Paterson, Pauline; Meurice, François; Stanberry, Lawrence R; Glismann, Steffen; Rosenthal, Susan L; Larson, Heidi J
While most people vaccinate according to the recommended schedule, this success is challenged by individuals and groups who delay or refuse vaccines. The aim of this article is to review studies on vaccine hesitancy among healthcare providers (HCPs), and the influences of their own vaccine confidence and vaccination behaviour on their vaccination recommendations to others. The search strategy was developed in Medline and then adapted across several multidisciplinary mainstream databases including Embase Classic & Embase, and PschInfo. All foreign language articles were included if the abstract was available in English. A total of 185 articles were included in the literature review. 66% studied the vaccine hesitancy among HCPs, 17% analysed concerns, attitudes and/or behaviour of HCPs towards vaccinating others, and 9% were about evaluating intervention(s). Overall, knowledge about particular vaccines, their efficacy and safety, helped to build HCPs own confidence in vaccines and their willingness to recommend vaccines to others. The importance of societal endorsement and support from colleagues was also reported. In the face of emerging vaccine hesitancy, HCPs still remain the most trusted advisor and influencer of vaccination decisions. The capacity and confidence of HCPs, though, are stretched as they are faced with time constraints, increased workload and limited resources, and often have inadequate information or training support to address parents' questions. Overall, HCPs need more support to manage the quickly evolving vaccine environment as well as changing public, especially those who are reluctant or refuse vaccination. Some recommended strategies included strengthening trust between HCPs, health authorities and policymakers, through more shared involvement in the establishment of vaccine recommendations.
Newbold, K Bruce; Willinsky, Jacqueline
Cultural impacts on health experiences and behaviours are profound in the area of reproductive health and family planning. Explored through interviews with family planning healthcare professionals, this paper evaluates their experiences in providing family planning and reproductive healthcare to immigrants in the Greater Toronto and Hamilton area of Ontario, Canada. Results reveal the complexity of delivering care to members of this group, particularly when dealing with language barriers, situations when professional and non-professional interpreters are used, and instances where healthcare professionals realize that they themselves have misconceptions and misunderstandings about other cultures. The paper concludes by discussing future research options and implications for the delivery of reproductive health family planning services to this population.
Krautscheid, Lorretta C
Communication errors are identified by the Joint Commission as the primary root cause of sentinel events across all categories. In addition, improving the effectiveness of communication among healthcare providers is listed as one of the Joint Commission's 2008 National Patient Safety Goals. Nursing programs are expected to graduate practice-ready nurses who demonstrate quality and safety in patient care, which includes interdisciplinary communication. Through objectively structured clinical assessment simulations, faculty evaluate each nursing student's ability to perform many aspects of care, including the ability to communicate effectively with physicians via telephone in an emergent situation. This quality improvement project reports the results of a three-year review of undergraduate student nurse performance (n = 285) related to effective clinical communication. Changes in teaching-learning strategies, implementation of a standardized communication tool, and clinical enhancements which resulted in improved student competency, will be presented.
Trotochaud, Karen; Coleman, Joyce Ramsey; Krawiecki, Nicolas; McCracken, Courtney
Pediatric providers across professions and clinical settings experience moral distress. Higher moral distress correlates with intent to leave for all professionals. Physicians as professional group had the highest moral distress. Intensive care nurses had the highest moral distress for nurses. While all providers describe distressing scenarios as disturbing, physicians report situations as occurring more frequently. The most distressing situations include requests for aggressive treatments not in child's best interest, poor team communication and lack of provider continuity. Understanding moral distress as experienced by all pediatric providers is needed to create interventions with a goal of reducing provider turnover.
Lopez, Fanny Y.; DeMeester, Rachel H.; Jia, Justin L.; Peek, Monica E.; Vela, Monica B.
Abstract Effective shared decision making (SDM) between patients and healthcare providers has been positively associated with health outcomes. However, little is known about the SDM process between Latino patients who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ), and their healthcare providers. Our review of the literature identified unique aspects of Latino LGBTQ persons’ culture, health beliefs, and experiences that may affect their ability to engage in SDM with their healthcare providers. Further research needs to examine Latino LGBTQ patient–provider experiences with SDM and develop tools that can better facilitate SDM in this patient population. PMID:27617356
Baig, Arshiya A; Lopez, Fanny Y; DeMeester, Rachel H; Jia, Justin L; Peek, Monica E; Vela, Monica B
Effective shared decision making (SDM) between patients and healthcare providers has been positively associated with health outcomes. However, little is known about the SDM process between Latino patients who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ), and their healthcare providers. Our review of the literature identified unique aspects of Latino LGBTQ persons' culture, health beliefs, and experiences that may affect their ability to engage in SDM with their healthcare providers. Further research needs to examine Latino LGBTQ patient-provider experiences with SDM and develop tools that can better facilitate SDM in this patient population.
Inamdar, Noorein; Kaplan, Robert S; Bower, Marvin
Several innovative healthcare executives have recently introduced a new business strategy implementation tool: the Balanced Scorecard. The scorecard's measurement and management system provides the following potential benefits to healthcare organizations: It aligns the organization around a more market-oriented, customer-focused strategy It facilitates, monitors, and assesses the implementation of the strategy It provides a communication and collaboration mechanism It assigns accountability for performance at all levels of the organization It provides continual feedback on the strategy and promotes adjustments to marketplace and regulatory changes. We surveyed executives in nine provider organizations that were implementing the Balanced Scorecard. We asked about the following issues relating to its implementation and effect: 1. The role of the Balanced Scorecard in relation to a well-defined vision, mission, and strategy 2. The motivation for adopting the Balanced Scorecard 3. The difference between the Balanced Scorecard and other measurement systems 4. The process followed to develop and implement the Balanced Scorecard 5. The challenges and barriers during the development and implementation process 6. The benefits gained by the organization from adoption and use. The executives reported that the Balanced Scorecard strategy implementation and performance management tool could be successfully applied in the healthcare sector, enabling organizations to improve their competitive market positioning, financial results, and customer satisfaction. This article concludes with guidelines for other healthcare provider organizations to capture the benefits of the Balanced Scorecard performance management system.
POURHOSSEINI, Samira Sadat; ARDALAN, Ali; MEHROLHASSANI, Mohammad Hossien
Abstract Background Health care management in disasters is one of the main parts of disaster management. Health in disasters is affected by performance of various sectors, and has an interactive impact on various aspects of disaster management. The aim of this study was to identify the most important themes affecting the healthcare management in disaster. Method In this qualitative study with a content analysis approach, in-depth interviews in two steps with 30 disaster experts and managers were conducted to collect the data. Results Eleven themes affecting healthcare management in disasters were identified. These themes were related to human resources management, resources management, victims’ management transfer, environmental hygiene monitoring, nutrition management, mental health control, inter-agency coordination, training, technology management, information and communication management, and budget management. Conclusion Providing effective health care service in disasters requires a comprehensive look at the various aspects of disaster management. Effective factors on the success of healthcare in disaster are not limited to the scope of healthcare. There should be a close relationship and interaction between different sectors of disaster management. PMID:26060782
Purpose The current Ebola epidemic that has devastated West Africa has infected and killed more healthcare providers than any other outbreak in the history of this virus. An improved understanding of pathogen transmission and the institution of strategies to protect infection healthcare providers are needed in infectious disease outbreak. This review connects what is known about Ebola virus transmission with personal protective equipment designed to arrest nosocomial transmission. Methods Articles pertaining to filovirus transmission and personal protective equipment in filovirus outbreaks were reviewed and are presented. Additionally, studies evaluating PPE as well as donning and doffing strategies are also presented. Findings Personal Protective equipment is one step in a comprehensive infection prevention and control strategy that is required to protect healthcare providers. Given that the Ebola virus is primarily transmitted through direct contact of mucous membranes and cuts in the skin with infected patients and/or their bodily fluids, it is necessary to cover these potential portals of infection with PPE as part of a structured and instructed donning and doffing procedure. Implications Current recommendations about PPE and the donning and doffing processes are based on anecdotal experience. However the use of non-human viruses can help provide evidence based guidelines on both PPE and processes. PMID:26452427
Starzyk, Erin J.; Kelley, Michele A.; Caskey, Rachel N.; Schwartz, Alan; Kennelly, Joan F.; Bailey, Robert C.
Background and Objectives The emerging science demonstrates various health benefits associated with infant male circumcision and adult male circumcision; yet rates are declining in the United States. The American Academy of Pediatrics and the Centers for Disease Control and Prevention recommend that healthcare providers present evidence-based risk and benefit information for infant male circumcision to parent(s) and guardian(s). The purpose of this study was to assess providers’ level of infant male circumcision knowledge and to identify the associated characteristics. Methods An online survey was administered to healthcare providers in the family medicine, obstetrics, and pediatrics medical specialties at an urban academic health center. To assess infant male circumcision knowledge, a 17 point summary score was constructed to identify level of provider knowledge within the survey. Results Ninety-two providers completed the survey. Providers scored high for the following knowledge items: adverse event rates, protects against phimosis and urinary tract infections, and does not prevent hypospadias. Providers scored lower for items related to more recent research: protection against cervical cancer, genital ulcer disease, bacterial vaginosis, and reduction in HIV acquisition. Two models were constructed looking at (1) overall knowledge about male circumcision, and (2) knowledge about male circumcision reduction in HIV acquisition. Pediatricians demonstrated greater overall infant male circumcision knowledge, while obstetricians exhibited significantly greater knowledge for the HIV acquisition item. Conclusion Providers’ knowledge levels regarding the risks and benefits of infant male circumcision are highly variable, indicating the need for system-based educational interventions. PMID:25635664
Bergh, Anne-Marie; Hoffmann, Willem A.
Background: Much has been written about the patient-centred approach in doctor–patient consultations. Little is known about interactions and communication processes regarding healthcare providers’ and patients’ perspectives on expectations and experiences of diagnostic imaging investigations within the medical encounter. Patients journey through the health system from the point of referral to the imaging investigation itself and then to the post-imaging consultation. Aim and setting: To explore healthcare provider and patient perspectives on interaction and communication processes during diagnostic imaging investigations as part of their clinical journey through a healthcare complex. Methods: A qualitative study was conducted, with two phases of data collection. Twenty-four patients were conveniently selected at a public district hospital complex and were followed throughout their journey in the hospital system, from admission to discharge. The second phase entailed focus group interviews conducted with providers in the district hospital and adjacent academic hospital (medical officers and family physicians, nurses, radiographers, radiology consultants and registrars). Results: Two main themes guided our analysis: (1) provider perspectives; and (2) patient dispositions and reactions. Golden threads that cut across these themes are interactions and communication processes in the context of expectations, experiences of the imaging investigations and the outcomes thereof. Conclusion: Insights from this study provide a better understanding of the complexity of the processes and interactions between providers and patients during the imaging investigations conducted as part of their clinical pathway. The interactions and communication processes are provider–patient centred when a referral for a diagnostic imaging investigation is included. PMID:26245604
Perrin, Eliana M.; Berry, Diane; Vu, Maihan B.; Pullen Davis, Lisa; Cai, Jianwen; Tzeng, Janice P.; Ammerman, Alice S.
Abstract Background To prevent childhood obesity, parents and their children's healthcare providers need to engage in effective dialogue. We know much about mothers' experiences, but very little about fathers' experiences. Methods We explored African-American, Caucasian, and Latino fathers' perceptions and experiences communicating with their children's provider during clinic visits regarding weight, diet, and physical activity. Focus groups (n=3), grouped by race/ethnicity, including a total of 24 fathers, were conducted. The men were asked open-ended questions; responses were recorded and transcribed, and analyzed using ATLAS.ti. Results Findings revealed that these fathers were involved in their children's healthcare and found providers to be helpful partners in keeping their children healthy, yet they generally felt “left out” during clinic appointments. The quality of the relationship with their children's provider influenced how receptive fathers were to discussing their children's weight, diet, and physical activity behaviors. Fathers made suggestions to help improve communication between providers and fathers, such as personalizing the discussion. Conclusions These fathers expressed strong feelings about the provider–parent relationship when discussing weight, diet, and physical activity. PMID:23472966
Benitez, Joseph; Coplan, Bettie; Dehn, Richard W; Hooker, Roderick S
Greater use of physician assistants (PAs) and nurse practitioners (NPs) to meet growing demand for healthcare in the United States is an increasingly common strategy to improve access to care and control costs. Evidence suggests that payment for services differs depending on the type of provider. This study sought to determine if the source of payment for a medical visit varies based on whether care is provided by a physician, PA, or NP. Data from the National Hospital Ambulatory Medical Care Survey (2006 through 2010) were analyzed. Physicians were proportionally more likely than NPs or PAs to provide care for medical visits compensated by private insurance or Medicare. Conversely, PAs and NPs were more likely to serve as providers of care for services with other payment sources such as Medicaid and out-of-pocket.
Seto, Karen; Klassen, Carolyn; Emokpare, Didi; Conway, Brian; Kelley, Melissa
Background and Aim. Despite advances in the treatment of chronic hepatitis C infection (CHC), it remains a major public health problem in Canada and globally. The knowledge of healthcare providers (HCPs) is critical to improve the care of CHC in Canada. To assess the current knowledge and educational needs of healthcare providers (HCPs) in the area of CHC management a national online survey was conducted. Method. An interprofessional steering committee designed a 29-question survey distributed through various direct and electronic routes. The survey assessed several domains (e.g., participant and practice demographics, access to resources, knowledge of new treatments, and educational preferences). Results. A total of 163 HCPs responded to the survey. All hepatologists and 8% of primary care providers (PCPs) reported involvement in treatment of CHC. Physicians most frequently screened patients who had abnormal liver enzymes, while nurses tended to screen based on lifestyle factors. More than 70% of PCPs were not aware of new medications and their mechanisms. Conclusion. Overall, the needs assessment demonstrated that there was a need for further education, particularly for primary care physicians, to maximize the role that they can play in screening, testing, and treatment of hepatitis C in Canada.
Boudreaux, Edwin D; Waring, Molly E; Hayes, Rashelle B; Sadasivam, Rajani S; Mullen, Sean; Pagoto, Sherry
Mobile applications (apps) to improve health are proliferating, but before healthcare providers or organizations can recommend an app to the patients they serve, they need to be confident the app will be user-friendly and helpful for the target disease or behavior. This paper summarizes seven strategies for evaluating and selecting health-related apps: (1) Review the scientific literature, (2) Search app clearinghouse websites, (3) Search app stores, (4) Review app descriptions, user ratings, and reviews, (5) Conduct a social media query within professional and, if available, patient networks, (6) Pilot the apps, and (7) Elicit feedback from patients. The paper concludes with an illustrative case example. Because of the enormous range of quality among apps, strategies for evaluating them will be necessary for adoption to occur in a way that aligns with core values in healthcare, such as the Hippocratic principles of nonmaleficence and beneficence.
Arican, Bilal; Guney, Murat; Akbal, Nuseybe; Demiral, Bahadir Han; Nadir, Ahmet; Kokar, Ilknur Kavci; Dabak, Mustafa Resat; Sargin, Mehmet
OBJECTIVE: Due to increase in elderly population as result of longer life expectancy and the incidence of chronic disease, greater importance should be given to elderly care and the needs of primary caregivers. The purpose of this study was to determine depression status of caregivers who were providing in-home healthcare services. METHODS: This study was conducted with caregivers for 63 home-dependent patients who benefited from the services provided by Kartal Dr. Lutfi Kirdar Training and Research Hospital Family Practice Clinic between May 15, 2013 and July 1, 2013 using a socio-demographic variables questionnaire and the Beck Depression Inventory. Data were analyzed using Kolmogorov-Smirnov test, Mann-Whitney U test, Student’s-t test and chi-square test. RESULTS: Of the total, 87.3% of survey participants were women. Average age was 52.47 years; 73% were married, 17.5% were single, and 9.5% were widows. Monthly income of 50.8% of participants was between TL 1000 and 3000. Of all the patients, 77.8% were totally, and 22.2% were semi-dependent. Depression was detected in 61.1% of patient relatives who were responsible for patient healthcare and in 22.2% of paid professional caregivers (p=0.052). Depression was detected at rate of 37% in caregivers who had been providing nursing care for less than 1 year, 63% for those who had been caregivers for 1 to 5 years, and for those providing care for more than 5 years, rate was 63 %. Rate of depression in study participants overall was 55.6%. CONCLUSION: Duration of providing care, dependency level of patient, and level of intimacy affect caregivers. They need psychological support. PMID:28058398
Paal, Piret; Helo, Yousef; Frick, Eckhard
This systematic review was conducted to assess the outcomes of spiritual care training. It outlines the training outcomes based on participants' oral/written feedback, course evaluation and performance assessment. Intervention was defined as any form of spiritual care training provided to healthcare professionals studying/working in an academic and/or clinical setting. An online search was conducted in MEDLINE, EMBASE, CINAHL, Web of Science, ERIC, PsycINFO, ASSIA, CSA, ATLA and CENTRAL up to Week 27 of 2013 by two independent investigators to reduce errors in inclusion. Only peer-reviewed journal articles reporting on training outcomes were included. A primary keyword-driven search found 4912 articles; 46 articles were identified as relevant for final analysis. The narrative synthesis of findings outlines the following outcomes: (1) acknowledging spirituality on an individual level, (2) success in integrating spirituality in clinical practice, (3) positive changes in communication with patients. This study examines primarily pre/post-effects within a single cohort. Due to an average study quality, the reported findings in this review are to be seen as indicators at most. Nevertheless, this review makes evident that without attending to one'the repeliefs and needs, addressing spirituality in patients will not be forthcoming. It also demonstrates that spiritual care training may help to challenge the spiritual vacuum in healthcare institutions.
Donnelly, Tam Truong; McKellin, William
Understanding how healthcare responsibility is distributed will give insight on how health-care is delivered and how members of a society are expected to practice health-care. The raising cost of health-care has resulted in restructuring of the existing Canadian healthcare system toward a system that controls costs by placing more healthcare responsibility on the individual. This shift might create more difficulty for immigrants and refugees to obtain equitable health-care and put blame on them when they experience illness. This paper is drawn from the results of a larger qualitative study exploring Vietnamese Canadian women's breast cancer and cervical cancer screening practices. Interview data were gathered from 15 Vietnamese Canadian women and six healthcare providers. We will demonstrate that (a) despite the strong influence of individualism, Vietnamese women and their healthcare providers value both individual liberty and the interrelationship between individual and society; (b) limited funding and unequal distribution of healthcare resources impacted how immigrant and refugee women practice health-care. Thus, motivating and fostering immigrant and refugee women's healthcare practice require both individual and institutional effort. To foster immigrant and refugees' healthcare practices, healthcare policy makers and providers need to consider how to distribute healthcare resources that meet immigrants' and refugees' healthcare needs in the most equitable way.
Carnevale, Anthony P.; Smith, Nicole; Gulish, Artem; Beach, Bennett H.
This report, provides detailed analyses and projections of occupations in healthcare fields, and wages earned. In addition, the important skills and work values associated with workers in those fields of healthcare are discussed. Finally, the authors analyze the implications of research findings for the racial, ethnic, and class diversity of the…
Zuardi, Antonio Waldo; Ishara, Sergio; Bandeira, Marina
Purpose: The authors compared the levels of job burden and stress in psychiatry residents with those of other healthcare professionals at inpatient and outpatient psychiatric hospitals in a medium-sized Brazilian city. Method: In this study, the levels of job burden and stress of 136 healthcare workers and 36 psychiatry residents from six various…
Although the use of embryonic stem cells to treat disease has caused much controversy, one type of stem cell treatment has slowly and steadily shown promise but has not engendered negative ethical media attention: the use of umbilical stem cells. Umbilical cord blood (UCB) contains stem cells that have already successfully treated a variety of diseases, including leukemias, lymphomas, hemoglobinopathies, immunodeficiencies, and disorders of metabolism; ongoing research continues to explore additional diseases for potential treatment. Cord blood can be stored in private banks or public banks. Private cord blood banks save cord blood for use by the family only, at a cost. Public cord blood banks accept donations and the cord blood is then used for the general public and/or research. A review of the literature finds that public banking is the preferred recommendation over private unless there is a known family member with a disease that can currently be treated with cord blood. This article discusses cord blood banking options as well as the ethical issues and barriers facing both healthcare providers and patients when dealing with cord blood banking.
Under pressure to remain competitive in the rapidly changing healthcare industry, policy leaders and healthcare administrators face the challenge of resolving antitrust matters arising from the creation of innovative healthcare provider affiliations. Although guidance from the Federal Trade Commission (FTC) is available, development of new affiliations is hindered due to contradictory rulings and ambiguous guidelines. Provider associations are further disadvantaged by a federal act granting insurance companies antitrust exemption, which enables insurance companies to affiliate more easily. Current antitrust regulations create unequal market powers, resulting in the development of inefficient systems. Softening antitrust laws in favor of provider-sponsored healthcare affiliations will provide for the flexibility necessary for effective healthcare reform.
Lee, David J; Fleming, Lora E; McCollister, Kathryn E; Caban, Alberto J; Arheart, Kristopher L; LeBlanc, William G; Chung‐Bridges, Katherine; Christ, Sharon L; Dietz, Noella; Clark, John D
Objective Among workers in dusty occupations, tobacco use is particularly detrimental to health because of the potential synergistic effects of occupational exposures (for example, asbestos) in causing disease. This study explored the prevalence of smoking and the reported smoking cessation discussion with a primary healthcare provider (HCP) among a representative sample of currently employed US worker groups. Methods Pooled data from the 1997–2003 National Health Interview Survey (NHIS) were used to estimate occupation specific smoking rates (n = 135 412). The 2000 NHIS Cancer Control Module was used to determine (among employed smokers with HCP visits) the prevalence of being advised to quit smoking by occupation (n = 3454). Results The average annual prevalence of current smoking was 25% in all workers. In 2000, 84% of smokers reported visiting an HCP during the past 12 months; 53% reported being advised by their physician to quit smoking (range 42%–66% among 30 occupations). However, an estimated 10.5 million smokers were not advised to quit smoking by their HCP. Workers with potentially increased occupational exposure to dusty work environments (including asbestos, silica, particulates, etc), at high risk for occupational lung disease and with high smoking prevalence, had relatively low reported discussions with an HCP about smoking cessation, including farm workers (30% overall smoking prevalence; 42% told to quit), construction and extractive trades (39%; 46%), and machine operators/tenderers (34%; 44%). Conclusion The relatively low reported prevalence of HCP initiated smoking cessation discussion, particularly among currently employed workers with potentially synergistic occupational exposures and high current smoking prevalence, needs to be addressed through educational campaigns targeting physicians and other HCPs. PMID:17897991
The level of burnout has been found to be high in medical students, alongside maladaptive coping behaviours such as heightened alcohol and drug intake and mental health issues in the US, Europe and other developed countries. While burnout and resilience in healthcare have been researched in the West, there is a paucity of data in Asia pertaining to these factors. In this article, we review stressors in medicine, specifically during medical school training, the consequences of burnout on physicians’ health and patient care, and the interventions that might expound resilience among students. Finally, we present potential solutions within an Asian context. PMID:28293600
Hweissa, N Ab; Lim, J N W; Su, T T
In Libya, cervical cancer is ranked third as the most frequent cancer among women with early diagnosis being shown to reduce morbidity and mortality. Health-care providers can influence women's screening behaviours, and their lack of recommendations for screening can be one of the barriers that affect women's participation in screening programmes. This study aims to assess the health-care provider's perception around cervical cancer screening. In-depth, face-to-face interviews were conducted with 16 health-care providers, from both public and private sectors in Az-Zawiya city, Libya, between February and July of 2014. The interviews were recorded and transcribed, then analysed using thematic analysis. Our findings suggest that health-care providers did not provide sufficient information regarding cervical cancer screening for women who attend health-care facilities. The results highlight the role played by health-care professionals in motivating women to attend cervical cancer screening programs, and the need for health education of health-care providers to offer a precious advice regarding the screening. On the other hand, health-care providers highlighted that implementation of reminding system of cervical cancer screening will support them to improve screening attendance. In addition, health-care providers stressed the necessity for educational and awareness campaigns of cervical cancer screening among Libyan women.
Attaining appropriate levels of physical activity can have many potential physiological and psychological benefits in older adults with cardiovascular disease. However, these individuals often report low levels of physical activity and high levels of sedentary behavior. Older adults encounter many potential “barriers” to physical activity, but numerous studies have demonstrated the ability to positively influence this important health behavior using well-established behavior change theories and models. The information provided in this review is directed at health-care providers who have the potential to impact physical activity behaviors during regular, often brief, clinical interactions. In addition to providing the latest physical activity recommendations, this update will provide a brief summary of some of the more widely used behavioral skills and strategies for promoting physical activity in older adults with cardiovascular disease. PMID:25396112
The challenges facing the healthcare industry have created a chasm between the focus on quality of care and financial survival. More than 46.5 million Americans are uninsured, and another 16 million are underinsured with health insurance plans that leave patients unable to afford their portion of hospital charges. There are literally hundreds of solutions to assist hospitals in solving payor, self-pay, billing, and charity issues. Examples of solutions that are available include advanced analytics and modeling, automated decisioning and business rules engines, automated insurance eligibility verification, work flow tools, collection services, patient payment calculators, and many others. As the industry becomes more self-regulated and proactive, the pressure concerning business operations hopefully will diminish and hospitals can focus more on the delivery of care.
Background In sub-Saharan Africa, women must overcome numerous barriers when they need modern healthcare. Respect of gender norms within the household and the community may still influence women's ability to obtain care. A lack of gender-sensitive instruments for measuring women's ability to overcome barriers compromises attempts to adequately quantify the burden and risk of exclusion they face when seeking modern healthcare. The aim of this study was to create and validate a synthetic measure of women's access to healthcare from a publicly available and possibly internationally comparable population-based survey. Method Seven questionnaire items from the Burkina Faso 2003 DHS were combined to create the index. Cronbach's alpha coefficient was used to test the reliability of the index. Exploratory factor analyses (EFA) and confirmatory factor analyses (CFA) were applied to evaluate the factorial structure and construct validity of the index while taking into account the hierarchical structure of the data. Results The index has a Cronbach's alpha of 0.75, suggesting adequate reliability. In EFA, three correlated factors fitted the data best. In CFA, the construct of perceived ability to overcome barriers to healthcare seeking emerged as a second-order latent variable with three domains: socioeconomic barriers, geographical barriers and psychosocial barriers. Model fit indices support the index's global validity for women of reproductive age in Burkina Faso. Evidence for construct validity comes from the finding that women's index scores increase with household living standard. Conclusion The DHS items can be combined into a reliable and valid, gender-sensitive index quantifying reproductive-age women's perceived ability to overcome barriers to healthcare seeking in Burkina Faso. The index complies conceptually with the sector-cross-cutting capability approach and enables measuring directly the perceived access to healthcare. Therefore it can help to improve the
This is a short commentary to the editorial issued by Marianna Fotaki, entitled: "Why and how is compassion necessary to provide good quality healthcare." It introduces the necessity of a more cognitive approach to explore further the determinants of behavior towards compassionate care. It raises questions about the importance of training towards a more patient-care and values driven healthcare system. PMID:26673339
Compton, David A.; Whitehead, Michael B.
Much is written about the availability of healthcare services among elements of the U.S. population, with a large proportion of the literature focusing on access. Although physical access is an overarching issue for many, educators must remember that a key factor in providing complete and competent healthcare is to understand the patient and any…
Gautham, Meenakshi; Shyamprasad, K M; Singh, Rajesh; Zachariah, Anshi; Singh, Rajkumari; Bloom, Gerald
Rural households in India rely extensively on informal biomedical providers, who lack valid medical qualifications. Their numbers far exceed those of formal providers. Our study reports on the education, knowledge, practices and relationships of informal providers (IPs) in two very different districts: Tehri Garhwal in Uttarakhand (north) and Guntur in Andhra Pradesh (south). We mapped and interviewed IPs in all nine blocks of Tehri and in nine out of 57 blocks in Guntur, and then interviewed a smaller sample in depth (90 IPs in Tehri, 100 in Guntur) about market practices, relationships with the formal sector, and their knowledge of protocol-based management of fever, diarrhoea and respiratory conditions. We evaluated IPs’ performance by observing their interactions with three patients per condition; nine patients per provider. IPs in the two districts had very different educational backgrounds—more years of schooling followed by various informal diplomas in Tehri and more apprenticeships in Guntur, yet their knowledge of management of the three conditions was similar and reasonably high (71% Tehri and 73% Guntur). IPs in Tehri were mostly clinic-based and dispensed a blend of allopathic and indigenous drugs. IPs in Guntur mostly provided door-to-door services and prescribed and dispensed mainly allopathic drugs. In Guntur, formal private doctors were important referral providers (with commissions) and source of new knowledge for IPs. At both sites, IPs prescribed inappropriate drugs, but the use of injections and antibiotics was higher in Guntur. Guntur IPs were well organized in state and block level associations that had successfully lobbied for a state government registration and training for themselves. We find that IPs are firmly established in rural India but their role has grown and evolved differently in different market settings. Interventions need to be tailored differently keeping in view these unique features. PMID:25012795
including: Moscow, St. Petersburg, Kiev, Minsk, Kishinev, Yerevan, Alma Ata, Dushanbe, Ashkhabad, Baku, Tashkent, and Bishkek.27 Fifty-four additional...DoD Medical Excess Distributed by OPH41 Supported Country Dollar Value of Support Provided Number of Missions (Timeframe) Republic of Georgia ...More than 150,000 Georgians were displaced from their homes as a result of conflict between Georgia and Russia in August 2008 that saw Russian soldiers
An estimated 550 to 650 surgical fires occur annually in the United States. Surgical fires may have severe consequences, including burns, disfigurement, long-term medical care, or death. This article introduces a potential certification program for the prevention of surgical fires. A pilot study was conducted with a convenience sample of 10 anesthesia providers who participated in the education module. The overall objective was to educate surgical team members and to prepare them to become certified in surgical fire prevention. On completion of the education module, participants completed the 50-question certification examination. The mean pretest score was 66%; none of the participants had enough correct responses (85%) to be considered competent in surgical fire prevention. The mean post- test score was 92.80%, with all participants answering at least 85% of questions correct. A paired-samples t test showed a statistically significant increase in knowledge: t (df = 9) = 11.40; P = .001. Results of the pilot study indicate that this course can remediate gaps in knowledge of surgical fire prevention for providers. Their poor performance on the pretest suggests that many providers may not receive sufficient instruction in surgical fire prevention.
Yip, Winnie Chi-Man; Hsiao, William; Meng, Qingyue; Chen, Wen; Sun, Xiaoming
Inappropriate incentives as part of China's fee-for-service payment system have resulted in rapid cost increase, inefficiencies, poor quality, unaffordable health care, and an erosion of medical ethics. To reverse these outcomes, a strategy of experimentation to realign incentives for providers with the social goals of improvement in quality and efficiency has been initiated in China. This Review shows how lessons that have been learned from international experiences have been improved further in China by realignment of the incentives for providers towards prevention and primary care, and incorporation of a treatment protocol for hospital services. Although many experiments are new, preliminary evidence suggests a potential to produce savings in costs. However, because these experiments have not been scientifically assessed in China, evidence of their effects on quality and health outcome is largely missing. Although a reform of the provider's payment can be an effective short-term strategy, professional ethics need to be re-established and incentives changed to alter the profit motives of Chinese hospitals and physicians alike. When hospitals are given incentives to achieve maximum profit, incentives for hospitals and physicians must be separated.
Patten, Yvonne A; Ojeda, Maria M; Lindgren, Carolyn L
Research shows that healthcare providers' palliative care training and their misconceptions impact the delivery of care. As a result, the need for continuing education with adequate training is paramount to improve their knowledge and confidence in addressing the needs of patients and families facing serious illnesses. A pre-experimental static-group comparison design was used to determine if there was a significant difference in perceived competency and knowledge between healthcare providers who participated in a palliative care training programme and those who did not. A non-randomised sample of healthcare providers were administered a questionnaire to assess perceived competence and knowledge. Responses from 388 participants revealed a significant association between perceived competency and knowledge scores. The authors concluded that participation in a palliative care programme makes a significant difference in the healthcare provider's knowledge. However, further exploration is necessary to deduce the underlying reason for the negative association between perceived competency and knowledge.
Caroni, Mariana Malheiros; Grossman, Eloisa
Nowadays, body art is widespread, especially among adolescents. This qualitative study seeks to assess whether the use of body art interferes with how nursing assistants care for hospitalized adolescents and to identify factors that influence the perceptions of these health care providers. Nursing assistants working in an adolescent-specific ward were interviewed. After the analysis, dominant themes emerged from the narratives, allowing for a better understanding of how nursing assistants perceive tattoos and piercing. Some themes were recurrent, especially the association of body art with deviant behavior, erotic appeal, consumerism, courage, health risks, and psychic disorders. Religion and family values prevail over professional knowledge in how body marks are perceived. It may thus be inferred that a negative attitude toward body art is directly related to quality of care. The number of marks, their location, their type, and the definite/temporary character of tattoos and piercing interfere with the providers' interpretation. However, piercing and tattoos are important semiological tools and must be included in the script for the evaluation of adolescents.
Mangione-Smith, R; McGlynn, E A
OBJECTIVE: To present a conceptual framework for evaluating quality of care for children and adolescents, summarize the key issues related to developing measures to assess pediatric quality of care, examine some existing measures, and present evidence about their current level of performance. PRINCIPAL FINDINGS: Assessing the quality of care for children poses many challenges not encountered when making these measurements in the adult population. Children and adolescents (from this point forward referred to collectively as children unless differentiation is necessary) differ from adults in two clinically important ways (Jameson and Wehr 1993): (1) their normal developmental trajectory is characterized by change, and (2) they have differential morbidity. These factors contribute to the limitations encountered when developing measures to assess the quality of care for children. The movement of a child through the various stages of development makes it difficult to establish what constitutes a "normal" outcome and by extension what constitutes a poor outcome. Additionally, salient developmental outcomes that result from poor quality of care may not be observed for several years. This implies that poor outcomes may be observed when the child is receiving care from a delivery system other than the one that provided the low-quality care. Attributing the suboptimal outcome to the new delivery system would be inappropriate. Differential morbidity refers to the fact that the type, prevalence, and severity of illness experienced by children is measurably different from that observed in adults. Most children experience numerous self-limited illness of mild severity. A minority of children suffer from markedly more severe diseases. Thus, condition-specific measures in children are problematic to implement for routine assessments because of the extremely low incidence and prevalence of most severe pediatric diseases (Halfon 1996). However, children with these conditions are
Tan, Ngiap Chuan
Singapore is facing an increasing noncommunicable disease burden due to its ageing population. Singapore’s primary healthcare services, provided by both polyclinic physicians and private general practitioners, are available to the public at differential fees for service. The resultant disproportionate patient loads lead to dissatisfaction for both healthcare providers and consumers. This article describes the ‘PAIR UP’ approach as a potential endeavour to facilitate primary care physicians (PCPs) in public and private sectors to collaborate to deliver enhanced primary care in Singapore. PAIR UP is an acronym referring to Policy, Academic development, Integration of healthcare information system, Research in primary care, Utility and safety evaluation, and Practice transformation. The current healthcare landscape is favourable to test out this multipronged approach. PCPs in both sectors can ride on it and work together synergistically to provide quality primary care in Singapore. PMID:24664374
Aboul-Fotouh, A M; Ismail, N A; Ez Elarab, H S; Wassif, G O
A previous study in Cairo, Egypt highlighted the need to improve the patient safety culture among health-care providers at Ain Shams University hospitals. This descriptive cross-sectional study assessed healthcare providers' perceptions of patient safety culture within the organization and determined factors that played a role in patient safety culture. A representative sample of 510 physicians, nurses, pharmacists, technicians and labourers in different departments answered an Arabic version of the Agency of Healthcare Research and Quality hospital survey for patient safety culture. The highest mean composite positive score among the 12 dimensions was for the organizational learning for continuous improvement (78.2%), followed by teamwork (58.1%). The lowest mean score was for the dimension of non-punitive response to error (19.5%). Patient safety culture still has many areas for improvement that need continuous evaluation and monitoring to attain a safe environment both for patients and health-care providers.
Kennedy, Betty M.; Jaligam, Vijayendra; Conish, Beverly K.; Johnson, William D.; Melancon, Brian; Katzmarzyk, Peter T.
Background: Heart failure (HF) is an incurable and frequently progressive disease. Symptoms of HF may impair the ability of patients to perform daily living activities. As HF progresses, patients typically increase their reliance on caregivers. The purpose of this study was to determine what roles patients and caregivers perceive and desire for themselves in managing HF and to compare and contrast these roles with those perceived by healthcare providers. Methods: A purposive sample (60 patients, 22 caregivers, and 11 healthcare providers) was enrolled in the study. Patients and caregivers individually participated in semistructured interviews, and healthcare providers participated in 1 of 2 focus groups. Results: Four key themes evolved from interviews with patients and caregivers—education on disease specifics, guidance to enhance quality of life, learning to cope with HF, and future outlook and care decisions—that may guide the development of caregiver interventions in HF. Healthcare providers in both structured focus groups regardless of rank order selected knowledge is powerful, adherence to treatment plan, and compliance with medication as the top 3 issues likely to have the greatest impact, and they identified education on the disease (knowledge is powerful) as the easiest strategy to implement for patients and caregivers in the management of HF. Conclusion: Interventions among caregivers of patients with HF are needed and should focus on education in family structures, family functioning, and skills training in family assessment and engagement. PMID:28331455
McRee, Annie-Laurie; Gilkey, Melissa B.; Dempsey, Amanda F.
Introduction Healthcare provider recommendations are critical for human papillomavirus (HPV) vaccine uptake. We sought to describe providers' HPV vaccine recommendation practices and explore their perceptions of parental hesitancy. Method A statewide sample (n=575) of Minnesota healthcare providers (20% pediatricians, 47% family medicine physicians, 33% nurse practitioners) completed our online survey in April 2013. Results Only 76% of healthcare providers reported routinely recommending HPV vaccine for girls ages 11-12, and far fewer (46%) did so for boys (p<.001). A majority of providers reported asking questions about parents' concerns (74%), but many lacked time to probe reasons (47%) or felt that they could not change parents' minds (55%). Higher levels of self-efficacy and outcome expectations were associated with routine recommendations (p<.05). Discussion Findings suggest that providers' perceptions of hesitancy may discourage them from routinely recommending HPV vaccine. Improving providers' self-efficacy to address hesitancy may be important for improving vaccination rates. PMID:25017939
Rossman, Beverly; Engstrom, Janet L; Meier, Paula P
In this qualitative descriptive study we examined the perceptions of 17 neonatal intensive care unit (NICU) healthcare providers (nurses, neonatologists, lactation consultants, and dietitians) about the role of breastfeeding peer counselors who were mothers of former NICU infants and who provided primary lactation care in the NICU. Findings revealed that the healthcare providers respected the peer counselors' lactation expertise and identified three critical elements that contributed to the effectiveness of the peer counseling program: having a champion for the program, counselors being mothers of former NICU infants, and a NICU culture supportive of using human milk. Healthcare providers thought the peer counselors enhanced care of the infant by empowering mothers to provide milk and by facilitating and modeling positive patterns of maternal-infant interactions.
Westheimer, Joshua M.; Steinley-Bumgarner, Michelle; Brownson, Chris
Objective and Participants: The authors examined the experiences of primary care providers participating in an integrated healthcare service between mental health and primary care in a university health center. In this program, behavioral health providers work collaboratively with primary care providers in the treatment of students. Participants…
Ginossar, Tamar; Oetzel, John; Hill, Ricky; Avila, Magdalena; Archiopoli, Ashley; Wilcox, Bryan
One of the major challenges facing those working with people living with HIV (PLWH) is the increased potential for burnout, which results in increased turnover and reduces quality of care provided for PLWH. The goal of this study was to examine the relationship among HIV health-care providers' burnout (emotional exhaustion and depersonalization) and organizational culture including teamwork, involvement in decision-making, and critical appraisal. Health-care providers for PLWH (N = 47) in federally funded clinics in a southwestern state completed a cross-sectional survey questionnaire about their perceptions of organizational culture and burnout. The results of multiple regression analysis indicated that positive organizational culture (i.e., teamwork) was negatively related to emotional burnout (p < .005, R(2) = .18). Further negative organizational culture (i.e., critical appraisal) was positively related to depersonalization (p < .005, R(2) = .18). These findings suggest that effective organizational communication interventions might protect HIV health-care providers from burnout.
Jenkins, Randall C; Warren, Lindsay A; Gravenstein, Nikolaus
The Florida Patient Safety and Pre-Suit Mediation Program (FLPSMP) was implemented as a pilot program to provide patients of healthcare providers and facilities associated with the University of Florida Health Science Center with timely and fair compensation when injured and to combat rising healthcare legal liability expenses. Prior to filing a formal lawsuit, participants of the FLPSMP join in a confidential and nonbinding pre-suit mediation conducted by a neutral third-party mediator. The process fosters confidential and candid communication between doctors and patients, saving thousands of dollars in legal expenses for both patients and providers.
Wohlgenant, Kelly C.; Cates, Sheryl C.; Godwin, Sandria L.; Speller-Henderson, Leslie
Adults aged 60 or older are more likely than younger adults to experience severe complications or even death as a result of foodborne infections. This study investigated which specific groups of healthcare providers or other caregivers are most receptive to providing food safety information to older adults. Telephone-based focus groups were…
Colberg, Sheri R.; Walsh, John
Exercise can decrease insulin resistance. Insulin pumps deliver precise insulin adjustments that improve fuel availability and provide glycemic control to help people with diabetes overcome obstacles to exercise. Physicians, patients, and healthcare providers should be familiar with the features and nuances of specific pump models and follow basic…
Stenner, Paul; Cross, Vinnette; McCrum, Carol; McGowan, Janet; Defever, Emmanuel; Lloyd, Phil; Poole, Robert; Moore, Ann P
A move towards self-management is central to health strategy around chronic low back pain, but its concept and meaning for those involved are poorly understood. In the reported study, four distinct and shared viewpoints on self-management were identified among people with pain and healthcare providers using Q methodology. Each construes self-management in a distinctive manner and articulates a different vision of change. Identification of similarities and differences among the viewpoints holds potential for enhancing communication between patients and healthcare providers and for better understanding the complexities of self-management in practice. PMID:28070378
Krakower, Douglas S.; Mayer, Kenneth H.
Purpose of Review To review the most recent studies assessing the preparedness of healthcare practitioners to provide anti-HIV pre-exposure prophylaxis (PrEP) and to suggest areas for future implementation research. Recent Findings As PrEP is a bio-behavioral intervention, healthcare providers are likely to play a critical role in implementing PrEP in care settings. Studies suggest that many specialized providers are aware of PrEP and support its provision as a public health intervention, though knowledge and acceptance are less among generalists. Therefore, utilization of PrEP by clinicians has been limited to a few early adopters. Concerns about the efficacy and long-term safety of PrEP, and perceived barriers to prescribing PrEP, could limit prescribing behaviors and intentions. Resistance to performing routine HIV risk assessments by clinicians is an additional barrier to implementing PrEP, though innovative tools to help clinicians routinely perform risk assessments are being developed. Summary Interventions are needed to engage a broader array of healthcare providers in PrEP provision. Utilizing a framework based on diffusion of innovation theory, this review proposes strategies that can be implemented and evaluated to increase PrEP prescribing by healthcare providers. If resources are invested in training clinicians to provide PrEP, then these stakeholders could enhance the use of PrEP as part of a prevention package by primary providers. PMID:26417953
De Castro, Filipa; Barrientos-Gutiérrez, Tonatiuh; Leyva-López, Ahideé
Objective Adolescents need sexual and reproductive health services but little is known about quality-of-care in lower- and middle-income countries where most of the world’s adolescents reside. Quality-of-care has important implications as lower quality may be linked to higher unplanned pregnancy and sexually transmitted infection rates. This study sought to generate evidence about quality-of-care in public sexual and reproductive health services for adolescents. Methods This cross-sectional study had a complex, probabilistic, stratified sampling design, representative at the national, regional and rural/urban level in Mexico, collecting provider questionnaires at 505 primary care units in 2012. A sexual and reproductive quality-of-healthcare index was defined and multinomial logistic regression was utilized in 2015. Results At the national level 13.9% (95%CI: 6.9–26.0) of healthcare units provide low quality, 68.6% (95%CI: 58.4–77.3) medium quality and 17.5% (95%CI: 11.9–25.0) high quality reproductive healthcare services to adolescents. Urban or metropolitan primary care units were at least 10 times more likely to provide high quality care than those in rural areas. Units with a space specifically for counseling adolescents were at least 8 times more likely to provide high quality care. Ministry of Health clinics provided the lowest quality of service, while those from Social Security for the Underserved provided the best. Conclusions The study indicates higher quality sexual and reproductive healthcare services are needed. In Mexico and other middle- to low-income countries where quality-of-care has been shown to be a problem, incorporating adolescent-friendly, gender-equity and rights-based perspectives could contribute to improvement. Setting and disseminating standards for care in guidelines and providing tools such as algorithms could help healthcare personnel provide higher quality care. PMID:28273129
Morgan, Stephen A; Agee, Nancy Howell
Mobile technology's presence in healthcare has exploded over the past five years. The increased use of mobile devices by all segments of the US population has driven healthcare systems, providers, and payers to accept this new form of communication and to develop strategies to implement and leverage the use of mobile healthcare (mHealth) within their organizations and practices. As healthcare systems move toward a more value-driven model of care, patient centeredness and engagement are the keys to success. Mobile healthcare will provide the medium to allow patients to participate more in their care. Financially, mHealth brings to providers the ability to improve efficiency and deliver savings to both them and the healthcare consumer. However, mHealth is not without challenges. Healthcare IT departments have been reluctant to embrace this shift in technology without fully addressing security and privacy concerns. Providers have been hesitant to adopt mHealth as a form of communication with patients because it breaks with traditional models. Our healthcare system has just started the journey toward the development of mHealth. We offer an overview of the mobile healthcare environment and our approach to solving the challenges it brings to healthcare organizations.
Nogami, Kentaro; Taniguchi, Shogo; Ichiyama, Tomoko
The aim of this study was to investigate the correlation between basic life support skills in dentists who had completed the American Heart Association's Basic Life Support (BLS) Healthcare Provider qualification and time since course completion. Thirty-six dentists who had completed the 2005 BLS Healthcare Provider course participated in the study. We asked participants to perform 2 cycles of cardiopulmonary resuscitation on a mannequin and evaluated basic life support skills. Dentists who had previously completed the BLS Healthcare Provider course displayed both prolonged reaction times, and the quality of their basic life support skills deteriorated rapidly. There were no correlations between basic life support skills and time since course completion. Our results suggest that basic life support skills deteriorate rapidly for dentists who have completed the BLS Healthcare Provider. Newer guidelines stressing chest compressions over ventilation may help improve performance over time, allowing better cardiopulmonary resuscitation in dental office emergencies. Moreover, it may be effective to provide a more specialized version of the life support course to train the dentists, stressing issues that may be more likely to occur in the dental office. PMID:27269662
Hassali, Ma; Shafie, Aa; Khan, Tm
The current study aimed to explore the public views and expectation about a successful communication process between the healthcare providers/physicians and patients in Penang Island, Malaysia. A cross-sectional study was conducted in Penang Island using a 14-item questionnaire. Statistical Package for Social Sciences (SPSS) software version 15.0(®) were used to analyze the collected data. A nonparametric statistics was applied; the Chi-square test was applied to measure the association among the variables. P-values less than 0.05 were considered statistically significant. A total of N (500) respondents have shown willingness to participate in the study with a response rate of 83.3%. The majority 319 (63.9%) have disclosed to communicate with their healthcare providers in the Malay language and about 401 (80.4%) of the respondents were found satisfied with the information provided by the physician. It was a common expectation by the most of the sample to focus more on the patient history before prescribing any medicine. Moreover, about 60.0% of the respondents expected that the healthcare providers must show patience to the patient's queries. The level of satisfaction with the information shared by the healthcare providers was higher among the respondents with a higher education level. Furthermore, patients with higher level of education expect that physician shouldwell understand their views and medical history to prescribe a better therapeutic regimen.
Hassali, MA; Shafie, AA; Khan, TM
The current study aimed to explore the public views and expectation about a successful communication process between the healthcare providers/physicians and patients in Penang Island, Malaysia. A cross-sectional study was conducted in Penang Island using a 14-item questionnaire. Statistical Package for Social Sciences (SPSS) software version 15.0® were used to analyze the collected data. A nonparametric statistics was applied; the Chi-square test was applied to measure the association among the variables. P-values less than 0.05 were considered statistically significant. A total of N (500) respondents have shown willingness to participate in the study with a response rate of 83.3%. The majority 319 (63.9%) have disclosed to communicate with their healthcare providers in the Malay language and about 401 (80.4%) of the respondents were found satisfied with the information provided by the physician. It was a common expectation by the most of the sample to focus more on the patient history before prescribing any medicine. Moreover, about 60.0% of the respondents expected that the healthcare providers must show patience to the patient's queries. The level of satisfaction with the information shared by the healthcare providers was higher among the respondents with a higher education level. Furthermore, patients with higher level of education expect that physician shouldwell understand their views and medical history to prescribe a better therapeutic regimen. PMID:23112539
Lester, Melissa; Boateng, Samuel; Studeny, Jana; Coustasse, Alberto
Personal health records (PHRs) have been mandated to be made available to patients to provide increased access to medical care information, encourage participation in healthcare decision making, and enable correction of errors within medical records. The purpose of this study was to analyze the usefulness of PHRs from the perspectives of patients and providers. The methodology of this qualitative study was a literature review using 34 articles. PHRs are powerful tools for patients and healthcare providers. Better healthcare results and correction of medical records have been shown to be positive outcomes of the use of PHRs. PHRs have also been shown to be difficult for patients to use and understand, and providers had concerns about correct information transferring to the portals and patients eliminating information from the record. Concerns regarding patient understanding of medical records, legal liability, and the response time required of providers were also identified. For the PHR to succeed in the US healthcare system, assurance that the information will be protected, useful, and easily accessed is necessary. PMID:27134613
NIKBAKHT-NASRABADI, Alireza; SHABANY-HAMEDAN, Maryam
Background: Increasing hospital costs and its social and cultural problems has led to the idea of providing healthcare services at home. Because of infrastructural and implementation problems, providing healthcare at home in Iran has not been initiated yet. Therefore, this study set out to elaborate the need for a comprehensive system in order to provide this service in Iran. Methods: All articles published in indexing sites with the defined keywords in English or Farsi were gathered. The indexing websites included Iran Medex, PubMed Central, Elsevier journals, WHO publications and Google scholar from 1985 to 2014 were surveyed. Other documents included the related books and regulations. Results: Despite of having dominant religious values and constitution laws related to stability of family relations and establishment of clinical services and health care at home in Iran, providing health care services faces some harsh challenges including ignoring entrepreneurship and lack of required infrastructures such as lack of required insurance regulations, the inappropriate and indifferent performance of some activists home services and absence of registration and identification system in this domain. Conclusion: Because of the increasing number of elderly people in Iran and healthcare costs becoming more and more expensive, establishing a system for providing healthcare at home is inevitable. PMID:27516992
With each tick of the clock, healthcare leaders are coming face to face with a pressing quandary: How can they best guide their organizations to success and sustainability in a rocky and ever-changing healthcare environment? A new "model of sustainability," developed with input from nine CEOs of top medical institutions, may provide some guidance. The model includes six leadership imperatives that underscore critical approaches to supporting the hospital of the future: Build strong organization-wide leadership, become the employer of choice, generate financial strength, redesign structures and processes, develop productive physician relationships, and engage consumers.
Wiysonge, Charles S; Abdullahi, Leila H; Ndze, Valantine N; Hussey, Gregory D
trial, 115 pharmacies: improvements in four of six pharmacy indicators; low-certainty evidence). The outcome in three multifaceted intervention studies was the quality of pharmacy practice; including the ability to ask questions, give advice, and provide appropriate treatment. The trials applied regulation, training, and peer influence in sequence; and the study design does not permit separation of the effects of the different interventions. Two trials conducted among 136 pharmacies in Vietnam found that the multifaceted intervention may improve the quality of pharmacy practice; but the third study, involving 146 pharmacies in Vietnam and Thailand, found that the intervention may have little or no effects on the quality of pharmacy practice (low-certainty evidence). Only two studies (both conducted in Vietnam) reported cost data, with no rigorous assessment of the economic implications of implementing the interventions in resource-constrained settings. No study reported data on equity, mortality, morbidity, adverse effects, satisfaction, or attitudes. Authors' conclusions Training probably improves quality of care (i.e. adherence to recommended practice), regulation may improve quality of care, and we are uncertain about the effects of co-ordination on quality of private for-profit healthcare services in LMICs. The likelihood that further research will find the effect of training to be substantially different from the results of this review is moderate; implying that monitoring of the impact is likely to be needed if training is implemented. The low certainty of the evidence for regulation implies that the likelihood of further research finding the effect of regulation to be substantially different from the results of this review is high. Therefore, an impact evaluation is warranted if government regulation of private for-profit providers is implemented in LMICs. Rigorous evaluations of these interventions should also assess other outcomes such as impacts on equity
Glasberg, Ronald; Hartmann, Michael; Tamm, Gerrit
We analyze risks and crises for healthcare providers and discuss the impact of cloud computing in such scenarios. The analysis is conducted in a holistic way, taking into account organizational and human aspects, clinical, IT-related, and utilities-related risks as well as incorporating the view of the overall risk management. PMID:24707207
Cueva, Melany; Kuhnley, Regina; Lanier, Anne P.; Dignan, Mark
Community Health Aides and Community Health Practitioners (CHA/Ps), the primary providers of healthcare in rural Alaska, share the importance of story as a culturally respectful way for creating meaning and broadening understanding. Story is woven into the fabric of cancer education courses for CHA/Ps. Between May 2004 and April 2007, 13 week-long…
McGowan, Jessie; Grad, Roland; Pluye, Pierre; Hannes, Karin; Deane, Katherine; Labrecque, Michel; Welch, Vivian; Tugwell, Peter
Background The movement towards evidence-based practice makes explicit the need for access to current best evidence to improve health. Advances in electronic technologies have made health information more available, but does availability affect the rate of use of evidence in practice? Objectives To assess the effectiveness of interventions intended to provide electronic retrieval (access to information) to health information by healthcare providers to improve practice and patient care. Search methods We obtained studies from computerized searches of multiple electronic bibliographic databases, supplemented by checking reference lists, and consultation with experts. Selection criteria Randomized controlled trials (RCTs) including cluster randomized trials (CRCTs), controlled clinical trials (CCT), and interrupted time series analyses (ITS) of any language publication status examining interventions of effectiveness of electronic retrieval of health information by healthcare providers. Data collection and analysis Duplicate relevancy screening of searches, data abstraction and risk of bias assessment was undertaken. Main results We found two studies that examined this question. Neither study found any changes in professional behavior following an intervention that facilitated electronic retrieval of health information. There was some evidence of improvements in knowledge about the electronic sources of information reported in one study. Neither study assessed changes in patient outcomes or the costs of provision of the electronic resource and the implementation of the recommended evidence-based practices. Authors’ conclusions Overall there was insufficient evidence to support or refute the use of electronic retrieval of healthcare information by healthcare providers to improve practice and patient care. PMID:19588361
Presser, Brynne E; Katz, Mira L; Shoben, Abigail B; Moore, Deborah; Ruffin, Mack T; Paskett, Electra D; Reiter, Paul L
Human papillomavirus (HPV) self-testing is an emerging cervical cancer screening strategy, yet efforts to educate healthcare providers and staff about HPV self-testing are lacking. We report the findings of a brief education intervention about HPV self-testing for healthcare providers and staff. We conducted education sessions during 2015 with healthcare providers and staff (n = 33) from five federally qualified health centers located in Appalachian Ohio. Participants attended a one-time session and completed pre- and post-intervention surveys. Analyses for paired data assessed changes in knowledge and beliefs about HPV, HPV-related disease, and HPV self-testing. The intervention increased participants' knowledge and affected many of the beliefs examined. Participants answered an average of 4.67 of six knowledge items correctly on pre-intervention surveys and 5.82 items correctly on post-intervention surveys (p < 0.001). The proportion of participants who answered all six knowledge items correctly increased substantially (pre-intervention =9% vs. post-intervention =82%, p < 0.001). Compared to pre-intervention surveys, participants more strongly believed on post-intervention surveys that it is important to examine HPV self-testing as a potential cervical cancer screening strategy, that their female patients would be willing to use an HPV self-test at home by themselves, and that they have the knowledge to talk with their patients about HPV self-testing (all p < 0.05). A brief education intervention can be a viable approach for increasing knowledge and affecting beliefs about HPV self-testing among healthcare providers and staff. Findings will be valuable for planning and developing future HPV self-test interventions that include an education component for healthcare providers and staff.
