Science.gov

Sample records for emergency care settings

  1. The Emergency Care of Patients With Cancer: Setting the Research Agenda.

    PubMed

    Brown, Jeremy; Grudzen, Corita; Kyriacou, Demetrios N; Obermeyer, Ziad; Quest, Tammie; Rivera, Donna; Stone, Susan; Wright, Jason; Shelburne, Nonniekaye

    2016-12-01

    To identify research priorities and appropriate resources and to establish the infrastructure required to address the emergency care of patients with cancer, the National Institutes of Health's National Cancer Institute and the Office of Emergency Care Research sponsored a one-day workshop, "Cancer and Emergency Medicine: Setting the Research Agenda," in March 2015 in Bethesda, MD. Participants included leading researchers and clinicians in the fields of oncology, emergency medicine, and palliative care, and representatives from the National Institutes of Health. Attendees were charged with identifying research opportunities and priorities to advance the understanding of the emergency care of cancer patients. Recommendations were made in 4 areas: the collection of epidemiologic data, care of the patient with febrile neutropenia, acute events such as dyspnea, and palliative care in the emergency department setting.

  2. Medical emergencies in the oral health care setting.

    PubMed

    Nunn, P

    2000-01-01

    On any given day a patient seen by the dental hygienist has the potential of experiencing a life-threatening medical emergency. All dental hygiene practitioners should be aware of potential risks that a patient may present, take steps to prevent life-threatening events from occurring, and plan for problems in advance of their happening. The primary goal of this course is to help dental hygienists carry out the ethical, moral, legal, and professional obligation owed any patient. The course will review the basics of medical emergencies, with particular emphasis on those that are most likely to occur in the dental office. Discussion will center on general aspects of prevention and preparation, and will focus on the recognition and emergency treatment of specific conditions. Vasodepressor syncope, orthostatic hypotension, acute adrenal insufficiency, hyperventilation, asthma, heart failure and acute pulmonary edema, cerebrovascular accident seizures, hyperglycemia, hypoglycemia, myocardial infarction, angina pectoris, and anaphylaxis will be emphasized.

  3. Emerging waterborne infections in health-care settings.

    PubMed Central

    Emmerson, A. M.

    2001-01-01

    Water is used in vast quantities in health-care premises. Many aquatic microorganisms can survive and flourish in water with minimal nutrients and can be transferred to vulnerable hospital patients in direct (e.g., inhalation, ingestion, surface absorption) and indirect ways (e.g., by instruments and utensils). Many outbreaks of infection or pseudoinfection occur through lack of prevention measures and ignorance of the source and transmission of opportunistic pathogens. PMID:11294722

  4. Research in Emergency and Critical Care Settings: Debates, Obstacles and Solutions.

    PubMed

    El-Menyar, Ayman; Asim, Mohammad; Latifi, Rifat; Al-Thani, Hassan

    2016-12-01

    Research is an integral part of evidence-based practice in the emergency department and critical care unit that improves patient management. It is important to understand the need and major obstacles for conducting research in emergency settings. Herein, we review the literature for the obligations, ethics and major implications of emergency research and the associated limiting factors influencing research activities in critical care and emergency settings. We reviewed research engines such as PubMed, MEDLINE, and EMBASE for the last two decades using the key words "emergency department", "critical care", "research", "consent", and "ethics" as the search terms. Research within emergency settings is slow or non-existent due to time and financial constraints as well as the lack of a research tradition. There are several barriers to conducting research studies in emergency situations such as who, what, when, and how to obtain patient consent. The emergency environment is highly pressurized, emotional, and overburdened. The time taken for research is a particular risk that could delay the desired immediate interventions. Ethical issues abound, particularly relating to informed consent. Research in emergency settings is still in its infancy. Thus, there is a strong need for extensive research in the emergency setting through community awareness, resource management, ethics, collaborations, capacity building, and the development of a research interest for the improvement of patient care and outcomes. We need to establish a well-structured plan to assess and track the decision-making capacity, consider a multistep enrolment and consent strategy, and develop an integrated approach for recruitment into studies.

  5. Improved triage and emergency care for children reduces inpatient mortality in a resource-constrained setting.

    PubMed Central

    Molyneux, Elizabeth; Ahmad, Shafique; Robertson, Ann

    2006-01-01

    PROBLEM: Early assessment, prioritization for treatment and management of sick children attending a health service are critical to achieving good outcomes. Many hospitals in developing countries see large numbers of patients and have few staff, so patients often have to wait before being assessed and treated. APPROACH: We present the example of a busy Under-Fives Clinic that provided outpatient services, immunizations and treatment for medical emergencies. The clinic was providing an inadequate service resulting in some inappropriate admissions and a high case-fatality rate. We assessed the deficiencies and sought resources to improve services. LOCAL SETTING: A busy paediatric outpatient clinic in a public tertiary care hospital in Blantyre, Malawi. RELEVANT CHANGES: The main changes we made were to train staff in emergency care and triage, improve patient flow through the department and to develop close cooperation between inpatient and outpatient services. Training coincided with a restructuring of the physical layout of the department. The changes were put in place when the department reopened in January 2001. LESSONS LEARNED: Improvements in the process and delivery of care and the ability to prioritize clinical management are essential to good practice. Making the changes described above has streamlined the delivery of care and led to a reduction in inpatient mortality from 10-18% before the changes were made (before 2001) to 6-8% after. PMID:16628305

  6. Emerging technologies in point-of-care molecular diagnostics for resource-limited settings.

    PubMed

    Peeling, Rosanna W; McNerney, Ruth

    2014-06-01

    Emerging molecular technologies to diagnose infectious diseases at the point at which care is delivered have the potential to save many lives in developing countries where access to laboratories is poor. Molecular tests are needed to improve the specificity of syndromic management, monitor progress towards disease elimination and screen for asymptomatic infections with the goal of interrupting disease transmission and preventing long-term sequelae. In simplifying laboratory-based molecular assays for use at point-of-care, there are inevitable compromises between cost, ease of use and test performance. Despite significant technological advances, many challenges remain for the development of molecular diagnostics for resource-limited settings. There needs to be more advocacy for these technologies to be applied to infectious diseases, increased efforts to lower the barriers to market entry through streamlined and harmonized regulatory approaches, faster policy development for adoption of new technologies and novel financing mechanisms to enable countries to scale up implementation.

  7. Improving the availability of emergency obstetric care in conflict-affected settings.

    PubMed

    Krause, S K; Meyers, J L; Friedlander, E

    2006-01-01

    This paper describes an emergency obstetric care (EmOC) project implemented by the Reproductive Health Response in Conflict (RHRC) Consortium in 12 conflict-affected settings in nine countries from 2000-2005 with funding and technical support from Columbia University's Mailman School of Public Health Averting Maternal Death and Disability (AMDD) programme. The overall goal of the project was to reduce maternal morbidity and mortality in select conflict-affected settings by improving the availability of EmOC. Another aim of the project was to institutionalize EmOC within RHRC Consortium agencies by modelling how to improve the availability of basic and comprehensive EmOC at clinics and hospitals. The specific project purpose was to increase the availability of EmOC in select conflict-affected settings. The project demonstrated that a great deal more can and should be done by humanitarian workers to improve the availability of basic and comprehensive emergency obstetric services in conflict-affected settings.

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

    PubMed Central

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

    2014-01-01

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

  9. Expanding the Application of Group Interventions: Emergence of Groups in Health Care Settings

    ERIC Educational Resources Information Center

    Drum, David; Becker, Martin Swanbrow; Hess, Elaine

    2011-01-01

    Changes in the health care arena and within the specialty of group work are contributing to the increased utilization of groups in health care settings. Psychoeducational, theme, and interpersonal therapy groups are highlighted for their contributions to treating challenging health conditions. An understanding of the evolution of these group…

  10. Emergency care toolkits.

    PubMed

    Black, Steven

    2004-06-01

    Emergency care services are the focus of a series of toolkits developed by the NHS National electronic Library for Health to provide resources for emergency care leads and others involved in modernising emergency care, writes Steven Black.

  11. Emergency department care for trauma patients in settings of active conflict versus urban violence: all of the same calibre?

    PubMed Central

    Valles, Pola; Van den Bergh, Rafael; van den Boogaard, Wilma; Tayler-Smith, Katherine; Gayraud, Olivia; Mammozai, Bashir Ahmad; Nasim, Masood; Cheréstal, Sophia; Majuste, Alberta; Charles, James Philippe; Trelles, Miguel

    2016-01-01

    Background Trauma is a leading cause of death and represents a major problem in developing countries where access to good quality emergency care is limited. Médecins Sans Frontières delivered a standard package of care in two trauma emergency departments (EDs) in different violence settings: Kunduz, Afghanistan, and Tabarre, Haiti. This study aims to assess whether this standard package resulted in similar performance in these very different contexts. Methods A cross-sectional study using routine programme data, comparing patient characteristics and outcomes in two EDs over the course of 2014. Results 31 158 patients presented to the EDs: 22 076 in Kunduz and 9082 in Tabarre. Patient characteristics, such as delay in presentation (29.6% over 24 h in Kunduz, compared to 8.4% in Tabarre), triage score, and morbidity pattern differed significantly between settings. Nevertheless, both EDs showed an excellent performance, demonstrating low proportions of mortality (0.1% for both settings) and left without being seen (1.3% for both settings), and acceptable triage performance. Physicians’ maximum working capacity was exceeded in both centres, and mainly during rush hours. Conclusions This study supports for the first time the plausibility of using the same ED package in different settings. Mapping of patient attendance is essential for planning of human resources needs. PMID:27810881

  12. An assessment of priority setting process and its implication on availability of emergency obstetric care services in Malindi District, Kenya

    PubMed Central

    Nyandieka, Lilian Nyamusi; Kombe, Yeri; Ng'ang'a, Zipporah; Byskov, Jens; Njeru, Mercy Karimi

    2015-01-01

    Introduction In spite of the critical role of Emergency Obstetric Care in treating complications arising from pregnancy and childbirth, very few facilities are equipped in Kenya to offer this service. In Malindi, availability of EmOC services does not meet the UN recommended levels of at least one comprehensive and four basic EmOC facilities per 500,000 populations. This study was conducted to assess priority setting process and its implication on availability, access and use of EmOC services at the district level. Methods A qualitative study was conducted both at health facility and community levels. Triangulation of data sources and methods was employed, where document reviews, in-depth interviews and focus group discussions were conducted with health personnel, facility committee members, stakeholders who offer and/ or support maternal health services and programmes; and the community members as end users. Data was thematically analysed. Results Limitations in the extent to which priorities in regard to maternal health services can be set at the district level were observed. The priority setting process was greatly restricted by guidelines and limited resources from the national level. Relevant stakeholders including community members are not involved in the priority setting process, thereby denying them the opportunity to contribute in the process. Conclusion The findings illuminate that consideration of all local plans in national planning and budgeting as well as the involvement of all relevant stakeholders in the priority setting exercise is essential in order to achieve a consensus on the provision of emergency obstetric care services among other health service priorities. PMID:26889337

  13. Pediatric emergency care capacity in a low-resource setting: An assessment of district hospitals in Rwanda

    PubMed Central

    Shoveller, Jean; Tuyisenge, Lisine; Kenyon, Cynthia; Cechetto, David F.; Lynd, Larry D.

    2017-01-01

    Background Health system strengthening is crucial to improving infant and child health outcomes in low-resource countries. While the knowledge related to improving newborn and child survival has advanced remarkably over the past few decades, many healthcare systems in such settings remain unable to effectively deliver pediatric advance life support management. With the introduction of the Emergency Triage, Assessment and Treatment plus Admission care (ETAT+)–a locally adapted pediatric advanced life support management program–in Rwandan district hospitals, we undertook this study to assess the extent to which these hospitals are prepared to provide this pediatric advanced life support management. The results of the study will shed light on the resources and support that are currently available to implement ETAT+, which aims to improve care for severely ill infants and children. Methods A cross-sectional survey was undertaken in eight district hospitals across Rwanda focusing on the availability of physical and human resources, as well as hospital services organizations to provide emergency triage, assessment and treatment plus admission care for severely ill infants and children. Results Many of essential resources deemed necessary for the provision of emergency care for severely ill infants and children were readily available (e.g. drugs and laboratory services). However, only 4/8 hospitals had BVM for newborns; while nebulizer and MDI were not available in 2/8 hospitals. Only 3/8 hospitals had F-75 and ReSoMal. Moreover, there was no adequate triage system across any of the hospitals evaluated. Further, guidelines for neonatal resuscitation and management of malaria were available in 5/8 and in 7/8 hospitals, respectively; while those for child resuscitation and management of sepsis, pneumonia, dehydration and severe malnutrition were available in less than half of the hospitals evaluated. Conclusions Our assessment provides evidence to inform new strategies

  14. THE MIXED EVIDENCE FOR BRIEF INTERVENTION IN EMERGENCY DEPARTMENTS, TRAUMA CARE CENTERS AND INPATIENT HOSPITAL SETTINGS: WHAT SHOULD WE DO?

    PubMed Central

    Field, Craig Andrew; Baird, Janette; Saitz, Richard; Caetano, Raul; Monti, Peter M.

    2010-01-01

    The purpose of this review is to provide a broad overview of the status of brief intervention in the emergency department, trauma center and inpatient hospital setting. This review is based on a symposia presented at the 2009 annual conference of the Research Society on Alcoholism (Baird et al., 2009; Field, et al., 2009; Monti et al., 2009; Saitz et al., 2009). While the general efficacy of brief alcohol interventions in these settings has been recognized, the evidence is increasingly mixed. Herein we discuss possible confounding factors; including the inconsistencies in interventions provided, differences in target population, study design and assessment procedures. Recent studies investigating potential moderators of treatment outcomes suggest that a more sophisticated approach to evaluating the effectiveness of brief interventions across varying patient populations is needed in order to further understand its effectiveness. Current dissemination efforts represent a significant advance in broadening the base of treatment for alcohol problems by providing an evidenced based intervention in health care settings and should not be curtailed. However, additional research is required to enhance treatment outcomes, refine current practice guidelines and continue to bridge the gap between science and practice. Given the current state of research, a multi-setting clinical trial is recommended to account for potential contextual differences while controlling for study design. PMID:20860610

  15. Costs of Emergency Care

    MedlinePlus

    ... pharmacy, supply, ancillary (laboratory, radiology), and miscellaneous. The fee for an emergency physician’s services on a medical ... the total charges for a visit. The hospital fees make up the difference. Q. Is emergency care ...

  16. Emergency care in Namibia.

    PubMed

    Tintinalli, J; Lisse, E; Begley, A; Campbell, C

    1998-09-01

    Namibia is a sparsely populated nation in southwest Africa. A state-run health service provides care to most of the population. The geography and population distribution dictate the delivery systems for prehospital and emergency care. A state-run ambulance service provides basic patient transportation to the state-run hospitals. There is no 911 system. Two private aeromedical companies in Namibia provide the full range of ground and aeromedical treatment, diver rescue, and helicopter and fixed-wing transport services. The scope of care includes cricothyrotomies, chest tubes, and rapid-sequence intubation. Equipment is modern and virtually identical to what is used in the United States. There are no emergency physicians in Namibia. General medical officers are the backbone of the state-run health service. General medical officers assigned to cover the ED are called casualty officers. No specialized training beyond internship is required, and assignments to casualty are viewed as temporary until better positions become available. Only the largest state hospital in the capital has a dedicated, 24-hour emergency staff. The private prehospital care/transport systems are well organized and sophisticated. Formal efforts should be undertaken to develop ties with our colleagues in Namibia. Potential areas for collaboration include injury surveillance and prevention, field trauma resuscitation, and prehospital care.

  17. SETTING UP TRIAGE SERVICES IN THE EMERGENCY DEPARTMENT: EXPERIENCE FROM A TERTIARY CARE INSTITUTE OF PAKISTAN. A JOURNEY TOWARD EXCELLENCE.

    PubMed

    Khursheed, Munawar; Fayyaz, Jabeen; Jamil, Ahsan

    2015-01-01

    The history of triage started from the French battle field for prioritizing patients. Emergency triage was started in early 1950's in USA in order to treat the sickest first. It has now become an integral component of all emergency departments (ED). The basic aim of triage is not only to sort out patients according to the criticality of their illness, but it also serves to streamline the patient flow. This will ultimately enable the ED physician to provide right management at the right time to the right patient in the available resources. In turn has a positive impact in reducing the ED overcrowding. The history of triage at AKUH-ED dated back in 2000. In the beginning physicians and nurse both were assigned to triage desk where they use to sort out the patient according to presenting complaints. At that time the documentation was manual with locally developed triage priorities. With the expansion of ED in 2008, responsibility of triage was shifted to nursing services. Triage policy was established and implemented. Specific triage protocols were developed for guidance and uniformity of care. Manual recording system was replaced by computerized triage data entry software. Enabling the department to monitor patient quality care indicators like total number of patients triaged, triage category, lag time reports and left without being seen by physicians.

  18. Medical History of Elderly Patients in the Emergency Setting: Not an Easy Point-of-Care Diagnostic Marker.

    PubMed

    Lindner, Tobias; Slagman, Anna; Senkin, Arthur; Möckel, Martin; Searle, Julia

    2015-01-01

    Background. Medical histories are a crucially important diagnostic tool. Elderly patients represent a large and increasing group of emergency patients. Due to cognitive deficits, taking a reliable medical history in this patient group can be difficult. We sought to evaluate the medical history-taking in emergency patients above 75 years of age with respect to duration and completeness. Methods. Anonymous data of consecutive patients were recorded. Times for the defined basic medical history-taking were documented, as were the availability of other sources and times to assess these. Results. Data of 104 patients were included in the analysis. In a quarter of patients (25%, n = 26) no complete basic medical history could be obtained. In the group of patients where complete data could be gathered, only 16 patients were able to provide all necessary information on their own. Including other sources like relatives or GPs prolonged the time until complete medical history from 7.3 minutes (patient only) to 26.4 (+relatives) and 56.3 (+GP) minutes. Conclusions. Medical histories are important diagnostic tools in the emergency setting and are prolonged in the elderly, especially if additional documentation and third parties need to be involved. New technologies like emergency medical cards might help to improve the availability of important patient data but implementation of these technologies is costly and faces data protection issues.

  19. Settings for Terminal Care.

    ERIC Educational Resources Information Center

    Corless, Inge B.

    1988-01-01

    Examines topics related to delivery of terminal care services: ability of various hospice programs to survive financially, contributions of various models of hospice care, impact of Medicare legislation on hospice movement, demonstration of unique hospice intervention, integration of spiritual care into hospice, and role of hospice in care of…

  20. SYMPTEK homemade foam models for client education and emergency obstetric care skills training in low-resource settings.

    PubMed

    Deganus, Sylvia A

    2009-10-01

    Clinical training for health care workers using anatomical models and simulation has become an established norm. A major requirement for this approach is the availability of lifelike training models or simulators for skills practice. Manufactured sophisticated human models such as the resuscitation neonatal dolls, the Zoë gynaecologic simulator, and other pelvic models are very expensive, and are beyond the budgets of many training programs or activities in low-resource countries. Clinical training programs in many low-resource countries suffer greatly because of this cost limitation. Yet it is also in these same poor countries that the need for skilled human resources in reproductive health is greatest. The SYMPTEK homemade models were developed in response to the need for cheaper, more readily available humanistic models for training in emergency obstetric skills and also for client education. With minimal training, a variety of cheap SYMPTEK models can easily be made, by both trainees and facilitators, from high-density latex foam material commonly used for furnishings. The models are reusable, durable, portable, and easily maintained. The uses, advantages, disadvantages, and development of the SYMPTEK foam models are described in this article.

  1. Randomization Methods in Emergency Setting Trials: A Descriptive Review

    ERIC Educational Resources Information Center

    Corbett, Mark Stephen; Moe-Byrne, Thirimon; Oddie, Sam; McGuire, William

    2016-01-01

    Background: Quasi-randomization might expedite recruitment into trials in emergency care settings but may also introduce selection bias. Methods: We searched the Cochrane Library and other databases for systematic reviews of interventions in emergency medicine or urgent care settings. We assessed selection bias (baseline imbalances) in prognostic…

  2. The FIFA medical emergency bag and FIFA 11 steps to prevent sudden cardiac death: setting a global standard and promoting consistent football field emergency care.

    PubMed

    Dvorak, Jiri; Kramer, Efraim B; Schmied, Christian M; Drezner, Jonathan A; Zideman, David; Patricios, Jon; Correia, Luis; Pedrinelli, André; Mandelbaum, Bert

    2013-12-01

    Life-threatening medical emergencies are an infrequent but regular occurrence on the football field. Proper prevention strategies, emergency medical planning and timely access to emergency equipment are required to prevent catastrophic outcomes. In a continuing commitment to player safety during football, this paper presents the FIFA Medical Emergency Bag and FIFA 11 Steps to prevent sudden cardiac death. These recommendations are intended to create a global standard for emergency preparedness and the medical response to serious or catastrophic on-field injuries in football.

  3. Reptile Critical Care and Common Emergencies.

    PubMed

    Music, Meera Kumar; Strunk, Anneliese

    2016-05-01

    Reptile emergencies are an important part of exotic animal critical care, both true emergencies and those perceived as emergencies by owners. The most common presentations for reptile emergencies are addressed here, with information on differential diagnoses, helpful diagnostics, and approach to treatment. In many cases, reptile emergencies are actually acute presentations originating from a chronic problem, and the treatment plan must include both clinical treatment and addressing husbandry and dietary deficiencies at home. Accurate owner expectations must be set in order to have owner compliance to long-term treatment plans.

  4. Doing challenging research studies in a patient-centred way: a qualitative study to inform a randomised controlled trial in the paediatric emergency care setting

    PubMed Central

    Woolfall, Kerry; Young, Bridget; Frith, Lucy; Appleton, Richard; Iyer, Anand; Messahel, Shrouk; Hickey, Helen; Gamble, Carrol

    2014-01-01

    Objective To inform the design of a randomised controlled trial (called EcLiPSE) to improve the treatment of children with convulsive status epilepticus (CSE). EcLiPSE requires the use of a controversial deferred consent process. Design Qualitative interview and focus group study. Setting 8 UK support groups for parents of children who have chronic or acute health conditions and experience of paediatric emergency care. Participants 17 parents, of whom 11 participated in telephone interviews (10 mothers, 1 father) and 6 in a focus group (5 mothers, 1 father). 6 parents (35%) were bereaved and 7 (41%) had children who had experienced seizures, including CSE. Results Most parents had not heard of deferred consent, yet they supported its use to enable the progress of emergency care research providing a child's safety was not compromised by the research. Parents were reassured by tailored explanation, which focused their attention on aspects of EcLiPSE that addressed their priorities and concerns. These aspects included the safety of the interventions under investigation and how both EcLiPSE interventions are used in routine clinical practice. Parents made recommendations about the appropriate timing of a recruitment discussion, the need to individualise approaches to recruiting bereaved parents and the use of clear written information. Conclusions Our study provided information to help ensure that a challenging trial was patient centred in its design. We will use our findings to help EcLiPSE practitioners to: discuss potentially threatening trial safety information with parents, use open-ended questions and prompts to identify their priorities and concerns and clarify related aspects of written trial information to assist understanding and decision-making. PMID:24833694

  5. [Severe infection in critical emergency care].

    PubMed

    Matsuda, Naoyuki; Takatani, Yudai; Higashi, Tomoko; Inaba, Masato; Ejima, Tadashi

    2016-02-01

    In the emergency and critical care medicine, infection is easy to merge to various basic conditions and diseases. In the social structure aging in critical care, the immune weakness was revealed as the result of severe infection and septic shock in the reduced function of neutrophils and lymphocytes. In the life-saving emergency care, cardiovascular diseases, diabetes, chronic renal failure and lever dysfunction are often observed, and the underlying diseases have the foundation of biological invasion after a first inflammatory attack of surgery, trauma, burn, and systemic injury. It will be placed into a susceptible situation such as artificial respiratory management. In this review, we discussed severe infection in emergency and critical care. It is necessary to pay attention to the drug resistance bacterias in own critical care setting by trends.

  6. Emergence of Ebola virus disease in a french acute care setting: a simulation study based on documented inter-individual contacts

    PubMed Central

    Vanhems, Philippe; Von Raesfeldt, Rosette; Ecochard, René; Voirin, Nicolas

    2016-01-01

    The potential spread of nosocomial Ebola virus disease (EVD) in non-outbreak areas is not known. The objective was to use detailed contact data on patients and healthcare workers (HCW) to estimate emergence probability and secondary incident cases (SIC) of EVD after hospitalization of an index case with undetected EVD. Contact data were collected through RFID devices used by patients and HCW during hospital care. A “susceptible-exposed-infected” model was used. Emergence probability, ranged from 7% to 84%. A plateau around 84% was observed. Emergence probability was proportional to time exposed to the dry phase of patients with nonspecific symptoms. Nurses were at higher risk of nosocomial EVD than physicians with around 60% emergence probability in this subgroup. The risk of nosocomial EVD in non-outbreak areas might be substantial if no preventive measures are implemented when asymptomatic patients or those with mild symptoms are hospitalized. PMID:27827383

  7. Text Messaging to Improve Hypertension Medication Adherence in African Americans From Primary Care and Emergency Department Settings: Results From Two Randomized Feasibility Studies

    PubMed Central

    Hirzel, Lindsey; Dawood, Rachelle M; Dawood, Katee L; Nichols, Lauren P; Artinian, Nancy T; Schwiebert, Loren; Yarandi, Hossein N; Roberson, Dana N; Plegue, Melissa A; Mango, LynnMarie C; Levy, Phillip D

    2017-01-01

    Background Hypertension (HTN) is an important problem in the United States, with an estimated 78 million Americans aged 20 years and older suffering from this condition. Health disparities related to HTN are common in the United States, with African Americans suffering from greater prevalence of the condition than whites, as well as greater severity, earlier onset, and more complications. Medication adherence is an important component of HTN management, but adherence is often poor, and simply forgetting to take medications is often cited as a reason. Mobile health (mHealth) strategies have the potential to be a low-cost and effective method for improving medication adherence that also has broad reach. Objective Our goal was to determine the feasibility, acceptability, and preliminary clinical effectiveness of BPMED, an intervention designed to improve medication adherence among African Americans with uncontrolled HTN, through fully automated text messaging support. Methods We conducted two parallel, unblinded randomized controlled pilot trials with African-American patients who had uncontrolled HTN, recruited from primary care and emergency department (ED) settings. In each trial, participants were randomized to receive either usual care or the BPMED intervention for one month. Data were collected in-person at baseline and one-month follow-up, assessing the effect on medication adherence, systolic and diastolic blood pressure (SBP and DBP), medication adherence self-efficacy, and participant satisfaction. Data for both randomized controlled pilot trials were analyzed separately and combined. Results A total of 58 primary care and 65 ED participants were recruited with retention rates of 91% (53/58) and 88% (57/65), respectively. BPMED participants consistently showed numerically greater, yet nonsignificant, improvements in measures of medication adherence (mean change 0.9, SD 2.0 vs mean change 0.5, SD 1.5, P=.26), SBP (mean change –12.6, SD 24.0 vs mean change

  8. Knowledge translation in international emergency medical care.

    PubMed

    Arnold, L Kristian; Alomran, Hisham; Anantharaman, V; Halpern, Pinchas; Hauswald, Mark; Malmquist, Pia; Molyneux, Elizabeth; Rajapakse, Bishan; Ranney, Megan; Razzak, Junaid

    2007-11-01

    More than 90% of the world population receives emergency medical care from different types of practitioners with little or no specific training in the field and with variable guidance and oversight. Emergency medical care is being recognized by actively practicing physicians around the world as an increasingly important domain in the overall health services package for a community. The know-do gap is well recognized as a major impediment to high-quality health care in much of the world. Knowledge translation principles for application in this highly varied young domain will require investigation of numerous aspects of the knowledge synthesis, exchange, and application domains in order to bring the greatest benefit of both explicit and tacit knowledge to increasing numbers of the world's population. This article reviews some of the issues particular to knowledge development and transfer in the international domain. The authors present a set of research proposals developed from a several-month online discussion among practitioners and teachers of emergency medical care in 16 countries from around the globe and from all economic strata, aimed at improving the flow of knowledge from developers and repositories of knowledge to the front lines of clinical care.

  9. Health systems organization for emergency care.

    PubMed

    Pedroto, Isabel; Amaro, Pedro; Romãozinho, José Manuel

    2013-10-01

    The increasing number of acute and severe digestive diseases presenting to hospital emergency departments, mainly related with an ageing population, demands an appropriate answer from health systems organization, taking into account the escalating pressure on cost reduction. However, patients expect and deserve a response that is appropriate, effective, efficient and safe. The huge variety of variables which can influence the evolution of such cases warranting intensive monitoring, and the coordination and optimization of a range of human and technical resources involved in the care of these high-risk patients, requires their admission in hospital units with conveniently equipped facilities, as is done for heart attack and stroke patients. Little information of gastroenterology emergencies as a function of structure, processes and outcome is available at the organizational level. Surveys that have been conducted in different countries just assess local treatment outcome and question the organizational structure and existing resources but its impact on the outcome is not clear. Most studies address the problem of upper gastrointestinal bleeding and the out-of-hours endoscopy services in the hospital setting. The demands placed on emergency (part of the overall continuum of care) are obvious, as are the needs for the efficient use of resources and processes to improve the quality of care, meaning data must cover the full care cycle. Gastrointestinal emergencies, namely gastrointestinal bleeding, must be incorporated into the overall emergency response as is done for heart attack and stroke. This chapter aims to provide a review of current literature/evidence on organizational health system models towards a better management of gastroenterology emergencies and proposes a research agenda.

  10. Emergency Victim Care. A Training Manual for Emergency Medical Technicians. Module 11--Childbirth, Pediatric Emergencies. Revised.

    ERIC Educational Resources Information Center

    Ohio State Dept. of Education, Columbus. Div. of Vocational Education.

    This training manual for emergency medical technicians, one of 14 modules that comprise the Emergency Victim Care textbook, covers childbirth and pediatric emergencies. Objectives stated for the two chapters are for the students to be able to describe: emergency procedures for normal childbirth, unusual childbirth emergencies, emergency care for…

  11. Emergency Victim Care. A Training Manual for Emergency Medical Technicians. Module 7--Medical Emergencies. Revised.

    ERIC Educational Resources Information Center

    Ohio State Dept. of Education, Columbus. Div. of Vocational Education.

    This training manual for emergency medical technicians, one of 14 modules that comprise the Emergency Victim Care textbook, covers medical emergencies. The objectives for the chapter are for students to be able to describe the causes, signs, and symptoms for specified medical emergencies and to describe emergency care for them. Informative…

  12. EMERGENCY VICTIM CARE AND RESCUE, INSTRUCTOR'S MANUAL.

    ERIC Educational Resources Information Center

    MORANDO, ROCCO V.; STOVER, WILBUR F.

    DEVELOPED AT THE STATE LEVEL BY SQUADMEN AND TRADE AND INDUSTRIAL PERSONNEL, THIS MANUAL IS FOR USE BY A QUALIFIED SQUADMAN IN TEACHING FULL-TIME AND VOLUNTEER EMERGENCY AND RESCUE WORKERS IN AN EMERGENCY SQUAD STATION OR TRAINING CENTER. TEACHING GUIDES ARE PROVIDED FOR A 30-HOUR COURSE ON EMERGENCY VICTIM CARE AND A 20-HOUR COURSE ON VICTIM…

  13. Improvement of Patient- and Family-Specific Care for Children With Special Behavioral Needs in the Emergency Setting: A Behavioral Needs Education.

    PubMed

    Brynes, Nicole; Lee, Heeyoung; Ren, Dianxu; Beach, Michael

    2016-09-03

    Improvements in staff training, identification, and treatment planning for children with special health care needs who have behavioral issues are routinely recommended, but a literature review revealed no coherent plans targeted specifically toward pediatric ED staff.

  14. 42 CFR 460.100 - Emergency care.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Emergency care. 460.100 Section 460.100 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY...

  15. 42 CFR 460.100 - Emergency care.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 4 2013-10-01 2013-10-01 false Emergency care. 460.100 Section 460.100 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY...

  16. 42 CFR 460.100 - Emergency care.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Emergency care. 460.100 Section 460.100 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) PROGRAMS OF ALL-INCLUSIVE CARE FOR THE ELDERLY...

  17. Wildlife Emergency and Critical Care.

    PubMed

    Riley, Jennifer; Barron, Heather

    2016-05-01

    Wildlife patients often present as emergencies. For veterinarians who do not typically treat wildlife, it is important to be able to stabilize and determine the underlying cause of the animal's signs. This article discusses initial assessment, stabilization, and treatment of common emergency presentations in wild birds, reptiles, and mammals.

  18. [Care organization at French pediatric emergency department].

    PubMed

    Gras-Le Guen, Christèle; Vrignaud, Bénédicte; Levieux, Karine

    2015-05-01

    The number of children admitted to paediatric emergencies is increasing steadily, and is responsible for an altered quality in the patients' reception and some major perturbations in the care organization. In this context, the primary care physicians play a major role in explaining their patients "how to use" the paediatric emergency department (priority in case of vital emergency, periods with lot of admissions and increased waiting time ...). Everything must be done to find an altemative to the pediatric emergency department passage by facilitating communication between caregivers and for example by offering semi urgent consultations possibility.

  19. Infectious disease emergencies in primary care.

    PubMed

    Kwitkowski, V E; Demko, S G

    1999-01-01

    Infectious disease emergencies can be described as infectious processes that, if not recognized and treated immediately, can lead to significant morbidity or mortality. These emergencies can present as common or benign infections, fooling the primary care provider into using more conservative treatment strategies than are required. This review discusses the pathophysiology, history and physical findings, diagnostic criteria, and treatment strategies for the following infectious disease emergencies: acute bacterial meningitis, ehrlichiosis, Rocky Mountain spotted fever, meningococcemia, necrotizing soft tissue infections, toxic shock syndrome, food-borne illnesses, and infective endocarditis. Because most of the discussed infectious disease emergencies require hospital care, the primary care clinician must be able to judge when a referral to a specialist or a higher-level care facility is indicated.

  20. Priority setting for health in emerging markets.

    PubMed

    Glassman, Amanda; Giedion, Ursula; McQueston, Kate

    2013-05-01

    The use of health technology assessment research in emerging economies is becoming an increasingly important tool to determine the uses of health spending. As low- and middle-income countries' gross domestic product grows, the funding available for health has increased in tandem. There is growing evidence that comparative effectiveness research and cost-effectiveness can be used to improve health outcomes within a predefined financial space. The use of these evaluation tools, combined with a systematized process of priority setting, can help inform national and global health payers. This review of country institutions for health technology assessment illustrates two points: the efforts underway to use research to inform priorities are widespread and not confined to wealthier countries; and many countries' efforts to create evidence-based policy are incomplete and more country-specific research will be needed. Further evidence shows that there is scope to reduce these gaps and opportunity to support better incorporation of data through better-defined priority-setting processes.

  1. Randomization methods in emergency setting trials: a descriptive review

    PubMed Central

    Moe‐Byrne, Thirimon; Oddie, Sam; McGuire, William

    2015-01-01

    Background Quasi‐randomization might expedite recruitment into trials in emergency care settings but may also introduce selection bias. Methods We searched the Cochrane Library and other databases for systematic reviews of interventions in emergency medicine or urgent care settings. We assessed selection bias (baseline imbalances) in prognostic indicators between treatment groups in trials using true randomization versus trials using quasi‐randomization. Results Seven reviews contained 16 trials that used true randomization and 11 that used quasi‐randomization. Baseline group imbalance was identified in four trials using true randomization (25%) and in two quasi‐randomized trials (18%). Of the four truly randomized trials with imbalance, three concealed treatment allocation adequately. Clinical heterogeneity and poor reporting limited the assessment of trial recruitment outcomes. Conclusions We did not find strong or consistent evidence that quasi‐randomization is associated with selection bias more often than true randomization. High risk of bias judgements for quasi‐randomized emergency studies should therefore not be assumed in systematic reviews. Clinical heterogeneity across trials within reviews, coupled with limited availability of relevant trial accrual data, meant it was not possible to adequately explore the possibility that true randomization might result in slower trial recruitment rates, or the recruitment of less representative populations. © 2015 The Authors. Research Synthesis Methods published by John Wiley & Sons, Ltd. PMID:26333419

  2. Pedestrian Injuries: Emergency Care Considerations

    PubMed Central

    Chakravarthy, Bharath; Lotfipour, Shahram; Vaca, Federico E.

    2007-01-01

    Traffic-related pedestrian injuries are a growing public health threat worldwide. The global economic burden of motor vehicle collisions and pedestrian injuries totals $500 billion.1 In 2004, there were 4,641 pedestrian deaths and over 70,000 injuries in the United States.2 Injury patterns vary depending on the age, gender and socioeconomic status of the individual. Children, older adults, and those of lower socioeconomic status are most affected. The burden of injury upon the individual, families and society is frequently overwhelming. Although pedestrian injuries and deaths are relatively on the decline in the United States, this is not universally true throughout the world. It requires particular attention by emergency medicine physicians, public health experts and policy makers. PMID:20440388

  3. Funding emergency care: Australian style.

    PubMed

    Bell, Anthony; Crilly, Julia; Williams, Ged; Wylie, Kate; Toloo, Ghasem Sam; Burke, John; FitzGerald, Gerry

    2014-08-01

    The ongoing challenge for ED leaders is to remain abreast of system-wide changes that impact on the day-to-day management of their departments. Changes to the funding model creates another layer of complexity and this introductory paper serves as the beginning of a discussion about the way in which EDs are funded and how this can and will impact on business decisions, models of care and resource allocation within Australian EDs. Furthermore it is evident that any funding model today will mature and change with time, and moves are afoot to refine and contextualise ED funding over the medium term. This perspective seeks to provide a basis of understanding for our current and future funding arrangements in Australian EDs.

  4. Dilemma in the emergency setting: hypomagnesemia mimicking acute stroke

    PubMed Central

    Rico, María; Martinez-Rodriguez, Laura; Larrosa-Campo, Davinia; Calleja, Sergio

    2016-01-01

    Background Stroke mimics may account for up to 30% of all acute stroke consultations. However, in the emergency setting, accurate diagnosis is not always possible. Methods Case report and review of the literature. Results A 73-year-old woman was admitted to the emergency department with acute aphasia and right hemiparesis. The National Institute of Health Stroke Score was 21, compatible with severe stroke, so she received thrombolysis. Laboratory testing demonstrated severe hypomagnesemia. She had been taking proton pump inhibitors for years and neuroimaging did not demonstrate signs of acute ischemic disease. After correcting the metabolic alterations with intravenous and oral supplemental magnesium, the patient was discharged asymptomatic. No further episodes have been registered to date. Conclusion Hypomagnesemia might cause acute neurological symptoms that could be confused with stroke. A careful history is essential for diagnosis but suspicion of stroke mimic should not prevent tPA administration. PMID:27354832

  5. Professionalism in Long-Term Care Settings

    ERIC Educational Resources Information Center

    Lubinski, Rosemary

    2006-01-01

    Speech-language pathologists who serve elders in a variety of long-term care settings have a variety of professional skills and responsibilities. Fundamental to quality service is knowledge of aging and communication changes and disorders associated with this process, institutional alternatives, and the changing nature of today's elders in…

  6. Renal scintigraphy in the acute care setting.

    PubMed

    Sfakianaki, Efrosyni; Sfakianakis, George N; Georgiou, Mike; Hsiao, Bernard

    2013-03-01

    Renal scintigraphy is a powerful imaging method that provides both functional and anatomic information, which is particularly useful in the acute care setting. In our institution, for the past 2 decades, we have used a 25-minute renal diuretic protocol, technetium-99m ((99m)Tc) mercaptoacetyltriglycine with simultaneous intravenous injection of furosemide, for all ages and indications, including both native and transplant kidneys. As such, this protocol has been widely used in the workup of acutely ill patients. In this setting, there are common clinical entities which affect patients with native and transplant kidneys. In adult patients with native kidneys one of the most frequent reasons for emergency room visits is renal colic due to urolithiasis. Although unenhanced computed tomography is useful to assess the anatomy in cases of renal colic, it does not provide functional information. Time zero furosemide renal scintigraphy can do both and we have shown that it can effectively stratify patients with renal colic. To this end, 4 characteristic patterns of scintirenography have been identified, standardized, and consistently applied: no obstruction, partial obstruction (mild vs high grade), complete obstruction, and stunned (postdecompressed) kidney. With the extensive use of this protocol over the past 2 decades, a pattern of "regional parenchymal dysfunction" indicative of acute pyelonephritis has also been delineated. This information has proved to be useful for patients presenting with urinary tract infection and suspected pyelonephritis, as well as for patients who were referred for workup of renal colic but were found to have acute pyelonephritis instead. In instances of abdominal trauma, renal scintigraphy is uniquely suited to identify urine leaks. This is also true in cases of suspected leak following renal transplant or from other iatrogenic/postsurgical causes. Patients presenting with acute renal failure can be evaluated with renal scintigraphy. A

  7. Treatment of acute burn blisters in unscheduled care settings.

    PubMed

    Payne, Sarah; Cole, Elaine

    2012-09-01

    Many patients with minor burns present at emergency departments and urgent care centres, where their management is often undertaken by experienced nurses rather than experts in treating burns. This article describes a small study of the clinical decision making that underpins nurses' management of minor burns in these non-specialist settings. The results suggest that, due to a lack of relevant research, nurses base their decisions on previous experience or expert colleagues' opinions and advice rather than on the evidence.

  8. Emergency Care Skills for Occupational Health Nurses.

    ERIC Educational Resources Information Center

    North Carolina State Dept. of Community Colleges, Raleigh. Occupational Information Center.

    Designed for use in community colleges, technical colleges, and technical institutes, this manual contains a course for teaching emergency care skills to both licensed practical and registered nurses employed in occupational health. The manual consists of three sections. In section 1 the need for the course, its content, objectives, length,…

  9. Emergency Care of the Snakebite Victim.

    ERIC Educational Resources Information Center

    Ballard, Carol N.

    1994-01-01

    Describes emergency care of snakebite victims, including noting signs and symptoms of venomous snakebites, keeping the victim calm, and seeking immediate medical attention. Provides information on variables that affect the amount of injected venom and how to distinguish nonpoisonous from poisonous snakes. (LP)

  10. Pressure ulcer prevention in care home settings.

    PubMed

    Ellis, Michael

    2017-03-31

    Pressure ulcer prevention in the care home setting can be challenging and is often compromised by a lack of access to education and resources. There are measures that have been shown to consistently improve outcomes in pressure ulcer prevention including assessment of the patient and their individual risks, delivery of a consistent plan of care that meets patients' needs, and regular evaluation to identify shortfalls. In addition, there should be a robust approach to investigating events that lead to a person developing a pressure ulcer and that information should be used to improve future practice. Pressure ulcer prevention in care homes is achievable and nurses should all be aware of the necessary measures detailed in this article.

  11. Identifying and managing patients with delirium in acute care settings.

    PubMed

    Bond, Penny; Goudie, Karen

    2015-11-01

    Delirium is an acute medical emergency affecting about one in eight acute hospital inpatients. It is associated with poor outcomes, is more prevalent in older people and it is estimated that half of all patients receiving intensive care or surgery for a hip fracture will be affected. Despite its prevalence and impact, delirium is not reliably identified or well managed. Improving the identification and management of patients with delirium has been a focus for the national improving older people's acute care work programme in NHS Scotland. A delirium toolkit has been developed, which includes the 4AT rapid assessment test, information for patients and carers and a care bundle for managing delirium based on existing guidance. This toolkit has been tested and implemented by teams from a range of acute care settings to support improvements in the identification and immediate management of delirium.

  12. Palliative Care in the Emergency Department

    PubMed Central

    Mierendorf, Susanne M; Gidvani, Vinita

    2014-01-01

    The Emergency Department (ED) is the place where people most frequently seek urgent care. For patients living with chronic disease or malignancy who may be in a crisis, this visit may be pivotal in determining the patients’ trajectory. There is a large movement in education of emergency medicine physicians, hospitalists, and intensivists from acute aggressive interventions to patient-goal assessment, recognizing last stages of life and prioritizing symptom management. Although the ED is not considered an ideal place to begin palliative care, hospital-based physicians may assist in eliciting the patient’s goals of care and discussing prognosis and disease trajectory. This may help shift to noncurative treatment. This article will summarize the following: identification of patients who may need palliation, discussing prognosis, eliciting goals of care and directives, symptom management in the ED, and making plans for further care. These efforts have been shown to improve outcomes and to decrease length of stay and cost. The focus of this article is relieving “patient” symptoms and family distress, honoring the patient’s goals of care, and assisting in transition to a noncurative approach and placement where this may be accomplished. PMID:24694318

  13. Providing high-quality care in primary care settings

    PubMed Central

    Beaulieu, Marie-Dominique; Geneau, Robert; Grande, Claudio Del; Denis, Jean-Louis; Hudon, Éveline; Haggerty, Jeannie L.; Bonin, Lucie; Duplain, Réjean; Goudreau, Johanne; Hogg, William

    2014-01-01

    Abstract Objective To gain a deeper understanding of how primary care (PC) practices belonging to different models manage resources to provide high-quality care. Design Multiple-case study embedded in a cross-sectional study of a random sample of 37 practices. Setting Three regions of Quebec. Participants Health care professionals and staff of 5 PC practices. Methods Five cases showing above-average results on quality-of-care indicators were purposefully selected to contrast on region, practice size, and PC model. Data were collected using an organizational questionnaire; the Team Climate Inventory, which was completed by health care professionals and staff; and 33 individual interviews. Detailed case histories were written and thematic analysis was performed. Main findings The core common feature of these practices was their ongoing effort to make trade-offs to deliver services that met their vision of high-quality care. These compromises involved the same 3 areas, but to varying degrees depending on clinic characteristics: developing a shared vision of high-quality care; aligning resource use with that vision; and balancing professional aspirations and population needs. The leadership of the physician lead was crucial. The external environment was perceived as a source of pressure and dilemmas rather than as a source of support in these matters. Conclusion Irrespective of their models, PC practices’ pursuit of high-quality care is based on a vision in which accessibility is a key component, balanced by appropriate management of available resources and of external environment expectations. Current PC reforms often create tensions rather than support PC practices in their pursuit of high-quality care. PMID:24829023

  14. An emerging action science of social settings.

    PubMed

    Seidman, Edward

    2012-09-01

    Seymour B. Sarason's innovative ideas have influenced much of my work. These same ideas-in particular, his concepts of social settings, behavioral and programmatic regularities, and the universe of alternatives-also serve as the foundation for an action science of social settings. Questions regarding theory, measurement, intervention, and research design and data analysis are central to the development of this action science, and there have been recent innovations in each of these areas. However, future challenges remain for the field. We must continue to move forward to advance an action science of social settings and make a real difference in people's lives.

  15. 42 CFR 405.440 - Emergency and urgent care services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Emergency and urgent care services. 405.440 Section... Emergency and urgent care services. (a) A physician or practitioner who has opted-out of Medicare under this subpart need not enter into a private contract to furnish emergency care services or urgent care...

  16. Death anxiety among emergency care workers.

    PubMed

    Brady, Mike

    2015-07-01

    Death anxiety, or 'thanatophobia', is a state in which people experience negative emotional reactions in recognition of their own mortality. Emergency and unscheduled healthcare workers, such as emergency nurses and paramedics, are constantly reminded of death and therefore of their own mortality, and this makes them susceptible to death anxiety. This article introduces the concept of death anxiety, and highlights the need for staff, employers and universities to recognise its signs and symptoms. It also suggests some interventions that could prevent the debilitating effects of death anxiety, to improve staff's mental health and the care they provide to patients.

  17. A mobile platform for emergency care.

    PubMed

    Losiouk, Eleonora; Quaglini, Silvana; Pesenti Campagnoni, Massimo; Lanzola, Giordano

    2015-01-01

    The paper describes the adaptation of a mobile platform initially developed for designing and administering questionnaires to a new context supporting checklists in emergency care. We took part in the checklists formalization process together with the domain experts and recognized that some tasks would highly benefit from the inherent features offered by the mobile technology. Thus we exploited the robustness of the model already designed for navigating among questionnaires and implemented additional functionalities that improved the usability of the mobile application, making it suitable for the paramedic staff and the volunteers that manage emergency cases.

  18. Evolution of emergency cardiac care in Canada.

    PubMed Central

    Webster, A. C.

    1977-01-01

    Acute myocardial infarction is the most common cause of death in Canada. Most deaths occur within the first 2 hours of the onset of symptoms, before the person seeks or is able to obtain medical aid, and are due to arrhythmias rather than massive myocardial damage. Effective electrical and drug treatment of arrhythmias has reduced the hospital mortality but not the community mortality. If mortality from acute myocardial infarction and other causes of sudden unexpected death is to be reduced substantially a major reorganization of emergency medical services is needed so that the benefits of the modern coronary care unit can be provided to the patient as rapidly as possible. Public education in basic life support procedures to sustain life until advanced life support aid arrives is the first step towards the development of a more effective system of emergency cardiac care. PMID:589537

  19. 32 CFR 1656.20 - Expenses for emergency medical care.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 6 2010-07-01 2010-07-01 false Expenses for emergency medical care. 1656.20... ALTERNATIVE SERVICE § 1656.20 Expenses for emergency medical care. (a) Claims for payment of actual and reasonable expenses for emergency medical care, including hospitalization, of ASWs who suffer illness...

  20. Optimizing antibiotic therapy in the intensive care unit setting

    PubMed Central

    Kollef, Marin H

    2001-01-01

    Antibiotics are one of the most common therapies administered in the intensive care unit setting. In addition to treating infections, antibiotic use contributes to the emergence of resistance among pathogenic microorganisms. Therefore, avoiding unnecessary antibiotic use and optimizing the administration of antimicrobial agents will help to improve patient outcomes while minimizing further pressures for resistance. This review will present several strategies aimed at achieving optimal use of antimicrobial agents. It is important to note that each intensive care unit should have a program in place which monitors antibiotic utilization and its effectiveness. Only in this way can the impact of interventions aimed at improving antibiotic use (e.g. antibiotic rotation, de-escalation therapy) be evaluated at the local level. PMID:11511331

  1. Access Barriers to Prenatal Care in Emerging Adult Latinas.

    PubMed

    Torres, Rosamar

    2016-03-01

    Despite efforts to improve access to prenatal care, emerging adult Latinas in the United States continue to enter care late in their pregnancies and/or underutilize these services. Since little is known about emerging adult Latinas and their prenatal care experiences, the purpose of this study was to identify actual and perceived prenatal care barriers in a sample of 54 emerging adult Latinas between 18 and 21 years of age. More than 95% of the sample experienced personal and institutional barriers when attempting to access prenatal care. Results from this study lend support for policy changes for time away from school or work to attend prenatal care and for group prenatal care.

  2. Mental Health in Long Term Care Settings.

    ERIC Educational Resources Information Center

    Shore, Herbert

    1978-01-01

    There are many ways in which long-term care facilities attempt to cope with the mental health problems of the elderly. The author reviews five factors crucial to effective care for the aged in these facilities. (Author/RK)

  3. Smoke Inhalation in a Rural Emergency Setting: A Simulation Session

    PubMed Central

    Jong, Robert; Krustev, Eugene; Heroux, Aron

    2016-01-01

    Smoke inhalation-associated lung injuries (SI-ALI) present multiple challenges to the rural emergency department, and they require timely and appropriate management to prevent significant mortality and morbidity. In this report, we outline an adaptable simulation of an SI-ALI patient that is designed for use in a rural emergency department. The aim of this simulation is to better equip clinicians and emergency department staff who may encounter SI-ALI in rural settings. The case is suitable for resident doctors and emergency department staff. PMID:27774354

  4. Substance use disorder patient privacy and comprehensive care in integrated health care settings.

    PubMed

    Schaper, Elizabeth; Padwa, Howard; Urada, Darren; Shoptaw, Steven

    2016-02-01

    The Affordable Care Act (ACA) expands health insurance coverage for substance use disorder (SUD) treatment, underscoring the value of improving SUD service integration in primarily physical health care settings. It is not yet known to what degree specialized privacy regulations-Code of Federal Regulations Title 42, Part 2 (42 CFR Part 2), in particular-will affect access to or the utilization and delivery of SUD treatment in primary care. In addition to exploring the emerging benefits and barriers that specialized confidentiality regulations pose to treatment in early adopting integrated health care settings, this article introduces and explicates 42 CFR Part 2 to support provider and administrator implementation of SUD privacy regulations in integrated settings. The authors also argue that, although intended to protect patients with SUD, special SUD information protection may inadvertently reinforce stigma against patients by purporting the belief that SUD is different from other health problems and must be kept private. In turn, this stigma may inhibit the delivery of comprehensive integrated care.

  5. Quality of care in hospital emergency departments and family physicians' offices.

    PubMed Central

    Spasoff, R. A.; Lane, P.; Steele, R.

    1977-01-01

    Indicator conditions were used to evaluate the quality of 686 episodes of care provided in two emergency departments and in five family physicians' offices. Overall, the care was considered adequate in 53% of the emergency department cases and in 40% of the cases dealt with in family physicians' offices, the difference being significant (P less than 0.01). Referrals were very common in both settings, and when quality was assessed solely on the basis of the care actually given by the primary-care providers the difference between the two settings disappeared. Half the observed deficiencies in care related to failure to document the findings from history-taking and physical examination. From these and earlier findings we conclude that the emergency department can be an appropriate setting for the care of nontraumatic illness. PMID:880525

  6. Perceptions of emergency care in Kenyan communities lacking access to formalised emergency medical systems: a qualitative study

    PubMed Central

    Broccoli, Morgan C; Calvello, Emilie J B; Skog, Alexander P; Wachira, Benjamin; Wallis, Lee A

    2015-01-01

    Objectives We undertook this study in Kenya to understand the community's emergency care needs and barriers they face when trying to access care, and to seek community members’ thoughts regarding high impact solutions to expand access to essential emergency services. Design We used a qualitative research methodology to conduct 59 focus groups with 528 total Kenyan community member participants. Data were coded, aggregated and analysed using the content analysis approach. Setting Participants were uniformly selected from all eight of the historical Kenyan provinces (Central, Coast, Eastern, Nairobi, North Eastern, Nyanza, Rift Valley and Western), with equal rural and urban community representation. Results Socioeconomic and cultural factors play a major role both in seeking and reaching emergency care. Community members in Kenya experience a wide range of medical emergencies, and seem to understand their time-critical nature. They rely on one another for assistance in the face of substantial barriers to care—a lack of: system structure, resources, transportation, trained healthcare providers and initial care at the scene. Conclusions Access to emergency care in Kenya can be improved by encouraging recognition and initial treatment of emergent illness in the community, strengthening the pre-hospital care system, improving emergency care delivery at health facilities and creating new policies at a national level. These community-generated solutions likely have a wider applicability in the region. PMID:26586324

  7. Terrorism and the ethics of emergency medical care.

    PubMed

    Pesik, N; Keim, M E; Iserson, K V

    2001-06-01

    The threat of domestic and international terrorism involving weapons of mass destruction-terrorism (WMD-T) has become an increasing public health concern for US citizens. WMD-T events may have a major effect on many societal sectors but particularly on the health care delivery system. Anticipated medical problems might include the need for large quantities of medical equipment and supplies, as well as capable and unaffected health care providers. In the setting of WMD-T, triage may bear little resemblance to the standard approach to civilian triage. To address these issues to the maximum benefit of our patients, we must first develop collective forethought and a broad-based consensus that these decisions must reach beyond the hospital emergency department. Critical decisions like these should not be made on an individual case-by-case basis. Physicians should never be placed in a position of individually deciding to deny treatment to patients without the guidance of a policy or protocol. Emergency physicians, however, may easily find themselves in a situation in which the demand for resources clearly exceeds supply. It is for this reason that emergency care providers, personnel, hospital administrators, religious leaders, and medical ethics committees need to engage in bioethical decision making before an acute bioterrorist event.

  8. Predicting Homelessness among Emerging Adults Aging Out of Foster Care.

    PubMed

    Shah, Melissa Ford; Liu, Qinghua; Mark Eddy, J; Barkan, Susan; Marshall, David; Mancuso, David; Lucenko, Barbara; Huber, Alice

    2016-11-10

    This study examines risk and protective factors associated with experiencing homelessness in the year after "aging out" of foster care. Using a state-level integrated administrative database, we identified 1,202 emerging adults in Washington State who exited foster care between July 2010 and June 2012. Initial bivariate analyses were conducted to assess the association between candidate predictive factors and an indicator of homelessness in a 12-month follow-up period. After deploying a stepwise regression process, the final logistic regression model included 15 predictive factors. Youth who were parents, who had recently experienced housing instability, or who were African American had approximately twice the odds of experiencing homelessness in the year after exiting foster care. In addition, youth who had experienced disrupted adoptions, had multiple foster care placements (especially in congregate care settings), or had been involved with the juvenile justice system were more likely to become homeless. In contrast, youth were less likely to experience homelessness if they had ever been placed with a relative while in foster care or had a high cumulative grade point average relative to their peers.

  9. Patient and public involvement in emergency care research.

    PubMed

    Hirst, Enid; Irving, Andy; Goodacre, Steve

    2016-09-01

    Patients participate in emergency care research and are the intended beneficiaries of research findings. The public provide substantial funding for research through taxation and charitable donations. If we do research to benefit patients and the public are funding the research, then patients and the public should be involved in the planning, prioritisation, design, conduct and oversight of research, yet patient and public involvement (or more simply, public involvement, since patients are also members of the public) has only recently developed in emergency care research. In this article, we describe what public involvement is and how it can help emergency care research. We use the development of a pioneering public involvement group in emergency care, the Sheffield Emergency Care Forum, to provide insights into the potential and challenges of public involvement in emergency care research.

  10. Emerging paradigms on glucose management in the intensive care unit.

    PubMed

    Evans, A S; Hosseinian, L; Mechanick, J I

    2014-12-01

    Hyperglycemia is common in critical illness and leads to increased morbidity and mortality. Controversy exists whether tight glycemic control via intensive insulin therapy can safely and effectively improve outcomes. In this review article, we will sort through the pertinent evidence base to identify salient, yet emergent, paradigms to guide management. To this end, we will discuss underlying biologic mechanisms relevant to hyperglycemia and insulinization in critical illness, summarize results of major randomized controlled clinical trials for glycemic control in the intensive care unit (ICU), and fill in the gaps with necessary information. We will conclude with specific messages, not only reflecting our own clinical experiences, but amenable to implementation in different ICU settings.

  11. Overview of point-of-care abdominal ultrasound in emergency and critical care.

    PubMed

    Kameda, Toru; Taniguchi, Nobuyuki

    2016-01-01

    Point-of-care abdominal ultrasound (US), which is performed by clinicians at bedside, is increasingly being used to evaluate clinical manifestations, to facilitate accurate diagnoses, and to assist procedures in emergency and critical care. Methods for the assessment of acute abdominal pain with point-of-care US must be developed according to accumulated evidence in each abdominal region. To detect hemoperitoneum, the methodology of a focused assessment with sonography for a trauma examination may also be an option in non-trauma patients. For the assessment of systemic hypoperfusion and renal dysfunction, point-of-care renal Doppler US may be an option. Utilization of point-of-care US is also considered in order to detect abdominal and pelvic lesions. It is particularly useful for the detection of gallstones and the diagnosis of acute cholecystitis. Point-of-case US is justified as the initial imaging modality for the diagnosis of ureterolithiasis and the assessment of pyelonephritis. It can be used with great accuracy to detect the presence of abdominal aortic aneurysm in symptomatic patients. It may also be useful for the diagnoses of digestive tract diseases such as appendicitis, small bowel obstruction, and gastrointestinal perforation. Additionally, point-of-care US can be a modality for assisting procedures. Paracentesis under US guidance has been shown to improve patient care. US appears to be a potential modality to verify the placement of the gastric tube. The estimation of the amount of urine with bladder US can lead to an increased success rate in small children. US-guided catheterization with transrectal pressure appears to be useful in some male patients in whom standard urethral catheterization is difficult. Although a greater accumulation of evidences is needed in some fields, point-of-care abdominal US is a promising modality to improve patient care in emergency and critical care settings.

  12. Emergency Victim Care. A Textbook for Emergency Medical Personnel.

    ERIC Educational Resources Information Center

    Ohio State Dept. of Education, Columbus. Trade and Industrial Education Service.

