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Sample records for health clinic pv

  1. Optimization and life-cycle cost of health clinic PV system for a rural area in southern Iraq using HOMER software

    SciTech Connect

    Al-Karaghouli, Ali; Kazmerski, L.L.

    2010-04-15

    This paper addresses the need for electricity of rural areas in southern Iraq and proposes a photovoltaic (PV) solar system to power a health clinic in that region. The total daily health clinic load is 31.6 kW h and detailed loads are listed. The National Renewable Energy Laboratory (NREL) optimization computer model for distributed power, ''HOMER,'' is used to estimate the system size and its life-cycle cost. The analysis shows that the optimal system's initial cost, net present cost, and electricity cost is US$ 50,700, US$ 60,375, and US$ 0.238/kW h, respectively. These values for the PV system are compared with those of a generator alone used to supply the load. We found that the initial cost, net present cost of the generator system, and electricity cost are US$ 4500, US$ 352,303, and US$ 1.332/kW h, respectively. We conclude that using the PV system is justified on humanitarian, technical, and economic grounds. (author)

  2. Student Health Clinics.

    ERIC Educational Resources Information Center

    Jelliffe, James H.; Schipp, Michael K.

    2002-01-01

    Discusses important issues concerning the design of student health clinics, including convenient access, privacy and security, showers and sinks, durability and safety, and special considerations. (EV)

  3. Rural Health Clinics (RHCs)

    MedlinePlus

    ... for Medicaid? What are the Quality Assessment and Performance Improvement (QAPI) requirements for RHCs? Can Rural Health Clinics be certified as Patient Centered Medical Homes (PCMHs)? Can RHCs join Accountable Care Organizations (ACOs)? What is the difference between a Federally ...

  4. Early identification and treatment of PV re-connections: role of observation time and impact on clinical results of atrial fibrillation ablation.

    PubMed

    Wang, Xin-hua; Liu, Xu; Sun, Yu-min; Gu, Jia-ning; Shi, Hai-feng; Zhou, Li; Hu, Wei

    2007-07-01

    Circumferential pulmonary vein isolation (CPVI) has been reported to account for 30% of atrial fibrillation (AF) recurrence after initial ablation, and pulmonary vein (PV) re-connection accounts for about 80% of AF recurrence. There is no information in the literature whether early identification and treatment of acute PV conduction recovery during initial ablation has an impact on subsequent clinical results. The objective is to investigate the prevalence of acute PV conduction recovery during the observation time after PV isolation for paroxysmal AF, and to evaluate the impact of re-isolation treatment on clinical results. Ninety cases with paroxysmal AF (51 males, mean age of 56.4 +/- 12.3 years) were randomized to 3 groups to undergo CPVI. In Group A, there was no observation time post-ablation. In Group B, there was 30 min of observation time post-ablation. In Group C, there was 60 min of observation time post-ablation. All PV re-conduction was re-isolated at the end of the observation time. ECG and Holter monitors were used to evaluate the clinical effectiveness of ablation. All cases underwent the procedure successfully. The mean procedural time in Group A was significantly shorter than in Group B and Group C, but there was no significant difference on fluoroscopic time and PV isolation time among the three groups. In Group B, PV re-conduction occurred in 8 cases (25%) at 30 min post-isolation, in 10 cases (31.2%) at 60 min post-isolation for left PVs, and in 6 cases (18.8%) at 30 min post-isolation for right PVs. In Group C, PV re-conduction for left PVs occurred in 9 cases (30%) at 30 min post-isolation and in 11 cases (36.7%) at 60 min post-isolation; for right PVs this occurred in 7 cases (23.3%) at 30 min post-isolation and in 8 cases (26.7%) at 60 min post-isolation. During a mean follow-up of 6.7 +/- 2.3 months, 17 cases (60.7%) in Group A, 27 cases (84.3%) in Group B, and 26 cases (86.7%) in Group C had no recurrence of atrial tachyarrhythmias, P = 0

  5. Rural health clinics infrastructure

    SciTech Connect

    Olson, K.

    1997-12-01

    The author discusses programs which were directed at the installation of photovoltaic power systems in rural health clinics. The objectives included: vaccine refrigeration; ice pack freezing; lighting; communications; medical appliances; sterilization; water purification; and income generation. The paper discusses two case histories, one in the Dominican Republic and one in Colombia. The author summarizes the results of the programs, both successes and failures, and offers an array of conclusions with regard to the implementation of future programs of this general nature.

  6. Clinical toxicology: clinical science to public health.

    PubMed

    Bateman, D N

    2005-11-01

    1. The aims of the present paper are to: (i) review progress in clinical toxicology over the past 40 years and to place it in the context of modern health care by describing its development; and (ii) illustrate the use of clinical toxicology data from Scotland, in particular, as a tool for informing clinical care and public health policy with respect to drugs. 2. A historical literature review was conducted with amalgamation and comparison of a series of published and unpublished clinical toxicology datasets from NPIS Edinburgh and other sources. 3. Clinical databases within poisons treatment centres offer an important method of collecting data on the clinical effects of drugs in overdose. These data can be used to increase knowledge on drug toxicity mechanisms that inform licensing decisions, contribute to evidence-based care and clinical management. Combination of this material with national morbidity datasets provides another valuable approach that can inform public health prevention strategies. 4. In conclusion, clinical toxicology datasets offer clinical pharmacologists a new study area. Clinical toxicology treatment units and poisons information services offer an important health resource.

  7. [Clinical-epidemiological aspects of pityriasis versicolor (PV) in a fishing community of the semiarid region in Falcon State, Venezuela].

    PubMed

    Acosta Quintero, María Eugenia; Cazorla Perfetti, Dalmiro José

    2004-12-01

    Between August 2001 and May 2002, the prevalence and several epidemiological and clinical characteristics of pityriasis versicolor (PV) were studied in 902 individuals aged two months- 60 years, 426 females and 476 males, from a fishery community of Río Seco, a semiarid region in the state of Falcon, north-western Venezuela. The overall prevalence of the disease was 15.52% (140/902). The frequency of infection was higher in females (65.7% vs. 34.3%), children under one year of age and adolescents (27.9% y 32.1%, respectively), and dark skin (67.9%). The most commonly affected anatomical areas were the face (57.9%) and thorax (27.1%). The most important clinical features of the disease were: hypochromic (91.4%), multicentric (73.6%), pruritic (92.9%), fine scaled (80.7%) and irregularly shaped borders (91.4%). On the basis of these results, the possible risk factors on transmission dynamic and maintenance of the disease endemically is discussed.

  8. Considering retail health clinics.

    PubMed

    Mullin, Kathy

    2009-12-01

    By gaining increasing acceptance from consumers and traditional providers, retail-based convenient care clinics have moved from the innovative fringe into the mainstream of healthcare delivery. Nationwide, resourceful administrators are experimenting with retail-based delivery systems, using the clinic's unique attributes to promote wellness, expand accessibility, reduce delivery costs, and enhance brand recognition. This article takes an in-depth look at the convenient care business model, pertinent regulatory issues, and some of the associated benefits and concerns.

  9. Health economics in clinical research.

    PubMed

    Manns, Braden J

    2015-01-01

    The pressure for health care systems to provide more resource intensive health care and newer, more costly, therapies is significant, despite limited health care budgets. As such, demonstration that a new therapy is effective is no longer sufficient to ensure that it is funded within publicly funded health care systems. The impact of a therapy on health care costs is also an important consideration for decision-makers who must allocate scarce resources. The clinical benefits and costs of a new therapy can be estimated simultaneously using economic evaluation, the strengths and limitations of which are discussed herein. In addition, this chapter includes discussion of the important economic outcomes that can be collected within a clinical trial (alongside the clinical outcome data) enabling consideration of the impact of the therapy on overall resource use, thus enabling performance of an economic evaluation, if the therapy is shown to be effective.

  10. Clinical care and health disparities.

    PubMed

    Starfield, B; Gérvas, J; Mangin, D

    2012-04-01

    Health disparities, also known as health inequities, are systematic and potentially remediable differences in one or more aspects of health across population groups defined socially, economically, demographically, or geographically. This topic has been the subject of research stretching back at least decades. Reports and studies have delved into how inequities develop in different societies and, with particular regard to health services, in access to and financing of health systems. In this review, we consider empirical studies from the United States and elsewhere, and we focus on how one aspect of health systems, clinical care, contributes to maintaining systematic differences in health across population groups characterized by social disadvantage. We consider inequities in clinical care and the policies that influence them. We develop a framework for considering the structural and behavioral components of clinical care and review the existing literature for evidence that is likely to be generalizable across health systems over time. Starting with the assumption that health services, as one aspect of social services, ought to enhance equity in health care, we conclude with a discussion of threats to that role and what might be done about them.

  11. Supported PV module assembly

    DOEpatents

    Mascolo, Gianluigi; Taggart, David F.; Botkin, Jonathan D.; Edgett, Christopher S.

    2013-10-15

    A supported PV assembly may include a PV module comprising a PV panel and PV module supports including module supports having a support surface supporting the module, a module registration member engaging the PV module to properly position the PV module on the module support, and a mounting element. In some embodiments the PV module registration members engage only the external surfaces of the PV modules at the corners. In some embodiments the assembly includes a wind deflector with ballast secured to a least one of the PV module supports and the wind deflector. An array of the assemblies can be secured to one another at their corners to prevent horizontal separation of the adjacent corners while permitting the PV modules to flex relative to one another so to permit the array of PV modules to follow a contour of the support surface.

  12. Health care clinics in Cambodia.

    PubMed

    Wollschlaeger, K

    1995-04-01

    Under the Pol Pot Khmer Rouge regime, most physicians with clinical experience were either killed or fled the country. The few practitioners who managed to survive were forced to hide their knowledge; much of that knowledge and experience is now lost. As part of a general process of national rehabilitation, Cambodia has trained since the 1980s hundreds of physicians and physician assistants. There were 700 physicians, 1300 physician assistants, and 4000 nurses in the country by 1992. Problems do, however, remain with medical education in Cambodia. In particular, the medical texts and lectures are in French, a language which very few of the younger generation speak; instructional texts are designed to meet the needs of developing nations, not a rehabilitating one like Cambodia; emphasis is upon curative health care, hospitals, and vertical programs instead of primary and preventive health care; Cambodian physicians are used to a system based upon the division of patients by ability to pay instead of by age, disease, or need; corruption has grown as the cost of living has outstripped the level of official salaries; and there is neither professional contact, feedback, nor program evaluation within health care programs. The authors is a resident in obstetrics and gynecology at the University of Chicago who worked at two clinics during a stay in Phnom Penh. She recommends that instead of simply training more doctors, these training-related problems should be addressed, including a revision of the curriculum to include both primary health care medicine and psychiatry. Moreover, people in Cambodia need to be taught the importance of preventive health care, which should then reduce the number of visits to physicians. This process will be accomplished more effectively with the cooperation of physicians, the government, nongovernmental organizations, and international organizations associated with health care.

  13. Energy 101: Solar PV

    ScienceCinema

    None

    2016-07-12

    Solar photovoltaic (PV) systems can generate clean, cost-effective power anywhere the sun shines. This video shows how a PV panel converts the energy of the sun into renewable electricity to power homes and businesses.

  14. Energy 101: Solar PV

    SciTech Connect

    2011-01-01

    Solar photovoltaic (PV) systems can generate clean, cost-effective power anywhere the sun shines. This video shows how a PV panel converts the energy of the sun into renewable electricity to power homes and businesses.

  15. Fire resistant PV shingle assembly

    DOEpatents

    Lenox, Carl J.

    2012-10-02

    A fire resistant PV shingle assembly includes a PV assembly, including PV body, a fire shield and a connection member connecting the fire shield below the PV body, and a support and inter-engagement assembly. The support and inter-engagement assembly is mounted to the PV assembly and comprises a vertical support element, supporting the PV assembly above a support surface, an upper interlock element, positioned towards the upper PV edge, and a lower interlock element, positioned towards the lower PV edge. The upper interlock element of one PV shingle assembly is inter-engageable with the lower interlock element of an adjacent PV shingle assembly. In some embodiments the PV shingle assembly may comprise a ventilation path below the PV body. The PV body may be slidably mounted to the connection member to facilitate removal of the PV body.

  16. National Institutes of Health, Clinical Center

    MedlinePlus

    ... Contact us | Site Map | Staff Only About the Clinical Center Search the Studies Patient Information Education & Training ... Events Staff Directory Dr. John I. Gallin Director, Clinical Center, National Institutes of Health Welcome to the ...

  17. Weaving Clinical Expertise in Online Health Communities.

    PubMed

    Huh, Jina; Pratt, Wanda

    Many patients visit online health communities to receive support. In face-to-face support groups, health professionals facilitate peer-patients exchanging experience while adding their clinical expertise when necessary. However, the large scale of online health communities makes it challenging for such health professional moderators' involvement to happen. To address this challenge of delivering clinical expertise to where patients need them, we explore the idea of semi-automatically providing clinical expertise in online health communities. We interviewed 14 clinicians showing them example peer-patient conversation threads. From the interviews, we examined the ideal practice of clinicians providing expertise to patients. The clinicians continuously assessed when peer-patients were providing appropriate support, what kinds of clinical help they could give online, and when to defer to patients' healthcare providers. The findings inform requirements for building a semi-automated system delivering clinical expertise in online health communities.

  18. Health Clinic Environments in Georgia Elementary Schools

    ERIC Educational Resources Information Center

    Simpson, Susan Rogers

    2005-01-01

    Schools seem to be the logical place to serve the health needs of students, since children spend a majority of their time there. Design standards were not available for health clinics in Georgia elementary schools; therefore, this study examined key characteristics of an elementary school clinic in order to determine the importance of each design…

  19. PV_LIB Toolbox

    SciTech Connect

    2012-09-11

    While an organized source of reference information on PV performance modeling is certainly valuable, there is nothing to match the availability of actual examples of modeling algorithms being used in practice. To meet this need, Sandia has developed a PV performance modeling toolbox (PV_LIB) for Matlab. It contains a set of well-documented, open source functions and example scripts showing the functions being used in practical examples. This toolbox is meant to help make the multi-step process of modeling a PV system more transparent and provide the means for model users to validate and understand the models they use and or develop. It is fully integrated into Matlab’s help and documentation utilities. The PV_LIB Toolbox provides more than 30 functions that are sorted into four categories

  20. Clinical Computer Applications in Mental Health

    PubMed Central

    Greist, John H.; Klein, Marjorie H.; Erdman, Harold P.; Jefferson, James W.

    1982-01-01

    Direct patient-computer interviews were among the earliest applications of computing in medicine. Yet patient interviewing and other clinical applications have lagged behind fiscal/administrative uses. Several reasons for delays in the development and implementation of clinical computing programs and their resolution are discussed. Patient interviewing, clinician consultation and other applications of clinical computing in mental health are reviewed.

  1. Clinical Mental Health Counselor Handbook & Study Guide.

    ERIC Educational Resources Information Center

    Bullard, Bonnie; Lawless, Linda; Williams, Midge; Bergstrom, Deborah

    This handbook and study guide were developed as a textbook to be used as a review course for preparation for the clinical licensing examination. It presents a summary of a graduate level academic program in clinical mental health counseling. It contains 17 chapters on clinical information; 4 chapters on test taking; 2 types of sample tests; and 3…

  2. Health as a clinic-epidemiological concept.

    PubMed

    Azevedo, Marco Antonio

    2015-06-01

    I propose a clinic-epidemiological concept of health as the best description of what physicians actually think about health within medical practice. Its aim is to be an alternative to the best approach in the philosophy of medicine about health, Christopher Boorse's biostatistical theory. Contrary to Boorse's 'theoretical' approach, I propose to take health as a practical clinical concept. In the first two parts of the paper, I will present my complaints against Boorse's view that health is a theoretical concept, a 'species normal functional ability'. I will claim that Boorse's view is actually a view on normal physiology. My claim is that health is best described as the state of absence of chronic diseases or disabilities (clinic-epidemiologically associated with a morbimortality index higher than the risk of death, disease and disabilities for individuals of the same population group or reference class free of that chronic clinical conditions). Health, therefore, is not the mere absence of disease. Diseases that do not increase patients' morbimortality and disability indexes are not incompatible with health; after all, clinical health is compatible with appropriate health care and medical treatments.

  3. Electronic health records to facilitate clinical research.

    PubMed

    Cowie, Martin R; Blomster, Juuso I; Curtis, Lesley H; Duclaux, Sylvie; Ford, Ian; Fritz, Fleur; Goldman, Samantha; Janmohamed, Salim; Kreuzer, Jörg; Leenay, Mark; Michel, Alexander; Ong, Seleen; Pell, Jill P; Southworth, Mary Ross; Stough, Wendy Gattis; Thoenes, Martin; Zannad, Faiez; Zalewski, Andrew

    2017-01-01

    Electronic health records (EHRs) provide opportunities to enhance patient care, embed performance measures in clinical practice, and facilitate clinical research. Concerns have been raised about the increasing recruitment challenges in trials, burdensome and obtrusive data collection, and uncertain generalizability of the results. Leveraging electronic health records to counterbalance these trends is an area of intense interest. The initial applications of electronic health records, as the primary data source is envisioned for observational studies, embedded pragmatic or post-marketing registry-based randomized studies, or comparative effectiveness studies. Advancing this approach to randomized clinical trials, electronic health records may potentially be used to assess study feasibility, to facilitate patient recruitment, and streamline data collection at baseline and follow-up. Ensuring data security and privacy, overcoming the challenges associated with linking diverse systems and maintaining infrastructure for repeat use of high quality data, are some of the challenges associated with using electronic health records in clinical research. Collaboration between academia, industry, regulatory bodies, policy makers, patients, and electronic health record vendors is critical for the greater use of electronic health records in clinical research. This manuscript identifies the key steps required to advance the role of electronic health records in cardiovascular clinical research.

  4. GridPV Toolbox

    SciTech Connect

    Broderick, Robert; Quiroz, Jimmy; Grijalva, Santiago; Reno, Matthew; Coogan, Kyle

    2014-07-15

    Matlab Toolbox for simulating the impact of solar energy on the distribution grid. The majority of the functions are useful for interfacing OpenDSS and MATLAB, and they are of generic use for commanding OpenDSS from MATLAB and retrieving GridPV Toolbox information from simulations. A set of functions is also included for modeling PV plant output and setting up the PV plant in the OpenDSS simulation. The toolbox contains functions for modeling the OpenDSS distribution feeder on satellite images with GPS coordinates. Finally, example simulations functions are included to show potential uses of the toolbox functions.

  5. Grid integrated distributed PV (GridPV).

    SciTech Connect

    Reno, Matthew J.; Coogan, Kyle

    2013-08-01

    This manual provides the documentation of the MATLAB toolbox of functions for using OpenDSS to simulate the impact of solar energy on the distribution system. The majority of the functions are useful for interfacing OpenDSS and MATLAB, and they are of generic use for commanding OpenDSS from MATLAB and retrieving information from simulations. A set of functions is also included for modeling PV plant output and setting up the PV plant in the OpenDSS simulation. The toolbox contains functions for modeling the OpenDSS distribution feeder on satellite images with GPS coordinates. Finally, example simulations functions are included to show potential uses of the toolbox functions. Each function in the toolbox is documented with the function use syntax, full description, function input list, function output list, example use, and example output.

  6. Masked polycythaemia vera: presenting features, response to treatment and clinical outcomes.

    PubMed

    Alvarez-Larrán, Alberto; Angona, Anna; Ancochea, Agueda; García-Pallarols, Francesc; Fernández, Concepción; Longarón, Raquel; Bellosillo, Beatriz; Besses, Carlos

    2016-01-01

    Masked polycythaemia vera (PV) has been proposed as a new entity with poorer outcome than overt PV. In this study, the initial clinical and laboratory characteristics, response to treatment and outcome of masked and overt PV were compared using red cell mass and haemoglobin or haematocrit levels for the distinction between both entities. Sixty-eight of 151 PV patients (45%) were classified as masked PV according to World Health Organisation diagnostic criteria, whereas 16 (11%) were classified as masked PV using the British Committee for Standards in Haematology (BCSH). In comparison with overt PV, a higher platelet count and a lower JAK2V617F allele burden at diagnosis were observed in masked PV. Patients with masked PV needed lower phlebotomies and responded faster to hydroxcarbamide than those with overt PV. Complete haematological response was more frequently achieved in masked than in overt PV (79% vs. 58%, P = 0.001). There were no significant differences in the duration of haematological response, the rate of resistance or intolerance to hydroxycarbamide and the probability of molecular response according to type of PV (masked vs. overt). Overall survival, rate of thrombosis and major bleeding, and probability of transformation was superimposable among patients with masked and overt PV.

  7. Health promotion: theoretical perspectives and clinical applications.

    PubMed

    Frenn, M; Malin, S

    1998-01-01

    The article addresses the realities of health promotion practice in a managed care environment, synthesizing the most important findings from the midrange theories currently guiding wellness-oriented research. Factors that have been shown to predict engagement in a number of health behaviors are identified and are formulated into a guide for clinical assessment, intervention, and outcome evaluation for clients across the life span.

  8. Chinese health care system and clinical epidemiology.

    PubMed

    Sun, Yuelian; Gregersen, Hans; Yuan, Wei

    2017-01-01

    China has gone through a comprehensive health care insurance reform since 2003 and achieved universal health insurance coverage in 2011. The new health care insurance system provides China with a huge opportunity for the development of health care and medical research when its rich medical resources are fully unfolded. In this study, we review the Chinese health care system and its implication for medical research, especially within clinical epidemiology. First, we briefly review the population register system, the distribution of the urban and rural population in China, and the development of the Chinese health care system after 1949. In the following sections, we describe the current Chinese health care delivery system and the current health insurance system. We then focus on the construction of the Chinese health information system as well as several existing registers and research projects on health data. Finally, we discuss the opportunities and challenges of the health care system in regard to clinical epidemiology research. China now has three main insurance schemes. The Urban Employee Basic Medical Insurance (UEBMI) covers urban employees and retired employees. The Urban Residence Basic Medical Insurance (URBMI) covers urban residents, including children, students, elderly people without previous employment, and unemployed people. The New Rural Cooperative Medical Scheme (NRCMS) covers rural residents. The Chinese Government has made efforts to build up health information data, including electronic medical records. The establishment of universal health care insurance with linkage to medical records will provide potentially huge research opportunities in the future. However, constructing a complete register system at a nationwide level is challenging. In the future, China will demand increased capacity of researchers and data managers, in particular within clinical epidemiology, to explore the rich resources.

  9. Chinese health care system and clinical epidemiology

    PubMed Central

    Sun, Yuelian; Gregersen, Hans; Yuan, Wei

    2017-01-01

    China has gone through a comprehensive health care insurance reform since 2003 and achieved universal health insurance coverage in 2011. The new health care insurance system provides China with a huge opportunity for the development of health care and medical research when its rich medical resources are fully unfolded. In this study, we review the Chinese health care system and its implication for medical research, especially within clinical epidemiology. First, we briefly review the population register system, the distribution of the urban and rural population in China, and the development of the Chinese health care system after 1949. In the following sections, we describe the current Chinese health care delivery system and the current health insurance system. We then focus on the construction of the Chinese health information system as well as several existing registers and research projects on health data. Finally, we discuss the opportunities and challenges of the health care system in regard to clinical epidemiology research. China now has three main insurance schemes. The Urban Employee Basic Medical Insurance (UEBMI) covers urban employees and retired employees. The Urban Residence Basic Medical Insurance (URBMI) covers urban residents, including children, students, elderly people without previous employment, and unemployed people. The New Rural Cooperative Medical Scheme (NRCMS) covers rural residents. The Chinese Government has made efforts to build up health information data, including electronic medical records. The establishment of universal health care insurance with linkage to medical records will provide potentially huge research opportunities in the future. However, constructing a complete register system at a nationwide level is challenging. In the future, China will demand increased capacity of researchers and data managers, in particular within clinical epidemiology, to explore the rich resources. PMID:28356772

  10. Some experience in an area health authority child health clinic.

    PubMed Central

    Illingworth, R S

    1979-01-01

    Three years' experience as a doctor taking two clinics a week in an area health authority child health clinic was reviewed. A wide range of clinical conditions was seen, including: problems associated with feeding in breast- and bottle-fed infants; minor developmental abnormalities (mental, behavioural, and physical); surgical and orthopaedic conditions requiring treatment; medical conditions, mainly respiratory and alimentary infections, skin conditions, and problems of over-treatment for minor ailments; and minor genetic abnormalities. Mothers asked for advice on a wide range of topics, risks and benefits of immunisation being the most common. The clinic doctor needs a wide experience in paediatrics to deal with such problems. It is suggested that all lecturers in child health and paediatric and senior registrars should take one clinic a week for six months, and all medical students should attend some clinics as part of their paediatric training. Health visitors have an important role in helping the clinic doctor, but their training should be more realistic and appropriate facilities should be provided to keep them up to date in their work. PMID:86374

  11. Continuous Quality Improvement in Rural Health Clinics

    PubMed Central

    Salman, Ghassan F

    2005-01-01

    Aim Continuous quality improvement has been shown to work in urban and suburban clinics. The objective of this project is to test whether continuous quality improvement would improve the quality of care for patients with diabetes mellitus and/or hypertension in a rural health clinic. Setting Rural health clinic with 3 providers and two and half full-time registered nurses. Patients were mostly older adults with Medicare health insurance. Program description Health care providers and nursing staff agreed on the quality improvement project. The intervention included providing quarterly feedback to health care providers, empowering the nurses to remind patients of diabetes care, and flagging the charts to remind providers. Program evaluation The proportions of diabetic patients who had ophthalmologic exam, pneumococcal vaccine and lipid screening significantly improved over 12-month period. The proportions of patients with hypertension who had blood pressure less than 140/90 and patients who were taking aspirin also significantly improved over 12-month period. Conclusion The quality of care for patients with diabetes and patients with hypertension could be improved in rural health clinics using repetitive cycles of measurements, implementation of interventions and evaluation of outcomes. This process could be used as the backbone for translation of evidence into practice and improving quality of care. PMID:16117758

  12. Ministry of Health Clinical Practice Guidelines: Lipids.

    PubMed

    Tai, E Shyong; Chia, Boon Lock; Bastian, Amber Carla; Chua, Terrance; Ho, Sally Chih Wei; Koh, Teck Siew; Low, Lip Ping; Tey, Jeannie S; Poh, Kian Keong; Tan, Chee Eng; Ting, Peter; Tham, Tat Yean; Toh, Sue-Anne; van Dam, Rob M

    2017-03-01

    The Ministry of Health (MOH) has updated the Clinical Practice Guidelines on Lipids to provide doctors and patients in Singapore with evidence-based treatment for lipids. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH Clinical Practice Guidelines on Lipids, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical.html.

  13. Open PV Project: Unlocking PV Installation Data (Brochure)

    SciTech Connect

    Not Available

    2012-04-01

    This brochure summarizes the Open PV Project, a collaborative effort of government, industry, and the public to compile a comprehensive database of PV installations in the United States. The brochure outlines the purpose and history of the project as well as the main capabilities and benefits of the online Open PV tool. The brochure also introduces how features of the tool are used, and it describes the sources and characteristics of Open PV's data and data collection processes.

  14. PV System Performance and Standards

    SciTech Connect

    Osterwald, C. R.

    2005-11-01

    This paper presents a brief overview of the status and accomplishments during fiscal year (FY) 2005 of the Photovoltaic (PV) System Performance and Standards Subtask, which is part of the PV Systems Engineering Project (a joint NREL-Sandia project).

  15. Computer Clinical Simulations in Health Sciences.

    ERIC Educational Resources Information Center

    Jones, Gary L; Keith, Kenneth D.

    1983-01-01

    Discusses the key characteristics of clinical simulation, some developmental foundations, two current research studies, and some implications for the future of health science education. Investigations of the effects of computer-based simulation indicate that acquisition of decision-making skills is greater than with noncomputerized simulations.…

  16. Testing for PV Reliability (Presentation)

    SciTech Connect

    Kurtz, S.; Bansal, S.

    2014-09-01

    The DOE SUNSHOT workshop is seeking input from the community about PV reliability and how the DOE might address gaps in understanding. This presentation describes the types of testing that are needed for PV reliability and introduces a discussion to identify gaps in our understanding of PV reliability testing.

  17. Health economics: the start of clinical freedom.

    PubMed

    Sacristán, José Antonio; Costi, María; Valladares, Amparo; Dilla, Tatiana

    2010-06-28

    Since Professor Hampton announced the death of clinical freedom in 1983, the increasing influence of Evidence-based Medicine and Health Technology Assessment has contributed to augment the feeling that clinicians have a secondary role in the therapeutic decision-making process. This article constitutes a reflection on how clinicians may use the results of economic evaluations in their daily clinical practice, making decisions about cost-effectiveness on a case by case basis, and addressing both the patient's and society's needs. To that end, some illustrating examples are taken from the literature to show there are factors with great impact on cost-effectiveness results that can be easily identified and modified by clinicians. The evolution of the discipline and the trend towards a tailored therapy suggest that health economics is not the end of clinical freedom but the start of it.

  18. Clinical health informatics education for a 21st Century World.

    PubMed

    Liaw, Siaw Teng; Gray, Kathleen

    2010-01-01

    This chapter gives an educational overview of: * health informatics competencies in medical, nursing and allied clinical health professions * health informatics learning cultures and just-in-time health informatics training in clinical work settings * major considerations in selecting or developing health informatics education and training programs for local implementation * using elearning effectively to meet the objectives of health informatics education.

  19. Polymorphism of the Pv200L Fragment of Merozoite Surface Protein-1 of Plasmodium vivax in Clinical Isolates from the Pacific Coast of Colombia

    PubMed Central

    Valderrama-Aguirre, Augusto; Zúñiga-Soto, Evelin; Mariño-Ramírez, Leonardo; Moreno, Luz Ángela; Escalante, Ananías A.; Arévalo-Herrera, Myriam; Herrera, Sócrates

    2011-01-01

    Merozoite surface protein 1 (MSP-1) is a polymorphic malaria protein with functional domains involved in parasite erythrocyte interaction. Plasmodium vivax MSP-1 has a fragment (Pv200L) that has been identified as a potential subunit vaccine because it is highly immunogenic and induces partial protection against infectious parasite challenge in vaccinated monkeys. To determine the extent of genetic polymorphism and its effect on the translated protein, we sequenced the Pv200L coding region from isolates of 26 P. vivax-infected patients in a malaria-endemic area of Colombia. The extent of nucleotide diversity (π) in these isolates (0.061 ± 0.004) was significantly lower (P ≤ 0.001) than that observed in Thai and Brazilian isolates; 0.083 ± 0.006 and 0.090 ± 0.006, respectively. We found two new alleles and several previously unidentified dimorphic substitutions and significant size polymorphism. The presence of highly conserved blocks in this fragment has important implications for the development of Pv200L as a subunit vaccine candidate. PMID:21292880

  20. Mobile clinics for women's and children's health.

    PubMed

    Abdel-Aleem, Hany; El-Gibaly, Omaima M H; El-Gazzar, Amira F E-S; Al-Attar, Ghada S T

    2016-08-11

    The accessibility of health services is an important factor that affects the health outcomes of populations. A mobile clinic provides a wide range of services but in most countries the main focus is on health services for women and children. It is anticipated that improvement of the accessibility of health services via mobile clinics will improve women's and children's health. To evaluate the impact of mobile clinic services on women's and children's health. For related systematic reviews, we searched the Database of Abstracts of Reviews of Effectiveness (DARE), CRD; Health Technology Assessment Database (HTA), CRD; NHS Economic Evaluation Database (NHS EED), CRD (searched 20 February 2014).For primary studies, we searched ISI Web of Science, for studies that have cited the included studies in this review (searched 18 January 2016); WHO ICTRP, and ClinicalTrials.gov (searched 23 May 2016); Cochrane Central Register of Controlled Trials (CENTRAL), part of The Cochrane Library. www.cochranelibrary.com (including the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register) (searched 7 April 2015); MEDLINE, OvidSP (searched 7 April 2015); Embase, OvidSP (searched 7 April 2015); CINAHL, EbscoHost (searched 7 April 2015); Global Health, OvidSP (searched 8 April 2015); POPLINE, K4Health (searched 8 April 2015); Science Citation Index and Social Sciences Citation Index, ISI Web of Science (searched 8 April 2015); Global Health Library, WHO (searched 8 April 2015); PAHO, VHL (searched 8 April 2015); WHOLIS, WHO (searched 8 April 2015); LILACS, VHL (searched 9 April 2015). We included individual- and cluster-randomised controlled trials (RCTs) and non-RCTs. We included controlled before-and-after (CBA) studies provided they had at least two intervention sites and two control sites. Also, we included interrupted time series (ITS) studies if there was a clearly defined point in time when the intervention occurred and at least three data points

  1. Quantifying PV power Output Variability

    SciTech Connect

    Hoff, Thomas E.; Perez, Richard

    2010-10-15

    This paper presents a novel approach to rigorously quantify power Output Variability from a fleet of photovoltaic (PV) systems, ranging from a single central station to a set of distributed PV systems. The approach demonstrates that the relative power Output Variability for a fleet of identical PV systems (same size, orientation, and spacing) can be quantified by identifying the number of PV systems and their Dispersion Factor. The Dispersion Factor is a new variable that captures the relationship between PV Fleet configuration, Cloud Transit Speed, and the Time Interval over which variability is evaluated. Results indicate that Relative Output Variability: (1) equals the inverse of the square root of the number of systems for fully dispersed PV systems; and (2) could be further minimized for optimally-spaced PV systems. (author)

  2. Organizing the public health-clinical health interface: theoretical bases.

    PubMed

    St-Pierre, Michèle; Reinharz, Daniel; Gauthier, Jacques-Bernard

    2006-01-01

    This article addresses the issue of the interface between public health and clinical health within the context of the search for networking approaches geared to a more integrated delivery of health services. The articulation of an operative interface is complicated by the fact that the definition of networking modalities involves complex intra- and interdisciplinary and intra- and interorganizational systems across which a new transversal dynamics of intervention practices and exchanges between service structures must be established. A better understanding of the situation is reached by shedding light on the rationale underlying the organizational methods that form the bases of the interface between these two sectors of activity. The Quebec experience demonstrates that neither the structural-functionalist approach, which emphasizes remodelling establishment structures and functions as determinants of integration, nor the structural-constructivist approach, which prioritizes distinct fields of practice in public health and clinical health, adequately serves the purpose of networking and integration. Consequently, a theoretical reframing is imperative. In this regard, structuration theory, which fosters the simultaneous study of methods of inter-structure coordination and inter-actor cooperation, paves the way for a better understanding of the situation and, in turn, to the emergence of new integration possibilities.

  3. PV Hourly Simulation Tool

    SciTech Connect

    Dean, Jesse; Metzger, Ian

    2010-12-31

    This software requires inputs of simple general building characteristics and usage information to calculate the energy and cost benefits of solar PV. This tool conducts and complex hourly simulation of solar PV based primarily on the area available on the rooftop. It uses a simplified efficiency calculation method and real panel characteristics. It includes a detailed rate structure to account for time-of-use rates, on-peak and off-peak pricing, and multiple rate seasons. This tool includes the option for advanced system design inputs if they are known. This tool calculates energy savings, demand reduction, cost savings, incentives and building life cycle costs including: simple payback, discounted payback, net-present value, and savings to investment ratio. In addition this tool also displays the environmental benefits of a project.

  4. Considering virtue: public health and clinical ethics.

    PubMed

    Meagher, Karen M

    2011-10-01

    As bioethicists increasingly turn their attention to the profession of public health, many candidate frameworks have been proposed, often with an eye toward articulating the values and foundational concepts that distinguish this practice from curative clinical medicine. First, I will argue that while these suggestions for a distinct ethics of public health are promising, they arise from problems within contemporary bioethics that must be taken into account. Without such cognizance of the impetus for public health ethics, we risk developing a set of ethical resources meant exclusively for public health professionals, thereby neglecting implications for curative medical ethics and the practice of bioethics more broadly. Second, I will present reasons for thinking some of the critiques of dominant contemporary bioethics can be met by a virtue ethics approach. I present a virtue ethics response to criticisms that concern (1) increased rigor in bioethics discourse; (2) the ability of normative theory to accommodate context; and (3) explicit attention to the nature of ethical conflict. I conclude that a virtue ethics approach is a viable avenue for further inquiry, one that leads us away from developing ethics of public health in a vacuum and has the potential for overcoming certain pitfalls of contemporary bioethics discourse. © 2011 Blackwell Publishing Ltd.

  5. PV water pumping: NEOS Corporation recent PV water pumping activities

    SciTech Connect

    Lane, C.

    1995-11-01

    NEOS Corporation has been very active in PV-powered water pumping, particularly with respect to electric utilities. Most of the recent activity has been through the Photovoltaic Services Network (PSN). The PSN is an independent, not-for-profit organization comprised of all types of electric utilities: rural electric coops, public power districts, investor-owned utilities, and power marketing agencies. The PSN`s mission is to work pro-actively to promote utility involvement in PV through education and training. PV information is distributed by the PSN in three primary forms: (1) consultation with PSN technical service representatives: (2) literature generated by the PSN; and (3) literature published by other organizations. The PSN can also provide assistance to members in developing PV customer service programs. The PSN`s product support activities include consolidation of information on existing packaged PV systems and facilitation of the development of new PV product packages that meet utility-defined specifications for cost performance, and reliability. The PSN`s initial product support efforts will be focused on commercially available packaged PV systems for a variety of off-grid applications. In parallel with this effort, if no products exist that meet the PSN`s functional specifications, the PSN will initiate the second phase of product development support process by encouraging the development of new packaged systems. Through these services and product support activities, the PSN anticipates engaging all segments for the PV industry, thus providing benefits to PV systems suppliers as well as local PV service contractors.This paper describes field testing of pv power systems for water pumping.

  6. Outdoor PV Degradation Comparison

    SciTech Connect

    Jordan, D. C.; Smith, R. M.; Osterwald, C. R.; Gelak, E.; Kurtz, S. R.

    2011-02-01

    As photovoltaic (PV) penetration of the power grid increases, it becomes vital to know how decreased power output; may affect cost over time. In order to predict power delivery, the decline or degradation rates must be determined; accurately. At the Performance and Energy Rating Testbed (PERT) at the Outdoor Test Facility (OTF) at the; National Renewable Energy Laboratory (NREL) more than 40 modules from more than 10 different manufacturers; were compared for their long-term outdoor stability. Because it can accommodate a large variety of modules in a; limited footprint the PERT system is ideally suited to compare modules side-by-side under the same conditions.

  7. [Clinical bioethics for primary health care].

    PubMed

    González-de Paz, L

    2013-01-01

    The clinical decision making process with ethical implications in the area of primary healthcare differs from other healthcare areas. From the ethical perspective it is important to include these issues in the decision making model. This dissertation explains the need for a process of bioethical deliberation for Primary Healthcare, as well as proposing a method for doing so. The decision process method, adapted to this healthcare area, is flexible and requires a more participative Healthcare System. This proposal involves professionals and the patient population equally, is intended to facilitate the acquisition of responsibility for personal and community health.

  8. Interband cascade (IC) photovoltaic (PV) architecture for PV devices

    DOEpatents

    Yang, Rui Q.; Tian, Zhaobing; Mishima, Tetsuya D.; Santos, Michael B.; Johnson, Matthew B.; Klem, John F.

    2015-10-20

    A photovoltaic (PV) device, comprising a PV interband cascade (IC) stage, wherein the IC PV stage comprises an absorption region with a band gap, the absorption region configured to absorb photons, an intraband transport region configured to act as a hole barrier, and an interband tunneling region configured to act as an electron barrier. An IC PV architecture for a photovoltaic device, the IC PV architecture comprising an absorption region, an intraband transport region coupled to the absorption region, and an interband tunneling region coupled to the intraband transport region and to the adjacent absorption region, wherein the absorption region, the intraband transport region, and the interband tunneling region are positioned such that electrons will flow from the absorption region to the intraband transport region to the interband tunneling region.

  9. [Clinical guidelines and health services research].

    PubMed

    Schütte, U

    2011-05-01

    Doctors are bound to ensure and improve the quality of their own work. This is a significant part of medical professionalism and lasts one's entire working life. In this regard clinical guidelines provide valuable and helpful information because they give recommendations on prevention, diagnosis, treatment, and aftercare based on current evidence. However, in their medical work potential users widely ignore such guidelines. Hence it is necessary to discover barriers to compliance with the guidelines and, based on the findings, to investigate more effective strategies for implementing the guidelines. Analyses and evaluation can be performed by using health services research. Undesirable developments in doctors' daily routines, associated with negative consequences for healthy and ill people, as well as for the economics of health care, can be detected and improvements can be identified systematically. This branch of research has become ever more important - even necessary. It ist likely that the increasing demand for assessing the needs, costs, structural conditions, and quality of health care will confirm the significance of such evaluation.

  10. Health Informatics and E-health Curriculum for Clinical Health Profession Degrees.

    PubMed

    Gray, Kathleen; Choo, Dawn; Butler-Henderson, Kerryn; Whetton, Sue; Maeder, Anthony

    2015-01-01

    The project reported in this paper models a new approach to making health informatics and e-health education widely available to students in a range of Australian clinical health profession degrees. The development of a Masters level subject uses design-based research to apply educational quality assurance practices which are consistent with university qualification frameworks, and with clinical health profession education standards; at the same time it gives recognition to health informatics as a specialised profession in its own right. The paper presents details of (a) design with reference to the Australian Qualifications Framework and CHIA competencies, (b) peer review within a three-university teaching team, (c) external review by experts from the professions, (d) cross-institutional interprofessional online learning, (e) methods for evaluating student learning experiences and outcomes, and (f) mechanisms for making the curriculum openly available to interested parties. The project has sought and found demand among clinical health professionals for formal health informatics and e-health education that is designed for them. It has helped the educators and organisations involved to understand the need for nuanced and complementary health informatics educational offerings in Australian universities. These insights may aid in further efforts to address substantive and systemic challenges that clinical informatics faces in Australia.

  11. Assessing clinical competency in the health sciences

    NASA Astrophysics Data System (ADS)

    Panzarella, Karen Joanne

    To test the success of integrated curricula in schools of health sciences, meaningful measurements of student performance are required to assess clinical competency. This research project analyzed a new performance assessment tool, the Integrated Standardized Patient Examination (ISPE), for assessing clinical competency: specifically, to assess Doctor of Physical Therapy (DPT) students' clinical competence as the ability to integrate basic science knowledge with clinical communication skills. Thirty-four DPT students performed two ISPE cases, one of a patient who sustained a stroke and the other a patient with a herniated lumbar disc. Cases were portrayed by standardized patients (SPs) in a simulated clinical setting. Each case was scored by an expert evaluator in the exam room and then by one investigator and the students themselves via videotape. The SPs scored each student on an overall encounter rubric. Written feedback was obtained from all participants in the study. Acceptable reliability was demonstrated via inter-rater agreement as well as inter-rater correlations on items that used a dichotomous scale, whereas the items requiring the use of the 4-point rubric were somewhat less reliable. For the entire scale both cases had a significant correlation between the Expert-Investigator pair of raters, for the CVA case r = .547, p < .05 and for the HD case r = .700, p < .01. The SPs scored students higher than the other raters. Students' self-assessments were most closely aligned with the investigator. Effects were apparent due to case. Content validity was gathered in the process of developing cases and patient scenarios that were used in this study. Construct validity was obtained from the survey results analyzed from the experts and students. Future studies should examine the effect of rater training upon the reliability. Criterion or predictive validity could be further studied by comparing students' performances on the ISPE with other independent estimates

  12. National Institutes of Health, Clinical Center

    MedlinePlus

    ... entirely to clinical research. More Patient Safety & Clinical Quality Improvements See Clinical Center advancements to foster the highest quality of patient safety and research support. More Free ...

  13. School Based Health Clinics: A Guide to Implementing Programs.

    ERIC Educational Resources Information Center

    Hadley, Elaine M.; And Others

    Extensive guidelines for the development of a comprehensive school-based health clinic at the middle, junior, or senior high school levels are presented. School-based clinics usually provide the primary health care services needed by adolescents: health maintenance examinations and assessments; diagnosis and treatment of acute and chronic…

  14. School Based Health Clinics: A Guide to Implementing Programs.

    ERIC Educational Resources Information Center

    Hadley, Elaine M.; And Others

    Extensive guidelines for the development of a comprehensive school-based health clinic at the middle, junior, or senior high school levels are presented. School-based clinics usually provide the primary health care services needed by adolescents: health maintenance examinations and assessments; diagnosis and treatment of acute and chronic…

  15. Department of Defense, Deployment Health Clinical Center

    MedlinePlus

    ... Five Things Health Care Providers Should Know About Postpartum Depression Five Things Health Care Providers Should Know About Postpartum Depression Read More Depression Awareness Month Depression Awareness Month ...

  16. Clinical care ratios: quantifying clinical versus non-clinical care for allied health professionals.

    PubMed

    Hearn, Cherie; Govier, Adam; Semciw, Adam Ivan

    2016-07-04

    Objective Clinical care ratios (CCRs) are a useful tool that can be used to quantify and benchmark the clinical and non-clinical workloads of allied health professionals. The purpose of this study was to determine if CCRs are influenced by level of seniority, type of role or profession. This will provide meaningful information for allied health service managers to better manage service demand and capacity.Method Data was collected from 2036 allied health professionals from five professions across 11 Australian tertiary hospitals. Mean (95% confidence intervals) CCRs were calculated according to profession, seniority and role type. A two-way ANOVA was performed to assess the association of CCRs (dependent variable) with seniority level and profession (independent variables). Post-hoc pairwise comparisons identified where significant main or interaction effects occurred (α = 0.05).Results Significant main effects for seniority level and profession were identified (P < 0.05), but there was no interaction effect. Post-hoc comparisons revealed significant differences between all tier combinations (P < 0.05) with more senior staff having the lowest CCRs.Conclusion The direct and non-direct clinical components of the allied health professional's workload can be quantified and benchmarked with like roles and according to seniority. The benchmarked CCRs for predominantly clinical roles will enable managers to compare and evaluate like roles and modify non-direct clinical components according to seniority and discipline.What is known about the topic? CCRs are a useful tool to quantify, monitor and compare workloads of allied health professionals. They are thought to change with increased seniority of roles. The CCRs for different allied health professional roles has yet to be defined in the literature.What does this paper add? CCRs decrease as level of seniority increases, indicating higher seniority increases non-clinical time. CCRs differ across professions, suggesting

  17. Platform links clinical data with electronic health records

    Cancer.gov

    To make data gathered from patients in clinical trials available for use in standard care, NCI has created a new computer tool to support interoperability between clinical research and electronic health record systems. This new software represents an inno

  18. What is Clinical Safety in Electronic Health Care Record Systems?

    NASA Astrophysics Data System (ADS)

    Davies, George

    There is mounting public awareness of an increasing number of adverse clinical incidents within the National Health Service (NHS), but at the same time, large health care projects like the National Programme for IT (NPFIT) are claiming that safer care is one of the benefits of the project and that health software systems in particular have the potential to reduce the likelihood of accidental or unintentional harm to patients. This paper outlines the approach to clinical safety management taken by CSC, a major supplier to NPFIT; discusses acceptable levels of risk and clinical safety as an end-to-end concept; and touches on the future for clinical safety in health systems software.

  19. IBM's Health Analytics and Clinical Decision Support.

    PubMed

    Kohn, M S; Sun, J; Knoop, S; Shabo, A; Carmeli, B; Sow, D; Syed-Mahmood, T; Rapp, W

    2014-08-15

    This survey explores the role of big data and health analytics developed by IBM in supporting the transformation of healthcare by augmenting evidence-based decision-making. Some problems in healthcare and strategies for change are described. It is argued that change requires better decisions, which, in turn, require better use of the many kinds of healthcare information. Analytic resources that address each of the information challenges are described. Examples of the role of each of the resources are given. There are powerful analytic tools that utilize the various kinds of big data in healthcare to help clinicians make more personalized, evidenced-based decisions. Such resources can extract relevant information and provide insights that clinicians can use to make evidence-supported decisions. There are early suggestions that these resources have clinical value. As with all analytic tools, they are limited by the amount and quality of data. Big data is an inevitable part of the future of healthcare. There is a compelling need to manage and use big data to make better decisions to support the transformation of healthcare to the personalized, evidence-supported model of the future. Cognitive computing resources are necessary to manage the challenges in employing big data in healthcare. Such tools have been and are being developed. The analytic resources, themselves, do not drive, but support healthcare transformation.

  20. Periodontal and general health: clinical recommendations.

    PubMed

    Bowen, Denise M

    2014-04-01

    The purpose of Linking Research to Clinical Practice is to present evidence based information to clinical dental hygienists so that they can make informed decisions regarding patient treatment and recommendations. Each issue will feature a different topic area of importance to clinical dental hygienists with A BOTTOM LINE to translate the research findings into clinical application.

  1. Pressure-equalizing PV assembly and method

    DOEpatents

    Dinwoodie, Thomas L.

    2004-10-26

    Each PV assembly of an array of PV assemblies comprises a base, a PV module and a support assembly securing the PV module to a position overlying the upper surface of the base. Vents are formed through the base. A pressure equalization path extends from the outer surface of the PV module, past the PV module, to and through at least one of the vents, and to the lower surface of the base to help reduce wind uplift forces on the PV assembly. The PV assemblies may be interengaged, such as by interengaging the bases of adjacent PV assemblies. The base may include a main portion and a cover and the bases of adjacent PV assemblies may be interengaged by securing the covers of adjacent bases together.

  2. PV module mounting method and mounting assembly

    DOEpatents

    Lenox, Carl J.S.; Johnson, Kurt M.

    2013-04-23

    A method for mounting PV modules to a deck includes selecting PV module layout pattern so that adjacent PV module edges are spaced apart. PV mounting and support assemblies are secured to the deck according to the layout pattern using fasteners extending into the deck. The PV modules are placed on the PV mounting and support assemblies. Retaining elements are located over and secured against the upper peripheral edge surfaces of the PV modules so to secure them to the deck with the peripheral edges of the PV modules spaced apart from the deck. In some examples a PV module mounting assembly, for use on a shingled deck, comprises flashing, a base mountable on the flashing, a deck-penetrating fastener engageable with the base and securable to the deck so to secure the flashing and the base to the shingled deck, and PV module mounting hardware securable to the base.

  3. PSCAD Modules Representing PV Generator

    SciTech Connect

    Muljadi, E.; Singh, M.; Gevorgian, V.

    2013-08-01

    Photovoltaic power plants (PVPs) have been growing in size, and the installation time is very short. With the cost of photovoltaic (PV) panels dropping in recent years, it can be predicted that in the next 10 years the contribution of PVPs to the total number of renewable energy power plants will grow significantly. In this project, the National Renewable Energy Laboratory (NREL) developed a dynamic modeling of the modules to be used as building blocks to develop simulation models of single PV arrays, expanded to include Maximum Power Point Tracker (MPPT), expanded to include PV inverter, or expanded to cover an entire PVP. The focus of the investigation and complexity of the simulation determines the components that must be included in the simulation. The development of the PV inverter was covered in detail, including the control diagrams. Both the current-regulated voltage source inverter and the current-regulated current source inverter were developed in PSCAD. Various operations of the PV inverters were simulated under normal and abnormal conditions. Symmetrical and unsymmetrical faults were simulated, presented, and discussed. Both the three-phase analysis and the symmetrical component analysis were included to clarify the understanding of unsymmetrical faults. The dynamic model validation was based on the testing data provided by SCE. Testing was conducted at SCE with the focus on the grid interface behavior of the PV inverter under different faults and disturbances. The dynamic model validation covers both the symmetrical and unsymmetrical faults.

  4. Mobile health clinics in the era of reform.

    PubMed

    Hill, Caterina F; Powers, Brian W; Jain, Sachin H; Bennet, Jennifer; Vavasis, Anthony; Oriol, Nancy E

    2014-03-01

    Despite the role of mobile clinics in delivering care to the full spectrum of at-risk populations, the collective impact of mobile clinics has never been assessed. This study characterizes the scope of the mobile clinic sector and its impact on access, costs, and quality. It explores the role of mobile clinics in the era of delivery reform and expanded insurance coverage. A synthesis of observational data collected through Mobile Health Map and published literature related to mobile clinics. Analysis of data from the Mobile Health Map Project, an online platform that aggregates data on mobile health clinics in the United States, supplemented by a comprehensive literature review. Mobile clinics represent an integral component of the healthcare system that serves vulnerable populations and promotes high-quality care at low cost. There are an estimated 1500 mobile clinics receiving 5 million visits nationwide per year. Mobile clinics improve access for vulnerable populations, bolster prevention and chronic disease management, and reduce costs. Expanded coverage and delivery reform increase opportunities for mobile clinics to partner with hospitals, health systems, and insurers to improve care and lower costs. Mobile clinics have a critical role to play in providing high-quality, low-cost care to vulnerable populations. The postreform environment, with increasing accountability for population health management and expanded access among historically underserved populations, should strengthen the ability for mobile clinics to partner with hospitals, health systems, and payers to improve care and lower costs.

  5. Clinical Preventive Services for Older Adults: The Interface Between Personal Health Care and Public Health Services

    PubMed Central

    Richards, Chesley L.; Shenson, Douglas

    2012-01-01

    Healthy aging must become a priority objective for both population and personal health services, and will require innovative prevention programming to span those systems. Uptake of essential clinical preventive services is currently suboptimal among adults, owing to a number of system- and office-based care barriers. To achieve maximum health results, prevention must be integrated across community and clinical settings. Many preventive services are portable, deliverable in either clinical or community settings. Capitalizing on that flexibility can improve uptake and health outcomes. Significant reductions in health disparities, mortality, and morbidity, along with decreases in health spending, are achievable through improved collaboration and synergy between population health and personal health systems. PMID:22390505

  6. Lifestyle and Clinical Health Behaviors and PSA Tests

    ERIC Educational Resources Information Center

    Norris, Cynthia; McFall, Stephanie

    2006-01-01

    This study assessed the association of lifestyle and clinical health behaviors with prostate specific antigen (PSA) tests. The study used cross-sectional data from the 2002 Behavioral Risk Factor Surveillance System (BRFSS). We used Stata 8.0 to take into account the complex sample design in analyses. Both lifestyle and clinical health behaviors…

  7. Locational Sensitivity Investigation on PV Hosting Capacity and Fast Track PV Screening

    SciTech Connect

    Ding, Fei; Mather, Barry; Ainsworth, Nathan; Gotseff, Peter; Baker, Kyri

    2016-05-05

    A 15% PV penetration threshold is commonly used by utilities to define photovoltaic (PV) screening methods where PV penetration is defined as the ratio of total solar PV capacity on a line section to peak load. However, this method doesn't take into account PV locational impact or feeder characteristics that could strongly change the feeder's capability to host PVs. This paper investigates the impact of PV location and phase connection type on PV hosting capacity, and then proposes a fast-track PV screening approach that leverages various PV hosting capacity metric responding to different PV locations and types. The proposed study could help utilities to evaluate PV interconnection requests and also help increase the PV hosting capacity of distribution feeders without adverse impacts on system voltages.

  8. Health Literacy Assessment in an Otolaryngology Clinic Population.

    PubMed

    Megwalu, Uchechukwu C; Lee, Jennifer Y

    2016-12-01

    To assess health literacy in an adult tertiary care otolaryngology clinic population and to explore potential determinants of inadequate health literacy. Cross-sectional study. Tertiary care otolaryngology clinic. The study population included all adult patients treated at 3 of Stanford University's adult otolaryngology clinic sites between March 1 and 11, 2016. Data were collected via an anonymous questionnaire. Health literacy was assessed with the Brief Health Literacy Screen. Ten percent of patients had inadequate health literacy. White race (odds ratio [OR], 0.23) and having English as the primary language (OR, 0.12) were associated with adequate health literacy, while high school or lower level of education (OR, 3.2) was associated with inadequate health literacy. Age, sex, and Hispanic ethnicity were not associated with health literacy. Our study highlights the need for health literacy screening in the otolaryngology clinic setting and identifies sociodemographic risk factors for inadequate health literacy. Further studies are needed to assess the impact of health literacy on patient outcomes and to test specific interventions to address health literacy and health outcomes. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

  9. Assessing uncertainty in outsourcing clinical services at tertiary health centers.

    PubMed

    Billi, John E; Pai, Chih-Wen; Spahlinger, David A

    2007-01-01

    When tertiary health centers face capacity constraint, one feasible strategy to meet service demand is outsourcing clinical services to qualified community providers. Clinical outsourcing enables tertiary health centers to meet the expectations of service timeliness and provides good opportunities to collaborate with other health care providers. However, outsourcing may result in dependence and loss of control for the tertiary health centers. Other parties involved in clinical outsourcing such as local partners, patients, and payers may also encounter potential risks as well as enjoy benefits in an outsourcing arrangement. Recommendations on selecting potential outsourcing partners are given to minimize the risks associated with an outsourcing contract.

  10. Computerization of Navy Outpatient Mental Health Clinics.

    DTIC Science & Technology

    1985-01-01

    Washington, D.C.: American Psychiatric Association , 1980. - .. - Congleton, M.W., Glogower, F., Baker, G.D. The Navy Mental Health Information ...34 "."* g Introduction ,.The Navy Mental Health Information System (NANHIS) h1s been developed to meet the requirements of clinicians and administrators...military environment. The NAMHIS MSE Form (see Figure 3) is divided .*... 7 MENTAL STATUS EXAMINATION NAVY MENKTAL HEALTH INFORMATION SYSTEM (NAMHIS

  11. "Tobacco Truths": Health Magazine, Clinical Epidemiology, and the Cigarette Connection.