The glory days of high school sports are no longer reserved for dream team athletes, as athletic directors are increasingly opening up sports to all students, regardless of ability, and seeing winning results on the field and off. This push is reflected in the most recent National Federation of State High School Associations (NFHS) survey, which…
Alkabba, Abdulaziz F.; Hussein, Ghaiath M. A.; Albar, Adnan A.; Bahnassy, Ahmad A.; Qadi, Mahdi
Background: Despite the relatively high expenditure on healthcare in Saudi Arabia, its health system remains highly centralized in the main cities with its primary focus on secondary and tertiary care rather than primary care. This has led to numerous ethical challenges for the healthcare providers. This article reports the results of a study conducted with a panel of practitioners, and non-clinicians, in Saudi Arabia, in order to identify the top ten ethical challenges for healthcare providers, patients, and their families. Materials and Methods: The study design was a cross-sectional, descriptive, and qualitative one. The participants were asked the question: “What top ten ethical challenges are Saudis likely to face in health care?” The participants were asked to rank the top ten ethical challenges throughout a modified Delphi process, using a ranking Scale. A consensus was reached after three rounds of questions and an experts’ meeting. Results: The major 10 ethical issues, as perceived by the participants in order of their importance, were: (1) Patients’ Rights, (2) Equity of resources, (3) Confidentiality of the patients, (4) Patient Safety, (5) Conflict of Interests, (6) Ethics of privatization, (7) Informed Consent, (8) Dealing with the opposite sex, (9) Beginning and end of life, and (10) Healthcare team ethics. Conclusion: Although many of the challenges listed by the participants have received significant public and specialized attention worldwide, scant attention has been paid to these top challenges in Saudi Arabia. We propose several possible steps to help address these key challenges. PMID:22518351
Hex, Nick; Setters, Jo; Little, Stuart
“Non-delivery” home oxygen technologies that allow self-filling of ambulatory oxygen cylinders are emerging. They can offer a relatively unlimited supply of ambulatory oxygen in suitably assessed people who require long-term oxygen therapy (LTOT), providing they can use these systems safely and effectively. This allows users to be self-sufficient and facilitates longer periods of time away from home. The evolution and evidence base of this technology is reported with the experience of a national service review in Scotland (UK). Given that domiciliary oxygen services represent a significant cost to healthcare providers globally, these systems offer potential cost savings, are appealing to remote and rural regions due to the avoidance of cylinder delivery and have additional lower environmental impact due to reduced fossil fuel consumption and subsequently reduced carbon emissions. Evidence is emerging that self-fill/non-delivery oxygen systems can meet the ambulatory oxygen needs of many patients using LTOT and can have a positive impact on quality of life, increase time spent away from home and offer significant financial savings to healthcare providers. Educational aims Provide update for oxygen prescribers on options for home oxygen provision. Provide update on the evidence base for available self-fill oxygen technologies. Provide and update for healthcare commissioners on the potential cost-effective and environmental benefits of increased utilisation of self-fill oxygen systems. PMID:27408629
Silver, Julie K; Binder, David S; Zubcevik, Nevena; Zafonte, Ross D
Physicians and other healthcare professionals are often the end users of medical innovation; however, they are rarely involved in the beginning design stages. This often results in ineffective healthcare solutions with poor adoption rates. At the early design stage, innovation would benefit from input from healthcare professionals. This report describes the first-ever rehabilitation hackathon-an interdisciplinary and competitive team event aimed at accelerating and improving healthcare solutions and providing an educational experience for participants. Hackathons are gaining traction as a way to accelerate innovation by bringing together a diverse group of interdisciplinary professionals from different industries who work collaboratively in teams and learn from each other, focus on a specific problem ("pain point"), develop a solution using design thinking techniques, pitch the solution to participants, gather fast feedback and quickly alter the prototype design ("pivoting"). 102 hackers including 19 (18.6 %) physicians and other professionals participated, and over the course of 2 days worked in teams, pitched ideas and developed design prototypes. Three awards were given for prototypes that may improve function in persons with disabilities. 43 hackers were women (42.2 %) and 59 men (57.8 %); they ranged in age from 16 to 79 years old; and, of the 75 hackers who reported their age, 63 (84 %) were less than 40 years old and 12 (16 %) were 40 years or older. This report contributes to the emerging literature on healthcare hackathons as a means of providing interdisciplinary education and training and supporting innovation.
By paying attention to our personal individuation process, our inner work, we can better deal with whatever the world presents. Much of the chaos healthcare is experiencing today is because we are currently trying to become more conscious both individually and organizationally. The future of Catholic healthcare is in recognizing the call, the challenge, the moral imperative to facilitate the creation of healthy communities. We must reflect on and understand health not as a commodity, but rather as both a process and a state of being that is at once personal and collective. In indigenous cultures there has always been an understanding of the deep connection between personal and community health and between spiritual, mental, and physical health. The current synchronistic shift from professional-directed, acute care to an awareness of how the individual psyche and society in general influence health and well-being is spurring Americans to focus on mind-body and healthy-community concepts. If we can "stay present" to the mission of healthcare-keep people well, prevent disease, deal with the causes and symptoms of illness, create healthy communities-we will have a future in healthcare delivery. We can do this by being healthy ourselves, recognizing our global responsibility for health, and providing direct services.
Stringer, Kristi L.; Turan, Bulent; McCormick, Lisa; Durojaiye, Modupeoluwa; Nyblade, Laura; Kempf, Mirjam-Colette; Lichtenstein, Bronwen; Turan, Janet M.
Stigma towards people living with HIV (PLWH) in healthcare settings is a barrier to optimal treatment. However, our understanding of attitudes towards PLWH from healthcare providers’ perspective in the United States is limited and out-of-date. We assessed HIV-related stigma among healthcare staff in Alabama and Mississippi, using online questionnaires. Participants included 651 health workers (60% White race; 83% female). Multivariate regression suggests that several factors independently predict stigmatizing attitudes: Protestant compared to other religions (β = 0.129, p≤0.05), White race compared to other races (β = 0.162, p ≤0.001), type of clinic (HIV/STI clinic: β = 0.112, p≤0.01), availability of post-exposure prophylaxis (yes: β = −.107, p≤0.05), and perceptions of policy enforcement (policies not enforced: β = 0.058, p = p≤0.05). These findings may assist providers wishing to improve the quality care for PLWH. Enforcement of policies prohibiting discrimination may be a useful strategy for reducing HIV-related stigma among healthcare workers. PMID:26650383
McShea, Michael; Holl, Randy; Badawi, Omar; Riker, Richard R; Silfen, Eric
As the volume of data that is electronically available promliferates, the health-care industry is identifying better ways to use this data for patient care. Ideally, these data are collected in real time, can support point-of-care clinical decisions, and, by providing instantaneous quality metrics, can create the opportunities to improve clinical practice as the patient is being cared for. The business-world technology supporting these activities is referred to as business intelligence, which offers competitive advantage, increased quality, and operational efficiencies. The health-care industry is plagued by many challenges that have made it a latecomer to business intelligence and data-mining technology, including delayed adoption of electronic medical records, poor integration between information systems, a lack of uniform technical standards, poor interoperability between complex devices, and the mandate to rigorously protect patient privacy. Efforts at developing a health care equivalent of business intelligence (which we will refer to as clinical intelligence) remains in its infancy. Until basic technology infrastructure and mature clinical applications are developed and implemented throughout the health-care system, data aggregation and interpretation cannot effectively progress. The need for this approach in health care is undisputed. As regional and national health information networks emerge, we need to develop cost-effective systems that reduce time and effort spent documenting health-care data while increasing the application of knowledge derived from that data.
Sale, Joanna E M; Hawker, Gillian; Cameron, Cathy; Bogoch, Earl; Jain, Ravi; Beaton, Dorcas; Jaglal, Susan; Funnell, Larry
To examine messages perceived by members of an osteoporosis (OP) patient group from various healthcare providers regarding bone health. We conducted a phenomenological (qualitative) study in members of an OP patient group who resided in Canada, had sustained a fragility fracture at 50+ years old, and were not taking antiresorptive medication at the time of that fracture. Participants were interviewed for approximately 1 h by telephone and responded to questions about visits to healthcare providers for their bone health and what was discussed during those visits. We analyzed the data guided by Giorgi's methodology. We interviewed 28 members (2 males, 26 females; 78 % response rate), aged 51-89 years old. Most participants perceived that their specialist was more interested than their primary care physician in bone health and took the time to discuss issues with them. Participants perceived very few messages from the fracture clinic and other providers. We found many instances where perceived messages within and across various healthcare providers were inconsistent, suggesting there is a need to raise awareness of bone health management guidelines to providers who treat fracture patients.
Background Infection causes neonatal mortality in both high and low income countries. While simple interventions to prevent neonatal infection are available, they are often poorly understood and implemented by clinicians. A basic understanding of healthcare providers' perceptions of infection control provides a platform for improving current practices. Our aim was to explore the views of healthcare providers in provincial hospitals in south and south central Vietnam to inform the design of programmes to improve neonatal infection prevention and control. Methods All fifty-four participants who attended a workshop on infection prevention and control were asked to complete an anonymous, written questionnaire identifying their priorities for improving neonatal infection prevention and control in provincial hospitals in south and south central Vietnam. Results Hand washing, exclusive breastfeeding and safe disposal of medical waste were nominated by most participants as priorities for preventing neonatal infections. Education through instructional posters and written guidelines, family contact, kangaroo-mother-care, limitation of invasive procedures and screening for maternal GBS infection were advocated by a smaller proportion of participants. Conclusions The opinions of neonatal healthcare providers at the workshop accurately reflect some of the current international recommendations for infection prevention. However, other important recommendations were not commonly identified by participants and need to be reinforced. Our results will be used to design interventions to improve infection prevention in Vietnam, and may be relevant to other low-resource countries. PMID:23570330
Gomes, Ludmila Mourão Xavier; Reis, Tatiana Carvalho; Vieira, Magda Mendes; de Andrade-Barbosa, Thiago Luis; Caldeira, Antônio Prates
Objective To evaluate the quality of healthcare provided to sickle cell disease children by primary healthcare services in a region of high prevalence. Methods A cross-sectional, descriptive study was performed by interviewing members of families with sickle cell disease children. The children had been identified from the Neonatal Screening Program in Minas Gerais state over the last 12 years in towns of the Montes Claros-Bocaiuva microregion. A structured questionnaire specially developed for this study and based on three axes was used: indicators of the child's health (immunization, growth and development, prophylaxis antibiotic therapy), perception of care by the family (health education and accessibility) and knowledge of the family about the disease. Results Sixty-three of 71 families with children identified as having sickle cell disease were interviewed. The predominant genotypes were Hb SS (44.4%) and Hb SC (41.2%). Adequate monitoring of growth and development was recorded for the first year of life in 23 children (36.6%) and for the second year of life in 18 children (28.6%). The basic vaccination schedule was completed by 44 children (69.8%) but 62 vaccination record cards (98.4%) identified delays of special vaccines. Regular use of prophylactic penicillin was reported by 55 caregivers (87.3%). The family's perception of the care provided suggests poor accessibility to health services and lack of opportunities to answer doubts. The average performance of families in knowledge testing was 59.8%. Conclusion The quality of healthcare is unsatisfactory. The care provided to children with sickle cell disease in primary healthcare services needs improvements. PMID:23049319
Padela, Aasim I
The United Nations Educational, Scientific and Cultural Organization's (UNESCO) Declaration on Bioethics and Human Rights asserts that governments are morally obliged to promote health and to provide access to quality healthcare, essential medicines and adequate nutrition and water to all members of society. According to UNESCO, this obligation is grounded in a moral commitment to promoting fundamental human rights and emerges from the principle of social responsibility. Yet in an era of ethical pluralism and contentions over the universality of human rights conventions, the extent to which the UNESCO Declaration can motivate behaviors and policies rests, at least in part, upon accepting the moral arguments it makes. In this essay I reflect on a state's moral obligation to provide healthcare from the perspective of Islamic moral theology and law. I examine how Islamic ethico-legal conceptual analogues for human rights and communal responsibility, ḥuqūq al-'ibād and farḍ al-kifāyah and other related constructs might be used to advance a moral argument for healthcare provision by the state. Moving from theory to application, I next illustrate how notions of human rights and social responsibility were used by Muslim stakeholders to buttress moral arguments to support American healthcare reform. In this way, the paper advance discourses on a universal bioethics and common morality by bringing into view the concordances and discordances between Islamic ethico-legal constructs and moral arguments advanced by transnational health policy advocates. It also provides insight into applied Islamic bioethics by demonstrating how Islamic ethico-legal values might inform the discursive outputs of Muslim organizations.
Moody-Thomas, Sarah; Celestin, Michael D.; Tseng, Tung-Sung; Horswell, Ronald
Background Although smoking rates in the United States (US) are high, healthcare systems and clinicians can increase cessation rates through application of the US Public Health Service tobacco treatment guideline (2000, 2008). In primary care settings, however, guideline implementation remains low. This report presents the results from an assessment of patient tobacco use, quit attempts, and perceptions of provider treatment before (2004) and after (2010) guideline implementation. Methods By use of a systems approach, the Louisiana Tobacco Control Initiative integrated evidence-based treatment of tobacco use into patient care practices in Louisiana's public hospital system. This prospective study, designed to collect data at 2 time points for the purpose of evaluating the effect of the 5A protocol (ask, advise, assess, assist, and arrange), included 571 and 889 adult patients selected from primary care clinics in 2004 and 2010, respectively. Chi-square analyses determined differences between survey administrations, along with direct standardization of weighted rates to control for confounding factors. Results Patient reports indicated that provider adherence to the 5A clinical protocol increased from 2004 to 2010. Significant (P<0.001) improvements were observed for the assess (39% vs 72%), assist (24% vs 76%), and arrange (8% vs 31%) treatment variables. Patient-reported quit attempts increased, along with awareness of cessation services (from 19% to 70%, P<0.001), while use of cessation medications decreased (from 23% to 5%, P<0.002). Conclusion Following implementation of the guideline, significant improvements were noted in patient reports of provider treatment and awareness of cessation services. PMID:24052766
Warnock, Carla Jean Pease
All US governmental, public, and private healthcare facilities and their staff fall under some form of regulatory requirement to provide opportunities for spiritual health assessment and care as a component of holistic healthcare. As often the case with regulations, these facilities face the predicament of funding un-reimbursable care. However, chaplains and nurses who provide most patient spiritual care are paid using funds the facility obtains from patients, private, and public sources. Furthermore, Veteran healthcare services, under the United States Department of Veterans Affairs (VA), are provided with taxpayer funds from local, state, and federal governments. With the recent legal action by the Freedom From Religion Foundation, Inc. (FFRF) against the Veterans Administration, the ethical dilemma surfaces between taxpayers funding holistic healthcare and the first amendment requirement for separation of church and state.
Stevens, Meriam; Berishaj, Kelly
Human trafficking is a major global public health concern. It is a grave crime that violates human rights. Contrary to healthcare providers' perceptions, victims of human trafficking come in contact with the healthcare system while being trafficked, with the emergency department being the most frequented setting for medical treatment. In this article, we explore the anatomy of human trafficking, including the scope of the problem, definitions, and types and elements of human trafficking. The roles of clinicians, particularly emergency department nurses and advanced practice nurses, in screening and identifying those at risk are examined. Clinical practice tools and guidelines that may be used by clinicians to guide the treatment of human trafficking victims are reviewed. Finally, current strategies and resources that address human trafficking are presented. For the purpose of this article, the terms "human trafficking" or "trafficking" will be used throughout.
Lindén, Maria; Björkman, Mats
Wearable, embedded sensor systems for health applications are foreseen to be enablers in the future healthcare. They will provide ubiquitous monitoring of multiple parameters without restricting the person to stay at home or in the hospital. By following trend changes in the health status, early deteriorations will be detected and treatment can start earlier. Also health prevention will be supported. Such future healthcare requires technology development, including miniaturized sensors, smart textiles and wireless communication. The tremendous amount of data generated by these systems calls for both signal processing and decision support to guarantee the quality of data and avoid overflow of information. Safe and secure communications have to protect the integrity of the persons monitored.
AZIZAM, Nor Azmaniza; SHAMSUDDIN, Khadija
Background: There is growing interest in research on patient satisfaction with healthcare provider (HCP) communication as a measure of healthcare quality and HCPs’ communication competency. This study aimed to determine the levels of patient satisfaction with healthcare provider-patient communication (HCP-PC) and its associated factors at the outpatient clinic at Hospital Kuala Lumpur. Methods: A cross-sectional study was conducted on a convenience sample in July 2012 using self-administered questionnaires for the data collection. Both overall and domain-specific satisfaction were measured, with the three domains being exchanging information (EI), socio-emotional behaviour (SB), and communication style (CS). Results: The findings show that 92.8% of the 283 respondents were satisfied with overall HCP-PC, 89.5% with EI, 91.3% with SB, and 72.2% with CS. Satisfaction was statistically higher among Malays for CS and higher among those with low education and poor health for EI, SB and CS. EI and overall communication satisfaction were also higher among patients who reported short wait times, and patients who were in gender concordance with their HCPs showed higher SB satisfaction. Conclusion: Basic and continuous communication skills training and patient activation programs should be established to increase patient satisfaction. Health information technology use should be actively promoted to allow for structured and standardised information exchange between HCPs and patients. PMID:26715897
Henrikson, Nora B; Tuzzio, Leah; Gilkey, Melissa B; McRee, Annie-Laurie
Healthcare providers have a strong influence on human papillomavirus (HPV) vaccination decisions, yet they often fail to recommend the vaccine to the 11- and 12-year-olds who are targeted by practice guidelines. We sought to understand how providers interpret and value age-based guidelines. We conducted a secondary analysis of data from two qualitative studies of healthcare providers' HPV vaccination attitudes and practices. Participants were physicians, nurse practitioners, and physician assistants in Minnesota (n = 27) and in Washington (n = 17) interviewed in 2012 and 2014 respectively. Verbatim transcripts from each study were analyzed independently using content analysis, and collective findings were then jointly analyzed. The research team worked via consensus to derive codes and describe representative themes. A high proportion of providers reported either a lack of concern about HPV vaccine completion, or concern beginning several years past the recommended target age. Many providers perceived a gradient of HPV vaccination timeliness ranging from age 12 to 26. Instead of age-based recommendations, providers timed recommendations based on perceptions of access to care and patient risk. They often offered "gentle" recommendations and deferred vaccination discussions as a tool to building trust with families. Interventions aimed at helping providers deliver effective recommendations for timely HPV vaccination are needed. Our findings suggest that changing the norm of provider culture to one in which "catch-up" schedules are seen as a suboptimal way to achieve vaccine uptake may be an important goal.
Pozo-Cano, MD; Castillo, RF; Guillen, J Francisco; Florido, J; García García, I
ABSTRACT Introduction: Prenatal care is a key strategy to reduce maternal mortality. The aims of this work were to ascertain the level of satisfaction of new mothers with their pregnancy monitoring and with the medical professionals who provided prenatal care. Subject and methods: A descriptive study was conducted on 265 new mothers, 18-43 years of age, who had given birth at the Virgen de las Nieves University Hospital and the San Cecilio University Hospital in Granada (Spain) in April and May 2012. The data were collected with a questionnaire consisting of 28 items that elicited information from the subjects about their pregnancy, prenatal care activities, the healthcare professionals that provided the care, and those that they would like to monitor future pregnancies. There were also two open questions. The first was about the perceived needs of the participants and the second asked them to suggest ways that prenatal care could be improved. Results: The majority of the subjects (59.6%) had given birth for the first time. The midwife was the healthcare professional who performed most of the monitoring activities and resolved their doubts and problems (32.74%), gave the subjects tranquillity and security (37.86%) and listened to their worries (34.53%). The subjects' satisfaction with the healthcare professionals was generally high. This was particularly true of the midwife (90.75%). Half of the subjects surveyed said that they wanted the midwife, obstetrician and general practitioner to monitor their pregnancy. They also underlined the need for longer and more visits with the midwife as well as more consultations with the obstetrician and higher number of ultrasounds. Conclusions: The subjects were very satisfied with the work of the healthcare professionals that monitored their pregnancy, particularly with the midwife. However, they also highlighted expectations and needs that, if met, would increase their satisfaction. PMID:25867581
MacDougall, D M; Halperin, B A; MacKinnon-Cameron, D; Li, Li; McNeil, S A; Langley, J M; Halperin, S A
Objectives Vaccine coverage for recommended vaccines is low among adults. The objective of this study was to assess the knowledge, attitudes, beliefs and behaviours of adults and healthcare providers related to four vaccine-preventable diseases and vaccines (diphtheria-tetanus-pertussis, zoster, pneumococcus and influenza). Design We undertook a survey and focus groups of Canadian adults and healthcare providers (doctors, nurses, pharmacists). A total of 4023 adults completed the survey and 62 participated in the focus groups; 1167 providers completed the survey and 45 participated in the focus groups. Results Only 46.3% of adults thought they were up-to-date on their vaccines; 30% did not know. In contrast, 75.6% of providers reported being up-to-date. Only 57.5% of adults thought it was important to receive all recommended vaccines (compared to 87.1–91.5% of providers). Positive attitudes towards vaccines paralleled concern about the burden of illness and confidence in the vaccines, with providers being more aware of disease burden and confident in vaccine effectiveness than the public. Between 55.0% and 59.7% of adults reported willingness to be vaccinated if recommended by their healthcare provider. However, such recommendations were variable; while 77.4% of the public reported being offered and 52.8% reported being recommended the influenza vaccine by their provider, only 10.8% were offered and 5.6% recommended pertussis vaccine. Barriers and facilitators to improved vaccine coverage in adults, such as trust-mistrust of health authorities, pharmaceutical companies and national recommendations, autonomy versus the public good and logistical issues (such as insufficient time and lack of vaccination status tracking), were identified by both the public and providers. Conclusions Despite guidelines for adult vaccination, there are substantial gaps in knowledge and attitudes and beliefs among both the public and healthcare providers that lead to low vaccine
Harris, Cornelia A.
This research project examined the views and perceptions of healthcare provider staff regarding HIV testing and the implementation of HIV testing as a routine part of medical practice in a university student health center at a Historically Black College or University (HBCU). This study further explored whether healthcare provider staff promoted…
Duckett, Jane; Hunt, Kate; Munro, Neil; Sutton, Matt
How trust affects health-care utilization is not well-understood, especially in low- and middle-income countries. This article focuses on China, a middle-income country where low trust in health-care settings has become a prominent issue, but actual levels of distrust and their implications for utilization are unknown. We conducted a nationally representative survey of the Chinese population (November 2012 to January 2013), which resulted in a sample of 3680 adult men and women. Respondents rated their trust in different types of health-care providers. Using multivariate logistic and negative binomial regression models, we estimated the association between distrust in clinics and respondents’ hospital visits in the last year; whether they had sought hospital treatment first for two common symptoms (headache, cold) in the last 2 months; and whether they said they would go first to a hospital if they had a minor or major illness. We analysed these associations before and after adjusting for performance evaluations of clinics and hospitals, controlling for sex, age, education, income, insurance status, household registration and self-assessed health. We found that distrust in hospitals is low, but distrust in clinics is high and strongly associated with increased hospital utilization, especially for minor symptoms and illnesses. Further research is needed to understand the reasons for distrust in clinics because its effects are not fully accounted for by poor evaluations of their competence. PMID:27117483
Rizzo, Albert A; Lange, Belinda; Buckwalter, John G; Forbell, Eric; Kim, Julia; Sagae, Kenji; Williams, Josh; Rothbaum, Barbara O; Difede, JoAnn; Reger, Greg; Parsons, Thomas; Kenny, Patrick
Over the last 15 years, a virtual revolution has taken place in the use of Virtual Reality simulation technology for clinical purposes. Shifts in the social and scientific landscape have now set the stage for the next major movement in Clinical Virtual Reality with the "birth" of intelligent virtual humans. Seminal research and development has appeared in the creation of highly interactive, artificially intelligent and natural language capable virtual human agents that can engage real human users in a credible fashion. No longer at the level of a prop to add context or minimal faux interaction in a virtual world, virtual humans can be designed to perceive and act in a 3D virtual world, engage in spoken dialogues with real users and can be capable of exhibiting human-like emotional reactions. This paper will present an overview of the SimCoach project that aims to develop virtual human support agents to serve as online guides for promoting access to psychological healthcare information and for assisting military personnel and family members in breaking down barriers to initiating care. The SimCoach experience is being designed to attract and engage military Service Members, Veterans and their significant others who might not otherwise seek help with a live healthcare provider. It is expected that this experience will motivate users to take the first step--to empower themselves to seek advice and information regarding their healthcare and general personal welfare and encourage them to take the next step towards seeking more formal resources if needed.
Background Stigma and discrimination against people living with human immunodeficiency virus (HIV) are obstacles in the way of effective responses to HIV. Understanding the extent of stigma / discrimination and the underlying causes is necessary for developing strategies to reduce them. This study was conducted to explore stigma and discrimination against PLHIV amongst healthcare providers in Jimma zone, Southwest Ethiopia. Methods A cross-sectional study, employing quantitative and qualitative methods, was conducted in 18 healthcare institutions of Jimma zone, during March 14 to April 14, 2011. A total of 255 healthcare providers responded to questionnaires asking about sociodemographic characteristics, HIV knowledge, perceived institutional support and HIV-related stigma and discrimination. Factor analysis was employed to create measurement scales for stigma and factor scores were used in one way analysis of variance (ANOVA), T-tests, Pearson’s correlation and multiple linear regression analyses. Qualitative data collected using key-informant interviews and Focus Group Discussions (FGDs) were employed to triangulate with the findings from the quantitative survey. Results Mean stigma scores (as the percentages of maximum scale scores) were: 66.4 for the extra precaution scale, 52.3 for the fear of work-related HIV transmission, 49.4 for the lack of feelings of safety, 39.0 for the value-driven stigma, 37.4 for unethical treatment of PLHIV, 34.4 for discomfort around PLHIV and 31.1 for unofficial disclosure. Testing and disclosing test results without consent, designating HIV clients and unnecessary referral to other healthcare institutions and refusal to treat clients were identified. Having in-depth HIV knowledge, the perception of institutional support, attending training on stigma and discrimination, educational level of degree or higher, high HIV case loads, the presence of ART service in the healthcare facility and claiming to be non-religious were negative
Dyer, Karen E.; Quinn, Gwendolyn P.
Purpose To examine healthcare provider perceptions of cancer-related infertility and fertility preservation (FP) in an underserved population, and to highlight cognitive and structural barriers to use. Methods In-depth, semi-structured interviews were conducted with a sample of 16 healthcare providers participating in a larger ethnographic study on cancer survivorship and cancer-related infertility in Puerto Rico, an unincorporated U.S. territory. Interviews were conducted in-person, audio-recorded, transcribed verbatim, and coded using the constant comparative method. Results Providers identified several barriers to FP in Puerto Rico: high cost in relation to income levels; lack of insurance coverage; gaps in provider knowledge of fertility clinics and financial assistance; lower prioritization of quality-of-life needs leading to inconsistent physician disclosure of fertility risks; geographical location of fertility clinics; and logistical challenges to maintaining FP offerings. Two factors act as facilitators: a high value placed on patient-provider communication and relationship, and the formation of local alliances between the oncology and reproductive medicine fields, potentially leading to increased cross-specialty communication and referral. Conclusions Infertility is a continuing source of distress for cancer patients and survivors, and barriers to FP vary cross-culturally. In Puerto Rico, context-specific factors indicate potential areas of intervention. Greater awareness of fertility risks and options can be fostered through physician training in conjunction with organizational measures targeting cost barriers. PMID:26980331
Friis, Karina; Lasgaard, Mathias; Osborne, Richard H; Maindal, Helle T
Objectives To (1) quantify levels of subjective health literacy in people with long-term health conditions (diabetes, cardiovascular disease, chronic obstructive pulmonary disease, musculoskeletal disorders, cancer and mental disorders) and compare these to levels in the general population and (2) examine the association between health literacy, socioeconomic characteristics and comorbidity in each long-term condition group. Design Population-based survey in the Central Denmark Region (n=29 473). Main outcome measures Health literacy was measured using two scales from the Health Literacy Questionnaire (HLQ): (1) Ability to understand health information and (2) Ability to actively engage with healthcare providers. Results People with long-term conditions reported more difficulties than the general population in understanding health information and actively engaging with healthcare providers. Wide variation was found between disease groups, with people with cancer having fewer difficulties and people with mental health disorders having more difficulties in actively engaging with healthcare providers than other long-term condition groups. Having more than one long-term condition was associated with more difficulty in engaging with healthcare providers and understanding health information. People with low levels of education had lower health literacy than people with high levels of education. Conclusions Compared with the general population, people with long-term conditions report more difficulties in understanding health information and engaging with healthcare providers. These two dimensions are critical to the provision of patient-centred healthcare and for optimising health outcomes. More effort should be made to respond to the health literacy needs among individuals with long-term conditions, multiple comorbidities and low education levels, to improve health outcomes and to reduce social inequality in health. PMID:26769783
Turner, Kathleen E; Fuller, Sherrilynne
Though improvements in infant and maternal mortality rates have occurred over time, women and children still die every hour from preventable causes. Various regional, social and economic factors are involved in the ability of women and children to receive adequate care and prevention services. Patient-held maternal and/or child health records have been used for a number of years in many countries to help track health risks, vaccinations and other preventative health measures performed. Though these records are primarily designed to record patient histories and healthcare information and guide healthcare workers providing care, because the records are patient-held, they also allow families a greater ability to track their own health and prevention strategies. A LITERATURE SEARCH WAS PERFORMED TO ANSWER THESE QUESTIONS: (1) What are maternal information needs regarding pregnancy, post-natal and infant healthcare, especially in developing countries? (2) What is known about maternal information seeking behavior in developing countries? (3) What is the history and current state of maternal and/or child patient-held healthcare records, do they provide for the information needs of the healthcare provider and what are the effects and outcomes of patient-held records in general and for maternal and/or child health in particular? Specific information needs of pregnant women and mothers are rarely studied. The small numbers of maternal information behavior results available indicate that mothers, in general, prefer to receive health information directly from their healthcare provider as opposed to from other sources (written, etc.) Overall, in developing countries, patient-held maternal and/or child healthcare records have a mostly positive effect for both patient and care provider. Mothers and children with records tend to have better outcomes in healthcare and preventative measures. Further research into the information behaviors of pregnant women and mothers to determine
The goal of this paper is both modest and ambitious. The modest goal is to show that intercountry adoption should be considered by ethicists and healthcare providers. The more ambitious goal is to introduce the many ethical issues that intercountry adoption raises. Intercountry adoption is an alternative to medical, assisted reproduction option such as in vitro fertilization (IVF), intracytoplasmic sperm injection, third party egg and sperm donation and surrogacy. Health care providers working with assisted reproduction are in a unique position to introduce their clients to intercountry adoption; however, providers should only do so if intercountry adoption is ethically equal or superior to the alternatives. This paper first presents a brief history of intercountry adoption. The second section compares intercountry adoption with medical alternatives. The third section examines the unique ethical challenges that are not shared by other medical alternatives. The final section concludes that it is simplistic for a healthcare provider to promote intercountry adoption unconditionally; however, in situation where intercountry adoption is practiced conscientiously it poses no greater ethical concern than several medical alternatives. This conclusion is preliminary and is intended as a start for further discussion.
Sudhinaraset, May; Ingram, Matthew; Lofthouse, Heather Kinlaw; Montagu, Dominic
Informal health care providers (IPs) comprise a significant component of health systems in developing nations. Yet little is known about the most basic characteristics of performance, cost, quality, utilization, and size of this sector. To address this gap we conducted a comprehensive literature review on the informal health care sector in developing countries. We searched for studies published since 2000 through electronic databases PubMed, Google Scholar, and relevant grey literature from The New York Academy of Medicine, The World Bank, The Center for Global Development, USAID, SHOPS (formerly PSP-One), The World Health Organization, DFID, Human Resources for Health Global Resource Center. In total, 334 articles were retrieved, and 122 met inclusion criteria and chosen for data abstraction. Results indicate that IPs make up a significant portion of the healthcare sector globally, with almost half of studies (48%) from Sub-Saharan Africa. Utilization estimates from 24 studies in the literature of IP for healthcare services ranged from 9% to 90% of all healthcare interactions, depending on the country, the disease in question, and methods of measurement. IPs operate in a variety of health areas, although baseline information on quality is notably incomplete and poor quality of care is generally assumed. There was a wide variation in how quality of care is measured. The review found that IPs reported inadequate drug provision, poor adherence to clinical national guidelines, and that there were gaps in knowledge and provider practice; however, studies also found that the formal sector also reported poor provider practices. Reasons for using IPs included convenience, affordability, and social and cultural effects. Recommendations from the literature amount to a call for more engagement with the IP sector. IPs are a large component of nearly all developing country health systems. Research and policies of engagement are needed. PMID:23405101
Shin, Somi; Schumacher, Christoph; Feess, Eberhard
One of the main concerns about capitation-based reimbursement systems is that tertiary institutions may be underfunded due to insufficient reimbursements of more complicated cases. We test this hypothesis with a data set from New Zealand that, in 2003, introduced a capitation system where public healthcare provider funding is primarily based on the characteristics of the regional population. Investigating the funding for all cases from 2003 to 2011, we find evidence that tertiary providers are at a disadvantage compared with secondary providers. The reasons are that tertiary providers not only attract the most complicated, but also the highest number of cases. Our findings suggest that accurate risk adjustment is crucial to the success of a capitation-based reimbursement system. Copyright © 2017 John Wiley & Sons, Ltd.
Koenig, Kristi L.; Shastry, Siri; Mzahim, Bandr; Almadhyan, Abdulmajeed; Burns, Michael J.
Mumps is a highly contagious viral infection that became rare in most industrialized countries following the introduction of measles-mumps-rubella (MMR) vaccine in 1967. The disease, however, has been re-emerging with several outbreaks over the past decade. Many clinicians have never seen a case of mumps. To assist frontline healthcare providers with detecting potential cases and initiating critical actions, investigators modified the “Identify-Isolate-Inform” tool for mumps infection. The tool is applicable to regions with rare incidences or local outbreaks, especially seen in college students, as well as globally in areas where vaccination is less common. Mumps begins with a prodrome of low-grade fever, myalgias and malaise/anorexia, followed by development of nonsuppurative parotitis, which is the pathognomonic finding associated with acute mumps infection. Orchitis and meningitis are the two most common serious complications, with hearing loss and infertility occurring rarely. Providers should consider mumps in patients with exposure to a known case or international travel to endemic regions who present with consistent signs and symptoms. If mumps is suspected, healthcare providers must immediately implement standard and droplet precautions and notify the local health department and hospital infection control personnel. PMID:27625709
For many years, hospitals and other institutional healthcare providers used fund accounting as a basis for presenting their financial statements. Recently, authoritative literature has placed less emphasis on separate fund reporting. This is evidenced by the reduction of fund classifications specified in the literature. This trend seems to follow the recognition that institutional healthcare activities should be reported in a manner comparable to other businesses. The Principles and Practices Board (P&P Board) of the Healthcare Financial management Association believes that general purpose financial statements of institutional healthcare providers should be comparable to reporting by other businesses. That is, all assets, liabilities, and equity are presented in a single aggregated balance sheet without differentiation by fund. This form of presentation, referred to in this statement as single fund reporting, should be used by all institutional healthcare providers including those that are part of HMOs, universities, municipalities, and other larger entities when separate reports of the provider are issued. The P&P Board is studying other significant issues concerning the reporting of revenues and components of equity and changes therein. The conclusion in this statement can be implemented even though conclusions on these related subjects are not yet complete. The P&P Board recognizes that certain circumstances may require detailed records and reports for special purposes. This statement deals only with those general purpose financial statements on which an independent accountant's opinion is expressed.
Tong, Allison; Jan, Stephen; Wong, Germaine; Craig, Jonathan C; Irving, Michelle; Chadban, Steven; Cass, Alan; Howard, Kirsten
Ongoing debate about how to maximize the benefit of scarce organs while maintaining equity of access to transplantation exists. This study aims to synthesize healthcare provider perspectives on wait-listing and organ allocation. MEDLINE, Embase, and PsycINFO were searched till February 21, 2011. Quantitative data were extracted, and a qualitative synthesis of the studies was conducted. Twenty studies involving 4254 respondents were included. We identified two goals underpinning healthcare provider preferences for organ allocation: (i) maximize clinical benefit (quality of life gains, patient survival, treatment adherence, and graft survival) and social outcomes (social support, productivity, and valuation); (ii) achieve equity (waiting time, patient preferences, access to live donation, and medical urgency). Maximizing clinical or social outcomes meant organs would be preferentially given to patients expected to achieve good transplant outcomes or wider social gain. Achieving equity meant all patients should have an equal chance of transplant, or patients deemed more urgent receive higher priority. A tension between equity and efficiency is apparent. Balanced against dimensions of efficiency were considerations to instill a degree of perceived fairness in organ allocation. Ongoing engagement with stakeholders is needed to enhance transparency, a reasonable balance between efficiency and equity, and avoid discrimination against specific populations.
Mosites, Emily; Carpenter, L Rand; McElroy, Kristina; Lancaster, Mary J; Ngo, Tue H; McQuiston, Jennifer; Wiedeman, Caleb; Dunn, John R
Tennessee has a high incidence of Rocky Mountain spotted fever (RMSF), the most severe tick-borne rickettsial illness in the United States. Some regions in Tennessee have reported increased illness severity and death. Healthcare providers in all regions of Tennessee were surveyed to assess knowledge, attitudes, and perceptions regarding RMSF. Providers were sent a questionnaire regarding knowledge of treatment, diagnosis, and public health reporting awareness. Responses were compared by region of practice within the state, specialty, and degree. A high proportion of respondents were unaware that doxycycline is the treatment of choice in children ≤ 8 years of age. Physicians practicing in emergency medicine, internal medicine, and family medicine; and nurse practitioners, physician assistants, and providers practicing for < 20 years demonstrated less knowledge regarding RMSF. The gaps in knowledge identified between specialties, designations, and years of experience can help target education regarding RMSF.
Boachie, Micheal Kofi
Background: In early 2012, National Health Insurance Scheme (NHIS) members in Ashanti Region were allowed to choose their own primary healthcare providers. This paper investigates the factors that enrolees in the Ashanti Region considered in choosing preferred primary healthcare providers (PPPs) and direction of association of such factors with the choice of PPP. Methods: Using a cross-sectional study design, the study sampled 600 NHIS enrolees in Kumasi Metro area and Kwabre East district. The sampling methods were a combination of simple random and systematic sampling techniques at different stages. Descriptive statistics were used to analyse demographic information and the criteria for selecting PPP. Multinomial logistic regression technique was used to ascertain the direction of association of the factors and the choice of PPP using mission PPPs as the base outcome. Results: Out of the 600 questionnaires administered, 496 were retained for further analysis. The results show that availability of essential drugs (53.63%) and doctors (39.92%), distance or proximity (49.60%), provider reputation (39.52%), waiting time (39.92), additional charges (37.10%), and recommendations (48.79%) were the main criteria adopted by enrolees in selecting PPPs. In the regression, income (-0.0027), availability of doctors (-1.82), additional charges (-2.14) and reputation (-2.09) were statistically significant at 1% in influencing the choice of government PPPs. On the part of private PPPs, availability of drugs (2.59), waiting time (1.45), residence (-2.62), gender (-2.89), and reputation (-2.69) were statistically significant at 1% level. Presence of additional charges (-1.29) was statistically significant at 5% level. Conclusion: Enrolees select their PPPs based on such factors as availability of doctors and essential drugs, reputation, waiting time, income, and their residence. Based on these findings, there is the need for healthcare providers to improve on their quality levels
Environmental factors that influence communication between people with communication disability and their healthcare providers in hospital: a review of the literature within the International Classification of Functioning, Disability and Health (ICF) framework.
O'Halloran, Robyn; Hickson, Louise; Worrall, Linda
The importance of effective healthcare communication between healthcare providers and people needing healthcare is well established. People with communication disabilities are at risk of not being able to communicate effectively with their healthcare providers and this might directly compromise their health, healthcare and their right to participate actively in decisions about their healthcare. This paper reviews the literature on the environmental factors that influence communication between adults with communication disabilities and their healthcare providers in the acute hospital setting within the framework of the World Health Organization's International Classification of Functioning, Disability and Health (ICF) (2001). It focuses in particular on the environmental factors that facilitate or create barriers for people with communication disabilities because environmental factors can be modified so that acute care hospitals can become more accessible communicative environments for all people. The paper describes the particular environmental factors that have been identified in acute hospitals that influence the ability of people with specific types of communication disabilities and their healthcare providers to communicate. It then goes on to describe the common environmental factors that have been identified across people with different types of communication disabilities when they are communicating with their healthcare providers. This paper concludes with suggestions for directions of future research.
This article discusses practices of parental support in the maternity healthcare provided by the welfare state. Drawing on ethnographic material from clinics in Finland, I discuss maternity healthcare practices and processes as the specific contexts of subjectification to parenthood in the Nordic welfare state. The analysis shows that in both nurses' (work) experience-based knowledge and population-statistical knowledge, parental competence is achieved largely through the 'natural' process of experiencing pregnant life. Care practices can be seen as enabling parenthood through respect for this process. Clinics encourage parents-to-be to self-reflect and be self-reliant. Emphasis on self-reflection and self-reliance has previously been interpreted as the state adoption of therapy culture, and as a response to market demands for the welfare state to offer to and require of its citizens more autonomy and choice. I argue, however, that the parental subject emerging from the practices of this welfare service cannot be reduced to a neoliberal reflexive individual for whom parenthood is an individual project and who is to blame for individual shortcomings. Equally, they are no mere disciplined product of governmentality being pushed to conform to an idealised parent figure derived from collective ideas of good parenthood.
Carpenter, Kelly M.; Cohn, Leslie G.; Glynn, Lisa H.; Stoner, Susan A.
One fifth of Americans smoke; many have no plans to quit. Motivational Interviewing (MI) is an effective approach to intervention with precontemplative smokers, yet a substantial number of healthcare practitioners lack training in this approach. Two interactive online tutorials were developed to teach practitioners to deliver brief tobacco cessation interventions grounded in the MI approach. The tutorials emphasized the unique aspects of working with precontemplative smokers, incorporating audio and video examples of best practices, interactive exercises, targeted feedback, and practice opportunities. One hundred and fifty-two healthcare providers-in-training were randomly assigned to use the online tutorials or to read training material that was matched for content. A virtual standardized patient evaluation was given before and after the training. Both groups improved their scores from pre- to posttest; however, the tutorial group scored significantly better than the reading group at posttest. The results of this study demonstrate the promise of interactive online tutorials as an efficient and effective way to deliver clinical education. PMID:22096413
Maltezou, Helena C.; Poland, Gregory A.
Health-care providers (HCPs) are at increased risk for exposure to vaccine-preventable diseases (VPDs) in the workplace. The rationale for immunization of HCPs relies on the need to protect them and, indirectly, their patients from health-care-associated VPDs. Published evidence indicates significant immunity gaps for VPDs of HCPs globally. Deficits in knowledge and false perceptions about VPDs and vaccines are the most common barriers for vaccine uptake and may also influence communication about vaccines between HCPs and their patients. Most countries have immunization recommendations for HCPs; however, there are no universal policies and significant heterogeneity exists between countries in terms of vaccines, schedules, frame of implementation (recommendation or mandatory), and target categories of HCPs. Mandatory influenza immunization policies for HCPs have been implemented with high vaccine uptake rates. Stronger recommendations for HCP immunization and commitment at the level of the health-care facility are critical in order to achieve high vaccine coverage rates. Given the importance to health, mandatory immunization policies for VPDs that can cause serious morbidity and mortality to vulnerable patients should be considered. PMID:27490580
Mensah, Sylvanus Brenya; Anderson, Joel G
Healthcare providers may experience a high level of stress, fatigue, and anxiety originating from different factors. Mind-body therapies, which include many interventions, have been proposed to alleviate these conditions. These interventions have been reported to decrease the level of stress, and the negative outcomes associated with these factors: high burnout rate, and poor quality of care for patients. Although research validating the effectiveness of healthcare providers' use of mind-body therapies to care for themselves is emerging, there is little focus on barriers and facilitators that healthcare providers encounter with these mind-body practices, thereby questioning the feasibility and sustainability of these interventions. As such, this systematic review examined the barriers preventing healthcare providers from using mind-body interventions to care for themselves and ways that it has been facilitated. Overall, 12 studies addressed the research question with a limited focus on the facilitators and barriers of the use of mind-body therapies.
The Relationship between Environmental Turbulence, Management Support, Organizational Collaboration, Information Technology Solution Realization, and Process Performance, in Healthcare Provider Organizations
Muglia, Victor O.
The Problem: The purpose of this study was to investigate relationships between environmental turbulence, management support, organizational collaboration, information technology solution realization, and process performance in healthcare provider organizations. Method: A descriptive/correlational study of Hospital medical services process…
Nwali, Silas Alegu; Amah, Christopher Chim; Nwankwo, Theophilus Ogochukwu; Lawani, Lucky Osaheni; Ozumba, Benjamin Chukwuma
Introduction Prenatal diagnosis comprises all diagnostic modalities aimed at gaining information about the embryo or fetal wellbeing. It enables antenatal care tailored to the individual need(s) of the fetus. Aim To determine the knowledge, practice and prospect of prenatal diagnosis among reproductive health care providers in Abakaliki, Nigeria. Materials and Methods This was a cross-sectional descriptive study in which completely filled self-administered semi-structured questionnaires were retrieved from 182 reproductive healthcare providers at Federal Teaching Hospital, Abakaliki (FETHA). The questionnaires contained 17 items covering the socio-demographic data, knowledge, practice and prospects of prenatal diagnosis among the respondents. Result A total of 179 respondents (98.4%) were aware of the prenatal diagnosis. One hundred and sixty four (90.1%) of the respondents agreed that, prenatal diagnostic services is offered in the study centre and 97% of these respondents cited ultrasound scan as the prenatal diagnostic investigation. While 133 respondents (73.1%) would allow parents to decide the next line of action after due counseling for the diagnosis of a condition not compatible with extrauterine life was made, 23(12.6%) of the respondents would offer termination of the pregnancy. Among the respondents, 173(95.1%) would encourage prenatal diagnosis at the study centre and 153(88.4%) of the 173 respondents would do so by educating the populace on the benefits of the procedure. However, 2(1.1%) of the respondent would not encourage the practice of prenatal diagnosis in FETHA citing adverse effects on the woman and her fetus. Conclusion Reproductive healthcare providers in Abakaliki have a high level of awareness and favorable disposition to prenatal diagnosis. However, prenatal diagnosis is still rudimentary in this environment. PMID:28384937
Fleming, Lila C; Ansumana, Rashid; Bockarie, Alfred; Alejandre, Joel; Bangura, Umaru; Jimmy, David Henry; Waters, Nigel; Baghi, Heibatollah; Stenger, David; Jacobsen, Kathryn H
Introduction Bypassing refers to a person's decision to seek care at a healthcare facility that is not the nearest one of its type to the person's home. Methods This study examined inpatient care facility bypassing in urban Bo, Sierra Leone using data from 1,980 women with children 15 years of age and younger who were interviewed in 2010-2011. The locations of residential structures and hospitals were identified using a geographic information system (GIS), and the road distances from participating households to the nearest and preferred inpatient care facilities were measured. Results Nine inpatient care facilities serve Bo residents, but more than 70% of the participating women reported that the city's main public hospital (Bo Government Hospital), located in the city center, was their preferred inpatient care provider. Participants resided within a median distance of 0.9 km (Interquartile range (IQR): 0.6, 1.8) from their closest inpatient facility, but they would travel a median distance of 2.4 km (IQR: 1.0, 3.3) to reach their preferred providers. About 87% of the women would bypass their nearest inpatient care facility to access care at a preferred provider. Bypassing rates were similar for various demographic and socioeconomic groups, but higher for women living farther from the city center. Conclusion Although Bo has a diverse healthcare marketplace, access to affordable advanced care options is limited. Most women in Bo would choose to bypass facilities nearer to their homes to seek the low-cost and comprehensive care offered by Bo Government Hospital. PMID:27279971
de Paula, Elaine Amaral; Costa, Mônica Barros; Colugnati, Fernando Antonio Basile; Bastos, Rita Maria Rodrigues; Vanelli, Chislene Pereira; Leite, Christiane Chaves Augusto; Caminhas, Márcio Santos; de Paula, Rogério Baumgratz
ABSTRACT Objective: to assess the structure and results obtained by the "Chronic Renal Patients Care Program" in a Brazilian city. Method: epidemiological, cross-sectional study conducted in 14 PHC units and a secondary center from 2010 to 2013. The Donabedian Model was the methodological framework used. A total of 14 physicians, 13 supervisors, and 11 community health agents from primary healthcare were interviewed for the assessment of structure and process and 1,534 medical files from primary healthcare and 282 from secondary care were consulted to assess outcomes. Results: most units lacked sufficient offices for physicians and nurses to provide consultations, had incomplete staffing, and most professionals had not received proper qualification to provide care for chronic renal disease. Physicians from PHC units classified as capable more frequently referred patients to the secondary care service in the early stages of chronic renal disease (stage 3B) when compared to physicians of units considered not capable (58% vs. 36%) (p=0.049). Capable PHC units also more frequently presented stabilized glomerular filtration rates (51%) when compared to partially capable units (36%) and not capable units (44%) (p=0.046). Conclusion: patients cared for by primary healthcare units that scored higher in structure and process criteria presented better clinical outcomes. Objective: to identify the coping strategies of family members of patients with mental disorders and relate them to family member sociodemographic variables and to the patient's clinical variables. Method: this was a descriptive study conducted at a psychiatric hospital in the interior of the state of São Paulo, with 40 family members of hospitalized patients over the age of 18, and who followed the patient before and during hospitalization. We used tools to characterize the subjects and the Folkman and Lazarus Inventory of Coping Strategies. Results: the coping strategies most often used by family members
How to instill compassion in a healthcare organization? In this article, I respond to Marianna Fotaki's proposals in her piece, 'Why and how is compassion necessary to provide good quality healthcare?' by drawing on insights from organization studies. Following Fotaki, I argue that to instill targets and formal measures for assessing compassion would be problematic. I conclude by drawing on psychoanalytic and feminist theories to introduce alternatives, specifically proposing an approach that is grounded in a shared sense of a common, embodied precarity, which necessitates our commitment to preserving the conditions in which life might flouris.
Recent disclosures of failures of care in the National Health Service (NHS) in England have led to debates about compassion deficits disallowing health professionals to provide high quality responsive care. While the link between high quality care and compassion is often taken for granted, it is less obvious how compassion – often originating in the individual’s emotional response – can become a moral sentiment and lead to developing a system of norms and values underpinning ethics of care. In this editorial, I argue why and how compassion might become a foundation of ethics guiding health professionals and a basis for ethics of care in health service organisations. I conclude by discussing a recent case of prominent healthcare failure in the NHS to highlight the relationship between compassion as an aspect of professional ethics on the one hand, and values and norms that institutions and specific policies promote on the other hand. PMID:25844380
Uebelacker, Lisa A; Broughton, Monica K
There is increasing interest in the use of yoga as way to manage or treat depression and anxiety. Yoga is afford- able, appealing, and accessible for many people, and there are plausible cognitive/affective and biologic mechanisms by which yoga could have a positive impact on depression and anxiety. There is indeed preliminary evidence that yoga may be helpful for these problems, and there are several ongoing larger-scale randomized clinical trials. The current evidence base is strongest for yoga as efficacious in reducing symptoms of unipolar depression. However, there may be risks to engaging in yoga as well. Healthcare providers can help patients evaluate whether a particular community-based yoga class is helpful and safe for them.
Sahay, Seema; Nagarajan, Karikalan; Mehendale, Sanjay; Deb, Sibnath; Gupta, Abhilasha; Bharat, Shalini; Bhatt, Shripad; Kumar, Athokpam Bijesh; Kanthe, Vidisha; Sinha, Anju; Chandhiok, Nomita
Background Although male circumcision (MC) is recommended as an HIV prevention option, the religious, cultural and biomedical dimensions of its feasibility, acceptability and practice in India have not been explored till date. This study explores beliefs, experiences and understanding of the community and healthcare providers (HCPs) about adult MC as an HIV prevention option in India. Methods This qualitative study covered 134 in-depth interviews from Belgaum, Kolkata, Meerut and Mumbai cities of India. Of these, 62 respondents were the members of circumcising (CC)/non-circumcising communities (NCC); including medically and traditionally circumcised men, parents of circumcised children, spouses of circumcised men, and religious clerics. Additionally, 58 registered healthcare providers (RHCPs) such as general and pediatric surgeons, pediatricians, skin and venereal disease specialists, general practitioners, and operation theatre nurses were interviewed. Fourteen traditional circumcisers were also interviewed. The data were coded and analyzed in QSR NUD*IST ver. 6.0. The study has not explored the participants' views about neonatal versus adult circumcision. Results Members of CC/NCC, traditional circumcisers and RCHPs expressed sharp religious sensitivities around the issue of MC. Six themes emerged: Male circumcision as the religious rite; Multiple meanings of MC: MC for ‘religious identity/privilege/sacrifice’ or ‘hygiene’; MC inflicts pain and cost; Medical indications outweigh faith; Hesitation exists in accepting ‘foreign’ evidence supporting MC; and communication is the key for acceptance of MCs. Medical indications could make members of NCC accept MC following appropriate counseling. Majority of the RHCPs demanded local in-country evidence. Conclusion HCPs must educate high-risk groups regarding the preventive and therapeutic role of MC. Communities need to discuss and create new social norms about male circumcision for better societal acceptance
Purcărea, T; Purcărea, LV; Raţiu, M
Life is changing dramatically, market position as part of life is becoming more and more important, and marketing, considered a key cultural architect of nowadays that involves voluntary relation exchanges between the communicating partners, is placing the patient in the center of most adequate action towards the medical future which represents his life quality. We think that the moment has come to resort to marketing as a new method to identify innovation opportunities in healthcare services' delivery, considering that the high quality of healthcare services, answering to demands of healthcare systems' consumers, represents a well recognized priority for the European citizens. Consequently, the model of ‘healthcare business’ has to rely on the value for patient by creating competition concerning the results at medical condition level. PMID:20108474
Popa, Florian; Purcărea, Theodor; Purcărea, Victor Lorin; Raţiu, Monica
Life is changing dramatically, market position as part of life is becoming more and more important, and marketing, considered a key cultural architect of nowadays that involves voluntary relation exchanges between the communicating partners, is placing the patient in the center of most adequate action towards the medical future which represents his life quality. We think that the moment has come to resort to marketing as a new method to identify innovation opportunities in healthcare services' delivery, considering that the high quality of healthcare services, answering to demands of healthcare systems' consumers, represents a well recognized priority for the European citizens. Consequently, the model of "healthcare business" has to rely on the value for patient by creating competition concerning the results at medical condition level.
Mathew, Anitha E.; Houry, Debra; Dente, Christopher J.; Salomone, Jeffrey P.
Introduction: This study assessed whether Georgia Senate Bill 360, a statewide law passed in August 2010, that prohibits text messaging while driving, resulted in a decrease in this behavior among emergency medicine (EM) and general surgery (GS) healthcare providers. Methods: Using SurveyMonkey®, we created a web-based survey containing up to 28 multiple choice and free-text questions about driving behaviors. EM and GS healthcare providers at a southeastern medical school and its affiliate county hospital received an email inviting them to complete this survey in February 2011. We conducted all analyses in SPSS (version 19.0, Chicago, IL, 2010), using chi-squared tests and logistic regression models. The primary outcome of interest was a change in participant texting or emailing while driving after passage of the texting ban in Georgia. Results: Two hundred and twenty-six providers completed the entire survey (response rate 46.8%). Participants ranged in age from 23 to 71 years, with an average age of 38 (SD=10.2; median=35). Only three-quarters of providers (n=173, 76.6%) were aware of a texting ban in the state. Out of these, 60 providers (36.6%) reported never or rarely sending texts while driving (0 to 2 times per year), and 30 engaged in this behavior almost daily (18.9%). Almost two-thirds of this group reported no change in texting while driving following passage of the texting ban (n=110, 68%), while 53 respondents texted less (31.8%). Respondents younger than 40 were more than twice as likely to report no change in texting post-ban compared to older participants (OR=2.31, p=0.014). Providers who had been pulled over for speeding in the previous 5 years were about 2.5 times as likely to not change their texting-while-driving behavior following legislation passage compared to those without a history of police stops for speeding (OR=2.55, p=0.011). Each additional ticket received in the past 5 years for a moving violation lessened the odds of reporting a
Epstein, Dana R; Babcock-Parziale, Judith L; Haynes, Patricia L; Herb, Christine A
Sleep difficulty is a prevalent problem among returning Veterans. Although there is strong evidence for the efficacy and durability of cognitive-behavioral treatment for insomnia (CBT-I) in the general population, the interventions require motivation, attention, and adherence from patients to achieve successful outcomes. Given the unique characteristics of Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) Veterans who have experienced blast-related injuries and other trauma, CBT-I for these patients may require modification, including alternative delivery methods, to ensure effective implementation and positive outcomes. We interviewed 18 OIF/OEF Veterans who screened positive for mild traumatic brain injury and 19 healthcare providers to determine the acceptability of insomnia treatments and preferences for the interventions and treatment delivery. Veterans and providers had distinct preferences for insomnia treatment and its delivery. The treatments the Veterans found most acceptable were also the ones they preferred: relaxation treatment and pharmacotherapy. The providers identified relaxation therapy as the most acceptable treatment. Veterans preferred the individual treatment format as well as electronic methods of treatment delivery. Despite some differences between patients and providers, a compromise through modification of empirically supported behavioral treatments is feasible, and implications for preference-based insomnia intervention development and testing are discussed.
Tobacco use is the leading cause of preventable mortality in the world. Article 14 of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) states that countries should promote cessation of tobacco use and adequate treatment for tobacco dependence. Health-care providers asking all patients about their tobacco use and advising tobacco users to quit are evidence-based strategies that increase tobacco abstinence. This report examines the proportion of tobacco smokers in 17 countries responding to the Global Adult Tobacco Survey (GATS) who saw a health-care provider in the past year and who reported that a health-care provider asked them about smoking and advised them to quit. Respondents were tobacco smokers aged ≥15 years surveyed during 2008-2011 in Bangladesh, Brazil, China, Egypt, India, Indonesia, Malaysia, Mexico, Philippines, Poland, Romania, Russia, Thailand, Turkey, Ukraine, Uruguay, and Vietnam. The proportion of smokers who had visited a health-care provider during the previous 12 months ranged from 21.6% in Egypt to 62.3% in Poland. Among these, the proportion reporting that a health-care provider asked if they smoked ranged from 34.9% in Vietnam to 82.1% in Romania. Among those screened for tobacco use, those who reported their health-care providers advised them to quit ranged from 17.3% in Mexico to 67.3% in Romania. In most countries, persons aged ≥45 years were more likely to report being screened and advised to quit than were persons aged ≤24 years. Health-care providers should identify smokers and provide advice and assistance in quitting at each visit as an adjunct to effective community interventions (e.g., increased price of tobacco products; smoke-free policies, mass media campaigns, and tobacco quitlines).
Crnica, Vanja; Mujkić, Aida; Young, Tracy; Miškulin, Maja; Peek-Asa, Corinne
Injuries are the leading cause of death for children and young adults in Croatia. Research has indicated that health care providers can be effective in reducing the risk for traumatic injury through anticipatory guidance, but successful guidance requires that providers have injury knowledge and informed safety attitudes. This is the first study in Croatia to identify health care provider's knowledge, attitudes, and practices regarding anticipatory guidance on injury prevention for children. A stratified, random sample of licensed Croatian healthcare providers was mailed a survey, with a response of rate of 39.5 %. Participants included pediatricians, family physicians, gynecologists, each with a focus on primary care, and community nurses. Participants filled out a 15-minute paper-and-pencil survey that tested their knowledge of injury risks and prevention strategies, assessed their safety-prone attitudes, and measured the extent to which they counselled their patients on injury prevention. Pediatricians had the highest knowledge of injury risks and intervention approaches, with an average correct score of six out of ten (significantly higher than all other provider types). Knowledge was highest regarding infant fall risk and lowest for safe sleep positions. Pediatricians and community nurses had the highest safety-prone attitudes. Safety prone attitudes were strongest for transportation safety and weakest for safe sleeping position for all providers. Community nurses reported the highest level of patient counselling, followed by pediatricians. Both factual education and support in translating knowledge into everyday practice are necessary for health care providers. Implementing anticipatory guidance for child safety is a promising approach in Croatia.