    This textbook for emergency medical personnel should be useful to fire departments, private ambulance companies, industrial emergency and rescue units, police departments, and nurses. The 30 illustrated chapters cover topics such as: (1) Emergency Medical Service Vehicles, (2) Safe Driving Practices, (3) Anatomy and Physiology, (4) Closed Chest…

  13. Advanced units: quality measures in urgency and emergency care

    PubMed Central

    Viola, Dan Carai Maia; Cordioli, Eduardo; Pedrotti, Carlos Henrique Sartorato; Iervolino, Mauro; Bastos, Antonio da Silva; de Almeida, Luis Roberto Natel; Neves, Henrique Sutton de Sousa; Lottenberg, Claudio Luiz

    2014-01-01

    Objective To evaluate, through care indicators, the quality of services rendered to patients considered urgency and emergency cases at an advanced emergency care unit. Methods We analyzed data from managerial reports of 64,891 medical visits performed in the Emergency Care Unit of the Ibirapuera Unit at Care during the period from June 1st, 2012 through May 31st, 2013. The proposed indicators for the assessment of care were rate of death in the emergency care unit; average length of stay of patients in the unit; rate of unplanned return visits; admission rate for patients screened as level 1 according to the Emergency Severity Index; rate of non-finalized medical consultations; rate of complaints; and door-to-electrocardiogram time. Results The rate of death in the emergency care unit was zero. Five of the 22 patients classified as Emergency Severity Index 1 (22.7%) arrived presenting cardiac arrest. All were treated with cardiopulmonary resuscitation and reestablishment of vital functions. The average length of stay of patients in the unit was 3 hours, 33 minutes, and 7 seconds. The rate of unscheduled return visits at the emergency care unit of the Ibirapuera unit was 13.64%. Rate of complaints was 2.8/1,000 patients seen during the period Conclusion The model of urgency and emergency care in advanced units provides an efficient and efficaious service to patients. Both critically ill patients and those considered less complex can receive proper treatment for their needs. PMID:25628203

  14. 65. FORWARD EMERGENCY DIESEL GENERATOR SET AFT LOOKING FORWARD ...

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

    65. FORWARD EMERGENCY DIESEL GENERATOR SET - AFT LOOKING FORWARD SHOWING TOP HALF OF FAIRBANKS MORSE 36D81/8 TEN CYLINDER DIESEL ENGINE SERIAL #951230 AND EXHAUST SYSTEM. - U.S.S. HORNET, Puget Sound Naval Shipyard, Sinclair Inlet, Bremerton, Kitsap County, WA

  15. 64. FORWARD EMERGENCY DIESEL GENERATOR SET STARBOARD LOOKING TO ...

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

    64. FORWARD EMERGENCY DIESEL GENERATOR SET - STARBOARD LOOKING TO PORT SHOWING BOTTOM HALF OF FAIRBANKS MORSE 36D81/8 TEN CYLINDER DIESEL ENGINE SERIAL #951230 AND GENERAL ELECTRIC 1,000KW GENERATOR KVA 1250, RPM 720, SERIAL #6920274. - U.S.S. HORNET, Puget Sound Naval Shipyard, Sinclair Inlet, Bremerton, Kitsap County, WA

  16. Promoting emergency medical care systems in the developing world: weighing the costs.

    PubMed

    Anthony, David R

    2011-01-01

    Despite the global health community's historical focus on providing basic, cost-effective primary health care delivered at the community level, recent trends in the developing world show increasing demand for the implementation of emergency care infrastructures, such as prehospital care systems and emergency departments, as well as specialised training programmes. However, the question remains whether, in a setting of limited global health care resources, it is logical to divert these already-sparse resources into the development of emergency care frameworks. The existing literature overwhelmingly supports the idea that emergency care systems, both community-based and within medical institutions, improve important outcomes, including significant morbidity and mortality. Crucial to the success of any public health or policy intervention, emergency care systems also seem to be strongly desired at the community and governmental levels. Integrating emergency care into existing health care systems will ideally rely on modest, low-cost steps to augment current models of primary health care delivery, focusing on adapting the lessons learned in the developed world to the unique needs and local variability of the rest of the globe.

  17. [Recruitment and training of prehospital emergency care nurses in Paris].

    PubMed

    Pladec, Boris Martin le; Menoret, Romuald; Rodes, Raphaël

    2016-11-01

    In collaboration with the ambulance driver and the emergency doctor, the prehospital nurse provides care in a universe which is often difficult and sometimes hostile. Whether they are a nurse from the Samu (urgent medical aid service) or from the Paris fire service, how are they recruited and what training do these emergency care professionals receive?

  18. What Should I Do? A Safety and Emergency Care Handbook.

    ERIC Educational Resources Information Center

    Crist, Mary Jo; And Others

    One of a series written especially for parents and other caregivers, this handbook offers an overview of emergency care and safety considerations. The discussion of emergency care focuses on supplies for the first aid kit and provides guidelines for dealing with bleeding, bites, burns, suffocation, eye injury, broken bones, head injuries, fevers,…

  19. Designing Groups to Meet Evolving Challenges in Health Care Settings

    ERIC Educational Resources Information Center

    McCarthy, Christopher J.; Hart, Sonia

    2011-01-01

    This article provides an overview of the special issue on groups in health care settings and describes how each contribution addresses challenges and opportunities in the health care field for group work. Fundamental criteria for evaluating groups in such settings are applied to each contribution. Finally, trends and opportunities about the future…

  20. Nosocomial infection control in healthcare settings: Protection against emerging infectious diseases.

    PubMed

    Fu, Chuanxi; Wang, Shengyong

    2016-04-12

    The Middle East respiratory syndrome (MERS) outbreak in Korea in 2015 may be attributable to poor nosocomial infection control procedures implemented. Strict infection control measures were taken in the hospital where an imported case with MERS was treated in southern China and 53 health care workers were confirmed to be MERS-CoV negative. Infection control in healthcare settings, in which patients with emerging infectious diseases such as MERS, Ebola virus disease, and the severe acute respiratory syndrome (SARS) are diagnosed and treated, are often imperfect. When it comes to emerging or unknown infectious diseases, before the imported case was finally identified or community transmission was reported, cases have often occurred in clusters in healthcare settings. Nosocomial infection control measures should be further strengthened among the workers and inpatients in designated healthcare settings that accommodate suspected cases suffering from emerging or unknown infectious diseases.

  1. Emerging Trends of Herbal Care in Dentistry

    PubMed Central

    Kumar, Gunjan; Jalaluddin, Md.; Rout, Purnendu; Mohanty, Rajat; Dileep, C.L.

    2013-01-01

    Herbs are staging a comeback and herbal ‘renaissance’ is happening all over the globe. The herbal products, today, symbolize safety, in contrast to the synthetics that are regarded as unsafe to humans and the environment. A herb, botanically speaking, is any plant that lacks the woody tissue which is characteristic of shrubs or trees. More specifically, herbs are plants which are used medicinally or for their flavour or scent. Herbs with medicinal properties are a useful and an effective source of treatment for various disease processes. Herbal extracts have been successfully used in dentistry as tooth cleaning and antimicrobial plaque agents. The use of herbal medicines continues to expand rapidly across the world. Many people take herbal medicines or herbal products now for their health care in different national healthcare settings. Herbal extracts have been used in dentistry for reducing inflammation, as antimicrobial plaque agents, for preventing release of histamine and as antiseptics, antioxidants, antimicrobials, antifungals, antibacterials, antivirals and analgesics. They also aid in healing and are effective in controlling microbial plaque in gingivitis and periodontitis, thereby improving immunity. PMID:24086929

  2. Complicated deliveries, critical care and quality in emergency obstetric care in Northern Tanzania.

    PubMed

    Olsen, Ø E; Ndeki, S; Norheim, O F

    2004-10-01

    Our objective was to determine the availability and quality of obstetric care to improve resource allocation in northern Tanzania. We surveyed all facilities providing delivery services (n=129) in six districts in northern Tanzania using the UN Guidelines for monitoring emergency obstetric care (EmOC). The three last questions in this audit outline are examined: Are the right women (those with obstetric complications) using emergency obstetric care facilities (Met Need)? Are sufficient quantities of critical services being provided (cesarean section rate (CSR))? Is the quality of the services adequate (case fatality rate (CFR))? Complications are calculated using Plan 3 of the UN Guidelines to assess the value of routine data for EmOC indicator monitoring. Nearly 60% of the expected complicated deliveries in the study population were conducted at EmOC qualified health facilities. 81.2% of the expected complicated deliveries are conducted in any facility (including facilities not qualifying as EmOC facilities). There is an inadequate level of critical services provided (CSR 4.6). Voluntary agencies provide most of these services in rural settings. All indicators show large variations with the setting (urban/rural location, level and ownership of facilities). Finally, there is large variation in the CFR with only one facility meeting the minimum accepted level. Utilization and quality of critical obstetric services at lower levels and in rural districts must be improved. The potential for improving the resource allocation within lower levels of the health care system is discussed. Given the small number of qualified facilities yet relatively high Met Need, we argue that it is neither the mothers' ignorance nor their lack of ability to get to a facility that is the main barrier to receiving quality care when needed, but rather the lack of quality care at the facility. Little can be concluded using the CFR to describe the quality of services provided.

  3. Point-of-care ultrasonography by pediatric emergency medicine physicians.

    PubMed

    Marin, Jennifer R; Lewiss, Resa E

    2015-04-01

    Emergency physicians have used point-of-care ultrasonography since the 1990 s. Pediatric emergency medicine physicians have more recently adopted this technology. Point-of-care ultrasonography is used for various scenarios, particularly the evaluation of soft tissue infections or blunt abdominal trauma and procedural guidance. To date, there are no published statements from national organizations specifically for pediatric emergency physicians describing the incorporation of point-of-care ultrasonography into their practice. This document outlines how pediatric emergency departments may establish a formal point-of-care ultrasonography program. This task includes appointing leaders with expertise in point-of-care ultrasonography, effectively training and credentialing physicians in the department, and providing ongoing quality assurance reviews.

  4. [Structure, organization and capacity problems in emergency medical services, emergency admission and intensive care units].

    PubMed

    Dick, W

    1994-01-01

    Emergency medicine is subjected worldwide to financial stringencies and organizational evaluations of cost-effectiveness. The various links in the chain of survival are affected differently. Bystander assistance or bystander CPR is available in only 30% of the emergencies, response intervals--if at all required by legislation--are observed to only a limited degree or are too extended for survival in cardiac arrest. A single emergency telephone number is lacking. Too many different phone numbers for emergency reporting result in confusion and delays. Organizational realities are not fully overcome and impair efficiency. The position of the emergency physician in the EMS System is inadequately defined, the qualification of too many emergency physicians are unsatisfactory. In spite of this, emergency physicians are frequently forced to answer out-of-hospital emergency calls. Conflicts between emergency physicians and EMTs may be overcome by providing both groups with comparable qualifications as well as by providing an explicit definition of emergency competence. A further source of conflict occurs at the juncture of prehospital and inhospital emergency care in the emergency department. Deficiencies on either side play a decisive role. At least in principle there are solutions to the deficiencies in the EMSS and in intensive care medicine. They are among others: Adequate financial compensation of emergency personnel, availability of sufficient numbers of highly qualified personnel, availability of a central receiving area with an adjacent emergency ward, constant information flow to the dispatch center on the number of available emergency beds, maintaining 5% of all beds as emergency beds, establishing intermediate care facilities. Efficiency of emergency physician activities can be demonstrated in polytraumatized patients or in patients with ventricular fibrillation or acute myocardial infarction, in patients with acute myocardial insufficiency and other emergency

  5. Building a transdisciplinary approach to palliative care in an acute care setting.

    PubMed

    Daly, Donnelle; Matzel, Stephen Chavez

    2013-01-01

    A transdisciplinary team is an essential component of palliative and end-of-life care. This article will demonstrate how to develop a transdisciplinary approach to palliative care, incorporating nursing, social work, spiritual care, and pharmacy in an acute care setting. Objectives included: identifying transdisciplinary roles contributing to care in the acute care setting; defining the palliative care model and mission; identifying patient/family and institutional needs; and developing palliative care tools. Methods included a needs assessment and the development of assessment tools, an education program, community resources, and a patient satisfaction survey. After 1 year of implementation, the transdisciplinary palliative care team consisted of seven palliative care physicians, two social workers, two chaplains, a pharmacist, and End-of-Life Nursing Consortium (ELNEC) trained nurses. Palomar Health now has a palliative care service with a consistent process for transdisciplinary communication and intervention for adult critical care patients with advanced, chronic illness.

  6. Asthma Care in Resource-Poor Settings

    PubMed Central

    2011-01-01

    Asthma prevalence in low-to middle-income countries is at least the same or higher than in rich countries, but with increased severity. Lack of control in these settings is due to various factors such as low accessibility to effective medications, multiple and uncoordinated weak infrastructures of medical services for the management of chronic diseases such as asthma, poor compliance with prescribed therapy, lack of asthma education, and social and cultural factors. There is an urgent requirement for the implementation of better ways to treat asthma in underserved populations, enhancing the access to preventive medications and educational approaches with modern technological methods. PMID:23282401

  7. Goal setting: an integral component of effective diabetes care.

    PubMed

    Miller, Carla K; Bauman, Jennifer

    2014-08-01

    Goal setting is a widely used behavior change tool in diabetes education and training. Prior research found specific relatively difficult but attainable goals set within a specific timeframe improved performance in sports and at the workplace. However, the impact of goal setting in diabetes self-care has not received extensive attention. This review examined the mechanisms underlying behavioral change according to goal setting theory and evaluated the impact of goal setting in diabetes intervention studies. Eight studies were identified, which incorporated goal setting as the primary strategy to promote behavioral change in individual, group-based, and primary care settings among patients with type 2 diabetes. Improvements in diabetes-related self-efficacy, dietary intake, physical activity, and A1c were observed in some but not all studies. More systematic research is needed to determine the conditions and behaviors for which goal setting is most effective. Initial recommendations for using goal setting in diabetes patient encounters are offered.

  8. The current scenario of emergency care policies in Brazil

    PubMed Central

    2013-01-01

    Background The regulation of emergency care has featured prominently in Brazil’s federal health agenda since the 2000s. The aim of this study was to review up to the present day the implementation of the National Emergency Care Policy. Methods The methods employed were documental review, analysis of official data and 11 interviews conducted with federal, state and local managers. The results were analyzed using Giddens’ Structuration Theory, relating the cognitive abilities of the agents to their action strategies, in view of the structural dimensions, rules and resources provided by the federal administration. Results Federal policy for emergency care in Brazil can be divided into three stages: from 1998 to 2003, the initial regulation; from 2004 to 2008, the expansion of the Mobile Emergency Medical Services (SAMU, in Brazil); and from 2009 onwards, the implementation of stationary pre-hospital care facilities, known as Emergency Care Units (UPA). The structuration elements identified for the emergency care policy were the public health system guidelines, legislation, standards and federal financing. Significant restrictions were found such as lack of hospital beds and intensive care treatment, gaps in the information system for producing evidence for management, ineffective Management Committees, as well as a low degree of commitment among physicians to the services. Conclusion Considering the financial constraints imposed on the SUS (Brazilian Unified Health System), emergency care was identified as a political priority with financial support. The individual actions by emergency care workers and governmental agents typified the first period of the policy, structuring the basis and producing changes in the circumstances of action. Federal strategies can be equated to the rules and resources provided to support the implementation process of the policy. PMID:23425342

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

    PubMed Central

    Razzak, Junaid A.; Kellermann, Arthur L.

    2002-01-01

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

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

    PubMed

    Razzak, Junaid A; Kellermann, Arthur L

    2002-01-01

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

  11. Language interpreter utilization in the emergency department setting: a clinical review.

    PubMed

    Ramirez, Dorian; Engel, Kirsten G; Tang, Tricia S

    2008-05-01

    The emergency department (ED) serves as the entry point into the U.S. health care system for many patients with limited English proficiency (LEP). This paper reviews the literature on language interpreter utilization in the ED setting. We focused on three clinical issues related to professional language interpretation: (1) patient satisfaction, (2) health care delivery, and (3) current interpreter utilization practices. Compared with-English speaking patients, LEP patients report less satisfaction with medical encounters, have different rates of diagnostic testing, and receive less explanation and follow-up. Although professional interpretation has been associated with improvements in patient satisfaction, communication, and health care access, these services are largely under-utilized in ED settings. Reliance on untrained ad hoc interpreters, perceived time and labor associated with obtaining and working with an interpreter, and costs of implementing professional interpreter services serve as barriers to implementation and utilization.

  12. Emergency Wound Care After a Natural Disaster

    MedlinePlus

    ... About CDC.gov . Natural Disasters and Severe Weather Earthquakes Being Prepared Emergency Supplies Home Hazards Indoor Safety ... Matters What's New Preparation & Planning Disasters & Severe Weather Earthquakes Extreme Heat Floods Hurricanes Landslides Tornadoes Tsunamis Volcanoes ...

  13. Cognitive design of a digital desk for the emergency room setting

    PubMed Central

    Bang, Magnus; Prytz, Erik; Rybing, Jonas; Timpka, Toomas

    2014-01-01

    Digital desk technology has a still mainly unexplored potential to support the everyday work of collaborating clinicians. This paper presents ER Desk – a digital desk that was designed to specifically support a team of healthcare professionals working in an emergency room setting. The underlying design requirements were elicited in a comprehensive distributed cognition study of paper-based practices in an emergency room of a middle-sized Swedish hospital. We present the user interface and visualization requirements for digital desks for small clinical emergency room teams. Moreover, we discuss key design issues more generally with a focus on supporting team awareness, cognition, and collaborative routines of healthcare personnel working in clinical environments such as emergency rooms and intensive care units. PMID:25954329

  14. Emerging trends in health care finance.

    PubMed

    Sterns, J B

    1994-01-01

    Access to capital will become more difficult. Capital access is dependent on ability to repay debt, which, in turn, is dependent on internally generated cash flows. Under any health care reform proposal, revenue inflows will be slowed. The use of corporate finance techniques to limit financial risk and lower cost will be a permanent response to fundamental changes to the health care system. These changes will result in greater balance sheet management, centralized capital allocation, and alternative sources of capital.

  15. The Role of Child Care Settings in Obesity Prevention

    ERIC Educational Resources Information Center

    Story, Mary; Kaphingst, Karen M.; French, Simone

    2006-01-01

    Mary Story, Karen Kaphingst, and Simone French argue that researchers and policymakers focused on childhood obesity have paid insufficient attention to child care. Although child care settings can be a major force in shaping children's dietary intake, physical activity, and energy balance--and thus in combating the childhood obesity…

  16. Assessing Health Literacy in Diverse Primary Care Settings

    ERIC Educational Resources Information Center

    McCune, Renee L.

    2010-01-01

    Patient health literacy skills are critical to effective healthcare communication and safe care delivery in primary care settings. Methods and strategies to identify patient health literacy (HL) capabilities and provider/staff knowledge, attitudes and beliefs (KAB) regarding HL must be known before addressing provider/staff communication skills.…

  17. Management of Teenage Pregnancies in Three Different Health Care Settings.

    ERIC Educational Resources Information Center

    Tatelbaum, Robert

    1978-01-01

    This paper reports a retrospective study undertaken to determine if differences existed in obstetric outcome, contraceptive usage, and repeat pregnancy rates of teenage patients cared for in three different health care settings: the Rochester Adolescent Maternity Project (RAMP), a traditional obstetric clinic, and a neighborhood health center.…

  18. An Introductory Clinical Course--Orientation to Patient Care Settings.

    ERIC Educational Resources Information Center

    Bober, Kenneth F.; And Others

    1982-01-01

    A second-year clinical course composed of weekly observation sessions of interactions between patients and health care professionals in a variety of health care settings within a hospital is described. Weekly discussion sessions summarize the observations and introduce such topics as communication skills, patients' rights, patient relationships,…

  19. Examination of Negative Peer Contagion in a Residential Care Setting

    ERIC Educational Resources Information Center

    Huefner, Jonathan C.; Ringle, Jay L.

    2012-01-01

    There has been ongoing concern about the negative impact of residential treatment on youth in care. Research examining the impact of negative peer influence in juvenile justice, education, and residential care settings is reviewed. A study was conducted to examine the impact of negative peer contagion on the level of problem behavior in a…

  20. Creating Discursive Order at the End of Life: The Role of Genres in Palliative Care Settings

    ERIC Educational Resources Information Center

    Schryer, Catherine; McDougall, Allan; Tait, Glendon R.; Lingard, Lorelei

    2012-01-01

    This article investigates an emerging practice in palliative care: dignity therapy. Dignity therapy is a psychotherapeutic intervention that its proponents assert has clinically significant positive impacts on dying patients. Dignity therapy consists of a physician asking a patient a set of questions about his or her life and returning to the…

  1. The Influence of Setting on Care Coordination for Childhood Asthma

    PubMed Central

    Kelly, R. Patrick; Stoll, Shelley C.; Bryant-Stephens, Tyra; Janevic, Mary R.; Lara, Marielena; Ohadike, Yvonne U.; Persky, Victoria; Ramos-Valencia, Gilberto; Uyeda, Kimberly; Malveaux, Floyd J.

    2015-01-01

    Asthma affects 7.1 million children in the United States, disproportionately burdening African American and Latino children. Barriers to asthma control include insufficient patient education and fragmented care. Care coordination represents a compelling approach to improve quality of care and address disparities in asthma. The sites of The Merck Childhood Asthma Network Care Coordination Programs implemented different models of care coordination to suit specific settings—school district, clinic or health care system, and community—and organizational structures. A variety of qualitative data sources were analyzed to determine the role setting played in the manifestation of care coordination at each site. There were inherent strengths and challenges of implementing care coordination in each of the settings, and each site used unique strategies to deliver their programs. The relationship between the lead implementing unit and entities that provided (1) access to the priority population and (2) clinical services to program participants played a critical role in the structure of the programs. The level of support and infrastructure provided by these entities to the lead implementing unit influenced how participants were identified and how asthma care coordinators were integrated into the clinical care team. PMID:26232778

  2. Pediatric Mental Health Emergencies and Special Health Care Needs

    PubMed Central

    Chun, Thomas H.; Katz, Emily R.; Duffy, Susan J.

    2013-01-01

    SYNOPSIS Children with mental health problems are increasingly being evaluated and treated by both pediatric primary care and pediatric emergency physicians. This article focuses on the epidemiology, evaluation, and management of the two most common pediatric mental health emergencies, suicidal and homicidal/aggressive patients, as well as the equally challenging population of children with autism or other developmental disabilities. PMID:24093903

  3. Code Blue! Establishing a Child Care Emergency Plan.

    ERIC Educational Resources Information Center

    Copeland, Margaret Leitch

    1996-01-01

    Discusses steps necessary to develop an emergency preparedness plan for child care centers: (1) identifying the need for policies through brainstorming and reviewing previous emergencies; (2) identifying potential issues through consultation; (3) establishing center procedures; (4) identifying a spokesperson to present accurate public information;…

  4. [Teamwork in a paediatric mobile emergency and intensive care service].

    PubMed

    Tison-Chambellan, Camille; Daussac, Élisabeth; Barnet, Lucile; Sirven, Sabine; Bambou, Dominique

    2016-01-01

    A paediatric mobile emergency and intensive care service team comprises several professionals with complementary skills. The cohesion of a team, as well as the listening and communication skills of each of its members, allow it to respond in the best possible way to emergency situations. Feedback sessions on practice and simulation exercises enhance teamwork.

  5. Estimating Uncompensated Care Charges at Rural Hospital Emergency Departments

    ERIC Educational Resources Information Center

    Bennett, Kevin J.; Moore, Charity G.; Probst, Janice C.

    2007-01-01

    Context: Rural hospitals face multiple financial burdens. Due to federal law, emergency departments (ED) provide a gateway for uninsured and self-pay patients to gain access to treatment. It is unknown how much uncompensated care in rural hospitals is due to ED visits. Purpose: To develop a national estimate of uncompensated care from patients…

  6. Emergent Subjectivity in Caring Institutions for Teenagers

    ERIC Educational Resources Information Center

    Severinsson, Susanne; Nord, Catharina

    2015-01-01

    We investigate how different mealtime situations help shape teenager and staff subjectivities in two Swedish residential care homes and a special school for girls and boys, 12-15 years old, with social, emotional and behavioural difficulties. Three mealtime networks are analysed using concepts from actor-network theory, treating architectural…

  7. Borderline personality disorder in the primary care setting.

    PubMed

    Dubovsky, Amelia N; Kiefer, Meghan M

    2014-09-01

    Borderline personality disorder is estimated to be present in approximately 6% of outpatient primary care settings. However, the time and energy spent on this population can greatly exceed what primary care doctors are able to spend. This article gives an overview of borderline personality disorder, including the clinical characteristics, epidemiology, and comorbidities, as well as pharmacologic and most important behavioral management. It is our hope that, with improved understanding of the disorder and skills for managing this population, caring for patients with the disorder can be more satisfying and less taxing for both primary care doctors and their patients.

  8. Tensions in setting health care priorities for South Africa's children.

    PubMed Central

    Landman, W A; Henley, L D

    1998-01-01

    The new South African constitution commits the government to guarantee "basic health services" for every child under 18. Primary health care for pregnant women and children under six and elements of essential primary health care have received priority. At present, there is little analysis of the moral considerations involved in making choices about more advanced or costly health care which may, arguably, also be "basic". This paper illustrates some of the tensions in setting priorities for a just macro-allocation of children's health care, given the realities of need and scarce resources, and the commitment to equality of basic opportunities. PMID:9752631

  9. [Paediatric mobile emergency and intensive care services, objectives and missions].

    PubMed

    Julliand, Sébastien; Lodé, Noëlla

    2016-01-01

    The paediatric mobile emergency and intensive care service care teams have expertise in taking care of children in life-threatening circumstances. At the Robert-Debré Hospital in Paris, the paediatric Smur is multi-skilled, specialising particularly in transporting neonates and infants with severe cardiac or respiratory difficulties. The pathologies handled are very varied and include both neonatal pathologies and trauma pathologies in older children.

  10. Toward Ubiquitous Communication Platform for Emergency Medical Care

    NASA Astrophysics Data System (ADS)

    Ishibashi, Kenichi; Morishima, Naoto; Kanbara, Masayuki; Sunahara, Hideki; Imanishi, Masami

    Interaction between emergency medical technicians (EMTs) and doctors is essential in emergency medical care. Doctors require diverse information related to a patient to provide efficient aid. In 2005, we started the Ikoma119 project and have developed a ubiquitous communication platform for emergency medical care called Mobile ER. Our platform, which is based on wireless internet technology, has such desirable properties as low-cost, location-independent service, and ease of service introduction. We provide an overview of our platform and describe the services that we have developed. We also discuss the remaining issues to realize our platform's actual operation.

  11. Skills required for maritime pre-hospital emergency care.

    PubMed

    Mellor, Adrian

    2012-01-01

    Pre-hospital emergency care (PHEC) in the military has undergone major changes during the last 10 years of warfighting in the land environment. Providing this care in the maritime environment presents several unique challenges. This paper examines the clinical capabilities required of a PHEC team in the maritime environment and how this role can be fulfilled as part of Role 2 Afloat. It applies to Pre-hospital emergency care projected from a hospital not to General Duties Medical Officers at Role 1.

  12. Emergency radiology today between philosophy of science and the reality of "emergency care".

    PubMed

    Romano, L; Scaglione, M; Rotondo, A

    2006-03-01

    In the past 20 years, emergency care concept has substantially changed on a cultural point of view, going well beyond the boundaries of medical science. It is now a general understanding that the real enemy of the critical patient is time; thus, functional organisation and collocation of human and technological resources in the emergency department (ED) can help avoid the loss of human lives. This "cultural revolution" led to the creation and development of structural and organisational models (layouts) of EDs. Now, emergency radiology has a central role in ED organisation, and the radiologist, providing 24-h coverage in the emergency room, is crucial for the correct diagnostic approach and rapid management of trauma. If this is the cultural background to the "emergency care" concept, an overview of such care in our country shows great differences from a structural, technological and organisational point of view. The presence of the radiologist providing 24-h coverage in the emergency room is still uncommon in many EDs The qualification of emergency care must be sought by studying the needs of the population and by seeking qualified personnel with high professional skill levels. All this must be understood and pursued by politicians and health care managers whose aim should be to coordinate and check the measures and human resources applied to the system. This process necessarily involves rewarding those health care professionals who prove to be up to the job.

  13. Emergency neurological care of strokes and bleeds

    PubMed Central

    Birenbaum, Dale

    2010-01-01

    Ischemic stroke and brain hemorrhage are common and challenging problems faced by emergency physicians. In this article, important details in the diagnosis and clinical management of these neurological emergencies are presented with the following goals: 1) To provide a more comprehensive understanding of the approach to the identification and management of patients who have sustained ischemic and hemorrhagic strokes; 2) to explain the importance and application of commonly used national stroke scoring and outcome scales; 3) to improve the ability to recognize important aspects in the approach and comprehensive treatment of ruptured and unruptured intracranial aneurysms; and 4) to demonstrate the difficulties in the neurological, neurosurgical, and endovascular treatment of these catastrophic diseases. PMID:20165722

  14. Trampoline injury in New Zealand: emergency care.

    PubMed Central

    Hume, P A; Chalmers, D J; Wilson, B D

    1996-01-01

    OBJECTIVE: To examine trampoline related injuries resulting in emergency department attendance. METHODS: Cases were identified by searching free text descriptions of the circumstances of injury contained in the records of the emergency department of a large city hospital. RESULTS: 114 cases were identified for a 12 month period, giving an incidence rate of 108 per 100,000 population per year (95% confidence interval = 89 to 129) compared with 9.3 hospital admissions per 100,000 population per year (95% confidence interval = 8.3 to 10.4) for a corresponding period reported in earlier research from New Zealand. This suggested that for every one hospital admission there are approximately 12 emergency department attendances. Of the cases, 95% were aged less than 20 years. As for the earlier research, falls from the trampoline to the surrounding surface were the commonest cause of injury. In the present study, sprains and strains were the commonest type of injury (40%), and the body site most frequently involved was the lower limb (46%). CONCLUSIONS: The findings support the conclusion from earlier research that although existing trampoline standards address many of the issues relating to trampoline safety, the need remains for measures to reduce the impact of falls from the trampoline to the ground surface and to prohibit the use of trampolines as unsupervised "play equipment". PMID:9015596

  15. Deciding to Seek Emergency Care for Acute Myocardial Infarction.

    PubMed

    Noureddine, Samar; Dumit, Nuhad Y; Saab, Mohammad

    2015-10-01

    The purpose of this qualitative descriptive study was to explore how patients who experience acute myocardial infarction (AMI) decide to seek emergency care. Fifty patients with AMI were interviewed at two hospitals in Lebanon. The perspective of 22 witnesses of the attack was also sought about the cardiac event. The themes that transpired from the data were as follows: making sense of the symptoms, waiting to see what happens, deciding to come to the hospital, and the family influenced the decision to seek care. The witnesses of the cardiac event, mostly family members, supported the decision to seek emergency care. Deciding to seek emergency care for AMI is complex. Nurses must solicit their patients' perception of the cardiac event to provide them with tailored education and counseling about heart attack symptoms and how to respond to them in case they recur. Family members must be included in the education process.

  16. A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings

    PubMed Central

    Honasoge, Akilesh; Lyons, Neal; Hesse, Kathleen; Parker, Braden; Mokszycki, Robert; Wesselhoff, Kelly; Sweis, Rolla; Kulstad, Erik B.

    2016-01-01

    The available routes of administration commonly used for medications and fluids in the acute care setting are generally limited to oral, intravenous, or intraosseous routes, but in many patients, particularly in the emergency or critical care settings, these routes are often unavailable or time-consuming to access. A novel device is now available that offers an easy route for administration of medications or fluids via rectal mucosal absorption (also referred to as proctoclysis in the case of fluid administration and subsequent absorption). Although originally intended for the palliative care market, the utility of this device in the emergency setting has recently been described. Specifically, reports of patients being treated for dehydration, alcohol withdrawal, vomiting, fever, myocardial infarction, hyperthyroidism, and cardiac arrest have shown success with administration of a wide variety of medications or fluids (including water, aspirin, lorazepam, ondansetron, acetaminophen, methimazole, and buspirone). Device placement is straightforward, and based on the observation of expected effects from the medication administrations, absorption is rapid. The rapidity of absorption kinetics are further demonstrated in a recent report of the measurement of phenobarbital pharmacokinetics. We describe here the placement and use of this device, and demonstrate methods of pharmacokinetic measurements of medications administered by this method. PMID:27911381

  17. Customer care. Patient satisfaction in the prehospital setting.

    PubMed

    Doering, G T

    1998-09-01

    The focus of the study was to prioritize six emergency medical service treatment factors in terms of their impact upon patient satisfaction in the prehospital setting. The six treatment areas analyzed were: EMS response time; medical care provided on scene; explanation of care by the provider; the provider's ability to reduce patient anxiety; the provider's ability to meet the patient's non-medical needs; and the level of courtesy/politeness shown by the EMS provider toward the patient. Telephone interviews were conducted with both patients and bystanders to obtain their perception of how well the system met their needs. The study analyzed how the six issues were rated and then evaluated the impact an individual's low score in a category had on that person's overall rating of the service provided. The overall satisfaction rating is not a calculated score, but an overall score specified by the respondent. The effect each issue had on the respondent's overall rating was determined by averaging the overall ratings for a category's low scorers, averaging the overall ratings for high scorers and then measuring the difference. Results of the study indicate that the factor with the greatest negative impact on patient satisfaction came from a perceived lack of crew courtesy and politeness. Respondents who indicated a fair to poor score in this category decreased their overall score by 60.2%. Ratings in other categories yielded the following results: When respondents rated the response time as fair to poor, their average overall rating showed an 18.4% decrease. When respondents rated the quality of medical care as fair to poor, their average overall rating showed a decrease of 22.6%. When the crew's ability to explain what was happening to the patient was rated as fair to poor, the average overall score dropped 33.6%. When the EMT's and medic's ability to reduce the patient's anxiety was rated fair to poor, average overall score declined by 32.6%. Finally, when the crew

  18. Grounded Theory of Barriers and Facilitators to Mandated Implementation of Mental Health Care in the Primary Care Setting

    PubMed Central

    Benzer, Justin K.; Beehler, Sarah; Miller, Christopher; Burgess, James F.; Sullivan, Jennifer L.; Mohr, David C.; Meterko, Mark; Cramer, Irene E.

    2012-01-01

    Objective. There is limited theory regarding the real-world implementation of mental health care in the primary care setting: a type of organizational coordination intervention. The purpose of this study was to develop a theory to conceptualize the potential causes of barriers and facilitators to how local sites responded to this mandated intervention to achieve coordinated mental health care. Methods. Data from 65 primary care and mental health staff interviews across 16 sites were analyzed to identify how coordination was perceived one year after an organizational mandate to provide integrated mental health care in the primary care setting. Results. Standardized referral procedures and communication practices between primary care and mental health were influenced by the organizational factors of resources, training, and work design, as well as provider-experienced organizational boundaries between primary care and mental health, time pressures, and staff participation. Organizational factors and provider experiences were in turn influenced by leadership. Conclusions. Our emergent theory describes how leadership, organizational factors, and provider experiences affect the implementation of a mandated mental health coordination intervention. This framework provides a nuanced understanding of the potential barriers and facilitators to implementing interventions designed to improve coordination between professional groups. PMID:22900158

  19. A toolkit for single-session groups in acute care settings.

    PubMed

    Keast, Kevin

    2012-01-01

    Single-session groups are an effective method for providing mutual aid to patients and families experiencing crisis in acute care/emergency settings. This toolkit provides health care professionals with practical guidance in establishing, recruiting for, and facilitating single-session groups in hospital settings. A two-step literature search was conducted to identify all relevant articles. The literature was retrieved and reviewed for inclusion. The results of this review form the basis of the toolkit. A framework for establishing this type of group is explored. Challenges and strategies concerning recruitment are discussed. The practice skills relevant to facilitating time-limited groups are outlined.

  20. Using integrated bio-physiotherapy informatics in home health-care settings: A qualitative analysis of a point-of-care decision support system.

    PubMed

    Canally, Culum; Doherty, Sean; Doran, Diane M; Goubran, Rafik A

    2015-06-01

    The growing need to gain efficiencies within a home care setting has prompted home care practitioners to focus on health informatics to address the needs of an aging clientele. The remote and heterogeneous nature of the home care environment necessitates the use of non-intrusive client monitoring and a portable, point-of-care graphical user interface. Using a grounded theory approach, this article examines the simulated use of a graphical user interface by practitioners in a home care setting to explore the salient features of monitoring the activity of home care clients. The results demonstrate the need for simple, interactive displays that can provide large amounts of geographical and temporal data relating to patient activity. Additional emerging themes from interviews indicate that home care professionals would use a graphical user interface of this type for patient education and goal setting as well as to assist in the decision-making process of home care practitioners.

  1. Patient care leadership within an emerging integrated delivery network.

    PubMed

    Moore, B W; Smith, S L; Schumacher, L P; Papke, R

    1996-01-01

    The emergence of integrated delivery networks provides an opportunity for leaders of patient care services to reach into our tool bags and refine the key leadership skills of strategist, facilitator, coach, and mentor. Shifting the focus from management to leadership is the hallmark of our success. As patient care leaders we will facilitate the achievement of the organization's strategic initiatives to improve clinical care delivery while decreasing cost. This article will explore the role of the patient care executive as part of the leadership team developing an integrated/organized delivery network.

  2. [Indications for low-dose CT in the emergency setting].

    PubMed

    Poletti, Pierre-Alexandre; Andereggen, Elisabeth; Rutschmann, Olivier; de Perrot, Thomas; Caviezel, Alessandro; Platon, Alexandra

    2009-08-19

    CT delivers a large dose of radiation, especially in abdominal imaging. Recently, a low-dose abdominal CT protocol (low-dose CT) has been set-up in our institution. "Low-dose CT" is almost equivalent to a single standard abdominal radiograph in term of dose of radiation (about one sixth of those delivered by a standard CT). "Low-dose CT" is now used routinely in our emergency service in two main indications: patients with a suspicion of renal colic and those with right lower quadrant pain. It is obtained without intravenous contrast media. Oral contrast is given to patients with suspicion of appendicitis. "Low-dose CT" is used in the frame of well defined clinical algorithms, and does only replace standard CT when it can reach a comparable diagnostic quality.

  3. The Chronic Care Model and Diabetes Management in US Primary Care Settings: A Systematic Review

    PubMed Central

    Stellefson, Michael; Stopka, Christine

    2013-01-01

    Introduction The Chronic Care Model (CCM) uses a systematic approach to restructuring medical care to create partnerships between health systems and communities. The objective of this study was to describe how researchers have applied CCM in US primary care settings to provide care for people who have diabetes and to describe outcomes of CCM implementation. Methods We conducted a literature review by using the Cochrane database of systematic reviews, CINAHL, and Health Source: Nursing/Academic Edition and the following search terms: “chronic care model” (and) “diabet*.” We included articles published between January 1999 and October 2011. We summarized details on CCM application and health outcomes for 16 studies. Results The 16 studies included various study designs, including 9 randomized controlled trials, and settings, including academic-affiliated primary care practices and private practices. We found evidence that CCM approaches have been effective in managing diabetes in US primary care settings. Organizational leaders in health care systems initiated system-level reorganizations that improved the coordination of diabetes care. Disease registries and electronic medical records were used to establish patient-centered goals, monitor patient progress, and identify lapses in care. Primary care physicians (PCPs) were trained to deliver evidence-based care, and PCP office–based diabetes self-management education improved patient outcomes. Only 7 studies described strategies for addressing community resources and policies. Conclusion CCM is being used for diabetes care in US primary care settings, and positive outcomes have been reported. Future research on integration of CCM into primary care settings for diabetes management should measure diabetes process indicators, such as self-efficacy for disease management and clinical decision making. PMID:23428085

  4. Health effects of training laypeople to deliver emergency care in underserviced populations: a systematic review protocol

    PubMed Central

    Orkin, Aaron M; Curran, Jeffrey D; Fortune, Melanie K; McArthur, Allison; Mew, Emma J; Ritchie, Stephen D; Van de Velde, Stijn; VanderBurgh, David

    2016-01-01

    Introduction The Disease Control Priorities Project recommends emergency care training for laypersons in low-resource settings, but evidence for these interventions has not yet been systematically reviewed. This review will identify the individual and community health effects of educating laypeople to deliver prehospital emergency care interventions in low-resource settings. Methods and analysis This systematic review addresses the following question: in underserviced populations and low-resource settings (P), does first aid or emergency care training or education for laypeople (I) confer any individual or community health benefit for emergency health conditions (O), in comparison with no training or other forms of education (C)? We restrict this review to studies reporting quantitatively measurable outcomes, and search 12 electronic bibliographic databases and grey literature sources. A team of expert content and methodology reviewers will conduct title and abstract screening and full-text review, using a custom-built online platform. Two investigators will independently extract methodological variables and outcomes related to patient-level morbidity and mortality and community-level effects on resilience or emergency care capacity. Two investigators will independently assess external validity, selection bias, performance bias, measurement bias, attrition bias and confounding. We will summarise the findings using a narrative approach to highlight similarities and differences between the gathered studies. Ethics and dissemination Formal ethical approval is not required. Results The results will be disseminated through a peer-reviewed publication and knowledge translation strategy. Review registration number CRD42014009685. PMID:27194315

  5. Access to Emergency Care in the United States

    PubMed Central

    Carr, Brendan G.; Branas, Charles C.; Metlay, Joshua P.; Sullivan, Ashley F.; Camargo, Carlos A.

    2009-01-01

    Objective Rapid access to emergency services is essential for emergency care sensitive conditions such as acute myocardial infarction, stroke, sepsis, and major trauma. We sought to determine US population access to an emergency department (ED). Methods The National Emergency Department Inventories (NEDI) – USA was used to identify the location, annual visit volume, and teaching status of all EDs in the US. EDs were categorized as 1) any ED, 2) by patient volume, and 3) by teaching status. Driving distances, driving speeds, and prehospital times were estimated using validated models and adjusted for population density. Access was determined by summing the population that could reach an ED within the specified time intervals. Results Overall, 71% of the US population has access to an ED within 30 minutes, and 98% has access within 60 minutes. Access to teaching hospitals was more limited, with 16% having access within 30 minutes and 44% within 60 minutes. Rural states had lower access to all types of EDs. Conclusions Although the majority of the US population has access to an ED, there are regional disparities in ED access, especially by rurality. Future efforts should measure the relationship between access to emergency services and outcomes for emergency care sensitive conditions. The development of a regionalized emergency care delivery system should be explored. PMID:19201059

  6. Emergency Point-of-Care Ultrasound Detection of Cancer in the Pediatric Emergency Department.

    PubMed

    Jamjoom, Roaa S; Etoom, Yousef; Solano, Tanya; Desjardins, Marie-Pier; Fischer, Jason W

    2015-08-01

    The use of point-of-care ultrasound in the pediatric emergency department is evolving beyond conventional applications as users become more expert with the technology. In this case series, we describe the potential utility of recognizing abnormal anatomy to impact care in the context of possible cancer in pediatric patients. We describe 4 patients with Langerhans histiocytosis, neuroblastoma, Wilms tumor, and rhabdomyosarcoma, in which point-of-care ultrasound was used to facilitate the diagnoses.

  7. Nurse practitioner organizational climate in primary care settings: implications for professional practice.

    PubMed

    Poghosyan, Lusine; Nannini, Angela; Stone, Patricia W; Smaldone, Arlene

    2013-01-01

    The expansion of the nurse practitioner (NP) workforce in primary care is key to meeting the increased demand for care. Organizational climates in primary care settings affect NP professional practice and the quality of care. This study investigated organizational climate and its domains affecting NP professional practice in primary care settings. A qualitative descriptive design, with purposive sampling, was used to recruit 16 NPs practicing in primary care settings in Massachusetts. An interview guide was developed and pretested with two NPs and in 1 group interview with 7 NPs. Data collection took place in spring of 2011. Individual interviews lasted from 30-70 minutes, were audio recorded, and transcribed. Data were analyzed using Atlas.ti 6.0 software by 3 researchers. Content analysis was applied. Three previously identified themes, NP-physician relations, independent practice and autonomy, and professional visibility, as well as two new themes, organizational support and resources and NP-administration relations emerged from the analyses. NPs reported collegial relations with physicians, challenges in establishing independent practice, suboptimal relationships with administration, and lack of support. NP contributions to patient care were invisible. Favorable organizational climates should be promoted to support the expanding of NP workforce in primary care and to optimize recruitment and retention efforts.

  8. Precision Medicine With Point-of-Care Ultrasound: The Future of Personalized Pediatric Emergency Care.

    PubMed

    Kessler, David; Ng, Lorraine; Tessaro, Mark; Fischer, Jason

    2017-03-01

    The Precision Medicine Initiative spearheaded by the National Institute of Health has pioneered a new model of health care focused on health care delivery that is tailored to an individual. Medical advances have already provided clinicians with the tools to better predict treatment outcomes based on the individual needs of each patient's disease process. Three-dimensional printing allows medical devices and implants to be custom made-to-order. Technological advances in preoperative imaging have augmented the ability for surgeons to plan a specific surgical approach for each patient. In a similar vein, point-of-care ultrasound offers the emergency care provider an opportunity to move beyond protocols and provide precise medical care tailored to the acute needs of each ill or injured emergent patient. In this article, we explore several cutting-edge applications of point-of-care ultrasound that can help providers develop a personalized approach to resuscitation and emergent procedures in pediatrics.

  9. Setting up and functioning of an Emergency Medicine Department: Lessons learned from a preliminary study

    PubMed Central

    Asish, K; Suresh, Varun

    2016-01-01

    Background and Aims: Tertiary care teaching hospitals remain referral centres for victims of trauma and mass casualty. Often specialists from various disciplines manage these crowded casualty areas. These age old casualty areas are being replaced, throughout the country by Emergency Medicine Departments (EMDs), presumed to be better planned to confront a crisis. We aimed to gather basic data contributive in setting up of an EMD at a tertiary care teaching hospital from the lessons learned from functioning existent systems. Methods: This is primarily a questionnaire-based descriptive study at tertiary care referral centres across the country, which was purposively selected. The study models included one from a hospital without designated EMD and the other four from hospitals with established EMDs. Direct observation and focus group meetings with experienced informants at these hospitals contributed to the data. In the absence of a validated hospital preparedness assessment scale, comparison was done with regard to quantitative, qualitative and corroborative parameters using descriptive analysis. Results: The EMDs at best practice models were headed by specialist in Emergency Medicine assisted by organised staff, had protocols for managing mass casualty incident (MCI), separate trauma teams, ergonomic use of infrastructure and public education programmes. In this regard, these hospitals seemed well organised to manage MCIs and disasters. Conclusion: The observation may provide a preliminary data useful in setting up an EMD. In the absence of published Indian literature, this may facilitate further research in this direction. Anaesthesiologists, presently an approved Faculty in Emergency Medicine training can provide creative input with regard to its initial organisation and functioning, thus widening our horizons in a country where there is a severe dearth of trained emergency physicians. PMID:27013749

  10. Addressing Family Smoking in Child Health Care Settings.

    PubMed

    Hall, Nicole; Hipple, Bethany; Friebely, Joan; Ossip, Deborah J; Winickoff, Jonathan P

    2009-08-01

    OBJECTIVE: To discuss strategies for integrating evidence-based tobacco use screening, cessation assistance, and referral to outside services into visits with families in outpatient child health care settings. METHODS: Presentation of counseling scenarios used in the Clinical Effort Against Secondhand Smoke Exposure (CEASE) training video and commentary. RESULTS: Demonstrated strategies include: eliciting information about interest and readiness to quit smoking, respectfully setting an agenda to discuss smoking, tailoring advice and education to the specific circumstances, keeping the dialogue open, prescribing cessation medication, helping the smoker set an action plan for cessation, enrolling the smoker in free telephone counseling through the state quitline, and working with family members to establish a completely smoke-free home and car. Video demonstrations of these techniques are available at www.ceasetobacco.org. CONCLUSION: Child health care clinicians have a unique opportunity to address family smoking and can be most effective by adapting evidence-based tobacco cessation counseling strategies for visits in the pediatric setting.

  11. Improving Quality of Emergency Care Through Integration of Mental Health.

    PubMed

    Okafor, Martha; Wrenn, Glenda; Ede, Victor; Wilson, Nana; Custer, William; Risby, Emile; Claeys, Michael; Shelp, Frank E; Atallah, Hany; Mattox, Gail; Satcher, David

    2016-04-01

    The goal of this study was to better integrate emergency medical and psychiatric care at a large urban public hospital, identify impact on quality improvement metrics, and reduce healthcare cost. A psychiatric fast track service was implemented as a quality improvement initiative. Data on disposition from the emergency department from January 2011 to May 2012 for patients impacted by the pilot were analyzed. 4329 patients from January 2011 to August 2011 (pre-intervention) were compared with 4867 patients from September 2011 to May 2012 (intervention). There was a trend of decline on overall quality metrics of time to triage and time from disposition to discharge. The trend analysis of the psychiatric length of stay and use of restraints showed significant reductions. Integrated emergency care models are evidence-based approach to ensuring that patients with mental health needs receive proper and efficient treatment. Results suggest that this may also improve overall emergency department's throughput.

  12. [Care management: nurses' actions in a hospital emergency service].

    PubMed

    dos Santos, José Luís Guedes; Lima, Maria Alice Dias da Silva

    2011-12-01

    This study aimed to analyze care management actions performed by nurses in a hospital emergency service. This is a qualiative research of the case study type, carried out with nurses from the Emergency Service of a University Hospital in southern Brazil. The data were collected through participant observation and semi-structured interviews, and analyzed using thematic analysis. The results show nurses' actions in care planning, forecasting and provisioning of resources, supervision, leadership and training of the nursing team. In care planning, there is the execution of the nursing process and the control of the realization of laboratory and radiological tests. The actions of forecasting and provisioning of resources were: elaboration of the monthly schedule of employees, daily distribution of the staff and the management of material resources. Leadership encourages the planning of care, the coordination of the nursing staff and the delegation of activities.

  13. Emergencies and Critical Care of Commonly Kept Fowl.

    PubMed

    Sabater González, Mikel; Calvo Carrasco, Daniel

    2016-05-01

    Fowl are birds belonging to one of the 2 biological orders, the game fowl or land fowl (Galliformes) and the waterfowl (Anseriformes). Studies of anatomic and molecular similarities suggest these two groups are close evolutionary relatives. Multiple fowl species have a long history of domestication. Fowl are considered food-producing animals in most countries and clinicians should follow legislation regarding reportable diseases and antibiotic use, even if they are pets. This article reviews aspects of emergency care for most commonly kept fowl, including triage, patient assessment, diagnostic procedures, supportive care, short-term hospitalization, and common emergency presentations.

  14. Transdisciplinary care in the emergency department: A qualitative analysis.

    PubMed

    Innes, Kelli; Crawford, Kimberley; Jones, Tamsin; Blight, Renee; Trenham, Catherine; Williams, Allison; Griffiths, D; Morphet, Julia

    2016-03-01

    In response to increasing demands some emergency departments have introduced transdisciplinary care coordination teams. Such teams comprise staff from multiple disciplines who are trained to perform roles outside their usual scope of practice. This study aimed to critically evaluate the patient, carer and ED staff perceptions of the transdisciplinary model of care in an emergency department in a Melbourne metropolitan hospital. The evaluation of the transdisciplinary team involved interviews with patients and carers who have received the transdisciplinary team services, and focus groups with emergency nursing and transdisciplinary team staff. Analysis of the data revealed that the transdisciplinary model provided an essential service, where staff members were capable of delivering care across all disciplines. The ability to perform comprehensive patient assessments ensured safe discharge, with follow-up services in place. The existence of this team was seen to free up time for the emergency nursing staff, enabling them to see other patients, and improving department efficiency while providing quality care and increasing staff satisfaction. This study identified several important factors which contributed to the success of the transdisciplinary team, which was well integrated into the larger emergency department team.

  15. [Value of lung ultrasound in emergency and intensive care medicine].

    PubMed

    Michels, G; Breitkreutz, R; Pfister, R

    2014-11-01

    Lung ultrasound has traditionally been limited to evaluation of pleural effusion and as guidance for thoracocentesis. However, in recent years, thoracic ultrasound became an increasingly valuable diagnostic tool in emergency and intensive care medicine. The relative easy use of bedside examination made chest ultrasonography diagnostic valuable additional tool to be used in any clinical acute context. Various pulmonary diseases like pleural effusion, pulmonary-venous congestion und edema, pneumonia and pneumothorax can be detected very fast under emergency conditions.

  16. Telemedicine for the care of children in the hospital setting.

    PubMed

    McSwain, S David; Marcin, James P

    2014-02-01

    Telemedicine is by no means a new technology, given that audio-video telecommunication links have been utilized for the provision of medical services since the 1950s. Nonetheless, telemedicine is currently in a phase of rapid growth and evolution. The combination of increasingly affordable and powerful networking, computing, and communication technology, along with the continued nationwide crisis in health care access and costs, has created a "tipping point," whereby telemedicine has progressed from a novel means of practicing medicine to practical tool to help address our nation's health care needs. Telemedicine has also evolved beyond a means of providing care to remote communities to becoming a versatile tool in the delivery of health care in a variety of non-rural settings. Although no one can be everywhere at once, telemedicine allows us to be in more places at once than we've ever been before. The problems of disparities and access to care are even more evident in pediatrics, where subspecialists are fewer in number and more regionalized than adult providers. Numerous successful telemedicine programs across the country have demonstrated the impact that these technologies can have in pediatrics, with many more programs in development. As a versatile means of delivering care, telemedicine can be used at any point during the course of a health care encounter as not only a means of expanding our reach, but also as a means of increasing efficiency. Using telemedicine to provide consultations to community hospitals has been shown to improve quality of care, strengthen the referral base for the consulting facilities, facilitate cost savings, and improve the financial bottom line for both referring and consulting facilities. This review highlights some of the ways in which telemedicine is being used to facilitate timely and effective pediatric care in a variety of hospital settings.

  17. The parents', hospitalized child's, and health care providers' perceptions and experiences of family centered care within a pediatric critical care setting: a metasynthesis of qualitative research.

    PubMed

    Foster, Mandie Jane; Whitehead, Lisa; Maybee, Patricia; Cullens, Victoria

    2013-11-01

    The delivery of family centered care (FCC) occurs within varied pediatric care settings with a belief that this model of care meets the psychosocial, emotional, and physical needs of the hospitalized child and family. The aim of this review was to explore the attitudes, experiences, and implementation of FCC from many studies and to facilitate a wider and more thorough understanding of this practice from a diverse sample of parents, hospitalized children, and their health care providers within a pediatric critical care setting. A metasynthesis is an integration of qualitative research findings based on a systematic review of the literature. Thirty original research articles focusing on family-centered care experiences from the hospitalized child's, parents', and health care providers' perception published between 1998 and 2011 met the criteria for the review. Nine syntheses from 17 themes emerged from the synthesis of the literature: Prehospital, Entry into the Hospital, Journeying Through Unknown Waters, Information, Relationships, The hospital Environment, The Possibility of Death, Religion and Spirituality, and The Journey Home. The individual cultures of the critical care units helped create and reinforce the context of parental needs where satisfaction with communication, information, and relationships were interconnecting factors that helped maintain the positive or negative experiences for the parent, hospitalized child, and/or health care providers.

  18. Filipino Arts among Elders in Institutionalized Care Settings

    ERIC Educational Resources Information Center

    de Guzman, Allan B.; Satuito, James Cyril B.; Satumba, Miko Anne E.; Segui, Diego Rey A.; Serquina, Faith Evelyn C.; Serrano, Lawrence Jan P.; Sevilla, Madelyn D.

    2011-01-01

    The use of traditional art in recreational therapies is unexplored. This paper, thus, attempts to surface the unique power of traditional Filipino arts (TFA) as synergizing lens in capturing the individual and the collective experiences of a select group of Filipino elderly in an institutionalized care setting relative to their feelings of…

  19. Assessing the Physical and Architectural Features of Sheltered Care Settings.

    ERIC Educational Resources Information Center

    Moos, Rudolf H.; Lemke, Sonne

    1980-01-01

    The Physical and Architectural Features Checklist (PAF) measures physical resources of sheltered care settings in terms of nine derived dimensions. Data show that facilities which have more physical resources are seen as attractive by outside observers and pleasant by residents. Cost is not related to any PAF dimension. (Author)

  20. Doctoral Clinical Geropsychology Training in a Primary Care Setting

    ERIC Educational Resources Information Center

    Zweig, Richard A.; Siegel, Lawrence; Hahn, Steven; Kuslansky, Gail; Byrne, Kathy; Fyffe, Denise; Passman, Vicki; Stewart, Douglas; Hinrichsen, Gregory

    2005-01-01

    Most older adults diagnosed with a mental disorder receive treatment in primary care settings that lack personnel skilled in geropsychological diagnosis and treatment. The Ferkauf Older Adult Program of Yeshiva University endeavors to bridge this gap by providing training in geriatric psychology, through coursework and diverse clinical practica,…

  1. Delivering pharmacogenetic testing in a primary care setting

    PubMed Central

    Mills, Rachel; Voora, Deepak; Peyser, Bruce; Haga, Susanne B

    2013-01-01

    Pharmacogenetic testing refers to a type of genetic test to predict a patient’s likelihood to experience an adverse event or not respond to a given drug. Despite revision to several labels of commonly prescribed drugs regarding the impact of genetic variation, the use of this testing has been limited in many settings due to a number of factors. In the primary care setting, the limited office time as well as the limited knowledge and experience of primary care practitioners have likely attributed to the slow uptake of pharmacogenetic testing. This paper provides talking points for primary care physicians to discuss with patients when pharmacogenetic testing is warranted. As patients and physicians become more familiar and accepting of pharmacogenetic testing, it is anticipated that discussion time will be comparable to that of other clinical tests. PMID:24101877

  2. Incentivizing health care behaviors in emerging adults: a systematic review

    PubMed Central

    Yu, Catherine H; Guarna, Giuliana; Tsao, Pamela; Jesuthasan, Jude R; Lau, Adrian NC; Siddiqi, Ferhan S; Gilmour, Julie Anne; Ladha, Danyal; Halapy, Henry; Advani, Andrew

    2016-01-01

    Purpose For emerging adults with chronic medical diseases, the transition from pediatric to adult health care is often a time of great upheaval, commonly associated with unhealthy self-management choices, loss to follow-up, and adverse outcomes. We conducted a systematic review to examine the use of incentive strategies to promote positive health-related behaviors in young adults with chronic medical diseases. Methods The Medline, CINAHL, Embase, PsycInfo, and Cochrane databases were searched through June 2014. Studies of any design where an incentive was used to achieve a target behavior or outcome in a pediatric or emerging adult population (age <30 years) with chronic medical conditions including addictions, were included. Results A total of 26 studies comprising 10,880 patients met our inclusion criteria after screening 10,305 abstracts and 301 full-text articles. Of these studies, 20 examined the effects of behavioral incentives on cigarette smoking or substance abuse, including alcohol; four studies explored behavioral incentives in the setting of HIV or sexual health; and two articles studied individuals with other chronic medical conditions. Seventeen articles reported a statistically significant benefit of the behavioral incentive on one or more outcomes, although only half reported follow-up after the incentive period was terminated. Conclusion While the majority of studies reported positive outcomes, these studies focused on promoting the cessation of adverse behaviors rather than promoting positive behaviors. In addition, conclusions were limited by the high risk of bias present in the majority of studies, as well as lack of follow-up after the incentive period. Whether behavioral incentives facilitate the adoption of positive health choices in this population remains to be determined. PMID:27069356

  3. Caring for the injured child in settings of limited resource.

    PubMed

    Stephenson, Jacob

    2016-02-01

    Children represent the most vulnerable members of our global society, a truth that is magnified when they are physically wounded. In much of the developed world, society has responded by offering protection in the form of law, injury prevention guidelines, and effective trauma systems to provide care for the injured child. Much of our world, though, remains afflicted by poverty and a lack of protective measures. As the globe becomes smaller by way of ease of travel and technology, surgeons are increasingly able to meet these children where they live and in doing so offer their hands and voices to care and protect these young ones. This article is intended as an overview of current issues in pediatric trauma care in the developing world as well as to offer some tips for the volunteer surgeon who may be involved in the care of the injured child in a setting of limited resource availability.

  4. Supporting relationships between family and staff in continuing care settings.

    PubMed

    Austin, Wendy; Goble, Erika; Strang, Vicki; Mitchell, Agnes; Thompson, Elizabeth; Lantz, Helen; Balt, Linda; Lemermeyer, Gillian; Vass, Kelly

    2009-08-01

    In this Canadian study, a participatory action research approach was used to examine the relationships between families of residents of traditional continuing care facilities and the health care team. The objectives were to (a) explore the formation and maintenance of family-staff relationships, with attention paid to the relational elements of engagement and mutual respect; (b) explore family and staff perspectives of environmental supports and constraints; and (c) identify practical ways to support and enhance these relationships. Results indicate that the resource-constrained context of continuing care has directly impacted family and staff relationships. The nature of these relationships are discussed using the themes of "Everybody Knows Your Name," "Loss and Laundry," "It's the Little Things That Count," and "The Chasm of Us Versus Them." Families' and staff's ideas of behaviors that support or undermine relationships are identified, as are concrete suggestions for improving family- staff relationships in traditional continuing care settings in Canada.