    PubMed

    Wilmshurst, Sara

    2015-01-01

    In the 1950s, Health, a magazine published by the Health League of Canada, was nonchalant about the risks of smoking and largely ignored early epidemiological studies of lung cancer. In the 1960s the magazine stopped accepting cigarette advertising and began to oppose smoking. Health's writers adjusted to new knowledge; the magazine gradually accepted clinical epidemiology as a source of medical knowledge and recognized smoking as a public health risk. As Canada's only devoted health publication for a lay audience at the time, Health provides a unique window into ways that smoking and health were portrayed to its readers.

  12. Sexual Health Attitudes, Knowledge, and Clinical Behaviors: Implications for Counseling

    ERIC Educational Resources Information Center

    Russell, Elizabeth B.

    2012-01-01

    This article explores the impact of practitioners' attitudes and knowledge of sexual health on clinical behaviors. Sexual health topics are often areas of concern for clients of any age in counseling. Thus, counselors must be trained and equipped to address sexual health across the life span. This study explored whether child and adolescent…

  13. Sexual Health Attitudes, Knowledge, and Clinical Behaviors: Implications for Counseling

    ERIC Educational Resources Information Center

    Russell, Elizabeth B.

    2012-01-01

    This article explores the impact of practitioners' attitudes and knowledge of sexual health on clinical behaviors. Sexual health topics are often areas of concern for clients of any age in counseling. Thus, counselors must be trained and equipped to address sexual health across the life span. This study explored whether child and adolescent…

  14. Low concentrator PV optics optimization

    NASA Astrophysics Data System (ADS)

    Sharp, Leonard; Chang, Ben

    2008-08-01

    Purpose: Cost reduction is a major focus of the solar industry. Thin film technologies and concentration systems are viable ways to reducing cost, with unique strengths and weakness for both. Most of the concentrating PV work focuses on high concentration systems for reducing energy cost. Meanwhile, many believe that low concentrators provide significant cost reduction potential while addressing the mainstream PV market with a product that acts as a flat panel replacement. This paper analyzes the relative benefit of asymmetric vs. symmetric optics for low-concentrators in light of specific PV applications. Approach: Symmetric and asymmetric concentrating PV module performance is evaluated using computer simulation to determine potential value across various geographic locations and applications. The selected optic design is modeled against standard cSi flat panels and thin film to determine application fit, system level energy density and economic value. Results: While symmetric designs may seem ideal, asymmetric designs have an advantage in energy density. Both designs are assessed for aperture, optimum concentration ratio, and ideal system array configuration. Analysis of performance across climate specific effects (diffuse, direct and circumsolar) and location specific effects (sunpath) are also presented. The energy density and energy production of low concentrators provide a compelling value proposition. More significantly, the choice of optics for a low concentrating design can affect real world performance. With the goal of maximizing energy density and return on investment, this paper presents the advantages of asymmetric optic concentration and illustrates the value of this design within specific PV applications.

  15. PV system testing and standards

    NASA Astrophysics Data System (ADS)

    DeBlasio, Richard

    1999-03-01

    The U.S. Department of Energy (DOE) PV Program System Performance and Engineering Project is being conducted by The National Renewable Energy Laboratory (NREL), Sandia National Laboratories (SNL), Southwest Technology Development Institute (SWTDI), and Florida Solar Energy Center (FSEC). It provides PV system, subsystem, and component-level technology-performance characterization testing; test-method development and validation; national and international consensus standards and codes development, test-facility product certification, and laboratory-accreditation program implementation; and information exchange and technical assistance to the PV community. Emphasis is placed on reducing technical and infrastructural barriers to system acceptance, reducing life-cycle cost of systems, providing systems-engineering best practices and guidelines, and leading the national effort in performance and reliability testing, and consensus standards, codes, and certification program development and implementation—thereby ensuring that PV systems meet customers' needs and expectations. A summary of project activities, accomplishments, and future plans is provided and highlighted by an overview of PV system test-procedure and standards development.

  16. Knowledge and perceptions of breast health among free clinic patients.

    PubMed

    Kamimura, Akiko; Christensen, Nancy; Mo, Wenjing; Ashby, Jeanie; Reel, Justine J

    2014-01-01

    Breast cancer is a significant women's health problem in the United States. However, critical information on specific populations is still lacking. In particular, it is not well known how free clinic patients perceive breast health. The purpose of this study was to assess knowledge and perceptions of breast health among uninsured women utilizing a free clinic that serves as a safety net for the underserved. A self-administrated survey that included knowledge and perceptions of breast health was conducted for female free clinic patients aged 40 or older in fall 2012. There were 146 participants. The participants were classified into three groups for comparison; U.S. citizen English speakers, non-U.S. citizen English speakers, and Spanish speakers. Spanish speakers had the highest average score on the knowledge of breast health, whereas the non-U.S. citizen English speakers had the lowest average score. Free clinic patients may consider breast health screening if recommended by health care providers. The non-U.S. citizen English speakers and Spanish speakers were more likely to have negative perceptions of breast health compared with the U.S. citizen English speakers. Promoting knowledge about breast health is important for free clinics. Recommendation by a health care provider is a key to increasing attendance at health education programs and breast health screening. Non-U.S. citizens and non-English speakers would need culturally competent interventions. Free clinics have limited human and financial resources. Such characteristics of free clinics should be considered for practice implementations. Copyright © 2014 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

  17. Clinical investigations for SUS, the Brazilian public health system.

    PubMed

    Paula, Ana Patrícia de; Giozza, Silvana Pereira; Pereira, Michelle Zanon; Boaventura, Patrícia Souza; Santos, Leonor Maria Pacheco; Sachetti, Camile Giaretta; Tamayo, César Omar Carranza; Kowalski, Clarissa Campos Guaragna; Elias, Flavia Tavares Silva; Serruya, Suzanne Jacob; Guimarães, Reinaldo

    2012-01-01

    Scientific and technological development is crucial for advancing the Brazilian health system and for promoting quality of life. The way in which the Brazilian Ministry of Health has supported clinical research to provide autonomy, self-sufficiency, competitiveness and innovation for the healthcare industrial production complex, in accordance with the National Policy on Science, Technology and Innovation in Healthcare, was analyzed. Descriptive investigation, based on secondary data, conducted at the Department of Science and Technology, Ministry of Health. The Ministry of Health's research management database, PesquisaSaúde, was analyzed from 2002 to 2009, using the key word "clinical research" in the fields "primary sub-agenda" or "secondary sub-agenda". The 368 projects retrieved were sorted into six categories: basic biomedical research, preclinical studies, expanded clinical research, clinical trials, infrastructure support and health technology assessment. From a structured review on "clinical research funding", results from selected countries are presented and discussed. The amount invested was R$ 140 million. The largest number of projects supported "basic biomedical research", while the highest amounts invested were in "clinical trials" and "infrastructure support". The southeastern region had the greatest proportion of projects and financial resources. In some respects, Brazil is ahead of other BRICS countries (Russia, India, China and South Africa), especially with regard to establishing a National Clinical Research Network. The Ministry of Health ensured investments to encourage clinical research in Brazil and contributed towards promoting cohesion between investigators, health policies and the healthcare industrial production complex.

  18. Extending Medical Center Computer Application to Rural Health Clinics

    PubMed Central

    Gottfredson, Douglas K.

    1983-01-01

    A paper entitled “A COMPUTER DATA BASE FOR CLINICIANS, MANAGERS AND RESEARCHERS,” presented during the 1981 SCAMC, described the Salt Lake VA Medical Center computer system. Since that time, two Rural Health Clinics each about 150 miles from Salt Lake City were established by the SL VAMC to reduce traveling distances and improve services for Veterans. Although many existing computer applications were available with no modifications, additional software was needed to support unique needs of the clinics. The Rural Health package of software was designed to gather and store demographic and clinical information on each Veteran, determine the types of services provided, track services over time, monitor services provided by local hospitals and clinical laboratories which are paid for by the VA, determine total clinic costs, etc. These computer applications may be of interest to Medical Centers with separate clinics or outreach programs and individuals or groups in private practice with programs similar to the VA Rural Health Clinics.

  19. Health Occupations: Clinical Rotations and Learning Packets.

    ERIC Educational Resources Information Center

    Perrine, Patricia

    A one-year introductory course covering twelve different health occupations is presented in this curriculum guide designed for use at the secondary education level. Following a list of course objectives and suggested time allotments for each unit, the health occupations course outline is provided. Unit titles are the following: orientation and…

  20. Health Occupations: Clinical Rotations and Learning Packets.

    ERIC Educational Resources Information Center

    Perrine, Patricia

    A one-year introductory course covering twelve different health occupations is presented in this curriculum guide designed for use at the secondary education level. Following a list of course objectives and suggested time allotments for each unit, the health occupations course outline is provided. Unit titles are the following: orientation and…

  1. Clinical Education In psychiatric mental health nursing: Overcoming current challenges.

    PubMed

    Choi, Heeseung; Hwang, Boyoung; Kim, Sungjae; Ko, Heesung; Kim, Sumi; Kim, Chanhee

    2016-04-01

    In response to current challenges in psychiatric mental health nursing education, nursing schools have implemented new strategies in teaching undergraduate nursing students. The objectives of the study were to evaluate learning outcomes of a mental health nursing clinical practicum and to explore students' perceptions of the clinical practicum. This was a mixed-method study. Sixty-three undergraduate nursing students, who were undertaking their first mental health clinical practicum, completed a set of structured questionnaires and answered open-ended questions about the clinical practicum. Answers to open-ended questions were analyzed qualitatively, and learning outcomes (i.e., empathy, mental illness prejudice, simulation-related efficacy, and satisfaction) were measured at three time points: pre-clinical, post-simulation, and post-clinical. Students reported improvement in empathy and simulation-related self-efficacy after the clinical practicum, but no change was found in mental illness prejudice. Students' expectations for and evaluation of the clinical practicum are summarized. The observed improvement in learning outcomes of the clinical practicum may be attributed to the unique contribution of each component of the clinical practicum and the synergic effect of these diverse components. To manage emerging challenges in clinical settings and nursing education, it is critical to develop systematic and comprehensive mental health nursing clinical practicums for undergraduate nursing students. Copyright © 2016 Elsevier Ltd. All rights reserved.

  2. Clinical teaching and learning in midwifery and women's health.

    PubMed

    Raisler, Jeanne; O'Grady, Michelle; Lori, Jody

    2003-01-01

    Although there is an abundance of literature about clinical teaching in the health professions, a much smaller body of information focuses on the art and science of clinical teaching in midwifery and women's health. We reviewed preceptor handbooks, training manuals, and Web sites created by nursing and nurse-midwifery education programs, medical and pharmacy schools, and national associations of health professionals. Using the search terms "clinical teaching, clinical learning, preceptor, clerkship, residency training, and midwifery education", we searched the MEDLINE and CINAHL databases and health sciences libraries for relevant articles and books. The information and practical strategies about clinical teaching that we found are synthesized and presented in this article. It includes a discussion of challenges in clinical teaching; an overview of expectations and responsibilities of the education program, students, and preceptors; suggestions about orienting students to clinical sites; clinical teaching strategies and skills; suggestions for incorporating critical thinking and evidence-based care into clinical teaching; guidelines for giving constructive feedback and evaluation; characteristics of excellent clinical teachers; and suggestions about how education programs and professional associations can support and develop clinical sites and preceptors. The Appendix contains manuals, books, and Web sites devoted to clinical teaching.

  3. Clinical supervision for allied health staff: necessary but not sufficient.

    PubMed

    Leggat, Sandra G; Phillips, Bev; Pearce, Philippa; Dawson, Margaret; Schulz, Debbie; Smith, Jenni

    2015-09-28

    Objectives The aim of the present study was to explore the perspectives of allied health professionals on appropriate content for effective clinical supervision of staff.Methods A set of statements regarding clinical supervision was identified from the literature and confirmed through a Q-sort process. The final set was administered as an online survey to 437 allied health professionals working in two Australian health services.Results Of the 120 respondents, 82 had experienced six or more clinical supervision sessions and were included in the analysis. Respondents suggested that clinical supervision was beneficial to both staff and patients, and was distinct from line management performance monitoring and development. Curiously, some of the respondents did not agree that observation of the supervisee's clinical practice was an aspect of clinical supervision.Conclusions Although clinical supervision is included as a pillar of clinical governance, current practice may not be effective in addressing clinical risk. Australian health services need clear organisational policies that outline the relationship between supervisor and supervisee, the role and responsibilities of managers, the involvement of patients and the types of situations to be communicated to the line managers.What is known about the topic? Clinical supervision for allied health professionals is an essential component of clinical governance and is aimed at ensuring safe and high-quality care. However, there is varied understanding of the relationship between clinical supervision and performance management.What does this paper add? This paper provides the perspectives of allied health professionals who are experienced as supervisors or who have experienced supervision. The findings suggest a clear role for clinical supervision that needs to be better recognised within organisational policy and procedure.What are the implications for practitioners? Supervisors and supervisees must remember their duty of

  4. A review of analytics and clinical informatics in health care.

    PubMed

    Simpao, Allan F; Ahumada, Luis M; Gálvez, Jorge A; Rehman, Mohamed A

    2014-04-01

    Federal investment in health information technology has incentivized the adoption of electronic health record systems by physicians and health care organizations; the result has been a massive rise in the collection of patient data in electronic form (i.e. "Big Data"). Health care systems have leveraged Big Data for quality and performance improvements using analytics-the systematic use of data combined with quantitative as well as qualitative analysis to make decisions. Analytics have been utilized in various aspects of health care including predictive risk assessment, clinical decision support, home health monitoring, finance, and resource allocation. Visual analytics is one example of an analytics technique with an array of health care and research applications that are well described in the literature. The proliferation of Big Data and analytics in health care has spawned a growing demand for clinical informatics professionals who can bridge the gap between the medical and information sciences.

  5. Flexible packaging for PV modules

    NASA Astrophysics Data System (ADS)

    Dhere, Neelkanth G.

    2008-08-01

    Economic, flexible packages that provide needed level of protection to organic and some other PV cells over >25-years have not yet been developed. However, flexible packaging is essential in niche large-scale applications. Typical configuration used in flexible photovoltaic (PV) module packaging is transparent frontsheet/encapsulant/PV cells/flexible substrate. Besides flexibility of various components, the solder bonds should also be flexible and resistant to fatigue due to cyclic loading. Flexible front sheets should provide optical transparency, mechanical protection, scratch resistance, dielectric isolation, water resistance, UV stability and adhesion to encapsulant. Examples are Tefzel, Tedlar and Silicone. Dirt can get embedded in soft layers such as silicone and obscure light. Water vapor transmittance rate (WVTR) of polymer films used in the food packaging industry as moisture barriers are ~0.05 g/(m2.day) under ambient conditions. In comparison, light emitting diodes employ packaging components that have WVTR of ~10-6 g/(m2.day). WVTR of polymer sheets can be improved by coating them with dense inorganic/organic multilayers. Ethylene vinyl acetate, an amorphous copolymer used predominantly by the PV industry has very high O2 and H2O diffusivity. Quaternary carbon chains (such as acetate) in a polymer lead to cleavage and loss of adhesional strength at relatively low exposures. Reactivity of PV module components increases in presence of O2 and H2O. Adhesional strength degrades due to the breakdown of structure of polymer by reactive, free radicals formed by high-energy radiation. Free radical formation in polymers is reduced when the aromatic rings are attached at regular intervals. This paper will review flexible packaging for PV modules.

  6. E-health stakeholders experiences with clinical modelling and standardizations.

    PubMed

    Gøeg, Kirstine Rosenbeck; Elberg, Pia Britt; Højen, Anne Randorff

    2015-01-01

    Stakeholders in e-health such as governance officials, health IT-implementers and vendors have to co-operate to achieve the goal of a future-proof interoperable e-health infrastructure. Co-operation requires knowledge on the responsibility and competences of stakeholder groups. To increase awareness on clinical modeling and standardization we conducted a workshop for Danish and a few Norwegian e-health stakeholders' and made them discuss their views on different aspects of clinical modeling using a theoretical model as a point of departure. Based on the model, we traced stakeholders' experiences. Our results showed there was a tendency that stakeholders were more familiar with e-health requirements than with design methods, clinical information models and clinical terminology as they are described in the scientific literature. The workshop made it possible for stakeholders to discuss their roles and expectations to each other.

  7. Comparison of Pyranometers vs. PV Reference Cells for Evaluation of PV Array Performance

    SciTech Connect

    Dunn, L.; Gostein, M.; Emery, K.

    2012-09-01

    As the photovoltaics (PV) industry has grown, the need for accurately monitoring the solar resource of PV power plants has increased. Historically, the PV industry has relied on thermopile pyranometers for irradiance measurements, and a large body of historical irradiance data taken with pyranometers exists. However, interest in PV reference devices is increasing. In this paper, we discuss why PV reference devices are better suited for PV applications, and estimate the typical uncertainties in irradiance measurements made with both pyranometers and PV reference devices. We assert that the quantity of interest in monitoring a PV power plant is the equivalent irradiance under the IEC 60904-3 reference solar spectrum that would produce the same electrical response in the PV array as the incident solar radiation. For PV-plant monitoring applications, we find the uncertainties in irradiance measurements of this type to be on the order of +/-5% for thermopile pyranometers and +/-2.4% for PV reference devices.

  8. Health System Consolidation and Diabetes Care Performance at Ambulatory Clinics.

    PubMed

    Crespin, Daniel J; Christianson, Jon B; McCullough, Jeffrey S; Finch, Michael D

    2016-10-01

    We addressed two questions regarding health system consolidation through the acquisition of ambulatory clinics: (1) Was increasing health system size associated with improved diabetes care performance and (2) Did the diabetes care performance of acquired clinics improve postacquisition? Six hundred sixty-one ambulatory clinics in Minnesota and bordering states that reported performance data from 2007 to 2013. We employed fixed effects regression to determine if increased health system size and being acquired improved clinics' performance. Using our regression results, we estimated the average effect of consolidation on the performance of clinics that were acquired during our study. Publicly reported performance data obtained from Minnesota Community Measurement. Acquired clinics experienced performance improvements starting in their third year postacquisition. By their fifth year postacquisition, acquired clinics had 3.6 percentage points (95 percent confidence interval: 2.0, 5.1) higher performance than if they had never been acquired. Increasing health system size was associated with slight performance improvements at the end of the study. Health systems modestly improved the diabetes care performance of their acquired clinics; however, we found little evidence that systems experienced large, system-wide performance gains by increasing their size. © Health Research and Educational Trust.

  9. Clinical Trials Shed Light on Minority Health

    MedlinePlus

    ... Devices Radiation-Emitting Products Vaccines, Blood & Biologics Animal & Veterinary Cosmetics Tobacco Products For Consumers Home For Consumers ... Info You Need More in Consumer Updates Animal & Veterinary Children's Health Cosmetics Dietary Supplements Drugs Food Medical ...

  10. Productive efficiency of rural health clinics: the Midwest experience.

    PubMed

    Sinay, T

    2001-01-01

    This article identifies the characteristics of efficient and inefficient rural clinics in the Midwest, using 1994 Medicare cost reports. Rural health clinics are compared on the basis of productive efficiency by estimating a nonparametric frontier. Six inputs and five output categories were employed to estimate an efficient frontier. The results show that an efficient clinic, on average, employs approximately 1.5 more physicians than an inefficient clinic and incurs capital expenses more than twice those of the inefficient clinic. Future rural clinics are expected to be larger, employing more capital and labor to take advantage of scale economies. However, given the steady (or decreasing) population of rural communities, the expansion of relatively small rural clinics could involve forming rural health care systems and/or networks in close proximity to create synergies from scale economies, staff recruitment, easier access to capital, shared information systems, improved mobility of physicians among several clinics and savings from management costs.

  11. 42 CFR 405.2462 - Payment for rural health clinic and Federally qualified health center services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... this chapter. (6) Payment for treatment of mental psychoneurotic or personality disorders is subject to... 42 Public Health 2 2010-10-01 2010-10-01 false Payment for rural health clinic and Federally qualified health center services. 405.2462 Section 405.2462 Public Health CENTERS FOR MEDICARE &...

  12. Managing risk: clinical decision-making in mental health services.

    PubMed

    Muir-Cochrane, Eimear; Gerace, Adam; Mosel, Krista; O'Kane, Debra; Barkway, Patricia; Curren, David; Oster, Candice

    2011-01-01

    Risk assessment and management is a major component of contemporary mental health practice. Risk assessment in health care exists within contemporary perspectives of management and risk aversive practices in health care. This has led to much discussion about the best approach to assessing possible risks posed by people with mental health problems. In addition, researchers and commentators have expressed concern that clinical practice is being dominated by managerial models of risk management at the expense of meeting the patient's health and social care needs. The purpose of the present study is to investigate the risk assessment practices of a multidisciplinary mental health service. Findings indicate that mental health professionals draw on both managerial and therapeutic approaches to risk management, integrating these approaches into their clinical practice. Rather than being dominated by managerial concerns regarding risk, the participants demonstrate professional autonomy and concern for the needs of their clients.

  13. Integration of clinical research documentation in electronic health records.

    PubMed

    Broach, Debra

    2015-04-01

    Clinical trials of investigational drugs and devices are often conducted within healthcare facilities concurrently with clinical care. With implementation of electronic health records, new communication methods are required to notify nonresearch clinicians of research participation. This article reviews clinical research source documentation, the electronic health record and the medical record, areas in which the research record and electronic health record overlap, and implications for the research nurse coordinator in documentation of the care of the patient/subject. Incorporation of clinical research documentation in the electronic health record will lead to a more complete patient/subject medical record in compliance with both research and medical records regulations. A literature search provided little information about the inclusion of clinical research documentation within the electronic health record. Although regulations and guidelines define both source documentation and the medical record, integration of research documentation in the electronic health record is not clearly defined. At minimum, the signed informed consent(s), investigational drug or device usage, and research team contact information should be documented within the electronic health record. Institutional policies should define a standardized process for this integration in the absence federal guidance. Nurses coordinating clinical trials are in an ideal position to define this integration.

  14. Cults and mental health: clinical conclusions.

    PubMed

    Levine, S V

    1981-12-01

    The field of cults and their relation to psychological and psychiatric disorder is reft with rhetoric and opinion. There has been a particular dearth of documentation and substantiated data supporting psychiatric opinion. As a result of considerable research, clinical work, and an extensive literature review, certain conclusions or strongly suggested positions are enunciated. An attempt is made to substantiate each of the ten assertions based on existing data, in the hope that they will clarify the muddy existing data, area, make clinical positions and interventions more soundly based, and inspire debate and heuristic efforts.

  15. Clinical genomics in the world of the electronic health record.

    PubMed

    Marsolo, Keith; Spooner, S Andrew

    2013-10-01

    The widespread adoption of electronic health records presents a number of benefits to the field of clinical genomics. They include the ability to return results to the practitioner, to use genetic findings in clinical decision support, and to have data collected in the electronic health record that serve as a source of phenotypic information for analysis purposes. Not all electronic health records are created equal, however. They differ in their features, capabilities, and ease of use. Therefore, to understand the potential of the electronic health record, it is first necessary to understand its capabilities and the impact that implementation strategy has on usability. Specifically, we focus on the following areas: (i) how the electronic health record is used to capture data in clinical practice settings; (ii) how the implementation and configuration of the electronic health record affect the quality and availability of data; (iii) the management of clinical genetic test results and the feasibility of electronic health record integration; and (iv) the challenges of implementing an electronic health record in a research-intensive environment. This is followed by a discussion of the minimum functional requirements that an electronic health record must meet to enable the satisfactory integration of genomic results as well as the open issues that remain.

  16. Progress & Frontiers in PV Performance

    SciTech Connect

    Deline, Chris; DiOrio, Nick; Jordan, Dirk; Toor, Fatima

    2016-09-12

    PowerPoint slides for a presentation given at Solar Power International 2016. Presentation includes System Advisor Model (SAM) introduction and battery modeling, bifacial PV modules and modeling, shade modeling and module level power electronics (MLPE), degradation rates, and PVWatts updates and validation.

  17. Review of Clinical Mental Health Counseling Process and Outcome Research.

    ERIC Educational Resources Information Center

    Kelly, Kevin R.

    1996-01-01

    Summarizes important advances in clinical knowledge regarding mental health counseling processes and outcomes of treatment as appeared in four major journals in 1994. Findings are summarized by topic and implications for practice are provided. Delineates current lines of inquiry. (EMK)

  18. Introductory Chemical Education of Health Professionals: An Integrated Clinical Approach.

    ERIC Educational Resources Information Center

    Farina, Joseph; Frechette, Michael

    1979-01-01

    Reports the development of an integrated clinical approach to introductory chemistry education at the undergraduate level for students majoring in nursing and the allied health professions at the University of Lowell. (BT)

  19. Architectural analysis of clinical ontologies for pHealth interoperability.

    PubMed

    Uribe, Gustavo A; López, Diego M; Blobel, Bernd

    2012-01-01

    Comprehensive interoperability between eHealth/pHealth systems requires properly represented shared knowledge. Formal ontologies allow specifying the semantics of health knowledge representation in a well-defined and unambiguous manner. The objective of this paper is to formally analyze - from a system-theoretical architectural perspective - existing clinical ontologies. The paper defines important ontology requirements for semantically interoperable pHealth/eHealth systems. Then, based on those requirements, 17 criteria are defined and used for analyzing 129 clinical ontologies. Statistical results confirm that most ontologies do not meet the defined criteria. OBO foundry defines a good approach to meet all defined criteria, but it does not cover yet the clinical domain as a whole. SNOMED CT was found the more comprehensive one, despite several restrictions.

  20. The role of health economics within clinical research.

    PubMed

    Manns, Braden J

    2009-01-01

    The pressure for health care systems to provide more resource-intensive health care and newer, more costly therapies is significant, despite limited health care budgets. It is not surprising, then, that demonstration that a new therapy is effective is no longer sufficient to ensure that it can be used in practice within publicly funded health care systems. The impact of the therapy on health care costs is also important and considered by decision makers, who must decide whether scarce resources should be invested in providing a new therapy. The impact of a therapy on both clinical benefits and costs can be estimated simultaneously using economic evaluation, the strengths and limitations of which are discussed. When planning a clinical trial, important economic outcomes can often be collected alongside the clinical outcome data, enabling consideration of the impact of the therapy on overall resource use, thus enabling performance of an economic evaluation, if appropriate.

  1. Enhancing electronic health records to support clinical research.

    PubMed

    Vawdrey, David K; Weng, Chunhua; Herion, David; Cimino, James J

    2014-01-01

    The "Learning Health System" has been described as an environment that drives research and innovation as a natural outgrowth of patient care. Electronic health records (EHRs) are necessary to enable the Learning Health System; however, a source of frustration is that current systems fail to adequately support research needs. We propose a model for enhancing EHRs to collect structured and standards-based clinical research data during clinical encounters that promotes efficiency and computational reuse of quality data for both care and research. The model integrates Common Data Elements (CDEs) for clinical research into existing clinical documentation workflows, leveraging executable documentation guidance within the EHR to support coordinated, standardized data collection for both patient care and clinical research.

  2. Clinical, classroom, or personal education: attitudes about health literacy*

    PubMed Central

    Logan, Robert A.

    2007-01-01

    Purpose: This study explores how diverse attitudes about health literacy are assessed by medical librarians and other health care professionals. Procedures: An online survey of thirty-six items was conducted using Q methodology in two phases in spring 2005 and winter 2006. Respondents (n = 51) were nonrandomly self-selected from a convenience sample of members of the Medical Library Association and a group of environmental health consultants to the National Library of Medicine. Findings: Three factors were identified. Factor 1 is optimistic and supportive of health literacy's transformative sociocultural and professional potential, if clinical settings become a launching point for health literacy activities. Factor 2 is less optimistic about health literacy's potential to improve clinical or patient outcomes and prefers to focus health literacy initiatives on classroom education settings. Factor 3 supports improving the nation's health literacy but tends to support health literacy initiatives when people privately interact with health information materials. Conclusions: Each factor's attitudes about the appropriate educational venue to initiate health literacy activities are different and somewhat mutually exclusive. This suggests that health literacy is seen through different perceptual frameworks that represent a possible source of professional disagreement. PMID:17443245

  3. Clinical, classroom, or personal education: attitudes about health literacy.

    PubMed

    Logan, Robert A

    2007-04-01

    This study explores how diverse attitudes about health literacy are assessed by medical librarians and other health care professionals. An online survey of thirty-six items was conducted using Q methodology in two phases in spring 2005 and winter 2006. Respondents (n = 51) were nonrandomly self-selected from a convenience sample of members of the Medical Library Association and a group of environmental health consultants to the National Library of Medicine. Three factors were identified. Factor 1 is optimistic and supportive of health literacy's transformative sociocultural and professional potential, if clinical settings become a launching point for health literacy activities. Factor 2 is less optimistic about health literacy's potential to improve clinical or patient outcomes and prefers to focus health literacy initiatives on classroom education settings. Factor 3 supports improving the nation's health literacy but tends to support health literacy initiatives when people privately interact with health information materials. Each factor's attitudes about the appropriate educational venue to initiate health literacy activities are different and somewhat mutually exclusive. This suggests that health literacy is seen through different perceptual frameworks that represent a possible source of professional disagreement.

  4. Health literacy and usability of clinical trial search engines.

    PubMed

    Utami, Dina; Bickmore, Timothy W; Barry, Barbara; Paasche-Orlow, Michael K

    2014-01-01

    Several web-based search engines have been developed to assist individuals to find clinical trials for which they may be interested in volunteering. However, these search engines may be difficult for individuals with low health and computer literacy to navigate. The authors present findings from a usability evaluation of clinical trial search tools with 41 participants across the health and computer literacy spectrum. The study consisted of 3 parts: (a) a usability study of an existing web-based clinical trial search tool; (b) a usability study of a keyword-based clinical trial search tool; and (c) an exploratory study investigating users' information needs when deciding among 2 or more candidate clinical trials. From the first 2 studies, the authors found that users with low health literacy have difficulty forming queries using keywords and have significantly more difficulty using a standard web-based clinical trial search tool compared with users with adequate health literacy. From the third study, the authors identified the search factors most important to individuals searching for clinical trials and how these varied by health literacy level.

  5. Perspectives on Clinical Informatics: Integrating Large-Scale Clinical, Genomic, and Health Information for Clinical Care

    PubMed Central

    Choi, In Young; Kim, Tae-Min; Kim, Myung Shin; Mun, Seong K.

    2013-01-01

    The advances in electronic medical records (EMRs) and bioinformatics (BI) represent two significant trends in healthcare. The widespread adoption of EMR systems and the completion of the Human Genome Project developed the technologies for data acquisition, analysis, and visualization in two different domains. The massive amount of data from both clinical and biology domains is expected to provide personalized, preventive, and predictive healthcare services in the near future. The integrated use of EMR and BI data needs to consider four key informatics areas: data modeling, analytics, standardization, and privacy. Bioclinical data warehouses integrating heterogeneous patient-related clinical or omics data should be considered. The representative standardization effort by the Clinical Bioinformatics Ontology (CBO) aims to provide uniquely identified concepts to include molecular pathology terminologies. Since individual genome data are easily used to predict current and future health status, different safeguards to ensure confidentiality should be considered. In this paper, we focused on the informatics aspects of integrating the EMR community and BI community by identifying opportunities, challenges, and approaches to provide the best possible care service for our patients and the population. PMID:24465229

  6. Perspectives on clinical informatics: integrating large-scale clinical, genomic, and health information for clinical care.

    PubMed

    Choi, In Young; Kim, Tae-Min; Kim, Myung Shin; Mun, Seong K; Chung, Yeun-Jun

    2013-12-01

    The advances in electronic medical records (EMRs) and bioinformatics (BI) represent two significant trends in healthcare. The widespread adoption of EMR systems and the completion of the Human Genome Project developed the technologies for data acquisition, analysis, and visualization in two different domains. The massive amount of data from both clinical and biology domains is expected to provide personalized, preventive, and predictive healthcare services in the near future. The integrated use of EMR and BI data needs to consider four key informatics areas: data modeling, analytics, standardization, and privacy. Bioclinical data warehouses integrating heterogeneous patient-related clinical or omics data should be considered. The representative standardization effort by the Clinical Bioinformatics Ontology (CBO) aims to provide uniquely identified concepts to include molecular pathology terminologies. Since individual genome data are easily used to predict current and future health status, different safeguards to ensure confidentiality should be considered. In this paper, we focused on the informatics aspects of integrating the EMR community and BI community by identifying opportunities, challenges, and approaches to provide the best possible care service for our patients and the population.

  7. Clinical engineering development in the Uruguayan public health system.

    PubMed

    Di Virgilio, Valerio; Ambrois, Gonzalo

    2010-01-01

    Establishment of the clinical engineering department with a network of 5 operational centers to strengthen public medical equipment management and maintenance, in the context of the Health System reform with the purpose of ensuring universal access to the health services in the Republic of Uruguay.

  8. Addressing Low Literacy and Health Literacy in Clinical Oncology Practice

    PubMed Central

    Garcia, Sofia F.; Hahn, Elizabeth A.; Jacobs, Elizabeth A.

    2011-01-01

    Low functional literacy and low health literacy continue to be under-recognized and are associated with poorer patient health outcomes. Health literacy is a dynamic state influenced by how well a healthcare system delivers information and services that match patients’ abilities, needs and preferences. Oncology care poses considerable health literacy demands on patients who are expected to process high stakes information about complex multidisciplinary treatment over lengths of time. Much of the information provided to patients in clinical care and research is beyond their literacy levels. In this paper, we provide an overview of currently available guidelines and resources to improve how the needs of patients with diverse literacy skills are met by cancer care providers and clinics. We present recommendations for health literacy assessment in clinical practice and ways to enhance the usability of health information and services by improving written materials and verbal communication, incorporating multimedia and culturally appropriate approaches, and promoting health literacy in cancer care settings. The paper also includes a list of additional resources that can be used to develop and implement health literacy initiatives in cancer care clinics. PMID:20464884

  9. Table Clinics: A Valuable Learning Experience for Allied Health Students.

    ERIC Educational Resources Information Center

    Melton, Jimmie H.

    Table clinics, or short oral presentations on techniques related to some phase of research, diagnosis, or treatment, can be used to enrich allied health education. To present a table clinic, students must choose a topic which lends itself to a 5- to 7-minute presentation and which imparts knowledge that participants can take back to their…

  10. Clinic Visit Data as a Tool to Improve Student Health

    ERIC Educational Resources Information Center

    Lamping, Jerry

    2012-01-01

    Typically, the number of student visits to a school clinic is interesting only to the health services department as a metric for setting levels for clinic staffing and medical supply stocking. However, the number of visits and the reasons for those visits can gauge a school's indoor environmental quality (IEQ) and can motivate the facility…

  11. Clinic Visit Data as a Tool to Improve Student Health

    ERIC Educational Resources Information Center

    Lamping, Jerry

    2012-01-01

    Typically, the number of student visits to a school clinic is interesting only to the health services department as a metric for setting levels for clinic staffing and medical supply stocking. However, the number of visits and the reasons for those visits can gauge a school's indoor environmental quality (IEQ) and can motivate the facility…

  12. Clinical Supervision Skills: Managing the Clinical Environment. Health Occupations Clinical Teacher Education Series for Secondary and Post-Secondary Educators.

    ERIC Educational Resources Information Center

    Shea, Mary Lou; And Others

    This learning module, which is part of a staff development program for health occupations clinical instructors, discusses the process of managing the physical clinical environment and students' experiences within the clinical environment. It includes learning activities dealing with various aspects of managing the physical environment and student…

  13. Grid Integrated Distributed PV (GridPV) Version 2.

    SciTech Connect

    Reno, Matthew J.; Coogan, Kyle

    2014-12-01

    This manual provides the documentation of the MATLAB toolbox of functions for using OpenDSS to simulate the impact of solar energy on the distribution system. The majority of the functio ns are useful for interfacing OpenDSS and MATLAB, and they are of generic use for commanding OpenDSS from MATLAB and retrieving information from simulations. A set of functions is also included for modeling PV plant output and setting up the PV plant in th e OpenDSS simulation. The toolbox contains functions for modeling the OpenDSS distribution feeder on satellite images with GPS coordinates. Finally, example simulations functions are included to show potential uses of the toolbox functions. Each function i n the toolbox is documented with the function use syntax, full description, function input list, function output list, example use, and example output.

  14. Adoption of Clinical Information Systems in Health Services Organizations

    PubMed Central

    Austin, Charles J.; Holland, Gloria J.

    1988-01-01

    This paper presents a conceptual model of factors which influence organizational decisions to invest in the installation of clinical information systems. Using results of previous research as a framework, the relative influence of clinical, fiscal, and strategic-institutional decision structures are examined. These adoption decisions are important in health services organizations because clinical information is essential for managing demand and allocating resources, managing quality of care, and controlling costs.

  15. Lightweight IMM PV Flexible Blanket Assembly

    NASA Technical Reports Server (NTRS)

    Spence, Brian

    2015-01-01

    Deployable Space Systems (DSS) has developed an inverted metamorphic multijunction (IMM) photovoltaic (PV) integrated modular blanket assembly (IMBA) that can be rolled or z-folded. This IMM PV IMBA technology enables a revolutionary flexible PV blanket assembly that provides high specific power, exceptional stowed packaging efficiency, and high-voltage operation capability. DSS's technology also accommodates standard third-generation triple junction (ZTJ) PV device technologies to provide significantly improved performance over the current state of the art. This SBIR project demonstrated prototype, flight-like IMM PV IMBA panel assemblies specifically developed, designed, and optimized for NASA's high-voltage solar array missions.

  16. Clinical trial registration in oral health journals.

    PubMed

    Smaïl-Faugeron, V; Fron-Chabouis, H; Durieux, P

    2015-03-01

    Prospective registration of randomized controlled trials (RCTs) represents the best solution to reporting bias. The extent to which oral health journals have endorsed and complied with RCT registration is unknown. We identified journals publishing RCTs in dentistry, oral surgery, and medicine in the Journal Citation Reports. We classified journals into 3 groups: journals requiring or recommending trial registration, journals referring indirectly to registration, and journals providing no reference to registration. For the 5 journals with the highest 2012 impact factors in each group, we assessed whether RCTs with results published in 2013 had been registered. Of 78 journals examined, 32 (41%) required or recommended trial registration, 19 (24%) referred indirectly to registration, and 27 (35%) provided no reference to registration. We identified 317 RCTs with results published in the 15 selected journals in 2013. Overall, 73 (23%) were registered in a trial registry. Among those, 91% were registered retrospectively and 32% did not report trial registration in the published article. The proportion of trials registered was not significantly associated with editorial policies: 29% with results in journals that required or recommended registration, 15% in those that referred indirectly to registration, and 21% in those providing no reference to registration (P = 0.05). Less than one-quarter of RCTs with results published in a sample of oral health journals were registered with a public registry. Improvements are needed with respect to how journals inform and require their authors to register their trials. © International & American Associations for Dental Research.

  17. Strategies for Improving Nursing Students' Mental Health Clinical Rotation.

    PubMed

    Kroning, Maureen

    2016-01-01

    Mental illness is a huge problem many people face in the U.S. and around the world. The American Psychiatric Nurses Association indicates there is a shortage of nurses in every level and role in psychiatric-mental health nursing. Raising up a generation of nurses who want to work with the mentally ill is a challenge for nurse educators. The use of role playing and simulation in the learning lab prior to entering the clinical setting and reflective journaling in the clinical rotation can improve undergraduate nursing students' mental health clinical experience.

  18. Clinical and Management Requirements for Computerized Mental Health Information Systems

    PubMed Central

    Levinton, Paula H.; Dunning, Tessa F.E.

    1980-01-01

    Information requirements of mental health providers are sufficiently different from those of other health care managers to warrant a different approach to the development of management information systems (MIS). Advances in computer technology and increased demands for fiscal accountability have led to developing integrated mental health information systems (MHIS) that support clinical and management requirements. In a study made to define a set of generic information requirements of mental health providers that can be supported by an MHIS, it was found that basic data needs can be defined and classified in functional terms: clinical, management, and consultation/education requirements. A basic set of data to support these needs was defined: demographic, financial, clinical, programmatic, and service delivery data.

  19. Teaching About Health Care Disparities in the Clinical Setting

    PubMed Central

    Fernandez, Leonor; Irby, David M.; Harleman, Elizabeth; Fernandez, Alicia

    2010-01-01

    Clinical teachers often observe interactions that may contribute to health care disparities, yet may hesitate to teach about them. A pedagogical model could help faculty structure teaching about health care disparities in the clinical setting, but to our knowledge, none have been adapted for this purpose. In this paper, we adapt an established model, Time-Effective Strategies for Teaching (TEST), to the teaching of health care disparities. We use several case scenarios to illustrate the core components of the model: diagnose the learner, teach rapidly to the learner’s need, and provide feedback. The TEST model is straightforward, easy to use, and enables the incorporation of teaching about health care disparities into routine clinical teaching. PMID:20352501

  20. [The family in mental health: support for clinical nursing care].

    PubMed

    da Silva, Kely Vanessa Leite Gomes; Monteiro, Ana Ruth Macedo

    2011-10-01

    This is a theoretical reflection on the clinical nursing care in mental health that is offered to the family. In view of having a family member with mental suffering, the family would delegate the care to that relative to the mental institution, thus there should be collaboration between the nursing and medical team to organize the environment and ensure family and social isolation. With the Psychiatric Reform, based on the proposal for psychosocial care, the family becomes the center of attention for health care professionals. The necessary support for clinical nursing care includes making conceptual changes in implementing health education, interdisciplinary work, and in the broadened clinic, so as to ensure comprehensiveness and subjects' autonomy. Clinical nursing care should permeate the subjects' politicalization, in which the actors militate to reach autonomy, and the practices involve dignity, creativity, welcoming, interdisciplinarity, hearing, and knowledge sharing.

  1. Employee Health in the Mental Health Workplace: Clinical, Administrative, and Organizational Perspectives.

    PubMed

    Shah, Jai L; Kapoor, Reena; Cole, Robert; Steiner, Jeanne L

    2016-04-01

    Issues of mental health and employee health have risen to increasing prominence in recent years. However, there have been few explorations of the clinical and administrative challenges that these issues raise, particularly in settings that are themselves mental health workplaces. In order to identify and understand such challenges, a brief case of acute employee illness in a mental health workplace is described followed by a discussion of salient clinical, administrative, and organizational considerations. The case raises questions about medicolegal responsibilities and relationships between clinicians and patients in mental health settings, illuminates tensions between clinical staff and human resources processes, and draws attention to the need for illness prevention and mental health promotion initiatives in the workplace. Increased awareness of these issues, complications, and potential solutions would benefit clinicians, administrators, and mental health institutions.

  2. Support for Offering Sexual Health Services through School-Based Health Clinics

    ERIC Educational Resources Information Center

    Moore, Michele Johnson; Barr, Elissa; Wilson, Kristina; Griner, Stacey

    2016-01-01

    Background: Numerous studies document support for sexuality education in the schools. However, there is a dearth of research assessing support for sexual health services offered through school-based health clinics (SBHCs). The purpose of this study was to assess voter support for offering 3 sexual health services (STI/HIV testing, STI/HIV…

  3. Support for Offering Sexual Health Services through School-Based Health Clinics

    ERIC Educational Resources Information Center

    Moore, Michele Johnson; Barr, Elissa; Wilson, Kristina; Griner, Stacey

    2016-01-01

    Background: Numerous studies document support for sexuality education in the schools. However, there is a dearth of research assessing support for sexual health services offered through school-based health clinics (SBHCs). The purpose of this study was to assess voter support for offering 3 sexual health services (STI/HIV testing, STI/HIV…

  4. Clinical health research in India: is there a way forward?

    PubMed

    Sayed, Suhail I; Dutta, Sourav; Mateen, Sayyad; Kazi, Rehan; Jagade, Mohan

    2011-04-01

    A vibrant health research industry is an indispensible asset for societal development. Health research focus and output in India is sadly not at par with the magnitude and distribution of the prevalent disease burden. In the current scenario of the ever evolving Indian public health sector, the balancing of research efforts between different competing fields, especially when resources are meagre, is a delicate one and quite typical of the problems anticipated in developing countries. To progress, the nation's clinical health research needs good quality, authentic and relevant research in the varied aspect of public health. Rhetoric or theoretical concepts alone cannot move the health status and research forward in this country. Evidence and evidence based medicine have revitalised the academic aspects of the public health sector. But, its up to the Indian policy makers, administrators and medical professionals to assure that the vast research opportunity this country offers is exploited to its maximum potential.

  5. Patients utilizing a free clinic: physical and mental health, health literacy, and social support.

    PubMed

    Kamimura, Akiko; Christensen, Nancy; Tabler, Jennifer; Ashby, Jeanie; Olson, Lenora M

    2013-08-01

    This cross sectional study assessed the physical and mental health, health literacy and social support of the uninsured utilizing a free clinic to develop intervention programs and research projects to improve the health of free clinic patients. Free clinics are nonprofit organizations that provide underserved and uninsured individuals access to a broad array of free or low cost healthcare services. English or Spanish speaking patients (N = 187) aged 18 years or older completed a self-administered survey. Physical, mental and oral health, health literacy, and social support were measured using standardized instruments. Eighty-two participants (45 US born and 37 non-US born) chose the English version of the survey (English speakers) while 105 participants (2 US born and 103 non-US born) chose the Spanish version (Spanish speakers). Overall, both the physical and mental health functioning of the participants was lower than that of the US general population. The participants reported being moderately depressed. US-born English speakers reported the poorest physical and mental health while Spanish speakers reported the best physical health and the lowest level of depression. A higher level of health literacy was associated with better physical health functioning, whereas reporting higher social support was associated with better mental health functioning and less severe depression. Because most free clinics have limited resources, developing services and programs that fit free clinics' circumstances are needed. Our study finding indicates that health literacy education, mental health services, and social support are key services needed by free clinic patients to achieve better health.

  6. Critical advances in bridging personal health informatics and clinical informatics.

    PubMed

    Koch, S; Vimarlund, V

    2012-01-01

    To provide a survey over significant developments in the area of linking personal health informatics and clinical informatics, to give insights into critical advances and to discuss open problems and opportunities in this area. A scoping review over the literature published in scientific journals and relevant conference proceedings in the intersection between personal health informatics and clinical informatics over the years 2010 and 2011 was performed. The publications analyzed are related to two main topics, namely "Sharing information and collaborating through personal health records, portals and social networks" and "Integration of personal health systems with clinical information systems". For the first topic, results are presented according to five different themes: "Patient expectations and attitudes", "Real use experiences", "Changes for care providers", "Barriers to adoption" and "Proposed technical infrastructures". For the second topic, two different themes were found, namely "Technical architectures and interoperability" and "Security, safety and privacy issues". Results show a number of gaps between the information needs of patients and the information care provider organizations provide to them as well as the lack of a trusted technical, ethical and regulatory framework regarding information sharing. Despite recent developments in the areas of personal health informatics and clinical informatics both fields have diverging needs. To support both clinical work processes and empower patients to effectively handle self-care, a number of issues remain unsolved. Open issues include privacy and confidentiality, including trusted sharing of health information and building collaborative environments between patients, their families and care providers. There are further challenges to meet around health and technology literacy as well as to overcome structural and organizational barriers. Frameworks for evaluating personal health informatics applications and

  7. Heritage Park Facilities PV Project

    SciTech Connect

    Hobaica, Mark

    2013-09-26

    Project Objective: To procure a photovoltaic array (PV) system which will generate approximately 256kW of power to be used for the operations of the Aquatic Complex and the adjacent Senior Facility at the Heritage Park. This project complies with the EERE’s work and objectives by promoting the development and deployment of an energy system that will provide current and future generations with clean, efficient, affordable, and reliable energy.

  8. Spiritual health, clinical practice stress, depressive tendency and health-promoting behaviours among nursing students.

    PubMed

    Hsiao, Ya-Chu; Chien, Li-Yu; Wu, Li-Yu; Chiang, Chih-Ming; Huang, Song-Yuan

    2010-07-01

    This paper is a report of an exploration of the association of spiritual health with clinical practice stress, depressive tendency and health-promoting behaviours among nursing students. Several studies in western countries have demonstrated an association between spirituality and health. Spirituality-related research in eastern countries, however, is still in its infancy. A cross-sectional design was adopted and structured questionnaires were used for data collection. We adopted the Probability Proportional to Size cluster sampling method to recruit nursing students in senior grades. Data were collected in 2005 using the Spiritual Health Scale, Perceived Clinical Practice Stress Scale, Beck Depression Inventory-II and Health Promotion Behaviours Scale. A total of 1276 nursing students with an average age of 20.1 years (sd = 1.6 years) participated in the study. Spiritual health was negatively associated with clinical practice stress (r = -0.211, P < 0.001) and depressive tendency (r = -0.324, P < 0.001) and positively associated with health-promoting behaviours (r = 0.611, P < 0.001). Using hierarchical regression analysis to control for demographic factors, spiritual health was found to be an important predictive factor for clinical practice stress, depressive tendency and health-promoting behaviours. These results are consistent with research findings from western countries. Educators should develop strategies to address nursing students' spiritual health. This may help nursing students to manage their stress, to reduce depressive symptoms and to enhance health-promoting behaviours.

  9. Open-access community child health clinics: the everyday experience of parents and child health nurses.

    PubMed

    Kearney, Lauren; Fulbrook, Paul

    2012-03-01

    In Australia, Community Child Health Services (CCHS) is the primary health care service which seeks to strengthen and support families, prevent illness and manage risks. Several nursing models of care exist within CCHS, and limited research has investigated which is the best way to provide child health surveillance and parenting support during the early years. This study qualitatively explored the everyday lived experience of parents and child health nurses involved with an open-access (appointment-free, parent-led) group child health surveillance clinic. Findings showed that participants considered the open-access clinic provided a helpful and supportive way of delivering child health surveillance and parental support to families with infants aged 0-18 months, without identified risk factors. The perspectives of multiple parents, nurses and other health workers found it effective, flexible and parent-directed, which may be in contrast to some traditional individual appointment child health surveillance methods.

  10. Establishing an Integrated Health Care Clinic in a Community Mental Health Center: Lessons Learned.

    PubMed

    Annamalai, Aniyizhai; Staeheli, Martha; Cole, Robert A; Steiner, Jeanne L

    2017-06-30

    Integrating primary care with behavioral health services at community mental health centers is one response to the disparity in mortality and morbidity experienced by adults with serious mental illnesses and co-occurring substance use disorders. Many integration models have been developed in response to the Primary and Behavioral Health Care Integration (PBHCI) initiative of the Substance Abuse and Mental Health Services Administration (SAMHSA). One model is a primary care clinic co-located within the mental health center. The Connecticut Mental Health Center (CMHC) Wellness Center is one such co-located clinic developed as a partnership between CMHC and a Federally Qualified Health Center (FQHC). In this article, we describe the process of developing this on-site clinic along with lessons learned during implementation. We review different aspects of building and maintaining such a clinic and outline lessons learned from both successes and challenges. We briefly describe the demographics and health characteristics of the patient population served in this clinic. We make recommendations for providers and agencies that are considering or are already developing a model for integrating care. Finally, we briefly review status of our clinic after completion of grant funding.

  11. Computerized mental health assessment in integrative health clinics: a cross-sectional study using structured interview.

    PubMed

    Leung, Sau Fong; French, Peter; Chui, Caroline; Arthur, David

    2007-12-01

    Computerized mental health assessment is gaining popularity. It enables the standardization of assessment of clinical problems, increases the capacity to collect sensitive or confidential information, facilitates personal assessment at one's own pace, and offers rapid screening of mental health status. The use of computer technology to conduct mental health assessment was an initiative proposed for two nurse-led integrative health clinics affiliated to a University in Hong Kong. It was intended to provide an efficient screening for depression, anxiety, alcohol abuse, and problem gambling common in the primary health-care settings to facilitate early intervention. This study was conducted to assess the effectiveness of using a computerized health assessment kiosk to perform mental health assessment. The assessment items were derived from an abbreviated World Health Organization Mental Disorders Checklist and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Criteria for Pathological Gambling. The study involved an opportunity sample of 31 subjects who volunteered to complete the computerized mental health assessment during their waiting time in the clinics. The results showed that most subjects had positive feelings about using a computer to perform a mental health assessment and had increased understanding of their mental health. Suggestions made to improve computerized mental health assessments included touch screen, voice instructions, and enlarged print font size.

  12. Electronic health records: new opportunities for clinical research.

    PubMed

    Coorevits, P; Sundgren, M; Klein, G O; Bahr, A; Claerhout, B; Daniel, C; Dugas, M; Dupont, D; Schmidt, A; Singleton, P; De Moor, G; Kalra, D

    2013-12-01

    Clinical research is on the threshold of a new era in which electronic health records (EHRs) are gaining an important novel supporting role. Whilst EHRs used for routine clinical care have some limitations at present, as discussed in this review, new improved systems and emerging research infrastructures are being developed to ensure that EHRs can be used for secondary purposes such as clinical research, including the design and execution of clinical trials for new medicines. EHR systems should be able to exchange information through the use of recently published international standards for their interoperability and clinically validated information structures (such as archetypes and international health terminologies), to ensure consistent and more complete recording and sharing of data for various patient groups. Such systems will counteract the obstacles of differing clinical languages and styles of documentation as well as the recognized incompleteness of routine records. Here, we discuss some of the legal and ethical concerns of clinical research data reuse and technical security measures that can enable such research while protecting privacy. In the emerging research landscape, cooperation infrastructures are being built where research projects can utilize the availability of patient data from federated EHR systems from many different sites, as well as in international multilingual settings. Amongst several initiatives described, the EHR4CR project offers a promising method for clinical research. One of the first achievements of this project was the development of a protocol feasibility prototype which is used for finding patients eligible for clinical trials from multiple sources.

  13. Whole genome sequencing in clinical and public health microbiology

    PubMed Central

    Kwong, J. C.; McCallum, N.; Sintchenko, V.; Howden, B. P.

    2015-01-01

    SummaryGenomics and whole genome sequencing (WGS) have the capacity to greatly enhance knowledge and understanding of infectious diseases and clinical microbiology. The growth and availability of bench-top WGS analysers has facilitated the feasibility of genomics in clinical and public health microbiology. Given current resource and infrastructure limitations, WGS is most applicable to use in public health laboratories, reference laboratories, and hospital infection control-affiliated laboratories. As WGS represents the pinnacle for strain characterisation and epidemiological analyses, it is likely to replace traditional typing methods, resistance gene detection and other sequence-based investigations (e.g., 16S rDNA PCR) in the near future. Although genomic technologies are rapidly evolving, widespread implementation in clinical and public health microbiology laboratories is limited by the need for effective semi-automated pipelines, standardised quality control and data interpretation, bioinformatics expertise, and infrastructure. PMID:25730631

  14. Whole genome sequencing in clinical and public health microbiology.

    PubMed

    Kwong, J C; McCallum, N; Sintchenko, V; Howden, B P

    2015-04-01

    Genomics and whole genome sequencing (WGS) have the capacity to greatly enhance knowledge and understanding of infectious diseases and clinical microbiology.The growth and availability of bench-top WGS analysers has facilitated the feasibility of genomics in clinical and public health microbiology.Given current resource and infrastructure limitations, WGS is most applicable to use in public health laboratories, reference laboratories, and hospital infection control-affiliated laboratories.As WGS represents the pinnacle for strain characterisation and epidemiological analyses, it is likely to replace traditional typing methods, resistance gene detection and other sequence-based investigations (e.g., 16S rDNA PCR) in the near future.Although genomic technologies are rapidly evolving, widespread implementation in clinical and public health microbiology laboratories is limited by the need for effective semi-automated pipelines, standardised quality control and data interpretation, bioinformatics expertise, and infrastructure.

  15. Publication bias in clinical trials of electronic health records.

    PubMed

    Vawdrey, David K; Hripcsak, George

    2013-02-01

    To measure the rate of non-publication and assess possible publication bias in clinical trials of electronic health records. We searched ClinicalTrials.gov to identify registered clinical trials of electronic health records and searched the biomedical literature and contacted trial investigators to determine whether the results of the trials were published. Publications were judged as positive, negative, or neutral according to the primary outcome. Seventy-six percent of trials had publications describing trial results; of these, 74% were positive, 21% were neutral, and 4% were negative (harmful). Of unpublished studies for which the investigator responded, 43% were positive, 57% were neutral, and none were negative; the lower rate of positive results was significant (p<0.001). The rate of non-publication in electronic health record studies is similar to that in other biomedical studies. There appears to be a bias toward publication of positive trials in this domain. Copyright © 2012 Elsevier Inc. All rights reserved.

  16. Education strategies to foster health professional students' clinical reasoning skills.

    PubMed

    Rochmawati, Erna; Wiechula, Rick

    2010-06-01

    Clinical reasoning is an important skill for health professionals that should be developed to achieve high levels of expertise. Several education strategies have been suggested for implementation by health professional educators to foster their students' clinical reasoning skills. The strategies have included the following: problem-based learning, the integrative curriculum, reflection, and concept mapping. This review assesses which is the most effective education strategy for developing the clinical reasoning skills of health professional students. Four publications, from a total of 692 identified records, were included. Overall, this review was not able to make a final conclusion to answer the question. Therefore, there is a need to conduct more studies with larger samples and to undertake research that evaluates the following aspects: more alternate education interventions, variations in the delivery of education interventions, and the cost-effectiveness of implementing education strategies.

  17. The dynamics of cooptation in a feminist health clinic.

    PubMed

    Morgen, S

    1986-01-01

    I examine the process of cooptation in a feminist health clinic, focusing on how the State shapes and absorbs the challenges of grassroots health activism. A familiar picture of of organizational change accompanies the clinic's decision to secure State funding: the erosion of collective decision-making, an immersion in service delivery to the exclusion of other activities, and a dependency on continued funding which decreases the political autonomy of the organization. Using Gramsci's analysis of hegemony, I demonstrate how the State's effect on this organization stemmed from both direct pressures for particular changes and the influence of dominant ideology and social relations in structuring the clinic staff's response to those pressures. Additionally, I explore the factors that laid the groundwork for a reversal of cooptive patterns and a revitalization of the clinic's social movement orientation and political goals.