Revere, Debra; Painter, Ian; Oberle, Mark
Objective The Rapid Emergency Alert Communication in Health (REACH) Trial was a randomized control trial to systematically compare and evaluate the effectiveness of traditional and mobile communication modalities for public health agencies to disseminate time-sensitive information to health-care providers (HCPs). We conducted a sub-study to identify the communication channels by which HCPs preferred receiving public health alerts and advisories. Methods Enrolled HCPs were blindly randomized into four message delivery groups to receive time-sensitive public health messages by e-mail, fax, or short message service (SMS) or to a no-message control group. Follow-up interviews were conducted 5–10 days after the message. In the final interview, additional questions were asked regarding HCP preferences for receiving public health alerts and advisories. We examined the relationship between key covariates and preferred method of receiving public health alert and advisory messages. Results Gender, age, provider type, and study site showed statistically significant associations with delivery method preference. Older providers were more likely than younger providers to prefer e-mail or fax, while younger providers were more likely than older providers to prefer receiving messages via SMS. Conclusions There is currently no evidence-based research to guide or improve communication between public health agencies and HCPs. Understanding the preferences of providers for receiving alerts and advisories may improve the effectiveness of vital public health communications systems and, in turn, may enhance disease surveillance, aid in early detection, and improve case finding and situational awareness for public health emergencies. PMID:25355977
Ekundayo, O James; Jones, Gennifer; Brown, Angela; Aliyu, Muktar; Levine, Robert; Goldzweig, Irwin
Introduction. Motor vehicle crashes are the leading cause of death among US children aged 4-14 years. In theory, health provider counseling about Child Passenger Safety (CPS) could be a useful deterrent. The data about the effectiveness of CPS dissemination is sparse, but existing results suggest that providers are not well informed. Moreover, there is insufficient evidence to determine whether provider counseling about CPS is effective. Methods. We therefore assessed CPS best practice knowledge among 217 healthcare workers at hospitals in seven cities throughout the USA and evaluated the impact of a brief, lunch and learn educational intervention with a five-item questionnaire. Attendees were comprised of physicians, nurses, social workers, pediatric residents, and pediatric trauma response teams. Results. Pre-post survey completion was nearly 100% (216 of 217 attendees). Participation was fairly evenly distributed according to age (18-29, 30-44, and 45+ years). More than 80% of attendees were women. Before intervention, only 4% of respondents (9/216) answered all five questions correctly; this rose to 77% (167/216) (P < 0.001, using a Wilcoxon signed-rank test) after intervention. Conclusion. Future research should consider implementation and controlled testing of comparable educational programs to determine if they improve dissemination of CPS best practice recommendations in the long term.
Following changes to the Interim Federal Health (IFH) program in Canada in 2012, this study investigates health service providers’ knowledge of the healthcare coverage for refugee claimants living in Quebec. An online questionnaire was completed by 1,772 staff and physicians from five hospitals and two primary care centres in Montreal. Low levels of knowledge and significant associations between knowledge and occupational group, age, and contact with refugees were documented. Social workers, respondents aged 40–49 years, and those who reported previous contact with refugee claimants seeking healthcare were significantly more likely to have 2 or more correct responses. Rapid and multiple changes to the complex IFH policy have generated a high level of confusion among healthcare providers. Simplification of the system and a knowledge transfer strategy aimed at improving healthcare delivery for IFH patients are urgently needed, proposing easy avenues to access rapidly updated information and emphasizing ethical and clinical issues. PMID:26789844
Chorney, Jill MacLaren; Torrey, Carrie; Blount, Ronald; McLaren, Christine; Chen, Wen-Pin; Kain, Zeev
Background To date, no study has evaluated the impact of specific healthcare provider and parent behaviors on children’s distress during anesthesia induction. Method Extensive digital video data were collected on 293, 2 to 10 year old children undergoing anesthesia induction with a parent present. Anesthesiologist, nurse, and parent behavior and children’s distress and coping were coded using the Revised Preoperative Child-Adult Medical Procedure Interaction Scale administered using specialized coding software. Results Anesthesiologists and parents engaged in higher rates of most behaviors than nurses. Overall, adult emotion-focused behavior such as Empathy and Reassurance was significantly positively related to children’s distress and negatively related to children’s coping behaviors. Adult distracting behavior such as humor and distracting talk showed the opposite pattern. Medical reinterpretation by anesthesiologists was significantly positively related to children’s coping behaviors, but the same behavior by parents was significantly positively related to children’s distress. Conclusions The data presented here provide evidence for a relation between adult behaviors and children’s distress and coping at anesthesia induction. These behaviors are trainable and hence it is possible to test if modifying physician behavior can influence child behavior in future studies. PMID:19934874
Bascombe, Ta Misha S; Scott, Kimberly N; Ballard, Denise; Smith, Samantha A; Thompson, Winifred; Berg, Carla J
Use prevalence of alternative tobacco products and marijuana has increased dramatically. Unfortunately, clinical guidelines have focused on traditional cigarettes with limited attention regarding these emerging public health issues. Thus, it is critical to understand how healthcare professionals view this issue and are responding to it. This qualitative study explored knowledge, beliefs and clinic-based practices regarding traditional and alternative tobacco products (cigar-like products, smokeless tobacco, hookah, e-cigarettes) and marijuana among rural and urban Georgia primary healthcare providers. The sample comprised 20 healthcare providers in primary care settings located in the Atlanta Metropolitan area and rural southern Georgia who participated in semi-structured interviews. Results indicated a lack of knowledge about these products, with some believing that some products were less harmful than traditional cigarettes or that they may be effective in promoting cessation or harm reduction. Few reported explicitly assessing use of these various products in clinic. In addition, healthcare providers reported a need for empirical evidence to inform their clinical practice. Healthcare providers must systematically assess use of the range of tobacco products and marijuana. Evidence-based recommendations or information sources are needed to inform clinical practice and help providers navigate conversations with patients using or inquiring about these products.
Keshvari, Mahrokh; Mohammadi, Eesa; Farajzadegan, Ziba; Zargham-Boroujeni, Ali
Background: Primary healthcare (PHC) providers play a major role in provision of public health in rural areas in Iran. They are considered as the key elements of health development in rural population. There is limited research on clarification of their experiences from provision of health services in their working conditions. This study aimed to clarify the experience of PHC providers from working conditions in giving primary health services in health houses (district branches of rural health care centers). Materials and Methods: This is a content analysis qualitative study, conducted through personal and group interviews with 12 health workers working in health care centers in rural areas in Isfahan province, 2010. Sampling continued until data saturation. Data were analyzed through conventional content analysis and constant comparative method. Results: Data analysis led to extraction of 11 categories, and finally, four themes of “ignoring the rights,” “causing tension in working climate,” “pressure or overload of expectations beyond the power,” and “occupational worn out” were yielded from the categories. These themes reveal the concepts and nature of PHC providers’ experiences from giving health care at health houses as the first level of PHC centers. Conclusion: The results of the present study showed that the PHC providers work in a tense condition in health houses. Although they devote themselves to the health of society members, their own health is neglected. Policy makers and authorities should amend working conditions of PHC providers through modification of resources and making supportive and collaborative strategies to improve the quality of services and promote the health level of the service receivers. PMID:27512699
Al-Ali, N M; Ibaid, A H Abu
This survey in primary health-care centres in north Jordan aimed to assess health-care providers' perceptions of their knowledge, skills and preparedness for disaster management. A multistage random sample was used to recruit nurses and physicians from 57 health centres. A total of 207 participants completed the Arabic version of the Disaster Preparedness Evaluation Tool. Participants perceived themselves as having moderate preparation for disaster management [mean score 74.9 (SD 21.6)], moderate knowledge [mean 49.9 (SD 12.3)] and moderate to weak skills in disaster management [mean 35.3 (SD 12.7)]. Significant differences were revealed in participants' perceptions of their disaster preparedness, knowledge and skills according to their sex, specialty and exposure to a real disaster situation. Further education and training courses are needed to enhance providers' preparedness for disaster management in Jordan.
Pratt, Michael A.; Chu, Henry
Performance of healthcare providers such as hospitals varies from one locale to another. Our goal is to study whether there is a geographical pattern of performance using metrics reported from over 3,000 hospitals distributed across the U.S. Empirical mode decomposition (EMD) is an effective analysis tool for nonlinear and non-stationary signals. It decomposes a data sequence into a series of intrinsic mode functions (IMFs) along with a residue sequence that represents the trend. Each IMF has zero local mean and has exactly one zero crossing between any two consecutive local extrema. An IMF can be used to assess the instantaneous frequency. Reconstruction of a signal using the residue and those IMFs of the lower frequency can reveal the underlying pattern of the signal without undue influence of the higher frequency fluctuations of the data. We used a space-filling curve to turn a set of performance metrics distributed irregularly across the two-dimensional planar surface into a one-dimensional sequence. The EMD decomposed a set of hospital emergency department median waiting times into 9 IMFs along with a residue. We used the residue and the lower frequency IMFs to reconstruct a sequence with fewer fluctuations. The sequence was transformed back to a two-dimensional map to reveal the geographical variations.
Kaboru, Berthollet Bwira
Background and objective: The involvement of traditional healthcare providers (THPs) has been suggested among strategies to increase tuberculosis case detection. Burkina Faso has embarked on such an attempt. This study is a preliminary assessment of that model. Methods: Qualitative data were collected using unstructured key informant interviews with policy makers, group interviews with THPs and health workers, and field visits to THPs. Quantitative data were collected from program reports and the national tuberculosis (TB) control database. Results and analysis: The distribution of tasks among THPs, intermediary organizations and clinicians is appealing, especially the focus on active referral. THPs are offered incentives based on numbers of suspected cases confirmed by health workers at the clinic, based on microscopy results or clinical assessment. The positivity rate was 23% and 9% for 2006 and 2007, respectively. The contribution of the program to national case detection was estimated at 2% for 2006. Because it relied totally on donor funding, the program suffered from irregular disbursements, resulting in periodic decreases in activities and outcomes. Conclusions: The study shows that single interventions require a broader positive policy environment to be sustainable. Even if the active referral approach seems effective in enhancing TB case detection, more complex policy work and direction, domestic financial contribution and additional evidence for cost-effectiveness are needed before the approach can be established as a national policy. PMID:24359717
Landis-Lewis, Zach; Douglas, Gerald P; Hochheiser, Harry; Kam, Matthew; Gadabu, Oliver; Bwanali, Mwatha; Jacobson, Rebecca S
Although performance feedback has the potential to help clinicians improve the quality and safety of care, healthcare organizations generally lack knowledge about how this guidance is best provided. In low-resource settings, tools for theory-informed feedback tailoring may enhance limited clinical supervision resources. Our objectives were to establish proof-of-concept for computer-supported feedback message tailoring in Malawi, Africa. We conducted this research in five stages: clinical performance measurement, modeling the influence of feedback on antiretroviral therapy (ART) performance, creating a rule-based message tailoring process, generating tailored messages for recipients, and finally analysis of performance and message tailoring data. We retrospectively generated tailored messages for 7,448 monthly performance reports from 11 ART clinics. We found that tailored feedback could be routinely generated for four guideline-based performance indicators, with 35% of reports having messages prioritized to optimize the effect of feedback. This research establishes proof-of-concept for a novel approach to improving the use of clinical performance feedback in low-resource settings and suggests possible directions for prospective evaluations comparing alternative designs of feedback messages.
Haberman, Shelby J.
In item-response theory, if a latent-structure model has an ability variable, then elementary information theory may be employed to provide a criterion for evaluation of the information the test provides concerning ability. This criterion may be considered even in cases in which the latent-structure model is not valid, although interpretation of…
Weech-Maldonado, Robert; Carle, Adam; Weidmer, Beverly; Hurtado, Margarita; Ngo-Metzger, Quyen; Hays, Ron D.
Background There is a need for reliable and valid measures of cultural competence from the patient’s perspective. Objective This paper evaluates the reliability and validity of the Consumer Assessments of Healthcare Providers and Systems (CAHPS®) Cultural Competence (CC) item set. Research Design Using 2008 survey data, we assessed the internal consistency of the CAHPS CC scales using Cronbach alphas, and examined the validity of the measures using exploratory and confirmatory factor analysis, multitrait scaling analysis, and regression analysis. Subjects A random stratified sample (based on race/ethnicity and language) of 991 enrollees, less than 65 years old, from two Medicaid managed care plans in California and New York. Measures CAHPS CC item set after excluding screener items and ratings. Results Confirmatory factor analysis (CFI= 0.98; TLI= 0.98; RMSEA= 0.06) provided support for a seven-factor structure: Doctor Communication-Positive Behaviors; Doctor Communication-Negative Behaviors; Doctor Communication-Health Promotion; Doctor Communication-Alternative Medicine; Shared Decision Making; Equitable Treatment; and Trust. Item--total correlations (corrected for item overlap) for the 7 scales exceeded 0.40. Exploratory factor analysis showed support for one additional factor: Access to Interpreter Services. Internal consistency reliability estimates ranged from 0.58 (Alternative Medicine) to 0.92 (Positive Behaviors), and was 0.70 or higher for four of the eight composites. All composites were positively and significantly associated with the overall doctor rating. Conclusions The CAHPS CC 26-item set demonstrates adequate measurement properties, and can be used as a supplemental item set to the CAHPS Clinician and Group Surveys in assessing culturally competent care from the patient’s perspective. PMID:22895226
Dhingra, Vibhu; Shariff, Afreen; Shariff, Aabid; Lerma, Edgar; Singla, Parteek; Kachare, Swapnil; Syed, Zoheb; Minhas, Deeba; Madanick, Ryan; Fang, Xiangming
Introduction Twitter channels are increasingly popular at medical conferences. Many groups, including healthcare providers and third party entities (e.g., pharmaceutical or medical device companies) use these channels to communicate with one another. These channels are unregulated and can allow third party commercial entities to exert an equal or greater amount of Twitter influence than healthcare providers. Third parties can use this influence to promote their products or services instead of sharing unbiased, evidence-based information. In this investigation we quantified the Twitter influence that third party commercial entities had in 13 major medical conferences. Methods We analyzed tweets contained in the official Twitter hashtags of thirteen medical conferences from 2011 to 2013. We placed tweet authors into one of four categories based on their account profile: healthcare provider, third party commercial entity, none of the above and unknown. We measured Twitter activity by the number of tweet authors per category and the tweet-to-author ratio by category. We measured Twitter influence by the PageRank of tweet authors by category. Results We analyzed 51159 tweets authored by 8778 Twitter account holders in 13 conferences that were sponsored by 5 medical societies. A quarter of all authors identified themselves as healthcare providers, while only 18% could be identified as third party commercial entities. Healthcare providers had a greater tweet-to-author ratio than their third party commercial entity counterparts (8.98 versus 6.93 tweets). Despite having less authors and composing less tweets, third party commercial entities had a statistically similar PageRank as healthcare providers (0.761 versus 0.797). Conclusion The Twitter influence of third party commercial entities (PageRank) is similar to that of healthcare providers. This finding is interesting because the number of tweets and third party commercial entity authors required to achieve this Page
Davis, Janis; Foley, Amy; Crigger, Nancy; Brannigan, Michael C.
The optimal relationship between healthcare provider and patient is one of trust. This therapeutic relationship is dependent on the ability of the healthcare provider to communicate effectively with the patient. Research indicates that when healthcare providers listen to patients, there is more compliance with medical regimens, patient…
When hope is discussed in bioethics' literature, it is most often in the context of 'false hopes' and/or how to maintain hope while breaking bad news to patients. Little or no time is generally devoted to the description of hope that supports these analyses. In this paper, I present a detailed description of hope, one designed primarily for the healthcare context. Noting that hope is an emotional attitude, four key aspects are explored. In particular, the function of imagination in hope is discussed in depth. Through an examination of the relationship between hope and vulnerability, I demonstrate how adequately describing hope can broaden the normative inquiry into the role of hope in healthcare. Three ways in which persons with hope can be vulnerable are illustrated, and the challenge of how healthcare providers can attend in moral ways to the hopes of patients is identified.
Hicks, Doris T.; Pivarnik, Lori F.; Richard, Nicole Leydon; Gable, Robert K.; Morrissey, Michael T.
An online needs assessment survey of healthcare providers was developed and implemented to determine knowledge and attitudes about the benefits and risks of consuming seafood along with how this might impact patient/clientele counseling. Only 6 of the 45 knowledge items queried (13%) met the 80% subject mastery or proficiency with a total…
Jacobsen, Kathryn H; Ansumana, Rashid; Abdirahman, Hafsa A; Bockarie, Alfred S; Bangura, Umaru; Meehan, Kate A; Jimmy, David H; Malanoski, Anthony P; Sundufu, Abu J; Stenger, David A
The factors that influence the selection of a healthcare provider once the decision to seek care has been made can be summarized using a triad of cost, location and reputation. The goal of this study was to identify which of these factors is the primary consideration when women in urban Bo, Sierra Leone, select a healthcare provider for themselves or their children. We interviewed 1091 mothers during a household census of two neighbourhoods of Bo in April 2010. Reputation was the top consideration for about half of the women, cost was the second most common priority, and the location of the healthcare facility was the primary consideration for less than 7% of the participants. The majority of women said they would select a new provider if cost was not a barrier. Socioeconomic characteristics were not significant predictors of whether cost, location or reputation was selected as the highest-ranked consideration. This evidence for the importance of reputation in healthcare decision-making even in low-resource areas highlights the need for health systems to address issues of quality and responsiveness, and not just cost, in order to increase access to and utilization of health services.
Westra, Daan; Angeli, Federica; Carree, Martin; Ruwaard, Dirk
Pro-competitive policy reforms have been introduced in several countries, attempting to contain increasing healthcare costs. Yet, research proves ambiguous when it comes to the effect of competition in healthcare, with a number of studies highlighting unintended and unwanted effects. We argue that current empirical work overlooks the role of inter-organizational relations as well as the interplay between policy at macro level, inter-organizational networks at meso level, and outcomes at micro level. To bridge this gap and stimulate a more detailed understanding of the effect of competition in health care, this article introduces a cross-level conceptual framework which emphasizes the intermediary role of cooperative inter-organizational relations at meso level. We discuss how patient transfers, specialist affiliations, and interlocking directorates constitute three forms of inter-organizational relations in health care which can be used within this framework. The paper concludes by deriving several propositions from the framework which can guide future research.
Ahmed, Ashir; Kabir, Lutfe; Kai, Eiko; Inoue, Sozo
Insufficient healthcare facilities and unavailability of medical experts in rural areas are the two major reasons that kept the people unreached to healthcare services. Recent penetration of mobile phone and the demand to basic healthcare services, remote health consultancy over mobile phone became popular in developing countries. In this paper, we introduce two such representative initiatives from Bangladesh and discuss the technical challenges they face to serve a remote patient. To solve these issues, we have prototyped a box with necessary diagnostic tools, we call it a "portable clinic" and a software tool, "GramHealth" for managing the patient information. We carried out experiments in three villages in Bangladesh to observe the usability of the portable clinic and verify the functionality of "GramHealth". We display the qualitative analysis of the results obtained from the experiment. GramHealth DB has a unique combination of structured, semi-structured and un-structured data. We are currently looking at these data to see whether these can be treated as BigData and if yes, how to analyze the data and what to expect from these data to make a better clinical decision support.
Environmental Factors that Influence Communication between People with Communication Disability and Their Healthcare Providers in Hospital: A Review of the Literature within the International Classification of Functioning, Disability and Health (ICF) Framework
O'Halloran, Robyn; Hickson, Louise; Worrall, Linda
The importance of effective healthcare communication between healthcare providers and people needing healthcare is well established. People with communication disabilities are at risk of not being able to communicate effectively with their healthcare providers and this might directly compromise their health, healthcare and their right to…
Zelingher, Julian; Ash, Nachman
The IsraeLi healthcare system has undergone major processes for the adoption of health information technologies (HIT), and enjoys high Levels of utilization in hospital and ambulatory care. Coding is an essential infrastructure component of HIT, and ts purpose is to represent data in a simplified and common format, enhancing its manipulation by digital systems. Proper coding of data enables efficient identification, storage, retrieval and communication of data. UtiLization of uniform coding systems by different organizations enables data interoperability between them, facilitating communication and integrating data elements originating in different information systems from various organizations. Current needs in Israel for heaLth data coding include recording and reporting of diagnoses for hospitalized patients, outpatients and visitors of the Emergency Department, coding of procedures and operations, coding of pathology findings, reporting of discharge diagnoses and causes of death, billing codes, organizational data warehouses and national registries. New national projects for cLinicaL data integration, obligatory reporting of quality indicators and new Ministry of Health (MOH) requirements for HIT necessitate a high Level of interoperability that can be achieved only through the adoption of uniform coding. Additional pressures were introduced by the USA decision to stop the maintenance of the ICD-9-CM codes that are also used by Israeli healthcare, and the adoption of ICD-10-C and ICD-10-PCS as the main coding system for billing purpose. The USA has also mandated utilization of SNOMED-CT as the coding terminology for the ELectronic Health Record problem list, and for reporting quality indicators to the CMS. Hence, the Israeli MOH has recently decided that discharge diagnoses will be reported using ICD-10-CM codes, and SNOMED-CT will be used to code the cLinical information in the EHR. We reviewed the characteristics, strengths and weaknesses of these two coding
This report updates the 1991 CDC recommendations for the management of hepatitis B virus (HBV)-infected health-care providers and students to reduce risk for transmitting HBV to patients during the conduct of exposure-prone invasive procedures (CDC. Recommendations for preventing transmission of human immunodeficiency virus and hepatitis B virus to patients during exposure-prone invasive procedures. MMWR 1991;40[No. RR-8]). This update reflects changes in the epidemiology of HBV infection in the United States and advances in the medical management of chronic HBV infection and policy directives issued by health authorities since 1991. The primary goal of this report is to promote patient safety while providing risk management and practice guidance to HBV-infected health-care providers and students, particularly those performing exposure-prone procedures such as certain types of surgery. Because percutaneous injuries sustained by health-care personnel during certain surgical, obstetrical, and dental procedures provide a potential route of HBV transmission to patients as well as providers, this report emphasizes prevention of operator injuries and blood exposures during exposure-prone surgical, obstetrical, and dental procedures. These updated recommendations reaffirm the 1991 CDC recommendation that HBV infection alone should not disqualify infected persons from the practice or study of surgery, dentistry, medicine, or allied health fields. The previous recommendations have been updated to include the following changes: no prenotification of patients of a health-care provider's or student's HBV status; use of HBV DNA serum levels rather than hepatitis B e-antigen status to monitor infectivity; and, for those health-care professionals requiring oversight, specific suggestions for composition of expert review panels and threshold value of serum HBV DNA considered "safe" for practice (<1,000 IU/ml). These recommendations also explicitly address the issue of medical and
Jin, Harry; Wickersham, Jeffrey A.; Kamarulzaman, Adeeba; John, Jacob; Lim, Sin How; Altice, Frederick L.
Men who have sex with men (MSM) living in countries with strong stigma toward MSM are vulnerable to HIV and experience significant barriers to HIV care. Research is needed to inform interventions to reduce stigma toward MSM in these countries, particularly among healthcare providers. A cross-sectional survey of 1158 medical and dental students was conducted at seven Malaysian universities in 2012. Multivariate analyses of variance suggest that students who had interpersonal contact with MSM were less prejudiced toward and had lower intentions to discriminate against MSM. Path analyses with bootstrapping suggest stereotypes and fear mediate associations between contact with prejudice and discrimination. Intervention strategies to reduce MSM stigma among healthcare providers in Malaysia and other countries with strong stigma toward MSM may include facilitating opportunities for direct, in-person or indirect, media-based prosocial contact between medical and dental students with MSM. PMID:26324078
Earnshaw, Valerie A; Jin, Harry; Wickersham, Jeffrey A; Kamarulzaman, Adeeba; John, Jacob; Lim, Sin How; Altice, Frederick L
Men who have sex with men (MSM) living in countries with strong stigma toward MSM are vulnerable to HIV and experience significant barriers to HIV care. Research is needed to inform interventions to reduce stigma toward MSM in these countries, particularly among healthcare providers. A cross-sectional survey of 1158 medical and dental students was conducted at seven Malaysian universities in 2012. Multivariate analyses of variance suggest that students who had interpersonal contact with MSM were less prejudiced toward and had lower intentions to discriminate against MSM. Path analyses with bootstrapping suggest stereotypes and fear mediate associations between contact with prejudice and discrimination. Intervention strategies to reduce MSM stigma among healthcare providers in Malaysia and other countries with strong stigma toward MSM may include facilitating opportunities for direct, in-person or indirect, media-based prosocial contact between medical and dental students with MSM.
Rogers, S J; Tureski, K; Cushnie, A; Brown, A; Bailey, A; Palmer, Q
While considerable research has documented stigma toward key populations affected by HIV and AIDS - men who have sex with men (MSM), sex workers (SWs) - it provided limited empirical evidence on the presence of layered stigma among health-care professionals providing services for these populations. C-Change conducted a survey among 332 staff of health-care and social service agencies in Jamaica and The Bahamas to understand the levels of stigma toward people living with HIV (PLHIV), including MSM and SWs and factors associated with stigma. While most health-care professionals responding to the survey said that PLHIV, MSM, and SWs deserved quality care, they expressed high levels of blame and negative judgments, especially toward MSM and SWs. Across a stigma assessment involving eight vignette characters, the highest levels of stigma were expressed toward PLHIV who were also MSM or SWs, followed by PLHIV, MSM, and SWs. Differences were assessed by gender, country, type of staff, type of agency, and exposure to relevant training. Findings indicate higher reported stigma among nonclinical vs. clinical staff, staff who worked in general vs. MSM/SW-friendly health facilities, and among untrained vs. training staff. This implies the need for targeted staff capacity strengthening as well as improved facility environments that are MSM/SW-friendly.
Nicpon, Megan Foley; Pfeiffer, Steven I.
Psychologists working in the schools have an opportunity to affect in new and exciting ways the services they provide to high-ability students. A talent development framework offers a unique lens through which gifted services is conceptualized. The framework moves school psychologists beyond viewing giftedness and high IQ as synonymous to…
DiGiovanni, Lisa Marie
The American Heart Association's HeartCode[TM] Healthcare Provider (HCP) Basic Life Support (BLS) e-learning program with voice-advisory manikins was implemented in an acute care hospital as the only teaching method offered for BLS certification. On course evaluations, healthcare provider staff commented that the VAM technology for skills practice…
Blanchette, Marc-André; Rivard, Michèle; Dionne, Clermont E; Hogg-Johnson, Sheilah; Steenstra, Ivan
Objective To compare the duration of financial compensation and the occurrence of a second episode of compensation of workers with occupational back pain who first sought three types of healthcare providers. Methods We analyzed data from a cohort of 5511 workers who received compensation from the Workplace Safety and Insurance Board for back pain in 2005. Multivariable Cox models controlling for relevant covariables were performed to compare the duration of financial compensation for the patients of each of the three types of first healthcare providers. Logistic regression was used to compare the occurrence of a second episode of compensation over the 2-year follow-up period. Results Compared with the workers who first saw a physician (reference), those who first saw a chiropractor experienced shorter first episodes of 100 % wage compensation (adjusted hazard ratio [HR] = 1.20 [1.10-1.31], P value < 0.001), and the workers who first saw a physiotherapist experienced a longer episode of 100 % compensation (adjusted HR = 0.84 [0.71-0.98], P value = 0.028) during the first 149 days of compensation. The odds of having a second episode of financial compensation were higher among the workers who first consulted a physiotherapist (OR = 1.49 [1.02-2.19], P value = 0.040) rather than a physician (reference). Conclusion The type of healthcare provider first visited for back pain is a determinant of the duration of financial compensation during the first 5 months. Chiropractic patients experience the shortest duration of compensation, and physiotherapy patients experience the longest. These differences raise concerns regarding the use of physiotherapists as gatekeepers for the worker's compensation system. Further investigation is required to understand the between-provider differences.
Saddiqi, H.A.; Jabbar, A.; Babar, W.; Sarwar, M.; Iqbal, Z.; Cabaret, J.
A questionnaire survey was conducted to determine the worm control practices and anthelmintic usage of 150 key respondents involved in sheep and goat production in the arid Thal area of Pakistan. The information was collected by visiting farms, and interviewing the key respondents which included veterinary officers (n = 15), veterinary assistants (n = 51), traditional practitioners (n = 24), and small and large scale sheep/goat farm herders and owners (n = 60). Among all interviewed animal healthcare providers, the veterinary officers had the highest level of awareness of parasitic infection and advocated the use of modern available anthelmintics according to the predefined schedule. The farmers on the other hand, had the lowest level of knowledge about parasitic infections. They used modern anthelmintics at low frequencies (every six months) following an unusual practice of diluting the medicine. Veterinary assistants had a medium level of awareness about the parasitic infections using anthelmintic treatments when they deemed necessary rather than following a predefined treatment schedule. Traditional practitioners were also aware of parasitic infections and used traditional anthelmintics or a combination of the traditional and modern anthelmintics. The animal health providers had a different awareness and knowledge of parasitic infections which resulted in contrasting proposals for its control. The farmers used worm control measures in accordance with their own views and those of animal healthcare advisors, combining modern and traditional treatments. This study provides the first insight into the differing views of those animal healthcare providers who form the basis for effective parasitic control within the sheep and goat industry of an arid region. PMID:22314240
Vanlaere, Linus; Timmermann, Madeleine; Stevens, Marleen; Gastmans, Chris
In recent approaches to ethics, the personal involvement of health care providers and their empathy are perceived as important elements of an overall ethical ability. Experiential working methods are used in ethics education to foster, inter alia, empathy. In 2008, the care-ethics lab 'sTimul' was founded in Flanders, Belgium, to provide training that focuses on improving care providers' ethical abilities through experiential working simulations. The curriculum of sTimul focuses on empathy sessions, aimed at care providers' empathic skills. The present study provides better insight into how experiential learning specifically targets the empathic abilities of care providers. Providing contrasting experiences that affect the care providers' self-reflection seems a crucial element in this study. Further research is needed to provide more insight into how empathy leads to long-term changes in behaviour.
Muskat, Barbara; Burnham Riosa, Priscilla; Nicholas, David B; Roberts, Wendy; Stoddart, Kevin P; Zwaigenbaum, Lonnie
Youth with autism spectrum disorder are a vulnerable, often poorly understood patient group, who may experience periodic and chronic health challenges, in addition to their primary developmental social and communication problems. Developmental and behavioural challenges can complicate management of acute health-care needs. To date, there is an absence of empirical research exploring the hospital experiences of children and youth with autism spectrum disorder, their families and their health-care providers. Therefore, the purpose of this study was to understand these experiences in order to inform hospital-based care. A total of 42 participants were interviewed (youth with autism spectrum disorder, their parents and health-care providers) at one of two Canadian paediatric hospitals, representing 20 distinct cases of patients with autism spectrum disorder. Results from the qualitative analyses indicated that patients with autism spectrum disorder faced several challenges in the context of health-care delivery in the hospital setting, as did their families and health-care provider team. Problems identified included communication and sensory challenges, and the degree of flexibility of health-care providers and the hospital organization. Supportive health-care providers were those who acknowledged parents as experts, inquired about the requirements of patients with autism spectrum disorder and implemented strategies that accommodated the unique clinical presentation of the individual patient. These recommendations have wide-reaching utility for hospital and health-care practices involving this patient group.
Alanazi, Mohammed R; Alamry, Ahmed; Alsurmi, Khaled
One of the main purposes of healthcare organizations is to serve patients by providing safe and high-quality patient-centered care. Patients are considered the most appropriate source to assess the quality level of healthcare services. The objectives of this paper were to describe the translation and adaptation process of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey for Arabic speaking populations, examine the degree of equivalence between the original English version and the Arabic translated version, and estimate and report the validity and reliability of the translated Arabic HCAHPS version. The translation process had four main steps: (1) qualified bilingual translators translated the HCAHPS from English to Arabic; (2) the Arabic version was translated back to English and reviewed by experts to ensure content accuracy (content equivalence); (3) both Arabic and English versions were verified for accuracy and validity of the translation, checking for the similarities and differences (semantic equivalence); (4) finally, two independent bilinguals reviewed and made the final revision of both the Arabic and English versions separately and agreed on one final version that is similar and equivalent to the original English version in terms of content and meaning. The study findings showed that the overall Cronbach's α for the Arabic HCAHPS version was 0.90, showing good internal consistency across the 9 separate domains, which ranged from 0.70 to 0.97 Cronbach's α. The correlation coefficient between each statement for each separate domain revealed a highly positive significant correlation ranging from 0.72 to 0.89. The results of the study show empirical evidence of validity and reliability of HCAHPS in its Arabic version. Moreover, the Arabic version of HCAHPS in our study presented good internal consistency and it is highly recommended to be replicated and applied in the context of other Arab countries.
Hogan, Michael V
An adaptation of a childhood game as a means of providing flawless service to customers will allow security departments to increase their scope and quality of service, the author points out. Teaching our officers the concept of playing "tag, " embracing being "it" and finishing the game will provide a significant return on investment by expanding the value of our departments, he says.
Manktelow, Bradley N; Seaton, Sarah E; Evans, T Alun
There is an increasing use of statistical methods, such as funnel plots, to identify poorly performing healthcare providers. Funnel plots comprise the construction of control limits around a benchmark and providers with outcomes falling outside the limits are investigated as potential outliers. The benchmark is usually estimated from observed data but uncertainty in this estimate is usually ignored when constructing control limits. In this paper, the use of funnel plots in the presence of uncertainty in the value of the benchmark is reviewed for outcomes from a Binomial distribution. Two methods to derive the control limits are shown: (i) prediction intervals; (ii) tolerance intervals Tolerance intervals formally include the uncertainty in the value of the benchmark while prediction intervals do not. The probability properties of 95% control limits derived using each method were investigated through hypothesised scenarios. Neither prediction intervals nor tolerance intervals produce funnel plot control limits that satisfy the nominal probability characteristics when there is uncertainty in the value of the benchmark. This is not necessarily to say that funnel plots have no role to play in healthcare, but that without the development of intervals satisfying the nominal probability characteristics they must be interpreted with care.
Mosack, Katie E.; Wandrey, Rachael L.
The purpose of this study was to investigate how HIV-positive patients and infectious disease healthcare providers think about death, dying, and end-of-life care planning. We conducted separate in-depth qualitative interviews with 47 patients and 11 providers. Interview data were transcribed and analyzed using a secondary comparative method. Patients and providers demonstrated profound differences in their perspectives on patient empowerment and attributions of control related to disease progression, imminence of death, and end-of-life care decision-making. Notably, patients described fears related to life-extending interventions that generally went unaddressed within the clinical context. We argue for the routinization of end-of-life care discussions and suggest novel research approaches to improve patient empowerment and medical engagement. PMID:24316681
DeVoe, JE; Stenger, R
Background The United States (US) is reforming primary care delivery systems, including the implementation of ‘patient-centered medical homes.’ Alignment of provider incentives with desired outcomes will likely be important to the success of these delivery system reforms. Methods This critical review uses a theoretical framework from game-theory models to discuss some of the dominant primary care provider payment models and how they create ‘prisoner’s dilemmas’ that have stalled past reform efforts. It then uses this framework to illustrate, hypothetically, how advantages from different models could be blended together to encourage cooperation and improve the quality of primary care services delivered, thus providing an escape from current prisoner’s dilemmas faced by providers. Findings Improvements in primary care delivery will largely hinge on blended payment mechanisms that can effectively combine the advantageous elements of fee-for-service, capitation, and incentive payments into a balanced equation that enables providers to escape the perverse financial incentives of current payment mechanisms and overcome collective action problems. Conclusions If balanced appropriately, a blend of guaranteed payment and selective incentives designed to encourage primary care providers to deliver high quality care, efficient and equitable care and to eliminate incentives towards over-servicing could reach outcomes leading to shared benefits for everyone involved. PMID:27942388
Whitten, Pamela; Buis, Lorraine
In Michigan, the use of telemedicine for dialysis patients began in three centres in 2005. A total of 747 clinical consultations was conducted in the following 22 months. Telephone surveys were conducted with 34 patients and four providers. The patients and providers all had positive perceptions of the telemedicine system and the care that was delivered. Most of the clinical measures of the patients met or exceeded the recommendations made by Renal Network 11. In addition to the clinical work, the telemedicine equipment was used for educational events. Twenty-six professional educational events were provided with a total audience of 105 individuals, and 35 administrative meetings were provided with 286 staff members in attendance. The study showed that patients and providers could participate in educational events that might not be available locally. Despite the success of dialysis telemedicine, the Marquette General Health System discontinued its use in 2007 when the Center for Medicare and Medicaid Services re-affirmed that dialysis centres were not approved sites for telemedicine.
Tomasone, Jennifer R; Brouwers, Melissa C; Vukmirovic, Marija; Grunfeld, Eva; O'Brien, Mary Ann; Urquhart, Robin; Walker, Melanie; Webster, Fiona; Fitch, Margaret
Coordination of patient care between primary care and oncology care providers is vital to care quality and outcomes across the cancer continuum, yet it is known to be challenging. We conducted a systematic review to evaluate current or new models of care and/or interventions aimed at improving coordination between primary care and oncology care providers for patients with adult breast and/or colorectal cancer. MEDLINE, EMBASE, CINAHL, Cochrane Library Database of Systematic Reviews, and the Centre for Reviews and Dissemination were searched for existing English language studies published between January 2000 and 15 May 2015. Systematic reviews, meta-analyses, randomised controlled trials (RCTs) and non-randomised studies were included if they evaluated a specific model/intervention that was designed to improve care coordination between primary care and oncology care providers, for any stage of the cancer continuum, for patients with adult breast and/or colorectal cancer. Two reviewers extracted data and assessed risk of bias. Twenty-two studies (5 systematic reviews, 6 RCTs and 11 non-randomised studies) were included and varied with respect to the targeted phase of the cancer continuum, type of model or intervention tested, and outcome measures. The majority of studies showed no statistically significant changes in any patient, provider or system outcomes. Owing to conceptual and methodological limitations in this field, the review is unable to provide specific conclusions about the most effective or preferred model/intervention to improve care coordination. Imprecise results that lack generalisability and definitiveness provide limited evidence to base the development of future interventions and policies. Trial registration number CRD42015025006. PMID:27843639
Jackson, Veronica E; Muckerman, Alexander
This article presents the findings of a collaborative effort between the Georgetown University Student Consulting Team and Booz Allen Hamilton to interview healthcare providers undergoing the transition to the International Classification of Diseases, Tenth Revision, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS). The goals of this study were to extract a common set of trends, challenges, and lessons learned surrounding the implementation of the ICD-10-CM/PCS code set and to produce actionable information that might serve as a resource for organizations navigating the transition to ICD-10-CM/PCS. The selected survey sample focused on a subset of large hospitals, integrated health systems, and other national industry leaders who are likely to have initiated the implementation process far in advance of the October 2013 deadline. Guided by a uniform survey tool, the team conducted a series of one-on-one provider interviews with department heads, senior staff members, and project managers leading ICD-10-CM/PCS conversion efforts from six diverse health systems. As expected, the integrated health systems surveyed seem to be on or ahead of schedule for the ICD-10-CM/PCS coding transition. However, results show that as of April 2010 most providers were still in the planning stages of implementation and were working to raise awareness within their organizations. Although individual levels of preparation varied widely among respondents, the study identified several trends, challenges, and lessons learned that will enable healthcare providers to assess their own status with respect to the industry and will provide useful insight into best practices for the ICD-10-CM/PCS transition. PMID:22548022
Afek, Arnon; Meilik, Ahuva; Rotstein, Zeev
Today, medical organizations have to contend with a highly competitive environment, an atmosphere saturated with a multitude of innovative new technologies and ever-increasing costs. The ability of these organizations to survive and to develop and expand their services mandates adoption of management guidelines based on the world of finance/commerce, adapted to make them relevant to the world of medical service. In this article the authors chose to present a management administration assessment which is a process that ensures that the management will effectively administer the organization's resources, and meet the goals set by the organization. The system demands that hospital "centers of responsibility" be defined, a management information system be set up, activities be priced, budget be defined and the expenses assessed. These processes make it possible to formulate a budget and assess any possible deviation between the budget and the actual running costs. An assessment of deviations will reveal any possible deviation of the most significant factor--efficiency. Medical organization managers, with the cooperation of the directors of the "centers of responsibility", can assess subunit activities and gain an understanding of the significance of management decisions and thus improve the quality of management, and the medical organization. The goal of this management system is not only to Lower costs and to meet the financial goals that were set; it is a tool that ensures quality. Decreasing expenditure is important in this case, but is only secondary in importance and will be a result of reducing the costs incurred by services lacking in quality.
Andrews, B C; Kaye, J; Bowcutt, M; Campbell, J
This study examines the consequences of adding a geriatric subacute unit to the traditional health care mix offered by a nonprofit hospital. Historically, geriatric health care offerings have been limited to either acute care units or long-term care facilities. The study's findings demonstrate that the addition of a subacute unit that is operated by an interdisciplinary team is a competitively rational move for two reasons. First, it provides a continuum of care that integrates services and departments, thereby reducing costs. Second, it provides a supportive environment for patients and their families. As a consequence patients have a higher probability of returning home than patients who are assigned to more traditional modes of care.
Khanal, Saval; Ibrahim, Mohamed Izham B Mohamed; Shankar, Pathiyil Ravi; Palaian, Subish; Mishra, Pranaya
Academic detailing is rarely practised in developing countries. A randomized control trial on healthcare service was conducted to evaluate the impact of academic detailing programme on the adherence of primary healthcare providers in Banke district, Nepal, to childhood diarrhoea treatment guidelines recommended by World Health Organization/United Nations Children's Fund (WHO/UNICEF). The participants (N=209) were systematically divided into control and intervention groups. Four different academic detailing sessions on childhood diarrhoea management were given to participants in the intervention group. At baseline, 6% of the participants in the control and 8.3% in the intervention group were adhering to the treatment guidelines which significantly (p < 0.05) increased among participants in the intervention (65.1%) than in the control group (16.0%) at the first follow-up. At the second follow-up, 69.7% of participants in the intervention group were adhering to the guidelines, which was significantly (p < 0.05) greater than those in the control group (19.0%). Data also showed significant improvement in prescribing pattern of the participants in the intervention group compared to the control group. Therefore, academic detailing can be used for promoting adherence to treatment guidelines in developing countries, like Nepal.
Ibrahim, Mohamed Izham b. Mohamed; Shankar, Pathiyil Ravi; Palaian, Subish; Mishra, Pranaya
Academic detailing is rarely practised in developing countries. A randomized control trial on healthcare service was conducted to evaluate the impact of academic detailing programme on the adherence of primary healthcare providers in Banke district, Nepal, to childhood diarrhoea treatment guidelines recommended by World Health Organization/United Nations Children's Fund (WHO/UNICEF). The participants (N=209) were systematically divided into control and intervention groups. Four different academic detailing sessions on childhood diarrhoea management were given to participants in the intervention group. At baseline, 6% of the participants in the control and 8.3% in the intervention group were adhering to the treatment guidelines which significantly (p<0.05) increased among participants in the intervention (65.1%) than in the control group (16.0%) at the first follow-up. At the second follow-up, 69.7% of participants in the intervention group were adhering to the guidelines, which was significantly (p<0.05) greater than those in the control group (19.0%). Data also showed significant improvement in prescribing pattern of the participants in the intervention group compared to the control group. Therefore, academic detailing can be used for promoting adherence to treatment guidelines in developing countries, like Nepal. PMID:23930342
Gordon, Adam J; Harding, John Daniel
Opioid misuse may be ignored by providers who are unwilling or not confident in engaging the complex nature of substance use disorders among their patient populations. Addiction is a complex disease and although providers often are comfortable in identifying, assessing, and treating the complex diseases of their patients, basic knowledge and skills of identification, assessment, and treatment expertise involving opioids for pain, addressing opioid misuse, and treatment of opioid use disorder are lacking. Initiatives to improve knowledge of opioid use, misuse, and opioid use disorder among health care providers are emerging. In this issue of the Substance Abuse journal, we examine the science and evidence base of educational interventions and public initiatives addressing opioid use and addiction. These initiatives include naloxone rescue awareness and programs, community-based training initiatives, and system or public health approaches to improve student, trainee, and clinician education/training revolving around opioid misuse and opioid use disorder. We call on stakeholders to fund more research to investigate and implement the proven means to educate undergraduate students, graduate trainees, and clinicians regarding pain and addiction. We also recognize the 2016 peer reviewers of our journal who have performed meritorious, volunteer service to advance the science of addiction.
Pearce, Kevin A; Jarrett, Traci D; Scutchfield, F Douglas; Talbert, Jeffery C; Bolt, W David; Barron, Mary A; Houlihan, Jessica M; Dignan, Mark B
Kentucky has among the highest rates of diabetes and obesity in the United States. The Kentucky Diabetes and Obesity Collaborative (KDOC) was designed to develop a novel research infrastructure that can be used by researchers focusing on obesity and diabetes among patients cared for by Federally Qualified Health Centers (FQHC) serving rural Kentucky. Focus groups were carried out to develop an understanding of the needs and interests of FQHC practitioners and staff regarding participation in KDOC. Focus groups were conducted with 6 FQHCs and included a total of 41 individuals including health care providers, administrative staff and clinical staff. The discussions ranged in time from 30 to 70 minutes and averaged 45 minutes. Analysis of the transcripts of the focus groups revealed 4 themes: 1) contextual factors, 2) infrastructure, 3) interpersonal relationships, and 4) clinical features. The participants also noted four requirements that should be met for a research project to be successful in rural primary care settings: 1) there must be a shared understanding of health priorities of rural communities between the researcher and the practices/providers; 2) the proposed research must be relevant to clinics and their communities; 3) research and recommendations for evidence-based interventions need to reflect the day-to-day challenges of rural primary care providers; and 4) there needs to be an understanding of community norms and resources. Although research-clinic partnerships were viewed favourably overall, challenges in data integration to support both research and clinical outcomes were identified.
Background The National Institutes of Health reported in 2007 that approximately 38% of United States adults have used at least one type of Complementary and Alternative Medicine (CAM). There are no studies available that assess general CAM use in US pregnant women. The objectives of our study were to determine the prevalence and type of CAM use during pregnancy at one medical center; understand who is using CAM and why they are using it; and assess the state of patients’ CAM use disclosure to their obstetrical providers. Methods A cross-sectional survey study of post-partum women was done to assess self-reported CAM use during pregnancy. Results of this survey were compared to results from a previous survey performed by this research team in 2006. Data were analyzed using binary logistic regression. Results In 2013, 153 women completed the survey, yielding a response rate of 74.3%. Seventy-two percent and 68.5% of participants reported CAM use during their pregnancies in 2006 and 2013 respectively. The percentage of participants who reported discussing CAM use with their obstetrical providers was less than 1% in 2006 and 50% in 2013. Increased use of different CAM therapies was associated with increased maternal age, primagravida, being US-born, and having a college education (p ≤ 0.05). However, these factors were poor predictors of CAM use. Conclusions Given the frequency of CAM use and the difficulty in predicting who is using it, obstetrical providers should consider being informed about CAM and incorporating discussions about its use into routine patient assessments. PMID:24592860
In the complex health arena, a key proposition is that no person acting alone is as effective as a team to drive best practices and outcomes. Another key factor supporting best outcomes is access to the best information to support best choices. Currently, stakeholders suffer from a paucity of real-world knowledge of actual practices and outcomes that allows care gaps to go undiscovered. A body of evidence indicates that measurement and timely feedback of actual practices can decrease the gaps between usual and best care. This is driven by the stakeholders' desire to be the best they can be, and it is enabled by the measured knowledge of where practices fall short of gold standards. The addition of patient partners to such communities of care offers promise of further acceleration and broader impact of knowledge translation and associated beneficial outcomes. For example, in the Improving Cardiac Outcomes in Nova Scotia (ICONS) community-based heart disease project, there was a marked decrease in rates of re-hospitalization over the five-year course of the project. This improvement was only very weakly, or not at all, related to traditional risk factors, such as the presence of multiple illnesses or older age, or to the use of efficacious medical therapies. However, ICONS provided an extensive and repeated multimedia communication among patients, families and providers of project goals, strategy and general news, as well as repeated measurements of practices and outcomes. One outcome of this shared knowledge may have been the reduced need for re-hospitalization. While exact cause-and-effect relationship remain uncertain, patient-provider integrated health networks appear feasible and offer promise for efficient knowledge creation and its population-effective translation. The model and its implementation may be improved by testing further locally responsive initiatives in innovative partnership clusters and by training more personnel resources in inter
Payyappallimana, Unnikrishnan; Venkatasubramanian, Padma
Ayurveda, a traditional system of medicine that originated over three millennia ago in the South Asian region, offers extensive insights about food and health based on certain unique conceptual as well as theoretical positions. Health is defined as a state of equilibrium with one's self (svasthya) but which is inextricably linked to the environment. Ayurvedic principles, such as the tridosa (three humors) theory, provide the relationship between the microcosm and the macrocosm that can be applied in day-to-day practice. Classical Ayurveda texts cover an array of themes on food ranging from diversity of natural sources, their properties in relation to seasons and places and to their specific function both in physiological and pathological states. The epistemic perspective on health and nutrition in Ayurveda is very different from that of biomedicine and modern nutrition. However, contemporary knowledge is reinventing and advancing several of these concepts in an era of systems biology, personalized medicine, and the broader context of a more holistic transition in sciences in general. Trans-disciplinary research could be important not only for pushing the boundaries of food and health sciences but also for providing practical solutions for contemporary health conditions. This article briefly reviews the parallels in Ayurveda and biomedicine and draws attention to the need for a deeper engagement with traditional knowledge systems, such as Ayurveda. It points out that recreation of the methodologies that enabled the holistic view point about health in Ayurveda may unravel some of the complex connections with Nature.
Payyappallimana, Unnikrishnan; Venkatasubramanian, Padma
Ayurveda, a traditional system of medicine that originated over three millennia ago in the South Asian region, offers extensive insights about food and health based on certain unique conceptual as well as theoretical positions. Health is defined as a state of equilibrium with one’s self (svasthya) but which is inextricably linked to the environment. Ayurvedic principles, such as the tridosa (three humors) theory, provide the relationship between the microcosm and the macrocosm that can be applied in day-to-day practice. Classical Ayurveda texts cover an array of themes on food ranging from diversity of natural sources, their properties in relation to seasons and places and to their specific function both in physiological and pathological states. The epistemic perspective on health and nutrition in Ayurveda is very different from that of biomedicine and modern nutrition. However, contemporary knowledge is reinventing and advancing several of these concepts in an era of systems biology, personalized medicine, and the broader context of a more holistic transition in sciences in general. Trans-disciplinary research could be important not only for pushing the boundaries of food and health sciences but also for providing practical solutions for contemporary health conditions. This article briefly reviews the parallels in Ayurveda and biomedicine and draws attention to the need for a deeper engagement with traditional knowledge systems, such as Ayurveda. It points out that recreation of the methodologies that enabled the holistic view point about health in Ayurveda may unravel some of the complex connections with Nature. PMID:27066472
van der Elst, Elise M; Smith, Adrian D; Gichuru, Evanson; Wahome, Elizabeth; Musyoki, Helgar; Muraguri, Nicolas; Fegan, Greg; Duby, Zoe; Bekker, Linda-Gail; Bender, Bonnie; Graham, Susan M; Operario, Don; Sanders, Eduard J
Introduction Healthcare workers (HCWs) in Africa typically receive little or no training in the healthcare needs of men who have sex with men (MSM), limiting the effectiveness and reach of population-based HIV control measures among this group. We assessed the effect of a web-based, self-directed sensitivity training on MSM for HCWs (www.marps-africa.org), combined with facilitated group discussions on knowledge and homophobic attitudes among HCWs in four districts of coastal Kenya. Methods We trained four district “AIDS coordinators” to provide a two-day training to local HCWs working at antiretroviral therapy-providing facilities in coastal Kenya. Self-directed learning supported by group discussions focused on MSM sexual risk practices, HIV prevention and healthcare needs. Knowledge was assessed prior to training, immediately after training and three months after training. The Homophobia Scale assessed homophobic attitudes and was measured before and three months after training. Results Seventy-four HCWs (68% female; 74% clinical officers or nurses; 84% working in government facilities) from 49 health facilities were trained, of whom 71 (96%) completed all measures. At baseline, few HCWs reported any prior training on MSM anal sexual practices, and most HCWs had limited knowledge of MSM sexual health needs. Homophobic attitudes were most pronounced among HCWs who were male, under 30 years of age, and working in clinical roles or government facilities. Three months after training, more HCWs had adequate knowledge compared to baseline (49% vs. 13%, McNemar's test p<0.001); this was most pronounced in those with clinical or administrative roles and in those from governmental health providers. Compared to baseline, homophobic attitudes had decreased significantly three months after training, particularly among HCWs with high homophobia scores at baseline, and there was some evidence of correlation between improvements in knowledge and reduction in homophobic
Villaseñor, Sally; Walker, Tara; Fetters, Lisa; McCoy, Maryanne
The study sought to determine the barriers to e-prescribing particular to the acute care setting, the educational and motivational needs of acute care providers, and the optimal process for incentive, education, and implementation of e-prescribing. A theoretically based survey instrument was adapted from previous work. Four domains were assessed: finesse, intent to use, perceived usefulness, and perceived ease of use. The survey was offered to a group of acute care providers. The educational and motivational needs of acute care providers are different from those in primary care. Perceived barriers centered on uncertain pharmacy hours, unconfirmed transmittal, and accidental transmission to wrong pharmacy. Healthcare providers with more self-assessed knowledge of e-prescribing are more likely to use e-prescribing. Providers with fewer years in practice seem to have greater knowledge of e-prescribing. Providing education and exposure to e-prescribing has the potential to decrease perception of barriers and increase perceived usefulness for acute care providers. Software redesign may be needed to remove barriers associated with uncertain pharmacy hours, controlled substance prescribing, transmittal confirmation, and bidirectional communication needs, thereby improving motivation to e-prescribe.
Zhang, Helen L.; Mnzava, Kunda W.; Mitchell, Sarah T.; Melubo, Matayo L.; Kibona, Tito J.; Cleaveland, Sarah; Kazwala, Rudovick R.; Crump, John A.; Sharp, Joanne P.; Halliday, Jo E. B.
Background Zoonoses are common causes of human and livestock illness in Tanzania. Previous studies have shown that brucellosis, leptospirosis, and Q fever account for a large proportion of human febrile illness in northern Tanzania, yet they are infrequently diagnosed. We conducted this study to assess awareness and knowledge regarding selected zoonoses among healthcare providers in Moshi, Tanzania; to determine what diagnostic and treatment protocols are utilized; and obtain insights into contextual factors contributing to the apparent under-diagnosis of zoonoses. Methodology/Results We conducted a questionnaire about zoonoses knowledge, case reporting, and testing with 52 human health practitioners and 10 livestock health providers. Immediately following questionnaire administration, we conducted semi-structured interviews with 60 of these respondents, using the findings of a previous fever etiology study to prompt conversation. Sixty respondents (97%) had heard of brucellosis, 26 (42%) leptospirosis, and 20 (32%) Q fever. Animal sector respondents reported seeing cases of animal brucellosis (4), rabies (4), and anthrax (3) in the previous 12 months. Human sector respondents reported cases of human brucellosis (15, 29%), rabies (9, 18%) and anthrax (6, 12%). None reported leptospirosis or Q fever cases. Nineteen respondents were aware of a local diagnostic test for human brucellosis. Reports of tests for human leptospirosis or Q fever, or for any of the study pathogens in animals, were rare. Many respondents expressed awareness of malaria over-diagnosis and zoonoses under-diagnosis, and many identified low knowledge and testing capacity as reasons for zoonoses under-diagnosis. Conclusions This study revealed differences in knowledge of different zoonoses and low case report frequencies of brucellosis, leptospirosis, and Q fever. There was a lack of known diagnostic services for leptospirosis and Q fever. These findings emphasize a need for improved diagnostic
Frisby, Joshua; Smith, Vernon; Traub, Stephen; Patel, Vimla L
Hospital Emergency Departments (EDs) frequently experience crowding. One of the factors that contributes to this crowding is the "door to doctor time", which is the time from a patient's registration to when the patient is first seen by a physician. This is also one of the Meaningful Use (MU) performance measures that emergency departments report to the Center for Medicare and Medicaid Services (CMS). Current documentation methods for this measure are inaccurate due to the imprecision in manual data collection. We describe a method for automatically (in real time) and more accurately documenting the door to physician time. Using sensor-based technology, the distance between the physician and the computer is calculated by using the single board computers installed in patient rooms that log each time a Bluetooth signal is seen from a device that the physicians carry. This distance is compared automatically with the accepted room radius to determine if the physicians are present in the room at the time logged to provide greater precision. The logged times, accurate to the second, were compared with physicians' handwritten times, showing automatic recordings to be more precise. This real time automatic method will free the physician from extra cognitive load of manually recording data. This method for evaluation of performance is generic and can be used in any other setting outside the ED, and for purposes other than measuring physician time.
Gálvez, Patricia; Valencia, Alejandra; Palomino, Ana M; Cataldo, Marjorie; Schwingel, Andiara
Good communication between health care providers (HCPs) and patients is critical in achieving positive health outcomes. The purpose of this article was to compare the perceptions of Chilean woman and their HCPs with respect to determinants of eating behaviors. Semi-structured interviews were conducted with women (n=15) visiting a public health care center in Chile and with their HCPs (n=8) who were in charge of promoting healthy eating behaviors among women. Data from the interviews indicated similarities and inconsistencies in determinants of eating behaviors between the groups. Both mentioned many important factors that influence women's eating behaviors, including food preferences, dietary knowledge, self-control and self-efficacy, family, food cost, and food availability. HCPs appeared to be less aware of the role that personality traits and past experiences play as potential determinants which women mentioned. In contrast, women were less aware of the influence of anxiety and low self-esteem on eating choices, which HCPs noted as key factors. Although it was encouraging to see agreement between women and their HCPs in some areas, it is important to work on increasing understanding among the groups with respect to the important role psychological factors play in influencing eating behavior. We suggest that HCPs should focus on the importance of women's personality traits and past eating behaviors, as well as work on improving women's self-esteem and helping to decrease their anxiety levels. HCPs should be encouraged to develop good communication with each person in order to help them understand the roles that external and internal factors play in eating behaviors.