  5. Emergency Protocol and Violence Prevention in a University Setting

    ERIC Educational Resources Information Center

    Rust, Dylan

    2012-01-01

    This study analyzed the emergency protocol and violence prevention methods utilized at an American university. The four research questions were: (1) What are the sources of violence at the university? a. How has the university addressed these sources? (2) What constitutes an emergency in the eyes of the university? (3) How do emergency protocols…

  6. [Essential data set's archetypes for nursing care of endometriosis patients].

    PubMed

    Spigolon, Dandara Novakowski; Moro, Claudia Maria Cabral

    2012-12-01

    This study aimed to develop an Essential Data Set for Nursing Care of Patients with Endometriosis (CDEEPE), represented by archetypes. An exploratory applied research with specialists' participation that was carried out at Heath Informatics Laboratory of PUCPR, between February and November of 2010. It was divided in two stages: CDEEPE construction and evaluation including Nursing Process phases and Basic Human Needs, and archetypes development based on this data set. CDEEPE was evaluated by doctors and nurses with 95.9% of consensus and containing 51 data items. The archetype "Perception of Organs and Senses" was created to represents this data set. This study allowed identifying important information for nursing practices contributing to computerization and application of nursing process during care. The CDEEPE was the basis for archetype creation, that will make possible structured, organized, efficient, interoperable, and semantics records.

  7. Implementation of newly adopted technology in acute care settings: a qualitative analysis of clinical staff.

    PubMed

    Langhan, Melissa L; Riera, Antonio; Kurtz, Jordan C; Schaeffer, Paula; Asnes, Andrea G

    2015-01-01

    Technologies are not always successfully implemented into practice. This study elicited experiences of acute care providers with the introduction of technology and identified barriers and facilitators in the implementation process. A qualitative study using one-on-one interviews among a purposeful sample of 19 physicians and nurses within 10 emergency departments and intensive care units was performed. Grounded theory, iterative data analysis and the constant comparative method were used to inductively generate ideas and build theories. Five major categories emerged: decision-making factors, the impact on practice, technology's perceived value, facilitators and barriers to implementation. Barriers included negative experiences, age, infrequent use and access difficulties. A positive outlook, sufficient training, support staff and user friendliness were facilitators. This study describes strategies implicated in the successful implementation of newly adopted technology in acute care settings. Improved implementation methods and evaluation of implementation processes are necessary for successful adoption of new technology.

  8. [Reflections concerning the care process in the emergency medical services].

    PubMed

    Castañón-González, Jorge Alberto; Barrientos-Fortes, Tomás; Polanco-González, Carlos

    2016-01-01

    In this paper we share some reflections regarding the care process in the emergency medical services, as well as some of the challenges with which these fundamental services deal. We highlight the increasing amount of patients and the complexity of some of the clinical cases, which are some of the causes that lead to the overcrowding of these services.

  9. Practical Approaches for Achieving Integrated Behavioral Health Care in Primary Care Settings

    PubMed Central

    Ratzliff, Anna; Phillips, Kathryn E.; Sugarman, Jonathan R.; Unützer, Jürgen; Wagner, Edward H.

    2016-01-01

    Behavioral health problems are common, yet most patients do not receive effective treatment in primary care settings. Despite availability of effective models for integrating behavioral health care in primary care settings, uptake has been slow. The Behavioral Health Integration Implementation Guide provides practical guidance for adapting and implementing effective integrated behavioral health care into patient-centered medical homes. The authors gathered input from stakeholders involved in behavioral health integration efforts: safety net providers, subject matter experts in primary care and behavioral health, a behavioral health patient and peer specialist, and state and national policy makers. Stakeholder input informed development of the Behavioral Health Integration Implementation Guide and the GROW Pathway Planning Worksheet. The Behavioral Health Integration Implementation Guide is model neutral and allows organizations to take meaningful steps toward providing integrated care that achieves access and accountability. PMID:26698163

  10. Dissociative Spectrum Disorders in the Primary Care Setting

    PubMed Central

    Elmore, James L.

    2000-01-01

    Dissociative disorders have a lifetime prevalence of about 10%. Dissociative symptoms may occur in acute stress disorder, posttraumatic stress disorder, somatization disorder, substance abuse, trance and possession trance, Ganser's syndrome, and dissociative identity disorder, as well as in mood disorders, psychoses, and personality disorders. Dissociative symptoms and disorders are observed frequently among patients attending our rural South Carolina community mental health center. Given the prevalence of mental illness in primary care settings and the diagnostic difficulties encountered with dissociative disorders, such illness may be undiagnosed or misdiagnosed in primary care settings. We developed an intervention model that may be applicable to primary care settings or helpful to primary care physicians. Key points of the intervention are identification of dissociative symptoms, patient and family education, review of the origin of the symptoms as a method of coping with trauma, and supportive reinforcement of cognitive and relaxation skills during follow-up visits. Symptom recognition, Education of the family, Learning new skills, and Follow-up may be remembered by the mnemonic device SELF. We present several cases to illustrate dissociative symptoms and our intervention. Physicians and other professionals using the 4 steps and behavioral approaches will be able to better recognize and triage patients with dissociative symptoms. Behaviors previously thought to be secondary to psychosis or personality disorders may be seen in a new frame of reference, strengthening the therapeutic alliance while reducing distress and acting-out behaviors. PMID:15014580

  11. Telemedicine in the intensive care unit: its role in emergencies and disaster management.

    PubMed

    Rolston, Daniel M; Meltzer, Joseph S

    2015-04-01

    Disasters and emergencies lead to an overburdened health care system after the event, so additional telemedicine support can improve patient outcomes. If telemedicine is going to become an integral part of disaster response, there needs to be improved preparation for the use of telemedicine technologies. Telemedicine can improve patient triage, monitoring, access to specialists, health care provider burnout, and disaster recovery. However, the evidence for telemedicine and tele-intensive care in the disaster setting is limited, and it should be further studied to identify situations in which it is the most clinically effective and cost-effective.

  12. Evaluation of demands, usage and unmet needs for emergency care in Yaoundé, Cameroon: a cross-sectional study

    PubMed Central

    Ro, Young Sun; Shin, Sang Do; Jeong, Joongsik; Kim, Min Jung; Jung, Young Hee; Kamgno, Joseph; Alain, Etoundi Mballa Georges; Hollong, Bonaventure

    2017-01-01

    Objectives To assess the burden of emergent illnesses and emergency care system usage by Yaoundé residents and to evaluate unmet needs for emergency care and associated barriers. Design A cross-sectional study using a community-based survey. Setting Yaoundé, Cameroon. Participants All residents living in Yaoundé were selected as the target population to investigate the needs and usage of emergency care in Yaoundé. 14 households in every health area (47 in total) were selected using 2-stage sampling. Primary outcome measures Unmet needs for emergency care. Results Among the 3201 participants from 619 households who completed the survey, 1113 (34.8%) with median age of 22 experienced 1 or more emergency conditions in the previous year. Respondents who experienced emergency conditions used emergency units (7.0%), outpatient clinics (46.5%) or hospitalisation (13.0%), and in overall, 68.8% of them reported unmet needs for emergency care. The primary reasons for not seeking healthcare were economic issues (37.2%) and use of complementary medicine (22.2%). Young age (adjusted OR (95% CI) 1.80 (1.23 to 2.62)), rental housing (1.50 (1.11 to 2.03)) and moderate household income (0.60 (0.36 to 0.99)) were associated with unmet needs for emergency care. Conclusions Residents of Yaoundé had a high demand for emergency care, and high unmet needs were observed due to low emergency care usage. Development of a cost-effective, universal emergency care system is urgently needed in Cameroon. PMID:28167749

  13. Curriculum on Resident Education in Care of Older Adults in Acute, Transitional and Extended Care Settings

    ERIC Educational Resources Information Center

    Kumar, Chandrika; Bensadon, Benjamin A.; Van Ness, Peter H.; Cooney, Leo M.

    2016-01-01

    Most geriatric care is provided in non-hospital settings. Internal Medicine and Family Medicine residents should therefore learn about these different clinical sites and acuity levels of care. To help facilitate this learning, a geriatrics training curriculum for internal medicine residents was developed that focused on cognition, function, goals…

  14. Impact of advanced autonomous non-medical practitioners in emergency care: protocol for a scoping study

    PubMed Central

    Sujan, Mark; Howard-Franks, Hannah; Swann, Garry; Soanes, Kirsti; Pope, Catherine; Crouch, Robert; Staniszewska, Sophie; Maxwell, Elaine; Huang, Huayi

    2017-01-01

    Introduction Emergency care services are looking for new models of care delivery to deal with changing patient demographics and increased pressures. It has been suggested that advanced non-medical practitioners might be valuable for delivering such new models of care. However, it is not clear what the impact of the deployment of advanced non-medical practitioners in emergency care is. This scoping study addresses the following research question: What is known from the literature about the different types of impact of the deployment of advanced (autonomous) non-medical practitioners in emergency care? Methods and analysis A scoping study will be undertaken to examine and map the impact of the deployment of advanced non-medical practitioners in emergency care. The scoping study follows the methodology proposed by Arksey and O'Malley. Searches will be carried out on databases of peer-reviewed literature and other sources to systematically identify and characterise the literature. Papers will be screened using a 2-stage process to identify the most relevant literature. Papers will be screened by title and abstract, followed by full-text review. Data abstraction and synthesis will be performed using a narrative thematic analysis. Ethics and dissemination We will communicate the findings to Health Education England, NHS Improvement and the Royal College of Emergency Medicine through existing links provided by members of the project team. We anticipate that the findings will also be of interest to other similar organisations internationally. By identifying gaps in the research literature, we anticipate that the study will generate recommendations for informing future high-quality research studies about the impact of advanced non-medical practitioners in emergency care as well as in other settings. The research findings will be submitted for publication to relevant peer-reviewed journals as well as professional magazines. The scoping study uses only previously published

  15. Cloud based emergency health care information service in India.

    PubMed

    Karthikeyan, N; Sukanesh, R

    2012-12-01

    A hospital is a health care organization providing patient treatment by expert physicians, surgeons and equipments. A report from a health care accreditation group says that miscommunication between patients and health care providers is the reason for the gap in providing emergency medical care to people in need. In developing countries, illiteracy is the major key root for deaths resulting from uncertain diseases constituting a serious public health problem. Mentally affected, differently abled and unconscious patients can't communicate about their medical history to the medical practitioners. Also, Medical practitioners can't edit or view DICOM images instantly. Our aim is to provide palm vein pattern recognition based medical record retrieval system, using cloud computing for the above mentioned people. Distributed computing technology is coming in the new forms as Grid computing and Cloud computing. These new forms are assured to bring Information Technology (IT) as a service. In this paper, we have described how these new forms of distributed computing will be helpful for modern health care industries. Cloud Computing is germinating its benefit to industrial sectors especially in medical scenarios. In Cloud Computing, IT-related capabilities and resources are provided as services, via the distributed computing on-demand. This paper is concerned with sprouting software as a service (SaaS) by means of Cloud computing with an aim to bring emergency health care sector in an umbrella with physical secured patient records. In framing the emergency healthcare treatment, the crucial thing considered necessary to decide about patients is their previous health conduct records. Thus a ubiquitous access to appropriate records is essential. Palm vein pattern recognition promises a secured patient record access. Likewise our paper reveals an efficient means to view, edit or transfer the DICOM images instantly which was a challenging task for medical practitioners in the

  16. Critical care by emergency physicians in American and English hospitals.

    PubMed Central

    Graff, L G; Clark, S; Radford, M J

    1993-01-01

    The object of this study was to compare emergency physician critical care services in an American (A) and an English (E) Emergency Department (ED). A prospective case comparison trial was used. The study was carried out at two university affiliated community hospitals, one in the U.S.A and one in England. Subjects were consecutive patients triaged as requiring critical care services and subsequently admitted to the hospital ward (A, n = 17; E, n = 18) or the intensive/critical care unit ([ICU] A, n = 14; E, n = 24). The study time period was randomly selected 8-h shifts occurring over a 4-week period. All patients were treated by standard guidelines for critical care services at the study hospital emergency department. For all study patients mean length of stay was significantly longer for the American (233 min, 95% CI 201, 264) than the English ED (24 min, 95% CI 23, 25). American emergency physicians spent less total time providing physician services (19.2 min, 95% CI 16.8, 21.6) vs. (23 min, 95% CI 21.6, 24.4) than English emergency physicians. American emergency physicians spent less time with the patient than English emergency physicians: 12.4 min (95% CI 10.3, 14.5) vs. 17 min (95% CI 15.8, 18.2). American emergency physicians spent more time on the telephone 1.8 min (95% CI 1.4, 2.2) vs. 1.2 min (95% CI 1.1, 1.3), and in patient care discussions/order giving 1.8 min (95% CI 1.4, 2.2) vs. 1.1 min (95% CI .8, 1.4), There was no significant difference in time charting (3.2 min, 95% CI 2.8, 3.6 vs. 3.5 min, 95% CI 3.2, 3.8). Results did not vary significantly whether analysed subgroups or the whole study group. American emergency physicians provided 81% of their service during the first hour. There were delays at the American hospital until the physician saw the patient: 4.9 min (95% CI 2.5, 7.3) for patients admitted to the ICU/CVU (Cardiovascular Unit), and 9.2 min (95% CI 4.6, 13.8) for patients admitted to the ward. At the American hospital, ICU

  17. [The place, role and importance of emergency medical care in the Serbian health care system].

    PubMed

    Nikić-Sovilj, Ljiljana

    2009-01-01

    Emergency medical assistance is immediate, the current medical support that is provided hurted person to avoid any possible harmful consequences for his life and health. Emergency medical aid is part of the health care system that is rarely thought, but is still expected to be available always and continuously in case of need. Emergency medical assistance should always be available throughout the territory where people live, because there is no adequate replacement. Emergency Medical Services and emergency medical transportation services are health care that is provided in terms of all persons in the state of medical urgency. In urgent or emergency conditions, health care can be provided on the site of injuries and disease or health institution. Cases of medical urgency are ranked by degrees. The first and most difficult level of medical urgency indicate all urgent pathological conditions, diseases, injuries and poisoning, which occur in the workplace and public places. To expect medical team of emergency medical assistance at the scene intervened medical urgency, it is necessary to make call it. Call the phone number refers to the 94. Call sent to this number to receive orderly dispatcher. Dispatchers are employees who perform their work in the dispatching center. They appear in the phone number 94, made the assessment and screening calls, worry about the degree of urgency, and the absorption team, which team is the nearest place of the event. After received calls they send expert medical teams to the place of accident. In the dispatching center work always doctor and medical technician. Emergency medical care cases is a great professional and educational challenge and imposes a constant need in education of doctors and the whole emergency medical teams. Education of all employees in the state of emergency care is required continualy and for students too to receive new knowledge in the field of medical urgency by various professional purposes.

  18. Reconciling conceptualizations of relationships and person-centred care for older people with cognitive impairment in acute care settings.

    PubMed

    Rushton, Carole; Edvardsson, David

    2017-02-10

    Relationships are central to enacting person-centred care of the older person with cognitive impairment. A fuller understanding of relationships and the role they play facilitating wellness and preserving personhood is critical if we are to unleash the productive potential of nursing research and person-centred care. In this article, we target the acute care setting because much of the work about relationships and older people with cognitive impairment has tended to focus on relationships in long-term care. The acute care setting is characterized by archetypal constraints which differentiate it from long-term care, in terms of acuity and haste, task-orientated work patterns and influence from "the rule of medicine," all of which can privilege particular types of relating. In this article, we drew on existing conceptualizations of relationships from theory and practice by tapping in to the intellectual resources provided by nurse researchers, the philosophy of Martin Buber and ANT scholars. This involved recounting two examples of dyadic and networked relationships which were re-interpreted using two complementary theoretical approaches to provide deeper and more comprehensive conceptualizations of these relationships. By re-presenting key tenets from the work of key scholars on the topic relationships, we hope to hasten socialization of these ideas into nursing into the acute care setting. First, by enabling nurses to reflect on how they might work toward cultivating relationships that are more salutogenic and consistent with the preservation of personhood. Second, by stimulating two distinct but related lines of research enquiry which focus on dyadic and networked relationships with the older person with cognitive impairment in the acute care setting. We also hope to reconcile the schism that has emerged in the literature between preferred approaches to care of the older person with cognitive impairment, that is person-centred care versus relationship-centred care

  19. Supporting the Integration of HIV Testing Into Primary Care Settings

    PubMed Central

    Bradley-Springer, Lucy; Kang Dufour, Mi-Suk; Koester, Kimberly A.; Beane, Stephanie; Warren, Nancy; Beal, Jeffrey; Frank, Linda Rose

    2012-01-01

    Objectives. We examined the efforts of the US network of AIDS Education and Training Centers (AETCs) to increase HIV testing capacity across a variety of clinical settings. Methods. We used quantitative process data from 8 regional AETCs for July 1, 2008, to June 30, 2009, and qualitative program descriptions to demonstrate how AETC education helped providers integrate HIV testing into routine clinical care with the goals of early diagnosis and treatment. Results. Compared with other AETC training, HIV testing training was longer and used a broader variety of strategies to educate more providers per training. During education, providers were able to understand their primary care responsibility to address public health concerns through HIV testing. Conclusions. AETC efforts illustrate how integration of the principles of primary care and public health can be promoted through professional training. PMID:22515867

  20. Trauma-informed care in inpatient mental health settings: a review of the literature.

    PubMed

    Muskett, Coral

    2014-02-01

    Trauma-informed care is an emerging value that is seen as fundamental to effective and contemporary mental health nursing practice. Trauma-informed care, like recovery, leaves mental health nurses struggling to translate these values into day-to-day nursing practice. Many are confused about what individual actions they can take to support these values. To date, the most clearly articulated policy to emerge from the trauma-informed care movement in Australia has been the agreement to reduce, and wherever possible, eliminate the use of seclusion and restraint. Confronted with the constant churn of admissions and readmissions of clients with challenging behaviours, and seemingly intractable mental illness, the elimination of seclusion and restraint is seen to be utopian by many mental health nurses in inpatient settings. Is trauma-informed care solely about eliminating seclusion and restraint, or are there other tangible practices nurses could utilize to effect better health outcomes for mental health clients, especially those with significant abuse histories? This article summarizes the findings from the literature from 2000-2011 in identifying those practices and clinical activities that have been implemented to effect trauma-informed care in inpatient mental health settings.

  1. Detection of autoantibodies in a point-of-care rheumatology setting.

    PubMed

    Konstantinov, Konstantin N; Tzamaloukas, Antonios; Rubin, Robert L

    2013-08-01

    Autoimmune rheumatic diseases are common and confront society with serious medical, social, and financial burdens imposed by their debilitating nature. Many autoimmune diseases are associated with a particular set of autoantibodies, which have emerged as highly useful to define and classify disease, predict flares, or monitor efficacy of therapy. However, current practice for monitoring autoantibodies is protracted, labor-intensive, and expensive. This review provides an overview on the value of point-of-care (POC) biosensor technology in the diagnosis and management of patients with autoimmune rheumatic diseases. Real-time measurement of autoantibodies will clearly benefit the rheumatology practice in emergency and urgent care settings, where definitive diagnosis is essential for initiation of correct critical care therapy. Immediate serological information in clinic will provide considerable value for long-term patient care and an opportunity for an instant, result-deduced therapeutic action, avoiding delays and improving compliance, especially in field-based and remote areas. We describe the particular autoantibodies that are useful disease and activity markers and would, therefore, be attractive to POC applications. Already existing biosensors and platforms that show promise for autoantibody testing are summarized and comparatively evaluated. As POC assessment is gaining momentum in several areas of patient care, we propose that rheumatology is poised to benefit from this innovative and affordable technology.

  2. Emergency Victim Care. A Training Manual for Emergency Medical Technicians. Module 12. Water Accidents, Electrical Emergencies, Hazardous Materials and Radiation Accidents. Revised.

    ERIC Educational Resources Information Center

    Ohio State Dept. of Education, Columbus. Div. of Vocational Education.

    This training manual for emergency medical technicians, one of 14 modules that comprise the Emergency Victim Care textbook, covers water accidents, electrical emergencies, and hazardous materials and radiation accidents. Objectives stated for the three chapters are for the students to be able to describe: emergency care for specified water…

  3. Quality of emergency rooms and urgent care services: user satisfaction

    PubMed Central

    Lima, Cássio de Almeida; dos Santos, Bruna Tatiane Prates; Andrade, Dina Luciana Batista; Barbosa, Francielle Alves; da Costa, Fernanda Marques; Carneiro, Jair Almeida

    2015-01-01

    Objective To evaluate the quality of emergency rooms and urgent care services according to the satisfaction of their users. Methods A cross-sectional descriptive study with a quantitative approach. The sample comprised 136 users and was drawn at random. Data collection took place between October and November 2012 using a structured questionnaire. Results Participants were mostly male (64.7%) aged less than 30 years (55.8%), and the predominant level of education was high school (54.4%). Among the items evaluated, those that were statistically associated with levels of satisfaction with care were waiting time, confidence in the service, model of care, and the reason for seeking care related to acute complaints, cleanliness, and comfortable environment. Conclusion Accessibility, hospitality, and infrastructure were considered more relevant factors for patient satisfaction than the cure itself. PMID:26313440

  4. Quality Indicators Sensitive to Nurse Staffing in Acute Care Settings

    DTIC Science & Technology

    2005-01-01

    Provisional NQF (n=13) ANA (n=10) Death in low mortality DRG X Decubitus /pressure ulcer X X X Failure to rescue X X X Infection due to medical care X...overlap in these measure sets, with the exception of decubitus /pressure ulcer and failure to rescue. Caution should be taken since the measure intent...patient falls, pressure ulcers , and mortality, with increasing detail in measure specification.11 For example, nosocomial infections are broken down into

  5. Fluoride use in caries prevention in the primary care setting.

    PubMed

    Clark, Melinda B; Slayton, Rebecca L

    2014-09-01

    Dental caries remains the most common chronic disease of childhood in the United States. Caries is a largely preventable condition, and fluoride has proven effectiveness in the prevention of caries. The goals of this clinical report are to clarify the use of available fluoride modalities for caries prevention in the primary care setting and to assist pediatricians in using fluoride to achieve maximum protection against dental caries while minimizing the likelihood of enamel fluorosis.

  6. How to care for a patient's eyes in critical care settings.

    PubMed

    Marsden, Janet; Davies, Richard

    2016-12-14

    Rationale and key points Eye care is an important aspect of the nursing management of patients who are critically ill. All patients in acute care settings with absent or compromised eye defence mechanisms are at risk of eye complications and ocular surface disease. This article aims to assist nurses to care for the eyes of patients in critical care settings to enable early detection and routine management of ophthalmic issues, thereby avoiding visual compromise on patient discharge from critical care settings. » Corneal exposure is reported to occur in many patients who are critically ill. » Incomplete eyelid closure and lack of lubrication are the main mechanisms that underlie the development of corneal damage in patients who are critically ill. » Unconscious, sedated and/or paralysed patients and those with a reduced Glasgow Coma Scale score depend on healthcare professionals to maintain their ocular surface to prevent complications such as corneal abrasion, infection and ulceration, perforations and blindness. » Meticulous nursing care is required to prevent ophthalmic complications that can result from corneal exposure in this patient group. Regular, evidence-based eye care should be part of routine nursing practice for patients who are critically ill. Reflective activity 'How to' articles can help you update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: 1. How this article might change your practice? 2. How you could use this resource to educate your colleagues in eye care of the unconscious patient?

  7. Nurses' Comfort Level with Emergency Interventions in the Rural Hospital Setting

    ERIC Educational Resources Information Center

    Ross, Erin L.; Bell, Sue E.

    2009-01-01

    Context: One quarter of the persons living in the United States receive their emergency care in a rural hospital. Nurses employed in these hospitals see few emergencies but must be prepared to provide expert and efficient care when they do occur. Purpose: The purpose of this study was to determine the influence of registered nurses' certifications…

  8. Improving the governance of patient safety in emergency care: a systematic review of interventions

    PubMed Central

    Hesselink, Gijs; Berben, Sivera; Beune, Thimpe

    2016-01-01

    Objectives To systematically review interventions that aim to improve the governance of patient safety within emergency care on effectiveness, reliability, validity and feasibility. Design A systematic review of the literature. Methods PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Database of Systematic Reviews and PsychInfo were searched for studies published between January 1990 and July 2014. We included studies evaluating interventions relevant for higher management to oversee and manage patient safety, in prehospital emergency medical service (EMS) organisations and hospital-based emergency departments (EDs). Two reviewers independently selected candidate studies, extracted data and assessed study quality. Studies were categorised according to study quality, setting, sample, intervention characteristics and findings. Results Of the 18 included studies, 13 (72%) were non-experimental. Nine studies (50%) reported data on the reliability and/or validity of the intervention. Eight studies (44%) reported on the feasibility of the intervention. Only 4 studies (22%) reported statistically significant effects. The use of a simulation-based training programme and well-designed incident reporting systems led to a statistically significant improvement of safety knowledge and attitudes by ED staff and an increase of incident reports within EDs, respectively. Conclusions Characteristics of the interventions included in this review (eg, anonymous incident reporting and validation of incident reports by an independent party) could provide useful input for the design of an effective tool to govern patient safety in EMS organisations and EDs. However, executives cannot rely on a robust set of evidence-based and feasible tools to govern patient safety within their emergency care organisation and in the chain of emergency care. Established strategies from other high-risk sectors need to be evaluated in emergency care settings, using an

  9. 75 FR 49507 - Recovery Policy, RP9525.4, Emergency Medical Care and Medical Evacuations

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-13

    ... SECURITY Federal Emergency Management Agency Recovery Policy, RP9525.4, Emergency Medical Care and Medical..., Emergency Medical Care and Medical Evacuations. This is an existing policy that is scheduled for review to... policy identifies the extraordinary emergency medical care and medical evacuation expenses that...

  10. Multiple relationships of nursing care: the emergence of care "of the us".

    PubMed

    Baggio, Maria Aparecida; Erdmann, Alacoque Lorenzini

    2010-01-01

    The aim of this qualitative study was to comprehend the relationships of the care of the self, of care of the other, and of care "of the us" in the different dimensions of care, through an educational/reflexive/interpretative process with nursing professionals in a University Hospital, using the complexity perspective. The data were collected through workshops and submitted to content analysis. The following categories emerged: reflecting upon the meaning of care of the self, care of the other, and "of the us" for the "I - human being", and for the "I - nursing professional"; and reflecting and (re)constructing the meanings of the relationships of care for the self, care for the other, and care "for the us". The care "for the us" is an emerging theme, in construction, and impels a concern for the collective, as well as remits to the comprehension of the multiple and unending phenomenon of constant movement among the beings and between them and their environment, modifying, altering, and causing to be altered the networks of existent relationships.

  11. Achievable standard of care in low-resource settings.

    PubMed

    Luo, C

    2000-11-01

    The gap between rich and resource-poor countries has continued to grow as reproductive care providers integrate interventions to limit mother-to-child transmission (MTCT) of HIV in a manner consistent with existing information. There are two major reasons for this difference: access to prophylactic antiretroviral therapy (ARV) for HIV-infected pregnant mothers and availability of alternative feeding for babies. In resource-poor settings, these options are beyond reach for the majority of the women. Infant and under-five mortality rates from other infections are high in these settings and breastfeeding remains the norm. Answering the question, What is an achievable standard of care in resource-poor settings? still remains a major challenge today. Dialogue has begun in most resource-poor settings to address the key elements in the package of interventions to reduce MTCT of HIV. These elements include the following: (1) overall prevention of HIV in mothers and fathers; (2) provision of good-quality voluntary testing and counseling (VCT) in antenatal clinics; (3) a comprehensive package of interventions during pregnancy, during labor, and after delivery, including screening for sexually transmitted diseases (STDs), family planning, and--where possible--ARVs; (4) provision of infant and maternal nutrition within the socioeconomic realities; (5) advocacy and program communication; and (6) other supportive measures, including community mobilization to address issues such as stigmatization of and violence against HIV-infected women. This paper discusses the challenges faced by most resource-poor settings in integrating some of these activities into reproductive care services.

  12. Tuberculosis diagnosis: primary health care or emergency medical services?

    PubMed Central

    Andrade, Rubia Laine de Paula; Scatolin, Beatriz Estuque; Wysocki, Anneliese Domingues; Beraldo, Aline Ale; Monroe, Aline Aparecida; Scatena, Lúcia Marina; Villa, Tereza Cristina Scatena

    2013-01-01

    OBJECTIVE To assess primary health care and emergency medical services performance for tuberculosis diagnosis. METHODS Cross-sectional study were conducted with 90 health professionals from primary health care and 68 from emergency medical services, in Ribeirao Preto, SP, Southeastern Brazil, in 2009. A structured questionnaire based on an instrument of tuberculosis care assessment was used. The association between health service and the variables of structure and process for tuberculosis diagnosis was assessed by Chi-square test, Fisher's exact test (both with 5% of statistical significance) and multiple correspondence analysis. RESULTS Primary health care was associated with the adequate provision of inputs and human resources, as well as with the sputum test request. Emergencial medical services were associated with the availability of X-ray equipment, work overload, human resources turnover, insufficient availability of health professionals, unavailability of sputum collection pots and do not request sputum test. In both services, tuberculosis diagnosis remained as a physician's responsibility. CONCLUSIONS Emergencial medical services presented weaknesses in its structure to identify tuberculosis suspects. Gaps on the process were identified in both primary health care and emergencial medical services. This situation highlights the need for qualification of health services that are the main gateway to health system to meet sector reforms that prioritize the timely diagnosis of tuberculosis and its control. PMID:24626553

  13. Enhancing Participation in Depression Care in Outpatient Perinatal Care Settings: A Systematic Review

    PubMed Central

    Byatt, Nancy; Levin, Leonard L.; Ziedonis, Douglas; Moore Simas, Tiffany A.; Allison, Jeroan

    2015-01-01

    Objective To examine a wide range of study designs and outcomes to estimate the extent to which interventions in outpatient perinatal care settings are associated with an increase in the uptake of depression care. Data Sources PubMed, CINAHL, PsycINFO, ClinicalTrials.gov, and Scopus (EMBASE) were searched for studies published between 1999 and 2014 that evaluated mental health care use after screening for depression in perinatal care settings. Methods of Study Selection Inclusion criteria were: 1) English language; 2) pregnant and postpartum women who screened positive for depression; 3) exposure (validated depression screening in outpatient perinatal care setting); and, 4) outcome (mental health care use). Searches yielded 392 articles, 42 met criteria for full text review, and 17 met inclusion criteria. Study quality was assessed using a modified Downs and Black scale. Tabulation, Integration, and Results Articles were independently reviewed by two abstractors and consensus reached. Study design, intervention components and mental health care use were defined and categorized. Seventeen articles representing a range of study designs, including one randomized controlled trial (RCT) and one cluster RCT, were included. The average quality rating was 61% (31.0-90.0%). When no intervention was in place, an average of 22% (13.8-33.0%) of women who screened positive for depression had at least one mental health visit. The average rate of mental health care use was associated with a doubling of this rate with patient engagement strategies (44%, 29.0-90.0%), on-site assessments (49%, 25.2-90.0%), and perinatal care provider training (54%, 1.0-90.0%). High rates of mental health care use (81%, 72.0-90.0%) was associated with implementation of additional interventions, including resource provision to women, perinatal care provider training, on-site assessment, and access to mental health consultation for perinatal care providers. Conclusion Screening alone was associated

  14. [Intraosseous access for in-hospital emergencies. Intensive medical care case study].

    PubMed

    Werner, M; Daniel, H-P; Hoitz, J

    2010-07-01

    Since the release of the 2005 resuscitation guidelines intraosseous infusion has been recognized as the favorite alternative vascular access in emergency patients. It is no longer restricted to paediatric emergencies but is also considered the vascular access of choice for adult patients with difficult venous access. Intraosseous access has been used in an increasing proportion of patients especially in an out-of-hospital emergency care setting while only limited experience exists for in-hospital usage of this technique. This article reports on a case of intraosseous access performed in a critically ill patient directly after admission to the intensive care unit (ICU) due to difficult peripheral venous access. Despite the extensive medical resources available in the ICU (i.e. central venous catheterization) less invasive means were used to render appropriate care. Based on this case different strategies of critical care and possible improvements will be discussed. Intraosseous infusion should be regarded as an infrequently needed but potentially life-saving procedure that is still too often considered as an option at later stages during in-hospital emergency care.

  15. Emergency care and the national quality strategy: highlights from the Centers for Medicare & Medicaid Services.

    PubMed

    Venkatesh, Arjun K; Goodrich, Kate

    2015-04-01

    The Centers for Medicare & Medicaid Services (CMS) of the US Department of Health and Human Services seeks to optimize health outcomes by leading clinical quality improvement and health system transformation through a variety of activities, including quality measure alignment, prioritization, and implementation. CMS manages more than 20 federal quality measurement and public reporting programs that cover the gamut of health care providers and facilities, including both hospital-based emergency departments (EDs) and individual emergency physicians. With more than 130 million annual visits, and as the primary portal of hospital admission, US hospital-based EDs deliver a substantial portion of acute care to Medicare beneficiaries. Given the position of emergency care across clinical conditions and between multiple settings of care, the ED plays a critical role in fulfilling all 6 priorities of the National Quality Strategy. We outline current CMS initiatives and future opportunities for emergency physicians and EDs to effect each of these priorities and help CMS achieve the triple aim of better health, better health care, and lower costs.

  16. Effects of practice setting on GPs’ provision of care

    PubMed Central

    Borgès Da Silva, Roxane; Contandriopoulos, André-Pierre; Pineault, Raynald; Tousignant, Pierre

    2014-01-01

    Abstract Objective To define a physician classification system based on practice settings and to analyze the service provision associated with those classifications. Design A cross-sectional, retrospective study. Setting Province of Quebec. Participants All GPs in Quebec in 2002 who had been practising for at least 2 years. Main outcome measures Practice setting variables were based on physician income in the different settings. Service provision was assessed using indicators related to continuity, comprehensiveness, accessibility, and productivity of services provided by the GPs. A multiple correspondence analysis with ascending hierarchical classification was conducted to construct the taxonomy of GPs based on their practice settings. Results Our study produced 7 practice setting models. Two were essentially single-practice models. The 5 others combined several settings. Service provision varied from one model to another. Continuity was greater in the private practice model, in which older GPs were predominant, while accessibility was greater in multi-institutional practice models, in which younger GPs were more active. Conclusion To ensure balance between continuity, accessibility, and comprehensiveness in primary care services provided by GPs, it is important to consider the service provision associated with different practice models. PMID:25316763

  17. [Identity's configuration of nurses of a mobile emergency care service].

    PubMed

    de Avelar, Vanessa Luciana Lima Melo; de Paiva, Kely César Martins

    2010-01-01

    This study considers the configuration of the identity of nurses working in a Mobile Emergency Care Service, based on the model of Dubar. This is a qualitative study, in which data were collected mainly through interviews, with nurses and other team members, and analyzed according to the technique of content analysis. About the identity of the nurse, the results point to a different subject, experienced, lonely, closer to the welfare activities, in search of training and recognition, wrapped in complex labor relations. Due the limitations of research and the issues that emerged in the research process, suggestions for future research are aligned at the end of the article.

  18. Caring for military children in the emergency department: the essentials.

    PubMed

    Ling, Catherine; Johnson, Heather

    2013-11-01

    The life of a military child has several challenges that can provide opportunities for resilience or risk for vulnerability. Nurses in emergent/urgent care may encounter military children when they are in a stressful transition such as during a move or deployment. Understanding the unique lifestyle of military children and implementing some key suggestions for practice can improve outcomes for this population. This article highlights the exceptional context of military children, military transitions, and opportunities to recognize families who are at risk and strategies to reach out using the I CARE (identify, correlate, ask, ready resources, and encourage) framework.

  19. Addressing Family Smoking in Child Health Care Settings

    PubMed Central

    Hall, Nicole; Hipple, Bethany; Friebely, Joan; Ossip, Deborah J.; Winickoff, Jonathan P.

    2009-01-01

    Objective To discuss strategies for integrating evidence-based tobacco use screening, cessation assistance, and referral to outside services into visits with families in outpatient child health care settings. Methods Presentation of counseling scenarios used in the Clinical Effort Against Secondhand Smoke Exposure (CEASE) training video and commentary. Results Demonstrated strategies include: eliciting information about interest and readiness to quit smoking, respectfully setting an agenda to discuss smoking, tailoring advice and education to the specific circumstances, keeping the dialogue open, prescribing cessation medication, helping the smoker set an action plan for cessation, enrolling the smoker in free telephone counseling through the state quitline, and working with family members to establish a completely smoke-free home and car. Video demonstrations of these techniques are available at www.ceasetobacco.org. Conclusion Child health care clinicians have a unique opportunity to address family smoking and can be most effective by adapting evidence-based tobacco cessation counseling strategies for visits in the pediatric setting. PMID:20448841

  20. Emergency care in 59 low- and middle-income countries: a systematic review

    PubMed Central

    Abujaber, Samer; Makar, Maggie; Stoll, Samantha; Kayden, Stephanie R; Wallis, Lee A; Reynolds, Teri A

    2015-01-01

    Abstract Objective To conduct a systematic review of emergency care in low- and middle-income countries (LMICs). Methods We searched PubMed, CINAHL and World Health Organization (WHO) databases for reports describing facility-based emergency care and obtained unpublished data from a network of clinicians and researchers. We screened articles for inclusion based on their titles and abstracts in English or French. We extracted data on patient outcomes and demographics as well as facility and provider characteristics. Analyses were restricted to reports published from 1990 onwards. Findings We identified 195 reports concerning 192 facilities in 59 countries. Most were academically-affiliated hospitals in urban areas. The median mortality within emergency departments was 1.8% (interquartile range, IQR: 0.2–5.1%). Mortality was relatively high in paediatric facilities (median: 4.8%; IQR: 2.3–8.4%) and in sub-Saharan Africa (median: 3.4%; IQR: 0.5–6.3%). The median number of patients was 30 000 per year (IQR: 10 296–60 000), most of whom were young (median age: 35 years; IQR: 6.9–41.0) and male (median: 55.7%; IQR: 50.0–59.2%). Most facilities were staffed either by physicians-in-training or by physicians whose level of training was unspecified. Very few of these providers had specialist training in emergency care. Conclusion Available data on emergency care in LMICs indicate high patient loads and mortality, particularly in sub-Saharan Africa, where a substantial proportion of all deaths may occur in emergency departments. The combination of high volume and the urgency of treatment make emergency care an important area of focus for interventions aimed at reducing mortality in these settings. PMID:26478615

  1. [Ethics in pediatric emergencies: Care access, communication, and confidentiality].

    PubMed

    Benoit, J; Berdah, L; Carlier-Gonod, A; Guillou, T; Kouche, C; Patte, M; Schneider, M; Talcone, S; Chappuy, H

    2015-05-01

    Children suffer most from today's increasing precariousness. In France, access to care is available for all children through various structures and existing measures. The support for foreign children is overseen by specific legislation often unfamiliar to caregivers. Pediatric emergencies, their location, organization, actors, and patient flow are a particular environment that is not always suitable to communication and may lead to situations of abuse. Communication should not be forgotten because of the urgency of the situation. The place of the child in the dialogue is often forgotten. Considering the triangular relationship, listening to the child and involving the parents in care are the basis for a good therapeutic alliance. Privacy and medical confidentiality in pediatric emergencies are governed by law. However, changes in treatments and medical practices along with the variety of actors involved imply both individual and collective limitations, to the detriment of medical confidentiality.

  2. International Federation for Emergency Medicine point of care ultrasound curriculum.

    PubMed

    Atkinson, Paul; Bowra, Justin; Lambert, Mike; Lamprecht, Hein; Noble, Vicki; Jarman, Bob

    2015-03-01

    To meet a critical and growing need for a standardized approach to emergency point of care ultrasound (PoCUS) worldwide, emergency physicians must be trained to deliver and teach this skill in an accepted and reliable format. Currently, there is no globally recognized, standard PoCUS curriculum that defines the accepted applications, as well as standards for training and practice of PoCUS by specialists and trainees in emergency medicine. To address this deficit, the International Federation for Emergency Medicine (IFEM) convened a sub-committee of international experts in PoCUS to outline a curriculum for training of specialists in emergency PoCUS. This curriculum document represents the consensus of recommendations by this sub-committee. The curriculum is designed to provide a framework for PoCUS education in emergency medicine. The focus is on the processes required to select core and enhanced applications, as well as the key elements required for the delivery of PoCUS training from introduction through to continuing professional development and skill maintenance. It is designed not to be prescriptive but to assist educators and emergency medicine leadership to advance PoCUS education in emergency medicine no matter the training venue. The content of this curriculum is relevant not just for communities with mature emergency medicine systems but in particular for developing nations or for nations seeking to develop PoCUS training programs within the current educational structure. We anticipate that there will be wide variability in how this curriculum is implemented and taught, reflecting the existing educational environment, resources and goals of educational programs.

  3. Doctoral clinical geropsychology training in a primary care setting.

    PubMed

    Zweig, Richard A; Siegel, Lawrence; Hahn, Steven; Kuslansky, Gail; Byrne, Kathy; Fyffe, Denise; Passman, Vicki; Stewart, Douglas; Hinrichsen, Gregory A

    2005-01-01

    Most older adults diagnosed with a mental disorder receive treatment in primary care settings that lack personnel skilled in geropsychological diagnosis and treatment. The Ferkauf Older Adult Program of Yeshiva University endeavors to bridge this gap by providing training in geriatric psychology, through coursework and diverse clinical practica, to clinical psychology doctoral students within a large urban professional psychology program. In an innovative effort to provide the most disadvantaged elderly with comprehensive mental health treatment and maximize trainee exposure to an interdisciplinary treatment model, the program also pairs selected doctoral psychology trainees with medical residents to optimize integrated mental health service delivery for primary care elderly. The program has the following core objectives: (1) Infuse the mental health and aging knowledge base into the regular graduate curriculum; (2) Provide interdisciplinary training in geropsychological diagnostic and consultative services within an urban primary care setting; (3) Provide interdisciplinary training in the practice of psychological and neuropsychological evaluation of elderly; (4) Provide training in geropsychological psychotherapeutic intervention, including individual, couples/family, and brief/psycho-educational therapies with outpatient older adults. These objectives are achieved by pooling the resources of a graduate school of psychology, a local public hospital, and an academic medical center to achieve educational and clinical service goals.

  4. Care mapping in clinical neuroscience settings: Cognitive impairment and dependency.

    PubMed

    Leigh, Andrew James; O'Hanlon, Katie; Sheldrick, Russell; Surr, Claire; Hare, Dougal Julian

    2015-01-01

    Person-centred care can improve the well-being of patients and is therefore a key driver in healthcare developments in the UK. The current study aims to investigate the complex relationship between cognitive impairment, dependency and well-being in people with a wide range of acquired brain and spinal injuries. Sixty-five participants, with varied acquired brain and spinal injuries, were selected by convenience sampling from six inpatient clinical neuroscience settings. Participants were observed using Dementia Care Mapping - Neurorehabilitation (DCM-NR) and categorised based on severity of cognitive impairment. A significant difference in the behaviours participants engaged in, their well-being and dependency was found between the severe cognitive impairment group and the mild, moderate or no cognitive impairment groups. Dependency and cognitive impairment accounted for 23.9% of the variance in well-ill-being scores and 17.2% of the variance in potential for positive engagement. The current study highlights the impact of severe cognitive impairment and dependency on the behaviours patients engaged in and their well-being. It also affirms the utility of DCM-NR in providing insights into patient experience. Consideration is given to developing DCM-NR as a process that may improve person-centred care in neuroscience settings.

  5. Emergency Care for Homeless Patients: A French Multicenter Cohort Study

    PubMed Central

    Feral-Pierssens, Anne-Laure; Aubry, Adeline; Truchot, Jennifer; Raynal, Pierre-Alexis; Boiffier, Mathieu; Hutin, Alice; Leleu, Agathe; Debruyne, Geraud; Joly, Luc-Marie; Juvin, Philippe; Riou, Bruno

    2016-01-01

    Objectives. To determine whether homeless patients experience suboptimal care in the emergency department (ED) by the provision of fewer health care resources. Methods. We conducted a prospective multicenter cohort study in 30 EDs in France. During 72 hours in March 2015, all homeless patients that visited the participating EDs were included in the study. The primary health care service measure was the order by the physician of a diagnostic investigation or provision of a treatment in the ED. Secondary measures of health care services included ED waiting time, number and type of investigations per patient, treatment in the ED, and discharge disposition. Results. A total of 254 homeless patients and 254 nonhomeless patients were included. After excluding homeless patients that attended the ED for the sole purpose of housing, we analyzed 214 homeless and 214 nonhomeless. We found no significant difference between the 2 groups in terms of health care resource consumption, and for our secondary endpoints. Conclusions. We did not find significant differences in the level of medical care delivered in French EDs to homeless patients compared with matched nonhomeless patients. PMID:26985613

  6. Turning point sets the stage for emergency preparedness planning.

    PubMed

    Bekemeier, Betty; Dahl, Jan

    2003-01-01

    Nearly a billion dollars were made available to state health departments through federal grants in the spring of 2002 for public health emergency preparedness plans. Twenty-one states had already been participating for some years in The Robert Wood Johnson Foundation's Turning Point Initiative. This article illustrates how earlier practice and experience in developing cross-sector collaborations and institutionalizing a model of broad-based partnerships for public health decision making can increase effectiveness and efficiency in responding to a call for action around an emergency.

  7. Regionalization of services improves access to emergency vascular surgical care.

    PubMed

    Roche-Nagle, G; Bachynski, K; Nathens, A B; Angoulvant, D; Rubin, B B

    2013-04-01

    Management of vascular surgical emergencies requires rapid access to a vascular surgeon and hospital with the infrastructure necessary to manage vascular emergencies. The purpose of this study was to assess the impact of regionalization of vascular surgery services in Toronto to University Health Network (UHN) and St Michael's Hospital (SMH) on the ability of CritiCall Ontario to transfer patients with life- and limb-threatening vascular emergencies for definitive care. A retrospective review of the CritiCall Ontario database was used to assess the outcome of all calls to CritiCall regarding patients with vascular disease from April 2003 to March 2010. The number of patients with vascular emergencies referred via CritiCall and accepted in transfer by the vascular centers at UHN or SMH increased 500% between 1 April 2003-31 December 2005 and 1 January 2006-31 March 2010. Together, the vascular centers at UHN and SMH accepted 94.8% of the 1002 vascular surgery patients referred via CritiCall from other hospitals between 1 January 2006 and 31 March 2010, and 72% of these patients originated in hospitals outside of the Toronto Central Local Health Integration Network. Across Ontario, the number of physicians contacted before a patient was accepted in transfer fell from 2.9 ± 0.4 before to 1.7 ± 0.3 after the vascular centers opened. In conclusion, the vascular surgery centers at UHN and SMH have become provincial resources that enable the efficient transfer of patients with vascular surgical emergencies from across Ontario. Regionalization of services is a viable model to increase access to emergent care.

  8. Management of orthodontic emergencies in primary care - self-reported confidence of general dental practitioners.

    PubMed

    Popat, H; Thomas, K; Farnell, D J J

    2016-07-08

    Objective To determine general dental practitioners' (GDPs) confidence in managing orthodontic emergencies.Design Cross-sectional study.Setting Primary dental care.Subjects and methods An online survey was distributed to dentists practicing in Wales. The survey collected basic demographic information and included descriptions of ten common orthodontic emergency scenarios.Main outcome measure Respondents' self-reported confidence in managing the orthodontic emergency scenarios on a 5-point Likert scale. Differences between the Likert responses and the demographic variables were investigated using chi-squared tests.Results The median number of orthodontic emergencies encountered by respondents over the previous six months was 1. Overall, the self-reported confidence of respondents was high with 7 of the 10 scenarios presented scoring a median of 4 indicating that GDPs were 'confident' in their management. Statistical analysis revealed that GDPs who saw more orthodontic emergencies in the previous six months were more confident when managing the presented scenarios. Other variables such as age, gender, geographic location of practice and number of years practising dentistry were not associated with self-reported confidence.Conclusions Despite GDPs encountering very few orthodontic emergencies in primary care, they appear to be confident in dealing with commonly arising orthodontic emergency situations.

  9. Measuring quality of care in psychiatric emergencies: construction and evaluation of a Bayesian index.

    PubMed Central

    Gustafson, D H; Sainfort, F; Johnson, S W; Sateia, M

    1993-01-01

    OBJECTIVE. This study was conducted to determine whether an index for measuring quality of care for psychiatric emergencies is reliable and valid. DATA SOURCES/STUDY SETTING. The study used primary data collected over a 12-month period from two urban hospitals in the Northeast. One had 700 inpatient beds, an inpatient psychiatric unit, and community mental health personnel located in the emergency department. The other had 300 beds but none of the other hospital's features. STUDY DESIGN. The index was developed by a panel of experts in emergency psychiatry using a subjective Bayesian statistical methodology and was evaluated in terms of its ability to: (1) predict a second panel's judgments of quality; (2) predict a specific quality-related patient outcome, i.e., compliance with follow-up recommendations; (3) provide a reliable measurement procedure; and (4) detect variations in patterns of emergency department practices. DATA COLLECTION/EXTRACTION METHODS. Data were collected on 2,231 randomly selected emergency psychiatric patients (psychiatric diagnosis, alcohol abuse, nonverbal patients experiencing a psychiatric emergency, and patients with somatic complaints such as life crisis) treated in the emergency departments of the two hospitals. PRINCIPAL FINDINGS. The index predicted physician judgments of quality, was reliable, exhibited sufficient variation in scores, and was strongly associated with patient compliance. CONCLUSIONS. The study demonstrated that a subjective Bayesian model can be used to develop a reliable and valid index for measuring quality of care, with potential for practical application in management of health services. PMID:8514497

  10. Noncontingent reinforcement of disruptive behaviors in personal care home settings.

    PubMed

    Yury, Craig A

    2013-06-01

    The purpose of this case study was to examine the potential of using noncontingent reinforcement (NCR) to reduce the frequency of disruptive behaviors of three elderly persons in personal care home (PCH) settings. Assessment indicated that participants were engaging in the disruptive behaviors to obtain social attention from PCH staff. Social attention, up to 1 min of staff making eye contact with the participant and directing positive verbal statements toward the participant, was given on a fixed time interval (from morning through early evening) beginning every 20 min and fading to every 30 min. Results indicate that NCR reduced the frequency of the disruptive behaviors.

  11. Mental health in humanitarian settings: shifting focus to care systems.

    PubMed

    Jordans, Mark J D; Tol, Wietse A

    2013-03-01

    Mental health in low- and middle income countries has received increasing attention. This attention has shifted focus, roughly moving from demonstrating the burden of mental health problems, to establishing an evidence base for interventions, to thinking about care delivery frameworks. This paper reviews these trends specifically for humanitarian settings and discusses lessons learned. Notably, that mental health assessments need to go beyond measuring the impact of traumatic events on circumscribed psychiatric disorders; that evidence for effectiveness of interventions is still too weak and its focus too limited; and that development of service delivery in the context of instable community and health systems should be an area of key priority.

  12. Overcoming the barriers to using kangaroo care in neonatal settings.

    PubMed

    Penn, Sarah

    2015-06-01

    Skin-to-skin contact, or kangaroo care (KC), has benefits for babies and parents, improving clinical outcomes, temperature control, breastfeeding rates and child-parent bonding; it reduces morbidity and mortality. Barriers to KC for neonates may include a lack of training for nurses, lack of time, maternal or child physical or mental ill health, and inappropriate settings. With education and helpful management, neonatal nurses can advocate for KC for all babies. Parents may need information and encouragement to begin with. Therefore, nurses can improve the experiences of their patients and, in the long run, free time to perform clinical procedures.

  13. Advancing aged care: a systematic review of economic evaluations of workforce structures and care processes in a residential care setting.

    PubMed

    Easton, Tiffany; Milte, Rachel; Crotty, Maria; Ratcliffe, Julie

    2016-01-01

    Long-term care for older people is provided in both residential and non-residential settings, with residential settings tending to cater for individuals with higher care needs. Evidence relating to the costs and effectiveness of different workforce structures and care processes is important to facilitate the future planning of residential aged care services to promote high quality care and to enhance the quality of life of individuals living in residential care. A systematic review conducted up to December 2015 identified 19 studies containing an economic component; seven included a complete economic evaluation and 12 contained a cost analysis only. Key findings include the potential to create cost savings from a societal perspective through enhanced staffing levels and quality improvement interventions within residential aged care facilities, while integrated care models, including the integration of health disciplines and the integration between residents and care staff, were shown to have limited cost-saving potential. Six of the 19 identified studies examined dementia-specific structures and processes, in which person-centred interventions demonstrated the potential to reduce agitation and improve residents' quality of life. Importantly, this review highlights methodological limitations in the existing evidence and an urgent need for future research to identify appropriate and meaningful outcome measures that can be used at a service planning level.

  14. Analysis of blood tests in the emergency department of a tertiary care hospital

    PubMed Central

    Rehmani, R.; Amanullah, S.

    1999-01-01

    There is ample evidence that many investigations sent from the accident and emergency department are inappropriate, thus affecting the quality of patient care. A study was designed to address this issue in the emergency department of a tertiary care hospital of a large city. A prospective cross-sectional study was carried out during the 3-month period 1 December 1996 to 28 February 1997. A set of guidelines was used to assess the appropriateness of different blood tests for the initial assessment of the patients presenting with common clinical conditions, although any investigation could be done if considered important for patient management. All other blood tests were considered inappropriate. A total of 6401 patients were seen in the emergency department and 14 300 blood tests were done on 3529 patients with diagnoses covered by the guidelines. Of these 62.2% were found to be inappropriate. Of the total 22 655 investigations done on all the 6401 patients seen, only 3.8% influenced the diagnosis, 3.0% influenced patient care in the emergency department, and 4.0% influenced the decision to admit or not. Amylase and arterial blood gases were found to be the most appropriate investigations. Analysis of reasons for unnecessary use of emergency tests suggested that improving supervision, decreasing the utilization of the emergency department as a phlebotomy service for the hospital, and abolition of routine blood tests would help to improve patient care.


Keywords: blood tests; accident and emergency medicine PMID:10621876

  15. Point-of-care sonographic detection of intestinal ascaris lumbricoides in the pediatric emergency department.

    PubMed

    Kessler, David O; Gurwitz, Avrahom; Tsung, James W

    2010-08-01

    Point-of-care ultrasound use is rapidly growing in acute-care settings such as pediatric emergency departments, and new applications are continually being explored. This is especially true in the developing world where the World Health Organization estimates that 75% of people have no access to any imaging or availability of more costly imaging technology may be limited (Essential Health Technologies Strategy 2004-2007). We report a case of intestinal roundworm infection in a 3-year-old boy and describe the ultrasound findings of Ascaris lumbricoides.

  16. Advances in addressing technical challenges of point-of-care diagnostics in resource-limited settings.

    PubMed

    Wang, ShuQi; Lifson, Mark A; Inci, Fatih; Liang, Li-Guo; Sheng, Ye-Feng; Demirci, Utkan

    2016-01-01

    The striking prevalence of HIV, TB and malaria, as well as outbreaks of emerging infectious diseases, such as influenza A (H7N9), Ebola and MERS, poses great challenges for patient care in resource-limited settings (RLS). However, advanced diagnostic technologies cannot be implemented in RLS largely due to economic constraints. Simple and inexpensive point-of-care (POC) diagnostics, which rely less on environmental context and operator training, have thus been extensively studied to achieve early diagnosis and treatment monitoring in non-laboratory settings. Despite great input from material science, biomedical engineering and nanotechnology for developing POC diagnostics, significant technical challenges are yet to be overcome. Summarized here are the technical challenges associated with POC diagnostics from a RLS perspective and the latest advances in addressing these challenges are reviewed.

  17. Advances in addressing technical challenges of point-of-care diagnostics in resource-limited settings

    PubMed Central

    Wang, ShuQi; Lifson, Mark A.; Inci, Fatih; Liang, Li-Guo; Sheng, Ye-Feng; Demirci, Utkan

    2016-01-01

    The striking prevalence of HIV, TB and malaria, as well as outbreaks of emerging infectious diseases, such as influenza A (H7N9), Ebola and MERS, poses great challenges for patient care in resource-limited settings (RLS). However, advanced diagnostic technologies cannot be implemented in RLS largely due to economic constraints. Simple and inexpensive point-of-care (POC) diagnostics, which rely less on environmental context and operator training, have thus been extensively studied to achieve early diagnosis and treatment monitoring in non-laboratory settings. Despite great input from material science, biomedical engineering and nanotechnology for developing POC diagnostics, significant technical challenges are yet to be overcome. Summarized here are the technical challenges associated with POC diagnostics from a RLS perspective and the latest advances in addressing these challenges are reviewed. PMID:26777725

  18. The Challenge of Child Day Care Needs and Improved Federal and State Approaches to Day Care Standard Setting and Enforcement.

    ERIC Educational Resources Information Center

    Costin, Lela B.; And Others

    This paper examines child day care needs and ways that federal and state approaches to day care standard setting and enforcement might be improved. Chapter I documents the magnitude of child day care needs, citing Department of Labor, Census, and other survey statistics on the numbers of children needing day care and the number of day care centers…

  19. The emerging primary care workforce: preliminary observations from the primary care team: learning from effective ambulatory practices project.

    PubMed

    Ladden, Maryjoan D; Bodenheimer, Thomas; Fishman, Nancy W; Flinter, Margaret; Hsu, Clarissa; Parchman, Michael; Wagner, Edward H

    2013-12-01

    Many primary care practices are changing the roles played by the members of their health care teams. The purpose of this article is to describe some of these new roles, using the authors' preliminary observations from 25 site visits to high-performing primary care practices across the United States in 2012-2013. These sites visits, to practices using their workforce creatively, were part of the Robert Wood Johnson Foundation-funded initiative, The Primary Care Team: Learning From Effective Ambulatory Practices.Examples of these new roles that the authors observed on their site visits include medical assistants reviewing patient records before visits to identify care gaps, ordering and administering immunizations using protocols, making outreach calls to patients, leading team huddles, and coaching patients to set self-management goals. The registered nurse role has evolved from an emphasis on triage to a focus on uncomplicated acute care, chronic care management, and hospital-to-home transitions. Behavioral health providers (licensed clinical social workers, psychologists, or licensed counselors) were colocated and integrated within practices and were readily available for immediate consults and brief interventions. Physicians have shifted from lone to shared responsibility for patient panels, with other team members empowered to provide significant portions of chronic and preventive care.An innovative team-based primary care workforce is emerging. Spreading and sustaining these changes will require training both health professionals and nonprofessionals in new ways. Without clinical experiences that model this new team-based care and role models who practice it, trainees will not be prepared to practice as a team.

  20. Determination of Medical Task Times in an Emergency Center Setting

    DTIC Science & Technology

    1990-08-01

    procedures are readily available in any standard textbook of surgery , but details of treatment protocols are still lacking. Given this situation, the...traumatic injuries with particular attention to penetrating injury to the thorax and abdomen was reviewed in current textbooks and review books of surgery ...Philadelphia, 1986. Klippel, A. and Anderson, C., eds. Manual of Emergency and Outpatient Techniques: Washington University Department of Surgery . Little, Brown

  1. Emergence and spread of antibiotic resistance: setting a parameter space

    PubMed Central

    Baquero, Fernando

    2014-01-01

    The emergence and spread of antibiotic resistance among human pathogens is a relevant problem for human health and one of the few evolution processes amenable to experimental studies. In the present review, we discuss some basic aspects of antibiotic resistance, including mechanisms of resistance, origin of resistance genes, and bottlenecks that modulate the acquisition and spread of antibiotic resistance among human pathogens. In addition, we analyse several parameters that modulate the evolution landscape of antibiotic resistance. Learning why some resistance mechanisms emerge but do not evolve after a first burst, whereas others can spread over the entire world very rapidly, mimicking a chain reaction, is important for predicting the evolution, and relevance for human health, of a given mechanism of resistance. Because of this, we propose that the emergence and spread of antibiotic resistance can only be understood in a multi-parameter space. Measuring the effect on antibiotic resistance of parameters such as contact rates, transfer rates, integration rates, replication rates, diversification rates, and selection rates, for different genes and organisms, growing under different conditions in distinct ecosystems, will allow for a better prediction of antibiotic resistance and possibilities of focused interventions. PMID:24678768

  2. Application of a Proactive Risk Analysis to Emergency Department Sickle Cell Care

    PubMed Central

    Thornton, Victoria L.; Holl, Jane L.; Cline, David M.; Freiermuth, Caroline E.; Sullivan, Dori T.; Tanabe, Paula

    2014-01-01

    Introduction Patients with sickle cell disease (SCD) often seek care in emergency departments (EDs) for severe pain. However, there is evidence that they experience inaccurate assessment, suboptimal care, and inadequate follow-up referrals. The aim of this project was to 1) explore the feasibility of applying a failure modes, effects and criticality analysis (FMECA) in two EDs examining four processes of care (triage, analgesic management, high risk/high users, and referrals made) for patients with SCD, and 2) report the failures of these care processes in each ED. Methods A FMECA was conducted of ED SCD patient care at two hospitals. A multidisciplinary group examined each step of four processes. Providers identified failures in each step, and then characterized the frequency, impact, and safeguards, resulting in risk categorization. Results Many “high risk” failures existed in both institutions, including a lack of recognition of high-risk or high-user patients and a lack of emphasis on psychosocial referrals. Specific to SCD analgesic management, one setting inconsistently used existing analgesic policies, while the other setting did not have such policies. Conclusion FMECA facilitated the identification of failures of ED SCD care and has guided quality improvement activities. Interventions can focus on improvements in these specific areas targeting improvements in the delivery and organization of ED SCD care. Improvements should correspond with the forthcoming National Heart, Lung and Blood-sponsored guidelines for treatment of patients with sickle cell disease. PMID:25035751

  3. The scope of cell phones in diabetes management in developing country health care settings.

    PubMed

    Ajay, Vamadevan S; Prabhakaran, Dorairaj

    2011-05-01

    Diabetes has emerged as a major public health concern in developing nations. Health systems in most developing countries are yet to integrate effective prevention and control programs for diabetes into routine health care services. Given the inadequate human resources and underfunctioning health systems, we need novel and innovative approaches to combat diabetes in developing-country settings. In this regard, the tremendous advances in telecommunication technology, particularly cell phones, can be harnessed to improve diabetes care. Cell phones could serve as a tool for collecting information on surveillance, service delivery, evidence-based care, management, and supply systems pertaining to diabetes from primary care settings in addition to providing health messages as part of diabetes education. As a screening/diagnostic tool for diabetes, cell phones can aid the health workers in undertaking screening and diagnostic and follow-up care for diabetes in the community. Cell phones are also capable of acting as a vehicle for continuing medical education; a decision support system for evidence-based management; and a tool for patient education, self-management, and compliance. However, for widespread use, we need robust evaluations of cell phone applications in existing practices and appropriate interventions in diabetes.

