisfaction with GIM training is lower and levels of dissatisfaction have increased significantly since 2008. Up to 50% of trainees are not achieving the minimum recommended number of colonoscopy procedures for their stage of training. Experience in GIM is seen as service orientated, with a lack of training opportunities. There is a worrying difficulty in gaining the minimum required experience in endoscopy. If the length of specialist training is shortened and generalised, training in key core specialist skills such as endoscopy may be compromised further. © 2015 Royal College of Physicians.

ThinkHazard!: an open-source, global tool for understanding hazard information

NASA Astrophysics Data System (ADS)

Fraser, Stuart; Jongman, Brenden; Simpson, Alanna; Nunez, Ariel; Deparday, Vivien; Saito, Keiko; Murnane, Richard; Balog, Simone

2016-04-01

Rapid and simple access to added-value natural hazard and disaster risk information is a key issue for various stakeholders of the development and disaster risk management (DRM) domains. Accessing available data often requires specialist knowledge of heterogeneous data, which are often highly technical and can be difficult for non-specialists in DRM to find and exploit. Thus, availability, accessibility and processing of these information sources are crucial issues, and an important reason why many development projects suffer significant impacts from natural hazards. The World Bank's Global Facility for Disaster Reduction and Recovery (GFDRR) is currently developing a new open-source tool to address this knowledge gap: ThinkHazard! The main aim of the ThinkHazard! project is to develop an analytical tool dedicated to facilitating improvements in knowledge and understanding of natural hazards among non-specialists in DRM. It also aims at providing users with relevant guidance and information on handling the threats posed by the natural hazards present in a chosen location. Furthermore, all aspects of this tool will be open and transparent, in order to give users enough information to understand its operational principles. In this presentation, we will explain the technical approach behind the tool, which translates state-of-the-art probabilistic natural hazard data into understandable hazard classifications and practical recommendations. We will also demonstrate the functionality of the tool, and discuss limitations from a scientific as well as an operational perspective.

Facilitators and barriers to implementing electronic referral and/or consultation systems: a qualitative study of 16 health organizations.

PubMed

Tuot, Delphine S; Leeds, Kiren; Murphy, Elizabeth J; Sarkar, Urmimala; Lyles, Courtney R; Mekonnen, Tekeshe; Chen, Alice H M

2015-12-19

Access to specialty care remains a challenge for primary care providers and patients. Implementation of electronic referral and/or consultation (eCR) systems provides an opportunity for innovations in the delivery of specialty care. We conducted key informant interviews to identify drivers, facilitators, barriers and evaluation metrics of diverse eCR systems to inform widespread implementation of this model of specialty care delivery. Interviews were conducted with leaders of 16 diverse health care delivery organizations between January 2013 and April 2014. A limited snowball sampling approach was used for recruitment. Content analysis was used to examine key informant interview transcripts. Electronic referral systems, which provide referral management and triage by specialists, were developed to enhance tracking and operational efficiency. Electronic consultation systems, which encourage bi-directional communication between primary care and specialist providers facilitating longitudinal virtual co-management, were developed to improve access to specialty expertise. Integrated eCR systems leverage both functionalities to enhance the delivery of coordinated, specialty care at the population level. Elements of successful eCR system implementation included executive and clinician leadership, established funding models for specialist clinician reimbursement, and a commitment to optimizing clinician workflows. eCR systems have great potential to streamline access to and enhance the coordination of specialty care delivery. While different eCR models help solve different organizational challenges, all require institutional investments for successful implementation, such as funding for program management, leadership and clinician incentives.

Ten Steps to Establishing an e-Consultation Service to Improve Access to Specialist Care

PubMed Central

Maranger, Julie; Afkham, Amir; Keely, Erin

2013-01-01

Abstract There is dissatisfaction among primary care physicians, specialists, and patients with respect to the consultation process. Excessive wait times for receiving specialist services and inefficient communication between practitioners result in decreased access to care and jeopardize patient safety. We created and implemented an electronic consultation (e-consultation) system in Eastern Ontario to address these problems and improve the consultation process. The e-consultation system has passed through the proof-of-concept and pilot study stages and has effectively reduced unnecessary referrals while receiving resoundingly positive feedback from physician-users. Using our experience, we have outlined the 10 steps to developing an e-consultation service. We detail the technical, administrative, and strategic considerations with respect to (1) identifying your partners, (2) choosing your platform, (3) starting as a pilot project, (4) designing your product, (5) ensuring patient privacy, (6) thinking through the process, (7) fostering relationships with your participants, (8) being prepared to provide physician payment, (9) providing feedback, and (10) planning the transition from pilot to permanency. In following these 10 steps, we believe that the e-consultation system and its associated improvements on the consultation process can be effectively implemented in other healthcare settings. PMID:24073898

Is something better than nothing? Food insecurity and eating patterns of young people experiencing homelessness.

PubMed

Crawford, Belinda; Yamazaki, Rowena; Franke, Elise; Amanatidis, Sue; Ravulo, Jioji; Torvaldsen, Siranda

2015-08-01

Food insecurity is an increasing problem in marginalised groups that affects diet quality. We aimed to examine the extent of food insecurity and the eating patterns of young people accessing support from specialist homelessness services. A cross-sectional survey with a researcher-administered food frequency and food insecurity questionnaire was undertaken with 50 young people experiencing homelessness, aged 14-26 years. Participants were recruited from 11 specialist homelessness services providing support and accommodation for young people in central and south-western Sydney. Food insecurity was a recent experience for 70% of participants. Eighty-five per cent of participants living independently experienced food insecurity, compared to 66% of young people in supported accommodation. Consumption of core food groups was low, as almost all participants did not meet recommended daily servings of vegetables and breads and cereals. Consumption of sugar-sweetened soft drinks was high. Food insecurity and poor diet quality are salient issues for this group of young people accessing support from specialist homelessness services. These findings highlight the need for a greater focus on advocacy and policy action to increase social supports and improve food security and nutrition for young people experiencing homelessness. © 2015 Public Health Association of Australia.

STS-61B Astronaut Spring During EASE Extravehicular Activity (EVA)

NASA Technical Reports Server (NTRS)

1985-01-01

The crew assigned to the STS-61B mission included Bryan D. O'Conner, pilot; Brewster H. Shaw, commander; Charles D. Walker, payload specialist; mission specialists Jerry L. Ross, Mary L. Cleave, and Sherwood C. Spring; and Rodolpho Neri Vela, payload specialist. Launched aboard the Space Shuttle Atlantis November 28, 1985 at 7:29:00 pm (EST), the STS-61B mission's primary payload included three communications satellites: MORELOS-B (Mexico); AUSSAT-2 (Australia); and SATCOM KU-2 (RCA Americom). Two experiments were conducted to test assembling erectable structures in space: EASE (Experimental Assembly of Structures in Extravehicular Activity), and ACCESS (Assembly Concept for Construction of Erectable Space Structure). In a joint venture between NASA/Langley Research Center in Hampton, Virginia, and the Marshall Space Flight Center (MSFC), the EASE and ACCESS were developed and demonstrated at MSFC's Neutral Buoyancy Simulator (NBS). In this STS-61B onboard photo, astronaut Spring was working on the EASE during an Extravehicular Activity (EVA). The primary objective of this experiment was to test the structural assembly concepts for suitability as the framework for larger space structures and to identify ways to improve the productivity of space construction.

STS-61B Astronauts Ross and Spring Work on Experimental Assembly of Structures in Extravehicular

NASA Technical Reports Server (NTRS)

1985-01-01

The crew assigned to the STS-61B mission included Bryan D. O'Conner, pilot; Brewster H. Shaw, commander; Charles D. Walker, payload specialist; mission specialists Jerry L. Ross, Mary L. Cleave, and Sherwood C. Spring; and Rodolpho Neri Vela, payload specialist. Launched aboard the Space Shuttle Atlantis November 28, 1985 at 7:29:00 pm (EST), the STS-61B mission's primary payload included three communications satellites: MORELOS-B (Mexico); AUSSAT-2 (Australia); and SATCOM KU-2 (RCA Americom). Two experiments were conducted to test assembling erectable structures in space: EASE (Experimental Assembly of Structures in Extravehicular Activity), and ACCESS (Assembly Concept for Construction of Erectable Space Structure). In a joint venture between NASA/Langley Research Center in Hampton, Virginia, and the Marshall Space Flight Center (MSFC), EASE and ACCESS were developed and demonstrated at MSFC's Neutral Buoyancy Simulator (NBS). This STS-61B onboard photo depicts astronauts Ross and Spring working on EASE. The primary objective of these experiments was to test the structural assembly concepts for suitability as the framework for larger space structures and to identify ways to improve the productivity of space construction.

[Factors associated with difficulty of access of the elderly with disabilities to the health services].

PubMed

Amaral, Fabienne Louise Juvêncio dos Santos; Motta, Márcia Heloyse Alves; da Silva, Laíla Pereira Gomes; Alves, Simone Bezerra

2012-11-01

This study seeks to analyze which are the variables associated with the difficulty of elderly people with disabilities gaining access to the health services. This is an observational study of an analytical cross-sectional nature, with a sample of 244 elderly people with disabilities. Data relating to socio-economic profile, the nature of the disability, and the conditions of access to health services were gathered. Version 11.0 of the Statistical Package for the Social Sciences software was used for descriptive, statistical and analytical assessment of the data. The protection variables for difficulties in being treated in the health services were: the lack of drains, culverts, trash, bags of refuse, or irregular floor surfaces; the absence of ramps on sidewalks and pavements; the availability of transport; ease in scheduling appointments; and the length of the waiting period to be attended. The number of factors listed shows that the architectonic barriers and the current situation of healthcare need to be adequate in order to ensure full access and use by the elderly with disabilities to the health services.

Specialist public health capacity in England: working in the new primary care organizations.

PubMed

Chapman, J; Shaw, S; Congdon, P; Carter, Y H; Abbott, S; Petchey, R

2005-01-01

To determine the capacity and development needs, in relation to key areas of competency and skills, of the specialist public health workforce based in primary care organizations following the 2001 restructuring of the UK National Health Service. Questionnaire survey to all consultants and specialists in public health (including directors of public health) based in primary care trusts (PCTs) and strategic health authorities (SHAs) in England. Participants reported a high degree of competency. However, skill gaps were evident in some areas of public health practice, most notably "developing quality and risk management" and in relation to media communication, computing, management and leadership. In general, medically qualified individuals were weaker on community development than non-medically qualified specialists, and non-medically qualified specialists were less able to perform tasks that require epidemiological or clinical expertise than medically qualified specialists. Less than 50% of specialists felt that their links to external organizations, including public health networks, were strong. Twenty-nine percent of respondents felt professionally isolated and 22% reported inadequate team working within their PCT or SHA. Approximately 21% of respondents expressed concerns that they did not have access to enough expertise to fulfil their tasks and that their skills were not being adequately utilized. Some important skill gaps are evident among the specialist public health workforce although, in general, a high degree of competency was reported. This suggests that the capacity deficit is a problem of numbers of specialists rather than an overall lack of appropriate skills. Professional isolation must be addressed by encouraging greater partnership working across teams.

A qualitative investigation of eating difficulties in adolescents with chronic fatigue syndrome/myalgic encephalomyelitis.

PubMed

Harris, Sarah; Gilbert, Matthew; Beasant, Lucy; Linney, Catherine; Broughton, Jessica; Crawley, Esther

2017-01-01

An estimated 10% of children and adolescents with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) experience eating difficulties; however, little is known about why these difficulties develop, what the impact is or how to manage them. Semi-structured interviews were conducted with adolescents (aged 12-17 years) attending a specialist service who have a primary diagnosis of CFS/ME and experience nausea, abdominal pain and/or eating difficulties. A total of 11 adolescents were interviewed (eight female, mean age: 15 years). Transcripts were analysed thematically using techniques of constant comparison which commenced soon after data collection and informed further interview protocols. Adolescents perceived their eating difficulties were caused by abdominal symptoms, being too fatigued to eat and changes to their senses of taste and smell. Some of the adolescents recognised how their eating difficulties were exacerbated and maintained by psychological factors of low mood and anxiety. The adolescents eating difficulties had a negative impact on their weight, fatigue, socialising and family life. They perceived helpful interventions to include modifying their diets, families adjusting and also medical interventions (e.g. medication). Adolescents identified that early education and support about diet and eating habits would have been helpful. If adolescents diagnosed with CFS/ME develop eating difficulties, this has a significant impact on their quality of life, illness and on their families. Not eating increases fatigue, low mood and anxiety which further exacerbates the eating difficulties. Clinicians should screen for eating difficulties in those with symptoms of nausea and abdominal pain, warn adolescents and their families of the risk of developing eating difficulties and provide interventions and support as early as possible.

A qualitative investigation of eating difficulties in adolescents with chronic fatigue syndrome/myalgic encephalomyelitis

PubMed Central

Harris, Sarah; Gilbert, Matthew; Beasant, Lucy; Linney, Catherine; Broughton, Jessica; Crawley, Esther

2016-01-01

Background: An estimated 10% of children and adolescents with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) experience eating difficulties; however, little is known about why these difficulties develop, what the impact is or how to manage them. Methods: Semi-structured interviews were conducted with adolescents (aged 12–17 years) attending a specialist service who have a primary diagnosis of CFS/ME and experience nausea, abdominal pain and/or eating difficulties. A total of 11 adolescents were interviewed (eight female, mean age: 15 years). Transcripts were analysed thematically using techniques of constant comparison which commenced soon after data collection and informed further interview protocols. Results: Adolescents perceived their eating difficulties were caused by abdominal symptoms, being too fatigued to eat and changes to their senses of taste and smell. Some of the adolescents recognised how their eating difficulties were exacerbated and maintained by psychological factors of low mood and anxiety. The adolescents eating difficulties had a negative impact on their weight, fatigue, socialising and family life. They perceived helpful interventions to include modifying their diets, families adjusting and also medical interventions (e.g. medication). Adolescents identified that early education and support about diet and eating habits would have been helpful. Conclusions: If adolescents diagnosed with CFS/ME develop eating difficulties, this has a significant impact on their quality of life, illness and on their families. Not eating increases fatigue, low mood and anxiety which further exacerbates the eating difficulties. Clinicians should screen for eating difficulties in those with symptoms of nausea and abdominal pain, warn adolescents and their families of the risk of developing eating difficulties and provide interventions and support as early as possible. PMID:27215228

The universal, collaborative and dynamic model of specialist and advanced nursing and midwifery practice: A way forward?

PubMed

O'Connor, Laserina; Casey, Mary; Smith, Rita; Fealy, Gerard M; Brien, Denise O'; O'Leary, Denise; Stokes, Diarmuid; McNamara, Martin S; Glasgow, Mary Ellen; Cashin, Andrew

2018-03-01

To inform and guide the development of a future model of specialist and advanced nursing and midwifery practice. There is a sizable body of empirical literature supporting the unique contributions of specialist and advanced practice roles to health care. However, there is very little international evidence to inform the integration of a future model for advanced or specialist practice in the Irish healthcare system. A qualitative study was conducted to initiate this important area of inquiry. Purposive sampling was used to generate a sample of informants (n = 15) for the interviews. Nurses and midwives working in specialist and advanced practice and participants from other areas such as legislative, regulatory, policy, medicine and education were included in the sampling frame. Arguments for a new model of specialist and advanced practice were voiced. A number of participants proposed that flexibility within specialist and advanced practitioner career pathways was essential. Otherwise, there existed the possibility of being directed into specialised "silos," precluding movement to another area of integrated practice. Future specialist and advanced practice education programmes need to include topics such as the development of emotional and political intelligence. The contribution of specialist and advanced practice roles to the health service includes providing rapid access to care, seamless patient flow across services, early discharge and lead coordinator of the patient's care trajectory. There was a recommendation of moving towards a universal model to cultivate specialist and advanced nurse and midwife practitioners. The model design has Universal application in a range of contexts "U." It is Collaborative in its inclusivity of all key stakeholders "C." The model is Dynamic pertinent to accommodating movement of nurses and midwives across health continua rather than plateauing in very specialised "silos" "D." © 2017 John Wiley & Sons Ltd.

Robot transparency, trust and utility

NASA Astrophysics Data System (ADS)

Wortham, Robert H.; Theodorou, Andreas

2017-07-01

As robot reasoning becomes more complex, debugging becomes increasingly hard based solely on observable behaviour, even for robot designers and technical specialists. Similarly, non-specialist users have difficulty creating useful mental models of robot reasoning from observations of robot behaviour. The EPSRC Principles of Robotics mandate that our artefacts should be transparent, but what does this mean in practice, and how does transparency affect both trust and utility? We investigate this relationship in the literature and find it to be complex, particularly in nonindustrial environments where, depending on the application and purpose of the robot, transparency may have a wider range of effects on trust and utility. We outline our programme of research to support our assertion that it is nevertheless possible to create transparent agents that are emotionally engaging despite having a transparent machine nature.

Factors supporting good partnership working between generalist and specialist palliative care services: a systematic review.

PubMed

Gardiner, Clare; Gott, Merryn; Ingleton, Christine

2012-05-01

The care that most people receive at the end of their lives is provided not by specialist palliative care professionals but by generalists such as GPs, district nurses and others who have not undertaken specialist training in palliative care. A key focus of recent UK policy is improving partnership working across the spectrum of palliative care provision. However there is little evidence to suggest factors which support collaborative working between specialist and generalist palliative care providers. To explore factors that support partnership working between specialist and generalist palliative care providers. Systematic review. A systematic review of studies relating to partnership working between specialist and generalist palliative care providers was undertaken. Six electronic databases were searched for papers published up until January 2011. Of the 159 articles initially identified, 22 papers met the criteria for inclusion. Factors supporting good partnership working included: good communication between providers; clear definition of roles and responsibilities; opportunities for shared learning and education; appropriate and timely access to specialist palliative care services; and coordinated care. Multiple examples exist of good partnership working between specialist and generalist providers; however, there is little consistency regarding how models of collaborative working are developed, and which models are most effective. Little is known about the direct impact of collaborative working on patient outcomes. Further research is required to gain the direct perspectives of health professionals and patients regarding collaborative working in palliative care, and to develop appropriate and cost-effective models for partnership working.

Establishment of an innovative specialist cardiac indigenous outreach service in rural and remote Queensland.

PubMed

Tibby, David; Corpus, Rohan; Walters, Darren L

2010-01-01

Cardiovascular diseases are the leading cause of mortality in Indigenous Australians. Indigneous Australians present at a younger age and have a greater incidence of cardiac risk including smoking and diabetes than non-Indigenous Australians. Access to specialist health services is an important determinant of health care outcomes for these patients. We describe an innovative and successful for model for providing Outreach Cardiac Specialist services to Indigenous communities in rural and remote locations. The approach involves a step-wise process of a) community engagement, b) delivering recovery interventions to improve health outcomes, c) building community capacity to self manage chronic illness and promoting health and well being with the aim of d) community self governance of chronic disease and health promotion. Key elements to this process are community participation in the program, disease self-management led by local health care workers, open access that is all-inclusive utilising community-generated referral, and the translation of scientific knowledge of disease processes into community understanding and making culturally relevant connections. Specialist cardiac services and point of care diagnostics have been provided to 18 sites across rural and remote Queensland. More than 1400 episodes of care have been provided to Indigenous Australians with rheumatic heart disease, ischaemic heart disease and congenital heart conditions. Traditional values can work harmoniously with an inclusive medical approach in this relational model. Crown Copyright 2010. Published by Elsevier B.V. All rights reserved.

Suicide in deaf populations: a literature review.

PubMed

Turner, Oliver; Windfuhr, Kirsten; Kapur, Navneet

2007-10-08

Studies have found that deaf individuals have higher rates of psychiatric disorder than those who are hearing, while at the same time encountering difficulties in accessing mental health services. These factors might increase the risk of suicide. However, the burden of suicidal behaviour in deaf people is currently unknown. The aim of the present review was to provide a summary of literature on suicidal behaviour with specific reference to deaf individuals. The objectives of the review were to establish the incidence and prevalence of suicidal behaviour in deaf populations; describe risk factors for suicidal behaviour in deaf populations; describe approaches to intervention and suicide prevention that have been used in deaf populations. A number of electronic databases (e.g. Medline, PsycINFO, CINAHL, EMBASE, Dissertation Abstracts International, Web of Science, ComDisDome, ASSIA, Education Sage Full Text, Google Scholar, and the grey literature databases FADE and SIGLE) were explored using a combination of key words and medical subject headings as search terms. Reference lists of papers were also searched. The Science and Social Sciences Citation Index electronic databases were used to identify studies that had cited key papers. We also contacted experts and organisations with an interest in the field. Very few studies focussed specifically on suicide in deaf populations. Those studies that were included (n = 13) generally involved small and unrepresentative samples. There were limited data on the rate of suicidal behaviour in deaf people. One study reported evidence of hearing impairment in 0.2% of all suicide deaths. Another found that individuals with tinnitus seen in specialist clinics had an elevated rate of suicide compared to the general population. The rates of attempted suicide in deaf school and college students during the previous year ranged from 1.7% to 18%, with lifetime rates as high as 30%. Little evidence was found to suggest that risk factors for suicide in deaf people differed systematically from those in the general population. However, studies did report higher levels of depression and higher levels of perceived risk among deaf individuals than hearing control groups. No firm evidence was found regarding the effectiveness of suicide prevention strategies in deaf people, but suggested strategies include developing specific screening tools, training clinical staff, promoting deaf awareness, increasing the availability of specialist mental health services for deaf people. There is a significant gap in our understanding of suicide in deaf populations. Clinicians should be aware of the possible association between suicide and deafness. Specialist mental health services should be readily accessible to deaf individuals and specific preventative strategies may be of benefit. However, further research using a variety of study designs is needed to increase our understanding of this issue.

CE: Original Research: Does Certification in Vascular Access Matter? An Analysis of the PICC1 Survey.

PubMed

Chopra, Vineet; Kuhn, Latoya; Vaughn, Valerie; Ratz, David; Winter, Suzanne; Moureau, Nancy; Meyer, Britt; Krein, Sarah

2017-12-01

: Background: Although certification by an accredited agency is often a practice prerequisite in health care, it is not required of vascular access specialists who insert peripherally inserted central catheters (PICCs). Whether certification is associated with differences in practice among inserters is unknown. The purpose of this study was to gather information regarding whether certified and noncertified PICC inserters differ with respect to their practices and views about PICC use. We conducted a national survey of vascular access specialists, identifying certified PICC inserters as those who had received board certification from the Association for Vascular Access, the Infusion Nurses Society, or both. The 76-item survey asked about PICC policies and procedures at respondents' facilities, use of insertion technologies, device management, management of complications, perceptions about PICC use, and relationships with other health care providers. Additional data about respondents, including years in practice and primary practice settings, were also gathered. Bivariable comparisons were made using χ tests; two-sided α with P ≤ 0.05 was considered statistically significant. Of the 1,450 respondents in the final sample, 1,007 (69%) said they were certified inserters and 443 (31%) said they were not. Significantly higher percentages of certified than noncertified inserters reported having practiced for five or more years (78% versus 54%) and having placed 1,000 or more PICCs (58% versus 32%). Significantly more certified than noncertified inserters also reported being the vascular access lead for their facility (56% versus 44%). Reported practice patterns for insertion, care, and management of PICCs varied based on certification status. Some evidence-based practices (such as the use of ultrasound to measure catheter-to-vein ratios) were more often reported by certified inserters, while others (such as the use of maximal sterile barriers during PICC insertion) were not. Asked about their perceptions of PICC use at their institution, certified inserters reported higher percentages of inappropriate insertion and removal than noncertified inserters. Certified PICC inserters appear to be a distinct group of vascular access specialists. A better understanding of how and why practices differ between certified and noncertified inserters is necessary to ensuring safer, high-quality patient care.

The Austrialian National Chinese Japanese Korean Project

NASA Technical Reports Server (NTRS)

Groom, Linda

1994-01-01

Providing access to Asian-language materials has always been a problem for libraries. There are particular difficulties in acquiring Asian materials, in cataloguing them and providing access, and in incorporating them in library systems. There is, however, an urgent and growing need for access to Asian materials. Part of the response of the Australian library community to the difficulties and to the increasing need has been the Australian National CJK (Chinese, Japanese and Korean) Project. The CJK Project is a co-operative project involving seven Australian universities and the National Library of Australia. Membership is expected to grow to include other Australian research libraries, some public research libraries and some overseas libraries.

Corsair microcatheter for retrograde coronary chronic total occlusion recanalization: early experience outside the realm of dedicated recanalization specialists.

PubMed

Joseph, George; Thomson, Viji Samuel; Radhakrishnan, Shanmugasundaram

2012-01-01

To determine the extent to which use of the Corsair microcatheter (CM, Asahi Intecc Co., Japan) improves procedural outcomes when an experienced operator who is not a dedicated recanalization specialist attempts retrograde chronic total occlusion (CTO) recanalization through collateral channels during percutaneous coronary intervention. The recently introduced CM has improved success rates of retrograde CTO recanalization to nearly 100% in the hands of dedicated coronary recanalization specialists; however, the impact the CM has on the results of non-specialist operators attempting retrograde CTO recanalization is not known. A non-specialist operator attempted CM-assisted recanalization in seven consecutive CTO cases requiring retrograde recanalization. The results obtained were compared with those achieved by the same operator in eleven consecutive retrograde CTO recanalization procedures during the last 2 years before the CM became available. CM-assisted retrograde CTO recanalization was successful in 6 of 7 cases (86%), but failed in one case attempted through a tortuous epicardial collateral; there were no complications. In contrast, during the 2 years before the CM became available, retrograde CTO recanalization was successful in only 3 of 11 attempted cases (27%), and was associated with significant morbidity. Lesions in the two groups were comparable in terms of technical difficulty and procedural risk. The non-specialist operator's retrograde CTO recanalization results improve significantly when using the CM. Given the effectiveness and safety of CM-assisted retrograde CTO recanalization, operators should be less aggressive with anterograde recanalization attempts, and should switch to the retrograde approach earlier and more often. Copyright © 2012 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

Missed opportunities for diabetes prevention: post-pregnancy follow-up of women with gestational diabetes mellitus in England

PubMed Central

Pierce, Mary; Modder, Jo; Mortagy, Iman; Springett, Anna; Hughes, Heather; Baldeweg, Stephanie

2011-01-01

Background Women with gestational diabetes mellitus (GDM) should be followed-up to exclude ongoing diabetes and for prevention of type 2 diabetes. The National Institute for Health and Clinical Excellence (NICE) diabetes in pregnancy guideline recommends checking fasting plasma glucose (FPG) at 6 weeks postpartum (short term), and annually thereafter (long term). Aim To examine the reported practice regarding GDM follow-up. Design and setting Nationwide postal survey in England 2008-2009. Method Questionnaires were distributed to a consultant diabetologist and obstetrician in all maternity units, and to a random sample of general practices (approximately 1 in 5). Results Response rates were: 60% (915/1532) GPs, 93% (342/368) specialists; 80% of GPs and 98% of specialists reported women with GDM had short-term follow-up. More GPs (55%) than specialists (13%) used a FPG test to exclude ongoing diabetes; 26% of GPs versus 89% of specialists thought the hospital was responsible for ordering the test. Twenty per cent of GPs had difficulty in discovering women had been diagnosed with GDM in secondary care. Seventy-three per cent of specialists recommended long-term follow-up; only 39% of GPs recalled women with GDM for this. A minority of GPs and specialists had joint follow-up protocols Conclusion Follow-up of GDM in England diverged from national guidance. Despite consensus that short-term follow-up occurred, primary and secondary care doctors disagreed about the tests and responsibility for follow-up. There was lack of long-term follow-up. Agreement about the NICE guideline, its promotion and effective implementation by primary and secondary care, and the systematic recall of women with GDM for long-term follow-up is required. PMID:22152832

Working during cancer treatment

MedlinePlus

... cancer treatment. www.cancer.gov/publications/patient-education/life-after-treatment.pdf . Updated May 2014. Accessed October 12, 2016. Review Date 8/15/2016 Updated by: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review ...

Learning about an Undiagosed Condition in a Child

MedlinePlus

... a specialist at a major university hospital or academic medical center. Health care professionals in this type ... Institutes of Health has developed ClinicalTrials.gov , a database accessible to the public through the Web. This ...

Processes of recovery through routine or specialist treatment for borderline personality disorder (BPD): a qualitative study.

PubMed

Katsakou, Christina; Pistrang, Nancy; Barnicot, Kirsten; White, Hayley; Priebe, Stefan

2017-07-04

Recovery processes in borderline personality disorder (BPD) are poorly understood. This study explored how recovery in BPD occurs through routine or specialist treatment, as perceived by service users (SUs) and therapists. SUs were recruited from two specialist BPD services, three community mental health teams, and one psychological therapies service. Semi-structured interviews were conducted with 48 SUs and 15 therapists. The "framework" approach was used to analyse the data. The findings were organized into two domains of themes. The first domain described three parallel processes that constituted SUs' recovery journey: fighting ambivalence and committing to taking action; moving from shame to self-acceptance and compassion; and moving from distrust and defensiveness to opening up to others. The second domain described four therapeutic challenges that needed to be addressed to support this journey: balancing self-exploration and finding solutions; balancing structure and flexibility; confronting interpersonal difficulties and practicing new ways of relating; and balancing support and independence. Therapies facilitating the identified processes may promote recovery. The recovery processes and therapeutic challenges identified in this study could provide a framework to guide future research.

Nonurgent patients in emergency departments: rational or irresponsible consumers? Perceptions of professionals and patients.

PubMed

Durand, Anne-Claire; Palazzolo, Sylvie; Tanti-Hardouin, Nicolas; Gerbeaux, Patrick; Sambuc, Roland; Gentile, Stéphanie

2012-09-25

For several decades, overcrowding in emergency departments (EDs) has been intensifying due to the increased number of patients seeking care in EDs. Demand growth is partly due to misuse of EDs by patients who seek care for nonurgent problems. This study explores the reasons why people with nonurgent complaints choose to come to EDs, and how ED health professionals perceive the phenomenon of "nonurgency". Semi-structured interviews were conducted in 10 EDs with 87 nonurgent patients and 34 health professionals. Interviews of patients revealed three themes: (1) fulfilled health care needs, (2) barriers to primary care providers (PCPs), and (3) convenience. Patients chose EDs as discerning health consumers: they preferred EDs because they had difficulties obtaining a rapid appointment. Access to technical facilities in EDs spares the patient from being overwhelmed with appointments with various specialists. Four themes were identified from the interviews of health professionals: (1) the problem of defining a nonurgent visit, (2) explanations for patients' use of EDs for nonurgent complaints, (3) consequences of nonurgent visits, and (4) solutions to counter this tendency. Studies on the underlying reasons patients opt for the ED, as well as on their decision-making process, are lacking. The present study highlighted discrepancies between the perceptions of ED patients and those of health professionals, with a special focus on patient behaviour. To explain the use of ED, health professionals based themselves on the acuity and urgency of medical problems, while patients focused on rational reasons to initiate care in the ED (accessibility to health care resources, and the context in which the medical problem occurred). In spite of some limitations due to the slightly outdated nature of our data, as well as the difficulty of categorizing nonurgent situations, our findings show the importance of conducting a detailed analysis of the demand for health care. Understanding it is crucial, as it is the main determining factor in the utilization of health care resources, and provides promising insights into the phenomenon of ED usage increase. For reforms to be successful, the process of decision-making for unscheduled patients will have to be thoroughly investigated.

Rural patients’ experiences accessing surgery in British Columbia

PubMed Central

Humber, Nancy; Dickinson, Paul

2010-01-01

Background More than 33% of Canadians live in rural areas. The vulnerability of rural surgical patients makes them particularly sensitive to barriers to accessing health care. This study aims to describe rural patients’ experiences accessing local non-specialist, family physician–surgeon care and regional specialist surgical care when no local surgical care was available. Methods We conducted a qualitative pilot study of self-selected patients. Interviews were analyzed using a modified Delphi technique and NVivo qualitative software. Results The needs of rural surgical patients were reflective of Maslow’s hierarchy of needs: physiologic, safety and security, community belonging and self-esteem/self-actualization. Rural patients expressed a strong desire for individualized care in a familiar environment. When such care was not available, patients found it difficult to meet even basic physiologic needs. Maternity patients and marginalized populations were particularly vulnerable. Conclusion Rural patients seem to prefer individualized care in a familiar environment to address more of their qualitative emotional, psychological and cultural needs rather than only the physiologic needs of surgery. Larger studies are needed to delineate more clearly the qualitative aspects of surgical care. PMID:21092429

Access to health services by lesbian, gay, bisexual, and transgender persons: systematic literature review.