  18. Can counselling take place in acute clinical mental health?

    PubMed

    Hamilton, Stephen; Irving, Pauline

    The environment in which acute clinical psychiatric nursing occurs actively militates against the possibility of 'counselling' taking place at a ward level. However, a proportion of mental health nurses working in this area continue to describe themselves as counsellors thus perpetuating a cycle of misconception. This article examines the reality of acute psychiatric service provision in an attempt to highlight that mental health nurses engaging with patient groups in this arena are actually demonstrating 'counselling skills practice'.

  19. Self-Esteem, Oral Health Behaviours, and Clinical Oral Health Status in Chinese Adults: An Exploratory Study

    ERIC Educational Resources Information Center

    Chin, Luzy Siu-Hei; Chan, Joanne Chung-Yan

    2013-01-01

    Objectives: This is an exploratory study to examine the relations among self-esteem, oral health behaviours and clinical oral health status in Chinese adults. In addition, gender differences in clinical oral health status and oral health behaviours were explored. Methods: Participants were 192 patients from a private dental clinic in Hong Kong…

  20. Self-Esteem, Oral Health Behaviours, and Clinical Oral Health Status in Chinese Adults: An Exploratory Study

    ERIC Educational Resources Information Center

    Chin, Luzy Siu-Hei; Chan, Joanne Chung-Yan

    2013-01-01

    Objectives: This is an exploratory study to examine the relations among self-esteem, oral health behaviours and clinical oral health status in Chinese adults. In addition, gender differences in clinical oral health status and oral health behaviours were explored. Methods: Participants were 192 patients from a private dental clinic in Hong Kong…

  1. 42 CFR 440.365 - Coverage of rural health clinic and federally qualified health center (FQHC) services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Coverage of rural health clinic and federally... clinic and federally qualified health center (FQHC) services. If a State provides benchmark or benchmark... otherwise, to rural health clinic services and FQHC services as defined in subparagraphs (B) and (C)...

  2. Introducing clinical supervision across Western Australian public mental health services.

    PubMed

    Taylor, Monica; Harrison, Carole A

    2010-08-01

    Retention and recruitment of the mental health nursing workforce is a critical issue in Australia and more specifically in Western Australia (WA), partly due to the isolation of the state. It has been suggested that these workforce issues might be minimized through the introduction of clinical supervision within WA mental health services, where, historically, it has been misunderstood and viewed with caution by mental health nurses. This may have been partly due to a lack of understanding of clinical supervision, its models, and its many benefits, due to a paucity of information delivered into initial nurse education programs. The aim of this pilot project is to explore and evaluate the introduction of clinical supervision in WA public mental health services. A quantitative approach informed the study and included the use of an information gathering survey initially, which was followed with evaluation questionnaires. The findings show that education can increase the uptake of clinical supervision. Further, the findings illustrate the importance of linking clinicians from all professional groups via a clinical supervision web-based database.

  3. Federally qualified health center dental clinics: financial information.

    PubMed

    Bailit, Howard L; Devitto, Judy; Myne-Joslin, Ronnie; Beazoglou, Tryfon; McGowan, Taegan

    2013-01-01

    Federally Qualified Health Center (FQHC) dental clinics are a major component of the dental safety net system, providing care to 3.75 million patients annually. This study describes the financial and clinical operations of a sample of FQHCs. In cooperation with the National Network for Oral Health Access, FQHC dental clinics that could provide 12 months of electronic dental record information were asked to participate in the study. Based on data from 28 dental clinics (14 FQHCs), 50 percent of patients were under 21 years of age. The primary payers were Medicaid (72.4 percent) and sliding-scale/self-pay patients (17.5 percent). Sites averaged 3.1 operatories, 0.66 dental hygienists, and 1.9 other staff per dentist. Annually, each FTE dentist and hygienist provided 2,801 and 2,073 patient visits, respectively. Eighty percent of services were diagnostic, preventive, and restorative. Patient care accounted for 82 percent of revenues, and personnel (64.2 percent) and central administration (13.4 percent) accounted for most expenses. Based on a small convenience sample of FQHC dental clinics, this study presents descriptive data on their clinical and financial operations. Compared with data from the UDS (Uniform Data System) report, study FQHCs were larger in terms of space, staff, and patients served. However, there was substantial variation among clinics for almost all measures. As the number and size of FQHC dental clinics increase, the Health Resources and Services Administration needs to provide them access to comparative data that they can use to benchmark their operations. © 2013 American Association of Public Health Dentistry.

  4. Ethical behaviours in clinical practice among Mexican health care workers.

    PubMed

    Valdez-Martínez, Edith; Lavielle, Pilar; Bedolla, Miguel; Squires, Allison

    2008-11-01

    The objective of this study was to describe the cultural domain of ethical behaviours in clinical practice as defined by health care providers in Mexico. Structured interviews were carried out with 500 health professionals employed at the Mexican Institute of Social Security in Mexico City. The Smith Salience Index was used to evaluate the relevance of concepts gathered from the free listings of the interviewees. Cluster analysis and factor analysis facilitated construction of the conceptual categories, which the authors refer to as ;dimensions of ethical practice'. Six dimensions emerged from the analysis to define the qualities that comprise ethical clinical practice for Mexican health care providers: overall quality of clinical performance; working conditions that favour quality of care; use of ethical considerations as prerequisites for any health care intervention; values favouring teamwork in the health professional-patient relationship; patient satisfaction scores; and communication between health care providers and patients. The findings suggest that improved working conditions and management practices that promote the values identified by the study's participants would help to improve quality of care.

  5. Health care technology assessment. Basic principles and clinical applications.

    PubMed

    Bozic, Kevin J; Pierce, Read G; Herndon, James H

    2004-06-01

    Health care technology (defined as all drugs, devices, and medical and surgical procedures used in medical care as well as the organizational and supportive systems within which such care is provided) is widely regarded as an important driver of escalating health care spending in the United States. Many new health care technologies are adopted and used in clinical practice with little or no evidence that their use is associated with improved patient outcomes. Orthopaedic surgeons are facing increasing scrutiny from hospitals and payers regarding the adoption and use of new technology for the treatment of patients with musculoskeletal disease. Health care technology assessment is a growing field that is concerned with the multidisciplinary evaluation of clinical data on the basis of safety and efficacy as well as economic aspects of technology acquisition. Through an understanding of the relevant literature and the concepts of health care technology assessment, orthopaedic surgeons have an opportunity to participate in the assessment process and thus influence clinical and health policy decisions regarding the adoption and use of new and existing technologies in the field of orthopaedic surgery.

  6. Ethical Behaviours in Clinical Practice Among Mexican Health Care Workers

    PubMed Central

    Valdez-Martínez, Edith; Lavielle, Pilar; Bedolla, Miguel; Squires, Allison

    2009-01-01

    The objective of this study was to describe the cultural domain of ethical behaviours in clinical practice as defined by health care providers in Mexico. Structured interviews were carried out with 500 health professionals employed at the Mexican Institute of Social Security in Mexico City. The Smith Salience Index was used to evaluate the relevance of concepts gathered from the free listings of the interviewees. Cluster analysis and factor analysis facilitated construction of the conceptual categories, which the authors refer to as ‘dimensions of ethical practice’. Six dimensions emerged from the analysis to define the qualities that comprise ethical clinical practice for Mexican health care providers: overall quality of clinical performance; working conditions that favour quality of care; use of ethical considerations as prerequisites for any health care intervention; values favouring teamwork in the health professional–patient relationship; patient satisfaction scores; and communication between health care providers and patients. The findings suggest that improved working conditions and management practices that promote the values identified by the study’s participants would help to improve quality of care. PMID:18849364

  7. Health Promotion Practices in Two Chiropractic Teaching Clinics

    PubMed Central

    Ndetan, Harrison; Evans, Marion Willard; Lo, Kaming; Walters, David; Ramcharan, Michael; Brandon, Patricia; Evans, Cathy; Rupert, Ronald

    2010-01-01

    Purpose: To retrospectively review patient files in two teaching clinics in the United States and to assess the documented attempts to deliver health promotion messages when a chart indicated a need for health promotion or a red-flag condition that could be helped with positive behavioral changes. Methods: Approximately 100 patient files were randomly selected from each of two separate chiropractic teaching clinics, for patients seen after January 2007. Files were assessed for pertinent family history of diseases, personal medical history, and red-flag conditions of patients that would warrant intervention with health promotion. Results: Health promotion advice on at least one occasion was noted in 108 (53.7%) patient charts. Only 7 of 98 overweight or obese patients and none of those with family history of obesity were advised on weight management. Among 23 hypertensive patients, only 5 were advised and 17 of the 97 patients with risk of cardiovascular disease were advised. Conclusion: Chiropractic teaching clinics should assess what they are doing to help Americans reach their health goals. There is an opportunity to shape future practitioners so they include primary prevention as a part of what they do if the profession cares to move in that direction. Future research should look at mechanisms of delivery for health promotion, including better tracking of patients who need it and how staff doctors are trained to deliver oversight to interns in the area of primary prevention. PMID:21048878

  8. Undergraduate nursing students integrating health literacy in clinical settings.

    PubMed

    Zanchetta, Margareth; Taher, Yasmin; Fredericks, Suzanne; Waddell, Janice; Fine, Carol; Sales, Rona

    2013-09-01

    Analyzing students' performance and self-criticism of their roles in promoting health literacy can inform nursing education in a social environment that expects new graduates to be health promoters. The pilot study reported here aimed to a) analyze students' understanding of and sensitivity to issues of health literacy, (b) identify students' perceptions of structural, organizational, and political barriers to the promotion of health literacy in social and health care organizations, and (c) document students' suggestions for curriculum changes that would develop their skills and competencies as health-literacy promoters. A qualitative pilot study. A collaborative undergraduate nursing degree program in the metropolitan area of Toronto, Canada. Sixteen undergraduate, Year 4 nursing students. Signed informed consent was obtained from the participants. Participation was unpaid and voluntary. Recruitment was through an email invitation sent by the School of Nursing Student Affairs Coordinator. Three, one-time individual interviews and three focus groups were conducted. All were audio-recorded. Recordings were transcribed, and the transcriptions were coded using the qualitative software ATLAS ti 6.0. The interview data were submitted to thematic analysis. Additional data were gathered from the two-page self-assessments in students' academic portfolios. Sensitivity to health literacy was documented. Students performed best as health promoters in supportive teaching hospitals. Their performance was hindered by clinical settings unsupportive of health education, absence of role models, and insufficient theoretical preparation for health teaching. Students' sensitivity to their clients' diversity reportedly reinforced the interconnection, in multicultural healthcare settings, between health literacy and other social determinants of health and a growing demand for educating future nurses in expanding their role also as health promoters. Students recommended more socially

  9. Prevalence of p.V37I variant of GJB2 among Chinese infants with mild or moderate hearing loss.

    PubMed

    Huang, Yue; Yang, Xiao-Lin; Chen, Wen-Xia; Duan, Bo; Lu, Ping; Wang, Yan; Xu, Zheng-Min

    2015-01-01

    GJB2 accounts for more than 80% of recessive forms of hereditary hearing loss (HL); however, the correlation between the p.V37I variant of GJB2 and hearing phenotype is controversial. This study aimed to investigate the clinical and epidemiological characteristics of the p.V37I variant in sensorineural hearing loss in Chinese infants (0-3 months). Hearing and gene tests were conducted in 300 infants (aged 0-3 months) with sensorineural hearing impairment and 484 normal infants (aged 0-3 months). Among the 300 hearing-impaired infants, 16 (5.33%) exhibited homozygous p.V37I variation and 7 (2.34%) showed a compound-heterozygous p.V37I variation, whereas no homozygous p.V37I (0%) or compound-heterozygous p.V37I (0%) condition was found among the 484 normal infants. The hearing impairment ranged from mild to profound in all patients exhibiting the homozygous p.V37I or the compound-heterozygous p.V37I condition, although most patients (61.54%) exhibit mild or moderate HL. Our results indicated that the p.V37I variation of GJB2 mutation is mainly associated with mild or moderate hearing impairment. Therefore, otolaryngologists should also screen the p.V37I variant of GJB2 in patients with mild or moderate HL.

  10. PV output smoothing with energy storage.

    SciTech Connect

    Ellis, Abraham; Schoenwald, David Alan

    2012-03-01

    This report describes an algorithm, implemented in Matlab/Simulink, designed to reduce the variability of photovoltaic (PV) power output by using a battery. The purpose of the battery is to add power to the PV output (or subtract) to smooth out the high frequency components of the PV power that that occur during periods with transient cloud shadows on the PV array. The control system is challenged with the task of reducing short-term PV output variability while avoiding overworking the battery both in terms of capacity and ramp capability. The algorithm proposed by Sandia is purposely very simple to facilitate implementation in a real-time controller. The control structure has two additional inputs to which the battery can respond. For example, the battery could respond to PV variability, load variability or area control error (ACE) or a combination of the three.

  11. The Relationship between the Use of Health Clinics in Rural Mississippi Schools and the CHIP-AE Adolescent Health Profile

    ERIC Educational Resources Information Center

    Bradford, Judith Young; O'Sullivan, Patricia S.

    2007-01-01

    School health clinics are one way to meet the objectives in "Healthy People 2010" for adolescent health. To determine the relationship between adolescent health status and use of the school health clinics in four Mississippi high schools, the Child Health and Illness Profile-Adolescent Edition (CHIP-AE) was used. The CHIP-AE identifies…

  12. Ensuring Quality of PV Modules: Preprint

    SciTech Connect

    Kurtz, S.; Wohlgemuth, J.; Hacke, P.; Kempe, M.; Sample, T.; Yamamichi, M.; Kondo, M.; Doi, T.; Otani, K.; Amano, J.

    2011-07-01

    Photovoltaic (PV) customers need to have confidence in the PV modules they purchase. Currently, no test can quantify a module's lifetime with confidence, but stress tests are routinely used to differentiate PV product designs. We suggest that the industry would be strengthened by using the wisdom of the community to develop a single set of tests that will help customers quantify confidence in PV products. This paper evaluates the need for quality assurance (QA) standards and suggests a path for creating these. Two types of standards are needed: 1) QA of the module design and 2) QA of the manufacturing process.

  13. Adoption of clinical and business trainings by child mental health clinics in New York State.

    PubMed

    Chor, Ka Ho Brian; Olin, Su-Chin Serene; Weaver, Jamie; Cleek, Andrew F; McKay, Mary M; Hoagwood, Kimberly E; Horwitz, Sarah M

    2014-12-01

    This study prospectively examined the naturalistic adoption of clinical and business evidence-informed training by all 346 outpatient mental health clinics licensed to treat children, adolescents, and their families in New York State. The study used attendance data (September 2011-August 2013) from the Clinic Technical Assistance Center, a training, consultation, and educational center funded by the state Office of Mental Health, to classify the clinics' adoption of 33 trainings. Adoption behavior was classified by number, type, and intensity of trainings. The clinics were classified into four adopter groups reflecting the highest training intensity in which they participated (low, medium, and high adopters and "super-adopters"). A total of 268 clinics adopted trainings (median=5); business and clinical trainings were about equally accessed (82% versus 78%). Participation was highest for hour-long Webinars (96%) followed by learning collaboratives, which take six to 18 months to complete (34%). Most (73%-94%) adopters of business learning collaboratives and all adopters of clinical learning collaboratives had previously sampled a Webinar, although maintaining participation in learning collaboratives was a challenge. The adopter groups captured meaningful adopter profiles: 41% of clinics were low adopters that selected fewer trainings and participated only in Webinars, and 34% were high or super-adopters that accessed more trainings and participated in at least one learning collaborative. More nuanced definitions of adoption behavior can improve the understanding of clinic adoption of training and hence promote the development of efficient rollout strategies by state systems.

  14. Increasing access by priority populations to Australian sexual health clinics.

    PubMed

    Ali, Hammad; Donovan, Basil; Fairley, Christopher K; Chen, Marcus Y; O'Connor, Catherine C; Grulich, Andrew E; McNulty, Anna; Ryder, Nathan; Hellard, Margaret E; Guy, Rebecca J

    2013-10-01

    Data from a network of 35 Australian sexual health clinics, in geographically diverse locations, showed that the number and proportion of patients from priority populations (ie, young people, men who have sex with men, indigenous people, and female sex workers) increased significantly between 2004 and 2011.

  15. Health Sciences Librarians and Education: Clinical Librarianship, Consortia, Extraterrestial Telemedicine

    ERIC Educational Resources Information Center

    Cummings, Polly; And Others

    1978-01-01

    Three speeches presented by a panel of health science librarians discuss: (1) clinical medical librarianship, with a definition and descriptions of programs in several medical school libraries; (2) consortia, including a definition and reasons for their development; and (3) use of telecommunications for sharing medical information. (MBR)

  16. Health Sciences Librarians and Education: Clinical Librarianship, Consortia, Extraterrestial Telemedicine

    ERIC Educational Resources Information Center

    Cummings, Polly; And Others

    1978-01-01

    Three speeches presented by a panel of health science librarians discuss: (1) clinical medical librarianship, with a definition and descriptions of programs in several medical school libraries; (2) consortia, including a definition and reasons for their development; and (3) use of telecommunications for sharing medical information. (MBR)

  17. Clinical Training in Aging and Mental Health. Final Report.

    ERIC Educational Resources Information Center

    Gatz, Margaret; And Others

    This report describes the University of Southern California's (USC) gerontology career preparation project, which was funded for the following training activities in mental health and aging: (1) traineeships for graduate students in USC's doctoral track in clinical psychology and aging and in the Leonard Davis School of Gerontology master's track…

  18. Depression Screening Patterns for Women in Rural Health Clinics

    ERIC Educational Resources Information Center

    Tudiver, Fred; Edwards, Joellen Beckett; Pfortmiller, Deborah T.

    2010-01-01

    Context: Rates and types of screening for depression in rural primary care practices are unknown. Purpose: To identify rates of depression screening among rural women in a sample of rural health clinics (RHCs). Methods: A chart review of 759 women's charts in 19 randomly selected RHCs across the nation. Data were collected from charts of female…

  19. Recentralization of Mental Health Services: Closing an Outpatient Clinic.

    ERIC Educational Resources Information Center

    Weirich, Thomas W.; Sheinfeld-Gorin, Sherri N.

    1982-01-01

    Evaluated the process and consequences of recentralizing services by surveying staff (N=24) and clients (N=15) of a community mental health clinic. Analyzes the planning, decision-making, implication, and effects of the change and illustrates the complexity of the adiministrator's role in restructuring services. (Author/JAC)

  20. Using Clinical Decision Support Software in Health Insurance Company

    NASA Astrophysics Data System (ADS)

    Konovalov, R.; Kumlander, Deniss

    This paper proposes the idea to use Clinical Decision Support software in Health Insurance Company as a tool to reduce the expenses related to Medication Errors. As a prove that this class of software will help insurance companies reducing the expenses, the research was conducted in eight hospitals in United Arab Emirates to analyze the amount of preventable common Medication Errors in drug prescription.

  1. Depression Screening Patterns for Women in Rural Health Clinics

    ERIC Educational Resources Information Center

    Tudiver, Fred; Edwards, Joellen Beckett; Pfortmiller, Deborah T.

    2010-01-01

    Context: Rates and types of screening for depression in rural primary care practices are unknown. Purpose: To identify rates of depression screening among rural women in a sample of rural health clinics (RHCs). Methods: A chart review of 759 women's charts in 19 randomly selected RHCs across the nation. Data were collected from charts of female…

  2. Generalized papillomatosis in three horses associated with a novel equine papillomavirus (EcPV8).

    PubMed

    Linder, Keith E; Bizikova, Petra; Luff, Jennifer; Zhou, Dan; Yuan, Hang; Breuhaus, Babetta; Nelson, Elizabeth; Mackay, Robert

    2017-08-22

    Currently, seven equine papillomaviruses (PV) are known and are associated with one of three different and distinct clinical presentations. To report the clinical, histopathological and immunohistochemical findings in horses with generalized papillomatosis associated with a novel equine PV, Equus caballus papillomavirus 8 (EcPV8). Three client-owned quarter horses. Case report, retrospective. Dozens to thousands of papillomas involved the axilla, inguinal area and proximal limbs as well as the ventral and lateral neck, thorax and abdomen. Lesions were sometimes confluent in ventral areas. Fewer lesions were on the face, ears, distal limbs and genitalia. Plaque-type papillomas were small, 0.5 to 1.5 cm in diameter and hyperkeratotic. Histologically, plaque-type papillomas prominently involved follicular infundibula. Immunohistochemical findings demonstrated PV antigen in superficial keratinocyte nuclei. PCR using degenerate primers for the PV L1 gene and sequencing of amplicons revealed PV DNA sequences that were 98% identical for all three cases, but shared <70% identity to other PVs. Horses were otherwise healthy; serum immunoglobulin levels and peripheral blood lymphocyte phenotyping did not identify a known immunodeficiency syndrome. Lesions nearly completely resolved after 1.5 years in one horse and persisted for two years in another, despite intralesional human IFN-alpha treatment. The oldest horse was lost to follow-up. A novel equine papillomavirus (EcPV8) is associated with a distinct, plaque-type, generalized papillomatosis. Papillomas persisted for months to years, with or without treatment. © 2017 ESVD and ACVD.

  3. 46 CFR 153.355 - PV venting systems.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 5 2011-10-01 2011-10-01 false PV venting systems. 153.355 Section 153.355 Shipping... Systems § 153.355 PV venting systems. When Table 1 requires a PV venting system, the cargo tank must have a PV valve in its vent line. The PV valve must be located between the tank and any connection to...

  4. 46 CFR 153.355 - PV venting systems.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 5 2010-10-01 2010-10-01 false PV venting systems. 153.355 Section 153.355 Shipping... Systems § 153.355 PV venting systems. When Table 1 requires a PV venting system, the cargo tank must have a PV valve in its vent line. The PV valve must be located between the tank and any connection to...

  5. Automatically identifying health- and clinical-related content in wikipedia.

    PubMed

    Liu, Feifan; Moosavinasab, Soheil; Agarwal, Shashank; Bennett, Andrew S; Yu, Hong

    2013-01-01

    Physicians are increasingly using the Internet for finding medical information related to patient care. Wikipedia is a valuable online medical resource to be integrated into existing clinical question answering (QA) systems. On the other hand, Wikipedia contains a full spectrum of world's knowledge and therefore comprises a large partition of non-health-related content, which makes disambiguation more challenging and consequently leads to large overhead for existing systems to effectively filter irrelevant information. To overcome this, we have developed both unsupervised and supervised approaches to identify health-related articles as well as clinically relevant articles. Furthermore, we explored novel features by extracting health related hierarchy from the Wikipedia category network, from which a variety of features were derived and evaluated. Our experiments show promising results and also demonstrate that employing the category hierarchy can effectively improve the system performance.

  6. Convenient care clinics: making a positive change in health care.

    PubMed

    Evans, Steven W

    2010-01-01

    To discuss the impact of retail health clinics, also known as convenient care clinics (CCC), on the changing landscape of health care in the United States. Selected articles from the scientific literature and data from the industry literature. The concept of the CCC has been well-received by the public, and nurse practitioners (NPs) have been intimately involved in the development and expansion of these clinics. The professional association of CCCs has been instrumental in promoting operational standards for CCCs to insure a high quality of service. Some resistance to the concept from physicians remains but the convenience for consumers appears to drive the high levels of satisfaction reported. Collaboration among all healthcare providers is essential to expand access to care for everyone. NPs are crucial to the operation of CCCs and provide care that is well-received by consumers.

  7. 40 CFR 180.1261 - Xanthomonas campestris pv. vesicatoria and Pseudomonas syringae pv. tomato specific Bacteriophages.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... and Pseudomonas syringae pv. tomato specific Bacteriophages. 180.1261 Section 180.1261 Protection of.... vesicatoria and Pseudomonas syringae pv. tomato specific Bacteriophages. An exemption from the requirement of... syringae pv. tomato specific bacteriophages in or on pepper and tomato. ...

  8. 40 CFR 180.1261 - Xanthomonas campestris pv. vesicatoria and Pseudomonas syringae pv. tomato specific Bacteriophages.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... and Pseudomonas syringae pv. tomato specific Bacteriophages. 180.1261 Section 180.1261 Protection of.... vesicatoria and Pseudomonas syringae pv. tomato specific Bacteriophages. An exemption from the requirement of... syringae pv. tomato specific bacteriophages in or on pepper and tomato....

  9. 40 CFR 180.1261 - Xanthomonas campestris pv. vesicatoria and Pseudomonas syringae pv. tomato specific Bacteriophages.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... and Pseudomonas syringae pv. tomato specific Bacteriophages. 180.1261 Section 180.1261 Protection of.... vesicatoria and Pseudomonas syringae pv. tomato specific Bacteriophages. An exemption from the requirement of... syringae pv. tomato specific bacteriophages in or on pepper and tomato....

  10. 40 CFR 180.1261 - Xanthomonas campestris pv. vesicatoria and Pseudomonas syringae pv. tomato specific Bacteriophages.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... and Pseudomonas syringae pv. tomato specific Bacteriophages. 180.1261 Section 180.1261 Protection of.... vesicatoria and Pseudomonas syringae pv. tomato specific Bacteriophages. An exemption from the requirement of... syringae pv. tomato specific bacteriophages in or on pepper and tomato....

  11. 40 CFR 180.1261 - Xanthomonas campestris pv. vesicatoria and Pseudomonas syringae pv. tomato specific Bacteriophages.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... and Pseudomonas syringae pv. tomato specific Bacteriophages. 180.1261 Section 180.1261 Protection of.... vesicatoria and Pseudomonas syringae pv. tomato specific Bacteriophages. An exemption from the requirement of... syringae pv. tomato specific bacteriophages in or on pepper and tomato....

  12. The clinical neuroscience course: viewing mental health from neurobiological perspectives.

    PubMed

    Lambert, Kelly G

    2005-01-01

    Although the field of neuroscience is booming, a challenge for researchers in mental health disciplines is the integration of basic research findings into applied clinical approaches leading to effective therapies. Recently the National Institute of Mental Health called for translational research grants to encourage collaboration between neuroscientists and mental health professionals. In order for this "clinical neuroscience" to emerge and thrive, an important first step is the provision of appropriate course offerings so that future neuroscience researchers and mental health practitioners will have a common neurobiological base from which to make informed decisions about the most efficacious treatments for mental illnesses. Accordingly, an integrative course, Clinical Neuroscience, was developed to address these issues. After reviewing the historical origins of this emerging discipline, students are exposed to fundamental overviews of neuroanatomy, neurochemistry, and neural development before approaching the neurobiological components of several disorders (e.g., schizophrenia, depression, Tourette's syndrome, drug abuse, obsessive compulsive disorder). Finally, the maintenance of mental health is emphasized as topics such as psychoneuroimmunology, coping with stress, and eating regulation are discussed. Important themes emphasized in this course include (1) the consideration of only empirically based evidence, (2) the view that mental illness represents a disruption of neurobiological homeostasis, (3) the acknowledgement that, because the brain is a plastic organ, the clinical relevance of environmental and behavioral influences is difficult to overestimate, and (4) the recognition of the value of ecologically relevant animal models in the investigation of various aspects of mental illness. Because of the importance of stress maintenance in mental health, exercises have been developed to increase students' awareness of their own coping strategies. Finally

  13. The Clinical Neuroscience Course: Viewing Mental Health from Neurobiological Perspectives

    PubMed Central

    Lambert, Kelly G.

    2005-01-01

    Although the field of neuroscience is booming, a challenge for researchers in mental health disciplines is the integration of basic research findings into applied clinical approaches leading to effective therapies. Recently the National Institute of Mental Health called for translational research grants to encourage collaboration between neuroscientists and mental health professionals. In order for this “clinical neuroscience” to emerge and thrive, an important first step is the provision of appropriate course offerings so that future neuroscience researchers and mental health practitioners will have a common neurobiological base from which to make informed decisions about the most efficacious treatments for mental illnesses. Accordingly, an integrative course, Clinical Neuroscience, was developed to address these issues. After reviewing the historical origins of this emerging discipline, students are exposed to fundamental overviews of neuroanatomy, neurochemistry, and neural development before approaching the neurobiological components of several disorders (e.g., schizophrenia, depression, Tourette’s syndrome, drug abuse, obsessive compulsive disorder). Finally, the maintenance of mental health is emphasized as topics such as psychoneuroimmunology, coping with stress, and eating regulation are discussed. Important themes emphasized in this course include (1) the consideration of only empirically based evidence, (2) the view that mental illness represents a disruption of neurobiological homeostasis, (3) the acknowledgement that, because the brain is a plastic organ, the clinical relevance of environmental and behavioral influences is difficult to overestimate, and (4) the recognition of the value of ecologically relevant animal models in the investigation of various aspects of mental illness. Because of the importance of stress maintenance in mental health, exercises have been developed to increase students’ awareness of their own coping strategies

  14. Health-related quality of life and cancer clinical trials

    PubMed Central

    Osoba, David

    2011-01-01

    The measurement of patient-reported outcomes, including health-related quality of life, is a new initiative which has emerged and grown over the past four decades. Following the development of reliable and valid self-report questionnaires, health-related quality of life has been assessed in tens of thousands of patients and a wide variety of cancers. This review is based on a selection of data published in the last decade and is intended primarily for healthcare professionals. The assessments in clinical trials have been particularly useful for elucidating the effects of various cancers and their treatments on patients’ lives and have provided additional information that enhances the usual clinical endpoints used for determining the benefits and toxicity of treatment. With growing experience the quality of the health-related quality of studies has improved and, in general, recent studies are more likely to be methodologically robust than those that were performed in earlier decades. Health-related quality of life has become a more accurate predictor of survival than some other clinical parameters, such as performance status. The overall outlook for the routine assessment of patient-reported outcomes in clinical trials is assured and, eventually, it is likely to become a standard part of clinical practice. However, there is still a need for a clear method for determining the clinical meaningfulness of changes in scores. The answer will probably come from the greater use of patient-reported outcomes and the consequent growth of experience that is necessary to make such judgements. PMID:21789156

  15. Clinical Quality Performance in U.S. Health Centers

    PubMed Central

    Shi, Leiyu; Lebrun, Lydie A; Zhu, Jinsheng; Hayashi, Arthur S; Sharma, Ravi; Daly, Charles A; Sripipatana, Alek; Ngo-Metzger, Quyen

    2012-01-01

    Objective To describe current clinical quality among the nation's community health centers and to examine health center characteristics associated with performance excellence. Data Sources National data from the 2009 Uniform Data System. Data Collection/Extraction Methods Health centers reviewed patient records and reported aggregate data to the Uniform Data System. Study Design Six measures were examined: first-trimester prenatal care, childhood immunization completion, Pap tests, low birth weight, controlled hypertension, and controlled diabetes. The top 25 percent performing centers were compared with lower performing (bottom 75 percent) centers on these measures. Logistic regressions were utilized to assess the impact of patient, provider, and institutional characteristics on health center performance. Principal Findings Clinical care and outcomes among health centers were generally comparable to national averages. For instance, 67 percent of pregnant patients received timely prenatal care (national = 68 percent), 69 percent of children achieved immunization completion (national = 67 percent), and 63 percent of hypertensive patients had blood pressure under control (national = 48 percent). Depending on the measure, centers with more uninsured patients were less likely to do well, while centers with more physicians and enabling service providers were more likely to do well. Conclusions Health centers provide quality care at rates comparable to national averages. Performance may be improved by increasing insurance coverage among patients and increasing the ratios of physicians and enabling service providers to patients. PMID:22594465

  16. Production of recombinant PvDBPII, receptor binding domain of Plasmodium vivax Duffy binding protein, and evaluation of immunogenicity to identify an adjuvant formulation for vaccine development.

    PubMed

    Bhardwaj, Rukmini; Shakri, Ahmad Rushdi; Hans, Dhiraj; Gupta, Pankaj; Fernandez-Becerra, Carmen; Del Portillo, Hernando A; Pandey, Gaurav; Chitnis, Chetan E

    2017-08-01

    Plasmodium vivax is dependent on interaction with the Duffy antigen receptor for chemokines (DARC) for invasion of human erythrocytes. The P. vivax Duffy binding protein (PvDBP) mediates interaction of P. vivax merozoites with DARC. The DARC receptor-binding domain lies in a conserved N-terminal cysteine-rich region of PvDBP referred to as region II (PvDBPII). PvDBPII is an attractive vaccine candidate since antibodies raised against PvDBPII block erythrocyte invasion by P. vivax. Here, we describe methods to produce recombinant PvDBPII in its correctly folded conformation. A synthetic gene optimized for expression of PvDBPII in Escherichia coli and fed batch fermentation process based on exponential feeding strategy was used to achieve high levels of expression of recombinant PvDBPII. Recombinant PvDBPII was isolated from inclusion bodies, refolded by rapid dilution and purified by ion exchange chromatography. Purified recombinant PvDBPII was characterized for identity, purity and functional activity using standardized release assays. Recombinant PvDBPII formulated with various human compatible adjuvants including glycosylpyranosyl lipid A-stable emulsion (GLA-SE) and alhydrogel was used for immunogenicity studies in small animals to downselect a suitable formulation for clinical development. Sera collected from immunized animals were tested for recognition of PvDBPII and inhibition of PvDBPII-DARC binding. GLA-SE formulations of PvDBPII yielded higher ELISA and binding inhibition titres compared to PvDBPII formulated with alhydrogel. These data support further development of a recombinant vaccine for P. vivax based on PvDBPII formulated with GLA-SE. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Health information technology: integration of clinical workflow into meaningful use of electronic health records.

    PubMed

    Bowens, Felicia M; Frye, Patricia A; Jones, Warren A

    2010-10-01

    This article examines the role that clinical workflow plays in successful implementation and meaningful use of electronic health record (EHR) technology in ambulatory care. The benefits and barriers of implementing EHRs in ambulatory care settings are discussed. The researchers conclude that widespread adoption and meaningful use of EHR technology rely on the successful integration of health information technology (HIT) into clinical workflow. Without successful integration of HIT into clinical workflow, clinicians in today's ambulatory care settings will continue to resist adoption and implementation of EHR technology.

  18. Marketing retail health clinics: challenges and controversies arising from a health care innovation.

    PubMed

    Williams, Cheryl-Ann N; Khanfar, Nile M; Harrington, Catherine; Loudon, David

    2011-01-01

    Since their founding in 2000, retail-based health care clinics, also called convenient care clinics, have flourished but continue to generate controversy. This article examines the literature with respect to the industry's background, establishment of industry standards, types of services offered, marketing of retail health clinics, industry growth with new target markets, and patient demographics. It also examines the growing relationship with insurers and third-party payers, quality-of-care concerns by medical associations, and legal regulations and their potential impact on industry growth nationwide.

  19. Clinical research and global health: mentoring the next generation of health care students.

    PubMed

    Shah, Sural K; Nodell, Bobbi; Montano, Silvia M; Behrens, Chris; Zunt, Joseph R

    2011-01-01

    Interest in global health and opportunities to conduct clinical research at international sites have increased markedly for health profession trainees. With this increase in demand comes an increase in the need for mentors at international and home institutions to provide guidance with designing, implementing and analysing clinical research projects that benefit both the trainees and the research site. In this article, we provide an overview of our insights gained through mentoring in the international setting and suggest a series of key points to help ensure an enjoyable and productive international clinical research experience for both trainees and mentors.

  20. Exercises in emergency preparedness for health professionals in community clinics.

    PubMed

    Fowkes, Virginia; Blossom, H John; Sandrock, Christian; Mitchell, Brenda; Brandstein, Kendra

    2010-10-01

    Health professionals in community settings are generally unprepared for disasters. From 2006 to 2008 the California Statewide Area Health Education Center (AHEC) program conducted 90 table top exercises in community practice sites in 18 counties. The exercises arranged and facilitated by AHEC trained local coordinators and trainers were designed to assist health professionals in developing and applying their practice site emergency plans using simulated events about pandemic influenza or other emergencies. Of the 1,496 multidisciplinary health professionals and staff participating in the exercises, 1,176 (79%) completed learner evaluation forms with 92-98% of participants rating the training experiences as good to excellent. A few reported helpful effects when applying their training to a real time local disaster. Assessments of the status of clinic emergency plans using 15 criteria were conducted at three intervals: when the exercises were scheduled, immediately before the exercises, and for one-third of sites, three months after the exercise. All sites made improvements in their emergency plans with some or all of the plan criteria. Of the sites having follow up, most (N = 23) were community health centers that made statistically significant changes in two-thirds of the plan criteria (P = .001-.046). Following the exercises, after action reports were completed for 88 sites and noted strengths, weaknesses, and plans for improvements in their emergency plans Most sites (72-90%) showed improvements in how to activate their plans, the roles of their staff, and how to participate in a coordinated response. Challenges in scheduling exercises included time constraints and lack of resources among busy health professionals. Technical assistance and considerations of clinic schedules mitigated these issues. The multidisciplinary table top exercises proved to be an effective means to develop or improve clinic emergency plans and enhance the dialogue and coordination among

  1. Exercises in Emergency Preparedness for Health Professionals in Community Clinics

    PubMed Central

    Blossom, H. John; Sandrock, Christian; Mitchell, Brenda; Brandstein, Kendra

    2010-01-01

    Health professionals in community settings are generally unprepared for disasters. From 2006 to 2008 the California Statewide Area Health Education Center (AHEC) program conducted 90 table top exercises in community practice sites in 18 counties. The exercises arranged and facilitated by AHEC trained local coordinators and trainers were designed to assist health professionals in developing and applying their practice site emergency plans using simulated events about pandemic influenza or other emergencies. Of the 1,496 multidisciplinary health professionals and staff participating in the exercises, 1,176 (79%) completed learner evaluation forms with 92–98% of participants rating the training experiences as good to excellent. A few reported helpful effects when applying their training to a real time local disaster. Assessments of the status of clinic emergency plans using 15 criteria were conducted at three intervals: when the exercises were scheduled, immediately before the exercises, and for one-third of sites, three months after the exercise. All sites made improvements in their emergency plans with some or all of the plan criteria. Of the sites having follow up, most (N = 23) were community health centers that made statistically significant changes in two-thirds of the plan criteria (P = .001–.046). Following the exercises, after action reports were completed for 88 sites and noted strengths, weaknesses, and plans for improvements in their emergency plans Most sites (72–90%) showed improvements in how to activate their plans, the roles of their staff, and how to participate in a coordinated response. Challenges in scheduling exercises included time constraints and lack of resources among busy health professionals. Technical assistance and considerations of clinic schedules mitigated these issues. The multidisciplinary table top exercises proved to be an effective means to develop or improve clinic emergency plans and enhance the dialogue and

  2. The pragmatic clinical trial in a learning health care system.

    PubMed

    Lewis, Roger J

    2016-10-01

    A learning health care system ideally incorporates the ability to adapt to the pace of change, the incorporation of new clinical research paradigms, and leverages electronic health record systems and clinical decision support systems to narrow the divide between research and clinical practice. An adaptive clinical trial can be embedded into the sites and practice of clinical care in a highly pragmatic way to simultaneously generate high-quality data on treatment efficacy and improve the care of patients. This approach can be expanded into a pragmatic platform trial, meaning a trial that is intended to evaluate multiple treatments for a disease or diseases, possibly in combination, and with the available treatments potentially changing over time. This strategy is illustrated using a trial currently being implemented in Europe and funded by the European Union, evaluating three different "domains" of treatments for patients with severe community-acquired pneumonia requiring intensive care. Simulation studies demonstrate that this approach has the potential to save lives while identifying the best treatment strategies for this critically ill population. Patients are likely to benefit if we can merge clinical trials and decision support into a single continuous learning process. © The Author(s) 2016.

  3. Reproductive health clinic raided and closed in Bogota, Colombia.

    PubMed

    1995-01-27

    On December 17, armed criminal investigative forces acting under the direction of Colombia's secretary and deputy secretary of health, brutally raided the main clinic of the Orientame reproductive health care federation in Bogota, Colombia. Allegedly responding to charges that the clinic was providing abortions, investigators entered the clinic without warning, brandishing automatic weapons. Once inside, they threatened and physically assaulted patients and clinic staff, destroyed office equipment, broke down doors, and ordered the clinic to close. Since its founding in 1977, Orientame has become Colombia's second largest non-governmental family planning organization. The federation, consisting of three clinics, provides a full range of obstetric, gynecological, and information services, including family planning counseling, cancer screening, treatment for sexually transmitted diseases, prenatal care, adoption placement and counseling, and treatment of incomplete abortion. Serving approximately 250,000 women in its 17 years of operation, Orientame has a sliding fee scale and often waives costs for women who are unable to pay. Were Orientame to close its doors permanently, women facing complications from unsafe abortions but unable to pay private doctors would be forced to go to public hospitals and risk arrest. Despite the country's prohibition of abortions not necessary to save a woman's life, an estimated 288,400 Colombian women underwent abortions in 1989; 57,680 were hospitalized for complications from unsafe or incomplete procedures. full text

  4. Role of pharmacogenetics in public health and clinical health care: a SWOT analysis.

    PubMed

    Kapoor, Ritika; Tan-Koi, Wei Chuen; Teo, Yik-Ying

    2016-12-01

    Pharmacogenomics has been lauded as an important innovation in clinical medicine as a result of advances in genomic science. As one of the cornerstones in precision medicine, the vision to determine the right medication in the right dosage for the right treatment with the use of genetic information has not exactly materialised, and few genetic tests have been implemented as the standard of care in health systems worldwide. Here we review the findings from a SWOT analysis to examine the strengths, weaknesses, opportunities and threats around the role of pharmacogenetics in public health and clinical health care, at the micro, meso and macro levels corresponding to the perspectives of the individuals (scientists, patients and physicians), the health-care institutions and the health systems, respectively.

  5. Precautions used by occupational health nursing students during clinical placements.

    PubMed

    Maja, T M M; Motshudi, M J

    2009-03-01

    Protection of health care workers including students from being infected when caring for high risk patients is a major cause for concern to all promoting occupational health. Safety of every employee is mandatory. Furthermore, universal guidelines for precautions must be used by all interacting with high risk patients and clients to protect themselves and prevent the spread of infection. The aim of this paper was to ascertain the availability of universal guidelines for precautions against the spread of infection in clinical settings and determine the precautions used by OHN students during their clinical placements. To realise these objectives, a quantitative and descriptive design was followed. A purposive sampling method was used to select 45 Occupational health nursing students who participated in the study. Data was collected with the use of a structured questionnaire and the results revealed that: most units where OHN students were placed for clinical experience had guidelines for universal precautions although these were not always accessible to them; regarding compliance to universal precautions, OHN students were reportedly aware of the hazards of failure to comply although in some emergencies and where personal protective material was not available, they had to provide care without using protective equipments. Recommendations made include that employers and staff at all occupational settings must ensure that updated guidelines for universal precautions are available and accessible to every body interacting with high risk patients; health care providers and students must be fully informed about and should always adhere to universal precautions.

  6. [Clinical medical anthropology and immigrant's mental health in France].

    PubMed

    Bennegadi, R

    1996-01-01

    Clinical anthropology offers a great advantage for understanding and managing patient/caretaker relationships in intercultural situations. Instead of falling into the trap of marginalizing and above all needless culturalization, health care workers must learn to integrate the cultural aspects of the representation of mental health and illness as opposed to using them as a guiding light. In this way, since the caretaker or therapist does not have to master anthropologic factors, he/she is not obliged to unknowingly hide his/her own nosographic explanatory model which does not necessarily take cultural aspects into account. Clinical anthropology allows the general practitioner and specialist as well as the psychologist and psychiatrist of all theoretical orientations to manage patient relationships and care more efficiently with regard to diagnosis, therapeutic decision-making, analysis, and psychotherapy. The question of whether the patient and caretaker are of the same origin is asked differently: the question of the universality of psychopathology is asked with greater clarity and less risk of error. Our health care system, which is based on common law benefits as do consulting immigrants since their request for services are answered more efficiently and directly. The only problem is that the conceptual and clinical horizon health care workers must be broadened. This goal cannot be achieved by magic and will require training and education.

  7. Mental health, pregnancy and self-rated health in antenatal women attending primary health clinics.

    PubMed

    Sonkusare, S; Adinegara; Hebbar, S

    2007-12-01

    The purpose of this study was to study the determinants of self rated health in the low-risk pregnant women of Melaka Tengah in Malaysia. A total of 387 subjects were analysed. The role of mental health, psychosocial stressors, support from husband, coping skills, socio-economic status and pregnancy characteristics in determining self- rated health were studied. Health items were taken from the Duke Health Profile. Bad obstetric history, poor mental health, stress from the family were found to be significantly associated with poor self - rated health whereas good support from the husband was related to good self - rated health.

  8. The normativity of clinical health care: perspectives on moral realism.

    PubMed

    Nortvedt, Per

    2012-06-01

    The paper argues that a particular version of moral realism constitutes an important basis for ethics in medicine and health care. Moral realism is the position that moral value is a part of the fabric of relational and interpersonal reality. But even though moral values are subject to human interpretations, they are not themselves the sole product of these interpretations. Moral values are not invented but discovered by the subject. Moral realism argues that values are open to perception and experience and that moral subjectivity must be portrayed in how moral values are discovered and perceived by the human subject. Moral values may exist independent of the particular subject's interpretative evaluations as a part of reality. This epistemological point about normativity is particularly significant in medical care and in health care. The clinician perceives moral value in the clinical encounter in a way that is important for competent clinical understanding. Clinical understanding in medical care and health care bears on the encounter with moral values in the direct and embodied relations to patients, with their experiences of illness and their vulnerabilities. Good clinical care is then partly conditioned upon adequate understanding of such moral realities.

  9. Teaching clinical reasoning by making thinking visible: an action research project with allied health clinical educators

    PubMed Central

    2014-01-01

    Background Clinical reasoning is fundamental to all forms of professional health practice, however it is also difficult to teach and learn because it is complex, tacit, and effectively invisible for students. In this paper we present an approach for teaching clinical reasoning based on making expert thinking visible and accessible to students. Methods Twenty-one experienced allied health clinical educators from three tertiary Australian hospitals attended up to seven action research discussion sessions, where they developed a tentative heuristic of their own clinical reasoning, trialled it with students, evaluated if it helped their students to reason clinically, and then refined it so the heuristic was targeted to developing each student’s reasoning skills. Data included participants’ written descriptions of the thinking routines they developed and trialed with their students and the transcribed action research discussion sessions. Content analysis was used to summarise this data and categorise themes about teaching and learning clinical reasoning. Results Two overriding themes emerged from participants’ reports about using the ‘making thinking visible approach’. The first was a specific focus by participating educators on students’ understanding of the reasoning process and the second was heightened awareness of personal teaching styles and approaches to teaching clinical reasoning. Conclusions We suggest that the making thinking visible approach has potential to assist educators to become more reflective about their clinical reasoning teaching and acts as a scaffold to assist them to articulate their own expert reasoning and for students to access and use. PMID:24479414

  10. Teaching clinical reasoning by making thinking visible: an action research project with allied health clinical educators.

    PubMed

    Delany, Clare; Golding, Clinton

    2014-01-30

    Clinical reasoning is fundamental to all forms of professional health practice, however it is also difficult to teach and learn because it is complex, tacit, and effectively invisible for students. In this paper we present an approach for teaching clinical reasoning based on making expert thinking visible and accessible to students. Twenty-one experienced allied health clinical educators from three tertiary Australian hospitals attended up to seven action research discussion sessions, where they developed a tentative heuristic of their own clinical reasoning, trialled it with students, evaluated if it helped their students to reason clinically, and then refined it so the heuristic was targeted to developing each student's reasoning skills. Data included participants' written descriptions of the thinking routines they developed and trialed with their students and the transcribed action research discussion sessions. Content analysis was used to summarise this data and categorise themes about teaching and learning clinical reasoning. Two overriding themes emerged from participants' reports about using the 'making thinking visible approach'. The first was a specific focus by participating educators on students' understanding of the reasoning process and the second was heightened awareness of personal teaching styles and approaches to teaching clinical reasoning. We suggest that the making thinking visible approach has potential to assist educators to become more reflective about their clinical reasoning teaching and acts as a scaffold to assist them to articulate their own expert reasoning and for students to access and use.

  11. Clinical medicine, public health and ecological health: a new basis for education and prevention?

    PubMed Central

    Schaller, Bernhard; Sandu, Nora

    2011-01-01

    In contrast to public health and the resolution to further increase the health care of the whole community in regions worldwide, current clinical medicine has its limits. Further improvement in public health – rather than individual diseases – can only be achieved by integrating new views into treatment. Some years ago, the concept of biopsychosocial medicine was integrated into patient treatment and is now generally accepted. Therefore the author describes here a new dimension to treatment and presents substantial evidence to include ecological health in this already existing concept. The problem of community education is discussed. PMID:22291784

  12. Distributed PV Adoption - Sensitivity to Market Factors

    SciTech Connect

    Gagnon, Pieter; Sigrin, Ben

    2016-02-01

    NREL staff used the dSolar (distributed solar) model to forecast the adoption of distributed, behind-the-meter PV through the year 2050 for 9 different scenarios. The scenarios varied in their assumptions about a carbon tax, the cost of PV systems in the future, and what credit would be given for excess generation once current net metering policies expire.

  13. PV reference cells: Calibration and stability problems

    SciTech Connect

    Koltun, M.M.

    1995-09-01

    The PV reference cells described in this paper were made and calibrated in Russia. Their parameters have also been measured in Italy, Germany and Israel, in recent years. Different calibration methods are discussed, as well as stability data of PV reference cell parameters, as measured from 1962 to date.

  14. PV integration into a CSP plant

    NASA Astrophysics Data System (ADS)

    Carvajal, Javier López; Barea, Jose M.; Barragan, Jose; Ortega, Carlos

    2017-06-01

    This paper describes a preliminary techno-economic analysis of the integration of a PV plant into an optimized Parabolic Trough Plant in order to reduce the online consumptions and thus, increase the net electricity injected into the grid. The idea is to assess the feasibility of such project and see what configuration would be the optimal. An extra effort has been made in terms of modelling as the analysis has to be done to the integrated CSP + PV plant instead of analyzing them independently. Two different technologies have been considered for the PV plant, fix and one-axis tracking. Additionally three different scenarios have been considered for the CSP plant auxiliary consumptions as they are essential for determining the optimal PV plant (the higher the auxiliary consumption the higher the optimal PV plant). As could be expected, the results for all cases with PV show an improvement in terms of electricity generation and also in terms of LCOE with respect to the CSP plant. Such improvement is slightly higher with tracking technology for this specific study. Although this exercise has been done to an already designed CSP plant (so only the PV plant had to be optimized), the methodology could be applied for the optimization of an integrated CSP + PV plant during the design phase.

  15. Health profiles of foreigners attending primary care clinics in Malaysia.

    PubMed

    Ab Rahman, Norazida; Sivasampu, Sheamini; Mohamad Noh, Kamaliah; Khoo, Ee Ming

    2016-06-14

    The world population has become more globalised with increasing number of people residing in another country for work or other reasons. Little is known about the health profiles of foreign population in Malaysia. The aim of this study was to provide a detailed description of the health problems presented by foreigners attending primary care clinics in Malaysia. Data were derived from the 2012 National Medical Care Survey (NMCS), a cross sectional survey of primary care encounters from public and private primary care clinics sampled from five regions in Malaysia. Patients with foreign nationality were identified and analysed for demographic profiles, reasons for encounter (RFEs), diagnosis, and provision of care. Foreigners accounted for 7.7 % (10,830) of all patient encounters from NMCS. Most encounters were from private clinics (90.2 %). Median age was 28 years (IQR: 24.0, 34.8) and 69.9 % were male. Most visits to the primary care clinics were for symptom-based complaints (69.5 %), followed by procedures (23.0 %) and follow-up visit (7.4 %). The commonest diagnosis in public clinics was antenatal care (21.8 %), followed by high risk pregnancies (7.5 %) and upper respiratory tract infection (URTI) (6.8 %). Private clinics had more cases for general medical examination (13.5 %), URTI (13.1 %) and fever (3.9 %). Medications were prescribed to 76.5 % of these encounters. More foreigners were seeking primary medical care from private clinics and the encounters were for general medical examinations and acute minor ailments. Those who sought care from public clinics were for obstetric problems and chronic diseases. Medications were prescribed to two-thirds of the encounters while other interventions: laboratory investigations, medical procedures and follow-up appointment had lower rates in private clinics. Foreigners are generally of young working group and are expected to have mandatory medical checks. The preponderance of obstetrics seen in public

  16. Integrated Behavioral Health Care in Pediatric Subspecialty Clinics.

    PubMed

    Samsel, Chase; Ribeiro, Monique; Ibeziako, Patricia; DeMaso, David R

    2017-10-01

    Comorbid behavioral and physical health conditions are accompanied by troubling symptom burden, functional impairment, and treatment complexity. Pediatric subspecialty care clinics offer an opportunity for the implementation of integrated behavioral health (BH) care models that promote resiliency. This article reviews integrated BH care in oncology, palliative care, pain, neuropsychiatry, cystic fibrosis, and transplantation. Examples include integrated care mandates, standards of care, research, and quality improvement by child and adolescent psychiatrists (CAPs) and allied BH clinicians. The role of CAPs in integrated BH care in subspecialty care is explored, focusing on cost, resource use, financial support, and patient and provider satisfaction. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Developing a manual for strengthening mental health nurses' clinical supervision.

    PubMed

    Buus, Niels; Cassedy, Paul; Gonge, Henrik

    2013-05-01

    In this article, we report findings from a study aimed at developing the content and implementation of a manual for a research-based intervention on clinical supervision of mental health nursing staff. The intervention was designed to strengthen already existing supervision practices through educational preparation for supervision and systematic reflection on supervision. The intervention consists of three sessions and was implemented on two groups of mental health hospital staff. We present an outline of the manual and explain how the trial sessions made us adjust the preliminary manual. The effects of implementing the manual will subsequently be analysed in an independent randomised controlled trial.

  18. SHAPING A NEW GENERATION OF HISPANIC CLINICAL AND TRANSLATIONAL RESEARCHERS ADDRESSING MINORITY HEALTH AND HEALTH DISPARITIES

    PubMed Central

    Estape, Estela S.; Segarra, Barbara; Baez, Adriana; Huertas, Aracelis; Diaz, Clemente; Frontera, Walter

    2012-01-01

    In 2011, research educators face significant challenges. Training programs in Clinical and Translational Research need to develop or enhance their curriculum to comply with new scientific trends and government policies. Curricula must impart the skills and competencies needed to help facilitate the dissemination and transfer of scientific advances at a faster pace than current health policy and practice. Clinical and translational researchers are facing also the need of new paradigms for effective collaboration, and resource sharing while using the best educational models. Both government and public policy makers emphasize addressing the goals of improving health quality and elimination of health disparities. To help achieve this goal, our academic institution is taking an active role and striving to develop an environment that fosters the career development of clinical and translational researchers. Consonant with this vision, in 2002 the University of Puerto Rico, Medical Sciences Campus School of Health Professions and School of Medicine initiated a multidisciplinary post-doctoral Master of Science in Clinical Research focused in training Hispanics who will address minority health and health disparities research. Recently, we proposed a curriculum revision to enhance this commitment in promoting competency-based curricula for clinician-scientists in clinical and translational sciences. The revised program will be a post-doctoral Master of Science in Clinical and Translational Research (MCTR), expanding its outreach by actively engaging in establishing new collaborations and partnerships that will increase our capability to diversify our educational efforts and make significant contributions to help reduce and eliminate the gap in health disparities. PMID:22263296

  19. Adolescent health care maintenance in a teen-friendly clinic.

    PubMed

    Chaisson, Nicole; Shore, William B

    2014-09-01

    Adolescence is marked by complex physical, cognitive, social, and emotional development, which can be stressful for families and adolescents. Before the onset of puberty, providers should clearly lay the groundwork for clinical care and office visits during the adolescent years. This article addresses the guidelines and current legal standards for confidentiality in adolescent care, the most frequently used psychosocial screening tools, and current recommendations for preventive health services and immunizations. Through the creation of teen-friendly clinics, primary care providers are well positioned to offer guidance and support to teens and their parents during this time of transition and growth. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. Health education for pregnancy care in Harare. A survey in seven primary health care clinics.

    PubMed

    Murira, N; Munjanja, S P; Zhanda, I; Lindmark, G; Nystrom, L

    1996-10-01

    The aim of this study was to evaluate how health education is currently practiced in the antenatal clinics in Harare and to make recommendations for its improvement. This was a descriptive study in which data was collected through subject interviews and by observations of antenatal clinics in progress. Antenatal sessions at primary care clinics in Harare. 100 pregnant women and 65 midwives. The timing, frequency and methods used in health education and the attitude of the pregnant mothers and staff to health education. The results revealed that health education was given once in pregnancy, on the first visit only. The lecture was the most used teaching method. The lecture was full of distractions which affected the concentration of the audience. Midwives decided on the subject matter for health education without consultation with the expectant women. As a result many women could not follow the practical advice given to them. Midwives overestimated their use of other methods of health education. Both the staff and the pregnant women agreed that there should be greater use of written material for women to read at home with their spouses. The lecture is not the most appropriate method of health education during pregnancy and greater use should be made of other methods of communication such as the mass media and pamphlets.

  1. The Ethical Use of Mobile Health Technology in Clinical Psychiatry.

    PubMed

    Torous, John; Roberts, Laura Weiss

    2017-01-01

    The rapid rise of mobile health technologies, such as smartphone apps and wearable sensors, presents psychiatry with new tools of potential value in caring for patients. Novel diagnostic and therapeutic applications of these technologies have been developed in private industry and utilized in mental health, although these methods do not yet constitute standard of care. In this article, we provide an ethical perspective on the practical use of this novel modality by psychiatrists. We propose that in the present context of limited scientific research and regulatory oversight, mobile technologies should serve to enhance the psychiatrist-patient relationship, rather than replace it, to minimize potential clinical and ethical harm to vulnerable patients. We analyze areas of possible ethical tension between clinical practice and the consumer-driven mobile industry, and develop a decision-tree model for implementing ethical safeguards in practice, focused on managing risk to the therapeutic relationship, informed consent, confidentiality, and mutual alignment of treatment goals and expectations.