  4. The mosh pit experience: emergency medical care for concert injuries.

    PubMed

    Janchar, T; Samaddar, C; Milzman, D

    2000-01-01

    Effective planning is essential for medical personnel preparing to provide emergency care at mass gatherings. At large concerts where audience members participate in "moshing," crowd surfing, and stage diving, there may be a potential for a dramatic increase in injuries requiring medical attention. Injuries seen at emergency medical stations at 3 concerts, all with large mosh pits, over 4 event days were recorded and evaluated. Each event day had over 60,000 attendees. A total of 1,542 medical incidents (82.9 per 10,000) were reported over the 4 event days. There were 37% (466 patients, 25.1 per 10,000) of incidents related to moshing activity. Hospital transport was required for 2.5% (39 patients, 2.1 per 10,000) of medical visits with 74% (29 patients, 1.5 per 10,000) of those transported being for mosh pit-related injuries. When planning emergency medical care for such concerts with mosh pits, the potential for an increase in the number of medical incidents and injuries requiring medical attention and hospital transport should be taken into account for efficient medical coverage.

  5. A Review of Pediatric Critical Care in Resource-Limited Settings: A Look at Past, Present, and Future Directions

    PubMed Central

    Turner, Erin L.; Nielsen, Katie R.; Jamal, Shelina M.; von Saint André-von Arnim, Amelie; Musa, Ndidiamaka L.

    2016-01-01

    Fifteen years ago, United Nations world leaders defined millenium development goal 4 (MDG 4): to reduce under-5-year mortality rates by two-thirds by the year 2015. Unfortunately, only 27 of 138 developing countries are expected to achieve MDG 4. The majority of childhood deaths in these settings result from reversible causes, and developing effective pediatric emergency and critical care services could substantially reduce this mortality. The Ebola outbreak highlighted the fragility of health care systems in resource-limited settings and emphasized the urgent need for a paradigm shift in the global approach to healthcare delivery related to critical illness. This review provides an overview of pediatric critical care in resource-limited settings and outlines strategies to address challenges specific to these areas. Implementation of these tools has the potential to move us toward delivery of an adequate standard of critical care for all children globally, and ultimately decrease global child mortality in resource-limited settings. PMID:26925393

  6. HIV-Related discrimination in European health care settings.

    PubMed

    Nöstlinger, Christiana; Rojas Castro, Daniela; Platteau, Tom; Dias, Sonia; Le Gall, Jean

    2014-03-01

    This cross-sectional European study assessed self-reported HIV-related discrimination and its associated factors in health care settings. Socio-demographics, health status, support needs relating to sexual and reproductive health (SRH), and self-reported HIV-related discrimination were measured using an anonymous survey in a sample of 1549 people living with HIV from 14 countries. Thirty-two per cent of the participants had experienced HIV-related discrimination during the previous 3 years; almost half of them felt discriminated against by health care providers. For this type of discrimination, logistic regression analysis revealed significant associations with not being a migrant (OR: 2.0; IC 1.0-3.7; p<0.05), having been forced into sexual activities (OR: 1.6; IC 1.2-2.2; p<0.001), reporting lack of time to discuss SRH during service provision (OR: 1.7; IC 1.0-2.7; p<0.05), and insufficient openness among service providers to discuss SRH (OR: 2.0; IC 1.1-3.4; p<0.05). Other significant associations related to unmet support needs on safer sex practices (OR: 1.8; IC 1.0-3.2; p<0.05), partner communication about sexuality (OR: 2.0; IC 1.1-3.4; p<0.05), and prevention of sexually transmitted infections (OR: 1.7; IC 1.0-3.0; p<0.05). Female gender had a protective effect (OR: 0.2; IC 0.0-0.9; p<0.05). Being denied the opportunity to discuss SRH may translate in feelings of discrimination. Improving health care providers' communication skills, and fostering openness about SRH topics in HIV care could contribute to destigmatization of PLHIV.

  7. HIV-Related Discrimination in European Health Care Settings

    PubMed Central

    Rojas Castro, Daniela; Platteau, Tom; Dias, Sonia; Le Gall, Jean

    2014-01-01

    Abstract This cross-sectional European study assessed self-reported HIV-related discrimination and its associated factors in health care settings. Socio-demographics, health status, support needs relating to sexual and reproductive health (SRH), and self-reported HIV-related discrimination were measured using an anonymous survey in a sample of 1549 people living with HIV from 14 countries. Thirty-two per cent of the participants had experienced HIV-related discrimination during the previous 3 years; almost half of them felt discriminated against by health care providers. For this type of discrimination, logistic regression analysis revealed significant associations with not being a migrant (OR: 2.0; IC 1.0–3.7; p<0.05), having been forced into sexual activities (OR: 1.6; IC 1.2–2.2; p<0.001), reporting lack of time to discuss SRH during service provision (OR: 1.7; IC 1.0–2.7; p<0.05), and insufficient openness among service providers to discuss SRH (OR: 2.0; IC 1.1–3.4; p<0.05). Other significant associations related to unmet support needs on safer sex practices (OR: 1.8; IC 1.0–3.2; p<0.05), partner communication about sexuality (OR: 2.0; IC 1.1–3.4; p<0.05), and prevention of sexually transmitted infections (OR: 1.7; IC 1.0–3.0; p<0.05). Female gender had a protective effect (OR: 0.2; IC 0.0–0.9; p<0.05). Being denied the opportunity to discuss SRH may translate in feelings of discrimination. Improving health care providers' communication skills, and fostering openness about SRH topics in HIV care could contribute to destigmatization of PLHIV. PMID:24568694

  8. Reductions in hospital admissions and mortality rates observed after integrating emergency care: a natural experiment

    PubMed Central

    Ahmed, Vazeer; Palmer, Christopher R; Bennett, Tom J H; Robinson, Susan M

    2012-01-01

    Objectives Reducing emergency admissions is a priority for the NHS. A single hospital's emergency care system was reorganised with the principles of front-loaded investigations, integration of specialties, reduced duplication, earlier decision making by senior clinicians and a combined emergency assessment area. The authors relocated our Medical Assessment Unit into our emergency department in 2006. The authors evaluated changes in admissions and mortality before and after 2006, compared with other similar hospitals. Design Quasi-experimental before and after study using routinely collected data. Setting and participants 1 acute hospital in England, the intervention site, was compared with 23 other English hospitals between 2001 and 2009. Outcome measures Our outcome measures were hospital standardised mortality ratios (HSMRs) for non-elective admissions and standardised admission ratios (SARs). Results The authors observed a statistically and clinically significant decrease in HSMR and SAR. The intervention hospital had the lowest HSMR and SAR of all the hospitals in our sample. This was statistically significant, p=0.0149 and p=0.0002, respectively. Conclusion Integrating emergency care in one location is associated with a meaningful reduction in mortality and emergency admissions to hospital. PMID:22858459

  9. A comparison of perspectives on costs in emergency care among emergency department patients and residents

    PubMed Central

    Gilbert, Stefanie K.; Wen, Leana S.; Pines, Jesse M.

    2017-01-01

    BACKGROUND: Costs of care are increasingly important in healthcare policy and, more recently, in clinical care in the emergency department (ED). We compare ED resident and patient perspectives surrounding costs in emergency care. METHODS: We conducted a mixed methods study using surveys and qualitative interviews at a single, academic ED in the United States. The two study populations were a convenience sample of adult ED patients (>17 years of age) and ED residents training at the same institution. Participants answered open- and closed-ended questions on costs, medical decision making, cost-related compliance, and communication about costs. Closed-ended data were tabulated and described using standard statistics while open-ended responses were analyzed using grounded theory. RESULTS: Thirty ED patients and 24 ED residents participated in the study. Both patients and residents generally did not have knowledge of medical costs. Patients were comfortable discussing costs while residents were less comfortable. Residents agreed that doctors should consider costs when making medical decisions whereas patients somewhat disagreed. Additionally, residents generally took costs into consideration during clinical decision-making, yet nearly all residents agreed that they had too little education on costs. CONCLUSION: There were several notable differences in ED patient and resident perspectives on costs in this U.S. sample. While patients somewhat disagree that cost should factor into decision making, generally they are comfortable discussing costs yet report having insufficient knowledge of what care costs. Conversely, ED residents view costs as important and agree that cost should factor into decision making but lack education on what emergency care costs. PMID:28123619

  10. Nursing Care as Perceived by Nurses Working in Disability Community Settings in Greece

    PubMed Central

    Fotiadou, Elpida; Malliarou, Maria; Zetta, Stella; Gouva, Mary; Kotrotsiou, Evaggelia

    2016-01-01

    Introduction-Aim: The concept of nursing care in learning disability community settings has not been investigated in Greece. The aim of this paper is to investigate how nurses working in learning disability community settings perceive the meaning of nursing care. Material and Methods: The sample consisted of 100 nurses and nursing assistants working in a social care hospice. Participants were asked to answer questions about socio- demographic characteristics of the sample and fill in a questionnaire of care (GR-NDI-24), the “Job-Communication-Satisfaction-Importance” (JCSI) questionnaire and the altruism scale of Ahmed and Jackson. The data analysis was realized with statistical methods of descriptive and inductive statistics. The analysis was made with the use of SPSS (version 19). Results: The majority of the sample was women (78%). The majority of participants were married (66 %), DE graduates (66%) without postgraduate studies (96.7%). The mean age of respondents was 36.98±6.70 years. On the scales of caring and altruism, the mean values were 40.89±15.87 and 28.12±4.16 respectively. Very or fully satisfied with his work was 72% of the sample. The scope of work emerges as the most important factor influencing job satisfaction. The wages and working conditions (73% and 40% respectively) are the parameters of work which gathers the most dissatisfaction, while the salary is emerging as the most important parameter, the improvement of which would provide the highest satisfaction. Marginally statistically significant difference was observed in the range between TE graduates (d=40) and those of the DE grade (d=37), p=0.053. No statistically significant differences were observed in relation to other working and demographic characteristics (p>0.05). Greater care importance was associated with greater job satisfaction (p<0.01), while the latter was associated with high levels of altruism (p<0.05). Conclusion: The scope of work provides high satisfaction to nurses

  11. Emergency Victim Care. A Training Manual for Emergency Medical Technicians. Module 3--Anatomy and Physiology. Revised.

    ERIC Educational Resources Information Center

    Ohio State Dept. of Education, Columbus. Div. of Vocational Education.

    This student manual, the third in a set of 14 modules, is designed to train emergency medical technicians (EMTs) in Ohio. The module contains one section covering the following topics: general anatomical terms, the body cavities and contents, the integumentary system, the skeletal system, the muscular system, the nervous system, the respiratory…

  12. Predictors of physical restraint in a psychiatric emergency setting

    PubMed Central

    Hadi, Fatemeh; Khosravi, Termeh; Shariat, Seyed Vahid; Jalali Nadoushan, Amir Hossein

    2015-01-01

    Background: Considering the negative consequences of using physical restraints, we conducted this study to identify patients who are more frequently restrained in a psychiatric emergency ward as an initial step to limit the use of restraint to the minimum possible. Methods: This was a retrospective case control study conducted in Iran Psychiatric Hospital in Tehran, Iran. We reviewed the files of 607 patients who were admitted during a one year period using convenience sampling; of them, 186 were in the restrained group and 421 in the unrestrained group. Results: Surprisingly, no significant difference was found between the restrained and unrestrained groups in demographic characteristics. The patients who were referred because of violence were diagnosed as having methamphetamine induced psychotic disorder or bipolar I disorder in manic 1episode and had a higher odds of being restrained (OR=2.51, OR=1.61, and OR=1.57 respectively). Being restrained was also associated with a longer duration of hospitalization and duration of staying in the emergency ward. Moreover, patients in their first admission were more frequently restrained. Conclusion: Medical and nursing staff should consider special measures for the patients who are at a higher risk for being restrained. More frequent visits and education for both patients and staff may be effective in reducing the number of physical restraints for these groups of patients. PMID:26913259

  13. Glycemic Targets in Diabetes Care: Emerging Clarity after Accord

    PubMed Central

    Buse, John B.

    2015-01-01

    Through the 1990s convincing evidence emerged from studies involving relatively recent onset diabetes that glycemic control achieving glycated hemoglobin A1c levels of approximately 7% was associated with improved microvascular outcomes. Based on advocacy groups' statements encouraging lower targets and recognition of cardiovascular disease as the leading cause of death in diabetes, the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study was funded in 1999 to explore more intensive targets and techniques in the treatment of type 2 diabetes. Most surprisingly, intensive management targeting normal levels of glycemia was associated with increased mortality and the ACCORD trial was terminated early in 2008. Post hoc analyses have allowed the emergence of some clarity around the role of glycemic management and targets in diabetes care and are the subject of this review. PMID:26330660

  14. Creating self-care units in the acute care setting: a case study.

    PubMed

    Shendell-Falik, N

    1990-02-01

    Creating an environment in which patient's responsibility for self is fostered and nurses can practice professional and autonomous nursing practice is a challenge in today's hospitals. Innovative systems and structures need to be developed to assure quality of patient care and a high quality work environment. Newark Beth Israel Medical Center responded to the many demands of the mid-1980s, including increasing acuity of patients hospitalized, personnel shortages in nursing, physical therapy and other disciplines, and diminishing dollars available to the health care institution, through the creation of Self-Care Units. This article reviews how they came about, the way in which Self-Care Units function within the acute care setting and the management philosophy and structure which make them work. The experience at Newark Beth Israel Medical Center demonstrates that the potential exists to put control back at the bedside with the patient and the health care team working with the patient to achieve mutual goals. The focus of care has shifted from a "doing for" to a "working with" patients to identify interventions which promote active participation in hospitalization and a sense of self responsibility.

  15. [Emergency care of vertigo patients: suggestions for efficient management].

    PubMed

    Kogashiwa, Yasunao; Takei, Yasuhiko; Matsuda, Takeaki; Karaho, Takehiro; Morita, Masahiro; Kohno, Naoyuki

    2009-10-01

    Some diseases in which persons show vertigo or dizziness may be life-threatening, regardless of symptom severity, and require careful attention. These include diseases of the inner ear, central nervous system, and cardiovascular manifestation. In May 2006, a group in charge of primary emergency consultation began work enabling physicians to treat vertigo patients more efficiently and safely, as detailed in this report. Of the 173 persons with vertigo hospitalized from January 2004 to March 2008, six had cerebrovascular manifestations clarified only after hospitalization, underscoring the importance of careful examination, especially of those 75 years of age older, having continuous headache, having severe trunk ataxia despite apparently mild eye nystagmus, or reporting a history of high blood pressure, diabetes mellitus, hyperlipidemia, or ischemic heart disease.

  16. 48 CFR 5119.1070-2 - Emerging small business set-aside.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 48 Federal Acquisition Regulations System 7 2012-10-01 2012-10-01 false Emerging small business... Competitiveness Demonstration Program 5119.1070-2 Emerging small business set-aside. (a)(S-90) Solicitations for... or less than the emerging small business reserve amount (ESBRA) of $600,000. (Except that...

  17. 48 CFR 5119.1070-2 - Emerging small business set-aside.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 7 2011-10-01 2011-10-01 false Emerging small business... Competitiveness Demonstration Program 5119.1070-2 Emerging small business set-aside. (a)(S-90) Solicitations for... or less than the emerging small business reserve amount (ESBRA) of $600,000. (Except that...

  18. 48 CFR 5119.1070-2 - Emerging small business set-aside.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 7 2014-10-01 2014-10-01 false Emerging small business... Competitiveness Demonstration Program 5119.1070-2 Emerging small business set-aside. (a)(S-90) Solicitations for... or less than the emerging small business reserve amount (ESBRA) of $600,000. (Except that...

  19. Decentralized health care priority-setting in Tanzania: evaluating against the accountability for reasonableness framework.

    PubMed

    Maluka, Stephen; Kamuzora, Peter; San Sebastiån, Miguel; Byskov, Jens; Olsen, Øystein E; Shayo, Elizabeth; Ndawi, Benedict; Hurtig, Anna-Karin

    2010-08-01

    Priority-setting has become one of the biggest challenges faced by health decision-makers worldwide. Fairness is a key goal of priority-setting and Accountability for Reasonableness has emerged as a guiding framework for fair priority-setting. This paper describes the processes of setting health care priorities in Mbarali district, Tanzania, and evaluates the descriptions against Accountability for Reasonableness. Key informant interviews were conducted with district health managers, local government officials and other stakeholders using a semi-structured interview guide. Relevant documents were also gathered and group priority-setting in the district was observed. The results indicate that, while Tanzania has a decentralized public health care system, the reality of the district level priority-setting process was that it was not nearly as participatory as the official guidelines suggest it should have been. Priority-setting usually occurred in the context of budget cycles and the process was driven by historical allocation. Stakeholders' involvement in the process was minimal. Decisions (but not the reasoning behind them) were publicized through circulars and notice boards, but there were no formal mechanisms in place to ensure that this information reached the public. There were neither formal mechanisms for challenging decisions nor an adequate enforcement mechanism to ensure that decisions were made in a fair and equitable manner. Therefore, priority-setting in Mbarali district did not satisfy all four conditions of Accountability for Reasonableness; namely relevance, publicity, appeals and revision, and enforcement. This paper aims to make two important contributions to this problematic situation. First, it provides empirical analysis of priority-setting at the district level in the contexts of low-income countries. Second, it provides guidance to decision-makers on how to improve fairness, legitimacy, and sustainability of the priority-setting process.

  20. Prince Edward Island: building capacity--the implementation of a critical care/emergency program.

    PubMed

    Cotton, Judith

    2012-03-01

    Like other Canadian provinces, Prince Edward Island has a shortage of experienced nurses, especially in critical and emergency care. To increase the numbers of competent nurses, a PEI-based nursing course in these areas was identified as key to building capacity. This Research to Action pilot program successfully involved nurses in PEI-based emergency and critical care courses developed by the Nova Scotia Registered Nurses Professional Development Centre and funded by Human Resources and Skills Development Canada. The programs were offered on a full-time basis, lasted 14 weeks and included classroom and simulation laboratory time, along with a strong clinical component.Sixteen RNs graduated from the courses and became Advanced Cardiovascular Life Support (ACLS) certified. An additional 12 RNs were trained as preceptors. Feedback from participants indicates greater job satisfaction and increased confidence in providing patient assessments and care. Based on the program's success, the RTA partners proposed the establishment of an ongoing, PEI-based critical care and emergency nursing program utilizing 80/20 staffing models and mentorship. Their proposal was approved, with courses set to resume in January, 2012.

  1. Fatigue in the acute care and ambulatory setting.

    PubMed

    McCabe, Margaret; Patricia, Branowicki

    2014-01-01

    Nurses commonly assess their patients for symptoms and intervene to ease any patient distress, yet children are seldom asked about feeling fatigued. The existing pediatric literature suggests that fatigue goes unrecognized and therefore untreated in children, particularly children experiencing stressful events, such as illness and/or hospitalization. In an effort to better understand the presence of the symptom in our environment we conducted a program specific point prevalence survey. Data were collected on nine inpatient and 11 outpatient units of a university affiliated tertiary care children's hospital. Overall, this sample reported higher levels of fatigue than published data from their healthy and chronically ill peers by total fatigue score and sub scores. This brief description of the symptom in our inpatient and ambulatory settings has provided information that will inform our nursing practice and drive future research.

  2. Burnout and Job Engagement in Emergency and Intensive Care Nurses

    NASA Astrophysics Data System (ADS)

    Argentero, Piergiorgio; Dell'Olivo, Bianca

    Burnout phenomenon emerges from a constellation of factors which cannot be described in terms of cause-effect relationships. This study investigated levels of burnout in nurses working in Critical Care Units with a systemic approach, giving evidence of relation between nurses staff burnout and psychosocial workplace factors. The purpose of this study was to examine the relationship between job burnout in emergency and intensive care nurse with specific areas of work life in their organizations, using Maslach and Leiter work life model [23]. A cross-sectional survey was designed using the Italian version of the "Organizational Checkup System" in a sample of 180 Italian nurses. Results showed that high burnout levels were strongly related to high demands, low control, low fairness, lack of social support, and individual disagreement on values in the workplace. High professional efficacy levels were instead correlated to professional reward and leadership involvement. The article concludes by suggesting the possible areas for intervention in order to prevent job burnout and building job engagement.

  3. PEarly Postoperative Emergency Department Care of Abdominal Transplant Recipients1

    PubMed Central

    McElroy, Lisa M.; Schmidt, Kathryn A.; Richards, Christopher T.; Lapin, Brittany; Abecassis, Michael M.; Holl, Jane L.; Adams, James; Ladner, Daniela P.

    2015-01-01

    Background Research on post-transplant care has predominantly focused on predictors of readmission with little attention to emergency department (ED) visits. The goal of this study was to describe early postoperative ED care of transplant recipients. Methods A secondary database analysis of adult patients who underwent abdominal organ transplantation between January 1, 2008 and December 31, 2013 and sought ED care within one year post-transplantation was conducted. Survival was compared using the Kaplan-Meier method with log-rank test. Cox proportional hazards regression analysis was performed to adjust for pertinent covariates. Results A total of 1,900 abdominal organ transplants were performed during the study period. Of these, 37% (N=711) transplant recipients sought care in the ED (1,343 total visits) with 1.89 mean ED visits per recipient. Of recipients seen in the ED, 58% received a kidney transplant and 28% received a liver transplant, with 45% of recipients presenting within the first 60 postoperative days. The most common chief complaints were gastroenterological (17%) and abnormal laboratory values or vital signs (17%). In total, 74% of recipients were readmitted and 50% of admitted patients were discharged in less than 24 hours. Transplant recipients with ED visits had lower 3-year graft (81% vs. 87%; p<0.001) and patient (89% vs. 93%; p=0.002) survival. Conclusion Transplant recipients have a high frequency of ED visits in the first post-transplantation year and high rates of subsequent hospital admission. Further investigation is needed to understand what drives recipient presentation to the ED and create care models that achieve the best outcomes. PMID:26050012

  4. Existing and Emerging Technologies for Point-of-Care Testing

    PubMed Central

    St John, Andrew; Price, Christopher P

    2014-01-01

    The volume of point-of-care testing (PoCT) has steadily increased over the 40 or so years since its widespread introduction. That growth is likely to continue, driven by changes in healthcare delivery which are aimed at delivering less costly care closer to the patient’s home. In the developing world there is the challenge of more effective care for infectious diseases and PoCT may play a much greater role here in the future. PoCT technologies can be split into two categories, but in both, testing is generally performed by technologies first devised more than two decades ago. These technologies have undoubtedly been refined and improved to deliver easier-to-use devices with incremental improvements in analytical performance. Of the two major categories the first is small handheld devices, providing qualitative or quantitative determination of an increasing range of analytes. The dominant technologies here are glucose biosensor strips and lateral flow strips using immobilised antibodies to determine a range of parameters including cardiac markers and infectious pathogens. The second category of devices are larger, often bench-top devices which are essentially laboratory instruments which have been reduced in both size and complexity. These include critical care analysers and, more recently, small haematology and immunology analysers. New emerging devices include those that are utilising molecular techniques such as PCR to provide infectious disease testing in a sufficiently small device to be used at the point of care. This area is likely to grow with many devices being developed and likely to reach the commercial market in the next few years. PMID:25336761

  5. Orthopaedic care coordination for the intellectually and developmentally disabled adult in the residential care setting: a perfect storm.

    PubMed

    Kurre, Paula A

    2014-01-01

    The role of the nurse as care coordinator is important in all patient populations, including orthopaedic settings, and is essential in promoting safe patient care for the intellectually and developmentally disabled (I/DD) person living in the residential setting. Care coordination for this population is challenging. Most healthcare providers, as well as nurses, are not familiar with the residential group home setting or with the special needs of this population, especially when presented with orthopaedic challenges. These factors, as well as funding issues, make for a "perfect storm" for care coordination. Educating nurses can help open the door to communication, smoother transitions, and collaboration among care coordinators in all settings.

  6. Education in the Wake of Healthcare Reform: Increasing Primary Care Usage by Individuals Currently Reliant upon Emergency Departments for Care

    ERIC Educational Resources Information Center

    Tannebaum, Michael; Wilkin, Holley A.; Keys, Jobia

    2014-01-01

    Background: The Affordable Care Act (ACA) was introduced, in part, to increase access to primary care, which has been shown to provide patients with myriad health benefits. Objective: To increase primary care usage by understanding the beliefs about primary and emergency care most salient to those whose healthcare-seeking practices may be impacted…

  7. [The impact of a better coordination between emergency and intensive care units in the care of critically ill patients].

    PubMed

    Lara, Bárbara A; Cataldo, Alejandro; Castro, Ricardo; Aguilera, Pablo R; Ruiz, Carolina; Andresen, Max

    2016-07-01

    The need for critical care services is increasing in Chile. Critical care beds and specialists in this area are scarce. In this article we discuss some aspects that hamper the care of critically ill patients from their arrival to the emergency department to their transfer to the ICU. Special emphasis is given to system saturation and its multiple causes. The benefits of an integrative approach between emergency medicine and critical care specialists are highlighted and some solutions are proposed to strengthen this partnership.

  8. Developing a Policy for Delegation of Nursing Care in the School Setting

    ERIC Educational Resources Information Center

    Spriggle, Melinda

    2009-01-01

    School nurses are in a unique position to provide care for students with special health care needs in the school setting. The incidence of chronic conditions and improved technology necessitate care of complex health care needs that had formerly been managed in inpatient settings. Delegation is a tool that may be used by registered nurses to allow…

  9. Implementing emergency manuals: can cognitive aids help translate best practices for patient care during acute events?

    PubMed

    Goldhaber-Fiebert, Sara N; Howard, Steven K

    2013-11-01

    In this article, we address whether emergency manuals are an effective means of helping anesthesiologists and perioperative teams apply known best practices for critical events. We review the relevant history of such cognitive aids in health care, as well as examples from other high stakes industries, and describe why emergency manuals have a role in improving patient care during certain events. We propose 4 vital elements: create, familiarize, use, and integrate, necessary for the widespread, successful development, and implementation of medical emergency manuals, using the specific example of the perioperative setting. The details of each element are presented, drawing from the medical literature as well as from our combined experience of more than 30 years of observing teams of anesthesiologists managing simulated and real critical events. We emphasize the importance of training clinicians in the use of emergency manuals for education on content, format, and location. Finally, we discuss cultural readiness for change, present a system example of successful integration, and highlight the importance of further research on the implementation of emergency manuals.

  10. Point-of-Care Diagnostics in Low-Resource Settings and Their Impact on Care in the Age of the Noncommunicable and Chronic Disease Epidemic.

    PubMed

    Weigl, Bernhard H; Neogi, Tina; McGuire, Helen

    2014-06-01

    The emergence of point-of-care (POC) diagnostics specifically designed for low-resource settings coupled with the rapid increase in need for routine care of patients with chronic diseases should prompt reconsideration of how health care can be delivered most beneficially and cost-effectively in developing countries. Bolstering support for primary care to provide rapid and appropriate integrated acute and chronic care treatment may be a possible solution. POC diagnostics can empower local and primary care providers and enable them to make better clinical decisions. This article explores the opportunity for POC diagnostics to strengthen primary care and chronic disease diagnosis and management in a low-resource setting (LRS) to deliver appropriate, consistent, and integrated care. We analyze the requirements of resource-appropriate chronic disease care, the characteristics of POC diagnostics in LRS versus the developed world, the many roles of diagnostics in the care continuum in LRS, and the process and economics of developing LRS-compatible POC diagnostics.

  11. Self-care of patients with diabetes mellitus cared for at an emergency service in Mexico.

    PubMed

    Baquedano, Irasema Romero; dos Santos, Manoel Antônio; Martins, Tatiane Aparecida; Zanetti, Maria Lúcia

    2010-01-01

    This study examines the self-care ability of type 2 diabetes mellitus patients and relates it to sociodemographic and clinical variables. The study included 251 patients who were cared for by an emergency service in Mexico, in 2007. Data were obtained through structured interviews held at participants' households, through a form, a questionnaire and the Self-Care Ability Scale. Descriptive and correlation statistics were used for data analysis. The results show that 83 (33.5%) individuals displayed good self-care ability and 168 (66.5%) individuals displayed regular ability. A directly proportional correlation was found between self-care ability and schooling (r=0.124; p<0.05), as well as a negative correlation for religion (rs=-0.435; p<0.05) and duration of disease evolution (r=-0.667; p<0.05). The conclusion is that most of the individuals with type 2 diabetes mellitus displayed regular ability for self-care. Self-care ability is related to multiple variables that should be taken into account by health professionals when suggesting educational programs.

  12. Optimal older adult emergency care: introducing multidisciplinary geriatric emergency department guidelines from the American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, and Society for Academic Emergency Medicine.

    PubMed

    Carpenter, Christopher R; Bromley, Marilyn; Caterino, Jeffrey M; Chun, Audrey; Gerson, Lowell W; Greenspan, Jason; Hwang, Ula; John, David P; Lyons, William L; Platts-Mills, Timothy F; Mortensen, Betty; Ragsdale, Luna; Rosenberg, Mark; Wilber, Scott

    2014-07-01

    In the United States and around the world, effective, efficient, and reliable strategies to provide emergency care to aging adults is challenging crowded emergency departments (EDs) and a strained health care system. In response, geriatric emergency medicine (EM) clinicians, educators, and researchers collaborated with the American College of Emergency Physicians (ACEP), American Geriatrics Society (AGS), Emergency Nurses Association (ENA), and the Society for Academic Emergency Medicine (SAEM) to develop guidelines intended to improve ED geriatric care by enhancing expertise, educational, and quality improvement expectations; equipment; policies; and protocols. These "Geriatric Emergency Department Guidelines" represent the first formal society-led attempt to characterize the essential attribute of the geriatric ED and received formal approval from the boards of directors for each of the four societies in 2013 and 2014. This article is intended to introduce EM and geriatric health care providers to the guidelines, while providing proposals for educational dissemination, refinement via formal effectiveness evaluations and cost-effectiveness studies, and institutional credentialing.

  13. Collaborative practices in unscheduled emergency care: role and impact of the emergency care practitioner—qualitative and summative findings

    PubMed Central

    Cooper, Simon; O'Carroll, Judith; Jenkin, Annie; Badger, Beryl

    2007-01-01

    Objective To identify collaborative instances and hindrances and to produce a model of collaborative practice. Methods A 12‐month (2005–2006) mixed methods clinical case study was carried out in a large UK ambulance trust. Collaboration was measured through direct observational ratings of communication skills, teamwork and leadership with 24 multi‐professional emergency care practitioners (ECPs), interviews with 45 ECPs and stakeholders, and an audit of 611 patients Results Using a generic qualitative approach, observational records and interviews showed that ECPs' numerous links with other professions were influenced by three major themes as follows. (i) The ECP role: for example, “restricted transport codes” of communication, focus on reducing admissions, frustrations about patient tasking and conflicting views about leadership and team work. (ii) Education and training: drivers for multi‐professional clinically focussed graduate level education, requirements for skill development in minor injury units (MIUs) and general practice, and the need for clinical supervision/mentorship. (iii) Cultural perspectives: a “crew room” blue collar view of inter‐professional working versus emerging professional white collar views, power and communication conflicts, and a lack of understanding of the ECPs' role. The quantitative findings are reported elsewhere. Conclusions The final model of collaborative practice suggests that ECPs are having an impact on patient care, but that improvements can be made. We recommend the appointment of ECP clinical leads, degree level clinically focussed multi‐professional education, communication skills training, clinical supervision and multi‐professional ECP appointments. PMID:17711937

  14. Exploring the mealtime experience in residential care settings for older people: an observational study.

    PubMed

    Barnes, Sarah; Wasielewska, Anna; Raiswell, Christine; Drummond, Barbara

    2013-07-01

    Improving the mealtime experience in residential care can be a major facilitator in improving care, well-being and QoL. Evidence suggests that, despite guidance on the subject of food, nutrition and hydration, there are still concerns. Although there is a range of methods to research and assess the quality of food provision, there is a challenge in capturing the experiences of those residents who are unable or unwilling to describe their feelings and experiences because of frailty, impaired communication or other vulnerability. The aim of this exploratory study was to capture and describe individual residents' mealtime experience. In spring 2011, a small-scale, observational study was carried out in seven dining settings in four residential care homes in Manchester. An adapted dementia care mapping tool was used alongside field notes. Observations showed two major differences in the way the mealtimes were organised: 'pre-plated' and 'family-style' (where either bowls of food are placed in the centre of the table or food is served directly from a hotplate by a chef). These two styles of service are discussed in relation to the emerging themes of 'task versus resident-centred mealtimes', 'fostering resident independence' and 'levels of interaction'. Although improving mealtimes alone is not enough to improve quality of life in care homes, findings showed that relatively small changes to mealtime delivery can potentially have an impact on resident well-being in these homes. Observation is a useful method of engaging residents in care settings for older people who may not otherwise be able to take part in research.

  15. Predictors for critical care admission among children presenting to emergency department with recurrent wheezing

    PubMed Central

    Saini, Aman; Kaushik, Jaya Shankar; Arya, Vandana; Gathwala, Geeta

    2017-01-01

    Context: Children with recurrent wheezing contribute to a significant burden of inpatient hospital admission in developing countries. However, many patients could be managed at home following a short observation period in emergency unit. Aim: This study aimed to determine the predictors of critical care admission in a population of children aged 6 months to 2 years attending pediatric emergency department (ED) for recurrent wheezing. Setting and Design: This is a case–control study conducted in pediatric ED of a tertiary care center in North India. Patients and Methods: Demographic and clinical details were recorded for children aged 6 months to 2 years who presented to ED for “recurrent wheezing” within 48 h of onset of symptoms. Those who were admitted to critical care unit were considered cases and those who were discharged within 6 h of stay at short observation units of ED were considered controls. Statistical Analysis: Logistic regression model was used to determine which of the various demographic and clinical factors best predicted the need for critical care admission. Results: The cases (n = 58) had significantly higher number of emergency visits in the preceding 1 month (P = 0. 018), had more episodes of wheezing in the last 3 months (P = 0.025), had higher respiratory rate (P < 0.001), and had higher clinical severity score (P < 0.001) when compared to control (n = 58) group. Logistic regression model revealed incomplete immunization status of children (P = 0.005) to be a significant risk factor that determine the need for critical care admission. Conclusion: The present cross-sectional study with limited sample size revealed incomplete immunization status of children to be a significant risk factor that determined the need for critical care admission among children below 2 years of age presenting to ED with recurrent wheezing. PMID:28243009

  16. [Antenatal emergency call. Indications. Role of the SAMU (Medical Emergency Care Services)].

    PubMed

    Lallemand, E; Drouet, N; Faudemay, C; Lacroute, J M; Menthonnex, P

    1989-01-01

    The increased incidence of antenatal distress calls to the SAMU (emergency medical squad) by pediatric obstetricians in maternity departments (6 times in 5 years) poses the problem of recognizing their indications. Based on case reports of 128 newborns who profited from antenatal assistance, the authors attempt to define the indications. The elimination of student physicians in training for anesthesiology-intensive care, additional participants during SAMU transportation of patients, makes it even more necessary to define these indications accurately so that a single language of communication and procedure may be instituted for all who are involved in this effort.

  17. Patient experience of different regional models of urgent and emergency care: a cross-sectional survey study

    PubMed Central

    Foley, Conor; Droog, Elsa; Boyce, Maria; Healy, Orla; Browne, John

    2017-01-01

    Objectives To compare user experiences of 8 regional urgent and emergency care systems in the Republic of Ireland, and explore potential avenues for improvement. Design A cross-sectional survey. Setting Several distinct models of urgent and emergency care operate in Ireland, as system reconfiguration has been implemented in some regions but not others. The Urgent Care System Questionnaire was used to explore service users' experiences with urgent and emergency care. Linear regression and logistic regression were used to detect regional variation in each of the 3 domains and overall ratings of care. Participants A nationally representative sample (N=8002) of the general population was contacted by telephone, yielding 1205 participants who self-identified as having used urgent and emergency care services in the previous 3 months. Main outcome measures Patient experience was assessed across 3 domains: entry into the system, progress through the system and patient convenience of the system. Participants were also asked to provide an overall rating of the care they received. Results Service users in Dublin North East gave lower ratings on the entry into the system scale than those in Dublin South (adjusted mean difference=−0.18; 95% CI −0.35 to −0.10; p=0.038). For overall ratings of care, service users in the Mid-West were less likely than those in Dublin North East to give an excellent rating (adjusted OR 0.57; 95% CI 0.35 to 0.92; p=0.022). Survey items relating to communication, and consideration of patients' needs were comparatively poorly rated. The use of public emergency departments and out-of-hours general practice care was associated with poorer patient experiences. Conclusions No consistent relationship was found between the type of urgent and emergency care model in different regions and patient experience. Scale-level data may not offer a useful metric for exploring the impact of system-level service change. PMID:28320790

  18. [The preclinical efficacy of emergency care. A prospective study].

    PubMed

    Hennes, H J; Reinhardt, T; Otto, S; Dick, W

    1993-07-01

    Quality assurance has become an important issue in emergency medicine. At present, no prospective studies are available that quantify the efficacy of interventions performed by emergency doctors. The development and implementation of a rapid, yet simple scoring system, allowing preclinical assessment of all emergency medicine patients, is required. Once the scoring system is implemented, evaluation of the prehospital intervention, based upon objective parameters, is possible. METHODS. The Mainz Emergency Evaluation Score (MEES) is based on seven parameters: level of consciousness, heart rate, heart rhythm, arterial blood pressure, respiratory rate, partial arterial oxygen saturation and pain. A coded value is assigned to each parameter, with the normal physiological condition securing a score of 4, while a life-threatening condition receives a value of 1. For the parameter of pain there is no life-threatening condition, so the lowest value allowed is 2 (Table 2). Addition of the respective values from the seven parameters yields the MEES value, which objectively reflects the patients' condition (minimum = 8, maximum = 28). Comparing the MEES value before (MEES1) and after the intervention (MEES2) allows an objective evaluation of the efficacy of the preclinical care (delta-MEES = MEES2-MEES1). A difference of > or = +2 is considered an improvement, +1, +/- 0, -1 are rated as unchanged and < or = -2 is considered a deterioration in the patients condition. For more detailed evaluation the patients were allocated to 16 diagnosis groups (Table 3). Statistical evaluation utilized analysis of variance, the rank sum test (Wilcoxon) and the correlation coefficient (Kendall-Tau). RESULTS. In 356 patients the condition of 187 (52%) patients improved during the preclinical treatment; the condition of 156 (44%) patients did not change. In 13 patients (3%) the condition became worse (Table 5, Fig. 2). Allocation to 16 diagnosis groups revealed that the improvement in the

  19. Essential basic and emergency obstetric and newborn care: from education and training to service delivery and quality of care.

    PubMed

    Otolorin, Emmanuel; Gomez, Patricia; Currie, Sheena; Thapa, Kusum; Dao, Blami

    2015-06-01

    Approximately 15% of expected births worldwide will result in life-threatening complications during pregnancy, delivery, or the postpartum period. Providers skilled in emergency obstetric and newborn care (EmONC) services are essential, particularly in countries with a high burden of maternal and newborn mortality. Jhpiego and its consortia partners have implemented three global programs to build provider capacity to provide comprehensive EmONC services to women and newborns in these resource-poor settings. Providers have been educated to deliver high-impact maternal and newborn health interventions, such as prevention and treatment of postpartum hemorrhage and pre-eclampsia/eclampsia and management of birth asphyxia, within the broader context of quality health services. This article describes Jhpiego's programming efforts within the framework of the basic and expanded signal functions that serve as indicators of high-quality basic and emergency care services. Lessons learned include the importance of health facility strengthening, competency-based provider education, global leadership, and strong government ownership and coordination as essential precursors to scale-up of high impact evidence-based maternal and newborn interventions in low-resource settings.

  20. Using electronic communication safely in health care settings.

    PubMed

    Broussard, Brenda S; Broussard, Anne B

    2013-01-01

    Nurses are increasingly using mobile and other devices, such as cell phones, smartphones, tablets, bar-coding scanners, monitoring equipment and bedside computers, to communicate with members of the health care team and with patients. Communication accomplished with such devices includes direct verbal communication, text-messaging, emailing, obtaining patient care information and accessing medical records for order entry and for documenting nursing care. Problems that could occur with such communication methods include distraction, errors, de-personalized care, violation of confidentiality and transmission of nosocomial pathogens. Policies are needed to prevent inappropriate use of technological devices in patient care and to promote patient safety and quality care with their use.

  1. Validity of the Manchester Triage System in emergency care: A prospective observational study

    PubMed Central

    Rood, Pleunie P. M.; Alves, Claudio F.; Freitas, Paulo; Smit, Frank J.; Roukema, Gert R.; Moll, Henriëtte A.

    2017-01-01

    Objectives To determine the validity of the Manchester Triage System (MTS) in emergency care for the general population of patients attending the emergency department, for children and elderly, and for commonly used MTS flowcharts and discriminators across three different emergency care settings. Methods This was a prospective observational study in three European emergency departments. All consecutive patients attending the emergency department during a 1-year study period (2010–2012) were included. Validity of the MTS was assessed by comparing MTS urgency as determined by triage nurses with patient urgency according to a predefined 3-category reference standard as proxy for true patient urgency. Results 288,663 patients were included in the analysis. Sensitivity of the MTS in the three hospitals ranged from 0.47 (95%CI 0.44–0.49) to 0.87 (95%CI 0.85–0.90), and specificity from 0.84 (95%CI 0.84–0.84) to 0.94 (95%CI 0.94–0.94) for the triage of adult patients. In children, sensitivity ranged from 0.65 (95%CI 0.61–0.70) to 0.83 (95%CI 0.79–0.87), and specificity from 0.83 (95%CI 0.82–0.83) to 0.89 (95%CI 0.88–0.90). The diagnostic odds ratio ranged from 13.5 (95%CI 12.1–15.0) to 35.3 (95%CI 28.4–43.9) in adults and from 9.8 (95%CI 6.7–14.5) to 23.8 (95%CI 17.7–32.0) in children, and was lowest in the youngest patients in 2 out of 3 settings and in the oldest patients in all settings. Performance varied considerably between the different emergency departments. Conclusions Validity of the MTS in emergency care is moderate to good, with lowest performance in the young and elderly patients. Future studies on the validity of triage systems should be restricted to large, multicenter studies to define modifications and improve generalizability of the findings. PMID:28151987

  2. Emergency obstetric care: Making the impossible possible through task shifting.

    PubMed

    Schneeberger, Caroline; Mathai, Matthews

    2015-10-01

    Task shifting-moving tasks to healthcare workers with a shorter training-for emergency obstetric care (EmOC) can potentially improve access to lifesaving interventions and thereby contribute to reducing maternal and neonatal morbidity and mortality. The present paper reviews studies on task shifting for the provision of EmOC. Most studies were performed in Sub-Saharan Africa and South Asia and focused primarily on task shifting for the performance of cesarean deliveries. Cesarean delivery rates increased following EmOC training without significant increase in adverse outcomes. The paper discusses the advantages and disadvantages of task shifting in EmOC and the role of this approach in improving maternal and newborn health in the short and long term.

  3. Project Kiddum: Early Intervention in a Health Care Setting.

    ERIC Educational Resources Information Center

    Tamir, Dov

    1981-01-01

    Project Kiddum functions in nine Mother and Child Health Care Centers in culturally deprived areas of Jerusalem. The project integrates a large scale infant intervention program into ongoing primary preventive mother and child health care. (Author/GC)

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

    PubMed

    Clark, Matthew G; Dalabih, Abdallah

    2014-09-01

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

  5. Review article: Clinical impact of non-cardiologist-performed transthoracic echocardiography in emergency medicine, intensive care medicine and anaesthesia.

    PubMed

    Haji, Darsim L; Royse, Alistair; Royse, Colin F

    2013-02-01

    There is increased realisation of the emerging role of point-of-care transthoracic echocardiography (TTE) as 'ultrasound-assisted examination', given the low sensitivity of clinical examination for cardiovascular pathologies and the time-critical nature of these pathologies. There is evidence that point-of-care TTE provides higher accuracy in patient assessment and management, with potential prognostic impact by assessing the severity of cardiac dysfunction and response to treatment. Point-of-care TTE is increasingly used by non-cardiologists, as a diagnostic, screening or monitoring tool. The literature shows that TTE identifies new clinical findings, and conversely can accurately rule out clinically important pathologies. Recent reports have examined more advanced ultrasound devices and patients in the critical care settings of emergency medicine, intensive care and anaesthesia. The diagnostic capability of new portable devices is improving rapidly and outdating its predecessors, thereby improving confidence in echocardiography findings.

  6. Internships in Nontraditional Health Care Settings: A Pilot Program.

    ERIC Educational Resources Information Center

    Kotarba, Joseph A.

    1990-01-01

    Addresses nontraditional health care issues by placing internship students in different health care agencies such as (1) workplace wellness programs; (2) centers for independent living for the physically handicapped; and (3) an Acquired Immune Deficiency Syndrome (AIDS) intervention program. Examines new problems in health care and the importance…

  7. Perceptions of Abuse in the Long-Term Care Setting.

    ERIC Educational Resources Information Center

    Gupta, D.; And Others

    Although elder abuse has received much attention in recent years, little is known about long-term care staff perceptions of active and passive abuse. Health care professionals (N=72) responsible for direct care of patients within a 275-bed skilled nursing facility completed questionnaires on elder abuse. Responses were from physicians (N=6),…

  8. A top-five list for emergency medicine: a pilot project to improve the value of emergency care.

    PubMed

    Schuur, Jeremiah D; Carney, Dylan P; Lyn, Everett T; Raja, Ali S; Michael, John A; Ross, Nicholas G; Venkatesh, Arjun K

    2014-04-01

    IMPORTANCE The mean cost of medical care in the United States is growing at an unsustainable rate; from 2003 through 2011, the cost for an emergency department (ED) visit rose 240%, from $560 to $1354. The diagnostic tests, treatments, and hospitalizations that emergency clinicians order result in significant costs. OBJECTIVE To create a "top-five" list of tests, treatments, and disposition decisions that are of little value, are amenable to standardization, and are actionable by emergency medicine clinicians. DESIGN, SETTING, AND PARTICIPANTS Modified Delphi consensus process and survey of 283 emergency medicine clinicians (physicians, physician assistants, and nurse practitioners) from 6 EDs. INTERVENTION We assembled a technical expert panel (TEP) and conducted a modified Delphi process to identify a top-five list using a 4-step process. In phase 1, we generated a list of low-value clinical decisions from TEP brainstorming and e-mail solicitation of clinicians. In phase 2, the TEP ranked items on contribution to cost, benefit to patients, and actionability by clinicians. In phase 3, we surveyed all ordering clinicians from the 6 EDs regarding distinct aspects of each item. In phase 4, the TEP voted for a final top-five list based on survey results and discussion. MAIN OUTCOMES AND MEASURES A top-five list for emergency medicine. The TEP ranked items on contribution to cost, benefit to patients, and actionability by clinicians. The survey asked clinicians to score items on the potential benefit or harm to patients and the provider actionability of each item. Voting and surveys used 5-point Likert scales. A Pearson interdomain correlation was used. RESULTS Phase 1 identified 64 low-value items. Phase 2 narrowed this list to 7 laboratory tests, 3 medications, 4 imaging studies, and 3 disposition decisions included in the phase 3 survey (71.0% response rate). All 17 items showed a significant positive correlation between benefit and actionability (r, 0.19-0.37 [P

  9. The emergence of a global right to health norm – the unresolved case of universal access to quality emergency obstetric care

    PubMed Central

    2014-01-01

    Background The global response to HIV suggests the potential of an emergent global right to health norm, embracing shared global responsibility for health, to assist policy communities in framing the obligations of the domestic state and the international community. Our research explores the extent to which this global right to health norm has influenced the global policy process around maternal health rights, with a focus on universal access to emergency obstetric care. Methods In examining the extent to which arguments stemming from a global right to health norm have been successful in advancing international policy on universal access to emergency obstetric care, we looked at the period from 1985 to 2013 period. We adopted a qualitative case study approach applying a process-tracing methodology using multiple data sources, including an extensive literature review and limited key informant interviews to analyse the international policy agenda setting process surrounding maternal health rights, focusing on emergency obstetric care. We applied John Kingdon's public policy agenda setting streams model to analyse our data. Results Kingdon’s model suggests that to succeed as a mobilising norm, the right to health could work if it can help bring the problem, policy and political streams together, as it did with access to AIDS treatment. Our analysis suggests that despite a normative grounding in the right to health, prioritisation of the specific maternal health entitlements remains fragmented. Conclusions Despite United Nations recognition of maternal mortality as a human rights issue, the relevant policy communities have not yet managed to shift the policy agenda to prioritise the global right to health norm of shared responsibility for realising access to emergency obstetric care. The experience of HIV advocates in pushing for global solutions based on right to health principles, including participation, solidarity and accountability; suggest potential avenues for

  10. Missed nursing care and predicting factors in the Italian medical care setting.

    PubMed

    Palese, Alvisa; Ambrosi, Elisa; Prosperi, Letizia; Guarnier, Annamaria; Barelli, Paolo; Zambiasi, Paola; Allegrini, Elisabetta; Bazoli, Letizia; Casson, Paola; Marin, Meri; Padovan, Marisa; Picogna, Michele; Taddia, Patrizia; Salmaso, Daniele; Chiari, Paolo; Marognolli, Oliva; Canzan, Federica; Gonella, Silvia; Saiani, Luisa

    2015-09-01

    Missed nursing care (MNC), such as nursing care omitted or delayed, has not been measured in the Italian context where several cost containment interventions affect the care offered in medical units. The aim of the study is to identify the amount, type, and reasons for MNC in the Italian medical care setting and to explore the factors that affect the occurrence of MNC. A 3-month longitudinal survey was carried out followed by a cross-sectional study design in 12 north eastern acute medical units. A total of 314 nursing staff members were involved. Multivariate logistic regression was performed to identify the predictors of MNC. Patient ambulation (91.4 %), turning the patient every 2 h (74.2 %), and right timing in administering medications (64.6 %) were the most perceived MNC. Among the most frequent reasons were the unexpected rise in patient volume or critical conditions (95.2 %), inadequate numbers of staff (94.9 %), and large numbers of admissions/discharges (93.3 %). The R (2) 33.2 % of the variance in MNC were explained by a full-time position (OR 4.743, 95 % CI 1.146-19.629), communication tensions between Registered Nurses and Nurses' Aides (OR 1.601, 95 % CI 1.020-2.515), the amount of experience in medical unit (OR 1.564, 95 % CI 1.021-2.397), and the amount of daily care offered by Nurses' Aides (1.039, 95 % CI 1.011-1.067). A substantial amount of basic and clinically relevant nursing interventions was perceived to be missed, and this may lead to an increase in negative outcomes for patients admitted to a medical unit. Appropriate standards of nursing care should be adopted urgently in medical units aiming to protect frail patients.

  11. The cost of emergency obstetric care: concepts and issues.

    PubMed

    Desai, J

    2003-04-01

    Emergency obstetric care (EmOC), like any health intervention, requires resources, and resources are almost always limited. This forces decision makers to take into account the costs (and effectiveness) of EmOC provision and compare them with the costs (and effectiveness) of other health interventions. This is not inordinately complicated, but it does require paying attention to the fact that EmOC services require different types of inputs and are produced in facilities that also provide other health care services. This paper discusses the basic concepts underlying the costing of EmOC services, and the essential issues one must take into account while assessing the cost-effectiveness of EmOC interventions. A definition of EmOC provision cost is offered and then explained by progressively refining a simple measure of expenditures on all that is used to provide EmOC services. Thereupon the process of collecting cost data and calculating costs is outlined using a simple spreadsheet format, and issues related to the analysis of costs and cost-effectiveness are discussed.

  12. Implementation of emergency obstetric care training in Bangladesh: lessons learned.

    PubMed

    Islam, Mohammad Tajul; Haque, Yasmin Ali; Waxman, Rachel; Bhuiyan, Abdul Bayes

    2006-05-01

    The Women's Right to Life and Health project aimed to reduce maternal morbidity and mortality in Bangladesh through provision of comprehensive emergency obstetric care (EmOC) in the country's district and sub-district hospitals. Human resources development was one of the project's major activities. This paper describes the project in 2000-2004 and lessons learned. Project documents, the training database, reports and training protocols were reviewed. Medical officers, nurses, facility managers and laboratory technicians received training in the country's eight medical college hospitals, using nationally accepted curricula. A 17-week competency-based training course for teams of medical officers and nurses was introduced in 2003. At baseline in 1999, only three sub-district hospitals were providing comprehensive EmOC and 33 basic EmOC, mostly due to lack of trained staff and necessary equipment. In 2004, 105 of the 120 sub-district hospitals had become functional for EmOC, 70 with comprehensive EmOC and 35 with basic EmOC, while 53 of 59 of the district hospitals were providing comprehensive EmOC compared to 35 in 1999. The scaling up of competency-based training, innovative incentives to retain trained staff, evidence-based protocols to standardise practice and improve quality of care and the continuing involvement of key stakeholders, especially trainers, will all be needed to reach training targets in future.

  13. Marketing: applications in a military health care setting.

    PubMed

    Roark, G A; Tucker, S L

    1997-08-01

    Military health care leaders must recognize the importance of satisfied consumers. As part of this recognition, the focus of military medicine must change from a coercive-power to a reward-power system. This change highlights the need for business practices such as marketing. Encouraging military health care administrators to learn and understand the applications of the marketing variables will enhance demand management and health care delivery for beneficiaries. This paper describes some applications of marketing variables, informs the military health care administrator about the process of marketing, and describes the utility of marketing in the current paradigm shift in military health care delivery.

  14. The Emergence of Student Creativity in Classroom Settings: A Case Study of Elementary Schools in Korea

    ERIC Educational Resources Information Center

    Cho, Younsoon; Chung, Hye Young; Choi, Kyoulee; Seo, Choyoung; Baek, Eunjoo

    2013-01-01

    This research explores the emergence of student creativity in classroom settings, specifically within two content areas: science and social studies. Fourteen classrooms in three elementary schools in Korea were observed, and the teachers and students were interviewed. The three types of student creativity emerging in the teaching and learning…

  15. The Australian public's preferences for emergency care alternatives and the influence of the presenting context: a discrete choice experiment

    PubMed Central

    Harris, Paul; Whitty, Jennifer A; Kendall, Elizabeth; Ratcliffe, Julie; Wilson, Andrew; Littlejohns, Peter; Scuffham, Paul A

    2015-01-01

    Objectives The current study seeks to quantify the Australian public's preferences for emergency care alternatives and determine if preferences differ depending on presenting circumstances. Setting Increasing presentations to emergency departments have led to overcrowding, long waiting times and suboptimal health system performance. Accordingly, new service models involving the provision of care in alternative settings and delivered by other practitioners continue to be developed. Participants A stratified sample of Australian adults (n=1838), 1382 from Queensland and 456 from South Australia, completed the survey. This included 951 females and 887 males from the 2045 people who met the screening criteria out of the 4354 people who accepted the survey invitation. Interventions A discrete choice experiment was used to elicit preferences in the context of one of four hypothetical scenarios: a possible concussion, a rash/asthma-related problem involving oneself or one's child and an anxiety-related presentation. Mixed logit regression was used to analyse the dependent variable choice and identify the relative importance of care attributes and the propensity to access care in each context. Results Results indicated a preference for treatment by an emergency physician in hospital for possible concussion and treatment by a doctor in ambulatory settings for rash/asthma-related and anxiety-related problems. Participants were consistently willing to wait longer before making trade-offs in the context of the rash/asthma-related scenario compared with when the same problem affected their child. Results suggest a clear preference for lower costs, shorter wait times and strong emphasis on quality care; however, significant preference heterogeneity was observed. Conclusions This study has increased awareness that the public's emergency care choices will differ depending on the presenting context. It has further demonstrated the importance of service quality as a determinant of

  16. Spectrum of vaginal discharge in a tertiary care setting

    PubMed Central

    Sivaranjini, R; Jaisankar, TJ; Thappa, Devinder Mohan; Kumari, Rashmi; Chandrasekhar, Laxmisha; Malathi, M; Parija, SC; Habeebullah, S

    2013-01-01

    Introduction: Vaginal discharge is one of the common reasons for gynecological consultation. Many of the causes of vaginitis have a disturbed vaginal microbial ecosystem associated with them. Effective treatment of vaginal discharge requires that the etiologic diagnosis be established and identifying the same offers a precious input to syndromic management and provides an additional strategy for human immunodeficiency virus prevention. The present study was thus carried out to determine the various causes of vaginal discharge in a tertiary care setting. Materials and Methods: A total of 400 women presenting with vaginal discharge of age between 20 and 50 years, irrespective of marital status were included in this study and women who had used antibiotics or vaginal medication in the previous 14 days and pregnant women were excluded. Results: Of the 400 women with vaginal discharge studied, a diagnosis was established in 303 women. Infectious causes of vaginal discharge were observed in 207 (51.75%) women. Among them, bacterial vaginosis was the most common cause seen in 105 (26.25%) women. The other infections observed were candidiasis alone (61, 15.25%), trichomoniasis alone (12, 3%), mixed infections (22, 5.5%) and mucopurulent cervicitis (7 of the 130 cases looked for, 8.46%). Among the non-infectious causes, 72 (18%) women had physiological vaginal discharge and 13 (3.3%) women had cervical in situ cancers/carcinoma cervix. Conclusion: The pattern of infectious causes of vaginal discharge observed in our study was comparable with the other studies in India. Our study emphasizes the need for including Papanicolaou smear in the algorithm for evaluation of vaginal discharge, as it helps establish the etiology of vaginal discharge reliably and provides a valuable opportunity to screen for cervical malignancies. PMID:24470998

  17. A Profile Approach to Child Care Quality, Quantity, and Type of Setting: Parent Selection of Infant Child Care Arrangements

    ERIC Educational Resources Information Center

    Sosinsky, Laura Stout; Kim, Se-Kang

    2013-01-01

    Building on prior variable-oriented research which demonstrates the independence of the associations of child care quality, quantity, and type of setting with family factors and child outcomes, the current study identifies four profiles of child care dimensions from the NICHD Study of Early Child Care and Youth Development. Profiles accounted for…

  18. Care and Respect for Elders in Emergencies program: a preliminary report of a volunteer approach to enhance care in the emergency department.

    PubMed

    Sanon, Martine; Baumlin, Kevin M; Kaplan, Shari Sirkin; Grudzen, Corita R

    2014-02-01

    Older adults who present to an emergency department (ED) generally have more-complex medical conditions with complicated care needs and are at high risk for preventable adverse outcomes during their ED visit. The Care and Respect for Elders with Emergencies (CARE) volunteer initiative is a geriatric-focused volunteer program developed to help prevent avoidable complications such as falls, delirium and use of restraints, and functional decline in vulnerable elders in the ED. The CARE program consists of bedside volunteer interventions ranging from conversation to various short activities designed to engage and reorient high-risk, older, unaccompanied individuals in the ED. This article describes the development and characteristics of the CARE program, the services provided, the experiences of the elderly patients and their volunteers, and the growth of the program over time. CARE volunteers provide elders with the additional attention needed in an often chaotic, unfamiliar environment by enhancing their care, improving satisfaction, and preventing potential decline.