PubMed

Alencar Albuquerque, Grayce; de Lima Garcia, Cintia; da Silva Quirino, Glauberto; Alves, Maria Juscinaide Henrique; Belém, Jameson Moreira; dos Santos Figueiredo, Francisco Winter; da Silva Paiva, Laércio; do Nascimento, Vânia Barbosa; da Silva Maciel, Érika; Valenti, Vitor Engrácia; de Abreu, Luiz Carlos; Adami, Fernando

2016-01-14

The relationship between users and health services is considered essential to strengthen the quality of care. However, the Lesbian, Gay, Bisexual, and Transgender population suffer from prejudice and discrimination in access and use of these services. This study aimed to identify the difficulties associated with homosexuality in access and utilization of health services. A systematic review conducted using PubMed, Cochrane, SciELO, and LILACS, considering the period from 2004 to 2014. The studies were evaluated according to predefined inclusion and exclusion criterias. Were included manuscripts written in English or Portuguese, articles examining the Lesbian, Gay, Bisexual, and Transgender population's access to health services and original articles with full text available online. The electronic databases search resulted in 667 studies, of which 14 met all inclusion criteria. Quantitative articles were predominant, showing the country of United States of America to be the largest producer of research on the topic. The studies reveal that the homosexual population have difficulties of access to health services as a result of heteronormative attitudes imposed by health professionals. The discriminatory attendance implies in human rights violations in access to health services. The non-heterosexual orientation was a determinant factor in the difficulties of accessing health care. A lot must still be achieved to ensure access to health services for sexual minorities, through the adoption of holistic and welcoming attitudes. The results of this study highlight the need for larger discussions about the theme, through new research and debates, with the aim of enhancing professionals and services for the health care of Lesbian, Gay, Bisexual, and Transgender Persons.

Toll motorway accessibility for wheelchair users: a survey.

PubMed

Prigent, Hélène; Roche, Nicolas; Guillon, Bruno; Hurand, Anne; Moreau, Bernadette; Dufresne, Jean Pierre; Ravaud, Jean-François; Lofaso, Frédéric

2008-09-01

To identify difficulties encountered by wheelchair users who travel on toll motorways, with the goal of defining areas for improvement. Survey. After observing a wheelchair user travelling on a toll motorway and using the associated services, we designed a self-questionnaire on perceptions by wheelchair users of toll motorway accessibility. Toll motorway and rehabilitation hospital in France. We recruited 167 wheelchair users by advertisement and, to assess selection bias, 19 consecutive outpatients who visited our hospital's wheelchair showroom. None. Of the 186 included subjects, 91 (49%) were used to driving independently on toll motorways. Among them, only 16% used automatic toll booths and 32% reported difficulties at toll booths. Furthermore, 53% routinely asked for help at filling stations, and only 27% were aware of the availability of a free-of-charge assistance service for disabled people at some filling stations. Among the 186 toll motorway users, only 84 (45%) reported never encountering difficulties in lay-bys; 162 (87%) felt that toilet accessibility was the most important feature of lay-bys and 143 (77%) preferred the locked toilets reserved for disabled people. Wheelchair users reported difficulties on toll motorways that could be corrected fairly easily.

Defense.gov Special Report: DOD Welcomes Ashton Carter - Secretary of

Science.gov Websites

with disabilities experiencing difficulties accessing content on archive.defense.gov, please use the ,' Secretary Says Focusing on the difficulties that lie ahead of the Defense Department is easy, but now is

Designing a Clinical Dashboard to Fill Information Gaps in the Emergency Department

PubMed Central

Swartz, Jordan L.; Cimino, James J.; Fred, Matthew R.; Green, Robert A.; Vawdrey, David K.

2014-01-01

Data fragmentation within electronic health records causes gaps in the information readily available to clinicians. We investigated the information needs of emergency medicine clinicians in order to design an electronic dashboard to fill information gaps in the emergency department. An online survey was distributed to all emergency medicine physicians at a large, urban academic medical center. The survey response rate was 48% (52/109). The clinical information items reported to be most helpful while caring for patients in the emergency department were vital signs, electrocardiogram (ECG) reports, previous discharge summaries, and previous lab results. Brief structured interviews were also conducted with 18 clinicians during their shifts in the emergency department. From the interviews, three themes emerged: 1) difficulty accessing vital signs, 2) difficulty accessing point-of-care tests, and 3) difficulty comparing the current ECG with the previous ECG. An emergency medicine clinical dashboard was developed to address these difficulties. PMID:25954420

Designing a clinical dashboard to fill information gaps in the emergency department.

PubMed

Swartz, Jordan L; Cimino, James J; Fred, Matthew R; Green, Robert A; Vawdrey, David K

2014-01-01

Data fragmentation within electronic health records causes gaps in the information readily available to clinicians. We investigated the information needs of emergency medicine clinicians in order to design an electronic dashboard to fill information gaps in the emergency department. An online survey was distributed to all emergency medicine physicians at a large, urban academic medical center. The survey response rate was 48% (52/109). The clinical information items reported to be most helpful while caring for patients in the emergency department were vital signs, electrocardiogram (ECG) reports, previous discharge summaries, and previous lab results. Brief structured interviews were also conducted with 18 clinicians during their shifts in the emergency department. From the interviews, three themes emerged: 1) difficulty accessing vital signs, 2) difficulty accessing point-of-care tests, and 3) difficulty comparing the current ECG with the previous ECG. An emergency medicine clinical dashboard was developed to address these difficulties.

Problematic topics in first-year mathematics: lecturer and student views

NASA Astrophysics Data System (ADS)

Ní Shé, Caitríona; Mac an Bhaird, Ciarán; Ní Fhloinn, Eabhnat; O'Shea, Ann

2017-07-01

In this paper we report on the outcomes of two surveys carried out in higher education institutions of Ireland; one of students attending first-year undergraduate non-specialist mathematics modules and another of their lecturers. The surveys aimed to identify the topics that these students found difficult, whether they had most difficulty with the concepts or procedures involved in the topics, and the resources they used to overcome these difficulties. In this paper we focus on the mathematical concepts and procedures that students found most difficult. While there was agreement between students and lecturers on certain problematic topics, this was not uniform across all topics, and students rated their conceptual understanding higher than their ability to do questions, in contrast to lecturers' opinions.

STS-46 'blue' shift crewmembers look up from work on OV-104's flight deck

NASA Technical Reports Server (NTRS)

1992-01-01

STS-46 'blue' shift crewmembers look up from checklist procedures to have their picture taken on the forward flight deck of Atlantis, Orbiter Vehicle (OV) 104. Seated at the commanders station (left) is Pilot Andrew M. Allen with Italian Payload Specialist Franco Malerba positioned in front of the center console and European Space Agency (ESA) Mission Specialist seated at the pilots station (right). MS Marsha S. Ivins is in the interdeck access hatch at the right bottom corner of the photo.

[Deontology in generalists-specialists relations in domestic emergencies].

PubMed

Leemans, P

2000-09-01

The deontological rules defining the relations between the general practitioners and specialists about domestic emergencies are clearly exposed in the code edited by the National Medical Council of Belgium. Ethical particularities exist. During an emergency situation, the patient could lose his freedom as well as his autonomy and might become a technical subject rather than an ethical person. The ethical values are in opposition with a medical practice trying to be more and more efficient with as a corollary, the necessity to have a full and permanent access to personal medical data.

Access to care and use of the Internet to search for health information: results from the US National Health Interview Survey.

PubMed

Amante, Daniel J; Hogan, Timothy P; Pagoto, Sherry L; English, Thomas M; Lapane, Kate L

2015-04-29

The insurance mandate of the Affordable Care Act has increased the number of people with health coverage in the United States. There is speculation that this increase in the number of insured could make accessing health care services more difficult. Those who are unable to access care in a timely manner may use the Internet to search for information needed to answer their health questions. The aim was to determine whether difficulty accessing health care services for reasons unrelated to insurance coverage is associated with increased use of the Internet to obtain health information. Survey data from 32,139 adults in the 2011 National Health Interview Study (NHIS) were used in this study. The exposure for this analysis was reporting difficulty accessing health care services or delaying getting care for a reason unrelated to insurance status. To define this exposure, we examined 8 questions that asked whether different access problems occurred during the previous 12 months. The outcome for this analysis, health information technology (HIT) use, was captured by examining 2 questions that asked survey respondents if they used an online health chat room or searched the Internet to obtain health information in the previous 12 months. Several multinomial logistic regressions estimating the odds of using HIT for each reported access difficulty were conducted to accomplish the study objective. Of a survey population of 32,139 adults, more than 15.90% (n=5109) reported experiencing at least one access to care barrier, whereas 3.63% (1168/32,139) reported using online health chat rooms and 43.55% (13,997/32,139) reported searching the Internet for health information. Adults who reported difficulty accessing health care services for reasons unrelated to their health insurance coverage had greater odds of using the Internet to obtain health information. Those who reported delaying getting care because they could not get an appointment soon enough (OR 2.2, 95% CI 1.9-2.5), were told the doctor would not accept them as a new patient or accept their insurance (OR 2.1, 95% CI 1.7-2.5 and OR 2.1, 95% CI 1.7-2.5, respectively), or because the doctor's office was not open when they could go (OR 2.2, 95% CI 1.9-2.7) had more than twice the odds of using the Internet to obtain health information compared to those who did not report such access difficulties. People experiencing trouble accessing health care services for reasons unrelated to their insurance status are more likely to report using the Internet to obtain health information. Improving the accuracy and reliability of health information resources that are publicly available online could help those who are searching for information due to trouble accessing health care services.

Do difficulties in accessing in-hours primary care predict higher use of out-of-hours GP services? Evidence from an English National Patient Survey.

PubMed

Zhou, Yin; Abel, Gary; Warren, Fiona; Roland, Martin; Campbell, John; Lyratzopoulos, Georgios

2015-05-01

It is believed that some patients are more likely to use out-of-hours primary care services because of difficulties in accessing in-hours care, but substantial evidence about any such association is missing. We analysed data from 567,049 respondents to the 2011/2012 English General Practice Patient Survey who reported at least one in-hours primary care consultation in the preceding 6 months. Of those respondents, 7% also reported using out-of-hours primary care. We used logistic regression to explore associations between use of out-of-hours primary care and five measures of in-hours access (ease of getting through on the telephone, ability to see a preferred general practitioner, ability to get an urgent or routine appointment and convenience of opening hours). We illustrated the potential for reduction in use of out-of-hours primary care in a model where access to in-hours care was made optimal. Worse in-hours access was associated with greater use of out-of-hours primary care for each access factor. In multivariable analysis adjusting for access and patient characteristic variables, worse access was independently associated with increased out-of-hours use for all measures except ease of telephone access. Assuming these associations were causal, we estimated that an 11% relative reduction in use of out-of-hours primary care services in England could be achievable if access to in-hours care were optimal. This secondary quantitative analysis provides evidence for an association between difficulty in accessing in-hours care and use of out-of-hours primary care services. The findings can motivate the development of interventions to improve in-hour access. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

A qualitative study of barriers to the implementation of a rheumatoid arthritis guideline among generalist and specialist physical therapists.

PubMed

van Bodegom-Vos, Leti; Verhoef, John; Dickmann, Margot; Kleijn, Marjon; van Vliet, Ingrid; Hurkmans, Emalie; van der Wees, Philip; Vliet Vlieland, Thea

2012-10-01

Although the increasing complexity and expansion of the body of knowledge in physical therapy have led to specialized practice areas to provide better patient care, the impact of specialization on guideline implementation has been scarcely studied. Objectives The objective of this study was to identify the similarities and differences in barriers to the implementation of a Dutch rheumatoid arthritis (RA) guideline by generalist and specialist physical therapists. Design This observational study consisted of 4 focus group interviews in which 24 physical therapists (13 generalist and 11 specialist physical therapists) participated. Physical therapists were asked to discuss barriers to the implementation of the RA guideline. Data were analyzed qualitatively using a directed approach to content analysis. Both the interviews and the interview analysis were informed by a previously developed conceptual framework. Besides a number of similarities (eg, lack of time), the present study showed important, although subtle, differences in barriers to the implementation of the RA guideline between generalist physical therapists and specialist physical therapists. Generalist physical therapists more frequently reported difficulties in interpreting the guideline (cognitive barriers) and had less favorable opinions about the guideline (affective barriers) than specialist physical therapists. Specialist physical therapists were hampered by external barriers that are outside the scope of generalist physical therapists, such as a lack of agreement about the roles and responsibilities of medical professionals involved in the care of the same patient. The identified differences in barriers to the implementation of the RA guideline indicated that the effectiveness of implementation strategies could be improved by tailoring them to the level of specialization of physical therapists. However, it is expected that tailoring implementation strategies to barriers that hamper both generalist and specialist physical therapists will have a larger effect on the implementation of the RA guideline.

No programming required. Mobile PCs can help physicians work more efficiently, especially when the application is designed to fit the practice.

PubMed

Campbell, J

2000-09-01

The Jacobson Medical Group San Antonio Jacobson Medical Group (JMG) needed a way to effectively and efficiently coordinate referral information between their hospitalist physicians and specialists. JMG decided to replace paper-based binders with something more convenient and easily updated. The organization chose to implement a mobile solution that would provide its physicians with convenient access to a database of information via a hand-held computer. The hand-held solution provides physicians with full demographic profiles of primary care givers for each area where the group operates. The database includes multiple profiles based on different healthcare plans, along with details about preferred and authorized specialists. JMG adopted a user-friendly solution that the hospitalists and specialists would embrace and actually use.

The National Health Insurance, the decentralised clinical training platform, and specialist outreach.

PubMed

Caldwell, R I; Aldous, C

2016-12-21

According to the Constitution of South Africa (SA), citizens living in remote areas are entitled to the same level of healthcare as those with access to tertiary hospitals. Specialist outreach has been shown to achieve this. When SA's National Health Services Commission convened (1942 - 1944), Gluckman summarised: 'Where the need is greatest the supply of hospitals is least.' Primary healthcare (PHC) characterised the Kark's Pholela Health Centre and was highly regarded. Although PHC underpins National Health Insurance (NHI) planning, both preventive and curative healthcare are needed. The KwaZulu-Natal (KZN) provincial Department of Health and the University of KZN College of Health Sciences' 5-year plan for a decentralised clinical teaching platform (DCTP) is ambitious, requiring optimum co-operation between health department and university. Reservations can be addressed through sustained specialist outreach. Above all, the patient mustbe the chief beneficiary. The NHI and DCTP overlap with specialist outreach, but cannot do without it.

The Role and Education of the Veterinary Pharmacist

PubMed Central

Fasser, Carl E.; Rush, John E.; Scheife, Richard T.; Orcutt, Connie J.; Michalski, Donald L.; Mazan, Melissa R.; Dorsey, Mary T.; Bernardi, Stephen P.

2009-01-01

Objective To define the role and education of the traditional pharmacist who supports the needs of the veterinarian (hereafter referred to as veterinary pharmacist) and a pharmacist who practices solely in veterinary pharmacy (here after referred to as veterinary pharmacy specialist). Methods The Delphi technique involving 7 panels of 143 experts was employed to reach consensus on the definition of the roles and education of the veterinary pharmacist and veterinary pharmacy specialist. Results The veterinary pharmacy specialist's role included dispensing medications, complying with regulations, advocating for quality therapeutic practices, and providing consultative services, research, and education. The perceived role of the veterinary pharmacist was viewed as being somewhat narrower. Compared to veterinary pharmacists, a more in-depth education in veterinary medicine was viewed as essential to the role development of veterinary pharmacy specialists. Conclusions The authors hope their research will promote widespread awareness of the emerging field of veterinary pharmacy and encourage schools to offer increased access to clinically relevant professional training programs. PMID:19513154

Your cancer diagnosis: Do you need a second opinion?

MedlinePlus

... Updated August 25, 2017. Accessed February 15, 2018. Review Date 1/31/2018 Updated by: Todd Gersten, ... Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by ...

Behnken in Interdeck Access Hatch

NASA Image and Video Library

2010-02-08

S130-E-005218 (8 Feb. 2010) --- NASA astronaut Robert Behnken, STS-130 mission specialist, smiles for the camera while in the hatch which connects the flight deck and middeck of space shuttle Endeavour during flight day one activities.

42 CFR 438.208 - Coordination and continuity of care.

Code of Federal Regulations, 2010 CFR

2010-10-01

... specified in the State's quality improvement strategy in § 438.202; and (ii) May use State staff, the State... PAHP must have a mechanism in place to allow enrollees to directly access a specialist (for example...

An integrated content and metadata based retrieval system for art.

PubMed

Lewis, Paul H; Martinez, Kirk; Abas, Fazly Salleh; Fauzi, Mohammad Faizal Ahmad; Chan, Stephen C Y; Addis, Matthew J; Boniface, Mike J; Grimwood, Paul; Stevenson, Alison; Lahanier, Christian; Stevenson, James

2004-03-01

A new approach to image retrieval is presented in the domain of museum and gallery image collections. Specialist algorithms, developed to address specific retrieval tasks, are combined with more conventional content and metadata retrieval approaches, and implemented within a distributed architecture to provide cross-collection searching and navigation in a seamless way. External systems can access the different collections using interoperability protocols and open standards, which were extended to accommodate content based as well as text based retrieval paradigms. After a brief overview of the complete system, we describe the novel design and evaluation of some of the specialist image analysis algorithms including a method for image retrieval based on sub-image queries, retrievals based on very low quality images and retrieval using canvas crack patterns. We show how effective retrieval results can be achieved by real end-users consisting of major museums and galleries, accessing the distributed but integrated digital collections.

Enhancing palliative care delivery in a regional community in Australia.

PubMed

Phillips, Jane L; Davidson, Patricia M; Jackson, Debra; Kristjanson, Linda; Bennett, Margaret L; Daly, John

2006-08-01

Although access to palliative care is a fundamental right for people in Australia and is endorsed by government policy, there is often limited access to specialist palliative care services in regional, rural and remote areas. This article appraises the evidence pertaining to palliative care service delivery to inform a sustainable model of palliative care that meets the needs of a regional population on the mid-north coast of New South Wales. Expert consultation and an eclectic literature review were undertaken to develop a model of palliative care service delivery appropriate to the needs of the target population and resources of the local community. On the basis of this review, a local palliative care system that is based on a population-based approach to service planning and delivery, with formalized integrated network agreements and role delineation between specialist and generalist providers, has the greatest potential to meet the palliative care needs of this regional coastal community.

The evolution of a teledentistry system within the Department of Defense.

PubMed Central

Rocca, M. A.; Kudryk, V. L.; Pajak, J. C.; Morris, T.

1999-01-01

Total Dental Access (TDA) is the teledentistry project within the Department of Defense. This project enables referring dentists from the US Armed Forces to consult with specialists on the status of a patient. TDA focuses on three areas of dentistry: patient care, continuing education and dentist-laboratory communications. One of the goals of this project is to increase patient access to quality dental care. The other goal is to establish a cost effective telemedicine system. This paper describes the evolution of a teledentistry system, the main features of POTS-based, ISDN-based and Web-based systems used, advantages, disadvantages and cost-effectiveness of these systems. Data has been collected on the frequency of use, technical problems occurred, avoided patient or specialist travel and the total number of consults. A cost-effectiveness analysis has been conducted on the data collected. The results of this analysis will be presented. PMID:10566495

The evolution of a teledentistry system within the Department of Defense.

PubMed

Rocca, M A; Kudryk, V L; Pajak, J C; Morris, T

1999-01-01

Total Dental Access (TDA) is the teledentistry project within the Department of Defense. This project enables referring dentists from the US Armed Forces to consult with specialists on the status of a patient. TDA focuses on three areas of dentistry: patient care, continuing education and dentist-laboratory communications. One of the goals of this project is to increase patient access to quality dental care. The other goal is to establish a cost effective telemedicine system. This paper describes the evolution of a teledentistry system, the main features of POTS-based, ISDN-based and Web-based systems used, advantages, disadvantages and cost-effectiveness of these systems. Data has been collected on the frequency of use, technical problems occurred, avoided patient or specialist travel and the total number of consults. A cost-effectiveness analysis has been conducted on the data collected. The results of this analysis will be presented.

Robotic single-access splenectomy using the Da Vinci Single-Site® platform: a case report.

PubMed

Corcione, Francesco; Bracale, Umberto; Pirozzi, Felice; Cuccurullo, Diego; Angelini, Pier Luigi

2014-03-01

Single-access laparoscopic splenectomy can offer patients some advantages. It has many difficulties, such as instrument clashing, lack of triangulation, odd angles and lack of space. The Da Vinci Single-Site® robotic surgery platform could decrease these difficulties. We present a case of single-access robotic splenectomy using this device. A 37 year-old female with idiopathic thrombocytopenic purpura was operated on with a single-site approach, using the Da Vinci Single-Site robotic surgery device. The procedure was successfully completed in 140 min. No intraoperative and postoperative complications occurred. The patient was discharged from hospital on day 3. Single-access robotic splenectomy seems to be feasible and safe using the new robotic single-access platform, which seems to overcome certain limits of previous robotic or conventional single-access laparoscopy. We think that additional studies should also be performed to explore the real cost-effectiveness of the platform. Copyright © 2013 John Wiley & Sons, Ltd.

[How representative is the healthcare assessment website Zorgkaart Nederland? The evaluation of medical specialists by patients in the Netherlands].

PubMed

Stehmann, Tijs A; Goudriaan, W A Alexander; In 't Veen, J C C M Hans; Kollen, Boudewijn J; Verheyen, C C P M Kees

2016-01-01

To describe the number of ratings and the corresponding scores given to medical specialists on the Dutch healthcare assessment website 'Zorgkaart Nederland.nl', and evaluation of this website as tool for evaluation of quality. Explorative descriptive study. In July 2015, data were gathered from the public section of the healthcare assessment website 'ZorgkaartNederland.nl'. The number of specialists, the mean ratings per department (group mark), the number of evaluations, the number of medical specialists without a rating and the number of specialists with at least 9 ratings were registered per speciality, per hospital. Outcomes measures were the median number of ratings per speciality and the group score. Data were analysed using descriptive and non-parametric statistics. Each month, 763,000 unique visitors access ZorgkaartNederland.nl; on average, 0.08% of these registers a vote. There were 15,337 medical specialists, spread across 97 hospitals and 2,060 specialities on ZorgkaartNederland.nl, with a total of 45,548 evaluations. Of these, 6,682 (43.4%) specialists were not rated, and 1.165 (7.6%) had ≥ 9 ratings. Additionally, 327 (15.9%) departments were unrated. Surgical departments were evaluated more often, and their grades were significantly higher, than those of non-surgical departments. The website ZorgkaartNederland.nl shows ratings for 56.6% of all medical specialists. When the lower limit of at least 9 evaluations per specialist introduced by ZorgkaartNederland.nl was applied, only the grades for 7.6% of all specialists are valid. On average, 0.08% of unique visitors cast a vote. Surgical specialities have a higher number of evaluations and a higher score than non-surgical ones. ZorgkaartNederland.nl in its current form does not constitute a valid tool for evaluation of the quality of medical specialist care in the Netherlands. This article provides recommendations for improvement.

Differences in the diagnosis and management of systemic lupus erythematosus by primary care and specialist providers in the American Indian/Alaska Native population.

PubMed

McDougall, J A; Helmick, C G; Lim, S S; Johnston, J M; Gaddy, J R; Gordon, C; Ferucci, E D

2018-06-01

Objectives The objective of this study is to investigate differences in the diagnosis and management of systemic lupus erythematosus (SLE) by primary care and specialist physicians in a population-based registry. Methods This study includes individuals from the 2009 Indian Health Service lupus registry population with a diagnosis of SLE documented by either a primary care provider or specialist. SLE classification criteria, laboratory testing, and medication use at any time during the course of disease were determined by medical record abstraction. Results Of the 320 individuals with a diagnosis of SLE, 249 had the diagnosis documented by a specialist, with 71 documented by primary care. Individuals with a specialist diagnosis of SLE were more likely to have medical record documentation of meeting criteria for SLE by all criteria sets (American College of Rheumatology, 79% vs 22%; Boston Weighted, 82% vs 32%; and Systemic Lupus International Collaborating Clinics, 83% vs 35%; p < 0.001 for all comparisons). In addition, specialist diagnosis was associated with documentation of ever having been tested for anti-double-stranded DNA antibody and complement 3 and complement 4 ( p < 0.001). Documentation of ever receiving hydroxychloroquine was also more common with specialist diagnosis (86% vs 64%, p < 0.001). Conclusions Within the population studied, specialist diagnosis of SLE was associated with a higher likelihood of having SLE classification criteria documented, being tested for biomarkers of disease, and ever receiving treatment with hydroxychloroquine. These data support efforts both to increase specialist access for patients with suspected SLE and to provide lupus education to primary care providers.

Strategic purchasing reform in Estonia: Reducing inequalities in access while improving care concentration and quality.

PubMed

Habicht, Triin; Habicht, Jarno; van Ginneken, Ewout

2015-08-01

As of 2014, the Estonian Health Insurance Fund has adopted new purchasing procedures and criteria, which it now has started to implement in specialist care. Main changes include (1) redefined access criteria based on population need rather than historical supply, which aim to achieve more equal access of providers and specialties; (2) stricter definition and use of optimal workload criteria to increase the concentration of specialist care (3) better consideration of patient movement; and (4) an increased emphasis on quality to foster quality improvement. The new criteria were first used in the contract cycle that started in 2014 and resulted in fewer contracted providers for a similar volume of care compared to the previous contract cycle. This implies that provision of specialized care has become concentrated at fewer providers. It is too early to draw firm conclusions on the impact on care quality or on actors, but the process has sparked debate on the role of selective contracting and the role of public and private providers in Estonian health care. Lastly, the Estonian experience may hold important lessons for other countries looking to overcome inequalities in access while concentrating care and improving care quality. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Experiences of French Speaking Immigrants and Non-immigrants Accessing Health Care Services in a Large Canadian City

PubMed Central

Ngwakongnwi, Emmanuel; Hemmelgarn, Brenda R.; Musto, Richard; Quan, Hude; King-Shier, Kathryn M.

2012-01-01

French speakers residing in predominantly English-speaking communities have been linked to difficulties accessing health care. This study examined health care access experiences of immigrants and non-immigrants who self-identify as Francophone or French speakers in a mainly English speaking province of Canada. We used semi-structured interviews to gather opinions of recent users of physician and hospital services (N = 26). Language barriers and difficulties finding family doctors were experienced by both French speaking immigrants and non-immigrants alike. This was exacerbated by a general preference for health services in French and less interest in using language interpreters during a medical consultation. Some participants experienced emotional distress, were discontent with care received, often delayed seeking care due to language barriers. Recent immigrants identified lack of insurance coverage for drugs, transportation difficulties and limited knowledge of the healthcare system as major detractors to achieving health. This study provided the groundwork for future research on health issues of official language minorities in Canada. PMID:23202772

Gaps in care for patients with memory deficits after stroke: views of healthcare providers.

PubMed

Tang, Eugene Yee Hing; Price, Christopher; Stephan, Blossom Christa Maree; Robinson, Louise; Exley, Catherine

2017-09-08

Stroke is a common cause of physical disability but is also strongly associated with cognitive impairment and a risk for future dementia. Despite national clinical guidelines, the service provided for stroke survivors with cognitive and memory difficulties varies across localities. This study critically evaluated the views of healthcare professionals about barriers and facilitators to their care. Seventeen semi-structured individual interviews were conducted by a single interviewer with both primary and secondary care clinicians in regular contact with stroke-survivors. This included stroke medicine specialists, specialist nurses, physiotherapists, occupational therapists, general practitioners and primary care nurses. Topics included individual experiences of the current care offered to patients with cognitive impairment, assessment processes and inter-professional communication. Interviews were audio recorded and transcribed verbatim. Transcripts were thematically analysed and themes grouped into broad categories to facilitate interpretation. Data analysis identified four key themes as barriers to optimal care for stroke-survivors with memory difficulties: 1) Less focus on memory and cognition in post-stroke care; 2) Difficulties bringing up memory and cognitive problems post-stroke; 3) Lack of clarity in current services; and, 4) Assumptions made by healthcare professionals introducing gaps in care. Facilitators included stronger links between primary and secondary care in addition to information provision at all stages of care. The care provided by stroke services is dominated by physical impairments. Clinicians are unsure who should take responsibility for follow-up of patients with cognitive problems. This is made even more difficult by the lack of experience in assessment and stigma surrounding potential diagnoses associated with these deficits. Service development should focus on increased cohesiveness between hospital and community care to create a clear care pathway for post-stroke cognitive impairment.

Freedom of choice of specialist physicians is important to Swiss resident: a cross-sectional study.

PubMed

Peytremann-Bridevaux, Isabelle; Ruffieux, Christiane; Burnand, Bernard

2011-12-19

To assess how important the possibility to choose specialist physicians is for Swiss residents and to determine which variables are associated with this opinion. This cross-sectional study used data from the 2007 Swiss population-based health survey and included 13,642 non-institutionalised adults who responded to the telephone and paper questionnaires. The dependent variable included answers to the question "How important is it for you to be able to choose the specialist you would like to visit?" Independent variables included socio-demographics, health and past year healthcare use measures. Crude and adjusted logistic regressions for the importance of being able to choose specialist physicians were performed, accounting for the survey design. 45% of participants found it very important to be able to choose the specialist physician they wanted to visit. The answers "rather important", "rather not important" and "not important" were reported by 28%, 20% and 7% of respondents. Women, individuals in middle/high executive position, those with an ordinary insurance scheme, those reporting ≥2 chronic conditions or poorer subjective health, or those who had had ≥2 outpatient visits in the preceding year were more likely to find this choice very important. In 2007, almost half of all Swiss residents found it very important to be able to choose his/her specialist physician. The further development of physician networks or other chronic disease management initiatives in Switzerland, towards integrated care, need to pay attention to the freedom of choice of specialist physicians that Swiss residents value. Future surveys should provide information on access and consultations with specialist physicians.

Rapid access to information resources in clinical biochemistry: medical applications of Personal Digital Assistants (PDA).

PubMed

Serdar, Muhittin A; Turan, Mustafa; Cihan, Murat

2008-06-01

Laboratory specialists currently need to access scientific-based information at anytime and anywhere. A considerable period of time and too much effort are required to access this information through existing accumulated data. Personal digital assistants (PDA) are supposed to provide an effective solution with commercial software for this problem. In this study, 11 commercial software products (UpToDate, ePocrates, Inforetrive, Pepid, eMedicine, FIRST Consult, and 5 laboratory e-books released by Skyscape and/or Isilo) were selected and the benefits of their use were evaluated by seven laboratory specialists. The assessment of the software was performed based on the number of the tests included, the software content of detailed information for each test-like process, method, interpretation of results, reference ranges, critical values, interferences, equations, pathophysiology, supplementary technical details such as sample collection principles, and additional information such as linked references, evidence-based data, test cost, etc. In terms of technique, the following items are considered: the amount of memory required to run the software, the graphical user interface, which is a user-friendly instrument, and the frequency of new and/or up-date releases. There is still no perfect program, as we have anticipated. Interpretation of laboratory results may require software with an integrated program. However, methodological data are mostly not included in the software evaluated. It seems that these shortcomings will be fixed in the near future, and PDAs and relevant medical applications will also become indispensable for all physicians including laboratory specialists in the field of training/education and in patient care.

GPs' experiences of children with anxiety disorders in primary care: a qualitative study.