Lindenmeyer, Antje; Redwood, Sabi; Griffith, Laura; Teladia, Zaheera; Phillimore, Jenny
Objectives The main objectives of the study were to explore the experiences of primary care professionals providing care to recent migrants in a superdiverse city and to elicit barriers and facilitators to meeting migrants' care needs. This paper focuses on a strong emergent theme: participants' descriptions and understandings of creating a fit between patients and practices. Design An exploratory, qualitative study based on the thematic analysis of semistructured interviews. Setting and participants A purposive sample of 10 practices. We interviewed 6 general practitioners, 5 nurses and 6 administrative staff; those based at the same practice opted to be interviewed together. 10 interviewees were from an ethnic minority background; some discussed their own experiences of migration. Results Creating a fit between patients and practice was complex and could be problematic. Some participants defined this in a positive way (reaching out, creating rapport) while others also focused on ways in which patients did not fit in, for example, different expectations or lack of medical records. A small but vocal minority put the responsibility to fit in on to migrant patients. Some participants believed that practice staff and patients sharing a language could contribute to achieving a fit but others outlined the disadvantages of over-reliance on language concordance. A clearly articulated, team-based strategy to create bridges between practice and patients was often seen as preferable. Conclusions Although participants agreed that a fit between patients and practice was desirable, some aimed to adapt to the needs of recently arrived migrants, while others thought that it was the responsibility of migrants to adapt to practice needs; a few viewed migrant patients as a burden to the system. Practices wishing to improve fit might consider developing strategies such as introducing link workers and other ‘bridging’ people; however, they could also aim to foster a general stance
Gálvez, Patricia; Valencia, Alejandra; Palomino, Ana M.; Cataldo, Marjorie; Schwingel, Andiara
Good communication between health care providers (HCPs) and patients is critical in achieving positive health outcomes. The purpose of this article was to compare the perceptions of Chilean woman and their HCPs with respect to determinants of eating behaviors. Semi-structured interviews were conducted with women (n=15) visiting a public health care center in Chile and with their HCPs (n=8) who were in charge of promoting healthy eating behaviors among women. Data from the interviews indicated similarities and inconsistencies in determinants of eating behaviors between the groups. Both mentioned many important factors that influence women's eating behaviors, including food preferences, dietary knowledge, self-control and self-efficacy, family, food cost, and food availability. HCPs appeared to be less aware of the role that personality traits and past experiences play as potential determinants which women mentioned. In contrast, women were less aware of the influence of anxiety and low self-esteem on eating choices, which HCPs noted as key factors. Although it was encouraging to see agreement between women and their HCPs in some areas, it is important to work on increasing understanding among the groups with respect to the important role psychological factors play in influencing eating behavior. We suggest that HCPs should focus on the importance of women's personality traits and past eating behaviors, as well as work on improving women's self-esteem and helping to decrease their anxiety levels. HCPs should be encouraged to develop good communication with each person in order to help them understand the roles that external and internal factors play in eating behaviors. PMID:25661846
Burgess, Diana J.
Systematic reviews of healthcare disparities suggest that clinicians’ diagnostic and therapeutic decision making varies by clinically irrelevant characteristics, such as patient race, and that this variation may contribute to healthcare disparities. However, there is little understanding of the particular features of the healthcare setting under which clinicians are most likely to be inappropriately influenced by these characteristics. This study delineates several hypotheses to stimulate future research in this area. It is posited that healthcare settings in which providers experience high levels of cognitive load will increase the likelihood of racial disparities via 2 pathways. First, providers who experience higher levels of cognitive load are hypothesized to make poorer medical decisions and provide poorer care for all patients, due to lower levels of controlled processing (H1). Second, under greater levels of cognitive load, it is hypothesized that healthcare providers’ medical decisions and interpersonal behaviors will be more likely to be influenced by racial stereotypes, leading to poorer processes and outcomes of care for racial minority patients (H2). It is further hypothesized that certain characteristics of healthcare settings will result in higher levels of cognitive load experienced by providers (H3). Finally, it is hypothesized that minority patients will be disproportionately likely to be treated in healthcare settings in which providers experience greater levels of cognitive load (H4a), which will result in racial disparities due to lower levels of controlled processing by providers (H4b) and the influence of racial stereotypes (H4c).The study concludes with implications for research and practice that flow from this framework. PMID:19726783
Paul, Mandira; Näsström, Sara B.; Klingberg-Allvin, Marie; Kiggundu, Charles; Larsson, Elin C.
Background Pregnancies among young women force girls to compromise education, resulting in low educational attainment with subsequent poverty and vulnerability. A pronounced focus is needed on contraceptive use, pregnancy, and unsafe abortion among young women. Objective This study aims to explore healthcare providers’ (HCPs) perceptions and practices regarding contraceptive counselling to young people. Design We conducted 27 in-depth interviews with doctors and midwives working in seven health facilities in central Uganda. Interviews were open-ended and allowed the participant to speak freely on certain topics. We used a topic guide to cover areas topics of interest focusing on post-abortion care (PAC) but also covering contraceptive counselling. Transcripts were transcribed verbatim and data were analysed using thematic analysis. Results The main theme, HCPs' ambivalence to providing contraceptive counselling to sexually active young people is based on two sub-themes describing the challenges of contraceptive counselling: A) HCPs echo the societal norms regarding sexual practice among young people, while at the same time our findings B) highlights the opportunities resulting from providers pragmatic approach to contraceptive counselling to young women. Providers expressed a self-identified lack of skill, limited resources, and inadequate support from the health system to successfully provide appropriate services to young people. They felt frustrated with the consultations, especially when meeting young women seeking PAC. Conclusions Despite existing policies for young people's sexual and reproductive health in Uganda, HCPs are not sufficiently equipped to provide adequate contraceptive counselling to young people. Instead, HCPs are left in between the negative influence of social norms and their pragmatic approach to address the needs of young people, especially those seeking PAC. We argue that a clear policy supported by a clear strategy with practical
Arnold, R; van Teijlingen, E; Ryan, K; Holloway, I
Objective To analyse the culture of a Kabul maternity hospital to understand the perspectives of healthcare providers on their roles, experiences, values and motivations and the impact of these determinants on the care of perinatal women and their babies. Design Qualitative ethnographic study. Setting A maternity hospital, Afghanistan. Population Doctors, midwives and care assistants. Methods Six weeks of observation followed by 22 semi-structured interviews and four informal group discussions with staff, two focus group discussions with women and 41 background interviews with Afghan and non-Afghan medical and cultural experts. Main outcome measures The culture of care in an Afghan maternity hospital. Results A large workload, high proportion of complicated cases and poor staff organisation affected the quality of care. Cultural values, social and family pressures influenced the motivation and priorities of healthcare providers. Nepotism and cronyism created inequality in clinical training and support and undermined the authority of management to improve standards of care. Staff without powerful connections were vulnerable in a punitive inequitable environment—fearing humiliation, blame and the loss of employment. Conclusions Suboptimal care put the lives of women and babies at risk and was, in part, the result of conflicting priorities. The underlying motivation of staff appeared to be the socio-economic survival of their own families. The hospital culture closely mirrored the culture and core values of Afghan society. In setting priorities for women's health post-2015 Millennium Development Goals, understanding the context-specific pressures on staff is key to more effective programme interventions and sustainability. PMID:25394518
Sinha, Samrat; David, Siddarth; Gerdin, Martin; Roy, Nobhojit
Background: Research on healthcare delivery in zones of conflict requires sustained and systematic attention. In the context of the South Asian region, there has been an absence of research on the vulnerabilities of health care workers and institutions in areas affected by armed conflict. The paper presents a case study of the varied nature of security challenges faced by local healthcare providers in the state of Manipur in the North-eastern region of India, located in the Indo-Myanmar frontier region which has been experiencing armed violence and civil strife since the late 1960s. . The aim of this study was to assess longitudinal and spatial trends in incidents involving health care workers in Manipur during the period 2008 to 2009. Methods: We conducted a retrospective database analysis of the Manipur Micro-level Insurgency Database 2008-2009, created by using local newspaper archives to measure the overall burden of violence experienced in the state over a two year period. Publicly available press releases of armed groups and local hospitals in the state were used to supplement the quantitative data. Simple linear regression was used to assess longitudinal trends. Data was visualized with GIS-software for spatial analysis. Results: The mean proportion of incidents involving health care workers per month was 2.7% and ranged between 0 and 6.1% (table 2). There was a significant (P=0.037) month-to-month variation in the proportion of incidents involving health care workers, as well as a upward trend of about 0.11% per month. Spatial analysis revealed different patterns depending on whether absolute, population-adjusted, or incident-adjusted frequencies served as the basis of the analysis. Conclusions: The paper shows a small but steady rise in violence against health workers and health institutions impeding health services in Manipur’s pervasive violence. More evidence-building backed by research along with institutional obligations and commitment is essential
Atchison, C. `; Stredney, D.; Hittle, B.; Irving, K.; Toomey, R. S., III; Lemon, N. N.; Price, A.; Kerwin, T.
Based on an identified need to accommodate students with mobility impairments in field-based instructional experiences, this presentation will discuss current efforts to promote participation, broaden diversity, and impart a historical perspective in the geosciences through the use of an interactive virtual environment. Developed through the integration of emerging simulation technologies, this prototypical virtual environment is created from LIDAR data of the Historic Tour route of Mammoth Cave National Park. The educational objectives of the simulation focus on four primary locations within the tour route that provide evidence of the hydrologic impact on the cave and karst formation. The overall objective is to provide a rich experience of a geological field-based learning for all students, regardless of their physical abilities. Employing a virtual environment that interchangeably uses two and three-dimensional representation of geoscience content, this synthetic field-based cave and karst module will provide an opportunity to assess the effectiveness in engaging the student community, and its efficacy in the curriculum when used as an alternative representation of a traditional field experience. The expected outcome is that based on the level of interactivity, the simulated environment will provide adequate pedagogical representation for content transfer without the need for physical experience in the uncontrolled field environment. Additionally, creating such an environment will impact all able-bodied students by providing supplemental resources that can both precede a traditional field experience and allow for students to re-examine a field site long after a the field experience, in both current formal and informal educational settings.
McDonald, Sheila W; Ginez, Heather K; Vinturache, Angela E; Tough, Suzanne C
Objectives The majority of mothers do not correctly identify their child's weight status. The reasons for the misperception are not well understood. This study's objective was to describe maternal perceptions of their child's body mass index (BMI) and maternal report of weight concerns raised by a health professional. Design Prospective, community-based cohort. Participants Data were collected in 2010 from 450 mothers previously included in a longitudinal birth cohort. Mothers of children aged 6–8 years reported their child's anthropometric measures and were surveyed concerning their opinion about their child's weight. They were also asked if a healthcare provider raised any concerns regarding their child's body weight. Child BMI was categorised according to the WHO Growth Charts adapted for Canada. Descriptive statistics and bivariate analyses were used to evaluate mothers' ability to correctly identify their children's body habitus. Results 74% of children had a healthy BMI, 10% were underweight, 9% were overweight and 7% were obese. 80%, 89% and 62% of mothers with underweight, overweight and obese children, respectively, believed that their child was at the right weight. The proportion of mothers who recalled a health professional raising concerns about their child being underweight, overweight, and obese was low (12.5%). Conclusions The majority of mothers with children at unhealthy weights misclassified and normalised their child's weight status, and they did not recall a health professional raising concerns regarding their child's weight. The highest rates of child body weight misclassification occurred in overweight children. This suggests that there are missed opportunities for healthcare professionals to improve knowledge exchange and early interventions to assist parents to recognise and support healthy weights for their children. PMID:27798005
innovation adoption in the healthcare context. The case identifies ‘negotiated order’, managerial performance of providers and disciplinary control as three media of power used in combination by commissioners. The case lends support for stewardship and resource dependency governance theories as explanations of the underpinning conditions for effective commissioning in certain circumstances within a quasi marketised healthcare system. PMID:23735082
Maunder, Robert G; Hunter, Jonathan J
Objectives To develop and assess the validity of measures of patients' attachment-related perceptions of experiences with healthcare providers (HCPs). Setting Online survey. Participants 181 people provided consent and 119 completed the survey (66%). Most participants were women (80%). Primary and secondary outcome measures Questions were developed to assess possible attachment functions served by an HCP and patients' attachment-related attitudes towards an HCP. Scales were constructed based on exploratory factor analysis. Measures of adult attachment, therapeutic alliance, perceived HCP characteristics and health utilisation were used to validate scales. Results Possible safe haven and secure base functions served by HCPs were strongly endorsed. A model with good fit (root mean square error of approximation=0.056) yielded 3 factors: ‘HCP experienced as supportive and safe’ (SUPPORT, α=0.94), ‘HCP experienced as aversive’ (AVERSE, α=0.86) and ‘more and closer contact wanted with HCP’ (WANT, α=0.85). SUPPORT was correlated with positive HCP characteristics and not with attachment insecurity. AVERSE was inversely correlated with positive HCP attributes and correlated with attachment insecurity. WANT was unrelated to positive HCP attributes, but correlated with attachment insecurity. Frequency of HCP contact was related to WANT (Kruskal-Wallis=21.9, p<0.001) and SUPPORT (Kruskal-Wallis=13.2, p=0.02), but not to AVERSE (Kruskal-Wallis=1.7, p=0.89). Conclusions Patients attribute attachment functions of secure base and safe haven to HCPs. SUPPORT is related to positive appraisal of HCP characteristics; AVERSE is associated with discomfort in the HCP relationship that is related with perceived HCP characteristics and patients' insecure attachment; WANT is associated with unmet needs for connection with an HCP related to insecure attachment, but not to perceived HCP characteristics. These scales may be useful in studying the application of attachment theory
Berg, Carla J; Nehl, Eric J; Wang, Xiaodong; Ding, Yingying; He, Na; Johnson, Brent A; Wong, Frank Y
Given the implications for smoking among HIV-positive individuals and high smoking and HIV rates among men who have sex with men (MSM) in China, we examined sociodemographic, smoking-related, psychosocial, and substance use factors in relation to HIV status; receiving some sort of healthcare provider intervention regarding smoking; and having made a quit attempt in the past year in a sample of MSM smokers in Chengdu. We conducted a cross-sectional survey of 381 MSM smokers recruited by a nongovernmental organization in Chengdu in 2012-2013. Of these, 350 disclosed their HIV status and 344 (188 HIV-positive and 156 HIV-negative) provided completed data. Half (50.0%) reported at least one quit attempt in their lifetime; 30.5% reported a quit attempt in the past year. The majority (59.4%) reported that a healthcare provider had intervened in some way (assessed smoking, advised quitting, provided assistance), most commonly by assessing smoking status (50.0%). HIV-positive individuals were more likely to report a healthcare provider intervening on their smoking (p < .001). Those who received provider intervention were more likely to have attempted to quit ever (p = .009) and in the past year (p < .001). Those HIV-positive were more likely to have attempted to quit since diagnosis if a provider had intervened (p = .001). Multivariate regression documented that being HIV-positive (p < .001), greater cigarette consumption (p = .02), less frequent drinking (p = .03), and greater depressive symptoms (p = .003) were significant correlates of healthcare provider intervention. Multivariate regression also found that healthcare provider intervention (p = .003), older age (p = .01), and higher autonomous motivation (p = .007) were significant correlates of attempting to quit in the past year. Given the impact of healthcare provider intervention regarding smoking on quit attempts among MSM, greater training and support is needed to promote consistent intervention on smoking in the
Mundongo, Tshamba Henri; Ditend, Yav Grevisse; VanCaillie, Didier; Malonga, Kaj Françoise
Introduction In the world, the health policies are necessary to satisfy with efficiency the requirements of the quality management in the health sector. The laboratory of the academic clinics of Lubumbashi in Africa was inspired by the EFQM model to improve its performance and the quality of its services offered to the community. The aim of this survey is to evaluate the level of job satisfaction of the healthcare providers after implementation of the model. Methods Qualitative study used an anonymous questionnaire consisted of 16 semi directional dichotomous and 12 according to four modality of the Likert's scale; to evaluate the job satisfaction of the healthcare providers. 40 workers are concerned and their informed consent is obtained. Epi Info 3.5.3 and SPSS 19.0 software, the Student t test and Chi-square test and the threshold set at p ≤ 0.05 were used. The mean score was calculated. Cronbach's ‘ coefficient and principal component analysis allowed the validity measurement of the questionnaire, and the correlations has been calculated. Results This survey had a rate of answer of 80% on a set of all questionnaires. The Cronbach's coefficient of reliability is 0.72 on 40 complete observations with 12 questions. The Kaiser Meyer Olkin (0.564) and the Bartlett test is significant (χ2= 57, 30, p=0.001). The Physicians are very dissatisfied (2.363) against the nurses, and the biologists who are moderately dissatisfied (3 and 3.312). The relative results to the global satisfaction of the workers show a meaningful difference between the workers satisfied versus those non satisfied (p = 0.003). More of the half of the workers is satisfied after the setting up of the EFQM model. Conclusion A certain number of the factors act together and simultaneously on the satisfaction of the workers particular in the health sector. The EFQM model permits the job satisfaction in the hospital because it combines several factors acting on the individuals. PMID:25852808
Whellan, David J; Reed, Shelby D; Liao, Lawrence; Gould, Stuart D; O'connor, Christopher M; Schulman, Kevin A
Although heart failure disease management (HFDM) programs improve patient outcomes, the implementation of these programs has been limited because of financial barriers. We undertook the present study to understand the economic incentives and disincentives for adoption of disease management strategies from the perspectives of a physician (group), a hospital, an integrated health system, and a third-party payer. Using the combined results of a group of randomized controlled trials and a set of financial assumptions from a single academic medical center, a financial model was developed to compute the expected costs before and after the implementation of a HFDM program by 3 provider types (physicians, hospitals, and health systems), as well as the costs incurred from a payer perspective. The base-case model showed that implementation of HFDM results in a net financial loss to all potential providers of HFDM. Implementation of HFDM as described in our base-case analysis would create a net loss of US dollars 179,549 in the first year for a physician practice, US dollars 464,132 for an integrated health system, and US dollars 652,643 in the first year for a hospital. Third-party payers would be able to save US dollars 713,661 annually for the care of 350 patients with heart failure in a HFDM program. In conclusion, although HFDM programs may provide patients with improved clinical outcomes and decreased hospitalizations that save third-party payers money, limited financial incentives are currently in place for healthcare providers and hospitals to initiate these programs.
Spaulding, Ryan J; Russo, Tracy; Cook, David J; Doolittle, Gary C
Twenty counties in Kansas were randomly selected from those designated as rural on the basis of their populations. A sample of 356 physicians and physicians' assistants in these counties was chosen. A postal survey was sent to the identified providers up to three times. One hundred and eighty-six of the questionnaires were returned (a response rate of 52%). In all, 76% of the respondents were physicians, 76% were men and 42% were family practitioners. Practitioners were classified as adopters or non-adopters of telemedicine, based on their report of whether they had ever referred one or more patients for a health-care consultation via telemedicine. Of the 167 participants who marked this item, 30 (18%) were adopters and 137 (82%) were non-adopters. Among the adopters, 16 (53%) said that they expected to use telemedicine with about the same frequency or more often in the future. In contrast, 61 (45%) non-adopters reported that they did not expect to refer patients by telemedicine in the future and 51 (37%) were unsure. Neither age (r = 0.16, P = 0.44) nor gender (chi2 = 2.35, P = 0.13) was related to the adoption variable or the number of referrals made to telemedicine clinics. The results suggest that adopters and non-adopters of telemedicine perceive its value very differently, and that an opportunity exists to promote the concept to non-adopters more effectively.
Johnson, Kevin W
The case of Brase v Rees was presented before the US Supreme Court to consider the constitutionality of death by lethal injection as practiced in the state of Kentucky. The 3-drug combination of sodium thiopental, pancuronium bromide, and potassium chloride is a key aspect in question. Capital punishment conflicts with medical and nursing code of ethics preventing providers who are skilled at difficult intravenous (IV) access, assessment of appropriate sedation, and involvement without fear of disciplinary action. Therefore, untrained or undertrained personnel from the prison have been delegated these duties. Cases in which failure to establish or maintain IV access has led to executions lasting up to 90 minutes before the execution was complete. Participation by skilled medical personnel has been a debate between the medical and legal communities since the inception of lethal injection. Healthcare should reevaluate the ethical and moral principle of beneficence as the legal system attempts to evaluate the constitutionality of lethal injection. Can a nurse or doctor step out of the role of medical professional, use knowledge and skill to make death by lethal injection more humane, and not violate the ethical principle of "do no harm"?
Bray, Judith; Fernandes, Aida; Nguyen, Geoffrey C; Otley, Anthony R; Heatherington, Joan; Stretton, Jennifer; Bollegala, Natasha; Benchimol, Eric I
Canada has one of the highest rates of inflammatory bowel disease (IBD) and the disease represents a significant health, social, and economic burden. There is currently no cure for IBD, although earlier diagnosis and new therapies have improved the overall health outcomes and quality of life for patients. Crohn's and Colitis Canada is Canada's only national, volunteer-based charity dedicated to finding cures for IBD and improving the lives of those affected, through research, education, patient programs, advocacy, and increased awareness. On April 30, 2015, Crohn's and Colitis Canada hosted the "Patient and Healthcare Professional Summit on the Burden of Disease in IBD" to obtain a deeper understanding of the unmet needs of IBD patients and their caregivers. Through personal vignettes, patients articulated a pressing need to increase understanding of the challenges faced by people suffering from IBD among both health care professionals and the general public, develop best practices for navigating life transitions and addressing the unique challenges faced by children with IBD, and provide equitable access to appropriate, effective, and affordable treatments. The recommendations that emerged from the summit will inform about efforts to increase public awareness, inform about advocacy strategies, and contribute to the development of research priorities.
Context. Despite improvement in pain management and availability of clinical treatment guidelines, patients in Jordan are still suffering from pain. Negative consequences of undertreated pain are being recognized as a reason for further illnesses and poor quality of life. Healthcare providers (HCPs) are responsible for relieving pain of their patients. Objective. To evaluate the knowledge and attitudes of HCPs toward pain management in Jordan. Methods. A 16-item questionnaire with agree or disagree options was given to 662 HCPs in seven hospitals in Jordan who volunteered to participate in the study. Following data collection, the responses were coded and entered into SPSS. Results. There was a statistically significant difference (p < 0.004) in percentage scores between physicians (36%) and pharmacists (36%) versus nurses (24%). The level of knowledge was the best among physicians, followed by pharmacists specifically in the area of cancer pain management. Nurses scored the lowest for knowledge of pain assessment and management among HCPs. However, HCPs overall scores indicated insufficient knowledge specifically in relation to pain assessment and management among children. PMID:27965524
Bray, Judith; Fernandes, Aida; Nguyen, Geoffrey C.; Otley, Anthony R.; Heatherington, Joan; Stretton, Jennifer; Bollegala, Natasha; Benchimol, Eric I.
Canada has one of the highest rates of inflammatory bowel disease (IBD) and the disease represents a significant health, social, and economic burden. There is currently no cure for IBD, although earlier diagnosis and new therapies have improved the overall health outcomes and quality of life for patients. Crohn's and Colitis Canada is Canada's only national, volunteer-based charity dedicated to finding cures for IBD and improving the lives of those affected, through research, education, patient programs, advocacy, and increased awareness. On April 30, 2015, Crohn's and Colitis Canada hosted the “Patient and Healthcare Professional Summit on the Burden of Disease in IBD” to obtain a deeper understanding of the unmet needs of IBD patients and their caregivers. Through personal vignettes, patients articulated a pressing need to increase understanding of the challenges faced by people suffering from IBD among both health care professionals and the general public, develop best practices for navigating life transitions and addressing the unique challenges faced by children with IBD, and provide equitable access to appropriate, effective, and affordable treatments. The recommendations that emerged from the summit will inform about efforts to increase public awareness, inform about advocacy strategies, and contribute to the development of research priorities. PMID:27446878
Johansson, Patrik; Jones, Deborah E; Watkins, Crystal C; Haisfield-Wolfe, Mary Ellen; Gaston-Johansson, Fannie
This qualitative content analysis examines data from African-American and Hispanic physician and nurse focus groups conducted by the Institute of Medicine (IOM). Participants discussed the influence of race and ethnicity regarding perspectives on healthcare provided to ethnic minority patients, and on the professional careers of ethnic minority physicians and nurses. A majority of responses related to Racism and Prejudice, which affected ethnic minority patients and health-care providers at three levels (health-care system to patient, provider to patient, and provider to provider). Racism and Prejudice interfered with promotions, obtaining hospital privileges, and advancement in careers. Communication and Culture was important among patients who preferred racially concordant care providers. Role Modeling was found to be important as participants entered and matured in their professional careers. Findings provide compelling evidence that racism and prejudice are shared experiences between ethnic minority physicians and nurses throughout their careers. One concerning finding was that perceived prejudice materialized at the onset of medical and nursing education and remained a predominant theme throughout the professionals' careers. Research should be directed towards providing equity in care and on the careers of ethnic minority health-care professionals.
Fike, Geraldine C.
The Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) is a standardized survey instrument used by many hospitals for the purpose of measuring patient's perspectives regarding care received during their hospitalization. The survey provides national benchmark information enabling consumers to make comparisons of…
Khatib, Rasha; Schwalm, Jon-David; Yusuf, Salim; Haynes, R. Brian; McKee, Martin; Khan, Maheer; Nieuwlaat, Robby
Background Although the importance of detecting, treating, and controlling hypertension has been recognized for decades, the majority of patients with hypertension remain uncontrolled. The path from evidence to practice contains many potential barriers, but their role has not been reviewed systematically. This review aimed to synthesize and identify important barriers to hypertension control as reported by patients and healthcare providers. Methods Electronic databases MEDLINE, EMBASE and Global Health were searched systematically up to February 2013. Two reviewers independently selected eligible studies. Two reviewers categorized barriers based on a theoretical framework of behavior change. The theoretical framework suggests that a change in behavior requires a strong commitment to change [intention], the necessary skills and abilities to adopt the behavior [capability], and an absence of health system and support constraints. Findings Twenty-five qualitative studies and 44 quantitative studies met the inclusion criteria. In qualitative studies, health system barriers were most commonly discussed in studies of patients and health care providers. Quantitative studies identified disagreement with clinical recommendations as the most common barrier among health care providers. Quantitative studies of patients yielded different results: lack of knowledge was the most common barrier to hypertension awareness. Stress, anxiety and depression were most commonly reported as barriers that hindered or delayed adoption of a healthier lifestyle. In terms of hypertension treatment adherence, patients mostly reported forgetting to take their medication. Finally, priority setting barriers were most commonly reported by patients in terms of following up with their health care providers. Conclusions This review identified a wide range of barriers facing patients and health care providers pursuing hypertension control, indicating the need for targeted multi-faceted interventions
Brown, Cary A.; Jones, Allyson; Crick, Katelyn
A large proportion of persons with dementia will also experience disordered sleep. Disordered sleep in dementia is a common reason for institutionalization and affects cognition, fall risk, agitation, self-care ability, and overall health and quality of life. This report presents findings of a survey of healthcare providers' awareness of sleep issues, assessment practices, and nonpharmacological sleep interventions for persons with dementia. There were 1846 participants, with the majority being from nursing and rehabilitation. One-third worked in long-term care settings and one-third in acute care. Few reported working in the community. Findings revealed that participants understated the incidence of sleep deficiencies in persons with dementia and generally lacked awareness of the relationship between disordered sleep and dementia. Their knowledge of sleep assessment tools was limited to caregiver reports, self-reports, and sleep diaries, with few using standardized tools or other assessment methods. The relationship between disordered sleep and comorbid conditions was not well understood. The three most common nonpharmacological sleep interventions participants identified using were a regular bedtime routine, increased daytime activity, and restricted caffeine. Awareness of other evidence-based interventions was low. These findings will guide evidence-informed research to develop and test more targeted and contextualized sleep and dementia knowledge translation strategies. PMID:24851185
Fields, Sylvia K; Mahan, Pamela; Tillman, Paula; Harris, Jeffrey; Maxwell, Kaye; Hojat, Mohammadreza
While empathy is commonly accepted as a mutually beneficial aspect of the health provider-patient relationship, evidence exists that many health profession students are unable to demonstrate this important skill. This study, the initial phase of a 2-year longitudinal series, examined measurement properties of the Jefferson Scale of Physician Empathy (JSPE) adapted for administration to health profession students (JSE-HPS version), and investigated group differences of empathy scores in the baccalaureate nursing (BSN) program within the College of Health Professions at a public university in the southeastern part of the USA. The 20-item survey and a demographic questionnaire were completed by 265 BSN students. Correlational analyses, t-test, and analysis of variance were used to examine internal relationships and group differences. Results showed the median item-total score correlation was statistically significant (0.42). The internal consistency of the scale (Cronbach's coefficient α) was 0.78, falling within the generally agreed standard. Test-retest reliability coefficients were acceptable at 0.58 (within 3 months interval) and 0.69 (within 6 months interval) between testing. Women scored higher than men and older students outscored younger classmates. No significant relationship was found between empathy scores and ethnicity, previous non-nursing degree, or importance of religion to the participant. These findings support measurement properties of the JSE-HPS version, and can bolster the confidence of researchers in using the Scale for measuring empathy in diverse health profession students, as one component of program evaluation as well as evaluating interprofessional learning activities among diverse healthcare professional students and interprofessional collaboration.
Jaiantilal, Prafulta; Gutin, Sarah A.; Cummings, Beverley; Mbofana, Francisco; Rose, Carol Dawson
Abstract Despite the Mozambique government's efforts to curb human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), national prevalence is 11.5% and support is needed to expand HIV-related services and improve program quality. Positive prevention (PP) programs, which prioritize HIV prevention with people living with HIV and AIDS (PLHIV), have been recognized as an important intervention for preventing new HIV infections. To address this, an evidence-based PP training intervention was implemented with HIV healthcare providers in Mozambique. This study focuses on the acceptability and feasibility of a PP intervention in HIV clinics from the healthcare provider perspective. In-depth interviews were conducted with 31 healthcare providers from three provinces who participated in PP trainings in Mozambique. Interview data were coded using content analysis. Study data suggest that healthcare providers found PP acceptable, feasible to implement in their HIV work in clinic settings, and valued this strategy to improve HIV prevention. The PP training also led providers to feel more comfortable counseling their patients about prevention, with a more holistic approach that included HIV testing, treatment and encouraging PLHIV to live positively. While overall acceptance of the PP training was positive, several barriers to feasibility surfaced in the data. Patient-level barriers included resistance to disclosing HIV status due to fear of stigma and discrimination, difficulty negotiating for condom use, difficulty engaging men in testing and treatment, and the effects of poverty on accessing care. Providers also identified work environment barriers including high patient load, time constraints, and frequent staff turnover. Recognizing PP as an important intervention, healthcare providers should be trained to provide comprehensive prevention, care and treatment for PLHIV. Further work is needed to explore the complex social dynamics and cultural challenges
Yuan, Shenfang; Qiu, Lei; Gao, Shang; Tong, Yao; Yang, Weiwei
Wireless sensor networks (WSNs) have received tremendous attention over the past ten years. In engineering applications of WSNs, a number of sensor nodes are usually spread across some specific geographical area. Some of these nodes have to work in harsh environments. Dependability of the Wireless Sensor Network (WSN) is very important for its successful applications in the engineering area. In ordinary research, when a node has a failure, it is usually discarded and the network is reorganized to ensure the normal operation of the WSN. Using appropriate WSN re-organization methods, though the sensor networks can be reorganized, this causes additional maintenance costs and sometimes still decreases the function of the networks. In those situations where the sensor networks cannot be reorganized, the performance of the whole WSN will surely be degraded. In order to ensure the reliable and low cost operation of WSNs, a method to develop a wireless sensor node with self-healing ability based on reconfigurable hardware is proposed in this paper. Two self-healing WSN node realization paradigms based on reconfigurable hardware are presented, including a redundancy-based self-healing paradigm and a whole FPAA/FPGA based self-healing paradigm. The nodes designed with the self-healing ability can dynamically change their node configurations to repair the nodes' hardware failures. To demonstrate these two paradigms, a strain sensor node is adopted as an illustration to show the concepts. Two strain WSN sensor nodes with self-healing ability are developed respectively according to the proposed self-healing paradigms. Evaluation experiments on self-healing ability and power consumption are performed. Experimental results show that the developed nodes can self-diagnose the failures and recover to a normal state automatically. The research presented can improve the robustness of WSNs and reduce the maintenance cost of WSNs in engineering applications. PMID:23202176
Bascombe, Ta Misha S.; Scott, Kimberly N.; Ballard, Denise; Smith, Samantha A.; Thompson, Winifred; Berg, Carla J.
Use prevalence of alternative tobacco products and marijuana has increased dramatically. Unfortunately, clinical guidelines have focused on traditional cigarettes with limited attention regarding these emerging public health issues. Thus, it is critical to understand how healthcare professionals view this issue and are responding to it. This…
DeBate, Rita D.; Severson, Herbert H.; Cragun, Deborah L.; Gau, Jeff M.; Merrell, Laura K.; Bleck, Jennifer R.; Christiansen, Steve; Koerber, Anne; Tomar, Scott L.; Brown, Kelli R. McCormack; Tedesco, Lisa A.; Hendricson, William
Oral healthcare providers have a clinical opportunity for early detection of disordered eating behaviors because they are often the first health professionals to observe overt oral and physical signs. Curricula regarding early recognition of this oral/systemic medical condition are limited in oral health educational programs. Web-based learning…
Stehling-Ariza, Tasha; Park, Yoon Soo; Sury, Jonathan J; Abramson, David
This paper examined the effect of Hurricane Katrina on children's access to personal healthcare providers and evaluated the use of propensity score methods to compare a nationally representative sample of children, as a proxy for an unexposed group, with a smaller exposed sample. 2007 data from the Gulf Coast Child and Family Health (G-CAFH) Study, a longitudinal cohort of households displaced or greatly impacted by Hurricane Katrina, were matched with 2007 National Survey of Children's Health (NSCH) data using propensity score techniques. Propensity scores were created using poverty level, household educational attainment, and race/ethnicity, with and without the addition of child age and gender. The outcome was defined as having a personal healthcare provider. Additional confounders (household structure, neighborhood safety, health and insurance status) were also examined. All covariates except gender differed significantly between the exposed (G-CAFH) and unexposed (NSCH) samples. Fewer G-CAFH children had a personal healthcare provider (65 %) compared to those from NSCH (90 %). Adjusting for all covariates, the propensity score analysis showed exposed children were 20 % less likely to have a personal healthcare provider compared to unexposed children in the US (OR = 0.80, 95 % CI 0.76, 0.84), whereas the logistic regression analysis estimated a stronger effect (OR = 0.28, 95 % CI 0.21, 0.39). Two years after Hurricane Katrina, children exposed to the storm had significantly lower odds of having a personal health care provider compared to unexposed children. Propensity score matching techniques may be useful for combining separate data samples when no clear unexposed group exists.
Connell, Braydon; Warner, Grace; Weeks, Lori E
Background/Question: Volunteers are important in the support of frail older adults requiring palliative care, especially in rural areas. However, there are challenges associated with volunteer supports related to training, management and capacity to work in partnership with healthcare providers (HCP). This review addresses the question: What is the feasibility of a volunteer-HCP partnership to support frail older adults residing in rural areas, as they require palliative care?
The purpose of this experimental study was to explore the instructional effectiveness of integrating varied instructor-provided concept maps into an online hypertext learning environment, and the effect of learners' self-directed learning abilities on their learning performance. The research adopted a randomized posttest with two-control-group…
Haag, Jordan D.; Davis, Amanda Z.; Hoel, Robert W.; Armon, Jeffrey J.; Odell, Laura J.; Dierkhising, Ross A.; Takahashi, Paul Y.
all 25 patients at baseline, representing 15 (60%) patients with ≥1 missing medications. Overall, 55 drug therapy problems were identified at baseline, 24 (43.6%) of which remained unresolved at 30-day follow-up. Conclusion The use of a pharmacist-provided MTM program did not achieve a significant difference compared with usual care in an existing CTP; however, the findings demonstrated frequent utilization of inappropriate medications as well as medication underuse, and many drug therapy problems remained unresolved. The small size of the study may have limited the ability to detect a difference between the intervention and usual care groups. PMID:27625743
Chew, Boon-How; Yasin, Mazapuspavina Md; Cheong, Ai-Theng; Rashid, Mohd-Radzniwan A; Hamzah, Zuhra; Ismail, Mastura; Ali, Norsiah; Bashah, Baizury; Mohd-Salleh, Noridah
Perception of healthcare providers who worked with family medicine specialists (FMSs) could translate into the effectiveness of primary healthcare delivery in daily practices. This study examined perceptions of public healthcare providers/professionals (PHCPs) on FMSs at public health clinics throughout Malaysia. This was a cross-sectional study in 2012-2013 using postal method targeting PHCPs from three categories of health facilities, namely health clinics, health offices and hospitals. A structured questionnaire was developed to assess PHCP's perception of FMS's clinical competency, safety practice, ethical and professional values, and research involvement. It consists of 37 items with Likert scale of strongly disagree (a score of 1) to strongly agree (a score of 5). Interaction and independent effect of the independent variables were tested and adjusted means score were reported. The participants' response rate was 58.0% (780/1345) with almost equal proportion from each of the three public healthcare facilities. There were more positive perceptions than negative among the PHCPs. FMSs were perceived to provide effective and safe treatment to their patients equally disregards of patient's social background. However, there were some concerns of FMSs not doing home visits, not seeing walk-in patients, had long appointment time, not active in scientific research, writing and publication. There were significant differences in perception based on a respondent's health care facility (p < 0.0001) and frequency of encounter (p < 0.0001). PHCPs had overall positive perceptions on FMSs across all the domains investigated. PHCPs from different health care facilities and frequency of encounter with FMSs had different perception. Practicing FMSs could improve on the critical service areas that were perceived to be important but lacking. FMSs might need further support in conducting research and writing for publication.
Ameh, Charles A.; Kerr, Robert; Madaj, Barbara; Mdegela, Mselenge; Kana, Terry; Jones, Susan; Lambert, Jaki; Dickinson, Fiona; White, Sarah; van den Broek, Nynke
Background Healthcare provider training in Emergency Obstetric and Newborn Care (EmOC&NC) is a component of 65% of intervention programs aimed at reducing maternal and newborn mortality and morbidity. It is important to evaluate the effectiveness of this. Methods We evaluated knowledge and skills among 5,939 healthcare providers before and after 3–5 days ‘skills and drills’ training in emergency obstetric and newborn care (EmOC&NC) conducted in 7 sub-Saharan Africa countries (Ghana, Kenya, Malawi, Nigeria, Sierra Leone, Tanzania, Zimbabwe) and 2 Asian countries (Bangladesh, Pakistan). Standardised assessments using multiple choice questions and objective structured clinical examination (OSCE) were used to measure change in knowledge and skills and the Improvement Ratio (IR) by cadre and by country. Linear regression was performed to identify variables associated with pre-training score and IR. Results 99.7% of healthcare providers improved their overall score with a median (IQR) increase of 10.0% (5.0% - 15.0%) for knowledge and 28.8% (23.1% - 35.1%) for skill. There were significant improvements in knowledge and skills for each cadre of healthcare provider and for each country (p<0.05). The mean IR was 56% for doctors, 50% for mid-level staff and nurse-midwives and 38% for nursing-aides. A teaching job, previous in-service training, and higher percentage of work-time spent providing maternity care were each associated with a higher pre-training score. Those with more than 11 years of experience in obstetrics had the lowest scores prior to training, with mean IRs 1.4% lower than for those with no more than 2 years of experience. The largest IR was for recognition and management of obstetric haemorrhage (49–70%) and the smallest for recognition and management of obstructed labour and use of the partograph (6–15%). Conclusions Short in-service EmOC&NC training was associated with improved knowledge and skills for all cadres of healthcare providers working
Allin, Michael J
Assisted reproductive technology encompasses methods of achieving pregnancy by artificial or partially artificial means. Whilst these methods are more commonly used by couples suffering from problems of infertility, some forms of assistance are employed by fertile couples, for example pre-implantation genetic diagnosis. The overall regulatory framework in the UK is predominantly found in the Human Fertilisation and Embryology Act 1990. The usual rules relating to consent and autonomy apply and were discussed in depth in Evans v Amicus Healthcare Ltd and later in Evans v United Kingdom. This paper considers whether the Evans litigation envisages the possibility of further encouraging joint autonomy in the use of zygotes and whether there is a continuing right to autonomy by the party not bearing the pregnancy.
Eisenman, David; Weine, Stevan; Green, Bonnie; de Jong, Joop; Rayburn, Nadine; Ventevogel, Peter; Keller, Allen; Agani, Ferid
Mental health care for trauma-exposed populations in conflict-affected developing countries often is provided by primary healthcare providers (PHPs), including doctors, nurses, and lay health workers. The Task Force on International Trauma Training, through an initiative sponsored by the International Society for Traumatic Stress Studies and the RAND Corporation, has developed evidence- and consensus-based guidelines for the mental health training of PHPs in conflict-affected developing countries. This article presents the Guidelines, which provide a conceptual framework and specific principles for improving the quality of mental health training for PHPs working with trauma-exposed populations.
Slok, Annerika H M; Twellaar, Mascha; Jutbo, Leslie; Kotz, Daniel; Chavannes, Niels H; Holverda, Sebastiaan; Salomé, Philippe L; Dekhuijzen, P N Richard; Rutten-van Mölken, Maureen P M H; Schuiten, Denise; in ’t Veen, Johannes C C M; van Schayck, Onno C P
In the management of chronic conditions, such as chronic obstructive pulmonary disease (COPD), there is a shift from doctor-driven care to patient-centred integrated care with active involvement of and self-management by the patient. A recently developed tool, the assessment of burden of COPD (ABC) tool, can be used in this transition to facilitate self-management support and shared decision-making. We performed a qualitative study, in which we collected and analysed the data using the methods of conventional content analyses. We performed in-depth interviews consisting of mainly open questions. Fifteen healthcare providers and 21 patients were interviewed who had worked with the ABC tool in daily care. In general, participants responded positively to the tool. Healthcare providers felt the visual representation provided was effective and comprehensible for patients and provided them with insight into their disease, a finding that patients confirmed. If patients were allowed to choose between a consultation with or without the ABC tool, the majority would prefer using the tool: it provides them with an overview and insight, which makes it easier to discuss all relevant topics related to COPD. The tool can provide structure in consultations, and is compatible with the concepts of ‘motivational interviewing’ and ‘individualised care-planning’. Suggestions for improvement related to content and layout. So far, the tool has only been available as a stand-alone online program, that is not connected to the electronic medical record systems. It was therefore suggested that the tool be integrated into the systems to enhance its usability and its uptake by healthcare providers. PMID:27853139
Slok, Annerika H M; Twellaar, Mascha; Jutbo, Leslie; Kotz, Daniel; Chavannes, Niels H; Holverda, Sebastiaan; Salomé, Philippe L; Dekhuijzen, P N Richard; Rutten-van Mölken, Maureen P M H; Schuiten, Denise; In 't Veen, Johannes C C M; van Schayck, Onno C P
In the management of chronic conditions, such as chronic obstructive pulmonary disease (COPD), there is a shift from doctor-driven care to patient-centred integrated care with active involvement of and self-management by the patient. A recently developed tool, the assessment of burden of COPD (ABC) tool, can be used in this transition to facilitate self-management support and shared decision-making. We performed a qualitative study, in which we collected and analysed the data using the methods of conventional content analyses. We performed in-depth interviews consisting of mainly open questions. Fifteen healthcare providers and 21 patients were interviewed who had worked with the ABC tool in daily care. In general, participants responded positively to the tool. Healthcare providers felt the visual representation provided was effective and comprehensible for patients and provided them with insight into their disease, a finding that patients confirmed. If patients were allowed to choose between a consultation with or without the ABC tool, the majority would prefer using the tool: it provides them with an overview and insight, which makes it easier to discuss all relevant topics related to COPD. The tool can provide structure in consultations, and is compatible with the concepts of 'motivational interviewing' and 'individualised care-planning'. Suggestions for improvement related to content and layout. So far, the tool has only been available as a stand-alone online program, that is not connected to the electronic medical record systems. It was therefore suggested that the tool be integrated into the systems to enhance its usability and its uptake by healthcare providers.
Agaku, Israel T; Adisa, Akinyele O; Ayo-Yusuf, Olalekan A; Connolly, Gregory N
Introduction This study assessed the perceptions and behaviors of US adults about the security of their protected health information (PHI). Methods The first cycle of the fourth wave of the Health Information National Trends Survey was analyzed to assess respondents’ concerns about PHI breaches. Multivariate logistic regression was used to assess the effect of such concerns on disclosure of sensitive medical information to a healthcare professional (p<0.05). Results Most respondents expressed concerns about data breach when their PHI was being transferred between healthcare professionals by fax (67.0%; 95% CI 64.2% to 69.8%) or electronically (64.5%; 95% CI 61.7% to 67.3%). About 12.3% (95% CI 10.8% to 13.8%) of respondents had ever withheld information from a healthcare provider because of security concerns. The likelihood of information withholding was higher among respondents who perceived they had very little say about how their medical records were used (adjusted OR=1.42; 95% CI 1.03 to 1.96). Conclusions This study underscores the need for enhanced measures to secure patients’ PHI to avoid undermining their trust. PMID:23975624
Hutchison, Lauren A; Raffin-Bouchal, Donna S; Syme, Charlotte A; Biondo, Patricia D; Simon, Jessica E
Objectives Advance care planning is the process by which people reflect upon their wishes and values for healthcare, discuss their choices with family and friends and document their wishes. Readiness represents a key predictor of advance care planning participation; however, the evidence for addressing readiness is scarce within the renal failure context. Our objectives were to assess readiness for advance care planning and barriers and facilitators to advance care planning uptake in a renal context. Methods Twenty-five participants (nine patients, nine clinicians and seven family members) were recruited from the Southern Alberta Renal Program. Semi-structured interviews were recorded, transcribed and then analyzed using interpretive description. Results Readiness for advance care planning was driven by individual values perceived by a collaborative encounter between clinicians and patients/families. If advance care planning is not valued, then patients/families and clinicians are not ready to initiate the process. Patients and clinicians are delaying conversations until "illness burden necessitates," so there is little "advance" care planning, only care planning in-the-moment closer to the end of life. Discussion The value of advance care planning in collaboration with clinicians, patients and their surrogates needs reframing as an ongoing process early in the patient's illness trajectory, distinguished from end-of-life decision making.
Olivier, Jill; Tsimpo, Clarence; Gemignani, Regina; Shojo, Mari; Coulombe, Harold; Dimmock, Frank; Nguyen, Minh Cong; Hines, Harrison; Mills, Edward J; Dieleman, Joseph L; Haakenstad, Annie; Wodon, Quentin
At a time when many countries might not achieve the health targets of the Millennium Development Goals and the post-2015 agenda for sustainable development is being negotiated, the contribution of faith-based health-care providers is potentially crucial. For better partnership to be achieved and for health systems to be strengthened by the alignment of faith-based health-providers with national systems and priorities, improved information is needed at all levels. Comparisons of basic factors (such as magnitude, reach to poor people, cost to patients, modes of financing, and satisfaction of patients with the services received) within faith-based health-providers and national systems show some differences. As the first report in the Series on faith-based health care, we review a broad body of published work and introduce some empirical evidence on the role of faith-based health-care providers, with a focus on Christian faith-based health providers in sub-Saharan Africa (on which the most detailed documentation has been gathered). The restricted and diverse evidence reported supports the idea that faith-based health providers continue to play a part in health provision, especially in fragile health systems, and the subsequent reports in this Series review controversies in faith-based health care and recommendations for how public and faith sectors might collaborate more effectively.
Nie, Jing-Bao; Walker, Simon Thomas; Qiao, Shan; Li, Xiaoming; Tucker, Joseph D
Patients’ rights are central in today's legislation and social policies related to health care, including HIV care, in not only Western countries but around the world. However, given obvious socio-cultural differences it is often asked how or to what extent patients’ rights should be respected in non-Western societies such as China. In this paper, it is argued that the patients’ rights framework is compatible with Chinese culture, and that from the perspective of contemporary patient rights healthcare providers have a duty to disclose truthfully the diagnosis and prognosis to their patients, that the Chinese cultural practice of involving families in care should – with consent from the patient – be promoted out of respect for patients’ rights and well-being, and that healthcare providers should be prepared to address the issue of disclosing a patient's HIV status to sexual partner(s). Legally, the provider should be permitted to disclose without consent from the patient but not obliged to in all cases. The decision to do this should be taken with trained sensitivity to a range of ethically relevant considerations. Post-disclosure counseling or psychological support should be in place to address the concerns of potentially adverse consequences of provider-initiated disclosure and to maximize the psychosocial and medical benefits of the disclosure. There is an urgent need for healthcare providers to receive training in ethics and disclosure skills. This paper concludes also with some suggestions for improving the centerpiece Chinese legislation, State Council's “Regulations on AIDS Prevention and Control” (2006), to further safeguard the rights and well-being of HIV patients. PMID:26616129
Nie, Jing-Bao; Walker, Simon Thomas; Qiao, Shan; Li, Xiaoming; Tucker, Joseph D
Patients' rights are central in today's legislation and social policies related to health care, including HIV care, in not only Western countries but around the world. However, given obvious socio-cultural differences it is often asked how or to what extent patients' rights should be respected in non-Western societies such as China. In this paper, it is argued that the patients' rights framework is compatible with Chinese culture, and that from the perspective of contemporary patient rights healthcare providers have a duty to disclose truthfully the diagnosis and prognosis to their patients, that the Chinese cultural practice of involving families in care should - with consent from the patient - be promoted out of respect for patients' rights and well-being, and that healthcare providers should be prepared to address the issue of disclosing a patient's HIV status to sexual partner(s). Legally, the provider should be permitted to disclose without consent from the patient but not obliged to in all cases. The decision to do this should be taken with trained sensitivity to a range of ethically relevant considerations. Post-disclosure counseling or psychological support should be in place to address the concerns of potentially adverse consequences of provider-initiated disclosure and to maximize the psychosocial and medical benefits of the disclosure. There is an urgent need for healthcare providers to receive training in ethics and disclosure skills. This paper concludes also with some suggestions for improving the centerpiece Chinese legislation, State Council's "Regulations on AIDS Prevention and Control" (2006), to further safeguard the rights and well-being of HIV patients.
Objectives To live with heart failure means that life is delimited. Still, people with heart failure can have a desire to stay active in working life as long as possible. Although a number of factors affect sick leave and rehabilitation processes, little is known about sick leave and vocational rehabilitation concerning people with heart failure. This study aimed to identify emotions and encounters with healthcare professionals as possible predictors for the self-estimated ability to return to work in people on sick leave due to heart failure. Design A population-based cross-sectional study design was used. Setting The study was conducted in Sweden. Data were collected in 2012 from 3 different sources: 2 official registries and 1 postal questionnaire. Participants A total of 590 individuals were included. Statistics Descriptive statistics, correlation analysis and linear multiple regression analysis were used. Results 3 variables, feeling strengthened in the situation (β=−0.21, p=0.02), feeling happy (β=−0.24, p=0.02) and receiving encouragement about work (β=−0.32, p≤0.001), were identified as possible predictive factors for the self-estimated ability to return to work. Conclusions To feel strengthened, happy and to receive encouragement about work can affect the return to work process for people on sick leave due to heart failure. In order to develop and implement rehabilitation programmes to meet these needs, more research is needed. PMID:28186921
Yellow-page advertising is thought to be necessary for many practices. Purchasing such advertising is a relatively complex and expensive undertaking. This article outlines some of the pitfalls managers should consider when making such purchases. They should not be left to a neophyte. They should be considered within the general context of the practice's ability to market to patients directly, and careful attention must be given to the type, pricing, and placement of the advertising.
Krakower, Douglas S.; Oldenburg, Catherine E.; Mitty, Jennifer A.; Wilson, Ira B.; Kurth, Ann E.; Maloney, Kevin M.; Gallagher, Donna; Mayer, Kenneth H.
Background Antiretroviral treatment for HIV-infection before immunologic decline (early ART) and pre-exposure chemoprophylaxis (PrEP) can prevent HIV transmission, but routine adoption of these practices by clinicians has been limited. Methods Between September and December 2013, healthcare practitioners affiliated with a regional AIDS Education and Training Center in New England were invited to complete online surveys assessing knowledge, beliefs and practices regarding early ART and PrEP. Multivariable models were utilized to determine characteristics associated with prescribing intentions and practices. Results Surveys were completed by 184 practitioners. Respondent median age was 44 years, 58% were female, and 82% were white. Among ART-prescribing clinicians (61% of the entire sample), 64% were aware that HIV treatment guidelines from the Department of Health and Human Services recommended early ART, and 69% indicated they would prescribe ART to all HIV-infected patients irrespective of immunologic status. However, 77% of ART-prescribing clinicians would defer ART for patients not ready to initiate treatment. Three-fourths of all respondents were aware of guidance from the U.S. Centers for Disease Control and Prevention recommending PrEP provision, 19% had prescribed PrEP, and 58% of clinicians who had not prescribed PrEP anticipated future prescribing. Practitioners expressed theoretical concerns and perceived practical barriers to prescribing early ART and PrEP. Clinicians with higher percentages of HIV-infected patients (aOR 1.16 per 10% increase in proportion of patients with HIV-infection, 95% CI 1.01–1.34) and infectious diseases specialists (versus primary care physicians; aOR 3.32, 95% CI 0.98–11.2) were more likely to report intentions to prescribe early ART. Higher percentage of HIV-infected patients was also associated with having prescribed PrEP (aOR 1.19, 95% CI 1.06–1.34), whereas female gender (aOR 0.26, 95% CI 0.10–0.71) was associated
A Descriptive Study to Determine the Level of Crisis Preparedness Frontline Leaders Are Trained to Perform during an Exploding Crisis in Los Angeles County Healthcare Facilities, Providing Emergency Services
Corbaley, Salomay Rose
Purpose: The purpose of this study was to determine the level of crisis leadership preparedness facility administrators report frontline healthcare leaders are trained to perform during an exploding crisis in Los Angeles County healthcare facilities, providing emergency services. Methodology: This was a mixed method descriptive study. The…
Reiss, Michael; Greene, Carolyn A; Ford, Julian D
Communication between pediatric mental health and primary care providers is often inconsistent and frequently rated as unsatisfactory by providers of both disciplines. While numerous studies report pediatricians' desire for increased feedback from mental health providers, less is known about mental health providers' perspectives on collaborative communication with pediatricians. In the current qualitative study, 9 practitioners at 2 mental health practices participated in interviews about their experiences related to collaborating and communicating with pediatric providers. The interviews were analyzed inductively using thematic analysis procedures. Mental health providers consistently described the decision to communicate with pediatric primary care providers as occurring primarily when initiated by them, and on a "case by case" basis. Four determinants of the decision to initiate communication emerged from the interviews: severity of client concerns, mental health providers' own positive beliefs about collaborative/integrative mental health-pediatric care, perceptions of and past experiences with the primary care providers with whom they interact, and professional relationships with specific primary care providers. The findings of this study suggest that understanding and addressing the attitudes and beliefs that underlie both mental health and pediatric health care providers' decisions to engage in interprofessional communication is essential to establishing truly collaborative care.
Kennedy, Kieran M; Green, Peter G; Payne-James, J Jason
Complaints management is an integral component of good clinical governance and an essential contributor to patient safety. Little is known about complaints against health-care professionals (HCPs) in police custodial settings and sexual assault referral centres. This study explored the frequency with which complaints are made against such HCPs working in England, Wales and Northern Ireland. It explored the nature of those complaints and the procedures by which they are investigated. Relevant information was requested from all police services in England, Wales and Northern Ireland; professional regulatory bodies; and the Independent Police Complaints Commission under the Freedom of Information Act (FOIA). Eighty-nine per cent of police services responded to the FOIA request. However, only a minority of these provided detailed information. Many police services cited the provision of health-care services by external providers as the reason for not holding information upon complaints. There was no evidence of any upward trend in the numbers of complaints over the study period. Delayed response to a request for attendance, incivility, medication issues and issues regarding the quality of reports and evidence were amongst the most common types of complaints described. A small number of responders provided copies of the disciplinary procedures used to manage complaints against HCPs. Significant heterogeneity exists in respect of complaints handling procedures across custodial and forensic medical/health-care services and sexual offence examiner services. An opportunity to identify learning for improvement is being missed as a result of the absence of standardised complaints handling procedures.
Sison, Nathan; Yolken, Annajane; Poceta, Joanna; Mena, Leandro; Chan, Philip A; Barnes, Arti; Smith, Erin; Nunn, Amy
The Mississippi Delta region is one of the communities most heavily impacted by HIV/AIDS in the United States. To understand local provider attitudes and practices regarding HIV testing and care, we conducted 25 in-depth qualitative interviews with local primary care providers and infectious disease specialists. Interviews explored attitudes and practices regarding HIV testing and linkage to care. Most providers did not routinely offer HIV testing, noting financial barriers, financial disincentives to offer routine screening, misperceptions about local informed consent laws, perceived stigma among patients, and belief that HIV testing was the responsibility of the health department. Barriers to enhancing treatment and care included stigma, long distances, lack of transportation, and paucity of local infectious disease specialists. Opportunities for enhancing HIV testing and care included provider education programs regarding billing, local HIV testing guidelines, and informed consent, as well as telemedicine services for underserved counties. Although most health care providers in our study did not currently offer routine HIV testing, all were willing to provide more testing and care services if they were able to bill for routine testing. Increasing financial reimbursement and access to care, including through the Affordable Care Act, may provide an opportunity to enhance HIV/AIDS services in the Mississippi Delta.
Background In India, approximately 49,000 women living with HIV become pregnant and deliver each year. While the government of India has made progress increasing the availability of prevention of mother-to-child transmission of HIV (PMTCT) services, only about one quarter of pregnant women received an HIV test in 2010, and about one-in-five that were found positive for HIV received interventions to prevent vertical transmission of HIV. Methods Between February 2012 to March 2013, 14 HIV-positive women who had recently delivered a baby were recruited from HIV positive women support groups, Government of India Integrated Counseling and Testing Centers, and nongovernmental organizations in Mysore and Pune, India. In-depth interviews were conducted to examine their general experiences with antenatal healthcare; specific experiences around HIV counseling and testing; and perceptions about their care and follow-up treatment. Data were analyzed thematically using the human rights framework for HIV testing adopted by the United Nations and India’s National AIDS Control Organization. Results While all of the HIV-positive women in the study received HIV and PMTCT services at a government hospital or antiretroviral therapy center, almost all reported attending a private clinic or hospital at some point in their pregnancy. According to the participants, HIV testing often occurred without consent; there was little privacy; breaches of confidentiality were commonplace; and denial of medical treatment occurred routinely. Among women living with HIV in this study, violations of their human rights occurred more commonly in private rather than public healthcare settings. Conclusions There is an urgent need for capacity building among private healthcare providers to improve standards of practice with regard to informed consent process, HIV testing, patient confidentiality, treatment, and referral of pregnant women living with HIV. PMID:24656059
This article sets out the moral failure of single-tier basic healthcare. Single-tier basic healthcare has been advocated on the grounds that the provision of healthcare should be divorced from ability to pay and unequal access to basic healthcare is morally intolerable. However, single-tier basic healthcare encounters a host of catastrophic moral failings. Given the fact of human pluralism it is impossible to objectively define "basic" healthcare. Attempts to provide single-tier healthcare therefore become political processes in which interest groups compete for control of scarce resources with the most privileged possessing an inherent advantage. The focus on outputs in arguments for single-tier provision neglects the question of justice between individuals when some people provide resources for others without reciprocal benefits. The principle that only healthcare that can be provided to everyone should be provided at all leads to a leveling-down problem in which advocates of single-tier provision must prefer a situation where some individuals are made worse-off without any individual being made better-off compared to plausible multi-tier alternatives. Contemporary single-tier systems require the exclusion of noncitizens, meaning that their universalism is a myth. In the light of these pathologies, it is judged that multi-tier healthcare is morally required.