  19. Optimal older adult emergency care: introducing multidisciplinary geriatric emergency department guidelines from the American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, and Society for Academic Emergency Medicine.

    PubMed

    Carpenter, Christopher R; Bromley, Marilyn; Caterino, Jeffrey M; Chun, Audrey; Gerson, Lowell W; Greenspan, Jason; Hwang, Ula; John, David P; Lyons, William L; Platts-Mills, Timothy F; Mortensen, Betty; Ragsdale, Luna; Rosenberg, Mark; Wilber, Scott

    2014-07-01

    In the United States and around the world, effective, efficient, and reliable strategies to provide emergency care to aging adults is challenging crowded emergency departments (EDs) and strained healthcare systems. In response, geriatric emergency medicine clinicians, educators, and researchers collaborated with the American College of Emergency Physicians, American Geriatrics Society, Emergency Nurses Association, and Society for Academic Emergency Medicine to develop guidelines intended to improve ED geriatric care by enhancing expertise, educational, and quality improvement expectations, equipment, policies, and protocols. These Geriatric Emergency Department Guidelines represent the first formal society-led attempt to characterize the essential attributes of the geriatric ED and received formal approval from the boards of directors of each of the four societies in 2013 and 2014. This article is intended to introduce emergency medicine and geriatric healthcare providers to the guidelines while providing recommendations for continued refinement of these proposals through educational dissemination, formal effectiveness evaluations, cost-effectiveness studies, and eventually institutional credentialing.

  20. Contamination of equipment in emergency settings: An exploratory study with a targeted automated intervention

    PubMed Central

    Obasi, Chidi; Agwu, Allison; Akinpelu, Wale; Hammons, Roger; Clark, Clyde; Etienne-cummings, Ralph; Hill, Peter; Rothman, Richard; Babalola, Stella; Ross, Tracy; Carroll, Karen; Asiyanbola, Bolanle

    2009-01-01

    Background Despite standard manual decontamination, hospital equipment remains contaminated with microorganisms, contributing to nosocomial transmission and hospital acquired infections. This has the potential to negate the effects of healthcare workers' hand-washing protocols. In order to decrease the likihood of equipment contamination, there has been a rise in the use of disposable pieces of equipment, especially non-critical disposables. However, these carry a significant cost, both a direct financial cost (running into billions of dollars), as well as a cost to the environment. This is important because we hope to contain the cost of healthcare, one way to do that, is to look to the hospitals themselves, for innovative solutions that maintain the standard of care. Objective To develop and evaluate the effectiveness of an simple decontamination device for use with portable hospital equipment, by comparing rates of residual contamination after use of the novel device versus those seen with standard manual decontamination methods. Methods The Self-cleaning Unit for the Decontamination of Small instruments (SUDS) is a user-friendly, automated instrument developed via multi-disciplinary collaboration for decontamination in the clinical area. Pre- and post- utilization of portable medical equipment in an emergency department (ED) setting were cultured. To evaluate durability of the decrease in antimicrobial contamination, objects were re-cultured 48 hours after SUDS cleaning and following re-introduction into the clinical setting. Results After manual decontamination, 25% (23/91) of the tested objects in the ED were found to be culture positive with clinically significant microorganisms(CSO). Fifteen percent (ED) of non-critical equipment tested had multiple organisms. Following the use of SUDS, the colonization rate decreased to 0%. Following SUDS treatment and re-introduction into the clinical settings, after 48 hours the contamination rates as reflected by the

  1. Indicators of Home Care Use in Urban and Rural Settings

    ERIC Educational Resources Information Center

    Mitchell, Lori A.; Strain, Laurel A.; Blandford, Audrey A.

    2007-01-01

    This study employs a longitudinal design to examine rural-urban differences in home care service use over time, drawing on data from the Manitoba Study of Health and Aging (MSHA). Characteristics of community-dwelling, cognitively intact adults aged 65 years or older not receiving home care services in the province of Manitoba (n = 855) were…

  2. The Future of Family Engagement in Residential Care Settings

    ERIC Educational Resources Information Center

    Affronti, Melissa L.; Levison-Johnson, Jody

    2009-01-01

    Residential programs for children and youth are increasingly implementing engagement strategies to promote family-centered and family-driven models of care (Leichtman, 2008). The practice of engagement is a fairly new area of research, especially in residential care. Driven by their goal to increase the use of state-of-the-art family engagement…

  3. Teaching Reflective Care in Japanese Early Childhood Settings

    ERIC Educational Resources Information Center

    Hellman, Anette

    2016-01-01

    The purpose of this article is to explore the way preschool teachers teach reflective care in Japan. The article builds on a two-month ethnographic study conducted in Japanese kindergartens and nurseries among children aged 3-6 years. The data were analysed using concepts of age and gender. The results show that care in Japan, in contrast to…

  4. Quality specifications and standard-setting for stoma care patients.

    PubMed

    Primer, M A

    1995-12-01

    Quality specifications can be used as an information resource by purchasers of health care. The nature of service provision and nursing care can be positively influenced by the formalisation of standards and quality specifications. Auditing is essential in the ongoing evaluation of a quality system.

  5. Identification of Violence in Turkish Health Care Settings

    ERIC Educational Resources Information Center

    Ayranci, Unal; Yenilmez, Cinar; Balci, Yasemin; Kaptanoglu, Cem

    2006-01-01

    This study sought to investigate the contributing factors to and frequency of violence against health care workers (HCWs) working in western Turkey. The population is composed of a random sample of 1,209 HCWs from 34 health care workplaces. Written questionnaires were given to HCWs at all sites, where staff were instructed to register all types of…

  6. [Panic disorders: differential diagnosis and care in emergencies].

    PubMed

    Damsa, Cristian; Lazignac, Coralie; Iancu, Ruxandra; Niquille, Marc; Miller, Nick; Mihai, Adriana; Virgillito, Salvatore; Adam, Eric

    2008-02-13

    Despite the high prevalence of panic disorders in patients in primary-care settings, this condition is frequently under-recognised and under-treated. After the description of DSM-IV diagnosis criteria of panic disorders, this paper underline the importance of an adequate somatic and psychiatric differential diagnosis. Even if cognitive-behavioural therapy is the best studied psychotherapeutical approach, several efficacious psychodynamic psychotherapies were also described. High-potency benzodiazepines provide a rapid efficacy with beneficial effects during the first days of treatment. However, benzodiazepines should be avoided in the long term, because of the development of tolerance and dependence. Antidepressants (SSRI, venlafaxine) are effective in preventing panic attacks, especially in improving anticipatory anxiety and avoidance behaviour.

  7. Opening School-Based Health Centers in a Rural Setting: Effects on Emergency Department Use

    ERIC Educational Resources Information Center

    Schwartz, Katherine E.; Monie, Daphne; Scribani, Melissa B.; Krupa, Nicole L.; Jenkins, Paul; Leinhart, August; Kjolhede, Chris L.

    2016-01-01

    Background: Previous studies of urban school-based health centers (SBHCs) have shown that SBHCs decrease emergency department (ED) utilization. This study seeks to evaluate the effect of SBHCs on ED utilization in a rural setting. Methods: This retrospective, controlled, quasi-experimental study used an ED patient data set from the Bassett…

  8. Needles and Other Sharps (Safe Disposal Outside of Health Care Settings)

    MedlinePlus

    ... are generally available through pharmacies, medical supply companies, health care providers and online. These containers are made of ... proper disposal methods for sharps used outside of health care settings visit this website or call (800) 643- ...

  9. [Compassionate care, emergence of a notion in the light and shade of the care environment].

    PubMed

    Casagrande, Alice

    2016-05-01

    Compassionate care is a recent notion. It is based on a shared culture which focuses on promoting the rights of vulnerable people, integral to the quality of professionals' life at work. Tangible and part of day-to-day practice, it requires room to be set aside for discussion and ethical considerations, essential for ensuring the long-lasting creativity of caregivers, at the source of their mobilisation.

  10. System facilitators and barriers to discussing older driver safety in primary care settings

    PubMed Central

    Betz, Marian E.; Jones, Jacqueline; Carr, David B.

    2015-01-01

    Background Primary care physicians play a leading role in counseling older drivers, but discussions often do not occur until safety concerns arise. Prior work suggests that routine questioning about driving might facilitate these difficult conversations. Objective To explore system-level factors affecting driving discussions in primary care settings, in order to inform the design and implementation of a program supporting routine conversations. Methods This qualitative descriptive study used iterative interviews with providers (physicians, nurses, medical assistants, social workers, and administrative staff) working at two clinics (one geriatric, one general internal medicine) at a tertiary-care teaching hospital. General inductive techniques in transcript analysis were used to identify stakeholder-perceived system-level barriers and facilitators to routine conversations with older drivers. Results From fifteen interviews, four themes emerged: (1) complexity of defined provider roles within primary care setting (which can both support team work and hamper efficiency); (2) inadequate resources to support providers (including clinical prompts, local guides, and access to social workers and driving specialists); (3) gaps in education of providers and patients about discussing driving; and (4) suggested models to enhance provider conversations with older drivers (including following successful examples and using defined pathways integrated into the electronic medical record). A fifth theme was that participants characterized their experiences in terms of current and ideal states. Conclusions Physicians have been tasked with assessing older driver safety and guiding older patients through the process of “driving retirement.” Attention to system-level factors such as provider roles, resources, and training can support them in this process. PMID:25617342

  11. Smokers' attitudes and behaviors related to consumer demand for cessation counseling in the medical care setting.

    PubMed

    Weber, Deanne; Wolff, Lisa S; Orleans, Tracy; Mockenhaupt, Robin E; Massett, Holly A; Vose, Kathryn Kahler

    2007-05-01

    This study describes a new segmentation strategy exploring smokers' interest levels in counseling in the medical care setting in order to understand how public health communications can be designed to increase consumer demand for cessation services within this population. A subsample of 431 smokers from a large, nationally representative mail survey was analyzed and categorized into three cessation-demand groups: Low demand (LD), medium demand (MD), and high demand (HD). HD smokers were most likely to be heavy smokers, to make quitting a high priority, and to have self-efficacy in quitting. MD and LD smokers were less likely than HD smokers to have been told to quit smoking by a health care provider in the past or to believe that counseling is effective. The first step in the regression analysis revealed that age, cigarettes smoked per month, whether smokers were currently trying to quit, and whether they were ever told to quit smoking by their health care provider accounted for 21% of the variance in smokers' interest in smoking cessation counseling, F(4, 234) = 16.49, p<.001. When additional variables on attitudes toward smoking and quitting and perceived effectiveness of receiving counseling in the medical care setting were added to the model, an additional 11% of the variance in smokers' interest in cessation counseling was explained, F(12, 234) = 10.07, p<.001. Results suggest that by categorizing smokers by interest level in cessation counseling, we emerge with three distinct portraits of smokers who might be activated in different ways to increase consumer demand for cessation counseling.

  12. Setting the Equation: Establishing Value in Spine Care

    PubMed Central

    Resnick, Daniel K.; Tosteson, Anna N. A.; Groman, Rachel F.; Ghogawala, Zoher

    2014-01-01

    Study Design Topic review Objective Describe value measurement in spine care and discuss the motivation for, methods for, and limitations of such measurement. Summary of Background Data Spinal disorders are common and are an important cause of pain and disability. Numerous complimentary and competing treatment strategies are used to treat spinal disorders and the costs of these treatments is substantial and continues to rise despite clear evidence of improved health status as a result of these expenditures. Methods The authors present the economic and legislative imperatives forcing the assessment of value in spine care. The definition of value in health care and methods to measure value specifically in spine care are presented. Limitations to the utility of value judgements and caveats to their use are presented. Results Examples of value calculations in spine care are presented and critiqued. Methods to improve and broaden the measurement of value across spine care are suggested and the role of prospective registries in measuring value is discussed. Conclusions Value can be measured in spine care through the use of appropriate economic measures and patient reported outcomes measures. Value must be interpreted in light of the perspective of the assessor, the duration of the assessment period, the degree of appropriate risk stratification, and the relative value of treatment alternatives. PMID:25299258

  13. High stakes and high emotions: providing safe care in Canadian emergency departments

    PubMed Central

    Ali, Samina; Thomson, Denise; Graham, Timothy A D; Rickard, Sean E; Stang, Antonia S

    2017-01-01

    Background The high-paced, unpredictable environment of the emergency department (ED) contributes to errors in patient safety. The ED setting becomes even more challenging when dealing with critically ill patients, particularly with children, where variations in size, weight, and form present practical difficulties in many aspects of care. In this commentary, we will explore the impact of the health care providers’ emotional reactions while caring for critically ill patients, and how this can be interpreted and addressed as a patient safety issue. Discussion ED health care providers encounter high-stakes, high-stress clinical scenarios, such as pediatric cardiac arrest or resuscitation. This health care providers’ stress, and at times, distress, and its potential contribution to medical error, is underrepresented in the current medical literature. Most patient safety research is limited to error reporting systems, especially medication-related ones, an approach that ignores the effects of health care provider stress as a source of error, and limits our ability to learn from the event. Ways to mitigate this stress and avoid this type of patient safety concern might include simulation training for rare, high-acuity events, use of pre-determined clinical order sets, and post-event debriefing. Conclusion While there are physiologic and anatomic differences that contribute to patient safety, we believe that they are insufficient to explain the need to address critical life-threatening event-related patient safety issues for both adults and, especially, children. Many factors make patient safety during critical medical events distinct from general patient safety issues, but it is, perhaps, this heightened high-stress, emotional climate that is the most distinct and important part of all. We believe that consideration of this concept is essential when discussing safety improvement in critical medical events. PMID:28176924

  14. A qualitative study on hypertensive care behavior in primary health care settings in Malaysia

    PubMed Central

    Shima, Razatul; Farizah, Mohd Hairi; Majid, Hazreen Abdul

    2014-01-01

    Purpose The aim of this study was to explore patients’ experiences with their illnesses and the reasons which influenced them in not following hypertensive care recommendations (antihypertensive medication intake, physical activity, and diet changes) in primary health clinic settings. Patients and methods A qualitative methodology was applied. The data were gathered from in-depth interviews with 25 hypertensive patients attending follow-up in nine government primary health clinics in two districts (Hulu Langat and Klang) in the state of Selangor, Malaysia. The transcribed data were analyzed using thematic analysis. Results There was evidence of lack of patient self-empowerment and community support in Malaysian society. Most of the participants did not take their antihypertensive medication or change their physical activity and diet after diagnosis. There was an agreement between the patients and the health care professionals before starting the treatment recommendation, but there lacked further counseling and monitoring. Most of the reasons given for not taking antihypertensive medication, not doing physical activity and not following diet recommendations were due to side effects or fear of the side effects of antihypertensive medication, patients’ attitudes, lack of information from health care professionals and insufficient social support from their surrounding environment. We also observed the differences on these reasons for nonadherence among the three ethnic groups. Conclusion Health care professionals should move toward supporting adherence in the management of hypertensive patients by maintaining a dialogue. Patients need to be given time to enable them to overcome their inhibition of asking questions and to accept the recommendations. A self-management approach must be responsive to the needs of individuals, ethnicities, and communities. PMID:25484577

  15. The Effect of Care Setting in the Delivery of High-Value Colon Cancer Care

    PubMed Central

    Veenstra, Christine M.; Epstein, Andrew J.; Liao, Kaijun; Morris, Arden M.; Pollack, Craig E.; Armstrong, Katrina A.

    2015-01-01

    BACKGROUND The effect of care setting on value of colon cancer care is unknown. METHODS A Surveillance, Epidemiology, and End Results (SEER)-Medicare cohort study of 6544 patients aged ≥66 years with stage IV colon cancer (based on the American Joint Committee on Cancer staging system) who were diagnosed between 1996 and 2005 was performed. All patients were followed through December 31, 2007. Using outpatient and carrier claims, patients were assigned to a treating hospital based on the hospital affiliation of the primary oncologist. Hospitals were classified academic or nonacademic using the SEER-Medicare National Cancer Institute Hospital File. RESULTS Of the 6544 patients, 1605 (25%) received care from providers affiliated with academic medical centers. The unadjusted median cancer-specific survival was 16.0 months at academic medical centers versus 13.9 months at nonacademic medical centers (P<.001). After adjustment, treatment at academic hospitals remained significantly associated with a reduced risk of death from cancer (hazard ratio, 0.87; 95% confidence interval [95% CI], 0.82–0.93 [P<.001]). Adjusted mean 12-month Medicare spending was $8571 higher at academic medical centers (95% CI, $2340–$14,802; P =.007). The adjusted median cost was $1559 higher at academic medical centers; this difference was not found to be statistically significant (95% CI, −$5239 to $2122; P =.41). A small percentage of patients who received very expensive care skewed the difference in mean cost; the only statistically significant difference in adjusted costs in quantile regressions was at the 99.9th percentile of costs (P<.001). CONCLUSIONS Among Medicare beneficiaries with stage IV colon cancer, treatment by a provider affiliated with an academic medical center was associated with a 2 month improvement in overall survival. Except for patients in the 99.9th percentile of the cost distribution, costs at academic medical centers were not found to be significantly

  16. Assessing knowledge, motivation and perceptions about falls prevention among care staff in a residential aged care setting.

    PubMed

    Hang, Jo-Aine; Francis-Coad, Jacqueline; Burro, Bianca; Nobre, Debbie; Hill, Anne-Marie

    Falls are a serious problem in residential aged care settings. The aims of the study were to determine the feasibility of surveying care staff regarding falls prevention, and describe care staff levels of knowledge and awareness of residents' risk of falls, knowledge about falls prevention, motivation and confidence to implement falls prevention strategies. A custom designed questionnaire was administered to care staff at one site of a large residential aged care organization in Australia. The survey response was 58.8%. Feedback from staff was used to inform the administration of the survey to the wider organization. Seven (29.2%) care staff reported they were unsure or thought residents were at low risk of falls. Only five (20.8%) care staff were able to suggest more than three preventive strategies. These preliminary findings suggest that education to change care staff behavior regarding falls prevention should target improving care staff knowledge and awareness of falls.

  17. Emerging trends in the outsourcing of medical and surgical care.

    PubMed

    Boyd, Jennifer B; McGrath, Mary H; Maa, John

    2011-01-01

    As total health care expenditures are expected to constitute an increasing portion of the US gross domestic product during the coming years, the US health care system is anticipating a historic spike in the need for care. Outsourcing medical and surgical care to other nations has expanded rapidly, and several ethical, legal, and financial considerations require careful evaluation. Ultimately, the balance between cost savings, quality, and patient satisfaction will be the key determinant in the future of medical outsourcing.

  18. [Emergency care for traffic accidents in Bavaria: current process analysis depending on hospital and emergency service structures].

    PubMed

    Lackner, C K; Bielmeier, S; Burghofer, K

    2010-03-01

    A change is emerging in the hospital landscape due to health political measures, which in consequence also influences the prehospital medical care in emergencies. The main focus of this study was to gather information about emergency medical care after traffic accidents on the basis of data from Bavarian emergency medical services. In 2006 there were 14,261 traffic accidents in Bavaria where an emergency doctor attended the scene. The patients were primarily cared for by land-based rescue services and air rescue services were only used in 19.1% of the cases. Of the patients involved in a traffic accident 47.6% were transported to a primary health care hospital. A prehospital interval of more than 60 min occurred in 20% of the missions. Of the patients 96.2% were transported to tertiary or maximum care hospital by air rescue services but emergency facilities were, however restricted to daylight hours. There was a further limitation due to the routine duty hours in hospitals as only 36.7% of accidents occurred during this time intervall. An increase of admission post trauma in maximum care clinics occurred from 2002 until 2006 while simultaneously the prehospital period was extended. In order to assure sufficient trauma care for seriously injured persons a continuous 24 h availability of emergency trauma facilities is necessary. For this purpose it is necessary to establish regional trauma networks between receiving hospitals as well as air rescue services at night time. Furthermore, a cost-efficient compensation of the structural, personnel and logistic expenses for the treatment of the severely injured has to be assured.

  19. Emergency and trauma care in Pakistan: a cross-sectional study of healthcare levels

    PubMed Central

    Razzak, Junaid A; Baqir, Syed M; Khan, Uzma Rahim; Heller, David; Bhatti, Junaid; Hyder, Adnan A

    2015-01-01

    Background The importance of emergency medical care for the successful functioning of health systems has been increasingly recognised. This study aimed to evaluate emergency and trauma care facilities in four districts of the province of Sindh, Pakistan. Method We conducted a cross-sectional health facility survey in four districts of the province of Sindh in Pakistan using a modified version of WHO’s Guidelines for essential trauma care. 93 public health facilities (81 primary care facilities, nine secondary care hospitals, three tertiary hospitals) and 12 large private hospitals were surveyed. Interviews of healthcare providers and visual inspections of essential equipment and supplies as per guidelines were performed. A total of 141 physicians providing various levels of care were tested for their knowledge of basic emergency care using a validated instrument. Results Only 4 (44%) public secondary, 3 (25%) private secondary hospitals and all three tertiary care hospitals had designated emergency rooms. The majority of primary care health facilities had less than 60% of all essential equipments overall. Most of the secondary level public hospitals (78%) had less than 60% of essential equipments, and none had 80% or more. A fourth of private secondary care facilities and all tertiary care hospitals (n=3; 100%) had 80% or more essential equipments. The average percentage score on the physician knowledge test was 30%. None of the physicians scored above 60% correct responses. Conclusions The study findings demonstrated a gap in both essential equipment and provider knowledge necessary for effective emergency and trauma care. PMID:24157684

  20. Vancomycin-resistant enterococci outside the health-care setting: prevalence, sources, and public health implications.

    PubMed Central

    McDonald, L. C.; Kuehnert, M. J.; Tenover, F. C.; Jarvis, W. R.

    1997-01-01

    Although nosocomial acquisition and subsequent colonization of vancomycin-resistant enterococci (VRE), an emerging international threat to public health, has been emphasized in the United States, colonization among nonhospitalized persons has been infrequently documented. In contrast, in Europe, colonization appears to occur frequently in persons outside the health-care setting. An important factor associated with VRE in the community in Europe has been avoparcin, a glycopeptide antimicrobial drug used for years in many European nations at subtherapeutic doses as a growth promoter in food-producing animals. In Europe, evidence suggests that foodborne VRE may cause human colonization. Although avoparcin has never been approved for use in the United States, undetected community VRE transmission may be occurring at low levels. Further studies of community transmission of VRE in the United States are urgently needed. If transmission with VRE from unrecognized community sources can be identified and controlled, increased incidence of colonization and infection among hospitalized patients may be prevented. PMID:9284375

  1. An alternative for rapid administration of medication and fluids in the emergency setting using a novel device.

    PubMed

    Lyons, Neal; Nejak, Daniel; Lomotan, Nadine; Mokszycki, Robert; Jamieson, Stephen; McDowell, Marc; Kulstad, Erik

    2015-08-01

    Routes of administration for medications and fluids in the acute care setting have primarily focused on oral, intravenous, or intraosseous routes, but, in many patients, none of these routes is optimal. A novel device (Macy Catheter; Hospi Corp) that offers an easy route for administration of medications or fluids via rectal mucosal absorption (proctoclysis) has recently become available in the palliative care market; we describe here the first known uses of this device in the emergency setting. Three patients presenting to the hospital with conditions limiting more typical routes of medication or fluid administration were treated with this new device; patients were administered water for hydration, lorazepam for treatment of alcohol withdrawal, ondansetron for nausea, acetaminophen for fever, aspirin for antiplatelet effect, and methimazole for hyperthyroidism. Placement of the device was straightforward, absorption of administered medications (judged by immediacy of effects, where observable) was rapid, and use of the device was well tolerated by patients, suggesting that this device may be an appealing alternative route to medication and fluid administration for a variety of indications in acute and critical care settings.

  2. Topical Review: Building Competency: Professional Skills for Pediatric Psychologists in Integrated Primary Care Settings.

    PubMed

    Hoffses, Kathryn W; Ramirez, Lisa Y; Berdan, Louise; Tunick, Rachel; Honaker, Sarah Morsbach; Meadows, Tawnya J; Shaffer, Laura; Robins, Paul M; Sturm, Lynne; Stancin, Terry

    2016-11-01

    OBJECTIVES : In the midst of large-scale changes across our nation's health care system, including the Affordable Care Act and Patient-Centered Medical Home initiatives, integrated primary care models afford important opportunities for those in the field of pediatric psychology. Despite the extensive and growing attention, this subspecialty has received in recent years, a comprehensive set of core professional competencies has not been established. METHODS : A subset of an Integrated Primary Care Special Interest Group used two well-established sets of core competencies in integrated primary care and pediatric psychology as a basis to develop a set of integrated pediatric primary care-specific behavioral anchors. CONCLUSIONS : The current manuscript describes these behavioral anchors and their development in the context of professional training as well as with regard to Triple Aim goals and securing psychology's role in integrated pediatric primary care settings.

  3. High dependency care in an obstetric setting in the UK.

    PubMed

    Saravanakumar, K; Davies, L; Lewis, M; Cooper, G M

    2008-10-01

    Our objective was to establish the utilisation and pattern of high dependency care in a tertiary referral obstetric unit. Data of pregnant or recently pregnant women admitted to the obstetric high dependency unit from 1984 to 2007 were included to evaluate the admission rate. Four years' information of an ongoing prospective audit was collated to identify the indications for admission, maternal monitoring, transfers to intensive care unit, and location of the baby. The overall high dependency unit admission rate is 2.67%, but increased to 5.01% in the most recent 4 years. Massive obstetric haemorrhage is now the most common reason for admission. Invasive monitoring was undertaken in 30% of women. Two-thirds of neonates (66.3%) stayed with their critically ill mothers in the high dependency unit. Transfer to the intensive care unit was needed in 1.4 per 1000 deliveries conducted. We conclude that obstetric high dependency care provides holistic care from midwives, obstetricians and anaesthetists while retaining the opportunity of early bonding with babies for critically ill mothers.

  4. Hospital Epidemiology and Infection Control in Acute-Care Settings

    PubMed Central

    Sydnor, Emily R. M.; Perl, Trish M.

    2011-01-01

    Summary: Health care-associated infections (HAIs) have become more common as medical care has grown more complex and patients have become more complicated. HAIs are associated with significant morbidity, mortality, and cost. Growing rates of HAIs alongside evidence suggesting that active surveillance and infection control practices can prevent HAIs led to the development of hospital epidemiology and infection control programs. The role for infection control programs has grown and continues to grow as rates of antimicrobial resistance rise and HAIs lead to increasing risks to patients and expanding health care costs. In this review, we summarize the history of the development of hospital epidemiology and infection control, common HAIs and the pathogens causing them, and the structure and role of a hospital epidemiology and infection control program. PMID:21233510

  5. Regionalization and emergency care: the institute of medicine reports and a federal government update.

    PubMed

    Carr, Brendan G; Asplin, Brent R

    2010-12-01

    The 2010 Academic Emergency Medicine consensus conference on regionalization in emergency care began with an update on the Institute of Medicine (IOM) reports on the Future of Emergency Care. This was followed by two presentations from federal officials, focusing on regionalization from the perspective of the White House National Security Staff and the Emergency Care Coordination Center. This article summarizes the content of these presentations. It should be noted that this summary is the perspective of the authors and does not represent the official policy of the U.S. government.

  6. Establishing a pharmacy presence in the emergency department: opportunities and challenges in the French setting.

    PubMed

    Roulet, Lucien; Asseray, Nathalie; Ballereau, Françoise

    2014-06-01

    Overview of clinical pharmacy practice around the world shows that pharmaceutical services in emergency departments (EDs) are far less common in Europe than in North America. Reported experiences have shown the impact of a clinical pharmacy service on drug utilisation and safety issues. This commentary presents the implementation of a pharmacy presence in the ED of a French tertiary care hospital. Our experience helps to define the role of the clinical pharmacist in the ED, including patient interviewing, providing medication reconciliation, promoting drug safety, and supporting specific interventions to improve quality of care and patient safety. The role of ED pharmacists in the improvement of quality of care is not necessarily limited to drug therapy, e.g. by helping outpatients to access care and treatment facilities as best suits their needs. Challenges of implementing ED pharmacy services have been identified well, but still require developing strategies to be overcome.

  7. Pediatric information seeking behaviour, information needs, and information preferences of health care professionals in general emergency departments: Results from the Translating Emergency Knowledge for Kids (TREKK) Needs Assessment.

    PubMed

    Scott, Shannon D; Albrecht, Lauren; Given, Lisa M; Hartling, Lisa; Johnson, David W; Jabbour, Mona; Klassen, Terry P

    2017-01-09

    The majority of children requiring emergency care are treated in general emergency departments (EDs) with variable levels of pediatric care expertise. The goal of the Translating Emergency Knowledge for Kids (TREKK) initiative is to implement the latest research in pediatric emergency medicine in general EDs to reduce clinical variation.

  8. The state of U.S. emergency care: a call to action for hospital pharmacists.

    PubMed

    Idrees, Umbreen; Clements, Elizabeth

    2006-12-01

    The recent publication of the Institute of Medicine/Board on Health Care Services reports on the future of emergency care in the US health system has identified the main limitations of the care provided by emergency departments (EDs). Increased development of ED pharmacy services and increased involvement of pharmacists in the ED can contribute to improvements in shortcomings identified in the report. Pharmacy training programs must take the initiative to incorporate emergency care into their curricula to meet the predicted increase in demand for ED pharmacists. Pharmacy associations, administrators, and ED practitioners must direct research on the impact of the pharmacist in the ED.

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

    PubMed

    Bika, O H; Edozien, L C

    2014-08-01

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

  10. [Evaluation of the Mobile Emergency Care Service in Santa Catarina State, Brazil].

    PubMed

    Ortiga, Angela Maria Blatt; Lacerda, Josimari Telino de; Natal, Sonia; Calvo, Maria Cristina Marino

    2016-12-15

    This case study evaluated the Mobile Emergency Care Service (SAMU) in Santa Catarina State, Brazil, in 2013/2014. The theoretical log frame and evaluation matrix were validated by expert consensus workshops. Two dimensions were proposed: emergency care management and emergency care, analyzed with 22 indicators. Data collection used interviews, direct observation in the eight regional SAMU dispatches, and a questionnaire sent to the coordinators of the municipal SAMU. The analysis and value judgment according to separate dimensions, sub-dimensions, and indicators allowed identifying strengths and weaknesses amenable to intervention. No regional dispatch performed well in both dimensions; all were classified as "fair" in emergency care and "bad" in emergency management. An important strength was agile communication with callers for help, standardization, and external support for care. The mechanisms for internal and external linkage and communication need to be effectively implemented. The quality of advanced support units requires improvement.

  11. Many emergency department visits could be managed at urgent care centers and retail clinics.

    PubMed

    Weinick, Robin M; Burns, Rachel M; Mehrotra, Ateev

    2010-09-01

    Americans seek a large amount of nonemergency care in emergency departments, where they often encounter long waits to be seen. Urgent care centers and retail clinics have emerged as alternatives to the emergency department for nonemergency care. We estimate that 13.7-27.1 percent of all emergency department visits could take place at one of these alternative sites, with a potential cost savings of approximately $4.4 billion annually. The primary conditions that could be treated at these sites include minor acute illnesses, strains, and fractures. There is some evidence that patients can safely direct themselves to these alternative sites. However, more research is needed to ensure that care of equivalent quality is provided at urgent care centers and retail clinics compared to emergency departments.

  12. A Secure Cloud-Assisted Wireless Body Area Network in Mobile Emergency Medical Care System.

    PubMed

    Li, Chun-Ta; Lee, Cheng-Chi; Weng, Chi-Yao

    2016-05-01

    Recent advances in medical treatment and emergency applications, the need of integrating wireless body area network (WBAN) with cloud computing can be motivated by providing useful and real time information about patients' health state to the doctors and emergency staffs. WBAN is a set of body sensors carried by the patient to collect and transmit numerous health items to medical clouds via wireless and public communication channels. Therefore, a cloud-assisted WBAN facilitates response in case of emergency which can save patients' lives. Since the patient's data is sensitive and private, it is important to provide strong security and protection on the patient's medical data over public and insecure communication channels. In this paper, we address the challenge of participant authentication in mobile emergency medical care systems for patients supervision and propose a secure cloud-assisted architecture for accessing and monitoring health items collected by WBAN. For ensuring a high level of security and providing a mutual authentication property, chaotic maps based authentication and key agreement mechanisms are designed according to the concept of Diffie-Hellman key exchange, which depends on the CMBDLP and CMBDHP problems. Security and performance analyses show how the proposed system guaranteed the patient privacy and the system confidentiality of sensitive medical data while preserving the low computation property in medical treatment and remote medical monitoring.

  13. Leadership and the Campus Child Care Setting: Theory into Practice.

    ERIC Educational Resources Information Center

    Bickimer, David A.

    1991-01-01

    Two motifs of the Prehensive Leadership Model (PLM) are applied to efforts to solve problems related to stepchild status and low morale that are typical of campus child care centers. The importance of the PLM distinction between general and special leadership is discussed. (SH)

  14. A Survey of Autism Knowledge in a Health Care Setting

    ERIC Educational Resources Information Center

    Heidgerken, Amanda, D.; Geffken, Gary; Modi, Avani; Frakey, Laura

    2005-01-01

    The current study extends research by Stone [Cross-disciplinary perspectives on autism? "Journal of Pediatric Psychology, 12", (1988) 615; A comparison of teacher and parent views of autism. "Journal of Autism and Development Disorders, 18", (1988) 403] exploring the knowledge and beliefs about autism across multiple health care professions. One…

  15. Using behavior modeling for supervisory development in health care settings.

    PubMed

    Decker, P J; Sullivan, E; Moore, R

    1982-01-01

    Behavior modeling is one training method found effective in helping health care managers deal with their day-to-day management problems. This article defines and explains the five basic steps of behavior modeling training, suggests the workshop format as its most effective mode of instruction, and presents examples of successful use of the method.

  16. The Burn-Out Syndrome in the Day Care Setting

    ERIC Educational Resources Information Center

    Maslach, Christina; Pines, Ayala

    1977-01-01

    Results of a study of personal job-stress factors among day care center personnel focus on impact of staff-child ratio, working hours, time out, staff meetings and program structure. Recommended institutional changes for prevention of staff "burn-out" involve reduction in amount of direct staff-child contact, development of social-professional…

  17. WSES Guidelines for the management of acute left sided colonic diverticulitis in the emergency setting.

    PubMed

    Sartelli, Massimo; Catena, Fausto; Ansaloni, Luca; Coccolini, Federico; Griffiths, Ewen A; Abu-Zidan, Fikri M; Di Saverio, Salomone; Ulrych, Jan; Kluger, Yoram; Ben-Ishay, Ofir; Moore, Frederick A; Ivatury, Rao R; Coimbra, Raul; Peitzman, Andrew B; Leppaniemi, Ari; Fraga, Gustavo P; Maier, Ronald V; Chiara, Osvaldo; Kashuk, Jeffry; Sakakushev, Boris; Weber, Dieter G; Latifi, Rifat; Biffl, Walter; Bala, Miklosh; Karamarkovic, Aleksandar; Inaba, Kenji; Ordonez, Carlos A; Hecker, Andreas; Augustin, Goran; Demetrashvili, Zaza; Melo, Renato Bessa; Marwah, Sanjay; Zachariah, Sanoop K; Shelat, Vishal G; McFarlane, Michael; Rems, Miran; Gomes, Carlos Augusto; Faro, Mario Paulo; Júnior, Gerson Alves Pereira; Negoi, Ionut; Cui, Yunfeng; Sato, Norio; Vereczkei, Andras; Bellanova, Giovanni; Birindelli, Arianna; Di Carlo, Isidoro; Kok, Kenneth Y; Gachabayov, Mahir; Gkiokas, Georgios; Bouliaris, Konstantinos; Çolak, Elif; Isik, Arda; Rios-Cruz, Daniel; Soto, Rodolfo; Moore, Ernest E

    2016-01-01

    Acute left sided colonic diverticulitis is one of the most common clinical conditions encountered by surgeons in acute setting. A World Society of Emergency Surgery (WSES) Consensus Conference on acute diverticulitis was held during the 3rd World Congress of the WSES in Jerusalem, Israel, on July 7th, 2015. During this consensus conference the guidelines for the management of acute left sided colonic diverticulitis in the emergency setting were presented and discussed. This document represents the executive summary of the final guidelines approved by the consensus conference.

  18. Pediatric Hearing Healthcare in Kentucky's Appalachian Primary Care Setting.

    PubMed

    Bush, Matthew L; Alexander, David; Noblitt, Bryce; Lester, Cathy; Shinn, Jennifer B

    2015-08-01

    Diagnosis and intervention for infant hearing loss is often delayed in areas of healthcare disparity, such as rural Appalachia. Primary care providers play a key role in timely hearing healthcare. The purpose of this study was to assess the practice patterns of rural primary care providers (PCPs) regarding newborn hearing screening (NHS) and experiences with rural early hearing diagnosis and intervention programs in an area of known hearing healthcare disparity. Cross sectional questionnaire study. Appalachian PCP's in Kentucky were surveyed regarding practice patterns and experiences regarding the diagnosis and treatment of congenital hearing loss. 93 Appalachian primary care practitioners responded and 85% reported that NHS is valuable for pediatric health. Family practitioners were less likely to receive infant NHS results than pediatricians (54.5 versus 95.2%, p < 0.01). A knowledge gap was identified in the goal ages for diagnosis and treatment of congenital hearing loss. Pediatrician providers were more likely to utilize diagnostic testing compared with family practice providers (p < 0.001). Very rural practices (Beale code 7-9) were less likely to perform hearing evaluations in their practices compared with rural practices (Beale code 4-6) (p < 0.001). Family practitioners reported less confidence than pediatricians in counseling and directing care of children who fail newborn hearing screening. 46% felt inadequately prepared or completely unprepared to manage children who fail the NHS. Rural primary care providers face challenges in receiving communication regarding infant hearing screening and may lack confidence in directing and providing rural hearing healthcare for children.

  19. Handbook on Quality Child Care for Young Children: Settings Standards and Resources.

    ERIC Educational Resources Information Center

    Baglin, Carol Ann, Ed.; Bender, Michael, Ed.

    Intended primarily for professionals teaching early childhood and infant intervention courses, this handbook presents an overview of child care as both a support to families and an economic necessity, meeting changing and dynamic needs. Child care settings and types of care are discussed, along with quality indicators, licensing, and provider…

  20. Perspectives of Health Care Providers Regarding Emergency Department Care of Children and Youth with Autism Spectrum Disorder

    ERIC Educational Resources Information Center

    Zwaigenbaum, Lonnie; Nicholas, David B.; Muskat, Barbara; Kilmer, Christopher; Newton, Amanda S.; Craig, William R.; Ratnapalan, Savithiri; Cohen-Silver, Justine; Greenblatt, Andrea; Roberts, Wendy; Sharon, Raphael

    2016-01-01

    This study aimed to characterize the perspectives of health professionals who care for children with autism spectrum disorder (ASD) in the emergency department (ED) and to determine what strategies could optimize care. Ten physicians and twelve nurses were interviewed individually. Questions related to experiences, processes, clinical…

  1. The criteria nurses use in assessing acute trauma in military emergency care.

    PubMed

    Andersson, Sten-Ove; Dahlgren, Lars Owe; Lundberg, Lars; Sjöström, Björn

    2007-07-01

    Emergency medical care for seriously injured patients in war or warlike situations is highly important when it comes to soldiers' survival and morale. The Swedish Armed Forces sends nurses, who have limited experience of caring for injured personnel in the field, on a variety of international missions. The aim of this investigation was to identify the kind of criteria nurses rely on when assessing acute trauma and what factors are affecting the emergency care of injured soldiers. A phenomenographic research approach based on interviews was used. The database for the study consists of twelve nurses who served in Bosnia in 1994-1996. The criteria nurses rely on, when assessing acute trauma in emergency care, could be described in terms of domain-specific criteria such as a physiological, an anatomical, a causal and a holistic approach as well as contextual criteria such as being able to communicate, having a sense of belonging, the military environment, the conscript medical orderly and familiarity with health-caring activity. The present study shows that the specific contextual factors affecting emergency care in the field must also be practised before the nurse faces military emergency care situations. This calls for realistic exercises and training programs, where experience from civilian emergency care is interwoven with the knowledge specific to military medical care.

  2. Distraction: an assessment of smartphone usage in health care work settings

    PubMed Central

    Gill, Preetinder S; Kamath, Ashwini; Gill, Tejkaran S

    2012-01-01

    Smartphone use in health care work settings presents both opportunities and challenges. The benefits could be severely undermined if abuse and overuse are not kept in check. This practice-focused research paper examines the current panorama of health software applications. Findings from existing research are consolidated to elucidate the level and effects of distraction in health care work settings due to smartphone use. A conceptual framework for crafting guidelines to regulate the use of smartphones in health care work settings is then presented. Finally, specific guidelines are delineated to assist in creating policies for the use of smartphones in a health care workplace. PMID:22969308

  3. Implementation of a Program of Outcomes Research in Residential Care Settings: Outcomes for Children and Youth

    ERIC Educational Resources Information Center

    Portwood, Sharon G.; Boyd, A. Suzanne; Murdock, Tamera B.

    2016-01-01

    Background: There is a need to examine behavioral and mental health outcomes for children in out-of-home care across settings. Objective: Using a participatory research approach, researchers and agency personnel aimed to implement a program of scientific outcomes research in residential care settings. Data were used to examine children's…

  4. Implications of the Emergency Medical Treatment and Labor Act (EMTALA) during public health emergencies and on alternate sites of care.

    PubMed

    Roszak, Andrew R; Jensen, Frances R; Wild, Richard E; Yeskey, Kevin; Handrigan, Michael T

    2009-12-01

    Hospitals throughout the country are using innovative strategies to accommodate the surge of patients brought on by the novel H1N1 virus. One strategy has been to help decompress the amount of patients seeking care within emergency departments by using alternate sites of care, such as tents, parking lots, and community centers as triage, staging, and screening areas. As at any other time an individual presents on hospital property, hospitals and providers must be mindful of the requirements of the Emergency Medical Treatment and Labor Act. In this article we review the act and its implications during public health emergencies, with a particular focus on its implications on alternative sites of care.

  5. Is Higher Education Following the Path Set by Health Care in the U.S.?

    ERIC Educational Resources Information Center

    Castiglia, Beth

    2012-01-01

    The recent emergence of higher education into political and economic debate is reminiscent of the ongoing arguments about the appropriate provision of health care in the United States. Health care reform has been a political battle cry in the United States for years, and there are similar calls for reforms of higher education. These two industries…

  6. Screening for depression in a primary care setting in Vietnam.

    PubMed

    Nguyen, Nguyen-Lan D; Hunt, D Daniel; Scott, Craig S

    2005-02-01

    A Vietnamese Depression Scale (VDS) was developed in 1982 in the United States and has been used as a screening tool for depression and as the basis for a standardized interview to assess depression in the Vietnamese refugee populations. In this current study, the VDS was used in Ho Chi Minh City, Vietnam, to assess depression in patients who were already diagnosed with depression by Vietnamese psychiatrists and in patients presenting at a local primary care clinic. Of the 177 primary care clinic patients, 8.4% met the criteria for clinical depression based on the VDS. Results indicate a higher risk for depression among married and/or less than high school educated individuals. Discrepancies were found between the depression diagnosis by Vietnamese psychiatrists and VDS screening results. Among the participants interviewed who met the VDS criteria for depression, culture-specific phrases such as "desperate," "going crazy," and "low spirited and bored" were highly associated with symptoms of depression.

  7. From generalized synchrony to topological decoherence: emergent sets in coupled chaotic systems.

    PubMed

    Barreto, E; So, P; Gluckman, B J; Schiff, S J

    2000-02-21

    We consider the evolution of the unstable periodic orbit structure of coupled chaotic systems. This involves the creation of a complicated set outside of the synchronization manifold (the emergent set). We quantitatively identify a critical transition point in its development (the decoherence transition). For asymmetric systems we also describe a migration of unstable periodic orbits that is of central importance in understanding these systems. Our framework provides an experimentally measurable transition, even in situations where previously described bifurcation structures are inapplicable.

  8. Caring for Refugee Youth in the School Setting.

    PubMed

    Johnson, Jennifer Leigh; Beard, Joyce; Evans, Dena

    2017-03-01

    Annually, over 80,000 refugees enter the United States as a result of political or religious persecution. Of these, approximately 35% to 40% are children and adolescents. Refugees are faced with challenges associated with living conditions, cultural and social norms, and socioeconomic status due to problems occurring in their homelands. These challenges include but are not limited to malnutrition, communicable disease, questionable immunization status, lack of formal education, sexual abuse, violence, torture, human trafficking, homelessness, poverty, and a lack of access to health care. Moreover, the psychological impact of relocation and the stress of acculturation may perpetuate many of these existing challenges, particularly for refugee youth, with limited or underdeveloped coping skills. School nurses are uniquely poised to support refugee youth in the transition process, improve overall health, and facilitate access to primary health services. The purpose of this article is to provide an overview of the unique refugee experience, examine the key health care needs of the population, and present school nurses with timely and relevant resources to assist in caring for refugee youth.

  9. Electronic cigarettes and thirdhand tobacco smoke: two emerging health care challenges for the primary care provider.

    PubMed

    Kuschner, Ware G; Reddy, Sunayana; Mehrotra, Nidhi; Paintal, Harman S

    2011-02-01

    PRIMARY CARE PROVIDERS SHOULD BE AWARE OF TWO NEW DEVELOPMENTS IN NICOTINE ADDICTION AND SMOKING CESSATION: 1) the emergence of a novel nicotine delivery system known as the electronic (e-) cigarette; and 2) new reports of residual environmental nicotine and other biopersistent toxicants found in cigarette smoke, recently described as "thirdhand smoke". The purpose of this article is to provide a clinician-friendly introduction to these two emerging issues so that clinicians are well prepared to counsel smokers about newly recognized health concerns relevant to tobacco use. E-cigarettes are battery powered devices that convert nicotine into a vapor that can be inhaled. The World Health Organization has termed these devices electronic nicotine delivery systems (ENDS). The vapors from ENDS are complex mixtures of chemicals, not pure nicotine. It is unknown whether inhalation of the complex mixture of chemicals found in ENDS vapors is safe. There is no evidence that e-cigarettes are effective treatment for nicotine addiction. ENDS are not approved as smoking cessation devices. Primary care givers should anticipate being questioned by patients about the advisability of using e-cigarettes as a smoking cessation device. The term thirdhand smoke first appeared in the medical literature in 2009 when investigators introduced the term to describe residual tobacco smoke contamination that remains after the cigarette is extinguished. Thirdhand smoke is a hazardous exposure resulting from cigarette smoke residue that accumulates in cars, homes, and other indoor spaces. Tobacco-derived toxicants can react to form potent cancer causing compounds. Exposure to thirdhand smoke can occur through the skin, by breathing, and by ingestion long after smoke has cleared from a room. Counseling patients about the hazards of thirdhand smoke may provide additional motivation to quit smoking.

  10. Joint policy statement--guidelines for care of children in the emergency department.

    PubMed

    2009-10-01

    Children who require emergency care have unique needs, especially when emergencies are serious or life-threatening. The majority of ill and injured children are brought to community hospital emergency departments (EDs) by virtue of their geography within communities. Similarly, emergency medical services (EMS) agencies provide the bulk of out-of-hospital emergency care to children. It is imperative, therefore, that all hospital EDs have the appropriate resources (medications, equipment, policies, and education) and staff to provide effective emergency care for children. This statement outlines resources necessary to ensure that hospital EDs stand ready to care for children of all ages, from neonates to adolescents. These guidelines are consistent with the recommendations of the Institute of Medicine's report on the future of emergency care in the United States health system. Although resources within emergency and trauma care systems vary locally, regionally, and nationally, it is essential that hospital ED staff and administrators and EMS systems' administrators and medical directors seek to meet or exceed these guidelines in efforts to optimize the emergency care of children they serve. This statement has been endorsed by the Academic Pediatric Association, American Academy of Family Physicians, American Academy of Physician Assistants, American College of Osteopathic Emergency Physicians, American College of Surgeons, American Heart Association, American Medical Association, American Pediatric Surgical Association, Brain Injury Association of America, Child Health Corporation of America, Children's National Medical Center, Family Voices, National Association of Children's Hospitals and Related Institutions, National Association of EMS Physicians, National Association of Emergency Medical Technicians, National Association of State EMS Officials, National Committee for Quality Assurance, National PTA, Safe Kids USA, Society of Trauma Nurses, Society for Academic

  11. Emergency shelter care utilization in child welfare: Who goes to shelter care? How long do they stay?

    PubMed

    Leon, Scott C; Jhe Bai, Grace; Fuller, Anne K; Busching, Michelle

    2016-01-01

    Emergency shelter care for children entering foster care is widely used as a temporary first placement, despite its contraindications. However, little research has examined predictors of utilization (e.g., entry into care, length of stay in care). A sample of 123 children (ages 6-13) entering foster care was studied to explore the variables associated with an initial placement in shelter care versus kinship care and variables associated with children staying less than 30 days in the shelter versus 30 days or longer. After applying a classification tree analysis (CTA via Optimal Data Analysis), results indicated that variables across the child's ecology--specifically the microsystem, mesosystem, and exosystem--were associated with increased emergency shelter utilization, including older age, entering as a dependency case, more relatives and fictive kin with barriers to involvement in the child's life, and the child welfare agency serving the child. These results suggest that although emergency shelter care utilization may be determined by a complex interaction of variables across the child's ecology, policy and programmatic attention to some of these risk factors might be effective in limiting utilization so that children can enter care with a more long-term, family-based placement.

  12. Emergency obstetric care availability: a critical assessment of the current indicator.

    PubMed

    Gabrysch, Sabine; Zanger, Philipp; Campbell, Oona M R

    2012-01-01

    Monitoring progress in reducing maternal and perinatal mortality requires suitable indicators. The density of emergency obstetric care (EmOC) facilities has been proposed as a potentially useful indicator, but different UN documents make inconsistent recommendations, and its current formulation is not associated with maternal mortality. We compiled recently published indicator benchmarks and distinguished three sources of inconsistency: (i) use of different denominator metrics (per birth and per population), (ii) different assumptions on need for EmOC and for EmOC facilities and (iii) failure to specify facility capacity (birth load). The UN guidelines and handbook require fewer EmOC facilities than the World Health Report 2005 and do not specify capacity for deliveries or staffing levels. We recommend (i) always using births as the denominator for EmOC facility density, (ii) clearly stating assumptions on the proportion of deliveries needing basic and comprehensive emergency obstetric care and the desired proportion of deliveries in EmOC facilities and (iii) specifying facility capacity and staffing and adapting benchmarks for settings with different population density to ensure geographical accessibility.

  13. Teacher Retention in Refugee and Emergency Settings: The State of the Literature

    ERIC Educational Resources Information Center

    Ring, Hannah Reeves; West, Amy R.

    2015-01-01

    Teacher quality is recognised as a primary driver of variation in student learning outcomes, particularly in refugee and emergency settings, but few studies have examined the factors that motivate or demotivate teachers in these contexts. In this article we use secondary source materials from academic experts and grey literature from United…

  14. Information Provision in Emergency Settings: The Experience of Refugee Communities in Zambia

    ERIC Educational Resources Information Center

    Kanyengo, Brendah Kakulwa; Kanyengo, Christine Wamunyima

    2011-01-01

    This article identifies information provision services in emergency settings using Zambia as a case study by identifying innovative ways of providing library and information services. The thrust of the article is to analyze information management practices of organizations that work within refugee camps and how they take specific cognizance of the…

  15. Between Two Advisors: Interconnecting Academic and Workplace Settings in an Emerging Field

    ERIC Educational Resources Information Center

    Hytönen, Kaisa; Palonen, Tuire; Lehtinen, Erno; Hakkarainen, Kai

    2016-01-01

    This article examines a new training design for continuing professional development that aims to support the learning of the novel knowledge and skills needed in emerging professional fields by interconnecting academic and workplace settings. The training design is based on using two advisors, one from working life and the other from an academic…

  16. Emergency service: a strategy for hospital-sponsored ambulatory care satellites.

    PubMed

    Gregory, D; Klegon, D; Steinhauer, B

    1984-01-01

    This analysis of the overall market position of free-standing emergency care was based on a telephone survey of 300 randomly chosen households in a southeastern metropolitan area. Results show that consumer preferences for cost and convenience create a strong market for free-standing emergency facilities. Emergicare centers are in an ideal situation to capture the market for acute and minor emergency care. To be worthwhile, the emergency room in a more comprehensive ambulatory care facility should serve as a feeder of new patients and be profitable in its own right. However, free-standing emergency facilities must not only attract patients through convenience and price, but they must also maintain patients through assuring quality care and satisfaction.

  17. Benign Paroxysmal Positional Vertigo in the Acute Care Setting.

    PubMed

    Fife, Terry D; von Brevern, Michael

    2015-08-01

    Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo characterized by brief episodes provoked by head movements. The first attack of BPPV usually occurs in bed or upon getting up. Because it often begins abruptly, it can be alarming and lead to emergency department evaluation. The episodes of spinning often last 10 to 20 seconds, but may occasionally last as long as 1 minute. There are several forms of BPPV. In nearly all cases, highly effective treatment can be offered to patients. This article reviews the current state of our understanding of this condition and its management.

  18. Cystic fibrosis carrier population screening in the primary care setting.

    PubMed Central

    Loader, S.; Caldwell, P.; Kozyra, A.; Levenkron, J. C.; Boehm, C. D.; Kazazian, H. H.; Rowley, P. T.

    1996-01-01

    To determine the receptivity of prenatal care providers and their patients to carrier testing for cystic fibrosis (CF), we offered free carrier screening, followed by genetic counseling of carriers, to all prenatal care providers in Rochester, NY, for all their female patients of reproductive age, pregnant or not. Of 124 prenatal care providers, only 37 elected to participate, but many of these offered screening only to pregnant women. The acceptance rate among pregnant women was approximately 57%. The most common reasons for accepting screening were to obtain reassurance (50.7%) and to avoid having a child with CF (27.8 %). The most common reasons for declining screening were not intending to terminate a pregnancy for CF (32.4%) and believing that the chance of having a CF child was very low (32.2%). Compared with decliners, acceptors were more likely to have no children, regarded having a child with CF as more serious, believed themselves more susceptible to having such a child, knew more about CF, would be more likely to terminate a pregnancy if the fetus were shown to have CF, and more strongly supported offering CF screening to women of reproductive age. Of 4,879 women on whom results were obtained, 124 were found to be carriers. Of these 124 carriers, the partners of 106 were tested. Of the five at-risk couples, four requested prenatal diagnosis and one requested neonatal diagnosis. No woman found to be a carrier whose partner tested negative requested prenatal diagnosis. Except for the imperfect knowledge of those testing negative, none of the adverse outcomes predicted for CF carrier testing in the general population were observed in this study. Images p236-a p236-b p236-c PMID:8659530

  19. Working with advanced dementia patients in a day care setting.

    PubMed

    Abramowitz, Leah

    2008-01-01

    Alzheimer's disease and most other causes of dementia are regressive by nature. As such one can expect patients with such types of mental impairment to gradually decline in function and ability to participate in day care activities. This paper attempts to show that with the right kind of orientation, staff can "tune into" the more advanced dementia patients, find the key to their personal needs, desires and remaining abilities and design a program that allows them not only to continue to participate in a social and therapeutic framework, but also to gain some meaningful human contact and quality of life despite their cognitive deterioration.

  20. Review of psychological issues in victims of domestic violence seen in emergency settings.

    PubMed

    Frank, J B; Rodowski, M F

    1999-08-01

    When a history of domestic violence is discovered during a universal screening in the emergency department, emergency staff typically feel ill equipped to address the underlying psychological, behavioral, and health problems of the victim. This article reviews the known characteristics of ongoing relationships in which one partner exerts coercive control over another, with emphasis on the effects of abuse on the victim's physical and mental health. These effects include actual injury, multiple stress-related physical conditions, substance abuse, and a variety of psychiatric problems, including depression, anxiety and anxiety disorders, dissociation and dissociative disorders, and post-traumatic stress disorder. A patient-centered approach allows emergency response staff to tailor intervention to victims' real and perceived needs, fulfilling their professional obligation to provide meaningful help to female victims of domestic violence seen in emergency settings.

  1. Differences in HIV risk behavior of injection drug users in New York City by health care setting.

    PubMed

    Turner, A K; Harripersaud, K; Crawford, N D; Rivera, A V; Fuller, C M

    2013-01-01

    The purpose of this study is to examine the HIV risk behaviors and demographic characteristics of injection drug users (IDUs) by type of health care setting, which can inform development of tailored structural interventions to increase access to HIV prevention and medical treatment services. IDU syringe customers were recruited from pharmacies as part of the "Pharmacist As Resources Making Links to Community Services" (PHARM-Link) study, a randomized community-based intervention in New York City (NYC) aimed at connecting IDUs to HIV prevention, medical, and social services. An ACASI survey ascertained demographics, risk behavior, health-care utilization, and location where health care services were received in the past year. Data were analyzed using logistic regression. Of 602 participants, 34% reported receiving health care at a community clinic, 46% a private medical office, 15% a mobile medical unit, and 59% an emergency room (ER). After adjustment, participants who attended a community clinic were significantly more likely to have health insurance, report syringe sharing, and be HIV positive. Whites, nondaily injectors, insured, and higher income IDUs were more likely to attend a private medical office. Participants who recently used a case manager and had multiple sexual partners were more likely to use a mobile medical unit. ER attendees were more likely to be homeless and report recent drug treatment use. These findings show that IDU demographics and risk behaviors differ by health care setting, suggesting that risk reduction interventions should be tailored to health care settings. Specifically, these data suggest that community clinics and mobile medical units serve high-risk IDUs, highlighting the need for more research to develop and test innovative prevention and care programs within these settings.

  2. The meaning of quality of care in home care settings: older lesbian and bisexual women's perspectives.

    PubMed

    Grigorovich, Alisa

    2016-03-01

    Research suggests that the experience of being a lesbian or bisexual woman influences women's interactions with health care providers, and their perception of the quality of care. Limited research to date, however, has examined how ageing and sexuality mediates women's experiences of quality, when accessing health care in the community. To fill a gap in the literature, this study investigated older lesbian and bisexual women's perspectives on the meaning of quality of care in the context of receiving home care services. This was a qualitative single case study. Sixteen participants, aged 55-72 from Ontario, Canada, participated in semi-structured interviews between 2011 and 2012. The interviews were recorded and transcribed. The interview data were analysed using iterative thematic analysis and guided by a feminist ethic of care perspective. Participants described quality of care in ways that were in line with a feminist ethic of care; that is, they wanted care providers to be responsive and attentive to their needs, to involve them in the caring process and to demonstrate respect and caring. Participants also indicated that providers' comfort with, and knowledge of, sexual diversity was important for enabling quality of care. These findings deepen our understanding of how to support quality of care for this population through changes to provider education and training, and health policy.

  3. Supportive care in pediatric oncology: oncologic emergencies and management of fever and neutropenia.

    PubMed

    Henry, Meret; Sung, Lillian

    2015-02-01

    Advancements in the care of children with cancer have, in part, been achieved through improvements in supportive care. Situations that require prompt care can occur at the time of presentation as well as during treatment. This article discusses the approach to children with fever and neutropenia, a complication encountered daily by care providers, as well as oncologic emergencies that can be seen at the time of a child's initial diagnosis: hyperleukocytosis, tumor lysis syndrome, superior vena cava syndrome, and spinal cord compression.

  4. Psychosocial screening and assessment in oncology and palliative care settings.

    PubMed

    Grassi, Luigi; Caruso, Rosangela; Sabato, Silvana; Massarenti, Sara; Nanni, Maria G; The UniFe Psychiatry Working Group Coauthors

    2014-01-01

    Psychiatric and psychosocial disorders among cancer patients have been reported as a major consequence of the disease and treatment. The problems in applying a pure psychiatric approach have determined the need for structuring more defined methods, including screening for distress and emotional symptoms and a more specific psychosocial assessment, to warrant proper care to cancer patients with psychosocial problems. This review examines some of the most significant issues related to these two steps, screening and assessment of psychosocial morbidity in cancer and palliative care. With regard to this, the many different variables, such as the factors affecting individual vulnerability (e.g., life events, chronic stress and allostatic load, well-being, and health attitudes) and the psychosocial correlates of medical disease (e.g., psychiatric disturbances, psychological symptoms, illness behavior, and quality of life) which are possibly implicated not only in "classical" psychiatric disorders but more broadly in psychosocial suffering. Multidimensional tools [e.g., and specific psychosocially oriented interview (e.g., the Diagnostic Criteria for Psychosomatic Research)] represent a way to screen for and assess emotional distress, anxiety and depression, maladaptive coping, dysfunctional attachment, as well as other significant psychosocial dimensions secondary to cancer, such as demoralization and health anxiety. Cross-cultural issues, such as language, ethnicity, race, and religion, are also discussed as possible factors influencing the patients and families perception of illness, coping mechanisms, psychological response to a cancer diagnosis.