PubMed

O'Brien, Doireann; Harvey, Kate; Young, Bridget; Reardon, Tessa; Creswell, Cathy

2017-12-01

Anxiety disorders have a median age of onset of 11 years and are the most common emotional disorders in childhood; however, a significant proportion of those affected do not access professional support. In the UK, GPs are often the first medical professional that families see so are in a prime position to support children with anxiety disorders; however, currently there is little research available on GPs' perspectives on and experiences of supporting children with these disorders. To explore the experiences of GPs in relation to identification, management, and access to specialist services for children (<12 years) with anxiety disorders. Twenty semi-structured interviews were conducted with GPs in primary care throughout England. GPs reflected a diverse group in relation to the ethnic and socioeconomic profile of registered patients, GP age, sex, professional status, previous engagement with research, and practice size and location. Purposive sampling was used to recruit GPs until theoretical saturation was reached. Data were analysed using a constant comparative method of thematic analysis. Data from 20 semi-structured interviews were organised into three themes: decision making, responsibility, and emotional response, with an overarching theme of GPs feeling ill equipped. These themes were retrospectively analysed to illustrate their role at different stages in the primary care process (identification, management, and access to specialist services). GPs feel ill equipped to manage and support childhood anxiety disorders, demonstrating a need for medical training to include greater emphasis on children's mental health, as well as potential for greater collaboration between primary and specialist services. © British Journal of General Practice 2017.

GPs’ experiences of children with anxiety disorders in primary care: a qualitative study

PubMed Central

O’Brien, Doireann; Harvey, Kate; Young, Bridget; Reardon, Tessa; Creswell, Cathy

2017-01-01

Background Anxiety disorders have a median age of onset of 11 years and are the most common emotional disorders in childhood; however, a significant proportion of those affected do not access professional support. In the UK, GPs are often the first medical professional that families see so are in a prime position to support children with anxiety disorders; however, currently there is little research available on GPs’ perspectives on and experiences of supporting children with these disorders. Aim To explore the experiences of GPs in relation to identification, management, and access to specialist services for children (<12 years) with anxiety disorders. Design and setting Twenty semi-structured interviews were conducted with GPs in primary care throughout England. Method GPs reflected a diverse group in relation to the ethnic and socioeconomic profile of registered patients, GP age, sex, professional status, previous engagement with research, and practice size and location. Purposive sampling was used to recruit GPs until theoretical saturation was reached. Data were analysed using a constant comparative method of thematic analysis. Results Data from 20 semi-structured interviews were organised into three themes: decision making, responsibility, and emotional response, with an overarching theme of GPs feeling ill equipped. These themes were retrospectively analysed to illustrate their role at different stages in the primary care process (identification, management, and access to specialist services). Conclusion GPs feel ill equipped to manage and support childhood anxiety disorders, demonstrating a need for medical training to include greater emphasis on children’s mental health, as well as potential for greater collaboration between primary and specialist services. PMID:29061716

The Sound Access Parent Outcomes Instrument (SAPOI): Construction of a new instrument for children with severe multiple disabilities who use cochlear implants or hearing aids.

PubMed

Hayward, Denyse V; Ritter, Kathryn; Mousavi, Amin; Vatanapour, Shabnam

2016-01-01

To report on the Phase 2 development of the Sound Access Parent Outcomes Instrument (SAPOI), a new instrument focused on formalizing outcomes that parents of children with severe multiple disabilities (SMD) who use amplification prioritize as important. Phase 2 of this project involved item selection and refinement of the SAPOI based on (a) Phase 1 study participant input, (b) clinical specialist feedback, and (c) test-retest instrument reliability. Phase 1 participant responses were utilized to construct a draft version of the SAPOI. Next, clinical specialists examined the instrument for content validity and utility and instrument reliability was examined through a test-retest process with parents of children with SMD. The draft SAPOI was constructed based on Phase 1 participant input. Clinical specialists supported content validity and utility of the instrument and the inclusion of 19 additional items across four categories, namely Child Affect, Child Interaction, Parent Well-being, and Child's Device Use. The SAPOI was completed twice at one-month intervals by parents of children with SMD to examine instrument reliability across the four categories (Child Affect, Child Interaction, Parent Well-being, and Child's Device Use). Instrument reliability was strong-to-excellent across all four sections. The SAPOI shows promise as a much-needed addition to the assessment battery currently used for children with SMD who use cochlear implants and hearing aids. It provides valuable information regarding outcomes resulting from access to sound in this population that currently used assessments do not identify.

[Essential aspects of ophthalmological expert assessment in private accident insurance].

PubMed

Tost, F

2014-06-01

Commissions for an expert assessment place basically high demands on commissioned eye specialists because this activity differs from the normal routine field of work. In addition to assessing objective symptoms and subjective symptomatics in a special analytical manner, eye specialists are expected to have knowledge of basic legal terminology, such as proximate cause, evidence and evidential value. Only under these prerequisites can an ophthalmologist fulfill the function of an expert with a high level of quality and adequately adjust the special medical ophthalmological expertise to the requirements of the predominantly legally based clients commissioning the report and oriented to the appropriate valid legal norms. Particularly common difficulties associated with making an ophthalmological expert report for private accident insurance, e.g. determination of the reduction in functional quality, consideration of partial causality and assessment of diplopia are discussed.

"Where's My Choice?" An Examination of Veteran and Provider Experiences With Hepatitis C Treatment Through the Veteran Affairs Choice Program.

PubMed

Tsai, Jack; Yakovchenko, Vera; Jones, Natalie; Skolnik, Avy; Noska, Amanda; Gifford, Allen L; McInnes, D Keith

2017-07-01

The Department of Veterans Affairs (VA) is the country's largest provider for chronic hepatitis C virus (HCV) infection. The VA created the Choice Program, which allows eligible veterans to seek care from community providers, who are reimbursed by the VA. This study aimed to examine perspectives and experiences with the VA Choice Program among veteran patients and their HCV providers. Qualitative study based on semistructured interviews with veteran patients and VA providers. Interview transcripts were analyzed using rapid assessment procedures based in grounded theory. A total of 38 veterans and 10 VA providers involved in HCV treatment across 3 VA medical centers were interviewed. Veterans and providers were asked open-ended questions about their experiences with HCV treatment in the VA and through the Choice Program, including barriers and facilitators to treatment access and completion. Four themes were identified: (1) there were difficulties in enrollment, ongoing support, and billing with third-party administrators; (2) veterans experienced a lack of choice in location of treatment; (3) fragmented care led to coordination challenges between VA and community providers; and (4) VA providers expressed reservations about sending veterans to community providers. The Choice Program has the potential to increase veteran access to HCV treatment, but veterans and VA providers have described substantial problems in the initial years of the program. Enhancing care coordination, incorporating shared decision-making, and establishing a wide network of community providers may be important areas for further development in designing community-based specialist services for needy veterans.

[Sociodemographic and health conditions of the Romá population in Milan].

PubMed

Colombo, Cinzia; Galli, Andrea; Pero, Margherita; Giani, Riccardo; Jucker, Simonetta; Oreste, Pierluigi; Giommarini, Claudia; Aiolfi, Ernestina; Judica, Elda

2011-01-01

To analyze the socioeconomic and health status of rom a people mainly living in not authorized settlements in Milan. Evaluation of socioeconomic and healthcare data collected by the mobile unit of Naga, a voluntary association based in Milan, during two years of activity (2009-2010). Healthcare data have been classified using an operational classification. Settlements located in Milan where rom a people live. 1 142 rom a people living in 14 settlements of Milan (only one authorized) were visited.Mean schooling years were 4.9. The mean number of children per family was 2.8. Of 803 people older than 13 years, 129 had an occupation (16%). 56%of subjetcs older than 12 years were smokers (53% females vs. 59%males); among smokers, 17%were heavy smokers (12%females vs 22% males). The most frequently reported diseases were: respiratory diseases (21%of total diagnoses), disorders of the orthopedic-rheumatologic-traumatology area (13%), gastroenterological diseases (10%) and dental problems (8%). Most residents had no healthcare coverage (94%). Almost all settlements (except the authorized one) had no sanitary facilities, no garbage collection system and were definitely overcrowded. Mild diseases were the most commonly found pathologies, with few chronic diseases reported probably due to difficulties in investigating more complex diseases in the study setting,and to the impossibility to follow the patients over time. Furthermore, the access to healthcare services for diagnostic tests and specialist visits is very very difficult for these patients. Poor living conditions, low educational level, low employment rate, barriers in the access to healthcare services are all risks factors for the health status of rom a people.

Exploring the evidence in pediatric hematology and oncology nursing through the "article of the month".

PubMed

Linder, Lauri

2010-01-01

As the scope of pediatric hematology and oncology nursing expands, nurses are challenged with staying current in the evidence guiding their practice. Nurse-reported barriers to accessing and utilizing research include lack of time as well as difficulty in accessing, understanding, and synthesizing findings. Journal clubs provide a process to guide nurses in the review of current literature related to their practice and promote utilization of research and evidence-based practice among nurses. This article describes the transition of an in-person journal club to an electronically delivered "Article of the Month." The "Article of the Month" is offered six times each year and is posted on the service line's password-protected intranet website. Oversight of the "Article of the Month" is provided by the service line clinical nurse specialist who selects articles based on an annual learning needs assessment and develops a quiz to assess learning and promote critical thinking among nursing staff. Outcomes include anecdotal reports of increased staff confidence in managing emergent patient care needs and greater appreciation of nursing care issues for children with cancer. Areas for future development include exploring options for increasing in-person discussion of issues addressed in the "Article of the Month" among staff members, extending the "Article of the Month" to nurses in other service areas who care for children with cancer, and increasing staff participation in article selection and quiz item development. An ultimate goal is to develop formal evaluation strategies to link this educational strategy to clinical outcomes.

Race, gender, and language concordance in the primary care setting.

PubMed

Martin, Brian C; Shi, Leiyu; Ward, Ryan D

2009-01-01

The purpose of this paper is to examine race, gender and language concordance in terms of importance to primary care. The 2003 Medical Expenditure Panel Survey Household Component (MEPS) was used. Four distinguishing primary care attributes and selected measures were operationalized primarily from a sample subset that identified a usual source of care (USC): accessibility to USC; interface between primary care and specialist services; treatment decisions; and preventive services received from the USC. Bivariate and multivariate results are reported. Adjusting for covariates, the following items remained statistically significant: race--choosing primary care physician as USC, USC having office hours, and going to USC for new health problems; gender--choosing primary care physician as USC and USC having office hours; and language--lack of difficulty contacting the USC after hours. However, these items appear to be isolated cases rather than indicators that concordance plays a key role in determining primary care quality. Language barriers/communication issues are the only areas where improvement appears warranted. While the study has strong accessibility and interpersonal relationship measures, service coordination and comprehensiveness indicators are limited. The analyses' cross-sectional nature also poses a problem in drawing causal relationships and conclusive findings. Finally, sample size limitations preclude stratified analyses across racial/ethnic groups, an important consideration as the relationships between concordance and quality may vary across groups. This study indicates that more research is needed in this area to determine future resource allocation and policy direction. The unique contribution of the study is to suggest that race and gender concordance may not accurately predict primary health care quality.

Students' Motivation to Access Academic Advising Services

ERIC Educational Resources Information Center

Henning, Marcus A.

2009-01-01

The interrelationships between motivation for choosing a program of study, intention to access academic advisors, academic difficulty, and actual appointments with academic advisors were based on student self-reports of motivation and intentions. In addition, academic achievement measures and data on student access to academic advisors were…

Individual specialization in a shorebird population with narrow foraging niche

NASA Astrophysics Data System (ADS)

Catry, Teresa; Alves, José A.; Gill, Jennifer A.; Gunnarsson, Tómas G.; Granadeiro, José P.

2014-04-01

Individual specialization in resource use is a widespread driver for intra-population trait variation, playing a crucial evolutionary role in free-living animals. We investigated the individual foraging specialization of Black-tailed Godwits (Limosa limosa islandica) during the wintering period. Godwits displayed distinct degrees of individual specialization in diet and microhabitat use, indicating the presence of both generalist and specialist birds. Females were overall more specialist than males, primarily consuming polychaetes. Specialist males consumed mainly bivalves, but some individuals also specialized on gastropods or polychaetes. Sexual dimorphism in bill length is probably important in determining the differences in specialization, as longer-billed individuals have access to deep-buried polychaetes inaccessible to most males. Different levels of specialization within the same sex, unrelated to bill length, were also found, suggesting that mechanisms other traits are involved in explaining individual specialization. Godwits specialized on bivalves achieved higher intake rates than non-specialist birds, supporting the idea that individual foraging choices or skills result in different short-term payoffs within the same population. Understanding whether short-term payoffs are good indicators of long-term fitness and how selection operates to favour the prevalence of specialist or generalist godwits is a major future challenge.

How is a specialist depression service effective for persistent moderate to severe depressive disorder?: a qualitative study of service user experience.

PubMed

Thomson, Louise; Barker, Marcus; Kaylor-Hughes, Catherine; Garland, Anne; Ramana, Rajini; Morriss, Richard; Hammond, Emily; Hopkins, Gail; Simpson, Sandra

2018-06-15

A specialist depression service (SDS) offering collaborative pharmacological and cognitive behaviour therapy treatment for persistent depressive disorder showed effectiveness against depression symptoms versus usual community based multidisciplinary care in a randomised controlled trial (RCT) in specialist mental health services in England. However, there is uncertainty concerning how specialist depression services effect such change. The current study aimed to evaluate the factors which may explain the greater effectiveness of SDS compared to Treatment as Usual (TAU) by exploring the experience of the RCT participants. Qualitative audiotaped and transcribed semi-structured interviews were conducted 12-18 months after baseline with 21 service users (12 SDS, 9 TAU arms) drawn from all three sites. Inductive thematic analysis using a grounded approach contrasted the experiences of SDS with TAU participants. Four themes emerged in relation to service user experience: 1. Specific treatment components of the SDS: which included sub-themes of the management of medication change, explaining and developing treatment strategies, setting realistic expectations, and person-centred and holistic approach; 2. Individual qualities of SDS clinicians; 3. Collaborative team context in SDS: which included sub-themes of communication between healthcare professionals, and continuity of team members; 4. Accessibility to SDS: which included sub-themes of flexibility of locations, frequent consultation as reinforcement, gradual pace of treatment, and challenges of returning to usual care. The study uncovered important mechanisms and contextual factors in the SDS that service users experience as different from TAU, and which may explain the greater effectiveness of the SDS: the technical expertise of the healthcare professionals, personal qualities of clinicians, teamwork, gradual pace of care, accessibility and managing service transitions. Usual care in other specialist mental health services may share many of the features from the SDS. "Trial of the Clinical and Cost Effectiveness of a Specialist Expert Mood Disorder Team for Refractory Unipolar Depressive Disorder" was registered in www.ClinicalTrials.gov ( NCT01047124 ) on 12-01-2010 and the ISRCTN registry was registered in www.isrctn.com ( ISRCTN10963342 ) on 25-11-2015 (retrospectively registered).

Job strain: a cross-sectional survey of dementia care specialists and other staff in Swedish home care services.

PubMed

Sandberg, Linda; Borell, Lena; Edvardsson, David; Rosenberg, Lena; Boström, Anne-Marie

2018-01-01

An increasing number of older persons worldwide live at home with various functional limitations such as dementia. So, home care staff meet older persons with extensive, complex needs. The staff's well-being is crucial because it can affect the quality of their work, although literature on job strain among home care staff is limited. To describe perceived job strain among home care staff and to examine correlations between job strain, personal factors, and organizational factors. The study applied a cross-sectional survey design. Participants were dementia care specialists who work in home care (n=34) and other home care staff who are not specialized in dementia care (n=35). The Strain in Dementia Care Scale (SDCS) and Creative Climate Questionnaire instruments and demographic variables were used. Descriptive and inferential statistics (including regression modeling) were applied. The regional ethical review board approved the study. Home care staff perceived job strain - particularly because they could not provide what they perceived to be necessary care. Dementia care specialists ranked job strain higher (m=5.71) than other staff members (m=4.71; p =0.04). Job strain (for total score and for all five SDCS factors) correlated with being a dementia care specialist. Correlations also occurred between job strain for SDCS factor 2 (difficulties understanding and interpreting) and not having Swedish as first language and SDCS factor 5 (lack of recognition) and stagnated organizational climate. The study indicates that home care staff and particularly dementia care specialists perceived high job strain. Future studies are needed to confirm or reject findings from this study.

Female specialists in intensive care medicine: job satisfaction, challenges and work-life balance.

PubMed

Hawker, Felicity H

2016-06-01

Women are under-represented in the intensive care medicine (ICM) specialist workforce. I aimed to better understand the challenges these women face so they can be considered in the training and support of ICM specialists. All female Fellows of the College of Intensive Care Medicine (CICM) of Australia and New Zealand were surveyed using an online questionnaire. The study was approved by the Cabrini Human Research Ethics Committee. Thirty respondents with children volunteered to complete a second questionnaire. I surveyed demographic and workforce data and women's experiences in the ICM specialist workforce in the first survey, and experiences with child-rearing in the second survey. The response rate was 80.3% (127/158). The median age bracket was 40-45 years, and 118 respondents were practising ICM, 85 full-time in a tertiary intensive care unit. Eighteen were ICU directors and 23 were CICM-appointed supervisors of training. Sixty-five women were mothers, and 70% returned to full-time work after their maternity leave. Child care was most commonly undertaken by family members or a nanny. Overall, 81% were satisfied with their experiences, but 37% felt they had been disadvantaged because of their sex. Fewer women with leadership roles felt disadvantaged. Their major challenges included the on-call work affecting child-rearing and family life, sexism in the workplace and difficulties with academic advancement. The participation and satisfaction rates of women working in the ICM specialist workforce are encouraging. Although challenges exist, women contemplating a career in ICM should see it as achievable and rewarding.

Variability in the organisation and management of hospital care for COPD exacerbations in the UK.

PubMed

Hosker, Harold; Anstey, Katharine; Lowe, Derek; Pearson, Michael; Roberts, C Michael

2007-04-01

Previous smaller UK audits have demonstrated wide variation in organisation, resources, and process of care for acute chronic obstructive pulmonary disease (COPD) admissions. Smallest units appeared to do less well. UK acute hospitals supplied information on (1) resources and organisation of care, (2) clinical data on process of care and outcomes for up to 40 consecutive COPD admissions. Comparisons were made against national recommendations. Eight thousand and thirteen admissions involved 7529 patients from 233 units (93% of UK acute Trusts). Twenty-six percent of units had at most one whole-time equivalent respiratory consultant while 12% had at least four. Thirty percent patients were admitted under a respiratory specialist and 48% discharged under their care whilst 28% had no specialist input at all. Variation in care provision was wide across all hospitals but patients in smaller hospitals had less access to specialist respiratory or admission wards, pulmonary rehabilitation programs, specialty triage or an early discharge scheme. Six percent of units did not have access to NIV and 18% to invasive ventilatory support. There remains wide variation in all aspects of acute hospital COPD care in the UK, with smaller hospitals offering fewest services. Those receiving specialist input are more likely to be offered interventions of proven effect. Management guidelines alone are insufficient to address inequalities of care and a clear statement of minimum national standards for resource provision and organisation of COPD care are required. This study provides a unique insight into the current state of care for patients admitted with COPD exacerbations in the UK.

Use of buprenorphine for addiction treatment: perspectives of addiction specialists and general psychiatrists.

PubMed

Thomas, Cindy Parks; Reif, Sharon; Haq, Sayeda; Wallack, Stanley S; Hoyt, Alexander; Ritter, Grant A

2008-08-01

In 2002 buprenorphine (Suboxone or Subutex) was approved by the U.S. Food and Drug Administration for office-based treatment of opioid addiction. The goal of office-based pharmacotherapy is to bring more opiate-dependent people into treatment and to have more physicians address this problem. This study examined prescribing practices for buprenorphine, including facilitators and barriers, and the organizational settings that facilitate its being incorporated into treatment. Addiction specialists and other psychiatrists in four market areas were surveyed by mail and Internet in fall 2005 to examine prescribing practices for buprenorphine. Respondents included 271 addiction specialists (72% response rate) and 224 psychiatrists who were not listed as addiction specialists but who had patients with addictions in their practice (57% response rate). Three years after approval of buprenorphine for office-based addiction treatment, nearly 90% of addiction specialists had been approved to prescribe it and two-thirds treated patients with buprenorphine. However, fewer than 10% of non-addiction specialist psychiatrists prescribed it. Regression-adjusted factors predicting prescribing of buprenorphine included support of training and use of buprenorphine by the physician's main affiliated organization, less time in general psychiatry compared with addictions treatment, more time in group practice rather than solo, ten or more opiate-dependent patients, belief that drugs play a large role in addiction treatment, and patient demand. Office-based pharmacotherapy offers a promising path to improved access to addictions treatment, but prescribing has expanded little beyond the addiction specialist community.

State of the art of chronic spontaneous urticaria in Italy: a multicentre survey to evaluate physicians’ and patients’ perspectives

PubMed Central

Rimoldi, Marco; Rossi, Oliviero; Rota, Nadia

2016-01-01

Objective To assess the clinical status of chronic spontaneous urticaria (CSU) and understand treatment approaches in Italy through specialists who treat CSU (dermatologists and allergy specialists) and CSU patients' experience. Design Multicentre survey. Setting Online structured questionnaires (one for physicians and one for patients). Participants Physicians and patients with CSU in Italy. Interventions None. Primary/secondary outcomes Physician and patient attitudes/experiences. Results Survey results from 160 allergy and 160 dermatology specialists show that specialists see a median of 40 (IQR 20–80) patients with CSU/year. While most specialists (56%) know the CSU guidelines, only 27% use them regularly (36% of allergy specialists vs 18% of dermatologists). This is reflected in treatment choices with differences between physicians who use guidelines regularly and those who do not: 91.6% vs 71.7% choose standard-dose, non-sedating antihistamines as first-line treatment; 85.9% vs 56.0% select up-dosing for second-line treatment and 65.3% vs 37.2% add leukotriene receptor antagonists or H2-antihistamines as third-line treatment. The diaries from 1385 patients highlight that, regardless of treatment regimen, 29.4% of currently treated patients are refractory to therapy. Specialists aim to resolve symptoms and only 7.8% report improving quality of life (QoL) as a priority. Only 16.6% of specialists are familiar with and use the Urticaria Activity Score while 46.9% do not know it. Overall, 537 patients with CSU were surveyed (median age 37 years, IQR 30–46; 44.3% men; median disease duration 5 years, IQR 3–20). Approximately 62% confirm that CSU negatively impacts their QoL. Patients also complain of difficulties in getting information and support: <5% of medical centres provide patient support services. Conclusions In Italy, the gap between guideline-based care and QoL-related needs in CSU patients affects treatment satisfaction. This information could be used to improve the management of CSU in Italy. PMID:27742625

State of the art of chronic spontaneous urticaria in Italy: a multicentre survey to evaluate physicians' and patients' perspectives.

PubMed

Rimoldi, Marco; Rossi, Oliviero; Rota, Nadia

2016-10-14

To assess the clinical status of chronic spontaneous urticaria (CSU) and understand treatment approaches in Italy through specialists who treat CSU (dermatologists and allergy specialists) and CSU patients' experience. Multicentre survey. Online structured questionnaires (one for physicians and one for patients). Physicians and patients with CSU in Italy. None. Physician and patient attitudes/experiences. Survey results from 160 allergy and 160 dermatology specialists show that specialists see a median of 40 (IQR 20-80) patients with CSU/year. While most specialists (56%) know the CSU guidelines, only 27% use them regularly (36% of allergy specialists vs 18% of dermatologists). This is reflected in treatment choices with differences between physicians who use guidelines regularly and those who do not: 91.6% vs 71.7% choose standard-dose, non-sedating antihistamines as first-line treatment; 85.9% vs 56.0% select up-dosing for second-line treatment and 65.3% vs 37.2% add leukotriene receptor antagonists or H 2 -antihistamines as third-line treatment. The diaries from 1385 patients highlight that, regardless of treatment regimen, 29.4% of currently treated patients are refractory to therapy. Specialists aim to resolve symptoms and only 7.8% report improving quality of life (QoL) as a priority. Only 16.6% of specialists are familiar with and use the Urticaria Activity Score while 46.9% do not know it. Overall, 537 patients with CSU were surveyed (median age 37 years, IQR 30-46; 44.3% men; median disease duration 5 years, IQR 3-20). Approximately 62% confirm that CSU negatively impacts their QoL. Patients also complain of difficulties in getting information and support: <5% of medical centres provide patient support services. In Italy, the gap between guideline-based care and QoL-related needs in CSU patients affects treatment satisfaction. This information could be used to improve the management of CSU in Italy. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

78 FR 46374 - Minority Depository Institution Preservation Program

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-31

... in preserving the economic viability of their institutions. These benefits include facilitating... goals and objectives related to credit union viability and access. Specifically, the program is...) Economic Development Specialist assistance in addressing examination concerns or topics of interest; (3...

Brown in Columbia's FD/MDK access way during STS-107

NASA Image and Video Library

2003-01-18

STS107-E-05025 (17 January 2003) --- Astronaut David M. Brown, STS-107 mission specialist, looks over paperwork as he prepares to work with experiments on the SPACEHAB Research Double Module aboard the Space Shuttle Columbia.

The prevalence of self-reported vision difficulty in economically disadvantaged regions of South Africa

PubMed Central

Naidoo, Kovin S.; Ramson, Prasidh; Chinanayi, Farai; Zhuwau, Tom; Øverland, Lene

2015-01-01

Background Vision impairment, resulting in vision difficulties, is a leading cause of disability, and hence one of the key barriers for people to access education and employment, which may force them into poverty. Objectives The objective of this study was to determine the prevalence of self-reported vision difficulties as an indicator of vision impairment in economically disadvantaged regions in South Africa, and to examine the relationship between self-reported vision difficulties and socio-economic markers of poverty, namely, income, education and health service needs. Methods A cross-sectional study was conducted in economically disadvantaged districts to collect data from households on poverty and health, including vision difficulty. As visual acuity measurements were not conducted, the researchers used the term vision difficulty as an indicator of vision impairment. Data were collected from 27 districts (74 901 respondents). Logistic regression analysis and chi-square tests were used to determine bivariate relationships between variables and self-reported vision difficulty. Kernel density estimators were used for age, categorised by self-reported and not reported vision difficulty. Results Prevalence of self-reported vision difficulty was 11.2% (95% CI, 8.7% – 13.7%). More women (12.7%) compared to men (9.5%) self-reported vision difficulty (p < 0.01). Self-reported vision difficulty was higher (14.2%) for respondents that do not spend any money. A statistically significant relationship was found between the highest level of education and self-reporting of vision difficulty; as completed highest level of education increased, self-reporting of vision difficulty became lower (p < 0.01). A significantly higher prevalence of self-reported vision difficulty was found in respondents who are employed (p < 0.01), 17% (95% CI: 12.8% – 21.1%). Conclusion The evidence from this study suggests associations between socio-economic factors and vision difficulties that have a two-fold relationship (some factors such as education, and access to eye health services are associated with vision difficulty whilst vision difficulty may trap people in their current poverty or deepen their poverty status). The results are thus indicative of the need for further research in South Africa. PMID:28730022

Do performance and image enhancing drug users in regional Queensland experience difficulty accessing health services?

PubMed

Dunn, Matthew; Henshaw, Richard; McKay, Fiona H

2016-07-01

To understand health service access and needs of people who use performance and image enhancing drugs (PIED) in regional Queensland. Semi-structured interviews were conducted with 21 people (n = 19 men) who reported the use of a range of PIEDs, including anabolic-androgenic steroids, human chorionic gonadotropin, growth hormone, clenbuterol, tamoxifen, insulin and peptides. Participants reported accessing a range of services, including needle and syringe programs and pharmacies, for sterile injecting equipment. While PIEDs users attributed some stigma to needle and syringe programs, they were seen as an important service for injecting equipment. Participants reported receiving either positive care from health-care providers, such as general practitioners (GP), or having negative experiences due to the stigma attached with PIED use. Few participants reported disclosing their PIED use to their GP not only because of the concerns that their GP would no longer see them but also because they felt their GP was not knowledgeable about these substances. Participants in the study reported no difficulty in accessing health services based on living in a regional area, with their concern focused more upon how they were viewed and treated by service staff. [Dunn M, Henshaw R, Mckay F. H. Do performance and image enhancing drug users in regional Queensland experience difficulty accessing health services? Drug Alcohol Rev 2016;35:377-382]. © 2015 Australasian Professional Society on Alcohol and other Drugs.

Factors affecting access to head and neck cancer care after a natural disaster: a post-Hurricane Katrina survey.

PubMed

Loehn, Bridget; Pou, Anna M; Nuss, Daniel W; Tenney, Justin; McWhorter, Andrew; DiLeo, Michael; Kakade, Anagha C; Walvekar, Rohan R

2011-01-01

Our aim was to survey the factors affecting access to cancer care in patients with head and neck cancer after Hurricane Katrina. In this cross-sectional survey, 207 patients with head and neck cancer were identified post-Hurricane Katrina, but only 83 patients completed the questionnaires and were analyzed. Clinical, demographic, and socioeconomic data were recorded. Chi-square test and t test were used for comparisons. Patients who felt that there was a lack of access to cancer care would have sought treatment earlier had they had better access to cancer care (chi-square[1] = 32; p < .0001). Patients who felt that there was a lack of access to cancer care also had difficulty receiving treatment (chi-square[1] = 48; p < .0001). Availability of transportation affected access to cancer care in patients with early-stage cancers (chi-square[1] = 4; p < .035). In the postdisaster environment, patients who felt the lack of access to cancer care post-Hurricane Katrina would have sought treatment earlier with better access to cancer care. These patients also reported difficulty obtaining cancer treatment. Availability of transportation affected access to cancer care in patients with early-stage cancers. Clinical, demographic, and socioeconomic factors did not influence access to cancer care. © 2010 Wiley Periodicals, Inc. Head Neck, 2011.

How Do You Measure Up?

ERIC Educational Resources Information Center

Miller, Marilyn L.; Shontz, Marilyn L.

1999-01-01

Presents findings from the "School Library Journal" survey of school library expenditures for FY 1997-98. Data include: budget allocation; salaries; library collection; technology; staff and certification; access to basic electronic resources; library policy; planning and communication between library media specialists and teachers; and…

Looking for a Few Good Librarians.

ERIC Educational Resources Information Center

Everhart, Nancy

2000-01-01

Discusses the impending shortage of school librarians. Topics include state hiring mandates that don't require certified media specialists; certified library personnel shortages; staffing ratios; support staff; access to library education programs, including distance education via the Internet; and future concerns. (LRW)

Discordant indigenous and provider frames explain challenges in improving access to arthritis care: a qualitative study using constructivist grounded theory.

PubMed

Thurston, Wilfreda E; Coupal, Stephanie; Jones, C Allyson; Crowshoe, Lynden F J; Marshall, Deborah A; Homik, Joanne; Barnabe, Cheryl

2014-06-11

Access to health services is a determinant of population health and is known to be reduced for a variety of specialist services for Indigenous populations in Canada. With arthritis being the most common chronic condition experienced by Indigenous populations and causing high levels of disability, it is critical to resolve access disparities through an understanding of barriers and facilitators to care. The objective of this study was to inform future health services reform by investigating health care access from the perspective of Aboriginal people with arthritis and health professionals. Using constructivist grounded theory methodology we investigated Indigenous peoples' experiences in accessing arthritis care through the reports of 16 patients and 15 healthcare providers in Alberta, Canada. Semi-structured interviews were conducted between July 2012 and February 2013 and transcribed verbatim. The patient and provider data were first analyzed separately by two team members then brought together to form a framework. The framework was refined through further analysis following the multidisciplinary research team's discussions. Once the framework was developed, reports on the patient and provider data were shared with each participant group independently and participants were interviewed to assess validity of the summary. In the resulting theoretical framework Indigenous participants framed their experience with arthritis as 'toughing it out' and spoke of racism encountered in the healthcare setting as a deterrent to pursuing care. Healthcare providers were frustrated by high disease severity and missed appointments, and framed Indigenous patients as lacking 'buy-in'. Constraints imposed by complex healthcare systems contributed to tensions between Indigenous peoples and providers. Low specialist care utilization rates among Indigenous people cannot be attributed to cultural and social preferences. Further, the assumptions made by providers lead to stereotyping and racism and reinforce rejection of healthcare by patients. Examples of 'working around' the system were revealed and showed potential for improved utilization of specialist services. This framework has significant implications for health policy and indicates that culturally safe services are a priority in addressing chronic disease management.