Boro, Maureen S; Korman, Nancy E; Davoren, J Ben
Objective To categorize the appropriateness of provider and pharmacist responses to warfarin critical drug–drug interaction (cDDI) alerts, assess responses and actions to the cDDI, and determine the occurrence of warfarin adverse drug events (ADE) after alerts. Design An 18-month, retrospective study of acute care admissions at a single Veterans Affairs medical center using computerized provider order entry (CPOE). Measurements Patients included had at least one warfarin cDDI alert. Chart reviews included baseline laboratory values and demographics, provider actions, patient outcomes, and associated factors, including other interacting medications and number of simultaneously processed alerts. Results 137 admissions were included (133 unique patients). Amiodarone, vitamin E in a multivitamin, sulfamethoxazole, and levothyroxine accounted for 75% of warfarin cDDI. Provider responses were clinically appropriate in 19.7% of admissions and pharmacist responses were appropriate in 9.5% of admissions. There were 50 ADE (36.6% of admissions) with warfarin; 80% were rated as having no or mild clinical effect. An increased number of non-critical alerts at the time of the reference cDDI alert was the only variable associated with an inappropriate provider response (p=0.01). Limitations This study was limited by being a retrospective review and the possibility of confounding variables, such as other interacting medications. Conclusion The large number of CPOE alerts may lead to inappropriate responses by providers and pharmacists. The high rate of ADE suggests a need for improved medication management systems for patients on warfarin. This study highlights the possibility of alert fatigue contributing to the high prevalence of inappropriate alert over-ride text responses. PMID:22037888
hypertension . The importance of monitoring high blood pressure (follow-up) and...research to provide contemporary approaches to hypertension control, and further classified a high normal blood pressure with hypertension in three stages...managing high blood pressure and its deleterious complications. The JNC VI (1997) recommendation (a) classified blood pressure ( hypertension ),
Katz, Mira L.; Heaner, Sarah; Reiter, Paul; van Putten, Julie; Murray, Lee; McDougle, Leon; Cegala, Donald J.; Post, Douglas; David, Prabu; Slater, Michael; Paskett, Electra D.
Background: Low rates of colorectal cancer (CRC) screening persist due to individual, provider, and system level barriers. Purpose: To develop and obtain initial feedback about a CRC screening educational video from community members and medical professionals. Methods: Focus groups of patients were conducted prior to the development of the CRC…
hypertension . The importance of monitoring high blood pressure (follow-up) and maintaining blood pressure control was examined...committee used evidence-based research to provide contemporary approaches to hypertension control, and further classified a high normal blood pressure ... Blood Pressure High Normal Hypertension 130-139 mm Hg 85-89 mm Hg Stage 1 140-159 mm Hg 90-99 mm Hg Stage 2 160-179 mm Hg 100-109 mm Hg Stage 3 ≥ 180
Abushaikha, Lubna; Khalaf, Inaam
Although the postpartum period is a significant time in a family's life, few studies have addressed the lack of continuity of care and service use during the postpartum period. The aim of this study was to explore the roles of family members in Jordanian women's decision to use postpartum health care services. An exploratory qualitative design was employed to elicit the perspectives of 24 women and 30 health care providers through six focus groups discussions conducted in April 2006. Interviews were transcribed verbatim, translated to English, and analyzed using an inductive content analysis approach. In our study, three roles of family members influencing Jordanian women's decision to use postpartum health care services emerged: supporter role, opponent role, and active participant in care role. Findings supported the need for a family-centered approach when providing postpartum care to enhance positive family roles and limit negative ones to promote continuity of healthcare services use during the postpartum period.
Royak-Schaler, Renee; Blocker, Deborah E.; Yali, Ann Marie; Bynoe, Monica; Briant, Katherine Josa; Smith, Shannon
BACKGROUND: Information on breast and colorectal cancer risk factors is widely available to women and the physicians who provide their healthcare; however, many women are unable to identify the major risk factors, continue to misperceive their personal risk of developing these cancers, and do not engage in routine early detection. METHODS: Qualitative methods were used to investigate breast and colorectal cancer risk knowledge, perceptions, behaviors, and risk communication formats with low-income African-American and Hispanic study participants in Harlem, NY, aged 40-60 years. RESULTS: Focus group results indicated strong participant interest in strategies necessary to understand and reduce the risk of developing breast and colorectal cancers. Preferred risk communication tools presented information about family history and personal risk in graphic and quantitative formats. CONCLUSIONS: Healthcare professionals who serve low-income African-American and Hispanic female populations should deliver information to them about the personal risk of developing targeted cancers and ways to reduce this risk in formats that are meaningful and effectively address the special needs of these populations. PMID:15160974
Belle, Ashwin; Thiagarajan, Raghuram; Soroushmehr, S M Reza; Navidi, Fatemeh; Beard, Daniel A; Najarian, Kayvan
The rapidly expanding field of big data analytics has started to play a pivotal role in the evolution of healthcare practices and research. It has provided tools to accumulate, manage, analyze, and assimilate large volumes of disparate, structured, and unstructured data produced by current healthcare systems. Big data analytics has been recently applied towards aiding the process of care delivery and disease exploration. However, the adoption rate and research development in this space is still hindered by some fundamental problems inherent within the big data paradigm. In this paper, we discuss some of these major challenges with a focus on three upcoming and promising areas of medical research: image, signal, and genomics based analytics. Recent research which targets utilization of large volumes of medical data while combining multimodal data from disparate sources is discussed. Potential areas of research within this field which have the ability to provide meaningful impact on healthcare delivery are also examined.
Belle, Ashwin; Thiagarajan, Raghuram; Soroushmehr, S. M. Reza; Navidi, Fatemeh; Beard, Daniel A.; Najarian, Kayvan
The rapidly expanding field of big data analytics has started to play a pivotal role in the evolution of healthcare practices and research. It has provided tools to accumulate, manage, analyze, and assimilate large volumes of disparate, structured, and unstructured data produced by current healthcare systems. Big data analytics has been recently applied towards aiding the process of care delivery and disease exploration. However, the adoption rate and research development in this space is still hindered by some fundamental problems inherent within the big data paradigm. In this paper, we discuss some of these major challenges with a focus on three upcoming and promising areas of medical research: image, signal, and genomics based analytics. Recent research which targets utilization of large volumes of medical data while combining multimodal data from disparate sources is discussed. Potential areas of research within this field which have the ability to provide meaningful impact on healthcare delivery are also examined. PMID:26229957
Amar, Claudia; Verma, Jennifer; King, Darla; MacAusland, Donna; Harper, Therese; Vallis, Michael
In Atlantic Canada, people live with greater risk factors and higher rates of chronic disease than the average Canadian; and health system costs have historically risen faster than other parts of the country. Many clinicians endorse self-management support (SMS) as a means to help patients manage their chronic conditions but often lack the confidence and proper expertise to do so due to limited literature on SMS implementation. This paper draws on two case examples from Atlantic Canada to address gaps between effective SMS interventions and the implementation and evaluation of such interventions that can support provider adoption.
Connell, Tanya; Fernandez, Ritin S; Griffiths, Rhonda; Tran, Duong; Agar, Meera; Harlum, Janeane; Langdon, Rachel
A wide range of services are provided to palliative care clients to alleviate pain and improve their quality of life. The purpose of this study was to explore the perceptions of clients and their carers regarding palliative care services in New South Wales, Austalia. Ten patients and their carers (n = 7) were randomly selected from a sample of palliative care clients and were informed of the study and interviewed. Interview data were coded independently by three researchers and thematic analysis was undertaken. The themes identified were similar for both clients and carers and included: access to services; service provision; impact on way of life; usefulness of services; and staffing. An additional theme identified by clients was the burden of caregiving on carers. Knowledge of perceptions and concerns of client and carers is important to consider when planning palliative care services.
Caulfield, Timothy; Duijst, Wilma; Bos, Mike; Chassis, Iris; Codreanu, Igor; Danovitch, Gabriel; Gill, John; Ivanovski, Ninoslav; Shin, Milbert
Physicians and other health care professionals seem well placed to play a role in the monitoring and, perhaps, in the curtailment of the trafficking in human beings for the purpose of organ removal. They serve as important sources of information for patients and may have access to information that can be used to gain a greater understanding of organ trafficking networks. However, well-established legal and ethical obligations owed to their patients can create challenging policy tensions that can make it difficult to implement policy action at the level of the physician/patient. In this article, we explore the role-and legal and ethical obligations-of physicians at 3 key stages of patient interaction: the information phase, the pretransplant phase, and the posttransplant phase. Although policy challenges remain, physicians can still play a vital role by, for example, providing patients with a frank disclosure of the relevant risks and harms associated with the illegal organ trade and an honest account of the physician's own moral objections. They can also report colleagues involved in the illegal trade to an appropriate regulatory authority. Existing legal and ethical obligations likely prohibit physicians from reporting patients who have received an illegal organ. However, given the potential benefits that may accrue from the collection of more information about the illegal transactions, this is an area where legal reform should be considered.
Caulfield, Timothy; Duijst, Wilma; Bos, Mike; Chassis, Iris; Codreanu, Igor; Danovitch, Gabriel; Gill, John; Ivanovski, Ninoslav; Shin, Milbert
Abstract Physicians and other health care professionals seem well placed to play a role in the monitoring and, perhaps, in the curtailment of the trafficking in human beings for the purpose of organ removal. They serve as important sources of information for patients and may have access to information that can be used to gain a greater understanding of organ trafficking networks. However, well-established legal and ethical obligations owed to their patients can create challenging policy tensions that can make it difficult to implement policy action at the level of the physician/patient. In this article, we explore the role—and legal and ethical obligations—of physicians at 3 key stages of patient interaction: the information phase, the pretransplant phase, and the posttransplant phase. Although policy challenges remain, physicians can still play a vital role by, for example, providing patients with a frank disclosure of the relevant risks and harms associated with the illegal organ trade and an honest account of the physician's own moral objections. They can also report colleagues involved in the illegal trade to an appropriate regulatory authority. Existing legal and ethical obligations likely prohibit physicians from reporting patients who have received an illegal organ. However, given the potential benefits that may accrue from the collection of more information about the illegal transactions, this is an area where legal reform should be considered. PMID:27500253
Background The problem list is a key part of the electronic health record (EHR) that allows practitioners to see a patient’s diagnoses and health issues. Yet, as the content of the problem list largely represents the subjective decisions of those who edit it, patients’ problem lists are often unreliable when shared across practitioners. The lack of standards for how the problem list is compiled in the EHR limits its effectiveness in improving patient care, particularly as a resource for clinical decision support and population management tools. The purpose of this study is to discover practitioner opinions towards the problem list and the logic behind their decisions during clinical situations. Materials and methods An observational cross-sectional study was conducted at two major Boston teaching hospitals. Practitioners’ opinions about the problem list were collected through both in-person interviews and an online questionnaire. Questions were framed using vignettes of clinical scenarios asking practitioners about their preferred actions towards the problem list. Results These data confirmed prior research that practitioners differ in their opinions over managing the problem list, but in most responses to a questionnaire, there was a common approach among the relative majority of respondents. Further, basic demographic characteristics of providers (age, medical experience, etc.) did not appear to strongly affect attitudes towards the problem list. Conclusion The results supported the premise that policies and EHR tools are needed to bring about a common approach. Further, the findings helped identify what issues might benefit the most from a defined policy and the level of restriction a problem list policy should place on the addition of different types of information. PMID:23140312
Barnes, Emily R.; Theeke, Laurie A.; Mallow, Jennifer
Rationale, aims and objectives Obesity is significantly underdiagnosed and undertreated in primary care settings. The purpose of this clinical practice change project was to increase provider adherence to national clinical practice guidelines for the diagnosis and treatment of obesity in adults. Methods Based upon the National Institutes of Health guidelines for the diagnosis and treatment of obesity, a clinical change project was implemented. Guided by the theory of planned behaviour, the Provider and Healthcare team Adherence to Treatment Guidelines (PHAT-G) intervention includes education sessions, additional provider resources for patient education, a provider reminder system and provider feedback. Results Primary care providers did not significantly increase on documentation of diagnosis and planned management of obesity for patients with body mass index (BMI) greater than or equal to 30. Medical assistants increased recording of height, weight and BMI in the patient record by 13%, which was significant. Conclusions Documentation of accurate BMI should lead to diagnosis of appropriate weight category and subsequent care planning. Future studies will examine barriers to adherence to clinical practice guidelines for obesity. Interventions are needed that include inter-professional team members and may be more successful if delivered separately from routine primary care visits. PMID:25558956
Kahn, Steven A; Iannuzzi, James C; Stassen, Nicole A; Bankey, Paul E; Gestring, Mark
Hospital quality metrics now reflect patient satisfaction and are measured by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Understanding these metrics and drivers will be integral in providing quality care as this process evolves. This study identifies factors associated with patient satisfaction as determined by HCAHPS survey responses in trauma and acute care surgery patients. HCAHPS survey responses from acute care surgery and trauma patients at a single institution between 3/11 and 10/12 were analyzed. Logistic regression determined which responses to individual HCAHPS questions predicted highest hospital score (a rating of 9-10/10). Demographic and clinical variables were also analyzed as predictors of satisfaction. Subgroup analysis for trauma patients was performed. In 70.3 per cent of 182 total survey responses, a 9-10/10 score was given. The strongest predictors of highest hospital ranking were respect from doctors (odds ratio [OR] = 24.5, confidence interval [CI]: 5.44-110.4), doctors listening (OR: 9.33, CI: 3.7-23.5), nurses' listening (OR = 8.65, CI: 3.62-20.64), doctors' explanations (OR = 8.21, CI: 3.5-19.2), and attempts to control pain (OR = 7.71, CI: 3.22-18.46). Clinical factors and outcomes (complications, intensive care unit/hospital length of stay, mechanism of injury, and having an operation) were nonsignificant variables. For trauma patients, Injury Severity Score was inversely related to score (OR = 0.93, CI: 0.87-0.98). Insurance, education, and disposition were also tied to satisfaction, whereas age, gender, and ethnicity were nonsignificant. In conclusion, patient perception of interactions with the healthcare team was most strongly associated with satisfaction. Complications did not negatively influence satisfaction. Insurance status might potentially identify patients at risk of dissatisfaction. Listening to patients, treating them with respect, and explaining the care plan are integral to a
Ferreira, Ronél; Ebersöhn, Liesel
The article describes the pilot phase of a participatory reflection and action (PRA) study. The longitudinal investigation explores teachers' ability to provide psychosocial support within the context of HIV/AIDS following an asset-based intervention. The study ensued from our desire to understand and contribute to knowledge about the changed roles of teachers due to adversity in the community, specifically in relation to HIV/AIDS and education. The supportive teachers, assets and resilience (STAR) intervention was facilitated from November 2003 to October 2005 and consisted of the research team undertaking nine field visits and facilitating 20 intervention sessions (2-3 hours each), and 12 post-intervention research visits have been conducted to date. Ten female teachers were selected for participation through random purposeful sampling at a primary school in an informal settlement outside Port Elizabeth, South Africa. Data-generation included PRA activities, observation, informal interactive interviews, and focus group discussions. The data were analysed by means of inductive thematic analysis. We found that the teachers did not view vulnerability as being related to children or HIV/AIDS in isolation, but rather that their psychosocial support to children and the school community was inclusive across a spectrum of vulnerabilities and services. We argue that teachers who are inclined to provide such support will fulfil this role irrespective of understanding policy or receiving training. We contend that teachers are well-positioned to manage school-based psychosocial support in order to create relevant and caring spaces for vulnerable individuals in the school community.
Brahmandam, Sruti; Holland, Wesley C.; Mangipudi, Sowmya A.; Braz, Valerie A.; Medlin, Richard P.; Hunold, Katherine M.; Jones, Christopher W.; Platts-Mills, Timothy F.
OBJECTIVES To estimate the proportion of older adults in the emergency department (ED) who are willing and able to use a tablet computer to answer questions. DESIGN Prospective, ED-based cross-sectional study. SETTING Two U.S. academic EDs. PARTICIPANTS Individuals aged 65 and older. MEASUREMENTS As part of screening for another study, potential study participants were asked whether they would be willing to use a tablet computer to answer eight questions instead of answering questions orally. A custom user interface optimized for older adults was used. Trained research assistants observed study participants as they used the tablets. Ability to use the tablet was assessed based on need for assistance and number of questions answered correctly. RESULTS Of 365 individuals approached, 248 (68%) were willing to answer screening questions, 121 of these (49%) were willing to use a tablet computer; of these, 91 (75%) were able to answer at least six questions correctly, and 35 (29%) did not require assistance. Only 14 (12%) were able to answer all eight questions correctly without assistance. Individuals aged 65 to 74 and those reporting use of a touchscreen device at least weekly were more likely to be willing and able to use the tablet computer. Of individuals with no or mild cognitive impairment, the percentage willing to use the tablet was 45%, and the percentage answering all questions correctly was 32%. CONCLUSION Approximately half of this sample of older adults in the ED was willing to provide information using a tablet computer, but only a small minority of these were able to enter all information correctly without assistance. Tablet computers may provide an efficient means of collecting clinical information from some older adults in the ED, but at present, it will be ineffective for a significant portion of this population. PMID:27804126
Brown, Cary A; Dickson, Rumona
To be critical healthcare consumers, patients must learn self-management skills and become active participants in knowledge management and exchange. eHealth literacy is considered critical to the development of these self-management skills. The World Health Organization identifies five core competencies required of all healthcare providers working with persons with chronic conditions, and this paper focuses on the fourth--the ability to employ information and communication technology. To supplement our literature-based argument, we also present findings from a class of first-year masters-level occupational therapy students asked to complete an existing standardized e-health literacy survey, eHEALS, as a learning activity. The eHEALS revealed that students reported confidence in their ability to critically appraise internet information but were not confident enough in those skills to use the information to make decisions without consulting a healthcare provider. It appeared that the students were not yet fully immersed in their role of healthcare professional and seemed to move between the roles of healthcare provider and healthcare recipient as they reflected on the class' answers to the eHEALS assessment. Evaluation of eHealth literacy is complex and needs to consider the multiple roles assumed by those whose knowledge is being assessed.
van der Elst, Elise M; Gichuru, Evans; Omar, Anisa; Kanungi, Jennifer; Duby, Zoe; Midoun, Miriam; Shangani, Sylvia; Graham, Susan M; Smith, Adrian D; Sanders, Eduard J; Operario, Don
Introduction Men who have sex with men (MSM) in Kenya are at high risk for HIV and may experience prejudiced treatment in health settings due to stigma. An on-line computer-facilitated MSM sensitivity programme was conducted to educate healthcare workers (HCWs) about the health issues and needs of MSM patients. Methods Seventy-four HCWs from 49 ART-providing health facilities in the Kenyan Coast were recruited through purposive sampling to undergo a two-day MSM sensitivity training. We conducted eight focus group discussions (FGDs) with programme participants prior to and three months after completing the training programme. Discussions aimed to characterize HCWs’ challenges in serving MSM patients and impacts of programme participation on HCWs’ personal attitudes and professional capacities. Results Before participating in the training programme, HCWs described secondary stigma, lack of professional education about MSM, and personal and social prejudices as barriers to serving MSM clients. After completing the programme, HCWs expressed greater acknowledgement of MSM patients in their clinics, endorsed the need to treat MSM patients with high professional standards and demonstrated sophisticated awareness of the social and behavioural risks for HIV among MSM. Conclusions Findings provide support for this approach to improving health services for MSM patients. Further efforts are needed to broaden the reach of this training in other areas, address identified barriers to HCW participation and evaluate programme effects on patient and HCW outcomes using rigorous methodology. PMID:24321109
Tuthill, Emily L; Chan, Jessica; Butler, Lisa M
Exclusive breastfeeding (EBF) has been identified as the optimal nutrition and critical behavior in attaining human immunodeficiency virus (HIV)-free infant survival in resource-limited settings. Health-care providers (HCPs) in clinic- and community-settings throughout sub-Saharan Africa (sSA) provide infant-feeding counseling. However, rates of EBF at 6 months of age are suboptimal. HCPs are uniquely positioned to educate HIV-positive mothers and provide support by addressing known barriers to EBF. However, limited evidence exists on the experiences faced by HCPs in providing counseling on infant feeding to HIV-positive women. Our objective is to describe experiences faced by HCPs when delivering infant-feeding counseling in the context of HIV in program settings in sSA. We searched a range of electronic databases, including PubMed, CINAHL, and PsycINFO from January 1990 to February 2013, in addition to hand-searching, cross-reference searching, and personal communications. The search was limited to publications in English. Empirical studies of HCP experiences providing infant-feeding counseling in the prevention of mother-to-child transmission (PMTCT) of HIV programs in sSA were selected. We identified 10 peer-reviewed articles reporting HCP challenges in infant-feeding counseling that met inclusion criteria. Articles included qualitative, cross-sectional and mixed-method studies, and cumulatively reported 31 challenges faced by HCPs. Among the challenges identified, the most commonly reported were personal beliefs held by the HCPs toward infant feeding in the context of HIV, contradictory messages, staff workload, directive counseling styles, and a lack of practical strategies to offer mothers, often leading to improvised counseling approaches. Counseling strategies need to be developed that are relevant, meaningful, and responsive to the needs of both HCPs and mothers.
Although Marianna Fotaki's Editorial is helpful and challenging by looking at both the professional and institutional requirements for reinstalling compassion in order to aim for good quality healthcare, the causes that hinder this development remain unexamined. In this commentary, 3 causes are discussed; the boundary between the moral and the political; Neoliberalism; and the underdevelopment of reflection on the nature of care. A plea is made for more philosophical reflection on the nature of care and its implications in healthcare education.
Langlois, Roxane; Fontaine, Francine; Hamel, Caroline; Joubert, Sven
ABSTRACTThe aim of this study was to investigate the impact of aging on the ability a) to name famous faces and b) to access biographical knowledge about famous people from different modalities of presentation (faces and names). Healthy elderly subjects (n = 117) divided into three different age groups were assessed using a semantic memory test of famous people. Results of this study indicate a decline in naming performance between oldest and youngest groups. In contrast, no difference between groups was found in terms of the ability to access semantic knowledge about famous people. Finally, a main effect of modality of presentation (faces vs. names) was found, revealing greater ability to identify famous people in the verbal (names) than in the visual modality (faces). Taken together, results of this study may contribute to developing new cognitive intervention programs in older adults presenting with proper-name anomia.
Kim, Min J; Winkler, Sabune J; Bierer, Barbara E; Wolf, Delia
The Food and Drug Administration (FDA) regulations require sponsors of clinical investigations involving an investigational drug or device to submit an Investigational New Drug (IND) or Investigational Device Exemption (IDE) application. Strict adherence to applicable regulations is vital to the success of clinical research. Unlike most major pharmaceutical sponsors, investigator sponsors often do not fully appreciate their regulatory obligations nor have resources to ensure compliance. As a result they can place themselves and their institutions at risk. Nevertheless, investigator-initiated clinical trials are vital to the further development of innovative drugs, biologics, and medical devices. The IND/IDE Subcommittee under the Regulatory Knowledge and Support Program at Harvard Catalyst, The Harvard Clinical and Translational Science Center worked in collaboration with Harvard and Harvard affiliated institutions to create and launch an IND/IDE Consult Service in a decentralized network of collaborating Academic Healthcare Centers (AHC). The IND/IDE Consult Service offers expertise, resources, and shared experiences to assist sponsor-investigators and IRBs in meeting regulatory requirements for conducting and reviewing investigator-initiated IND/IDE studies. The scope of the services provided by the Harvard Catalyst IND/IDE Consult Service are described, including the specifics of the service, lessons learned, and challenges faced, in a scalable model that builds inter-institutional capacity.
Gupta, Anshu; Gupta, Chhavi
Context: Certain quality indicators are mandatory in the maintenance and improvement of quality in blood transfusion. Monitoring of such indicators should be done regularly and deficiencies are to be corrected for effective blood transfusion services. Aims: To study the usefulness of monitoring of the National Accreditation Board for Hospitals and Healthcare Providers (NABH) core indicators in blood transfusion and in the maintenance of hemovigilance. Settings and Design: Hemovigilance is a quality process to improve quality and increase the safety of blood transfusion. It covers and surveys all activities of the blood transfusion chain from donors to recipients. Core indicators’ monitoring is a part of the hemovigilance process. Materials and Methods: A 2-year retrospective study was conducted in a blood storage unit of a NABH accredited tertiary care hospital of a metropolitan city. Four NABH core indicators in blood transfusion were observed and monitored by the clinical and blood storage unit staff of different levels. Results: It was observed that there was an improvement in quality by core indicators monitoring with decreased wastage of blood and blood components, decreased average turnaround time for issue of blood and blood components, and lesser number of transfusion reactions. Conclusion: This study demonstrated that monitoring of NABH core indicators results in the enhancement of quality and safety in blood transfusion services, reducing the incidence of transfusion reactions. PMID:27011668
Wright, Kylie M; Simpson, Grahame K; Koh, Eng-Siew; Whiting, Diane L; Gillett, Lauren; Simpson, Teresa; Firth, Rochelle
Behavioral and cognitive changes in patients with primary brain tumor (PBT) are common and may be distressing to patients and their family members. Healthcare professionals report a strong need for information, practical strategies, and training to assist consumers and better address management issues. A literature review by the current project found that 53% of the information resources currently available to consumers and health professionals contained minimal or no information about cognitive/behavioral changes after PBT, and 71% of the resources contained minimal or no information on associated strategies to manage these changes. This project aimed to develop an information resource for patients, carers, and health professionals addressing the behavioral and cognitive sequelae of PBT, including strategies to minimize the disabling impact of such behaviors. In consultation with staff and patient groups, 16 key information topics were identified covering cognitive and communication changes and challenging behaviors including executive impairment, behavioral disturbance, and social/emotional dysfunction. Sixteen fact sheets and 11 additional resource sheets were developed and evaluated according to established consumer communication guidelines. Preliminary data show that these resources have been positively received and well utilized. These sheets are the first of their kind addressing challenging behaviors in the neuro-oncology patient group and are a practical and useful information resource for health professionals working with these patients and their families. The new resource assists in reinforcing interventions provided to individual patients and their relatives who are experiencing difficulties in managing challenging behaviors after PBT.
Nordgren, Lena; Söderlund, Anne
Younger people with heart failure often experience poor self-rated health. Furthermore, poor self-rated health is associated with long-term sick leave and disability pension. Socio-demographic factors affect the ability to return to work. However, little is known about people on sick leave due to heart failure. The aim of this study was to investigate associations between self-rated health, mood, socio-demographic factors, sick leave compensation, encounters with healthcare professionals and social insurance officers and self-estimated ability to return to work, for people on sick leave due to heart failure. This population-based investigation had a cross-sectional design. Data were collected in Sweden in 2012 from two official registries and from a postal questionnaire. In total, 590 subjects, aged 23-67, responded (response rate 45.8%). Descriptive statistics, correlation analyses (Spearman bivariate analysis) and logistic regression analyses were used to investigate associations. Poor self-rated health was strongly associated with full sick leave compensation (OR = 4.1, p < .001). Compared self-rated health was moderately associated with low income (OR = .6, p = .003). Good self-rated health was strongly associated with positive encounters with healthcare professionals (OR = 3.0, p = .022) and to the impact of positive encounters with healthcare professionals on self-estimated ability to return to work (OR = 3.3, p < .001). People with heart failure are sicklisted for long periods of time and to a great extent receive disability pension. Not being able to work imposes reduced quality of life. Positive encounters with healthcare professionals and social insurance officers can be supportive when people with heart failure struggle to remain in working life.
Background The need to understand preferred sources of health information remains important to providing patient-centered care. The Internet remains a popular resource for health information, but more traditional sources may still be valid for patients during a recent health need. This study sought to understand the characteristics of patients that turn to their doctor or healthcare provider first for a recent health or medical information need. Methods Using the national cross-sectional survey, Health Information National Trend Study [HINTS], characteristics of those who sought a doctor or healthcare provider for a recent health information need were compared to other sources. Weighted survey responses from Cycle 1 and Cycle 2 of the HINTS survey were used for multivariable logistic regression. Results A total 5,307 patient responses were analyzed. Overall, those who seek a doctor or healthcare provider first for a health need are female, 46–64 years, White non-Hispanic, educated, in good health and users of the Internet. Yet, adjusted logistic regressions showed that those who sought a doctor or healthcare provider first during a recent health information need compared to other sources were most likely to be 65+ years, in poor health, less educated and have health insurance. Conclusions Patients who seek their doctor or healthcare provider first for health information rather than other sources of information represent a unique population. Doctors or healthcare providers remain an important resource for these patients during recent needs, despite the wide use of the Internet as a source of health information. PMID:24906558
Previous research in cognitive diagnostic assessment (CDA) of L2 reading ability has been frequently conducted using large-scale English proficiency exams (e.g., TOEFL, MELAB). Using CDA, it is possible to analyze individual learners' strengths and weaknesses in multiple attributes (i.e., knowledge, skill, strategy) measured at the item level.…
It is now commonly realized that the globalization of the world economy is shaping the patterns of global health, and that associated morbidity and mortality is affecting countries' ability to achieve economic growth. The globalization of public health has important implications for access to essential healthcare. The rise of inequalities among and within countries negatively affects access to healthcare. Poor people use healthcare services less frequently when sick than do the rich. The negative impact of globalization on access to healthcare is particularly well demonstrated in countries of transitional economies. No longer protected by a centralized health sector that provided free universal access to services for everyone, large segments of the populations in the transition period found themselves denied even the most basic medical services. Only countries where regulatory institutions are strong, domestic markets are competitive and social safety nets are in place, have a good chance to enjoy the health benefits of globalization.
Underhill, Kristen; Morrow, Kathleen M.; Colleran, Christopher M.; Holcomb, Richard; Operario, Don; Calabrese, Sarah K.; Galárraga, Omar; Mayer, Kenneth H.
Background Pre-exposure prophylaxis (PrEP) is a promising strategy for HIV prevention among men who have sex with men (MSM) and men who engage in sex work. But access will require routine HIV testing and contacts with healthcare providers. This study investigated men’s healthcare and HIV testing experiences to inform PrEP implementation. Methods We conducted 8 focus groups (n = 38) in 2012 and 56 in-depth qualitative interviews in 2013–14 with male sex workers (MSWs) (n = 31) and other MSM (n = 25) in Providence, RI. MSWs primarily met clients in street-based sex work venues. Facilitators asked participants about access to healthcare and HIV/STI testing, healthcare needs, and preferred PrEP providers. Results MSWs primarily accessed care in emergency rooms (ERs), substance use clinics, correctional institutions, and walk-in clinics. Rates of HIV testing were high, but MSWs reported low access to other STI testing, low insurance coverage, and unmet healthcare needs including primary care, substance use treatment, and mental health services. MSM not engaging in sex work were more likely to report access to primary and specialist care. Rates of HIV testing among these MSM were slightly lower, but they reported more STI testing, more insurance coverage, and fewer unmet needs. Preferred PrEP providers for both groups included primary care physicians, infectious disease specialists, and psychiatrists. MSWs were also willing to access PrEP in substance use treatment and ER settings. Conclusions PrEP outreach efforts for MSWs and other MSM should engage diverse providers in many settings, including mental health and substance use treatment, ERs, needle exchanges, correctional institutions, and HIV testing centers. Access to PrEP will require financial assistance, but can build on existing healthcare contacts for both populations. PMID:25386746
The growing use of wearable technologies increases the ability to have more information from the patient including clinical, behavioural and self-monitored data. The availability and large amounts of data that did not exist before brings an opportunity to develop new tools with intelligent analyses and decision support tools for use in clinical practice. It also opens new possibilities for the patients by providing them with more information and decision support tools specially designed for them, and empowers them in managing their own health conditions, keeping their autonomy. These new developments drive a change in healthcare delivery models and the relationship between patients and healthcare providers. It raises challenges for the healthcare systems in how to implement these new technologies and the growing amount of information in clinical practice, integrate it into the clinical workflows of the various healthcare providers. The future challenge for healthcare will be how to use the developing knowledge in a way that will bring added value to healthcare professionals, healthcare organisations and patients without increasing the workload and cost of the healthcare services. For wearable technology developers, the challenge is to develop solutions that can be easily integrated and used by healthcare professionals considering the existing constraints.
Lown, Beth A
Compassion is a complex process that is innate, determined in part by individual traits, and modulated by a myriad of conscious and unconscious factors, immediate context, social structures and expectations, and organizational "culture." Compassion is an ethical foundation of healthcare and a widely shared value; it is not an optional luxury in the healing process. While the interrelations between individual motivation and social structure are complex, we can choose to act individually and collectively to remove barriers to the innate compassion that most healthcare professionals bring to their work. Doing so will reduce professional burnout, improve the well-being of the healthcare workforce, and facilitate our efforts to achieve the triple aim of improving patients' experiences of care and health while lowering costs.
Zastocki, Deborah K
Previous successes of healthcare organizations and effective governance practices in the pre-reform environment are not predictive of future success. Healthcare has been through numerous phases of growth and development using tried-and-true strategies. The challenge is that our toolbox does not contain what is needed to build the future healthcare delivery systems required in the post-reform world. Healthcare has had a parochial focus at the local level, with some broadening of horizons at the state and national levels. But healthcare delivery is now a global issue that requires a totally different perspective, and many countries are confronting similar issues. US healthcare reform initiatives have far-reaching implications. Compounding the reform dynamics are the simultaneously occurring, gamechanging accelerants such as enabling information technologies and mobile health, new providers of healthcare, increased consumer demands, and limited healthcare dollars, to name a few. Operating in this turbulent environment requires transformational board, executive, and physician leadership because traditional ways of planning for incremental change and attempting to time those adjustments can prove disastrous. Creating the legacy healthcare system for tomorrow requires governing boards and executive leadership to act today as they would in the desired future system. Boards need to create a culture that fosters.innovation with a tolerance for risk and some failure. To provide effective governance, boards must essentially develop new skills, expertise, and ways of thinking. The rapid rate of change requires board members to possess certain capabilities, including the ability to deal with ambiguity and uncertainty while demonstrating flexibility and adaptability, all with a driving commitment to metrics and results. This requires development plans for both individual members and the overall board. In short, the board needs to function differently, particularly regarding the
Larrabee, Glenn J.
Literature on test validity and performance validity is reviewed to propose a framework for specification of an ability-focused battery (AFB). Factor analysis supports six domains of ability: first, verbal symbolic; secondly, visuoperceptual and visuospatial judgment and problem solving; thirdly, sensorimotor skills; fourthly, attention/working memory; fifthly, processing speed; finally, learning and memory (which can be divided into verbal and visual subdomains). The AFB should include at least three measures for each of the six domains, selected based on various criteria for validity including sensitivity to presence of disorder, sensitivity to severity of disorder, correlation with important activities of daily living, and containing embedded/derived measures of performance validity. Criterion groups should include moderate and severe traumatic brain injury, and Alzheimer's disease. Validation groups should also include patients with left and right hemisphere stroke, to determine measures sensitive to lateralized cognitive impairment and so that the moderating effects of auditory comprehension impairment and neglect can be analyzed on AFB measures. PMID:25280794
Komaromy, Miriam; Duhigg, Dan; Metcalf, Adam; Carlson, Cristina; Kalishman, Summers; Hayes, Leslie; Burke, Tom; Thornton, Karla; Arora, Sanjeev
ABSTRACT Background: Project ECHO (Extension for Community Healthcare Outcomes) trains and mentors primary care providers (PCPs) in the care of patients with complex conditions. ECHO is a distance education model that connects specialists with numerous PCPs via simultaneous video link for the purpose of facilitating case-based learning. This article describes a teleECHO clinic based at the University of New Mexico Health Sciences Center that is focused on treatment of substance use disorders (SUDs) and behavioral health disorders. Methods: Since 2005, specialists in treatment of SUDs and behavioral health disorders at Project ECHO have offered a weekly 2-hour Integrated Addictions and Psychiatry (IAP) TeleECHO Clinic focused on supporting PCP evaluation and treatment of SUDs and behavioral health disorders. We tabulate the number of teleECHO clinic sessions, participants, and CME/CEU (continuing medical education/continuing education unit) credits provided annually. This teleECHO clinic has also been used to recruit physicians to participate in DATA-2000 buprenorphine waiver trainings. Using a database of the practice location of physicians who received the buprenorphine waiver since 2002, the number of waivered physicians per capita in US states was calculated. The increase in waivered physicians practicing in underserved areas in New Mexico was evaluated and compared with the rest of the United States. Results: Since 2008, approximately 950 patient cases have been presented during the teleECHO clinic, and more than 9000 hours of CME/CEU have been awarded. Opioids are the substances discussed most commonly (31%), followed by alcohol (21%) and cannabis (12%). New Mexico is near the top among US states in DATA-2000 buprenorphine-waivered physicians per capita, and it has had much more rapid growth in waivered physicians practicing in traditionally underserved areas compared with the rest of the United States since the initiation of the teleECHO clinic focused on
Robb, Melissa; Robb, Craig S.; Higgins, Melanie A.; Hobbs, Joanne K.; Paton, James C.; Boraston, Alisdair B.
An important facet of the interaction between the pathogen Streptococcus pneumoniae (pneumococcus) and its human host is the ability of this bacterium to process host glycans. To achieve cleavage of the glycosidic bonds in host glycans, S. pneumoniae deploys a wide array of glycoside hydrolases. Here, we identify and characterize a new family 20 glycoside hydrolase, GH20C, from S. pneumoniae. Recombinant GH20C possessed the ability to hydrolyze the β-linkages joining either N-acetylglucosamine or N-acetylgalactosamine to a wide variety of aglycon residues, thus revealing this enzyme to be a generalist N-acetylhexosaminidase in vitro. X-ray crystal structures were determined for GH20C in a ligand-free form, in complex with the N-acetylglucosamine and N-acetylgalactosamine products of catalysis and in complex with both gluco- and galacto-configured inhibitors O-(2-acetamido-2-deoxy-d-glucopyranosylidene)amino N-phenyl carbamate (PUGNAc), O-(2-acetamido-2-deoxy-d-galactopyranosylidene)amino N-phenyl carbamate (GalPUGNAc), N-acetyl-d-glucosamine-thiazoline (NGT), and N-acetyl-d-galactosamine-thiazoline (GalNGT) at resolutions from 1.84 to 2.7 Å. These structures showed N-acetylglucosamine and N-acetylgalactosamine to be recognized via identical sets of molecular interactions. Although the same sets of interaction were maintained with the gluco- and galacto-configured inhibitors, the inhibition constants suggested preferred recognition of the axial O4 when an aglycon moiety was present (Ki for PUGNAc > GalPUGNAc) but preferred recognition of an equatorial O4 when the aglycon was absent (Ki for GalNGT > NGT). Overall, this study reveals GH20C to be another tool that is unique in the arsenal of S. pneumoniae and that it may implement the effort of the bacterium to utilize and/or destroy the wide array of host glycans that it may encounter. PMID:26491009
Mosadeghrad, Ali Mohammad
Background: The main purpose of this study was to identify factors that influence healthcare quality in the Iranian context. Methods: Exploratory in-depth individual and focus group interviews were conducted with 222 healthcare stakeholders including healthcare providers, managers, policy-makers, and payers to identify factors affecting the quality of healthcare services provided in Iranian healthcare organisations. Results: Quality in healthcare is a production of cooperation between the patient and the healthcare provider in a supportive environment. Personal factors of the provider and the patient, and factors pertaining to the healthcare organisation, healthcare system, and the broader environment affect healthcare service quality. Healthcare quality can be improved by supportive visionary leadership, proper planning, education and training, availability of resources, effective management of resources, employees and processes, and collaboration and cooperation among providers. Conclusion: This article contributes to healthcare theory and practice by developing a conceptual framework that provides policy-makers and managers a practical understanding of factors that affect healthcare service quality. PMID:25114946
Muskat, Barbara; Burnham Riosa, Priscilla; Nicholas, David B.; Roberts, Wendy; Stoddart, Kevin P.; Zwaigenbaum, Lonnie
Youth with autism spectrum disorder are a vulnerable, often poorly understood patient group, who may experience periodic and chronic health challenges, in addition to their primary developmental social and communication problems. Developmental and behavioural challenges can complicate management of acute health-care needs. To date, there is an…
An efficient, integrated health services delivery enterprise requires the ability to coordinate service delivery across the provider network and avoid duplication of services. It must be able to associate relevant clinical information with patients regardless of which facility delivered the services. There are significant challenges in collecting, organizing, and extracting value from data collected in the course of providing healthcare. This paper follows a large urban public healthcare enterprise in its attempts to address some of these challenges. Using a case-study methodology, the paper shows how information technology (IT) can help a healthcare organization derive improved information and generate knowledge from data stored in disjoint systems.
As healthcare organizations look for new and improved ways to reduce costs and still offer quality healthcare, many are turning to the Toyota Production System of doing business. Rather than focusing on cutting personnel and assets, "lean healthcare" looks to improve patient satisfaction through improved actions and processes.
Ohtsu, Tadahiro; Toda, Ryouhei; Shiraishi, Tomonobu; Toyoda, Hirokuni; Toyozawa, Hideyasu; Kamioka, Yasuaki; Ochiai, Hirotaka; Shimada, Naoki; Shirasawa, Takako; Hoshino, Hiromi; Kokaze, Akatsuki
Empirical data indicative of the health conditions and medical needs of homeless persons are scarce in Japan. In this study, with the aim of contributing to the formulation of future healthcare strategies for the homeless, we conducted a self-administered questionnaire survey and interviews at a park in Shinjuku Ward, Tokyo, to clarify the living conditions of homeless persons and their health conditions and awareness about the availability of medical treatment. Responses from 55 homeless men were recorded (response rate: 36.7%). With the exception of one person, none of them possessed a health insurance certificate. Half of the respondents reported having a current income source, although their modal monthly income was 30,000 yen($1 was approximately 90 yen). The number of individuals who responded "yes" to the questions regarding "Consulting a doctor on the basis of someone's recommendation" and "Being aware of the location of the nearest hospital or clinic" was significantly higher among those who had someone to consult when they were ill than among those who did not (the odds ratios [95% confidence intervals] were 15.00 [3.05-93.57] and 11.45 [1.42-510.68], respectively). This showed that whether or not a homeless person had a person to consult might influence his healthcare-seeking behavior. When queried about the entity they consulted (multiple responses acceptable), respondents mentioned "life support organizations" (61.1%) and "public offices" (33.3%). Overall, 94.5% of the respondents were aware of swine flu (novel influenza A (H1N1)). Their main sources of information were newspapers and magazines. On the basis of these findings, with regard to the aim of formulating healthcare strategies for homeless persons, while life support organizations and public offices play significant roles as conduits to medical institutions, print media should be considered useful for communicating messages to homeless persons.
Gabis, Lidia V; Hacham-Pilosof, Keren; Yosef, Omer Bar; Rabinovitz, Gila; Leshem, Gili; Shilon-Hadass, Aya; Biran, Yael; Reichman, Brian; Kuint, Jacob; Bart, Orit
Evaluation of a multisensory intervention based on the developmental approach provided by parents, during neonatal intensive care unit hospitalization of their preterm infants. After guidance of parents and implementation of intervention program, children were followed up to 2 to 3 years using scales for evaluation of parental stress levels and child's development. Our 2 to 3 years' follow-up study included 41 infants (20 controls and 21 who received parental-guided intervention) as part of a group of 95 preterm infants who participated in a short-term study. The intervention group showed significantly higher scores in receptive language and fine-motor domains of the Bayley Scale of Infant and Toddler Development-3rd Edition. Boys showed superior improvements in language skills. No differences were found in the cognitive and adaptive domains. There were no differences in parental stress levels. A multisensory intervention program for preterm infants provided by trained and supervised parents may improve language and motor outcomes at 2 to 3 years.
Saxena, Sonal; Singh, Trishla; Agarwal, Hemika; Mehta, Geeta; Dutta, Renu
Our objective was to assess the presence of pathogenic organisms on the rings (worn on fingers) and cell phones carried by health-care workers (HCWs) and the public. Forty-two percent of mobile phones carried by HCWs and 18% carried by the general public were found to carry one or more organisms; 82% of the rings worn by HCWs and 36% of those worn by the general public were found to be positive for the presence of at least one type of microbe.
Effects of illness representation, perceived quality of information provided by the health-care professional, and perceived social support on depressive symptoms of the caregivers of children with leukemia.
Bozo, Ozlem; Anahar, Selin; Ateş, Gizem; Etel, Evren
The present study examined the effects of illness representation, perceived quality of information provided by the health-care professional, and perceived social support on the depressive symptoms of the caregivers of children with leukemia. The sample was composed of 71 caregivers of children with leukemia living in Turkey. The obtained data were analyzed by path analysis. The results show that caregivers of children with leukemia experience higher levels of depressive symptoms when they have negative illness representation and lower levels of depressive symptoms when they perceive higher levels of social support. Moreover, they perceive higher social support when they perceive high quality of information provided by health-care professionals. It can be suggested that intervention programs which aim to increase caregivers' social support and change their illness representation in a positive way would be helpful for the caregivers showing depressive symptoms.
In response to the International Journal of Health Policy and Management (IJHPM) editorial, this commentary adds to the debate about ethical dimensions of compassionate care in UK service provision. It acknowledges the importance of the original paper, and attempts to explore some of the issues that are raised in the context of nursing practice, research and education. It is argued that each of these fields of the profession are enacted in an escalating culture of corporatism, be that National Health Service (NHS) or university campus, and global neoliberalism. Post-structuralist ideas, notably those of Foucault, are borrowed to interrogate healthcare as discursive practice and disciplinary knowledge; where an understanding of the ways in which power and language operate is prominent. Historical and contemporary evidence of institutional and ideological degradation of sections of humanity, a 'history of the present,' serve as reminders of the import, and fragility, of ethical codes.
Dusabe, John; Mchome, Zaina; Nnko, Soori; Changalucha, John; Obasi, Angela
Objectives Young people in Tanzania are known to access reproductive health services from a range of close-to-community providers outside formal health settings such as drug stores, village AIDS committees, traditional healers and traditional birth attendants (TBAs). However, questions remain about the quality of services such agents provide. This study investigated their capacity to provide adolescent reproductive health (ARH) services and explored their readiness and ability to integrate with the mainstream health sector through community referral interventions. Methods Thirty-five focus group discussions exploring close-to-community provider experiences and attitudes to ARH service provision were carried out in two districts in Northern Tanzania. Discussions were conducted in Kiswahili, digitally recorded, verbatim-transcribed, translated and back-translated from Swahili to English. A thematic analysis was conducted using NVivo 9. Results The major close-to-community cadres providing reproductive health services were drug stores, traditional healers, TBAs and village health workers. They reported being the first port of call for adolescents seeking reproductive health services, but their knowledge of ARH needs was poor. They had negative attitudes to, and lacked the necessary resources for, the provision of such services for adolescents. Some were particularly unwilling to provide condom services and were prejudiced against adolescents using them. There was poor integration between the close-to-community providers and the formal health sector, further limiting their ability to provide adequate services. Conclusions Although close-to-community providers are considered a key resource in the community, most have limited capacity to provide ARH services. Without capacity-building investments such as training and cooperation with the mainstream health sector, their contribution to positive reproductive health outcomes is limited, or could indeed lead to adverse
Schut, F T; Varkevisser, M
In the Dutch healthcare system, healthcare insurers act as purchasers of care on behalf of their insured clients. To this end, the insurers form contractual agreements with healthcare providers. In the interest of balanced negotiations regarding price and quality, it is important that neither of the two parties has a disproportionate position of power. This paper discusses whether healthy power relationships exist between healthcare insurers and healthcare providers.
Healthcare expenditure is divided between medical infrastructure and individual patient management. Total healthcare costs in France amount to roughly 175 billion euros, financed through public health insurance (77%), private insurance (14%), and individual expenditure (9%). The principal expenditures are for hospitalization (44%), community medical, dental and paramedical care (28%), drugs (20%) and miscellaneous resources (8%). The main factors of rising costs are medical progress and aging. More controllable costs include healthcare provision, the level of reimbursement, public education and information, and physician training. France devotes 9.2% of its gross national product to healthcare, compared to 7-8% in Sweden, Germany and the United Kingdom, representing a diference of about 18 billion euros. In France there is a chronic imbalance between resources and expenditure, creating a cumulative budget deficit of about 100 billlion euros. Major efforts must be made to improve efficiency, and it will be necessary to choose between preserving our healthcare system or our financial system. If the latter is prioritized, healthcare will inevitably deteriorate.
Bryce, Elizabeth; Choi, Peter; Landstrom, Margaret; LoChang, Justin
The potential impact of on-line learning in health care is significant. By providing access to educational material from an internet-connected computer anytime and anywhere, healthcare workers (HCWs), whose workload demands are often changing and somewhat unpredictable, have increased ability to self-educate. For example, the growing recognition…
Wettstein Rosenkranz, K; Rothenanger, E; Brodard, I; Collaud, A; Overesch, G; Bigler, B; Marschall, J; Perreten, V
We screened a total of 340 veterinarians (including general practitioners, small animal practitioners, large animal practitioners, veterinarians working in different veterinary services or industry), and 29 veterinary assistants for nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) and Staphylococcus pseudintermedius (MRSP) at the 2012 Swiss veterinary annual meeting. MRSA isolates (n = 14) were detected in 3.8 % (95 % CI 2.1 - 6.3 %) of the participants whereas MRSP was not detected. Large animal practitioners were carriers of livestock-associated MRSA (LA-MRSA) ST398-t011-V (n = 2), ST398-t011-IV (n = 4), and ST398-t034-V (n = 1). On the other hand, participants working with small animals harbored human healthcare-associated MRSA (HCA-MRSA) which belonged to epidemic lineages ST225-t003-II (n = 2), ST225-t014-II (n = 1), ST5-t002-II (n = 2), ST5-t283-IV (n = 1), and ST88-t186-IV (n = 1). HCA-MRSA harbored virulence factors such as enterotoxins, β-hemolysin converting phage and leukocidins. None of the MRSA isolates carried Panton-Valentine leukocidin (PVL). In addition to the methicillin resistance gene mecA, LA-MRSA ST398 isolates generally contained additional antibiotic resistance genes conferring resistance to tetracycline [tet(M) and tet(K)], trimethoprim [dfrK, dfrG], and the aminoglycosides gentamicin and kanamycin [aac(6')-Ie - aph(2')-Ia]. On the other hand, HCA-MRSA ST5 and ST225 mainly contained genes conferring resistance to the macrolide, lincosamide and streptogramin B antibiotics [erm(A)], to spectinomycin [ant(9)-Ia], amikacin and tobramycin [ant(4')-Ia], and to fluoroquinolones [amino acid substitutions in GrlA (S84L) and GyrA (S80F and S81P)]. MRSA carriage may represent an occupational risk and veterinarians should be aware of possible MRSA colonization and potential for developing infection or for transmitting these strains. Professional exposure to animals should be reported upon hospitalization and before medical
Cardoso, Marly A.; Augusto, Rosangela A.; Bortolini, Gisele A.; Oliveira, Cristieli S. M.; Tietzman, Daniela C.; Sequeira, Leopoldina A. S.; Hadler, Maria Claret C. M.; Peixoto, Maria do Rosario G.; Muniz, Pascoal T.; Vitolo, Márcia R.; Lira, Pedro I. C.; Jaime, Patrícia C.
Background Multiple micronutrients in powder (MNP) are recommended by WHO to prevent anemia in young children. However, evidences for its effectiveness in different populations and improvements in other outcomes (e.g. linear growth and vitamin A deficiency) are scarce. Methods A multicentre pragmatic controlled trial was carried out in primary health centres. At study baseline, a control group (CG) of children aged 10- to 14 months (n = 521) was recruited in the routine healthcare for assessing anemia, anthropometric and micronutrient status. At the same time, an intervention group (IG) of infants aged 6- to 8 months (n = 462) was recruited to receive MNP daily in complementary feeding over a period of 60 days. Both study groups were compared when the IG infants reached the age of the CG children at enrolment. Results In CG, the prevalence of anemia [hemoglobin (Hb) < 110 g/L], iron deficiency (ID, plasma ferritin < 12 μg/L or TfR > 8.3 mg/L), and vitamin A deficiency (VAD, serum retinol < 0.70μmol/L) were 23.1%, 37.4%, and 17.4%, respectively. Four to six months after enrolment, when the IG participants had the same age of the controls at the time of testing, the prevalence of anemia, ID and VAD in IG were 14.3%, 30.1% and 7.9%, respectively. Adjusting for city, health centre, maternal education, and age, IG children had a lower likelihood of anemia and VAD [Prevalence Ratio (95% CI) = 0.63 (0.45, 0.88) and 0.45 (0.29, 0.69), respectively] when compared with CG children. The adjusted mean distributions of Hb and length-for-age Z-scores improved by 2 SE in the IG compared to CG children. Conclusions MNP effectively reduced anemia and improved growth and micronutrient status among young Brazilian children. Trial Registration Registro Brasileiro de Ensaios Clinicos RBR-5ktv6b PMID:26974146
Healthcare transformation requires a change in how the business of healthcare is done. Traditional decision-making approaches based on stable and predictable systems are inappropriate in healthcare because of the complex nature of healthcare delivery. This article reviews challenges to using traditional decision-making approaches in healthcare and how insight from Complex Adaptive Systems (CAS) could support healthcare management. The article also provides a system model to guide decision-making in healthcare as a CAS.
McMahon, Shannon A; Ho, Lara S; Brown, Hannah; Miller, Laura; Ansumana, Rashid; Kennedy, Caitlin E
Although research on the epidemiology and ecology of Ebola has expanded since the 2014-15 outbreak in West Africa, less attention has been paid to the mental health implications and the psychosocial context of the disease for providers working in primary health facilities (rather than Ebola-specific treatment units). This study draws on 54 qualitative interviews with 35 providers working in eight peripheral health units of Sierra Leone's Bo and Kenema Districts. Data collection started near the height of the outbreak in December 2014 and lasted 1 month. Providers recounted changes in their professional, personal and social lives as they became de facto first responders in the outbreak. A theme articulated across interviews was Ebola's destruction of social connectedness and sense of trust within and across health facilities, communities and families. Providers described feeling lonely, ostracized, unloved, afraid, saddened and no longer respected. They also discussed restrictions on behaviors that enhance coping including attending burials and engaging in physical touch (hugging, handshaking, sitting near, or eating with colleagues, patients and family members). Providers described infection prevention measures as necessary but divisive because screening booths and protective equipment inhibited bonding or 'suffering with' patients. To mitigate psychiatric morbidities and maladaptive coping mechanisms-and to prevent the spread of Ebola-researchers and program planners must consider the psychosocial context of this disease and mechanisms to enhance psychological first aid to all health providers, including those in peripheral health settings.
McMahon, Shannon A.; Ho, Lara S.; Brown, Hannah; Miller, Laura; Ansumana, Rashid; Kennedy, Caitlin E.
Although research on the epidemiology and ecology of Ebola has expanded since the 2014–15 outbreak in West Africa, less attention has been paid to the mental health implications and the psychosocial context of the disease for providers working in primary health facilities (rather than Ebola-specific treatment units). This study draws on 54 qualitative interviews with 35 providers working in eight peripheral health units of Sierra Leone's Bo and Kenema Districts. Data collection started near the height of the outbreak in December 2014 and lasted 1 month. Providers recounted changes in their professional, personal and social lives as they became de facto first responders in the outbreak. A theme articulated across interviews was Ebola’s destruction of social connectedness and sense of trust within and across health facilities, communities and families. Providers described feeling lonely, ostracized, unloved, afraid, saddened and no longer respected. They also discussed restrictions on behaviors that enhance coping including attending burials and engaging in physical touch (hugging, handshaking, sitting near, or eating with colleagues, patients and family members). Providers described infection prevention measures as necessary but divisive because screening booths and protective equipment inhibited bonding or ‘suffering with’ patients. To mitigate psychiatric morbidities and maladaptive coping mechanisms—and to prevent the spread of Ebola—researchers and program planners must consider the psychosocial context of this disease and mechanisms to enhance psychological first aid to all health providers, including those in peripheral health settings. PMID:27277598
Koh, Hian Chye; Tan, Gerald
Data mining has been used intensively and extensively by many organizations. In healthcare, data mining is becoming increasingly popular, if not increasingly essential. Data mining applications can greatly benefit all parties involved in the healthcare industry. For example, data mining can help healthcare insurers detect fraud and abuse, healthcare organizations make customer relationship management decisions, physicians identify effective treatments and best practices, and patients receive better and more affordable healthcare services. The huge amounts of data generated by healthcare transactions are too complex and voluminous to be processed and analyzed by traditional methods. Data mining provides the methodology and technology to transform these mounds of data into useful information for decision making. This article explores data mining applications in healthcare. In particular, it discusses data mining and its applications within healthcare in major areas such as the evaluation of treatment effectiveness, management of healthcare, customer relationship management, and the detection of fraud and abuse. It also gives an illustrative example of a healthcare data mining application involving the identification of risk factors associated with the onset of diabetes. Finally, the article highlights the limitations of data mining and discusses some future directions.
Long, John C
Lean Thinking is an integrated approach to designing, doing and improving the work of people that have come together to produce and deliver goods, services and information. Healthcare Lean is based on the Toyota production system and applies concepts and techniques of Lean Thinking to hospitals and physician practices.
Though President Barack Obama has rarely made healthcare references in his State of the Union addresses, health policy experts are hoping he changes that strategy this year. "The question is: Will he say anything? You would hope that he would, given that that was the major issue he started his presidency with," says Dr. James Weinstein, left, of the Dartmouth-Hitchcock health system.