  2. Clinical alarm hazards: a "top ten" health technology safety concern.

    PubMed

    Keller, James P

    2012-01-01

    For the past several years ECRI Institute has published a list of Top Ten Health Technology Hazards. This list is based on ECRI's extensive research in health technology safety and on data provided to its problemreporting systems. For every year that the Top Ten list has been published, Alarm Hazards have been at or near the top of the list. Improving alarm safety requires a systematic review of a hospital's alarm-based technologies and analysis of alarm management policies like alarm escalation strategies and staffing patterns. It also requires careful selection of alarm setting criteria for each clinical care area. This article will overview the clinical alarm problems that have been identified through ECRI Institute's research and analysis of various problem reporting databases, including those operated by ECRI Institute. It will also highlight suggestions for improvement, particularly from a technology design and technology management perspective. Copyright © 2012 Elsevier Inc. All rights reserved.

  3. Ministry of Health Clinical Practice Guidelines: Diabetes Mellitus

    PubMed Central

    Goh, Su Yen; Ang, Seng Bin; Bee, Yong Mong; Chen, Richard YT; Gardner, Daphne; Ho, Emily; Adaikan, Kala; Lee, Alvin; Lee, Chung Horn; Lim, Fong Seng; Lim, Hwee Boon; Lim, Su Chi; Seow, Julie; Soh, Abel Wah Ek; Sum, Chee Fang; Tai, E Shyong; Thai, Ah Chuan; Wong, Tien Yin; Yap, Fabian

    2014-01-01

    The Ministry of Health (MOH) have updated the clinical practice guidelines on Diabetes Mellitus to provide doctors and patients in Singapore with evidence-based treatment for diabetes mellitus. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on Diabetes Mellitus, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical.html. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines. PMID:25017409

  4. Ministry of Health Clinical Practice Guidelines: Diabetes Mellitus.

    PubMed

    Goh, S Y; Ang, S B; Bee, Y M; Chen, Y T; Gardner, D S; Ho, E T; Adaikan, K; Lee, Y C; Lee, C H; Lim, F S; Lim, H B; Lim, S C; Seow, J; Soh, A W; Sum, C F; Tai, E S; Thai, A C; Wong, T Y; Yap, F

    2014-06-01

    The Ministry of Health (MOH) have updated the clinical practice guidelines on Diabetes Mellitus to provide doctors and patients in Singapore with evidence-based treatment for diabetes mellitus. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on Diabetes Mellitus, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical.html. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.

  5. Ministry of Health Clinical Practice Guidelines: Anxiety Disorders.

    PubMed

    Lim, Leslie; Chan, Hong Ngee; Chew, Peng Hoe; Chua, Sze Ming; Ho, Carolyn; Kwek, Seow Khee Daniel; Lee, Tih Shih; Loh, Patricia; Lum, Alvin; Tan, Yong Hui Colin; Wan, Yi Min; Woo, Matthew; Yap, Hwa Ling

    2015-06-01

    The Ministry of Health (MOH) has developed the clinical practice guidelines on Anxiety Disorders to provide doctors and patients in Singapore with evidence-based treatment for anxiety disorders. This article reproduces the introduction and executive summary (with recommendations from the guidelines) from the MOH clinical practice guidelines on anxiety disorders, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Ministry of Health website: http://www.moh.gov.sg/content/moh_web/healthprofessionalsportal/doctors/guidelines/cpg_medical.html. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.

  6. Measuring Workplace Climate in Community Clinics and Health Centers.

    PubMed

    Friedberg, Mark W; Rodriguez, Hector P; Martsolf, Grant R; Edelen, Maria O; Vargas Bustamante, Arturo

    2016-10-01

    The effectiveness of community clinics and health centers' efforts to improve the quality of care might be modified by clinics' workplace climates. Several surveys to measure workplace climate exist, but their relationships to each other and to distinguishable dimensions of workplace climate are unknown. To assess the psychometric properties of a survey instrument combining items from several existing surveys of workplace climate and to generate a shorter instrument for future use. We fielded a 106-item survey, which included items from 9 existing instruments, to all clinicians and staff members (n=781) working in 30 California community clinics and health centers, receiving 628 responses (80% response rate). We performed exploratory factor analysis of survey responses, followed by confirmatory factor analysis of 200 reserved survey responses. We generated a new, shorter survey instrument of items with strong factor loadings. Six factors, including 44 survey items, emerged from the exploratory analysis. Two factors (Clinic Workload and Teamwork) were independent from the others. The remaining 4 factors (staff relationships, quality improvement orientation, managerial readiness for change, and staff readiness for change) were highly correlated, indicating that these represented dimensions of a higher-order factor we called "Clinic Functionality." This 2-level, 6-factor model fit the data well in the exploratory and confirmatory samples. For all but 1 factor, fewer than 20 survey responses were needed to achieve clinic-level reliability >0.7. Survey instruments designed to measure workplace climate have substantial overlap. The relatively parsimonious item set we identified might help target and tailor clinics' quality improvement efforts.

  7. National Institute for Health and Clinical Excellence appraisal and ageism.

    PubMed

    Stevens, Andrew; Doyle, Nick; Littlejohns, Peter; Docherty, Mary

    2012-05-01

    The requirements of the UK Equality Act 2010 and some high profile criticism for using a potentially ageist methodology have prompted the National Institute for Health and Clinical Excellence (NICE) to assess the processes and methodology it uses to make appraisal decisions. This paper argues that NICE has established rigorous systems to protect against ageist decisions, has no track record of ageism and is well placed to meet the requirements of new UK equality legislation.

  8. The European Clinical, Molecular, and Pathological (ECMP) Criteria and the 2007/2008 Revisions of the World Health Organization for the Diagnosis, Classification, and Staging of Prefibrotic Myeloproliferative Neoplasms Carrying the JAK2V617F Mutation

    PubMed Central

    Michiels, Jan Jacques; Kate, Fibo Ten; Lam, King H.; Schroyens, Wilfried; Berneman, Zwi; De Raeve, Hendrik

    2014-01-01

    Objective: The prefibrotic stages of JAK2V617F essential thrombocythemia (ET) and JAK2V617F polycythemia vera (PV) can easily be diagnosed clinically without use of bone marrow biopsy histology. We assessed the 2008 WHO and European Clinical, Molecular, and Pathological (ECMP) criteria for the diagnosis of myeloproliferative neoplasms (MPNs). Materials and Methods: Studied patients included 6 JAK2V617F-mutated ET and 4 PV patients during long-term follow-up in view of critical analysis of the literature. The bone marrow biopsy histology diagnosis without use of clinical data was PV in 7 (of which 3 were cases of ET with features of early prodromal PV) and classical PV in 4. Results: The ECMP criteria distinguish 3 sequential phenotypes (1, 2, or 3) of JAK2V617F-mutated ET: normocellular ET-1; ET-2, with clinical and bone marrow features of PV (prodromal PV), and ET-3, with hypercellular dysmorphic megakaryocytic and granulocytic myeloproliferation (ET.MGM). The 3 patients with ET-2 or prodromal PV developed slow-onset PV after a follow-up of about 10 years. Bone marrow biopsy histology differentiates MPNs of various molecular etiologies from all variants of primary or secondary erythrocytoses and thrombocytoses with sensitivity and specificity of near 100%. Conclusion: Normocellular ET (WHO-ET), prodromal PV, and classical PV show overlapping bone marrow biopsy histology features with similar pleomorphic clustered megakaryocytes in the prefibrotic stages of JAK2V617F mutated MPN. Erythrocytes are below 6x1012/L in normocellular ET and prodromal PV, and are consistently above 6x1012/L in classical PV and at the time of transition from prodromal PV into classical PV. Red cell count at a cut-off level of 6x1012/L separates ET from PV and obviates the need for red cell mass measurement when bone marrow histology and JAK2V617F mutation screening are included in the diagnostic work-up of MPNs.

  9. Implementation of an Electronic Health Records System in a Small Clinic: The Viewpoint of Clinic Staff

    ERIC Educational Resources Information Center

    Carayon, Pascale; Smith, Paul; Hundt, Ann Schoofs; Kuruchittham, Vipat; Li, Qian

    2009-01-01

    In this study, we examined the implementation of an electronic health records (EHR) system in a small family practice clinic. We used three data collection instruments to evaluate user experience, work pattern changes, and organisational changes related to the implementation and use of the EHR system: (1) an EHR user survey, (2) interviews with…

  10. Implementation of an Electronic Health Records System in a Small Clinic: The Viewpoint of Clinic Staff

    ERIC Educational Resources Information Center

    Carayon, Pascale; Smith, Paul; Hundt, Ann Schoofs; Kuruchittham, Vipat; Li, Qian

    2009-01-01

    In this study, we examined the implementation of an electronic health records (EHR) system in a small family practice clinic. We used three data collection instruments to evaluate user experience, work pattern changes, and organisational changes related to the implementation and use of the EHR system: (1) an EHR user survey, (2) interviews with…

  11. Using Mobile Health Clinics to Reach College Students: A National Demonstration Project

    ERIC Educational Resources Information Center

    Fennell, Reginald; Escue, Christopher

    2013-01-01

    Background: The mobile health unit (MHU) was a grant-funded national initiative to explore the utilization of a mobile clinic to provide health promotion and clinical services for college students in the United States. Purpose: In 2010 and 2011, a 38-foot mobile clinic tested the feasibility of utilizing the clinic to deliver health promotion and…

  12. Using Mobile Health Clinics to Reach College Students: A National Demonstration Project

    ERIC Educational Resources Information Center

    Fennell, Reginald; Escue, Christopher

    2013-01-01

    Background: The mobile health unit (MHU) was a grant-funded national initiative to explore the utilization of a mobile clinic to provide health promotion and clinical services for college students in the United States. Purpose: In 2010 and 2011, a 38-foot mobile clinic tested the feasibility of utilizing the clinic to deliver health promotion and…

  13. Characterizing Clinic Adoption of Clinical and Business Trainings in Child Mental Health in New York State

    PubMed Central

    Chor, Ka Ho Brian; Olin, Serene; Weaver, Jamie; Cleek, Andrew F; McKay, Mary M; Hoagwood, Kimberly; Horwitz, Sarah McCue

    2014-01-01

    Objective: This study prospectively examined the naturalistic adoption of clinical and business evidence-informed trainings by all outpatient mental health clinics licensed to treat children, adolescents, and their families in New York State. Methods: Using September 2011-August 2013 attendance data from the New York State-funded Clinic Technical Assistance Center, this study classified the adoption behavior of 346 clinics in four ways: by number, type, intensity, and an adopter group category characterizing clinics by the highest training intensity in which they participated. Descriptive statistics on these adoption classifications were examined. Results: Among the 268 adopting clinics, a median of five out of 33 trainings were adopted; business and clinical trainings were about equally accessed (82% vs. 78%). Hour-long webinars were most popular (96% participation) compared to 6-18 month-long learning collaboratives (34% participation). Among adopters of business and clinical learning collaboratives, 73-100% sampled a webinar first before they committed to the learning collaboratives, though consistent participation in learning collaborative sessions over time was a challenge. Adopter groups captured meaningful adopter profiles: 41% were low-adopters that selected fewer trainings and only participated in webinars; 34% were high-/super-adopters that accessed more trainings and participated in learning collaboratives. Conclusions: More nuanced definitions of adoption behavior can improve the understanding of clinic adoption of trainings and hence promote the development of efficient roll-out strategies by state systems. PMID:25082362

  14. Neuroplasticity and Clinical Practice: Building Brain Power for Health

    PubMed Central

    Shaffer, Joyce

    2016-01-01

    The focus of this review is on driving neuroplasticity in a positive direction using evidence-based interventions that also have the potential to improve general health. One goal is to provide an overview of the many ways new neuroscience can inform treatment protocols to empower and motivate clients to make the lifestyle choices that could help build brain power and could increase adherence to healthy lifestyle changes that have also been associated with simultaneously enhancing vigorous longevity, health, happiness, and wellness. Another goal is to explore the use of a focus in clinical practice on helping clients appreciate this new evidence and use evolving neuroscience in establishing individualized goals, designing strategies for achieving them and increasing treatment compliance. The timing is urgent for such interventions with goals of enhancing brain health across the lifespan and improving statistics on dementia worldwide. PMID:27507957

  15. [Hospital clinical experience: meanings for Family Health resident nurses].

    PubMed

    Landim, Simone Alves; Batista, Nildo Alves; da Silva, Gilberto Tadeu Reis

    2010-01-01

    This qualitative research in phenomenological design aimed at understanding the meaning of hospital clinical experience in the nurse's training in a Multiprofessional Family Health Residency. The study was developed in a teaching institution. Data collection was based on interviews and had as study population eight resident nurses. I investigated the residents' experience according to their speeches, by making the following guiding question: "Talk about your hospital experience, how does it show itself in your training as a resident"? One open category emerged from the subject' description: Causing to approach the hospital experience and the Primary Health Care. Among the meanings attributed to the hospital experience, there is the need and relevance as an integrant part of the curriculum vitae of the Multiprofessional Family Health Residency for the nurses.

  16. Adult Dental Health Survey 2009: implications of findings for clinical practice and oral health policy.

    PubMed

    Watt, R G; Steele, J G; Treasure, E T; White, D A; Pitts, N B; Murray, J J

    2013-01-01

    This is the final paper in a series reporting on the results of the 2009 Adult Dental Health Survey. Since 1968 national adult surveys have been repeated every decade with broadly similar methods providing a unique overview of trends in oral health over a 40-year period. This paper aims to explore the implications for dentists and oral health policy of the key results from the Adult Dental Health Survey 2009. Although repeat, cross-sectional, epidemiological surveys provide very valuable data on trends in disease patterns, they do not provide answers to test causal relationships and therefore cannot identify the causes for the significant improvements in oral health over the last 40 years. Evidence would indicate, however, that broad societal shifts in population norms and behaviours, combined with changes in clinical diagnostic criteria, treatment planning and clinical procedures are the main reasons for the changes that have taken place. Key implications of the survey results include the need to monitor, support and maintain the good state of oral health of the increasing proportion of younger adults with relatively simple treatment needs. A smaller number of young and middle aged adults but a significant proportion of older adults will have far more complex treatment needs requiring advanced restorative and periodontal care. Future oral health policy will need to address oral health inequalities, encourage skill mix and promote and facilitate the dental profession to deliver appropriate and high quality care relevant to the needs of their local population.

  17. Computer-assisted self interviewing in sexual health clinics.

    PubMed

    Fairley, Christopher K; Sze, Jun Kit; Vodstrcil, Lenka A; Chen, Marcus Y

    2010-11-01

    This review describes the published information on what constitutes the elements of a core sexual history and the use of computer-assisted self interviewing (CASI) within sexually transmitted disease clinics. We searched OVID Medline from 1990 to February 2010 using the terms "computer assisted interviewing" and "sex," and to identify published articles on a core sexual history, we used the term "core sexual history." Since 1990, 3 published articles used a combination of expert consensus, formal clinician surveys, and the Delphi technique to decide on what questions form a core sexual health history. Sexual health histories from 4 countries mostly ask about the sex of the partners, the number of partners (although the time period varies), the types of sex (oral, anal, and vaginal) and condom use, pregnancy intent, and contraceptive methods. Five published studies in the United States, Australia, and the United Kingdom compared CASI with in person interviews in sexually transmitted disease clinics. In general, CASI identified higher risk behavior more commonly than clinician interviews, although there were substantial differences between studies. CASI was found to be highly acceptable and individuals felt it allowed more honest reporting. Currently, there are insufficient data to determine whether CASI results in differences in sexually transmitted infection testing, diagnosis, or treatment or if CASI improves the quality of sexual health care or its efficiency. The potential public health advantages of the widespread use of CASI are discussed.

  18. [A future image of clinical inspection from health economics].

    PubMed

    Kakihara, Hiroaki

    2006-06-01

    Do you let medical costs increase in proportion to the growth rate of GDP? A way of thinking of the Council on Economic and Fiscal Policy. Should we exclude public medical insurance? It is not a problem, it is an absolute sum if you are effective. If there is no insurance, and individuals pay the total amount, there is no problem, but it is impossible. Economic development will cease if there is no insurance. As medical personnel, to offer good medical care with an appropriate cost. An appeal to the nation is necessary. Economic technical evaluation to identify a cheap method for each clinical inspection. Does medical insurance have a deficit? I. Japanese Health insurance system. (1) Health insurance union. When you look at the contribution money, it is originally 2,479,800,000,000 yen, with premium income and a profit of 45%. (2) Government management health insurance. When you look at the contribution money, it is originally 2,163,300,000,000 yen, with premium income and a profit of 36%. (1) + (2) Employed insurance meter. (3) Mutual aid. (4) National Health Insurance. II. A clinical economic method. III. Expense of medical care and its effect. A. Expense. B. A medical economic technical evaluation method. 1. Cost-effectiveness analysis CEA. 2. Cost utility analysis CUA. 3. Cost-benefit analysis CBA. 4. Expense minimization analysis.

  19. Diabetes and bone health: latest evidence and clinical implications

    PubMed Central

    Sundararaghavan, Vikram; Mazur, Matthew M.; Evans, Brad; Liu, Jiayong; Ebraheim, Nabil A.

    2017-01-01

    As the prevalence of diabetes is increasing worldwide, research on some of the lesser-known effects, including impaired bone health, are gaining a lot of attention. The two most common forms of diabetes are type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). These two differ in their physiology, with T1DM stemming from an inability to produce insulin, and T2DM involving an insufficient response to the insulin that is produced. This review aims to highlight the most current information regarding diabetes as it relates to bone health. It looks at biochemical changes that characterize diabetic bone; notably increased adiposity, altered bone metabolism, and variations in bone mineral density (BMD). Then several hypotheses are analyzed, concerning how these changes may be detrimental to the highly orchestrated processes that are involved in bone formation and turnover, and ultimately result in the distinguishing features of diabetic bone. The review proceeds by explaining the effects of antidiabetes medications on bone health, then highlighting several ways that diabetes can play a part in other clinical treatment outcomes. With diabetes negatively affecting bone health and creating other clinical problems, and its treatment options potentiating these effects, physicians should consider the use of anti-osteoporotic drugs to supplement standard anti-diabetes medications in patients suffering with diabetic bone loss. PMID:28344668

  20. Clinical Research Informatics and Electronic Health Record Data

    PubMed Central

    Horvath, M. M.; Rusincovitch, S. A.

    2014-01-01

    Summary Objectives The goal of this survey is to discuss the impact of the growing availability of electronic health record (EHR) data on the evolving field of Clinical Research Informatics (CRI), which is the union of biomedical research and informatics. Results Major challenges for the use of EHR-derived data for research include the lack of standard methods for ensuring that data quality, completeness, and provenance are sufficient to assess the appropriateness of its use for research. Areas that need continued emphasis include methods for integrating data from heterogeneous sources, guidelines (including explicit phenotype definitions) for using these data in both pragmatic clinical trials and observational investigations, strong data governance to better understand and control quality of enterprise data, and promotion of national standards for representing and using clinical data. Conclusions The use of EHR data has become a priority in CRI. Awareness of underlying clinical data collection processes will be essential in order to leverage these data for clinical research and patient care, and will require multi-disciplinary teams representing clinical research, informatics, and healthcare operations. Considerations for the use of EHR data provide a starting point for practical applications and a CRI research agenda, which will be facilitated by CRI’s key role in the infrastructure of a learning healthcare system. PMID:25123746

  1. Clinical working postures of bachelor of oral health students.

    PubMed

    Horton, S J; Johnstone, C L; Hutchinson, C M W; Taylor, P A; Wade, K J

    2011-09-01

    To observe and describe the clinical working postures of final-year Bachelor of Oral Health (BOH) students. Pilot observational study. The University of Otago Faculty of Dentistry and School of Physiotherapy. Eight final-year BOH students voluntarily participated in this study, where postural data were collected using a digital video camera during a standard clinical treatment session. The postural data were analysed using 3D Match biomechanical software. Final-year BOH students who work in the seated position are exposed to neck flexion of greater than 35 degrees, together with trunk flexion greater than 20 degrees and bilateral elbow flexion greater than 90 degrees. The findings of this study agree with the findings of previous postural studies of dental professionals. Dental hygiene students, together with their clinical supervisors, need to be aware of the importance of good working posture early in their careers, and pay particular attention to the degree of neck flexion occurring for prolonged periods.

  2. South Texas Veterans Health Care System Mobile Health Clinic: Business Case Analysis

    DTIC Science & Technology

    2009-06-11

    diabetes, HIV/AIDs, and cancer treatment and therapy. The system has a National Institute of Health (NIH) funded General Clinical Research Center, a...Bend Division (V/ CBD ) includes primary care outpatient clinics located in Harlingen, McAllen, Corpus Christi, and Laredo. The new Harlingen facility...care expansion into rural areas. In FY11, the V/ CBD will be designated as its own healthcare system, making it the fourth healthcare system in VISN 17

  3. Meeting new health care challenges with a proven innovation: nurse-managed health care clinics.

    PubMed

    Link, Denise G; Perry, Diane; Cesarotti, Evelyn L

    2014-01-01

    Beginning in January 2014, millions of Americans will enroll in health insurance plans under the Affordable Care Act. Some of these individuals were obtaining health care in safety net health clinics, emergency departments, or urgent care centers; many were going without needed care and will be new to the health care system. In addition to these newly insured, the ranks of older Americans and persons in need of chronic disease management will be on the rise. The way in which health care is delivered will have to change in order for the health care workforce to meet the demand for their services without sacrificing quality or access. Nurse practitioners and registered nurses have the education and skills to provide health promotion, disease prevention, and chronic disease management services that will make up a sizable portion of the demand. Amending state practice acts so that the authority to practice matches the ability to practice and opening provider panels to advanced practice nurses will provide opportunities to establish or expand sustainable nurse-led primary care practices in health care shortage areas. Along with these changes, models of health care delivery that incorporate differentiated practice roles and shared interprofessional responsibility for providing care will maximize the capacity of the system to provide the health care that people need.

  4. Health Services and Health Care Needs Fulfilled by Structured Clinical Programs for Children with Medical Complexity

    PubMed Central

    Kuo, Dennis Z.; Berry, Jay G.; Glader, Laurie; Morin, Melinda J.; Johaningsmeir, Sarah; Gordon, John

    2015-01-01

    Objective To describe family-reported health service needs of children with medical complexity, and to assess which needs are more often addressed in a tertiary care center-based structured clinical program for children with medical complexity. Study design Mailed survey to families of children with medical complexity enrolled in a structured-care program providing care coordination and oversight at one of three children’s hospitals. Outcomes included receipt of 14 specific health service needs. Paired t-tests compared unmet health care needs prior to and following program enrollment. Results 441 of 968 (46%) surveys were returned and analyzed. Respondents reported their children had a mean age of 7 (standard deviation 5) years. A majority of respondents reported the child had developmental delay (79%) and feeding difficulties (64%). Of respondents, 56% regarded the primary care provider as the primary point of contact for medical issues. Respondents reported an increase in meeting all fourteen health services needs after enrollment in a tertiary care center-based structured clinical program, including primary care checkups (82% v 96%), therapies (78% v 91%), mental health care (34% v 58%), respite care (56% v 75%), and referrals (51% v 83%) (all p<.001). Conclusions Tertiary care center-based structured clinical care programs for children with medical complexity may address and fulfill a broad range of health service needs that are not met in the primary care setting. PMID:26526361

  5. Health Services and Health Care Needs Fulfilled by Structured Clinical Programs for Children with Medical Complexity.

    PubMed

    Kuo, Dennis Z; Berry, Jay G; Glader, Laurie; Morin, Melinda J; Johaningsmeir, Sarah; Gordon, John

    2016-02-01

    To describe family-reported health service needs of children with medical complexity (CMC) and to assess which needs are more often addressed in a tertiary care center-based structured clinical program for CMC. Mailed survey to families of CMC enrolled in a structured-care program providing care coordination and oversight at 1 of 3 children's hospitals. Outcomes included receipt of 14 specific health service needs. Paired t tests compared unmet health care needs prior to and following program enrollment. Four hundred forty-one of 968 (46%) surveys were returned and analyzed. Respondents reported their children had a mean age of 7 (SD 5) years. A majority of respondents reported the child had developmental delay (79%) and feeding difficulties (64%). Of the respondents, 56% regarded the primary care provider as the primary point of contact for medical issues. Respondents reported an increase in meeting all 14 health services needs after enrollment in a tertiary care center-based structured clinical program, including primary care checkups (82% vs 96%), therapies (78% vs 91%), mental health care (34% vs 58%), respite care (56% vs 75%), and referrals (51% vs 83%) (all P < .001). Tertiary care center-based structured clinical care programs for CMC may address and fulfill a broad range of health service needs that are not met in the primary care setting. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. [Ethics in clinical practice and in health care].

    PubMed

    Pintor, S; Mennuni, G; Fontana, M; Nocchi, S; Giarrusso, P; Serio, A; Fraioli, A

    2015-01-01

    The clinical ethics is the identification, analysis and solution of moral problems that can arise during the care of a patient. Given that when dealing with ethical issues in health care some risks will be encountered (talking about ethics in general, or as a problem overlapped with others in this area, or by delegation to legislative determinations) in the text certain important aspects of the topic are examined. First of all ethics as human quality of the relationship between people for the common good, especially in health services where there are serious problems like the life and the health. It is also necessary a "humanizing relationship" between those who work in these services in order to achieve quality and efficiency in this business. It is important a proper training of health professionals, especially doctors, so that they can identify the real needs and means of intervention. It is also important that scientific research must respect fundamental ethical assumptions. In conclusion, ethics in health care is not a simple matter of "cookbook" rules, but involves the responsibility and consciousness of individual operators.

  7. Health promotion initiatives: An experience of a Well Women's Clinic

    PubMed Central

    Dudeja, Puja; Singh, Amarjeet; Jindal, A.K.

    2013-01-01

    Background Army Medical Corps provides comprehensive health care services to troops and their dependents. This approach is in consonance with the concept of Health Promoting Hospitals (HPH) initiative introduced by WHO in 1986. However, the concept is still at an infancy stage in civil health care system in India. This article describes the experiences and advantages of establishing a Well Women's Clinic (WWC) in a station of North India. Methods A system analysis approach was followed for analyzing input, process and output of the WWC during 2007–2009. Inputs included manpower and material i.e public health expert, non medical attendant and a nursing officer charts, poster, models, Television with Compact Disc (CD) player and CDs etc. Health promotion activities were conducted in the form of lectures, demonstrations, workshops, training, screening of movies, quiz, essay writing and declamation contests etc. Results Overall 385 lectures, 12 competitions, 07 training capsules were conducted. Coverage of target population was 92%. First aid training workshop trained 300 women. Six percent of the counseled women opted for tubectomy. Twelve new cases of diabetes and four new cases of hypertension were detected through screening. Seventy-two women were referred for dental treatment after a dental screening camp. Conclusion Establishment of WWC using HPH approach was quite cost effective. PMID:24623950

  8. Semantic interoperability between clinical and public health information systems for improving public health services.

    PubMed

    Lopez, Diego M; Blobel, Bernd G M E

    2007-01-01

    Improving public health services requires comprehensively integrating all services including medical, social, community, and public health ones. Therefore, developing integrated health information services has to start considering business process, rules and information semantics of involved domains. The paper proposes a business and information architecture for the specification of a future-proof national integrated system, concretely the requirements for semantic integration between public health surveillance and clinical information systems. The architecture is a semantically interoperable approach because it describes business process, rules and information semantics based on national policy documents and expressed in a standard language such us the Unified Modeling Language UML. Having the enterprise and information models formalized, semantically interoperable Health IT components/services development is supported.

  9. Terawatt Challenge for Thin-Film PV

    SciTech Connect

    Zweibel, K.

    2005-08-01

    The evolution of PV into one of the world's largest industries is not going to happen without major unforeseen problems. However, this study attempts to address the obvious ones, so that we can put aside the mythology of PV (for example, that it is only ''boutique power'' or that one must pave the world with it to be useful) and get on with changing the world's energy infrastructure. With the years of rapid market growth now under way in PV, the author is sure this will not be the last effort to understand the real potential and pitfalls of meeting the Challenge.

  10. Timing of Clinical Billing Reimbursement for a Local Health Department

    PubMed Central

    2016-01-01

    Objectives A major responsibility of a local health department (LHD) is to assure public health service availability throughout its jurisdiction. Many LHDs face expanded service needs and declining budgets, making billing for services an increasingly important strategy for sustaining public health service provision. Yet, little practice-based data exist to guide practitioners on what to expect financially, especially regarding timing of reimbursement receipt. This study provides results from one LHD on the lag from service delivery to reimbursement receipt. Methods Reimbursement records for all transactions at Maricopa County Department of Public Health immunization clinics from January 2013 through June 2014 were compiled and analyzed to determine the duration between service and reimbursement. Outcomes included daily and cumulative revenues received. Time to reimbursement for Medicaid and private payers was also compared. Results Reimbursement for immunization services was received a median of 68 days after service. Payments were sometimes taken back by payers through credit transactions that occurred a median of 333 days from service. No differences in time to reimbursement between Medicaid and private payers were found. Conclusions Billing represents an important financial opportunity for LHDs to continue to sustainably assure population health. Yet, the lag from service provision to reimbursement may complicate budgeting, especially in initial years of new billing activities. Special consideration may be necessary to establish flexibility in the budget-setting processes for services with clinical billing revenues, because funds for services delivered in one budget period may not be received in the same period. LHDs may also benefit from exploring strategies used by other delivery organizations to streamline billing processes. PMID:26957663

  11. Public Health and Hospitals: a Common Area for Clinical and Public Health Medicine.

    PubMed

    Muzzi, A; Panà, A

    2017-01-01

    Contrary to what has happened so far, hospitals should become a setting which jointly exercise Clinical and Public Health Medicine. The areas of activity that require the presence of multidisciplinary teams and can bring benefits both to the patients and to the community is briefly described.

  12. Partner change among Norwegian teenage girls attending youth health clinics.

    PubMed

    Egil Skjeldestad, Finn; Nilsen, Stine

    2008-01-01

    To examine incidence and risk factors of partner change among Norwegian teenage girls attending youth health clinics. Prospective cohort study. Setting. Study subjects were 691 girls, aged 16 to 19 years, who participated in a study on prescription of oral contraceptives at three youth health clinics in the city of Trondheim, Norway. Eligible for analysis were participants who were sexually active, and who returned for at least one follow-up visit more than 120 days after study start. All demographic and behavior data were collected through interview by public health nurses. All analyses were performed with SPSS for Windows (version 15.0) using chi-square test, survival analyses and logistic regression. New sexual male partners. Four out of five girls (80%) did not have any new partner during the study period of 12 months. From survival analyses the 12-month incidence rate were 29.8 (95% CI: 25.3-34.1) and 10.6 per 100-women months (95% CI: 7.3-13.9) for one or two or more partners, respectively. Predictors of partner change were partner change during the last six month prior study start, being single and sexual debut within three years after menarche. CONCLUSION. Being in a regular relationship with a boyfriend reduce considerably the risk of having a new sexual partner. Recent history of partner change is the strongest predictor of future partner change.

  13. Evaluation of a pharmacist-managed asthma clinic in an Indian Health Service clinic.

    PubMed

    Pett, Ryan G; Nye, Shane

    2016-01-01

    To observe whether American Indian and Alaskan Native (AI/AN) patients at the Yakama Indian Health Service seen at the pharmacist-managed asthma clinic improved asthma outcomes. Retrospective chart review, single group, preintervention and postintervention. Pharmacist-managed asthma clinic at an Indian Health Service ambulatory care clinic. Sixty-one AI/AN patients who were seen at least once in the asthma clinic from 2010 to 2014. Pharmacist-provided asthma education and medication management. Asthma-related hospitalizations and emergency department or urgent care (ED) visits. The total number of asthma-related hospitalizations and ED visits between the 12-month periods preceding and following the initial asthma clinic visit were 11 versus 2 hospitalizations (P = 0.02) and 43 versus 25 ED visits (P = 0.02), respectively. Over the same period, asthma-related oral corticosteroid use showed a nonsignificant decrease in the number of prescriptions filled (n = 59, P = 0.08). In contrast, inhaled corticosteroid prescription fills significantly increased (n = 42, P = 0.01). A reduction of asthma-related hospitalizations and ED visits were observed during the course of the intervention. Increased access to formal asthma education and appropriate asthma care benefit the Yakama AI/AN people. A controlled trial is needed to confirm that the intervention causes the intended effect. Published by Elsevier Inc.

  14. Health promotion board-ministry of health clinical practice guidelines: treating tobacco use and dependence.

    PubMed

    Chan, K; Chandler, J; Cheong, K; Giam, P E; Kanagalingam, D; Lee, L L; Leong, L L; Ng, Y; Oh, C; Shi, M; Tan, A S L; Tan, C M; Tan, T L; Utravathy, V

    2013-07-01

    The Health Promotion Board (HPB) has updated the clinical practice guidelines on Treating Tobacco Use and Dependence to provide health professionals in Singapore with evidence-based interventions for smoking cessation. This article reproduces the introduction and executive summary of key guideline recommendations (with recommendations from the guidelines) from the HPB-MOH Clinical Practice Guidelines on Treating Tobacco Use and Dependence, for the information of SMJ readers. Chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Health Promotion Board website: http://www.hpb.gov.sg/cpg-smoking-cessation. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.

  15. Promoting oral health practice among patients with diabetes attending primary health care clinics

    PubMed Central

    Aljaber, Abeer; Al-Surimi, Khaled

    2015-01-01

    The oral public health program for patients with diabetes was initiated by Saudi Arabia Ministry of Health (MoH) based on international quality standard to control the severity of oral disease in patients with diabetes through improving the accessibility of patients to dental clinics in primary health care centers (PHCC). This program intends to deliver oral health care (OHC) for each patient with diabetes at least one visit every six months. However, we found that more than 90% of patients with diabetes that visited prince Mohammed bin Saud PHCC in Riyadh do not get their regular dental check up every six months. We developed a quality improvement project (QIP) using the quality improvement model to activate MoH oral health program for patients with diabetes visiting prince Mohamed bin Saud PHCC. The aim of our QIP was to increase number of patients with diabetes receiving their regular oral health check up during the PHC visit. The quality team tested two simple improvement ideas. The first idea was having the dentist signature on appointment request. The testing of the first idea led to the second idea, that both physician and dentist should sign the referral form. After running several PDSA cycles to test these interventions ideas, we found the number of patients with diabetes seen in dental clinic had increased dramatically compared with the baseline assessment. We conclude that the idea of signing the referral form by both physician and dentist is a practical and simple strategy to be executed and has a direct impact on the patient clinical flow between clinics. PMID:26734427

  16. A new flexible a-Si PV module and its application to rooftop PV systems

    SciTech Connect

    Ichikawa, Yukimi; Ihara, Takuro; Hama, Toshio

    1994-12-31

    A novel photovoltaic (PV) module for roof top systems, solar roofing, was proposed. Solar roofing is a flexible amorphous silicon (a-Si) PV sheet having the function of roofing. Tempered glass is used as roof covering material. Technical items for roof top systems using solar roofing were discussed. Preliminary studies on module component materials showed feasibility of solar roofing. The authors designed a construction technology for tempered glass covered roofs. Effects of shadows on PV module upon its performance were also analyzed.

  17. Health technology assessment in Australia: a role for clinical registries?

    PubMed

    Scott, Anna Mae

    2016-03-31

    Objective Health technology assessment (HTA) is a process of assessing evidence to inform policy decisions about public subsidy of new drugs and medical procedures. Where evidence is uncertain but the technology itself is promising, funders may recommend funding on an interim basis. It is unknown whether evidence from clinical registries is used to resolve uncertainties identified in interim-funded decisions made by Australian HTA bodies. Therefore, the present study evaluated the role of evidence from clinical registries in resolving evidence uncertainties identified by the Medical Services Advisory Committee (MSAC).Methods All HTAs considered by MSAC between 1998 and 2015 were reviewed and assessments that recommended interim funding were identified. The MSAC website was searched to identify reassessments of these recommendations and sources of evidence used to resolve the uncertainties were identified.Results Of 173 HTA reports considered by MSAC, 17 (10%) contained an interim funding recommendation. Eight recommendations cited uncertainty around safety, 15 cited uncertainty around clinical effectiveness and 13 cited uncertainty around economics (cost-effectiveness and/or budget impact). Of the 17 interim funding recommendations, 11 (65%) have been reassessed. Only two reassessments relied on clinical registry evidence to resolve evidence gaps identified at the time of the interim funding recommendation.Conclusions Clinical registries are underused as a source of evidence for resolving uncertainties around promising new health technologies in Australia. An open dialogue between stakeholders on the role of registries in this context is needed.What is known about the topic? HTA is a process of assessing the evidence to inform policy decisions about public subsidy of new health technologies (e.g. pharmaceuticals, diagnostic tests, medical procedures). Where evidence is uncertain but the technology under evaluation is promising, funders may recommend the funding of

  18. [The auditing of the clinical histories of a health center].

    PubMed

    Corral Gómez, F J; Arrojo López, I; Gallego Valdeiglesias, A; Martínez Barredo, J M; Meilán Pérez, A; Míguez Gallego, M; Machín Fernández, A J

    1993-09-15

    To assess how fully clinical records (CR) at a health centre are filled in, using quality control techniques. Retrospective, descriptive study. SITE. The "Sagrado Corazón" (Lugo) Health team, made up of 6 General practitioners, 7 nursing staff (ATS-DUE) and 1 paediatrician. A systematic sample of 400 adult CR. The data card and follow-up sections were correct in over 90% of CR. Weight and height were correct in 25.75%. The composite indicator showed that 32.25% of CR were correct. Results were better for CR of users over 44. The differences were significant for: personal case histories, Arterial Pressure, allergies, weight and height and composite indicator. The lack and bad distribution of nursing offices and weighing-scales could explain the results of the height and weight sections. The CR is not just a document store. However it must be improved.

  19. Aggregate/community-centered undergraduate community health nursing clinical experience.

    PubMed

    Flick, L H; Reese, C; Harris, A

    1996-02-01

    Debate continues about the appropriateness of clinical experiences targeting aggregates in undergraduate community health nursing education. This paper describes a practical model to teach, through experience, the concepts of aggregate/community-centered practice at the baccalaureate level. As a voluntary alternative to the usual community assessment paper, groups of students worked in partnership with community groups to define health needs and to address one need. Sequential student groups focused the assessment and implemented a plan. The required time for each project varied. One project is described to illustrate the model. While independent community-centered practice is not expected of the B.S.N. graduate, the model described here develops comprehension of the concepts and process of such practice.

  20. Sleep Health Issues for Children with FASD: Clinical Considerations

    PubMed Central

    Jan, James E.; Asante, Kwadwo O.; Conry, Julianne L.; Fast, Diane K.; Bax, Martin C. O.; Ipsiroglu, Osman S.; Bredberg, Elizabeth; Loock, Christine A.; Wasdell, Michael B.

    2010-01-01

    This article describes the combined clinical experience of a multidisciplinary group of professionals on the sleep disturbances of children with fetal alcohol spectrum disorders (FASD) focusing on sleep hygiene interventions. Such practical and comprehensive information is not available in the literature. Severe, persistent sleep difficulties are frequently associated with this condition but few health professionals are familiar with both FASD and sleep disorders. The sleep promotion techniques used for typical children are less suitable for children with FASD who need individually designed interventions. The types, causes, and adverse effects of sleep disorders, the modification of environment, scheduling and preparation for sleep, and sleep health for their caregivers are discussed. It is our hope that parents and also researchers, who are interested in the sleep disorders of children with FASD, will benefit from this presentation and that this discussion will stimulate much needed evidence-based research. PMID:20706655

  1. Alzheimer's Disease Clinical and Research Update for Health Care Practitioners

    PubMed Central

    DeFina, Philip A.; Lichtenstein, Jonathan D.; Fellus, Jonathan

    2013-01-01

    Of the approximately 6.8 million Americans who have been diagnosed with dementia, over 5 million have been diagnosed with Alzheimer's Disease (AD). Due to the rise in the aging population, these figures are expected to double by 2050. The following paper provides an up-to-date review of clinical issues and relevant research. Research related to the methods of the earliest possible detection of AD is ongoing. Health care professionals should play a critical role in differentially diagnosing AD patients, as well as supporting their families. Novel interventions, including medications, natural supplements, and behavioral techniques, are constantly appearing in the literature. It is necessary for the health practitioner to remain current, regarding AD, as such information will facilitate better care for patients and their families. PMID:24083026

  2. The Fountain of Health: Bringing Seniors’ Mental Health Promotion into Clinical Practice

    PubMed Central

    Thoo, Vanessa; Freer, Janya; Cassidy, Keri-Leigh

    2015-01-01

    Background The Fountain of Health (FoH) initiative offers valuable evidence-based mental health knowledge and provides clinicians with evaluated tools for translating knowledge into practice, in order to reduce seniors’ risks of mental disorders, including dementia. Methods A presentation on mental health promotion and educational materials were disseminated to mental health clinicians including physicians and other allied health professionals either in-person or via tele-education through a provincial seniors’ mental health network. Measures included: 1) a tele-education quality evaluation form, 2) a knowledge transfer questionnaire, 3) a knowledge translation-to-practice evaluation tool, and 4) a quality assurance questionnaire. Results A total of 74 mental health clinicians received the FoH education session. There was a highly significant (p < .0001) difference in clinicians’ knowledge transfer questionnaire scores pre- and post-educational session. At a two-month follow-up, 19 (25.7%) participants completed a quality assurance questionnaire, with all 19 (100%) of respondents stating they would positively recommend the FoH information to colleagues and patients. Eleven (20.4%) translation-to-practice forms were also collected at this interval, tracking clinician use of the educational materials. Conclusions The use of a formalized network for knowledge transfer allows for education and evaluation of health-care practitioners in both acquisition of practical knowledge and subsequent clinical behavior change. PMID:26740830

  3. Rating PV Power and Energy: Cell, Module, and System Measurements

    SciTech Connect

    Emery, Keith

    2016-06-02

    A summary of key points related to research-level measurements of current vs. voltage measurement theory including basic PV operation, equivalent circuit, and concept of spectral error; PV power performance including PV irradiance sensors, simulators and commercial and generic I-V systems; PV measurement artifacts, intercomparisons, and alternative rating methods.

  4. PV Module Reliability Research (Fact Sheet)

    SciTech Connect

    Not Available

    2013-06-01

    This National Center for Photovoltaics sheet describes the capabilities of its PV module reliability research. The scope and core competencies and capabilities are discussed and recent publications are listed.

  5. Distributed PV Adoption in Maine Through 2021

    SciTech Connect

    Gagnon, Pieter; Sigrin, Ben

    2015-11-06

    NREL has used its dSolar (distributed solar) model to generate low-medium-high estimates of distributed PV adoption in Maine through 2021. This presentation gives a high-level overview of the model and modeling results.

  6. Global Health and Emergency Care: Defining Clinical Research Priorities.

    PubMed

    Hansoti, Bhakti; Aluisio, Adam R; Barry, Meagan A; Davey, Kevin; Lentz, Brian A; Modi, Payal; Newberry, Jennifer A; Patel, Melissa H; Smith, Tricia A; Vinograd, Alexandra M; Levine, Adam C

    2017-06-01

    Despite recent strides in the development of global emergency medicine (EM), the field continues to lag in applying a scientific approach to identifying critical knowledge gaps and advancing evidence-based solutions to clinical and public health problems seen in emergency departments (EDs) worldwide. Here, progress on the global EM research agenda created at the 2013 Academic Emergency Medicine Global Health and Emergency Care Consensus Conference is evaluated and critical areas for future development in emergency care research internationally are identified. A retrospective review of all studies compiled in the Global Emergency Medicine Literature Review (GEMLR) database from 2013 through 2015 was conducted. Articles were categorized and analyzed using descriptive quantitative measures and structured data matrices. The Global Emergency Medicine Think Tank Clinical Research Working Group at the Society for Academic Emergency Medicine 2016 Annual Meeting then further conceptualized and defined global EM research priorities utilizing consensus-based decision making. Research trends in global EM research published between 2013 and 2015 show a predominance of observational studies relative to interventional or descriptive studies, with the majority of research conducted in the inpatient setting in comparison to the ED or prehospital setting. Studies on communicable diseases and injury were the most prevalent, with a relative dearth of research on chronic noncommunicable diseases. The Global Emergency Medicine Think Tank Clinical Research Working Group identified conceptual frameworks to define high-impact research priorities, including the traditional approach of using global burden of disease to define priorities and the impact of EM on individual clinical care and public health opportunities. EM research is also described through a population lens approach, including gender, pediatrics, and migrant and refugee health. Despite recent strides in global EM research and

  7. Clinical Benefits of Electronic Health Record Use: National Findings

    PubMed Central

    King, Jennifer; Patel, Vaishali; Jamoom, Eric W; Furukawa, Michael F

    2014-01-01

    Objective To assess whether physicians’ reported electronic health record (EHR) use provides clinical benefits and whether benefits depend on using an EHR meeting Meaningful Use criteria or length of EHR experience. Data Source The 2011 Physician Workflow study, representative of U.S. office-based physicians. Study Design Cross-sectional data were used to examine the association of EHR use with enhanced patient care overall and nine specific clinical benefits. Principal Findings Most physicians with EHRs reported EHR use enhanced patient care overall (78 percent), helped them access a patient’s chart remotely (81 percent), and alerted them to a potential medication error (65 percent) and critical lab values (62 percent). Between 30 and 50 percent of physicians reported that EHR use was associated with clinical benefits related to providing recommended care, ordering appropriate tests, and facilitating patient communication. Using EHRs that met Meaningful Use criteria and having 2 or more years of EHR experience were independently associated with reported benefits. Physicians with EHRs meeting Meaningful Use criteria and longer EHR experience were most likely to report benefits across all 10 measures. Conclusions Physicians reported EHR use enhanced patient care overall. Clinical benefits were most likely to be reported by physicians using EHRs meeting Meaningful Use criteria and longer EHR experience. PMID:24359580

  8. Community health equipment loans: developing a clinical prioritization system.

    PubMed

    Oldman, Crystal; Brodie, David; Nmatsakanova, Naira

    2003-06-01

    This project aimed to develop an objective method for making equipment loans to home-based patients using a prioritisation system based on clinical need. An action research approach was selected as the most appropriate method because of the collaborative nature of the project. It involved working mainly with community nurses using questionnaires, focus groups, telephone and direct interviews. An important part of the process was a workshop with all stakeholders to involve them in decision-making. The resulting unique clinical referral form was implemented successfully. The research also highlighted existing attitudes and perceptions of the equipment loans service among health professionals. The new clinical referral form has improved service provision, is more equitable and now allows decisions to be made using agreed clinical criteria. The results of the research have been disseminated locally in the process of integration of NHS and social services equipment loans. This is a unique example of collaboration between community nursing practitioners, primary care trust managers and researchers producing a measurable difference to patient care.

  9. PV System Energy Evaluation Method (Presentation)

    SciTech Connect

    Kurtz, S.

    2014-01-01

    This presentation describes a comparison of the "predicted" energy (based on historical weather data) with the "expected" energy (based on the measured weather data) to determine whether a PV system is performing as modeled in order to verify the accuracy of a model. A key factor in defining this energy test is determining the test boundary so that weather variations are not inadvertently included in what is considered to be PV system performance.

  10. The 374 clinic: an outreach sexual health clinic for young men

    PubMed Central

    Lewis, D; McDonald, A; Thompson, G; Bingham, J

    2004-01-01

    Objectives: To describe the establishment of a community based walk-in outreach genitourinary medicine clinic, the "374 clinic," in south London to target young men under 25 in an area with high rates of sexually transmitted infections (STIs). Methods: The outreach clinic was set up within a Brook advisory centre, which already had gained the trust of local young people. Epidemiological, clinical, and laboratory data were obtained retrospectively for the first 24 weeks of the service. Results: 134 attendances were recorded, including 94 new and 10 rebook events. The age range of the young men seen was 12–27 years (mean 18.2 years), the patients were mainly from black and ethnic minority groups, and all but one were heterosexual. Most men had heard about the clinic by "word of mouth," recommendation by Brook staff or through clinic promotional material. Condoms were used more frequently with non-regular sexual partners than with regular partners. The uptake of screening for gonococcal and chlamydial infections, mostly by urine based molecular techniques, was 98%. The uptake for HIV testing in men aged 16 or more was 72%. An overall STI prevalence rate of 26% was detected in the clinic population, which consisted almost equally of asymptomatic and symptomatic patients. The most prevalent STI was chlamydial infection (12%). Conclusions: The young men who attended the outreach clinic were happy to undergo both non-invasive urine based testing for gonorrhoea and chlamydia as well as phlebotomy to test for HIV and syphilis. The 374 clinic approach may prove to be a useful model for further outreach services to combat poor sexual health of young men in inner city areas. PMID:15572619

  11. Clinical Evaluation: Theory and Practice in the Health Occupations. Health Occupations Clinical Teacher Education Series for Secondary and Post-Secondary Educators.

    ERIC Educational Resources Information Center

    Shea, Mary Lou; And Others

    This learning module, which is part of a staff development program for health occupations clinical instructors, discusses the process of clinical evaluation. It includes learning activities dealing with the concept of clinical evaluation, evaluation terminology, problems in and legal aspects of clinical evaluation, and approaches to and techniques…

  12. "Roadblocks, Stop Signs": Health Literacy, Education and Communication at a Free Medical Clinic

    ERIC Educational Resources Information Center

    Huntington, Sally J.

    2012-01-01

    This qualitative study, which takes place in a free medical clinic for low-income and uninsured patients, addresses the patients' health literacy and access to health information inside and outside of the clinic setting, as well as the strategies clinic providers use to effectively communicate health information. This study is based on participant…

  13. "Roadblocks, Stop Signs": Health Literacy, Education and Communication at a Free Medical Clinic

    ERIC Educational Resources Information Center

    Huntington, Sally J.

    2012-01-01

    This qualitative study, which takes place in a free medical clinic for low-income and uninsured patients, addresses the patients' health literacy and access to health information inside and outside of the clinic setting, as well as the strategies clinic providers use to effectively communicate health information. This study is based on participant…

  14. 42 CFR 447.371 - Services furnished by rural health clinics.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... other ambulatory services and rural health clinic services at a single rate per visit that is based on... visit that is based on the cost of dental services furnished by the clinic. The rate must be determined... 42 Public Health 4 2010-10-01 2010-10-01 false Services furnished by rural health clinics....

  15. Updating Technical Screens for PV Interconnection: Preprint

    SciTech Connect

    Coddington, M.; Ellis, A.; Lynn, K.; Razon, A.; Key, T.; Kroposki, B.; Mather, B.; Hill, R.; Nicole, K.; Smith, J.

    2012-08-01

    Solar photovoltaics (PV) is the dominant type of distributed generation (DG) technology interconnected to electric distribution systems in the United States, and deployment of PV systems continues to increase rapidly. Considering the rapid growth and widespread deployment of PV systems in United States electric distribution grids, it is important that interconnection procedures be as streamlined as possible to avoid unnecessary interconnection studies, costs, and delays. Because many PV interconnection applications involve high penetration scenarios, the process needs to allow for a sufficiently rigorous technical evaluation to identify and address possible system impacts. Existing interconnection procedures are designed to balance the need for efficiency and technical rigor for all DG. However, there is an implicit expectation that those procedures will be updated over time in order to remain relevant with respect to evolving standards, technology, and practical experience. Modifications to interconnection screens and procedures must focus on maintaining or improving safety and reliability, as well as accurately allocating costs and improving expediency of the interconnection process. This paper evaluates the origins and usefulness of the capacity penetration screen, offers potential short-term solutions which could effectively allow fast-track interconnection to many PV system applications, and considers longer-term solutions for increasing PV deployment levels in a safe and reliable manner while reducing or eliminating the emphasis on the penetration screen.

  16. Trends in rural health Clinics and needs during U.S. health care reform.

    PubMed

    Ortiz, Judith; Meemon, Natthani; Zhou, Yue; Wan, Thomas T H

    2013-10-01

    Rural Health Clinics (RHCs) are primary care clinics certified through Medicare and Medicaid to provide health care to the medically underserved in rural areas of the United States. The purpose of this paper is to describe how the characteristics of RHCs have either changed or remained stable over a 10-year period in the past: from the late 1990s to 2007. In addition, it is also to describe some of the outstanding needs of RHCs as they navigate the transitions of U.S. health care reform. Using a panel of RHCs continuously in existence from 2006 through 2007, we calculated and compared statistics with corresponding statistics from the literature. We described the geographic distribution of RHCs, demographics of their counties of location, and characteristics of RHC structure and staffing. We also explored the implications of the recently enacted health reform law (the Patient Protection and Affordable Care Act or ACA) for RHCs, and the improvements that RHCs need as it is implemented. By the end of the study period, the highest percentages of RHCs were in the South and Midwest, the percentage of RHCs in the West had grown, and that in the South had declined. RHCs served counties with increasing proportions of individuals below poverty and Hispanics/Latinos. The percentage of independent clinics had grown, as had the percentage of for profit clinics. Finally, the percentage of nurse practitioner full-time equivalents had grown as a proportion of the total for three providers. In investigating the performance of RHCs, many managerial and operational factors are not well understood. It is imperative that RHCs gather the information that could help them maximize the elements of their performance that would keep them financially stable. In addition, a broader awareness of the unique challenges that RHCs face in this era of health care reform is needed.

  17. TRENDS IN RURAL HEALTH CLINICS AND NEEDS DURING U.S. HEALTH CARE REFORM

    PubMed Central

    Ortiz, Judith; Meemon, Natthani; Zhou, Yue; Wan, Thomas T.H.

    2013-01-01

    Aim Rural Health Clinics (RHCs) are primary care clinics certified through Medicare and Medicaid to provide health care to the medically underserved in rural areas of the United States. The purpose of this paper is to describe how the characteristics of RHCs have either changed or remained stable over a 10-year period in the past: from the late 1990s to 2007. In addition, it is also to describe some of the outstanding needs of RHCs as they navigate the transitions of U.S. health care reform. Methods Using a panel of RHCs continuously in existence from 2006 through 2007, we calculated and compared statistics with corresponding statistics from the literature. We describe the geographic distribution of RHCs, demographics of their counties of location, and characteristics of RHC structure and staffing. We also explore the implications of the recently enacted health reform law (the Patient Protection and Affordable Care Act or ACA) for RHCs, and the improvements that RHCs need as it is implemented. Findings By the end of the study period the highest percentages of RHCs were in the South and Midwest, the percentage of RHCs in the West had grown, and that in the South had declined. RHCs served counties with increasing proportions of individuals below poverty and Hispanics/Latinos. The percentage of independent clinics had grown, as had the percentage of for-profit clinics. Finally, the percentage of nurse practitioner full-time equivalents had grown as a proportion of the total for three providers. Conclusions In investigating the performance of RHCs, many managerial and operational factors are not well understood. It is imperative that RHCs gather the information that could help them maximize the elements of their performance that would keep them financially stable. In addition, a broader awareness of the unique challenges that RHCs face in this era of health care reform is needed. PMID:23092581

  18. Acceptability of health information technology aimed at environmental health education in a prenatal clinic.

    PubMed

    Rosas, Lisa G; Trujillo, Celina; Camacho, Jose; Madrigal, Daniel; Bradman, Asa; Eskenazi, Brenda

    2014-11-01

    To describe the acceptability of an interactive computer kiosk that provides environmental health education to low-income Latina prenatal patients. A mixed-methods approach was used to assess the acceptability of the Prenatal Environmental Health Kiosk pregnant Latina women in Salinas, CA (n=152). The kiosk is a low literacy, interactive touch-screen computer program with an audio component and includes graphics and an interactive game. The majority had never used a kiosk before. Over 90% of women reported that they learned something new while using the kiosk. Prior to using the kiosk, 22% of women reported their preference of receiving health education from a kiosk over a pamphlet or video compared with 57% after using the kiosk (p<0.01). Qualitative data revealed: (1) benefit of exposure to computer use; (2) reinforcing strategy of health education; and (3) popularity of the interactive game. The Prenatal Environmental Health Kiosk is an innovative patient health education modality that was shown to be acceptable among a population of low-income Latino pregnant women in a prenatal care clinic. This pilot study demonstrated that a health education kiosk was an acceptable strategy for providing Latina prenatal patients with information on pertinent environmental exposures. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  19. Acceptability of health information technology aimed at environmental health education in a prenatal clinic

    PubMed Central

    Rosas, Lisa G; Trujillo, Celina; Camacho, Jose; Madrigal, Daniel; Bradman, Asa; Eskenazi, Brenda

    2014-01-01

    Objective To describe the acceptability of an interactive computer kiosk that provides environmental health education to low-income Latina prenatal patients. Methods A mixed-methods approach was used to assess the acceptability of the Prenatal Environmental Health Kiosk pregnant Latina women in Salinas, CA (n=152). The kiosk is a low literacy, interactive touch-screen computer program with an audio component and includes graphics and an interactive game. Results The majority had never used a kiosk before. Over 90% of women reported that they learned something new while using the kiosk. Prior to using the kiosk, 22% of women reported their preference of receiving health education from a kiosk over a pamphlet or video compared with 57% after using the kiosk (p<0.01). Qualitative data revealed: 1) benefit of exposure to computer use; 2) reinforcing strategy of health education; and 3) popularity of the interactive game. Conclusion The Prenatal Environmental Health Kiosk is an innovative patient health education modality that was shown to be acceptable among a population of low-income Latino pregnant women in a prenatal care clinic. Practice Implications This pilot study demonstrated that a health education kiosk was an acceptable strategy for providing Latina prenatal patients with information on pertinent environmental exposures. PMID:25085548

  20. Diet and Sleep Physiology: Public Health and Clinical Implications.

    PubMed

    Frank, Sarah; Gonzalez, Kelli; Lee-Ang, Lorraine; Young, Marielle C; Tamez, Martha; Mattei, Josiemer

    2017-01-01

    This mini-review examines the complex relationship between diet and sleep and explores the clinical and public health implications of the current evidence. Dietary quality and intake of specific nutrients can impact regulatory hormonal pathways to alter sleep quantity and quality. Sleep, in turn, affects the intake of total energy, as well as of specific foods and nutrients, through biological and behavioral mechanisms. Initial research in this field focused primarily on the effects of short sleep duration on nutritional quality. However, more recent studies have explored the dynamic relationship between long sleep duration and diet. Current evidence suggests that extremes of sleep duration alter sleep patterns, hormonal levels, and circadian rhythms, which contribute to weight-related outcomes and obesity, and other risk factors for the development of chronic disease such as type 2 diabetes and cardiovascular disease. These patterns may begin as early as childhood and have impacts throughout the life course. Given that non-communicable diseases are among the leading causes of death globally, deeper understanding of the interactions between sleep and nutrition has implications for both public health and clinical practice.