Interpersonal problems across restrictive and binge-purge samples: data from a community-based eating disorders clinic.

PubMed

Raykos, Bronwyn C; McEvoy, Peter M; Carter, Olivia; Fursland, Anthea; Nathan, Paula

2014-08-01

Contemporary models of eating disorders suggest that interpersonal problems contribute to the maintenance of eating disorders. This study examined whether baseline interpersonal problems differed across eating disorder diagnoses and across eating disorder subtypes ("restrictors" vs. "binge-purge" patients) in a large clinical sample. Patients with a primary eating disorder diagnosis (N=406) completed measures of interpersonal problems, eating disorder symptoms, and mood prior to treatment at a specialist eating disorder clinic. Across the sample, more severe eating disorder psychopathology was associated with significantly greater difficulty socializing. Anorexia Nervosa (AN)/restrictor patients reported significantly greater difficulty socializing than Bulimia Nervosa (BN)/binge-purge patients. AN patients reported significantly greater difficulty on a measure of competitiveness/assertiveness compared to BN and Eating Disorder Not Otherwise Specified patients. All findings were significant after controlling for comorbid depression and anxiety symptoms. Interpersonal problems appear to be unique risk factors for eating disorders. Specific interpersonal mechanisms include difficulties socializing and being assertive, which were most pronounced in AN patients. These findings provide potential avenues for enhancing interventions, such as adjunctive assertiveness training for AN. Copyright © 2014 Elsevier Ltd. All rights reserved.

The Australian and New Zealand regional neurology training survey.

PubMed

McAulay-Powell, C; Ranta, A

2016-06-01

There is inequitably poorer access to specialist neurologists in regional areas. Recruitment could be improved if more neurology trainees chose to spend some time at regional training sites, which they currently appear to avoid for unclear reasons. We surveyed neurology advanced trainees to assess their attitudes and perceptions about regional training. Aside from innate geographical challenges, there are concerning negative perceptions of the impact of regional training on future metropolitan employment prospects. Minimisation of bias against regional trainees or even rewarding regional exposure would likely improve regional trainee and subsequent specialist recruitment. © 2016 Royal Australasian College of Physicians.

Extrasensory Perception Research: Difficulties and Implications for Education.

ERIC Educational Resources Information Center

McAdams, Elizabeth E.

In recent years, gradually increased acceptance and heightened attention have been granted to extrasensory perception (ESP) research as a legitimate branch of scientific inquiry. This research holds significant implications for education despite difficulties involved with its consideration. Extrasensory perception, an organism's apparent access to…

Improving Health Care Accessibility: Strategies and Recommendations.

PubMed

Almorsy, Lamia; Khalifa, Mohamed

2016-01-01

Access time refers to the interval between requesting and actual outpatient appointment. It reflects healthcare accessibility and has a great influence on patient treatment and satisfaction. King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia studied the accessibility to outpatient services in order to develop useful strategies and recommendations for improvement. Utilized, unutilized and no-show appointments were analyzed. It is crucial to manage no-shows and short notice appointment cancellations by preparing a waiting list for those patients who can be called in to an appointment on the same day using an open access policy. An overlapping appointment scheduling model can be useful to minimize patient waiting time and doctor idle time in addition to the sensible use of appointment overbooking that can significantly improve productivity.

Motivational Profiles and Motivation for Lifelong Learning of Medical Specialists.

PubMed

van der Burgt, Stéphanie M E; Kusurkar, Rashmi A; Wilschut, Janneke A; Tjin A Tsoi, Sharon L N M; Croiset, Gerda; Peerdeman, Saskia M

2018-05-22

Medical specialists face the challenge of maintaining their knowledge and skills and continuing professional development, that is, lifelong learning. Motivation may play an integral role in many of the challenges facing the physician workforce today including maintenance of a high performance. The aim of this study was to determine whether medical specialists show different motivational profiles and if these profiles predict differences in motivation for lifelong learning. An online questionnaire was sent to every medical specialist working in five hospitals in the Netherlands. The questionnaire included the validated Multidimensional Work Motivation Scale and the Jefferson Scale of Physician Lifelong Learning together with background questions like age, gender, and type of hospital. Respondents were grouped into different motivational profiles by using a two-step clustering approach. Four motivational profiles were identified: (1) HAMC profile (for High Autonomous and Moderate Controlled motivation), (2) MAMC profile (for Moderate Autonomous and Moderate Controlled motivation), (3) MALC profile (for Moderate Autonomous and Low Controlled motivation), and (4) HALC profile (for High Autonomous and Low Controlled motivation). Most of the female specialists that work in an academic hospital and specialists with a surgical specialty were represented in the HALC profile. Four motivational profiles were found among medical specialists, differing in gender, experience and type of specialization. The profiles are based on the combination of autonomous motivation (AM) and controlled motivation (CM) in the specialists. The profiles that have a high score on autonomous motivation have a positive association with lifelong learning.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

Implementation and Evaluation of the Safety Net Specialty Care Program in the Denver Metropolitan Area

PubMed Central

Fort, Meredith P; Namba, Lynnette M; Dutcher, Sarah; Copeland, Tracy; Bermingham, Neysa; Fellenz, Chris; Lantz, Deborah; Reusch, John J; Bayliss, Elizabeth A

2017-01-01

Objectives: In response to limited access to specialty care in safety-net settings, an integrated delivery system and three safety-net organizations in the Denver, CO, metropolitan area launched a unique program in 2013. The program offers safety-net providers the option to electronically consult with specialists. Uninsured patients may be seen by specialists in office visits for a defined set of services. This article describes the program, identifies aspects that have worked well and areas that need improvement, and offers lessons learned. Methods: We quantified electronic consultations (e-consults) between safety-net clinicians and specialists, and face-to-face specialist visits between May 2013 and December 2014. We reviewed and categorized all e-consults from November and December 2014. In 2015, we interviewed 21 safety-net clinicians and staff, 12 specialists, and 10 patients, and conducted a thematic analysis to determine factors facilitating and limiting optimal program use. Results: In the first 20 months of the program, safety-net clinicians at 23 clinics made 602 e-consults to specialists, and 81 patients received face-to-face specialist visits. Of 204 primary care clinicians, 103 made e-consults; 65 specialists participated in the program. Aspects facilitating program use were referral case managers’ involvement and the use of clear, concise questions in e-consults. Key recommendations for process improvement were to promote an understanding of the different health care contexts, support provider-to-provider communication, facilitate hand-offs between settings, and clarify program scope. Conclusion: Participants perceived the program as responsive to their needs, yet opportunities exist for continued uptake and expansion. Communitywide efforts to assess and address needs remain important. PMID:28241908

Training and manpower issues for specialist registrars in paediatrics. How are we doing and where are we going?

PubMed

Byrne, O C; Boland, B; Nicholson, A J; Waldron, M; O'Neill, M B

2005-01-01

All Irish paediatric higher specialist trainees' opinions about the paediatric higher specialist training (HST) scheme and related manpower issues were surveyed. Information was obtained on 1) trainees' level of satisfaction with HST, 2) their ultimate career ambitions including location of final posts, 3) attitudes to both flexible training and consultancies and 4) demographics to assess the significance of gender variations. Fifty-two eligible trainees were identified using the Royal College of Physicians of Ireland database. The survey was administered as an anonymous postal survey. The response rate was 88%. Results indicated a high level of satisfaction with HST (78%) overall although problems were noted with the half-day release programme as only 63% were facilitated. Only 30% wish to practice as subspecialists, 76% of trainees wish to work in an urban hospital and 43.5% desire a flexible consultancy suggesting an incompatibility of trainees' desires with current Irish medical manpower policy. To address these difficulties we suggest establishing more rigorous audit of training posts to ensure deficiencies are corrected and the establishment of flexible training to address gender imbalance and to promote the concept of consultant job sharing.

Effects of mobility and location on food access.

PubMed

Coveney, John; O'Dwyer, Lisel A

2009-03-01

Access to healthy food has become an important area of investigation for researchers interested in health disparities and inequalities. The debate about the existence and characteristics of 'food deserts' has increased the interest in food availability and equity in health research. This debate is crucial to an understanding of the factors leading to food security. Research reported here used in-depth interviews with respondents without private transport living within and outside food deserts in Adelaide, South Australia. The respondents came from a variety of households, including single and double parent families, and people living alone. The research found that living in a food desert did not, by itself, impose food access difficulties. Far more important was the access to independent transport to shops. A number of features were identified in this research including reliance on supermarkets, difficulties with public transport, and the provision of government schemes and systems that for some made food shopping much easier. The research suggests that food access problems in Adelaide are not so much the product of geographic distance between home and shop, as the social or welfare networks that allow people to access private transport.

Web-based access, aggregation, and visualization of future climate projections with emphasis on agricultural assessments

NASA Astrophysics Data System (ADS)

Villoria, Nelson B.; Elliott, Joshua; Müller, Christoph; Shin, Jaewoo; Zhao, Lan; Song, Carol

2018-01-01

Access to climate and spatial datasets by non-specialists is restricted by technical barriers involving hardware, software and data formats. We discuss an open-source online tool that facilitates downloading the climate data from the global circulation models used by the Inter-Sectoral Impacts Model Intercomparison Project. The tool also offers temporal and spatial aggregation capabilities for incorporating future climate scenarios in applications where spatial aggregation is important. We hope that streamlined access to these data facilitates analysis of climate related issues while considering the uncertainties derived from future climate projections and temporal aggregation choices.

[Access to high-cost drugs in Brazil from the perspective of physicians, pharmacists and patients].

PubMed

Rover, Marina Raijche Mattozo; Vargas-Pelaez, Claudia Marcela; Rocha Farias, Mareni; Nair Leite, Silvana

2016-01-01

To explore perceptions on access to medication supplied by the Specialized Component of Pharmaceutical Assistance (CEAF) within the Brazilian Unified Health System (which includes high-cost drugs) by the actors involved in the healthcare services of this component. A descriptive, qualitative study was carried out by using a focal group with 7 users and 11 semi-structured interviews with health professionals (physicians and pharmacist) in the state of Santa Catarina. According to the participants, access to medicines had improved. Two main perceptions of the CEAF Clinical Guidelines were identified: the requirements constitute a bureaucracy that limits access, and the requisites increase the demand for tests and specialized healthcare services, exceeding the capacity of the healthcare services network. These assumptions generated the search for other means of access that revealed a lack of information and understanding of the right to health among the users. In addition, according to the participants, because of the difficulties of accessing services as a whole, full access to CEAF medicines is a goal that remains to be achieved. Although access to CEAF medicines has improved, there are still some difficulties in guaranteeing treatment access and comprehensiveness. Copyright © 2016 SESPAS. Published by Elsevier Espana. All rights reserved.

Validation of a new measure of availability and accommodation of health care that is valid for rural and urban contexts.

PubMed

Haggerty, Jeannie L; Levesque, Jean-Frédéric

2017-04-01

Patients are the most valid source for evaluating the accessibility of services, but a previous study observed differential psychometric performance of instruments in rural and urban respondents. To validate a measure of organizational accessibility free of differential rural-urban performance that predicts consequences of difficult access for patient-initiated care. Sequential qualitative-quantitative study. Qualitative findings used to adapt or develop evaluative and reporting items. Quantitative validation study. Primary data by telephone from 750 urban, rural and remote respondents in Quebec, Canada; follow-up mailed questionnaire to a subset of 316. Items were developed for barriers along the care trajectory. We used common factor and confirmatory factor analysis to identify constructs and compare models. We used item response theory analysis to test for differential rural-urban performance; examine individual item performance; adjust response options; and exclude redundant or non-discriminatory items. We used logistic regression to examine predictive validity of the subscale on access difficulty (outcome). Initial factor resolution suggested geographic and organizational dimensions, plus consequences of access difficulty. After second administration, organizational accommodation and geographic indicators were integrated into a 6-item subscale of Effective Availability and Accommodation, which demonstrates good variability and internal consistency (α = 0.84) and no differential functioning by geographic area. Each unit increase predicts decreased likelihood of consequences of access difficulties (unmet need and problem aggravation). The new subscale is a practical, valid and reliable measure for patients to evaluate first-contact health services accessibility, yielding valid comparisons between urban and rural contexts. © 2016 The Authors. Health Expectations published by John Wiley & Sons Ltd.

Climate services: Lessons learned and future prospects

NASA Astrophysics Data System (ADS)

Brasseur, Guy P.; Gallardo, Laura

2016-03-01

This perspective paper reviews progress made in the last decades to enhance the communication and use of climate information relevant to the political and economic decision process. It focuses, specifically, on the creation and development of climate services, and highlights a number of difficulties that have limited the success of these services. Among them are the insufficient awareness by societal actors of their vulnerability to climate change, the lack of relevant products and services offered by the scientific community, the inappropriate format in which the information is provided, and the inadequate business model adopted by climate services. The authors suggest that, to be effective, centers should host within the same center a diversity of staff including experts in climate science, specialists in impact, adaptation, and vulnerability, representatives of the corporate world, agents of the public service as well as social managers and communication specialists. The role and importance of environmental engineering is emphasized.

Improving access to care through the patient-centered medical home.

PubMed

North, Stephen W; McElligot, James; Douglas, Gaye; Martin, Amanda

2014-02-01

School-based health centers (SBHCs) serve an essential role in providing access to high-quality, comprehensive care to underserved children and adolescents in more than 2,000 schools across the United States. SBHCs are an essential component of the health care safety net, and their role in the patient-centered medical home (PCMH) continues to evolve as both collaborating partners and, when fully functioning, independent PCMHs. The American Academy of Pediatrics (AAP) supports the use of SBHCs, citing the proven benefits and exciting potential as justification, but also offers caution and recommends a focus on communication within the community. Traditional "brick and mortar" SBHCs are more likely to be located in urban communities (54.2% urban versus 18.0% rural) and be in schools with more students, allowing for a greater return on investment. Current SBHCs are located in schools with an average population of 997 students. The need for a large school population to help an SBHC approach financial viability excludes children in rural communities who are more likely to attend a school with fewer than 500 students, be poor, and have difficulty accessing health care.2 The expansion of telehealth technologies allows the creation of solutions to decrease geographic barriers that have limited the growth of SBHCs in rural communities. Telehealth school-based health centers (tSBHCs) that exclusively provide services through telemedicine are operating and developing in communities where geographic barriers and financial challenges have prevented the establishment of brick and mortar SBHCs. TSBHCs are beginning to increase the number and variety of services they provide through the use of telehealth to include behavioral health, nutrition services, and pediatric specialists. Understanding the role of tSBHCs in the growth of the PCMH model is critical for using these tools to continue to improve child and adolescent health. Copyright 2014, SLACK Incorporated.

Immigrants' utilization of specialist mental healthcare according to age, country of origin, and migration history: a nation-wide register study in Norway.

PubMed

Abebe, Dawit Shawel; Lien, Lars; Elstad, Jon Ivar

2017-06-01

As the immigrant population rises in Norway, it becomes ever more important to consider the responsiveness of health services to the specific needs of these immigrants. It has been questioned whether access to mental healthcare is adequate among all groups of immigrants. This study aims to examine the use of specialist mental healthcare services among ethnic Norwegians and specific immigrants groups. Register data were used from the Norwegian Patient Registry and Statistics Norway. The sample (age 0-59) consisted of 3.3 million ethnic Norwegians and 200,000 immigrants from 11 countries. Poisson regression models were applied to examine variations in the use of specialist mental healthcare during 2008-2011 according to country of origin, age group, reason for immigration, and length of stay. Immigrant children and adolescents had overall significantly lower use of specialist mental healthcare than ethnic Norwegians of the same age. A distinct exception was the high utilization rate among children and youth from Iran. Among adult immigrants, utilization rates were generally lower than among ethnic Norwegians, particularly those from Poland, Somalia, Sri Lanka, and Vietnam. Adult immigrants from Iraq and Iran, however, had high utilization rates. Refugees had high utilization rates of specialist mental healthcare, while labour immigrants had low use. Utilization rates of specialist mental healthcare are lower among immigrants than Norwegians. Immigrants from Poland, Somalia, Sri Lanka, and Vietnam, had generally quite low rates, while immigrants from Iran had high utilization rates. The findings suggest that specialist mental healthcare in Norway is underutilized among considerable parts of the immigrant population.

The patient experience of services for thyroid eye disease in the United Kingdom: results of a nationwide survey.

PubMed

Estcourt, Stephanie; Hickey, Janis; Perros, Petros; Dayan, Colin; Vaidya, Bijay

2009-09-01

A recent consensus statement from the European Group on Graves' Orbitopathy recommends referring all patients with thyroid eye disease (TED), except the mildest cases, to a specialist multidisciplinary clinic. To study the patients' experiences of accessing services for the treatment of TED in the UK. A postal questionnaire survey of 395 members of two patients support organisations for TED in the UK, the TED Charitable Trust and the British Thyroid Foundation. The response rate was 67%. The majority of responders were females (91%) and aged above 45 (74%). There were delays in the diagnosis and referral. In 26% of responders, the time lapsed from the first symptoms to the diagnosis of TED for over 12 months. There was a wide variation in the type of clinic and healthcare professionals involved in the treatment of TED. Only 25% of the responders attended a specialist TED clinic. Out of these, 33% waited over 6 months from the first consultation with a doctor to being seen at a specialist TED clinic. Only 56% of responders were satisfied with the treatment they received for TED. More responders who had attended a specialist TED clinic were satisfied with the treatment than those who had not attended a specialist clinic (67 vs 52%, P<0.05). Only a minority of patients with TED are treated at a specialist TED clinic in the UK. Those patients who are treated at a specialist TED clinic are more likely to be satisfied with the treatment.

Lung cancer treatment rates and the role of the lung cancer nurse specialist: a qualitative study

PubMed Central

Redman, Judy; McDonnell, Ann; Borthwick, Diana; White, John

2015-01-01

Objectives This qualitative study examines how the Lung Cancer Nurse Specialist (LCNS) role operates and why they may be able to increase access to treatment. Setting 4 Hospital NHS Foundation Trusts in England. Design A multiple case study design using semistructured interviews, observation and Framework Analysis techniques. Participants Four LCNSs, comprised the ‘cases’. Twenty four clinicians who worked with the LCNS participated in individual interviews. Six LCNSs took part in a group interview and 60 lung cancer multidisciplinary team (MDT) members and co-ordinators were observed in the MDT meeting. Results The LCNS is crucial within the MDT and can act as a catalyst to patient access to treatment. The study identified the clinical activity (assessment, managing symptoms, psychological support and information provision) and role characteristics that can facilitate treatment access. These characteristics are the LCNS's presence across the patient pathway, acting as the ‘hub’ of the MDT, maintaining a holistic patient focus and working to an advanced level of practice. The findings indicate how factors may have a cumulative impact on treatment access. Conclusions If UK patient with lung cancer survival rates are to improve in line with comparable countries, we need to employ every advantage. This study demonstrates how the LCNS role may open doors to positive patient outcomes, including treatment. Further research is required to explore patients’ experiences, decision-making and attitudes to treatment. PMID:26685023

Everyday ethics and help-seeking in early rheumatoid arthritis

PubMed Central

Townsend, A.; Adam, P.; Cox, S.M.; Li, L.C.

2018-01-01

Background Sociological understandings of chronic illness have revealed tensions and complexities around help-seeking. Although ethics underpins healthcare, its application in the area of chronic illness is limited. Here we apply an ethical framework to interview accounts and identify ethical challenges in the early rheumatoid arthritis (RA) experience. Methods In-depth interviews were conducted with eight participants who had been diagnosed with RA in the 12 months prior to recruitment. Applying the concepts of autonomous decision-making and procedural justice highlighted ethical concerns which arose throughout the help-seeking process. Analysis was based on the constant-comparison approach. Results Individuals described decision-making, illness actions and the medical encounter. The process was complicated by inadequate knowledge about symptoms, common-sense understandings about the GP appointment, difficulties concerning access to specialists, and patient–practitioner interactions. Autonomous decision-making and procedural justice were compromised. The accounts revealed contradictions between the policy ideals of active self-management, patient-centred care and shared decision-making, and the everyday experiences of individuals. Conclusions For ethical healthcare there is a need for: public knowledge about early RA symptoms; more effective patient–practitioner communication; and increased support during the wait between primary and secondary care. Healthcare facilities and the government may consider different models to deliver services to people requiring rheumatology consults. PMID:20610465

Loop-mediated Isothermal Amplification (LAMP) Assays for the Species-specific Detection of Eimeria that Infect Chickens

PubMed Central

Barkway, Christopher P.; Pocock, Rebecca L.; Vrba, Vladimir; Blake, Damer P.

2015-01-01

Eimeria species parasites, protozoa which cause the enteric disease coccidiosis, pose a serious threat to the production and welfare of chickens. In the absence of effective control clinical coccidiosis can be devastating. Resistance to the chemoprophylactics frequently used to control Eimeria is common and sub-clinical infection is widespread, influencing feed conversion ratios and susceptibility to other pathogens such as Clostridium perfringens. Despite the availability of polymerase chain reaction (PCR)-based tools, diagnosis of Eimeria infection still relies almost entirely on traditional approaches such as lesion scoring and oocyst morphology, but neither is straightforward. Limitations of the existing molecular tools include the requirement for specialist equipment and difficulties accessing DNA as template. In response a simple field DNA preparation protocol and a panel of species-specific loop-mediated isothermal amplification (LAMP) assays have been developed for the seven Eimeria recognised to infect the chicken. We now provide a detailed protocol describing the preparation of genomic DNA from intestinal tissue collected post-mortem, followed by setup and readout of the LAMP assays. Eimeria species-specific LAMP can be used to monitor parasite occurrence, assessing the efficacy of a farm’s anticoccidial strategy, and to diagnose sub-clinical infection or clinical disease with particular value when expert surveillance is unavailable. PMID:25741643

Loop-mediated isothermal amplification (LAMP) assays for the species-specific detection of Eimeria that infect chickens.

PubMed

Barkway, Christopher P; Pocock, Rebecca L; Vrba, Vladimir; Blake, Damer P

2015-02-20

Eimeria species parasites, protozoa which cause the enteric disease coccidiosis, pose a serious threat to the production and welfare of chickens. In the absence of effective control clinical coccidiosis can be devastating. Resistance to the chemoprophylactics frequently used to control Eimeria is common and sub-clinical infection is widespread, influencing feed conversion ratios and susceptibility to other pathogens such as Clostridium perfringens. Despite the availability of polymerase chain reaction (PCR)-based tools, diagnosis of Eimeria infection still relies almost entirely on traditional approaches such as lesion scoring and oocyst morphology, but neither is straightforward. Limitations of the existing molecular tools include the requirement for specialist equipment and difficulties accessing DNA as template. In response a simple field DNA preparation protocol and a panel of species-specific loop-mediated isothermal amplification (LAMP) assays have been developed for the seven Eimeria recognised to infect the chicken. We now provide a detailed protocol describing the preparation of genomic DNA from intestinal tissue collected post-mortem, followed by setup and readout of the LAMP assays. Eimeria species-specific LAMP can be used to monitor parasite occurrence, assessing the efficacy of a farm's anticoccidial strategy, and to diagnose sub-clinical infection or clinical disease with particular value when expert surveillance is unavailable.

Health care on equal terms? Assessing horizontal equity in health care use in Northern Sweden.

PubMed

San Sebastián, Miguel; Mosquera, Paola A; Ng, Nawi; Gustafsson, Per E

2017-08-01

The Swedish health care system has successively moved toward increased market-orientation, which has raised concerns as to whether Sweden still offers health on equal terms. To explore this issue, this study aimed (i) to assess if the principles of horizontal equity (equal access for equal need regardless of socio-economic factors) are met in Northern Sweden 2006-14; and (ii) to explore the contribution of different factors to the inequalities in access along the same period. Data came from cross sectional surveys known in 2006, 2010 and 2014 targeting 16-84-year-old residents in the four northern-most counties in Sweden. The horizontal inequity index was calculated based on variables representing (i) the individual socioeconomic status, (ii) the health care needs, (iii) non-need factors as well as (iv) health care utilization: general practitioner (GP), specialist doctors, hospitalization. Decomposition analysis of the concentration index for need-standardized health care utilization was applied. Adjusting for needs, there was a higher use of GP services by rich people during the two last surveys, a roughly equal use of specialists, and hospitalization concentrated among the poor but with a clear time trend toward equality. The pro-rich inequalities in GP use were to a large part explained by the income gap. While health care utilization can be considered equitable regarding specialist and hospital use, the increasing pro-rich trend in the use of GP is a concern. Further studies are required to investigate the reasons and a constant monitoring of socioeconomic differences in health care access is recommended. © The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Medication management for community palliative care patients and the role of a specialist palliative care pharmacist: A qualitative exploration of consumer and health care professional perspectives.

PubMed

Kuruvilla, Lisha; Weeks, Greg; Eastman, Peter; George, Johnson

2018-05-01

Pharmacists have a key role to play in optimisation of medication regimens and promotion of medication safety. The role of specialist pharmacists as part of the multidisciplinary palliative care team, especially in the primary care setting, is not widely recognised. To explore the perspectives of stakeholders about the gaps in the current model of community palliative care services in relation to medication management and to assess their opinions pertaining to the role of a specialist palliative care pharmacist in addressing some of those gaps. Qualitative study utilising three focus groups involving 20 stakeholders. Thematic analysis was carried out using a framework approach and interpreted in the context of the Chronic Care Model for improving primary care for patients with chronic illness. Setting was a large regional Australian palliative care service. Participants included palliative care consumers and clinicians specifically patients, caregivers, physicians, nurses and pharmacists. Five major themes emerged from the focus groups: access to resources, medicines and information; shared care; challenges of polypharmacy; informal caregiver needs and potential roles of a palliative care pharmacist. Gaps in access to medicines/resources, training for generalist practitioners, communication between treating teams and lack of support for patients and carers were cited as factors adversely impacting medication management in community-based palliative care. While community-based palliative care is an essential aspect of meeting the health care demands of an ageing society, the current model has several gaps and limitations. An appropriately qualified and skilled pharmacist within the palliative care team may help to address some of the gaps in relation to medication access and appropriateness.

Experiences of adolescents and young adults with ADHD in Hong Kong: treatment services and clinical management.

PubMed

Cheung, Kerry K W; Wong, Ian C K; Ip, Patrick; Chan, Phyllis K L; Lin, Candy H Y; Wong, Lisa Y L; Chan, Esther W

2015-05-01

Specialist services for the treatment of attention deficit hyperactivity disorder (ADHD) in adulthood in Hong Kong are yet to be developed. This study aims to explore the experiences of adolescents and young adults with ADHD in accessing treatment and services, coping with ADHD-related impairment, and their expectations of future treatment in Hong Kong. Qualitative interviews were conducted with a semi-structured guide. Forty young adult patients aged between 16 and 23 were included in the study. The interview recordings were transcribed verbatim and anonymised. Data were analysed with a thematic approach based on key principles of Grounded Theory. Four meta-themes were developed: Accessing ADHD diagnosis and treatment services; ADHD-related impairment; Experience of ADHD treatments; and Attitudes and expectations of future ADHD treatment. The role of parents and schools were highly significant in accessing services for patients diagnosed with ADHD in childhood. In general, ADHD affected every aspect of patients' lives including academic outcome, employment, family and social relationships. Medications were the principal treatment for ADHD amongst the interviewees and were reported to be generally effective. Half of the patients received non-pharmacological treatments in childhood but these effects were reported to be temporary. There was general consensus that the needs of patients with ADHD could not be met by the current service. In particular, there is a lack of specialist service for adults with ADHD, follow-up by different clinicians, and insufficient provision of non-pharmacological treatments. The findings suggest that further development of specialist ADHD services and non-pharmacological options for young adults are essential to meet their diverse needs with a holistic approach.

GP perceptions of the adequacy of community-based care for patients with advanced heart failure in a UK region (NI): a qualitative study

PubMed Central

Chen, Jingwen Jessica; Gamble, Kathryn; Graham-Wisener, Lisa; McGlade, Kieran; Doherty, Jennifer; Donnelly, Patrick; Stone, Carol A

2018-01-01

Objective To assess the adequacy of community-based services available in Northern Ireland (NI) and to meet the multidimensional needs of patients living with New York Heart Association Stage III and IV heart failure (HF), as experienced and perceived by general practitioners (GP). Methods Semistructured interviews were conducted with GPs recruited via the University Department of General Practice and Northern Ireland Medical and Dental Agency. Interviews were transcribed, independently coded and analysed using a six-step thematic analysis approach. Results Twenty semistructured interviews were conducted. GPs reported managing patients in a ‘reactive rather than proactive’ way, responding only to acute medical needs, with hospital admission the default option due to lack of community-based expertise and services. Care provided by HF specialists was highly regarded but ‘access and coordination’ were lacking, related to inequity of access to Heart Failure Nursing Teams, lack of access to specialist advice and inadequate handover of information to GPs. Conversations regarding current and future care needs and preferences were important, but GPs described ‘neglecting conversations with the patient’, due to time constraints, prognostic uncertainty and fear of causing distress. They expressed the view that ‘specialist palliative care (SPC) is only a credible option in end stages’ related to limited understanding of the scope of SPC, a perception that timing of referral must depend on prognosis and concern that SPC services are cancer-focused. Conclusions Despite the extensive body of research which evidences the unmet multidimensional needs of patients with advanced HF, and more recent evidence for the effectiveness of integrated SPC in improving quality of life for patients with HF, health and social care services within NI have not adapted to assess and meet these needs. PMID:29632677

Provision of NHS generalist and specialist services to care homes in England: review of surveys.

PubMed

Iliffe, Steve; Davies, Susan L; Gordon, Adam L; Schneider, Justine; Dening, Tom; Bowman, Clive; Gage, Heather; Martin, Finbarr C; Gladman, John R F; Victor, Christina; Meyer, Julienne; Goodman, Claire

2016-03-01

The number of beds in care homes (with and without nurses) in the United Kingdom is three times greater than the number of beds in National Health Service (NHS) hospitals. Care homes are predominantly owned by a range of commercial, not-for-profit or charitable providers and their residents have high levels of disability, frailty and co-morbidity. NHS support for care home residents is very variable, and it is unclear what models of clinical support work and are cost-effective. To critically evaluate how the NHS works with care homes. A review of surveys of NHS services provided to care homes that had been completed since 2008. It included published national surveys, local surveys commissioned by Primary Care organisations, studies from charities and academic centres, grey literature identified across the nine government regions, and information from care home, primary care and other research networks. Data extraction captured forms of NHS service provision for care homes in England in terms of frequency, location, focus and purpose. Five surveys focused primarily on general practitioner services, and 10 on specialist services to care home. Working relationships between the NHS and care homes lack structure and purpose and have generally evolved locally. There are wide variations in provision of both generalist and specialist healthcare services to care homes. Larger care home chains may take a systematic approach to both organising access to NHS generalist and specialist services, and to supplementing gaps with in-house provision. Access to dental care for care home residents appears to be particularly deficient. Historical differences in innovation and provision of NHS services, the complexities of collaborating across different sectors (private and public, health and social care, general and mental health), and variable levels of organisation of care homes, all lead to persistent and embedded inequity in the distribution of NHS resources to this population. Clinical commissioners seeking to improve the quality of care of care home residents need to consider how best to provide fair access to health care for older people living in a care home, and to establish a specification for service delivery to this vulnerable population.

A telephone hotline for transient ischaemic attack and stroke: prospective audit of a model to improve rapid access to specialist stroke care.