  5. A preconception care program for women in a college setting.

    PubMed

    Wade, Gail Holland; Herrman, Judy; McBeth-Snyder, Lisa

    2012-01-01

    Preconception healthcare is a way to enhance positive pregnancy outcomes by encouraging women to engage in healthy lifestyles before they become pregnant. Because approximately 50% of pregnancies are unplanned, fetal development may be affected before a woman receives prenatal care. Young women are especially vulnerable to poor outcomes due to risky behaviors. Education about preconception health is not common practice. This article describes a peer education preconception health program for college women that provided a basis for an expanded program with larger, more diverse populations. Nursing students as peer educators presented the program to over 100 young women using the mnemonic REFRAMED PLUS to address eight preconception risk areas and reproductive life planning. Materials to augment the program, developed by peer educators, included a brochure on preconception health, a risk assessment tool, a DVD with stories of young women who experienced unplanned pregnancies, and a Reproductive Life Plan book. Peer educators administered a pretest, showed the DVD, guided discussions, assessed each woman's health risks and administered a posttest. The risk assessment revealed that young women have several preconception health risks. Following the preconception program, posttest scores indicated increased knowledge of preconception health. For preconception healthcare to be successful, preconception risk assessments, education and counseling must be addressed by nurses every time a young woman receives care. When possible, peer educators should be used to disseminate the message to all women of childbearing age.

  6. Bringing back the house call: how an emergency mobile nursing service is reducing avoidable emergency department visits for residents in long-term care homes.

    PubMed

    Bandurchin, Annabelle; McNally, Mary Jane; Ferguson-Paré, Mary

    2011-04-01

    Avoidable emergency department (ED) visits are a source of clinical risk, stress and anxiety for older, more vulnerable patients. The complexity of health conditions and the unique challenges associated with the care of older patients can also contribute to overcrowding and longer wait times in EDs--issues of significant concern for both healthcare providers and patients. Generally, older patients are more likely than younger patients to visit EDs and be admitted to hospital. In addition, older adults living in long-term care (LTC) homes are more likely to be transferred to EDs for preventable issues than those living in other settings. This paper describes how mobilizing a team of registered nurses working at full scope of practice might reduce the number of avoidable transfers of older patients to the ED. Utilizing nurses in this capacity demonstrates how the nursing profession can drive systemwide change to improve care between healthcare sectors for older adults.

  7. Care planning for nursing home residents: incorporating the Minimum Data Set requirements into practice.

    PubMed

    Taunton, Roma Lee; Swagerty, Daniel L; Smith, Barbara; Lasseter, Joyce A; Lee, Robert H

    2004-12-01

    This study was designed to describe the care-planning process used in nursing homes and identify links among care planning, care provided, and the Resident Assessment Instrument and Minimum Data Set (MDS). Study participants in three Midwestern nursing homes included residents and family members, MDS coordinators, direct care staff, administrators, directors of nursing, and medical directors. Data were collected via semi-structured interview, observation, and resident record audit. The care-planning process differed among the three facilities despite the common MDS system structure. Care planning and the MDS system were linked to the care provided to residents through documentation in residents' records, translation of the MDS care plan to the documents used for daily care, and ongoing communication through end-of-shift report and other venues.

  8. Emerging roles for telemedicine and smart technologies in dementia care

    PubMed Central

    Bossen, Ann L; Kim, Heejung; Williams, Kristine N; Steinhoff, Andreanna E; Strieker, Molly

    2015-01-01

    Demographic aging of the world population contributes to an increase in the number of persons diagnosed with dementia (PWD), with corresponding increases in health care expenditures. In addition, fewer family members are available to care for these individuals. Most care for PWD occurs in the home, and family members caring for PWD frequently suffer negative outcomes related to the stress and burden of observing their loved one’s progressive memory and functional decline. Decreases in cognition and self-care also necessitate that the caregiver takes on new roles and responsibilities in care provision. Smart technologies are being developed to support family caregivers of PWD in a variety of ways, including provision of information and support resources online, wayfinding technology to support independent mobility of the PWD, monitoring systems to alert caregivers to changes in the PWD and their environment, navigation devices to track PWD experiencing wandering, and telemedicine and e-health services linking caregivers and PWD with health care providers. This paper will review current uses of these advancing technologies to support care of PWD. Challenges unique to widespread acceptance of technology will be addressed and future directions explored. PMID:26636049

  9. Supporting Nutrition in Early Care and Education Settings: The Child and Adult Care Food Program (CACFP)

    ERIC Educational Resources Information Center

    Stephens, Samuel A.

    2016-01-01

    Child care centers, Head Start programs, and family child care providers serving young children--as well as after school programs and homeless shelters that reach older children, adults, and families--are supported in providing healthy meals and snacks by reimbursements through the Child and Adult Care Food Program (CACFP). Administered by the…

  10. Individual versus Significant Other-Enhanced Brief Motivational Intervention for Alcohol in Emergency Care

    PubMed Central

    Monti, Peter M.; Colby, Suzanne M.; Mastroleo, Nadine R.; Barnett, Nancy P.; Gwaltney, Chad J.; Apodaca, Timothy R.; Rohsenow, Damaris J.; Magill, Molly; Gogineni, Aruna; Mello, Michael J.; Biffl, Walter L.; Cioffi, William G.

    2014-01-01

    Objective Effects of brief motivational interventions (BMIs) for heavy drinkers identified by alcohol-related emergency department (ED) visits are mixed. The successes of including significant others (SOs) in behavioral treatment suggest that involving SOs in ED-delivered BMI might prove beneficial. This study investigated the relative efficacy of an SO-enhanced Motivational Intervention (SOMI) compared to an Individual Motivational Intervention (IMI) to address heavy drinking in emergency care settings. Method ED (n = 317) or trauma unit (n = 89) patients were randomly assigned to receive either an IMI or an SOMI and were re-assessed at 6 and 12 months for alcohol consumption, alcohol-related consequences, and perceived alcohol-specific SO support. Results GEE analyses showed consistent reductions over time for both alcohol consumption and consequences. At one-year follow up, the average reduction in total drinks consumed per week was greater for patients in the SOMI condition than the IMI condition. In SOMI, 9.4% more patients moved to within the national guidelines for weekly drinking than did IMI patients. Frequency of heavy drinking and negative alcohol consequences showed no differential effects of intervention. Conclusions Emergence of a modest treatment effect at 12 months suggests that SO involvement in the SOMI condition may have led to more sustained positive influence on patient drinking than in the IMI condition. Implications and limitations regarding SO involvement in brief treatment are discussed. PMID:25111430

  11. Registered Nurses in Primary Care: Emerging New Roles and Contributions to Team-Based Care in High-Performing Practices.

    PubMed

    Flinter, Margaret; Hsu, Clarissa; Cromp, DeAnn; Ladden, MaryJoan D; Wagner, Edward H

    2017-03-20

    The years since the passage of the Affordable Care Act have seen substantial changes in the organization and delivery of primary care. These changes have emphasized greater team involvement in care and expansion of the roles of each team member including registered nurses (RNs). This study examined the roles of RNs in 30 exemplary primary care practices. We identified the emergence of new roles and activities for RNs characterized by greater involvement in face-to-face patient care and care management, their own daily schedule of patient visits and contacts, and considerable autonomy in the care of their patients.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.

  12. Subsidized child care by grandparents: profiles of caregivers in an emerging public service context.

    PubMed

    Anderson, Steven G; Liu, Meirong; Liao, Minli

    2013-01-01

    Grandparents have become an important source of subsidized noncustodial child care provision as states have developed child care subsidy programs for working families. Based on a sample of 140 grandparents providing care in one state subsidy program, this article examines grandparent characteristics, caregiving patterns, experiences with care provision, and training and resource needs in this emerging public service context. Our findings indicate that grandparents provide care largely for altruistic reasons. They offer vital care during nontraditional work hours and are more receptive to training provision than often is understood. Based on study findings, several strategies are presented for supporting subsidized grandparent caregivers.

  13. Dimensions and Determinants of Trust in Health Care in Resource Poor Settings – A Qualitative Exploration

    PubMed Central

    Gopichandran, Vijayaprasad; Chetlapalli, Satish Kumar

    2013-01-01

    Background Trust in health care has been intensely researched in resource rich settings. Some studies in resource poor settings suggest that the dimensions and determinants of trust are likely to be different. Objectives This study was done as a qualitative exploration of the dimensions and determinants of trust in health care in Tamil Nadu, a state in south India to assess the differences from dimensions and determinants in resource rich settings. Methodology The participants included people belonging to marginalized communities with poor access to health care services and living in conditions of resource deprivation. A total of thirty five in depth interviews were conducted. The interviews were summarized and transcribed and data were analyzed following thematic analysis and grounded theory approach. Results The key dimensions of trust in health care identified during the interviews were perceived competence, assurance of treatment irrespective of ability to pay or at any time of the day, patients’ willingness to accept drawbacks in health care, loyalty to the physician and respect for the physician. Comfort with the physician and health facility, personal involvement of the doctor with the patient, behavior and approach of doctor, economic factors, and health awareness were identified as factors determining the levels of trust in health care. Conclusions The dimensions and determinants of trust in health care in resource poor settings are different from that in resource rich settings. There is a need to develop scales to measure trust in health care in resource poor settings using these specific dimensions and determinants. PMID:23874904

  14. Anaphylaxis in an emergency department: a 2-year study in a tertiary-care hospital.

    PubMed

    Piromrat, Kanika; Chinratanapisit, Sasawan; Trathong, Sommai

    2008-01-01

    The aim of this study was to estimate the incidence of anaphylaxis in the emergency department of a tertiary-care hospital, describe the clinical features and the management of the patients and determine those with mild manifestations. A retrospective study was conducted from 2005 to 2006 using anaphylaxis-related ICD-10 terms. Two different sets of criteria for the diagnosis of anaphylaxis were applied, first the criteria previously accepted by emergency practice, followed by the recent criteria set forth at the 2005 international meeting. Sixty-four patients fulfilled the previous criteria with an average incidence of 52.5 per 100,000 patients per year with a shift towards females in 2006. The most common presentations were cutaneous, followed by respiratory symptoms. Food allergy was the most common cause, especially prawn. After applying the recent criteria, 13 patients (20.4%) were excluded, which reduced the incidence to 42.2 per 100,000 patients per year. Long term follow up is suggested for the possible or mild cases that were re-categorized.

  15. Diagnosing binge eating disorder in a primary care setting.

    PubMed

    Montano, C Brendan; Rasgon, Natalie L; Herman, Barry K

    2016-01-01

    Binge eating disorder (BED), now recognized as a distinct eating disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, is the most prevalent eating disorder. Although nearly half of individuals with BED are obese, BED also occurs in nonobese individuals. Despite the relatively high percentage of weight loss treatment-seeking individuals meeting BED criteria, primary care physicians may not be familiar with or have ever diagnosed BED. Many providers may also have difficulty distinguishing BED as a contributory factor in obesity. This review differentiates BED from other causes of obesity by describing how obese individuals with BED differ from obese individuals without BED and from nonobese individuals with BED in areas including psychopathology, behavior, genetics, physiology, quality of life and productivity. The ways in which health-care providers can identify individuals who may have BED are also highlighted so the proper course of treatment is pursued. Overall, obese individuals with BED demonstrate a number of key characteristics that differentiate them from obese individuals without eating disorders, including increased impulsivity in response to food stimuli with loss of control over eating, resulting in the consumption of more calories. They also experience significant guilt and other negative emotions following a meal. In addition, individuals with BED patients have more psychiatric comorbidity, display more psychopathology, exhibit longer binge durations, consume more meals as snacks during the day and have less dietary restraint compared with individuals with BED who are not obese. However, the differences between individuals with BED who are obese versus not obese are not as prominent. Taken together, the evidence appears to support the conclusion that BED is a unique and treatable neurobehavioral disorder associated with distinct behavioral and psychological profiles and distinct medical and functional outcomes, and that

  16. Ipratropium bromide for acute asthma exacerbations in the emergency setting: a literature review of the evidence.

    PubMed

    Dotson, Kurtis; Dallman, Michael; Bowman, C Michael; Titus, M Olivia

    2009-10-01

    Since the 1970s, when inhaled anticholinergic agents were first introduced as adjunct therapies for the immediate treatment of pediatric asthma exacerbations, several trials have shown varying degrees of benefit from their use as bronchodilators in combination with inhaled short-acting beta-adrenergic agonists and systemic corticosteroids. Although other anticholinergics exist, ipratropium bromide (IB) specifically has emerged as the overwhelming choice of pulmonologists and emergency physicians because of its limited systemic absorption from the lungs when given as an inhaled preparation. However, although the varying trials, predominantly in the emergency department setting, have typically shown a trend toward improved outcomes, none has set forth clear dosing protocol recommendations for use by practicing physicians. It is our goal in this review of the available literature on the use of IB, as an adjunct to inhaled short-acting beta-adrenergic agonists, to summarize practical, evidence-based recommendations for use in the pediatric emergency department setting for acute asthma exacerbations. We also hope to better delineate the most effective dosing regimen in those patients who might benefit most from the addition of IB and to explore proposed additional benefits it may have as a modulator of cholinergic-induced effects from high-dose beta-agonist therapy and viral triggers.

  17. Primary Palliative Care for the General Internist: Integrating Goals of Care Discussions into the Outpatient Setting

    PubMed Central

    Ahia, Chad L.; Blais, Christopher M.

    2014-01-01

    Background Primary palliative care consists of the palliative care competencies required of all primary care clinicians. Included in these competencies is the ability to assist patients and their families in establishing appropriate goals of care. Goals of care help patients and their families understand the patient's illness and its trajectory and facilitate medical care decisions consistent with the patient's values and goals. General internists and family medicine physicians in primary care are central to getting patients to articulate their goals of care and to have these documented in the medical record. Case Report Here we present the case of a 71-year-old male patient with chronic obstructive pulmonary disorder, congestive heart failure, and newly diagnosed Alzheimer dementia to model pertinent end-of-life care communication and discuss practical tips on how to incorporate it into practice. Conclusion General internists and family medicine practitioners in primary care are central to eliciting patients' goals of care and achieving optimal end-of-life outcomes for their patients. PMID:25598737

  18. A Smartphone App and Cloud-Based Consultation System for Burn Injury Emergency Care

    PubMed Central

    Wallis, Lee A.; Fleming, Julian; Hasselberg, Marie; Laflamme, Lucie; Lundin, Johan

    2016-01-01

    Background Each year more than 10 million people worldwide are burned severely enough to require medical attention, with clinical outcomes noticeably worse in resource poor settings. Expert clinical advice on acute injuries can play a determinant role and there is a need for novel approaches that allow for timely access to advice. We developed an interactive mobile phone application that enables transfer of both patient data and pictures of a wound from the point-of-care to a remote burns expert who, in turn, provides advice back. Methods and Results The application is an integrated clinical decision support system that includes a mobile phone application and server software running in a cloud environment. The client application is installed on a smartphone and structured patient data and photographs can be captured in a protocol driven manner. The user can indicate the specific injured body surface(s) through a touchscreen interface and an integrated calculator estimates the total body surface area that the burn injury affects. Predefined standardised care advice including total fluid requirement is provided immediately by the software and the case data are relayed to a cloud server. A text message is automatically sent to a burn expert on call who then can access the cloud server with the smartphone app or a web browser, review the case and pictures, and respond with both structured and personalized advice to the health care professional at the point-of-care. Conclusions In this article, we present the design of the smartphone and the server application alongside the type of structured patient data collected together with the pictures taken at point-of-care. We report on how the application will be introduced at point-of-care and how its clinical impact will be evaluated prior to roll out. Challenges, strengths and limitations of the system are identified that may help materialising or hinder the expected outcome to provide a solution for remote consultation on

  19. Migrants' and professionals' views on culturally sensitive pre-hospital emergency care.

    PubMed

    Kietzmann, Diana; Hannig, Christian; Schmidt, Silke

    2015-08-01

    This study was designed to explore the views of migrants and professionals on culturally sensitive pre-hospital emergency care in order to adapt such care to migrants' needs. Interviews were conducted with 41 migrants who had received direct (as a patient) or indirect (as a significant other) pre-hospital emergency care. Furthermore, 20 professionals in the field of pre-hospital emergency care were interviewed. The content analysis showed five distinguishable categories based on the statements by the migrants and six categories based on the statements by the professionals. While migrants gave priority to basic proficiencies of first responders such as 'social/emotional competencies' and 'communication skills', the professionals considered '(basic) cultural knowledge', 'awareness' and 'attitude' the most important. Furthermore, migrants provided practical indications, e.g. regarding areas of cultural knowledge, whereas professionals seemed to view the issue of culturally pre-hospital emergency care from a more theoretical perspective. The issues of the culturally sensitive pre-hospital emergency care itself, as well as the varying points of view of the two groups interviewed, resulted in eight recommendations for culturally sensitive pre-hospital emergency care.

  20. Exposure of medical students to pharmaceutical marketing in primary care settings: frequent and influential.

    PubMed

    Sarikaya, Ozlem; Civaner, Murat; Vatansever, Kevser

    2009-12-01

    It is known that interaction between pharmaceutical companies and medical professionals may lead to corruption of professional values, irrational use of medicine, and negative effects on the patient-physician relationship. Medical students frequently interact with pharmaceutical company representatives and increasingly accept their gifts. Considering the move toward early clinical encounters and community-based education, which expose students early to pharmaceutical representatives, the influence of those gifts is becoming a matter of concern. This study examines the frequency and influence of student exposure to drug marketing in primary care settings, as well as student perceptions of physician-pharmaceutical company relationships. This was a two-phase study consisting of qualitative research followed by a cross-sectional survey. Clinical experience logbooks of 280 second-year students in one school were analysed, and the themes that emerged were used to develop a survey that was administered to 308 third-year students from two medical schools. Survey results showed a 91.2% exposure to any type of marketing, and 56.8% of students were exposed to all classes of marketing methods studied. Deliberate targeting of students by pharmaceutical representatives, in particular, was correlated with being less sensitive to the negative effects of and having positive opinions about interactions with pharmaceutical companies. The vast majority of students are exposed to drug marketing in primary care settings, and may become more vulnerable to that strategy. Considering that medical students are vulnerable and are targeted deliberately by pharmaceutical companies, interventions aimed at developing skills in the rational use of medicines and in strategies for coping with drug marketing should be devised.

  1. Role of public transport in accessibility to emergency dental care in Melbourne, Australia.

    PubMed

    Rocha, Carla M; Kruger, Estie; McGuire, Shane; Tennant, Marc

    2015-01-01

    The aim of this study was to develop a method for the analysis of the influence of public transport supply in a large city (Melbourne) on the access to emergency dental treatment. Geographic Information Systems (GIS) tools were used to associate the geographical distribution of patients (and their socioeconomic status) with accessibility (through public transport supply, i.e. bus, tram and/or train) to emergency dental care. The methodology used allowed analysis of the socioeconomic status of patient residential areas and both spatial location and supply frequency of public transport by using existing data from patient records, census and transport departments. In metropolitan Melbourne, a total of 13 784 patients met the inclusion criteria for the study sample, of which 95% (n = 13 077) were living within a 50 km radius of the Royal Dental Hospital of Melbourne. Low socioeconomic areas had a higher demand for dental emergency care in the Royal Dental Hospital of Melbourne. Public transport supply was similar across the various socioeconomic strata in the population, with 80% of patients having good access to public transport. However, when considering only high-frequency bus stops, the percentage of patients living within 400 m from a bus stop dropped to 65%. Despite this, the number of patients (adjusted to the population) coming from areas not supplied by public transport, and from areas with good or poor public transport supply, was similar. The methodology applied in the present study highlights the importance of evaluating not only the spatial distribution but also the frequency of public transport supply when studying access to services. This methodology can be extrapolated to other settings to identity transport/access patterns for a variety of services.

  2. Key elements of successful care process of patients with heart symptoms in an emergency care - could an ERP system help?

    PubMed

    Kontio, Elina; Korvenranta, Heikki; Lundgren-Laine, Heljä; Salanterä, Sanna

    2009-01-01

    The aim of the study was to identify key elements of successful care process of patients with heart symptoms from the nursing management viewpoint in an emergency care. Through these descriptions, we aimed at identifying possibilities for using enterprise resource planning (ERP) systems to support decision making in emergency care. Hospitals are increasingly moving to process-based workings and at the same time new information system in healthcare are developed and therefore it is essential to understand the strengths and weaknesses of current processes better. A qualitative descriptive design using critical incident technique was employed. Critical Incidents were collected with an open-ended questionnaire. The sample (n=50), 13 head nurses and 37 registered nurses, was purposeful selected from three acute hospitals in southern Finland. The process of patients with heart symptoms in emergency care was described. We identified three competence categories where special focus should be placed to achieve successful process of patients with heart symptoms: process-oriented competencies, personal/management competencies and logistics oriented competencies. Improvement of decision making requires that the care processes are defined and modeled. The research showed that there are several happenings in emergency care where an ERP system could help and support decision making. These happenings can be categorized in two groups: 1) administrative related happenings and 2) patient processes related happenings.

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

    PubMed

    Pines, Jesse M

    2006-05-01

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

  4. Paediatric cardiac intensive care unit: current setting and organization in 2010.

    PubMed

    Fraisse, Alain; Le Bel, Stéphane; Mas, Bertrand; Macrae, Duncan

    2010-10-01

    Over recent decades, specialized paediatric cardiac intensive care has emerged as a central component in the management of critically ill, neonatal, paediatric and adult patients with congenital and acquired heart disease. The majority of high-volume centres (dealing with over 300 surgical cases per year) have dedicated paediatric cardiac intensive care units, with the smallest programmes more likely to care for paediatric cardiac patients in mixed paediatric or adult intensive care units. Specialized nursing staff are also a crucial presence at the patient's bedside for quality of care. A paediatric cardiac intensive care programme should have patients (preoperative and postoperative) grouped together geographically, and should provide proximity to the operating theatre, catheterization laboratory and radiology department, as well as to the regular ward. Age-appropriate medical equipment must be provided. An optimal strategy for running a paediatric cardiac intensive care programme should include: multidisciplinary collaboration and involvement with paediatric cardiology, anaesthesia, cardiac surgery and many other subspecialties; a risk-stratification strategy for quantifying perioperative risk; a personalized patient approach; and anticipatory care. Finally, progressive withdrawal from heavy paediatric cardiac intensive care management should be institutionalized. Although the countries of the European Union do not share any common legislation on the structure and organization of paediatric intensive care or paediatric cardiac intensive care, any paediatric cardiac surgery programme in France that is agreed by the French Health Ministry must perform at least '150 major procedures per year in children' and must provide a 'specialized paediatric intensive care unit'.

  5. 38 CFR 17.121 - Limitations on payment or reimbursement of the costs of emergency hospital care and medical...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... reimbursement of the costs of emergency hospital care and medical services not previously authorized. 17.121... reimbursement of the costs of emergency hospital care and medical services not previously authorized. Claims for payment or reimbursement of the costs of emergency hospital care or medical services not...

  6. 38 CFR 17.121 - Limitations on payment or reimbursement of the costs of emergency hospital care and medical...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... reimbursement of the costs of emergency hospital care and medical services not previously authorized. 17.121... reimbursement of the costs of emergency hospital care and medical services not previously authorized. Claims for payment or reimbursement of the costs of emergency hospital care or medical services not...

  7. [High blood pressure care: beyond the clinical setting].

    PubMed

    Ordúñez García, Pedro; Pérez Flores, Enrique; Hospedales, James

    2010-10-01

    The recommendations from the seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) were compared with those of a recent article by Aram V. Chobanian, Chairman of the JNC 7. The purpose was to identify the changes that this author proposed and determine how they might affect clinical work, as well as the health services and public health implications. The JNC 7 and the article in question coincide on all essential points, except that the article is more flexible when it comes to the use of diuretics at the start of treatment for high blood pressure. Chronic disease management should take place in health systems with primary care approach, where the epidemiology of such diseases and scientific advances in prevention offer an excellent opportunity for redesigning the health services and making them more effective. High blood pressure, as a public health problem, demands health interventions aimed not only at reducing harm but modifying its etiologic determinants. The challenge is to recognize that an integrated approach to clinical medicine, health services, and public health would offer an attractive opportunity to interrupt and prevent the continuous and costly vicious circle that managing high blood pressure and its complications implies.

  8. Systematic review of safety checklists for use by medical care teams in acute hospital settings - limited evidence of effectiveness

    PubMed Central

    2011-01-01

    Background Patient safety is a fundamental component of good quality health care. Checklists have been proposed as a method of improving patient safety. This systematic review, asked "In acute hospital settings, would the use of safety checklists applied by medical care teams, compared to not using checklists, improve patient safety?" Methods We searched the Cochrane Library, MEDLINE, CINAHL, and EMBASE for randomised controlled trials published in English before September 2009. Studies were selected and appraised by two reviewers independently in consultation with colleagues, using inclusion, exclusion and appraisal criteria established a priori. Results Nine cohort studies with historical controls studies from four hospital care settings were included-intensive care unit, emergency department, surgery, and acute care. The studies used a variety of designs of safety checklists, and implemented them in different ways, however most incorporated an educational component to teach the staff how to use the checklist. The studies assessed outcomes occurring a few weeks to a maximum of 12 months post-implementation, and these outcomes were diverse. The studies were generally of low to moderate quality and of low levels of evidence, with all but one of the studies containing a high risk of bias. The results of these studies suggest some improvements in patient safety arising from use of safety checklists, but these were not consistent across all studies or for all outcomes. Some studies showed no difference in outcomes between checklist use and standard care without a checklist. Due to the variations in setting, checklist design, educational training given, and outcomes measured, it was unfeasible to accurately summarise any trends across all studies. Conclusions The included studies suggest some benefits of using safety checklists to improve protocol adherence and patient safety, but due to the risk of bias in these studies, their results should be interpreted with

  9. 13 Animal Emergencies That Should Receive Immediate Veterinary Consultation and/or Care

    MedlinePlus

    ... Public Health 13 Animal Emergencies that Require Immediate Veterinary Consultation and/or Care Severe bleeding or bleeding ... Map | Privacy | Terms of Use Copyright © 2017 American Veterinary Medical Association

  10. Rising pressure: hospital emergency departments as barometers of the health care system.

    PubMed

    O'Malley, Ann S; Gerland, Anneliese M; Pham, Hoangmai H; Berenson, Robert A

    2005-11-01

    Pressures--ranging from persuading specialists to provide on-call coverage to dealing with growing numbers of patients with serious mental illness--are building in already-crowded hospital emergency departments (EDs) across the country, according to findings from the Center for Studying Health System Change's (HSC) 2005 site visits to 12 nationally representative communities. As the number of ED visits rises significantly faster than population growth, many hospitals are expanding emergency department capacity. At the same time, hospitals face an ongoing nursing shortage, contributing to tight inpatient capacity that in turn hinders admitting ED patients. In their role as hospitals' "front door" for attracting insured inpatient admissions, emergency departments also increasingly are expected to help hospitals compete for insured patients while still meeting obligations to provide emergency care to all-comers under federal law. Failure to address these growing pressures may compromise access to emergency care for patients and spur already rapidly rising health care costs.

  11. Maternal mortality and its relationship to emergency obstetric care (EmOC) in a tertiary care hospital in South India

    PubMed Central

    2015-01-01

    Objective: To determine the trends in maternal mortality ratio over 5 years at JIPMER Hospital and to find out the proportion of maternal deaths in relation to emergency admissions. Methods: A retrospective analysis of maternal deaths from 2008 to 2012 with respect to type of admission, referral and ICU care and cause of death according to WHO classification of maternal deaths. Results: Of the 104 maternal deaths 90% were emergency admissions and 59% of them were referrals. Thirty two percent of them died within 24 hours of admission. Forty four percent could be admitted to ICU and few patients could not get ICU bed. The trend in cause of death was increasing proportion of indirect causes from 2008 to 2012. Conclusion: The trend in MMR was increasing proportion of indirect deaths. Ninety percent of maternal deaths were emergency admissions with complications requiring ICU care. Hence comprehensive EmOC facilities should incorporate Obstetric ICU care. PMID:27512460

  12. The emergence of the vertical birth in Ecuador: an analysis of agenda setting and policy windows for intercultural health.

    PubMed

    Llamas, Ana; Mayhew, Susannah

    2016-07-01

    Maternal mortality continues to claim the lives of thousands of women in Latin America despite the availability of effective treatments to avert maternal death. In the past, efforts to acknowledge cultural diversity in birth practices had not been clearly integrated into policy. However, in Otavalo (Ecuador) a local hospital pioneered the implementation of the 'Vertical Birth'-a practical manifestation of an intercultural health policy aimed at increasing indigenous women's access to maternity care. Drawing on agenda-setting theory, this qualitative research explores how the vertical birth practice made it onto the local policy agenda and the processes that allowed actors to seize a window of opportunity allowing the vertical birth practice to emerge. Our results show that the processes that brought about the vertical birth practice took place over a prolonged period of time and resulted from the interplay between various factors. Firstly, a maternal health policy community involving indigenous actors played a key role in identifying maternal mortality as a policy problem, defining its causes and framing it as an indigenous rights issue. Secondly, previous initiatives to address maternal mortality provided a wealth of experience that gave these actors the knowledge and experience to formulate a feasible policy solution and consolidate support from powerful actors. Thirdly, the election of a new government that had incorporated the demands of the indigenous movement opened up a window of opportunity to push intercultural health policies such as the vertical birth. We conclude that the socioeconomic and political changes at both national and local level allowed the meaningful participation of indigenous actors that made a critical contribution to the emergence of the vertical birth practice. These findings can help us advance our knowledge of strategies to set the agenda for intercultural maternal health policy and inform future policy in similar settings. Our

  13. [Emergency care for patients in palliative situations--algorithm for decision-making and recommendations for treatment].

    PubMed

    Makowski, Corinna; Marung, Hartwig; Callies, Andreas; Knacke, Peter; Kerner, Thoralf

    2013-03-01

    Emergency care for patients in palliative situations is not a rare event, but often difficult to handle, because training in palliative care for emergency physicians is often insufficient. This article proposes an algorithm that should facilitate the decision-making process in such emergencies. In addition, recommendations concerning the management of symptoms in the emergency medical services are presented.

  14. [Nursing care management in hospital settings: the building of a construct].

    PubMed

    Christovam, Barbara Pompeu; Porto, Isaura Setenta; de Oliveira, Denise Cristina

    2012-06-01

    The objective of this study was to build and present a theoretical definition of the concept of nursing care management in hospital settings, based on specific literature. We chose to use Concept Analysis strategies for building concepts, the rules of Archeological Analysis for forming concepts, and Lexical Analysis as the theoretical-methodological framework. The operationalization of the strategies and rules for forming the concept permitted the construction of the concept of nursing care in hospital settings. The constructed concept presented, by its nature, the capacity to form a dialectic integration of the aspects relative to the knowing-doing of care and management. The theoretical definition of the concept of Nursing Care Management in Hospital Settings assigned meaning to the term, in the initial context of the construction of a theory of Nursing Care Management in Health Services.

  15. Emergency medical services responders’ perceptions of the effect of stress and anxiety on patient safety in the out-of-hospital emergency care of children: a qualitative study

    PubMed Central

    Hansen, Matthew; O'Brien, Kerth; Dickinson, Caitlin; Meckler, Garth; Engle, Phil; Lambert, William; Jui, Jonathan

    2017-01-01

    Objective Prehospital emergency medical services (EMS) providers report anxiety as the second most common contributor to paediatric patient safety events. The objective of this study was to understand how EMS providers perceive the effect of stress and anxiety on paediatric out-of-hospital patient safety. Setting This was a nationwide study of EMS providers from 44 of 50 (88%) US states. Participants A total of 753 eligible EMS professionals, including emergency medical technicians, emergency department physicians and nurses (general and paediatric), and respiratory therapists who participate in out-of-hospital transports. Primary and secondary outcome measures Outcomes included responses to: (1) clinical situations where heightened stress or anxiety was likely to contribute to safety events, (2) aspects of these clinical situations that cause stress or anxiety and (3) how stress or anxiety may lead to paediatric safety events. Results EMS providers reported that the clinical situations where stress and anxiety were more likely to contribute to paediatric patient safety events were trauma, respiratory distress and cardiac issues. Key themes were: (1) provider sympathy or identification with children, (2) difficulty seeing an innocent child hurt and the inherent value of children and (3) insufficient exposure to paediatric emergencies. Conclusions Caring for paediatric emergencies creates unique stresses on providers that may affect patient safety. Many of the factors reported to cause provider stress and anxiety are inherent attributes of children and therefore not modifiable. Tools that support care during stressful conditions such as cognitive aids may help to mitigate anxiety in the prehospital care of children. Further research is needed to identify opportunities for and attributes of interventions. PMID:28246139

  16. World Health Assembly Resolution 60.22 and its importance as a health care policy tool for improving emergency care access and availability globally.

    PubMed

    Anderson, Philip D; Suter, Robert E; Mulligan, Terrence; Bodiwala, Gautam; Razzak, Junaid A; Mock, Charles

    2012-07-01

    The recent adoption of World Health Assembly Resolution 60.22, titled "Health Systems: Emergency Care Systems," has established an important health care policy tool for improving emergency care access and availability globally. The resolution highlights the role that strengthened emergency care systems can play in reducing the increasing burden of disease from acute illness and injury in populations across the socioeconomic spectrum and calls on governments and the World Health Organization to take specific and concrete actions to make this happen. This resolution constitutes recognition by the World Health Assembly of the growing public health role of emergency care systems and is the highest level of international attention ever devoted to emergency care systems worldwide. Emergency care systems for secondary prevention of acute illnesses and injury remain inadequately developed in many low- and middle-income countries, despite evidence that basic strategies for improving emergency care systems can reduce preventable mortality and morbidity and can in many cases also be cost-effective. Emergency care providers and their professional organizations have used their comprehensive expertise to strengthen emergency care systems worldwide through the development of tools for emergency medicine education, systems assessment, quality improvement, and evidence-based clinical practice. World Health Assembly 60.22 represents a unique opportunity for emergency care providers and other advocates for improved emergency care to engage with national and local health care officials and policymakers, as well as with the World Health Organization, and leverage the expertise within the international emergency medicine community to make substantial improvements in emergency care delivery in places where it is most needed.

  17. Identifying the turning point: using the transtheoretical model of change to map intimate partner violence disclosure in emergency department settings.

    PubMed

    Catallo, Cristina; Jack, Susan M; Ciliska, Donna; Macmillan, Harriet L

    2012-01-01

    Background. The transtheoretical model of change (TTM) was used as a framework to examine the steps that women took to disclose intimate partner violence (IPV) in urban emergency departments. Methods. Mapping methods portrayed the evolving nature of decisions that facilitated or inhibited disclosure. This paper is a secondary analysis of qualitative data from a mixed methods study that explored abused women's decision making process about IPV disclosure. Findings. Change maps were created for 19 participants with movement from the precontemplation to the maintenance stages of the model. Disclosure often occurred after a significant "turning point event" combined with a series of smaller events over a period of time. The significant life event often involved a weighing of options where participants considered the perceived risks against the potential benefits of disclosure. Conclusions. Abused women experienced intrusion from the chaotic nature of the emergency department. IPV disclosure was perceived as a positive experience when participants trusted the health care provider and felt control over their decisions to disclose IPV. Practice Implications. Nurses can use these findings to gauge the readiness of women to disclose IPV in the emergency department setting.

  18. Measuring non-technical skills in medical emergency care: a review of assessment measures

    PubMed Central

    Cooper, Simon; Endacott, Ruth; Cant, Robyn

    2010-01-01

    Aim To review the literature on non-technical skills and assessment methods relevant to emergency care. Background Non-technical skills (NTS) include leadership, teamwork, decision making and situation awareness, all of which have an impact on healthcare outcomes. Significant concerns have been raised about the rates of adverse medical events, many of which are attributed to NTS failures. Methods Ovid, Medline, ProQUEST, PsycINFO and specialty websites were searched for NTS measures using applicable access strategies, inclusion and exclusion criteria. Publications identified were assessed for relevance. Results A range of non-technical skill measures relevant to emergency care was identified: leadership (n = 5), teamwork (n = 7), personality/behavior (n = 3) and situation awareness tools (n = 1). Of these, 9 have been used with emergency care populations/clinicians. All had varying degrees of reliability and validity. In the last decade there has been some development of teamwork measures specific to emergency care with a predominantly global and collective rating of broad skills. Conclusion A variety of non-technical skill measures are available; only a few have been used in the emergency care arena. There is a need for an increase in the focused assessment of teamwork skills for a greater understanding of team performance to enhance patient safety in medical emergency care. PMID:27147832

  19. How community members and health professionals conceptualize medical emergencies: implications for primary care promotion.

    PubMed

    Wilkin, Holley A; Tannebaum, Michael A; Cohen, Elizabeth L; Leslie, Travie; Williams, Nora; Haley, Leon L

    2012-12-01

    Access to continuous care through a primary care provider is associated with improved health outcomes, but many communities rely on emergency departments (EDs) for both emergent and non-emergent health problems. This article describes one portion of a community-based participatory research project and investigates the type of education that might be needed as part of a larger intervention to encourage use of a local primary care clinic. In this article we examine how people who live in a low-income urban community and the healthcare workers who serve them conceptualize 'emergency medical condition'. We conducted forum and focus group discussions with 52 community members and individual interviews with 32 healthcare workers. Our findings indicate that while community members share a common general definition of what constitutes a medical emergency, they also desire better guidelines for how to assess health problems as requiring emergency versus primary care. Pain, uncertainty and anxiety tend to influence their choice to use EDs rather than availability of primary care. Implications for increasing primary care use are discussed.

  20. Use of Humidex to Set Thermal Work Limits for Emergency Workers in Protective Clothing

    DTIC Science & Technology

    2005-05-01

    OF ABSTRACT 8. M05-21 1. AGENCY USE ONLY (Leave blank) 4. TITLE AND SUBTITLE USE OF HUMIDEX TO SET THERMAL WORK LIMITS FOR EMERGENCY WORKERS IN...unlimited 14. SUBJECT TERMS heat index, humidex , thermal modeling. 13. ABSTRACT (Maximum 200 w ords) Humidex (HD) is a temperature-humidity index used to...280-5500 Standard Form 298 (Rev. 2-89)Prescribed by ANSI Std. Z39-18 298-102 USAPPC V1.00 511 USE OF HUMIDEX TO SET THERMAL WORK LIMITS FOR

  1. Paliperidone Palmitate Treatment in Outpatient Care Setting: A Naturalistic Study

    PubMed Central

    Di Lorenzo, Rosaria; Cameli, Michela; Bolondi, Marisa; Landi, Giulia; Moretti, Valentina; Piemonte, Chiara; Pollutri, Gabriella

    2016-01-01

    Objectives To evaluate paliperidone palmitate (PP) effectiveness, safety and adherence to treatment. Methods We collected data of all patients (n = 50) affected by Schizophrenia Disorders, treated with PP for a 3 month minimum period in the outpatient setting of Mental Health Department in Modena, from 01/01/2014 to 31/01/2015. We evaluated reasons and modality for PP implementation, improvement in symptom and functioning scales, adverse effects, discontinuations and relapses. We statistically correlated socio-demographic and clinical variables of our sample with PP therapeutic variables. Results We registered an improvement in all scales, with a superior percentage in PANSS positive subscale. The mean PP dose in some patients was lower than official indications, although our sample was clinically severe. Illness relapses affected 60% and dropout 18% of patients. PP was well tolerated and in just a few cases adverse events required treatment interruption. The risk factors for discontinuation were represented by “lack of therapeutic compliance” (HR = 4.11, p < 0.0001) and “inefficacy” (HR = 1.67, p < 0.0001). Conclusions With limitations of observational design, this research highlights that PP was well tolerated and effective in improving both psychotic symptoms and functioning, but moderately effective in preventing relapse, probably due to clinical severity of our patients associated with extremely cautious and flexible PP prescriptions. PMID:27738372

  2. Emergency department use in a rural Australian setting: are the factors prompting attendance appropriate?

    PubMed

    Callen, Joanne L; Blundell, Leanne; Prgomet, Mirela

    2008-11-01

    Increases in attendance rates at emergency departments (EDs) have prompted concerns regarding inappropriate utilisation. Factors instigating patient ED attendance were examined using a cross sectional survey of 522 patients presenting to the ED of a rural hospital in Australia, during a 1-week period. The results highlighted the importance of the rural hospital ED as an additional and alternate service to existing primary care facilities, particularly outside of business hours. The findings indicated that although patients' perception of an emergency does not necessarily correspond with clinical interpretations, the primary factors prompting attendance, including general practitioner unavailability, referrals and special service needs, suggest that, from a patients' perspective, the majority of presentations to the ED are justified.

  3. Child Care Teachers' Perspectives on Including Children with Challenging Behavior in Child Care Settings

    ERIC Educational Resources Information Center

    Quesenberry, Amanda C.; Hemmeter, Mary Louise; Ostrosky, Michaelene M.; Hamann, Kira

    2014-01-01

    In this study, 9 teachers from 5 child care centers were interviewed to examine their perceptions on including children with challenging behavior in their classrooms. The findings provide a firsthand view into how child care teachers support children's social and emotional development and address challenging behavior. Results confirm previous…

  4. Medicinal Cannabis: History, Pharmacology, And Implications for the Acute Care Setting.

    PubMed

    Bridgeman, Mary Barna; Abazia, Daniel T

    2017-03-01

    The authors review the historical use of medicinal cannabis and discuss the agent's pharmacology and pharmacokinetics, select evidence on medicinal uses, and the implications of evolving regulations on the acute care hospital setting.

  5. [Patients forgoing health care for economic reasons: how to identify this in a primary care setting?].

    PubMed

    Bodenmann, Patrick; Wolff, Hans; Bischoff, Thomas; Herzig, Lilli; Warin, Philippe; Chatelard, Sophia; Burnand, Bernard; Vaucher, Paul; Favrat, Bernard; Panese Francesco; Jackson, Yves L; Vu, Francis; Guessous, Idris

    2014-11-26

    Although the performance of the Swiss health system is high, one out of ten patients in general practitioner's (GP) office declares having foregone care in the previous twelve months for economic reasons. Reasons for foregoing care are several and include a lack of knowledge of existing social aids in getting health insurance, unavailability of GPs and long waiting lists for various types of care. Although long term knowledge of patients or a psychosocial history of deprivation or poverty may help identify individuals at risk of foregoing care, many may remain undetected. We propose then a few instruments to help GPs to identify, in a simple and structured approach, patients at risk of forgoing care for economic reasons; these patients are frequently deprived and sometimes poor.

  6. Marketing health care to minorities: tapping an emerging market.

    PubMed

    Harris, M S

    2000-01-01

    A number of myths have prevented the development of a formal health care marketing strategy for the 100 million-plus racial and ethnic group members in the United States, despite their relatively greater need for health services. This market continues to grow in numbers, resources, and influence as the majority market level off. Marketers must look to minorities for new business, but traditional health care marketers have a long way to go before they are in a position to truly maximize this opportunity.

  7. An Emerging Best Practice Model for Perinatal Depression Care

    PubMed Central

    Sit, Dorothy K. Y.; Flint, Cheryl; Svidergol, Donald; White, Joanne; Wimer, Michelle; Bish, Bettina; Wisner, Katherine L.

    2009-01-01

    Perinatal depression is a significant health problem, especially among inner-city women. The authors explored the feasibility of an innovative model that integrated depression screening and treatment within an agency for maternal-child health. The team conducted depression screening with the Edinburgh Postnatal Depression Scale; they confirmed the primary diagnosis with the PRIME-MD instrument for 29 women with positive screens. Most participants had moderate or severe major depressive disorder. Women contended with multiple treatment barriers. Colocated depression care was highly acceptable and enabled evidence-based care delivery for at-risk mothers. PMID:19880455

  8. Palliative Care Psychiatry: Update on an Emerging Dimension of Psychiatric Practice

    PubMed Central

    Fairman, Nathan

    2013-01-01

    Palliative care psychiatry is an emerging subspecialty field at the intersection of Palliative Medicine and Psychiatry. The discipline brings expertise in understanding the psychosocial dimensions of human experience to the care of dying patients and support of their families. The goals of this review are (1) to briefly define palliative care and summarize the evidence for its benefits, (2) to describe the roles for psychiatry within palliative care, (3) to review recent advances in the research and practice of palliative care psychiatry, and (4) to delineate some steps ahead as this sub-field continues to develop, in terms of research, education, and systems-based practice. PMID:23794027

  9. Guiding Principles for Providing High-Quality Education in Juvenile Justice Secure Care Settings

    ERIC Educational Resources Information Center

    US Department of Education, 2014

    2014-01-01

    Providing high-quality education in juvenile justice secure care settings presents unique challenges for the administrators, teachers, and staff who are responsible for the education, rehabilitation, and welfare of youths committed to their care. The United States departments of Education (ED) and Justice (DOJ) recognize that while these…

  10. HIV/AIDS in Early Childhood Day-Care Settings. Final Report. Phase I.

    ERIC Educational Resources Information Center

    McKinney, David D., Ed.; And Others

    A feasibility study regarding the training and information needs of preschool and day care administrators, staff, and teachers regarding HIV/AIDS was conducted. This study also examined the issues associated with the presence of HIV-positive children in preschool and day care settings and the need for designing a program to help preschools and day…

  11. Palliative and Curative Care Nurses' Attitudes Toward Dying and Death in the Hospital Setting.

    ERIC Educational Resources Information Center

    Thompson, Edward H.

    1986-01-01

    Examined sociodemographic background, nursing unit, amount of experience caring for dying patients, death anxiety, and attitudes toward working with dying patients among 56 nurses in palliative, surgical, and pediatric services. Work setting was found to be a more significant force in shaping attitudes toward caring for the dying than was…

  12. MICRO-CARES: An Information Management System for Psychosocial Services in Hospital Settings

    PubMed Central

    Hammer, Jeffrey S.; Lyons, John S.; Strain, James J.

    1984-01-01

    This paper presents a flexible software system that is adaptable to a variety of information management uses across different psychosocial service departments in hospital settings. Initially developed for Consultation Liaison Psychiatry, the present system has now been adapted for a Social Work department and is being adapted to Hospice, Home Care, Patient Representative, and Pastoral Care departmental uses.

  13. Contextualizing an Expanded Definition of Health Literacy among Adolescents in the Health Care Setting

    ERIC Educational Resources Information Center

    Massey, Philip M.; Prelip, Michael; Calimlim, Brian M.; Quiter, Elaine S.; Glik, Deborah C.

    2012-01-01

    The current emphasis on preventive health care and wellness services suggests that measures of skills and competencies needed to effectively navigate the health care system need to be better defined. We take an expanded perspective of health literacy and define it as a set of skills used to organize and apply health knowledge, attitudes and…

  14. The Influence of Culture in Infant-Toddler Child Care Settings

    ERIC Educational Resources Information Center

    Test, Joan

    2015-01-01

    It is not only in families that young children are influenced to become members of their culture. Around the world and within individual countries, culture influences how care is provided to infants and toddlers in child care settings. In turn, infants and toddlers begin to learn how to act and think as members of their culture. From ways that…

  15. An Innovative Model of Integrated Behavioral Health: School Psychologists in Pediatric Primary Care Settings

    ERIC Educational Resources Information Center

    Adams, Carolyn D.; Hinojosa, Sara; Armstrong, Kathleen; Takagishi, Jennifer; Dabrow, Sharon

    2016-01-01

    This article discusses an innovative example of integrated care in which doctoral level school psychology interns and residents worked alongside pediatric residents and pediatricians in the primary care settings to jointly provide services to patients. School psychologists specializing in pediatric health are uniquely trained to recognize and…

  16. Clinical Instructor Characteristics, Behaviors and Skills in Allied Health Care Settings: A Literature Review

    ERIC Educational Resources Information Center

    Levy, Linda S.; Sexton, Patrick; Willeford, K. Sean; Barnum, Mary G.; Guyer, M. Susan; Gardner, Greg; Fincher, A. Louise

    2009-01-01

    The purpose of this literature review is to compare both clinical instructor and student perceptions of helpful and hindering clinical instructor characteristics, behaviors and skills in athletic training and allied health care settings. Clinical education in athletic training is similar to that of other allied health care professions. Clinical…

  17. Outpatient Care of Young People after Emergency Treatment of Deliberate Self-Harm

    ERIC Educational Resources Information Center

    Bridge, Jeffrey A.; Marcus, Steven C.; Olfson, Mark

    2012-01-01

    Objective: Little is known about the mental health care received by young people after an episode of deliberate self-harm. This study examined predictors of emergency department (ED) discharge, mental health assessments in the ED, and follow-up outpatient mental health care for Medicaid-covered youth with deliberate self-harm. Method: A…

  18. 77 FR 50551 - Agency Information Collection: Emergency Submission for OMB Review (PACT VISN20 Health Care...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-21

    ... AFFAIRS Agency Information Collection: Emergency Submission for OMB Review (PACT VISN20 Health Care... No. 2900-New (VA Form 10-0535). SUPPLEMENTARY INFORMATION: Title: PACT VISN20 Health Care Experiences...); Comment Request AGENCY: Veterans Health Administration, Department of Veterans Affairs. ACTION:...

  19. [The mobile emergency and intensive care service, a place of transition for families].

    PubMed

    Mattioni, Violaine; Micaëlli, Delphine

    2016-01-01

    When the mobile emergency and intensive care service (Smur) intervenes with a child, the parents are in a completely unknown and anxiety-generating situation. The care team helps families to find their place, depending on the medical context and health status of the child. The intervention of the Smur therefore represents a place of transition for the parents.

  20. The Con Edison Emergency Child Care Plan for Management Employees: Summary Plan Description.

    ERIC Educational Resources Information Center

    Consolidated Edison Co., Brooklyn, NY.

    This summary plan description offers guidelines for participation in a pilot program that provides short-term emergency care for children of Con Edison managers who are under 13 years old. The plan offers professional, in-home child care that can be used when usual arrangements have collapsed. The summary plan description addresses the following…

  1. Health Care Use and Spending for Medicaid Enrollees in Federally Qualified Health Centers Versus Other Primary Care Settings

    PubMed Central

    Nocon, Robert S.; Lee, Sang Mee; Sharma, Ravi; Ngo-Metzger, Quyen; Mukamel, Dana B.; Gao, Yue; White, Laura M.; Shi, Leiyu; Chin, Marshall H.; Laiteerapong, Neda; Huang, Elbert S.

    2016-01-01

    Objectives To compare health care use and spending of Medicaid enrollees seen at federally qualified health centers versus non–health center settings in a context of significant growth. Methods Using fee-for-service Medicaid claims from 13 states in 2009, we compared patients receiving the majority of their primary care in federally qualified health centers with propensity score–matched comparison groups receiving primary care in other settings. Results We found that health center patients had lower use and spending than did non–health center patients across all services, with 22% fewer visits and 33% lower spending on specialty care and 25% fewer admissions and 27% lower spending on inpatient care. Total spending was 24% lower for health center patients. Conclusions Our analysis of 2009 Medicaid claims, which includes the largest sample of states and more recent data than do previous multistate claims studies, demonstrates that the health center program has provided a cost-efficient setting for primary care for Medicaid enrollees. PMID:27631748

  2. Modeling bacterial colonization and infection routes in health care settings: analytic and numerical approaches.

    PubMed

    Simon, Carl P; Percha, Bethany; Riolo, Rick; Foxman, Betsy

    2013-10-07

    Health-care associated infections are a major problem in our society, accounting for tens of thousands of patient deaths and millions of dollars in wasted health care expenditures each year. Many of these infections are caused by bacteria that are transmitted from patient to patient either through direct contact or via the hands or clothing of health care workers. Because of the complexity of bacterial transmission routes in health care settings, computational approaches are essential, though often analytically intractable. Here we describe the construction and detailed analysis of a model for bacterial transmission in health care settings. Our model includes both colonization and disease stages for patients and health care workers, as well as an isolation ward and both patient-patient and patient-HCW-patient transmission pathways. We explicitly derive the basic reproductive ratio for this complex model, a nine-term expression that contains all nine ways with which a new colonization can occur. Using key parameters found in the medical literature, we use our model to gain insight into the relative importance of various bacterial transmission pathways within health care facilities, and to identify which forms of interventions are likely to prove most effective in hospitals and long-term care settings. We show that analytical and numerical approaches can complement each other as we seek to untangle the complex web of interactions that occur within a health care facility.

  3. [Palliative care at home, transferring information to emergency medical teams].

    PubMed

    Ribeaucoup, Luc; Roche, Blandine

    2015-11-01

    Many people wish to die at home. However, the end-of-life period can be marked by the occurrence of numerous symptoms causing situations of crisis. Emergency medical teams are therefore frequently called upon. In order to be able to make the right decisions in a short space of time, they must have quick access to all the relevant information.

  4. Injuries in Youth Hockey. On-Ice Emergency Care.

    ERIC Educational Resources Information Center

    Blanchard, Bradford M.; Castaldi, Cosmo R.

    1991-01-01

    Reviews the nature and frequency of injuries in youth hockey (which range from musculoskeletal injuries to life-threatening emergencies). Overall injury rates have decreased, but there is an increase in head, neck, and spine injuries. Those injuries that are serious demand prompt, skillful attention. A comprehensive format for on-ice management is…

  5. Growth Hormone Utilization Review in a Pediatric Primary Care Setting

    PubMed Central

    Sayarifard, Fatemeh; Imcheh, Fereshteh Bakhshi; Badri, Shirinsadat; Faghihi, Toktam; Qorbani, Mostafa; Radfar, Mania

    2017-01-01

    : Diagnostic tests and monitoring of height, weight, IGF-1 level and thyroid function was properly performed in this setting. However, a number of patients with ISS and Turner's syndrome were under-dosed. PMID:28331865

  6. Methylisothiazolinone: an emergent allergen in common pediatric skin care products.

    PubMed

    Schlichte, Megan J; Katta, Rajani

    2014-01-01

    Recalcitrant dermatitis, such as that of the hands, face, or genitals, may be due to allergic contact dermatitis (ACD) from ingredients in seemingly innocuous personal care products. Rising rates of allergy have been noted due to the preservative methylisothiazolinone (MI). This preservative is commonly found in skin and hair care products, especially wipes. This study evaluated the use of MI in products specifically marketed for babies and children and examined the associated marketing terms of such products. Ingredients of skin care products specifically marketed for babies and children were surveyed at two major retailers. Of 152 products surveyed, 30 products contained MI. Categories of products surveyed included facial or body wipes, antibacterial hand wipes, hair products, soaps, bubble baths, moisturizers, and sunscreens. Facial or body wipes and hair products were the categories with the greatest number of MI-containing products. MI-containing products were manufactured by a number of popular brands. Of note, products marketed as "gentle," "sensitive," "organic," or "hypoallergenic" often contained MI, thus emphasizing the importance of consumer scrutiny of product choices. These findings reinforce the importance of educating parents and providing consumer decision-making advice regarding common skin care products, in order to help prevent ACD in children.

  7. Methylisothiazolinone: An Emergent Allergen in Common Pediatric Skin Care Products

    PubMed Central

    Schlichte, Megan J.

    2014-01-01

    Recalcitrant dermatitis, such as that of the hands, face, or genitals, may be due to allergic contact dermatitis (ACD) from ingredients in seemingly innocuous personal care products. Rising rates of allergy have been noted due to the preservative methylisothiazolinone (MI). This preservative is commonly found in skin and hair care products, especially wipes. This study evaluated the use of MI in products specifically marketed for babies and children and examined the associated marketing terms of such products. Ingredients of skin care products specifically marketed for babies and children were surveyed at two major retailers. Of 152 products surveyed, 30 products contained MI. Categories of products surveyed included facial or body wipes, antibacterial hand wipes, hair products, soaps, bubble baths, moisturizers, and sunscreens. Facial or body wipes and hair products were the categories with the greatest number of MI-containing products. MI-containing products were manufactured by a number of popular brands. Of note, products marketed as “gentle,” “sensitive,” “organic,” or “hypoallergenic” often contained MI, thus emphasizing the importance of consumer scrutiny of product choices. These findings reinforce the importance of educating parents and providing consumer decision-making advice regarding common skin care products, in order to help prevent ACD in children. PMID:25342949

  8. Full-term newborns with normal birth weight requiring special care in a resource-constrained setting

    PubMed Central

    Olusanya, Bolajoko O.

    2013-01-01

    Introduction The level of clinical care and facilities to support the often more viable full-term newborns with normal birth weight compared with preterm/low birth weight newborns that require special care at birth are likely to be attainable in many resource-poor settings. However, the nature of the required care is not evident in current literature. This study therefore set out to determine maternal and perinatal profile of surviving full-term newborns with normal birth weight in a poorly-resourced setting. Methods A retrospective cohort study of newborns with gestational age ≥37 weeks and birth weight ≥2500g recruited in an inner-city maternity hospital in Lagos, Nigeria. Primary factors/outcomes were determined by multivariate logistic regression analyses and population attributable risk (PAR). Results Of the 2687 full-term newborns with normal birth weight studied, 242 (9.0%) were admitted into special care baby unit (SCBU) representing 53.6% of all SCBU admissions. Fetal distress, low 5-minute Apgar scores, neonatal sepsis and hyperbilirubinemia as well as maternal factors such as primiparity, type of employment, lack of antenatal care and emergency cesarean delivery were predictive of SCBU admission. The leading contributors to SCBU admission were neonatal sepsis (PAR=96.8%), and hyperbilirubinemia (PAR=58.7%). Conclusion A significant proportion of newborns requiring special care are full-term with normal birth weight and are associated with modifiable risk factors that can be effectively addressed at appropriately equipped secondary-level hospitals. Prenatal maternal education on avoidable risk factors is warranted. PMID:24062865

  9. Effectively using communication to enhance the provision of pediatric palliative care in an acute care setting.

    PubMed

    Hubble, Rosemary; Trowbridge, Kelly; Hubbard, Claudia; Ahsens, Leslie; Ward-Smith, Peggy

    2008-08-01

    The capability of effectively communicating is crucial when providing palliative care, especially when the patient is a child. Communication among healthcare professionals with the child and family members must be clear, concise, and consistent. Use of a communication tool provides documentation for conversations, treatment plans, and specific desires related to care. This paper describes communication theory, portrays the use of this theory to develop a communication tool, and illustrates the use of this tool by multidisciplinary members of a healthcare team to provide pediatric palliative care.

  10. The sound of spiritual care: music interventions in a palliative care setting.

    PubMed

    Tees, Bob; Budd, Jennifer

    2011-01-01

    The article describes how music has been integrated into spiritual and supportive care for palliative care patients at Brantford General Hospital (Ontario). Numerous case examples illustrate how a song or piece of music can play a vital role in the spiritual dimension of end of life care. The article expands the concept of the "living human document" by positing that a life story has an accompanying soundtrack: a musical memory and sensorial attunement that can be energized when music is offered at the bedside. The writers suggest that music provides an alternate spiritual language for patients whether or not they have a religious affiliation.

  11. The Role of Emergency Medical Services in Geriatrics: Bridging the Gap between Primary and Acute Care.

    PubMed

    Goldstein, Judah; McVey, Jennifer; Ackroyd-Stolarz, Stacy

    2016-01-01

    Caring for older adults is a major function of emergency medical services (EMS). Traditional EMS systems were designed to treat single acute conditions; this approach contrasts with best practices for the care of frail older adults. Care might be improved by the early identification of those who are frail and at highest risk for adverse outcomes. Paramedics are well positioned to play an important role via a more thorough evaluation of frailty (or vulnerability). These findings may inform both pre-hospital and subsequent emergency department (ED) based decisions. Innovative programs involving EMS, the ED, and primary care could reduce the workload on EDs while improving patient access to care, and ultimately patient outcomes. Some frail older adults will benefit from the resources and specialized knowledge provided by the ED, while others may be better helped in alternative ways, usually in coordination with primary care. Discerning between these groups is a challenge worthy of further inquiry. In either case, care should be timely, with a focus on identifying emergent or acute care needs, frailty evaluation, mobility assessments, identifying appropriate goals for treatment, promoting functional independence, and striving to have the patient return to their usual place of residence if this can be done safely. Paramedics are uniquely positioned to play a larger role in the care of our aging population. Improving paramedic education as it pertains to geriatrics is a critical next step.

  12. [Announce a death rapes to the close relations in emergency situation and taken care].

    PubMed

    Romano, H; Aurore, A; Chollet-Xemard, C; Marty, J

    2012-05-01

    The death is a part of the everyday life of the emergency medical teams, but to announce the death and to take care in immediate of the saddened close relations rest a testing experience for which the professionals of the emergency care are not still prepared. Our comment aims from the experience of care of families, saddened in immediate and also recorded within the framework of a specialized consultation, to pass on what the saddened persons can feel during the intervention of the help and the confrontation in the death of their close. Our objective being to bring to the professionals of the tracks of reflection to limit the risks of survictimisation.