  1. Characterizing Implicit Mental Health Associations across Clinical Domains

    PubMed Central

    Werntz, Alexandra J.; Steinman, Shari A.; Glenn, Jeffrey J.; Nock, Matthew K.; Teachman, Bethany A.

    2016-01-01

    Background and objectives Implicit associations are relatively uncontrollable associations between concepts in memory. The current investigation focuses on implicit associations in four mental health domains (alcohol use, anxiety, depression, and eating disorders) and how these implicit associations: a) relate to explicit associations and b) self-reported clinical symptoms within the same domains, and c) vary based on demographic characteristics (age, gender, race, ethnicity, and education). Methods Participants (volunteers over age 18 to a research website) completed implicit association (Implicit Association Tests), explicit association (self+psychopathology or attitudes toward food, using semantic differential items), and symptom measures at the Project Implicit Mental Health website tied to: alcohol use (N=12,387), anxiety (N=21,304), depression (N=24,126), or eating disorders (N=10,115). Results Within each domain, implicit associations showed small to moderate associations with explicit associations and symptoms, and predicted self-reported symptoms beyond explicit associations. In general, implicit association strength varied little by race and ethnicity, but showed small ties to age, gender, and education. Limitations This research was conducted on a public research and education website, where participants could take more than one of the studies. Conclusions Among a large and diverse sample, implicit associations in the four domains are congruent with explicit associations and self-reported symptoms, and also add to our prediction of self-reported symptoms over and above explicit associations, pointing to the potential future clinical utility and validity of using implicit association measures with diverse populations. PMID:26962979

  2. Clinical supervision for allied health professionals: a systematic review.

    PubMed

    Dawson, Margaret; Phillips, Bev; Leggat, Sandy

    2013-01-01

    It is recommended that allied health professionals (AHPs) participate in regular clinical supervision (CS). However, AHP understanding of CS processes and outcomes is unclear. This systematic review reports the evidence for CS for AHPs and other health professionals. Five databases and reference lists of included articles were searched. Papers included described CS definitions, processes and outcomes of CS. Due to the paucity of CS research for AHPs, nursing and medical disciplines were included. Two reviewers critically appraised the 33 included papers. The majority of papers were exploratory. Definitions and processes for CS were not clearly identified. Outcomes of CS included the relationships between CS and job satisfaction and workplace stress. Proctor's model and the Manchester Clinical Supervision Scale were the most common framework and evaluation approach. Contradictory positions of which components of Proctor's model should be included in CS were reported. Methodological flaws and a lack of comparative studies were common. Although not extensively supported by evidence, CS was generally held to be a positive experience and tends to be provided without a clear definition or model, using new or untested tools. Further research to evaluate CS for AHPs, is needed.

  3. Introduction to the special issue on advances in clinical and health-care knowledge management.

    PubMed

    Bali, Rajeev K; Feng, David Dagan; Burstein, Frada; Dwivedi, Ashish N

    2005-06-01

    Clinical and health-care knowledge management (KM) as a discipline has attracted increasing worldwide attention in recent years. The approach encompasses a plethora of interrelated themes including aspects of clinical informatics, clinical governance, artificial intelligence, privacy and security, data mining, genomic mining, information management, and organizational behavior. This paper introduces key manuscripts which detail health-care and clinical KM cases and applications.

  4. Ultrastructural and sequence characterization of Penaeus vannamei nodavirus (PvNV) from Belize.

    PubMed

    Tang, Kathy F J; Pantoja, Carlos R; Redman, Rita M; Navarro, Solangel A; Lightner, Donald V

    2011-05-09

    The Penaeus vannamei nodavirus (PvNV), which causes muscle necrosis in Penaeus vannamei from Belize, was identified in 2005. Infected shrimp show clinical signs of white, opaque lesions in the tail muscle. Under transmission electron microscopy, the infected cells exhibit increases in various organelles, including mitochondria, Golgi stacks, and rough endoplasmic reticulum. Cytoplasmic inclusions containing para-crystalline arrays of virions were visualized. The viral particle is spherical in shape and 19 to 27 nm in diameter. A cDNA library was constructed from total RNA extracted from infected shrimp. Through nucleotide sequencing from the cDNA clones and northern blot hybridization, the PvNV genome was shown to consist of 2 segments: RNA1 (3111 bp) and RNA2 (1183 bp). RNA1 contains 2 overlapped open reading frames (ORF A and B), which may encode a RNA-dependent RNA polymerase (RdRp) and a B2 protein, respectively. RNA2 contains a single ORF that may encode the viral capsid protein. Sequence analyses showed the presence of 4 RdRp characteristic motifs and 2 conserved domains (RNA-binding B2 protein and viral coat protein) in the PvNV genome. Phylogenetic analysis based on the translated amino acid sequence of the RdRp reveals that PvNV is a member of the genus Alphanodavirus and closely related to Macrobrachium rosenbergii nodavirus (MrNV). In a study investigating potential PvNV vectors, we monitored the presence of PvNV by RT-PCR in seabird feces and various aquatic organisms collected around a shrimp farm in Belize. PvNV was detected in mosquitofish, seabird feces, barnacles, and zooplankton, suggesting that PvNV can be spread via these carriers.

  5. Clinical guideline implementation strategies for common mental health disorders.

    PubMed

    Moreno, Eliana María; Moriana, Juan Antonio

    2016-01-01

    There has been a considerable proliferation of clinical guidelines recently, but their practical application is low, and organisations do not always implement their own ones. The aim of this study is to analyse and describe key elements of strategies and resources designed by the National Institute for Health and Care Excellence for the implementation of guidelines for common mental health disorders in adults, which are some of the most prevalent worldwide. A systematic review was performed following PRISMA model. Resources, tools and implementation materials where included and categorised considering type, objectives, target and scope. A total of 212 elements were analysed, of which 33.5 and 24.5% are related to the implementation of generalized anxiety and depression guidelines, respectively. Applied tools designed to estimate costs and assess the feasibility of the setting up at local level are the most frequent type of resource. The study highlights the important variety of available materials, classified into 3 main strategies: tools targeting the professionals (30.6%), structural (26.4%), and organizational (24%). Developing guidelines is not enough; it is also necessary to promote their implementation in order to encourage their application. The resources and strategies described in this study may be potentially applicable to other contexts, and helpful to public health managers and professionals in the design of programmes and in the process of informed decision making to help increase access to efficient treatments. Copyright © 2015. Published by Elsevier España.

  6. After the clinic? Researching sexual health technology in context.

    PubMed

    Davis, Mark

    2015-01-01

    There is great interest in what testing, pharmaceutical, information and social media technology can do for sexual health. Much programmatic and research activity is focused on assessing how these technologies can be used to best effect. Less obvious are analyses that place technology into historical, political and real-world settings. Developing an 'in-context' analysis of sexual health technology, this paper draws on interviews with leading community advocates, researchers and clinicians in Australia, Canada and the UK and looks across examples, including social media, rapid HIV testing, pre-Exposure Prophylaxis for HIV and polymerase chain reaction Chlamydia testing. The analysis is framed by studies of techno-society and the dialectics of sex-affirmative advocacy with biomedical authority and attends to: the rationalistic and affective dimensions of the imaginary associated with technology; the role of technology in the re-spatialisation and re-temporalisation of the sexual health clinic; and the re-invention of technology in its real-world contexts. This in-context approach is important for: the effective implementation of new technology; strengthening the social science contribution to the field; and enriching social theory in general on life in techno-societies.

  7. Process quality indicators for general clinical occupational health practice.

    PubMed

    Baker, A; Madan, I

    2013-03-01

    The development and use of occupational health (OH) clinical process quality indicators are an essential component of a quality improvement programme in OH practice. To develop generic quality indicators (QI) in order to improve the quality of OH practice in rehabilitating sick-listed individuals back to work. A systematic search of literature on relevant governmental and academic websites was undertaken. Studies were analysed for evidence of interventions that led to a reduction of incidence or duration of sickness absence, or return-to-work rates. The studies were categorized thematically and reviewed by a small expert group who produced four draft QI. The draft QI were piloted in six OH departments to determine whether the indicators were clear, whether the data were feasible to collect and whether any changes to the indicators were recommended. 1605 reports or papers were retrieved and six met the criteria for inclusion as evidence for the development of QI. Four QI were developed based on temporary modification for work for those off sick for >4 weeks; timeliness of appointment and advice to manager; high level of patient satisfaction and the production of informative reports. The pilot indicated that the QI were feasible to use in practice and easy to implement in a busy OH clinical environment. Four QI have been developed for use in general OH practice. The pilot study demonstrated that the indicators are both feasible to use and easy to implement by clinical OH departments.

  8. Learning Style of Undergraduate Allied Health Students: clinical versus classroom.

    PubMed

    Cox, Lisa; Clutter, Jill; Sergakis, Georgianna; Harris, Laura

    2013-01-01

    Recognizing and valuing the diversity of student learning and learning styles allow educators to construct more effective and efficient teaching methods and create mutually beneficial learning environments. Kolb(s Learning Style Inventories (LSI) were administered to 82 seniors enrolled in a School of Allied Health at a large midwestern university. The students completed LSI in relation to both their didactic and clinical coursework. Sets of instruments were matched and evaluated using descriptive statistics. Overall, in the didactic classroom setting, 24.2% (n=16) of the students were divergers, 28.8% (n=19) were accommodators, 19.4% (n=13) were convergers, and 27.3% (n=18) were assimilators. In the clinical settings, 27.8% (n=20) of the students were divergers, 36.1% (n=26) were accommodators, 23.6% (n=17) were convergers, and only 12.5% (n=9) were assimilators. Learning style did change for 66.7% (n=10) of athletic training majors. Over half of the students in medical dietetics, radiological sciences, and respiratory therapy LSIs did not change from classroom to clinical. The diverse nature of the students' preferences reinforces the need for various teaching strategies. Both the students and the educators need to work cooperatively to maximize the balance of the learning environment and make meaning of the educational experience.

  9. Subgroup analyses of clinical effectiveness to support health technology assessments.

    PubMed

    Paget, Marie-Ange; Chuang-Stein, Christy; Fletcher, Christine; Reid, Carol

    2011-01-01

    Subgroup analysis is an integral part of access and reimbursement dossiers, in particular health technology assessment (HTA), and their HTA recommendations are often limited to subpopulations. HTA recommendations for subpopulations are not always clear and without controversies. In this paper, we review several HTA guidelines regarding subgroup analyses. We describe good statistical principles for subgroup analyses of clinical effectiveness to support HTAs and include case examples where HTA recommendations were given to subpopulations only. Unlike regulatory submissions, pharmaceutical statisticians in most companies have had limited involvement in the planning, design and preparation of HTA/payers submissions. We hope to change this by highlighting how pharmaceutical statisticians should contribute to payers' submissions. This includes early engagement in reimbursement strategy discussions to influence the design, analysis and interpretation of phase III randomized clinical trials as well as meta-analyses/network meta-analyses. The focus on this paper is on subgroup analyses relating to clinical effectiveness as we believe this is the first key step of statistical involvement and influence in the preparation of HTA and reimbursement submissions.

  10. A rule-based clinical decision model to support interpretation of multiple data in health examinations.

    PubMed

    Kuo, Kuan-Liang; Fuh, Chiou-Shann

    2011-12-01

    Health examinations can obtain relatively complete health information and thus are important for the personal and public health management. For clinicians, one of the most important works in the health examinations is to interpret the health examination results. Continuously interpreting numerous health examination results of healthcare receivers is tedious and error-prone. This paper proposes a clinical decision support system to assist solving above problems. In order to customize the clinical decision support system intuitively and flexibly, this paper also proposes the rule syntax to implement computer-interpretable logic for health examinations. It is our purpose in this paper to describe the methodology of the proposed clinical decision support system. The evaluation was performed by the implementation and execution of decision rules on health examination results and a survey on clinical decision support system users. It reveals the efficiency and user satisfaction of proposed clinical decision support system. Positive impact of clinical data interpretation is also noted.

  11. Health-related quality of life in clinical practice.

    PubMed

    1999-12-01

    This month's question addressed something that many of us perhaps still have not formally incorporated into clinical practice, although we all are interested in our patients' health-related quality of life and want our inventions to result in improvements within this area. This view is exemplified by the response from Australia, which is one of several similar, unpublished, replies from the International Panel on this month's question (others came from Germany and Sweden). As mentioned in the introduction, health-related quality of life is becoming increasingly important as an outcome measure in clinical trials of new therapeutic interventions and several new measures have been and are developed. It is interesting and encouraging to hear about the new developments within this area that are being made by neuroscience nurses in different countries and within different subspecialties around the globe. As reported from the International Panel in here, new HRQL measures are currently developed in Canada and the UK focusing on patients with brains injuries and Huntington's disease (HD), respectively. In contrast to most established measures, the Canadian study has primarily been aimed at the positive aspects of life and not merely absence of the negative ones. Steve Smith in the UK has recently started developing a scale for use in clinical management of patients with HD. As far as I have been able to determine, this is the first measure of this kind to be developed for HD. Anyone who would like to know more about Steve's work or take part thereof is encouraged to contact him at this address above. Despite the fact that there already are several HRQL measures available, there is still a need for new instruments reflecting new aspects of health and disease. In addition, tools need to be designed for challenging conditions not readily addressed by existing measures. The replies from Canada and the UK represent these needs. It will be very interesting to eventually take

  12. Health Promotion Board–Ministry of Health Clinical Practice Guidelines: Obesity

    PubMed Central

    Lee, Yung Seng; Biddle, Stuart; Chan, Mei Fen; Cheng, Anton; Cheong, Magdalin; Chong, Yap Seng; Foo, Ling Li; Lee, Chung Horn; Lim, Su Chi; Ong, Wee Sian; Pang, Jonathan; Pasupathy, Shanker; Sloan, Robert; Seow, Mollie; Soon, Grace; Tan, Benedict; Tan, Thiam Chye; Teo, Soo Lay; Tham, Kwang Wei; van Dam, Rob M; Wang, John

    2016-01-01

    The Health Promotion Board (HPB) has developed the Clinical Practice Guidelines (CPG) on Obesity to provide health professionals in Singapore with recommendations for evidence-based interventions for obesity. This article summarises the introduction, epidemiology and executive summary of the key recommendations from the HPB-MOH CPG on Obesity for the information of SMJ readers. The chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Health Promotion Board website: http://www.hpb.gov.sg/cpg-obesity. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines. PMID:27353244

  13. Health Promotion Board-Ministry of Health Clinical Practice Guidelines: Obesity.

    PubMed

    Lee, Yung Seng; Biddle, Stuart; Chan, Mei Fen; Cheng, Anton; Cheong, Magdalin; Chong, Yap Seng; Foo, Ling Li; Lee, Chung Horn; Lim, Su Chi; Ong, Wee Sian; Pang, Jonathan; Pasupathy, Shanker; Sloan, Robert; Seow, Mollie; Soon, Grace; Tan, Benedict; Tan, Thiam Chye; Teo, Soo Lay; Tham, Kwang Wei; van Dam, Rob M; Wang, John

    2016-06-01

    The Health Promotion Board (HPB) has developed the Clinical Practice Guidelines (CPG) on Obesity to provide health professionals in Singapore with recommendations for evidence-based interventions for obesity. This article summarises the introduction, epidemiology and executive summary of the key recommendations from the HPB-MOH CPG on Obesity for the information of SMJ readers. The chapters and page numbers mentioned in the reproduced extract refer to the full text of the guidelines, which are available from the Health Promotion Board website: http://www.hpb.gov.sg/cpg-obesity. The recommendations should be used with reference to the full text of the guidelines. Following this article are multiple choice questions based on the full text of the guidelines.

  14. Person: centre both of clinical ethics and of public health ethics. Commentary.

    PubMed

    Petrini, Carlo

    2012-01-01

    The "public health" perspective is different from the ″patient-centred″ clinical perspective for various reasons. Tensions between collective and individual interests are unavoidable in public health. Intersections between public health ethics and clinical bioethics can be traced to a set of duties which derive from respect of the person. Human rights and solidarity are "person-centred" cornerstones of both clinical and public health ethics.

  15. Lyme borreliosis: reviewing potential vaccines, clinical aspects and health economics.

    PubMed

    Šmit, Renata; Postma, Maarten J

    2015-01-01

    Lyme borreliosis (LB) is a multisystem infectious disease with a growing burden in many parts of North America, Asia and Europe. Persistent infection of LB can usually be treated effectively with antibiotic therapy, but it may be followed by post-treatment Lyme disease syndrome. Therefore, it is important to begin with treatment in the early phase of the disease. Vaccination shows potential as the most effective way of preventing LB and reducing its burden in these continents. It is concluded that there is a need for continuous effort in research from all perspectives on LB, especially regarding prevention with novel vaccines, their development, clinical efficacy and cost-effectiveness. This review may help to further develop (cost-) effective strategies for prevention and control of the disease to reduce its burden and achieve population-wide health benefits.

  16. Guidelines for clinical supervision in health service psychology.

    PubMed

    2015-01-01

    This document outlines guidelines for supervision of students in health service psychology education and training programs. The goal was to capture optimal performance expectations for psychologists who supervise. It is based on the premises that supervisors (a) strive to achieve competence in the provision of supervision and (b) employ a competency-based, meta-theoretical approach to the supervision process. The Guidelines on Supervision were developed as a resource to inform education and training regarding the implementation of competency-based supervision. The Guidelines on Supervision build on the robust literatures on competency-based education and clinical supervision. They are organized around seven domains: supervisor competence; diversity; relationships; professionalism; assessment/evaluation/feedback; problems of professional competence, and ethical, legal, and regulatory considerations. The Guidelines on Supervision represent the collective effort of a task force convened by the American Psychological Association (APA) Board of Educational Affairs (BEA). PsycINFO Database Record (c) 2015 APA, all rights reserved.

  17. Clinical decision support system for the diagnosis of adolescence health.

    PubMed

    Moutsouri, Irene; Nikou, Amalia; Pampalou, Machi; Lentza, Maria; Spyridakis, Paulos; Mathiopoulou, Natassa; Konsoulas, Dimitris; Lampou, Marianna; Alexiou, Athanasios

    2015-01-01

    It is common that children confront psychological problems when they reach puberty. These problems could easily be overcome, but in many cases they could be severe, leading to social estrangement or worse in madness or death. According to information collected we designed a questionnaire about the psychology of adolescents in order to help people in that age or their elders find out if they have health issues. We used already published researches and material concerning all the psychological problems a child can confront in order to make a reliable questionnaire and to develop the clinical decision support system. Our main objective is to publish and administrate a web-based free tool for sharing medical knowledge about any psychological disease a child can already have or develop during puberty.

  18. PV performance modeling workshop summary report.

    SciTech Connect

    Stein, Joshua S.; Tasca, Coryne Adelle; Cameron, Christopher P.

    2011-05-01

    During the development of a solar photovoltaic (PV) energy project, predicting expected energy production from a system is a key part of understanding system value. System energy production is a function of the system design and location, the mounting configuration, the power conversion system, and the module technology, as well as the solar resource. Even if all other variables are held constant, annual energy yield (kWh/kWp) will vary among module technologies because of differences in response to low-light levels and temperature. A number of PV system performance models have been developed and are in use, but little has been published on validation of these models or the accuracy and uncertainty of their output. With support from the U.S. Department of Energy's Solar Energy Technologies Program, Sandia National Laboratories organized a PV Performance Modeling Workshop in Albuquerque, New Mexico, September 22-23, 2010. The workshop was intended to address the current state of PV system models, develop a path forward for establishing best practices on PV system performance modeling, and set the stage for standardization of testing and validation procedures for models and input parameters. This report summarizes discussions and presentations from the workshop, as well as examines opportunities for collaborative efforts to develop objective comparisons between models and across sites and applications.

  19. DOE High Performance Concentrator PV Project

    SciTech Connect

    McConnell, R.; Symko-Davies, M.

    2005-08-01

    Much in demand are next-generation photovoltaic (PV) technologies that can be used economically to make a large-scale impact on world electricity production. The U.S. Department of Energy (DOE) initiated the High-Performance Photovoltaic (HiPerf PV) Project to substantially increase the viability of PV for cost-competitive applications so that PV can contribute significantly to both our energy supply and environment. To accomplish such results, the National Center for Photovoltaics (NCPV) directs in-house and subcontracted research in high-performance polycrystalline thin-film and multijunction concentrator devices with the goal of enabling progress of high-efficiency technologies toward commercial-prototype products. We will describe the details of the subcontractor and in-house progress in exploring and accelerating pathways of III-V multijunction concentrator solar cells and systems toward their long-term goals. By 2020, we anticipate that this project will have demonstrated 33% system efficiency and a system price of $1.00/Wp for concentrator PV systems using III-V multijunction solar cells with efficiencies over 41%.

  20. PV system field experience and reliability

    NASA Astrophysics Data System (ADS)

    Durand, Steven; Rosenthal, Andrew; Thomas, Mike

    1997-02-01

    Hybrid power systems consisting of battery inverters coupled with diesel, propane, or gasoline engine-driven electrical generators, and photovoltaic arrays are being used in many remote locations. The potential cost advantages of hybrid systems over simple engine-driven generator systems are causing hybrid systems to be considered for numerous applications including single-family residential, communications, and village power. This paper discusses the various design constraints of such systems and presents one technique for reducing hybrid system losses. The Southwest Technology Development Institute under contract to the National Renewable Energy Laboratory and Sandia National Laboratories has been installing data acquisition systems (DAS) on a number of small and large hybrid PV systems. These systems range from small residential systems (1 kW PV - 7 kW generator), to medium sized systems (10 kW PV - 20 kW generator), to larger systems (100 kW PV - 200 kW generator). Even larger systems are being installed with hundreds of kilowatts of PV modules, multiple wind machines, and larger diesel generators.

  1. Estimating Wisconsin Asthma Prevalence Using Clinical Electronic Health Records and Public Health Data

    PubMed Central

    Tomasallo, Carrie D.; Hanrahan, Lawrence P.; Tandias, Aman; Chang, Timothy S.; Cowan, Kelly J.

    2014-01-01

    Objectives. We compared a statewide telephone health survey with electronic health record (EHR) data from a large Wisconsin health system to estimate asthma prevalence in Wisconsin. Methods. We developed frequency tables and logistic regression models using Wisconsin Behavioral Risk Factor Surveillance System and University of Wisconsin primary care clinic data. We compared adjusted odds ratios (AORs) from each model. Results. Between 2007 and 2009, the EHR database contained 376 000 patients (30 000 with asthma), and 23 000 (1850 with asthma) responded to the Behavioral Risk Factor Surveillance System telephone survey. AORs for asthma were similar in magnitude and direction for the majority of covariates, including gender, age, and race/ethnicity, between survey and EHR models. The EHR data had greater statistical power to detect associations than did survey data, especially in pediatric and ethnic populations, because of larger sample sizes. Conclusions. EHRs can be used to estimate asthma prevalence in Wisconsin adults and children. EHR data may improve public health chronic disease surveillance using high-quality data at the local level to better identify areas of disparity and risk factors and guide education and health care interventions. PMID:24228643

  2. Harvard Community Health Plan's Mental Health Redesign Project: a managerial and clinical partnership.

    PubMed

    Abrams, H S

    1993-01-01

    Harvard Community Health Plan, founded in 1969 as a staff model HMO, is currently a staff and group model HMO with 521,000 members, 19 health centers and 12 independently owned group practices with 26 locations. In 1987, the Plan initiated a review of its mental health benefit and program because its costs were rising, member and clinician dissatisfaction was increasing and many believed the problem was the nature and scope of the benefit. After two years of study, surveys, interviews, cost and utilization analysis, the Plan identified its professional staff as its key asset but recognized many problem areas, including problems with access, variation from site to site, inconsistent service delivery, lack of consistent utilization management and the need for greater diversity along the spectrum of care available to members. From 1989 to 1990, more than 200 clinicians and support staff were engaged in the process of developing a variety of components to the "mental health redesign program." Three simultaneous efforts included developing a method of categorizing patients, restructuring the delivery system and redesigning the benefit. A Mental Health Patient Assessment Tool was created which assists clinicians in performing comprehensive evaluations, administers the benefit, measures progress and supports outcomes research. Delivery system changes included the implementation of self-referral, access standards, intake triage functions by non-clinical staff, program development and an outpatient utilization management function.

  3. Investigation of indirect benefits of PV rooftop in Thailand

    NASA Astrophysics Data System (ADS)

    Khumkrong, T.; Chuangchote, S.; Chenvidhya, D.; Kirtikara, K.

    2017-05-01

    Other than electricity generation, which is the direct benefit of PV rooftop, cooling load reduction due to PV shading is a benefit impact in the uses of PV rooftop. This report is a study of those indirect benefits of PV rooftop. Relation of shading of PV modules and reduction of cooling load was studied in a real testing cite at the office building of CES Solar Cell Testing Center (CSSC). Several data, i.e. solar radiation, rooftop temperatures before/after PV-panel installation, and electricity consumed by equipment, were monitored and collected. This data could be further estimated for cooling load via transient heat conduction approach.

  4. The Prostate Health Index Selectively Identifies Clinically Significant Prostate Cancer

    PubMed Central

    Loeb, Stacy; Sanda, Martin G.; Broyles, Dennis L.; Shin, Sanghyuk S.; Bangma, Chris H.; Wei, John T.; Partin, Alan W.; Klee, George G.; Slawin, Kevin M.; Marks, Leonard S.; van Schaik, Ron H. N.; Chan, Daniel W.; Sokoll, Lori J.; Cruz, Amabelle B.; Mizrahi, Isaac A.; Catalona, William J.

    2015-01-01

    Purpose The Prostate Health Index (phi) is a new test combining total, free and [-2]proPSA into a single score. It was recently approved by the FDA and is now commercially available in the U.S., Europe and Australia. We investigate whether phi improves specificity for detecting clinically significant prostate cancer and can help reduce prostate cancer over diagnosis. Materials and Methods From a multicenter prospective trial we identified 658 men age 50 years or older with prostate specific antigen 4 to 10 ng/ml and normal digital rectal examination who underwent prostate biopsy. In this population we compared the performance of prostate specific antigen, % free prostate specific antigen, [-2]proPSA and phi to predict biopsy results and, specifically, the presence of clinically significant prostate cancer using multiple criteria. Results The Prostate Health Index was significantly higher in men with Gleason 7 or greater and “Epstein significant” cancer. On receiver operating characteristic analysis phi had the highest AUC for overall cancer (AUCs phi 0.708, percent free prostate specific antigen 0.648, [-2]proPSA 0.550 and prostate specific antigen 0.516), Gleason 7 or greater (AUCs phi 0.707, percent free prostate specific antigen 0.661, [-2]proPSA 0.558, prostate specific antigen 0.551) and significant cancer (AUCs phi 0.698, percent free prostate specific antigen 0.654, [-2]proPSA 0.550, prostate specific antigen 0.549). At the 90% sensitivity cut point for phi (a score less than 28.6) 30.1% of patients could have been spared an unnecessary biopsy for benign disease or insignificant prostate cancer compared to 21.7% using percent free prostate specific antigen. Conclusions The new phi test outperforms its individual components of total, free and [-2]proPSA for the identification of clinically significant prostate cancer. Phi may be useful as part of a multivariable approach to reduce prostate biopsies and over diagnosis. PMID:25463993

  5. PV Systems Reliability Final Technical Report.

    SciTech Connect

    Lavrova, Olga; Flicker, Jack David; Johnson, Jay; Armijo, Kenneth Miguel; Gonzalez, Sigifredo; Schindelholz, Eric John; Sorensen, Neil R.; Yang, Benjamin Bing-Yeh

    2015-12-01

    The continued exponential growth of photovoltaic technologies paves a path to a solar-powered world, but requires continued progress toward low-cost, high-reliability, high-performance photovoltaic (PV) systems. High reliability is an essential element in achieving low-cost solar electricity by reducing operation and maintenance (O&M) costs and extending system lifetime and availability, but these attributes are difficult to verify at the time of installation. Utilities, financiers, homeowners, and planners are demanding this information in order to evaluate their financial risk as a prerequisite to large investments. Reliability research and development (R&D) is needed to build market confidence by improving product reliability and by improving predictions of system availability, O&M cost, and lifetime. This project is focused on understanding, predicting, and improving the reliability of PV systems. The two areas being pursued include PV arc-fault and ground fault issues, and inverter reliability.

  6. Evaluation of Encapsulant Materials for PV Applications

    SciTech Connect

    Kempe, M.

    2010-01-01

    Encapsulant materials used in PV modules serve multiple purposes. They physically hold components in place, provide electrical insulation, optically couple superstrate materials (e.g., glass) to PV cells, protect components from mechanical stress by mechanically de-coupling components via strain relief, and protect materials from corrosion. To do this, encapsulants must adhere well to all surfaces, remain compliant, and transmit light after exposure to temperature, humidity, and UV radiation histories. Encapsulant materials by themselves do not completely prevent water vapour ingress [1-3], but if they are well adhered, they will prevent the accumulation of liquid water providing protection against corrosion as well as electrical shock. Here, a brief review of some of the polymeric materials under consideration for PV applications is provided, with an explanation of some of their advantages and disadvantages.

  7. Consumer health information technology in an adult public health primary care clinic: a heart health education feasibility study.

    PubMed

    Gleason-Comstock, Julie A; Streater, Alicia; Jen, Kai-Lin Catherine; Artinian, Nancy T; Timmins, Jessica; Baker, Suzanne; Joshua, Bosede; Paranjpe, Aniruddha

    2013-12-01

    To explore the feasibility and short term outcomes of using an interactive kiosk integrated into office flow to deliver health information in a primary care clinic. Fifty-one adults with BMI ≥25 were randomly assigned to use a kiosk with attached devices to receive a six-week healthy eating/weight monitoring (intervention) or general health/BP monitoring (attention-control) program. Outcomes were measured at baseline, 8 weeks (post) and three month follow-up. Participants completed an average of 2.73 weekly sessions, with transportation and time given as limiting factors. They found the kiosk easy to use (97%), liked the touchscreen (94%), and would use the kiosk again (81%). Although there were no differences between groups, the 27 completing all assessments showed reduced weight (p=.02), and decreased systolic (p=.01) and diastolic BP (p<.001) at follow-up. Although healthy eating behaviors increased, the change was not statistically significant. Using a kiosk within a clinic setting is a feasible method of providing health information and self-monitoring. Multi-session educational content can provide beneficial short-term outcomes in overweight adults. A kiosk with attached peripherals in a clinic setting is a viable adjunct to provider education, particularly in medically underserved areas. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  8. Maintenance of health care providers clinical proficiency: Transdisciplinary analysis, modeling and intervention

    DTIC Science & Technology

    2015-10-13

    to be completed effectively, productively and within budget. Health care quality and safety; skill decay; physicians; declarative knowledge; clinical...context for studying skill degradation among pediatric health care providers • Objective 2: Develop and validate quality metrics, test alternative...experience less demand for certain clinical skills. Upon resuming domestic practice, they may exhibit skill decay, reducing health care quality and

  9. Developing standards for PV packaging materials

    NASA Astrophysics Data System (ADS)

    Wohlgemuth, John; Kempe, Michael; Miller, David; Kurtz, Sarah

    2011-09-01

    The initial qualification standards for photovoltaic modules were designed to help develop a product that is safe, and able to survive reasonably long time periods when deployed in the field. To accomplish this, TC-82 of the International Electro-Technical Commission (IEC), developed and published module qualification standards (IEC 61215 for crystalline Si, IEC 61646 for thin films and IEC 62108 for concentrating modules) and a module safety standard (IEC 61730 -1 and 2). As PV has developed and the technology has become better understood, the properties of materials used in the module package play an increasingly important part in achieving long-term durability and safety. Certain basic properties are required of the materials in order for the modules to be safe and to be able to survive in the field for 25 years or more. Therefore Working Group 2 (Modules) of TC-82 began work to develop new material-level standards for PV that will utilize existing standards, whenever available, but tailored for characterizing the properties that are important for PV modules and modified to take into account the environmental conditions specific to PV applications. The goal is to provide a uniform approach to characterizing candidate materials, providing the necessary information to designers selecting materials for use in their PV products as well as to certification bodies assessing the quality and safety of the products made from these materials. This paper will describe the details of the effort underway to determine what PV material standards are necessary and the progress on developing those standards.

  10. Real time PV manufacturing diagnostic system

    SciTech Connect

    Kochergin, Vladimir; Crawford, Michael A.

    2015-09-01

    The main obstacle Photovoltaic (PV) industry is facing at present is the higher cost of PV energy compared to that of fossil energy. While solar cell efficiencies continue to make incremental gains these improvements are so far insufficient to drive PV costs down to match that of fossil energy. Improved in-line diagnostics however, has the potential to significantly increase the productivity and reduce cost by improving the yield of the process. On this Phase I/Phase II SBIR project MicroXact developed and demonstrated at CIGS pilot manufacturing line a high-throughput in-line PV manufacturing diagnostic system, which was verified to provide fast and accurate data on the spatial uniformity of thickness, an composition of the thin films comprising the solar cell as the solar cell is processed reel-to-reel. In Phase II project MicroXact developed a stand-alone system prototype and demonstrated the following technical characteristics: 1) ability of real time defect/composition inconsistency detection over 60cm wide web at web speeds up to 3m/minute; 2) Better than 1mm spatial resolution on 60cm wide web; 3) an average better than 20nm spectral resolution resulting in more than sufficient sensitivity to composition imperfections (copper-rich and copper-poor regions were detected). The system was verified to be high vacuum compatible. Phase II results completely validated both technical and economic feasibility of the proposed concept. MicroXact’s solution is an enabling technique for in-line PV manufacturing diagnostics to increase the productivity of PV manufacturing lines and reduce the cost of solar energy, thus reducing the US dependency on foreign oil while simultaneously reducing emission of greenhouse gasses.

  11. Burnout in Veterans Health Administration mental health providers in posttraumatic stress clinics.

    PubMed

    Garcia, Hector A; McGeary, Cindy A; McGeary, Donald D; Finley, Erin P; Peterson, Alan L

    2014-02-01

    The purpose of this study was to conduct the first assessment of burnout among Veterans Health Administration (VHA) mental health clinicians providing evidence-based posttraumatic stress disorder (PTSD) care. This study consisted of 138 participants and the sample was mostly female (67%), Caucasian (non-Hispanic; 81%), and married (70%) with a mean age of 44.3 years (SD = 11.2). Recruitment was directed through VHA PTSD Clinical Teams (PCT) throughout the United States based on a nationwide mailing list of PCT Clinic Directors. Participants completed an electronic survey that assessed demographics, organizational work factors, absenteeism, and burnout (assessed through the Maslach Burnout Inventory-General Survey, MBI-GS). Twelve percent of the sample reported low Professional Efficacy, 50% reported high levels of Exhaustion, and 47% reported high levels of Cynicism as determined by the MBI-GS cut-off scores. Only workplace characteristics were significantly associated with provider scores on all 3 scales. Exhaustion and Cynicism were most impacted by perceptions of organizational politics/bureaucracy, increased clinical workload, and control over how work is done. Organizational factors were also significantly associated with provider absenteeism and intent to leave his or her job. Findings suggest that providers in VHA specialty PTSD-care settings may benefit from programs or supports aimed at preventing and/or ameliorating burnout. PsycINFO Database Record (c) 2014 APA, all rights reserved.

  12. Burnout in Veterans Health Administration Mental Health Providers in Posttraumatic Stress Clinics

    PubMed Central

    Garcia, Hector A.; McGeary, Cindy A.; McGeary, Donald D.; Finley, Erin P.; Peterson, Alan L.

    2015-01-01

    The purpose of this study was to conduct the first assessment of burnout among Veterans Health Administration (VHA) mental health clinicians providing evidence-based posttraumatic stress disorder (PTSD) care. This study consisted of 138 participants and the sample was mostly female (67%), Caucasian (non-Hispanic; 81%), and married (70%) with a mean age of 44.3 years (SD = 11.2). Recruitment was directed through VHA PTSD Clinical Teams (PCT) throughout the United States based on a nationwide mailing list of PCT Clinic Directors. Participants completed an electronic survey that assessed demographics, organizational work factors, absenteeism, and burnout (assessed through the Maslach Burnout Inventory-General Survey, MBI-GS). Twelve percent of the sample reported low Professional Efficacy, 50% reported high levels of Exhaustion, and 47% reported high levels of Cynicism as determined by the MBI-GS cut-off scores. Only workplace characteristics were significantly associated with provider scores on all 3 scales. Exhaustion and Cynicism were most impacted by perceptions of organizational politics/bureaucracy, increased clinical workload and control over how work is done. Organizational factors were also significantly associated with provider absenteeism and intent to leave his/her job. Findings suggest that providers in VHA specialty PTSD care settings may benefit from programs or supports aimed at preventing and/or ameliorating burnout. PMID:24564443

  13. 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…

  14. A Mental Health Clinic for Toddlers with Developmental Delays and Behavior Problems

    ERIC Educational Resources Information Center

    Fox, Robert A.; Keller, Kathryn M.; Grede, Patricia L.; Bartosz, Ann M.

    2007-01-01

    A mental health clinic was developed for toddlers with developmental disabilities and significant behavior problems from families living in poverty. The clinic was a collaborative effort between a community-based Birth-to-Three agency and a university. The purpose of this clinic was threefold: to provide direct mental health services for these…

  15. 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…

  16. Radiometric instrumentation for PV system performance monitoring

    SciTech Connect

    Stoffel, T.

    1995-09-01

    This paper provides an overview of existing instrumentation options and solicits user needs for improving outdoor solar radiation measurements for determining PV system performance. The following topics are discussed: (1) historical overview and terminology; (2) radiometer calibration and characterization methods used by NREL; (3) sample calibration results for various commercial instruments; (4) current research topics; (5) user needs for improved PV performance monitoring. Emphasis is placed on the need for the user to understand the measurement capabilities of commercially available radiometers and interpret the measurement results accordingly. A list of radiometer manufacturers is also provided.

  17. Large-Scale PV Integration Study

    SciTech Connect

    Lu, Shuai; Etingov, Pavel V.; Diao, Ruisheng; Ma, Jian; Samaan, Nader A.; Makarov, Yuri V.; Guo, Xinxin; Hafen, Ryan P.; Jin, Chunlian; Kirkham, Harold; Shlatz, Eugene; Frantzis, Lisa; McClive, Timothy; Karlson, Gregory; Acharya, Dhruv; Ellis, Abraham; Stein, Joshua; Hansen, Clifford; Chadliev, Vladimir; Smart, Michael; Salgo, Richard; Sorensen, Rahn; Allen, Barbara; Idelchik, Boris

    2011-07-29

    This research effort evaluates the impact of large-scale photovoltaic (PV) and distributed generation (DG) output on NV Energy’s electric grid system in southern Nevada. It analyzes the ability of NV Energy’s generation to accommodate increasing amounts of utility-scale PV and DG, and the resulting cost of integrating variable renewable resources. The study was jointly funded by the United States Department of Energy and NV Energy, and conducted by a project team comprised of industry experts and research scientists from Navigant Consulting Inc., Sandia National Laboratories, Pacific Northwest National Laboratory and NV Energy.

  18. Updating Interconnection Screens for PV System Integration

    SciTech Connect

    Coddington, M.; Mather, B.; Kroposki, B.; Lynn, K.; Razon, A.; Ellis, A.; Hill, R.; Key, T.; Nicole, K.; Smith, J.

    2012-02-01

    This white paper evaluates the origins and usefulness of the capacity penetration screen, offer short-term solutions which could effectively allow fast-track interconnection to many PV system applications, and considers longer-term solutions for increasing PV deployment levels in a safe and reliable manner while reducing or eliminating the emphasis on the penetration screen. Short-term and longer-term alternatives approaches are offered as examples; however, specific modifications to screening procedures should be discussed with stakeholders and must ultimately be adopted by state and federal regulatory bodies.

  19. Impact of environmental chemicals, sociodemographic variables, depression, and clinical indicators of health and nutrition on self-reported health status

    EPA Science Inventory

    Public health researchers ideally integrate social, environmental, and clinical measures to identify predictors of poor health. Chemicals measured in human tissues are often evaluated in relation to intangible or rare health outcomes, or are studied one chemical at a time. Using ...

  20. Impact of environmental chemicals, sociodemographic variables, depression, and clinical indicators of health and nutrition on self-reported health status

    EPA Science Inventory

    Public health researchers ideally integrate social, environmental, and clinical measures to identify predictors of poor health. Chemicals measured in human tissues are often evaluated in relation to intangible or rare health outcomes, or are studied one chemical at a time. Using ...

  1. Service quality in public health clinics: perceptions of users and health professionals.

    PubMed

    Campos, Domingos Fernandes; Negromonte Filho, Rinaldo Bezerra; Castro, Felipe Nalon

    2017-10-09

    Purpose The purpose of this paper is to investigate the expectations and quality gaps in services provided at city public health clinics in the city of Natal, Brazil, from the perspective of patients and healthcare service providers. Design/methodology/approach The research sample consisted of 1,200 patients who used public health services and 265 providers - doctors, nutritionists, physiotherapists, psychologists, pharmacists and managers at three health clinics in the city of Natal, Brazil. A scale with 25 health service attributes was used in data collection. Summary statistics and t-test were used to analyze the data. Findings The results show that the providers think that users have lower levels of expectations than those indicated by the users in all attributes. Providers and users have the most approximate insights into what attributes are considered most important: explanations, level of knowledge and attention dispensed by health professionals. Users and providers perceived similar quality gaps for most of the attributes. The gaps were statistically the same, when comparing the mean quality shortcomings by means of a Student's test, considering a significance level of 5 percent, obtained independently by the manifestation of users and providers. Research limitations/implications The results reveal only a photograph of the moment. The study did not consider the differences that may exist between groups with different income levels, genders or age groups. A qualitative study could improve the understanding of the differences and coincidences of the diverse points of views. A more advanced research could even study possibilities so that health managers could promote changes in the service, some of them low cost, as the health professionals training for contact with patients. Practical implications The evaluation of the service quality complemented by the matrix of opportunities, importance × quality gaps generates information to help make decisions in the

  2. International PV QA Task Force's Proposed Comparative Rating System for PV Modules: Preprint

    SciTech Connect

    Wohlgemuth, J.; Kurtz, S.

    2014-10-01

    The International PV Quality Assurance Task Force is developing a rating system that provides comparative information about the relative durability of PV modules. Development of accelerated stress tests that can provide such comparative information is seen as a major step toward being able to predict PV module service life. This paper will provide details of the ongoing effort to determine the format of such an overall module rating system. The latest proposal is based on using three distinct climate zones as defined in IEC 60721-2-1 for two different mounting systems. Specific stresses beyond those used in the qualification tests are being developed for each of the selected climate zones.

  3. Structurally Designed Attenuated Subunit Vaccines for S. aureus LukS-PV and LukF-PV Confer Protection in a Mouse Bacteremia Model

    PubMed Central

    Sarwar, Jawad; Devi, V. Sathya; Abaandou, Laura; Haudenschild, Christian; Mahmoudieh, Mahta; Boroun, Atefeh R.; Vu, Hong; Nguyen, Tam; Warfield, Kelly L.; Shulenin, Sergey; Aman, M. Javad

    2013-01-01

    Previous efforts towards S. aureus vaccine development have largely focused on cell surface antigens to induce opsonophagocytic killing aimed at providing sterile immunity, a concept successfully applied to other Gram-positive pathogens such as Streptococcus pneumoniae. However, these approaches have largely failed, possibly in part due to the remarkable diversity of the staphylococcal virulence factors such as secreted immunosuppressive and tissue destructive toxins. S. aureus produces several pore-forming toxins including the single subunit alpha hemolysin as well as bicomponent leukotoxins such as Panton-Valentine leukocidin (PVL), gamma hemolysins (Hlg), and LukED. Here we report the generation of highly attenuated mutants of PVL subunits LukS-PV and LukF-PV that were rationally designed, based on an octameric structural model of the toxin, to be deficient in oligomerization. The attenuated subunit vaccines were highly immunogenic and showed significant protection in a mouse model of S. aureus USA300 sepsis. Protection against sepsis was also demonstrated by passive transfer of rabbit immunoglobulin raised against LukS-PV. Antibodies to LukS-PV inhibited the homologous oligomerization of LukS-PV with LukF-PV as well heterologous oligomerization with HlgB. Importantly, immune sera from mice vaccinated with the LukS mutant not only inhibited the PMN lytic activity produced by the PVL-positive USA300 but also blocked PMN lysis induced by supernatants of PVL-negative strains suggesting a broad protective activity towards other bicomponent toxins. These findings strongly support the novel concept of an anti-virulence, toxin-based vaccine intended for prevention of clinical S. aureus invasive disease, rather than achieving sterile immunity. Such a multivalent vaccine may include attenuated leukotoxins, alpha hemolysin, and superantigens. PMID:23762356

  4. A health information network for managing innercity tuberculosis: bridging clinical care, public health, and home care.

    PubMed

    Hripcsak, G; Knirsch, C A; Jain, N L; Stazesky, R C; Pablos-Mendez, A; Fulmer, T

    1999-02-01

    The purpose of this study was to use a health information network and innovative technology to coordinate tuberculosis care. An innercity medical center, a local health department, and a home care nurse service in northern Manhattan were used. The organizations were linked with computer networks. An automated decision support system with a natural language processor was used to detect tuberculosis cases and report them to the health department, and to select patients for respiratory isolation. Educational materials were placed on the World Wide Web and a Web-based kiosk. Home care nurses were outfitted with wireless pen-based computers, and data were relayed to the medical center. Automated tuberculosis case reporting resulted in time savings but not improved accuracy. Automated rules resulted in significant improvements in respiratory isolation. Kiosk educational materials were well-used. Wireless computing led to better access to information for both nurses and physicians, but not to reduction of workload. The key success element was recognition of critical priorities. It is concluded that innovative technology can facilitate the coordination of clinical care, public health, and home care. Copyright 1999 Academic Press.

  5. PV Cephei: Young Star Caught Speeding?

    NASA Astrophysics Data System (ADS)

    Goodman, Alyssa A.; Arce, Héctor G.

    2004-06-01

    Three independent lines of evidence imply that the young star PV Cep is moving at roughly 20 km s-1 through the interstellar medium. The first and strongest suggestion of motion comes from the geometry of the Herbig-Haro (HH) knots in the ``giant'' HH flow associated with PV Cep. Bisectors of lines drawn between pairs of knots at nearly equal distances from PV Cep imply an east-west motion of the source, and a plasmon model fitted to the knot positions gives a good fit of 22 km s-1 motion for the star. The second bit of damning evidence comes from a redshifted trail of molecular gas pointing in the same east-west direction implied by the HH knot geometry. The third exhibit we offer in accusing PV Cep of speeding involves the apparent tilt in the high-velocity molecular jet now emanating from the star. This tilt is best explained if the true, current jet direction is north-south, as it is in Hubble Space Telescope WFPC2 images, and the star is moving, again at roughly 20 km s-1. Tracing the motion of PV Cep backward in time to the nearest cluster from which it might have been ejected, we find that it is very likely to have been thrown out of the massive star-forming cluster NGC 7023, more than 10 pc away. PV Cep and NGC 7023 are at similar distances, and the backward trace of PV Cep's motion is astonishingly well aligned with a dark, previously unexplained rift in NGC 7023. We propose that PV Cep was ejected, at a speed large enough to escape NGC 7023, at least 100,000 yr ago but that it did not enter the molecular cloud in which it now finds itself until more like 35,000 yr ago. Our calculations show that the currently observable molecular outflow associated with PV Cep is about 10,000 yr old, so the flow has had plenty of time to form while in its current molecular cloud. However, the question of what PV Cep was doing and what gas/disk it took along with it in the time it was traveling through the low-density region between NGC 7023 and its current home is an open

  6. PV Ceph: Young Star Caught Speeding?

    NASA Astrophysics Data System (ADS)

    Goodman, A. A.; Arce, H. G.

    2003-12-01

    Three independent lines of evidence imply that the young star PV Ceph is moving at roughly 20 km s-1 through the interstellar medium. The first, and strongest, suggestion of motion comes from the geometry of the HH knots in the ``giant" Herbig-Haro flow associated with PV Ceph. Bisectors of lines drawn between pairs of knots at nearly equal distances from PV Ceph imply an E-W motion of the source, and a plasmon model fit to the knot positions gives a good fit of 22 km s-1 motion for the star. The second bit of damning evidence comes from a redshifted ``trail" of molecular gas, pointing in the same E-W direction implied by the HH knot geometry. The third exhibit we offer in accusing PV Ceph of speeding involves the tilt apparent in the high-velocity molecular jet now emanating from the star. This tilt is best explained if the true, current, jet direction is N-S, as it is in HST WFPC images, and the star is moving--again at roughly 20 km s-1. Tracing the motion of PV Ceph backward in time, to the nearest cluster from which it might have been ejected, we find that it is very likely to have been thrown out of the massive star-forming cluster NGC7023--more than 10 pc away. PV Ceph and NGC7023 are at similar distances, and the backward-trace of PV Ceph's motion is astonishingly well-aligned with a dark, previously unexplained, rift in NGC7023. We propose that PV Ceph was ejected, at a speed large enough to escape NGC7023, at least 100,000 years ago, but that it did not enter the molecular cloud in which it now finds itself until more like 10,000 years ago. Our calculations show that currently-observable molecular outflow associated with PV Ceph is about 10,000 years old, so that the flow has had plenty of time to form while in its current molecular cloud. But, the question of what PV Ceph was doing, and what gas/disk it took along with it in the time it was traveling through the low-density region between NGC7023 and its current home is open to question. Recent numerical

  7. National Institutes of Health Clinical Alerts and Advisories

    MedlinePlus

    ... Catalog & Services History of Medicine Online Exhibitions & Digital Projects Information for Publishers Visit the Library Research at NLM Human Genome Resources Biomedical Research & Informatics Environmental Health & Toxicology Health ...

  8. Leveraging Electronic Health Record Implementation to Facilitate Clinical and Operational Quality Improvement in an Ambulatory Surgical Clinic.

    PubMed

    Bobadilla, Joseph L; Roe, Cathy S; Estes, Patricia; Lackey, Jennifer; Steltenkamp, Carol L

    The implementation of electronic health records is a challenging, complex process requiring significant resources. The temptation is to convert a paper process into electronic format. This strategy fosters a familiar product to the users but is fraught with pitfalls. We chose to utilize the opportunity of the implementation of an enterprise-wide ambulatory electronic health record to foster an overreaching clinical and operational improvement project in a multispecialty surgical ambulatory clinic practice. We interrogated every aspect of the practice: clinic design, scheduling, physical space, staffing, and clinical and operational workflows. We present here the results of a 3-year process improvement.

  9. Molecular characterisation of Porcine rubulavirus (PorPV) isolates from different outbreaks in Mexico.

    PubMed

    Cuevas-Romero, S; Rivera-Benítez, J F; Blomström, A-L; Ramliden, M; Hernández-Baumgarten, E; Hernández-Jáuregui, P; Ramírez-Mendoza, H; Berg, M

    2016-02-01

    Since the report of the initial outbreak of Porcine rubulavirus (PorPV) infection in pigs, only one full-length genome from 1984 (PorPV-LPMV/1984) has been characterised. To investigate the overall genetic variation, full-length gene nucleotide sequences of current PorPV isolates were obtained from different clinical cases of infected swine. Genome organisation and sequence analysis of the encoded proteins (NP, P, F, M, HN and L) revealed high sequence conservation of the NP protein and the expression of the P and V proteins in all PorPV isolates. The V protein of one isolate displayed a mutation that has been implicated to antagonise the antiviral immune responses of the host. The M protein indicated a variation in a short region that could affect the electrostatic charge and the interaction with the membrane. One PorPV isolate recovered from the lungs showed a mutation at the cleavage site (HRKKR) of the F protein that could represent an important factor to determine the tissue tropism and pathogenicity of this virus. The HN protein showed high sequence identity through the years (up to 2013). Additionally, a number of sequence motifs of very high amino acid conservation among the PorPV isolates important for polymerase activity of the L protein have been identified. In summary, genetic comparisons and phylogenetic analyses indicated that three different genetic variants of PorPV are currently spreading within the swine population, and a new generation of circulating virus with different characteristics has begun to emerge.

  10. Spectral radiometric instrumentation and modelling for PV applications

    SciTech Connect

    Cannon, T.W.

    1995-09-01

    This paper describes issues dealing with instrumentation and atmospheric transmission modelling for determining solar spectral irradiance for outdoor photovoltaic (PV) applications. The relevance of these determinations to PV testing and evaluation is discussed with examples.