PubMed

Kerr, Enda; Arulraj, Nolan; Scott, Maggie; McDowall, Mike; van Dijke, Margrethe; Keir, Sarah; Sandercock, Peter; Dennis, Martin

2010-07-02

Patients with transient ischaemic attack or stroke benefit from early diagnosis, specialist assessment, and treatment with thrombolysis, and from stroke unit care and secondary prevention. The challenge with such patients is to minimise delays and ensure that treatment is appropriate, and to provide this care with the available resources. An ongoing prospective audit of a transient ischaemic attack and stroke clinic (1 January 2005 to 30 September 2009), as part of the Scottish Stroke Care Audit, and a three month targeted audit of immediate telephone access to a specialist stroke consultant (1 February 2009 to 30 April 2009). Stroke and transient ischaemic attack services in Lothian, a region of Scotland with a population of 810,000. Delays to assessment at a rapid access transient ischaemic attack and stroke clinic; delays to appropriate treatment. In February 2007 we introduced a 24 hours a day, seven days a week hotline to a consultant, who provided immediate advice on diagnosis, investigation, and emergency treatment for patients with transient ischaemic attack or stroke, and suggested the most appropriate care pathway, which might include an early appointment in a transient ischaemic attack and stroke clinic. The introduction of the hotline was associated with an immediate and sustained reduction in delays to assessment (from 13 to three days) and treatment. The proportion of participants taking statins at the time of visiting the clinic increased from 40% before the introduction of the hotline to 60% after the hotline was in place. Also, the hotline contributed to a reduction in the delay from last event to carotid surgery, from 58 days to 21.5 days. A total of 376 calls were received during the three month audit. Of the 273 (88%) referrers who responded to our questionnaire, 257 (94%) were very satisfied with the advice given over the hotline. Although associated with some disruption to the activities of the consultants, a 24 hours a day, seven days a week telephone hotline to a consultant is a feasible and effective means of reducing delays to specialist assessment and treatment of patients with transient ischaemic attack or stroke.

The role of public and private natural space in children's social, emotional and behavioural development in Scotland: A longitudinal study.

PubMed

Richardson, Elizabeth A; Pearce, Jamie; Shortt, Niamh K; Mitchell, Richard

2017-10-01

Poor mental health in childhood has implications for health and wellbeing in later life. Natural space may benefit children's social, emotional and behavioural development. We investigated whether neighbourhood natural space and private garden access were related to children's developmental change over time. We asked whether relationships differed between boys and girls, or by household educational status. We analysed longitudinal data for 2909 urban-dwelling children (aged 4 at 2008/9 baseline) from the Growing Up in Scotland (GUS) survey. The survey provided social, emotional and behavioural difficulty scores (Strengths and Difficulties Questionnaire (SDQ)), and private garden access. Area (%) of total natural space and parks within 500m of the child's home was quantified using Scotland's Greenspace Map. Interactions for park area, total natural space area, and private garden access with age and age 2 were modelled to quantify their independent contributions to SDQ score change over time. Private garden access was strongly related to most SDQ domains, while neighbourhood natural space was related to better social outcomes. We found little evidence that neighbourhood natural space or garden access influenced the trajectory of developmental change between 4 and 6 years, suggesting that any beneficial influences had occurred at younger ages. Stratified models showed the importance of parks for boys, and private gardens for the early development of children from low-education households. We conclude that neighbourhood natural space may reduce social, emotional and behavioural difficulties for 4-6 year olds, although private garden access may be most beneficial. Copyright © 2017. Published by Elsevier Inc.

Social service offices as a point of entry into substance abuse treatment for poor South Africans

PubMed Central

2012-01-01

Background In South Africa, district social service offices are often the first point of entry into the substance abuse treatment system. Despite this, little is known about the profile of people presenting with substance-related problems at these service points. This has a negative impact on treatment service planning. This paper begins to redress this gap through describing patterns of substance use and service needs among people using general social services in the Western Cape and comparing findings against the profile of persons attending specialist substance abuse treatment facilities in the region. Methods As part of a standard client information system, an electronic questionnaire was completed for each person seeking social assistance. Data on socio-demographic characteristics, the range of presenting problems, patterns of substance use, perceived consequences of substance use, as well as types of services provided were analysed for the 691 social welfare clients who reported substance use between 2007 and 2009. These data were compared against clients attending substance abuse treatment centres during the same time period. Results Findings indicate that social services offices are used as a way of accessing specialist services but are also used as a service point, especially by groups under-represented in the specialist treatment sector. Women, people from rural communities and people with alcohol-related problems are more likely to seek assistance at social service offices providing low threshold intervention services than from the specialist treatment sector. Conclusions The study provides evidence that social services are a point of entry and intervention for people from underserved communities in the Western Cape. If these low-threshold services can be supported to provide good quality services, they may be an effective and efficient way of improving access to treatment in a context of limited service availability. PMID:22642796

An evaluation of the professional, social and demographic profile and quality of life of physicians working at the Prehospital Emergency Medical System (SAMU) in Brazil.

PubMed

Tallo, Fernando Sabia; Campos Vieira Abib, Simone de; Baitello, André Luciano; Lopes, Renato Delascio

2014-09-01

To describe the profile of physicians working at the Prehospital Emergency Medical System (SAMU) in Brazil and to evaluate their quality of life. Both a semi-structured questionnaire with 57 questions and the SF-36 questionnaire were sent to research departments within SAMU in the Brazilian state capitals, the Federal District and inland towns in Brazil. Of a total of 902 physicians, including 644 (71.4%) males, 533 (59.1%) were between 30 and 45 years of age and 562 (62.4%) worked in a state capital. Regarding education level, 45.1% had graduated less than five years before and only 43% were specialists recognized by the Brazilian Medical Association. Regarding training, 95% did not report any specific training for their work at SAMU. The main weaknesses identified were psychiatric care and surgical emergencies in 57.2 and 42.9% of cases, respectively; traumatic pediatric emergencies, 48.9%; and medical emergencies, 42.9%. As for procedure-related skills, the physicians reported difficulties in pediatric advanced support (62.4%), airway surgical access (45.6%), pericardiocentesis (64.4%) and thoracentesis (29.9%). Difficulties in using an artificial ventilator (43.3%) and in transcutaneous pacing (42.2%) were also reported. Higher percentages of young physicians, aged 25-30 years (26.7 vs 19.0%; p<0.01), worked exclusively in prehospital care (18.0 vs 7.7%; p<0.001), with workloads >48 h per week (12.8 vs 8.6%; p<0.001), and were non-specialists with the shortest length of service (<1 year) at SAMU (30.1 vs 18.2%; p<0.001) who were hired without having to pass public service exams (i.e., for a temporary job) (61.8 vs 46.2%; p<0.001). Regarding quality of life, the pain domain yielded the worst result among physicians at SAMU. The doctors in this sample were young and within a few years of graduation, and they had no specific training in prehospital emergencies. Deficiencies were mostly found in pediatrics and psychiatry, with specific deficiencies in the handling of essential equipment and in the skills necessary to adequately attend to prehospital emergencies. A disrespectful labor scenario was also found; the evaluation of quality of life showed a notable presence of pain on the SF-36 among physicians at SAMU and especially among doctors who had worked for a longer length of time at SAMU.

Patients' Experiences with Specialist Care via Video Consultation in Primary Healthcare in Rural Areas

PubMed Central

Johansson, Annette M.; Lindberg, Inger; Söderberg, Siv

2014-01-01

Introduction. Video consultation (VC) can improve access to specialist care, especially for individuals who live in rural areas that are long distances from specialist clinics. Aim. The aim of this study was to describe patients' experiences with specialist care via VC encounters. Method. Interviews were conducted with 26 patients who had participated in a VC encounter. The data were analysed using thematic content analysis. Result. The analysis resulted in two themes. The theme “confident with the technology” was constructed from the categories “possibilities and obstacles in using VC encounters” and “advantages and disadvantages of the technology.” The theme “personal satisfaction with the VC encounters” was constructed from the categories “support from the healthcare personnel,” “perceived security,” and “satisfaction with the specialist consultation.” Conclusion. The patients who did not think that the VC was the best care still considered that the visit was adequate because they did not have to travel. An important finding was that the patients' perceived even short distances to specialty care as expensive journeys because many patients had low incomes. Among the patients who had more than one VC, the second encounter was perceived as safer. Additionally, good communication was essential for the patient's perception of security during the VC encounter. PMID:25243009

Patients' Experiences with Specialist Care via Video Consultation in Primary Healthcare in Rural Areas.

PubMed

Johansson, Annette M; Lindberg, Inger; Söderberg, Siv

2014-01-01

Introduction. Video consultation (VC) can improve access to specialist care, especially for individuals who live in rural areas that are long distances from specialist clinics. Aim. The aim of this study was to describe patients' experiences with specialist care via VC encounters. Method. Interviews were conducted with 26 patients who had participated in a VC encounter. The data were analysed using thematic content analysis. Result. The analysis resulted in two themes. The theme "confident with the technology" was constructed from the categories "possibilities and obstacles in using VC encounters" and "advantages and disadvantages of the technology." The theme "personal satisfaction with the VC encounters" was constructed from the categories "support from the healthcare personnel," "perceived security," and "satisfaction with the specialist consultation." Conclusion. The patients who did not think that the VC was the best care still considered that the visit was adequate because they did not have to travel. An important finding was that the patients' perceived even short distances to specialty care as expensive journeys because many patients had low incomes. Among the patients who had more than one VC, the second encounter was perceived as safer. Additionally, good communication was essential for the patient's perception of security during the VC encounter.

Role expectations in dementia care among family physicians and specialists.

PubMed

Hum, Susan; Cohen, Carole; Persaud, Malini; Lee, Joyce; Drummond, Neil; Dalziel, William; Pimlott, Nicholas

2014-09-01

The assessment and ongoing management of dementia falls largely on family physicians. This pilot study explored perceived roles and attitudes towards the provision of dementia care from the perspectives of family physicians and specialists. Semi-structured, one-to-one interviews were conducted with six family physicians and six specialists (three geriatric psychiatrists, two geriatricians, and one neurologist) from University of Toronto-affiliated hospitals. Transcripts were subjected to thematic content analysis. Physicians' clinical experience averaged 16 years. Both physician groups acknowledged that family physicians are more confident in diagnosing/treating uncomplicated dementia than a decade ago. They agreed on care management issues that warranted specialist involvement. Driving competency was contentious, and specialists willingly played the "bad cop" to resolve disputes and preserve long-standing therapeutic relationships. While patient/caregiver education and support were deemed essential, most physicians commented that community resources were fragmented and difficult to access. Improving collaboration and communication between physician groups, and clarifying the roles of other multi-disciplinary team members in dementia care were also discussed. Future research could further explore physicians' and other multi-disciplinary members' perceived roles and responsibilities in dementia care, given that different health-care system-wide dementia care strategies and initiatives are being developed and implemented across Ontario.

Role Expectations in Dementia Care Among Family Physicians and Specialists

PubMed Central

Hum, Susan; Cohen, Carole; Persaud, Malini; Lee, Joyce; Drummond, Neil; Dalziel, William; Pimlott, Nicholas

2014-01-01

Background The assessment and ongoing management of dementia falls largely on family physicians. This pilot study explored perceived roles and attitudes towards the provision of dementia care from the perspectives of family physicians and specialists. Methods Semi-structured, one-to-one interviews were conducted with six family physicians and six specialists (three geriatric psychiatrists, two geriatricians, and one neurologist) from University of Toronto-affiliated hospitals. Transcripts were subjected to thematic content analysis. Results Physicians’ clinical experience averaged 16 years. Both physician groups acknowledged that family physicians are more confident in diagnosing/treating uncomplicated dementia than a decade ago. They agreed on care management issues that warranted specialist involvement. Driving competency was contentious, and specialists willingly played the “bad cop” to resolve disputes and preserve long-standing therapeutic relationships. While patient/caregiver education and support were deemed essential, most physicians commented that community resources were fragmented and difficult to access. Improving collaboration and communication between physician groups, and clarifying the roles of other multi-disciplinary team members in dementia care were also discussed. Conclusions Future research could further explore physicians’ and other multi-disciplinary members’ perceived roles and responsibilities in dementia care, given that different health-care system-wide dementia care strategies and initiatives are being developed and implemented across Ontario. PMID:25232368

Paediatric conscious sedation: views and experience of specialists in paediatric dentistry.

PubMed

Woolley, S M; Hingston, E J; Shah, J; Chadwick, B L

2009-09-26

The objectives were three-fold: to investigate the level of conscious sedation training received prior to and during specialist training in paediatric dentistry; to establish the use of conscious sedation during and following specialisation; and to determine the attitudes of specialists in paediatric dentistry to conscious sedation. A self-administered postal questionnaire was sent to all specialists in paediatric dentistry registered with the General Dental Council in January 2008. Non-responders were contacted again after a four-week period. A response rate of 60% was achieved. Of the 122 respondents, 67 (55%) had received sedation training as an undergraduate; 89 (75%) had been trained during specialisation. All respondents performed dental treatment under sedation as a trainee and the majority used nitrous oxide inhalation sedation (NOIS). Over 90% of respondents felt that NOIS should be available to all children, both in appropriate primary care settings and in hospitals. One hundred and twenty-one (99%) respondents thought that all trainees in paediatric dentistry should have sedation training. The most popular form of sedation amongst specialists in paediatric dentistry was NOIS. However, some of the respondents felt that children should have access to other forms of sedation in both the primary care and hospital settings. Additional research on other forms of sedation is required to evaluate their effectiveness and safety.

Job strain: a cross-sectional survey of dementia care specialists and other staff in Swedish home care services

PubMed Central

Sandberg, Linda; Borell, Lena; Edvardsson, David; Rosenberg, Lena; Boström, Anne-Marie

2018-01-01

Introduction An increasing number of older persons worldwide live at home with various functional limitations such as dementia. So, home care staff meet older persons with extensive, complex needs. The staff’s well-being is crucial because it can affect the quality of their work, although literature on job strain among home care staff is limited. Aim To describe perceived job strain among home care staff and to examine correlations between job strain, personal factors, and organizational factors. Methods The study applied a cross-sectional survey design. Participants were dementia care specialists who work in home care (n=34) and other home care staff who are not specialized in dementia care (n=35). The Strain in Dementia Care Scale (SDCS) and Creative Climate Questionnaire instruments and demographic variables were used. Descriptive and inferential statistics (including regression modeling) were applied. The regional ethical review board approved the study. Results Home care staff perceived job strain – particularly because they could not provide what they perceived to be necessary care. Dementia care specialists ranked job strain higher (m=5.71) than other staff members (m=4.71; p=0.04). Job strain (for total score and for all five SDCS factors) correlated with being a dementia care specialist. Correlations also occurred between job strain for SDCS factor 2 (difficulties understanding and interpreting) and not having Swedish as first language and SDCS factor 5 (lack of recognition) and stagnated organizational climate. Conclusion The study indicates that home care staff and particularly dementia care specialists perceived high job strain. Future studies are needed to confirm or reject findings from this study. PMID:29861636

Predictors of and barriers to service use for children at risk of ADHD: longitudinal study.

PubMed

Sayal, Kapil; Mills, Jonathan; White, Kate; Merrell, Christine; Tymms, Peter

2015-05-01

Many children with, or at risk of, ADHD do not receive healthcare services for their difficulties. This longitudinal study investigates barriers to and predictors of specialist health service use. This is a 5-year follow-up study of children who participated in a cluster randomised controlled trial, which investigated school-level interventions (provision of books with evidence-based information and/or feedback of names of children) for children at risk of ADHD. 162 children who had high levels of ADHD symptoms at age 5 (baseline) were followed up at age 10 years. Using baseline data and follow-up information collected from parents and teachers, children who had and had not used specialist health services over the follow-up period were compared and predictors (symptom severity, comorbid problems, parental perception of burden, parental mental health, and socio-demographic factors) of specialist service use investigated. The most common parent-reported barrier reflected lack of information about who could help. Amongst children using specialist health services who met criteria for ADHD at follow-up, 36% had been prescribed stimulant medication. Specialist health service use was associated with each one-point increase in teacher-rated symptoms at baseline [inattention symptoms (adjusted OR = 1.40; 95% CI 1.12-1.76) and hyperactivity/impulsivity symptoms (adjusted OR = 1.23; 95% CI 1.05-1.44)]. Parental mental health problems were also independently associated with service use (for each one-point increase in symptoms, adjusted OR = 1.41; 95% CI 1.04-1.91). Severity of teacher-rated ADHD symptoms in early school years is a determinant of subsequent service use. Clinicians and teachers should be aware that parental mental health problems are independently associated with service use for children at risk of ADHD.

Evaluation Results of an Ontology-based Design Model of Virtual Environments for Upper Limb Motor Rehabilitation of Stroke Patients.

PubMed

Ramírez-Fernández, Cristina; Morán, Alberto L; García-Canseco, Eloísa; Gómez-Montalvo, Jorge R

2017-03-23

1) To enhance the content of an ontology for designing virtual environments (VEs) for upper limb motor rehabilitation of stroke patients according to the suggestions and comments of rehabilitation specialists and software developers, 2) to characterize the perceived importance level of the ontology, 3) to determine the perceived usefulness of the ontology, and 4) to identify the safety characteristics of the ontology for VEs design according to the rehabilitation specialists. Using two semi-structured Web questionnaires, we asked six rehabilitation specialists and six software developers to provide us with their perception regarding the level of importance and the usability of the ontology. From their responses we have identified themes related to perceived and required safety characteristics of the ontology. Significant differences in the importance level were obtained for the Stroke Disability, VE Configuration, Outcome Measures, and Safety Calibration classes, which were perceived as highly important by rehabilitation specialists. Regarding usability, the ontology was perceived by both groups with high usefulness, ease of use, learnability and intention of use. Concerning the thematic analysis of recommendations, eight topics for safety characteristics of the ontology were identified: adjustment of therapy strategies; selection and delimitation of movements; selection and proper calibration of the interaction device; proper selection of measuring instruments; gradual modification of the difficulty of the exercise; adaptability and variability of therapy exercises; feedback according to the capabilities of the patient; and real-time support for exercise training. The rehabilitation specialists and software developers confirmed the importance of the information contained in the ontology regarding motor rehabilitation of the upper limb. Their recommendations highlight the safety features and the advantages of the ontology as a guide for the effective design of VEs.

Influence of socio-demographic factors on distances travelled to access HIV services: enhanced surveillance of HIV patients in north west England

PubMed Central

Cook, Penny A; Downing, Jennifer; Wheater, C Philip; Bellis, Mark A; Tocque, Karen; Syed, Qutub; Phillips-Howard, Penelope A

2009-01-01

Background Patient choice and access to health care is compromised by many barriers including travel distance. Individuals with the human immunodeficiency virus (HIV) can seek free specialist care in Britain, without a referral, providing flexible access to care services. Willingness to travel beyond local services for preferred care has funding and service implications. Data from an enhanced HIV surveillance system were used to explore geodemographic and clinical factors associated with accessing treatment services. Methods We extracted data on the location, type and frequency of care services utilized by HIV positive persons (n = 3983) accessing treatment in north west England between January 1st 2005 and June 30th 2006. Individuals were allocated a deprivation score and grouped by urban/rural residence, and distance to care services was calculated. Analysis identified independent predictors of distance travelled (general linear modelling) and, for those bypassing their nearest clinic, the probability of accessing a specialist service (logistic regression, SPSS ver 14). Inter-relationships between variables and distance travelled were visualised using detrended correspondence analysis (PC-ORD ver 4.1). Results HIV infected persons travelled an average of 4.8 km (95% confidence intervals (CI) 4.6–4.9) per trip and had on average 6 visits (95% CI 5.9–6.2) annually for care. Longer trips were made by males (4.8 km vs 4.5 km), white people (6.2 km), the young (>15 years, 6.8 km) and elderly (60+ years, 6.3 km), those on multiple therapy (5.3 km vs 4.0 km), and the more affluent living in rural areas (16.1 km, P < 0.05). Half the individuals bypassed their nearest clinic to visit a more distant facility, and this was associated with being aged under 20 years, multiple therapy, being a male infected by sex between men, relative wealth, and living in rural areas (P < 0.05). Of those bypassing local facilities, poorer people were more likely to access a specialist centre but did not have as far to travel to do so (3.6 km) compared to those from less deprived areas (8.6 km). Conclusion Distance travelled, and type of HIV services used, were associated with socioeconomic status, even after accounting for ethnicity, route of infection and age. Thus despite offering an 'equitable' service, travel costs may advantage those with higher income. PMID:19267895

Classroom Amplification: Not Just for the Hearing Impaired Anymore.

ERIC Educational Resources Information Center

Dahlquist, Lori Hubble

This paper discusses the difficulties that children with central auditory processing difficulties can have in the classroom environment. Classroom acoustics that can hinder a child's accessibility to instruction are discussed, including open windows or windows not designed to be acoustic barriers, increased reverberation time in rooms with high…

Stigma and Student Mental Health in Higher Education

ERIC Educational Resources Information Center

Martin, Jennifer Marie

2010-01-01

Stigma is a powerful force in preventing university students with mental health difficulties from gaining access to appropriate support. This paper reports on an exploratory study of university students with mental health difficulties that found most students did not disclose their mental health problems to staff at university. This was primarily…

General Child Benefit Fund Experiments in Providing Differentiated Services

ERIC Educational Resources Information Center

Serres, Anne-Marie

2005-01-01

Populations not autonomous in their administrative relations has difficulties with access to social benefits of the Caisses d'Allocations Familiales (CAFs). These difficulties, whether rooted in cultural, educational, social, or other issues, disrupt the management of their documents of social benefits and thereby weigh on their economic…

Accommodation Use during Content Area Instruction for Students with Reading Difficulties: Teacher and Student Perspectives

ERIC Educational Resources Information Center

Witmer, Sara; Schmitt, Heather; Clinton, Marianne; Mathes, Nicole

2018-01-01

Accommodations are often necessary to help students with reading difficulties access instructional materials that facilitate learning across content areas. However, the extent to which students with disabilities use accommodations during instruction is unclear. We surveyed and interviewed special educators and students with reading-related…

Reflections on Teaching Struggling Middle School Readers.

ERIC Educational Resources Information Center

Ivey, Gay

1999-01-01

Shares four working generalizations on what it takes for middle school students with persistent reading difficulties to become successful readers: (1) access to materials that span the gamut of interests and difficulty levels; (2) opportunities to share reading experiences with teachers and classmates; (3) real purposes for reading; and (4)…

Certified Health Education Specialists' Participation in Professional Associations: Implications for Marketing and Membership

ERIC Educational Resources Information Center

Thackeray, Rosemary; Neiger, Brad L.; Roe, Kathleen M.

2005-01-01

A number of health education professional associations exist to advance the profession through research, practice, and professional development. Benefits of individual membership may include continuing education, networking, leadership, professional recognition, advocacy, professional mobility, access to research findings, advances in the…

National Airspace System. Operational Requirements.

DTIC Science & Technology

1984-10-01

1. Access to manned NAS tacilities shall be control’ed at all times to prevent intc.rruptio;i of service., distraction of specialists, and theft of...user requirements which cannot otherwise be accomplished. ALTRVs are approved by the appropriate FAA facility. AREA CONTROL1 FACILITY (ACF) - A

Where Field Staff Get Information. Approaching the Electronic Times.

ERIC Educational Resources Information Center

Shih, Win-Yuan; Evans, James F.

1991-01-01

Top 3 information sources identified in a survey of 109 extension agents were extension publications, specialists, and personal files. Electronic sources such as satellite programing and bibliographic databases were used infrequently, because of lack of access, user friendliness, and ready applicability of information. (SK)

Database in Artificial Intelligence.

ERIC Educational Resources Information Center

Wilkinson, Julia

1986-01-01

Describes a specialist bibliographic database of literature in the field of artificial intelligence created by the Turing Institute (Glasgow, Scotland) using the BRS/Search information retrieval software. The subscription method for end-users--i.e., annual fee entitles user to unlimited access to database, document provision, and printed awareness…

The Availability and Utility of Services to Address Risk Factors for Recidivism among Justice-Involved Veterans

PubMed Central

Blonigen, Daniel M.; Rodriguez, Allison L.; Manfredi, Luisa; Britt, Jessica; Nevedal, Andrea; Finlay, Andrea K.; Rosenthal, Joel; Smelson, David; Timko, Christine

2016-01-01

The availability and utility of services to address recidivism risk factors among justice-involved veterans is unknown. We explored these issues through qualitative interviews with 63 Specialists from the Department of Veterans Affairs’ (VA) Veterans Justice Programs. To guide the interviews, we utilized the Risk-Need-Responsivity (RNR) model of offender rehabilitation. Specialists reported that justice-involved veterans generally have access to services to address most RNR-based risk factors (substance abuse; lack of positive school/work involvement; family/marital dysfunction; lack of prosocial activities/interests), but have less access to services targeting risk factors of antisocial tendencies and associates and empirically-based treatments for recidivism in VA. Peer-based services, motivational interviewing/cognitive-behavioral therapy, and Veterans Treatment Courts were perceived as useful to address multiple risk factors. These findings highlight potential gaps in provision of evidence-based care to address recidivism among justice-involved veterans, as well as promising policy-based solutions that may have widespread impact on reducing recidivism in this population. PMID:26924887

NGSI student activities in open source information analysis in support of the training program of the U.S. DOE laboratories for the entry into force of the additional protocol

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

Sandoval, M Analisa; Uribe, Eva C; Sandoval, Marisa N

2009-01-01

In 2008 a joint team from Los Alamos National Laboratory (LANL) and Brookhaven National Laboratory (BNL) consisting of specialists in training of IAEA inspectors in the use of complementary access activities formulated a training program to prepare the U.S. Doe laboratories for the entry into force of the Additional Protocol. As a major part of the support of the activity, LANL summer interns provided open source information analysis to the LANL-BNL mock inspection team. They were a part of the Next Generation Safeguards Initiative's (NGSI) summer intern program aimed at producing the next generation of safeguards specialists. This paper describesmore » how they used open source information to 'backstop' the LANL-BNL team's effort to construct meaningful Additional Protocol Complementary Access training scenarios for each of the three DOE laboratories, Lawrence Livermore National Laboratory, Idaho National Laboratory, and Oak Ridge National Laboratory.« less

On the availability of geoscientific data and scientific collaborators of an in Africa

USGS Publications Warehouse

Hastings, David A.

1982-01-01

In addition to the technical papers, the major topic of discussion at the symposium which formed the stepping-off point for this issue of Geoexplorution was the difficult communications between specialists on Africa and the lack of available geological and geophysical data. However, much of this difficulty stems from a lack of advice on where to turn for data and for eollaboration with other interested scientists. This short note attempts to address these problems with some possible solutions.

New hospital consultant: surviving a difficult period.

PubMed

Robinson, Geoffrey; Morreau, Johan; Leighton, Marion; Beasley, Richard

2007-08-10

The first years of consultant practice are amongst the most stressful in a medical specialist's career. Recognising the likely difficulties is essential if measures are to be put in place to lessen their impact. In this article, recommendations are made on how to balance clinical and non-clinical duties and to obtain the support required for professional development. Self-care of mental and physical health is vital and planning is necessary to ensure that both personal health and a work/life balance are maintained.

[School adaptation of children with borderline mental disorders].

PubMed

Shalimov, V F

2007-01-01

Three hundreds and forty children with borderline mental disorders (BMD) experiencing difficulties in learning have been studied. The typology of BMD has been elaborated and the types have been specified as follows: disontogenetic, with cerebral alteration and deprived. In accordance to these types, the differentiated modules of corrective and rehabilitative programs have been singled out. The elaborated technology of corrective and rehabilitative work of specialists in educational institutions of compensative character allows to optimize the transition of children with BMB to a common educational setting.

Biowatch South Africa and the Challenges in Enforcing its Constitutional Right to Access to Information

ERIC Educational Resources Information Center

Peekhaus, Wilhelm

2011-01-01

This paper examines the difficulties encountered by Biowatch, a South African civil society environmental organization, in its attempts to obtain access to government information in respect of genetically engineered plants. After establishing the context of South Africa's access to information regime, including a brief discussion of several of its…

Variation in use of technology among vascular access specialists: an analysis of the PICC1 survey.

PubMed

Chopra, Vineet; Kuhn, Latoya; Ratz, David; Winter, Suzanne; Carr, Peter J; Paje, David; Krein, Sarah L

2017-05-15

While the use of technologies such as ultrasound and electrocardiographic (ECG) guidance systems to place peripherally inserted central catheters (PICCs) has grown, little is known about the clinicians who use these tools or their work settings. Using data from a national survey of vascular access specialists, we identified technology users as PICC inserters that: (a) use ultrasound to find a suitable vein for catheter placement; (b) measure catheter-to-vein ratio; and (c) use ECG for PICC placement. Individual and organizational-level characteristics between technology users versus non-users were assessed. Bivariable comparisons were made using Chi-squared or Fisher's exact tests; two-sided alpha with p<0.05 was considered statistically significant. Of the 2762 PICC inserters who accessed the survey, 1518 (55%) provided information regarding technology use. Technology users reported greater experience than non-technology users, with a higher percentage stating they had placed >1000 PICCs (55% vs. 45%, p<0.001). A significantly greater percentage of technology users also reported being certified in vascular access by an external agency than non-technology users (75% vs. 63%, p<0.001). Technology users were more often part of vascular access teams with ≥10 members compared to non-technology users (35% vs. 22%, p<0.001). Some practices also varied between the two groups: for example, use of certain securement devices and dressings differed between technology users and non-users (p<0.001). Technology use by vascular access clinicians while placing PICCs is associated with clinician characteristics, work setting and practice factors. Understanding whether such differences influence clinical care or patient outcomes appears necessary.

National Randomized Controlled Trial of Virtual House Calls for People with Parkinson's Disease: Interest and Barriers

PubMed Central

Achey, Meredith A.; Beck, Christopher A.; Beran, Denise B.; Biglan, Kevin M.; Boyd, Cynthia M.; Schmidt, Peter N.; Simone, Richard; Willis, Allison W.; Galifianakis, Nicholas B.; Katz, Maya; Tanner, Caroline M.; Dodenhoff, Kristen; Ziman, Nathan; Aldred, Jason; Carter, Julie; Jimenez-Shahed, Joohi; Hunter, Christine; Spindler, Meredith; Mari, Zoltan; Morgan, John C.; McLane, Dedi; Hickey, Patrick; Gauger, Lisa; Richard, Irene Hegeman; Bull, Michael T.; Mejia, Nicte I.; Bwala, Grace; Nance, Martha; Shih, Ludy; Anderson, Lauren; Singer, Carlos; Zadikoff, Cindy; Okon, Natalia; Feigin, Andrew; Ayan, Jean; Vaughan, Christina; Pahwa, Rajesh; Cooper, Jessica; Webb, Sydney; Dhall, Rohit; Hassan, Anhar; Weis, Delana; DeMello, Steven; Riggare, Sara S.; Wicks, Paul; Smith, Joseph; Keenan, H. Tait; Korn, Ryan; Schwarz, Heidi; Sharma, Saloni; Stevenson, E. Anna; Zhu, William

2016-01-01

Abstract Background: Delivering specialty care remotely directly into people's homes can enhance access for and improve the healthcare of individuals with chronic conditions. However, evidence supporting this approach is limited. Materials and Methods: Connect.Parkinson is a randomized comparative effectiveness study that compares usual care of individuals with Parkinson's disease in the community with usual care augmented by virtual house calls with a Parkinson's disease specialist from 1 of 18 centers nationally. Individuals in the intervention arm receive four virtual visits from a Parkinson's disease specialist over 1 year via secure, Web-based videoconferencing directly into their homes. All study activities, including recruitment, enrollment, and assessments, are conducted remotely. Here we report on interest, feasibility, and barriers to enrollment in this ongoing study. Results: During recruitment, 11,734 individuals visited the study's Web site, and 927 unique individuals submitted electronic interest forms. Two hundred ten individuals from 18 states enrolled in the study from March 2014 to June 2015, and 195 were randomized. Most participants were white (96%) and college educated (73%). Of the randomized participants, 73% had seen a Parkinson's disease specialist within the previous year. Conclusions: Among individuals with Parkinson's disease, national interest in receiving remote specialty care directly into the home is high. Remote enrollment in this care model is feasible but is likely affected by differential access to the Internet. PMID:26886406

Exploring aspects of physiotherapy care valued by breast cancer patients.