  13. Therapeutic communication part 2: strategies that can enhance the quality of the emergency care consultation.

    PubMed

    O'gara, Paula E; Fairhurst, Wendy

    2004-10-01

    Therapeutic, patient-centred communication as well as being desirable in its own right may also have the potential to improve satisfaction, health outcomes and change health behaviours in Emergency Care. This paper, the second of two, identifies from a substantive literature review five specific communication strategies that, when employed in an Emergency Care consultation, could significantly enhance its therapeutic potential. The five strategies: questioning, listening and noticing, communicating empathy, establishing and incorporating the patient's cares and concerns and concluding the consultation have been derived from the purposeful selection and analysis of communication research between 1990 and 2002.

  14. Linking uninsured patients treated in the emergency department to primary care shows some promise in Maryland.

    PubMed

    Kim, Theresa Y; Mortensen, Karoline; Eldridge, Barbara

    2015-05-01

    Use of the emergency department (ED) has increased significantly over the past twenty years, especially among people who lack access to regular care, such as from a primary care provider. Not only are many ED visits avoidable, but receiving care through the ED also may disrupt continuity of care and result in increased overall health care costs. This article analyzes one of the twenty-nine local projects funded by the Centers for Medicare and Medicaid Services: the Emergency Department-Primary Care Connect initiative of the Primary Care Coalition of Montgomery County, Maryland. The initiative linked low-income or uninsured patients with local safety-net primary care providers. In the period 2009-11, five participating hospital EDs referred 10,761 low-income uninsured ED patients to four local primary care clinics. The intervention did not significantly reduce overall subsequent ED visits, but there was a significant reduction in subsequent ED visits among the subpopulation with chronic physical or behavioral conditions if they had more than two visits to the same primary care clinic. Our findings suggest that expansion of safety-net clinics, combined with strategies to link high-need patients in the ED with these primary care providers, can reduce subsequent ED use.

  15. Manchester Triage System: main flowcharts, discriminators and outcomes of a pediatric emergency care 1

    PubMed Central

    Amthauer, Camila; da Cunha, Maria Luzia Chollopetz

    2016-01-01

    ABSTRACT Objetive: to characterize the care services performed through risk rating by the Manchester Triage System, identifying demographics (age, gender), main flowcharts, discriminators and outcomes in pediatric emergency Method: cross-sectional quantitative study. Data on risk classification were obtained through a search of computerized registration data from medical records of patients treated in the pediatric emergency within one year. Descriptive statistics with absolute and relative frequencies was used for the analysis. Results: 10,921 visits were conducted in the pediatric emergency, mostly male (54.4%), aged between 29 days and two years (44.5%). There was a prevalence of the urgent risk category (43.6%). The main flowchart used in the care was worried parents (22.4%) and the most prevalent discriminator was recent event (15.3%). The hospitalization outcome occurred in 10.4% of care performed in the pediatric emergency, however 61.8% of care needed to stay under observation and / or being under the health team care in the pediatric emergency. Conclusion: worried parents was the main flowchart used and recent events the most prevalent discriminator, comprising the hospitalization outcomes and permanency in observation in the pediatric emergency before discharge from the hospital. PMID:27579934

  16. Mobile prehospital emergency care: an analysis of implementation in the State of Rio de Janeiro, Brazil.

    PubMed

    O'Dwyer, Gisele; Machado, Cristiani Vieira; Alves, Renan Paes; Salvador, Fernanda Gonçalves

    2016-06-01

    Mobile prehospital care is a key component of emergency care. The aim of this study was to analyze the implementation of the State of Rio de Janeiro's Mobile Emergency Medical Service (SAMU, acronym in Portuguese). The methodology employed included document analysis, visits to six SAMU emergency call centers, and semistructured interviews conducted with 12 local and state emergency care coordinators. The study's conceptual framework was based on Giddens' theory of structuration. Intergovernmental conflicts were observed between the state and municipal governments, and between municipal governments. Despite the shortage of hospital beds, the SAMUs in periphery regions were better integrated with the emergency care network than the metropolitan SAMUs. The steering committees were not very active and weaknesses were observed relating to the limited role played by the state government in funding, management, and monitoring. It was concluded that the SAMU implementation process in the state was marked by political tensions and management and coordination weaknesses. As a result, serious drawbacks remain in the coordination of the SAMU with the other health services and the regionalization of emergency care in the state.

  17. Care of women and marginalized populations in the critical care setting.

    PubMed

    Koci, Anne

    2010-01-01

    Cardiovascular disease (CVD), the leading cause of death, disability, and lost productivity in adults, drains our society physically and economically. Once considered a male domain, hospital mortality attributed to CVD has become more prevalent among women. As a result of this trend, critical care nurses can expect to care for more women with CVD. The psychobiological model of CVD suggests that psychological factors, such as anxiety and depression, contribute to the development and progression of CVD. Anxiety and depression occur more often in women than in men and possibly could be explained by the fact that women report experiencing physical and sexual abuse at a much higher rate than do men. Women with a history of physical and sexual abuse report more anxiety and depression than do women without such a history. A possible means by which abuse may begin and continue within the lives of women is marginality. Marginality serves as a perspective for viewing women's health in terms of physical and psychological health outcomes. By understanding marginality and its impact on health outcomes, critical care nurses may recognize patients at risk for adverse CVD health outcomes while in their care. These patients present unique health care challenges in critical care.

  18. Rapid emergence of day-care anaesthesia: A review

    PubMed Central

    Gangadhar, SB; Gopal, TM; Sathyabhama; Paramesh, KS

    2012-01-01

    The number of day-care surgeries is increasing every day. The boundaries of day-care surgeries are being redefined on a continual basis. Multi-dimensional benefits to the patient, hospital and national economy are the driving forces behind the changing scenario on the horizon of day surgery. The literature search included Google, medlinx, pubmed and medline. We have attempted to look at the controversies in patient selection with comorbidities, pre-operative assessment and an acceptable ASA grade of patients. An attempt is also made to look at suitable surgical procedures, a pathway of introducing procedures, which are still complex and specialist procedures in challenging environment. The techniques of general anaesthesia, central neuraxial blocks, regional nerve blocks with indwelling catheters and monitoring techniques are deliberated upon. Finally the most important post-operative issues of discharge criteria, including recovery after spinal anaesthetic, oral fluid intake, voiding and travel after day surgery, are considered. PMID:23087454

  19. Telemedical support of prehospital emergency care in mass casualty incidents.

    PubMed

    Plischke, M; Wolf, K H; Lison, T; Pretschner, D P

    1999-09-09

    In the German emergency medical service system (EMSS) medical treatment can be improved in most of mass casualty incidents (MCI). Currently, the incident commander who is responsible for classification of the victims (depending on their urgency and condition, the so called triage) and ordered transportation uses paper-based documentation. Triage tags are used to identify and classify patients and gather treatment information. This can cause problems in medical treatment and in transportation of injured victims. Object-oriented modelling, simulation, and visualisation of processes can show deficits in treatment and data processing and thereby help to optimise medical workflow and logistics. If documentation by paramedics and emergency physicians is done electronically, all patient records could be send to a telemedical centre for central data administration. A telemedical supported triage tag helps identifying victims and managing detailed identification protocols. The paper-based documentation in emergency would become obsolete, if hospitals can query all protocols, diagnoses, and findings from the telemedical centre. Safety and security aspects can be guaranteed. The complete medical treatment workflow can be supported by telemedicine. Therefore, in case of MCI, telemedicine can optimise medical treatment and exonerate the paramedics from unnecessary documentation.

  20. The Development of Valid Subtypes for Depression in Primary Care Settings

    PubMed Central

    Karasz, Alison

    2009-01-01

    A persistent theme in the debate on the classification of depressive disorders is the distinction between biological and environmental depressions. Despite decades of research, there remains little consensus on how to distinguish between depressive subtypes. This preliminary study describes a method that could be useful, if implemented on a larger scale, in the development of valid subtypes of depression in primary care settings, using explanatory models of depressive illness. Seventeen depressed Hispanic patients at an inner city general practice participated in explanatory model interviews. Participants generated illness narratives, which included details about symptoms, cause, course, impact, health seeking, and anticipated outcome. Two distinct subtypes emerged from the analysis. The internal model subtype was characterized by internal attributions, specifically the notion of an “injured self.” The external model subtype conceptualized depression as a reaction to life situations. Each subtype was associated with a distinct constellation of clinical features and health seeking experiences. Future directions for research using explanatory models to establish depressive subtypes are explored. PMID:18414123

  1. Red Cell Physiology and Signaling Relevant to the Critical Care Setting

    PubMed Central

    Said, Ahmed; Rogers, Stephen; Doctor, Allan

    2015-01-01

    Purpose of Review Oxygen (O2) delivery, the maintenance of which is fundamental to supporting those with critical illness, is a function of blood O2 content and flow. Here, we review red blood cell (RBC) physiology relevant to disordered O2 delivery in the critically ill. Recent Findings Flow (rather then content) is the focus of O2 delivery regulation: O2 content is relatively fixed, whereas flow fluctuates by several orders of magnitude. Thus, blood flow volume and distribution vary to maintain coupling between O2 delivery and demand. The trapping, processing and delivery of nitric oxide (NO) by RBCs has emerged as a conserved mechanism through which regional blood flow is linked to biochemical cues of perfusion sufficiency. We will review conventional RBC physiology influencing O2 delivery (O2 affinity & rheology) and introduce a new paradigm for O2 delivery homeostasis based on coordinated gas transport and vascular signaling by RBCs. Summary By coordinating vascular signaling in a fashion that links O2 and NO flux, RBCs couple vessel caliber (and thus blood flow) to O2 need in tissue. Malfunction of this signaling system is implicated in a wide array of pathophysiologies and may be explanatory for the dysoxia frequently encountered in the critical care setting. PMID:25888155

  2. A systematic review of contemporary models of shared HIV care and HIV in primary care in high-income settings.

    PubMed

    Mapp, Fiona; Hutchinson, Jane; Estcourt, Claudia

    2015-12-01

    HIV shared care is uncommon in the UK although shared care could be a beneficial model of care. We review the literature on HIV shared care to determine current practice and clinical, economic and patient satisfaction outcomes. We searched MEDLINE, EMBASE, NICE Evidence, Cochrane collaboration, Google and websites of the British HIV Association, Aidsmap, Public Health England, World Health Organization and Terrence Higgins Trust using relevant search terms in August 2014. Studies published after 2000, from healthcare settings comparable to the UK that described links between primary care and specialised HIV services were included and compared using principles of the Critical Appraisal Skills Programme and Authority, Accuracy, Coverage, Objectivity, Date, Significance frameworks. Three of the nine included models reported clinical or patient satisfaction outcomes but data collection and analyses were inadequate. None reported economic outcomes although some provided financial costings. Facilitators of shared care included robust clinical protocols, training and timely communication. Few published examples of HIV shared care exist and quality of evidence is poor. There is no consistent association with improved clinical outcomes, cost effectiveness or acceptability. Models are context specific, driven by local need, although some generalisable features could inform novel service delivery. Further evaluative research is needed to determine optimal components of shared HIV care.

  3. The Current Crisis in Emergency Care and the Impact on Disaster Preparedness

    PubMed Central

    Cherry, Robert A; Trainer, Marcia

    2008-01-01

    Background The Homeland Security Act (HSA) of 2002 provided for the designation of a critical infrastructure protection program. This ultimately led to the designation of emergency services as a targeted critical infrastructure. In the context of an evolving crisis in hospital-based emergency care, the extent to which federal funding has addressed disaster preparedness will be examined. Discussion After 9/11, federal plans, procedures and benchmarks were mandated to assure a unified, comprehensive disaster response, ranging from local to federal activation of resources. Nevertheless, insufficient federal funding has contributed to a long-standing counter-trend which has eroded emergency medical care. The causes are complex and multifactorial, but they have converged to present a severely overburdened system that regularly exceeds emergency capacity and capabilities. This constant acute overcrowding, felt in communities all across the country, indicates a nation at risk. Federal funding has not sufficiently prioritized the improvements necessary for an emergency care infrastructure that is critical for an all hazards response to disaster and terrorist emergencies. Summary Currently, the nation is unable to meet presidential preparedness mandates for emergency and disaster care. Federal funding strategies must therefore be re-prioritized and targeted in a way that reasonably and consistently follows need. PMID:18452615

  4. Peer pressure and public reporting within healthcare setting: improving accountability and health care quality in hospitals.

    PubMed

    Specchia, Maria Lucia; Veneziano, Maria Assunta; Cadeddu, Chiara; Ferriero, Anna Maria; Capizzi, Silvio; Ricciardi, Walter

    2012-01-01

    In the last few years, the need of public reporting of health outcomes has acquired a great importance. The public release of performance results could be a tool for improving health care quality and many attempts have been made in order to introduce public reporting programs within the health care context at different levels. It would be necessary to promote the introduction of a standardized set of outcome and performance measures in order to improve quality of health care services and to make health care providers aware of the importance of transparency and accountability.

  5. Marketing the dental hygienist as a manager in oral health care settings.

    PubMed

    Thomson, E M

    1989-09-01

    In 1985, the ADHA, in response to the changing health care environment, identified six roles for the future of dental hygiene. The administrator/manager role, one of the six, is an expansion of dental hygiene skills to facilitate the provision of quality oral health care. Oral health care settings require personnel trained in management to accomplish practice-related goals and objectives. Dental hygiene is preparing individuals to assume managerial roles to fill this health care need. This paper discusses the skills and knowledge level required to assume managerial roles and strategies for marketing the dental hygienist as a manager.

  6. Professional Competencies of Cuban Specialists in Intensive Care and Emergency Medicine.

    PubMed

    Véliz-Martínez, Pedro L; Jorna-Calixto, Ana R; Oramas-González, René

    2016-10-01

    INTRODUCTION The quality of medical training and practice reflects the competency level of the professionals involved. The intensive care and emergency medicine specialty in Cuba has not defined its competencies. OBJECTIVE Identify the competencies required for specialty practice in intensive care and emergency medicine. METHODS The study was conducted from January 2014 to December 2015, using qualitative techniques; 48 professionals participated. We undertook functional occupational analysis, based on functions defined in a previous study. Three expert groups were utilized: the first used various group techniques; the second, the Delphi method; and the third, the Delphi method and a Likert questionnaire. RESULTS A total of 73 specific competencies were defined, grouped in 11 units: 44 in the patient care function, 16 in management, 7 in teaching and 6 in research. A competency map is provided. CONCLUSIONS The intensive care and emergency medicine specialty competencies identified will help improve professional standards, ensure health workforce quality, improve patient care and academic performance, and enable objective evaluation of specialists' competence and performance. KEYWORDS Clinical competency, competency-based education, professional education, intensive care, emergency medicine, urgent care, continuing medical education, curriculum, medical residency, Cuba.

  7. Challenges in managing elderly people with diabetes in primary care settings in Norway

    PubMed Central

    2013-01-01

    Abstract Objective To explore the experiences and clinical challenges that nurses and nursing assistants face when providing high-quality diabetes-specific management and care for elderly people with diabetes in primary care settings. Design Focus-group interviews. Subjects and setting Sixteen health care professionals: 12 registered nurses and four nursing assistants from nursing homes (10), district nursing service (5), and a service unit (1) were recruited by municipal managers who had local knowledge and knew the workforce. All the participants were women aged 32–59 years with clinical experience ranging from 1.5 to 38 years. Results Content analysis revealed a discrepancy between the level of expertise which the participants described as important to delivering high-quality care and their capacity to deliver such care. The discrepancy was due to lack of availability and access to current information, limited ongoing support, lack of cohesion among health care professionals, and limited confidence and autonomy. Challenges to delivering high-quality care included complex, difficult patient situations and lack of confidence to make decisions founded on evidence-based guidelines. Conclusion Participants lacked confidence and autonomy to manage elderly people with diabetes in municipal care settings. Lack of information, support, and professional cohesion made the role challenging. PMID:24205973

  8. Pathways of care-seeking during fatal infant illnesses in under-resourced South African settings

    PubMed Central

    Sharkey, Alyssa B; Chopra, Mickey; Jackson, Debra; Winch, Peter J; Minkovitz, Cynthia S

    2011-01-01

    Summary The purpose of this study was to examine care-seeking during fatal infant illnesses in under-resourced South African settings to inform potential strategies for reducing infant mortality. We interviewed 22 caregivers of deceased infants in a rural community and 28 in an urban township. We also interviewed seven local leaders and 12 health providers to ascertain opinions about factors contributing to infant death. Despite the availability of free public health services in these settings, many caregivers utilised multiple sources of care including allopathic, indigenous and home treatments. Urban caregivers reported up to eight points of care while rural caregivers reported up to four points of care. The specific pathways taken and combinations of care varied, but many caregivers used other types of care shortly after presenting at public services, indicating dissatisfaction with the care they received. Many infants died despite caregivers’ considerable efforts, pointing to critical deficiencies in the system of care serving these families. Initiatives that aim to improve assessment, management and referral practices by both allopathic and traditional providers (for example, through training and improved collaboration), and caregiver recognition of infant danger signs may reduce the high rate of infant death in these settings. PMID:22136954

  9. Rotavirus Prevalence in the Primary Care Setting in Nicaragua after Universal Infant Rotavirus Immunization

    PubMed Central

    Becker-Dreps, Sylvia; Paniagua, Margarita; Zambrana, Luis Enrique; Bucardo, Filemon; Hudgens, Michael G.; Weber, David J.; Morgan, Douglas R.; Espinoza, Félix

    2011-01-01

    Nicaragua was the first developing nation to implement universal infant rotavirus immunization with the pentavalent rotavirus vaccine (RV5). Initial studies of vaccine effectiveness in Nicaragua and other developing nations have focused on the prevention of hospitalizations and severe rotavirus diarrhea. However, rotavirus diarrhea is more commonly treated in the primary care setting, with only 1–3% of rotavirus cases receiving hospital care. We measured the prevalence of rotavirus infection in primary care clinics in León, Nicaragua, after introduction of the immunization program. In the post-vaccine period, 3.5% (95% confidence interval = 1.9–5.8) of children seeking care for diarrhea tested positive for rotavirus. A high diversity of rotavirus genotypes was encountered among the few positive samples. In conclusion, rotavirus was an uncommon cause of childhood diarrhea in this primary care setting after implementation of a rotavirus immunization program. PMID:22049057

  10. Re-thinking HIV-Related Stigma in Health Care Settings: A Qualitative Study.

    PubMed

    Gagnon, Marilou

    2015-01-01

    People living with HIV (PLWH) continue to endure stigma and discrimination in the context of health care. This paper presents the findings of a qualitative study designed to (a) describe stigmatizing and discriminatory practices in health care settings, and (b) explore both symbolic and structural stigma from the perspectives of PLWH. For the purpose of this qualitative study, 21 semi-structured in-depth interviews were conducted in the province of Quebec, Canada. The data were analyzed following the principles of thematic analysis. During analysis, three themes were identified, and relations between these themes were delineated to reflect the experiences of participants. The findings suggest that HIV-related stigma in health care settings is episodic in nature. The findings also suggest that HIV-related stigma is experienced through interactions with health care providers (symbolic stigma) and, finally, that it is applied systematically to manage risk in the context of health care (structural stigma).

  11. Settings of Care within Hospice: New Options and Questions about Dying “At Home”

    PubMed Central

    Lysaght, Susan; Ersek, Mary

    2012-01-01

    Although place of death has been routinely studied in end-of-life (EOL) care, more analysis on place of death within hospice is needed because of the recent, dramatic rise in the number of hospice patients dying in inpatient settings. Using a case study to illustrate the complexity of determinants of place of death within hospice, this article highlights important known factors and elucidate gaps for further research. Individual and system level factors, sociocultural meanings, caregiving and preferences are shown to have important implications. Additionally, the unique components of home hospice, inpatient hospice and transitions between these settings may have a fundamental role in the future of quality EOL care. Further research on determinants of hospice settings of care is essential to the care of older adults at the end of life. PMID:23853526

  12. Collaboration, credibility, compassion, and coordination: professional nurse communication skill sets in health care team interactions.

    PubMed

    Apker, Julie; Propp, Kathleen M; Zabava Ford, Wendy S; Hofmeister, Nancee

    2006-01-01

    This study explored how nurses communicate professionalism in interactions with members of their health care teams. Extant research show that effective team communication is a vital aspect of a positive nursing practice environment, a setting that has been linked to enhanced patient outcomes. Although communication principles are emphasized in nursing education as an important component of professional nursing practice, actual nurse interaction skills in team-based health care delivery remain understudied. Qualitative analysis of interview transcripts with 50 participants at a large tertiary hospital revealed four communicative skill sets exemplified by nursing professionals: collaboration, credibility, compassion, and coordination. Study findings highlight specific communicative behaviors associated with each skill set that exemplify nurse professionalism to members of health care teams. Theoretical and pragmatic conclusions are drawn regarding the communicative responsibilities of professional nurses in health care teams. Specific interaction techniques that nurses could use in nurse-team communication are then offered for use in baccalaureate curriculum and organizational in-service education.

  13. Despite Federal Legislation, Shortages Of Drugs Used In Acute Care Settings Remain Persistent And Prolonged.

    PubMed

    Chen, Serene I; Fox, Erin R; Hall, M Kennedy; Ross, Joseph S; Bucholz, Emily M; Krumholz, Harlan M; Venkatesh, Arjun K

    2016-05-01

    Early evidence suggests that provisions of the Food and Drug Administration Safety and Innovation Act of 2012 are associated with reductions in the total number of new national drug shortages. However, drugs frequently used in acute unscheduled care such as the care delivered in emergency departments may be increasingly affected by shortages. Our estimates, based on reported national drug shortages from 2001 to 2014 collected by the University of Utah's Drug Information Service, show that although the number of new annual shortages has decreased since the act's passage, half of all drug shortages in the study period involved acute care drugs. Shortages affecting acute care drugs became increasingly frequent and prolonged compared with non-acute care drugs (median duration of 242 versus 173 days, respectively). These results suggest that the drug supply for many acutely and critically ill patients in the United States remains vulnerable despite federal efforts.

  14. Critical pathways for the management of preeclampsia and severe preeclampsia in institutionalised health care settings

    PubMed Central

    Perez-Cuevas, Ricardo; Fraser, William; Reyes, Hortensia; Reinharz, Daniel; Daftari, Ashi; Heinz, Cristina S; Roberts, James M

    2003-01-01

    Background Preeclampsia is a complex disease in which several providers should interact continuously and in a coordinated manner to provide proper health care. However, standardizing criteria to treat patients with preeclampsia is problematical and severe flaws have been observed in the management of the disease. This paper describes a set of critical pathways (CPs) designed to provide uniform criteria for clinical decision-making at different levels of care of pregnant patients with preeclampsia or severe preeclampsia. Methods Clinicians and researchers from different countries participated in the construction of the CPs. The CPs were developed using the following steps: a) Definition of the conceptual framework; b) Identification of potential users: primary care physicians and maternal and child health nurses in ambulatory settings; ob/gyn and intensive care physicians in secondary and tertiary care levels. c) Structural development. Results The CPs address the following care processes: 1. Screening for preeclampsia, risk assessment and classification according to the level of risk. 2. Management of preeclampsia at primary care clinics. 3. Evaluation and management of preeclampsia at secondary and tertiary care hospitals: 4. Criteria for clinical decision-making between conservative management and expedited delivery of patients with severe preeclampsia. Conclusion Since preeclampsia continues to be one of the primary causes of maternal deaths and morbidity worldwide, the expected impact of these CPs is the contribution to improving health care quality in both developed and developing countries. The CPs are designed to be applied in a complex health care system, where different physicians and health providers at different levels of care should interact continuously and in a coordinated manner to provide care to all preeclamptic women. Although the CPs were developed using evidence-based criteria, they could require careful evaluation and remodelling according to

  15. Critical pathways for the management of preeclampsia and severe preeclampsia in institutionalised health care settings.

    PubMed

    Perez-Cuevas, Ricardo; Fraser, William; Reyes, Hortensia; Reinharz, Daniel; Daftari, Ashi; Heinz, Cristina S; Roberts, James M

    2003-10-03

    BACKGROUND: Preeclampsia is a complex disease in which several providers should interact continuously and in a coordinated manner to provide proper health care. However, standardizing criteria to treat patients with preeclampsia is problematical and severe flaws have been observed in the management of the disease. This paper describes a set of critical pathways (CPs) designed to provide uniform criteria for clinical decision-making at different levels of care of pregnant patients with preeclampsia or severe preeclampsia. METHODS: Clinicians and researchers from different countries participated in the construction of the CPs. The CPs were developed using the following steps: a) Definition of the conceptual framework; b) Identification of potential users: primary care physicians and maternal and child health nurses in ambulatory settings; ob/gyn and intensive care physicians in secondary and tertiary care levels. c) Structural development. RESULTS: The CPs address the following care processes: 1. Screening for preeclampsia, risk assessment and classification according to the level of risk. 2. Management of preeclampsia at primary care clinics. 3. Evaluation and management of preeclampsia at secondary and tertiary care hospitals: 4. Criteria for clinical decision-making between conservative management and expedited delivery of patients with severe preeclampsia. CONCLUSION: Since preeclampsia continues to be one of the primary causes of maternal deaths and morbidity worldwide, the expected impact of these CPs is the contribution to improving health care quality in both developed and developing countries. The CPs are designed to be applied in a complex health care system, where different physicians and health providers at different levels of care should interact continuously and in a coordinated manner to provide care to all preeclamptic women. Although the CPs were developed using evidence-based criteria, they could require careful evaluation and remodelling according

  16. Learning in Australian Early Childhood Education and Care Settings: Changing Professional Practice

    ERIC Educational Resources Information Center

    Tayler, Collette

    2012-01-01

    For the first time across Australia, early education and care services are subject to a single, national set of regulations and standards governing the quality of provision. Concurrently, a set of outcomes for all children aged from birth to 5 years and a ranking system to make transparent the performance of programmes have been developed. This…

  17. Graduate Leaders in Early Childhood Education and Care Settings, the Practitioner Perspective

    ERIC Educational Resources Information Center

    Davis, Geraldine

    2014-01-01

    Since 2006, UK policy has identified a professionalisation agenda for staff working in early childhood education and care settings. This has included the development of graduate leaders with a specific purpose to lead improvements in these settings by leading change, and hence improving outcomes for children. This article reports on findings from…

  18. Barriers to Real-Time Medical Direction via Cellular Communication for Prehospital Emergency Care Providers in Gujarat, India

    PubMed Central

    Strehlow, Matthew C; Rao, G.V. Ramana; Newberry, Jennifer A

    2016-01-01

    Background: Many low- and middle-income countries depend on emergency medical technicians (EMTs), nurses, midwives, and layperson community health workers with limited training to provide a majority of emergency medical, trauma, and obstetric care in the prehospital setting. To improve timely patient care and expand provider scope of practice, nations leverage cellular phones and call centers for real-time online medical direction. However, there exist several barriers to adequate communication that impact the provision of emergency care. We sought to identify obstacles in the cellular communication process among GVK Emergency Management and Research Institute (GVK EMRI) EMTs in Gujarat, India. Methods: A convenience sample of practicing EMTs in Gujarat, India were surveyed regarding the barriers to call initiation and completion. Results: 108 EMTs completed the survey. Overall, ninety-seven (89.8%) EMTs responded that the most common reason they did not initiate a call with the call center physician was insufficient time. Forty-six (42%) EMTs reported that they were unable to call the physician one or more times during a typical workweek (approximately 5-6 twelve-hour shifts/week) due to their hands being occupied performing direct patient care. Fifty-eight (54%) EMTs reported that they were unable to reach the call center physician, despite attempts, at least once a week. Conclusion: This study identified multiple barriers to communication, including insufficient time to call for advice and inability to reach call center physicians. Identification of simple interventions and best practices may improve communication and ensure timely and appropriate prehospital care.  PMID:27551654

  19. Emergency preparedness for those who care for infants in developed country contexts

    PubMed Central

    2011-01-01

    Emergency management organisations recognise the vulnerability of infants in emergencies, even in developed countries. However, thus far, those who care for infants have not been provided with detailed information on what emergency preparedness entails. Emergency management authorities should provide those who care for infants with accurate and detailed information on the supplies necessary to care for them in an emergency, distinguishing between the needs of breastfed infants and the needs of formula fed infants. Those who care for formula fed infants should be provided with detailed information on the supplies necessary for an emergency preparedness kit and with information on how to prepare formula feeds in an emergency. An emergency preparedness kit for exclusively breastfed infants should include 100 nappies and 200 nappy wipes. The contents of an emergency preparedness for formula fed infants will vary depending upon whether ready-to-use liquid infant formula or powdered infant formula is used. If ready-to-use liquid infant formula is used, an emergency kit should include: 56 serves of ready-to-use liquid infant formula, 84 L water, storage container, metal knife, small bowl, 56 feeding bottles and teats/cups, 56 zip-lock plastic bags, 220 paper towels, detergent, 120 antiseptic wipes, 100 nappies and 200 nappy wipes. If powdered infant formula is used, an emergency preparedness kit should include: two 900 g tins powdered infant formula, 170 L drinking water, storage container, large cooking pot with lid, kettle, gas stove, box of matches/lighter, 14 kg liquid petroleum gas, measuring container, metal knife, metal tongs, feeding cup, 300 large sheets paper towel, detergent, 100 nappies and 200 nappy wipes. Great care with regards hygiene should be taken in the preparation of formula feeds. Child protection organisations should ensure that foster carers responsible for infants have the resources necessary to formula feed in the event of an emergency. Exclusive

  20. Emergency preparedness for those who care for infants in developed country contexts.

    PubMed

    Gribble, Karleen D; Berry, Nina J

    2011-11-07

    Emergency management organisations recognise the vulnerability of infants in emergencies, even in developed countries. However, thus far, those who care for infants have not been provided with detailed information on what emergency preparedness entails. Emergency management authorities should provide those who care for infants with accurate and detailed information on the supplies necessary to care for them in an emergency, distinguishing between the needs of breastfed infants and the needs of formula fed infants. Those who care for formula fed infants should be provided with detailed information on the supplies necessary for an emergency preparedness kit and with information on how to prepare formula feeds in an emergency. An emergency preparedness kit for exclusively breastfed infants should include 100 nappies and 200 nappy wipes. The contents of an emergency preparedness for formula fed infants will vary depending upon whether ready-to-use liquid infant formula or powdered infant formula is used. If ready-to-use liquid infant formula is used, an emergency kit should include: 56 serves of ready-to-use liquid infant formula, 84 L water, storage container, metal knife, small bowl, 56 feeding bottles and teats/cups, 56 zip-lock plastic bags, 220 paper towels, detergent, 120 antiseptic wipes, 100 nappies and 200 nappy wipes. If powdered infant formula is used, an emergency preparedness kit should include: two 900 g tins powdered infant formula, 170 L drinking water, storage container, large cooking pot with lid, kettle, gas stove, box of matches/lighter, 14 kg liquid petroleum gas, measuring container, metal knife, metal tongs, feeding cup, 300 large sheets paper towel, detergent, 100 nappies and 200 nappy wipes. Great care with regards hygiene should be taken in the preparation of formula feeds. Child protection organisations should ensure that foster carers responsible for infants have the resources necessary to formula feed in the event of an emergency. Exclusive

  1. Non-trauma surgical emergencies in adults: Spectrum, challenges and outcome of care

    PubMed Central

    Ibrahim, N.A.; Oludara, M.A.; Ajani, A.; Mustafa, I.; Balogun, R.; Idowu, O.; Osuoji, R.; Omodele, F.O.; Aderounmu, A.O.A.; Solagberu, B.A.

    2015-01-01

    Introduction Significant deaths of between 21% and 38% occur from non-trauma surgical conditions in the accident and emergency room. Access to emergency surgical care is limited in many developing countries including Nigeria. We aimed to study the spectrum of non-trauma surgical emergencies, identify challenges in management and evaluate outcomes. Methods A one year prospective cohort study of all non-trauma emergencies in adults seen at the surgical emergency room of LASUTH from 1st October, 2011 to 30th September, 2012 was conducted. Data was analyzed using SPSS version 15.0. Results Of a total of 7536 patients seen, there were 7122 adults. Those with non-trauma conditions were 2065 representing 29% of adult emergencies. Age ranged between 15 and 97 years and male to female ratio was 1.7:1. Acute abdomen (30%), urological problems (18%) and malignancies (10%) were the most common. Among 985 patients requiring admission only 464 (47%) were admitted while the remaining 53% were referred to other centers. Emergency surgical intervention was carried out in 222 patients representing 48% of admitted patients. There were 12 (24%) non-trauma deaths in the emergency room. They were due to acute abdomen and malignancies in half of the cases. Conclusion Facilities for patients needing emergency care were inadequate with more than half of those requiring admission referred. Attention should be paid to the provision of emergency surgical services to the teeming number of patients seen on yearly basis in the Teaching Hospital. PMID:26566434

  2. An evaluation of two incontinence skin care protocols in a long-term care setting.

    PubMed

    Lewis-Byers, Kari; Thayer, Debra

    2002-12-01

    Caring for the skin of patients with incontinence is an essential activity in long-term care. A prospective descriptive study to compare the effect of two skin care protocols on skin condition, pain, and caregiver time was conducted. Thirty-two (32) skilled nursing facility residents with incontinence participated in the 3-week study. Patients were randomly assigned to a standard care regimen (soap and water cleansing after each incontinence episode, followed by application of a moisturizing lotion) or study care protocol (no-rinse skin cleanser after each episode and application of a barrier cream with durable properties after the first incontinence episode of each shift). Number and type of incontinence episodes, skin condition, pain, and caregiver time spent were assessed. Skin integrity was maintained in the majority of control (69%) and study group (72%) patients and improvement occurred in 8% of control and 17% of the study group (NS). Study protocol procedures took less time to complete than control procedures (a savings of 79 minutes/patient/day). A positive correlation between pain intensity and level of skin impairment was observed (r = 0.88). The results of this study suggest that at this facility, use of soap, water, and a moisturizer may be less effective and more time-consuming than using a no-rinse cleanser and a durable barrier product.

  3. Straight Talk. Communicating in Health Care Settings. An Offering of Step Ahead: A Partnership for Improved Health Care Communication.

    ERIC Educational Resources Information Center

    Dutson-Mallory, Cate; And Others

    This coursebook provides materials for a course to improve the oral communication skills of workers in health care settings. The course is designed to be delivered in eight sessions over a 4-week period. Stated objectives for the participants are as follows: feel more comfortable with communication in the hospital, avoid becoming defensive or…

  4. Towards systemic sustainable performance of TBI care systems: emergency leadership frontiers

    PubMed Central

    2010-01-01

    Background Traumatic brain injuries (TBIs) continue as a twenty-first century subterranean and almost invisible scourge internationally. TBI care systems provide a safety net for survival, recovery, and reintegration into social communities from this scourge, particularly in Canada, the European Union, and the USA. Aims This paper examines the underlying issues of systemic performance and sustainability of TBI care systems, in the light of decreasing care resources and increasing demands for services. Methods This paper reviews the extant literature on TBI care systems, systems reengineering, and emergency leadership literature. Results This paper presents a seven care layer paradigm, which forms the essence of systemic performance in the care of patients with TBIs. It also identifies five key strategic drivers that hold promise for the future systemic sustainability of TBI care systems. Conclusions Transformational leadership and engagement from the international emergency medical community is the key to generating positive change. The sustainability/performance care framework is relevant and pertinent for consideration internationally and in the context of other emergency medical populations. PMID:21373305

  5. The Feasibility of Utilizing a Comic for Education in the Emergency Department Setting.

    PubMed

    Hanson, Aaron; Drendel, Amy L; Ashwal, Gary; Thomas, Alex

    2017-05-01

    The objective of this study was to determine the feasibility of a comic education module in the Emergency Department setting. A convenience sample of 50 injured children and their caregivers were enrolled. The comic was found to be likeable, easy to read, and provided important information to both children and their caregivers. Total time to read the comic was three minutes (SD 1.4, range 1.4-7.1). Most children (60%) read the comic independently, including all children over age 14 years. At 72-hour phone follow-up, 86% of caregivers had accurate recall of all three comic teaching points. This innovative comic educational module is feasible for use for children ages 4-18 years in the Emergency Department. Though this comic was intended to educate children, caregivers recalled all three teaching points 72 hours after discharge.

  6. [What you can do when dealing with emergencies in the dementia setting].

    PubMed

    Balmer, Hannes

    2015-01-01

    Frequent emergencies in patients with dementia include aggressiveness, screaming, day/night reversal, other behavioral disorders, and falls. They are often caused by delirium, especially if there has been a rapid change in the patient's state of health. Hypoactive delirium in particular is difficult to recognize in the dementia setting. Acute somatic diseases bear a different meaning in dementia than in non-dementia patients, and priorities must be given to the impaired cerebral performance. In addition to medical decisions, ethical ones need to be made. Special attention should be paid to the resources of the caregiver network. This article describes both non-pharmacological and pharmacological treatment modalities when dealing with emergencies in dementia patients.

  7. Appropriate technology for rural India - solar decontamination of water for emergency settings and small communities.

    PubMed

    Kang, Gagandeep; Roy, Sheela; Balraj, Vinohar

    2006-09-01

    A commercial solar water heating system was evaluated for its effectiveness in decontaminating drinking water with a view to use in emergency situations. A total of 18 seeding experiments carried out over 6 months with 10(5) to 10(7)Escherichia coli/ml showed that the solar heater produced 125 l of bacteriologically safe water in 4 h when the ambient temperature was above 30 degrees C, with a holding time of at least 2 h. The solar water heating system is inexpensive, easy to transport and set up and could provide safer drinking water for 50 people a day. It would be effective in the decrease and prevention of waterborne disease in emergency situations, and is appropriate for use in small communities.

  8. Adverse Drug Reactions in a Tertiary Care Emergency Medicine Ward - Prevalence, Preventability and Reporting

    PubMed Central

    Rydberg, Diana M.; Holm, Lennart; Engqvist, Ida; Fryckstedt, Jessica; Lindh, Jonatan D.; Stiller, Carl-Olav; Asker-Hagelberg, Charlotte

    2016-01-01

    Purpose To identify the prevalence and preventability of adverse drug reactions (ADRs) in an emergency ward setting in a tertiary hospital in Sweden and to what extent the detected ADRs were reported to the Medical Product Agency (MPA). Methods In this prospective cross sectional observational study, 706 patients admitted to one of the Emergency Wards, at the Karolinska University Hospital in Solna, Stockholm during September 2008 –September 2009, were included. The electronic patient records were reviewed for patients’ demographic parameters, prevalence of possible ADRs and assessment of their preventability. In addition, the extent of formal and required ADR reporting to national registers was studied. Results Approximately 40 percent of the patient population had at least one possible ADR (n = 284). In the multivariable regression model, age and number of drugs were significantly associated with risk of presenting with an ADR (p<0.01 and p<0.001, respectively). Sex was not identified as a significant predictor of ADRs (p = 0.27). The most common ADRs were cardiovascular, followed by electrolyte disturbances, and hemorrhage. In 18 percent of the patient population ADRs were the reason for admission or had contributed to admission and 24% of these ADRs were assessed as preventable. The under-reporting of ADRs to the MPA was 99%. Conclusions ADRs are common in Emergency Medicine in tertiary care in Sweden, but under-reporting of ADRs is substantial. The most frequent ADRs are caused by cardiovascular drugs, and significantly associated with age and number of drugs. However, only a minority of the detected serious ADRs contributing to admission could have been avoided by increased risk awareness. PMID:27622270

  9. Clinical care of persons with dementia in the emergency department: a review of the literature and agenda for research.

    PubMed

    Clevenger, Carolyn K; Chu, Thasha A; Yang, Zhou; Hepburn, Kenneth W

    2012-09-01

    The segment of older adults who present to the emergency department (ED) with cognitive impairment ranges from 21% to 40%. Difficulties inherent in the chaotic ED setting combined with dementia may result in a number of unwanted clinical outcomes, but strategies to minimize these outcomes are lacking. A review of the literature was conducted to examine the practices undertaken in the care of persons with dementia (PWD) specific to the ED setting. PubMed and Cumulative Index to Nursing and Allied Health Literature were searched for published articles specific to the care of PWD provided in the ED. All English-language articles were reviewed; editorials and reflective journals were excluded. Seven articles ultimately met inclusion criteria; all provided Level 7 evidence: narrative review or opinions from authorities. The articles recommended clinical practices that can be categorized into five themes: assessment of cognitive impairment, dementia communication strategies, avoidance of adverse events, alterations to the physical environment, and education of ED staff. Many recommendations are extrapolated from residential care settings. Review results indicate that there is minimal guidance for the care of PWD specific to the ED setting. There are no empirical studies of the care (assessment, interventions) of PWD in the ED. The existing (Level 7) recommendations lack a research base to support their effectiveness or adoption as evidence-based practice. There is a significant opportunity for research to identify and test ways to meet the needs of PWD in the ED to ensure a safe visit, accurate diagnosis, and prudent transfer to the most appropriate level of care.

  10. Scanning the horizon: emerging hospital-wide technologies and their impact on critical care

    PubMed Central

    Suntharalingam, Ganesh; Cousins, Jonathan; Gattas, David; Chapman, Martin

    2005-01-01

    This commentary represents a selective survey of developments relevant to critical care. Selected themes include advances in point-of-care diagnostic testing, glucose control, novel microbiological diagnostics and infection control measures, and developments in information technology that have implications for intensive care. The latter encompasses an early example of an artificially intelligent clinical decision support mechanism, the introduction of a national health care information technology programme (UK NPfIT) and its implications, and exotic threats to patient safety due to emergent behaviour in complex information systems. PMID:15693973

  11. Exploring the Potential of Predictive Analytics and Big Data in Emergency Care.

    PubMed

    Janke, Alexander T; Overbeek, Daniel L; Kocher, Keith E; Levy, Phillip D

    2016-02-01

    Clinical research often focuses on resource-intensive causal inference, whereas the potential of predictive analytics with constantly increasing big data sources remains largely unexplored. Basic prediction, divorced from causal inference, is much easier with big data. Emergency care may benefit from this simpler application of big data. Historically, predictive analytics have played an important role in emergency care as simple heuristics for risk stratification. These tools generally follow a standard approach: parsimonious criteria, easy computability, and independent validation with distinct populations. Simplicity in a prediction tool is valuable, but technological advances make it no longer a necessity. Emergency care could benefit from clinical predictions built using data science tools with abundant potential input variables available in electronic medical records. Patients' risks could be stratified more precisely with large pools of data and lower resource requirements for comparing each clinical encounter to those that came before it, benefiting clinical decisionmaking and health systems operations. The largest value of predictive analytics comes early in the clinical encounter, in which diagnostic and prognostic uncertainty are high and resource-committing decisions need to be made. We propose an agenda for widening the application of predictive analytics in emergency care. Throughout, we express cautious optimism because there are myriad challenges related to database infrastructure, practitioner uptake, and patient acceptance. The quality of routinely compiled clinical data will remain an important limitation. Complementing big data sources with prospective data may be necessary if predictive analytics are to achieve their full potential to improve care quality in the emergency department.

  12. Youth Psychotherapy Change Trajectories and Outcomes in Usual Care: Community Mental Health versus Managed Care Settings

    ERIC Educational Resources Information Center

    Warren, Jared S.; Nelson, Philip L.; Mondragon, Sasha A.; Baldwin, Scott A.; Burlingame, Gary M.

    2010-01-01

    Objective: The authors compared symptom change trajectories and treatment outcome categories in children and adolescents receiving routine outpatient mental health services in a public community mental health system and a private managed care organization. Method: Archival longitudinal outcome data from parents completing the Youth Outcome…

  13. Neonatal survival in complex humanitarian emergencies: setting an evidence-based research agenda

    PubMed Central

    2014-01-01

    Background Over 40% of all deaths among children under 5 are neonatal deaths (0–28 days), and this proportion is increasing. In 2012, 2.9 million newborns died, with 99% occurring in low- and middle-income countries. Many of the countries with the highest neonatal mortality rates globally are currently or have recently been affected by complex humanitarian emergencies. Despite the global burden of neonatal morbidity and mortality and risks inherent in complex emergency situations, research investments are not commensurate to burden and little is known about the epidemiology or best practices for neonatal survival in these settings. Methods We used the Child Health and Nutrition Research Initiative (CHNRI) methodology to prioritize research questions on neonatal health in complex humanitarian emergencies. Experts evaluated 35 questions using four criteria (answerability, feasibility, relevance, equity) with three subcomponents per criterion. Using SAS 9.2, a research prioritization score (RPS) and average expert agreement score (AEA) were calculated for each question. Results Twenty-eight experts evaluated all 35 questions. RPS ranged from 0.846 to 0.679 and the AEA ranged from 0.667 to 0.411. The top ten research priorities covered a range of issues but generally fell into two categories– epidemiologic and programmatic components of neonatal health. The highest ranked question in this survey was “What strategies are effective in increasing demand for, and use of skilled attendance?” Conclusions In this study, a diverse group of experts used the CHRNI methodology to systematically identify and determine research priorities for neonatal health and survival in complex humanitarian emergencies. The priorities included the need to better understand the magnitude of the disease burden and interventions to improve neonatal health in complex humanitarian emergencies. The findings from this study will provide guidance to researchers and program implementers in

  14. Emergency Department redirection to primary care: a prospective evaluation of practice.

    PubMed

    Bentley, James A; Thakore, Shobhan; Morrison, William; Wang, Weijie

    2017-02-01

    Background and aim Non-urgent Emergency Department presentations contribute to overcrowding, which can adversely affect patient care. Redirecting patients to a more appropriate service is an option to help address this. We conducted a prospective evaluation of a major Scottish hospital's Emergency Department redirection policy to assess its safety. Methods and results Over two months, 620 patients triggered senior assessment for redirection with 444 (72%) redirected to primary care. Information on presentation was collected with subsequent management and outcome of redirection provided by the patient's general practitioner. Those who required admission within seven days of redirection triggered review. This was carried out independently by an Emergency Department Consultant and a GP Principal to assess the incidence of sub-optimal care or harm as a consequence of redirection. Most patients presented during daytime hours with no significant variation between days. 'Patient factors' accounted for 74% of presentations with 'convenience' (20%) cited as the most common reason. Twenty-two patients were subsequently admitted, with one case of sub-optimal care (incidence 0.23%) and no cases of harm. Conclusions Our redirection policy provides a safe and effective means of directing patients to more appropriate care. The authors believe this to be in the patient s best interest as Emergency Department clinicians are not specifically trained to manage primary care issues.

  15. Implementing oral care to reduce aspiration pneumonia amongst patients with dysphagia in a South African setting.

    PubMed

    Seedat, Jaishika; Penn, Claire

    2016-02-16

    Oral care is a crucial routine for patients with dysphagia that, when completed routinely, can prevent the development of aspiration pneumonia. There is no standardised protocol for oral care within government hospitals in South Africa. This study aimed to investigate the outcome of an oral care protocol. Participants were patients with oropharyngeal dysphagia, with either stroke or traumatic brain injury as the underlying medical pathology, and nurses. All participants were recruited from one tertiary level government hospital in Gauteng, South Africa. 139 nurses participated in the study and received training on the oral care protocol. There were two groups of participants with oropharyngeal dysphagia. Group one (study group, n = 23) was recruited by consecutive sampling, received regular oral care and were not restricted from drinking water; however, all other liquids were restricted. Group two (comparison group, n = 23) was recruited via a retrospective record review, received inconsistent oral care and were placed on thickened liquids or liquid restricted diets. Results showed that a regimen of regular oral care and free water provision when combined with dysphagia intervention did prevent aspiration pneumonia in patients with oropharyngeal dysphagia. The article highlights two key findings: that regular and routine oral care is manageable within an acute government hospital context and a strict routine of oral care can reduce aspiration pneumonia in patients with oropharyngeal dysphagia. An implication from these findings is confirmation that teamwork in acute care settings in developing contexts must be prioritised to improve dysphagia management and patient prognosis.

  16. Beyond bureaucracy: emerging trends in social care informatics.

    PubMed

    Wastell, David; White, Sue

    2014-09-01

    Existing information technology systems in much of UK social care have been designed to serve the interests of the bureaucracy rather than supporting professional practice or improving services to the public. The ill-starred Integrated Children's System in statutory children's services is typical. The Integrated Children's System is a system for form-filling, micro-managing professional practice through an enforced regime of standard processes and time scales. In this article, we argue against this dominant design. We provide several examples where technology has enabled alternative modes of support for professional work, based on socio-technical principles. One such system is Patchwork, which describes itself as a 'Facebook for Social Work'; its aim is to support multi-professional teams working with vulnerable families.

  17. ASSTC and field sensors: new technology for emergency care

    NASA Astrophysics Data System (ADS)

    Morrison, G. Wayne; Vo-Dinh, Tuan

    2000-05-01

    The US Army Medical Research and Material Command together with the US Marine Corps Combat Development Command sponsored the design and production of a far-forward, lightweight, small footprint, reconfigurable, highly mobile Advanced Surgical Suite for Trauma Casualties (ASSTC) to reduce combat casualties and morbidity. The KIA fraction has remained relatively constant over major wars and conflicts since the early 1900s. One third of the KIA perish after 10 minutes. ASSTC has the potential to dramatically lower this fraction by providing resuscitative care within a short period of wound infliction and not requiring long transport times to the caregivers. ASSTC is also unique in its capability to serve in multiple missions including humanitarian aid, infectious disease control, and disaster relief. Adding field sensor to ASSTC greatly enhances the capability of this highly mobile system to operate in many areas.

  18. Why a successful task substitution in glaucoma care could not be transferred from a hospital setting to a primary care setting: a qualitative study

    PubMed Central

    2013-01-01

    Background Healthcare systems are challenged by a demand that exceeds available resources. One policy to meet this challenge is task substitution-transferring tasks to other professions and settings. Our study aimed to explore stakeholders’ perceived feasibility of transferring hospital-based monitoring of stable glaucoma patients to primary care optometrists. Methods A case study was undertaken in the Rotterdam Eye Hospital (REH) using semi-structured interviews and document reviews. They were inductively analysed using three implementation related theoretical perspectives: sociological theories on professionalism, management theories, and applied political analysis. Results Currently it is not feasible to use primary care optometrists as substitutes for optometrists and ophthalmic technicians working in a hospital-based glaucoma follow-up unit (GFU). Respondents’ narratives revealed that: the glaucoma specialists’ sense of urgency for task substitution outside the hospital diminished after establishing a GFU that satisfied their professionalization needs; the return on investments were unclear; and reluctant key stakeholders with strong power positions blocked implementation. The window of opportunity that existed for task substitution in person and setting in 1999 closed with the institutionalization of the GFU. Conclusions Transferring the monitoring of stable glaucoma patients to primary care optometrists in Rotterdam did not seem feasible. The main reasons were the lack of agreement on professional boundaries and work domains, the institutionalization of the GFU in the REH, and the absence of an appropriate reimbursement system. Policy makers considering substituting tasks to other professionals should carefully think about the implementation process, especially in a two-step implementation process (substitution in person and in setting) such as this case. Involving the substituting professionals early on to ensure all stakeholders see the change as a

  19. Primary care access barriers as reported by nonurgent emergency department users: implications for the US primary care infrastructure.

    PubMed

    Hefner, Jennifer L; Wexler, Randy; McAlearney, Ann Scheck

    2015-01-01

    The objective was to explore variation by insurance status in patient-reported barriers to accessing primary care. The authors fielded a brief, anonymous, voluntary survey of nonurgent emergency department (ED) visits at a large academic medical center and conducted descriptive analysis and thematic coding of 349 open-ended survey responses. The privately insured predominantly reported primary care infrastructure barriers-wait time in clinic and for an appointment, constraints related to conventional business hours, and difficulty finding a primary care provider (because of geography or lack of new patient openings). Half of those insured by Medicaid and/or Medicare also reported these infrastructure barriers. In contrast, the uninsured predominantly reported insurance, income, and transportation barriers. Given that insured nonurgent ED users frequently report infrastructure barriers, these should be the focus of patient-level interventions to reduce nonurgent ED use and of health system-level policies to enhance the capacity of the US primary care infrastructure.

  20. Stereotype threat among black and white women in health care settings.

    PubMed

    Abdou, Cleopatra M; Fingerhut, Adam W

    2014-07-01

    The first of its kind, the present experiment applied stereotype threat-the threat of being judged by or confirming negative group-based stereotypes-to the health sciences. Black and White women (N = 162) engaged in a virtual health care situation. In the experimental condition, one's ethnic identity and negative stereotypes of Black women specifically were made salient. As predicted, Black women in the stereotype threat condition who were strongly identified as Black (in terms of having explored what their ethnic identity means to them and the role it plays in their lives) reported significantly greater anxiety while waiting to see the doctor in the virtual health care setting than all other women. It is hypothesized that stereotype threat experienced in health care settings is one overlooked social barrier contributing to disparities in health care utilization and broader health disparities among Black women.

  1. Project School Care: integrating children assisted by medical technology into educational settings.

    PubMed

    Palfrey, J S; Haynie, M; Porter, S; Bierle, T; Cooperman, P; Lowcock, J

    1992-02-01

    The increasing number of children assisted by medical technology in the U.S. has led to a need for systematic planning for the children's care in community settings such as schools. Project School Care in Massachusetts provides consultation to school systems as schools respond to the challenge of integrating children assisted by medical technology into educational settings. The model of practice described includes the step-wise planning process and the ensuing training, enrollment, and monitoring procedures. Implications are explored with particular emphasis on upgrading of skills at all medical and educational levels. More input from school health personnel in administrative decision-making around enrollment of children with special health care needs is recommended. For these children, a health care plan should be incorporated into their Individualized Education Plans and into their school records.

  2. Finding the Primary Care Providers in the Specialist-Dominant Primary Care Setting of Korea: A Cluster Analysis

    PubMed Central

    Lee, Jin Yong; Eun, Sang Jun; Kim, Hyun Joo; Jo, Min-Woo

    2016-01-01

    Objective This study aimed to identify private clinics that have a potential to perform the role of primary care providers (PCPs) in a primary care setting in Korea where private specialists are dominant. Methods The 2013 National Patient Sample claim data of Health Insurance Review and Assessment Service in Korea was used. Two-step cluster analysis was performed using characteristics of private clinics, and patient and utilization characteristics of 27,797 private clinics. External validation of clusters was performed by assessing the association among clusters and outcomes of care provided by private clinics. Stability of clusters was cross-validated using discriminant analysis. Results The result classified more than a half of private clinics into a potential PCP cluster. These were private clinics with specialties considered to be those of primary care physicians and were more likely to be located in non-metropolitan areas than specialized PCPs were. Compared to specialized PCPs, they had a higher percentage of pediatric and geriatric patients, patients with greater disease severity, a higher percentage of patients with complex comorbidities or with simple or minor disease groups, a higher number of patients and visits, and the same or higher quality of primary care. The most important factor in explaining variations between PCP clusters was the number of simple or minor disease groups per patient. Conclusion This study identified potential PCPs and suggested the identifying criteria for PCPs. It will provide useful information for formulation of a primary care strengthening policy to policy makers in Korea as well as other countries with similar specialist-dominant primary care settings. PMID:27560181

  3. Health, Health Care, and Systems Science: Emerging Paradigm

    PubMed Central

    2017-01-01

    Health is a continuum of an optimized state of a biologic system, an outcome of positive relationships with the self and others. A healthy system follows the principles of systems science derived from observations of nature, highlighting the character of relationships as the key determinant. Relationships evolve from our decisions, which are consequential to the function of our own biologic system on all levels, including the genome, where epigenetics impact our morphology. In healthy systems, decisions emanate from the reciprocal collaboration of hippocampal memory and the executive prefrontal cortex. We can decide to change relationships through choices. What is selected, however, only represents the cognitive interpretation of our limited sensory perception; it strongly reflects inherent biases toward either optimizing state, making a biologic system healthy, or not. Health or its absence is then the outcome; there is no inconsequential choice. Public health effort should not focus on punitive steps (e.g. taxation of unhealthy products or behaviors) in order to achieve a higher level of public’s health. It should teach people the process of making healthy decisions; otherwise, people will just migrate/shift from one unhealthy product/behavior to another, and well-intended punitive steps will not make much difference. Physical activity, accompanied by nutrition and stress management, have the greatest impact on fashioning health and simultaneously are the most cost-effective measures. Moderate-to-vigorous exercise not only improves aerobic fitness but also positively influences cognition, including memory and senses. Collective, rational societal decisions can then be anticipated. Health care is a business system principally governed by self-maximizing decisions of its components; uneven and contradictory outcomes are the consequences within such a non-optimized system. Health is not health care. We are biologic systems subject to the laws of biology in spite

  4. Laparoscopic Finney pyloroplasty in the emergency setting: first case report in the literature and technical challenges

    PubMed Central

    Athanasopoulos, Panagiotis G.; Hadjittofi, Christopher; Berti, Stefano

    2016-01-01

    Pyloroplasty is currently reserved for emergencies (perforation, bleeding), but may occasionally be performed to treat benign gastric outlet obstruction (GOO). Historically, two techniques are available: the Mikulicz pyloroplasty, by which the pylorus is incised longitudinally and sutured vertically, and the Finney pyloroplasty, by which a U-shaped inverted incision is made in the second part of duodenum (D1–D2), followed by a side-to-side gastroduodenostomy. We report our experience in this single case of laparoscopic Finney pyloroplasty (LFP) performed in the emergency setting for a woman with a perforated duodenal ulcer and severe loss of tissue in D1–D2. Due to the presence of severely inflamed perforation edges and the risk of duodenal narrowing with subsequent GOO, Finney technique was favored over direct ulcer repair. The patient achieved a full postoperative recovery free of complications, with a dynamic oral contrast study demonstrating good gastric evacuation. Review of the current literature revealed no similar cases, as LFP has only been performed in the canine model. Although LFP requires a specific surgical skill-set, we believe it can be effective and feasible in cases of duodenal perforation with significant loss of mural substance. PMID:27294093

  5. THE DEVELOPMENT AND USE OF A MODEL TO PREDICT SUSTAINABILITY OF CHANGE IN HEALTH CARE SETTINGS

    PubMed Central

    2011-01-01

    Innovations adopted through organizational change initiatives are often not sustained leading to diminished quality, productivity, and consumer satisfaction. Research explaining variance in the use of adopted innovations in health care settings is sparse, suggesting the need for a theoretical model to guide research and practice. In this article, we describe the development of a hybrid conjoint decision theoretic model designed to predict the sustainability of organizational change in health care settings. An initial test of the model’s predictive validity using expert scored hypothetic profiles resulted in an r-squared value of .77. The test of this model offers a theoretical base for future research on the sustainability of change in health care settings. PMID:22262947

  6. Undergraduate medical education in emergency medical care: A nationwide survey at German medical schools

    PubMed Central

    Beckers, Stefan K; Timmermann, Arnd; Müller, Michael P; Angstwurm, Matthias; Walcher, Felix

    2009-01-01

    Background Since June 2002, revised regulations in Germany have required "Emergency Medical Care" as an interdisciplinary subject, and state that emergency treatment should be of increasing importance within the curriculum. A survey of the current status of undergraduate medical education in emergency medical care establishes the basis for further committee work. Methods Using a standardized questionnaire, all medical faculties in Germany were asked to answer questions concerning the structure of their curriculum, representation of disciplines, instructors' qualifications, teaching and assessment methods, as well as evaluation procedures. Results Data from 35 of the 38 medical schools in Germany were analysed. In 32 of 35 medical faculties, the local Department of Anaesthesiology is responsible for the teaching of emergency medical care; in two faculties, emergency medicine is taught mainly by the Department of Surgery and in another by Internal Medicine. Lectures, seminars and practical training units are scheduled in varying composition at 97% of the locations. Simulation technology is integrated at 60% (n = 21); problem-based learning at 29% (n = 10), e-learning at 3% (n = 1), and internship in ambulance service is mandatory at 11% (n = 4). In terms of assessment methods, multiple-choice exams (15 to 70 questions) are favoured (89%, n = 31), partially supplemented by open questions (31%, n = 11). Some faculties also perform single practical tests (43%, n = 15), objective structured clinical examination (OSCE; 29%, n = 10) or oral examinations (17%, n = 6). Conclusion Emergency Medical Care in undergraduate medical education in Germany has a practical orientation, but is very inconsistently structured. The innovative options of simulation technology or state-of-the-art assessment methods are not consistently utilized. Therefore, an exchange of experiences and concepts between faculties and disciplines should be promoted to guarantee a standard level of education

  7. Rapid assessment and initial patient treatment team -- a way forward for emergency care.

    PubMed

    Cronin, J G; Wright, J

    2005-04-01

    As a consequence of the UK Department of Health drive to introduce the 4-h emergency care target acute trusts have attempted to initialize a myriad of programmes to improve the patients' experience in this sector. Changes to how patients are managed and the flow that they enter within the emergency care system have become a popular option. This paper seeks to explore the concept of the Rapid Assessment and Initial Patient Treatment team (RAPT) within the Accident and Emergency (A and E) environment. We intend to provide information for readers who may be considering introducing such teams. The paper will explore the initial practical difficulties that were encountered. We will explore associated benefits for the RAPT approach including improved teamwork, better communication with the family, avoiding unnecessary duplication of work and discuss the benefits of having a direct referral process in place for emergency patients.