Honeybourne, D; Moore, A J; Butterfield, A K; Azzan, L
The Lion Intoximeter 3000 has been used for evidential breath testing in the U.K. for some years. Some individuals with lung diseases have difficulty in providing evidential breath samples using the device. This study describes an investigation that we have carried out on a newer instrument--the Lion Intoxilyzer 6000UK--which is now in use in the U.K. The study was designed to investigate the ability of subjects with a variety of lung diseases to provide evidential breath samples using this device. The 40 adult subjects investigated comprized 10 normal controls, 10 with asthma, 10 with chronic obstructive pulmonary disease (COPD) and 10 with restrictive lung disease. After baseline spirometry, subjects were given alcohol to drink, the quantity based upon body weight. After a gap of at least 20 min, subjects were asked to provide evidential breath samples in accordance with.the test procedure built into the Lion Intoxilyzer 6000UK. The results showed that two asthmatic subjects, four with COPD and three with restrictive lung disease failed to provide evidential breath samples even after four attempts. Despite the device requiring a minimum sample volume of 1.2 l, eight of the nine subjects who failed had a forced vital capacity (FVC) of more than 1.5 l. Seven of these nine subjects had a forced expiratory volume in 1 sec (FEV1) of less than 1.0 l. In conclusion, this study has shown that some subjects with lung diseases may have difficulty in providing evidential breath samples using the Lion Intoxilyzer 6000 UK.
Al-Roubaie, Abdul Rahim; Goldlust, Eric Jonathan
Objective (1) To determine the effects of adding a provider in triage on average length of stay (LOS) and proportion of patients with >6 h LOS. (2) To assess the accuracy of computer simulation in predicting the magnitude of such effects on these metrics. Methods A group-level quasi-experimental trial comparing the St. Louis Veterans Affairs Medical Center emergency department (1) before intervention, (2) after institution of provider in triage, and discrete event simulation (DES) models of similar (3) ‘before’ and (4) ‘after’ conditions. The outcome measures were daily mean LOS and percentage of patients with LOS >6 h. Results The DES-modelled intervention predicted a decrease in the %6-hour LOS from 19.0% to 13.1%, and a drop in the daily mean LOS from 249 to 200 min (p<0.0001). Following (actual) intervention, the number of patients with LOS >6 h decreased from 19.9% to 14.3% (p<0.0001), with the daily mean LOS decreasing from 247 to 210 min (p<0.0001). Conclusion Physician and mid-level provider coverage at triage significantly reduced emergency department LOS in this setting. DES accurately predicted the magnitude of this effect. These results suggest further work in the generalisability of triage providers and in the utility of DES for predicting quantitative effects of process changes. PMID:22398851
Singleton, Peter; Kalra, Dipak
This paper considers issues of trust and privacy in healthcare around increased data-sharing through Electronic Health Records (EHRs). It uses a model structured around different aspects of trust in the healthcare organisation’s reasons for greater data-sharing and their ability to execute EHR projects, particularly any associated confidentiality controls. It reflects the individual’s personal circumstances and attitude to use of health records.
A judge's decision that a Florida hospital is a federal subcontractor because it provides care through the military's Tricare program has put the industry on alert. Hospitals fear they'll be forced to to jump through lots of hoops to comply with federal rules regarding hiring. "Many of the substantive obligations that are sought to be imposed ... are already fully applicable to hospitals through state and other federal laws," says Curt Kirschner, left, a lawyer with Jones Day.
Mulaudzi, Fhumulani M.; Peu, Mmapheko D.; Mataboge, Mamakwa S.; Nagunyulu, Roinah; Phiri, Salaminah S.
Background Despite the redesigning of the Reality condom (FC) to a new version of the second generation female condom commonly known as (FC2), the users are persistently constrained and concerned about the size and shape of this new version. Condom use is aligned to the Millennium Development Goals (MDG) 3, 5 and 6, which address gender equality, improving maternal health and preventing HIV and AIDS. Aim To explore and describe the constraints and concerns regarding the size and/or shape of the FC2. Setting The study was conducted at Tshwane health district in Gauteng province. Methods A qualitative exploratory descriptive design was used. Individual in-depth interviews that yielded narratives in a designated health district in South Africa were conducted. Results From the analysis of narratives three specific themes emerged. Firstly, the specific theme was that the size and shape of FC2 is undesirable for the health care providers, which may lead women to contract HIV and AIDS. The second theme was that the size and shape of FC2 and female genitals makes insertion complicated and predisposes women to be vulnerable in sexual relationships. The third was that the size and shape of FC2 results in pain and discomfort during coitus, exposing women to unwanted pregnancies and HIV and AIDS. Conclusions The findings indicated the need for an evocative collaborative, interdisciplinary ‘walk the talk’ sexual health and AIDS education training programme for health care providers in primary health care facilities. Such programmes, if maintained, may assist health care providers to achieve the MDG 3, 5 and 6. PMID:27380853
Ali, Ahmed Yousif M; Safwat, Tarek; Onyemelukwe, Geoffrey; Otaibi, Moh'd Amin Al; Amir, Ashraf A; Nawas, Yousef N; Aouina, Hichem; Afif, Moulay Hicham; Bolliger, Chris T
Despite the abundance of scientific evidence confirming the health consequences of smoking and other forms of tobacco use, the tobacco epidemic remains an important public health problem and by 2030 it is predicted that more than 80% of tobacco deaths will be in developing countries. In Africa and the Middle East, many local factors contribute to the initiation and maintenance of tobacco use. Although efforts to reduce the mortality and morbidity associated with smoking and tobacco dependence are underway, there is a need for guidance on how to utilize appropriate tobacco control policies and psychology- and pharmacology-based therapies to counter tobacco dependence as recommended by the Framework Convention on Tobacco Control (FCTC). A group of tobacco cessation experts from public health services and/or academic institutions in Africa and the Middle East participated in a series of four meetings held in Cairo, Cape Town, and Dubai between May 2008 and February 2011 to develop a draft guideline tailored to their region. This article provides the background to the development of this draft smoking cessation guideline and discusses how the recommendations can be implemented and progress monitored to promote both primary prevention and cessation of tobacco use within our countries. The draft guideline for Africa and the Middle East provides an important resource in combating the devastating effects of tobacco use in these regions which can be further localized through engagement with local stakeholders in the countries of the region.
Chan, Emily Ying Yang
Although older people may be recognized as a vulnerable group post-natural disasters, their particular needs are rarely met by the providers of emergency services. Studies about older people's health needs post disasters in the South East Asia Tsunami, Kashmir, Pakistan, China, and United States has revealed the lack of concern for older people's health needs. Recent study of older people's health needs post the Kashmir Pakistan earthquake (2005) found older peoples' health needs were masked within the general population. This survey study examines the providers' perceptions of older people's vulnerabilities post-2005 Pakistan earthquake. It aims to understand the awareness of geriatric issues and issues related to current service provision/planning for older people's health needs post disasters. Specifically, service delivery patterns will be compared among different relief agencies. Cross-sectional, structured stakeholder interviews were conducted within a 2 weeks period in February 2006, 4 months post-earthquake in Pakistan-administrated Kashmir. Health/medical relief agencies of three different types of organizational nature: international nongovernmental organization (INGO), national organization, and local/community group were solicited to participate in the study. Descriptive analysis was conducted. Important issues identified include the need to sensitize relief and health workers about older people's health needs post disaster the development of relevant clinical guidelines for chronic disease management postdisaster in developing countries and the advocacy of building in geriatric related components in natural disaster medical relief programs. To effectively address the vulnerability of older people, it is important for governments, relief agencies, and local partners to include and address these issues during their relief operations and policy planning.
As one of the active participants in the global fight against the 2014 outbreak of Ebola virus disease (EVD) in West Africa, China supplied many resources, including medical experts and scientists as well as medical supplies, to the affected countries. A member of the first contingent of Chinese public health experts who worked in Sierra Leone for 65 days, I am pleased to have this opportunity to review the major work done by our team to help deal with the Ebola epidemic in Sierra Leone. This is the first time that a Chinese public health training team has worked in West Africa. The team provides trainings for people from local communities in an effort to encourage local residents to get involved in the war against Ebola. However, the implementation of active measures against Ebola in West Africa was hampered somewhat by certain drawbacks in the area in terms of the health system, the shortage of medical resources, the high illiteracy rate, unhealthy lifestyles, and traditional funeral rites. All of these aspects need to be gradually improved in the aftermath of Ebola, and I believe that this is an area in which the Chinese public health system can play an important role.
Matinga, Margaret Njirambo; Annegarn, Harold J; Clancy, Joy S
Policymakers at global level recognise that household biomass use in developing countries has significant health consequences. However, it is unclear how local-level health professionals perceive and respond to such health effects. This paper which is derived from the findings of a larger study on perceptions and responses to the harmful health effects of carrying heavy firewood loads and to smoke from cooking fires is based on a study conducted in South Africa among managers of health programmes and community nurses of Qaukeni and Mhlontlo municipalities in rural Eastern Cape. Interviews and participant observations were conducted in 2009 using ethnographic grounded theory approaches. In addition to a 10-month period of ethnographic fieldwork, ten programme managers and nurses in two villages were interviewed about health patterns in the villages that they serve, their perceptions of, and responses to the health effects of carrying heavy firewood loads, and inhalation of smoke from wood and dung cooking fires, their professional qualifications and experience, their own household energy use; and observations made as they served clinic clients. Results show that these programme managers and nurses perceive the health effects of carrying heavy loads of firewood and of cooking smoke as minor. Sometimes, nurses give women symptomatic relief for musculoskeletal pain resulting from carrying heavy loads. We posit that their perceptions are derived from customary neglect of work-related health and non-communicable diseases, cultural interpretations of womanhood, limited access to relevant information, and limited interactions between health and energy sector professionals. We conclude that culturally and gender-sensitive awareness programmes are needed for local-level health professionals to effectively address health effects of biomass collection and use. This paper provides new insights into overlooked differences between globally-driven initiatives to address health
Mittoo, Shikha; Frankel, Sid; LeSage, Daphne; Strand, Vibeke; Shah, Ami A.; Christopher-Stine, Lisa; Danoff, Sonye; Hummers, Laura K.; Swigris, Jeffery J.; Huscher, Dörte; Christensen, Angela M.; Cenac, Sophia L.; Erbil, Jen K.; Ferguson, Sancia; Garcia-Valladares, Ignacio; Grewal, Harmanjot K.; Orbai, Ana-Maria; Smith, Katherine Clegg; Tran, Maithy; Bingham, Clifton O.; Castelino, Flavia V.; Fischer, Aryeh; Saketkoo, Lesley Ann
Objective The impact and natural history of connective tissue disease related interstitial lung disease (CTD-ILD) are poorly understood; and have not been previously described from the patient’s perspective. This investigation sought insight into CTD-ILD from the patients’ perspective to add to our knowledge of CTD-ILD, identify disease-specific areas of unmet need and gather potentially meaningful information towards development of disease-specific patient-reported outcome measures (PROMs). Methods A mixed methods design incorporating patient focus groups (FGs) querying disease progression and life impact followed by questionnaires with items of importance generated by >250 ILD specialists were implemented among CTD-ILD patients with rheumatoid arthritis, idiopathic inflammatory myopathies, systemic sclerosis, and other CTD subtypes. FG data were analyzed through inductive analysis with five independent analysts, including a patient research partner. Questionnaires were analyzed through Fisher’s Exact tests and hierarchal cluster analysis. Results Six multicenter FGs included 45 patients. Biophysiologic themes were cough and dyspnea, both pervasively impacting health related quality of life (HRQoL). Language indicating dyspnea was unexpected, unique and contextual. Psycho-social themes were Living with Uncertainty, Struggle over Self-Identity, and Self-Efficacy - with education and clinician communication strongly emphasised. All questionnaire items were rated ‘moderately’ to ‘extremely’ important with 10 items of highest importance identified by cluster analysis. Conclusion Patients with CTD-ILD informed our understanding of symptoms and impact on HRQoL. Cough and dyspnea are central to the CTD-ILD experience. Initial FGs have provided disease-specific content, context and language essential for reliable PROM development with questionnaires adding value in recognition of patients’ concerns. PMID:26568747
Diaz, L.F. Eggerth, L.L.; Enkhtsetseg, Sh.; Savage, G.M.
A comprehensive understanding of the quantities and characteristics of the material that needs to be managed is one of the most basic steps in the development of a plan for solid waste management. In this case, the material under consideration is the solid waste generated in healthcare facilities, also known as healthcare waste. Unfortunately, limited reliable information is available in the open literature on the quantities and characteristics of the various types of wastes that are generated in healthcare facilities. Thus, sound management of these wastes, particularly in developing countries, often is problematic. This article provides information on the quantities and properties of healthcare wastes in various types of facilities located in developing countries, as well as in some industrialized countries. Most of the information has been obtained from the open literature, although some information has been collected by the authors and from reports available to the authors. Only data collected within approximately the last 15 years and using prescribed methodologies are presented. The range of hospital waste generation (both infectious and mixed solid waste fractions) varies from 0.016 to 3.23 kg/bed-day. The relatively wide variation is due to the fact that some of the facilities surveyed in Ulaanbaatar include out-patient services and district health clinics; these facilities essentially provide very basic services and thus the quantities of waste generated are relatively small. On the other hand, the reported amount of infectious (clinical, yellow bag) waste varied from 0.01 to 0.65 kg/bed-day. The characteristics of the components of healthcare wastes, such as the bulk density and the calorific value, have substantial variability. This literature review and the associated attempt at a comparative analysis point to the need for worldwide consensus on the terms and characteristics that describe wastes from healthcare facilities. Such a consensus would greatly
Koufi, Vassiliki; Vassilacopoulos, George
Healthcare is an increasingly collaborative enterprise involving a broad range of healthcare services provided by many individuals and organizations. Grid technology has been widely recognized as a means for integrating disparate computing resources in the healthcare field. Moreover, Grid portal applications can be developed on a wireless and mobile infrastructure to execute healthcare processes which, in turn, can provide remote access to Grid database services. Such an environment provides ubiquitous and pervasive access to integrated healthcare services at the point of care, thus improving healthcare quality. In such environments, the ability to provide an effective access control mechanism that meets the requirement of the least privilege principle is essential. Adherence to the least privilege principle requires continuous adjustments of user permissions in order to adapt to the current situation. This paper presents a context-aware access control mechanism for HDGPortal, a Grid portal application which provides access to workflow-based healthcare processes using wireless Personal Digital Assistants. The proposed mechanism builds upon and enhances security mechanisms provided by the Grid Security Infrastructure. It provides tight, just-in-time permissions so that authorized users get access to specific objects according to the current context. These permissions are subject to continuous adjustments triggered by the changing context. Thus, the risk of compromising information integrity during task executions is reduced.
Recktenwald, Kathy; Hunsaker, Donna M; Corey, Tracey S; Weakley-Jones, Barbara
Clinical forensic medicine (CFM) is "the application of appropriate forensic practices and principles, heretofore reserved for use by the pathologist at autopsy, to living patients in a clinical setting." "Living forensic" patients include survivors of trauma and potentially catastrophic experiences resulting in injury. CFM arose from "clinically" affirming that not all abuse or assault victims sustain fatal injuries. Appropriate medical documentation and interpretation of physical findings may aid law enforcement and/or social services in the legal evaluation of a case or situation. Additionally, timely collection of pertinent evidence may be performed as the case necessitates.
Marks, Florian; Rabehanta, Nathalie; Baker, Stephen; Panzner, Ursula; Park, Se Eun; Fobil, Julius N; Meyer, Christian G; Rakotozandrindrainy, Raphaël
A healthcare utilization survey was conducted as a component of the Typhoid Fever Surveillance in Africa Program (TSAP). The findings of this survey in Madagascar contrasted with those in other sites of the program; namely, only 30% of the population sought healthcare at the government-provided healthcare facilities for fever. These findings promoted us to determine the drivers and barriers in accessing and utilizing healthcare in Madagascar. Here we review the results of the TSAP healthcare utilization initiative and place them in the context of the current organization of the Madagascan healthcare system. Our work highlights the demands of the population for access to appropriate healthcare and the need for novel solutions that can quickly provide an affordable and sustainable basic healthcare infrastructure until a government-funded scheme is in place.
Mantler, Ed; Szeto, Andrew
Mental illness-related stigma, including that which exists in the healthcare system and among healthcare providers, creates serious barriers to access and quality care. It is also a major concern for healthcare practitioners themselves, both as a workplace culture issue and as a barrier for help seeking. This article provides an overview of the main barriers to access and quality care created by stigmatization in healthcare, a consideration of contributing factors, and a summary of Canadian-based research into promising practices and approaches to combatting stigma in healthcare environments.
Wei, Han-Ting; Chen, Mu-Hong; Ku, Wen-Wei
LGBT (lesbian, gay, bisexual, transgender) patients suffer from stigma and discrimination when seeking healthcare. A large LGBT healthcare survey revealed that 56% of gay patients and 70% of transgender patients suffered some type of discrimination while seeking healthcare in 2014. The fostering of LGBT-friendly healthcare services is not just an advanced step of gender mainstreaming but also a fulfillment of health equality and equity. Additionally, LGBT-friendly healthcare services are expected to provide new opportunities for healthcare workers. Therefore, proactive government policies, education, research, and clinical practice should all encourage the development of these healthcare services. We look forward to a well-developed LGBT-friendly healthcare system in Taiwan.
Erdogan, Serap; Baran, Gulen
This study was conducted to examine the effect of mathematics teaching given through the drama method on the mathematical ability of six-year-old children. The research was conducted in Ankara on 105 children from the kindergarten classes of two different primary schools of the Ministry of National Education, which are at middle socio-economic…
12 months) of the research study was to collect data about the medics ability to retain and demonstrate acquisition of knowledge and skills to be... skills to assess the manifestations of TBI and identify what actions to take for management of TBI, in a mock battlefield setting. The hypotheses...State University. “Juxtopia® CAMMRAD Platform for Improving Trauma Skills Training” Oct. 2015-Sept. 2017 Development of simulation scenarios
Ownby, Raymond L; Czaja, Sara J
Research shows that the elderly often use the Internet to search for healthcare information. Other studies show that many widely-implemented features of web site design may interfere with elders' ability to access the information they seek. This poster will illustrate principles of elder-friendly web site design by presenting a demonstration web site that provides information about neurological and psychiatric conditions for adults 50 years of age and older
With the healthcare industry changing rapidly, organizations seek finance leaders who have skills that go beyond traditional expertise in revenue and expenses. These additional competencies fall under the heading of soft-leadership skills and include the ability to be strategy-oriented, agile, passionate, inspirational, influential, communicative, dependable, driven, integrative, and engaged. Networking, participation in a mentoring program, and continuing education provide avenues for finance leaders to develop these sorts of skills.
Yorker, Beatrice Crofts; Kizer, Kenneth W; Lampe, Paula; Forrest, A R W; Lannan, Jacquetta M; Russell, Donna A
The prosecution of Charles Cullen, a nurse who killed at least 40 patients over a 16-year period, highlights the need to better understand the phenomenon of serial murder by healthcare professionals. The authors conducted a LexisNexis search which yielded 90 criminal prosecutions of healthcare providers that met inclusion criteria for serial murder of patients. In addition we reviewed epidemiologic studies, toxicology evidence, and court transcripts, to provide data on healthcare professionals who have been prosecuted between 1970 and 2006. Fifty-four of the 90 have been convicted; 45 for serial murder, four for attempted murder, and five pled guilty to lesser charges. Twenty-four more have been indicted and are either awaiting trial or the outcome has not been published. The other 12 prosecutions had a variety of legal outcomes. Injection was the main method used by healthcare killers followed by suffocation, poisoning, and tampering with equipment. Prosecutions were reported from 20 countries with 40% taking place in the United States. Nursing personnel comprised 86% of the healthcare providers prosecuted; physicians 12%, and 2% were allied health professionals. The number of patient deaths that resulted in a murder conviction is 317 and the number of suspicious patient deaths attributed to the 54 convicted caregivers is 2113. These numbers are disturbing and demand that systemic changes in tracking adverse patient incidents associated with presence of a specific healthcare provider be implemented. Hiring practices must shift away from preventing wrongful discharge or denial of employment lawsuits to protecting patients from employees who kill.
Weaver, Betsy; Lindsay, Bill; Gitelman, Betsy
Electronic patient education and communications, such as email, text messaging, and social media, are on the rise in healthcare today. This article explores potential uses of technology to seek solutions in healthcare for such challenges as modifying behaviors related to chronic conditions, improving efficiency, and decreasing costs. A brief discussion highlights the role of technologies in healthcare informatics and considers two theoretical bases for technology implementation. Discussion focuses more extensively on the ability and advantages of electronic communication technology, such as e-mail, social media, text messaging, and electronic health records, to enhance patient-provider e-communications in nursing today. Effectiveness of e-communication in healthcare is explored, including recent and emerging applications designed to improve patient-provider connections and review of current evidence supporting positive outcomes. The conclusion addresses the vision of nurses' place in the vanguard of these developments.
Krepper, R; Young, A; Cummings, E
Although parents may welcome having their ill child cared for at home, they are not prepared to compromise privacy and family rituals, nor share control of their child. The purpose of this article is to provide a snapshot of problems that parents have encountered with pediatric home healthcare. Home care parents offer suggestions for other parents and home healthcare nurses and agencies, encouraging them to be proactive in preventing potential problems.
Young, J. W.; Goode, M. W.
A simulation study has been made to determine a pilot's ability to control a low L/D vehicle to a desired point on the earth with initial conditions ranging from parabolic orbits to abort conditions along the boost phase of a deep-space mission. The program was conducted to develop procedures which would allow the pilot to perform the energy management functions required while avoiding the high deceleration or skipout region and to determine the information display required to aid the pilot in flying these procedures. The abort conditions studied extend from a region of relatively high flight-path angles at suborbital velocities while leaving the atmosphere to a region between orbital and near-escape velocity outside the atmosphere. The conditions studied included guidance from suborbital and superorbital aborts as well as guidance following return from a deepspace mission. In this paper, the role of the human pilot?s ability to combine safe return abort procedures with guidance procedures has been investigated. The range capability from various abort and entry conditions is also presented.
Devlin, Ann Sloan
The ability to successfully navigate in healthcare facilities is an important goal for patients, visitors, and staff. Despite the fundamental nature of such behavior, it is not infrequent for planners to consider wayfinding only after the fact, once the building or building complex is complete. This review argues that more recognition is needed for the pivotal role of wayfinding in healthcare facilities. First, to provide context, the review presents a brief overview of the relationship between environmental psychology and healthcare facility design. Then, the core of the article covers advances in wayfinding research with an emphasis on healthcare environments, including the roles of plan configuration and manifest cues, technology, and user characteristics. Plan configuration and manifest cues, which appeared early on in wayfinding research, continue to play a role in wayfinding success and should inform design decisions. Such considerations are joined by emerging technologies (e.g., mobile applications, virtual reality, and computational models of wayfinding) as a way to both enhance our theoretical knowledge of wayfinding and advance its applications for users. Among the users discussed here are those with cognitive and/or visual challenges (e.g., Down syndrome, age-related decrements such as dementia, and limitations of vision). In addition, research on the role of cross-cultural comprehension and the effort to develop a system of universal healthcare symbols is included. The article concludes with a summary of the status of these advances and directions for future research. PMID:25431446
de Vries McClintock, Heather F.; Barg, Frances K.; Katz, Sam P.; Stineman, Margaret G.; Krueger, Alice; Colletti, Patrice M.; Boellstorff, Tom; Bogner, Hillary R.
BACKGROUND Little is known about healthcare experiences among people with and without disabilities. OBJECTIVE We sought to explore perceptions of people with and without disabilities related to their healthcare experiences. METHODS Nineteen persons with and without disabilities participated in one of four focus groups. Focus groups were conducted in the physical world in Milwaukee, WI and in the virtual world in Second Life® with Virtual Ability, a well-established community designed by and for people with a wide range of disabilities. A grounded theory methodology was employed to analyze focus group data. Inclusion of physical and virtual world focus groups enabled people with a wide range of disabilities to participate. RESULTS While some participants described instances of receiving good care, many discussed numerous barriers. The main themes that emerged in focus groups among both persons with and without disabilities related to their healthcare experiences including poor coordination among providers; difficulties with insurance, finances, transportation and facilities; short duration of visits with physicians; inadequate information provision; feelings of being diminished and deflated; and self-advocacy as a tool. Transportation was a major concern for persons with disabilities influencing mobility. Persons with disabilities described particularly poignant experiences wherein they felt invisible or were viewed as incompetent. CONCLUSIONS Both persons with and without disabilities experienced challenges in obtaining high quality healthcare. However, persons with disabilities experienced specific challenges often related to their type of disability. Participants stressed the need for improving healthcare coordination and the importance of self-advocacy. PMID:26482010
Lee, Seunghae; Dazkir, Sibel Seda; Paik, Hae Sun; Coskun, Aykut
Healthcare facilities are often complex and overwhelming for visitors, and wayfinding in healthcare facilities can be challenging. As there is an increasing number of global citizens who travel to seek medical care in another country, it is critical to make wayfinding easy for visitors who are not familiar with the language in a foreign country. Among many wayfinding aids, symbols are helpful for those visitors who have limited ability to understand written language. This study tested universal healthcare symbols in the United States, South Korea, and Turkey to compare the comprehension of symbols cross-country and identify predictors of the correct comprehension. To explore statistically significant relationships between symbol comprehension and countries, Pearson's Chi-square tests, logistic regression, and ANOVA were conducted. The test results showed that ten symbols among 14 tested have significant relationship with countries. Results of this study demonstrate that symbol comprehension can be varied significantly in different countries.
Perspectives of healthcare providers and HIV-affected individuals and couples during the development of a Safer Conception Counseling Toolkit in Kenya: stigma, fears, and recommendations for the delivery of services.
Mmeje, Okeoma; Njoroge, Betty; Akama, Eliud; Leddy, Anna; Breitnauer, Brooke; Darbes, Lynae; Brown, Joelle
Reproduction is important to many HIV-affected individuals and couples and healthcare providers (HCPs) are responsible for providing resources to help them safely conceive while minimizing the risk of sexual and perinatal HIV transmission. In order to fulfill their reproductive goals, HIV-affected individuals and their partners need access to information regarding safer methods of conception. The objective of this qualitative study was to develop a Safer Conception Counseling Toolkit that can be used to train HCPs and counsel HIV-affected individuals and couples in HIV care and treatment clinics in Kenya. We conducted a two-phased qualitative study among HCPs and HIV-affected individuals and couples from eight HIV care and treatment sites in Kisumu, Kenya. We conducted in-depth interviews (IDIs) and focus group discussions (FGDs) to assess the perspectives of HCPs and HIV-affected individuals and couples in order to develop and refine the content of the Toolkit. Subsequently, IDIs were conducted among HCPs who were trained using the Toolkit and FGDs among HIV-affected individuals and couples who were counseled with the Toolkit. HIV-related stigma, fears, and recommendations for delivery of safer conception counseling were assessed during the discussions. One hundred and six individuals participated in FGDs and IDIs; 29 HCPs, 49 HIV-affected women and men, and 14 HIV-serodiscordant couples. Participants indicated that a safer conception counseling and training program for HCPs is needed and that routine provision of safer conception counseling may promote maternal and child health by enhancing reproductive autonomy among HIV-affected couples. They also reported that the Toolkit may help dispel the stigma and fears associated with reproduction in HIV-affected couples, while supporting them in achieving their reproductive goals. Additional research is needed to evaluate the Safer Conception Toolkit in order to support its implementation and use in HIV care and
Koufi, Vassiliki; Malamateniou, Flora; Vassilacopoulos, George
Healthcare organizations increasingly navigate a highly volatile, complex environment in which technological advancements and new healthcare delivery business models are the only constants. In their effort to out-perform in this environment, healthcare organizations need to be agile enough in order to become responsive to these increasingly changing conditions. To act with agility, healthcare organizations need to discover new ways to optimize their operations. To this end, they focus on healthcare processes that guide healthcare delivery and on the technologies that support them. Business process management (BPM) and Service-Oriented Architecture (SOA) can provide a flexible, dynamic, cloud-ready infrastructure where business process analytics can be utilized to extract useful insights from mountains of raw data, and make them work in ways beyond the abilities of human brains, or IT systems from just a year ago. This paper presents a framework which provides healthcare professionals gain better insight within and across your business processes. In particular, it performs real-time analysis on process-related data in order reveal areas of potential process improvement.
Zuckerman, Alan M
The passage of federal healthcare reform legislation, in combination with other factors, makes it likely that the next few years will be a major period of consolidation for healthcare organizations. This article examines the seven key forces reshaping healthcare delivery--from insurance industry consolidation to cost inflation to the increasing gap between financially strong and struggling providers--and provides advice for organizations on both sides of an acquisition.
Ruiz, Francisco; Garcia, Felix; Calahorra, Luis; Llorente, César; Gonçalves, Luis; Daniel, Christel; Blobel, Bernd
The importance of the process point of view is not restricted to a specific enterprise sector. In the field of health, as a result of the nature of the service offered, health institutions' processes are also the basis for decision making which is focused on achieving their objective of providing quality medical assistance. In this chapter the application of business process modelling - using the Business Process Modelling Notation (BPMN) standard is described. Main challenges of business process modelling in healthcare are the definition of healthcare processes, the multi-disciplinary nature of healthcare, the flexibility and variability of the activities involved in health care processes, the need of interoperability between multiple information systems, and the continuous updating of scientific knowledge in healthcare.
Mohrmann, Gregg; Schlusberg, Craig; Kropf, Roger
Healthcare is behind other industries in the ability to manage and control increasing demand for IT services, and to ensure that IT staff are available when and where needed. From everyday support requests to large capital projects, the IT department's ability to meet demand is limited. Organizational and IT leaders need to proactively address this issue and do a better job of predicting when services will be needed and whether appropriate resources will be available. This article describes the common issues that healthcare IT departments face in the efficient delivery of services as a result of factors such as budget constraints, skill sets and project dependencies. Best practices for controlling demand are discussed, including resource allocation, governance processes and a graphical analysis of forecasted vs. actual thresholds. Using specific healthcare provider examples, the article intends to provide IT management with an approach to predicting and controlling resource demand.
Computer-based clinical simulations are a powerful teaching and learning tool because of their ability to expand healthcare students' clinical experience by providing practice-based learning. Despite the benefits of traditional computer-based clinical simulations, there are significant issues that arise when incorporating them into a flexible,…
Assessing the Knowledge Level, Attitudes, Risky Behaviors and Preventive Practices on Sexually Transmitted Diseases among University Students as Future Healthcare Providers in the Central Zone of Malaysia: A Cross-Sectional Study
Folasayo, Adigun Temiloluwa; Oluwasegun, Afolayan John; Samsudin, Suhailah; Saudi, Siti Nor Sakinah; Osman, Malina; Hamat, Rukman Awang
This study was done to assess the knowledge, attitudes, risky behaviors and preventive practices related to sexually-transmitted diseases (STDs) among health and non-health sciences university students as future healthcare providers in Malaysia. A total of 700 health and non-health sciences university students (255 male; 445 female) aged between 17 and 30 years were surveyed by using a self-administered questionnaire. The majority (86.6%) had heard of STDs, and 50.4% knew STDs could present without symptoms. HIV remains the best known STD (83.6%) by the students, while chlamydia (26%) and trichomoniasis (21.0%) were rarely known. Gender, age group, educational level and faculty type were strongly associated with knowledge level (p-values < 0.05). Most of them (88.8%) were aware that STD screening was important while use of condoms was protective (63.8%). The majority of them strongly felt that treatment should be sought immediately if they (85.5%) and their partners (87.4%) have symptoms. Among the sexually-active students, 66.7% and 18% had sexual intercourse with multiple partners and commercial sex workers, while 17.4% and 9.4% took alcohol and drugs before having sex, respectively. By logistic regression analysis, students aged 24–30 years old (an odds ratio (AOR) = 0.57, 95% confidence interval (CI) = 0.377–0.859) and faculty type (AOR = 5.69, 95% CI = 4.019–8.057) were the significant predictors for the knowledge level. Knowledge on the non-HIV causes of STDs is still lacking, and the risky behavior practiced by the sexually-active students in this study is alarming. There is a need to revisit the existing STD education curriculum in both schools and universities so that appropriate intervention on STDs can be implemented. PMID:28208724
Assessing the Knowledge Level, Attitudes, Risky Behaviors and Preventive Practices on Sexually Transmitted Diseases among University Students as Future Healthcare Providers in the Central Zone of Malaysia: A Cross-Sectional Study.
Folasayo, Adigun Temiloluwa; Oluwasegun, Afolayan John; Samsudin, Suhailah; Saudi, Siti Nor Sakinah; Osman, Malina; Hamat, Rukman Awang
This study was done to assess the knowledge, attitudes, risky behaviors and preventive practices related to sexually-transmitted diseases (STDs) among health and non-health sciences university students as future healthcare providers in Malaysia. A total of 700 health and non-health sciences university students (255 male; 445 female) aged between 17 and 30 years were surveyed by using a self-administered questionnaire. The majority (86.6%) had heard of STDs, and 50.4% knew STDs could present without symptoms. HIV remains the best known STD (83.6%) by the students, while chlamydia (26%) and trichomoniasis (21.0%) were rarely known. Gender, age group, educational level and faculty type were strongly associated with knowledge level (p-values < 0.05). Most of them (88.8%) were aware that STD screening was important while use of condoms was protective (63.8%). The majority of them strongly felt that treatment should be sought immediately if they (85.5%) and their partners (87.4%) have symptoms. Among the sexually-active students, 66.7% and 18% had sexual intercourse with multiple partners and commercial sex workers, while 17.4% and 9.4% took alcohol and drugs before having sex, respectively. By logistic regression analysis, students aged 24-30 years old (an odds ratio (AOR) = 0.57, 95% confidence interval (CI) = 0.377-0.859) and faculty type (AOR = 5.69, 95% CI = 4.019-8.057) were the significant predictors for the knowledge level. Knowledge on the non-HIV causes of STDs is still lacking, and the risky behavior practiced by the sexually-active students in this study is alarming. There is a need to revisit the existing STD education curriculum in both schools and universities so that appropriate intervention on STDs can be implemented.
West-Oram, Peter; Buyx, Alena
The right to conscientious objection in the provision of healthcare is the subject of a lengthy, heated and controversial debate. Recently, a new dimension was added to this debate by the US Supreme Court's decision in Burwell vs. Hobby Lobby et al. which effectively granted rights to freedom of conscience to private, for-profit corporations. In light of this paradigm shift, we examine one of the most contentious points within this debate, the impact of granting conscience exemptions to healthcare providers on the ability of women to enjoy their rights to reproductive autonomy. We argue that the exemptions demanded by objecting healthcare providers cannot be justified on the liberal, pluralist grounds on which they are based, and impose unjustifiable costs on both individual persons, and society as a whole. In doing so, we draw attention to a worrying trend in healthcare policy in Europe and the United States to undermine women's rights to reproductive autonomy by prioritizing the rights of ideologically motivated service providers to an unjustifiably broad form of freedom of conscience.
Fidsa, Gianfranco Zaccai
This paper describes the application of a holistic design process to a variety of problems plaguing current healthcare systems. A design process for addressing complex, multifaceted problems is contrasted with the piecemeal application of technological solutions to specific medical or administrative problems. The goal of this design process is the ideal customer experience, specifically the ideal experience for patients, healthcare providers, and caregivers within a healthcare system. Holistic design is shown to be less expensive and wasteful in the long run because it avoids solving one problem within a complex system at the cost of creating other problems within that system. The article applies this approach to the maintenance of good health throughout life; to the creation of an ideal experience when a person does need medical care; to the maintenance of personal independence as one ages; and to the enjoyment of a comfortable and dignified death. Virginia Mason Medical Center is discussed as an example of a healthcare institution attempting to create ideal patient and caregiver experiences, in this case by applying the principles of the Toyota Production System ("lean manufacturing") to healthcare. The article concludes that healthcare is inherently dedicated to an ideal, that science and technology have brought it closer to that ideal, and that design can bring it closer still.
Wood, Ben D; Killion, Jeffrey B
*From many accounts healthcare professionals are at increased risk for professional burnout. Professional burnout is generally described as prolonged stress that impairs one's ability to perform his or her job in demanding situations. *Precursors to professional burnout include, but are not limited to, employee workload, chronic fatigue, compassion fatigue, balance between family and career, sickness absence, and loss of confidence. *Administrators must watch for early signs of professional burnout to improve retention and promote employee morale. To reduce professional burnout, administrators must implement strategies to reduce burnout while also promoting productivity. *When professional burnout occurs, management must consider each employee's generational differences. All generations have differing values, beliefs, and opinions that influence his or her work ethic in regard to employee productivity.
Lusky, Richard A.; Spicker, Stuart F.
This demonstration project provided specialized training to members of newly constituted healthcare ethics committees (HECs) across the United States. Between 1992 and 1996, 25 faculty with experience in healthcare ethics provided on-site training at hospitals and health centers in 54 communities in 32 states. Sixty training modules were developed…
Wu, Li-Fen; Koo, Malcolm; Tseng, Hui-Chen; Liao, Yu-Chen; Chen, Yuh-Min
Spiritual care is essential to the well-being of patients, and nurses provide spiritual care as a fundamental part of nursing practice. In this study, we investigated the spiritual care needs of hospitalized patients to determine whether the perceived knowledge of nurses corresponded with these spiritual care needs. A cross-sectional study was conducted on 1351 hospitalized patients and 200 registered nurses recruited from a medical center in central Taiwan. A questionnaire, including the 21-item Spiritual Care Needs Inventory (patient and nurse version) and basic demographic information, was distributed to eligible participants. The top three items of the spiritual care needs expressed by the hospitalized patients were respect for privacy and dignity, showing concern, and guidance in gaining a sense of hope in life; the percentages of nurses not knowing how to provide these spiritual care needs were 0%, 1%, and 15%, respectively. The spiritual care needs of patients showed a significant relationship with the knowledge of nurses, suggesting that the perceived knowledge of the nurses generally corresponded with the spiritual care items that the patients required most.
The Commonwealth of Puerto Rico is an organized nonincorporated territory of the United States with a population of more than 3.5 million U.S. citizens. The island has been the focus of much recent attention due to the recent default on its debt (estimated at more than $70 billion), high poverty rates, and increasing unemployment. Less attention, however, has been given to the island's healthcare system, which many believe is on the verge of collapsing. Healthcare makes up 20% of the Puerto Rican economy, and this crisis affects reimbursement rates for physicians while promoting the disintegration of the island's healthcare infrastructure. A major contributor relates to a disparity in federal funding provided to support the island's healthcare system when compared with that provided to the states in the mainland and Hawaii. Puerto Rico receives less federal funding for healthcare than the other 50 states and the District of Columbia even though it pays its share of social security and Medicare taxes. To make matters worse, the U.S. Center for Medicaid and Medicare Services is planning soon to implement another 11% cut in Medical Advantage reimbursements. This disparity in support for healthcare is considered responsible for ∼$25 billion of Puerto Rico's total debt. The impact of these events on the health of Puerto Ricans in the island cannot be entirely predicted, but the loss of healthcare providers and diminished access to care are a certainty, and quality care will suffer, leading to serious implications for those with chronic medical disorders including respiratory disease.
Parente, Ronaldo; Kock, Ned; Sonsini, John
This paper develops a conceptual framework and offers research propositions for understanding the adoption of speech-recognition technology, drawing from Rogers's work on the diffusion of innovation, from interview findings, and from case study analysis. The study's focus was the analysis of the implementation of speech recognition and its impact on performance in the healthcare industry. Our interview findings indicated that, while there is still much room for improvement in the way speech-recognition technology is adopted and implemented, this particular technology has had a significant impact on the ability of healthcare providers to operate more cost effectively and provide a better level of patient care.
Tello-Leal, Edgar; Chiotti, Omar; Villarreal, Pablo David
The paper presents a methodology that follows a top-down approach based on a Model-Driven Architecture for integrating and coordinating healthcare services through cross-organizational processes to enable organizations providing high quality healthcare services and continuous process improvements. The methodology provides a modeling language that enables organizations conceptualizing an integration agreement, and identifying and designing cross-organizational process models. These models are used for the automatic generation of: the private view of processes each organization should perform to fulfill its role in cross-organizational processes, and Colored Petri Net specifications to implement these processes. A multi-agent system platform provides agents able to interpret Colored Petri-Nets to enable the communication between the Healthcare Information Systems for executing the cross-organizational processes. Clinical documents are defined using the HL7 Clinical Document Architecture. This methodology guarantees that important requirements for healthcare services integration and coordination are fulfilled: interoperability between heterogeneous Healthcare Information Systems; ability to cope with changes in cross-organizational processes; guarantee of alignment between the integrated healthcare service solution defined at the organizational level and the solution defined at technological level; and the distributed execution of cross-organizational processes keeping the organizations autonomy.
Schweitzer, Marco; Hoerbst, Alexander
Electronic Health Records (EHRs) play a crucial role in healthcare today. Considering a data-centric view, EHRs are very advanced as they provide and share healthcare data in a cross-institutional and patient-centered way adhering to high syntactic and semantic interoperability. However, the EHR functionalities available for the end users are rare and hence often limited to basic document query functions. Future EHR use necessitates the ability to let the users define their needed data according to a certain situation and how this data should be processed. Workflow and semantic modelling approaches as well as Web services provide means to fulfil such a goal. This thesis develops concepts for dynamic interfaces between EHR end users and a service oriented eHealth infrastructure, which allow the users to design their flexible EHR needs, modeled in a dynamic and formal way. These are used to discover, compose and execute the right Semantic Web services.
Niland, Joyce C.; Rouse, Layla; Stahl, Douglas C.
There is a critical gap in our nation's ability to accurately measure and manage the quality of medical care. A robust healthcare quality information system (HQIS) has the potential to address this deficiency through the capture, codification, and analysis of information about patient treatments and related outcomes. Because non-technical issues often present the greatest challenges, this paper provides an overview of these socio-technical issues in building a successful HQIS, including the human, organizational, and knowledge management (KM) perspectives. Through an extensive literature review and direct experience in building a practical HQIS (the National Comprehensive Cancer Network Outcomes Research Database system), we have formulated an “informatics blueprint” to guide the development of such systems. While the blueprint was developed to facilitate healthcare quality information collection, management, analysis, and reporting, the concepts and advice provided may be extensible to the development of other types of clinical research information systems. PMID:16622161
The Healthcare Identifiers Bill 2010 (Cth), which will establish "the national e-health Healthcare Identifiers Service to provide that patients, healthcare providers and provider organisations can be consistently identified", is in the process of being enacted by the Australian Federal Parliament. The legislation will enable the government to assign to each "healthcare recipient" a 26-digit electronic "Healthcare Identifier", which will be accessible, with or without the recipient's consent, to a broad range of health care service providers as well as other entities. The individual Healthcare Identifier file will initially contain such identifying information as, where applicable, the Medicare number and/or the Veterans' Affairs number; name; address; gender; date of birth; and "the date of birth accuracy indicator" presumably birth certificate. However, since each "service" provided by a health care provider to a health care recipient will be automatically recorded on each individual's Healthcare Identifier file, in time these electronic files should contain a full record of such services or contacts. Moreover, the Healthcare Identifiers are considered a "key" to, or a "foundation stone" for, the implementation of the shared electronic health records scheme, because they will enable linkage with and retrieval of each patient's clinical records throughout the health care service system. However, there has been virtually no discussion about the legal, ethical and social implications of this legislation.
Carriere, Brian K; Muise, Melanie; Cummings, Greta; Newburn-Cook, Chris
Succession planning is a business strategy that has recently gained attention in the healthcare literature, primarily because of nursing shortage concerns and the demand for retaining knowledgeable personnel to meet organizational needs. Little research has been conducted in healthcare settings that clearly defines best practices for succession planning frameworks. To effectively carry out such organizational strategies during these challenging times, an integrative review of succession planning in healthcare was performed to identify consistencies in theoretical approaches and strategies for chief nursing officers and healthcare managers to initiate. Selected articles were compared with business succession planning to determine whether healthcare strategies were similar to best practices already established in business contexts. The results of this integrative review will aid leaders and managers to use succession planning as a tool in their recruitment, retention, mentoring, and administration activities and also provide insights for future development of healthcare succession planning frameworks.
Furnell, S; Gritzalis, D; Katsikas, S; Mavroudakis, K; Sanders, P; Warren, M
This paper considers the increasing requirement for security in healthcare IT systems and, in particular, identifies the need for appropriate means by which healthcare establishments (HCEs) may respond to incidents. The main discussion focuses upon two significant initiatives that have been established in order to improve understanding and awareness of healthcare security issues. The first is the establishment of a dedicated Incident Reporting Scheme (IRS) for HCEs, enabling the level and types of security incidents faced within the healthcare community to be monitored and advice appropriately targeted. The second aspect presents a description of healthcare security World Wide Web service, which provides a comprehensive source of advice and guidance for establishments when trying to address and prevent IT security breaches. The discussion is based upon work that is currently being undertaken with the ISHTAR (Implementing Secure Healthcare Telematics Applications in Europe) project, as part of the Telematics Applications for Health programme of the European Commission.
Chandola, Varun; Schryver, Jack C; Sukumar, Sreenivas R
We discuss the problem of fraud detection in healthcare in this chapter. Given the recent scrutiny of the ineciencies in the US healthcare system, identifying fraud has been on the forefront of the eorts towards reducing the healthcare costs. In this chapter we will focus on understanding the issue of healthcare fraud in detail, and review methods that have been proposed in the literature to combat this issue using data driven approach.
Carnevale, Anthony P.; Smith, Nicole; Gulish, Artem; Beach, Bennett H.
This executive summary highlights several findings about healthcare. These are: (1) Healthcare is 18 percent of the U.S. economy, twice as high as in other countries; (2) There are two labor markets in healthcare: high-skill, high-wage professional and technical jobs and low-skill, low-wage support jobs; (3) Demand for postsecondary education in…
Damianov, Damian S; Pagán, José A
We develop a theoretical model of a local healthcare system in which consumers, health insurance companies, and healthcare providers interact with each other in markets for health insurance and healthcare services. When income and health status are heterogeneous, and healthcare quality is associated with fixed costs, the market equilibrium level of healthcare quality will be underprovided. Thus, healthcare reform provisions and proposals to cover the uninsured can be interpreted as an attempt to correct this market failure. We illustrate with a numerical example that if consumers at the local level clearly understand the linkages between health insurance coverage and the quality of local healthcare services, health insurance coverage proposals are more likely to enjoy public support.
Carroll, Mark; James, Judith A; Lardiere, Michael R; Proser, Michelle; Rhee, Kyu; Sayre, Michael H; Shore, Jay H; Ternullo, Joseph
Partnerships between patient communities, healthcare providers, and academic researchers are key to stepping up the pace and public health impact of clinical and translational research supported by the National Institutes of Health. With emphasis shifting toward community engagement and faster translation of research advances into clinical practice, academic researchers have a vital stake in widening the use of health information technology systems and telehealth networks to support collaboration and innovation. However, limited interaction between academic institutions and healthcare providers hinders the ability to form and sustain the integrated networks that are needed to conduct meaningful community-engaged research that improves public health outcomes. Healthcare providers, especially those affiliated with smaller practices, will need sustainable infrastructure and real incentives to utilize such networks, as well as training and additional resources for ongoing technical assistance.
Carroll, Mark; James, Judith A.; Lardiere, Michael R.; Proser, Michelle; Rhee, Kyu; Sayre, Michael H.; Shore, Jay H.
Abstract Partnerships between patient communities, healthcare providers, and academic researchers are key to stepping up the pace and public health impact of clinical and translational research supported by the National Institutes of Health. With emphasis shifting toward community engagement and faster translation of research advances into clinical practice, academic researchers have a vital stake in widening the use of health information technology systems and telehealth networks to support collaboration and innovation. However, limited interaction between academic institutions and healthcare providers hinders the ability to form and sustain the integrated networks that are needed to conduct meaningful community-engaged research that improves public health outcomes. Healthcare providers, especially those affiliated with smaller practices, will need sustainable infrastructure and real incentives to utilize such networks, as well as training and additional resources for ongoing technical assistance. PMID:20043702
Neumann, C L; Blouin, A S; Byrne, E M
As the healthcare market continues to evolve, technology will play an increasingly important role in an integrated delivery system's ability to provide high-quality, cost-effective care. Healthcare leaders must be proactive and forward thinking about their technology investments. The financial investment for technology innovation can be significant. Therefore, it is important that healthcare executives deliberately design the role of technology and develop a consistent method for evaluating, identifying, and prioritizing technology investments. The article begins by describing technology's role in a healthcare organization as a window to the organization, a key driver of business strategy, and a high-performance enabler, and it develops a seven-step process for building a business case to ensure that an organization's technology investments are wise, well-reasoned, and will provide value to its customers. In addition, the article discusses the importance of combining people and process reengineering with new technology to exponentially increase the value to an organization. Healthcare leaders must understand the multiple roles of technology and consistently develop a business case when making technology investment decisions. Organizations driven by such an understanding will have a robust infrastructure of enabling technology designed to integrate people and process elements with technology to achieve the goals and initiatives of the organization. These organizations will lead the healthcare industry into the next millennium.
... Employment and Training Administration Apria Healthcare Customer Service Department; Fourteen Locations in... Healthcare, Customer Service Department, Thirteen Locations in Missouri: Cameron, Cape Girardeau, Columbia... Healthcare, Customer Service Department. The Clinton, Missouri location provided data entry services in...
Yue, Xiao; Wang, Huiju; Jin, Dawei; Li, Mingqiang; Jiang, Wei
Healthcare data are a valuable source of healthcare intelligence. Sharing of healthcare data is one essential step to make healthcare system smarter and improve the quality of healthcare service. Healthcare data, one personal asset of patient, should be owned and controlled by patient, instead of being scattered in different healthcare systems, which prevents data sharing and puts patient privacy at risks. Blockchain is demonstrated in the financial field that trusted, auditable computing is possible using a decentralized network of peers accompanied by a public ledger. In this paper, we proposed an App (called Healthcare Data Gateway (HGD)) architecture based on blockchain to enable patient to own, control and share their own data easily and securely without violating privacy, which provides a new potential way to improve the intelligence of healthcare systems while keeping patient data private. Our proposed purpose-centric access model ensures patient own and control their healthcare data; simple unified Indicator-Centric Schema (ICS) makes it possible to organize all kinds of personal healthcare data practically and easily. We also point out that MPC (Secure Multi-Party Computing) is one promising solution to enable untrusted third-party to conduct computation over patient data without violating privacy.
Zhang, Jiuyang; Yan, Jing; Pageni, Parasmani; Yan, Yi; Wirth, Adam; Chen, Yun-Ping; Qiao, Yali; Wang, Qian; Decho, Alan W.; Tang, Chuanbing
Metallopolymers combine a processable, versatile organic polymeric skeleton with functional metals, providing multiple functions and methodologies in materials science. Taking advantage of cationic cobaltocenium as the key building block, organogels could be simply switched to hydrogels via a highly efficient ion exchange. With the unique ionic complexion ability, cobaltocenium moieties provide a robust soft substrate for recycling antibiotics from water. The essential polyelectrolyte nature offers the metallopolymer hydrogels to kill multidrug resistant bacteria. The multifunctional characteristics of these hydrogels highlight the potential for metallopolymers in the field of healthcare and environmental treatment. PMID:26202475
Dietert, Rodney R.; Dietert, Janice M.
Increasing prevalences, morbidity, premature mortality and medical needs associated with non-communicable diseases and conditions (NCDs) have reached epidemic proportions and placed a major drain on healthcare systems and global economies. Added to this are the challenges presented by overuse of antibiotics and increased antibiotic resistance. Solutions are needed that can address the challenges of NCDs and increasing antibiotic resistance, maximize preventative measures, and balance healthcare needs with available services and economic realities. Microbiome management including microbiota seeding, feeding, and rebiosis appears likely to be a core component of a path toward sustainable healthcare. Recent findings indicate that: (1) humans are mostly microbial (in terms of numbers of cells and genes); (2) immune dysfunction and misregulated inflammation are pivotal in the majority of NCDs; (3) microbiome status affects early immune education and risk of NCDs, and (4) microbiome status affects the risk of certain infections. Management of the microbiome to reduce later-life health risk and/or to treat emerging NCDs, to spare antibiotic use and to reduce the risk of recurrent infections may provide a more effective healthcare strategy across the life course particularly when a personalized medicine approach is considered. This review will examine the potential for microbiome management to contribute to sustainable healthcare. PMID:27417751
Herndon, James H; Hwang, Raymond; Bozic, K J; Bozic, K H
New technology is one of the primary drivers for increased healthcare costs in the United States. Both physician and industry play important roles in the development, adoption, utilization and choice of new technologies. The Federal Drug Administration regulates new drugs and new medical devices, but healthcare technology assessment remains limited. Healthcare technology assessment originated in federal agencies; today it is decentralized with increasing private sector efforts. Innovation is left to free market forces, including direct to consumer marketing and consumer choice. But to be fair to the consumer, he/she must have free knowledge of all the risks and benefits of a new technology in order to make an informed choice. Physicians, institutions and industry need to work together by providing proven, safe, clinically effective and cost effective new technologies, which require valid pre-market clinical trials and post-market continued surveillance with national and international registries allowing full transparency of new products to the consumer--the patient.
Silva, Raimunda Magalhães da; Costa, Milena Silva; Matsue, Regina Yoshie; Sousa, Girliani Silva de; Catrib, Ana Maria Fontenelle; Vieira, Luiza Jane Eyre de Souza
This work uses cartography as a method for mapping the trajectory of primary healthcare provided to pregnant women. The scope of the study comprises 9 Basic Healthcare Units located in the city of Juazeiro do Norte in the State of Ceará. In all, fifteen women in the 37th to 39th week of pregnancy were selected. Interviews were conducted with these women during the period from January to June 2010. The cartographic findings were depicted in stages in the flowchart, which exposed lacunas in prenatal healthcare, such as the low number of oncotic cytology exams conducted and the lack of educational counseling. Nevertheless, in the interviews, a significant number of pregnant women expressed satisfaction with the prenatal care provided. The good relationships developed between the healthcare professionals and the pregnant women were the main reason that led them to continue the treatment. This fact reinforces the importance of dialogue between these two actors for the success of prenatal healthcare.
Damaskinos, P; Koletsi-Kounari, H; Economou, C; Eaton, K A; Widström, E
This paper presents a description of the healthcare system and how oral healthcare is organised and provided in Greece, a country in a deep economic and social crisis. The national health system is underfunded, with severe gaps in staffing levels and the country has a large private healthcare sector. Oral healthcare has been largely provided in the private sector. Most people are struggling to survive and have no money to spend on general and oral healthcare. Unemployment is rising and access to healthcare services is more difficult than ever. Additionally, there has been an overproduction of dentists and no development of team dentistry. This has led to under or unemployment of dentists in Greece and their migration to other European Union member states, such as the United Kingdom, where over 600 Greek dentists are currently working.
Jarboe, G R; Gates, R H; McDaniel, C D
Healthcare providers of multiple option plans may be confronted with special market segmentation problems. This study demonstrates how cluster analysis may be used for discovering distinct patterns of preference for multiple option plans. The availability of metric, as opposed to categorical or ordinal, data provides the ability to use sophisticated analysis techniques which may be superior to frequency distributions and cross-tabulations in revealing preference patterns.
Globalization-the increasing transnational circulation of money, goods, people, ideas, and information worldwide-is generally recognized as one of the most powerful forces shaping our current and future history. How is it affecting healthcare, and in that context, what is the purpose and significance of Global Advances in Health and Medicine (GAHM), publisher of this journal? Our goal is not homogenization but rather to provide an opportunity for integration, convergence, and collaboration across cultures. By respecting and conserving the richness and diversity of each new medicine, we embrace globalization. Globalization is of course not new; it began in the Renaissance and particularly with the 15th- and 16th-century voyages of exploration by Columbus, Magellan, and others. Since the beginning of time, there have been interactions and exchanges among different peoples and cultures. However, the current magnitude of globalization is unprecedented and yet still expanding rapidly.
Erdmier, Casey; Hatcher, Jason; Lee, Michael
This manuscript analyses the impact of wearable device technology in the healthcare industry. The authors provide an exploration of the different types of wearable technology that are becoming popular or are emerging into the consumer market and the personal health information and other user data these devices collect. The applications of wearable technology to healthcare and wellness are discussed, along with the impact of these devices on the industry. Finally, an analysis is provided, describing the current regulations in the US and UK that govern wearable devices and the impact of these device regulations on users and healthcare professionals.
Cecilio, Luiz Carlos de Oliveira; Carapinheiro, Graça; Andreazza, Rosemarie; Souza, Ana Lúcia Medeiros de; Andrade, Maria da Graça Garcia; Santiago, Silvia Maria; Meneses, Consuelo Sampaio; Reis, Denizi Oliveira; Araújo, Eliane Cardoso; Pinto, Nicanor Rodrigues da Silva; Spedo, Sandra Maria
This study aimed to characterize which regulatory logics (other than government regulation) result in healthcare output, using a two-stage qualitative study in two municipalities in the ABCD Paulista region in São Paulo State, Brazil. The first stage included interviews with strategic actors (managers and policymakers) and key health professionals. The second phase collected life histories from 18 individuals with high health-services utilization rates. An analysis of the researchers' involvement in the field allowed a better understanding of the narratives. Four regulatory systems were characterized (governmental, professional, clientelistic, and lay), indicating that regulation is a field in constant dispute, a social production. Users' action produces healthcare maps that reveal the existence of other possible health system arrangements, calling on us to test shared management of healthcare between health teams and users as a promising path to the urgent need to reinvent health.
Kawamoto, Kensaku; Honey, Alan; Rubin, Ken
Context The healthcare industry could achieve significant benefits through the adoption of a service-oriented architecture (SOA). The specification and adoption of standard software service interfaces will be critical to achieving these benefits. Objective To develop a replicable, collaborative framework for standardizing the interfaces of software services important to healthcare. Design Iterative, peer-reviewed development of a framework for generating interoperable service specifications that build on existing and ongoing standardization efforts. The framework was created under the auspices of the Healthcare Services Specification Project (HSSP), which was initiated in 2005 as a joint initiative between Health Level7 (HL7) and the Object Management Group (OMG). In this framework, known as the HSSP Service Specification Framework, HL7 identifies candidates for service standardization and defines normative Service Functional Models (SFMs) that specify the capabilities and conformance criteria for these services. OMG then uses these SFMs to generate technical service specifications as well as reference implementations. Measurements The ability of the framework to support the creation of multiple, interoperable service specifications useful for healthcare. Results Functional specifications have been defined through HL7 for four services: the Decision Support Service; the Entity Identification Service; the Clinical Research Filtered Query Service; and the Retrieve, Locate, and Update Service. Technical specifications and commercial implementations have been developed for two of these services within OMG. Furthermore, three additional functional specifications are being developed through HL7. Conclusions The HSSP Service Specification Framework provides a replicable and collaborative approach to defining standardized service specifications for healthcare. PMID:19717796
Goldburgh, Mitchell M.; Glicksman, Robert A.; Wilson, Dennis L.