PubMed

Pidlyskyj, K; Roddam, H; Rawlinson, G; Selfe, J

2014-06-01

To explore the reported value of physiotherapy care received by patients who had accessed a Specialist Breast Care Physiotherapy Service. Exploratory qualitative study using in-depth interviews to explore aspects of physiotherapy care valued by breast cancer patients. Thematic network analysis was used to interpret the data and bring together the different experiences of the participants and identify common themes. Physiotherapy Department at a NHS Foundation Trust Teaching Hospital. Nineteen participants were recruited and three were selected to take part in the in-depth interviews. All participants had received physiotherapy care from a Specialist Breast Care Physiotherapy Service and had been discharged within the last six months. Participants valued a patient-centred holistic approach to care and access to a Specialist Service with an experienced clinician. In particular the importance of the therapeutic alliance and the value of psychological, emotional and educational support emerged, with the participants feeling empowered in their recovery. Participants reported an overall positive experience of their physiotherapy care. This study supports the need for service providers to evaluate their current physiotherapy provision and subsequently develop Specialised Services to meet the physiotherapy needs of breast cancer patients throughout all stages of their treatment pathway from the delivery of pre-operative care through to post-treatment follow-up. Copyright © 2014 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Connecting People to Places : Spatiotemporal Analysis of Transit Supply Using Travel Time Cubes

DOT National Transportation Integrated Search

2016-06-01

Despite its importance, temporal measures of accessibility are rarely used in transit research or practice. This is primarily due to the inherent difficulty and complexity in computing time-based accessibility metrics. Estimating origin-to-destinatio...

Access to healthcare, HIV/STI testing, and preferred pre-exposure prophylaxis providers among men who have sex with men and men who engage in street-based sex work in the US.

PubMed

Underhill, Kristen; Morrow, Kathleen M; Colleran, Christopher M; Holcomb, Richard; Operario, Don; Calabrese, Sarah K; Galárraga, Omar; Mayer, Kenneth H

2014-01-01

Pre-exposure prophylaxis (PrEP) is a promising strategy for HIV prevention among men who have sex with men (MSM) and men who engage in sex work. But access will require routine HIV testing and contacts with healthcare providers. This study investigated men's healthcare and HIV testing experiences to inform PrEP implementation. We conducted 8 focus groups (n = 38) in 2012 and 56 in-depth qualitative interviews in 2013-14 with male sex workers (MSWs) (n = 31) and other MSM (n = 25) in Providence, RI. MSWs primarily met clients in street-based sex work venues. Facilitators asked participants about access to healthcare and HIV/STI testing, healthcare needs, and preferred PrEP providers. MSWs primarily accessed care in emergency rooms (ERs), substance use clinics, correctional institutions, and walk-in clinics. Rates of HIV testing were high, but MSWs reported low access to other STI testing, low insurance coverage, and unmet healthcare needs including primary care, substance use treatment, and mental health services. MSM not engaging in sex work were more likely to report access to primary and specialist care. Rates of HIV testing among these MSM were slightly lower, but they reported more STI testing, more insurance coverage, and fewer unmet needs. Preferred PrEP providers for both groups included primary care physicians, infectious disease specialists, and psychiatrists. MSWs were also willing to access PrEP in substance use treatment and ER settings. PrEP outreach efforts for MSWs and other MSM should engage diverse providers in many settings, including mental health and substance use treatment, ERs, needle exchanges, correctional institutions, and HIV testing centers. Access to PrEP will require financial assistance, but can build on existing healthcare contacts for both populations.

Access to Healthcare, HIV/STI Testing, and Preferred Pre-Exposure Prophylaxis Providers among Men Who Have Sex with Men and Men Who Engage in Street-Based Sex Work in the US

PubMed Central

Underhill, Kristen; Morrow, Kathleen M.; Colleran, Christopher M.; Holcomb, Richard; Operario, Don; Calabrese, Sarah K.; Galárraga, Omar; Mayer, Kenneth H.

2014-01-01

Background Pre-exposure prophylaxis (PrEP) is a promising strategy for HIV prevention among men who have sex with men (MSM) and men who engage in sex work. But access will require routine HIV testing and contacts with healthcare providers. This study investigated men’s healthcare and HIV testing experiences to inform PrEP implementation. Methods We conducted 8 focus groups (n = 38) in 2012 and 56 in-depth qualitative interviews in 2013–14 with male sex workers (MSWs) (n = 31) and other MSM (n = 25) in Providence, RI. MSWs primarily met clients in street-based sex work venues. Facilitators asked participants about access to healthcare and HIV/STI testing, healthcare needs, and preferred PrEP providers. Results MSWs primarily accessed care in emergency rooms (ERs), substance use clinics, correctional institutions, and walk-in clinics. Rates of HIV testing were high, but MSWs reported low access to other STI testing, low insurance coverage, and unmet healthcare needs including primary care, substance use treatment, and mental health services. MSM not engaging in sex work were more likely to report access to primary and specialist care. Rates of HIV testing among these MSM were slightly lower, but they reported more STI testing, more insurance coverage, and fewer unmet needs. Preferred PrEP providers for both groups included primary care physicians, infectious disease specialists, and psychiatrists. MSWs were also willing to access PrEP in substance use treatment and ER settings. Conclusions PrEP outreach efforts for MSWs and other MSM should engage diverse providers in many settings, including mental health and substance use treatment, ERs, needle exchanges, correctional institutions, and HIV testing centers. Access to PrEP will require financial assistance, but can build on existing healthcare contacts for both populations. PMID:25386746

Access to dental care and the capacity of the California dental care system.

PubMed

Brown, Timothy T; Pourat, Nadereh; Glassman, Paul; Chung, Jessica; Nicholson, Gina; Hong, Juliette S

2012-03-01

The authors estimated the following levels of technical efficiency for three types of dental practices in California where technical efficiency is defined as the maximum output that can be produced from a given set of inputs: generalists (including pediatric dentists), 96.5 percent; specialists, 77.1 percent; community dental clinics, 83.6 percent. Combining this with information on access, it is estimated that the California dental care system in 2009-10 could serve approximately 74 percent of the population.

Difficulties regulating emotions: Do binge eaters have fewer strategies to modulate and tolerate negative affect?

PubMed

Whiteside, Ursula; Chen, Eunice; Neighbors, Clayton; Hunter, Dorian; Lo, Tracy; Larimer, Mary

2007-04-01

The current study evaluated whether difficulties regulating emotions explained unique variance in binge eating and examined which types of emotion regulation difficulties are most strongly associated with binge eating. The Eating Disorders Diagnostic Scale and the Difficulties in Emotion Regulation Scale were completed by 695 undergraduates. Hierarchical regression results indicated that difficulties regulating emotions accounted for a significant amount of the variance in binge eating over and above sex, food restriction, and over-evaluation of weight and shape. Results also indicated that greater difficulty identifying and making sense of emotional states, and limited access to emotion regulation strategies were primarily responsible for the link between emotion regulation difficulties and binge eating. This supports a model of binge eating that includes emotional vulnerability and a deficit of skills to functionally modulate negative moods.

Tele-periodontics - Oral health care at a grass root level.

PubMed

Avula, Haritha

2015-01-01

A new concept of tele-periodontics, which merges the innovative technology of telecommunications and the field of periodontics, is proposed. This new field of tele-periodontics will have an infinite potential where access to a specialist will be provided at a grass root level, enhancing effective delivery of therapy and information to the rural and under privileged areas. It would allow the specialist and the patient to interact either by video conferencing (real time) or through supportive information (store and forward) over geographic distances. Different probabilities of tele-periodontics such as tele consultation, tele training, tele education and tele support are also discussed in this paper.

Tele-periodontics - Oral health care at a grass root level

PubMed Central

Avula, Haritha

2015-01-01

A new concept of tele-periodontics, which merges the innovative technology of telecommunications and the field of periodontics, is proposed. This new field of tele-periodontics will have an infinite potential where access to a specialist will be provided at a grass root level, enhancing effective delivery of therapy and information to the rural and under privileged areas. It would allow the specialist and the patient to interact either by video conferencing (real time) or through supportive information (store and forward) over geographic distances. Different probabilities of tele-periodontics such as tele consultation, tele training, tele education and tele support are also discussed in this paper. PMID:26644730

Focus on Library Media Skills for the Young Reader.

ERIC Educational Resources Information Center

School Library Media Activities Monthly, 1989

1989-01-01

Offers suggestions relating to the general characteristics of young readers to aid library media specialists in effective teaching and communication. Topics discussed include physical access, dependence, and activity levels; the use of games and dramatic play; children's interests; conceptual development; and emotional needs and behaviors. (CLB)

Partners for Success: A School Library Advocacy Training Program for Principals.

ERIC Educational Resources Information Center

Kachel, Debra E.

2003-01-01

Describes a program developed to help school principals understand the importance of school library media specialists based on "Information Power." Explains modules on academic achievement and school libraries, information literacy and academic standards, library collections and flexible access, and revitalization and evaluation of…

Barriers to managing child and adolescent mental health problems: a systematic review of primary care practitioners' perceptions.

PubMed

O'Brien, Doireann; Harvey, Kate; Howse, Jessica; Reardon, Tessa; Creswell, Cathy

2016-10-01

Mental health problems are common and typically have an early onset. Effective treatments for mental health problems in childhood and adolescence are available, yet only a minority of children who are affected access them. This is of serious concern, considering the far-reaching and long-term negative consequences of such problems. Primary care is usually the first port of call for concerned parents so it is important to understand how primary care practitioners manage child and adolescent mental health problems and the barriers they face. To ascertain primary care practitioners' perceptions of the barriers that prevent effective management of child and adolescent mental health problems. A systematic review of qualitative and quantitative literature in a primary care setting. A database search of peer-reviewed articles using PsycINFO, MEDLINE(®), Embase, and Web of Science, from inception (earliest 1806) until October 2014, was conducted. Additional studies were identified through hand searches and forward-citation searches. Studies needed to have at least one search term in four categories: primary care, childhood/adolescence, mental health, and barriers. A total of 4151 articles were identified, of which 43 were included (30 quantitative studies and 13 qualitative studies). The majority of the barriers related to identification, management, and/or referral. Considerable barriers included a lack of providers and resources, extensive waiting lists, and financial restrictions. The identification of a broad range of significant barriers highlights the need to strengthen the ability to deal with these common difficulties in primary care. There is a particular need for tools and training to aid accurate identification and management, and for more efficient access to specialist services. © British Journal of General Practice 2016.

Barriers to managing child and adolescent mental health problems: a systematic review of primary care practitioners’ perceptions

PubMed Central

O’Brien, Doireann; Harvey, Kate; Howse, Jessica; Reardon, Tessa; Creswell, Cathy

2016-01-01

Background Mental health problems are common and typically have an early onset. Effective treatments for mental health problems in childhood and adolescence are available, yet only a minority of children who are affected access them. This is of serious concern, considering the far-reaching and long-term negative consequences of such problems. Primary care is usually the first port of call for concerned parents so it is important to understand how primary care practitioners manage child and adolescent mental health problems and the barriers they face. Aim To ascertain primary care practitioners’ perceptions of the barriers that prevent effective management of child and adolescent mental health problems. Design and setting A systematic review of qualitative and quantitative literature in a primary care setting. Method A database search of peer-reviewed articles using PsycINFO, MEDLINE®, Embase, and Web of Science, from inception (earliest 1806) until October 2014, was conducted. Additional studies were identified through hand searches and forward-citation searches. Studies needed to have at least one search term in four categories: primary care, childhood/adolescence, mental health, and barriers. Results A total of 4151 articles were identified, of which 43 were included (30 quantitative studies and 13 qualitative studies). The majority of the barriers related to identification, management, and/or referral. Considerable barriers included a lack of providers and resources, extensive waiting lists, and financial restrictions. Conclusion The identification of a broad range of significant barriers highlights the need to strengthen the ability to deal with these common difficulties in primary care. There is a particular need for tools and training to aid accurate identification and management, and for more efficient access to specialist services. PMID:27621291

Barriers to accessing and using health insurance cards among methadone maintenance treatment patients in northern Vietnam.

PubMed

Tran, Bach Xuan; Boggiano, Victoria L; Nguyen, Cuong Tat; Nguyen, Long Hoang; Le Nguyen, Anh Tuan; Latkin, Carl A

2017-07-17

Methadone maintenance treatment (MMT) patients face unique costs associated with their healthcare expenditures. As such, it is important that these patients have access to health insurance (HI) to help them pay for both routine and unforeseen health services. In this study, we explored factors related to health insurance enrollment and utilization among MMT patients, to move Vietnam closer to universal coverage among this patient population. A cross-sectional study was conducted with 1003 patients enrolled in MMT in five clinics in Hanoi and Nam Dinh provinces. Patients were asked a range of questions about their health, health expenditures, and health insurance access and utilization. We used multivariate logistic regressions to determine factors associated with health insurance access among participants. The majority of participants (nearly 80%) were not currently enrolled in health insurance at the time of the study. Participants from rural regions were significantly more likely than urban participants to report difficulty using HI. Family members of participants from rural regions were more likely to have overall poor service quality through health insurance compared with family members of participants from urban regions. Overall, 37% of participants endorsed a lack of information about HI, nearly 22% of participants reported difficulty accessing HI, 22% reported difficulty using HI, and more than 20% stated they had trouble paying for HI. Older, more highly educated, and employed participants were more likely to have an easier time accessing HI than their younger, less well educated, and unemployed counterparts. HIV-positive participants were more likely to have sufficient information about health insurance options. Our study highlights the dearth of health insurance utilization among MMT patients in northern Vietnam. It also sheds light on factors associated with increased access to and utilization of health insurance among this underserved population. These results can help improve health insurance enrollment among MMT patients, a population that is at increased need of financial assistance in accessing health services.

The gap between entitlement and access to healthcare: An analysis of "candidacy" in the help-seeking trajectories of asylum seekers in Montreal.

PubMed

Chase, Liana E; Cleveland, Janet; Beatson, Jesse; Rousseau, Cécile

2017-06-01

In 2012 the Canadian government made significant cuts to its historically strong federal refugee health coverage plan. While this policy had negligible effects on the level of coverage provided to asylum seekers in Quebec, there is evidence that this group nonetheless experienced reduced healthcare access during the period of polarized national debate that ensued. This study engaged the "candidacy" model of healthcare access to illuminate factors contributing to the observed gap between entitlement and access. Twenty-five semi-structured interviews were conducted with asylum seekers in Montreal to elicit narrative accounts of difficulties encountered in the pursuit of healthcare. Thematic content analysis in conjunction with a holistic examination of help-seeking trajectories revealed several important barriers to obtaining care, including widespread confusion and misinformation about refugee health coverage, cumbersome administrative procedures specific to asylum seekers, and long wait times. Feelings of marginalization and insecurity associated with precarious migratory status appeared to amplify the effects of these barriers to care such that even a minor access difficulty could have dramatic effects on future help-seeking and access outcomes. Demonstrating awareness of public discourses interrogating their deservingness of health coverage, participants often interpreted access difficulties as evidence of health professionals' unwillingness to serve them. Such interpretations conspired with fears associated with the asylum claim process to suppress self-advocacy, further help-seeking, and at times even information-seeking. This finding is particularly significant in that it suggests a mechanism through which hostile public representations of forced migrants-increasingly prevalent in Western host countries-can themselves endanger the physical, psychological, and social health of highly disadvantaged populations, even in the presence of strong entitlement policies. We close with reflections on how theoretical models of healthcare access might be adjusted to better accommodate the unique experiences of precarious status migrants. Copyright © 2017 Elsevier Ltd. All rights reserved.

Accessing Mainstream: Examining the Struggle for Parents of Children Who Have Learning Difficulties

ERIC Educational Resources Information Center

Kenny, Mairin; Shevlin, Michael; Walsh, Patricia Noonan; McNeela, Eileen

2005-01-01

In the past decade Ireland has witnessed substantial changes in policy and provision for children with general learning difficulties as government policies and legislation increasingly underpin the move towards more inclusive provision. Despite this series of policy initiatives parents of children who experience Down syndrome and general learning…

An analysis of perceived access to health care in Europe: How universal is universal coverage?

PubMed

Cylus, Jonathan; Papanicolas, Irene

2015-09-01

The objective of this paper is to examine variations in perceptions of access to health care across and within 29 European countries. Using data from the 2008 round of the European Social Survey, we investigate the likelihood of an individual perceiving that they will experience difficulties accessing health care in the next 12 months, should they need it (N=51,835). We find that despite most European countries having mandates for universal health coverage, individuals who are low income, in poor health, lack citizenship in the country where they reside, 20-30 years old, unemployed and/or female have systematically greater odds of feeling unable to access care. Focusing on the role of income, we find that while there is a strong association between low income and perceived access barriers across countries, within many countries, perceptions of difficulties accessing care are not concentrated uniquely among low-income groups. This implies that factors that affect all income groups, such as poor quality care and long waiting times may serve as important barriers to access in these countries. Despite commitments to move towards universal health coverage in Europe, our results suggest that there is still significant heterogeneity among individuals' perceptions of access and important barriers to accessing health care. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Addressing cultural diversity: the hepatitis B clinical specialist perspective.

PubMed

Wallace, Jack; Smith, Elizabeth; Hajarizadeh, Behzad; Richmond, Jacqueline; Lucke, Jayne

2017-08-31

Hepatitis B is a viral infection primarily affecting people from culturally diverse communities in Australia. While vaccination prevents infection, there is increasing mortality resulting from liver damage associated with chronic infection. Deficits in the national policy and clinical response to hepatitis B result in a low diagnosis rate, inadequate testing and diagnosis processes, and poor access to hepatitis B treatment services. While research identifies inadequate hepatitis B knowledge among people with the virus and primary health care workers, this project sought to identify how specialist clinicians in Australia negotiate cultural diversity, and provide often complex clinical information to people with hepatitis B. A vignette was developed and presented to thirteen viral hepatitis specialist clinicians prior to an electronically recorded interview. Recruitment continued until saturation of themes was reached. Data were thematically coded into themes outlined in the interview schedule. Ethical approval for the research was provided by the La Trobe University Human Research Ethics Committee. Key messages provided to patients with hepatitis B by clinical specialists were identified. These messages were not consistently provided to all patients with hepatitis B, but were determined on perceptions of patient knowledge, age and highest educational level. While the vignette stated that English was not an issue for the patient, most specialists identified the need for an interpreter. Combating stigma related to hepatitis B was seen as important by the specialists and this was done through normalising the virus. Having an awareness of different cultural understandings about hepatitis B specifically, and health and well-being generally, was noted as a communication strategy. Key core competencies need to be developed to deliver educational messages to people with hepatitis B within clinical encounters. The provision of adequate resources to specialist clinics will assist in addressing gaps in the clinical response to hepatitis B.

A preliminary investigation of the relationship between emotion regulation difficulties and posttraumatic stress symptoms.

PubMed

Tull, Matthew T; Barrett, Heidi M; McMillan, Elaine S; Roemer, Lizabeth

2007-09-01

This study examined the relationship between posttraumatic stress (PTS) symptoms and particular aspects of emotion regulation difficulties among trauma-exposed individuals. Participants were an ethnically diverse sample of 108 undergraduates from an urban university. PTS symptom severity was found to be associated with lack of emotional acceptance, difficulty engaging in goal-directed behavior when upset, impulse-control difficulties, limited access to effective emotion regulation strategies, and lack of emotional clarity. Further, overall difficulties in emotion regulation were associated with PTS symptom severity, controlling for negative affect. Finally, individuals exhibiting PTS symptoms indicative of a PTSD diagnosis reported greater difficulties with emotion regulation than those reporting PTS symptoms at a subthreshold level. The implications of these findings for research and treatment are discussed.

Repair of traumatic tricuspid insufficiency via minimally invasive port access.

PubMed

Kasahara, Hirofumi; Kudo, Mikihiko; Kawajiri, Hiroyuki; Yozu, Ryohei

2010-04-01

We report on a successful tricuspid valve plasty using port-access minimally invasive cardiac surgery (MICS) for severe traumatic tricuspid insufficiency caused by blunt chest trauma suffered 15 years previously. A combination repair procedure, consisting of cleft closures, plication of the anteroseptal commissure, and ring annuloplasty, was necessary to achieve valve competence and proved possible via port access without difficulty. Port-access MICS is an alternative approach for tricuspid valve surgery.

[FIRST: a tool for facilitating reading comprehension in high-functioning autism spectrum disorder].

PubMed

González-Navarro, Ana; Freire-Prudencio, Sandra; Gil, David; Martos-Pérez, Juan; Jordanova, Vesna; Cerga-Pashoja, Arlinda; Shishkova, Antoneta; Evans, Richard

2014-02-24

Numerous studies have been documenting during the last decades the difficulties of reading comprehension shown by people with autism spectrum disorder (ASD), including those with preserved intelligence. These difficulties can condition their educational path and directly impact on social inclusion, autonomy and access to employment. This article presents the work developed by a multidisciplinary team under the framework of a project funded by the European Union. It is an explanatory document intended to justify the needs that the population with high-functioning ASD have to access written information. The project is developing a software (Open Book) designed not only 'for' people with ASD, but 'with' people with ASD. Both the child population as well as the adult population of persons with ASD show difficulties in all formal components of written language. The tool needs to be flexible and facilitate it's personalized use in order to respond to the great heterogeneity of this population.

An evaluation of clinical treatment of convergence insufficiency for children with reading difficulties.

PubMed

Dusek, Wolfgang A; Pierscionek, Barbara K; McClelland, Julie F

2011-08-11

The present study investigates two different treatment options for convergence insufficiency CI for a group of children with reading difficulties referred by educational institutes to a specialist eye clinic in Vienna. One hundred and thirty four subjects (aged 7-14 years) with reading difficulties were referred from an educational institute in Vienna, Austria for visual assessment. Each child was given either 8Δ base-in reading spectacles (n=51) or computerised home vision therapy (HTS) (n=51). Thirty two participants refused all treatment offered (clinical control group). A full visual assessment including reading speed and accuracy were conducted pre- and post-treatment. Factorial analyses demonstrated statistically significant changes between results obtained for visits 1 and 2 for total reading time, reading error score, amplitude of accommodation and binocular accommodative facility (within subjects effects) (p<0.05). Significant differences were also demonstrated between treatment groups for total reading time, reading error score and binocular accommodative facility (between subjects effects) (p<0.05). Reading difficulties with no apparent intellectual or psychological foundation may be due to a binocular vision anomaly such as convergence insufficiency. Both the HTS and prismatic correction are highly effective treatment options for convergence insufficiency. Prismatic correction can be considered an effective alternative to HTS.

Improving student dentist competencies and perception of difficulty in delivering care to children with developmental disabilities using a virtual patient module.

PubMed

Kleinert, Harold L; Sanders, Carla; Mink, John; Nash, David; Johnson, Jeff; Boyd, Sara; Challman, Sandra

2007-02-01

An interactive, multimedia, virtual patient module was designed and developed on compact disc (CD-ROM) to address the need for student dentists to increase their competence and decrease their perception of difficulty in caring for children with developmental disabilities. A development team consisting of pediatric dentistry faculty members, parents of children with developmental disabilities, an individual with a developmental disability, and educational specialists developed an interactive virtual patient case. The case involved a ten-year-old child with Down syndrome presenting with a painful tooth. Student dentists were required to make decisions regarding proper interactions with the child, as well as appropriate clinical procedures throughout the case. Differences in perceived difficulty level and knowledge change were measured, as well as the student dentists' overall satisfaction with the learning experience. Significant results were obtained in both perceived difficulty level and knowledge-based measures for student dentists. Participants reported overall satisfaction with the modules. Preparing student dentists to provide sensitive and competent care for children with developmental disabilities is a critical need within dentistry. This study demonstrated that an interactive, multimedia (CD-ROM), virtual patient learning module for student dentists is potentially an effective tool in meeting this need.

Accessibility, Availability, and Potential Benefits of Psycho-Oncology Services: The Perspective of Community-Based Physicians Providing Cancer Survivorship Care.

PubMed

Zimmermann-Schlegel, Verena; Hartmann, Mechthild; Sklenarova, Halina; Herzog, Wolfgang; Haun, Markus W

2017-06-01

As persons of trust, community-based physicians providing survivorship care (e.g., general practitioners [GPs]) often serve as the primary contacts for cancer survivors disclosing distress. From the perspective of physicians providing survivorship care for cancer patients, this study explores (a) the accessibility, availability, and potential benefits of psycho-oncology services; (b) whether physicians themselves provide psychosocial support; and (c) predictors for impeded referrals of survivors to services. In a cross-sectional survey, all GPs and community-based specialists in a defined region were interviewed. In addition to descriptive analyses, categorical data were investigated by applying chi-square tests. Predictors for impeded referrals were explored through logistic regression. Of 683 responding physicians, the vast majority stated that survivors benefit from psycho-oncology services (96.8%), but the physicians also articulated that insufficient coverage of psycho-oncology services (90.9%) was often accompanied by impeded referrals (77.7%). A substantial proportion (14.9%) of physicians did not offer any psychosocial support. The odds of physicians in rural areas reporting impeded referrals were 1.91 times greater than the odds of physicians in large urban areas making a similar report (95% confidence interval [1.07, 3.40]). Most community-based physicians providing survivorship care regard psycho-oncology services as highly beneficial. However, a large number of physicians report tremendous difficulty referring patients. Focusing on those physicians not providing any psychosocial support, health policy approaches should specifically (a) raise awareness of the role of physicians as persons of trust for survivors, (b) highlight the effectiveness of psycho-oncology services, and (c) encourage a proactive attitude toward the assessment of unmet needs and the initiation of comprehensive care. Community-based physicians providing survivorship care for cancer patients regard psycho-oncology services as a highly reasonable and beneficial addition to medical care. In light of insufficient local coverage with services, difficulties with seamless referrals constitute a major challenge for physicians. Apart from emphasizing the effectiveness of psycho-oncology services and proactive attitudes toward the assessment of unmet needs, future policies should focus on the integration of medical and psychosocial follow-up of cancer survivors, especially in rural areas. © AlphaMed Press 2017.

Effectiveness of a digital platform for sharing knowledge on headache management: a two-year experience.

PubMed

Raieli, Vincenzo; Correnti, E; Sandullo, A; Romano, M; Marchese, F; Loiacono, C; Brighina, Filippo

It is crucial that all headache specialists receive adequate training. Considering the unsatisfactory results obtained with standard updating courses and the growing need for continuing professional education, a digital platform was developed as a training tool. The platform has been active since 1 October 2014. It is readily accessible to doctors by free registration. Users have access to all the material available on the platform, which includes scientific articles, e-books, presentations and images. Users can share their own material and clinical cases directly. At the time of this study, the platform had 37 users. In the second year following its launch 316 files were downloaded and five discussions were started. These saw 22 contributions. Fifteen of the 37 members did not perform any action on the platform. In total, 74 files were uploaded in the second year of activity, but 90% of the contributions came from a very small group of users. There were no significant differences in use of the platform between members of the Italian Society for the Study of Headache and other specialists. Even though the platform appears to be an easily accessible, interactive and inexpensive instrument, the higher number of downloads than uploads suggests that it is used passively.

Bridges to Accessibility: A Primer for Including Persons with Disabilities in Adventure Curricula.

ERIC Educational Resources Information Center

Havens, Mark D.

This book encourages the inclusion of persons with disabilities in ongoing adventure programs, motivates adventure leaders to learn more about people with disabilities, and assists specialists in advocating for integrated adventure programming. Centered on attitudinal awareness, the book encourages practitioners to want to make their services…

Multicultural Mosaic: A Family Book Club.

ERIC Educational Resources Information Center

Dias-Mitchell, Laurie; Harris, Elizabeth

2001-01-01

Authors, a library media specialist and a literature/language arts teacher, both recipients of Theodore R. Sizer Fellowships, describe their joint project, "Multicultural Mosaic: A Family Book Club." Their proposal was to strengthen the home-school connection by establishing a book club accessible to all middle and high school students…

Seven Years of Gender Equity: Building California's Workforce.

ERIC Educational Resources Information Center

California Community Colleges, Sacramento. Office of the Chancellor.

Since 1984, the Gender Equity and Civil Rights specialist of the Chancellor's Office of the California Community Colleges (CCC) has led the colleges in the strategic development of statewide and college-based Gender Equity, Single Parent, Displaced Homemaker, and Single Pregnant Woman programs designed to improve access and eliminate barriers to…

Information Literacy: An Online Course for Student Library Assistants

ERIC Educational Resources Information Center

Lincoln, Margaret

2009-01-01

As technology advances continue to impact K-12 schools, online education options offer alternative choices for both teaching and learning. Library media specialists, long committed to providing physical and intellectual access to instructional materials, have responded to changing needs in this online world. They had previously created a virtual…

Standpoint Theory, Realism and the Search for Objectivity in the Sociology of Education

ERIC Educational Resources Information Center

Edwards, Gail

2014-01-01

This paper evaluates the contribution of "social realism" in resolving questions of knowledge and curriculum in the sociology of education. Social realists argue that, in the interests of educational equality, all pupils should have access to "powerful" knowledge produced by specialist intellectual communities. Social realism…

Discovery and Use of Online Learning Resources: Case Study Findings

ERIC Educational Resources Information Center

Recker, Mimi M.; Dorward, James; Nelson, Laurie Miller

2004-01-01

Much recent research and funding have focused on building Internet-based repositories that contain collections of high-quality learning resources, often called "learning objects." Yet little is known about how non-specialist users, in particular teachers, find, access, and use digital learning resources. To address this gap, this article…

Development Principles of the Pedagogical System Aimed at Bachelor Training Based on Modern Information Technology

ERIC Educational Resources Information Center

Kurymbayev, Sayat G.; Samashova, Gulfarida E.; Alshynbayeva, Zhuldyz E.; Mukhametzhanova, Aigul O.; Sharazdin, Adilzada M.; Kalybekova, Kalamkas S.; Kosybaeva, Umitzhan A.

2016-01-01

Modern education is aimed at training competent specialists, which requires modernizing the training process by implementing innovative technologies, especially information technologies. Information technologies allow quickly accessing necessary data, which speeds up the training process. This paper deals with issues related to training bachelors…

Planning for the Automation of School Library Media Centers.

ERIC Educational Resources Information Center

Caffarella, Edward P.

1996-01-01

Geared for school library media specialists whose centers are in the early stages of automation or conversion to a new system, this article focuses on major components of media center automation: circulation control; online public access catalogs; machine readable cataloging; retrospective conversion of print catalog cards; and computer networks…

Data Bases and Libraries.

ERIC Educational Resources Information Center

Cote, L. G.

A system in which the function of the library is to acquire, store, and organize materials is proposed which separates the reference function into a group of subject specialists backed up by computerized information retrieval systems. This division of labor is caused by the scientific community's need for access to graphic and other specific (not…

Training For Rural Practice: The Way Ahead.

ERIC Educational Resources Information Center

Doolan, Thomas; Nichols, Anna

This report describes a program initiated in 1992 to provide appropriate training for rural physicians and to address the shortage of physicians in rural Australia. Rural medical practice differs dramatically from urban practice in that there is limited access to specialist services in rural areas, thus requiring rural practitioners to be…

Tele-yoga for Chronic Pain: Current Status and Future Directions.

PubMed

Mathersul, Danielle C; Mahoney, Louise A; Bayley, Peter J

2018-01-01

Pain is a pervasive, debilitating disorder that is resistant to long-term pharmacological interventions. Although psychological therapies such as cognitive behavior therapy demonstrate moderate efficacy, many individuals continue to have ongoing difficulties following treatment. There is a current trend to establish complementary and integrative health interventions for chronic pain, for which yoga has been found to have exciting potential. Nevertheless, an important consideration within the field is accessibility to adequate care. Telehealth can be used to provide real-time interactive video conferencing leading to increased access to health care for individuals located remotely or who otherwise have difficulty accessing services, perhaps through issues of mobility or proximity of adequate services. This article assesses the current status and feasibility of implementing tele-yoga for chronic pain. Methodological limitations and recommendations for future research are discussed.