  8. Factors associated with the use of emergency dental care facilities in a French public hospital.

    PubMed

    Tramini, Paul; Al Qadi Nassar, Buthaïna; Valcarcel, Jean; Gibert, Philippe

    2010-01-01

    This study was undertaken to qualitatively analyze patients' profiles and to identify the sociodemographic and oral health factors associated with emergency visits to the public dental service in Montpellier, France. A cross-sectional survey was conducted in the dental care service at Montpellier Hospital. Socioeconomic and clinical variables were compared between the patients using the emergency dental care service and those utilizing the general dental services, which were by appointment. An evaluation of the results indicated that younger patients and people from lower socioeconomic groups used the emergency dental service more frequently. Unemployed people (OR = 1.60) and manual workers (OR = 1.86) were also more likely to use this service. The need for treatment of caries was significantly higher in the group that used the emergency service. It appeared that the two groups of patients had different attendance behavior and showed significantly different socioeconomic and oral health status.

  9. Exploring the Medical Home in Ryan White HIV Care Settings: A Pilot Study

    PubMed Central

    Beane, Stephanie N.; Culyba, Rebecca J.; DeMayo, Michael; Armstrong, Wendy

    2014-01-01

    Amid increased attention to the cost of health care, health information technology, and specialization and fragmentation in medicine, the medical home has achieved recognition as a model for more effective and efficient health care. Little data are available on recently funded HIV medical home demonstration projects, and no research richly describes existing medical home characteristics, implementation challenges, and impact on outcomes in longstanding HIV outpatient settings. The Ryan White HIV/AIDS Program (RWP) provides federal funding for primary and specialty care for people living with HIV. Although RWP clinics developed independently of the medical home model, existing data indirectly support that, with emphasis on primary, comprehensive, and patient-centered care, RWP clinics operate as medical homes. This study explores the development, definition, and implementation of medical home characteristics by RWP-funded providers in order to better understand how it fits with broader debates about medical homes and health care reform. PMID:24560357

  10. Setting a Minimum Standard of Care in Clinical Trials: Human Rights and Bioethics as Complementary Frameworks.

    PubMed

    Marouf, Fatma E; Esplin, Bryn S

    2015-06-11

    For the past few decades, there has been intense debate in bioethics about the standard of care that should be provided in clinical trials conducted in developing countries. Some interpret the Declaration of Helsinki to mean that control groups should receive the best intervention available worldwide, while others interpret this and other international guidelines to mean the best local standard of care. Questions of justice are particularly relevant where limited resources mean that the local standard of care is no care at all. Introducing human rights law into this complex and longstanding debate adds a new and important perspective. Through non-derogable rights, including the core obligations of the right to health, human rights law can help set a minimum standard of care.

  11. ADHD in school-aged youth: Management and special treatment considerations in the primary care setting.

    PubMed

    Weed, Elizabeth D

    Attention-deficit/hyperactivity disorder is considered one of the most common neurodevelopmental disorders of childhood. Primary care providers are in the unique position of providing comprehensive care-routine care, well child visits, immunizations, and other healthcare needs-to a majority of children and adolescents with attention-deficit/hyperactivity disorder. As such, primary care providers are pivotal in the diagnosis, management, and treatment of this population. This article will address special treatment considerations to aid in the management of attention-deficit/hyperactivity disorder in the primary care setting, including substance use disorders and diversion, cardiac issues and stimulant medication, medication holidays and follow-up monitoring. The database of PubMed was searched using keywords that included attention-deficit/hyperactivity disorder, children, prevalence, medication holidays, safety, cardiovascular, cardiac, blood pressure, substance use, diversion, adverse drug reactions; inclusion dates were January 1, 2011 to September 30, 2015.

  12. Managing disruptive behaviors in the health care setting: focus on obstetrics services.

    PubMed

    Rosenstein, Alan H

    2011-03-01

    Disruptive behaviors can have a significant negative impact on staff relationships, communication flow, task responsibility, and team collaboration, all of which can adversely impact patient outcomes of care. Addressing disruptive behaviors in a positive manner by emphasizing the benefits of mutual understanding, shared goals and priorities, and adherence to accepted standards of care will enhance communication flow and improve the process and outcomes of care. This is particularly relevant in the obstetrics setting, where care is delivered over a continuum of time, with multiple different members of the health care team playing a vital role as the patient progresses from labor to delivery. Critical strategies for success include having strong organizational commitment and leadership support, raising provider insight and awareness, implementing appropriate policies and procedures, providing appropriate educational and training programs, and facilitating action-oriented interventional support.

  13. Enhancing adult therapeutic interpersonal relationships in the acute health care setting: an integrative review

    PubMed Central

    Kornhaber, Rachel; Walsh, Kenneth; Duff, Jed; Walker, Kim

    2016-01-01

    Therapeutic interpersonal relationships are the primary component of all health care interactions that facilitate the development of positive clinician–patient experiences. Therapeutic interpersonal relationships have the capacity to transform and enrich the patients’ experiences. Consequently, with an increasing necessity to focus on patient-centered care, it is imperative for health care professionals to therapeutically engage with patients to improve health-related outcomes. Studies were identified through an electronic search, using the PubMed, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO databases of peer-reviewed research, limited to the English language with search terms developed to reflect therapeutic interpersonal relationships between health care professionals and patients in the acute care setting. This study found that therapeutic listening, responding to patient emotions and unmet needs, and patient centeredness were key characteristics of strategies for improving therapeutic interpersonal relationships. PMID:27789958

  14. Secondary-care costs associated with lung cancer diagnosed at emergency hospitalisation in the United Kingdom.

    PubMed

    Kennedy, Martyn P T; Hall, Peter S; Callister, Matthew E J

    2017-01-30

    Lung cancer diagnosis during emergency hospital admission has been associated with higher early secondary-care costs and lower longer-term costs than outpatient diagnoses. This retrospective cohort study analyses the secondary-care costs of 3274 consecutive patients with lung cancer. Patients diagnosed during emergency admissions incurred greater costs during the first month and had a worse prognosis compared with outpatient diagnoses. In patients who remained alive, costs after the first month were comparable between diagnostic routes. In addition to improving patient experience and outcome, strategies to increase earlier diagnosis may reduce the additional healthcare costs associated with this route to diagnosis.

  15. Invited clinical suggestion: "on the sidelines"- emergency care basics for the sports physical therapist.

    PubMed

    Smith, Danny D

    2011-03-01

    An integral part of the responsibilities of the sports physical therapist is emergency care that is provided on the sidelines and courtside during athletic events. Often times, the sports physical therapist is the "most medical" individual present at athletic events, especially at high school, middle school, and club level events. The sports physical therapist is looked upon to provide appropriate care in the event of an injury to or sudden illness of an athlete, or in the event of an unexpected medical emergency that arises in members of the coaching staff, officials, and fans.

  16. Triclosan: a review of effectiveness and safety in health care settings.

    PubMed

    Jones, R D; Jampani, H B; Newman, J L; Lee, A S

    2000-04-01

    Triclosan is a widely accepted antimicrobial ingredient because of its safety and antimicrobial efficacy. Triclosan is a unique antimicrobial well suited for use in the health care industry in which mildness is a necessity to protect the health care worker during repeated use and antimicrobial activity is a necessity to protect public health. Triclosan has demonstrated immediate, persistent, broad-spectrum antimicrobial effectiveness and utility in clinical health care settings. This review highlights the utility and effectiveness of a 1% triclosan formulation for use in high-risk, high-frequency handwashing.

  17. Vaccination in the primary care setting: when is it safe to proceed?

    PubMed

    Ngoh, Hui Lee Sharon; Ng, Mark Chung Wai

    2016-01-01

    Primary care practitioners play an important role in administering and advocating vaccinations against vaccine-preventable infectious diseases and ensuring herd immunity in our population. This is a follow-up article to an earlier one which dealt with the principles of vaccine scheduling and administration. This article describes several false contraindications to vaccination that a primary care practitioner may encounter, including pregnancy, current breastfeeding, history of febrile seizures, and having immunosuppressed or pregnant household contacts. We aimed to provide a guide for safe and timely vaccine administration in the primary care setting.

  18. A successful model of collaborative practice in a university-based maternity care setting.

    PubMed

    Blanchard, May Hsieh; Kriebs, Jan M

    2012-09-01

    When building an integrated practice, the ability of each team member to work comfortably with other professionals is key. Midwives need to understand departmental expectations for participation in resident/student education, be willing to provide midwifery care in a high-acuity setting with limited opportunities for low-intervention care, and understand expectations for clinical leadership. Physicians need to build on the group expectation of mutual respect and best use of each group member. Confusion about midwifery and physician roles in maternity care still exists.

  19. Affordability of emergency obstetric and neonatal care at public hospitals in Madagascar.

    PubMed

    Honda, Ayako; Randaoharison, Pierana Gabriel; Matsui, Mitsuaki

    2011-05-01

    Timely access to emergency obstetric care is necessary to save the lives of women experiencing complications at delivery, and for newborn babies. Out-of-pocket costs are one of the critical factors hindering access to such services in low- and middle-income countries. This study measured out-of-pocket costs for caesarean section and neonatal care at an urban tertiary public hospital in Madagascar, assessed affordability in relation to household expenditure and investigated where families found the money to cover these costs. Data were collected for 103 women and 73 newborns at the Centre Hospitalier Universitaire de Mahajanga in the Boeny region of Madagascar between September 2007 and January 2008. Out-of-pocket costs for caesarean section were catastrophic for middle and lower socio-economic households, and treatment for neonatal complications also created a big financial burden, with geographical and other financial barriers further limiting access to hospital care. This study identified 12 possible cases where the mother required an emergency caesarean section and her newborn required emergency care, placing a double burden on the household. In an effort to make emergency obstetric and neonatal care affordable and available to all, including those living in rural areas and those of medium and lower socio-economic status, well-designed financial risk protection mechanisms and a strong commitment by the government to mobilise resources to finance the country's health system are necessary.

  20. Primary care and accident and emergency departments in an urban area

    PubMed Central

    Reilly, Philip M.

    1981-01-01

    During one year all initial attendance from one Belfast general practice to local accident and emergency departments was studied. Of the 784 attenders, 616 (78.4 per cent) referred themselves; the remaining 168 (21.6 per cent) were referred by the general practitioners. The clinical and social characteristics of both groups are compared. The discussion focuses on the appropriate use of primary care and accident and emergency services. PMID:7277300

  1. An interdisciplinary memory clinic: a novel practice setting for pharmacists in primary care.

    PubMed

    Rojas-Fernandez, Carlos H; Patel, Tejal; Lee, Linda

    2014-06-01

    Pharmacists have developed innovative practices in various settings as singular providers or as members of multidisciplinary or interdisciplinary teams. Examples include pharmacists practicing in heart failure, hypertension, or hyperlipidemia clinics. There is a paucity of literature describing pharmacists in interdisciplinary memory clinics and specifically pharmacists practicing in interdisciplinary, primary care-based memory clinics. New practice models should be disseminated to guide others in the development of similar models given the complexity of this population. Patients with dementia are more difficult to manage because of cognitive impairment, behavioral and psychological symptoms, the common presence of multiple comorbidities, and related polypharmacy and caregiver issues. These challenges require expertise in neurodegenerative disorders and geriatrics. The purpose of this article is to describe the role of clinical pharmacists providing care to patients with cognitive complaints in a primary care-based, interdisciplinary memory clinic, with a focus on how the pharmacist practices and is integrated in this collaborative care setting. Patients are assessed using an interdisciplinary approach, with team consensus for assessment and planning of care. Pharmacists' activities include assessment of (1) appropriateness of medications based on frailty, (2) medications that can impair cognition and/or function, (3) medication adherence and management skills, and (4) vascular risk factor control. Pharmacists provide education regarding medications and diseases, ensure appropriate transitions in care, and conduct home visits. Pharmacist participation in this clinic represents a novel opportunity to advance pharmacy practice in primary care, interdisciplinary models. Work is ongoing to describe outcomes attributable to pharmacist participation in this clinic.

  2. Structured sedation programs in the emergency department, hospital and other acute settings: protocol for systematic review of effects and events

    PubMed Central

    2013-01-01

    Background The use of procedural sedation outside the operating theatre has increased in hospital settings and has gained popularity among non-anesthesiologists. Sedative agents used for procedural pain, although effective, also pose significant risks to the patient if used incorrectly. There is currently no universally accepted program of education for practitioners using or introducing procedural sedation into their practice. There is emerging literature identifying structured procedural sedation programs (PSPs) as a method of ensuring a standardized level of competency among staff and reducing risks to the patient. We hypothesize that programs of education for healthcare professionals using procedural sedation outside the operating theatre are beneficial in improving patient care, safety, practitioner competence and reducing adverse event rates. Methods/Design Electronic databases will be systematically searched for studies (randomized and non-randomized) examining the effectiveness of structured PSPs from 1966 to present. Database searches will be supplemented by contact with experts, reference and citation checking, and a grey literature search. No language restriction will be imposed. Screening of titles and abstracts, and data extraction will be performed by two independent reviewers. All disagreements will be resolved by discussion with an independent third party. Data analysis will be completed adhering to procedures outlined in the Cochrane Handbook of Systematic Reviews of Interventions. If the data allows, a meta-analysis will be performed. Discussion This review will cohere evidence on the effectiveness of structured PSPs on sedation events and patient outcomes within the hospital and other acute care settings. In addition, it will examine key components identified within a PSP associated with patient safety and improved patient outcomes. Trial registration PROSPERO registration number: CRD42013003851 PMID:24083519

  3. Antibiogram of Medical Intensive Care Unit at Tertiary Care Hospital Setting of Pakistan

    PubMed Central

    Qadeer, Aayesha; Akhtar, Aftab; Ain, Qurat Ul; Saadat, Shoab; Mansoor, Salman; Ishtiaq, Wasib; Ilyas, Abid; Khan, Ali Y; Ajam, Yousaf

    2016-01-01

    Objective: To determine the frequency of micro-organisms causing sepsis as well as to determine the antibiotic susceptibility and resistance of microorganisms isolated in a medical intensive care unit. Materials and methods: This is a cross-sectional analysis of 802 patients from a medical intensive care unit (ICU) of Shifa International Hospital, Islamabad, Pakistan over a one-year period from August 2015 to August 2016. Specimens collected were from blood, urine, endotracheal secretions, catheter tips, tissue, pus swabs, cerebrospinal fluid, ascites, bronchoalveolar lavage (BAL), and pleural fluid. All bacteria were identified by standard microbiological methods, and antibiotic sensitivity/resistance was performed using the disk diffusion technique, according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Data was collected using a critical care unit electronic database and data analysis was done by using  the Statistical Package for Social Sciences (SPSS), version 20 (IBM SPSS Statistics, Armonk, NY). Results: Gram-negative bacteria were more frequent as compared to gram-positive bacteria. Most common bacterial isolates were Acinetobacter (15.3%), Escherichia coli (15.3%), Pseudomonas aeruginosa (13%), and Klebsiella pneumoniae (10.2%), whereas Enterococcus (7%) and methicillin-resistant staphylococcus aureus (MRSA) (6.2%) were the two most common gram-positive bacteria. For Acinetobacter, colistin was the most effective antibiotic (3% resistance). For E.coli, colistin (0%), tigecycline (0%), amikacin (7%), and carbapenems (10%) showed low resistance. Pseudomonas aeruginosa showed low resistance to colistin (7%). For Klebsiella pneumoniae, low resistance was seen for tigecycline (0%) and minocycline (16%). Overall, ICU mortality was 31.3%, including miscellaneous cases. Conclusion: Gram-negative infections, especially by multidrug-resistant organisms, are on the rise in ICUs. Empirical antibiotics should be used according to the local

  4. Health Care Utilisation and Transitions between Health Care Settings in the Last 6 Months of Life in Switzerland

    PubMed Central

    Bähler, Caroline; Signorell, Andri; Reich, Oliver

    2016-01-01

    Background Many efforts are undertaken in Switzerland to enable older and/or chronically ill patients to stay home longer at the end-of-life. One of the consequences might be an increased need for hospitalisations at the end-of-life, which goes along with burdensome transitions for patients and higher health care costs for the society. Aim We aimed to examine the health care utilisation in the last six months of life, including transitions between health care settings, in a Swiss adult population. Methods The study population consisted of 11'310 decedents of 2014 who were insured at the Helsana Group, the leading health insurance in Switzerland. Descriptive statistics were used to analyse the health care utilisation by age group, taking into account individual and regional factors. Zero-inflated Poisson regression model was used to predict the number of transitions. Results Mean age was 78.1 in men and 83.8 in women. In the last six months of life, 94.7% of the decedents had at least one consultation; 61.6% were hospitalised at least once, with a mean length of stay of 28.3 days; and nursing home stays were seen in 47.4% of the decedents. Over the same time period, 64.5% were transferred at least once, and 12.9% experienced at least one burdensome transition. Main predictors for transitions were age, sex and chronic conditions. A high density of home care nurses was associated with a decrease, whereas a high density of ambulatory care physicians was associated with an increase in the number of transitions. Conclusions Health care utilisation was high in the last six months of life and a considerable number of decedents were being transferred. Advance care planning might prevent patients from numerous and particularly from burdensome transitions. PMID:27598939

  5. Exemplary Care and Learning Sites: A Model for Achieving Continual Improvement in Care and Learning in the Clinical Setting

    PubMed Central

    Ogrinc, Greg; Hoffman, Kimberly G.; Stevenson, Katherine M.; Shalaby, Marc; Beard, Albertine S.; Thörne, Karin E.; Coleman, Mary T.; Baum, Karyn D.

    2016-01-01

    Problem Current models of health care quality improvement do not explicitly describe the role of health professions education. The authors propose the Exemplary Care and Learning Site (ECLS) model as an approach to achieving continual improvement in care and learning in the clinical setting. Approach From 2008–2012, an iterative, interactive process was used to develop the ECLS model and its core elements—patients and families informing process changes; trainees engaging both in care and the improvement of care; leaders knowing, valuing, and practicing improvement; data transforming into useful information; and health professionals competently engaging both in care improvement and teaching about care improvement. In 2012–2013, a three-part feasibility test of the model, including a site self-assessment, an independent review of each site’s ratings, and implementation case stories, was conducted at six clinical teaching sites (in the United States and Sweden). Outcomes Site leaders reported the ECLS model provided a systematic approach toward improving patient (and population) outcomes, system performance, and professional development. Most sites found it challenging to incorporate the patients and families element. The trainee element was strong at four sites. The leadership and data elements were self-assessed as the most fully developed. The health professionals element exhibited the greatest variability across sites. Next Steps The next test of the model should be prospective, linked to clinical and educa tional outcomes, to evaluate whether it helps care delivery teams, educators, and patients and families take action to achieve better patient (and population) outcomes, system performance, and professional development. PMID:26760058

  6. Organizational factors and depression management in community-based primary care settings

    PubMed Central

    2009-01-01

    Background Evidence-based quality improvement models for depression have not been fully implemented in routine primary care settings. To date, few studies have examined the organizational factors associated with depression management in real-world primary care practice. To successfully implement quality improvement models for depression, there must be a better understanding of the relevant organizational structure and processes of the primary care setting. The objective of this study is to describe these organizational features of routine primary care practice, and the organization of depression care, using survey questions derived from an evidence-based framework. Methods We used this framework to implement a survey of 27 practices comprised of 49 unique offices within a large primary care practice network in western Pennsylvania. Survey questions addressed practice structure (e.g., human resources, leadership, information technology (IT) infrastructure, and external incentives) and process features (e.g., staff performance, degree of integrated depression care, and IT performance). Results The results of our survey demonstrated substantial variation across the practice network of organizational factors pertinent to implementation of evidence-based depression management. Notably, quality improvement capability and IT infrastructure were widespread, but specific application to depression care differed between practices, as did coordination and communication tasks surrounding depression treatment. Conclusions The primary care practices in the network that we surveyed are at differing stages in their organization and implementation of evidence-based depression management. Practical surveys such as this may serve to better direct implementation of these quality improvement strategies for depression by improving understanding of the organizational barriers and facilitators that exist within both practices and practice networks. In addition, survey information can

  7. Health care professionals' perspectives of advance care planning for people with dementia living in long-term care settings: A narrative review of the literature.

    PubMed

    Beck, Esther-Ruth; McIlfatrick, Sonja; Hasson, Felicity; Leavey, Gerry

    2015-09-16

    This paper provides an overview of the evidence on the perspective of health care professionals (HCPs) in relation to advance care planning (ACP) for people with dementia, residing in long-term care settings. A narrative approach was adopted to provide a comprehensive synthesis of previously published literature in the area. A systematic literature search identified 14 papers for inclusion. Following review of the studies four themes were identified for discussion; Early integration and planning for palliative care in dementia; HCPs ethical and moral concerns regarding ACP; Communication challenges when interacting with the person with dementia and their families and HCPs need for education and training. Despite evidence, that HCPs recognise the potential benefits of ACP, they struggle with its implementation in this setting. Greater understanding of dementia and the concept of ACP is required to improve consistency in practice. Synthesising the existing evidence will allow for further understanding of the key issues, potentially resulting in improved implementation in practice.

  8. The emergence of the vertical birth in Ecuador: an analysis of agenda setting and policy windows for intercultural health

    PubMed Central

    Llamas, Ana; Mayhew, Susannah

    2016-01-01

    Maternal mortality continues to claim the lives of thousands of women in Latin America despite the availability of effective treatments to avert maternal death. In the past, efforts to acknowledge cultural diversity in birth practices had not been clearly integrated into policy. However, in Otavalo (Ecuador) a local hospital pioneered the implementation of the ‘Vertical Birth’—a practical manifestation of an intercultural health policy aimed at increasing indigenous women’s access to maternity care. Drawing on agenda-setting theory, this qualitative research explores how the vertical birth practice made it onto the local policy agenda and the processes that allowed actors to seize a window of opportunity allowing the vertical birth practice to emerge. Our results show that the processes that brought about the vertical birth practice took place over a prolonged period of time and resulted from the interplay between various factors. Firstly, a maternal health policy community involving indigenous actors played a key role in identifying maternal mortality as a policy problem, defining its causes and framing it as an indigenous rights issue. Secondly, previous initiatives to address maternal mortality provided a wealth of experience that gave these actors the knowledge and experience to formulate a feasible policy solution and consolidate support from powerful actors. Thirdly, the election of a new government that had incorporated the demands of the indigenous movement opened up a window of opportunity to push intercultural health policies such as the vertical birth. We conclude that the socioeconomic and political changes at both national and local level allowed the meaningful participation of indigenous actors that made a critical contribution to the emergence of the vertical birth practice. These findings can help us advance our knowledge of strategies to set the agenda for intercultural maternal health policy and inform future policy in similar settings

  9. Factors Affecting Patient Satisfaction With Emergency Department Care: An Italian Rural Hospital

    PubMed Central

    Messina, Gabriele; Vencia, Francesco; Mecheroni, Silvana; Dionisi, Susanna; Baragatti, Lorenzo; Nante, Nicola

    2015-01-01

    Background: In the emergency department satisfaction is strictly linked to the role of the nurses, namely the first interface between patients and hospital services. Objectives: The purpose of the study was to identify areas of emergency nursing activity associated with minor or major patient satisfaction. Methods: A descriptive cross-sectional study was conducted from December 2010 - May 2011, in the rural hospital of Orbetello, Tuscany (Italy). Convenience sampling was used to select patients, namely patients presenting at the emergency unit in the study period. The Consumer Emergency Care Satisfaction Scale was used to collect information on two structured subscale (Caring and Teaching). Results: 259 questionnaire were collected. Analysis indicated that only two characteristics significantly influenced overall satisfaction: “receiving continuous information from personnel about delay” positively effect (OR=7.98; p=0.022) while “waiting time for examination” had a negative effect (OR 0.42; p=0.026) Conclusions: The study was the first conduced in Italy using this instrument that enabled to obtain much important information about patient satisfaction with nursing care received in the emergency department. The results showing improvements must be related to educational aspects, such as explaining patients the colour waiting list, and communication towards patients, such as informing about emergences that cause queue. PMID:25946915

  10. 911 (nueve once): Spanish-speaking parents' perspectives on prehospital emergency care for children.

    PubMed

    Watts, Jennifer; Cowden, John D; Cupertino, A Paula; Dowd, M Denise; Kennedy, Chris

    2011-06-01

    Racial, ethnic and language-based disparities occur throughout the US health system. Pediatric prehospital emergency medical services are less likely to be used by Latinos. We identified perceptions of and barriers to prehospital pediatric emergency care (911) access among Spanish-speaking parents. A qualitative study involving six focus groups was conducted. Spanish-speaking parents participated with a bilingual moderator. Topics discussed included experiences, knowledge, beliefs, fears, barriers, and improvement strategies. All groups were audiotaped, transcribed, and reviewed for recurring themes. Forty-nine parents participated. Though parents believed 911 was available to all, many were uncertain how to use it, and what qualified as an emergency. Barriers included language discordance, fear of exposing immigration status, and fear of financial consequences. Parents strongly desired to learn more about 911 through classes, brochures, and media campaigns. Prehospital emergency care should be available to all children. Further quantitative studies may help solidify the identified barriers and uncover areas needing improvement within Emergency Medical Systems. Addressing barriers to 911 use in Spanish-speaking communities could improve the equity of health care delivery, while also decreasing the amount of non-emergency 911 use.

  11. Elderly patients’ participation in emergency medical services when offered an alternative care pathway

    PubMed Central

    Vicente, Veronica; Castren, Maaret; Sjöstrand, Fredrik; Sundström, Birgitta Wireklint

    2013-01-01

    As organizational changes in the healthcare system are in progress, to enhance care quality and reduce costs, it is important to investigate how these changes affect elderly patients’ experiences and their rights to participate in the choice of healthcare. The aim of this study is to describe elderly patients’ lived experience of participating in the choice of healthcare when being offered an alternative care pathway by the emergency medical services, when the individual patient's medical needs made this choice possible. This study was carried out from the perspective of caring science, and a phenomenological approach was applied, where data were analysed for meaning. Data consist of 11 semi-structured interviews with elderly patients who chose a healthcare pathway to a community-based hospital when they were offered an alternative level of healthcare. The findings show that the essence of the phenomenon is described as “There was a ray of hope about a caring encounter and about being treated like a unique human being”. Five meaningful constituents emerged in the descriptions: endurable waiting, speedy transference, a concerned encounter, trust in competence, and a choice based on memories of suffering from care. The conclusion is that patient participation in the choice of a healthcare alternative instead of the emergency department is an opportunity of avoiding suffering from care and being objectified. PMID:23445898

  12. Assessment of Chronic Illness Care with the German version of the ACIC in different primary care settings in Switzerland

    PubMed Central

    2010-01-01

    Background In Switzerland the extent to which patients with chronic illnesses receive care congruent with the Chronic Care Model (CCM) is unknown. Methods According to guidelines we translated the Assessment of Chronic Illness Care (ACIC) into German (G-ACIC). We tested the instrument in different primary care settings and compared subscales with the original testing. Results Difficulties encountered during the translation process consisted in the difference of health care settings in Switzerland and USA. However initial testing showed the G-ACIC to be a suitable instrument. The average ACIC subscale scores in Swiss managed care (MC)-, group (GP)- and single handed practices (SP) were higher for MC practices than for group- and single handed practices: Organization of the healthcare delivery system: MC mean (m) = 6.80 (SD 1.55), GP m = 5.42 (SD 0.99), SP m = 4.60 (SD 2.07); community linkages: MC m = 4.19 (SD 1.47), GP m = 4.83 (SD 1.81), SP m = 3.10 (SD 2.12); self-management support: MC m = 4.96 (SD 1.13), GP m = 4.73 (SD 1.40), SP m = 4.43 (SD 1.34); decision support: MC m = 4.75 (SD 1.06); GP m = 4.20 (SD 0.87), SP m = 3.25 (SD 1.59); delivery system design: MC m = 5.98 (SD 1.61), GP m = 5.05 (SD 2.05), SP m = 3.86 (SD 1.51) and clinical information systems: MC m = 4.34 (SD = 2.49), GP m = 2.06 (SD 1.35), SP m = 3.20 (SD 1.57). Conclusions The G-ACIC is applicable and useful for comparing different health care settings in German speaking countries. Managed care organizations seem to implement the different components of the CCM in a greater extend than group and single handed practices. However, much room exists for further improvement. PMID:20979632

  13. Team behaviors in emergency care: a qualitative study using behavior analysis of what makes team work

    PubMed Central

    2011-01-01

    Objective Teamwork has been suggested as a promising approach to improving care processes in emergency departments (ED). However, for teamwork to yield expected results, implementation must involve behavior changes. The aim of this study is to use behavior analysis to qualitatively examine how teamwork plays out in practice and to understand eventual discrepancies between planned and actual behaviors. Methods The study was set in a Swedish university hospital ED during the initial phase of implementation of teamwork. The intervention focused on changing the environment and redesigning the work process to enable teamwork. Each team was responsible for entire care episodes, i.e. from patient arrival to discharge from the ED. Data was collected through 3 days of observations structured around an observation scheme. Behavior analysis was used to pinpoint key teamwork behaviors for consistent implementation of teamwork and to analyze the contingencies that decreased or increased the likelihood of these behaviors. Results We found a great discrepancy between the planned and the observed teamwork processes. 60% of the 44 team patients observed were handled solely by the appointed team members. Only 36% of the observed patient care processes started according to the description in the planned teamwork process, that is, with taking patient history together. Beside this behavior, meeting in a defined team room and communicating with team members were shown to be essential for the consistent implementation of teamwork. Factors that decreased the likelihood of these key behaviors included waiting for other team members or having trouble locating each other. Getting work done without delay and having an overview of the patient care process increased team behaviors. Moreover, explicit instructions on when team members should interact and communicate increased adherence to the planned process. Conclusions This study illustrates how behavior analysis can be used to understand

  14. Person-Centered Care in the Home Setting for Parkinson's Disease: Operation House Call Quality of Care Pilot Study

    PubMed Central

    Akbar, Umer; Eilers, Amanda; Thompson-Avila, Amanda; Malaty, Irene A.; Okun, Michael S.

    2015-01-01

    Objective. (1) To evaluate the feasibility of implementing and evaluating a home visit program for persons with Parkinson's disease (PD) in a rural setting. (2) To have movement disorders fellows coordinate and manage health care delivery. Background. The University of Florida, Center for Movement Disorders and Neurorestoration established Operation House Call to serve patients with PD who could not otherwise afford to travel to an expert center or to pay for medical care. PD is known to lead to significant disability, frequent hospitalization, early nursing home placement, and morbidity. Methods. This was designed as a quality improvement project. Movement disorders fellows travelled to the home(s) of underserved PD patients and coordinated their clinical care. The diagnosis of Parkinson's disease was confirmed using standardized criteria, and the Unified Parkinson's Disease Rating Scale was performed and best treatment practices were delivered. Results. All seven patients have been followed up longitudinally every 3 to 6 months in the home setting, and they remain functional and independent. None of the patients have been hospitalized for PD related complications. Each patient has a new updatable electronic medical record. All Operation House Call cases are presented during video rounds for the interdisciplinary PD team to make recommendations for care (neurology, neurosurgery, neuropsychology, psychiatry, physical therapy, occupational therapy, speech therapy, and social work). One Operation House Call patient has successfully received deep brain stimulation (DBS). Conclusion. This program is a pilot program that has demonstrated that it is possible to provide person-centered care in the home setting for PD patients. This program could provide a proof of concept for the construction of a larger visiting physician or nurse program. PMID:26078912

  15. Person-Centered Care in the Home Setting for Parkinson's Disease: Operation House Call Quality of Care Pilot Study.

    PubMed

    Hack, Nawaz; Akbar, Umer; Monari, Erin H; Eilers, Amanda; Thompson-Avila, Amanda; Hwynn, Nelson H; Sriram, Ashok; Haq, Ihtsham; Hardwick, Angela; Malaty, Irene A; Okun, Michael S

    2015-01-01

    Objective. (1) To evaluate the feasibility of implementing and evaluating a home visit program for persons with Parkinson's disease (PD) in a rural setting. (2) To have movement disorders fellows coordinate and manage health care delivery. Background. The University of Florida, Center for Movement Disorders and Neurorestoration established Operation House Call to serve patients with PD who could not otherwise afford to travel to an expert center or to pay for medical care. PD is known to lead to significant disability, frequent hospitalization, early nursing home placement, and morbidity. Methods. This was designed as a quality improvement project. Movement disorders fellows travelled to the home(s) of underserved PD patients and coordinated their clinical care. The diagnosis of Parkinson's disease was confirmed using standardized criteria, and the Unified Parkinson's Disease Rating Scale was performed and best treatment practices were delivered. Results. All seven patients have been followed up longitudinally every 3 to 6 months in the home setting, and they remain functional and independent. None of the patients have been hospitalized for PD related complications. Each patient has a new updatable electronic medical record. All Operation House Call cases are presented during video rounds for the interdisciplinary PD team to make recommendations for care (neurology, neurosurgery, neuropsychology, psychiatry, physical therapy, occupational therapy, speech therapy, and social work). One Operation House Call patient has successfully received deep brain stimulation (DBS). Conclusion. This program is a pilot program that has demonstrated that it is possible to provide person-centered care in the home setting for PD patients. This program could provide a proof of concept for the construction of a larger visiting physician or nurse program.

  16. Child Care Enrollment Decisions Among Dual Language Learner Families: The Role of Spanish Language Instruction in the Child Care Setting

    PubMed Central

    Miller, Elizabeth B.

    2016-01-01

    Data from the Head Start Impact Study (N = 1,141) and the Head Start Family and Child Experiences Survey, 2009 Cohort (N = 825) were used to describe child care enrollment decisions among Spanish-speaking Dual Language Learner (DLL) families. In particular, logistic regression models tested which child, family, and institutional characteristics predicted enrollment in early care and education (ECE) settings that used Spanish for instruction versus enrollment in settings that did not use Spanish. Results showed that whether the child’s first language was exclusively Spanish and whether other DLL families previously attended the ECE arrangement strongly predicted whether that child enrolled. Policy implications for Head Start-eligible Spanish-speaking DLLs are discussed. PMID:26900255

  17. Cerebral Microdialysis for Protein Biomarker Monitoring in the Neurointensive Care Setting – A Technical Approach

    PubMed Central

    Hillered, Lars; Dahlin, Andreas P.; Clausen, Fredrik; Chu, Jiangtao; Bergquist, Jonas; Hjort, Klas; Enblad, Per; Lewén, Anders

    2014-01-01

    Cerebral microdialysis (MD) was introduced as a neurochemical monitoring method in the early 1990s and is currently widely used for the sampling of low molecular weight molecules, signaling energy crisis, and cellular distress in the neurointensive care (NIC) setting. There is a growing interest in MD for harvesting of intracerebral protein biomarkers of secondary injury mechanisms in acute traumatic and neurovascular brain injury in the NIC community. The initial enthusiasm over the opportunity to sample protein biomarkers with high molecular weight cut-off MD catheters has dampened somewhat with the emerging realization of inherent methodological problems including protein–protein interaction, protein adhesion, and biofouling, causing an unstable in vivo performance (i.e., fluid recovery and extraction efficiency) of the MD catheter. This review will focus on the results of a multidisciplinary collaborative effort, within the Uppsala Berzelii Centre for Neurodiagnostics during the past several years, to study the features of the complex process of high molecular weight cut-off MD for protein biomarkers. This research has led to new methodology showing robust in vivo performance with optimized fluid recovery and improved extraction efficiency, allowing for more accurate biomarker monitoring. In combination with evolving analytical methodology allowing for multiplex biomarker analysis in ultra-small MD samples, a new opportunity opens up for high-resolution temporal mapping of secondary injury cascades, such as neuroinflammation and other cell injury reactions directly in the injured human brain. Such data may provide an important basis for improved characterization of complex injuries, e.g., traumatic and neurovascular brain injury, and help in defining targets and treatment windows for neuroprotective drug development. PMID:25520696

  18. A critical policy analysis of an emerging agenda for home care in one Canadian province.

    PubMed

    Duncan, Susan; Reutter, Linda

    2006-05-01

    Amidst projections of the increased care demands and expectations for home care, policy in this area demands urgent attention. Home care is inherently complex as it challenges us to deliberate fundamental issues of responsibility for care, and the limits of care for people in their most immediate contexts and needs. This research takes the form of a critical policy analysis of the interaction of the context, process and content of policy proposals in home care in a regional health system in one Canadian province. The method of study includes thematic and comparative analyses of perspectives derived from policy documents, and interviews with policy actors (decision-makers, healthcare providers, public advocates) regarding their perspectives of policy problems and processes. The content and process of policy in home care interact in important ways with political, economic, social and historical contexts. This critical analysis revealed that the emerging policy agenda in regional home care is one of medicalisation, which stands in contrast to the principles of primary health care, and potentially leads to further marginalisation of the most vulnerable. This contrast is characterised by tensions between the fundamental values of equity and efficiency, choice and universality, and public vis-à-vis individual responsibility for the provision of care.

  19. Convergence and divergence: assessing criteria of consumer satisfaction across general practice, dental and hospital care settings.

    PubMed

    Williams, S J; Calnan, M

    1991-01-01

    This paper describes the results of the first-stage of a study carried out in the spring of 1988 in the South East of England. The study looked at general and specific aspects of consumer satisfaction with general practitioner services, general dental care services and hospital in-patients care. It also examined which specific consumer criteria were the key predictors of overall satisfaction within each of these particular medical care settings. A related aim was to assess the degree of congruence or divergence of consumer criteria across these differing medical care settings. The evidence suggests that whilst general levels of consumer satisfaction are high (i.e. 83-97%), questions of a more detailed and specific nature revealed greater levels of expressed dissatisfaction (e.g. 38% of the sample felt that they could not discuss personal problems with their GP, 51% felt their dentist was not easy to reach at weekends/holidays, whilst 35% felt hospital doctors did not give sufficient information). Whilst different areas of dissatisfaction were found in each specific medical care setting examined, what was particularly striking was the degree of convergence of the key predictors of overall consumer satisfaction across the medical care settings. That is to say, our findings clearly suggest that issues concerning 'professional competence', together with the nature and quality of the patient-professional relationship, are the key predictors of overall consumer satisfaction with general practice, dental and hospital care [e.g. GP giving sufficient information correlated 0.64 (P less than 0.001) with overall GP satisfaction scores; competent dentist 0.52 (P less than 0.001) with overall dental satisfaction scores; and full confidence in hospital doctors 0.49 (P less than 0.001) with overall hospital satisfaction scores]. The theoretical importance and policy implications of these findings, particularly in the light of the recent NHS reforms, are discussed.

  20. Predictors of patient satisfaction in an emergency care centre in central Saudi Arabia: a prospective study

    PubMed Central

    Abolfotouh, Mostafa A; Al-Assiri, Mohammed H; Alshahrani, Rabab T; Almutairi, Zainab M; Hijazi, Raid A; Alaskar, Ahmed S

    2017-01-01

    Aim This study aimed to (i) assess the level of patient satisfaction and its association with different sociodemographic and healthcare characteristics in an emergency care centre (ECC) in Saudi Arabia and (ii) to identify the predictors of patients' satisfaction. Methods A prospective cohort study of 390 adult patients with Canadian triage category III and IV who visited ECC at King Abdulaziz Medical City, Riyadh, Saudi Arabia, between 1 July and end of September 2011 was conducted. All patients were followed up from the time of arrival at the front desk of ECC until being seen by a doctor, and were then interviewed. Patient satisfaction was measured using a previously validated interview-questionnaire, within two domains: clarity of medical information and relationship with staff. Patient perception of health status after as compared with before the visit, and overall life satisfaction were also measured. Data on patient characteristics and healthcare characteristics were collected. Multiple linear regression analysis was used, and significance was considered at p≤0.05. Results One-third (32.8%) of patients showed high level of overall satisfaction and 26.7% were unsatisfied, with percentage mean score of 70.36% (17.40), reflecting moderate satisfaction. After adjusting for all potential confounders, lower satisfaction with the ED visit was significantly associated with male gender (p<0.001), long waiting time (p=0.032) and low perceived health status compared with status at admission (p<0.001). Overall life satisfaction was not a significant predictor of patient satisfaction. Conclusions An appreciation of waiting time as the only significant modifiable risk factor of patient satisfaction is essential to improve the healthcare services, especially at emergency settings. PMID:27480456

  1. The Development and Psychometric Properties of the Humanitarian Emergency Settings Perceived Needs (HESPER) Scale

    PubMed Central

    Semrau, Maya; van Ommeren, Mark; Blagescu, Monica; Griekspoor, Andre; Howard, Louise M.; Jordans, Mark; Lempp, Heidi; Marini, Anita; Pedersen, Jon; Pilotte, Isabelle; Slade, Mike

    2012-01-01

    Objectives. We developed the Humanitarian Emergency Settings Perceived Needs (HESPER) Scale, a valid and reliable scale to rapidly assess perceived needs of populations in humanitarian settings in low- and middle-income countries. Methods. We generated items through a literature review; reduced the number of items on the basis of a survey with humanitarian experts; pilot-tested the scale in Gaza, Jordan, Sudan, and the United Kingdom; and field-tested it in Haiti, Jordan, and Nepal. Results. During field-testing, intraclass correlation coefficients (absolute agreement) for the total number of unmet needs were 0.998 in Jordan, 0.986 in Haiti, and 0.995 in Nepal (interrater reliability), and 0.961 in Jordan and 0.773 in Nepal (test–retest reliability). Cohen’s κ for the 26 individual HESPER items ranged between 0.66 and 1.0 (interrater reliability) and between 0.07 and 1.0 (test–retest reliability) across sites. Most HESPER items correlated as predicted with related questions of the World Health Organization Quality of Life-100 (WHOQOL-100), and participants found items comprehensive and relevant, suggesting criterion (concurrent) validity and content validity. Conclusions. The HESPER Scale rapidly provides valid and reliable population-based data on perceived needs in humanitarian settings. PMID:22897533

  2. [The expertise evaluation of organization of rendering of acute, emergency and urgent medical care in rural regions of Novosibirsk oblast'].

    PubMed

    Ivaninskiĭ, O I; Sharapov, I V; Sadovoĭ, M A

    2013-01-01

    The most problematic spheres in the resource support of emergency medical care to rural residents are the completeness of staff of physicians in rural medical surgeries, community hospitals and departments of emergency medical care in central district hospitals. The provision of feldsher obstetrics posts with sanitary motor transport and medical equipment is yet another problematic sphere. The main troubles during provision of emergency medical care at feldsher obstetrics posts are related to surgery treatment. The organization of emergency and urgent medical care suffers of many unresolved problems related to informational program support at feldsher obstetrics posts, polyclinics of central district hospitals.

  3. Infection Prevention and Control for Ebola in Health Care Settings - West Africa and United States.

    PubMed

    Hageman, Jeffrey C; Hazim, Carmen; Wilson, Katie; Malpiedi, Paul; Gupta, Neil; Bennett, Sarah; Kolwaite, Amy; Tumpey, Abbigail; Brinsley-Rainisch, Kristin; Christensen, Bryan; Gould, Carolyn; Fisher, Angela; Jhung, Michael; Hamilton, Douglas; Moran, Kerri; Delaney, Lisa; Dowell, Chad; Bell, Michael; Srinivasan, Arjun; Schaefer, Melissa; Fagan, Ryan; Adrien, Nedghie; Chea, Nora; Park, Benjamin J

    2016-07-08

    The 2014-2016 Ebola virus disease (Ebola) epidemic in West Africa underscores the need for health care infection prevention and control (IPC) practices to be implemented properly and consistently to interrupt transmission of pathogens in health care settings to patients and health care workers. Training and assessing IPC practices in general health care facilities not designated as Ebola treatment units or centers became a priority for CDC as the number of Ebola virus transmissions among health care workers in West Africa began to affect the West African health care system and increasingly more persons became infected. CDC and partners developed policies, procedures, and training materials tailored to the affected countries. Safety training courses were also provided to U.S. health care workers intending to work with Ebola patients in West Africa. As the Ebola epidemic continued in West Africa, the possibility that patients with Ebola could be identified and treated in the United States became more realistic. In response, CDC, other federal components (e.g., Office of the Assistant Secretary for Preparedness and Response) and public health partners focused on health care worker training and preparedness for U.S. health care facilities. CDC used the input from these partners to develop guidelines on IPC for hospitalized patients with known or suspected Ebola, which was updated based on feedback from partners who provided care for Ebola patients in the United States. Strengthening and sustaining IPC helps health care systems be better prepared to prevent and respond to current and future infectious disease threats.The activities summarized in this report would not have been possible without collaboration with many U.S. and international partners (http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/partners.html).

  4. Beyond emergencies: the use of physical restraints in medical and psychiatric settings.

    PubMed

    Glezer, Anna; Brendel, Rebecca Weintraub

    2010-01-01

    Physical restraints, such as locked-door seclusion and two- or four-point leather restraints, are frequently used in both the medical and psychiatric settings. Efforts are currently under way to reduce the use of physical restraints in psychiatric settings; various institutional, state, and federal policies are place. However, using these same restraints in the context of providing medical care for psychiatric patients is more complicated, as it is uncertain which principles and regulations apply in a particular setting. For example, is the restraint governed by the policies that regulate the psychiatric application of restraints, by those that regulate the medical application of restraints, or by both? This article reviews the principles and regulations governing the use of restraints on psychiatric patients, with specific attention to the use of restraints in providing medical treatment to that patient population. Also addressed are general principles of risk management to help avoid negative outcomes and to reduce the risk of litigation for unauthorized or unlawful restraint. A case example is used to illustrate these concepts.

  5. Recommendations for renovating an operating theater at an emergency obstetric care facility.

    PubMed

    Abreu, E; Potter, D

    2001-12-01

    The importance of emergency obstetric care (EmOC) in reducing maternal mortality has focused attention on both the skills of the clinicians to provide high quality care and on the health facilities in which the care is provided. Essential elements of EmOC include the capacity to perform cesarean sections for which an operating theater is needed. This article focuses on renovation of existing operating theaters to meet the necessary standards. While building, adding to, or renovating operating theaters can be expensive, this article emphasizes appropriate materials that are likely to be locally available and relatively inexpensive. The importance of proper maintenance is discussed.

  6. Experience in Strategic Networking to Promote Palliative Care in a Clinical Academic Setting in India

    PubMed Central

    Nair, Shoba; Tarey, SD; Barathi, B; Mary, Thiophin Regina; Mathew, Lovely; Daniel, Sudha Pauline

    2016-01-01

    Background: Palliative care in low and middle-income countries is a new discipline, responding to a greater patient need, than in high-income countries. By its very nature, palliative as a specialty has to network with other specialties to provide quality care to patients. For any medical discipline to grow as a specialty, it should be well established in the teaching medical institutions of that country. Data show that palliative care is more likely to establish and grow in an academic health care institution. It is a necessity that multiple networking strategies are adopted to reach this goal. Objectives: (1) To describe a strategic approach to palliative care service development and integration into clinical academic setting. (2) To present the change in metrics to evaluate progress. Design and Setting: This is a descriptive study wherein, the different strategies that are adopted by the Department of Palliative Medicine for networking in an academic health care institution and outside the institution are scrutinized. Measurement: The impact of this networking was assessed, one, at the level of academics and the other, at the level of service. The number of people who attended various training programs conducted by the department and the number of patients who availed palliative care service over the years were assessed. Results: Ten different strategies were identified that helped with networking of palliative care in the institution. During this time, the referrals to the department increased both for malignant diseases (52–395) and nonmalignant diseases (5–353) from 2000 to 2013. The academic sessions conducted by the department for undergraduates also saw an increase in the number of hours from 6 to 12, apart from the increase in a number of courses conducted by the department for doctors and nurses. Conclusion: Networking is an essential strategy for the establishment of a relatively new medical discipline like palliative care in a developing and

  7. Characteristics and mortality of neonates in an emergency obstetric and neonatal care facility, rural Burundi

    PubMed Central

    Van den Bergh, R.; Ndelema, B.; Bulckaert, D.; Manzi, M.; Lambert, V.; Zachariah, R.; Reid, A. J.; Harries, A. D.

    2013-01-01

    Setting: A Médecins Sans Frontières emergency obstetric and neonatal care facility specialising as a referral centre for three districts for women with complications during pregnancy or delivery in rural Burundi. Objective: To describe the characteristics and in-facility mortality rates of neonates born in 2011. Design: Descriptive study involving a retrospective review of routinely collected facility data. Results: Of 2285 women who delivered, the main complications were prolonged labour 331 (14%), arrested labour 238 (10%), previous uterine intervention 203 (9%), breech 171 (8%) and multiple gestations 150 (7%). There were 175 stillbirths and 2110 live neonates, of whom 515 (24%) were of low birth weight, 963 (46%) were delivered through caesarean section and 267 (13%) required active birth resuscitation. Overall, there were 102 (5%) neonatal deaths. A total of 453 (21%) neonates were admitted to dedicated neonatal special services for sick and low birth weight babies. A high proportion of these neonates were delivered by caesarean section and needed active birth resuscitation. Of 67 (15%) neonatal deaths in special services, 85% were due to conditions linked to low birth weight and birth asphyxia. Conclusion: Among neonates born to women with complications during pregnancy or delivery, in-facility deaths due to low birth weight and birth asphyxia were considerable. Sustained attention is needed to reduce these mortality rates. PMID:26393046

  8. A prospective observational study of quality of diabetes care in a shared care setting: trends and age differences (ZODIAC-19)

    PubMed Central

    van Hateren, Kornelis J J; Drion, Iefke; Kleefstra, Nanne; Groenier, Klaas H; Houweling, Sebastiaan T; van der Meer, Klaas; Bilo, Henk J G

    2012-01-01

    Objective The Zwolle Outpatient Diabetes project Integrating Available Care (ZODIAC) study was initiated in 1998 to investigate the effects of shared care for patients with type 2 diabetes mellitus (T2DM) in the Netherlands, and to reduce the number of diabetes-related complications. Benchmarking the performance of diabetes care was and is an important aspect of this study. We aimed to investigate trends in diabetes care, within the ZODIAC study for a wide variety of quality indicators during a long follow-up period (1998–2008), with special interest for different age groups. Design Prospective observational cohort study. Setting Primary care, Zwolle, The Netherlands. Participants Patients with T2DM. Methods A dataset of quality measures was collected annually during the patient's visit to the practice nurse or general practitioner. Linear time trends from 1998 to 2008 were estimated using linear mixed models in which we adjusted for age and gender. Age was included in the model as a categorical variable: for each follow-up year all participants were categorised into the categories <60, 60–75 and >75 years. Differences in trends between the age categories were investigated by adding an interaction term to the model. Results The number of patients who were reported to participate increased in the period 1998–2008 from 1622 to 27 438. All quality indicators improved in this study, except for body mass index. The prevalence albuminuria decreased in an 11-year-period from 42% to 21%. No relevant differences between the trends for the three age categories were observed. During all years of follow-up, mean blood pressure and body mass index were the lowest and highest, respectively, in the group of patients <60 years (data not shown). Conclusions Quality of diabetes care within the Dutch ZODIAC study, a shared care project, has considerably improved in the period 1998–2008. There were no relevant differences between trends across various age categories

  9. [Spiritual care in hospitals and other healthcare settings in Israel--a profession in the making].

    PubMed

    Bar-Sela, Gil; Bentur, Netta; Schultz, Michael; Corn, Benjamin W

    2014-05-01

    Faced with a serious, incurable illness, disability, and other symptoms, both physical and mental, some patients find themselves wondering about the meaning of their Lives. They need the help of a professional who can perceive their mental turmoil and identify their spiritual needs, and who knows how to help them find meaning in their uncertain state. Spiritual care providers are professionals whose role it is to provide patients with support in their hour of need, to help them preserve their identity in life-threatening situations, and to help them re-endow their world with meaning, employing a special language and set of tools that enable patients to get in touch with their spiritual resources and internal powers of healing. Spiritual care providers serve on the medical staff in Western countries. In the United States, some 2,600 are employed in general hospitals, psychiatric hospitals, long-term care facilities, and palliative care units. Approximately ten years ago, the profession began developing in Israel. Today, dozens of spiritual care providers are now working in the healthcare system. There is a spiritual care network with 21 member organizations. Although the profession is laying down roots in the healthcare system in this country, it is still in its infancy and has to contend with substantial barriers and challenges, including professional recognition, creating positions, and identifying sources of funding for positions. The profession still has much room to grow as it is further incorporated into the healthcare system and continues undergoing adaptation to the Israeli cultural setting.

  10. Infectious diarrhoea in children: controlling transmission in the child care setting.

    PubMed

    Thompson, S C

    1994-06-01

    An increase in the number of preschool children cared for within groups in child care centres has been associated with increasing numbers of women in the workforce. Children at this age are at high risk for gastrointestinal diseases caused by a large number of enteric pathogens, and the risk is increased by the greater potential for person-to-person transmission within group care. This report considers the pathogens that may cause diarrhoeal illness in children, with particular reference to those that have been reported in formal day care settings. The major risk factors for transmission of these agents and a high rate of diarrhoeal illness in the child care setting include attendance of non-toilet-trained children, staff combining nappy changing and food preparation duties, large enrollment, low staff-to-child ratio, and poor hygiene and child handling practices. Investigations undertaken during an outbreak of diarrhoea have frequently used limited diagnostic testing, often suitable for identifying only bacterial and protozoal agents. Such limited investigations have tended to incriminate agents that have prolonged carriage and are easily identifiable in standard microbiology laboratories. Finding a pathogen in these circumstances needs to be interpreted with caution. Prevention and control measures include training and education in good personal hygiene, emphasis on the need for frequent handwashing, separation of change areas from food handling and eating areas, routine cleaning and disinfection of environmental surfaces and personal items, and exclusion of any child or child care worker with diarrhoea.

  11. Identifying futility in a paediatric critical care setting: a prospective observational study

    PubMed Central

    Goh, A; Mok, Q

    2001-01-01

    AIMS—To determine the extent of futile care provided to critically ill children admitted to a paediatric intensive care setting.
METHODS—Prospective evaluation of consecutive admissions to a 20 bedded multidisciplinary paediatric intensive care unit of a North London teaching hospital over a nine month period. Three previously defined criteria for futility were used: (1) imminent demise futility (those with a mortality risk greater than 90% using the Paediatric Risk of Mortality (PRISM II) score); (2) lethal condition futility (those with conditions incompatible with long term survival); and (3) qualitative futility (those with unacceptable quality of life and high morbidity).
RESULTS—A total of 662 children accounting for 3409 patient bed days were studied. Thirty four patients fulfilled at least one of the criteria for futility, and used a total of 104 bed days (3%). Only 33 (0.9%) bed days were used by patients with mortality risk greater than 90%, 60 (1.8%) by patients with poor long term prognosis, and 16 (0.5%) by those with poor quality of life. Nineteen of 34 patients died; withdrawal of treatment was the mode of death in 15 (79%).
CONCLUSIONS—Cost containment initiatives focusing on futility in the paediatric intensive care unit setting are unlikely to be successful as only relatively small amounts of resources were used in providing futile care. Paediatricians are recognising futility early and may have taken ethically appropriate measures to limit care that is futile.

 PMID:11207181

  12. Using design effects from previous cluster surveys to guide sample size calculation in emergency settings.

    PubMed

    Kaiser, Reinhard; Woodruff, Bradley A; Bilukha, Oleg; Spiegel, Paul B; Salama, Peter

    2006-06-01

    A good estimate of the design effect is critical for calculating the most efficient sample size for cluster surveys. We reviewed the design effects for seven nutrition and health outcomes from nine population-based cluster surveys conducted in emergency settings. Most of the design effects for outcomes in children, and one-half of the design effects for crude mortality, were below two. A reassessment of mortality data from Kosovo and Badghis, Afghanistan revealed that, given the same number of clusters, changing sample size had a relatively small impact on the precision of the estimate of mortality. We concluded that, in most surveys, assuming a design effect of 1.5 for acute malnutrition in children and two or less for crude mortality would produce a more efficient sample size. In addition, enhancing the sample size in cluster surveys without increasing the number of clusters may not result in substantial improvements in precision.

  13. Management of benign paroxysmal positional vertigo with the canalith repositioning maneuver in the emergency department setting.

    PubMed

    Burmeister, David B; Sacco, Regina; Rupp, Valerie

    2010-10-01

    Vertigo is a common clinical manifestation in the emergency department (ED). It is important for physicians to determine if the peripheral cause of vertigo is benign paroxysmal positional vertigo (BPPV), a disorder accounting for 20% of all vertigo cases. However, the Dix-Hallpike test--the standard for BPPV diagnosis--is not common in the ED setting. If no central origin of the vertigo is determined, patients in the ED are typically treated with benzodiazepine, antihistamine, or anticholinergic agents. Studies have shown that these pharmaceutical treatment options may not be the best for patients with BPPV. The authors describe a case of a 38-year-old woman who presented to the ED with complaints of severe, sudden-onset vertigo. The patient's BPPV was diagnosed by means of a Dix-Hallpike test and the patient was acutely treated in the ED with physical therapy using the canalith repositioning maneuver.

  14. An unusual cause of rhabdomyolysis in emergency setting: challenges of diagnosis.

    PubMed

    Petrov, Mikhail; Yatsynovich, Yan; Lionte, Catalina

    2015-01-01

    Rhabdomyolysis is a rare phenomenon that may be challenging to recognize in an emergency setting. Drugs are one of the common causes. Trimethoprim-sulfamethoxazole is a commonly used antibiotic effective in the treatment of upper and lower respiratory tract infections as well as renal, urinary, and gastrointestinal tract infections. It has variable side effects, ranging from mild symptoms of fatigue and insomnia to a potentially life-threatening Steven-Johnson syndrome and renal failure. Rhabdomyolysis is a rare complication of therapy with this drug and is commonly seen in immunocompromised patients or those with an allogenic stem cell transplant. In this article, we report a case of rhabdomyolysis in an immunocompetent patient who has undergone treatment with trimethoprim-sulfamethoxazole and a possible drug interaction with nonsteroidal anti-inflammatory drugs, with the latter acting as an aggravating factor of this complication.

  15. The Minimum Data Set Prevalence of Restraint Quality Indicator: Does It Reflect Differences in Care?

    ERIC Educational Resources Information Center

    Schnelle, John F.; Bates-Jensen, Barbara M.; Levy-Storms, Lene; Grbic, Valena; Yoshii, June; Cadogan, Mary; Simmons, Sandra F.

    2004-01-01

    Purpose: This study investigated whether the use of restraining devices and related measures of care quality are different in nursing homes that score in the upper and lower quartiles on the Minimum Data Set (MDS) "prevalence of restraint" quality indicator, which assesses daily use of restraining devices when residents are out of bed. Design and…

  16. The Minimum Data Set Depression Quality Indicator: Does It Reflect Differences in Care Processes?

    ERIC Educational Resources Information Center

    Simmons, S.F.; Cadogan, M.P.; Cabrera, G.R.; Al-Samarrai, N.R.; Jorge, J.S.; Levy-Storms, L.; Osterweil, D.; Schnelle, J.F.

    2004-01-01

    Purpose. The objective of this work was to determine if nursing homes that score differently on prevalence of depression, according to the Minimum Data Set (MDS) quality indicator, also provide different processes of care related to depression. Design and Methods. A cross-sectional study with 396 long-term residents in 14 skilled nursing…

  17. Procedure Guidelines for Health Care of Special Needs Students in the School Setting.

    ERIC Educational Resources Information Center

    Viele, Elizabeth; Hertel, Victoria

    This manual presents detailed instructions for delivering health care services to students with special health needs within the school setting. Individual chapters address the following areas: dressing; vital signs; height and weight; fluids/nourishment; medications; oxygen and use of the respirator/ventilator; suctioning; respiratory therapy;…

  18. Optimising the Collaborative Practice of Nurses in Primary Care Settings Using a Knowledge Translation Approach

    ERIC Educational Resources Information Center

    Oelke, Nelly; Wilhelm, Amanda; Jackson, Karen

    2016-01-01

    The role of nurses in primary care is poorly understood and many are not working to their full scope of practice. Building on previous research, this knowledge translation (KT) project's aim was to facilitate nurses' capacity to optimise their practice in these settings. A Summit engaging Alberta stakeholders in a deliberative discussion was the…

  19. Dignity Versus Dehumanization in Long-Term Care Settings for Older Persons: A Training Outline.

    ERIC Educational Resources Information Center

    Kampfe, Charlene M.

    This paper describes the types of attitudes and behaviors that might be destructive to an individual's sense of self-worth, and suggests that counselors in long-term care settings face the challenge of changing these. One strategy for counteracting potential dehumanization, offering in-service training to all levels of staff and administrators, is…

  20. The Experiences of Registered Nurses Transitioning from Patient Care Settings to Academia

    ERIC Educational Resources Information Center

    Gwin, Teresa

    2012-01-01

    Registered nurses (RNs) who make the move from a patient-care service setting to an academic teaching environment often go through a transition phase in their first semesters of teaching that is difficult and traumatic. RNs that go on to higher academic degrees often do so in order to teach in schools of nursing. However, graduate work in nursing…