The rapid and dramatic shifts within the US healthcare industry have created unprecedented needs to implement changes in the delivery systems. These changes must not only address the access to healthcare, but the costs of delivery, and outcomes reporting. The resulting vision to address these needs has been called the Integrated Healthcare Solution whose core is the Electronic Patient Record. The integration of information by itself is not the issue, nor will it address the challenges in front of the healthcare providers. The process and business of healthcare delivery must adopt, apply and expand its use of technology which can assist in re-engineering the tools for healthcare. Imaging is becoming a larger part of the practice of healthcare both as a recorder of health status and as a defensive record for gatekeepers of healthcare. It is thus imperative that imaging specialists adopt technology which competitively integrates them into the process, reduces the risk, and positively effects the outcome.
Son, Jiseong; Kim, Jeong-Dong; Na, Hong-Seok; Baik, Doo-Kwon
When sharing and storing healthcare data in a cloud environment, access control is a central issue for preserving data privacy as a patient's personal health data may be accessed without permission from many stakeholders. Specifically, dynamic authorization for the access of data is required because personal health data is stored in cloud storage via wearable devices. Therefore, we propose a dynamic access control model for preserving the privacy of personal healthcare data in a cloud environment. The proposed model considers context information for dynamic access. According to the proposed model, access control can be dynamically determined by changing the context information; this means that even for a subject with the same role in the cloud, access permission is defined differently depending on the context information and access condition. Furthermore, we experiment the ability of the proposed model to provide correct responses by representing a dynamic access decision with real-life personalized healthcare system scenarios.
Carnevale, Anthony P.; Smith, Nicole; Gulish, Artem; Beach, Bennett H.
This report projects education requirements linked to forecasted job growth in healthcare by state and the District of Columbia from 2010 through 2020. It complements a larger national report which projects educational demand for healthcare for the same time period. The national report shows that with or without Obamacare, the United States will…
Tuckman, H P; Chang, C F
Every year, volunteers contribute billions of dollars worth of time to the healthcare industry. Despite their contributions, however, little is known about who these volunteers are, what they do, why they volunteer, as well as the costs and benefits they bring to institutions. This article examines these and other characteristics of the healthcare volunteer.
Aggarwal, A K; Travers, S
The healthcare industry, with more than one trillion dollars in revenue, accounts for about one-seventh of the U.S. economy. A significant portion of this revenue is lost to escalating healthcare system costs. This article examines the shortcomings of the traditional healthcare delivery system in terms of information flow, communication standards, case collections, and IT spending. It makes the case that e-commerce has the ability to transact some healthcare business more efficiently and cost-effectively. With the Internet as a delivery platform, several models offer improvement over the status quo.
The increasing availability of Big Data in healthcare encourages investigators to seek answers to big questions. However, nonparametric approaches to analyzing these data can suffer from the curse of dimensionality, and traditional parametric modeling does not necessarily scale. Targeted learning (TL) combines semiparametric methodology with advanced machine learning techniques to provide a sound foundation for extracting information from data. Predictive models, variable importance measures, and treatment benefits and risks can all be addressed within this framework. TL has been applied in a broad range of healthcare settings, including genomics, precision medicine, health policy, and drug safety. This article provides an introduction to the two main components of TL, targeted minimum loss-based estimation and super learning, and gives examples of applications in predictive modeling, variable importance ranking, and comparative effectiveness research.
Consumer health-care information technology is intended to improve patients' opportunities to gather information about their own health. Ideally, this will be achieved through an improved involvement of existing data bases and an improved communication of information to patients and to care providers, if desired by patients. Additionally, further interconnection of existing and new systems and pervasive system design may be used. All consumer health-care information technology services are optional and leave patients in control of their medical data at all times. This article reflects the current status of consumer health-care information technology research and suggests further research areas that should be addressed.
Because of the trend toward consolidation in the healthcare field, many organizations have massive amounts of data stored in various information systems organizationwide, but access to the data by end users may be difficult. Healthcare organizations are being pressured to provide managers easy access to the data needed for critical decision making. One solution many organizations are turning to is implementing decision-support data warehouses. A data warehouse instantly delivers information directly to end users, freeing healthcare information systems staff for strategic operations. If designed appropriately, data warehouses can be a cost-effective tool for business analysis and decision support.
Munoz-Price, L Silvia; Safdar, Nasia; Beier, John C; Doggett, Stephen L
Infestations caused by bed bugs have resurfaced during the past decade across all continents. Even though bed bugs primarily cause skin manifestations in humans, a major stigma is placed upon people or institutions found to carry them. It is important for healthcare facilities to be prepared for this pest by implementing policies, carefully selecting materials used for hospital furniture, and educating providers on early identification and control.
There are very few within or outside of the American healthcare system who would argue that the current system of providing healthcare is badly broken and needs fixing. The cost of healthcare has outpaced every other sector of American life. We spend 2.5 times more on healthcare than do most developed countries in the world. Do we have the best healthcare in the world? The average life expectancy is 78.49 years, which ranks us 51st in the world. We spend more on healthcare than any other nation but get less for our hard-earned dollars. This article will provide suggestions for repairing the broken healthcare system with excerpts taken from the book Practical Wisdom, by Dr. Barry Schwartz and Kenneth Sharpe.
Ameri, Cinzia; Fiorini, Fulvio
If the "old economy" preached standardization of products/services in order to reduce costs, the "new economy" is based on the recognition of the needs and the management of information. It is aimed at providing better and more usable services. One scenario is a national health service with regional management but based on competition between hospitals/companies.This led to a different handling of the user/patient, which has become the center of the health system: marketing seeks to retain the patient, trying to push a client-patient to not change their healthcare service provider. In costs terms, it is more economical to retain a customer rather than acquire a new one: a satisfied customer is also the best sounding board for each company. Customer equity is the management of relations with patients which can result in a greater customer value: it is possible to recognize an equity of the value, of the brand and of the report. Loyalty uses various marketing activities (basic, responsive, responsible, proactive and collaborative): each hospital/company chooses different actions depending on how many resources it plans to invest in loyalty.
Briggs, J S; Early, G H
This paper reviews some recent developments in the technology of the Internet, and shows how they may affect the way in which healthcare is provided. Starting with a brief technical history of the Internet, the paper discusses some of the technical developments that have taken place or been proposed in recent years, and speculates on the realities of their adoption within the next five years. The paper also discusses trends in public accessibility to the Internet and the development of Internet services. Finally, the impact of the technological developments on the way in which new healthcare services may be provided is discussed. Our conclusions are that the growth rate in Internet access and the improvements in performance resulting from the new technologies will make the Internet the focus of many new healthcare developments, in particular in the areas of telemedicine and in communication between patient and healthcare professionals. Increasingly, the Internet will be used to convey more 'real-time' information.
Wagner, L; Burda, D; Kenkel, P J; Nemes, J; Lutz, S; Weissenstein, E; Greene, J; Pallarito, K; Gardner, E; Wagner, M
Whether it's with apprehension or expectation, most of us are wondering what the new year will hold. With that question in mind, Modern Healthcare staff writers and healthcare industry leaders offer their short- and long-range forecasts for all sectors and on a variety of all-encompassing issues. Some key questions: Will presidential politics pressure healthcare reform efforts? How will investor-owned companies fare under another year of regulatory scrutiny? What awaits hospitals and physicians under the new fee schedule and other Medicare rule changes?
Wolf, Bernhard; Herzog, Karolin
Microelectronics and microsystem technology have changed our daily lives considerably in the past 50 years. Countless everyday objects contain microelectronic components. In healthcare up to the present, however, it has not been possible to make major alterations in introducing electronics and information technology that would lead to innovative improvements and greater transparency. This paper describes initial steps in diagnostics and oncological therapy including telematic healthcare systems which can, for example, assist patients with cardiovascular diseases and shows, through these areas, how electronics and microsystems technology can contribute to better healthcare.
He, Chenguang; Fan, Xiaomao; Li, Ye
Ubiquitous healthcare services are becoming more and more popular, especially under the urgent demand of the global aging issue. Cloud computing owns the pervasive and on-demand service-oriented natures, which can fit the characteristics of healthcare services very well. However, the abilities in dealing with multimodal, heterogeneous, and nonstationary physiological signals to provide persistent personalized services, meanwhile keeping high concurrent online analysis for public, are challenges to the general cloud. In this paper, we proposed a private cloud platform architecture which includes six layers according to the specific requirements. This platform utilizes message queue as a cloud engine, and each layer thereby achieves relative independence by this loosely coupled means of communications with publish/subscribe mechanism. Furthermore, a plug-in algorithm framework is also presented, and massive semistructure or unstructured medical data are accessed adaptively by this cloud architecture. As the testing results showing, this proposed cloud platform, with robust, stable, and efficient features, can satisfy high concurrent requests from ubiquitous healthcare services.
Lerum, Sverre Vigeland; Solbraekke, Kari Nyheim; Frich, Jan C
Motor neurone disease (MND) is a progressive neurological disease causing muscle wasting, gradual paralysis and respiratory failure, with a life expectancy of 2-4 years. In order to better understand how MND is managed in the community, we conducted a qualitative study to explore the challenges healthcare professionals encounter when managing MND in primary healthcare. Based on data from 15 semi-structured interviews with primary healthcare professionals in Norway, we found that MND is viewed as a condition that requires exceptional effort and detailed planning. Healthcare professionals reported five main challenges in managing MND in primary healthcare: (i) building relationships with those giving and receiving care in the home; (ii) preventing caregiver burnout and breakdown; (iii) providing tailored care; (iv) ensuring good working conditions in patients' homes; and (v) recruiting and retaining qualified nursing assistants. Healthcare professionals reported needing working conditions that allow them to tailor their approach to the personal, emotional and existential nature of care preferences of those living with MND. However, people with MND and their families were sometimes perceived by healthcare professionals to prefer a strictly task-focused relationship with care providers. Such relationships limited the healthcare professionals' control over the MND trajectory and their capacity to prevent family caregiver burnout and breakdown. Adequate resources, along with training and support of nursing assistants, may increase the continuity of nursing assistants. Responsiveness to patient and family needs may enhance collaboration and promote tailored primary care and support for patients with MND and their families.
Carayon, Pascale; Karsh, Ben-Tzion; Gurses, Ayse P.; Holden, Richard; Hoonakker, Peter; Hundt, Ann Schoofs; Montague, Enid; Rodriguez, Joy; Wetterneck, Tosha B.
The US Institute of Medicine and healthcare experts have called for new approaches to manage healthcare quality problems. In this chapter, we focus on macroergonomics, a branch of human factors and ergonomics that is based on the systems approach and considers the organizational and sociotechnical context of work activities and processes. Selected macroergonomic approaches to healthcare quality and patient safety are described such as the SEIPS model of work system and patient safety and the model of healthcare professional performance. Focused reviews on job stress and burnout, workload, interruptions, patient-centered care, health IT and medical devices, violations, and care coordination provide examples of macroergonomics contributions to healthcare quality and patient safety. Healthcare systems and processes clearly need to be systematically redesigned; examples of macroergonomic approaches, principles and methods for healthcare system redesign are described. Further research linking macroergonomics and care processes/patient outcomes is needed. Other needs for macroergonomics research are highlighted, including understanding the link between worker outcomes (e.g., safety and well-being) and patient outcomes (e.g., patient safety), and macroergonomics of patient-centered care and care coordination. PMID:24729777
Chandola, Varun; Sukumar, Sreenivas R; Schryver, Jack C
The role of big data in addressing the needs of the present healthcare system in US and rest of the world has been echoed by government, private, and academic sectors. There has been a growing emphasis to explore the promise of big data analytics in tapping the potential of the massive healthcare data emanating from private and government health insurance providers. While the domain implications of such collaboration are well known, this type of data has been explored to a limited extent in the data mining community. The objective of this paper is two fold: first, we introduce the emerging domain of big"healthcare claims data to the KDD community, and second, we describe the success and challenges that we encountered in analyzing this data using state of art analytics for massive data. Specically, we translate the problem of analyzing healthcare data into some of the most well-known analysis problems in the data mining community, social network analysis, text mining, and temporal analysis and higher order feature construction, and describe how advances within each of these areas can be leveraged to understand the domain of healthcare. Each case study illustrates a unique intersection of data mining and healthcare with a common objective of improving the cost-care ratio by mining for opportunities to improve healthcare operations and reducing hat seems to fall under fraud, waste,and abuse.
Dauvrin, Marie; Lorant, Vincent
Background International migration is a global phenomenon challenging healthcare professionals to provide culturally competent care. Objectives The purpose of this study was to investigate the influence of leaders on the cultural competence of healthcare professionals. Methods A cross-sectional survey was conducted from 2010 to 2012 to obtain data for a social network analysis in 19 inpatient services and five primary care services in Belgium. The Competences in Ethnicity and Health questionnaire was used. A total of 507 healthcare professionals, including 302 nurses, identified their social relationships with other healthcare professionals working in their service. Highest in-degree centrality was used to identify the leaders within each health service. Multiple regressions with the Huber sandwich estimator were used to link cultural competence of leaders with the cultural competence of the rest of the healthcare staff. Results Cultural competence of the healthcare staff was associated with the cultural competence of the leaders. This association remained significant for two specific domains of cultural competence—mediation and paradigm—after controlling for contextual and sociodemographic variables. Interaction analysis suggested that the leadership effect varied with the degree of cultural competence of the leaders. Discussion Cultural competence among healthcare professionals is acquired partly through leadership. Social relationships and leadership effects within health services should be considered when developing and implementing culturally competent strategies. This requires a cautious approach as the most central individuals are not always the same persons as the formal leaders. PMID:25871625
Simeone, Cynthia L
The responsibility of risk management in healthcare is fractured, with multiple stakeholders. Most hospitals and healthcare systems do not have a fully integrated risk management system that spans the entire organizational and operational structure for the delivery of key services. This article provides insight toward utilizing a comprehensive Business Resilience program and associated methodology to understand and manage organizational risk leading to organizational effectiveness and operational efficiencies, with the fringe benefit of realizing sustainable operational capability during adverse conditions.
Batalden, Maren; Batalden, Paul; Margolis, Peter; Seid, Michael; Armstrong, Gail; Opipari-Arrigan, Lisa; Hartung, Hans
Efforts to ensure effective participation of patients in healthcare are called by many names—patient centredness, patient engagement, patient experience. Improvement initiatives in this domain often resemble the efforts of manufacturers to engage consumers in designing and marketing products. Services, however, are fundamentally different than products; unlike goods, services are always ‘coproduced’. Failure to recognise this unique character of a service and its implications may limit our success in partnering with patients to improve health care. We trace a partial history of the coproduction concept, present a model of healthcare service coproduction and explore its application as a design principle in three healthcare service delivery innovations. We use the principle to examine the roles, relationships and aims of this interdependent work. We explore the principle's implications and challenges for health professional development, for service delivery system design and for understanding and measuring benefit in healthcare services. PMID:26376674
... Evaluating Environmental Cleaning Appendices to the Conceptual Program Model for Environmental Evaluation Basic Infection Control and Prevention Plan for Outpatient Oncology Settings Appendices Outpatient Care Guide Tools for Protecting Healthcare Personnel PPE Training ...
Batalden, Maren; Batalden, Paul; Margolis, Peter; Seid, Michael; Armstrong, Gail; Opipari-Arrigan, Lisa; Hartung, Hans
Efforts to ensure effective participation of patients in healthcare are called by many names-patient centredness, patient engagement, patient experience. Improvement initiatives in this domain often resemble the efforts of manufacturers to engage consumers in designing and marketing products. Services, however, are fundamentally different than products; unlike goods, services are always 'coproduced'. Failure to recognise this unique character of a service and its implications may limit our success in partnering with patients to improve health care. We trace a partial history of the coproduction concept, present a model of healthcare service coproduction and explore its application as a design principle in three healthcare service delivery innovations. We use the principle to examine the roles, relationships and aims of this interdependent work. We explore the principle's implications and challenges for health professional development, for service delivery system design and for understanding and measuring benefit in healthcare services.
In the U.S., we now spend about 13% of the gross domestic product (CDP) on healthcare. This figure represents nearly $3000 per year per man, woman, and child. Moreover, this expenditure is projected to grow to about 20% of the GDP by the year 2000. Medical research and development accounts for only about 3% of national healthcare spending, and technology development represents only a small fraction of that 3%. New technologies that are far more cost-effective than previous ones - such as minimally invasive surgical procedures, advanced automated diagnostics, and better information systems - could save the nation billions of dollars per year to say nothing of the potential reductions in pain and suffering. A center is described that will coordinate ongoing Laboratory research aimed at developing more cost-effective tools for use by the healthcare community. The new Center for Healthcare Technologies will have many long-term benefits for the region and the nation.
Jang, Hyeju; Kim, Sanghyun; Bae, Changseok
An intelligent gadget is a wearable platform which is reconfigurable, scalable, and component-based and which can be equipped, carried as a personal accessory, or in a certain case, implanted internally into a body. Various kinds of personal information can be gathered with intelligent gadgets, and that information is used to provide specially personalized services to people in the ubiquitous computing environment. In this paper, we show a personalized healthcare service through intelligent gadgets. A service based on intelligent gadgets can be built intuitively and easily with a context representation language, called the intelligent gadget markup language (IGML) based on the event-condition-action (ECA) rule. The inherent nature of extensibility, not only environmental information but also physiological information can be specified as a context in IGML and can be dealt with an intelligent gadget with ease. It enables intelligent gadgets to be adopted to many different kinds of personalized healthcare services.
Clegg, T A
Replacing an antiquated computer system with state of the art equipment and software is a lengthy, at times frustrating, and never an easy decision. At Wesley Woods Center on Aging, Atlanta, an integrated provider of healthcare for the elderly affiliated with Emory University, the process consumed more than two and a half years. This article takes the reader through the entire process, from the initial decision to replace an existing system, through the final purchase and installation. It looks candidly at the problems that were encountered, including turnover among key personnel, difficulties with involving all of the user groups, changes in the technology and coordination with the University. The lessons Wesley Woods learned in its experience can be of benefit to any healthcare facility contemplating an information system change.
Rodríguez Perera, Francisco de Paula; Peiró, Manel
Strategic planning is a completely valid and useful tool for guiding all types of organizations, including healthcare organizations. The organizational level at which the strategic planning process is relevant depends on the unit's size, its complexity, and the differentiation of the service provided. A cardiology department, a hemodynamic unit, or an electrophysiology unit can be an appropriate level, as long as their plans align with other plans at higher levels. The leader of each unit is the person responsible for promoting the planning process, a core and essential part of his or her role. The process of strategic planning is programmable, systematic, rational, and holistic and integrates the short, medium, and long term, allowing the healthcare organization to focus on relevant and lasting transformations for the future.
Lipcamon, James D; Mainwaring, Brian A
Conflict causes decided tension in the workplace and often produces poor professional outcomes. A manager dealing with conflict can experience a crisis of confidence and often ends up second-guessing himself or herself, regardless of how a situation has been handled. In some organizations, conflict is not viewed positively or as an opportunity for improvement. In these organizations, most individuals will see conflict as being unproductive, unpleasant, and a waste of time and energy. Yet, conflict provides employees with critical feedback on how things are going. When viewed in a positive context, even personality conflicts may provide information to the healthcare manager about what is not working in the organization. If conflict is not directed and controlled, it can have damaging effects in the workplace, stifling the growth of departments and deflating employee morale. Our job as healthcare managers is to deal with conflict so that it does not decrease productivity or detract from the provision of patient-centered care. There are 4 general sources for interpersonal conflict: personal differences, informational deficiency, role incompatibility, and environmental stress. There are 5 common responses used in dealing with conflict: forcing, accommodating, avoiding, compromising, and collaborating. Healthcare managers should become comfortable with using all of these approaches.
Shinkman, R; Weissenstein, E
When charges were made last summer against 12 men affiliated with a New Jersey-based third-party administrator firm, headlines trumpeted the arrests as the first major case of organized crime infiltrating the healthcare industry. While law enforcement experts don't believe the mob has established a major role in healthcare, they acknowledge the $1 trillion-a-year industry is a lucrative target for illicit activity.
expenditure through measures of access, cost and quality . While the quality of the U.S. healthcare system is unparalleled in the areas of acute...system’s outcomes as measured by cost, access and quality , and makes recommendations targeted at government’s role in promoting the health of our...the system combine to produce an output that we call healthcare. That output can be measured in terms of access, cost and quality --the same market
Young, Judith S
Home healthcare and hospice clinicians are increasingly working with patients for whom English is not their primary language. Provision of culturally respectful and acceptable patient-centered care includes both an awareness of cultural beliefs that influence the patient's health and also the ability to provide the patient with health information in the language with which he or she is most comfortable. This article identifies resources for understanding the cultural norms of different Spanish-speaking groups as well as materials appropriate for Spanish-speaking patients that healthcare professionals and government agencies from around the world have made available for others to use.
Holst, Jens; Gericke, Christian A
Yemen is a low-middle-income country where more than half of the population live in rural areas and lack access to the most basic health care. At US$40 per capita, Yemen's annual total health expenditure (THE) is among the lowest worldwide. This study analyses the preconditions and options for implementing basic social health protection in Yemen. It reveals a four-tiered healthcare system characterised by high geographic and financial access barriers mainly for the poor. Out-of-pocket payments constitute 55% of THE, and cost-sharing exemption schemes are not well organised. Resource-allocation practices are inequitable because about 30% of THE gets spent on treatment abroad for a small number of patients, mainly from better-off families. Against the background of a lack of social health protection, a series of small-scale and often informal solidarity schemes have developed, and a number of public and private companies have set up health benefit schemes for their employees. Employment-based schemes usually provide reasonable health care at an average annual cost of YR44 000 (US$200) per employee. In contrast, civil servants contribute to a mandatory health-insurance scheme without receiving any additional health benefits in return. A number of options for initiating a pathway towards a universal health-insurance system are discussed.
Chryssanthou, Anargyros; Varlamis, Iraklis; Latsiou, Charikleia
Virtual healthcare communities aim to bring together healthcare professionals and patients, improve the quality of healthcare services and assist healthcare professionals and researchers in their everyday activities. In a secure and reliable environment, patients share their medical data with doctors, expect confidentiality and demand reliable medical consultation. Apart from a concrete policy framework, several ethical, legal and technical issues must be considered in order to build a trustful community. This research emphasises on security issues, which can arise inside a virtual healthcare community and relate to the communication and storage of data. It capitalises on a standardised risk management methodology and a prototype architecture for healthcare community portals and justifies a security model that allows the identification, estimation and evaluation of potential security risks for the community. A hypothetical virtual healthcare community is employed in order to portray security risks and the solutions that the security model provides.
Lund, Barbara M; O'Brien, Sarah J
Cases and outbreaks of foodborne infection in healthcare settings can result in serious illness, wastage of expensive medical treatments, spread of infection to other patients and staff and disruption of services. Providing nutritious meals for vulnerable people in healthcare settings involves a systematic approach to microbiological safety, as provided by hazard analysis and critical control point (HACCP) principles. The types of food served in healthcare settings should be selected to minimise the risk of foodborne infection.
Weerasinghe, Dasun; Rajarajan, Muttukrishnan; Rakocevic, Veselin
The rapid growth in mobile technology makes the delivery of healthcare data and services on mobile phones a reality. However, the healthcare data is very sensitive and has to be protected against unauthorized access. While most of the development work on security of mobile healthcare today focuses on the data encryption and secure authentication in remote servers, protection of data on the mobile device itself has gained very little attention. This paper analyses the requirements and the architecture for a secure mobile capsule, specially designed to protect the data that is already on the device. The capsule is a downloadable software agent with additional functionalities to enable secure external communication with healthcare service providers, network operators and other relevant communication parties.
The backdrop to this article is provided by the Better Health, Better Care Action Plan (Scottish Government, 2007), Section 1 of which is entitled 'Towards a Mutual NHS'. According to Better Health, Better Care (Scottish Government, 2007: 5): 'Mutual organisations are designed to serve their members. They are designed to gather people around a common sense of purpose. They are designed to bring the organisation together in what people often call "co-production."' The aim of this article is to précis the current knowledge of mutuality in the provision of Scottish healthcare. In detail, it will: introduce the 'mutual' organisation; offer a historical perspective of mutuality; suggest why healthcare mutuality is important; and briefly, detail the differences in mutual health-care policy in England and Scotland. It is hoped that this analysis will help researchers and practitioners alike appreciate further the philosophy of mutuality in the provision of Scottish healthcare.
Hewko, Sarah J; Cummings, Greta G
Purpose - The purpose of this paper is to explore the underlying theoretical assumptions and implications of current micro-level performance management and evaluation (PME) practices, specifically within health-care organizations. PME encompasses all activities that are designed and conducted to align employee outputs with organizational goals. Design/methodology/approach - PME, in the context of healthcare, is analyzed through the lens of critical theory. Specifically, Habermas' theory of communicative action is used to highlight some of the questions that arise in looking critically at PME. To provide a richer definition of key theoretical concepts, the authors conducted a preliminary, exploratory hermeneutic semantic analysis of the key words "performance" and "management" and of the term "performance management". Findings - Analysis reveals that existing micro-level PME systems in health-care organizations have the potential to create a workforce that is compliant, dependent, technically oriented and passive, and to support health-care systems in which inequalities and power imbalances are perpetually reinforced. Practical implications - At a time when the health-care system is under increasing pressure to provide high-quality, affordable services with fewer resources, it may be wise to investigate new sector-specific ways of evaluating and managing performance. Originality/value - In this paper, written for health-care leaders and health human resource specialists, the theoretical assumptions and implications of current PME practices within health-care organizations are explored. It is hoped that readers will be inspired to support innovative PME practices within their organizations that encourage peak performance among health-care professionals.
Cochrane, J D
opportunity to play a leadership role. A number of the sites reviewed for this article, for example, offer the patient the ability to develop his or her own health record and maintain it on the web. It is not conceivable that a healthcare system, along with its affiliated physician, might develop a secure web site that included a combined inpatient and outpatient rcord, accessible electronically by patients and authorized providers from any telephone in the world. It is clear that armed with Internet data, consumers will play an increasingly important role in their own care. Employers are acquiescing to their demands for increasing choice. Copayments are also going up and employees are likely to vote with their feet in selecting providers. Companies like WebMd, Physicians Online, Planetrx.com, drugstore.com, Yahoo and the other mentioned above are filling a need. It should be a wakeup call for healthcare systems and physicians. According to the latest data from Medimetrix, (see medimetrix.com), the most frequently visited health sites on the web today are Intelihealth.com (Johns Hopkins), Mayohealth.org, and OnHealth.com. These sites provide a highly interactive experience for consumers and tons of news and information. They are compelling and traffic-building, have fresh news that is frequently updated and many are transaction. That's what people want. There are so many potential uses of the Internet for physicians and hospitals that it is difficult to properly cover them in this article. Why shouldn't a patient be able to check the status of their account? Has the insurance paid? Is there a patient balance? Consumers can check their bank balances on the Internet. Why not their hospital or medical office accounts? Why not let them pay their balances online? As noted above, some the the HMOs are providing account status information to patients already. Why not the hospitals and physicians? Web sites are multiplying like rabbits. It's going to take a lot of effort to
Booker, Catriona; Turbutt, Adam; Fox, Robyn
Currently, healthcare organisations are being challenged to provide optimal clinical services within budget limitations while simultaneously being confronted by aging consumers and labour and skill shortages. Within this dynamic and changing environment, the ability to remain responsive to patient needs while managing these issues poses further challenges. Development or review of the model of care (MOC) may provide a possible solution to support efficiencies in service provision. Although MOC are not readily understood or appreciated as an efficiency strategy, they can be more easily explained by considering several recurring pillars when developing or redesigning an MOC. Generic and recurring foundational pillars include integrated care models, team functioning and communication, leadership, change management and lean thinking. These foundational pillars should be incorporated into the development and application of MOC in order to achieve desired outcomes. However, sustainability requires continuous review to enable improvement and must be integrated into routine business. Moreover, successful review of MOC requires collaboration and commitment by all stakeholders. Leaders are critical to motivating clinicians and stakeholders in the review process. Further, it is imperative that leaders engage stakeholders to commit to support the agreed strategies designed to provide efficient and comprehensive healthcare services. Redesign of MOC can significantly improve patient care by applying the agreed strategies. In the current healthcare environment, these strategies can favourably affect healthcare expenditure and, at the same time, improve the quality of interprofessional health services.
Karampelas, Vasilios; Pallikarakis, Nicholas; Mantas, John
The healthcare researchers', academics' and practitioners' interest concerning the development of Healthcare Information Systems has been on a steady rise for the last decades. Fueling this steady rise has been the healthcare professional need of quality information, in every healthcare provision incident, whenever and wherever this incident may take place. In order to address this need a truly mobile health care system is required, one that will be able to provide a healthcare provider with accurate patient-related information regardless of the time and place that healthcare is provided. In order to fulfill this role the present study proposes the architecture for a Healthcare Smartcard system, which provides authenticated healthcare professionals with remote mobile access to a Patient's Healthcare Record, through their Smartphone. Furthermore the research proceeds to develop a working prototype system.
India is undergoing a rapid transformation in terms of governance, administrative reforms, newer policy develoment, and social movements. India is also considered one of the most vibrant economies in the world. The current discourse in public space is dominated by issues such as economic development, security, corruption free governance, gender equity, and women safety. Healthcare though remains a pressing need of population; seems to have taken a backseat. In the era of decreasing subsidies and cautious investment in social sectors, the 2(nd) National Conference on Family Medicine and Primary Care 2015 (FMPC) brought a focus on "healthcare" in India. The theme of this conference was "Healthcare is Primary." The conference participants discussed on the theme of why healthcare should be a national priority and why strong primary care should remain at the center of healthcare delivery system. The experts recommended that India needs to strengthen the "general health system" instead of focusing on disease based vertical programs. Public health system should have capacity and skill pool to be able to deliver person centered comprehensive health services to the community. Proactive implementation of policies towards human resource in health is the need of the hour. As the draft National Health Policy 2015 is being debated, "family medicine" (academic primary care), the unfinished agenda of National Health Policy 2002, remains a priority area of implementation.
Securitization of receivables allows healthcare providers to obtain an additional funding source by selling their accounts receivables to investors. A double-lock-box structure allows providers to securitize Medicare and Medicaid receivables without violating federal laws. A 2001 revision to the Uniform Commercial Code facilitates providers' securitization of private healthcare insurance receivables by underscoring rights of a purchaser of those receivables. HIPAA privacy standards appear to permit the use and disclosure of protected health information in crafting a securitization program. The securitization should be structured to shield the value of the receivables to be transferred from the potential backruptcies of the originator and the purchaser.
The care of patients with chronic disease is a significant challenge for any healthcare system. Intermountain Healthcare is trying a variety of approaches to chronic disease management. There are five general areas that have been organized centrally. These areas are provider education, patient education, outcomes data, clinical support (ideas that make it easier to do the right thing), and multidisciplinary coordination of care. Typically within each area a variety of tools are developed. The clinical application of the tools varies from provider to provider and from patient to patient. Innovative tools have come from unexpected sources. Significant improvement in measured outcomes has been demonstrated.
Schewe, C D; Spotts, H E
The health-care marketplace is aging by leaps and bounds and bringing with it new and different medical needs. As costs soar and public assistance programs dwindle in impact, health-care providers will need better marketing strategies to bring treatments to patients/consumers. This article looks at the research findings of behavioral scientists and offers guidelines for effective communication with aging audiences. Health-care providers can use these findings to design more effective advertising, promotional brochures, newsletters, and a host of other communication tools targeted at an older market. Health-care managers and other professionals should find the guidelines useful in their daily interactions with patients and colleagues.
Mundy, Darren P
Privacy has been and continues to be one of the key challenges of an age devoted to the accumulation, processing, and mining of electronic information. In particular, privacy of healthcare-related information is seen as a key issue as health organizations move towards the electronic provision of services. The aim of the research detailed in this paper has been to analyse privacy policies on popular UK healthcare-related websites to determine the extent to which consumer privacy is protected. The author has combined approaches (such as approaches focused on usability, policy content, and policy quality) used in studies by other researchers on e-commerce and US healthcare websites to provide a comprehensive analysis of UK healthcare privacy policies. The author identifies a wide range of issues related to the protection of consumer privacy through his research analysis using quantitative results. The main outcomes from the author's research are that only 61% of healthcare-related websites in their sample group posted privacy policies. In addition, most of the posted privacy policies had poor readability standards and included a variety of privacy vulnerability statements. Overall, the author's findings represent significant current issues in relation to healthcare information protection on the Internet. The hope is that raising awareness of these results will drive forward changes in the industry, similar to those experienced with information quality.
Cooper, Jason G.; Pauley, Keith A.
Software assurance is a rigorous, lifecycle phase-independent set of activities which ensure completeness, safety, and reliability of software processes and products. This is accomplished by guaranteeing conformance to all requirements, standards, procedures, and regulations. These assurance processes are even more important when coupled with healthcare software systems, embedded software in medical instrumentation, and other healthcare-oriented life-critical systems. The current Food and Drug Administration (FDA) regulatory requirements and guidance documentation do not address certain aspects of complete software assurance activities. In addition, the FDA’s software oversight processes require enhancement to include increasingly complex healthcare systems such as Hospital Information Systems (HIS). The importance of complete software assurance is introduced, current regulatory requirements and guidance discussed, and the necessity for enhancements to the current processes shall be highlighted. PMID:17238324
Abraham, Jean; Sick, Brian; Anderson, Joseph; Berg, Andrea; Dehmer, Chad; Tufano, Amanda
Each year consumers make a variety of decisions relating to their healthcare. Some experts argue that stronger consumer engagement in decisions about where to obtain medical care is an important mechanism for improving efficiency in healthcare delivery and financing. Consumers' ability and motivation to become more active decision makers are affected by several factors, including financial incentives and access to information. This study investigates the set of factors that consumers consider when selecting a provider, including attributes of the provider and the care experience and the reputation of the provider. Additionally, the study evaluates consumers awareness and use of formal sources of provider selection information. Our results from analyzing data from a survey of 467 patients at four clinics in Minnesota suggest that the factors considered of greatest importance include reputation of the physician and reputation of the healthcare organization. Contractual and logistical factors also play a role, with respondents highlighting the importance of seeing a provider affiliated with their health plan and appointment availability. Few respondents indicated that advertisements or formal sources of quality information affected their decision making. The key implication for provider organizations is to carefully manage referral sources to ensure that they consistently meet the needs of referrers. Excellent service to existing patients and to the network of referring physicians yields patient and referrer satisfaction that is critical to attracting new patients. Finally, organizations more generally may want to explore the capabilities of new media and social networking sites for building reputation.
Identification of the factors that govern the ability of therapeutic antibodies to provide postchallenge protection against botulinum toxin: a model for assessing postchallenge efficacy of medical countermeasures against agents of bioterrorism and biological warfare.
Al-Saleem, Fetweh H; Nasser, Zidoon; Olson, Rebecca M; Cao, Linsen; Simpson, Lance L
Therapeutic antibodies are one of the major classes of medical countermeasures that can provide protection against potential bioweapons such as botulinum toxin. Although a broad array of antibodies are being evaluated for their ability to neutralize the toxin, there is little information that defines the circumstances under which these antibodies can be used. In the present study, an effort was made to quantify the temporal factors that govern therapeutic antibody use in a postchallenge scenario. Experiments were done involving inhalation administration of toxin to mice, intravenous administration to mice, and direct application to murine phrenic nerve-hemidiaphragm preparations. As part of this study, several pharmacokinetic characteristics of botulinum toxin and neutralizing antibodies were measured. The core observation that emerged from the work was that the window of opportunity within which postchallenge administration of antibodies exerted a beneficial effect increased as the challenge dose of toxin decreased. The critical factor in establishing the window of opportunity was the amount of time needed for fractional redistribution of a neuroparalytic quantum of toxin from the extraneuronal space to the intraneuronal space. This redistribution event was a dose-dependent phenomenon. It is likely that the approach used to identify the factors that govern postchallenge efficacy of antibodies against botulinum toxin can be used to assess the factors that govern postchallenge efficacy of medical countermeasures against any agent of bioterrorism or biological warfare.
Health is for most of us the most precious thing one can have. However, in practice situations occur where the patient is harmed within the healthcare institution. Traditionally, there are several ways to protect individuals in society: with civil, criminal and administrative procedures. Over the years in the Netherlands complaints procedures were established in which the complaints about healthcare providers' performance can be handled. Recently, there are some developments within the criminal law that concern the healthcare sector. Examples are: the establishment of the Public Prosecution Service's Expertise Center on Medical Matters, appointments of medical prosecutors. In addition, in legal literature suggestions are made that criminal law is nowadays applied in order to provide redress to the patients (relatives) and as a 'safety tool' that is to ensure security and to counter the risks within the healthcare sector. The article discusses the role of criminal law within the healthcare sector, and in particular, whether criminal procedure is suitable for handling complaints about healthcare.
Hii, Pei-Cheng; Chung, Wan-Young
Provision of ubiquitous healthcare solutions which provide healthcare services at anytime anywhere has become more favorable nowadays due to the emphasis on healthcare awareness and also the growth of mobile wireless technologies. Following this approach, an Android™ smart phone device is proposed as a mobile monitoring terminal to observe and analyze ECG (electrocardiography) waveforms from wearable ECG devices in real time under the coverage of a wireless sensor network (WSN). The exploitation of WSN in healthcare is able to substitute the complicated wired technology, moving healthcare away from a fixed location setting. As an extension to the monitoring scheme, medicine care is taken into consideration by utilizing the mobile phone as a barcode decoder, to verify and assist out-patients in the medication administration process, providing a better and more comprehensive healthcare service.
Musical ability is the ability to 'make sense' of music, and develops in most people over the first decade of life through normal enculturation. Whether this ability is developed to a high level usually depends on the decision to start learning a musical instrument, which forces high levels of focused cognitive engagement (practice) with musical materials. Performance ability has both technical and expressive aspects. These aspects are not always developed equally well. Factors contributing to the development of a well-balanced musical performer include (a) lengthy periods of engagement with music through practice and exploration, (b) high levels of material and emotional support from parents and other adults, (c) relationships with early teachers characterized by warmth and mutual liking, and (d) early experiences with music that promote, rather than inhibit, intense sensuous/affective experiences. It is argued that much formal education inhibits the development of musical ability through over-emphasis on assessment, creating performance anxiety, coupled with class and sex stereotyping of approved musical activities. Early free exploration of a medium is a necessity for the development of high levels of musicality.
Pagano, Matthew Wallach
The conversion of paper-based medical records into electronic formats is set to bring many benefits to healthcare. This includes creating a more seamless exchange of electronic health records (EHRs) between providers, improving healthcare while lowering its costs, and providing patients with increased access to their EHRs. As more medical…
Johnson, Natalie A; Inder, Kerry J; Ewald, Ben D; James, Erica L; Bowe, Steven J
We test the hypothesis that the odds of self-reported receipt of lifestyle advice from a health care provider will be lower among outpatient cardiac rehabilitation (OCR) nonattendees and nonreferred patients compared to OCR attendees. Logistic regression was used to analyse cross-sectional data provided by 65% (4971/7678) of patients aged 20 to 84 years discharged from public hospitals with a diagnosis indicating eligibility for OCR between 2002 and 2007. Among respondents, 71% (3518) and 55% (2724) recalled advice regarding physical activity and diet, respectively, while 88% (592/674) of smokers recalled quit advice. OCR attendance was low: 36% (1764) of respondents reported attending OCR, 11% (552) did not attend following referral, and 45% (2217) did not recall being invited. The odds of recalling advice regarding physical activity and diet were significantly lower among OCR nonattendees compared to attendees (OR 0.34, 95% CI 0.21, 0.56 and OR 0.33, 95% CI 0.25, 0.44, resp.) and among nonreferred respondents compared to OCR attendees (OR 0.10, 95% CI 0.07, 0.15 and OR 0.17, 95% CI 0.14, 0.22, resp.). Patients hospitalised for coronary heart disease should be referred to OCR or a suitable alternative to improve recall of lifestyle advice that will reduce the risk of further coronary events.
Brennan, C D
Today's integrated delivery systems (IDSs) require efficient supply chain processes to speed products to users at the lowest possible cost. Most excess costs within the supply chain are a result of inefficient and redundant processes involved in the transport and delivery of supplies from suppliers to healthcare providers. By integrating and assuming control of these supply chain processes, improving supply chain management practices, and organizing and implementing a disciplined redesign plan, IDSs can achieve substantial savings and better focus their organizations on their core patient care mission.
Evaluation of Skill-oriented Training on Enhanced Syndromic Case Management (ESCM) of Reproductive Tract Infections / Sexually Transmitted Infections (RTI/STIs) of Care Providers from Three-tier Health-care System of Gujarat
Sharma, Rashmi; Prajapati, Shailesh; Patel, Brijesh; Kumar, Pradeep
Background: Enhanced syndromic case management (ESCM) deals with reproductive tract and sexually transmitted infections. Capacity building of service providers not only boosts the program but also inputs from them improve the quality of services. Objectives: To (1) identify problem areas from providers' perspectives and the gaps in knowledge and application and (2) assess the gains (if any) through pre and post-training evaluation. Materials and Methods: A total of 121 participants (medical/para medical) from various medical colleges, district/sub-district hospitals/ community health centers, and urban dispensaries across Gujarat were trained at a teaching institute. Trainings were of 2-3 days duration involving different learning methodology. Pre- and post-training evaluation were done on a designed pro forma and data were entered in MS office Excel 2007. Gains in knowledge/skills if any were assessed by comparing pre-/post-evaluation responses and applying test of significance (x2 test). Observations: Out of total 121 participants, half (60) were doctors and the rest were paramedics [staff nurse (SN) and lab technicians (LT)]. Doctors revealed significant gain in basics of reproductive tract infections (RTI) and sexually transmitted infections (STI), syndrome identification, STI/HIV co-infection, and ESCM and less gain in asymptomatic STI/ complications, vulnerability, male reproductive organs, causes of vaginal/urethral discharge, STI complications, cervical cancer screening, and limitation of syndromic management. Gain was statistically significant in basics of RTI/STI amongst adolescent in paramedics; lab technicians showed significant gain in knowledge of laboratory-related areas. Conclusion: Assessment revealed (1) poor baseline knowledge and (2) gains following training sometimes significant and other times not significant even in core areas. Quality monitoring and contents/ methodologies modification are essential for robust trainings. Gains in skills
Cheah, Y N; Abidi, S S
In this paper we suggest that the healthcare enterprise needs to be more conscious of its vast knowledge resources vis-à-vis the exploitation of knowledge management techniques to efficiently manage its knowledge. The development of healthcare enterprise memory is suggested as a solution, together with a novel approach advocating the operationalisation of healthcare enterprise memories leading to the modelling of healthcare processes for strategic planning. As an example, we present a simulation of Service Delivery Time in a hospital's OPD.
For nearly 4 years, the Pittsburgh Regional Healthcare Initiative (PRHI) has been working to improve the way healthcare is delivered in southwestern Pennsylvania by combining the voices and resources of hospitals, providers, the business community, insurers, health plans, and federal agencies. As one example of borrowing from business, the PRHI has created a new learning and management system, called Perfecting Patient Care, which is based on the Toyota Production System model and is now being used successfully in hospitals.
Photography as an art is a way of accessing our emotions, naming them, understanding them and taking them into account in the healthcare relationship. A training session on the Photolangage method enables us not only to increase our knowledge but also to share our emotional experience and encourages reflection.
Peter Jennings, technical director for ACO Building Drainage, which specialises in the development of corrosion-resistant drainage systems and building products, looks at the key issues to consider when specifying and installing pipework and drainage for hygiene-critical environments such as hospitals and other healthcare facilities.
Hucíková, Anežka; Babic, Ankica
Transitioning enterprise operations to the cloud brings a variety of opportunities and challenges. Such step requires a deep and complex understanding of all elements related to the technology as well as defining the manner in which specific cloud challenges can be dealt with. To provide a better understanding of these opportunities and challenges within healthcare, systematic literature overview and industrial cases review is used. Results of the two methods show interconnection between cloud deployment advantages and constrains. However, healthcare case studies provide interesting insights emphasizing cloud complexity and superposition which seems to balance organizational limitations.
Educational change is necessary to meet the demands of the current healthcare environment. An outcome-based approach to healthcare education is optimal to support organizational change. Learning objectives should focus on the best practice outcomes and should emphasize what the healthcare provider is expected to do after the educational activity is over. Regulating agencies and consumers hold healthcare accountable for providing high-quality, safe patient care. Educational activities should provide the skills and knowledge that enable nurses to meet this goal.
Background Healthcare systems globally have experienced intensive changes, reforms, developments, and improvement over the past 30 years. Multiple actors (governmental and non-governmental) and countries have played their part in the reformation of the global healthcare system. New opportunities are presenting themselves while multiple challenges still remain especially in developing countries. Better way to proceed would be to learn from historical patterns while we plan for the future in a technology-driven society with dynamic demographic, epidemiological and economic uncertainties. Methods A structured review of both peer-reviewed and gray literature on the topic was carried out. Results On the whole, people are healthier, doing better financially and live longer today than 30 years ago. The number of under-5 mortality worldwide has declined from 12.7 million in 1990 to 6.3 million in 2013. Infant and maternal mortality rates have also been reduced. However, both rates are still considered high in Africa and some Asian countries. The world’s population nearly doubled in these 30 years, from 4.8 billion in 1985 to 7.2 billion in 2015. The majority of the increasing population was coming from the least developed countries, i.e., 3.66 to 5.33 billion. The world will be short of 12.9 million health-care workers by 2035; today, that figure stands at 7.2 million. Health care expenditures among countries also show sharp differences. In high income countries, per person health expenditure is over USD 3,000 on average, while in poor countries, it is as low as USD 12, WHO estimate of minimum spending per person per year needed to provide basic, life-saving services is USD 44. The challenges faced by the global health system over the past 30 years have been increased in population and urbanization, behavioral changes, rise in chronic diseases, traumatic injuries, infectious diseases, specific regional conflicts and healthcare delivery security. Over the next 30 years
Harrop, V. M.
Provider organizations lack: 1. a definition of "virtual" healthcare delivery relative to the products, services, and processes offered by dot.coms, web-compact disk healthcare content providers, telemedicine, and telecommunications companies, and 2. a model for integrating real and virtual healthcare delivery. This paper defines virtual healthcare delivery as asynchronous, outsourced, and anonymous, then proposes a 2x2 Real-Virtual Healthcare Delivery model focused on real and virtual patients and real and virtual provider organizations. Using this model, provider organizations can systematically deconstruct healthcare delivery in the real world and reconstruct appropriate pieces in the virtual world. Observed barriers to virtual healthcare delivery are: resistance to telecommunication integrated delivery networks and outsourcing; confusion over virtual infrastructure requirements for telemedicine and full-service web portals, and the impact of integrated delivery networks and outsourcing on extant cultural norms and revenue generating practices. To remain competitive provider organizations must integrate real and virtual healthcare delivery. PMID:11825189
Healthcare professionals are moral agents whose fiduciary relationship with the public is animated by responsibility and the promise to use knowledge and skills to aid those in their care. When their ability to keep this promise is constrained or compromised, moral distress can result. Moral distress in healthcare is defined and outlined. Constraints and factors that lead to moral distress are identified as are the means that individual professionals and organizations use to address it. A call is made for transformative change to overcome a culture of silence and to sustain a healthcare system that is morally habitable.
Vickers, Caroline H; Zychowicz, Suzanne; Morones, José R
The purpose of this study is to demonstrate how individual experiences shape ideologies toward healthcare. To demonstrate, we analyze conversational narrative data about health and healthcare between a dominant Spanish-speaking Mexican immigrant woman, Maria, and the researcher, Caroline. Findings demonstrate that Maria's narrative about her experience receiving healthcare for a knee injury reveals her ideological stance toward healthcare in both the United States and Mexico. In particular, the narrative reflects an ideological position in which medical providers neglect patients and strip them of agency in making choices about their own healthcare. Cultural competence, then, is not only about gaining knowledge of patients' cultural groups but also about understanding how patients' life experiences shape them as autonomous individuals with socially constructed attitudes toward healthcare.
Sheets, Lincoln; Popejoy, Lori; APRN, GCNS-BC; Khalilia, Mohammed; Petroski, Greg; Parker, Jerry C.
Objective. To develop a systematic and reproducible way to identify patients at increased risk for higher healthcare costs. Methods. Medical records were analyzed for 9,581 adults who were primary care patients in the University of Missouri Health System and who were enrolled in Medicare or Medicaid. Patients were categorized into one of four risk tiers as of October 1, 2013, and the four tiers were compared on demographic characteristics, number of healthcare episodes, and healthcare charges in the year before and the year after cohort formation. Results. The mean number of healthcare episodes and the sum of healthcare charges in the year following cohort formation were higher for patients in the higher-risk tiers. Conclusions. Retrospective information that is easily extracted from medical records can be used to create risk tiers that provide highly useful information about the prospective risk of healthcare utilization and costs. PMID:28269910
Zuckerman, Alan M
A recent survey of the state of strategic planning among healthcare organizations indicates that planners and executives believe that healthcare strategic planning practices are effective and provide the appropriate focus and direction for their organizations. When compared to strategic planning practices employed outside of the healthcare field, however, most healthcare strategic planning processes have not evolved to the more advanced, state-of-the-art levels of planning being used successfully outside of healthcare. While organizations that operate in stable markets may be able to survive using basic strategic planning practices, the volatile healthcare market demands that providers be nimble competitors with advanced, ongoing planning processes that drive growth and organizational effectiveness. What should healthcare organizations do to increase the rigor and sophistication of their strategic planning practices? This article identifies ten current healthcare strategic planning best practices and recommends five additional innovative approaches from pathbreaking companies outside of healthcare that have used advanced strategic planning practices to attain high levels of organizational success.
Chao, Chia Chen; Jen, Wen Yuan; Li, Yu-Chuan; Chi, Y P; Chen, Chang-I; Feng, Chen Chjeh
Improving healthcare service quality for illness of treatment, illness prevention and patient service is difficult for most hospitals because the hospitals are lack adequate resources and labor. In order to provide better healthcare service quality for patients, mobile technology can be used to manage healthcare in a way that provides the optimal healthcare service for patients. Pursuing utilization of mobile technology for better patient service, Taipei Medical University Municipal W. F. Teaching Hospital has implemented a mobile healthcare service (m-HS) system to increase healthcare service quality. The m-HS system improves the quality of medical care as well as healthcare service. The m-HS is a multi-functional healthcare management agent, meets the mobile tendency of the present society. This study seeks to discuss the m-HS architecture and workflow processes. We believe the m-HS does have the potential to improve healthcare service quality. Finally, the conclusions and suggestions for the m-HS are given.
Dreessen, Katrien; Huybrechts, Liesbeth; Grönvall, Erik; Hendriks, Niels
This paper stresses the need for more research in the field of Participatory Design (PD) and in particular into how to design Health Information Technology (HIT) together with care providers and -receivers in multicultural settings. We contribute to this research by describing a case study, the 'Health-Cultures' project, in which we designed HIT for the context of home care of older people with a migration background. The Health-Cultures project is located in the city of Genk, Belgium, which is known for its multicultural population, formed by three historical migration waves of people coming to work in the nowadays closed coal mines. Via a PD approach, we studied existing means of dialogue and designed HIT that both care receivers and care providers in Genk can use in their daily exchanges between cultures in home care contexts. In discussing relevant literature as well as the results of this study, we point to the need and the ways of taking spatio-historical aspects of a specific healthcare situation into account in the PD of HIT to support multicultural perspectives on healthcare.
Tien, James M; Goldschmidt-Clermont, Pascal J
Engineering has and will continue to have a critical impact on healthcare; the application of technology-based techniques to biological problems can be defined to be technobiology applications. This paper is primarily focused on applying the technobiology approach of systems engineering to the development of a healthcare service system that is both integrated and adaptive. In general, healthcare services are carried out with knowledge-intensive agents or components which work together as providers and consumers to create or co-produce value. Indeed, the engineering design of a healthcare system must recognize the fact that it is actually a complex integration of human-centered activities that is increasingly dependent on information technology and knowledge. Like any service system, healthcare can be considered to be a combination or recombination of three essential components - people (characterized by behaviors, values, knowledge, etc.), processes (characterized by collaboration, customization, etc.) and products (characterized by software, hardware, infrastructures, etc.). Thus, a healthcare system is an integrated and adaptive set of people, processes and products. It is, in essence, a system of systems which objectives are to enhance its efficiency (leading to greater interdependency) and effectiveness (leading to improved health). Integration occurs over the physical, temporal, organizational and functional dimensions, while adaptation occurs over the monitoring, feedback, cybernetic and learning dimensions. In sum, such service systems as healthcare are indeed complex, especially due to the uncertainties associated with the human-centered aspects of these systems. Moreover, the system complexities can only be dealt with methods that enhance system integration and adaptation.
Tang, Qi; Song, Peipei; Xu, Lingzhong
On June 6, 2016, as a mode expected to open a new prospect for tiered system of medical care in China, family physicians contracted healthcare was officially launched, intending to facilitate such healthcare be universal coverage by 2020.There are some doubts as to whether this goal is possible. The role of family physicians contracted healthcare in China should also be carefully identified. We hold that family physicians contracted healthcare will promote healthcare reform if it provides a "Cardiotonic" that alleviates the long-standing inequitable allocation of healthcare resources. However, this form of care faces many obstacles given the current state of medical care in China. It will just be a "Band-Aid" if the aforementioned issues of the shortage of family physicians, coordination with referring hospitals, and incomplete oversight are not resolved.
Pedroso, Marcelo Caldeira; Malik, Ana Maria
This article presents a model of the healthcare value chain which consists of a schematic representation of the Brazilian healthcare system. The proposed model is adapted for the Brazilian reality and has the scope and flexibility for use in academic activities and analysis of the healthcare sector in Brazil. It places emphasis on three components: the main activities of the value chain, grouped in vertical and horizontal links; the mission of each link and the main value chain flows. The proposed model consists of six vertical and three horizontal links, amounting to nine. These are: knowledge development; supply of products and technologies; healthcare services; financial intermediation; healthcare financing; healthcare consumption; regulation; distribution of healthcare products; and complementary and support services. Four flows can be used to analyze the value chain: knowledge and innovation; products and services; financial; and information.
Radnor, Zoe J; Holweg, Matthias; Waring, Justin
In an effort to improve operational efficiency, healthcare services around the world have adopted process improvement methodologies from the manufacturing sector, such as Lean Production. In this paper we report on four multi-level case studies of the implementation of Lean in the English NHS. Our results show that this generally involves the application of specific Lean 'tools', such as 'kaizen blitz' and 'rapid improvement events', which tend to produce small-scale and localised productivity gains. Although this suggests that Lean might not currently deliver the efficiency improvements desired in policy, the evolution of Lean in the manufacturing sector also reveals this initial focus on the 'tool level'. In moving to a more system-wide approach, however, we identify significant contextual differences between healthcare and manufacturing that result in two critical breaches of the assumptions behind Lean. First, the customer and commissioner in the private sector are the one and the same, which is essential in determining 'customer value' that drives process improvement activities. Second, healthcare is predominantly designed to be capacity-led, and hence there is limited ability to influence demand or make full use of freed-up resources. What is different about this research is that these breaches can be regarded as not being primarily 'professional' in origin but actually more 'organisational' and 'managerial' and, if not addressed could severely constrain Lean's impact on healthcare productivity at the systems level.
Anshari, M; Almunawar, M N; Low, P K C; Al-Mudimigh, A S
The adoption of Web 2.0 in many business sectors is increasing because it offers the ability for customers to have a greater control in generating contents to their personalized web. Customers are empowered in the sense of controlling the process of interaction(s) between a firm with its customers, and among customers themselves. However, providing empowerment in any state of interaction levels to customers (patients) in a healthcare organization is challenging. Many healthcare organizations have adopted empowerment in their e-health scenario; therefore, it needs a mechanism to measure at which level they have implemented empowerment within their organizations. This article proposes three layers of customers' empowerment in e-health systems based on a reference model called Personal Health Cycle (PHC). The layers of empowerment are personal, social, and medical layers respectively. The modular approach is used to simplify healthcare organizations identifying which modules to be adopted in implementing a strategy for customers' empowerment. The model is derived based on recent studies of empowerment in healthcare organizations. A survey also has been conducted in Brunei Darussalam (Brunei) to verify and improve our initial model and to understand the responses of people regarding empowerment in the e-health services. Questions for the survey are derived from the features of the PHC. The respondents reacted positively to the features of empowerment proposed. We use PHC to define and distinguish electronic health record (EHR) from electronic medical record (EMR).
Exposure to high altitude imposes significant strain on cardiopulmonary system and the brain. As a consequence, sojourners to high altitude frequently experience sleep disturbances, often reporting restless and sleepless nights. At altitudes above 3,000 meters (9,800 ft) almost all healthy subjects develop periodic breathing especially during NREM sleep. Sleep architecture gradually improves with increased NREM and REM sleep despite persistence of periodic breathing. The primary reason for periodic breathing at high altitude is a hypoxic-induced increase in chemoreceptor sensitivity to changes in PaCO2 – both above and below eupnea, leading to periods of apnea and hyperpnea. Acetazolamide improves sleep by reducing the periodic breathing through development of metabolic acidosis and induced hyperventilation decreasing the plant gain and widening the PCO2 reserve. This widening of the PCO2 reserve impedes development of central apneas during sleep. Benzodiazepines and GABA receptor antagonist such as zolpidem improve sleep without affecting breathing pattern or cognitive functions. PMID:27057512
Braga, Luis H.; Lorenzo, Armando J.
Cryptorchidism is one of the most common congenital anomalies of the male genitalia, occurring in 1% of boys by the age of one year. Even though the etiology of cryptorchidism is multifactorial, management has evolved with the clear recognition that hormonal treatment is not effective and surgery between 6–18 months of age leads to better testicular outcomes. Diagnostic laparoscopy is considered the standard approach for management of non-palpable testes, and can be combined with one or two-stage orchidopexy, with up to 80–90% success rates. This review discusses the natural history of retractile testicles, indications for hormonal treatment and orchidectomy, ultrasound’s role as a diagnostic tool, risks of infertility and testicular cancer, and surgical techniques for inguinal and intra-abdominal testes. PMID:28265313
... recommendations for conducting forensic exams of adult sexual assault victims in the U.S. Department of Justice... of adult sexual victims in the U.S. Department of Justice Protocol. In addition, verify that as part... the U.S. Department of Justice Protocol for conducting forensic exams. (4) Implement procedures...
... recommendations for conducting forensic exams of adult sexual assault victims in the U.S. Department of Justice... of adult sexual victims in the U.S. Department of Justice Protocol. In addition, verify that as part... the U.S. Department of Justice Protocol for conducting forensic exams. (4) Implement procedures...
Free online resources, many produced in the North American Pediatric Environmental Health Specialty Unit (PEHSU) network, covering general information, air quality, asthma, climate change, lead, mercury, mold, pesticides, and water.