Tele-yoga for Chronic Pain: Current Status and Future Directions

PubMed Central

Mahoney, Louise A; Bayley, Peter J

2018-01-01

Pain is a pervasive, debilitating disorder that is resistant to long-term pharmacological interventions. Although psychological therapies such as cognitive behavior therapy demonstrate moderate efficacy, many individuals continue to have ongoing difficulties following treatment. There is a current trend to establish complementary and integrative health interventions for chronic pain, for which yoga has been found to have exciting potential. Nevertheless, an important consideration within the field is accessibility to adequate care. Telehealth can be used to provide real-time interactive video conferencing leading to increased access to health care for individuals located remotely or who otherwise have difficulty accessing services, perhaps through issues of mobility or proximity of adequate services. This article assesses the current status and feasibility of implementing tele-yoga for chronic pain. Methodological limitations and recommendations for future research are discussed. PMID:29637012

Improving access to health care for undocumented immigrants in the United States.

PubMed

Wallace, Steven P; Rodriguez, Michael; Padilla-Frausto, Imelda; Arredondo, Armando; Orozco, Emanuel

2013-01-01

To identify policies that increase access to health care for undocumented Mexican immigrants. Four focus groups (n=34 participants) were conducted with uninsured Mexican immigrants in Los Angeles, California. The feasibility and desirability of different policy proposals for increasing access were discussed by each group. Respondents raised significant problems with policies including binational health insurance, expanded employer-provided health insurance, and telemedicine. The only solution with a consensus that the change would be feasible, result in improved access, and they had confidence in was expanded access to community health centers (CHC's). Given the limited access to most specialists at CHC's and the continued barriers to hospital care for those without health insurance, the most effective way of improving the complete range of health services to undocumented immigrants is through immigration reform that will bring these workers under the other health care reform provisions.

Positive Clinical Outcomes Are Synergistic With Positive Educational Outcomes When Using Telehealth Consulting in General Practice: A Mixed-Methods Study.

PubMed

Knight, Patricia; Bonney, Andrew; Teuss, Grigorijs; Guppy, Michelle; Lafferre, Danielle; Mullan, Judy; Barnett, Stephen

2016-02-08

The use of telehealth technology to enable real-time consultations between patients and specialist services (to whom travel may be an impediment to the patient's care) has recently been encouraged in Australia through financial incentives. However, the uptake has been both fragmented and inconsistent. The potential benefits for patients include access to a broader range of specialist referral services, cost and time saving, and more rapid access to specialist services and a continuum of care through the triangulation of interaction between patient, primary health care providers (general practitioners and nurses), and specialists. Enhanced broadband connectivity and higher-grade encryption present an opportunity to trial the use of telehealth consulting as an intrinsic element of medical education for both medical students and doctors-in-training within rural practices and Aboriginal Medical Services. This paper discusses the reported, and varied, benefits of telehealth consulting arising from a multisite trial in New South Wales, Australia. The purpose of this study is to encourage the use of selected telehealth consultations between patients in a primary care setting with a specialist service as an integral aspect of medical education. The trial closely followed the protocol developed for this complex and multiaspect intervention. This paper discusses one aspect of the research protocol--using telehealth consultations for medical education--in detail. Qualitative and quantitative analyses were conducted. In the quantitative analysis, free-text comments were made on aspects of Telehealth Consulting for the patient, concerning the quality of the interactions, and the time and cost saving, and also on the leaning opportunities. Students commented that their involvement enhanced their learning. All respondents agreed or strongly agreed that that the interpersonal aspects were satisfactory, with some brief comments supporting their views. In the analysis of the qualitative data, five themes emerged from the analyses concerning the educational benefits of Telehealth Consulting for different levels of learners, while three themes were identified concerning clinical benefits. The results demonstrated strong synergies between the learning derived from the telehealth consulting and the clinical benefits to the patient and clinicians involved.

Perceived importance and difficulty of online activities among visually impaired persons in Nigeria.

PubMed

Okonji, Patrick Emeka; Okiki, Olatokunbo Christopher; Ogwezzy, Darlington

2018-03-26

This study investigated perceived relevance of and difficulties in access to day-to-day online activities among visually impaired computer users who used screen readers. The 98 participants in the study were grouped into visually impaired adults (aged 20-59, n = 60) and visually impaired older adults (aged 60 and over, n = 38). Data were collected in structured interview questionnaires with Likert scales exploring ratings of perceived importance and difficulty of access to 11 online platforms of various internet activities. Analyses revealed that the two groups did not differ significantly in ratings of perceived importance of four major online activities, namely sending or reading email (p = 0.5224), online banking (p = 0.2833), online shopping (p = 0.1829), and health information seeking (p = 0.1414). The topmost rated activity of priority among both groups was sending and reading emails. Findings also show that, apart from sending and reading emails, activities rated as important were mostly perceived as difficult to access. The implications of the study for inclusive design and strategies and/or interventions to encourage uptake of internet use among the visually impaired population are discussed.

The work left undone. Understanding the challenge of providing holistic lung cancer nursing care in the UK.

PubMed

Leary, Alison; White, John; Yarnell, Laura

2014-02-01

In England best practice guidance in cancer recommends that all patients have access to a specialist nurse such as the tumour specific clinical nurse specialist. The role has become pivotal providing aspects of care e.g. meeting information needs, holistic nurse led follow up including symptom control, managing care and providing psychological and social interventions including referral to others in the role of keyworker. There are approximately 295 lung cancer nurse specialists in England and recent study to model optimum caseload used an on line survey to look at workload of lung cancer specialist nurses. A survey of 100 lung cancer nurses from across the UK (RR78%) examined the perception of the work left undone against best practice guidance, caseload size, workload and other factors. 67 of 78 respondents perceived they left work such as proactive management (52) undertaking holistic needs assessments (46) providing appropriate psychological care (26) and meeting information needs (16). The majority (70) worked unpaid overtime (mean 3.8 h range 1-10 h) per week. Although proactive management is thought to result in better outcomes for lung cancer patients in terms of survival, quality of life and decisions of end of life a substantial number of the specialist nurses felt that factors such as caseload and organisational factors inhibited this. Copyright © 2013 Elsevier Ltd. All rights reserved.

Canadian practice assessment in chronic obstructive pulmonary disease: respiratory specialist physician perception versus patient reality.

PubMed

Hernandez, Paul; Balter, Meyer S; Bourbeau, Jean; Chan, Charles K; Marciniuk, Darcy D; Walker, Shannon L

2013-01-01

Chronic obstructive pulmonary disease (COPD) is a common respiratory condition and the fourth leading cause of death in Canada. Optimal COPD management requires patients to participate in their care and physician knowledge of patients' perceptions of their disease. A prospective study in which respiratory specialist physicians completed a practice assessment questionnaire and patient assessments for 15 to 20 consecutive patients with COPD. Patients also completed a questionnaire regarding their perceptions of COPD and its management. A total of 58 respiratory specialist physicians from across Canada completed practice assessments and 931 patient assessments. A total of 640 patients with COPD (96% with moderate, severe or very severe disease) completed questionnaires. Symptom burden was high and most patients had experienced a recent exacerbation. Potential COPD care gaps were identified with respect to appropriate medication prescription, lack of an action plan, and access to COPD educators and pulmonary rehabilitation. Perceived knowledge needs and gaps differed between physicians and patients. Despite the dissemination of Canadian and international COPD clinical practice guidelines for more than a decade, potential care gaps remain among patients seen by respiratory specialist physicians. Differing perceptions regarding many aspects of COPD among physicians and patients may contribute to these care gaps.

Barriers and Motivators for Referral of Patients with Suspected Lynch Syndrome to Cancer Genetic Services: A Qualitative Study

PubMed Central

Tan, Yen Y.; Fitzgerald, Lisa J.

2014-01-01

This article explores the views of general practitioners and specialists on their referral of patients with suspected Lynch syndrome to cancer genetic services. Using a purposive maximum variation sampling strategy, we conducted semi-structured interviews face-to-face with 28 general practitioners and specialists in public or private hospitals and specialist clinics between March and August 2011. General practitioners and specialists were recruited in a major metropolitan area in Australia. Interview transcripts were reviewed by two independent researchers, and thematic analysis was performed using NVivo10 software. The main barriers and motivators identified were: (1) clinician-related (e.g., familiarity with Lynch syndrome and family history knowledge); (2) patient-related (e.g., patients’ interests and personal experience with cancer); and (3) organizational-related (e.g., access to services, guidelines and referral pathway). Referral of patients with suspected Lynch syndrome to cancer genetic services is motivated and hindered by a range of individual, interpersonal and organizational factors. In order to improve the care and quality of life of patients and family with suspected Lynch syndrome, further research is needed to develop supportive tools for clinicians. PMID:25562140

More doctors and dentists are needed in South Africa.

PubMed

Strachan, B; Zabow, T; van der Spuy, Z

2011-07-25

BACKGROUND. An aim of the Colleges of Medicine of South Africa (CMSA) project 'Strengthening Academic Medicine and Specialist Training' was to research the number and needs of specialists and subspecialists within South Africa. METHODS. Data were collected from several sources: Deans of the 8 Faculties of Health Sciences and the Presidents of the 27 constituent Colleges of the CMSA completed a survey; and the HPCSA's Register of Approved Registrar Posts for Faculties of Health Sciences was examined and the results tabulated. RESULTS. South Africa compares unfavourably with middle-income countries on the ratios of medical and dental professionals; many districts have limited access to specialists and subspecialists. The unacceptable ratio of doctors, dentists and other health professionals per capita needs to be remedied, given South Africa's impressive reputation for its output of health professionals, including the areas of medical training, clinical practice and clinical research. The existing output from South Africa's 8 medical schools of MB ChB and specialist graduates is not being absorbed into the public health system, and neither are other health professionals. CONCLUSION. Dynamic leadership and policy interventions are required to advocate and finance the planned increase of medical, dental and other health professionals in South Africa.

Determinants of Health Care Services Utilization among First Generation Afghan Migrants in Istanbul

PubMed Central

Alemi, Qais; Stempel, Carl; Koga, Patrick Marius; Smith, Valerie; Danis, Didem; Baek, Kelly; Montgomery, Susanne

2017-01-01

There is insufficient empirical evidence on the correlates of health care utilization of irregular migrants currently living in Turkey. The aim of this study was to identify individual level determinants associated with health service and medication use. One hundred and fifty-five Afghans completed surveys assessing service utilization including encounters with primary care physicians and outpatient specialists in addition to the use of prescription and nonprescription medicines. Multivariate logistic regression analyses were employed to examine associations between service use and a range of predisposing, enabling, and perceived need factors. Health services utilization was lowest for outpatient specialists (20%) and highest for nonprescription medications (37%). Female gender and higher income predicted encounters with primary care physicians. Income, and other enabling factors such as family presence in Turkey predicted encounters with outpatient specialists. Perceived illness-related need factors had little to no influence on use of services; however, asylum difficulties increased the likelihood for encounters with primary care physicians, outpatient services, and the use of prescription medications. This study suggests that health services use among Afghan migrants in Turkey is low considering the extent of their perceived illness-related needs, which may be further exacerbated by the precarious conditions in which they live. PMID:28218688

The physical examination in telecardiology and televascular consultations: a study using conversation analysis.

PubMed

Pappas, Yannis; Seale, Clive

2010-10-01

This paper describes communication in the physical examination phases of telemedicine consultations. Using the method of conversation analysis, we draw on 10 telemedicine consultations (five telecardiology and five televascular) between primary and tertiary care in the UK. Physical examination is absent in telecardiology consultations. In televascular consultations the professionals try to compensate for the lack of physical proximity by getting involved in a form of collaboration that constitutes a novel environment for all. Separated from the patient by physical space, the specialist orchestrates the positioning of the patient, the camera and the primary care nurse's activity via the use of a video-link. Telemedicine offers primary care nurses a unique opportunity to engage in active collaboration with hospital specialists. The nurses' examination skills are recruited because physical examination is conducted from distance and the specialist cannot touch the patient or see parts of the body with ease. We speculate that difficulties with the physical examination may have contributed to the relatively slow adoption of telemedicine. The analysis reveals some new communication practices that participants in telemedicine are called to adopt. This can be used to inform training interventions that focus both on patient and professional. (c) 2010 Elsevier Ireland Ltd. All rights reserved.

Preparation time and perceptions of Brazilian specialists and dental students regarding simulated root canals for endodontic teaching: a preliminary study.

PubMed

dos S Luz, Diandra; de S Ourique, Fernanda; Scarparo, Roberta K; Vier-Pelisser, Fabiana V; Morgental, Renata D; Waltrick, Silvana B G; de Figueiredo, José A P

2015-01-01

The aim of this preliminary study was to evaluate the desirability of alternative models of artificial teeth versus extracted natural teeth for use in preclinical dental education. Specifically, the study was designed to compare the preparation time and perceptions of difficulty of undergraduate dental students and endodontists in carrying out root canal preparations on resin models (both clear and opaque) and extracted natural teeth. Twenty participants-ten fifth-year students at a Brazilian dental school and ten endodontists with at least five years' experience in the specialty-performed root canal instrumentation on two samples of each model. Preparation times were recorded, and the participants completed a questionnaire about the anatomical and physical characteristics of these models. The results showed that the time required for performing endodontic procedures in the natural teeth was higher than in the alternative models. The perceptions of the students and specialists regarding some topics on the questionnaire were significantly different. The students had more positive opinions about artificial teeth made of opaque resin, while the specialists had more positive opinions about simulated root canals in clear resin blocks. This study suggests that neither of the alternative models fulfilled requirements to replace natural teeth in endodontic teaching; improvements are still necessary to accomplish this goal.

Rural outreach by specialist doctors in Australia: a national cross-sectional study of supply and distribution.

PubMed

O'Sullivan, Belinda G; Joyce, Catherine M; McGrail, Matthew R

2014-09-04

Outreach has been endorsed as an important global strategy to promote universal access to health care but it depends on health workers who are willing to travel. In Australia, rural outreach is commonly provided by specialist doctors who periodically visit the same community over time. However information about the level of participation and the distribution of these services nationally is limited. This paper outlines the proportion of Australian specialist doctors who participate in rural outreach, describes their characteristics and assesses how these characteristics influence remote outreach provision. We used data from the Medicine in Australia: Balancing Employment and Life (MABEL) survey, collected between June and November 2008. Weighted logistic regression analyses examined the effect of covariates: sex, age, specialist residential location, rural background, practice arrangements and specialist group on rural outreach. A separate logistic regression analysis studied the effect of covariates on remote outreach compared with other rural outreach. Of 4,596 specialist doctors, 19% (n = 909) provided outreach; of which, 16% (n = 149) provided remote outreach. Most (75%) outreach providers were metropolitan specialists. In multivariate analysis, outreach was associated with being male (OR 1.38, 1.12 to 1.69), having a rural residence (both inner regional: OR 2.07, 1.68 to 2.54; and outer regional/remote: OR 3.40, 2.38 to 4.87) and working in private consulting rooms (OR 1.24, 1.01 to 1.53). Remote outreach was associated with increasing 5-year age (OR1.17, 1.05 to 1.31) and residing in an outer regional/remote location (OR 10.84, 5.82 to 20.19). Specialists based in inner regional areas were less likely than metropolitan-based specialists to provide remote outreach (OR 0.35, 0.17 to 0.70). There is a healthy level of interest in rural outreach work, but remote outreach is less common. Whilst most providers are metropolitan-based, rural doctors are more likely to provide outreach services. Remote distribution is influenced differently: inner regional specialists are less likely to provide remote services compared with metropolitan specialists. To benefit from outreach services and ensure adequate remote distribution, we need to promote coordinated delivery of services arising from metropolitan and rural locations according to rural and remote health need.

Defective Number Module or Impaired Access? Numerical Magnitude Processing in First Graders with Mathematical Difficulties

ERIC Educational Resources Information Center

De Smedt, Bert; Gilmore, Camilla K.

2011-01-01

This study examined numerical magnitude processing in first graders with severe and mild forms of mathematical difficulties, children with mathematics learning disabilities (MLD) and children with low achievement (LA) in mathematics, respectively. In total, 20 children with MLD, 21 children with LA, and 41 regular achievers completed a numerical…

Perceived Self-Efficacy in Parents of Adolescents and Adults with Autism Spectrum Disorder

ERIC Educational Resources Information Center

Weiss, Jonathan A.; Tint, Ami; Paquette-Smith, Melissa; Lunsky, Yona

2016-01-01

Many parents of adolescents and adults with autism spectrum disorder experience difficulty accessing appropriate services for their children, and may report low levels of parent self-efficacy. In an effort to identify the factors that contribute to the difficulties these families face, this study examined the role of demographic, systemic, and…

Single Student Parents Face Financial Difficulties, Debt, without Adequate Aid. Fact Sheet #C394

ERIC Educational Resources Information Center

Miller, Kevin

2012-01-01

Parents with dependent children were nearly one quarter of students enrolled for credit at American postsecondary institutions in 2008. These students face significant challenges to remaining enrolled and graduating, including limited access to affordable child care, difficulty balancing the demands of school with the demands of work and family,…

Responding to the Needs of Students with Mental Health Difficulties in Higher Education: An Irish Perspective

ERIC Educational Resources Information Center

Murphy, Esther

2017-01-01

This article presents findings from a recent national study supported by Association for Higher Education Access & Disability and the National Learning Network (2016) to investigate the experiences of students with mental health difficulties in higher education in Ireland. The data investigation was a combination of both survey and qualitative…

Building better systems of care for Aboriginal and Torres Strait Islander people: findings from the Kanyini health systems assessment.

PubMed

Peiris, David; Brown, Alex; Howard, Michael; Rickards, Bernadette A; Tonkin, Andrew; Ring, Ian; Hayman, Noel; Cass, Alan

2012-10-28

Australian federal and jurisdictional governments are implementing ambitious policy initiatives intended to improve health care access and outcomes for Aboriginal and Torres Strait Islander people. In this qualitative study we explored Aboriginal Medical Service (AMS) staff views on factors needed to improve chronic care systems and assessed their relevance to the new policy environment. Two theories informed the study: (1) 'candidacy', which explores "the ways in which people's eligibility for care is jointly negotiated between individuals and health services"; and (2) kanyini or 'holding', a Central Australian philosophy which describes the principle and obligations of nurturing and protecting others. A structured health systems assessment, locally adapted from Chronic Care Model domains, was administered via group interviews with 37 health staff in six AMSs and one government Indigenous-led health service. Data were thematically analysed. Staff emphasised AMS health care was different to private general practices. Consistent with kanyini, community governance and leadership, community representation among staff, and commitment to community development were important organisational features to retain and nurture both staff and patients. This was undermined, however, by constant fear of government funding for AMSs being withheld. Staff resourcing, information systems and high-level leadership were perceived to be key drivers of health care quality. On-site specialist services, managed by AMS staff, were considered an enabling strategy to increase specialist access. Candidacy theory suggests the above factors influence whether a service is 'tractable' and 'navigable' to its users. Staff also described entrenched patient discrimination in hospitals and the need to expend considerable effort to reinstate care. This suggests that Aboriginal and Torres Strait Islander people are still constructed as 'non-ideal users' and are denied from being 'held' by hospital staff. Some new policy initiatives (workforce capacity strengthening, improving chronic care delivery systems and increasing specialist access) have potential to address barriers highlighted in this study. Few of these initiatives, however, capitalise on the unique mechanisms by which AMSs 'hold' their users and enhance their candidacy to health care. Kanyini and candidacy are promising and complementary theories for conceptualising health care access and provide a potential framework for improving systems of care.

Pathways to care and psychological problems of general practice patients in a "gate keeper" and an "open access" health care system: a comparison of Germany and the Netherlands.

PubMed

Linden, M; Gothe, H; Ormel, J

2003-12-01

The comparison of different health care systems is one way to give empirical evidence to health care reform and policy. The differences between health care systems in which general practitioners serve as gate keepers in comparison to systems in which patients are free to contact every physician and specialist they like are a question of high interest. This study compares the Netherlands and Germany, two countries with very similar political, social, and health system structures, but different types of access to the health care system. While Germany offers unconstrained access to specialist ambulatory care, the Netherlands restricts health care utilization by giving primary care a 'gate keeper' function not allowing patients direct access to specialist care. Data from the WHO international collaborative study on psychological problems in general health care (Ustün and Sartorius 1995) were analysed with respect to pathways to care, treatment, and health status. In an initial cross-sectional assessment, in 3-month and 12-month follow-ups, contacts to physicians or hospital admission have also been monitored. There were only marginal differences between the Dutch and the German sample in the sociodemographic characteristics as well as in the diagnostic status with respect to mental disorders. In the Netherlands, 95.5%, and in Germany, 68.8% of the patients presented their 'reason for visit' for the first time to any physician at this index contact with a general practitioner. During the following 3 months, 24% of the Dutch patients, but 60.2% of the German patients, additionally contacted other physicians ( P < 0.001). At 12 months, this rate was 62.9% vs. 78.6% ( P < 0.001). During the 12-month follow-up period, there were 15.7 0/00 hospital admissions in Germany vs. 25.4 0/00 in the Netherlands ( P < 0.005) [corrected]. Family physicians in a gate keeper system reduce the number of contacts to other physicians and the intensity of treatment, while at the same time the rate of hospital admissions is increased.

Enhancing Memory Access for Less Skilled Readers

ERIC Educational Resources Information Center

Smith, Emily R.; O'Brien, Edward J.

2016-01-01

Less skilled readers' comprehension often suffers because they have an impoverished representation of text in long-term memory; this, in turn, increases the difficulty of gaining access to backgrounded information necessary for maintaining coherence. The results of four experiments demonstrated that providing less skilled readers with additional…

Planning for Accessibility.

ERIC Educational Resources Information Center

Spoor, Dana L.

1997-01-01

Argues that barrier-free designs should be incorporated in the first steps of school facility planning to avoid the difficulties in meeting Americans with Disabilities Act (ADA) guidelines during renovations. Explains why not all barriers need be removed to make a facility accessible to everyone. Discusses issues involving ADA guidelines and child…

Specializing in accountability: strategies to prepare a subspecialty workforce for care delivery redesign.

PubMed

Nambudiri, Vinod E; Sober, Arthur J; Kimball, Alexa B

2013-12-01

Accountable care organizations (ACOs) emphasize cost-effectiveness, rewarding health care systems that provide the highest-quality care delivered by the most cost-efficient providers. Transitioning to an ACO model introduces distinct challenges for specialist physicians within academic health centers. As skin diseases constitute a large number of visits to primary care providers and specialists and place a significant financial burden on the health care system, the authors sought to identify specialist-driven strategies for cost-effective, patient-centered care delivery in dermatology. As part of the Massachusetts General Hospital's transition to an ACO, the Department of Dermatology in 2012 employed a team-based strategy to identify measures aimed at curbing the rate of rise in per-patient medical expense. Their approach may represent a methodological framework that translates to other specialist workforces. The authors identified four action areas: (1) rational, cost-conscious prescribing within therapeutic classes; (2) enhanced management of urgent access and follow-up appointment scheduling; (3) procedure standardization; and (4) interpractitioner variability assessment. They describe the practices implemented in these action areas, which include a mix of changes in both clinical decision making and operational practice and are aimed at improving overall quality and value of care delivery. They also offer recommendations for other specialty departments Involving specialist physicians in care delivery redesign efforts provides unique insights to enhance quality, cost-effectiveness, and efficiency of care delivery. With increasing emphasis on ACO models, further specialist-driven strategies for ensuring patient-centered delivery warrant development alongside other delivery reform efforts.

Does the use of specialist palliative care services modify the effect of socioeconomic status on place of death? A systematic review.

PubMed

Chen, Hong; Nicolson, Donald J; Macleod, Una; Allgar, Victoria; Dalgliesh, Christopher; Johnson, Miriam

2016-05-01

Cancer patients in lower socioeconomic groups are significantly less likely to die at home and experience more barriers to access to palliative care. It is unclear whether receiving palliative care may mediate the effect of socioeconomic status on place of death. This review examines whether and how use of specialist palliative care may modify the effect of socioeconomic status on place of death. A systematic review was conducted. Eligible papers were selected and the quality appraised by two independent reviewers. Data were synthesised using a narrative approach. MEDLINE, Embase, CINAHL, PsycINFO and Web of Knowledge were searched (1997-2013). Bibliographies were scanned and experts contacted. Papers were included if they reported the effect of both socioeconomic status and use of specialist palliative care on place of death for adult cancer patients. Nine studies were included. All study subjects had received specialist palliative care. With regard to place of death, socioeconomic status was found to have (1) no effect in seven studies and (2) an effect in one study. Furthermore, one study found that the effect of socioeconomic status on place of death was only significant when patients received standard specialist palliative care. When patients received more intense care adapted to their needs, the effect of socioeconomic status on place of death was no longer seen. There is some evidence to suggest that use of specialist palliative care may modify the effect of socioeconomic status on place of death. © The Author(s) 2015.

Public health services knowledge and utilization among immigrants in Greece: a cross-sectional study

PubMed Central

2013-01-01

Background During the 90s, Greece has been transformed to a host country for immigrants mostly from the Balkans and Eastern European Countries, who currently constitute approximately 9% of the total population. Despite the increasing number of the immigrants, little is known about their health status and their accessibility to healthcare services. This study aimed to explore the perceived barriers to access and utilization of healthcare services by immigrants in Greece. Methods A pilot cross-sectional study was conducted from January to April 2012 in Athens, Greece. The study population consisted of 191 immigrants who were living in Greece for less than 10 years. We developed a questionnaire that included information about sociodemographic characteristics, health status, public health services knowledge and utilization and difficulties in health services access. Statistical analysis included Pearson’s ×2 test, ×2 test for trend, Student’s t-test, analysis of variance and Pearson’s correlation coefficient. Results Only 20.4% of the participants reported that they had a good/very good degree of knowledge about public health services in Greece. A considerable percentage (62.3%) of the participants needed at least once to use health services but they could not afford it, during the last year, while 49.7% used public health services in the last 12 months in Greece. Among the most important problems were long waiting times in hospitals, difficulties in communication with health professionals and high cost of health care. Increased ability to speak Greek was associated with increased health services knowledge (p<0.001). Increased family monthly income was also associated with less difficulties in accessing health services (p<0.001). Conclusions The empowerment and facilitation of health care access for immigrants in Greece is necessary. Depending on the needs of the migrant population, simple measures such as comprehensive information regarding the available health services and the terms for accessibility is an important step towards enabling better access to needed services. PMID:24034077

Ethical difficulties in nursing, educational needs and attitudes about using ethics resources.

PubMed

Leuter, Cinzia; Petrucci, Cristina; Mattei, Antonella; Tabassi, Gianpietro; Lancia, Loreto

2013-05-01

Ethical difficulties arise in healthcare practices. However, despite extensive research findings that demonstrate that most nurses are involved in recurrent ethical problems, institutions are not always able to effectively support nursing care professionals. The limited availability of ethics consultation services and traditional nursing training fails to meet the frequent and strong requests by health workers to support their ethical dilemmas. A questionnaire was administered to 374 nurses attending a specialist training and a lifetime learning programme in Italy. The respondents reported a high frequency of ethically sensitive situations, and they described the poor development of ethics support and a scarcity of ethics training programmes. The results suggest the importance of promoting ethics services that include consultation and ethics training. A need for systematic ethics educational activities was identified for improving the capacity of nurses to manage ethical issues in patient care.

Equity in health services use and intensity of use in Canada

PubMed Central

Asada, Yukiko; Kephart, George

2007-01-01

Background The Canadian health care system has striven to remove financial or other barriers to access to medically necessary health care services since the establishment of the Canada Health Act 20 years ago. Evidence has been conflicting as to what extent the Canadian health care system has met this goal of equitable access. The objective of this study was to examine whether and where socioeconomic inequities in health care utilization occur in Canada. Methods We used a nationally representative cross-sectional survey, the 2000/01 Canadian Community Health Survey, which provides a large sample size (about 110,000) and permits more comprehensive adjustment for need indicators than previous studies. We separately examined general practitioner, specialist, and hospital services using two-part hurdle models: use versus non-use by logistic regression, and the intensity of use among users by zero-truncated negative binomial regression. Results We found that lower income was associated with less contact with general practitioners, but among those who had contact, lower income and education were associated with greater intensity of use of general practitioners. Both lower income and education were associated with less contact with specialists, but there was no statistically significant relationship between these socioeconomic variables and intensity of specialist use among the users. Neither income nor education was statistically significantly associated with use or intensity of use of hospitals. Conclusion Our study unveiled possible socioeconomic inequities in the use of health care services in Canada. PMID:17349059

Advanced musculoskeletal physiotherapists in post arthroplasty review clinics: a state wide implementation program evaluation.

PubMed

Harding, Paula; Burge, Angela; Walter, Kerrie; Shaw, Bridget; Page, Carolyn; Phan, Uyen; Terrill, Desiree; Liew, Susan

2018-03-01

To evaluate outcomes following a state-wide implementation of post arthroplasty review (PAR) clinics for patients following total hip and knee arthroplasty, led by advanced musculoskeletal physiotherapists in collaboration with orthopaedic specialists. A prospective observational study analysed data collected by 10 implementation sites (five metropolitan and five regional/rural centres) between September 2014 and June 2015. The Victorian Innovation and Reform Impact Assessment Framework was used to assess efficiency, effectiveness (access to care, safety and quality, workforce capacity, utilisation of skill sets, patient and workforce satisfaction) and sustainability (stakeholder engagement, succession planning and availability of ongoing funding). 2362 planned occasions of service (OOS) were provided for 2057 patients. Reduced patient wait times from referral to appointment were recorded and no adverse events occurred. Average cost savings across 10 sites was AUD$38 per OOS (Baseline $63, PAR clinic $35), representing a reduced pathway cost of 44%. Average annual predicted total value of increased orthopaedic specialist capacity was $11,950 per PAR clinic (range $6149 to $23,400). The Australian Orthopaedic Association review guidelines were met (8/10 sites, 80%) and patient-reported outcome measures were introduced as routine clinical care. High workforce and patient satisfaction were expressed. Eighteen physiotherapists were trained creating a sustainable workforce. Eight sites secured ongoing funding. The PAR clinics delivered a safe, cost-efficient model of care that improved patient access and quality of care compared to traditional specialist-led workforce models. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

Barriers to the Collaboration Between Hematologists and Palliative Care Teams on Relapse or Refractory Leukemia and Malignant Lymphoma Patients' Care: A Qualitative Study.

PubMed

Morikawa, Miharu; Shirai, Yuki; Ochiai, Ryota; Miyagawa, Kiyoshi

2016-12-01

Palliative care service (PCS) has been shown to be utilized less in patients with leukemia and malignant lymphoma than in those with solid tumors. Previous studies have suggested hematologists' limited awareness of PCS as one of the reason for low PCS referral in hematology. However, little is known about such an awareness and potential barriers to collaboration between hematologists and PCS. The present study aimed to assess ematologists and palliative care specialists' perception about the roles of the hospital-based palliative care team (HPCT) and the barriers to collaboration between hematologists and palliative care teams on relapse or refractory leukemia and malignant lymphoma patients' care MATERIALS AND METHODS: A qualitative study was conducted using semistructured interviews with hematologists and palliative care specialists recruited from a hospital that provides hematology and palliative care by the HPCT. Data were evaluated via content analysis. The study included 11 hematologists and 10 palliative care specialists. Our results revealed that they shared many common perceptions about the roles and expectations of the HPCT. Additionally, 7 categories of barriers to collaboration were identified, including not feeling the need to refer, the difficulty in referral timing, the lack of aggressive approach, the negative image of the HPCT, the need for hematologic malignancy-oriented management, the lack of communication, and others. We have identified hematologists' and palliative care specialists' perceptions of the HPCT's roles and the barriers to their collaboration. A better understanding of such barriers may lead to effective collaboration between hematologists and the HPCT. © The Author(s) 2015.

KSC-08pd0721

NASA Image and Video Library

2008-03-10

KENNEDY SPACE CENTER, FLA. -- On Launch Pad 39A at NASA's Kennedy Space Center, STS-123 Mission Specialist Takao Doi of the Japan Aerospace Exploration Agency is helped with the final flight suit fit check in the White Room before entering space shuttle Endeavour for launch. In the background is Mission Specialist Robert L. Behnken. The White Room provides access into the shuttle. Liftoff was on time at 2:28 a.m. EDT. The crew will make a record-breaking 16-day mission to the International Space Station and deliver the first section of the Japan Aerospace Exploration Agency's Kibo laboratory and the Canadian Space Agency's two-armed robotic system, Dextre. Photo credit: NASA/Scott Haun, Richard Prickett

The care of adolescents and young adults with cancer: results of the ESMO/SIOPE survey.

