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Sample records for improve patient understanding

  1. Improving Patient Understanding of Prescription Drug Label Instructions

    PubMed Central

    Davis, Terry C.; Federman, Alex D.; Bass, Pat F.; Jackson, Robert H.; Middlebrooks, Mark; Parker, Ruth M.

    2008-01-01

    Background Patient misunderstanding of instructions on prescription drug labels is common and a likely cause of medication error and less effective treatment. Objective To test whether the use of more explicit language to describe dose and frequency of use for prescribed drugs could improve comprehension, especially among patients with limited literacy. Design Cross-sectional study using in-person, structured interviews. Patients Three hundred and fifty-nine adults waiting for an appointment in two hospital-based primary care clinics and one federally qualified health center in Shreveport, Louisiana; Chicago, Illinois; and New York, New York, respectively. Measurement Correct understanding of each of ten label instructions as determined by a blinded panel review of patients’ verbatim responses. Results Patient understanding of prescription label instructions ranged from 53% for the least understood to 89% for the most commonly understood label. Patients were significantly more likely to understand instructions with explicit times periods (i.e., morning) or precise times of day compared to instructions stating times per day (i.e., twice) or hourly intervals (89%, 77%, 61%, and 53%, respectively,  < 0.001). In multivariate analyses, dosage instructions with specific times or time periods were significantly more likely to be understood compared to instructions stating times per day (time periods — adjusted relative risk ratio (ARR) 0.42, 95% Confidence Interval (CI) 0.34–0.52; specific times — ARR 0.60, 95% CI 0.49–0.74). Low and marginal literacy remained statistically significant independent predictors of misinterpreting instructions (low - ARR 2.70, 95% CI 1.81–4.03; marginal -ARR 1.66, 95% CI 1.18–2.32). Conclusions Use of precise wording on prescription drug label instructions can improve patient comprehension. However, patients with limited literacy were more likely to misinterpret instructions despite use of more explicit language. PMID

  2. Improving health outcomes with better patient understanding and education.

    PubMed

    Adams, Robert John

    2010-01-01

    A central plank of health care reform is an expanded role for educated consumers interacting with responsive health care teams. However, for individuals to realize the benefits of health education also requires a high level of engagement. Population studies have documented a gap between expectations and the actual performance of behaviours related to participation in health care and prevention. Interventions to improve self-care have shown improvements in self-efficacy, patient satisfaction, coping skills, and perceptions of social support. Significant clinical benefits have been seen from trials of self-management or lifestyle interventions across conditions such as diabetes, coronary heart disease, heart failure and rheumatoid arthritis. However, the focus of many studies has been on short-term outcomes rather that long term effects. There is also some evidence that participation in patient education programs is not spread evenly across socio economic groups. This review considers three other issues that may be important in increasing the public health impact of patient education. The first is health literacy, which is the capacity to seek, understand and act on health information. Although health literacy involves an individual's competencies, the health system has a primary responsibility in setting the parameters of the health interaction and the style, content and mode of information. Secondly, much patient education work has focused on factors such as attitudes and beliefs. That small changes in physical environments can have large effects on behavior and can be utilized in self-management and chronic disease research. Choice architecture involves reconfiguring the context or physical environment in a way that makes it more likely that people will choose certain behaviours. Thirdly, better means of evaluating the impact of programs on public health is needed. The Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework has been