Lim, Seong Mi; Cha, Won Chul; Chae, Minjung Kathy; Jo, Ik Joon
Objective In this study, we aimed to describe the processes of both the donning and the doffing of personal protective equipment for Ebola and evaluate contamination during the doffing process. Methods We recruited study participants among physicians and nurses of the emergency department of Samsung Medical Center in Seoul, Korea. Participants were asked to carry out doffing and donning procedures with a helper after a 50-minute brief training and demonstration based on the 2014 Centers for Disease Control and Prevention protocol. Two separate cameras with high-density capability were set up, and the donning and doffing processes were video-taped. A trained examiner inspected all video recordings and coded for intervals, errors, and contaminations defined as the outside of the equipment touching the clinician’s body surface. Results Overall, 29 participants were enrolled. Twenty (68.9%) were female, and the mean age was 29.2 years. For the donning process, the average interval until the end was 234.2 seconds (standard deviation [SD], 65.7), and the most frequent errors occurred when putting on the outer gloves (27.5%), respirator (20.6%), and hood (20.6%). For the doffing process, the average interval until the end was 183.7 seconds (SD, 38.4), and the most frequent errors occurred during disinfecting the feet (37.9%), discarding the scrubs (17.2%), and putting on gloves (13.7%), respectively. During the doffing process, 65 incidences of contamination occurred (2.2 incidents/person). The most vulnerable processes were removing respirators (79.2%), removing the shoe covers (65.5%), and removal of the hood (41.3%). Conclusion A significant number of contaminations occur during the doffing process of personal protective equipment. PMID:27752591
The White Paper The New NHS: Modern, Dependable (DoH 1997) clearly expects nurses, in partnership with other professionals, to contribute to the planning and shaping of future healthcare services. This article proposes that comprehensive models of alternative planning frameworks, when applied to healthcare services, can provide nurses with an understanding of the skills they require to participate in the planning process.
Hardt, Jeffrey H.; Hollis-Sawyer, Lisa
Due to an aging population and increases in healthcare costs, particular attention needs to be focused on developing Internet sites that provide older adults with credible and accurate healthcare information. Present research findings suggest that motivation is only one factor that influences whether or not older adults utilize the World Wide Web…
Latt, Nyi Nyi; Myat Cho, Su; Htun, Nang Mie Mie; Yu Mon Saw; Myint, Myat Noe Htin Aung; Aoki, Fumiko; Reyer, Joshua A; Yamamoto, Eiko; Yoshida, Yoshitoku; Hamajima, Nobuyuki
Myanmar transitioned to a civilian government in March, 2011. Although the democratic process has accelerated since then, many problems in the field of healthcare still exist. Since there is a limited overview on the healthcare in Myanmar, this article briefly describes the current states surrounding health services in Myanmar. According to the Census 2014, the population in the Republic of the Union of Myanmar was 51,410,000. The crude birth rate in the previous one year was estimated to be 18.9 per 1,000, giving the annual population growth rate of 0.89% between 2003 and 2014. The Ministry of Health reorganized into six departments. National non-governmental organizations and community-based organizations support healthcare, as well as international non-governmental organizations. Since hospital statistics by the government cover only public facilities, the information on private facilities is limited. Although there were not enough medical doctors (61 per 100,000 population), the number of medical students was reduced from 2,400 to 1,200 in 2012 to ensure the quality of medical education. The information on causes of death in the general population could not be retrieved, but some data was available from hospital statistics. Although the improvement was marked, the figures did not reach the levels set by Millennium Development Goals 4 and 5. A trial prepaid health insurance system started in July 2015, to be followed by evaluation one year later. There are many international donors, including the Japan International Cooperation Agency, supporting health in Myanmar. With these efforts and support, a marked progress is expected in the field of healthcare.
Thirteen years after the law of 4th March 2002, known as the "Kouchner law", what is the situation regarding the much talked about healthcare democracy? Individual and collective rights have been granted to the users of the health care system. In addition, a series of actions have been promoted in order to exert them. Finally, a number of places and processes favouring consultation have been put in place.
Latt, Nyi Nyi; Myat Cho, Su; Htun, Nang Mie Mie; Yu Mon Saw; Myint, Myat Noe Htin Aung; Aoki, Fumiko; Reyer, Joshua A.; Yamamoto, Eiko; Yoshida, Yoshitoku; Hamajima, Nobuyuki
ABSTRACT Myanmar transitioned to a civilian government in March, 2011. Although the democratic process has accelerated since then, many problems in the field of healthcare still exist. Since there is a limited overview on the healthcare in Myanmar, this article briefly describes the current states surrounding health services in Myanmar. According to the Census 2014, the population in the Republic of the Union of Myanmar was 51,410,000. The crude birth rate in the previous one year was estimated to be 18.9 per 1,000, giving the annual population growth rate of 0.89% between 2003 and 2014. The Ministry of Health reorganized into six departments. National non-governmental organizations and community-based organizations support healthcare, as well as international non-governmental organizations. Since hospital statistics by the government cover only public facilities, the information on private facilities is limited. Although there were not enough medical doctors (61 per 100,000 population), the number of medical students was reduced from 2,400 to 1,200 in 2012 to ensure the quality of medical education. The information on causes of death in the general population could not be retrieved, but some data was available from hospital statistics. Although the improvement was marked, the figures did not reach the levels set by Millennium Development Goals 4 and 5. A trial prepaid health insurance system started in July 2015, to be followed by evaluation one year later. There are many international donors, including the Japan International Cooperation Agency, supporting health in Myanmar. With these efforts and support, a marked progress is expected in the field of healthcare. PMID:27303099
Marnewick, J C; van Zyl, A W
The abuse of both licit and illicit substances by the general population affects at least one in ten people. Research shows that the oral healthcare worker has at least the same prevalence of substance abuse, perhaps even higher. The emergence of prescription drug abuse is one of the most worrying and dangerous aspects for the healthcare worker, due to ease of access to such drugs. According to the United Nations, prescription drug abuse is amongst the top three practices of substance abuse. We have an obligation to incorporate the evidence of substance abuse among oral healthcare professionals in our undergraduate dental curricula in order to combat this phenomenon. As the stress of daily survival in single practitioner practices increase, so will the danger of substance abuse. This may lead to impairment of the healthcare worker and ultimately loss of registration. It will take a combined effort from organised dentistry and academic institutions to establish a national strategy to ensure we address this important issue at undergraduate level and provide support at practitioner level. This paper will deal with substance abuse and the implications of impairment it holds for the oral healthcare worker.
Bourka, A; Polemi, N; Koutsouris, D
The scope of this paper is to present the current needs and trends in the field of healthcare systems security. The approach applied within the described review was based on three major steps. The first step was to define the point and ways of penetration and integration of security services in current healthcare related applications addressing technical, organisational and legal/regulatory issues. The second step was to specify and evaluate common security technologies applied in healthcare information systems pointing out gaps and efficient solutions, whereas the third was to draw conclusions for the present conditions and identify the future trends of healthcare information security. A number of EU RTD Projects were selected, categorised, analysed and comparatively evaluated in terms of security. The technical focus was on key security technologies, like Public Key Infrastructures (PKIs) based on Trusted Third Parties (TTPs) in conjunction with other state-of-the-art security components (programming tools, data representation formats, security standards and protocols, security policies and risk assessment techniques). The experience gained within this review will provide valuable input for future security applications in the healthcare sector, solving existing problems and addressing real user needs.
Kim, Duk-Su; Shepley, Mardelle McCuskey
The purpose of this project was to understand the nature of an architect's professional power. The central questions were: (1) What is the impact of specialized knowledge on the professional autonomy of architects in general? and (2) What are the relationships between task complexity, specialized knowledge, and the professional autonomy of healthcare architects in particular? To answer these questions, this research utilized interviews and focus groups. Focus groups provided in-depth knowledge on a sub-question: How do real-world situations restrict or reinforce the professional autonomy of healthcare architects? The interviews on this sub-question were project-specific to help gain an understanding of the impact that healthcare design complexity and research utilization have on practice and professional autonomy. Two main relationships were discovered from the interviews and focus groups. One was the relationship between the context of healthcare design complexity and the culture of healthcare design practice. The other was the relationship between changing professional attitudes and the consequences of changes in the profession.
Tahmasbi, Arezoo; Adabi, Sahar; Rezaee, Ali
The emergence of mobile healthcare systems is an important outcome of application of pervasive computing concepts for medical care purposes. These systems provide the facilities and infrastructure required for automatic and ubiquitous sharing of medical information. Healthcare systems have a dynamic structure and configuration, therefore having an architecture is essential for future development of these systems. The need for increased response rate, problem limited storage, accelerated processing and etc. the tendency toward creating a new generation of healthcare system architecture highlight the need for further focus on cloud-based solutions for transfer data and data processing challenges. Integrity and reliability of healthcare systems are of critical importance, as even the slightest error may put the patients' lives in danger; therefore acquiring a behavioral model for these systems and developing the tools required to model their behaviors are of significant importance. The high-level designs may contain some flaws, therefor the system must be fully examined for different scenarios and conditions. This paper presents a software architecture for development of healthcare systems based on pervasive computing concepts, and then models the behavior of described system. A set of solutions are then proposed to improve the design's qualitative characteristics including, availability, interoperability and performance.
Kelly, J C
The combatant soldier on the battlefield remains protected from any claim in negligence by the doctrine of combat immunity for any negligent act or omission they may make when fighting. In other words, the combatant soldier does not owe a fellow soldier a duty of care on the battlefield, as the duty of care is non-justiciable. However, the non-combatant Military Healthcare Professional, although sometimes operating in the same hostile circumstances as the fighting soldier, is unlikely to benefit from combat immunity for any clinical negligence on the battlefield. This is because they continue to owe their patient a duty of care, although this has not been tested in the courts. This paper considers if any military healthcare professional could ever benefit from combat immunity, which is unlikely due to their non-combatant status. Instead, this paper suggests that a modified form of immunity; namely, Military Healthcare Battlefield Immunity could be a new, unique and viable doctrine, however, this could only be granted in rare circumstances and to a much lesser degree than combat immunity.
Many serious medical errors result from violations of recognized standards of practice. Over time, even egregious violations of standards of practice may become “normalized” in healthcare delivery systems. This article describes what leads to this normalization and explains why flagrant practice deviations can persist for years, despite the importance of the standards at issue. This article also provides recommendations to aid healthcare organizations in identifying and managing unsafe practice deviations before they become normalized and pose genuine risks to patient safety, quality care, and employee morale. PMID:20161685
Luo, Huabin; Sotnikov, Sergey; Winterbauer, Nancy
Introduction The scope of local health department (LHD) involvement in providing personal healthcare services versus population-based services has been debated for decades. A 2012 IOM report suggests that LHDs should gradually withdraw from providing personal healthcare services. The purpose of this study is to assess the level of LHD involvement in provision of personal healthcare services during 2008–2013 and examine the association between provision of personal healthcare services and per capita public health expenditures. Methods Data are from the 2013 survey of LHDs and Area Health Resource Files. The number, ratio, and share of revenue from personal healthcare services were estimated. Both linear and panel fixed effects models were used to examine the association between provision of personal healthcare services and per capita public health expenditures. Data were analyzed in 2014. Results The mean number of personal healthcare services provided by LHDs did not change significantly in 2008–2013. Overall, personal services constituted 28% of total service items. The share of revenue from personal services increased from 16.8% in 2008 to 20.3% in 2013. Results from the fixed effect panel models show a positive association between personal healthcare services’ share of revenue and per capita expenditures (b=0.57, p<0.001). Conclusions A lower share of revenue from personal healthcare services is associated with lower per capita expenditures. LHDs, especially those serving <25,000 people, are highly dependent on personal healthcare revenue to sustain per capita expenditures. LHDs may need to consider strategies to replace lost revenue from discontinuing provision of personal healthcare services. PMID:25997902
Kim, Dae-Hyeong; Son, Donghee; Kim, Jaemin
The Universal Declaration of Human Rights was adopted by the United Nations in 1948, and since that time, human rights have become widely recognized and legally enforceable in many countries. Patient rights are now included in healthcare constitutions, such as that of the English National Health Service, and in professional codes of practice. Patient rights have a number of implications for the control of healthcare-associated infections (HCAI), including: (1) justification for infection control over and above economic benefit; (2) focus and emphasis on the individual patient experience; (3) identification of some of the actions taken to control infection as breaches of rights; (4) bridging professional, infection control and public health ethics; (5) a requirement to specify the conditions under which rights can be breached; and (6) grounds for those seeking compensation for HCAI. Assuring patient rights has the potential to improve the patient experience, and in so doing, improve public confidence in healthcare provision and providers.
The competitive advantage that an IT system provides for healthcare organizations does not result from the application system itself; rather, it depends on three factors: How the organization implements the system. Whether the organization is able to develop means to implement IT faster or cheaper than its competitors. The strengths of the organization's IT staff and technical platform.
Harrison, Krista Lyn; Taylor, Holly A.
Purpose Using the example of community access programs (CAPs), the purpose of this paper is to describe resource allocation and policy decisions related to providing health services for the uninsured in the USA and the organizational values affecting these decisions. Design/methodology/approach The study used comparative case study methodology at two geographically diverse sites. Researchers collected data from program documents, meeting observations, and interviews with program stakeholders. Findings Five resource allocation or policy decisions relevant to providing healthcare services were described at each site across three categories: designing the health plan, reacting to funding changes, and revising policies. Organizational values of access to care and stewardship most frequently affected resource allocation and policy decisions, while economic and political pressures affect the relative prioritization of values. Research limitations/implications Small sample size, the potential for social desirability or recall bias, and the exclusion of provider, member or community perspectives beyond those represented among participating board members. Practical implications Program directors or researchers can use this study to assess the extent to which resource allocation and policy decisions align with organizational values and mission statements. Social implications The description of how healthcare decisions are actually made can be matched with literature that describes how healthcare resource decisions ought to be made, in order to provide a normative grounding for future decisions. Originality/value This study addresses a gap in literature regarding how CAPs actually make resource allocation decisions that affect access to healthcare services. PMID:27934550
GE Healthcare has launched a multi-phase marketing campaign aimed at promoting the technological breakthroughs and state-of-the-art equipment that it provides hospitals and health systems to ensure that patients are given the best care possible. The campaign boasts four new commercials and an interactive Web site designed to illustrate healthy living on a global scale.
How a healthcare security department has undertaken a program to prevent employees, patients, and visitors from becoming victims of Identity Theft as well as providing help for victims of this crime in mitigating their losses. An Identity Theft affidavit for ID theft victims is illustrated.
Vranes, Aleksandra Jovic; Mikanovic, Vesna Bjegovic; Vukovic, Dejana; Djikanovic, Bosiljka; Babic, Momcilo
Ensuring and enforcing human rights in patient care are important to promote health and to provide quality and appropriate healthcare services. Therefore, continued medical education (CME) is essential for healthcare professionals to utilize their sphere of influence to affect change in healthcare practice. A total of 123 participants attended three CME courses. Course topics covered: (i) the areas of human rights and healthcare, (ii) rights, obligations and responsibilities of healthcare professionals in relation to human rights and the rights of patients, (iii) healthcare of vulnerable groups and (iv) access to essential medical services. Evaluation of the CME courses involved two components: evaluation of participants' performance and the participants' evaluation of the teaching process. The participants were assessed at the beginning and end of each course. Each of the courses was evaluated by the participants through a questionnaire distributed at the end of each course. Descriptive statistics was used for data interpretation. Knowledge of the healthcare professionals improved at the end of all the three courses. The participants assessed several aspects of the courses, including the course topics, educational methods, the course methods, organization, duration and dynamics as well as the physical environment and the technical facilities of the course, and rated each very highly. Our results corroborate the importance and necessity of courses to heighten awareness of the state of current healthcare and human rights issues to increase the involvement of healthcare professionals both locally and globally.
Plaza, Christine; Beard, Leslie; Fonzo, Anthony Di; Tommaso, Michael Di; Mujawaz, Yaman; Serra-Julia, Marcel; Morra, Dante
Healthcare delivery is evolving from individual, autonomous practice to collaborative team practice. However, barriers such as professional autonomy, time constraints and the perception of error as failure preclude learning behaviours that can facilitate organizational learning and improvement. Although experimentation, engaging in questions and feedback, discussing errors and reflecting on results can facilitate learning and promote effective performance, the cultural barriers within healthcare can prevent or inhibit this type of behaviour among teams. At the University Health Network's Centre for Innovation in Complex Care, we realize the need for a tool that facilitates learning behaviour and is sensitive to the risk-averse nature of the clinical environment. The vehicle for the Team Feedback Tool is a web-based application called Rypple (www.rypple.com), which allows team members to provide anonymous, rapid-fire feedback on team processes and performance. Rypple facilitates communication, elicits feedback and provokes discussion. The process enables follow-up face-to-face team discussions and encourages teams to create actionable solutions for incremental changes to enhance team health and performance. The Team Feedback Tool was implemented and piloted in general internal medicine at the University Health Network's Toronto General Hospital from early May 2009 to July 2009 to address the issues of teamwork and learning behaviour in the clinical environment. This article explores the opportunities and barriers associated with the implementation of the Team Feedback Tool.
Williams, David R; Duncan, W Jack; Ginter, Peter M
This paper recommends the broadening of the course content in several of the current required courses within the core curriculum of healthcare management education to include entrepreneurship topics and the inclusion of a separate entrepreneurship course. The current state of entrepreneurship within healthcare is described through the discussion of a healthcare entrepreneurship continuum. Because of the evolution of the healthcare industry in the past ten years, healthcare administration programs must also evolve to make our curriculum more relevant and increase student placement options. The current healthcare administration education shortcomings are discussed and recommendations for curriculum change are presented. Finally, a readings and resources list is provided as a basis for further curriculum development.
Bosco, Joseph; Iorio, Richard; Barber, Thomas; Barron, Chloe; Caplan, Arthur
The United States health-care expenditure is rising precipitously. The Congressional Budget Office has estimated that, in 2025, at our current rate of increased spending, 25% of the gross domestic product will be allocated to health care. Our per-capita spending on health care also far exceeds that of any other industrialized country. Health-care costs must be addressed if our country is to remain competitive in the global marketplace and to maintain its financial solvency. If unchecked, the uncontrolled rise in health-care expenditures will not only affect our capacity to provide our patients with high-quality care but also threaten the ability of our nation to compete economically on the global stage. This is not hyperbole but fiscal reality.As physicians, we are becoming increasingly familiar with the economics impacting health-care policy. Thus, we are in a unique position to control the cost of health care. This includes an increased reliance on creating and adhering to evidence-based guidelines. We can do this and still continue to respect the primacy of patient welfare and the right of patients to act in their own self-interest. However, as evidenced by the use of high-volume centers of excellence, each strategy adapted to control costs must be vetted and must be monitored for its unintended ethical consequences.The solution to this complex problem must involve the input of all of the health-care stakeholders, including the patients, payers, and providers. Physicians ought to play a role in designing and executing a remedy. After all, we are the ones who best understand medicine and whose moral obligation is to the welfare of our patients.
Friedman, Nurit L; Kokia, Ehud; Shemer, Joshua
This paper describes "Health Value Added"--an innovative model that links performance measurement to strategy in health maintenance organizations. The HVA model was developed by Maccabi Healthcare Services, Israel's second largest HMO, with the aim of focusing all its activities on providing high quality care within budgetary and regulatory constraints. HVA draws upon theory and practice from strategic management and performance measurement in order to assess an HMO's ability to improve the health of its members. The model consists of four interrelated levels--mission, goals, systems, and resources--and builds on the existence of advanced computerized information systems that make comprehensive measurements available to decision makers in real time. HVA enables management to evaluate overall organizational performance as well as the performance of semi-autonomous units. In simple terms, the sophisticated use of performance measures can help healthcare organizations obtain more health for the same money.
Background To date, online public healthcare reports have not been effectively used by consumers. Therefore, we qualitatively examined how healthcare consumers process and evaluate comparative healthcare information on the Internet. Methods Using semi-structured cognitive interviews, interviewees (n = 20) were asked to think aloud and answer questions, as they were prompted with three Dutch web pages providing comparative healthcare information. Results We identified twelve themes from consumers' thoughts and evaluations. These themes were categorized under four important areas of interest: (1) a response to the design; (2) a response to the information content; (3) the use of the information, and (4) the purpose of the information. Conclusion Several barriers to an effective use of comparative healthcare information were identified, such as too much information and the ambiguity of terms presented on websites. Particularly important for future research is the question of how comparative healthcare information can be integrated with alternative information, such as patient reviews on the Internet. Furthermore, the readability of quality of care concepts is an issue that needs further attention, both from websites and communication experts. PMID:19930564
In the healthcare sector, race, ethnicity and religion have become an increasingly important factor in terms of patient care due to an increasingly diverse population. Health agencies at a national and local level produce a number of guides to raise awareness of cultural issues among healthcare professionals and hospitals may implement additional non-medical services, such as the provision of specific types of food and dress to patients or the hiring of chaplains, to accommodate the needs of patients with religious requirements. However, in an attempt to address the spiritual, cultural and religious needs of patients healthcare providers often assume that ethnic minority groups are homogenous blocks of people with similar needs and fail to recognize that a diverse range of views and practices exist within specific groups themselves. This paper describes the example of the Sikh community and the provision of palliative care in hospitals and hospices. Although, the majority of patients classifying themselves as Sikhs have a shared language and history, they can also be divided on a number of lines such as caste affiliation, degree of assimilation in the west, educational level and whether baptized or not, all of which influence their beliefs and practices and hence impact on their needs from a health provider. Given that it is unfeasible for health providers to have knowledge of the multitude of views within specific religious and ethnic communities and accounting for the tight fiscal constraints of healthcare budgets, this paper concludes by raising the question whether healthcare providers should step away from catering for religious and cultural needs that do not directly affect treatment outcomes, and instead put the onus on individual communities to provide resources to meet spiritual, cultural and religious needs of patients.
Dulin, Michael F; Lovin, Carol A; Wright, Jean A
The use of big data to transform care delivery is rapidly becoming a reality. To deliver on the promise of value-based care, providers must know the key drivers of wellness at the patient and community levels, as well as understand resource constraints and opportunities to improve efficiency in the healthcare system itself. Data are the linchpin. By gathering the right data and finding innovative ways to glean knowledge, we can improve clinical care, advance the health of our communities, improve the lives of our patients, and operate more efficiently. At Carolinas HealthCare System-one of the nation's largest healthcare systems, with nearly 12 million patient encounters annually at more than 900 care locations-we have made substantial investments to establish a centralized data and analytics infrastructure that is transforming the way we deliver care across the continuum. Although the impetus and vision for our program have evolved over the past decade, our efforts coalesced into a strategic, centralized initiative with the launch of the Dickson Advanced Analytics (DA2) group in 2012. DA2 has yielded significant gains in our ability to use data, not only for reporting purposes and understanding our business but also for predicting outcomes and informing action.While these efforts have been successful, the path has not been easy. Effectively harnessing big data requires navigating myriad technological, cultural, operational, and other hurdles. Building a program that is feasible, effective, and sustainable takes concerted effort and a rigorous process of continuous self-evaluation and strategic adaptation.
Dulin, Michael F; Lovin, Carol A; Wright, Jean A
The use of big data to transform care delivery is rapidly becoming a reality. To deliver on the promise of value-based care, providers must know the key drivers of wellness at the patient and community levels, as well as understand resource constraints and opportunities to improve efficiency in the health-care system itself. Data are the linchpin. By gathering the right data and finding innovative ways to glean knowledge, we can improve clinical care, advance the health of our communities, improve the lives of our patients, and operate more efficiently. At Carolinas HealthCare System-one of the nation's largest health-care systems, with nearly 12 million patient encounters annually at more than 900 care locations-we have made substantial investments to establish a centralized data and analytics infrastructure that is transforming the way we deliver care across the continuum. Although the impetus and vision for our program have evolved over the past decade, our efforts coalesced into a strategic, centralized initiative with the launch of the Dickson Advanced Analytics (DA) group in 2012. DA has yielded significant gains in our ability to use data, not only for reporting purposes and understanding our business but also for predicting outcomes and informing action.While these efforts have been successful, the path has not been easy. Effectively harnessing big data requires navigating myriad technological, cultural, operational, and other hurdles. Building a program that is feasible, effective, and sustainable takes concerted effort and a rigorous process of continuous self-evaluation and strategic adaptation.
In spite of a growing recognition of the importance of doctor-patient communication, the issue of language barriers to healthcare has received very little attention in India. The Indian population speaks over 22 major languages with English used as the lingua franca for biomedicine. Large-scale internal migration has meant that health workers are encountering increasing instances of language discordance within clinical settings. Research done predominantly in the West has shown language discordance to significantly affect access to care, cause problems of comprehension and adherence, and decrease the satisfaction and quality of care. Addressing language barriers to healthcare in India requires a stronger political commitment to providing non-discriminatory health services, especially to vulnerable groups such as illiterate migrant workers. Research will have to address three broad areas: the ways in which language barriers affect health and healthcare, the efficacy of interventions to overcome language barriers, and the costs of language barriers and efforts to overcome them. There is a need to address such barriers in health worker education and clinical practice. Proven strategies such as hiring multilingual healthcare workers, providing language training to health providers, employing in situ translators or using telephone interpretation services will have to be evaluated for their appropriateness to the Indian context. Internet-based initiatives, the proliferation of mobile phones and recent advances in machine translation promise to contribute to the solution.
van Soeren, Mary; Hurlock-Chorostecki, Christina; Pogue, Pamela; Sanders, Jane
Primary healthcare renewal was an important government initiative arising in the early 21st century. This sector of the healthcare system in Canada had been under-resourced and ignored for decades. Recent changes include the development of salaried models for physician care, the use of other professionals in primary care, the integration of inter-professional teams, funding for information management systems and some incentives to provide directed primary care services. However, these changes are limited by a lack of overall policy direction to drive innovation, the absence of a shift in the locus of control of healthcare, a lack of education for healthcare providers to support inter-professional team-based practices and a failure to be more accountable to the Canadian public's needs. Without these innovations, the primary healthcare system will again be overwhelmed by future healthcare needs. Based on these limitations, we question whether this renewal represents lasting change in primary healthcare or a band-aid solution to the continued issue of primary healthcare delivery.
AbstractDemographic change and advances in medical science pose increased challenges to healthcare systems globally: The economic basis is aging and thus health is becoming more and more a productivity factor. At the same time, with today’s new communication possibilities the demand and expectations of effective medical treatment have been increased. This presentation will illustrate the need for the “industrialization” of healthcare in order to achieve highest results at limited budgets. Thereby, industrialization is not meaning the medical treatment based on the assembly line approach. Rather it is to recognize the cost of medical care as an investment with respective expectations on the return of the investment. Innovations in imaging and pharmaceutical products as well as in processes - that lead to similar medical results, but with lower efforts - are keys in such scenarios.BiographyProf. Dr. Hermann Requardt, 54, is a member of the Managing Board of Siemens AG and Chief Executive Officer of the Healthcare Sector. In addition he is the CTO of Siemens AG and Head of Corporate Technology, the central research department at Siemens.After completing his studies in physics and philosophy at the Darmstadt University of Technology and Johann Wolfgang Goethe University in Frankfurt and receiving a doctorate in biophysics, he worked at the Institute of Aerospace Medicine at the German Aerospace Center.In 1984 he joined the Medical Technology Group of Siemens AG, where he was responsible for projects in the Magnetic Resonance (MR) division. He was appointed head of the division in 1995. From 2001 to 2006, as a member of the Executive Management of the Medical Solutions Group, he was responsible for several areas, including technological development.In 2006 he became a Member of the Siemens’ Managing Board and head of Corporate Technology. He was additionally appointed as the Sector Healthcare CEO in 2008.Since 2006 he is an honorary professor in physics of the
Koumaditis, Konstantinos; Themistocleous, Marinos; Vassilakopoulos, Georgios
Service Oriented Architecture (SOA) is increasingly adopted by many sectors, including healthcare. Due to the nature of healthcare systems there is a need to increase SOA adoption success rates as the non integrated nature of healthcare systems is responsible for medical errors that cause the loss of tens of thousands patients per year. Following our previous research  we propose that SOA governance is a critical success factor for SOA success in healthcare. Literature reports multiple SOA governance models that have limitations and they are confusing. In addition to this, there is a lack of healthcare specific SOA governance models. This highlights a literature void and thus the purpose of this paper is to proposed a healthcare specific SOA governance framework.
Surface Display of the Receptor-Binding Region of the Lactobacillus brevis S-Layer Protein in Lactococcus lactis Provides Nonadhesive Lactococci with the Ability To Adhere to Intestinal Epithelial Cells
Åvall-Jääskeläinen, Silja; Lindholm, Agneta; Palva, Airi
Lactobacillus brevis is a promising lactic acid bacterium for use as a probiotic dietary adjunct and a vaccine vector. The N-terminal region of the S-layer protein (SlpA) of L. brevis ATCC 8287 was recently shown to mediate adhesion to various human cell lines in vitro. In this study, a surface display cassette was constructed on the basis of this SlpA receptor-binding domain, a proteinase spacer, and an autolysin anchor. The cassette was expressed under control of the nisA promoter in Lactococcus lactis NZ9000. Western blot assay of lactococcal cell wall extracts with anti-SlpA antibodies confirmed that the SlpA adhesion domain of the fusion protein was expressed and located within the cell wall layer. Whole-cell enzyme-linked immunosorbent assay and immunofluorescence microscopy verified that the SlpA adhesion-mediating region was accessible on the lactococcal cell surface. In vitro adhesion assays with the human intestinal epithelial cell line Intestine 407 indicated that the recombinant lactococcal cells had gained an ability to adhere to Intestine 407 cells significantly greater than that of wild-type L. lactis NZ9000. Serum inhibition assay further confirmed that adhesion of recombinant lactococci to Intestine 407 cells was indeed mediated by the N terminus-encoding part of the slpA gene. The ability of the receptor-binding region of SlpA to adhere to fibronectin was also confirmed with this lactococcal surface display system. These results show that, with the aid of the receptor-binding region of the L. brevis SlpA protein, the ability to adhere to gut epithelial cells can indeed be transferred to another, nonadhesive, lactic acid bacterium. PMID:12676705
Surface display of the receptor-binding region of the Lactobacillus brevis S-layer protein in Lactococcus lactis provides nonadhesive lactococci with the ability to adhere to intestinal epithelial cells.
Avall-Jääskeläinen, Silja; Lindholm, Agneta; Palva, Airi
Lactobacillus brevis is a promising lactic acid bacterium for use as a probiotic dietary adjunct and a vaccine vector. The N-terminal region of the S-layer protein (SlpA) of L. brevis ATCC 8287 was recently shown to mediate adhesion to various human cell lines in vitro. In this study, a surface display cassette was constructed on the basis of this SlpA receptor-binding domain, a proteinase spacer, and an autolysin anchor. The cassette was expressed under control of the nisA promoter in Lactococcus lactis NZ9000. Western blot assay of lactococcal cell wall extracts with anti-SlpA antibodies confirmed that the SlpA adhesion domain of the fusion protein was expressed and located within the cell wall layer. Whole-cell enzyme-linked immunosorbent assay and immunofluorescence microscopy verified that the SlpA adhesion-mediating region was accessible on the lactococcal cell surface. In vitro adhesion assays with the human intestinal epithelial cell line Intestine 407 indicated that the recombinant lactococcal cells had gained an ability to adhere to Intestine 407 cells significantly greater than that of wild-type L. lactis NZ9000. Serum inhibition assay further confirmed that adhesion of recombinant lactococci to Intestine 407 cells was indeed mediated by the N terminus-encoding part of the slpA gene. The ability of the receptor-binding region of SlpA to adhere to fibronectin was also confirmed with this lactococcal surface display system. These results show that, with the aid of the receptor-binding region of the L. brevis SlpA protein, the ability to adhere to gut epithelial cells can indeed be transferred to another, nonadhesive, lactic acid bacterium.
... 45 Public Welfare 1 2012-10-01 2012-10-01 false Confidentiality of Healthcare Integrity and... GENERAL ADMINISTRATION HEALTHCARE INTEGRITY AND PROTECTION DATA BANK FOR FINAL ADVERSE INFORMATION ON HEALTH CARE PROVIDERS, SUPPLIERS AND PRACTITIONERS Disclosure of Information by the Healthcare...
... 45 Public Welfare 1 2011-10-01 2011-10-01 false Confidentiality of Healthcare Integrity and... GENERAL ADMINISTRATION HEALTHCARE INTEGRITY AND PROTECTION DATA BANK FOR FINAL ADVERSE INFORMATION ON HEALTH CARE PROVIDERS, SUPPLIERS AND PRACTITIONERS Disclosure of Information by the Healthcare...
... 45 Public Welfare 1 2011-10-01 2011-10-01 false The Healthcare Integrity and Protection Data Bank... HEALTHCARE INTEGRITY AND PROTECTION DATA BANK FOR FINAL ADVERSE INFORMATION ON HEALTH CARE PROVIDERS, SUPPLIERS AND PRACTITIONERS General Provisions § 61.1 The Healthcare Integrity and Protection Data Bank....
... 45 Public Welfare 1 2012-10-01 2012-10-01 false The Healthcare Integrity and Protection Data Bank... HEALTHCARE INTEGRITY AND PROTECTION DATA BANK FOR FINAL ADVERSE INFORMATION ON HEALTH CARE PROVIDERS, SUPPLIERS AND PRACTITIONERS General Provisions § 61.1 The Healthcare Integrity and Protection Data Bank....
Moreño, Patricienn K.
The breakdown of care transitions between various healthcare facilities, providers, and services is a major issue in healthcare, and accounts for over US$15 billion in healthcare expenditures annually. The transition between inpatient care and home care is a very delicate period where, too often, chronically ill patients get worse and wind up back…
... 45 Public Welfare 1 2010-10-01 2010-10-01 false The Healthcare Integrity and Protection Data Bank... HEALTHCARE INTEGRITY AND PROTECTION DATA BANK FOR FINAL ADVERSE INFORMATION ON HEALTH CARE PROVIDERS, SUPPLIERS AND PRACTITIONERS General Provisions § 61.1 The Healthcare Integrity and Protection Data Bank....
McGuigan, Patrick J
This article reviews negotiation best practices while highlighting some of the factors that confound or enhance the ability to negotiate. Healthcare professionals will benefit by obtaining a set of practices that they can consistently apply to obtain more value from negotiation. In today's turbulent healthcare market, more relationships are governed by and through negotiated agreements, so it is imperative that healthcare professionals develop and sharpen their negotiating acumen.
Sherertz, R. J.; Bassetti, S.; Bassetti-Wyss, B.
Certain bacteria dispersed by health-care workers can cause hospital infections. Asymptomatic health-care workers colonized rectally, vaginally, or on the skin with group A streptococci have caused outbreaks of surgical site infection by airborne dispersal. Outbreaks have been associated with skin colonization or viral upper respiratory tract infection in a phenomenon of airborne dispersal of Staphylococcus aureus called the "cloud" phenomenon. This review summarizes the data supporting the existence of cloud health-care workers. PMID:11294715
Almeida, Lígia Moreira; Caldas, José; Ayres-de-Campos, Diogo; Salcedo-Barrientos, Dora; Dias, Sónia
Pregnancy is a period of increased vulnerability for migrant women, and access to healthcare, use and quality of care provided during this period are important aspects to characterize the support provided to this population. A systematic review of the scientific literature contained in the MEDLINE and SCOPUS databases was carried out, searching for population based studies published between 1990 and 2012 and reporting on maternal healthcare in immigrant populations. A total of 854 articles were retrieved and 30 publications met the inclusion criteria, being included in the final evaluation. The majority of studies point to a higher health risk profile in immigrants, with an increased incidence of co-morbidity in some populations, reduced access to health facilities particularly in illegal immigrants, poor communication between women and caregivers, a lower rate of obstetrical interventions, a higher incidence of stillbirth and early neonatal death, an increased risk of maternal death, and a higher incidence of postpartum depression. Incidences vary widely among different population groups. Some migrant populations are at a higher risk of serious complications during pregnancy, for reasons that include reduced access and use of healthcare facilities, as well as less optimal care, resulting in a higher incidence of adverse outcomes. Tackling these problems and achieving equality of care for all is a challenging aim for public healthcare services.
Milton, Constance L
Current healthcare advertising and customer relations terminology acknowledge that healthcare providers, including nurses, are to act as hosts for persons who enter into healthcare agencies and institutions. Indeed, much has been written aligning nursing and other healthcare services with consumer-oriented roles of the hospitality service industry commonly associated with hotels and restaurants. From a human becoming perspective, this article discusses possible ethical, administrative, and practice implications of nurses acting as guests entering into the lives of those we serve.
Rajiah, Kingston; Khoo, Suan Phaik; Chellappan, Dinesh Kumar; De Alwis, Ranjit; Chui, Hui Cing; Tan, Lui Lee; Tan, Yee Ning; Lau, Shin Yee
Objectives To evaluate the attitudes and readiness of students of healthcare professions towards interprofessional learning. Methodology A cross-sectional study design was used. Two different scales were used to measure the readiness for and perception of interprofessional learning; these were the 'Readiness for Interprofessional Learning Scale' and the 'Interdisciplinary Education Perception Scale'. A convenience sampling method was employed. The sample was drawn from undergraduate students enrolled in years 1 to 5 of medical, dental, pharmacy and health sciences programme. Descriptive and inferential statistics were used to analyse the data. Results The overall response rate was 83%. The students mentioned that shared learning with other healthcare professional students will increase their ability to understand clinical problems. The students also mentioned that such shared learning will help them to communicate better with patients and other professionals. The students preferred to work with individuals from their own profession. Participants from medical, dental, pharmacy, and health sciences had a difference in opinion about 'negative professional identity', a domain of the Readiness for Interprofessional Learning Scale. Based on the different year of study of the students, 'team work and collaboration', 'negative professional identity' and 'roles and responsibility' were the Interdisciplinary Education Perception Scale domains where students had a difference in opinion. Conclusions Attitudes and readiness towards interprofessional learning showed significant differences among students of various healthcare professions; these differences also depended on the students' year of study. Interprofessional learning should be incorporated in the curriculum of all healthcare professional programs, which may foster students to become competent healthcare providers and understand each profession's role. PMID:28060838
Yuksel, M.; Ertürkmen, G. L.; Kabak, Y.; Namli, T.; Yıldız, M. H.; Ay, Y.; Ceyhan, B.; Hülür, Ü.; Öztürk, H.; Atbakan, E.
Summary Objectives The objective of this paper is to describe some of the major healthcare information technology (IT) infrastructures in Turkey, namely, Sağlık-Net (Turkish for “Health-Net”), the Centralized Hospital Appointment System, the Basic Health Statistics Module, the Core Resources Management System, and the e-prescription system of the Social Security Institution. International collaboration projects that are integrated with Sağlık-Net are also briefly summarized. Methods The authors provide a survey of the some of the major healthcare IT infrastructures in Turkey. Results Sağlık-Net has two main components: the National Health Information System (NHIS) and the Family Medicine Information System (FMIS). The NHIS is a nation-wide infrastructure for sharing patients’ Electronic Health Records (EHRs). So far, EHRs of 78.9 million people have been created in the NHIS. Similarly, family medicine is operational in the whole country via FMIS. Centralized Hospital Appointment System enables the citizens to easily make appointments in healthcare providers. Basic Health Statistics Module is used for collecting information about the health status, risks and indicators across the country. Core Resources Management System speeds up the flow of information between the headquarters and Provincial Health Directorates. The e-prescription system is linked with Sağlık-Net and seamlessly integrated with the healthcare provider information systems. Finally, Turkey is involved in several international projects for experience sharing and disseminating national developments. Conclusion With the introduction of the “Health Transformation Program” in 2003, a number of successful healthcare IT infrastructures have been developed in Turkey. Currently, work is going on to enhance and further improve their functionality. PMID:24853036
Seenandan-Sookdeo, Kendra-Ann I
This article presents a review of the literature as it relates to the influence of the word power in the context of the Canadian healthcare system. The concept of power is used to explore issues of gender and the evolution of advanced nurse practice in the development of the Canadian healthcare system. Furthermore, issues related to the call for interprofessional collaboration are addressed. Healthcare workers, in particular nurses, are trusted in a society that seeks, promotes, and aspires for power and control. In addition, societal norms continue to shape our healthcare reform. As a consequence, the discussion centers on a call for true collaboration among our healthcare providers and concludes with implications for nursing.
Beni, Juliet B
Patient nonadherence is a growing and costly problem in the healthcare system, especially for patients with chronic illness. Between 25% and 40% of patients are nonadherent to treatment, and estimated costs directly associated with patient nonadherence in the US healthcare system are $290 billion a year. Nonadherence to preventive and treatment regimens is correlated to negative consequences for patients; however, many barriers to the promotion of successful adherence remain. Some such barriers include financial constraints, physical disability, side effects, forgetfulness, age and complex multi-drug regimens. The implementation of technology in healthcare systems is changing the way in which healthcare providers and patients must approach adherence. The following review applies a framework, the Information-Motivation-Strategy Model?, developed by DiMatteo and colleagues, to the field to conceptualise the changing factors affecting patient adherence as global healthcare moves toward increasingly technology-based systems of care.
Syed-Abdul, Shabbir; Hsu, Min-Huei; Iqbal, Usman; Scholl, Jeremiah; Huang, Chih-Wei; Nguyen, Phung Anh; Lee, Peisan; García-Romero, Maria Teresa; Li, Yu-Chuan Jack; Jian, Wen-Shan
Recent discussions have focused on using health information technology (HIT) to support goals related to universal healthcare delivery. These discussions have generally not reflected on the experience of countries with a large amount of experience using HIT to support universal healthcare on a national level. HIT was compared globally by using data from the Ministry of the Interior, Republic of China (Taiwan). Taiwan has been providing universal healthcare since 1995 and began to strategically implement HIT on a national level at that time. Today the national-level HIT system is more extensive in Taiwan than in many other countries and is used to aid administration, clinical care, and public health. The experience of Taiwan thus can provide an illustration of how HIT can be used to support universal healthcare delivery. In this article we present an overview of some key historical developments and successes in the adoption of HIT in Taiwan over a 17-year period, as well as some more recent developments. We use this experience to offer some strategic perspectives on how it can aid in the adoption of large-scale HIT systems and on how HIT can be used to support universal healthcare delivery.
Corchado, Juan M; Bajo, Javier; Tapia, Dante I; Abraham, Ajith
Ambient intelligence has acquired great importance in recent years and requires the development of new innovative solutions. This paper presents a distributed telemonitoring system, aimed at improving healthcare and assistance to dependent people at their homes. The system implements a service-oriented architecture based platform, which allows heterogeneous wireless sensor networks to communicate in a distributed way independent of time and location restrictions. This approach provides the system with a higher ability to recover from errors and a better flexibility to change their behavior at execution time. Preliminary results are presented in this paper.
Crum, Kathleen I.
Abstract Objectives: Leading telemental healthcare programs are increasingly harnessing new technologies in innovative ways to broaden the reach of supported care for children and adolescents. Technology-based delivery methods drawing on synchronous videoteleconferencing can transcend geographic barriers to quality care and remotely provide real-time services to affected families, regardless of their proximity to an expert mental health facility. Methods: The present review considers critical issues specific to family-based telemental healthcare, including: 1) Navigating varying levels of technological literacy across generations of participants; 2) deciding which family members to include in family-based telemental healthcare; 3) ensuring the safety of participants in family-based telemental healthcare; 4) optimizing therapeutic alliance and engagement in family-based telemental healthcare; 5) navigating logistical concerns in the conducting of sessions; and 6) ensuring privacy in family-based telemental healthcare. Results: We discuss illustrations of recent child telemental healthcare advances that have focused explicitly on family-based treatment approaches, including Internet-delivered Parent–Child Interaction Therapy and Internet-delivered family-based cognitive-behavioral therapy for early-onset OCD. Conclusions: We conclude with a consideration of future directions for the field of family-based telemental healthcare. PMID:26465388
Jankowska, Dorota M.; Karwowski, Maciej
Over the decades, creativity and imagination research developed in parallel, but they surprisingly rarely intersected. This paper introduces a new theoretical model of creative visual imagination, which bridges creativity and imagination research, as well as presents a new psychometric instrument, called the Test of Creative Imagery Abilities (TCIA), developed to measure creative imagery abilities understood in accordance with this model. Creative imagination is understood as constituted by three interrelated components: vividness (the ability to create images characterized by a high level of complexity and detail), originality (the ability to produce unique imagery), and transformativeness (the ability to control imagery). TCIA enables valid and reliable measurement of these three groups of abilities, yielding the general score of imagery abilities and at the same time making profile analysis possible. We present the results of nine studies on a total sample of more than 1700 participants, showing the factor structure of TCIA using confirmatory factor analysis, as well as provide data confirming this instrument's validity and reliability. The availability of TCIA for interested researchers may result in new insights and possibilities of integrating the fields of creativity and imagination science. PMID:26539140
Glaser, John; Aske, Jennings
A provider's initial priorities for protecting the security of healthcare IT should include the following: Security governance and management. Laptop and device encryption. Internal content filtering. E-mail encryption. Access management. Social media policies and guidelines.
McKinnies, Richard C; Collins, Sandra K; Collins, Kevin S
*Employee incentives are an important part of a radiology department's ability to attract and maintain employees. For incentive programs to be successful, radiology managers must diligently look for the incentives that motivate each particular employee. *The types of incentives being used frequently in the field of healthcare vary between technical, managerial, and executive positions. The process of identifying the right employee incentive for each group of individuals may be challenging, but if the result is a more productive and satisfied group of employees, the process is worth the effort.
Trevino, Kelly M.; Cadge, Wendy; Balboni, Michael J.; Thiel, Mary Martha; Fitchett, George; Gallivan, Kathleen; VanderWeele, Tyler; Balboni, Tracy A.
Abstract Background: Health care providers' lack of education on spiritual care is a significant barrier to the integration of spiritual care into health care services. Objective: The study objective was to describe the training program, Clinical Pastoral Education for Healthcare Providers (CPE-HP) and evaluate its impact on providers' spiritual care skills. Methods: Fifty CPE-HP participants completed self-report surveys at baseline and posttraining measuring frequency of and confidence in providing religious/spiritual (R/S) care. Four domains were assessed: (1) ability and (2) frequency of R/S care provision; (3) comfort using religious language; and (4) confidence in providing R/S care. Results: At baseline, participants rated their ability to provide R/S care and comfort with religious language as “fair.” In the previous two weeks, they reported approximately two R/S patient conversations, initiated R/S conversations less than twice, and prayed with patients less than once. Posttraining participants' reported ability to provide spiritual care increased by 33% (p<0.001). Their comfort using religious language improved by 29% (p<0.001), and frequency of R/S care increased 75% (p<0.001). Participants reported having 61% more (p<0.001) R/S conversations and more frequent prayer with patients (95% increase; p<0.001). Confidence in providing spiritual care improved by 36% overall, by 20% (p<0.001) with religiously concordant patients, and by 43% (p<0.001) with religiously discordant patients. Conclusions: This study suggests that CPE-HP is an effective approach for training health care providers in spiritual care. Dissemination of this training may improve integration of spiritual care into health care, thereby strengthening comprehensive patient-centered care. PMID:25871494
Abin, Jorge; Nemeth, Horacio; Friedmann, Ignacio
From a national level to give Internet technology support, the Nationwide Integrated Healthcare System in Uruguay requires a model of Information Systems Architecture. This system has multiple healthcare providers (public and private), and a strong component of supplementary services. Thus, the data processing system should have an architecture that considers this fact, while integrating the central services provided by the Ministry of Public Health. The national electronic health record, as well as other related data processing systems, should be based on this architecture. The architecture model described here conceptualizes a federated framework of electronic health record systems, according to the IHE affinity model, HL7 standards, local standards on interoperability and security, as well as technical advice provided by AGESIC. It is the outcome of the research done by AGESIC and Systems Integration Laboratory (LINS) on the development and use of the e-Government Platform since 2008, as well as the research done by the team Salud.uy since 2013.
Poker, Anna; Hubbard, Heddy; Sharp, Beth A Collins
In the Healthcare Research and Quality Act of 1999 (Public Law 106-129), Congress mandated that the Agency for Healthcare Research and Quality (AHRQ) produce annual reports on healthcare quality and disparities in the United States. The National Healthcare Quality Report and the National Healthcare Disparities Report were first released in 2003 by the AHRQ. These reports include broad sets of performance measures to portray the nation's progress toward improving the quality of care provided to all Americans. This article provides an overview of the framework, development, and future uses of the reports by consumers, practitioners, researchers, and policy makers.
Boniface, Mike; Watkins, E Rowland; Saleh, Ahmed; Dogac, Asuman; Eichelberg, Marco
Healthcare professionals need access to accurate and complete healthcare records for effective assessment, diagnosis and treatment of patients. The non-interoperability of healthcare information systems means that interenterprise access to a patient's history over many distributed encounters is difficult to achieve. The ARTEMIS project has developed a secure semantic web service infrastructure for the interoperability of healthcare information systems. Healthcare professionals share services and medical information using a web service annotation and mediation environment based on functional and clinical semantics derived from healthcare standards. Healthcare professionals discover medical information about individuals using a patient identification protocol based on pseudonymous information. The management of care pathways and access to medical information is based on a well-defined business process allowing healthcare providers to negotiate collaboration and data access agreements within the context of strict legislative frameworks.
Sharma, J; Osrin, D; Patil, B; Neogi, S B; Chauhan, M; Khanna, R; Kumar, R; Paul, V K; Zodpey, S
The rapid population growth in urban India has outpaced the municipal capacity to build essential infrastructures that make life in cities safe and healthy. Local and national governments alike are grappling with the challenges of urbanization with thousands migrating from villages to cities. Thus, urbanization in India has been accompanied by a concentration of poverty and urban public healthcare has emerged as one of the most pressing priorities facing our country. Newborn mortality rates in urban settings are lower than rural areas, early neonatal deaths account for greater proportion than late neonatal deaths. The available evidence suggests that socio-economic inequalities and poor environment pose major challenges for newborn health. Moreover, fragmented and weak public health system, multiplicity of actors and limited capacity of public health planning further constrain the delivery of quality and affordable health care service. Though healthcare is concentrated in urban areas, delay in deciding to seek health care, reaching a source of it and receiving appropriate care affects the health outcomes disproportionately. However, a few city initiatives and innovations piloted in different states and cities have brought forth the evidences of effectiveness of different strategies. Recently launched National Urban Health Mission (NUHM) provides an opportunity for strategic thinking and actions to improve newborn health outcomes in India. There is also an opportunity for coalescence of activities around National Health Mission (NHM) and Reproductive, Maternal, Newborn and Child Health+Adolescent (RMNCH+A) strategy to develop feasible and workable models in different urban settings. Concomitant operational research needs to be carried out so that the obstacles, approaches and response to the program can be understood. PMID:27924107
Sharma, J; Osrin, D; Patil, B; Neogi, S B; Chauhan, M; Khanna, R; Kumar, R; Paul, V K; Zodpey, S
The rapid population growth in urban India has outpaced the municipal capacity to build essential infrastructures that make life in cities safe and healthy. Local and national governments alike are grappling with the challenges of urbanization with thousands migrating from villages to cities. Thus, urbanization in India has been accompanied by a concentration of poverty and urban public healthcare has emerged as one of the most pressing priorities facing our country. Newborn mortality rates in urban settings are lower than rural areas, early neonatal deaths account for greater proportion than late neonatal deaths. The available evidence suggests that socio-economic inequalities and poor environment pose major challenges for newborn health. Moreover, fragmented and weak public health system, multiplicity of actors and limited capacity of public health planning further constrain the delivery of quality and affordable health care service. Though healthcare is concentrated in urban areas, delay in deciding to seek health care, reaching a source of it and receiving appropriate care affects the health outcomes disproportionately. However, a few city initiatives and innovations piloted in different states and cities have brought forth the evidences of effectiveness of different strategies. Recently launched National Urban Health Mission (NUHM) provides an opportunity for strategic thinking and actions to improve newborn health outcomes in India. There is also an opportunity for coalescence of activities around National Health Mission (NHM) and Reproductive, Maternal, Newborn and Child Health+Adolescent (RMNCH+A) strategy to develop feasible and workable models in different urban settings. Concomitant operational research needs to be carried out so that the obstacles, approaches and response to the program can be understood.
The aim of this paper is to analyze and quantify the average healthcare centres' energy behavior and estimate the possibilities of savings through the use of concrete measures to reduce their energy demand in Extremadura, Spain. It provides the average energy consumption of 55 healthcare centres sized between 500 and 3,500 m². The analysis evaluated data of electricity and fossil fuel energy consumption as well as water use and other energy-consuming devices. The energy solutions proposed to improve the efficiency are quantified and listed. The average annual energy consumption of a healthcare centre is 86.01 kWh/m², with a standard deviation of 16.8 kWh/m². The results show that an annual savings of €4.77/m² is possible. The potential to reduce the energy consumption of a healthcare centre of size 1,000 m² is 10,801 kWh by making an average investment of €11,601, thus saving €2,961/year with an average payback of 3.92 years.
Yan, Fei; Tang, Shenglan; Zhang, Jian
The ongoing healthcare reform in China has a powerful spillover effect beyond the health sector and the borders of China. A successful completion of the Chinese reform will offer a new model for social justice development, shift the global economy toward sustainability and create a new hub for science and technology in medical and health science. However, reforming the healthcare system in the most populated country is a daunting task. China will not live up to its promise, and all the potentials may end with hype not hope if coherent national strategies are not constructed and state-of-the-art navigation is not achieved with staggering domestic and global challenges. The cost of failure will be immensely high, socioeconomic costs for Chinese and an opportunity cost for the world as a whole. A full appreciation of the global implications of China's healthcare reform is crucial in keeping China receptive toward good practices evidence-approved elsewhere and open minded to fulfill its international obligations. More critically, the appreciation yields constructive engagements from global community toward a joint development and global prosperity. The current report provides a multiple disciplinary assessment on the global implications of the healthcare reform in China.
AbstractDemographic change and advances in medical science pose increased challenges to healthcare systems globally: The economic basis is aging and thus health is becoming more and more a productivity factor. At the same time, with todayâs new communication possibilities the demand and expectations of effective medical treatment have been increased. This presentation will illustrate the need for the âindustrializationâ of healthcare in order to achieve highest results at limited budgets. Thereby, industrialization is not meaning the medical treatment based on the assembly line approach. Rather it is to recognize the cost of medical care as an investment with respective expectations on the return of the investment. Innovations in imaging and pharmaceutical products as well as in processes - that lead to similar medical results, but with lower efforts - are keys in such scenarios.BiographyProf. Dr. Hermann Requardt, 54, is a member of the Managing Board of Siemens AG and Chief Executive Officer of the Healthcare Sector. In addition he is the CTO of Siemens AG and Head of Corporate Technology, the central research department at Siemens.After completing his studies in physics and philosophy at the Darmstadt University of Technology and Johann Wolfgang Goethe University in Frankfurt and receiving a doctorate in biophysics, he worked at the Institute of Aerospace Medicine at the German Aerospace Center.In 1984 he joined the Medical Technology Group of Siemens AG, where he was responsible for projects in the Magnetic Resonance (MR) division. He was appointed head of the division in 1995. From 2001 to 2006, as a member of the Executive Management of the Medical Solutions Group, he was responsible for several areas, including technological development.In 2006 he became a Member of the Siemensâ Managing Board and head of Corporate Technology. He was additionally appointed as the Sector Healthcare CEO in 2008.Since 2006 he is an honorary professor in
Brambilla, Antonio; Maciocco, Gavino
The central attributes of primary care are: first contact (accessibility), longitudinality (person- focused preventive and curative care overtime), patient-oriented comprehensiveness and coordination (including navigation towards secondary and tertiary care). Besides taking care of the needs of the individuals, primary health care teams are also looking at the community, especially when addressing social determinants of health. The rationale for the benefits for primary care for health has been found in: 1) greater access to needed services; 2) better quality of care; 3) a greater focus on prevention; 4) early management of health problems; 5) organizing and delivering high quality care for chronic non-communicable diseases. This paper describes the role of primary healthcare centres in strengthening community primary services and in reducing health inequalities. Furthemore, the experiences of Regional Health Services from Tuscany and Emilia-Romagna are discussed, with a brief overview of the literature.
Kumar, R Krishna
Medicine in the 21st century is increasingly dependent on technology. Unlike in many other areas, the cost of medical technology is not declining and its increasing use contributes to the spiraling healthcare costs. Many medical professionals equate progress in medicine to increasing use of sophisticated technology that is often expensive and beyond the reach of the average citizen. Pediatric heart care is very technology-intensive and therefore very expensive and beyond the reach of the vast majority of children in the developing world. There is an urgent need to address this situation through development and use of appropriate technology in accordance with the needs and priorities of the society. A number of simple and inexpensive quality measures that have the potential of improving outcomes substantially without the need for expensive equipment should be instituted before embracing high-end technology. Innovations to reduce costs that are commonly used in limited resource environments should be tested systematically. PMID:21677816
Investments in the extension of health insurance coverage, the strengthening of public health services, as well as primary care and better hospitals, highlights the emerging role of healthcare as part of China’s new growth regime, based on an expansion of services, and redistributive policies. Such investments, apart from their central role in terms of relief for low-income people, serve to rebalance the Chinese economy away from export-led growth toward the domestic market, particularly in megacity-regions as Shanghai and the Pearl River Delta, which confront the challenge of integrating migrant workers. Based on the paper by Gusmano and colleagues, one would expect improvements in population health for permanent residents of China’s cities. The challenge ahead, however, is how to address the growth of inequalities in income, wealth and the social wage. PMID:25774379
Klein, R F
How do consumers view healthcare advertising? This question, along with many others, was addressed in a national survey conducted by Market Strategies for The Alliance For Healthcare Strategy And Marketing, and presented during The Alliance's annual advertising and promotion conference last June.
Lee, Eugine; Kim, Ji Hye; Park, Seon Mi; Jeong, Yeon Ik; Lee, Jong Yun; Park, Sun Woo; Choi, Jiho; Kim, Huen Suk; Jeong, Yeon Woo; Kim, Sue; Hyun, Sang Hwan; Hwang, Woo Suk
The restricted supply of oocytes in the domestic dog limits the development of reproductive biotechnologies in this species. Inter-species somatic cell nuclear transfer could be an alternative for cloning animals whose oocytes are difficult to obtain. In this study, the possibility of cloning dog embryos using pig oocytes was investigated by evaluating nuclear remodeling. Chromatin remodeling, assessed by premature chromosome condensation, pseudo-pronuclei formation, DNA methylation and histone acetylation, along with the developmental ability was compared between intra- and inter-species cloned embryos. The incidence of premature chromosome condensation was significantly higher in intra-species cloned embryos relative to inter-species cloned embryos (87.2% vs. 61.7%; P<0.05), but comparable pseu