  11. Transcription Factors PvERF15 and PvMTF-1 Form a Cadmium Stress Transcriptional Pathway1[OPEN

    PubMed Central

    Lin, Tingting; Yang, Wanning; Lu, Wen; Wang, Ying

    2017-01-01

    In plants, cadmium (Cd)-responsive transcription factors are key downstream effectors of Cd stress transcriptional pathways, which are capable of converging Cd stress signals through triggering the expression of Cd detoxification genes. However, the upstream transcriptional regulatory pathways that modulate their responses to Cd are less clear. Previously, we identified the bean (Phaseolus vulgaris) METAL RESPONSE ELEMENT-BINDING TRANSCRIPTION FACTOR1 (PvMTF-1) that responds to Cd and confers Cd tolerance in planta. Here, we demonstrate an upstream transcriptional regulation of the PvMTF-1 response to Cd. Using a yeast one-hybrid system, we cloned the bean ETHYLENE RESPONSE FACTOR15 (PvERF15) that binds to the PvMTF-1 promoter. PvERF15 was strongly induced by Cd stress, and its overexpression resulted in the up-regulation of PvMTF-1. DNA-protein interaction assays further revealed that PvERF15 binds directly to a 19-bp AC-rich element in the PvMTF-1 promoter. The AC-rich element serves as a positive element bound by PvERF15 to activate gene expression. More importantly, knockdown of PvERF15 by RNA interference resulted in reduced Cd-induced expression of PvMTF-1. PvERF15 seems to be involved in Cd tolerance, since knockdown of PvERF15 by RNA interference in bean leaf discs decreased Cd tolerance in a transient assay. Since PvERF15 is a component of the Cd stress transcriptional pathway in beans and PvMTF-1 is one of its downstream targets, our findings provide a PvERF15/PvMTF-1 transcriptional pathway and thereby contribute to the understanding of Cd stress transcriptional regulatory pathways in plants. PMID:28073984

  12. Global Health and Emergency Care: Overcoming Clinical Research Barriers.

    PubMed

    Levine, Adam C; Barry, Meagan A; Agrawal, Pooja; Duber, Herbert C; Chang, Mary P; Mackey, Joy M; Hansoti, Bhakti

    2017-04-01

    There are many barriers impeding the conduct of high-quality emergency care research, particularly in low- and middle-income countries. Several of these barriers were originally outlined in 2013 as part of the Academic Emergency Medicine Global Health and Emergency Care Consensus Conference. This paper seeks to establish a broader consensus on the barriers to emergency care research globally and proposes a comprehensive array of new recommendations to overcome these barriers. An electronic survey was conducted of a purposive sample of global emergency medicine research experts from around the world to describe the major challenges and solutions to conducting emergency care research in low-resource settings and rank them by importance. The Global Emergency Medicine Think Tank Clinical Research Working Group at the Society for Academic Emergency Medicine 2016 Annual Meeting utilized a modified Delphi technique for consensus-based decision making to categorize and expand upon these barriers and develop a comprehensive array of proposed solutions. The working group identified four broad categories of barriers to conducting emergency care research globally, including 1) the limited availability of research personnel, particularly those with prior research training; 2) logistic barriers and lack of standardization of data collection; 3) ethical barriers to conducting research in resource-limited settings, particularly when no local institutional review board is available; and 4) the relative dearth of funding for global emergency care research. Proposed solutions included building a diverse and interdisciplinary research team structured to promote mentorship of junior researchers, utilizing local research assistants or technologic tools such as telemedicine for language translation, making use of new tools such as mobile health (mHealth) to standardize and streamline data collection, identifying alternatives to local institutional review board approval and the use of

  13. Integrating Patient-Generated Health Data Into Clinical Care Settings or Clinical Decision-Making: Lessons Learned From Project HealthDesign

    PubMed Central

    Keller, Sara R; Hayes, Gillian R; Dorr, David A; Ash, Joan S; Sittig, Dean F

    2016-01-01

    Background Patient-generated health data (PGHD) are health-related data created or recorded by patients to inform their self-care and understanding about their own health. PGHD is different from other patient-reported outcome data because the collection of data is patient-driven, not practice- or research-driven. Technical applications for assisting patients to collect PGHD supports self-management activities such as healthy eating and exercise and can be important for preventing and managing disease. Technological innovations (eg, activity trackers) are making it more common for people to collect PGHD, but little is known about how PGHD might be used in outpatient clinics. Objective The objective of our study was to examine the experiences of health care professionals who use PGHD in outpatient clinics. Methods We conducted an evaluation of Project HealthDesign Round 2 to synthesize findings from 5 studies funded to test tools designed to help patients collect PGHD and share these data with members of their health care team. We conducted semistructured interviews with 13 Project HealthDesign study team members and 12 health care professionals that participated in these studies. We used an immersion-crystallization approach to analyze data. Our findings provide important information related to health care professionals’ attitudes toward and experiences with using PGHD in a clinical setting. Results Health care professionals identified 3 main benefits of PGHD accessibility in clinical settings: (1) deeper insight into a patient’s condition; (2) more accurate patient information, particularly when of clinical relevance; and (3) insight into a patient’s health between clinic visits, enabling revision of care plans for improved health goal achievement, while avoiding unnecessary clinic visits. Study participants also identified 3 areas of consideration when implementing collection and use of PGHD data in clinics: (1) developing practice workflows and protocols

  14. Electronic health record systems in ophthalmology: impact on clinical documentation.

    PubMed

    Sanders, David S; Lattin, Daniel J; Read-Brown, Sarah; Tu, Daniel C; Wilson, David J; Hwang, Thomas S; Morrison, John C; Yackel, Thomas R; Chiang, Michael F

    2013-09-01

    To evaluate quantitative and qualitative differences in documentation of the ophthalmic examination between paper and electronic health record (EHR) systems. Comparative case series. One hundred fifty consecutive pairs of matched paper and EHR notes, documented by 3 attending ophthalmologist providers. An academic ophthalmology department implemented an EHR system in 2006. Database queries were performed to identify cases in which the same problems were documented by the same provider on different dates, using paper versus EHR methods. This was done for 50 consecutive pairs of examinations in 3 different diseases: age-related macular degeneration (AMD), glaucoma, and pigmented choroidal lesions (PCLs). Quantitative measures were used to compare completeness of documenting the complete ophthalmologic examination, as well as disease-specific critical findings using paper versus an EHR system. Qualitative differences in paper versus EHR documentation were illustrated by selecting representative paired examples. (1) Documentation score, defined as the number of examination elements recorded for the slit-lamp examination, fundus examination, and complete ophthalmologic examination and for critical clinical findings for each disease. (2) Paired comparison of qualitative differences in paper versus EHR documentation. For all 3 diseases (AMD, glaucoma, PCL), the number of complete examination findings recorded was significantly lower with paper than the EHR system (P ≤ 0.004). Among the 3 individual examination sections (general, slit lamp, fundus) for the 3 diseases, 5 of the 9 possible combinations had significantly lower mean documentation scores with paper than EHR notes. For 2 of the 3 diseases, the number of critical clinical findings recorded was significantly lower using paper versus EHR notes (P ≤ 0.022). All (150/150) paper notes relied on graphical representations using annotated hand-drawn sketches, whereas no (0/150) EHR notes contained drawings. Instead

  15. Honey and Health: A Review of Recent Clinical Research

    PubMed Central

    Samarghandian, Saeed; Farkhondeh, Tahereh; Samini, Fariborz

    2017-01-01

    Honey is one of the most appreciated and valued natural products introduced to humankind since ancient times. Honey is used not only as a nutritional product but also in health described in traditional medicine and as an alternative treatment for clinical conditions ranging from wound healing to cancer treatment. The aim of this review is to emphasize the ability of honey and its multitude in medicinal aspects. Traditionally, honey is used in the treatment of eye diseases, bronchial asthma, throat infections, tuberculosis, thirst, hiccups, fatigue, dizziness, hepatitis, constipation, worm infestation, piles, eczema, healing of ulcers, and wounds and used as a nutritious supplement. The ingredients of honey have been reported to exert antioxidant, antimicrobial, anti-inflammatory, antiproliferative, anticancer, and antimetastatic effects. Many evidences suggest the use of honey in the control and treatment of wounds, diabetes mellitus, cancer, asthma, and also cardiovascular, neurological, and gastrointestinal diseases. Honey has a potential therapeutic role in the treatment of disease by phytochemical, anti-inflammatory, antimicrobial, and antioxidant properties. Flavonoids and polyphenols, which act as antioxidants, are two main bioactive molecules present in honey. According to modern scientific literature, honey may be useful and has protective effects for the treatment of various disease conditions such as diabetes mellitus, respiratory, gastrointestinal, cardiovascular, and nervous systems, even it is useful in cancer treatment because many types of antioxidant are present in honey. In conclusion, honey could be considered as a natural therapeutic agent for various medicinal purposes. Sufficient evidence exists recommending the use of honey in the management of disease conditions. Based on these facts, the use of honey in clinical wards is highly recommended. SUMMARY There are several evidence that suggesting the usage of honey in the management of disease

  16. National solar technology roadmap: Film-silicon PV

    SciTech Connect

    Keyes, Brian

    2007-06-01

    Silicon photovoltaic (PV) technologies are addressed in two different technology roadmaps: Film-Silicon PV and Wafer-Silicon PV. This Film-Silicon PV roadmap applies to all silicon-film technologies that rely on a supporting substrate such as glass, polymer, aluminum, stainless steel, or metallurgical-grade silicon. Such devices typically use amorphous, nanocrystalline, fine-grained polycrystalline, or epitaxial silicon layers that are 1–20 μm thick.

  17. TRNSYS HYBRID wind diesel PV simulator

    SciTech Connect

    Quinlan, P.J.A.; Mitchell, J.W.; Klein, S.A.; Beckman, W.A.; Blair, N.J.

    1996-12-31

    The Solar Energy Laboratory (SEL) has developed a wind diesel PV hybrid systems simulator, UW-HYBRID 1.0, an application of the TRNSYS 14.2 time-series simulation environment. An AC/DC bus links up to five diesels and wind turbine models, along with PV modules, a battery bank, and an AC/DC converter. Multiple units can be selected. PV system simulations include solar angle and peak power tracking options. Weather data are Typical Meteorological Year data, parametrically generated synthesized data, or external data files. PV performance simulations rely on long-standing SEL-developed algorithms. Loads data are read as scalable time series. Diesel simulations include estimated fuel-use and waste heat output, and are dispatched using a least-cost of fuel strategy. Wind system simulations include varying air density, wind shear and wake effects. Time step duration is user-selectable. UW-HYBRID 1.0 runs in Windows{reg_sign}, with TRNSED providing a customizable user interface. 12 refs., 6 figs.

  18. Final Technical Report: PV Fault Detection Tool.

    SciTech Connect

    King, Bruce Hardison; Jones, Christian Birk

    2015-12-01

    The PV Fault Detection Tool project plans to demonstrate that the FDT can (a) detect catastrophic and degradation faults and (b) identify the type of fault. This will be accomplished by collecting fault signatures using different instruments and integrating this information to establish a logical controller for detecting, diagnosing and classifying each fault.

  19. PV Theories For Planetary Atmospheric Circulations

    NASA Technical Reports Server (NTRS)

    Allison, Michael; Travis, Larry (Technical Monitor)

    2000-01-01

    Potential vorticity (or PV) has become an important tool for the diagnosis and modeling of the Earth's atmospheric and oceanic circulations. More recently, the application of PV thinking to numerical simulations and spacecraft observations of other atmospheres, including those of Mars, Venus, and Titan, has encouraged the hope for a unified understanding of planetary circulation regimes encompassing a wide range of rotation, stratification, and forcing parameters. Specifically, the accumulated evidence suggests that zonal-mean winds and temperatures at upper tropospheric levels approximate a state of zero potential vorticity within the bounding latitudes of the westerly jets, while the poleward regions of cyclonic shear conform to a PV state that is well mixed with respect to its polar limit. This review of the prospects for conceptual planetary circulation models will explore the possibility that the zonal-mean state of an atmosphere can be calculated in terms of a simple link between the latitudinal PV and potential temperature variation at an upper baroclinic steering level.

  20. PV Theories For Planetary Atmospheric Circulations

    NASA Technical Reports Server (NTRS)

    Allison, Michael; Travis, Larry (Technical Monitor)

    2000-01-01

    Potential vorticity (or PV) has become an important tool for the diagnosis and modeling of the Earth's atmospheric and oceanic circulations. More recently, the application of PV thinking to numerical simulations and spacecraft observations of other atmospheres, including those of Mars, Venus, and Titan, has encouraged the hope for a unified understanding of planetary circulation regimes encompassing a wide range of rotation, stratification, and forcing parameters. Specifically, the accumulated evidence suggests that zonal-mean winds and temperatures at upper tropospheric levels approximate a state of zero potential vorticity within the bounding latitudes of the westerly jets, while the poleward regions of cyclonic shear conform to a PV state that is well mixed with respect to its polar limit. This review of the prospects for conceptual planetary circulation models will explore the possibility that the zonal-mean state of an atmosphere can be calculated in terms of a simple link between the latitudinal PV and potential temperature variation at an upper baroclinic steering level.

  1. IBM’s Health Analytics and Clinical Decision Support

    PubMed Central

    Sun, J.; Knoop, S.; Shabo, A.; Carmeli, B.; Sow, D.; Syed-Mahmood, T.; Rapp, W.

    2014-01-01

    Summary Objectives This survey explores the role of big data and health analytics developed by IBM in supporting the transformation of healthcare by augmenting evidence-based decision-making. Methods Some problems in healthcare and strategies for change are described. It is argued that change requires better decisions, which, in turn, require better use of the many kinds of healthcare information. Analytic resources that address each of the information challenges are described. Examples of the role of each of the resources are given. Results There are powerful analytic tools that utilize the various kinds of big data in healthcare to help clinicians make more personalized, evidenced-based decisions. Such resources can extract relevant information and provide insights that clinicians can use to make evidence-supported decisions. There are early suggestions that these resources have clinical value. As with all analytic tools, they are limited by the amount and quality of data. Conclusion Big data is an inevitable part of the future of healthcare. There is a compelling need to manage and use big data to make better decisions to support the transformation of healthcare to the personalized, evidence-supported model of the future. Cognitive computing resources are necessary to manage the challenges in employing big data in healthcare. Such tools have been and are being developed. The analytic resources, themselves, do not drive, but support healthcare transformation. PMID:25123736

  2. Dairy products on metabolic health: current research and clinical implications.

    PubMed

    Da Silva, Marine S; Rudkowska, Iwona

    2014-03-01

    Dairy products have been thought to have a beneficial role in the metabolic syndrome (MetS). MetS constitutes a cluster of risk factors for an increased mortality, including obesity, impaired glucose homeostasis, hypertension and atherogenic dyslipidemia. Individuals with MetS are also often in a chronic, low-grade inflammatory state. The objective of this review is to examine recent meta-analyses and clinical studies on the association between dairy products consumption and these MetS risk factors. Findings from studies demonstrate that weight loss related to dairy product intake is due to the combination of an energy-restricted diet with consumption of dairy products. Further, a limited number of studies have shown beneficial effects of dairy consumption on plasma lipids, blood pressure, glucose homeostasis or inflammatory and oxidative stress profiles. Overall, this review article suggests that adults should consume at least 2-3 servings of dairy products per day within a well-balanced diet and a healthy lifestyle for metabolic health. Yet, higher dairy product consumption may have additional beneficial effects, but more well-designed intervention studies are needed to ascertain these effects.

  3. Clinical-outcome-based demand management in health services.

    PubMed

    Brogan, C; Lawrence, D; Mayhew, L

    2008-01-01

    THE PROBLEM OF MANAGING DEMAND: Most healthcare systems have 'third-party payers' who face the problem of keeping within budgets despite pressures to increase resources due to the ageing population, new technologies and patient demands to lower thresholds for care. This paper uses the UK National Health Service as a case study to suggest techniques for system-based demand management, which aims to control demand and costs whilst maintaining the cost-effectiveness of the system. The technique for managing demand in primary, elective and urgent care consists of managing treatment thresholds for appropriate care, using a whole-systems approach and costing the care elements in the system. It is important to analyse activity in relation to capacity and demand. Examples of using these techniques in practice are given. The practical effects of using such techniques need evaluation. If these techniques are not used, managing demand and limiting healthcare expenditure will be at the expense of clinical outcomes and unmet need, which will perpetuate financial crises.

  4. Clinical decisions support malfunctions in a commercial electronic health record.

    PubMed

    Kassakian, Steven Z; Yackel, Thomas R; Gorman, Paul N; Dorr, David A

    2017-09-06

    Determine if clinical decision support (CDS) malfunctions occur in a commercial electronic health record (EHR) system, characterize their pathways and describe methods of detection. We retrospectively examined the firing rate for 226 alert type CDS rules for detection of anomalies using both expert visualization and statistical process control (SPC) methods over a five year period. Candidate anomalies were investigated and validated. Twenty-one candidate CDS anomalies were identified from 8,300 alert-months. Of these candidate anomalies, four were confirmed as CDS malfunctions, eight as false-positives, and nine could not be classified. The four CDS malfunctions were a result of errors in knowledge management: 1) inadvertent addition and removal of a medication code to the electronic formulary list; 2) a seasonal alert which was not activated; 3) a change in the base data structures; and 4) direct editing of an alert related to its medications. 154 CDS rules (68%) were amenable to SPC methods and the test characteristics were calculated as a sensitivity of 95%, positive predictive value of 29% and F-measure 0.44. CDS malfunctions were found to occur in our EHR. All of the pathways for these malfunctions can be described as knowledge management errors. Expert visualization is a robust method of detection, but is resource intensive. SPC-based methods, when applicable, perform reasonably well retrospectively. CDS anomalies were found to occur in a commercial EHR and visual detection along with SPC analysis represents promising methods of malfunction detection.

  5. Adolescents with Special Needs: Clinical Challenges in Reproductive Health Care.

    PubMed

    Quint, Elisabeth H

    2016-02-01

    Adolescents with special needs have unique reproductive health care needs related to their physical and cognitive issues. This review discusses some of the most common concerns that are encountered in clinical practice, as the clinician will partner with the adolescent and her family to guide her through the pubertal transition and to help navigate the risks and rights of reproduction. Families often seek anticipatory guidance before menarche on menstrual hygiene, abuse risk and sexuality and can be reassured that most teens with special needs do very well with menstruation. The clinician needs to evaluate the teenager's reproductive knowledge as well her risk for abuse and coercion and her ability to consent to sexual activity, if she requests contraception. Menstrual management is mostly based on the impact of the menstrual cycles on the teenager's life and activities. The adolescents may have a decreased ability to tolerate menses or pain, or experience changes in seizure pattern or altered mood. Hormonal treatment is often used to assist with menstrual hygiene, cyclical mood changes or dysmenorrhea. The goal of treatment can be complete amenorrhea, alleviate pain or regulate and decrease menstrual flow. The unique risks and benefits of hormonal treatment for this special population are highlighted.

  6. Nurturing the Global Workforce in Clinical Research: The National Institutes of Health Fogarty International Clinical Scholars and Fellows Program

    PubMed Central

    Heimburger, Douglas C.; Carothers, Catherine Lem; Gardner, Pierce; Primack, Aron; Warner, Tokesha L.; Vermund, Sten H.

    2011-01-01

    The Fogarty International Clinical Research Scholars and Fellows Program's goal is to foster the next generation of clinical investigators and to help build international health research partnerships between American and international investigators and institutions. Through June 2012, 61 sites in 27 countries have hosted 436 Scholars (American students or junior trainees from the host countries) and/or 122 Fellows (American and host country postdoctoral fellows) for year-long experiences in global health research. Initially, the program was oriented toward infectious diseases, but recently emphasis on chronic disease research has increased. At least 521 manuscripts have been published, many in high-impact journals. Projects have included clinical trials, observational studies, translational research, clinical-laboratory interface initiatives, and behavioral research. Strengths of the program include training opportunities for American and developing country scientists in well-established international clinical research settings, and mentorship from experienced global health experts. PMID:22144429

  7. Nurturing the global workforce in clinical research: the National Institutes of Health Fogarty International Clinical Scholars and Fellows Program.

    PubMed

    Heimburger, Douglas C; Carothers, Catherine Lem; Gardner, Pierce; Primack, Aron; Warner, Tokesha L; Vermund, Sten H

    2011-12-01

    The Fogarty International Clinical Research Scholars and Fellows Program's goal is to foster the next generation of clinical investigators and to help build international health research partnerships between American and international investigators and institutions. Through June 2012, 61 sites in 27 countries have hosted 436 Scholars (American students or junior trainees from the host countries) and/or 122 Fellows (American and host country postdoctoral fellows) for year-long experiences in global health research. Initially, the program was oriented toward infectious diseases, but recently emphasis on chronic disease research has increased. At least 521 manuscripts have been published, many in high-impact journals. Projects have included clinical trials, observational studies, translational research, clinical-laboratory interface initiatives, and behavioral research. Strengths of the program include training opportunities for American and developing country scientists in well-established international clinical research settings, and mentorship from experienced global health experts.

  8. Role of Polycrystalline Thin-Film PV Technologies in Competitive PV Module Markets: Preprint

    SciTech Connect

    von Roedern, B.; Ullal, H. S.

    2008-05-01

    This paper discusses the developments in thin-film PV technologies and provides an outlook on future commercial module efficiencies achievable based on today's knowledge about champion cell performance.

  9. Commercialization of PV-powered pumping systems for use in utility PV service programs. Final report

    SciTech Connect

    1997-03-01

    The project described in this report was a commercialization effort focused on cost-effective remote water pumping systems for use in utility-based photovoltaic (PV) service programs. The project combined a commercialization strategy tailored specifically for electric utilities with the development of a PV-powered pumping system that operates conventional ac pumps rather than relying on the more expensive and less reliable PV pumps on the market. By combining these two attributes, a project goal was established of creating sustained utility purchases of 250 PV-powered water pumping systems per year. The results of each of these tasks are presented in two parts contained in this Final Summary Report. The first part summarizes the results of the Photovoltaic Services Network (PSN) as a new business venture, while the second part summarizes the results of the Golden Photon system installations. Specifically, results and photographs from each of the system installations are presented in this latter part.

  10. The UCSD Student-Run Free Clinic Project: transdisciplinary health professional education.

    PubMed

    Beck, Ellen

    2005-05-01

    In the face of the serious problem of lack of access to health care in the United States, with over 45 million uninsured,1 there exist many models of collaborative local programs serving the uninsured. One such approach is the student-run free clinic, small projects managed by health professional students, supervised by licensed health professionals, offering free health services to those without health access. The purpose of this article is to describe the UCSD Student-Run Free Clinic Project, its history, mission, partners, clinical services, curriculum, funding, replicability, outcomes, elements of success, transdisciplinary nature, and hopes for the future.

  11. Calibration of Self-Reported Oral Health to Clinically Determined Standards

    PubMed Central

    Liu, Honghu; Maida, Carl A.; Spolsky, Vladimir W.; Shen, Jie; Li, Helen; Zhou, Xiaomeng; Marcus, Marvin

    2010-01-01

    Objective Self-report of oral health is an inexpensive approach to assessing an individual’s oral health status, but it is heavily influenced by personal views and usually differs from that of clinically determined oral health status. To assist researchers and clinicians in estimating oral health self-report, we summarize clinically determined oral health measures that can objectively measure oral health and evaluate the discrepancies between self-reported and clinically determined oral health status. We test hypotheses of trends across covariates, thereby creating optimal calibration models and tools that can adjust self-reported oral health to clinically determined standards. Methods Using National Health and Nutrition Examination Survey (NHANES) data, we examined the discrepancy between self-reported and clinically determined oral health. We evaluated the relationship between the degree of this discrepancy and possible factors contributing to this discrepancy, such as patient characteristics and general health condition. We used a regression approach to develop calibration models for self-reported oral health. Results The relationship between self-reported and clinically determined oral health is complex. Generally, there is a discrepancy between the two that can best be calibrated by a model that includes general health condition, number of times a person has received health care, gender, age, education, and income. Conclusion The model we developed can be used to calibrate and adjust self-reported oral health status to that of clinically determined standards and for oral health screening of large populations in federal, state, and local programs, enabling great savings in resources used in dental care. PMID:21054482

  12. High Resolution PV Power Modeling for Distribution Circuit Analysis

    SciTech Connect

    Norris, B. L.; Dise, J. H.

    2013-09-01

    NREL has contracted with Clean Power Research to provide 1-minute simulation datasets of PV systems located at three high penetration distribution feeders in the service territory of Southern California Edison (SCE): Porterville, Palmdale, and Fontana, California. The resulting PV simulations will be used to separately model the electrical circuits to determine the impacts of PV on circuit operations.

  13. Beacons In Brief. P/PV In Brief. Issue 2

    ERIC Educational Resources Information Center

    Blank, Susan; Farley, Chelsea

    2004-01-01

    This second issue in P/PV's "In Brief" series focuses on the San Francisco Beacon Initiative and P/PV's recently released evaluation results. The Beacon Initiative established after-school programs in eight public schools in low-income San Francisco neighborhoods. P/PV's 36-month evaluation examined key developmental and academic outcomes.…

  14. Beacons In Brief. P/PV In Brief. Issue 2

    ERIC Educational Resources Information Center

    Blank, Susan; Farley, Chelsea

    2004-01-01

    This second issue in P/PV's "In Brief" series focuses on the San Francisco Beacon Initiative and P/PV's recently released evaluation results. The Beacon Initiative established after-school programs in eight public schools in low-income San Francisco neighborhoods. P/PV's 36-month evaluation examined key developmental and academic outcomes.…

  15. Determination of Parameters of PV Concentrating System With Heliostat

    NASA Astrophysics Data System (ADS)

    Vardanyan, R.; Norsoyan, A.; Dallakyan, V.

    2010-10-01

    The structure of PV concentrating system with heliostat is analyzed. The mathematical model of system consisting of PV concentrating module and heliostat is developed. With the use of developed mathematical model the optimal parameters of the system are determined. The results of this work can be used during the design of PV concentrating systems with heliostats.

  16. The possibility of developing hybrid PV/T solar system

    NASA Astrophysics Data System (ADS)

    Dobrnjac, M.; Zivkovic, P.; Babic, V.

    2017-05-01

    An alternative and cost-effective solution to developing integrated PV system is to use hybrid photovoltaic/thermal (PV/T) solar system. The temperature of PV modules increases due to the absorbed solar radiation that is not converted into electricity, causing a decrease in their efficiency. In hybrid PV/T solar systems the reduction of PV module temperature can be combined with a useful fluid heating. In this paper we present the possibility of developing a new hybrid PV/T solar system. Hybrid PV/T system can provide electrical and thermal energy, thus achieving a higher energy conversion rate of the absorbed solar radiation. We developed PV/T prototype consisted of commercial PV module and thermal panel with our original solution of aluminium absorber with special geometric shapes. The main advantages of our combined PV/T system are: removing of heat from the PV panel; extending the lifetime of photovoltaic cells; excess of the removing heat from PV part is used to heat the fluid in the thermal part of the panel; the possibility of using on the roof and facade constructions because less weight.

  17. Effect of immersive workplace experience on undergraduate nurses' mental health clinical confidence.

    PubMed

    Patterson, Christopher; Moxham, Lorna; Taylor, Ellie K; Perlman, Dana; Brighton, Renee; Sumskis, Susan; Heffernan, Tim; Lee-Bates, Benjamin

    2017-02-03

    Preregistration education needs to ensure that student nurses are properly trained with the required skills and knowledge, and have the confidence to work with people who have a mental illness. With increased attention on non-traditional mental health clinical placements, further research is required to determine the effects of non-traditional mental health clinical placements on mental health clinical confidence. The aim of the present study was to investigate the impact of a non-traditional mental health clinical placement on mental health nursing clinical confidence compared to nursing students undergoing traditional clinical placements. Using the Mental Health Nursing Clinical Confidence Scale, the study investigated the relative effects of two placement programmes on the mental health clinical confidence of 79 nursing students. The two placement programmes included a non-traditional clinical placement of Recovery Camp and a comparison group that attended traditional clinical placements. Overall, the results indicated that, for both groups, mental health placement had a significant effect on improving mean mental health clinical confidence, both immediately upon conclusion of placement and at the 3-month follow up. Students who attended Recovery Camp reported a significant positive difference, compared to the comparison group, for ratings related to communicating effectively with clients with a mental illness, having a basic knowledge of antipsychotic medications and their side-effects, and providing client education regarding the effects and side-effects of medications. The findings suggest that a unique clinical placement, such as Recovery Camp, can improve and maintain facets of mental health clinical confidence for students of nursing.

  18. Model based non-invasive estimation of PV loop from echocardiography.

    PubMed

    Itu, Lucian; Sharma, Puneet; Georgescu, Bogdan; Kamen, Ali; Suciu, Constantin; Comaniciu, Dorin

    2014-01-01

    We introduce a model-based approach for the non-invasive estimation of patient specific, left ventricular PV loops. A lumped parameter circulation model is used, composed of the pulmonary venous circulation, left atrium, left ventricle and the systemic circulation. A fully automated parameter estimation framework is introduced for model personalization, composed of two sequential steps: first, a series of parameters are computed directly, and, next, a fully automatic optimization-based calibration method is employed to iteratively estimate the values of the remaining parameters. The proposed methodology is first evaluated for three healthy volunteers: a perfect agreement is obtained between the computed quantities and the clinical measurements. Additionally, for an initial validation of the methodology, we computed the PV loop for a patient with mild aortic valve regurgitation and compared the results against the invasively determined quantities: there is a close agreement between the time-varying LV and aortic pressures, time-varying LV volumes, and PV loops.

  19. Retail Health Clinics: A Policy Position Paper From the American College of Physicians.

    PubMed

    Daniel, Hilary; Erickson, Shari

    2015-12-01

    Retail health clinics are walk-in clinics located in retail stores or pharmacies that are typically staffed by nurse practitioners or physician assistants. When they entered the marketplace in the early 2000s, retail clinics offered a limited number of services for low-acuity conditions that were paid for out of pocket by the consumer. Over the past decade, business models for these clinics have evolved to accept public and private health insurance, and some are expanding their services to include diagnosis, treatment, and management of chronic conditions. Retail health clinics are one of several methods of health care delivery that challenge the traditional primary care delivery model. The positions and recommendations offered by the American College of Physicians in this paper are intended to establish a framework that underscores patient safety, communication, and collaboration among retail health clinics, physicians, and patients.

  20. Behavioral medicine and clinical health psychology: introduction to the special issue.

    PubMed

    Christensen, Alan J; Nezu, Arthur M

    2013-04-01

    This issue represents the 4th Journal of Consulting and Clinical Psychology special issue on behavioral medicine and clinical health psychology over the past 4 decades. Recent developments in health care policy, as well as in the maturation of the science, make a special issue in this area particularly timely. This collection includes state of the clinical science reviews, reports of clinical trials, and articles addressing theory and methods in behavioral medicine and clinical health psychology. A multilevel, ecological perspective that considers multiple levels of influences (e.g., cultural influences on behavior-health linkages, individual differences) is salient throughout many of the articles. Our hope is that this sampling of this broad field, and coverage of some key issues and areas, will play a role in stimulating the next 10 years of research, practice, and policy implementation in behavioral medicine and clinical health psychology.

  1. Community health clinical education in Canada: part 1--"state of the art".

    PubMed

    Cohen, Benita E; Gregory, David

    2009-01-01

    This paper presents the findings of a survey of community health clinical education in twenty-four Canadian pre-licensure baccalaureate nursing programs. A qualitative research design was used, involving a content analysis of Canadian course syllabi and supporting documents for community health courses. This study afforded a cross-sectional understanding of the "state of the art" of community health clinical education in Canadian schools of nursing. Clinical course conceptual approaches, course objectives, types of clinical sites, format and number of clinical hours, and methods of student evaluation are identified. The findings suggest the need for a national dialogue or consensus building exercise regarding curriculum content for community health nursing. Informing this dialogue are several strengths including the current focus on community health (as opposed to community-based) nursing education, and a solid socio-environmental perspective informing clinical learning and practice. The national data set generated by this study may have relevance to nursing programs globally.

  2. Student Activism Seventies Style Helps Small Town Get Health Clinic.

    ERIC Educational Resources Information Center

    Coogan, Mercy Hardie

    1979-01-01

    Student health professionals, working as assistants to communities with serious health care problems, helped develop the Shuqualak health center in an area with the highest infant mortality rate in the United States. Describes the Community Technical Assistance Program and the history of the Shuqualak project. (SB)

  3. [Comparisons between clinical practice consultation in a prison and in community health centres: differences and repercussions].

    PubMed

    Chérrez, C; Alás, R; Sanchiz, J R

    2007-02-01

    To describe and quantify clinical practice consultancy in a prison health care unit so as to evaluate likely differences from a community Health Care Centre. To identify possible training needs when transferring health care staff from one system to another in the light of probable integration of Prison Health Care into the Public Health System. A transversal descriptive study was used for three Primary Health Care teams: an urban health centre with a high work load, a rural health centre with a low work load, and the health care unit of a provincial prison (not a mega-prison). Ransom sequential sampling was used to include all the medical activity generated in the consultancy. All activity programmed by the health professional and administrative consultancy was excluded, while efforts were made to locate troubled consultations. Comparisons were made by contrasting differences in proportions. The Prison Health Care Unit showed higher statistically significant clinical activity in mental health, drug abuse, HIV and HCV infection management and specific Primary Health Care problems (biopsychosocial integration is a therapeutic priority). In both community Health Centres there is more statistically significant activity in Internal Medicine and Geriatrics. In the prison environment there is significantly higher troubled consultation. In a future context of integration of prison health care services into the Public Health Service, training in mental health care (especially addictive disorders) and in HIV-HCV infection management may be necessary for community health centre professionals wishing to transfer to prison health care units. The prison health care professional who wants to work in a public health centre may need training in Internal Medicine (especially Geriatrics). The statistically significant results for health care in prison, Primary Health Care and troubled consultation suggest that the GP plays a more active role in prison than in the community health

  4. Comprehensive school-based health clinics: a growing movement to improve adolescent health and reduce teen-age pregnancy.

    PubMed

    Kirby, D

    1986-09-01

    The lack of needed health care and the number of unintended pregnancies among young people in the U.S. have caused many schools to increase the scope of their health services in the past 2 decades. Beginning in the 1970s, some communities also responded to that need with more comprehensive health clinics. By August of 1986, the Support Center for School-Based Clinics at the Center for Population Options had identified more than 60 comprehensive clinics in the U.S. having the characteristics identified in this discussion. Locations of these clinics include Chicago, Kansas City, St. Paul, and West Dallas. These comprehensive health centers provide direct comprehensive primary care, prescribe and/or dispense medications, provide family planning and other services related to sexuality, commonly are operated by established medical providers rather than the schools, and are staffed by nurse practitioners and physicians. These comprehensive centers represent the next step in an evolutionary process of improving adolescent health care in the schools. The Support Center for School-Based clinics collected questionnaire data on the clinics. Most of the comprehensive clinics offer a variety of services. All of the clinics facilitate family planning and minimally provide counseling about sexual activity and birth control, make referrals, and engage in follow-up activities. Direct management of all but 1 clinic is by nonschool agencies. Most clinics strongly encourage patients to discuss any health problems as well as sexual decisions with their parents. Virtually all clinics obtain written consent from parents before students receive medical services. According to the providers, the location of clinics in schools offers many advantages, including: each clinic is accessible and familiar; because the clinic is strictly an adolescent clinic, it can hire staff that like adolescents and are skilled at working with adolescents; many clinic services are consolidated; and the clinics

  5. Enabling professional development in mental health nursing: the role of clinical leadership.

    PubMed

    Ennis, G; Happell, B; Reid-Searl, K

    2015-10-01

    Clinical leadership is acknowledged as important to the nursing profession. While studies continue to identify its significance in contributing to positive outcomes for consumers, the role that clinical leadership has in enabling and supporting professional development in mental health nursing is poorly understood. This study utilized a grounded theory methodology to explore the characteristics clinicians consider important for clinical leadership and its significance for mental health nursing in day-to-day clinical practice. Individual face-to-face, semi-structured interviews were conducted with nurses working in mental health settings. Participants described the important role that clinical leaders play in enabling professional development of others through role modelling and clinical teaching. They describe how nurses, whom they perceive as clinical leaders, use role modelling and clinical teaching to influence the professional development of nursing staff and undergraduate nursing students. Attributes such as professionalism and honesty were seen, by participants, as enablers for clinical leaders in effectively and positively supporting the professional development of junior staff and undergraduate nurses in mental health nursing. This paper examines clinical leadership from the perspective of mental health nurses delivering care, and highlights the important role of clinical leaders in supporting professional development in mental health nursing. © 2015 John Wiley & Sons Ltd.

  6. Characterizing Primary Care Visit Activities at Veterans Health Administration Clinics.

    PubMed

    Gutierrez, Jennifer C; Terwiesch, Christian; Pelak, Mary; Pettit, Amy R; Marcus, Steven C

    2015-01-01

    Medical home models seek to increase efficiency and maximize the use of resources by ensuring that all care team members work at the top of their licenses. We sought to break down primary care office visits into measurable activities to better under stand how primary care providers (PCPs) currently spend visit time and to provide insight into potential opportunities for revision or redistribution of healthcare tasks. We videotaped 27 PCPs during office visits with 121 patients at four Veterans Health Administration medical centers. Based on patterns emerging from the data, we identified a taxonomy of 12 provider activity categories that enabled us to quantify the frequency and duration of activities occurring during routine primary care visits. We conducted descriptive and multivariate analyses to examine associations between visit characteristics and provider and clinic characteristics. We found that PCPs spent the greatest percentage of their visit time discussing existing conditions (20%), discussing new conditions (18%), record keeping (13%), and examining patients (13%). Providers spent the smallest percentage of time on preventive care and coordination of care. Mean visit length was 22.9 minutes (range 7.9-58.0 minutes). Site-level ratings of medical home implementation were not associated with differences in how visit time was spent. These data provide a window into how PCPs are spending face-to-face time with patients. The methodology and taxonomy presented here may prove useful for future quality improvement and research endeavors, particularly those focused on opportunities to increase nonappointment care and to ensure that team members work at the top of their skill level.

  7. Clinical Trials: A Crucial Key to Human Health Research

    MedlinePlus

    ... that work in people, and there are clinical trials going on all the time in virtually every area of medical research. People who volunteer to take part in clinical trials do so for several reasons, including the chance ...

  8. Patient-Centered Participatory Research in Three Health Clinics: Benefits, Challenges, and Lessons Learned.

    PubMed

    Fava, Nicole M; Munro-Kramer, Michelle L; Felicetti, Irene L; Darling-Fisher, Cynthia S; Pardee, Michelle; Helman, Abigail; Trucco, Elisa M; Martyn, Kristy K

    2016-06-23

    Research informed by individuals' lived experiences is a critical component of participatory research and nursing interventions for health promotion. Yet, few examples of participatory research in primary care settings with adolescents and young adults exist, especially with respect to their sexual health and health-risk behaviors. Therefore, we implemented a validated patient-centered clinical assessment tool to improve the quality of communication between youth patients and providers, sexual risk assessment, and youths' health-risk perception to promote sexual health and reduce health-risk behaviors among adolescents and young adults in three community health clinic settings, consistent with national recommendations as best practices in adolescent health care. We describe guiding principles, benefits, challenges, and lessons learned from our experience. Improving clinical translation of participatory research requires consideration of the needs and desires of key stakeholders (e.g., providers, patients, and researchers) while retaining flexibility to successfully navigate imperfect, real-world conditions.

  9. Technologies to Increase PV Hosting Capacity in Distribution Feeders

    SciTech Connect

    Ding, Fei; Mather, Barry; Gotseff, Peter

    2016-11-14

    This paper studies the distributed photovoltaic (PV) hosting capacity in distribution feeders by using the stochastic analysis approach. Multiple scenario simulations are conducted to analyze several factors that affect PV hosting capacity, including the existence of voltage regulator, PV location, the power factor of PV inverter and Volt/VAR control. Based on the conclusions obtained from simulation results, three approaches are then proposed to increase distributed PV hosting capacity, which can be formulated as the optimization problem to obtain the optimal solution. All technologies investigated in this paper utilize only existing assets in the feeder and therefore are implementable for a low cost. Additionally, the tool developed for these studies is described.

  10. Technologies to Increase PV Hosting Capacity in Distribution Feeders: Preprint

    SciTech Connect

    Ding, Fei; Mather, Barry; Gotseff, Peter

    2016-08-01

    This paper studies the distributed photovoltaic (PV) hosting capacity in distribution feeders by using the stochastic analysis approach. Multiple scenario simulations are conducted to analyze several factors that affect PV hosting capacity, including the existence of voltage regulator, PV location, the power factor of PV inverter and Volt/VAR control. Based on the conclusions obtained from simulation results, three approaches are then proposed to increase distributed PV hosting capacity, which can be formulated as the optimization problem to obtain the optimal solution. All technologies investigated in this paper utilize only existing assets in the feeder and therefore are implementable for a low cost. Additionally, the tool developed for these studies is described.

  11. PV_LIB Toolbox v. 1.3

    SciTech Connect

    2015-12-09

    PV_LIB comprises a library of Matlab? code for modeling photovoltaic (PV) systems. Included are functions to compute solar position and to estimate irradiance in the PV system’s plane of array, cell temperature, PV module electrical output, and conversion from DC to AC power. Also included are functions that aid in determining parameters for module performance models from module characterization testing. PV_LIB is open source code primarily intended for research and academic purposes. All algorithms are documented in openly available literature with the appropriate references included in comments within the code.

  12. Advancing LGBT Health Care Policies and Clinical Care Within a Large Academic Health Care System: A Case Study.

    PubMed

    Ruben, Mollie A; Shipherd, Jillian C; Topor, David; AhnAllen, Christopher G; Sloan, Colleen A; Walton, Heather M; Matza, Alexis R; Trezza, Glenn R

    2017-01-01

    Culturally competent health care is especially important among sexual and gender minority patients because poor cultural competence contributes to health disparities. There is a need to understand how to improve health care quality and delivery for lesbian, gay, bisexual, and transgender (LGBT) veterans in particular, because they have unique physical and mental health needs as both LGBT individuals and veterans. The following article is a case study that focuses on the policy and clinical care practices related to LGBT clinical competency, professional training, and ethical provision of care for veteran patients in the VA Boston Healthcare System. We apply Betancourt et al.'s (2003) cultural competence framework to outline the steps that VA Boston Healthcare System took to increase cultural competency at the organizational, structural, and clinical level. By sharing our experiences, we aim to provide a model and steps for other health care systems and programs, including other VA health care systems, large academic health care systems, community health care systems, and mental health care systems, interested in developing LGBT health initiatives.

  13. The importance of communication for clinical leaders in mental health nursing: the perspective of nurses working in mental health.

    PubMed

    Ennis, Gary; Happell, Brenda; Broadbent, Marc; Reid-Searl, Kerry

    2013-11-01

    Communication has been identified as an important attribute of clinical leadership in nursing. However, there is a paucity of research on its relevance in mental health nursing. This article presents the findings of a grounded theory informed study exploring the attributes and characteristics required for effective clinical leadership in mental health nursing, specifically the views of nurses working in mental health about the importance of effective communication in day to day clinical leadership. In-depth interviews were conducted to gain insight into the participants' experiences and views on clinical leadership in mental health nursing. The data that emerged from these interviews were constantly compared and reviewed, ensuring that any themes that emerged were based on the participants' own experiences and views. Participants recognized that effective communication was one of the attributes of effective clinical leadership and they considered communication as essential for successful working relationships and improved learning experiences for junior staff and students in mental health nursing. Four main themes emerged: choice of language; relationships; nonverbal communication, and listening and relevance. Participants identified that clinical leadership in mental health nursing requires effective communication skills, which enables the development of effective working relationships with others that allows them to contribute to the retention of staff, improved outcomes for clients, and the development of the profession.

  14. The Adolescent Health Review: Test of a Computerized Screening Tool in School-Based Clinics.

    ERIC Educational Resources Information Center

    Harrison, Patricia A.; Beebe, Timothy J.; Funk, Eunkyung; Rancome, Jeanne

    2003-01-01

    Implemented a computerized screening instrument, the Adolescent Health Review, in urban school-based clinics to test the viability of a stand-alone screening process and its acceptance by patients and providers, examining the relationship between health risks and the stated purpose for the clinic visit. Patients and providers readily accepted the…

  15. Student Contributions to Clinical Agencies: A Comparison of Adult Health and Psychiatric Staff Nurses' Perceptions.

    ERIC Educational Resources Information Center

    Grindel, Cecelia Gatson; Bateman, Anne L.; Patsdaughter, Carol A.; Babington, Lynn M.; Medici, Geraldine

    2001-01-01

    Adult health/medical-surgical nurses (n=54) and mental health/psychiatric nurses (n=54) were surveyed about contributions of nursing students in clinical placements. Students provided clinical staff with opportunities for mentoring, reciprocal learning, and professional development and made direct contributions to patient care. (SK)

  16. Student Contributions to Clinical Agencies: A Comparison of Adult Health and Psychiatric Staff Nurses' Perceptions.

    ERIC Educational Resources Information Center

    Grindel, Cecelia Gatson; Bateman, Anne L.; Patsdaughter, Carol A.; Babington, Lynn M.; Medici, Geraldine

    2001-01-01

    Adult health/medical-surgical nurses (n=54) and mental health/psychiatric nurses (n=54) were surveyed about contributions of nursing students in clinical placements. Students provided clinical staff with opportunities for mentoring, reciprocal learning, and professional development and made direct contributions to patient care. (SK)

  17. National Assessment of Clinical Education of Allied Health Manpower: Volume III, Monographs.

    ERIC Educational Resources Information Center

    Booz Allen and Hamilton, Inc., Washington, DC.

    The document is the third volume of a four-part report of a study conducted to evaluate and assess the state of allied health manpower clinical education and training. Four monographs focus on important issues related to clinical education as a major factor in the training of allied health manpower. In "A Critical Analysis of Methods of Ensuring…

  18. Form and Function of Written Agreements in the Clinical Education of Health Professionals.

    ERIC Educational Resources Information Center

    Moore, Margaret L.; And Others

    The book discusses the current problems of arranging clinical experiences for allied health personnels which will meet student needs as well as the interdependent objectives of educational and clinical institutions. Chapter 1 reviews general trends in the education of health practitioners with particular consideration of the status of physical…

  19. Serum antibodies and DNA indicate a high prevalence of equine papillomavirus 2 (EcPV2) among horses in Switzerland.

    PubMed

    Fischer, Nina M; Favrot, Claude; Birkmann, Katharina; Jackson, Michele; Schwarzwald, Colin C; Müller, Martin; Tobler, Kurt; Geisseler, Marco; Lange, Christian E

    2014-06-01

    The DNA of equine papillomavirus type 2 (EcPV2) is consistently found in equine papillomas and squamous cell carcinomas, indicating a causal association of EcPV2 in the pathogenesis of these tumours; however, little is known about the prevalence of this virus. The aim of this study was to determine the geno- and seroprevalence of EcPV2 in clinically healthy horses in Switzerland. Fifty horses presented to the equine department of the university clinic, displaying no skin or mucous membrane lesions or severe signs of other diseases, were sampled. Cytobrush samples from the penis or vulva and serum samples were collected. To determine the genoprevalence of EcPV2, DNA was extracted from cytobrush samples and tested for viral DNA with a PCR assay amplifying a 338 bp fragment of the E7/E1 region of the viral genome. Seroprevalence was tested using an enzyme-linked immunosorbent assay aimed to detect antibodies against the major capsid protein (L1) of EcPV2. In five of 50 horses (10%), EcPV2-specific DNA was amplified but no antibodies could be detected, whereas in 14 of 50 horses (28%), antibodies against EcPV2 but no DNA were demonstrated. Both antibodies and viral DNA were detected in four of 50 horses (8%). Neither antibodies nor viral DNA were found in 27 of 50 horses (54%). The seroprevalence suggests that EcPV2 is prevalent in the Swiss equine population, while the genoprevalence indicates that currently ongoing infections are less common. The discrepancy between geno- and seroprevalence probably indicates different stages of infection in the tested cohort. © 2014 ESVD and ACVD.

  20. Assessing integration of clinical and public health skills in preventive medicine residencies: using competency mapping.

    PubMed

    Wells, Eden V; Sarigiannis, Amy N; Boulton, Matthew L

    2012-06-01

    We evaluated the utility of a competency mapping process for assessing the integration of clinical and public health skills in a newly developed Community Health Center (CHC) rotation at the University of Michigan School of Public Health Preventive Medicine residency. Learning objectives for the CHC rotation were derived from the Accreditation Council for Graduate Medical Education core clinical preventive medicine competencies. CHC learning objectives were mapped to clinical preventive medicine competencies specific to the specialty of public health and general preventive medicine. Objectives were also mapped to The Council on Linkages Between Academia and Public Health Practice's tier 2 Core Competencies for Public Health Professionals. CHC learning objectives mapped to all 4 (100%) of the public health and general preventive medicine clinical preventive medicine competencies. CHC population-level learning objectives mapped to 32 (94%) of 34 competencies for public health professionals. Utilizing competency mapping to assess clinical-public health integration in a new CHC rotation proved to be feasible and useful. Clinical preventive medicine learning objectives for a CHC rotation can also address public health competencies.

  1. Assessing integration of clinical and public health skills in preventive medicine residencies: using competency mapping.

    PubMed

    Wells, Eden V; Sarigiannis, Amy N; Boulton, Matthew L

    2012-06-01

    To evaluate the utility of a competency mapping process for assessing the integration of clinical and public health skills in a newly developed Community Health Center (CHC) rotation at the University of Michigan School of Public Health Preventive Medicine residency. Learning objectives for the CHC rotation were derived from the Accreditation Council for Graduate Medical Education core clinical preventive medicine competencies. CHC learning objectives were mapped to clinical preventive medicine competencies specific to the specialty of public health and general preventive medicine. Objectives were also mapped to The Council on Linkages Between Academia and Public Health Practice's Tier-2 Core Competencies for Public Health Professionals. CHC learning objectives mapped to all four (100%) of the public health and general preventive medicine clinical preventive medicine competencies. CHC population-level learning objectives mapped to 32 (94%) of 34 competencies for public health professionals. Utilizing competency mapping to assess clinical-public health integration in a new CHC rotation proved to be feasible and useful. Clinical preventive medicine learning objectives for a CHC rotation can also address public health competencies. Copyright © 2012 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  2. The new production theory for health care through clinical reengineering: a study of clinical guidelines--Part II.

    PubMed

    Sharp, J R

    1995-01-01

    In Part I of this two-part article, in the December 1994 issue of the journal, the author discussed the manufacturing theories of Peter Drucker in terms of their applicability for the health care field. He concluded that Drucker's four principles and practices of manufacturing--statistical quality control, manufacturing accounting, modular organization, and systems approach--do have application to the health care system. Clinical guidelines, a variation on the Drucker theory, are a specific example of the manufacturing process in health. The performance to date of some guidelines and their implications for the health care reform debate are discussed in Part II of the article.

  3. [The micropolitics of desire: the clinic of the individual in the mental health institution].

    PubMed

    Rinaldi, Doris Luz

    2015-02-01

    The scope of this article is to discuss clinical practice issues in public mental health institutions, their predicaments and potential conditions, focusing especially on the practice "among others" of the psycho analyst in this clinic. The mental health field is a field in permanent revitalization, marked by the heterogeneity and plurality of guidelines, permeated by tensions between old models of care, new political objectives to redeem the minimum rights of a population traditionally excluded from social coexistence and proposals for a new clinical practice that concentrates on the individual. Based on clinical perceptions, I intend to approach the clinical treatment of the individual in a mental health institution, as well as the challenges of working in a team, bearing in mind the impositions of mental health policy arounnd which the services are structured. Our proposal is to think of the clinic as the micro politics of desire that sustains the daily work of monitoring the course of treatment for each individual.

  4. Materials Testing for PV Module Encapsulation

    SciTech Connect

    Jorgensen, G.; Terwilliger, K.; Glick, S.; Pern, J.; McMahon, T.

    2003-05-01

    Important physical properties of materials used in PV module packaging are presented. High-moisture-barrier, high-resistivity, adhesion-promoting coatings on polyethyl-ene terephthalate (PET) films have been fabricated and characterized for use in PV module application and com-pared to standard polymer backsheet materials. Ethylene vinyl acetate (EVA) and an encapsulant replacement for EVA are studied for their water vapor transmission rate (WVTR) and adhesion properties. WVTR, at test conditions up to 85C/100% relative humidity (RH), and adhesion val-ues are measured before and after filtered xenon arc lamp ultraviolet (UV) exposure and damp heat exposure at 85C/85% RH. Water ingress is quantified by weight gain and embedded humidity sensors.

  5. Cascaded Microinverter PV System for Reduced Cost

    SciTech Connect

    Bellus, Daniel R.; Ely, Jeffrey A.

    2013-04-29

    In this project, a team led by Delphi will develop and demonstrate a novel cascaded photovoltaic (PV) inverter architecture using advanced components. This approach will reduce the cost and improve the performance of medium and large-sized PV systems. The overall project objective is to develop, build, and test a modular 11-level cascaded three-phase inverter building block for photovoltaic applications and to develop and analyze the associated commercialization plan. The system will be designed to utilize photovoltaic panels and will supply power to the electric grid at 208 VAC, 60 Hz 3-phase. With the proposed topology, three inverters, each with an embedded controller, will monitor and control each of the cascade sections, reducing costs associated with extra control boards. This report details the final disposition on this project.

  6. Public health for the twenty-first century: what role do veterinarians in clinical practice play?

    PubMed

    Trevejo, Rosalie T

    2009-03-01

    All veterinarians, regardless of their formal job description, serve the public good and contribute to public health. The public health activities veterinarians engage in most frequently in clinical practice are in the areas of disease detection, reporting, and prevention. This article provides a brief overview of the basic functions of public health, while emphasizing the public health roles that veterinary clinicians play in their day-to-day practice of veterinary medicine and how they might extend their interest and involvement in this field. The multidisciplinary nature of the field of public health and the benefits of collaboration with other health care and public health professionals are also discussed.

  7. The prescribing clinical health psychologist: a hybrid skill set in the new era of integrated healthcare.

    PubMed

    McGuinness, Kevin M

    2012-12-01

    The prescribing clinical health psychologist brings together in one individual a combination of skills to create a hybrid profession that can add value to any healthcare organization. This article addresses the high demand for mental health services and the inequitable distribution of mental health practitioners across the nation. The close link between physical and mental health and evidence that individuals in psychological distress often enter the mental health system via primary care medical clinics is offered as background to a discussion of the author's work as a commissioned officer of the U.S. Public Health Service assigned to the Chaparral Medical Center of La Clinica de Familia, Inc. near the U.S.-Mexico border. The prescribing clinical health psychologist in primary care medical settings is described as a valuable asset to the future of professional psychology.

  8. Barriers and Enablers to Clinical Fieldwork Education in Rural Public and Private Allied Health Practice

    ERIC Educational Resources Information Center

    Maloney, Phoebe; Stagnitti, Karen; Schoo, Adrian

    2013-01-01

    There is a need to maximise rural clinical fieldwork placement to build health workforce capacity. This study investigated allied health professionals' (AHPs) experience of supervising students as part of work-integrated learning in public and private rural health settings. An anonymous postal questionnaire with 30 questions was used to collect…

  9. Oral Health Status and Behaviour of Mauritians Visiting Private Dental Clinics

    ERIC Educational Resources Information Center

    Gunsam, P. Pugo; Banka, S.

    2011-01-01

    Purpose: This paper seeks to assess the oral health status and behaviour of a sample of the Mauritian population visiting private dental clinics. Design/methodology/approach: Oral health status was determined using the World Health Organization (Decayed, Missing, Filled Teeth (DMFT) index indicating the prevalence of caries, and factors associated…

  10. Oral Health Status and Behaviour of Mauritians Visiting Private Dental Clinics

    ERIC Educational Resources Information Center

    Gunsam, P. Pugo; Banka, S.

    2011-01-01

    Purpose: This paper seeks to assess the oral health status and behaviour of a sample of the Mauritian population visiting private dental clinics. Design/methodology/approach: Oral health status was determined using the World Health Organization (Decayed, Missing, Filled Teeth (DMFT) index indicating the prevalence of caries, and factors associated…

  11. Barriers and Enablers to Clinical Fieldwork Education in Rural Public and Private Allied Health Practice

    ERIC Educational Resources Information Center

    Maloney, Phoebe; Stagnitti, Karen; Schoo, Adrian

    2013-01-01

    There is a need to maximise rural clinical fieldwork placement to build health workforce capacity. This study investigated allied health professionals' (AHPs) experience of supervising students as part of work-integrated learning in public and private rural health settings. An anonymous postal questionnaire with 30 questions was used to collect…

  12. Clinical decision support: the power behind the electronic health record.

    PubMed

    Glaser, John

    2008-07-01

    There are six strategic objectives for promoting adoption of clinical decision support: Use a standardized format for representing clinical data and CDS interventions. Ensure appropriate access to clinical data and CDS interventions. Provide support and incentives for providers to use CDS. Disseminate information about best practices for system design, CDS delivery, and CDS implementation. Continue national demonstrations and evaluation of CDS use. Leverage data interchange between EHRs.

  13. Multiplex Nested PCR for Detection of Xanthomonas axonopodis pv. allii from Onion Seeds▿ †

    PubMed Central

    Robène-Soustrade, Isabelle; Legrand, Delphine; Gagnevin, Lionel; Chiroleu, Frédéric; Laurent, Annie; Pruvost, Olivier

    2010-01-01

    Bacterial blight of onion (BBO) is an emerging disease that is present in many onion-producing areas. The causal agent, Xanthomonas axonopodis pv. allii, is seed transmitted. A reliable and sensitive diagnostic tool for testing seed health is needed. Detection of X. axonopodis pv. allii was achieved using a multiplex nested PCR assay developed using two randomly amplified polymorphic DNA (RAPD) and amplified fragment length polymorphism (AFLP) sequences corresponding to pilus assembly genes (pilW and pilX) and the avrRxv gene, respectively. The multiplex nested PCR was used with a large collection of X. axonopodis pv. allii strains pathogenic to onion and/or other Allium species isolated in different regions of the world. The internal primers used in the multiplex PCR assay directed amplification for all 86 X. axonopodis pv. allii strains tested, resulting in a 401-bp amplicon, a 444- to 447-bp amplicon, or both amplicons, depending on the strain. No amplification was obtained for 41 unrelated phytopathogenic bacteria and for 14 saprophytic bacteria commonly isolated from onion leaves and seeds. Most Xanthomonas strains also did not produce amplicons, except for nine strains classified in X. axonopodis genetic subgroup 9.1 or 9.2 and not pathogenic to onion. Nevertheless, sequence signatures distinguished most of these strains from X. axonopodis pv. allii. The assay detected X. axonopodis pv. allii in seed lots with contamination levels of 5 × 102 CFU g−1 or higher. The sensitivity threshold of the multiplex nested PCR assay was found to be 1 infected seed in 27,340 seeds. This PCR-based assay should be useful for certifying that commercial seed lots are free of this important seed-borne pathogen. PMID:20208024

  14. 42 CFR 410.165 - Payment for rural health clinic services and ambulatory surgical center services: Conditions.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Payment for rural health clinic services and... (SMI) BENEFITS Payment of SMI Benefits § 410.165 Payment for rural health clinic services and ambulatory surgical center services: Conditions. (a) Medicare Part B pays for covered rural health clinic...

  15. PV Manufacturing R&D Project -- Trends in the U.S. PV Industry

    SciTech Connect

    Brown, K. E.; Mitchell, R. L.; Bower, W. I.; King, R.

    2005-01-01

    To foster continued growth in the U.S. photovoltaic (PV) industry, the U.S. Department of Energy initiated the PV Manufacturing R&D (PVMR&D) Project--a partnership with U.S. PV industry participants to perform cost-shared manufacturing research and development. Throughout FY 2004, PVMR&D managed fourteen subcontracts across the industry. The impact of PVMR&D is quantified by reductions in direct module manufacturing costs, scale-up of existing PV production capacity, and accrual of cost savings to the public and industry. An analysis of public and industry investment shows that both recaptured funds by mid-1998 based on estimated manufacturing cost savings from PVMR&D participation. Since project inception, total PV manufacturing capacity has increased from 14 MW to 201 MW at the close of 2003, while direct manufacturing costs declined from $5.55/W to $2.49/W. These results demonstrate continued progress toward the overriding goals of the PVMR&D project.

  16. [Clinical practice guidelines: juridical and medico legal issues in health care malpractice liability].

    PubMed

    Moreschi, Carlo; Broi, Ugo Da

    2014-01-01

    Clinical Practice Guidelines are clinical tools addressed to medical and health professionals and are normally employed to improve quality and safety of diagnostic and therapeutical procedures but may sometimes limit the autonomy of medical and other health care professionals. The adherence to Clinical Practice Guidelines should not be an exclusive step to evaluate the liability and respect of standards of care in case of medico-legal investigations being each clinical case very specific. Medical liability and respect of standards of care should be evaluated with the support of Clinical Practice Guidelines and the extensive examination of all specific features, professional background and experience requested to treat each single patient.