PubMed

Saloustros, Emmanouil; Stark, Daniel P; Michailidou, Kyriaki; Mountzios, Giannis; Brugieres, Laurence; Peccatori, Fedro Alessandro; Jezdic, Svetlana; Essiaf, Samira; Douillard, Jean-Yves; Bielack, Stefan

2017-01-01

Adolescents and young adults (AYA) with cancer require dedicated clinical management and care. Little is known about the training and practice of European healthcare providers in regard to AYA and the availability of specialised services. A link to an online survey was sent to members of the European Society for Medical Oncology (ESMO) and the European Society for Paediatric Oncology (SIOPE). The link was also sent to ESMO National Representatives and circulated to other European oncology groups. Questions covered the demographics and clinical training of respondents, their definition of AYA, education about AYA cancer, access to specialised clinical and supportive care, research and further education. Data from Europe were analysed by region. Three hundred tweenty two questionnaires were submitted and we focused on data from the 266 European healthcare professionals. Responses revealed considerable variation both within and between countries in the definition of AYA. Over two-thirds of respondents did not have access to specialised centres for AYA (67%), were not aware of research initiatives focusing on AYA with cancer (69%) and had no access to specialist services for managing the late effects of treatment (67%). The majority of the respondents were able to refer AYA patients to professional psychological support and specialised social workers. However, more than half had no access to an age-specialised nurse or specialised AYA education. Overall, 38% of respondents reported that their AYA patients did not have access to fertility specialists. This figure was 76% in Eastern Europe. Lack of specialised AYA care was particularly evident in Eastern and South-Eastern Europe. There is important underprovision and inequity of AYA cancer care across Europe. Improving education and research focused on AYA cancer care should be a priority.

Weekend specialist intensity and admission mortality in acute hospital trusts in England: a cross-sectional study.

PubMed

Aldridge, Cassie; Bion, Julian; Boyal, Amunpreet; Chen, Yen-Fu; Clancy, Mike; Evans, Tim; Girling, Alan; Lord, Joanne; Mannion, Russell; Rees, Peter; Roseveare, Chris; Rudge, Gavin; Sun, Jianxia; Tarrant, Carolyn; Temple, Mark; Watson, Sam; Lilford, Richard

2016-07-09

Increased mortality rates associated with weekend hospital admission (the so-called weekend effect) have been attributed to suboptimum staffing levels of specialist consultants. However, evidence for a causal association is elusive, and the magnitude of the weekend specialist deficit remains unquantified. This uncertainty could hamper efforts by national health systems to introduce 7 day health services. We aimed to examine preliminary associations between specialist intensity and weekend admission mortality across the English National Health Service. Eligible hospital trusts were those in England receiving unselected emergency admissions. On Sunday June 15 and Wednesday June 18, 2014, we undertook a point prevalence survey of hospital specialists (consultants) to obtain data relating to the care of patients admitted as emergencies. We defined specialist intensity at each trust as the self-reported estimated number of specialist hours per ten emergency admissions between 0800 h and 2000 h on Sunday and Wednesday. With use of data for all adult emergency admissions for financial year 2013-14, we compared weekend to weekday admission risk of mortality with the Sunday to Wednesday specialist intensity ratio within each trust. We stratified trusts by size quintile. 127 of 141 eligible acute hospital trusts agreed to participate; 115 (91%) trusts contributed data to the point prevalence survey. Of 34,350 clinicians surveyed, 15,537 (45%) responded. Substantially fewer specialists were present providing care to emergency admissions on Sunday (1667 [11%]) than on Wednesday (6105 [42%]). Specialists present on Sunday spent 40% more time caring for emergency patients than did those present on Wednesday (mean 5·74 h [SD 3·39] vs 3·97 h [3·31]); however, the median specialist intensity on Sunday was only 48% (IQR 40-58) of that on Wednesday. The Sunday to Wednesday intensity ratio was less than 0·7 in 104 (90%) of the contributing trusts. Mortality risk among patients admitted at weekends was higher than among those admitted on weekdays (adjusted odds ratio 1·10, 95% CI 1·08-1·11; p<0·0001). There was no significant association between Sunday to Wednesday specialist intensity ratios and weekend to weekday mortality ratios (r -0·042; p=0·654). This cross-sectional analysis did not detect a correlation between weekend staffing of hospital specialists and mortality risk for emergency admissions. Further investigation is needed to evaluate whole-system secular change during the implementation of 7 day services. Policy makers should exercise caution before attributing the weekend effect mainly to differences in specialist staffing. National Institute for Health Research Health Services and Delivery Research Programme. Copyright © 2016 Aldridge et al. Open Access article distributed under the terms of CC BY. Published by Elsevier Ltd.. All rights reserved.

Preparing Daughters: The Context of Rurality on Mothers' Role in Contraception

ERIC Educational Resources Information Center

Noone, Joanne; Young, Heather M.

2009-01-01

Context: The United States continues to have the highest rate of adolescent childbearing among developed countries. Lack of access and disadvantage contribute to this problem, which disproportionately impacts rural women. Given the increased difficulty rural young women face regarding contraceptive access, parental communication and support play…

Dyscalculia and Access Arrangements for Exams and Assessments. NIACE Briefing Sheet 87

ERIC Educational Resources Information Center

National Institute of Adult Continuing Education, 2009

2009-01-01

Dyscalculia is considered to be a learning difficulty or difference. It is increasingly being recognised and "diagnosed" within adult learning. However, practitioners are often unclear about whether learners who are considered to have dyscalculia are entitled to access arrangements for examinations and assessments, and which access…

12 CFR 1102.103 - Disclosure of requested records.

Code of Federal Regulations, 2013 CFR

2013-01-01

... shall be informed in writing of the difficulties encountered and an indication shall be given as to when... access, unless the individual making the request is notified in writing within the 30 day period that... amended, the individual requesting the records, before being granted access, shall execute a written...

12 CFR 1102.103 - Disclosure of requested records.

Code of Federal Regulations, 2010 CFR

2010-01-01

... shall be informed in writing of the difficulties encountered and an indication shall be given as to when... access, unless the individual making the request is notified in writing within the 30 day period that... amended, the individual requesting the records, before being granted access, shall execute a written...

12 CFR 1102.103 - Disclosure of requested records.

Code of Federal Regulations, 2014 CFR

2014-01-01

... shall be informed in writing of the difficulties encountered and an indication shall be given as to when... access, unless the individual making the request is notified in writing within the 30 day period that... amended, the individual requesting the records, before being granted access, shall execute a written...

12 CFR 1102.103 - Disclosure of requested records.

Code of Federal Regulations, 2011 CFR

2011-01-01

... shall be informed in writing of the difficulties encountered and an indication shall be given as to when... access, unless the individual making the request is notified in writing within the 30 day period that... amended, the individual requesting the records, before being granted access, shall execute a written...

12 CFR 1102.103 - Disclosure of requested records.

Code of Federal Regulations, 2012 CFR

2012-01-01

... shall be informed in writing of the difficulties encountered and an indication shall be given as to when... access, unless the individual making the request is notified in writing within the 30 day period that... amended, the individual requesting the records, before being granted access, shall execute a written...

Current Approaches to Assessment in Self-Access Language Learning

ERIC Educational Resources Information Center

Reinders, Hayo; Lázaro, Noemí

2007-01-01

Assessment is generally seen as one of the key challenges in the field of self-access learning (Gardner & Miller, 1999; Champagne et al., 2001; Lai, 2001; Kinoshita Thomson, 1996). Many researchers and practitioners point to difficulties with assessing language gains in an environment in which variables cannot comprehensively be controlled…

Defense Health Care: More-Specific Guidance Needed for Assessing Nonenrolled TRICARE Beneficiaries’ Access to Care

DTIC Science & Technology

2014-04-01

doctor or nurse possible and 10 is the best personal doctor or nurse possible, what number would you use to rate your personal doctor or nurse ?” For...was it to get a personal doctor or nurse you are happy with?” For access to specialist doctor: “In the last 12 months, how much of a problem, if any...additional information. Connect with GAO on Facebook, Flickr, Twitter, and YouTube . Subscribe to our RSS Feeds or E-mail Updates. Listen to our Podcasts

Information Technologies, Health, and Globalization: Anyone Excluded?

PubMed Central

Parent, Florence; Parent, Marc

2001-01-01

Modern information technologies and worldwide communication through the Internet promise both universal access to information and the globalization of the medico-social network's modes of communication between doctors, laboratories, patients, and other players. The authors, specialists in public health and members of an association that aims to create opportunities for access to training in public health in developing countries, warn that the use of the term "globalization" ignores the reality of the "digital divide," that is, the fact that social inequalities may preclude the realization of this promise on a truly global scale. PMID:11720953

Information technologies, health, and "globalization": anyone excluded?

PubMed

Parent, F; Coppieters, Y; Parent, M

2001-01-01

Modern information technologies and worldwide communication through the Internet promise both universal access to information and the globalization of the medico-social network s modes of communication between doctors, laboratories, patients, and other players. The authors, specialists in public health and members of an association that aims to create opportunities for access to training in public health in developing countries, warn that the use of the term "globalization" ignores the reality of the "digital divide," that is, the fact that social inequalities may preclude the realization of this promise on a truly global scale.

Sensitivity to emotional ill health

NASA Technical Reports Server (NTRS)

Felton, J. S.

1969-01-01

The services of mental specialists, such as psychologists, psychiatrists, or psychiatric social workers are required to assure maximum human performance in Government facilities. Contemporary mental health programming covers emotionally generated problems at operational sites to complete disclaiming of the existence of such difficulties among workers. Frequent taking of sick leave or annual leave when work seems demanding or when a promotion does not materialize, chronic or repeated tardiness, requests for frequent transfers, work over-loading, accidental injuries, and alcoholism are all forms of stress responses and indicate a need for emotional counselling.

Transformation of scientists and engineers into managers

NASA Technical Reports Server (NTRS)

Bayton, J. A.; Chapman, R. L.

1972-01-01

The purposes of this research were to determine the principal problems and obstacles faced by specialists during the transition period when they are becoming managers, and to discover ways by which their difficulties might be avoided or overcome. It was found that senior management officials are unaware--or tend to ignore the importance--of the transition process and its problems, that little attention has been given to developing management training to overcome transition problems, and that much of the training which is offered is largely irrelevant to these problems.

Evaluation of outreach clinics held by specialists in general practice in England

PubMed Central

Bond, M.; Bowling, A.; Abery, A.; McClay, M.; Dickinson, E.

2000-01-01

OBJECTIVES—To measure the processes of care, health benefits and costs of outreach clinics held by hospital specialists in primary care settings.
DESIGN—The study was designed as a case-referent (comparative) study in which the features of 19 outreach clinics (cases) were compared with matched outpatient clinics (controls). The measuring instruments were self administered questionnaires. Patients were followed up at six months to reassess health status. The specialties included in the study were cardiology, ENT, general medicine, general surgery, gynaecology and rheumatology.
SETTING—Specialist outreach clinics in general practice in England, with matched outpatient clinic controls.
SUBJECTS—Consecutive patient attenders in the outreach and outpatient clinics, their specialists, the outreach patients' general practitioners, practice managers and trust accountants. Patients' response rate at baseline: 78% (1420).
MAIN OUTCOME MEASURES—Patient satisfaction, doctors' attitudes, processes and health outcomes, costs.
RESULTS—Outreach patients were more satisfied with the processes of their care than outpatients, their access to specialist care was better than that for outpatients and they were more likely to be discharged. Doctors reported that the main advantages of the outreach clinic were improved patient access to specialists and convenience for patients, in comparison with outpatients, and most GPs and specialists felt the outreach clinic was "worthwhile". At six month follow up, the health status of the outreach sample had significantly improved more than that of the outpatients on all eight sub-scales of the HSQ-12, but this was probably because of their better starting point at baseline. The impact of outreach on health outcomes was small. The NHS costs of outreach were significantly higher than outpatients. An increase in outreach clinic size would reduce cost per patient, but would lead to the loss of most of the clinics' benefits.
CONCLUSIONS—While the process of care was of higher quality in outreach than in outpatients, and the efficiency of care was also greater in the latter, the effect on patients' health outcomes was small. Responsiveness to patients' views and preferences is an essential component of good quality service provision. However, the greater cost of outreach raises the issue of whether improvements in the quality and efficiency of health care, without a substantial impact on health outcomes, is money well spent in a publicly funded health service. On the other hand, the real costs of outreach in comparison with outpatients clinics can probably only be truly estimated in a longitudinal study with a resource based costing model derived from documented patient attendances and treatment costs over time in relation to longer term outcome (for example, at a two year end point).


Keywords: outreach clinics; general practice PMID:10715749

Do specialist self-referral insurance policies improve access to HIV-experienced physicians as a regular source of care?

PubMed

Heslin, Kevin C; Andersen, Ronald M; Ettner, Susan L; Kominski, Gerald F; Belin, Thomas R; Morgenstern, Hal; Cunningham, William E

2005-10-01

Health insurance policies that require prior authorization for specialty care may be detrimental to persons with HIV, according to evidence that having a regular physician with HIV expertise leads to improved patient outcomes. The objective of this study is to determine whether HIV patients who can self-refer to specialists are more likely to have physicians who mainly treat HIV. The authors analyze cross-sectional survey data from the HIV Costs and Services Utilization Study. At baseline, 67 percent of patients had insurance that permitted self-referral. In multivariate analyses, being able to self-refer was associated with an 8-12 percent increased likelihood of having a physician at a regular source of care that mainly treats patients with HIV. Patients who can self-refer are more likely to have HIV-experienced physicians than are patients who need prior authorization. Insurance policies allowing self-referral to specialists may result in HIV patients seeing physicians with clinical expertise relevant to HIV care.

The value transformation of health care: Impact on neuromuscular and electrodiagnostic medicine.

PubMed

Narayanaswami, Pushpa; Suk, Millie; Jones, Lyell K

2017-10-01

Beginning in 2017, most physicians who participate in Medicare are subject to the Medicare Access and CHIP Reauthorization Act (MACRA), the milestone legislation that signals the US health care system's transition from volume-based to value-based care. Here we review emerging trends in development of value-based healthcare systems in the US. MACRA and the resulting Quality Payment Program create 2 participation pathways, the Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (AAPM) pathway. Although there are several program incentives for AAPM participation, to date there have been few AAPM options for specialists. MIPS and its widening bonus and penalty window will likely be the primary participation pathway in the early years of the program. Value-based payment has the potential to reshape health care delivery in the United States, with implications for neuromuscular and electrodiagnostic (EDX) specialists. Meaningful quality measures are required for neuromuscular and EDX specialists. Muscle Nerve 56: 679-683, 2017. © 2017 Wiley Periodicals, Inc.

Facilitators and Barriers to the Provision of Therapeutic Interventions by School Psychologists

ERIC Educational Resources Information Center

Atkinson, Cathy; Squires, Garry; Bragg, Joanna; Muscutt, Janet; Wasilewski, David

2014-01-01

There is growing concern internationally about the prevalence of mental health problems among school-aged children and their access to specialist services. School psychologists (SPs) may be one group of professionals well-positioned to support the well-being of children and young people, due to their position as applied psychologists working…

An Introduction to Online Resources for ATOD Prevention Specialists.

ERIC Educational Resources Information Center

Collver, Randy

Written to provide a brief introduction of online resources and searching the Internet, this document highlights Internet sites relating to alcohol, tobacco, and other drug (ATOD) prevention. Information is provided on the following topics: (1) software and hardware needed to access Internet sites; (2) the variety of online services available; and…

Innovative Professional Development: Expanding Your Professional Learning Network

ERIC Educational Resources Information Center

Perez, Lisa

2012-01-01

To assume the role of technology leaders and information literacy specialists in their schools, librarians need access to the most current information. And, they do this by helping each other. There are many definitions, but professional learning networks (PLNs) involve sharing work-related ideas with a network of colleagues via various digital…

An Analysis of the Mechanisms of the Social Control of Corruption in the Higher Education System

ERIC Educational Resources Information Center

Borisova, E. A.

2014-01-01

Corruption in the system of higher education in Russia is a barrier to fair access to the labor market for educated specialists, and a survey of programs to combat this type of corruption shows that it needs to be taken more seriously as a problem.

Literary Education and Digital Learning: Methods and Technologies for Humanities Studies

ERIC Educational Resources Information Center

van Peer, Willie, Ed.; Zyngier, Sonia, Ed.; Viana, Vander, Ed.

2010-01-01

Today's popularization of modern technologies has allowed literature specialists to access an array of new opportunities in the digital medium, which have brought about an equal number of challenges and questions. This book provides insight into the most relevant issues in literary education and digital learning. This unique reference fills a gap…

Censorship of Library Books in School Library Media Centers Today.

ERIC Educational Resources Information Center

Saykanic, Donna

For many years, there has been pressure on American schools to restrict or deny students access to books or periodicals deemed objectionable by some individual or group on moral, political, religious, ethnic, racial, or philosophical grounds. Censorship of library books in school media centers is present today. The library media specialist is…

Key Words in Instruction. Online Learning and Virtual Schools

ERIC Educational Resources Information Center

Lamb, Annette; Callison, Daniel

2005-01-01

Online learning and virtual schools allow students to take classes any time and anywhere. These emerging learning environments require school library media specialists to expand their thinking about their resources and services. Creation of a virtual library can provide access to remote materials that enhance the experience of online learners.…

Opportunistic Collaboration: Unlocking the Archives of the Birmingham Institute of Art and Design

ERIC Educational Resources Information Center

Everitt, Sian

2005-01-01

Purpose: To review a small specialist repository's strategic and opportunistic approach to utilising collaborative regional and national digital initiatives to increase access. The Birmingham Institute of Art and Design (BIAD) Archives activity is evaluated to determine whether a project-based approach recognises and meets the needs of historians,…

Steps for Evaluating a Fifth Grade Science Collection

ERIC Educational Resources Information Center

Griffin, Gail Guidry

2011-01-01

A well balanced curriculum is an area of great concern in a school. With an enhanced collection, the library media specialist can further educational progress on all levels. Through accessing a good science collection in the library, students can achieve their learning goals. This article describes a process used to evaluate a science collection…

Radioactive waste handling and disposal at King Faisal Specialist Hospital and Research Centre.

PubMed

Al-Haj, Abdalla N; Lobriguito, Aida M; Al Anazi, Ibrahim

2012-08-01

King Faisal Specialist Hospital & Research Centre (KFSHRC) is the largest specialized medical center in Saudi Arabia. It performs highly specialized diagnostic imaging procedures with the use of various radionuclides required by sophisticated dual imaging systems. As a leading institution in cancer research, KFSHRC uses both long-lived and short-lived radionuclides. KFSHRC established the first cyclotron facility in the Middle East, which solved the in-house high demand for radionuclides and the difficulty in importing them. As both user and producer of high standard radiopharmaceuticals, KFSHRC generates large volumes of low and high level radioactive wastes. An old and small radioactive facility that was used for storage of radioactive waste was replaced with a bigger warehouse provided with facilities that will reduce radiation exposure of the staff, members of the public, and of the environment in the framework of "as low as reasonably achievable." The experiences and the effectiveness of the radiation protection program on handling and storage of radioactive wastes are presented.

The training of specialists in Family and Community Health Nursing according to the supervisors of the teaching units.

PubMed

Oltra-Rodríguez, Enrique; Martínez-Riera, José Ramón; Mármol-López, María Isabel; Pastor-Gallardo, Francisco Javier; Gras-Nieto, Elvira; Holgado-Fernández, Ana

To analyze the current situation of the training of specialists in family and community nursing from the perspective of nurses responsible for teaching units. Exploratory analysis using nominal group technique of the contributions made by representatives of 19 multidisciplinary teaching units in family and community care from 11 Spanish autonomous communities. They categorized and weighted those contributions. The emerging categories on the strengths and difficulties encountered related to the tutors, the environment where the training took place, the structure of the teaching unit, the organization of the teaching and the official programme of the speciality, the external supports and the theoretical training. Training in Family and Community Nursing is an opportunity to improve primary health care to train in news and necessary but complex skills. Support is required for training to be effective and the specialty and training should be made known. Tutors are a key part of this process. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Pelvic pain: a pathway for care developed for both men and women by the British Pain Society.

PubMed

Baranowski, A P; Lee, J; Price, C; Hughes, J

2014-03-01

This paper aims to explain the key points and highlight some of the controversies in the development of the British Pain Society's pelvic pain patient pathway map. Many clinicians lack experience and confidence with this group of patients, and this issue is highlighted. Additionally, the difficulties of classification and definitions in this area are discussed in detail. These are historical causes of disagreement among specialists which can lead to confused clinical care. This group of patients have multiple issues that cross many professional boundaries; they are best managed by the co-ordinated involvement of multiple teams. Patients suffer from significant distress and disability that often needs specialist assessment and intervention (interdisciplinary). This suggests that an integrated approach is required across the historic boundaries of primary and secondary care. A variety of interventions, including opioids and neuromodulation are recommended in the pathway and the controversies surrounding these inclusions are aired in detail.

A practical approach to classifying and managing feeding difficulties.

PubMed

Kerzner, Benny; Milano, Kim; MacLean, William C; Berall, Glenn; Stuart, Sheela; Chatoor, Irene

2015-02-01

Many young children are thought by their parents to eat poorly. Although the majority of these children are mildly affected, a small percentage have a serious feeding disorder. Nevertheless, even mildly affected children whose anxious parents adopt inappropriate feeding practices may experience consequences. Therefore, pediatricians must take all parental concerns seriously and offer appropriate guidance. This requires a workable classification of feeding problems and a systematic approach. The classification and approach we describe incorporate more recent considerations by specialists, both medical and psychological. In our model, children are categorized under the 3 principal eating behaviors that concern parents: limited appetite, selective intake, and fear of feeding. Each category includes a range from normal (misperceived) to severe (behavioral and organic). The feeding styles of caregivers (responsive, controlling, indulgent, and neglectful) are also incorporated. The objective is to allow the physician to efficiently sort out the wide variety of conditions, categorize them for therapy, and where necessary refer to specialists in the field. Copyright © 2015 by the American Academy of Pediatrics.

Driving Intervention for Returning Combat Veterans.

PubMed

Classen, Sherrilene; Winter, Sandra; Monahan, Miriam; Yarney, Abraham; Link Lutz, Amanda; Platek, Kyle; Levy, Charles

2017-04-01

Increased crash incidence following deployment and veterans' reports of driving difficulty spurred traffic safety research for this population. We conducted an interim analysis on the efficacy of a simulator-based occupational therapy driving intervention (OT-DI) compared with traffic safety education (TSE) in a randomized controlled trial. During baseline and post-testing, OT-Driver Rehabilitation Specialists and one OT-Certified Driver Rehabilitation Specialist measured driving performance errors on a DriveSafety CDS-250 high-fidelity simulator. The intervention group ( n = 13) received three OT-DI sessions addressing driving errors and visual-search retraining. The control group ( n = 13) received three TSE sessions addressing personal factors and defensive driving. Based on Wilcoxon rank-sum analysis, the OT-DI group's errors were significantly reduced when comparing baseline with Post-Test 1 ( p < .0001) and comparing the OT-DI group with the TSE group at Post-Test 1 ( p = .01). These findings provide support for the efficacy of the OT-DI and set the stage for a future effectiveness study.

Access to transportation for Chittenden County Vermont older adults.

PubMed

Hadley Strout, Emily; Fox, Leah; Castro, Alejandro; Haroun, Pishoy; Leavitt, Blake; Ross, Cordelia; Sayan, Mutlay; Delaney, Thomas; Platzer, Alyson; Hutchins, Jeanne; Carney, Jan K

2016-08-01

Aging often leads to decreased independence and mobility, which can be detrimental to health and well-being. The growing population of older adults will create a greater need for reliable transportation. Explore whether and how lack of transportation has compromised areas of daily lives in older adults. 1221 surveys with 36 questions assessing transportation access, usage, and impact on activities were distributed to Chittenden County, Vermont older adults; 252 met criteria for analysis. Older adults reported overwhelming difficulty getting to activities considered important, with 69 % of participants delaying medical appointments due to transportation barriers. Although family and friends represent a primary method of transportation, older adults reported difficulty asking them for help. Lack of accessible transportation leads to missed healthcare appointments and social isolation, which may have detrimental effects on older adults' quality of life. Many older adults face significant transportation challenges that negatively affect their health and well-being.

PHYSICS EDUCATION AND THE INTERNET: Graduate education on the Internet

NASA Astrophysics Data System (ADS)

Venables, John A.

1998-05-01

The Internet can be advantageous for specialist graduate and research-based teaching and learning. Positive points include: ( a) faculty members can consult students interactively about the choice of material; ( b) students can access/download notes and interact with faculty members, independent of location and time; ( c) students can access web pages put up by other groups working in related areas, and can incorporate them into course projects; ( d) the fact that specialist courses cannot be given in person each term/semester/year becomes relatively unimportant: they can still be studied at other times; ( e) further material, including working programs/models can be prepared/explored as part of undergraduate projects, and/or in collaboration with other institutions. Experience has been gained delivering graduate courses and individual lectures on surface and thin film physics, and quantum physics, during 1996-8 in an international context, and attending and contributing to related workshops. Points needing further discussion and resolution include: accreditation and costing between institutions, the nature and extent of copyright problems, and most useful forms of student interaction. More details can be found at http://venables.asu.edu/grad/index.html.

Knowledge Management - A Necessity For The Training Of Future Specialists Of The Sustainable Entreprises

NASA Astrophysics Data System (ADS)

Rotaru, Ionela Magdalena

2015-09-01

The world we are living in is shaped by what is a reality for years already: globalisation of economy. The lack of borders makes the impact that technology has on society to be a major one. The virtual world so accessible today is not just about new markets, access to cheaper work force, work online but also fierce competition. The common denominator of most efforts in the area of industry is performance. Limits continuously moving willingness to pay for products that delineate the performance delivered be the same range. Here too we can see the role of the education. For example, Landes shows that both knowledge and know-how are the ones that determine how well off societies are. The education of engineers is therefore critical to every nation to ensure the prosperity of its citizens. This paper here intends to approach the educational process of the engineering specific area of knowledge from the management perspective. The training process becomes sustainable in accordance with the requirements of the future: trained specialists for sustainable enterprises.

2015 Relaunch as Open Access Pediatric Neurology Briefs.

PubMed

Millichap, John J; Millichap, J Gordon

2015-01-01

Pediatric Neurology Briefs (PNB) has been published monthly since 1987 as a continuing education service designed to expedite and facilitate review of current medical literature concerning pediatric neurology. In 2015, PNB is relaunched as an open access, peer-reviewed, journal with an expanded editorial board. PNB has a new website and content management system capable of organizing peer-review and providing improved indexing, DOI assignment, and online full-text article view. Digitization of back issues, archiving, and inclusion in PubMed are future goals. The new online open access PNB aims to reach more physicians, researchers, and other healthcare providers with highlights of the latest advances in pediatric neurology and commentaries by specialists in the field.

Social communication difficulties and autism spectrum disorder in young children with optic nerve hypoplasia and/or septo-optic dysplasia.

PubMed

Parr, Jeremy R; Dale, Naomi J; Shaffer, Lara M; Salt, Alison T

2010-10-01

the aim of this study was to study systematically social, communication, and repetitive/restrictive (SCRR) behavioural difficulties and clinical autism spectrum disorder (ASD) in children with optic nerve hypoplasia (ONH) and/or septo-optic dysplasia (SOD), and to investigate the relationship between visual impairment, SCRR difficulties, ASD, and cognition. a case-note study of clinic records from a specialist developmental vision service was completed. Standardized assessments of vision and development and clinician judgements about SCRR difficulties and clinical ASD were made by a multidisciplinary team. a total of 45 females and 38 males (mean age 3y 5mo; range 10mo-6y 10mo) with ONH or SOD and profound visual impairment (PVI) or severe visual impairment (SVI) were assessed. A total of 58% of children had at least one SCRR difficulty, and 31% had a clinical diagnosis of ASD. The prevalence of ASD was slightly higher in children with SOD than in children with ONH (36% vs 26%) also slightly more frequent in children with PVI than in children with SVI (36% vs 27%). The prevalence of SCRR difficulties was statistically higher in children with PVI than in children with SVI (p=0.003). Clinical ASD was most likely to be diagnosed between 2 years 4 months and 4 years 6 months. Development was significantly delayed in children with ASD compared with children without social communication difficulties (p=0.001). children with SVI or PVI are at risk of SCRR difficulties and clinical ASD. Children with ONH and/or SOD and visual impairment have a similar risk of developing clinical ASD as other visual impairment groups. However, ASD prevalence data from this study are a minimum estimate, as some young children may have developed ASD behaviours in later childhood. Developmental surveillance for children with ONH and/or SOD should continue until at least the age of 4 years 6 months.

Individual differences in hemispheric preference and emotion regulation difficulties

PubMed Central

Gupta, Garima; Dubey, Akanksha; Saxena, Prachi; Pandey, Rakesh

2011-01-01

Background: Hemisphericity or individual difference in the preference to use the left or the right hemispheric mode of information processing has been associated with various emotion-related differences. For example, the right hemisphericity has been linked with inhibition of emotional expression, feeling of tension, greater impulsivity etc. These observations suggest that right hemisphericity may be associated with greater difficulties in regulating emotions. However, direct empirical tests of such theoretical proposition are very thin. Aim: In view of this, the present study aims to investigate how and to what extent individual difference in hemispheric preference relate to emotion regulation. Materials and Methods: Thirty-two right-handed male subjects in the age range 18 to 20 years were assessed on self-report measures of hemispheric preference and emotion regulation difficulties. The correlation between dimensions of hemispheric preference and difficulties in regulating emotions was computed. A series of stepwise multiple regression analyses were also done to explore the relative significance of various dimensions of hemispheric preference in predicting emotion regulation difficulties. Results: The findings revealed that in general a preference for the right hemispheric mode of information processing was associated with greater emotion regulation difficulties. The correlation analysis indicated that while impulse control difficulties and difficulties in engaging goal directed behavior was associated with preference for almost all the right hemispheric mode of information processing, the nonacceptance of emotional responses and limited access to emotion regulation was related to preference for only global/synthetic (a right hemispheric) mode of information processing. Similarly, the lack of emotional clarity facet of emotion regulation difficulties correlated significantly with a preference for the emotional mode of information processing (again a right hemispheric mode). The results of stepwise multiple regression analyses, however, indicated that “nonacceptance of emotional responses’ and ‘limited access to emotion regulation strategies” facets of emotion regulation difficulties were best predicted by a preference for the global/synthetic mode of information processing. While others like difficulties engaging in goal-directed behaviour, impulse control difficulties, and lack of emotional clarity were best predicted by a preference for visuo-spatial rather than the verbal mode of information processing. Conclusion: Overall, the findings imply that greater preference for right hemispheric mode of information processing as compared to the left is associated with greater difficulties in regulating emotions. PMID:22969178

Metacognitive Reading and Study Strategies and Academic Achievement of University Students with and without a History of Reading Difficulties

ERIC Educational Resources Information Center

Bergey, Bradley W.; Deacon, S. Hélène; Parrila, Rauno K.

2017-01-01

University students who report a history of reading difficulties have been demonstrated to have poorer word reading and reading comprehension skills than their peers; yet, without a diagnosed learning disability, these students do not have access to the same support services, potentially placing them at academic risk. This study provides a…

The use of depth interviewing with vulnerable subjects: lessons from a research study of parents with learning difficulties.

PubMed

Booth, T; Booth, W

1994-08-01

This paper explores the practicalities of using the technique of depth interviewing with people who have learning difficulties. The authors set out to provide other researchers with guidance in the use of the life story approach and to demonstrate its utility with this vulnerable and devalued group of informants. They conclude that depth interviewing can provide new knowledge not accessible through other methods of data collection, and offers a way of giving people with learning difficulties a voice in the making of their own history.