  17. Methodological quality of systematic reviews and clinical trials on women's health published in a Brazilian evidence-based health journal

    PubMed Central

    Macedo, Cristiane Rufino; Riera, Rachel; Torloni, Maria Regina

    2013-01-01

    OBJECTIVES: To assess the quality of systematic reviews and clinical trials on women's health recently published in a Brazilian evidence-based health journal. METHOD: All systematic reviews and clinical trials on women's health published in the last five years in the Brazilian Journal of Evidence-based Health were retrieved. Two independent reviewers critically assessed the methodological quality of reviews and trials using AMSTAR and the Cochrane Risk of Bias Table, respectively. RESULTS: Systematic reviews and clinical trials accounted for less than 10% of the 61 original studies on women's health published in the São Paulo Medical Journal over the last five years. All five reviews were considered to be of moderate quality; the worst domains were publication bias and the appropriate use of study quality in formulating conclusions. All three clinical trials were judged to have a high risk of bias. The participant blinding, personnel and outcome assessors and allocation concealment domains had the worst scores. CONCLUSIONS: Most of the systematic reviews and clinical trials on women's health recently published in a Brazilian evidence-based journal are of low to moderate quality. The quality of these types of studies needs improvement. PMID:23778332

  18. Religion, spirituality, and health: the research and clinical implications.

    PubMed

    Koenig, Harold G

    2012-01-01

    This paper provides a concise but comprehensive review of research on religion/spirituality (R/S) and both mental health and physical health. It is based on a systematic review of original data-based quantitative research published in peer-reviewed journals between 1872 and 2010, including a few seminal articles published since 2010. First, I provide a brief historical background to set the stage. Then I review research on R/S and mental health, examining relationships with both positive and negative mental health outcomes, where positive outcomes include well-being, happiness, hope, optimism, and gratefulness, and negative outcomes involve depression, suicide, anxiety, psychosis, substance abuse, delinquency/crime, marital instability, and personality traits (positive and negative). I then explain how and why R/S might influence mental health. Next, I review research on R/S and health behaviors such as physical activity, cigarette smoking, diet, and sexual practices, followed by a review of relationships between R/S and heart disease, hypertension, cerebrovascular disease, Alzheimer's disease and dementia, immune functions, endocrine functions, cancer, overall mortality, physical disability, pain, and somatic symptoms. I then present a theoretical model explaining how R/S might influence physical health. Finally, I discuss what health professionals should do in light of these research findings and make recommendations in this regard.

  19. Building Bridges between School-Based Health Clinics and Schools

    ERIC Educational Resources Information Center

    Richardson, Jeanita W.

    2007-01-01

    Background: The 2 institutions that hold great promise in mitigating the negative cyclical relationship between poor health and educational readiness are schools and school-based health care facilities (SBHCs). In partnership with schools, SBHCs could have a profound effect on learning outcomes, which include, but are not limited to, poor…

  20. Clinical Issues in Mental Health Service Delivery to Refugees.

    ERIC Educational Resources Information Center

    Gong-Guy, Elizabeth; And Others

    1991-01-01

    Serious limitations exist in the delivery of mental health services to refugees throughout the resettlement process: fragmentation, instability, language barriers, culturally inappropriate treatment methods, and severe staff shortages. Suggested improvements for refugee mental health services emphasize outreach, prevention, treatment approaches,…

  1. School-Located Influenza Vaccination Clinics: Local Health Department Perspectives

    ERIC Educational Resources Information Center

    Ransom, James

    2009-01-01

    Universal childhood influenza vaccination presents challenges and opportunities for health care and public health systems to vaccinate the children who fall under the new recommendation. Advisory Committee on Immunization Practices (ACIP) recommendations and guidelines are helpful, but they do not provide strategies on how to deliver immunization…

  2. Building Bridges between School-Based Health Clinics and Schools

    ERIC Educational Resources Information Center

    Richardson, Jeanita W.

    2007-01-01

    Background: The 2 institutions that hold great promise in mitigating the negative cyclical relationship between poor health and educational readiness are schools and school-based health care facilities (SBHCs). In partnership with schools, SBHCs could have a profound effect on learning outcomes, which include, but are not limited to, poor…

  3. Religion, Spirituality, and Health: The Research and Clinical Implications

    PubMed Central

    Koenig, Harold G.

    2012-01-01

    This paper provides a concise but comprehensive review of research on religion/spirituality (R/S) and both mental health and physical health. It is based on a systematic review of original data-based quantitative research published in peer-reviewed journals between 1872 and 2010, including a few seminal articles published since 2010. First, I provide a brief historical background to set the stage. Then I review research on R/S and mental health, examining relationships with both positive and negative mental health outcomes, where positive outcomes include well-being, happiness, hope, optimism, and gratefulness, and negative outcomes involve depression, suicide, anxiety, psychosis, substance abuse, delinquency/crime, marital instability, and personality traits (positive and negative). I then explain how and why R/S might influence mental health. Next, I review research on R/S and health behaviors such as physical activity, cigarette smoking, diet, and sexual practices, followed by a review of relationships between R/S and heart disease, hypertension, cerebrovascular disease, Alzheimer's disease and dementia, immune functions, endocrine functions, cancer, overall mortality, physical disability, pain, and somatic symptoms. I then present a theoretical model explaining how R/S might influence physical health. Finally, I discuss what health professionals should do in light of these research findings and make recommendations in this regard. PMID:23762764

  4. The Health Clinic. School of the Future: Houston.

    ERIC Educational Resources Information Center

    Iscoe, Louise

    The Hogg Foundation for Mental Health created the School of the Future (SoF) project to enable selected Texas schools to coordinate and implement school-based social and health services on their campuses and to demonstrate the effectiveness of this method of service delivery by evaluating the project. SoF operated in four urban sites in Texas,…

  5. School-Located Influenza Vaccination Clinics: Local Health Department Perspectives

    ERIC Educational Resources Information Center

    Ransom, James

    2009-01-01

    Universal childhood influenza vaccination presents challenges and opportunities for health care and public health systems to vaccinate the children who fall under the new recommendation. Advisory Committee on Immunization Practices (ACIP) recommendations and guidelines are helpful, but they do not provide strategies on how to deliver immunization…

  6. Understanding Clinician Information Demands and Synthesis of Clinical Documents in Electronic Health Record Systems

    ERIC Educational Resources Information Center

    Farri, Oladimeji Feyisetan

    2012-01-01

    Large quantities of redundant clinical data are usually transferred from one clinical document to another, making the review of such documents cognitively burdensome and potentially error-prone. Inadequate designs of electronic health record (EHR) clinical document user interfaces probably contribute to the difficulties clinicians experience while…

  7. Automated Methods to Extract Patient New Information from Clinical Notes in Electronic Health Record Systems

    ERIC Educational Resources Information Center

    Zhang, Rui

    2013-01-01

    The widespread adoption of Electronic Health Record (EHR) has resulted in rapid text proliferation within clinical care. Clinicians' use of copying and pasting functions in EHR systems further compounds this by creating a large amount of redundant clinical information in clinical documents. A mixture of redundant information (especially outdated…

  8. Guidelines for Clinical Experiences in Health Occupations Education. Information Series: Report No. 12.

    ERIC Educational Resources Information Center

    Walters, Norma J., Ed.; Johnson, Lois H., Ed.

    This manual is intended to assist health occupations education (HOE) teachers in planning clinical experiences for their students. Addressed in the individual sections of the guide are the following topics: the purpose, philosophy, and legal aspects of clinical experiences in HOE; the HOE clinical structure (teacher qualifications, the role of the…

  9. Automated Methods to Extract Patient New Information from Clinical Notes in Electronic Health Record Systems

    ERIC Educational Resources Information Center

    Zhang, Rui

    2013-01-01

    The widespread adoption of Electronic Health Record (EHR) has resulted in rapid text proliferation within clinical care. Clinicians' use of copying and pasting functions in EHR systems further compounds this by creating a large amount of redundant clinical information in clinical documents. A mixture of redundant information (especially outdated…

  10. Understanding Clinician Information Demands and Synthesis of Clinical Documents in Electronic Health Record Systems

    ERIC Educational Resources Information Center

    Farri, Oladimeji Feyisetan

    2012-01-01

    Large quantities of redundant clinical data are usually transferred from one clinical document to another, making the review of such documents cognitively burdensome and potentially error-prone. Inadequate designs of electronic health record (EHR) clinical document user interfaces probably contribute to the difficulties clinicians experience while…

  11. Assessing Integration of Clinical and Public Health Skills in Preventive Medicine Residencies: Using Competency Mapping

    PubMed Central

    Sarigiannis, Amy N.; Boulton, Matthew L.

    2012-01-01

    Objectives. We evaluated the utility of a competency mapping process for assessing the integration of clinical and public health skills in a newly developed Community Health Center (CHC) rotation at the University of Michigan School of Public Health Preventive Medicine residency. Methods. Learning objectives for the CHC rotation were derived from the Accreditation Council for Graduate Medical Education core clinical preventive medicine competencies. CHC learning objectives were mapped to clinical preventive medicine competencies specific to the specialty of public health and general preventive medicine. Objectives were also mapped to The Council on Linkages Between Academia and Public Health Practice’s tier 2 Core Competencies for Public Health Professionals. Results. CHC learning objectives mapped to all 4 (100%) of the public health and general preventive medicine clinical preventive medicine competencies. CHC population-level learning objectives mapped to 32 (94%) of 34 competencies for public health professionals. Conclusions. Utilizing competency mapping to assess clinical–public health integration in a new CHC rotation proved to be feasible and useful. Clinical preventive medicine learning objectives for a CHC rotation can also address public health competencies. PMID:22690972

  12. Energy balance of the global photovoltaic (PV) industry--is the PV industry a net electricity producer?

    PubMed

    Dale, Michael; Benson, Sally M

    2013-04-02

    A combination of declining costs and policy measures motivated by greenhouse gas (GHG) emissions reduction and energy security have driven rapid growth in the global installed capacity of solar photovoltaics (PV). This paper develops a number of unique data sets, namely the following: calculation of distribution of global capacity factor for PV deployment; meta-analysis of energy consumption in PV system manufacture and deployment; and documentation of reduction in energetic costs of PV system production. These data are used as input into a new net energy analysis of the global PV industry, as opposed to device level analysis. In addition, the paper introduces a new concept: a model tracking energetic costs of manufacturing and installing PV systems, including balance of system (BOS) components. The model is used to forecast electrical energy requirements to scale up the PV industry and determine the electricity balance of the global PV industry to 2020. Results suggest that the industry was a net consumer of electricity as recently as 2010. However, there is a >50% that in 2012 the PV industry is a net electricity provider and will "pay back" the electrical energy required for its early growth before 2020. Further reducing energetic costs of PV deployment will enable more rapid growth of the PV industry. There is also great potential to increase the capacity factor of PV deployment. These conclusions have a number of implications for R&D and deployment, including the following: monitoring of the energy embodied within PV systems; designing more efficient and durable systems; and deploying PV systems in locations that will achieve high capacity factors.

  13. Clinical supervision of allied health professionals in country South Australia: A mixed methods pilot study.

    PubMed

    Kumar, Saravana; Osborne, Kate; Lehmann, Tanya

    2015-10-01

    Recent times have witnessed dramatic changes in health care with overt recognition for quality and safety to underpin health care service delivery. In addition to systems-wide focus, the importance of supporting and mentoring people delivering the care has also been recognised. This can be achieved through quality clinical supervision. In 2010, Country Health South Australia Local Health Network developed a holistic allied health clinical governance structure, which was implemented in 2011. This research reports on emergent findings from the evaluation of the clinical governance structure, which included mandating clinical supervision for all allied health staff. A mixed method approach was chosen with evaluation of the impact of clinical supervision undertaken by a psychometrically sound instrument (Manchester Clinical Supervision Scale 26-item version), collected through an anonymous online survey and qualitative data collected through semistructured interviews and focus groups. Overall, 189 allied health professionals responded to the survey. Survey responses indicated allied health professionals recognised the importance of and valued receiving clinical supervision (normative domain), had levels of trust and rapport with, and were supported by supervisors (restorative domain) and positively affected their delivery of care and improvement in skills (formative domain). Qualitative data identified enablers such as profession specific gains, improved opportunities and consistency for clinical supervision and barriers such as persistent organisational issues, lack of clarity (delineation of roles) and communication issues. The findings from this research highlight that while clinical supervision has an important role to play, it is not a panacea for all the ills of the health care system. © 2015 National Rural Health Alliance Inc.

  14. Achieving the World Health Organization's vision for clinical pharmacology.

    PubMed

    Martin, Jennifer H; Henry, David; Gray, Jean; Day, Richard; Bochner, Felix; Ferro, Albert; Pirmohamed, Munir; Mörike, Klaus; Schwab, Matthias

    2016-02-01

    Clinical pharmacology is a medical specialty whose practitioners teach, undertake research, frame policy, give information and advice about the actions and proper uses of medicines in humans and implement that knowledge in clinical practice. It involves a combination of several activities: drug discovery and development, training safe prescribers, providing objective and evidence-based therapeutic information to ethics, regulatory and pricing bodies, supporting patient care in an increasingly subspecialized arena where co-morbidities, polypharmacy, altered pharmacokinetics and drug interactions are common and developing and contributing to medicines policies for Governments. Clinical pharmacologists must advocate drug quality and they must also advocate for sustainability of the Discipline. However for this they need appropriate clinical service and training support. This Commentary discusses strategies to ensure the Discipline is supported by teaching, training and policy organizations, to communicate the full benefits of clinical pharmacology services, put a monetary value on clinical pharmacology services and to grow the clinical pharmacology workforce to support a growing clinical, academic and regulatory need. © 2015 The British Pharmacological Society.

  15. Achieving the World Health Organization's vision for clinical pharmacology

    PubMed Central

    Henry, David; Gray, Jean; Day, Richard; Bochner, Felix; Ferro, Albert; Pirmohamed, Munir; Mörike, Klaus; Schwab, Matthias

    2015-01-01

    Clinical pharmacology is a medical specialty whose practitioners teach, undertake research, frame policy, give information and advice about the actions and proper uses of medicines in humans and implement that knowledge in clinical practice. It involves a combination of several activities: drug discovery and development, training safe prescribers, providing objective and evidence‐based therapeutic information to ethics, regulatory and pricing bodies, supporting patient care in an increasingly subspecialized arena where co‐morbidities, polypharmacy, altered pharmacokinetics and drug interactions are common and developing and contributing to medicines policies for Governments. Clinical pharmacologists must advocate drug quality and they must also advocate for sustainability of the Discipline. However for this they need appropriate clinical service and training support. This Commentary discusses strategies to ensure the Discipline is supported by teaching, training and policy organizations, to communicate the full benefits of clinical pharmacology services, put a monetary value on clinical pharmacology services and to grow the clinical pharmacology workforce to support a growing clinical, academic and regulatory need. PMID:26466826

  16. New York City's Child Health Clinics: Providing Quality Primary Care to Children in Low-Income and Immigrant Families.

    ERIC Educational Resources Information Center

    Citizens' Committee for Children of New York, NY.

    A study was conducted to determine whether the New York City Health and Hospitals Corporation (HHC) is fulfilling dual public health and primary care missions of its Child Health Clinics, which provide services to 78,000 New York City children every year. Among the services provided by Child Health Clinics are health examinations for school and…

  17. Integrating Solar PV in Utility System Operations

    SciTech Connect

    Mills, A.; Botterud, A.; Wu, J.; Zhou, Z.; Hodge, B-M.; Heany, M.

    2013-10-31

    This study develops a systematic framework for estimating the increase in operating costs due to uncertainty and variability in renewable resources, uses the framework to quantify the integration costs associated with sub-hourly solar power variability and uncertainty, and shows how changes in system operations may affect these costs. Toward this end, we present a statistical method for estimating the required balancing reserves to maintain system reliability along with a model for commitment and dispatch of the portfolio of thermal and renewable resources at different stages of system operations. We estimate the costs of sub-hourly solar variability, short-term forecast errors, and day-ahead (DA) forecast errors as the difference in production costs between a case with “realistic” PV (i.e., subhourly solar variability and uncertainty are fully included in the modeling) and a case with “well behaved” PV (i.e., PV is assumed to have no sub-hourly variability and can be perfectly forecasted). In addition, we highlight current practices that allow utilities to compensate for the issues encountered at the sub-hourly time frame with increased levels of PV penetration. In this analysis we use the analytical framework to simulate utility operations with increasing deployment of PV in a case study of Arizona Public Service Company (APS), a utility in the southwestern United States. In our analysis, we focus on three processes that are important in understanding the management of PV variability and uncertainty in power system operations. First, we represent the decisions made the day before the operating day through a DA commitment model that relies on imperfect DA forecasts of load and wind as well as PV generation. Second, we represent the decisions made by schedulers in the operating day through hour-ahead (HA) scheduling. Peaking units can be committed or decommitted in the HA schedules and online units can be redispatched using forecasts that are improved

  18. PV solar electricity: status and future

    NASA Astrophysics Data System (ADS)

    Hoffmann, Winfried

    2006-04-01

    Within the four main market segments of PV solar electricity there are already three areas competitive today. These are off-grid industrial and rural as well as consumer applications. The overall growth within the past 8 years was almost 40 % p.a. with a "normal" growth of about 18 % p.a. for the first three market segments whereas the grid connected market increased with an astonishing 63 % p.a. The different growth rates catapulted the contribution of grid connected systems in relation to the total market from about one quarter 6 years ago towards more than three quarters today. The reason for this development is basically due to industry-politically induced market support programs in the aforementioned countries. It is quite important to outline under which boundary conditions grid connected systems will be competitive without support programs like the feed in tariff system in Germany, Spain and some more to come in Europe as well as investment subsidies in Japan, US and some other countries. It will be shown that in a more and more liberalized utility market worldwide electricity produced by PV solar electricity systems will be able to compete with their generating cost against peak power prices from utilities. The point of time for this competitiveness is mainly determined by the following facts: 1. Price decrease for PV solar electricity systems leading to an equivalent decrease in the generated cost for PV produced kWh. 2. Development of a truly liberalized electricity market. 3. Degree of irradiation between times of peak power demand and delivery of PV electricity. The first topic is discussed using price experience curves. Some explanations will be given to correlate the qualitative number of 20 % price decrease for doubling cumulative worldwide sales derived from the historic price experience curve with a more quantitative analysis based on our EPIA-Roadmap (productivity increase and ongoing improvements for existing technologies as well as development

  19. Illegal private clinics: ideal health services choices among rural-urban migrants in China?

    PubMed

    Li, Yan

    2014-01-01

    The main purpose of this article is to explore the important issues and the role of illegal private clinics in health services access among rural-urban migrants in China. The function that illegal private clinics substantially play on the health among rural-urban migrants in China is rarely discussed in studies. A study on a migrant community in Beijing shows the disadvantaged status of health services choices and the constraints for access to health services among migrants. It argues that the existence of illegal private clinics provides a channel to migrants for medical services in the city and reflects the difficulties and high cost of providing medical services to migrants in urban public hospitals. Occasionally the illegal private clinics can cause danger to the health of migrants.

  20. What Would It Take? Stakeholders’ Views and Preferences for Implementing a Health Care Manager Program in Community Mental Health Clinics Under Health Care Reform

    PubMed Central

    Cabassa, Leopoldo J.; Gomes, Arminda P.; Lewis-Fernández, Roberto

    2015-01-01

    Health care manager interventions can improve the physical health of people with serious mental illness (SMI). In this study, we used concepts from the theory of diffusion of innovations, the consolidated framework for implementation research and a taxonomy of implementation strategies to examine stakeholders’ recommendations for implementing a health care manager intervention in public mental health clinics serving Hispanics with SMI. A purposive sample of 20 stakeholders was recruited from mental health agencies, primary care clinics, and consumer advocacy organizations. We presented participants a vignette describing a health care manager intervention and used semistructured qualitative interviews to examine their views and recommendations for implementing this program. Interviews were recorded, professionally transcribed, and content analyzed. We found that a blend of implementation strategies that demonstrates local relative advantage, addresses cost concerns, and enhances compatibility to organizations and the client population is critical for moving health care manager interventions into practice. PMID:25542194

  1. What would it take? Stakeholders' views and preferences for implementing a health care manager program in community mental health clinics under health care reform.

    PubMed

    Cabassa, Leopoldo J; Gomes, Arminda P; Lewis-Fernández, Roberto

    2015-02-01

    Health care manager interventions can improve the physical health of people with serious mental illness (SMI). In this study, we used concepts from the theory of diffusion of innovations, the consolidated framework for implementation research and a taxonomy of implementation strategies to examine stakeholders' recommendations for implementing a health care manager intervention in public mental health clinics serving Hispanics with SMI. A purposive sample of 20 stakeholders was recruited from mental health agencies, primary care clinics, and consumer advocacy organizations. We presented participants a vignette describing a health care manager intervention and used semistructured qualitative interviews to examine their views and recommendations for implementing this program. Interviews were recorded, professionally transcribed, and content analyzed. We found that a blend of implementation strategies that demonstrates local relative advantage, addresses cost concerns, and enhances compatibility to organizations and the client population is critical for moving health care manager interventions into practice.

  2. The clinical adoption meta-model: a temporal meta-model describing the clinical adoption of health information systems

    PubMed Central

    2014-01-01

    Health information systems (HISs) hold the promise to transform health care; however, their adoption is challenged. We have developed the Clinical Adoption Meta-Model (CAMM) to help describe processes and possible challenges with clinical adoption. The CAMM, developed through an action research study to evaluate a provincial HIS, is a temporal model with four dimensions: availability, use, behaviour changes, and outcome changes. Seven CAMM archetypes are described, illustrating classic trajectories of adoption of HISs over time. Each archetype includes an example from the literature. The CAMM and its archetypes can support HIS implementers, evaluators, learners, and researchers. PMID:24884588

  3. Proactive outreach for smokers using VHA mental health clinics: protocol for a patient-randomized clinical trial.

    PubMed

    Rogers, Erin S; Fu, Steven S; Krebs, Paul; Noorbaloochi, Siamak; Nugent, Sean M; Rao, Radha; Schlede, Carolyn; Sherman, Scott E

    2014-12-17

    Persons with a mental health diagnosis have high rates of tobacco use and face numerous barriers to cessation including high levels of nicotine dependence, low rates of tobacco treatment referrals from mental health providers, and limited availability of tobacco treatment targeted to their needs. This manuscript describes the rationale and methods of a clinical trial with the following aims: 1) Compare the reach and efficacy of a proactive telephone-based tobacco cessation program for Veterans Health Administration (VHA) mental health clinic patients to VHA usual care and 2) Model longitudinal associations between baseline patient characteristics and long-term abstinence. We will use the electronic medical record to identify patients across four VHA healthcare facilities who have a clinical reminder code indicating current tobacco use in the past six months and who have had a mental health clinic visit in the past 12 months. We will send each patient an introductory letter and baseline survey. Survey respondents (N = 3840) will be randomized in a 1:1 fashion to intervention or control. Control participants will receive VHA usual care. Intervention participants will receive proactive motivational telephone outreach to offer tobacco treatment. Intervention participants interested in treatment will receive eight weeks of nicotine replacement therapy plus eight sessions of specialized telephone counseling over two months, followed by monthly maintenance counseling for four months. We will conduct telephone surveys with participants at six and 12 months to assess study outcomes. We will collect a mailed saliva sample from patients reporting 7-day abstinence on the telephone surveys. The primary outcome will be cotinine-validated abstinence at 12-month follow-up. Mental health patients are a high-risk smoking population with significant barriers to cessation. This study will evaluate the efficacy of a program that proactively reaches out to smokers with a mental health

  4. School-located influenza vaccination clinics: local health department perspectives.

    PubMed

    Ransom, James

    2009-02-01

    Universal childhood influenza vaccination presents challenges and opportunities for health care and public health systems to vaccinate the children who fall under the new recommendation. Advisory Committee on Immunization Practices (ACIP) recommendations and guidelines are helpful, but they do not provide strategies on how to deliver immunization services to the groups affected by their recommendations. Community stakeholders need to develop and sustain new partnerships to achieve the goals of universal childhood immunization recommendations, including expanding the points of access to influenza vaccination. Schools are a key community venue for annual delivery of influenza vaccination. Over the past 2 years, the National Association of County and City Health Officials has examined local health department-school system relationships in regard to delivery of influenza vaccination to identify and document common elements of success, challenges, and key lessons learned.

  5. Nurse-Managed Health Clinic Investment Act of 2009

    THOMAS, 111th Congress

    Sen. Inouye, Daniel K. [D-HI

    2009-05-20

    Senate - 05/20/2009 Read twice and referred to the Committee on Health, Education, Labor, and Pensions. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

  6. Nutrition education and counselling practices in mother and child health clinics: study amongst nurses.

    PubMed

    Ilmonen, Johanna; Isolauri, Erika; Laitinen, Kirsi

    2012-10-01

    To investigate current nutrition counselling practices, knowledge of nutrition and the need for nutrition education by nurses in mother and child health clinics. Nutrition counselling of young families offers a tangible means to implement preventive measures for lifestyle-related chronic diseases. Nurses in health clinics are at prime position to execute this preventive work, which demands knowledge of current nutrition research as well as skill in counselling. Knowledge is limited regarding the current nutrition counselling practices of nurses and their needs in improving counselling. Descriptive questionnaire survey. A questionnaire was formulated and sent to nurses in mother and child health clinics (n=650) nationwide via e-mail links using a computerised program. Non-respondents were re-contacted twice, the final response rate being 50% (n=327). Nurses considered nutrition counselling an important but challenging task in the clinics. In addition to promotion of health, they had counselled clients in the management of various disorders ranging from constipation to coeliac disease. Variability was noted in the extent to which nurses had adopted nutrition guidelines. As means to improve counselling, better collaboration with both families and healthcare professionals and an increase in resources, including time available for counselling, up-to-date educational material and clinical guidelines, as well as increased education in nutrition were suggested. The results demonstrated a need and a readiness amongst nurses to develop nutrition counselling in health clinics. Given the health benefits presumably deriving from nutrition counselling, investments in operational counselling, comprising advancement of both knowledge and skills in the health clinics, are clearly warranted. RELEVANCE TO CLINICAL PRACTICES: The findings provide important insights into the current clinical practice in health clinics and can be exploited in designing nutrition counselling and in

  7. Prevalence and demographic and clinical associations of health literacy in patients on maintenance hemodialysis.

    PubMed

    Green, Jamie A; Mor, Maria K; Shields, Anne Marie; Sevick, Mary Ann; Palevsky, Paul M; Fine, Michael J; Arnold, Robert M; Weisbord, Steven D

    2011-06-01

    Although limited health literacy is estimated to affect over 90 million Americans and is recognized as an important public health concern, there have been few studies examining this issue in patients with chronic kidney disease. We sought to characterize the prevalence of and associations of demographic and clinical characteristics with limited health literacy in patients receiving maintenance hemodialysis. As part of a prospective clinical trial of symptom management strategies in 288 patients treated with chronic hemodialysis, we assessed health literacy using the Rapid Estimate of Adult Literacy in Medicine (REALM). We defined limited health literacy as a REALM score ≤60 and evaluated independent associations of demographic and baseline clinical characteristics with limited health literacy using multivariable logistic regression. Of the 260 patients who completed the REALM, 41 demonstrated limited health literacy. African-American race, lower educational level, and veteran status were independently associated with limited health literacy. There was no association of limited health literacy with age, gender, serologic values, dialysis adequacy, overall symptom burden, quality of life, or depression. Limited health literacy is common among patients receiving chronic hemodialysis. African-American race and socioeconomic factors are strong independent predictors of limited health literacy. These findings can help inform the design and implementation of interventions to improve health literacy in the hemodialysis population.

  8. Electronic health record tools' support of nurses' clinical judgment and team communication.

    PubMed

    Kossman, Susan P; Bonney, Leigh Ann; Kim, Myoung Jin

    2013-11-01

    Nurses need to quickly process information to form clinical judgments, communicate with the healthcare team, and guide optimal patient care. Electronic health records not only offer potential for enhanced care but also introduce unintended consequences through changes in workflow, clinical judgment, and communication. We investigated nurses' use of improvised (self-made) and electronic health record-generated cognitive artifacts on clinical judgment and team communication. Tanner's Clinical Judgment Model provided a framework and basis for questions in an online survey and focus group interviews. Findings indicated that (1) nurses rated self-made work lists and medication administration records highest for both clinical judgment and communication, (2) tools aided different dimensions of clinical judgment, and (3) interdisciplinary tools enhance team communication. Implications are that electronic health record tool redesign could better support nursing work.

  9. Serving transgender people: clinical care considerations and service delivery models in transgender health.

    PubMed

    Wylie, Kevan; Knudson, Gail; Khan, Sharful Islam; Bonierbale, Mireille; Watanyusakul, Suporn; Baral, Stefan

    2016-07-23

    The World Professional Association for Transgender Health (WPATH) standards of care for transsexual, transgender, and gender non-conforming people (version 7) represent international normative standards for clinical care for these populations. Standards for optimal individual clinical care are consistent around the world, although the implementation of services for transgender populations will depend on health system infrastructure and sociocultural contexts. Some clinical services for transgender people, including gender-affirming surgery, are best delivered in the context of more specialised facilities; however, the majority of health-care needs can be delivered by a primary care practitioner. Across high-income and low-income settings alike, there often remains a dearth of educational programming for health-care professionals in transgender health, although the best evidence supports introducing modules on transgender health early during clinical education of clinicians and allied health professionals. While these challenges remain, we review the increasing evidence and examples of the defined roles of the mental health professional in transgender health-care decisions, effective models of health service provision, and available surgical interventions for transgender people. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. The Interplay between socioeconomic inequalities and clinical oral health.

    PubMed

    Steele, J; Shen, J; Tsakos, G; Fuller, E; Morris, S; Watt, R; Guarnizo-Herreño, C; Wildman, J

    2015-01-01

    Oral health inequalities associated with socioeconomic status are widely observed but may depend on the way that both oral health and socioeconomic status are measured. Our aim was to investigate inequalities using diverse indicators of oral health and 4 socioeconomic determinants, in the context of age and cohort. Multiple linear or logistic regressions were estimated for 7 oral health measures representing very different outcomes (2 caries prevalence measures, decayed/missing/filled teeth, 6-mm pockets, number of teeth, anterior spaces, and excellent oral health) against 4 socioeconomic measures (income, education, Index of Multiple Deprivation, and occupational social class) for adults aged ≥21 y in the 2009 UK Adult Dental Health Survey data set. Confounders were adjusted and marginal effects calculated. The results showed highly variable relationships for the different combinations of variables and that age group was critical, with different relationships at different ages. There were significant income inequalities in caries prevalence in the youngest age group, marginal effects of 0.10 to 0.18, representing a 10- to 18-percentage point increase in the probability of caries between the wealthiest and every other quintile, but there was not a clear gradient across the quintiles. With number of teeth as an outcome, there were significant income gradients after adjustment in older groups, up to 4.5 teeth (95% confidence interval, 2.2-6.8) between richest and poorest but none for the younger groups. For periodontal disease, income inequalities were mediated by other socioeconomic variables and smoking, while for anterior spaces, the relationships were age dependent and complex. In conclusion, oral health inequalities manifest in different ways in different age groups, representing age and cohort effects. Income sometimes has an independent relationship, but education and area of residence are also contributory. Appropriate choices of measures in relation to age

  11. PV technology and success of solar electricity in Vietnam

    SciTech Connect

    Dung, T.Q.

    1997-12-31

    Since 1990 the PV Technology and the Solar electricity have been strongly developed in Vietnam. The PV experts of Solarlab have studied and set up an appropriate PV Technology responding to local Market needs. It has not only stood well but has been also transferred to Mali Republic and Lao P.D.R. The PV off grid systems of Solarlab demonstrate good efficiency and low prices. Over 60 solar stations and villages have been built to provide solar lighting for about 3000 families along the country in remote, mountainous areas and islands. 400 families are using stand-alone Solar Home Systems. The Solar electricity has been chosen for Rural Electrification and National Telecommunication Network in remote and mountainous regions. Many International projects in cooperation with FONDEM-France, SELF USA and Governmental PV projects have been realized by Solarlab. The experiences of maintenance, management and finance about PV development in Vietnam are also mentioned.

  12. High blood pressure in children: clinical and health policy implications.

    PubMed

    Falkner, Bonita; Lurbe, Empar; Schaefer, Franz

    2010-04-01

    Hypertension is a global problem, affecting both developed and developing nations. In addition to being a major cause of morbidity and mortality, hypertension places a heavy burden on health care systems, families, and society as a whole. Despite evidence of an increasing prevalence of hypertension among youth, the consequences of early onset are poorly established and often overlooked. Childhood hypertension is often asymptomatic and easily missed, even by health professionals. Target organ damage is detectable in children and adolescents, however, and hypertension continues into adulthood. Additional strategies to improve cardiovascular health among children and adolescents are needed, including methods to achieve healthy lifestyles at home and in school, improved systems for diagnosis, and research on mechanisms and timing of interventions. The burden of hypertension in the young will continue to grow unless it is given the attention it deserves by policy makers, health care providers, schools, parents, and society. This report aims to increase awareness of the problem of hypertension in childhood. Recent reports on prevalence and target organ injury are discussed and health policy initiatives to improve blood pressure control are proposed.

  13. Patient experiences with full electronic access to health records and clinical notes through the My HealtheVet Personal Health Record Pilot: qualitative study.

    PubMed

    Woods, Susan S; Schwartz, Erin; Tuepker, Anais; Press, Nancy A; Nazi, Kim M; Turvey, Carolyn L; Nichol, W Paul

    2013-03-27

    Full sharing of the electronic health record with patients has been identified as an important opportunity to engage patients in their health and health care. The My HealtheVet Pilot, the initial personal health record of the US Department of Veterans Affairs, allowed patients and their delegates to view and download content in their electronic health record, including clinical notes, laboratory tests, and imaging reports. A qualitative study with purposeful sampling sought to examine patients' views and experiences with reading their health records, including their clinical notes, online. Five focus group sessions were conducted with patients and family members who enrolled in the My HealtheVet Pilot at the Portland Veterans Administration Medical Center, Oregon. A total of 30 patients enrolled in the My HealtheVet Pilot, and 6 family members who had accessed and viewed their electronic health records participated in the sessions. Four themes characterized patient experiences with reading the full complement of their health information. Patients felt that seeing their records positively affected communication with providers and the health system, enhanced knowledge of their health and improved self-care, and allowed for greater participation in the quality of their care such as follow-up of abnormal test results or decision-making on when to seek care. While some patients felt that seeing previously undisclosed information, derogatory language, or inconsistencies in their notes caused challenges, they overwhelmingly felt that having more, rather than less, of their health record information provided benefits. Patients and their delegates had predominantly positive experiences with health record transparency and the open sharing of notes and test results. Viewing their records appears to empower patients and enhance their contributions to care, calling into question common provider concerns about the effect of full record access on patient well-being. While shared

  14. Breaking ground: combining community service, critical thinking, and writing in a mental health clinical course.

    PubMed

    Nardi, D; Schlotman, E; Siwinski-Hebel, S

    1997-04-01

    This article describes the experience of a team of nursing educators who, over the course of 2 years, redesigned the delivery of an undergraduate nursing clinical course to reflect the changing face of mental health care near the turn of this century. Case studies of student learning experiences show the value of nontraditional clinical settings such as homeless shelters to the professional growth and training of nursing students. Recommendations offer practical advice for combining nontraditional community-based clinical experiences with critical thinking exercises as key components of the mental health clinical course delivery.

  15. Health utility decreases with increasing clinical stage in amyotrophic lateral sclerosis.

    PubMed

    Jones, Ashley R; Jivraj, Naheed; Balendra, Rubika; Murphy, Caroline; Kelly, Joanna; Thornhill, Marie; Young, Carolyn; Shaw, Pamela J; Leigh, P Nigel; Turner, Martin R; Steen, I Nick; McCrone, Paul; Al-Chalabi, Ammar

    2014-06-01

    Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease typically causing death within three years. Understanding the impact of disease on patients using health utility at different stages of ALS would allow meaningful cost-benefit analysis of new potential therapies. A common health-related quality of life measurement, developed and validated for the UK, is the EQ-5D. Using clinical trial data from the LiCALS study, we calculated health utility using the EQ-5D for each King's ALS clinical stage from 214 patients. We analysed whether health utility, and other health-related measures, significantly changed between each of the clinical stages. Results showed that mean health utility decreased by 0.487 (the scale runs from 1 to - 0.594) between clinical stages 2A and 4. Emotional states, measured using the Hospital Anxiety and Depression Scale (HADS), showed worsening depression and anxiety scores as ALS progressed. Age of onset, disease onset, gender and treatment group were not predictors of EQ-5D, depression or anxiety. In conclusion, increasing severity of King's ALS Clinical Stage is associated with a progressive decrease in EQ-5D health utility. This is useful for cost-benefit analysis of new therapies and validates this ALS clinical staging system.

  16. UK National Audit of chlamydial infection management in sexual health clinics. clinic policies audit.

    PubMed

    Carne, Chris; McClean, Hugo; Bhaduri, Sumit; Bunting, Paul; Fernandes, Arnold; Dhar, Jyoti; Estreich, Steve; Daniels, David

    2008-07-01

    There was a wide range of activity and chlamydial diagnoses between the 177 clinics that responded. Most (92%) clinics have nucleic acid tests for chlamydial diagnosis. Different practitioners largely share roles in providing advice to patients about partner notification, treatment adherence, safer sex advice and abstinence. Most (97%) clinics have information leaflets about chlamydia, although about 30% of clinics lack leaflets containing information about antibiotics and hormonal contraception. About two-third clinics follow the National Guideline recommended interval for providing a test of cure where this is indicated. Only 18% of clinics routinely ask patients to reattend, with 40% having a policy of no routine follow-up and 62% using telephone or text follow-up. These categories were not mutually exclusive. Most (86%) of the 146 English clinics had a local Chlamydia Screening Programme coordinator for their Primary Care Trust area, although cooperation varies, with cooperation over treatment of 70% and Programme policy of 62%.

  17. Beyond the limits of clinical governance? The case of mental health in English primary care

    PubMed Central

    Gask, Linda; Rogers, Anne; Campbell, Stephen; Sheaff, Rod

    2008-01-01

    Background Little research attention has been given to attempts to implement organisational initiatives to improve quality of care for mental health care, where there is a high level of indeterminacy and clinical judgements are often contestable. This paper explores recent efforts made at an organisational level in England to improve the quality of primary care for people with mental health problems through the new institutional processes of 'clinical governance'. Methods Framework analysis, based on the Normalisation Process Model (NPM), of attempts over a five year period to develop clinical governance for primary mental health services in Primary Care Trusts (PCTs). The data come from a longitudinal qualitative multiple case-study approach in a purposive sample of 12 PCTs, chosen to reflect a maximum variety of organisational contexts for mental health care provision. Results The constant change within the English NHS provided a difficult context in which to attempt to implement 'clinical governance' or, indeed, to reconstruct primary mental health care. In the absence of clear evidence or direct guidance about what 'primary mental health care' should be, and a lack of actors with the power or skills to set about realising it, the actors in 'clinical governance' had little shared knowledge or understanding of their role in improving the quality of mental health care. There was a lack of ownership of 'mental health' as an integral, normalised part of primary care. Conclusion Despite some achievements in regard to monitoring and standardisation of prescribing practice, mental health care in primary care seems to have so far largely eluded the gaze of 'clinical governance'. Clinical governance in English primary mental health care has not yet become normalised. We make some policy recommendations which we consider would assist in the process normalisation and suggest other contexts to which our findings might apply. PMID:18366779

  18. Ecosystem Health Disorders - changing perspectives in clinical medicine and nutrition.

    PubMed

    Wahlqvist, Mark L

    2014-01-01

    The inseparability of people from their ecosystem without biological change is increasingly clear. The discrete species concept is becoming more an approximation as the interconnectedness of all things, animate and inanimate, becomes more apparent. Yet this was evident even to our earliest Homo Sapiens sapiens ancestors as they hunted and gathered from one locality to another and migrated across the globe. During a rather short 150-200,000 years of ancestral history, we have changed the aeons-old planet and our ecology with dubious sustainability. As we have changed the ecosystems of which we are a part, with their opportunities for shelter, rest, ambulation, discourse, food, recreation and their sensory inputs, we have changed our shared biology and our health prospects. The rate of ecosystem change has increased quantitatively and qualitatively and so will that of our health patterns, depending on our resilience and how linear, non-linear or fractal-like the linkage. Our health-associated ecosystem trajectories are uncertain. The interfaces between us and our environment are blurred, but comprise time, biorhythms, prokaryotic organisms, sensory (auditory, visual, tactile, taste and smell), conjoint movement, endocrine with various external hormonal through food and contaminants, the reflection of soil and rock composition in the microbes, plants, insects and animals that we eat (our biogeology) and much more. We have sought ways to optimise our health through highly anthropocentric means, which have proven inadequate. Accumulated ecosystem change may now overwhelm our health. On these accounts, more integrative approaches and partnerships for health care practice are required.

  19. Structural Vulnerability: Operationalizing the Concept to Address Health Disparities in Clinical Care.

    PubMed

    Bourgois, Philippe; Holmes, Seth M; Sue, Kim; Quesada, James

    2017-03-01

    The authors propose reinvigorating and extending the traditional social history beyond its narrow range of risk behaviors to enable clinicians to address negative health outcomes imposed by social determinants of health. In this Perspective, they outline a novel, practical medical vulnerability assessment questionnaire that operationalizes for clinical practice the social science concept of "structural vulnerability." A structural vulnerability assessment tool designed to highlight the pathways through which specific local hierarchies and broader sets of power relationships exacerbate individual patients' health problems is presented to help clinicians identify patients likely to benefit from additional multidisciplinary health and social services. To illustrate how the tool could be implemented in time- and resource-limited settings (e.g., emergency department), the authors contrast two cases of structurally vulnerable patients with differing outcomes. Operationalizing structural vulnerability in clinical practice and introducing it in medical education can help health care practitioners think more clearly, critically, and practically about the ways social structures make people sick. Use of the assessment tool could promote "structural competency," a potential new medical education priority, to improve understanding of how social conditions and practical logistics undermine the capacities of patients to access health care, adhere to treatment, and modify lifestyles successfully. Adoption of a structural vulnerability framework in health care could also justify the mobilization of resources inside and outside clinical settings to improve a patient's immediate access to care and long-term health outcomes. Ultimately, the concept may orient health care providers toward policy leadership to reduce health disparities and foster health equity.

  20. Preliminary Outcomes from an Integrated Pediatric Mental Health Outpatient Clinic.

    PubMed

    Maslow, Gary R; Banny, Adrienne; Pollock, McLean; Stefureac, Kristen; Rosa, Kendra; Walter, Barbara Keith; Hobbs Knutson, Katherine; Lucas, Joseph; Heilbron, Nicole

    2017-10-01

    An estimated 1 in 5 children in the United States meet criteria for a diagnosable mental disorder, yet fewer than 20% receive mental health services. Unmet need for psychiatric treatment may contribute to patterns of increasing use of the emergency department. This article describes an integrated pediatric evaluation center designed to prevent the need for treatment in emergency settings by increasing access to timely and appropriate care for emergent and critical mental health needs. Preliminary results showed that the center provided rapid access to assessment and treatment services for children and adolescents presenting with a wide range of psychiatric concerns. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Photovoltaic (PV) Power Systems for Enhancing Energy Security

    DTIC Science & Technology

    2012-05-24

    Energy and Environment Technology Transition – Supporting DoD Readiness, Sustainability, and the Warfighter Photovoltaic (PV) Power Systems for...to 00-00-2012 4. TITLE AND SUBTITLE Photovoltaic (PV) Power Systems for Enhancing Energy Security 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c...use of 235W solar panels Note [2] System AC Rating based upon typical .77 conversion factor from DC power to AC power ConsiderationNo. PV LAYOUT OPTION

  2. Factors shaping effective utilization of health information technology in urban safety-net clinics.

    PubMed

    George, Sheba; Garth, Belinda; Fish, Allison; Baker, Richard

    2013-09-01

    Urban safety-net clinics are considered prime targets for the adoption of health information technology innovations; however, little is known about their utilization in such safety-net settings. Current scholarship provides limited guidance on the implementation of health information technology into safety-net settings as it typically assumes that adopting institutions have sufficient basic resources. This study addresses this gap by exploring the unique challenges urban resource-poor safety-net clinics must consider when adopting and utilizing health information technology. In-depth interviews (N = 15) were used with key stakeholders (clinic chief executive officers, medical directors, nursing directors, chief financial officers, and information technology directors) from staff at four clinics to explore (a) nonhealth information technology-related clinic needs, (b) how health information technology may provide solutions, and (c) perceptions of and experiences with health information technology. Participants identified several challenges, some of which appear amenable to health information technology solutions. Also identified were requirements for effective utilization of health information technology including physical infrastructural improvements, funding for equipment/training, creation of user groups to share health information technology knowledge/experiences, and specially tailored electronic billing guidelines. We found that despite the potential benefit that can be derived from health information technologies, the unplanned and uninformed introduction of these tools into these settings might actually create more problems than are solved. From these data, we were able to identify a set of factors that should be considered when integrating health information technology into the existing workflows of low-resourced urban safety-net clinics in order to maximize their utilization and enhance the quality of health care in such settings.

  3. Factors shaping effective utilization of health information technology in urban safety-net clinics

    PubMed Central

    George, Sheba; Garth, Belinda; Fish, Allison; Baker, Richard

    2016-01-01

    Urban safety-net clinics are considered prime targets for the adoption of health information technology innovations; however, little is known about their utilization in such safety-net settings. Current scholarship provides limited guidance on the implementation of health information technology into safety-net settings as it typically assumes that adopting institutions have sufficient basic resources. This study addresses this gap by exploring the unique challenges urban resource-poor safety-net clinics must consider when adopting and utilizing health information technology. In-depth interviews (N = 15) were used with key stakeholders (clinic chief executive officers, medical directors, nursing directors, chief financial officers, and information technology directors) from staff at four clinics to explore (a) nonhealth information technology-related clinic needs, (b) how health information technology may provide solutions, and (c) perceptions of and experiences with health information technology. Participants identified several challenges, some of which appear amenable to health information technology solutions. Also identified were requirements for effective utilization of health information technology including physical infrastructural improvements, funding for equipment/training, creation of user groups to share health information technology knowledge/experiences, and specially tailored electronic billing guidelines. We found that despite the potential benefit that can be derived from health information technologies, the unplanned and uninformed introduction of these tools into these settings might actually create more problems than are solved. From these data, we were able to identify a set of factors that should be considered when integrating health information technology into the existing workflows of low-resourced urban safety-net clinics in order to maximize their utilization and enhance the quality of health care in such settings. PMID:23981394

  4. [Conflicts of interests in clinical research in primary health care].

    PubMed

    González-de Paz, L; Navarro-Rubio, M D; Sisó-Almirall, A

    2014-03-01

    Conflicts of interests between professionals and patients in biomedical research, is an ethical problem. None of the laws in Spain mention whether the clinical researcher has to clarify to participants the reasons why it proposes them to participate in a clinical trial. In this article, conflicts of interests in research are discussed in the context of primary healthcare. In this area conflicts of interests might alter the confidence between patients and healthcare professionals. Finally, we suggest some practical strategies that can help participants make the decision to participate in a clinical trial more willingly and freely. Copyright © 2013 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  5. Adolescents' Use of School-Based Health Clinics for Reproductive Health Services: Data from the National Longitudinal Study of Adolescent Health.

    ERIC Educational Resources Information Center

    Crosby, Richard A.; St. Lawrence, Janet

    2000-01-01

    Describes adolescents' use of school-based health clinics (SBCs) for family planning and sexually transmitted disease (STD)-related services, using data from the National Longitudinal Study of Adolescent Health. Results indicated that 13 percent received family planning and 8.9 percent received STD-related services from SBCs. Factors affecting the…

  6. Women in Free Clinics: An Assessment of Health-Related Quality of Life for Prevention and Health Education.

    PubMed

    Kamimura, Akiko; Myers, Kyl; Ashby, Jeanie; Trinh, Ha Ngoc; Nourian, Maziar M; Reel, Justine J

    2015-08-01

    Understanding gender influences on health-related quality of life (HRQoL) is important to improve women's health when considering diseases that afflict women specifically. The target population of this study was uninsured female free clinic patients who are low socio-economic status and lack access to healthcare resources. Free clinics provide free or reduced fee healthcare to individuals who lack access to primary care and are socio-economically disadvantaged. While approximately half of free clinic patients are women, there is a paucity of comprehensive health-related data for female free clinic patients. US born English, non-US born English, and Spanish speaking female free clinic patients completed a self-administered survey using a standardized women's HRQoL measure in Fall 2014 (N = 389). Female free clinic patients reported lower HRQoL on all aspects of women's health compared to the US baseline scores, and were less likely to utilize preventive care including: mammograms, Pap smear, and HPV vaccination compared to the US general population. Spanish speakers reported a higher percentage of having had mammography and Pap smear, and heard about HPV compared to the other two groups. US born English speakers reported lower levels of HRQoL in vasomotor symptoms and sleep symptoms, and the lowest percentage of breast health and Pap smear screenings compared to non-US born English and Spanish speakers. Non-US born English speakers reported higher preference for female physician compared to US born English speakers and Spanish speakers. Free clinic female patients need preventative interventions and educational opportunities to improve their overall HRQoL.

  7. Willingness to Use Health Insurance at a Sexually Transmitted Disease Clinic: A Survey of Patients at 21 US Clinics.

    PubMed

    Pearson, William S; Cramer, Ryan; Tao, Guoyu; Leichliter, Jami S; Gift, Thomas L; Hoover, Karen W

    2016-08-01

    To survey patients of publicly funded sexually transmitted disease (STD) clinics across the United States about their willingness to use health insurance for their visit. In 2013, we identified STD clinics in 21 US metropolitan statistical areas with the highest rates of chlamydia, gonorrhea, and syphilis according to Centers for Disease Control and Prevention surveillance reports. Patients attending the identified STD clinics completed a total of 4364 surveys (response rate = 86.6%). Nearly half of the insured patients were willing to use their health insurance. Patients covered by government insurance were more likely to be willing to use their health insurance compared with those covered by private insurance (odds ratio [OR] =  3.60; 95% confidence interval [CI] = 2.79, 4.65), and patients covered by their parents' insurance were less likely to be willing to use their insurance compared with those covered by private insurance (OR = 0.72; 95% CI = 0.52, 1.00). Reasons for unwillingness to use insurance were privacy and out-of-pocket cost. Before full implementation of the Affordable Care Act, privacy and cost were barriers to using health insurance for STD services. Barriers to using health insurance for STD services could be reduced through addressing issues of stigma associated with STD care and considering alternative payment sources for STD services.

  8. Retention of Physician Assistants in Rural Health Clinics

    ERIC Educational Resources Information Center

    Henry, Lisa R.; Hooker, Roderick S.

    2007-01-01

    Context: Improvement of rural health care access has been a guiding principle of federal and state policy regarding physician assistants (PAs). Purpose: To determine the factors that influence autonomous rural PAs (who work less than 8 hours per week with their supervising physician) to remain in remote locations. Methods: A qualitative…

  9. Clinical Interventions to Enhance Infant Mental Health: A Selective Review

    ERIC Educational Resources Information Center

    Zeanah, Paula D.; Stafford, Brian; Zeanah, Charles H.

    2005-01-01

    The unique focus of infant mental health interventions is most often the caregiver-infant relationship, rather than the traditional approach of focusing specifically on the child or caregiver. Because a relationship approach to assessment and treatment is new, the development of evidence-based approaches is still in its own infancy. Furthermore,…

  10. Long-Term Performance of the SERF PV Systems

    SciTech Connect

    Marion, B.; Adelstein, J.

    2003-05-01

    This paper provides the changes in performance ratings of two photovoltaic (PV) systems located on the roof of the Solar Energy Research Facility (SERF) building at the National Renewable Energy Laboratory (NREL) in Golden, Colorado. For the period of May 1994 to April 2002, the performance rating of the two PV systems decreased at the rate of 1% per year. Most of the changes in performance rating are attributed to changes in the performance of the PV arrays. But about a fifth of the observed changes were from the inverter not tracking the peak-power as effectively as the PV arrays aged.

  11. Coherent PV anomalies associated with deep moist convection

    NASA Astrophysics Data System (ADS)

    Weijenborg, C.; Chagnon, J.; Friederichs, P.; Hense, A.

    2016-12-01

    Potential Vorticity (PV) elegantly describes synoptic and planetary scale dynamics, but it has received less attention on smaller scales. On the convective scale PV is characterised by dipoles associated with convective cells. We hypothesise that the PV dipoles are quasi-balanced. If so, one should see a coherent evolution of the PV dipoles. Moreover, the PV dipoles might be described by a reduced order model. This hypothesis is tested by tracking convective cells in the nonhydrostatic COSMO-DE Numerical Weather Prediction (NWP) model during nine severe weather events. The 3135 convective cells used in this study are representative of deep moist convection over western Europe in the COSMO-DE model. Composites of the evolution of convective cells are discussed. Even when averaging over 3135 cells during nine cases, a clear horizontal PV dipole pattern can be seen, with associated flow anomalies. A normal mode analysis is performed, starting with the Chagnon-Gray model. We compare the quasi-stationary PV found using the normal modes analysis with the dominant patterns in the modeled convection. This is compared with the dominant patterns in modeled deep moist convection. We discuss a multivariate linear regression between the steady state wind and potential temperature fields obtained using the normal modes expansion with the dominant structures in the modeled data. The consistency of the PV dipoles implies that PV could be quasi-invertible on the convective weather scale. An application could therefore be data reduction.

  12. PV modules with optimized energy balance

    NASA Astrophysics Data System (ADS)

    Weixlberger, Johann; Bruckner, Richard

    2011-09-01

    The overall energy balance of a solar PV-module across its life time needs a consideration incl. its energy consumption during manufacturing process versus its energy harvesting capabilities during life time. A glass-glass-module based on thin tempered glass on front and backside can dramatically influence this overall balance, since more than 50 % of encapsulation materials manufacturing energy can be saved, followed by a an further impact on frameless mounting of light-weighted modules, reducing mounting costs and enabling simpler BIPV.

  13. Clinical diagnosis of syphilis: a ten-year retrospective analysis in a South Australian urban sexual health clinic.

    PubMed

    Forrest, C E; Ward, A

    2016-12-01

    National notifications for infectious syphilis in Australia have increased in recent years. Outside of sexual health clinics, junior clinicians seldom encounter this disease in its infectious stage (primary, secondary and early latent). With such a variable clinical presentation, textbook teaching is no substitute for real-life experience. The importance of accurate classification and staging of disease is relevant to the risk of transmission and determines treatment duration. In this article, the authors review the clinical presentation of syphilis over ten years in an urban sexual health clinic with a focus on the clinical presentation and diagnosis of infectious syphilis, in particular secondary syphilis, compared with that outlined in the Australian National Notifiable Diseases Surveillance System guidelines. This retrospective review of all patients diagnosed with syphilis at an urban sexual health clinic showed that between 2005 and 2015, 226 cases of syphilis were diagnosed. Documentation of impression of clinical staging of disease was present in 46% of the cases. Seventeen of these cases were recorded as secondary syphilis. The criteria used by clinicians to diagnose the secondary syphilis cases were consistent with criteria defined by the Australian National Notifiable Diseases Surveillance System. All cases of secondary syphilis had at least one cutaneous manifestation of disease. The demographic of the cohort of syphilis cases was consistent with that recorded in the literature. This review showed that the clinician's diagnosis of secondary syphilis in this service is consistent with the National Notifiable Diseases Surveillance System guidelines. Continuing education of junior medical staff is important to facilitate diagnosis and improve documentation of clinical staging, minimise disease transmission and ensure appropriate treatment. © The Author(s) 2016.

  14. Addiction Competencies in the 2009 CACREP Clinical Mental Health Counseling Program Standards

    ERIC Educational Resources Information Center

    Lee, Tiffany K.; Craig, Stephen E.; Fetherson, Bianca T. L.; Simpson, C. Dennis

    2013-01-01

    The Council for Accreditation of Counseling and Related Educational Programs developed addiction competencies for clinical mental health counseling students. This article highlights these competencies, provides an overview of current addiction training, and describes methods to integrate addiction education into curricula.

  15. Incorporating community-based clinical experiences into a maternal-women's health nursing course.

    PubMed

    Aurilio, Louise A; O'Dell, Valerie M

    2010-01-01

    Many barriers to increasing enrollment in nursing programs currently exist. One barrier is increased competition for clinical site placement from competing nursing and multidisciplinary programs. A critical component of nursing educational programs is providing clinical experiences that reinforce didactic learning. Incorporating women's health in a maternity course required clinical experiences to reflect this content. Faculty incorporated new strategies to help students integrate relevant theoretical concepts of maternity and women's health nursing by placing students in more community sites. Although labor and delivery and mother-baby units are located in the hospital, a wealth of community experiences for maternal and women's health nursing students exists. This article discusses strategies implemented by faculty at Youngstown State University to meet these challenges and promote appropriate clinical learning experiences for student nurses enrolled in a maternal-women's health nursing course. Copyright 2010, SLACK Incorporated.

  16. Addiction Competencies in the 2009 CACREP Clinical Mental Health Counseling Program Standards

    ERIC Educational Resources Information Center

    Lee, Tiffany K.; Craig, Stephen E.; Fetherson, Bianca T. L.; Simpson, C. Dennis

    2013-01-01

    The Council for Accreditation of Counseling and Related Educational Programs developed addiction competencies for clinical mental health counseling students. This article highlights these competencies, provides an overview of current addiction training, and describes methods to integrate addiction education into curricula.

  17. Development of a Dispatchable PV Peak Shainv System. PV: Bonus Program - Phase 1 Report. Volume 1

    SciTech Connect

    1995-10-01

    This report summarizes the work performed by Delmarva Power and Light and its subcontractors in Phase 1 of the US Department of Energy's PV:BONUS Program. The purpose of the program is to develop products and systems for buildings which utilize photovoltaic (N) technology. Beginning with a cooperative research effort with the University of Delaware's Center for Energy and Environmental Policy Research Delmarva Power developed and demonstrated the concept of Dispatchable PV Peak Shaving. This concept and the system which resulted horn the development work are unique from other grid-connected PV systems because it combines a PV, battery energy storage, power conversion and control technologies into an integrated package. Phase 1 began in July 1993 with the installation of a test and demonstration system at Delmarva's Northern Division General Office building near Newark, Delaware. Following initial testing throughout the summer and fall of 1993, significant modifications were made under an amendment to the DOE contract. Work on Phase 1 concluded in the early spring of 1995. Significant progress towards the goal of commercializing the system was made during Phase 1, and is summarized. Based on progress in Phase 1, a proposal to continue the work in Phase 2 was submitted to the US DOE in May 1995. A contract amendment and providing funds for the Phase 2 work is expected in July 1995.

  18. Chairside Assisting Skill Evaluation (CASE). Clinical Setting. Health Manpower References.

    ERIC Educational Resources Information Center

    Innovative Programming Systems, Minneapolis, Minn.

    These checklists are designed for use during the dental assistant student's extramural clinical experience assignment. Checklists test students on their knowledge of terminology, equipment, procedures, and patient relations. Objectives are listed outline style with columns to check progress during a first and a second evaluation. Areas included…

  19. Clinical Genomics in the World of the Electronic Health Record

    PubMed Central

    Marsolo, Keith; Spooner, S. Andrew

    2014-01-01

    The widespread of adoption of EHRs presents a number of benefits to the field of clinical genomics. They include the ability to return results to the practitioner, the ability to use genetic findings in clinical decision support, and to have data collected in the EHR serve as a source of phenotypic information for analysis purposes. Not all EHRs are created equal, however. They differ in their features, capabilities and ease-of-use. Therefore, in order to understand the potential of the EHR, it is first necessary to understand its capabilities and the impact that implementation strategy has on usability. Specifically, we focus on the following areas: 1) how the EHR is used to capture data in clinical practice settings; 2) how the implementation and configuration of the EHR affects the quality and availability of data; 3) the management of clinical genetic test results and the feasibility of EHR integration; and 4) the challenges of implementing an EHR in a research-intensive environment. This is followed by a discussion of the minimum functional requirements that an EHR must meet to enable the satisfactory integration of genomic results as well as the open issues that remain. PMID:23846403

  20. Chairside Assisting Skill Evaluation (CASE). Clinical Setting. Health Manpower References.

    ERIC Educational Resources Information Center

    Innovative Programming Systems, Minneapolis, Minn.

    These checklists are designed for use during the dental assistant student's extramural clinical experience assignment. Checklists test students on their knowledge of terminology, equipment, procedures, and patient relations. Objectives are listed outline style with columns to check progress during a first and a second evaluation. Areas included…

  1. Service quality and clinical outcomes: an example from mental health rehabilitation services in England.

    PubMed

    Killaspy, Helen; Marston, Louise; Omar, Rumana Z; Green, Nicholas; Harrison, Isobel; Lean, Melanie; Holloway, Frank; Craig, Tom; Leavey, Gerard; King, Michael

    2013-01-01

    Current health policy assumes better quality services lead to better outcomes. To investigate the relationship between quality of mental health rehabilitation services in England, local deprivation, service user characteristics and clinical outcomes. Standardised tools were used to assess the quality of mental health rehabilitation units and service users' autonomy, quality of life, experiences of care and ratings of the therapeutic milieu. Multiple level modelling investigated relationships between service quality, service user characteristics and outcomes. A total of 52/60 (87%) National Health Service trusts participated, comprising 133 units and 739 service users. All aspects of service quality were positively associated with service users' autonomy, experiences of care and therapeutic milieu, but there was no association with quality of life. Quality of care is linked to better clinical outcomes in people with complex and longer-term mental health problems. Thus, investing in quality is likely to show real clinical gains.

  2. A framework to link international clinical research to the promotion of justice in global health.

    PubMed

    Pratt, Bridget; Loff, Bebe

    2014-10-01

    How international research might contribute to justice in global health has not been substantively addressed by bioethics. Theories of justice from political philosophy establish obligations for parties from high-income countries owed to parties from low and middle-income countries. We have developed a new framework that is based on Jennifer Ruger's health capability paradigm to strengthen the link between international clinical research and justice in global health. The 'research for health justice' framework provides direction on three aspects of international clinical research: the research target, research capacity strengthening, and post-trial benefits. It identifies the obligations of justice owed by national governments, research funders, research sponsors, and investigators to trial participants and host communities. These obligations vary from those currently articulated in international research ethics guidelines. Ethical requirements of a different kind are needed if international clinical research is to advance global health equity. © 2012 John Wiley & Sons Ltd.

  3. Acupuncture and women's health: an overview of the role of acupuncture and its clinical management in women's reproductive health.

    PubMed

    Cochrane, Suzanne; Smith, Caroline A; Possamai-Inesedy, Alphia; Bensoussan, Alan

    2014-01-01

    Acupuncture and other modalities of Chinese/East Asian medicine have been used to treat women's health for many centuries. Gynecology specialties focus particularly on menstrual and reproductive disorders. Both the adoption of the use of acupuncture outside Asia, and the incorporation of scientific analysis in Asia have challenged biomedical conceptions of what can be achieved with this treatment method. The scale of research activity in relation to acupuncture and women's health has increased over the last 20 years. This review aims to explore the research evidence in relation to acupuncture use for women's reproductive disorders, focusing on both clinical findings and experimental research on acupuncture's mechanisms of action in relation to women's health. A narrative literature search was undertaken using searches of electronic databases and manual searches of journals and textbooks. The search included all literature published prior to June 2013. The literature was assessed as to the nature of the study it was reporting and findings synthesized into a commentary. For acupuncture's mechanism of action the search resulted in 114 relevant documents; in relation to clinical reports on the use of acupuncture for women's health 204 documents were found and assessed. There is preliminary data indicating acupuncture may improve menstrual health and coping for women experiencing delays falling pregnant. There is experimental data showing that acupuncture can influence female reproductive functioning, although the actual mechanisms involved are not yet clarified. Further well-conducted clinical research would benefit our understanding of the usefulness of acupuncture to women's health.

  4. Health promotion practices in two chiropractic teaching clinics: does a review of patient files reflect advice on health promotion?

    PubMed

    Ndetan, Harrison; Evans, Marion Willard; Lo, Kaming; Walters, David; Ramcharan, Michael; Brandon, Patricia; Evans, Cathy; Rupert, Ronald

    2010-01-01

    To retrospectively review patient files in two teaching clinics in the United States and to assess the documented attempts to deliver health promotion messages when a chart indicated a need for health promotion or a red-flag condition that could be helped with positive behavioral changes. Approximately 100 patient files were randomly selected from each of two separate chiropractic teaching clinics, for patients seen after January 2007. Files were assessed for pertinent family history of diseases, personal medical history, and red-flag conditions of patients that would warrant intervention with health promotion. Health promotion advice on at least one occasion was noted in 108 (53.7%) patient charts. Only 7 of 98 overweight or obese patients and none of those with family history of obesity were advised on weight management. Among 23 hypertensive patients, only 5 were advised and 17 of the 97 patients with risk of cardiovascular disease were advised. Chiropractic teaching clinics should assess what they are doing to help Americans reach their health goals. There is an opportunity to shape future practitioners so they include primary prevention as a part of what they do if the profession cares to move in that direction. Future research should look at mechanisms of delivery for health promotion, including better tracking of patients who need it and how staff doctors are trained to deliver oversight to interns in the area of primary prevention.

  5. Encouraging participation in health system reform: is clinical engagement a useful concept for policy and management?

    PubMed

    Bonias, Dimitra; Leggat, Sandra G; Bartram, Timothy

    2012-11-01

    Recent health system enquiries and commissions, including the National Health and Hospital Reform Commission, have promoted clinical engagement as necessary for improving the Australian healthcare system. In fact, the Rudd Government identified clinician engagement as important for the success of the planned health system reform. Yet there is uncertainty about how clinical engagement is understood in health policy and management. This paper aims to clarify how clinical engagement is defined, measured and how it might be achieved in policy and management in Australia. We review the literature and consider clinical engagement in relation to employee engagement, a defined construct within the management literature. We consider the structure and employment relationships of the public health sector in assessing the relevance of this literature. Based on the evidence, we argue that clinical engagement is similar to employee engagement, but that engagement of clinicians who are employees requires a different construct to engagement of clinicians who are independent practitioners. The development of this second construct is illustrated using the case of Visiting Medical Officers in Victoria. Antecedent organisational and system conditions to clinical engagement appear to be lacking in the Australian public health system, suggesting meaningful engagement will be difficult to achieve in the short-term. This has the potential to threaten proposed reforms of the Australian healthcare system.

  6. Towards Horizon 2020: challenges and advances for clinical mental health research - outcome of an expert survey.

    PubMed

    van der Feltz-Cornelis, Christina M; van Os, Jim; Knappe, Susanne; Schumann, Gunter; Vieta, Eduard; Wittchen, Hans-Ulrich; Lewis, Shôn W; Elfeddali, Iman; Wahlbeck, Kristian; Linszen, Donald; Obradors-Tarragó, Carla; Haro, Josep Maria

    2014-01-01

    The size and increasing burden of disease due to mental disorders in Europe poses substantial challenges to its population and to the health policy of the European Union. This warrants a specific research agenda concerning clinical mental health research as one of the cornerstones of sustainable mental health research and health policy in Europe. The aim of this research was to identify the top priorities needed to address the main challenges in clinical research for mental disorders. The research was conducted as an expert survey and expert panel discussion during a scientific workshop. Eighty-nine experts in clinical research and representing most European countries participated in this survey. Identified top priorities were the need for new intervention studies, understanding the diagnostic and therapeutic implications of mechanisms of disease, and research in the field of somatic-psychiatric comorbidity. The "subjectivity gap" between basic neuroscience research and clinical reality for patients with mental disorders is considered the main challenge in psychiatric research, suggesting that a shift in research paradigms is required. Innovations in clinical mental health research should bridge the gap between mechanisms underlying novel therapeutic interventions and the patient experience of mental disorder and, if present, somatic comorbidity. Clinical mental health research is relatively underfunded and should receive specific attention in Horizon 2020 funding programs.

  7. Bronx Teens Connection's Clinic Linkage Model: Connecting Youth to Quality Sexual and Reproductive Health Care.

    PubMed

    O'Uhuru, Deborah J; Santiago, Vivian; Murray, Lauren E; Travers, Madeline; Bedell, Jane F

    2017-03-01

    Teen pregnancy and birth rates in the Bronx have been higher than in New York City, representing a longstanding health disparity. The New York City Department of Health and Mental Hygiene implemented a community-wide, multicomponent intervention to reduce unintended teen pregnancy, the Bronx Teens Connection. The Bronx Teens Connection Clinic Linkage Model sought to increase teens' access to and use of sexual and reproductive health care by increasing community partner capacity to link neighborhood clinics to youth-serving organizations, including schools. The Bronx Teens Connection Clinic Linkage Model used needs assessments, delineated the criteria for linkages, clarified roles and responsibilities of partners and staff, established trainings to support the staff engaged in linkage activities, and developed and used process evaluation methods. Early results demonstrated the strength and feasibility of the model over a 4-year period, with 31 linkages developed and maintained, over 11,300 contacts between clinic health educators and teens completed, and increasing adherence to the Centers for Disease Control and Prevention-defined clinical best practices for adolescent reproductive health. For those eight clinics that were able to provide data, there was a 25% increase in the number of teen clients seen over 4 years. There are many factors that relate to an increase in clinic utilization; some of this increase may have been a result of the linkages between schools and clinics. The Bronx Teens Connection Clinic Linkage Model is an explicit framework for clinical and youth-serving organizations seeking to establish formal linkage relationships that may be useful for other municipalities or organizations. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  8. Ethics and the electronic health record in dental school clinics.

    PubMed

    Cederberg, Robert A; Valenza, John A

    2012-05-01

    Electronic health records (EHRs) are a major development in the practice of dentistry, and dental schools and dental curricula have benefitted from this technology. Patient data entry, storage, retrieval, transmission, and archiving have been streamlined, and the potential for teledentistry and improvement in epidemiological research is beginning to be realized. However, maintaining patient health information in an electronic form has also changed the environment in dental education, setting up potential ethical dilemmas for students and faculty members. The purpose of this article is to explore some of the ethical issues related to EHRs, the advantages and concerns related to the use of computers in the dental operatory, the impact of the EHR on the doctor-patient relationship, the introduction of web-based EHRs, the link between technology and ethics, and potential solutions for the management of ethical concerns related to EHRs in dental schools.

  9. Obesity in America: implications for clinical and health psychologists.

    PubMed

    Bean, Melanie K; Stewart, Karen; Olbrisch, Mary Ellen

    2008-09-01

    The number of individuals classified as overweight and obese is increasing at alarming rates and these conditions are associated with numerous psychological and physiological health problems. Within this epidemic, there is an increasing need and demand for psychologists and other mental health professionals to participate in the care of patients with obesity, both in assessment and treatment domains. The current paper provides a review of the status of the obesity epidemic, including psychological comorbidities and treatment approaches. Throughout this review, we highlight and discuss the important roles and impact psychologists can have. These roles include serving as members of multidisciplinary obesity treatment programs, conducting assessments for bariatric surgery, and treating related psychiatric disorders, such as depression and disordered eating. Other considerations, such as weight gain associated with psychiatric medications, and directions for future involvement of psychologists in addressing the obesity epidemic are also discussed.

  10. Clinical communication among health providers and systems using Web tools.

    PubMed Central

    Flanagan, J. R.; Montgomery, R. R.

    1997-01-01

    Three needs have driven the development of a Web front end to our legacy system. 1) A Web Intranet is needed to provide service for the quantity and diversity of platforms within our health care system. 2) Information transfer in our system is required in more than one format: in viewer-friendly, HTML format and in a database-friendly, down-loadable format. 3) The system encounters the need to electronically exchange information with providers that are not employees of our health care enterprise. This presents a problem with the authentication aspect of security for which we have devised a system to allow the carefully-monitored exchange of records with care providers who are "strangers" to our system. PMID:9357647

  11. Transformational Impact of Health Information Technology on the Clinical Practice of Child and Adolescent Psychiatry.

    PubMed

    Peters, Todd E

    2017-01-01

    Compared with other medical specialties, psychiatrists have been slower adopters of health information technology (IT) practices, such as electronic health records (EHRs). This delay in implementation could compromise patient safety and impede integration into accountable care organizations and multidisciplinary treatment settings. This article focuses on optimizing use of EHRs for clinical practice, leveraging health IT to improve quality of care, and focusing on the potential for future growth in health IT in child and adolescent psychiatric practice. Aligning with other medical fields and focusing on transparency of mental health treatment will help psychiatrists reach parity with other medical specialties.

  12. The clinical nurse leader: helping psychiatric mental health nurses transform their practice.

    PubMed

    Seed, Mary S; Torkelson, Diane J; Karshmer, Judith F

    2009-04-01

    The national movement to transform the health care delivery systems must include a focus on mental health treatment. To address similar deficits across other practice domains, the Clinical Nurse Leader (CNL) role has been created. The CNL is a master's degree that prepares a nurse to use a systems perspective to improve outcomes for a cohort of patient, deliver care based on best practices, and coordinate care in a multidisciplinary team. Applying the CNL role to mental health care could help psychiatric mental health nursing be at the forefront in the transformation of mental health care delivery.

  13. A comparison of measures of access to child health clinics and the implications for modelling the location of new clinics.

    PubMed

    Hyndman, J C; Holman, C D; de Klerk, N H

    1999-04-01

    To determine whether measurement of access to existing child health clinics, and modelled location of new clinics, was affected by the spatial definitions of the target population. Populations requiring childhood screening services were defined as located at individual households, and at geographic and population-weighted centroids of small and large areas. Straight-line and network distances were measured and compared from these origins to varying numbers of existing clinics. The same origins were used to model sets of locations for new clinics, and access levels were again compared. Travel distances for 82,499 annual baby-visits to 140 existing clinics were between 136,000 km and 84,000 km, depending on origin definition. An analysis based on small area centroid data was as accurate as one based on household data. Planning solutions for new clinics located on the basis of few large areas, with populations centred at spatially defined centroids, resulted in poorer access for the population (231,000 km of travel) than one based on many small areas with populations centred at population weighted centroids (194,000 km of travel). Public access to health facilities will be improved if decisions about their locations are aided by the application of spatial analysis techniques based on small area definitions.

  14. Oral health related quality of life and its association with sociodemographic and clinical findings in 3 northern outreach clinics.

    PubMed

    Walter, Michael H; Woronuk, John I; Tan, Han-Kuang; Lenz, Ulrike; Koch, Rainer; Boening, Klaus W; Pinchbeck, Yvonne J

    2007-03-01

    Aspects of oral health related quality of life (OHQOL) are attracting increased attention in dentistry. Knowledge in this field is limited, especially in terms of significant indicators and predictors of impaired OHQOL. The aim of this cross-sectional study was to examine the influence of various sociodemographic and clinical variables on OHQOL in the setting of outreach clinics in northern Alberta, Canada. OHQOL was measured with the 49-item Oral Health Impact Profile questionnaire (OHIP-49), administered to adult patients attending 3 dental outreach clinics managed by the University of Alberta. Sociodemographic and clinical data were also collected. Data were analyzed using descriptive and multivariable methods. The OHIP-49 scores were comparatively low for a patient sample. After multivariable stepwise logistic regression analysis, only gender, missing anterior teeth and need for endodontic treatment remained as significant variables in the final model for impaired OHQOL. Missing anterior teeth (regardless of replacement) had the strongest effect. Subjects with this feature had an approximately 21-fold greater risk of impaired OHQOL relative to those who retained all of their anterior teeth. The clientele of these outreach clinics was generally young but had high treatment needs. OHQOL results can be useful in considering treatment strategies in similar rural environments, but the complexity of this indicator necessitates an individual patient-centred approach in clinical decision-making.

  15. The impact of photovoltaic (PV) installations on downwind particulate matter concentrations: Results from field observations at a 550-MWAC utility-scale PV plant.

    PubMed

    Ravikumar, Dwarakanath; Sinha, Parikhit

    2017-10-01

    With utility-scale photovoltaic (PV) projects increasingly developed in dry and dust-prone geographies with high solar insolation, there is a critical need to analyze the impacts of PV installations on the resulting particulate matter (PM) concentrations, which have environmental and health impacts. This study is the first to quantify the impact of a utility-scale PV plant on PM concentrations downwind of the project site. Background, construction, and post-construction PM2.5 and PM10 (PM with aerodynamic diameters <2.5 and <10 μm, respectively) concentration data were collected from four beta attenuation monitor (BAM) stations over 3 yr. Based on these data, the authors evaluate the hypothesis that PM emissions from land occupied by a utility-scale PV installation are reduced after project construction through a wind-shielding effect. The results show that the (1) confidence intervals of the mean PM concentrations during construction overlap with or are lower than background concentrations for three of the four BAM stations; and (2) post-construction PM2.5 and PM10 concentrations downwind of the PV installation are significantly lower than the background concentrations at three of the four BAM stations. At the fourth BAM station, downwind post-construction PM2.5 and PM10 concentrations increased marginally by 5.7% and 2.6% of the 24-hr ambient air quality standards defined by the U.S. Environmental Protection Agency, respectively, when compared with background concentrations, with the PM2.5 increase being statistically insignificant. This increase may be due to vehicular emissions from an access road near the southwest corner of the site or a drainage berm near the south station. The findings demonstrate the overall environmental benefit of downwind PM emission abatement from a utility-scale PV installation in desert conditions due to wind shielding. With PM emission reductions observed within 10 months of completion of construction, post

  16. Health benefits of cereal fibre: a review of clinical trials.

    PubMed

    Smith, Caren E; Tucker, Katherine L

    2011-06-01

    Cereal fibre and whole-grain intakes have been consistently associated in the epidemiological literature with reduced mortality and risk of chronic disease including obesity, CVD and type 2 diabetes. The present review focuses on intervention trials with three primary aims: (1) understanding the mechanisms through which fibre consumption improves health (for example, examination of intermediate endpoints reflecting improved lipid, glucose and energy metabolism); (2) close evaluation of qualitative factors which modify fibre's effectiveness including physiochemical properties (for example, solubility, fermentability and viscosity), fibre extract molecular weight, fibre particle size and botanical structure of the fibre source grain; and (3) identification of areas in which additional research is needed. The first two aims typify the goals of nutrition research, in that improved understanding of the specific factors which determine fibre's health benefits has critical implications for dietary recommendations as well as improving understanding of physiological mechanisms. The third aim acknowledges the substantial gap between recommended and actual fibre intakes in many developed countries including the USA and the UK. In recognition of this deficit in total fibre intake, food manufacturing processes increasingly utilise fibre extracts and concentrates as food additives. However, whether fibre extracts provide similar health benefits to the fibre supplied in the constituents of whole grain is largely unexplored. The relative benefits of fibre extracts compared with whole-grain fibre sources therefore represent a critical area in which additional research is needed.

  17. Human health implications of clinically relevant bacteria in wastewater habitats.

    PubMed

    Varela, Ana Rita; Manaia, Célia M

    2013-06-01

    The objective of this review is to reflect on the multiple roles of bacteria in wastewater habitats with particular emphasis on their harmful potential for human health. Indigenous bacteria promote a series of biochemical and metabolic transformations indispensable to achieve wastewater treatment. Some of these bacteria may be pathogenic or harbour antibiotic resistance or virulence genes harmful for human health. Several chemical contaminants (heavy metals, disinfectants and antibiotics) may select these bacteria or their genes. Worldwide studies show that treated wastewater contain antibiotic resistant bacteria or genes encoding virulence or antimicrobial resistance, evidencing that treatment processes may fail to remove efficiently these bio-pollutants. The contamination of the surrounding environment, such as rivers or lakes receiving such effluents, is also documented in several studies. The current state of the art suggests that only some of antibiotic resistance and virulence potential in wastewater is known. Moreover, wastewater habitats may favour the evolution and dissemination of new resistance and virulence genes and the emergence of new pathogens. For these reasons, additional research is needed in order to obtain a more detailed assessment of the long-term effects of wastewater discharges. In particular, it is important to measure the human and environmental health risks associated with wastewater reuse.

  18. Seniors' perspectives on care: a case study of the Alex Seniors health clinic, Calgary.

    PubMed

    Shaw, Marta; Rypien, Candace; Drummond, Neil; Harasym, Patricia; Nixon, Lara

    2015-02-25

    Primary care initiatives face an imperative to not only reduce barriers to care for their patients but also to uniquely accommodate the complex needs of at-risk patient populations. Patient-centered multidisciplinary care team models for primary care, like the Alex Seniors Clinic, are one approach for providing comprehensive care for marginalized seniors. The purpose of this qualitative study was to explore patient perspectives on the responsiveness of the Alex Seniors Clinic to their stated health needs. Themes reflected participants' perspectives on factors impacting their health needs as vulnerable seniors as well as on the measures that the Alex Seniors Clinic has taken to meet those needs. Factors impacting health included: the nature of their relationships to the physical environment in which they lived, the nature of the relationships they had to others in that environment, and independence and autonomy. Participants identified accessibility, respect and support, and advocacy as the ways in which the clinic was working to address those health needs. While respect and support, as well as advocacy, effectively addressed some patient needs, participants felt that accessibility problems continue to be health-related barriers for clinic patients. This may be due to the fact that issues of accessibility reflect larger community and social problems. Nevertheless, it is only through engaging the patient community for input on clinic approaches that an understanding can be gained of how closely a clinic's care goals are currently aligning with patient perspectives of the care and services they receive.

  19. Health Care Infrastructure for Financially Sustainable Clinical Genomics.

    PubMed

    Lennerz, Jochen K; McLaughlin, Heather M; Baron, Jason M; Rasmussen, David; Sumbada Shin, Meini; Berners-Lee, Nancy; Miller Batten, Julie; Swoboda, Kathryn J; Gala, Manish K; Winter, Harland S; Schmahmann, Jeremy D; Sweetser, David A; Boswell, Marianne; Pacula, Maciej; Stenzinger, Albrecht; Le, Long P; Hynes, William; Rehm, Heidi L; Klibanski, Anne; Black-Schaffer, Stephen W; Golden, Jeffrey A; Louis, David N; Weiss, Scott T; Iafrate, A John

    2016-09-01

    Next-generation sequencing has evolved technically and economically into the method of choice for interrogating the genome in cancer and inherited disorders. The introduction of procedural code sets for whole-exome and genome sequencing is a milestone toward financially sustainable clinical implementation; however, achieving reimbursement is currently a major challenge. As part of a prospective quality-improvement initiative to implement the new code sets, we adopted Agile, a development methodology originally devised in software development. We implemented eight functionally distinct modules (request review, cost estimation, preauthorization, accessioning, prebilling, testing, reporting, and reimbursement consultation) and obtained feedback via an anonymous survey. We managed 50 clinical requests (January to June 2015). The fraction of pursued-to-requested cases (n = 15/50; utilization management fraction, 0.3) aimed for a high rate of preauthorizations. In 13 of 15 patients the insurance plan required preauthorization, which we obtained in 70% and ultimately achieved reimbursement in 50%. Interoperability enabled assessment of 12 different combinations of modules that underline the importance of an adaptive workflow and policy tailoring to achieve higher yields of reimbursement. The survey confirmed a positive attitude toward self-organizing teams. We acknowledge the individuals and their interactions and termed the infrastructure: human pipeline. Nontechnical barriers currently are limiting the scope and availability of clinical genomic sequencing. The presented human pipeline is one approach toward long-term financial sustainability of clinical genomics. Copyright © 2016 American Society for Investigative Pathology and the Association for Molecular Pathology. Published by Elsevier Inc. All rights reserved.

  20. Appointment Template Redesign in a Women’s Health Clinic Using Clinical Constraints to Improve Service Quality and Efficiency

    PubMed Central

    Verduzco, S.

    2015-01-01

    Summary Background Patient wait time is a critical element of access to care that has long been recognized as a major problem in modern outpatient health care delivery systems. It impacts patient and medical staff productivity, stress, quality and efficiency of medical care, as well as health-care cost and availability. Objectives This study was conducted in a Women’s Health Clinic. The objective was to improve clinic service quality by redesigning patient appointment template using the clinical constraints. Methods The proposed scheduling template consisted of two key elements: the redesign of appointment types and the determination of the length of time slots using defined constraints. The re-classification technique was used for the redesign of appointment visit types to capture service variation for scheduling purposes. Then, the appointment length was determined by incorporating clinic constraints or goals, such as patient wait time, physician idle time, overtime, finish time, lunch hours, when the last appointment was scheduled, and the desired number of appointment slots, to converge the optimal length of appointment slots for each visit type. Results The redesigned template was implemented and the results indicated a 73% reduction in average patient waiting from the reported 40 to 11 minutes. The patient no-show rate was reduced by 4% from 24% to 20%. The morning section on average finished about 11:50 am. The clinic day was finished around 4:45 pm. Provider average idle time was estimated to be about 5 minutes, which can be used for charting/documenting patients. Conclusions This study provided an alternative method of redesigning appointment scheduling templates using only the clinical constraints rather than the traditional way that required an objective function. This paper also documented the employed methods step by step in a real clinic setting. The implementation results concluded a significant improvement on patient wait time and no-show rate

  1. A fatal case of poisoning related to new cathinone designer drugs, 4-methoxy PV8, PV9, and 4-methoxy PV9, and a dissociative agent, diphenidine.

    PubMed

    Kudo, Keiko; Usumoto, Yosuke; Kikura-Hanajiri, Ruri; Sameshima, Naomi; Tsuji, Akiko; Ikeda, Noriaki

    2015-09-01

    A woman in her thirties was found dead on a bed. Considerable amounts of "aroma liquid" and "bath salt" products and hypnotic drug tablets were scattered beside the bed. Autopsy showed pulmonary congestion and edema. Gas chromatography-mass spectrometry (GC-MS) and liquid chromatography-mass spectrometry (LC-MS) analyses of "aroma liquid" and "bath salt" products showed the presence of new cathinone designer drugs, 4-methoxy PV8 (4-methoxy PHPP), PV9 (α-POP), and 4-methoxy PV9 (4-methoxy α-POP), and a dissociative agent, diphenidine. Drug screening in stomach contents, blood and hydrolyzed urine of the woman by GC-MS and liquid chromatography-tandem mass spectrometry (LC-MS/MS) revealed the presence of the above 4 types of drugs and 3 types of benzodiazepines, triazolam, flunitrazepam, and nitrazepam, and their metabolites. The above 7 drugs and 3 benzodiazepine metabolites were simultaneously determined by LC-MS/MS after modified QuEChERS (Quick, Easy, Cheap, Effective, Rugged, Safe) extraction using diazepam-d5 as the internal standard. The concentrations of 4-methoxy PV8, PV9, 4-methoxy PV9, and diphenidine in the femoral blood were 2.69, 0.743, 0.261, and 1.38μg/ml, respectively, which were significantly higher than concentrations reported in previous cases. Alcohol concentration in the femoral blood was 1.52mg/ml. Based on the pathological and toxicological findings, the cause of death was determined to be 3 types of cathinone drugs, 4-methoxy PV8, PV9, and 4-methoxy PV9, and diphenidine poisoning under the influence of 3 benzodiazepines and alcohol.

  2. Rural Health Clinics and Diabetes-Related Primary Care for Medicaid Beneficiaries in Oregon

    ERIC Educational Resources Information Center

    Kirkbride, Kelly; Wallace, Neal

    2009-01-01

    Background: This study assessed whether Rural Health Clinics (RHCs) were associated with higher rates of recommended primary care services for adult beneficiaries diagnosed with diabetes in Oregon's Medicaid program, the Oregon Health Plan (OHP). Methods: OHP claims data from 2002 to 2003 were used to assess quality of diabetic care for…

  3. Use of Clinical Health Information Technology in Nursing Homes: Nursing Home Characteristics and Quality Measures

    ERIC Educational Resources Information Center

    Spinelli-Moraski, Carla

    2014-01-01

    This study compares quality measures among nursing homes that have adopted different levels of clinical health information technology (HIT) and examines the perceived barriers and benefits of the adoption of electronic health records as reported by Nursing Home Administrators and Directors of Nursing. A cross-sectional survey distributed online to…

  4. 42 CFR 440.20 - Outpatient hospital services and rural health clinic services.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Definitions § 440.20 Outpatient hospital services and rural health clinic services. (a) Outpatient hospital... agency may exclude from the definition of “outpatient hospital services” those types of items and... 42 Public Health 4 2010-10-01 2010-10-01 false Outpatient hospital services and rural...

  5. Assessing Students with Serious Mental Health and Behavioral Problems: Clinical Assessment for Educators.

    ERIC Educational Resources Information Center

    Hansen, Jo-Ida C.; Conlon, Amy L.

    The current intervention trend for many of the mental health and behavioral problems faced by today's youth is an integrative approach that involves the community, families, and schools. Clinical assessment for serious mental health and behavioral problems can be an important component in the development of school-based screening programs. The…

  6. School-Based Health Clinics: An Analysis of the Johns Hopkins Study. Research Developments.

    ERIC Educational Resources Information Center

    Demsko, Tobin W.

    School-based health clinics, adolescent pregnancy prevention programs offering comprehensive health services, represent the latest initiative to reduce the incidence of teenage pregnancy. Researchers at Johns Hopkins University designed and administered a pregnancy prevention program which offered sexuality education and family planning services…

  7. The Development and Testing of a Community Health Nursing Clinical Evaluation Tool.

    ERIC Educational Resources Information Center

    Hawranik, Pamela

    2000-01-01

    Describes the development and testing of a clinical evaluation tool for a community health nursing course for registered nurses through review of the literature and focus groups with community health nurses and faculty. The article contains 22 references and an abbreviated form of the evaluation tool. (Author/JOW)

  8. Building Competency in Infant Mental Health Practice: The Edith Cowan University Pregnancy to Parenthood Clinic

    ERIC Educational Resources Information Center

    Matacz, Rochelle; Priddis, Lynn

    2016-01-01

    This article describes a unique Australian infant mental health (IMH) service for families from pregnancy through to early parenthood (0-3 years) and training center for postgraduate clinical psychology students. The Australian Association for Infant Mental Health Incorporated, West Australia Branch (AAIMHI WA) "Competency Guidelines"®…

  9. Management Development in Health Care: Exploring the Experiences of Clinical Nurse Managers

    ERIC Educational Resources Information Center

    Purcell, Laura; Milner, Brigid

    2005-01-01

    Purpose--The purpose of this paper is to investigate the dramatic reforms in the health service in recent years. Design/methodology/approach--Examines management development in health care, and explores the experiences of clinical nurse managers. Findings--Duplication of agencies and multiplication of roles have led to tensions in terms of both…

  10. Accuracy and Agreement in Clinical Assessment in a State Mental Health System.

    ERIC Educational Resources Information Center

    Willinger, Ken; And Others

    Accountability has become a concern for public mental health programs, including the Hawaii State Mental Health Division which relies on the Multi-State Information System (MSIS) for program planning and evaluation. Accuracy in reporting and agreement in clinical judgment on the MSIS has been assumed but never tested until an analogue study was…

  11. Rural Health Clinics and Diabetes-Related Primary Care for Medicaid Beneficiaries in Oregon

    ERIC Educational Resources Information Center

    Kirkbride, Kelly; Wallace, Neal

    2009-01-01

    Background: This study assessed whether Rural Health Clinics (RHCs) were associated with higher rates of recommended primary care services for adult beneficiaries diagnosed with diabetes in Oregon's Medicaid program, the Oregon Health Plan (OHP). Methods: OHP claims data from 2002 to 2003 were used to assess quality of diabetic care for…

  12. Building Competency in Infant Mental Health Practice: The Edith Cowan University Pregnancy to Parenthood Clinic

    ERIC Educational Resources Information Center

    Matacz, Rochelle; Priddis, Lynn

    2016-01-01

    This article describes a unique Australian infant mental health (IMH) service for families from pregnancy through to early parenthood (0-3 years) and training center for postgraduate clinical psychology students. The Australian Association for Infant Mental Health Incorporated, West Australia Branch (AAIMHI WA) "Competency Guidelines"®…

  13. Integrative cases for preclinical medical students: connecting clinical, basic science, and public health approaches.

    PubMed

    Schapiro, Renie; Stickford-Becker, Amy E; Foertsch, Julie A; Remington, Patrick L; Seibert, Christine S

    2011-10-01

    Healthcare and public health systems are each transforming, resulting in a need for better integration between clinical and population-based approaches to improve the health of populations. These changes also demand substantial transformations in the curriculum for medical students. Integrative Cases were designed for all first- and second-year medical students to provide them with more awareness, knowledge, and skills in integrating public health into clinical medicine. Each case examines basic science factors, clinical approaches, and public health determinants, including risk factors and direct and indirect contributing factors. This study was designed to evaluate the effectiveness of Integrative Cases in the medical student curriculum. Integrative Cases were formatively evaluated using standardized online post-event questionnaires emailed to students after each case. The questionnaires focused on goals specific to each case, ratings of particular sessions and facilitators, general impressions of the case, and student suggestions for improvement. Student evaluations indicate that Integrative Cases achieved their goals, especially providing experiences that offer a more expansive view of medicine and public health, stimulating interest and questions that anticipate future learning and making connections across basic science, medicine, and health. Students also indicated that these cases added to their understanding of public health issues and how to apply what they had learned to patient care. Integrative Cases demonstrate the effectiveness of a comprehensive approach that integrates clinical medicine with basic science and public health perspectives. Copyright © 2011 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  14. School-Based Health Clinics: An Analysis of the Johns Hopkins Study. Research Developments.

    ERIC Educational Resources Information Center

    Demsko, Tobin W.

    School-based health clinics, adolescent pregnancy prevention programs offering comprehensive health services, represent the latest initiative to reduce the incidence of teenage pregnancy. Researchers at Johns Hopkins University designed and administered a pregnancy prevention program which offered sexuality education and family planning services…

  15. Public health nurses perception of clinical leadership in Ireland: narrative descriptions.

    PubMed

    Carney, Marie

    2009-05-01

    The aim of the study was to identify how clinical leadership skills are perceived by Public Health Nurses in the course of their everyday work and the effectiveness and consequences of such skills in primary care delivery. Public health nurses deliver primary care to children and adults as part of small teams or in individual situations. Leadership skills are needed to fulfil their many roles. Rigorous analysis of narrative interviews with public health nurses working in primary care environments in Ireland was undertaken. Narrative information was obtained by having conversations with 20 public health nurses relating to their perceptions on what clinical leadership meant to them and how their leadership skills influenced effective primary care delivery. Analysis of conversations identified the tensions existing between the various roles and responsibilities of the public health nurse and other primary care workers. This tension was perceived by the nurses as being the main barrier to effective primary care delivery from their perspective. Clinical leadership is viewed narrowly by public health nurses as management skills rather than leadership skills were mainly identified. Education for the role was identified as a critical success factor. RELEVANCE TO NURSE MANAGERS: Public health nurses are well placed to shape and influence health service culture through effective clinical leadership.

  16. A New Conceptual Framework for Mental Health Clinical Service Research on Hispanic Populations.

    ERIC Educational Resources Information Center

    Rogler, Lloyd H.; And Others

    1982-01-01

    This report examines selected studies on the search for and utilization of mental health facilities among Hispanic populations and presents a framework for research on mental health services for Hispanics. Shortcomings of available data on this topic are reviewed. The research framework proposed is based on the assumption that clinical service…

  17. Health literacy and child health promotion: implications for research, clinical care, and public policy.

    PubMed

    Sanders, Lee M; Shaw, Judith S; Guez, Ghislaine; Baur, Cynthia; Rudd, Rima

    2009-11-01

    The nation's leading sources of morbidity and health disparities (eg, preterm birth, obesity, chronic lung disease, cardiovascular disease, type 2 diabetes, mental health disorders, and cancer) require an evidence-based approach to the delivery of effective preventive care across the life course (eg, prenatal care, primary preventive care, immunizations, physical activity, nutrition, smoking cessation, and early diagnostic screening). Health literacy may be a critical and modifiable factor for improving preventive care and reducing health disparities. Recent studies among adults have established an independent association between lower health literacy and poorer understanding of preventive care information and poor access to preventive care services. Children of parents with higher literacy skills are more likely to have better outcomes in child health promotion and disease prevention. Adult studies in disease prevention have suggested that addressing health literacy would be an efficacious strategy for reducing health disparities. Future initiatives to reduce child health inequities should include health-promotion strategies that meet the health literacy needs of children, adolescents, and their caregivers.

  18. Oxynitride Thin Film Barriers for PV Packaging

    SciTech Connect

    Glick, S. H.; delCueto, J. A.; Terwilliger, K. M.; Jorgensen, G. J.; Pankow, J. W.; Keyes, B. M.; Gedvilas, L. M.; Pern, F. J.

    2005-11-01

    Dielectric thin-film barrier and adhesion-promoting layers consisting of silicon oxynitride materials (SiOxNy, with various stoichiometry) were investigated. For process development, films were applied to glass (TCO, conductive SnO2:F; or soda-lime), polymer (PET, polyethylene terephthalate), aluminized soda-lime glass, or PV cell (a-Si, CIGS) substrates. Design strategy employed de-minimus hazard criteria to facilitate industrial adoption and reduce implementation costs for PV manufacturers or suppliers. A restricted process window was explored using dilute compressed gases (3% silane, 14% nitrous oxide, 23% oxygen) in nitrogen (or former mixtures, and 11.45% oxygen mix in helium and/or 99.999% helium dilution) with a worst-case flammable and non-corrosive hazard classification. Method employed low radio frequency (RF) power, less than or equal to 3 milliwatts per cm2, and low substrate temperatures, less than or equal to 100 deg C, over deposition areas less than or equal to 1000 cm2. Select material properties for barrier film thickness (profilometer), composition (XPS/FTIR), optical (refractive index, %T and %R), mechanical peel strength and WVTR barrier performance are presented.

  19. Wiki Activities in Blended Learning for Health Professional Students: Enhancing Critical Thinking and Clinical Reasoning Skills

    ERIC Educational Resources Information Center

    Snodgrass, Suzanne

    2011-01-01

    Health professionals use critical thinking, a key problem solving skill, for clinical reasoning which is defined as the use of knowledge and reflective inquiry to diagnose a clinical problem. Teaching these skills in traditional settings with growing class sizes is challenging, and students increasingly expect learning that is flexible and…

  20. Clinical Perspectives on Colorectal Cancer Screening at Latino-Serving Federally Qualified Health Centers

    ERIC Educational Resources Information Center

    Coronado, Gloria D.; Petrik, Amanda F.; Spofford, Mark; Talbot, Jocelyn; Do, Huyen Hoai; Taylor, Victoria M.

    2015-01-01

    Purpose: Colorectal cancer is the second most common cause of cancer death in the United States, and rates of screening for colorectal cancer are low. We sought to gather the perceptions of clinic personnel at Latino-serving Federally Qualified Health Centers (operating 17 clinics) about barriers to utilization of screening services for colorectal…

  1. Medication Abortion within a Student Health Care Clinic: A Review of the First 46 Consecutive Cases

    ERIC Educational Resources Information Center

    Godfrey, Emily M.; Bordoloi, Anita; Moorthie, Mydhili; Pela, Emily

    2012-01-01

    Objective: Medication abortion with mifepristone and misoprostol has been available in the United States since 2000. The authors reviewed the first 46 medication abortion cases conducted at a university-based student health care clinic to determine the safety and feasibility of medication abortion in this type of clinical setting. Participants:…

  2. Wiki Activities in Blended Learning for Health Professional Students: Enhancing Critical Thinking and Clinical Reasoning Skills

    ERIC Educational Resources Information Center

    Snodgrass, Suzanne

    2011-01-01

    Health professionals use critical thinking, a key problem solving skill, for clinical reasoning which is defined as the use of knowledge and reflective inquiry to diagnose a clinical problem. Teaching these skills in traditional settings with growing class sizes is challenging, and students increasingly expect learning that is flexible and…

  3. Leadership Practices of Clinical Trials Office Leaders in Academic Health Centers

    ERIC Educational Resources Information Center

    Naser, Diana D.

    2012-01-01

    In the ever-changing clinical research environment, academic health centers seek leaders who are visionary and innovative. Clinical trials offices across the country are led by individuals who are charged with promoting growth and change in order to maximize performance, develop unique research initiatives, and help institutions achieve a…

  4. Usefulness of a Survey on Underage Drinking in a Rural American Indian Community Health Clinic

    ERIC Educational Resources Information Center

    Gilder, David A.; Luna, Juan A.; Roberts, Jennifer; Calac, Daniel; Grube, Joel W.; Moore, Roland S.; Ehlers, Cindy L.

    2013-01-01

    This study examined the usefulness of a survey on underage drinking in a rural American Indian community health clinic. One hundred ninety-seven youth (90 male, 107 female; age range 8-20 years) were recruited from clinic waiting rooms and through community outreach. The study revealed that the usefulness of the survey was twofold: Survey results…

  5. Information-seeking behavior of nursing students and clinical nurses: implications for health sciences librarians*

    PubMed Central

    Dee, Cheryl; Stanley, Ellen E.

    2005-01-01

    Objectives: This research was conducted to provide new insights on clinical nurses' and nursing students' current use of health resources and libraries and deterrents to their retrieval of electronic clinical information, exploring implications from these findings for health sciences librarians. Methods: Questionnaires, interviews, and observations were used to collect data from twenty-five nursing students and twenty-five clinical nurses. Results: Nursing students and clinical nurses were most likely to rely on colleagues and books for medical information, while other resources they frequently cited included personal digital assistants, electronic journals and books, and drug representatives. Significantly more nursing students than clinical nurses used online databases, including CINAHL and PubMed, to locate health information, and nursing students were more likely than clinical nurses to report performing a database search at least one to five times a week. Conclusions and Recommendations: Nursing students made more use of all available resources and were better trained than clinical nurses, but both groups lacked database-searching skills. Participants were eager for more patient care information, more database training, and better computer skills; therefore, health sciences librarians have the opportunity to meet the nurses' information needs and improve nurses' clinical information-seeking behavior. PMID:15858624

  6. National Assessment of Clinical Education of Allied Health Manpower: Volume IV: Bibliography.

    ERIC Educational Resources Information Center

    Booz Allen and Hamilton, Inc., Washington, DC.

    The document is the last volume of a four-part report of a study conducted to evaluate and assess the national state of clinical education and training of allied health manpower. It presents a bibliography of all significant clinical education materials, documentary materials and ongoing studies, through August 30, 1973 but after 1965. The…

  7. Integration of Health Maintenance Guidelines into a Clinical Workstation Using Expert System and Relational Database Technology

    PubMed Central

    Jenders, Robert A.; Barnett, G. Octo

    1993-01-01

    We are developing a clinical workstation which integrates access to health maintenance guidelines with a computer-based medical record. We discuss the use of relational database and expert system technology to provide both patient-specific and patient-independent access to clinical guidelines.

  8. Leadership Practices of Clinical Trials Office Leaders in Academic Health Centers

    ERIC Educational Resources Information Center

    Naser, Diana D.

    2012-01-01

    In the ever-changing clinical research environment, academic health centers seek leaders who are visionary and innovative. Clinical trials offices across the country are led by individuals who are charged with promoting growth and change in order to maximize performance, develop unique research initiatives, and help institutions achieve a…

  9. Medication Abortion within a Student Health Care Clinic: A Review of the First 46 Consecutive Cases

    ERIC Educational Resources Information Center

    Godfrey, Emily M.; Bordoloi, Anita; Moorthie, Mydhili; Pela, Emily

    2012-01-01

    Objective: Medication abortion with mifepristone and misoprostol has been available in the United States since 2000. The authors reviewed the first 46 medication abortion cases conducted at a university-based student health care clinic to determine the safety and feasibility of medication abortion in this type of clinical setting. Participants:…

  10. Clinical Perspectives on Colorectal Cancer Screening at Latino-Serving Federally Qualified Health Centers

    ERIC Educational Resources Information Center

    Coronado, Gloria D.; Petrik, Amanda F.; Spofford, Mark; Talbot, Jocelyn; Do, Huyen Hoai; Taylor, Victoria M.

    2015-01-01

    Purpose: Colorectal cancer is the second most common cause of cancer death in the United States, and rates of screening for colorectal cancer are low. We sought to gather the perceptions of clinic personnel at Latino-serving Federally Qualified Health Centers (operating 17 clinics) about barriers to utilization of screening services for colorectal…

  11. Promoting the place of the allied health professions in clinical research.

    PubMed

    Rothan-Tondeur, Monique; Courcier, Soizic; Béhier, Jehan-Michel; Leblanc, Judith; Peoch, Nadia; Lefort, Marie-Claude; Barthélémy, Philippe; Bassompierre, François; Bilbault, Pascal; Déal, Cécile; Diebolt, Vincent; Fraleux, Michèle; François, Bruno; Gambotti, Laetitia; Lévy-Marchal, Claire; Misse, Christophe; Roussel, Christophe; Sibenaler, Claire; Simon, Tabassome; Tavernier, Blanche; Thoby, Frédérique

    2014-01-01

    Clinical research is of major importance to today's society, as scientific evidence is increasingly demanded as a basis for progress, whether this involves developing new healthcare products, improving clinical practice and care protocols or progress in prevention. Clinical research therefore requires professionals who are both experienced and increasingly well trained. Against this background, allied health professionals are becoming involved more and more, both as team members supporting clinical research projects and as managers or coordinators of projects in their own field. Clinical research activities provide an ideal opportunity for continuing professional development. All of this means that the professional skills of the allied health professions and clinical research support professions must be enhanced, their role promoted in the context of lecturer status and in the longer term, their status recognised by the supervisory authorities.

  12. [Impact of Morbidity on Health Care Costs of a Department of Health through Clinical Risk Groups. Valencian Community, Spain].

    PubMed

    Caballer Tarazona, Vicent; Guadalajara Olmeda, Natividad; Vivas Consuelo, David; Clemente Collado, Antonio

    2016-06-08

    Risk adjustment systems based on diagnosis stratify the population according to the observed morbidity. The aim of this study was to analyze the total health expenditure in a health area, relating to age, gender and morbidity observed in the population. Observational cross-sectional study of population and area of health care costs in the Health District of Denia-Marina Salud (Alicante) in 2013. Population (N=156,811) were stratified by Clinical Risk Groups into 9 states of health, state 1 being healthy, and state 9 the highest disease burden. Each inhabitant was charged with the hospital costs, primary care and outpatient pharmacy to obtain the total costs. Health status and severity by age and gender, as well as the costs of each group were analysed. The statistical tests, student t and χ2 were applied to verify the existence of significant differences between and intra groups. The average cost per inhabitant was 983 euros which increased from 240 euros to 42,881 at the state 9 and severity level 6. Patients of health states 5 and 6 caused the largest expenditure by concentration of the population, but health states 8 and 9 had the highest average expenditure, with 80% of hospitalised cost. A different composition of health expenditure per individual morbidity was corroborated, with an exponential growth in hospital spending.

  13. Women's Health Care Minimum Data Set: pilot test and validation for use in clinical practice.

    PubMed

    Farley, Cindy L; Tharpe, Nell; Miller, Liane; Ruxer, Debbie Jenkins

    2006-01-01

    Basic elements of the structure, process, and outcomes of midwifery practice have not been fully determined, particularly in the areas of women's gynecologic and primary health care. The American College of Nurse-Midwives (ACNM) supported the development of clinical data sets to describe structure, process, and outcomes of midwifery practice for use by clinical practitioners. The Woman's Health Care Minimum Data Set was developed using a panel of expert midwives and other women's health care professionals, as well as literature resources. Students of the Graduate Midwifery Program at Philadelphia University performed pilot testing of the Woman's Health Care Minimum Data Set as a service to the profession of midwifery while applying concepts learned in their research methods courses. Each student (n = 19) recruited a midwifery practice in which she had a clinical affiliation, and gathered data sets on the previous 30 consecutive women's health care encounters by CNMs or CMs (n = 569). Item analysis and refinement were done. Criterion-related validity and construct-related validity of the Woman's Health Care Minimum Data Set were explored through comparison with the medical record and through the testing of plausible hypotheses. The Woman's Health Care Minimum Data Set has the potential to be an important instrument in documenting and understanding the evolving nature of the practice of primary women's health care by midwives and other women's health care providers.

  14. Self-esteem, stress and self-rated health in family planning clinic patients.

    PubMed

    Rohrer, James E; Young, Rodney

    2004-06-03

    The independent effects of stress on the health of primary care patients might be different for different types of clinic populations. This study examines these relationships in a low-income female population of patients attending a family planning clinic. This study investigated the relevance of different sources of personal stress and social support to self-rated health, adjusting for mental health, health behavior and demographic characteristics of subjects. Five hundred women who attended family planning clinics were surveyed and 345 completed the form for a response rate of 72 percent. Multiple logistic regression analysis revealed that liking oneself was related to good self-rated health (Odds ratio = 7.11), but stress or support from children, parents, friends, churches or spouses were not significant. White non-Hispanic and non-white non-Hispanic respondents had lower odds of reporting good self-rated health than Hispanic respondents (odds ratios were 2.87 and 2.81, respectively). Exercising five or more days per week also was related to good self-rated health. Smoking 20 or more cigarettes per day, and obese III were negatively related to good self-rated health (odds ratios were.19 and.22, respectively with corresponding p-values equal to.0043 and.0332). Among younger low-income women, addressing low self-esteem might improve health status.

  15. Crowdsourced health research studies: an important emerging complement to clinical trials in the public health research ecosystem.

    PubMed

    Swan, Melanie

    2012-03-07

    conditions. PatientsLikeMe and 23andMe are the leading operators of researcher-organized, crowdsourced health research studies. These operators have published findings in the areas of disease research, drug response, user experience in crowdsourced studies, and genetic association. Quantified Self, Genomera, and DIYgenomics are communities of participant-organized health research studies where individuals conduct self-experimentation and group studies. Crowdsourced health research studies have a diversity of intended outcomes and levels of scientific rigor. Participatory health initiatives are becoming part of the public health ecosystem and their rapid growth is facilitated by Internet and social networking influences. Large-scale parameter-stratified cohorts have potential to facilitate a next-generation understanding of disease and drug response. Not only is the large size of crowdsourced cohorts an asset to medical discovery, too is the near-immediate speed at which medical findings might be tested and applied. Participatory health initiatives are expanding the scope of medicine from a traditional focus on disease cure to a personalized preventive approach. Crowdsourced health research studies are a promising complement and extension to traditional clinical trials as a model for the conduct of health research.

  16. Crowdsourced Health Research Studies: An Important Emerging Complement to Clinical Trials in the Public Health Research Ecosystem

    PubMed Central

    2012-01-01

    outcomes for a variety of health conditions. PatientsLikeMe and 23andMe are the leading operators of researcher-organized, crowdsourced health research studies. These operators have published findings in the areas of disease research, drug response, user experience in crowdsourced studies, and genetic association. Quantified Self, Genomera, and DIYgenomics are communities of participant-organized health research studies where individuals conduct self-experimentation and group studies. Crowdsourced health research studies have a diversity of intended outcomes and levels of scientific rigor. Conclusions Participatory health initiatives are becoming part of the public health ecosystem and their rapid growth is facilitated by Internet and social networking influences. Large-scale parameter-stratified cohorts have potential to facilitate a next-generation understanding of disease and drug response. Not only is the large size of crowdsourced cohorts an asset to medical discovery, too is the near-immediate speed at which medical findings might be tested and applied. Participatory health initiatives are expanding the scope of medicine from a traditional focus on disease cure to a personalized preventive approach. Crowdsourced health research studies are a promising complement and extension to traditional clinical trials as a model for the conduct of health research. PMID:22397809

  17. Integrating a clinical service line for maternal-child health.

    PubMed

    Stichler, J F; Branciforte, L

    1998-01-01

    Clinical integration is a developmental process that calls on the combined resources, expertise, and knowledge of individuals who may be working together for the first time. The process is dependent on the acknowledgment of the value of integration and a shared vision for the service line. By using a strategic thinking and planning process, the service line can be reshaped to function as an integrated system of programs and services that is sensitive to needs at a local level. While the task of integration is not an easy one, the outcomes of the process lead to a synergy that cannot be realized in any other manner.

  18. Medical Students as Health Educators at a Student-Run Free Clinic: Improving the Clinical Outcomes of Diabetic Patients

    PubMed Central

    Peltz, Alon; Ladner, Travis R.; Reddy, India; Miller, Bonnie M.; Miller, Robert F.; Fowler, Michael J.

    2014-01-01

    Purpose Student-run free clinics (SRFCs) provide service–learning opportunities for medical students and care to underserved patients. Few published studies, however, support that they provide high-quality care. In this study, the authors examined the clinical impact of a medical student health educator program for diabetic patients at an SRFC. Method In 2012, the authors retrospectively reviewed the electronic medical records of diabetic patients who established care at Shade Tree Clinic in Nashville, Tennessee, between 2008 and 2011. They compared clinical outcomes at initial presentation to the clinic and 12 months later. They analyzed the relationship between the number of patient–student interactions (touchpoints) and change in hemoglobin A1c values between these two time points and compared the quality of care provided to best-practice benchmarks (process and outcomes measures). Results The authors studied data from 45 patients. Mean hemoglobin A1c values improved significantly from 9.6 to 7.9, after a mean of 12.5 ± 1.5 months (P < .0001). A trend emerged between increased number of touchpoints and improvement in A1c values (r2 = 0.06, P = .10). A high percentage of patients were screened during clinic visits, whereas a low to moderate percentage met benchmarks for A1c, LDL, and blood pressure levels. Conclusions These findings demonstrate that a medical student health educator program at an SRFC can provide high-quality diabetes care and facilitate clinical improvement one year after enrollment, despite inherent difficulties in caring for underserved patients. Future studies should examine the educational and clinical value of care provided at SRFCs. PMID:24556762

  19. Identifying mental health services in clinical genetic settings.

    PubMed

    Cappelli, M; Esplen, M J; Wilson, B J; Dorval, M; Bottorff, J L; Ly, M; Carroll, J C; Allanson, J; Humphreys, E; Rayson, D

    2009-10-01

    The purpose of this study was to examine the mental health needs of individuals at risk for adult onset hereditary disorder (AOHD) from the perspective of their genetic service providers, as it is unknown to what extent psychosocial services are required and being met. A mail-out survey was sent to 281 providers on the membership lists of the Canadian Association of Genetic Counsellors and the Canadian College of Medical Geneticists. The survey assessed psychosocial issues that were most commonly observed by geneticists, genetic counsellors (GCs), and nurses as well as availability and types of psychosocial services offered. Of the 129 respondents, half of genetic service providers reported observing signs of depression and anxiety, while 44% noted patients' concerns regarding relationships with family and friends. In terms of providing counselling to patients, as the level of psychological risk increased, confidence in dealing with these issues decreased. In addition, significantly more GCs reported that further training in psychosocial issues would be most beneficial to them if resources were available. As a feature of patient care, it is recommended that gene-based predictive testing include an integrative model of psychosocial services as well as training for genetic service providers in specific areas of AOHD mental health.

  20. Systemic Hydration: Relating Science to Clinical Practice in Vocal Health

    PubMed Central

    Hartley, Naomi A.; Thibeault, Susan L.

    2014-01-01

    Objectives To examine the current state of the science regarding the role of systemic hydration in vocal function and health. Study Design Literature Review Methods Literature search spanning multiple disciplines, including speech-language pathology, nutrition and dietetics, medicine, sports and exercise science, physiology and biomechanics. Results The relationship between hydration and physical function is an area of common interest amongst multiple professions. Each discipline provides valuable insight into the connection between performance and water balance, as well as complimentary methods of investigation. Existing voice literature suggests a relationship between hydration and voice production, however the underlying mechanisms are not yet defined and a treatment effect for systemic hydration remains to be demonstrated. Literature from other disciplines sheds light on methodological shortcomings and in some cases offers an alternative explanation for observed phenomena. Conclusions A growing body of literature in the field of voice science is documenting a relationship between hydration and vocal function, however greater understanding is required to guide best practice in the maintenance of vocal health and management of voice disorders. Integration of knowledge and technical expertise from multiple disciplines facilitates analysis of existing literature and provides guidance as to future research. PMID:24880674