  3. UNDERSTANDING OR NURSES' REACTIONS TO ERRORS AND USING THIS UNDERSTANDING TO IMPROVE PATIENT SAFETY.

    PubMed

    Taifoori, Ladan; Valiee, Sina

    2015-09-01

    The operating room can be home to many different types of nursing errors due to the invasiveness of OR procedures. The nurses' reactions towards errors can be a key factor in patient safety. This article is based on a study, with the aim of investigating nurses' reactions toward nursing errors and the various contributing and resulting factors, conducted at Kurdistan University of Medical Sciences in Sanandaj, Iran in 2014. The goal of the study was to determine how OR nurses' reacted to nursing errors with the goal of having this information used to improve patient safety. Research was conducted as a cross-sectional descriptive study. The participants were all nurses employed in the operating rooms of the teaching hospitals of Kurdistan University of Medical Sciences, which was selected by a consensus method (170 persons). The information was gathered through questionnaires that focused on demographic information, error definition, reasons for error occurrence, and emotional reactions for error occurrence, and emotional reactions toward the errors. 153 questionnaires were completed and analyzed by SPSS software version 16.0. "Not following sterile technique" (82.4 percent) was the most reported nursing error, "tiredness" (92.8 percent) was the most reported reason for the error occurrence, "being upset at having harmed the patient" (85.6 percent) was the most reported emotional reaction after error occurrence", with "decision making for a better approach to tasks the next time" (97.7 percent) as the most common goal and "paying more attention to details" (98 percent) was the most reported planned strategy for future improved outcomes. While healthcare facilities are focused on planning for the prevention and elimination of errors it was shown that nurses can also benefit from support after error occurrence. Their reactions, and coping strategies, need guidance and, with both individual and organizational support, can be a factor in improving patient safety. PMID

  4. Gastrointestinal symptoms after pelvic radiotherapy: a new understanding to improve management of symptomatic patients.

    PubMed

    Andreyev, Jervoise

    2007-11-01

    Gastrointestinal symptoms after pelvic radiotherapy, which affect quality of life, are substantially more common than generally recognised and are frequently poorly managed. These symptoms develop because radiation can induce change in one or more specific physiological functions in widely separated parts of the gastrointestinal tract that lie in the path of the radiotherapy beam. Radiation-induced changes are not confined by normal anatomical boundaries. Furthermore, pre-existing subclinical disease might be destabilised because of minor gastrointestinal changes induced by radiotherapy. New diseases might manifest after radiotherapy and be confused with symptoms induced by radiotherapy. Different functional deficits might cause the same symptoms. Many patients have more than one cause for their symptoms, which sometimes need very different treatments. Simple diagnostic tests that are used in other contexts, if applied appropriately to patients with new gastrointestinal symptoms after radiotherapy, can identify the underlying causes of new-onset symptoms. Starting treatment without knowing the cause of the symptom is commonly ineffective because prediction of the combination of treatments needed is difficult. Evidence suggests that many patients have unusual but highly treatable malfunctions of gastrointestinal physiology, which if correctly diagnosed may enable a patient with difficult symptoms to be helped.

  5. Ethics seminar: the hospice patient in the ED: an ethical approach to understanding barriers and improving care.

    PubMed

    Zieske, Michael; Abbott, Jean

    2011-11-01

    Emergency physicians (EPs) are asked to evaluate and treat a growing population of hospice patients who present to the emergency department (ED) for a number of important reasons. Hospice patients pose unique ethical challenges, and "best practices" for these patients can differ from the life-preserving interventions of usual ED care. Having a solid understanding of professional responsibilities and ethical principles is useful for guiding EP management of these patients. In end-of-life care, EPs need to recognize that there are barriers and complexities to the best management of hospice patients, but they need to commit to strategies that optimize their care. This article describes the case of a hospice patient who presented with sepsis and end-stage cancer to the ED. Patient, system, and physician factors made management decisions in the ED difficult. The goal in the ED should be to determine the best way to address terminally ill patient needs while respecting wishes to limit interventions that will only increase suffering near the end of life.

  6. Understanding Fire Through Improved Technology

    NASA Technical Reports Server (NTRS)

    2004-01-01

    Aztec(TradeMark) is the commercial name for Southwest Sciences laser. The laser has coarse tuning ranges of 10 nanometers (nm) to 30 nm at wavelengths ranging from 630 nm to 2,300 nm, making it the only commercially available external cavity diode laser with wavelengths beyond 1,650 nm. The laser's high-speed tuning in both coarse and fine wavelength regimes allows for increased trace gas detection. With the automated coarse tuning option, the Aztec sweeps through its wavelength range in less than 1 millisecond. While some diode lasers can only detect one type, or species, of a trace gas, the Aztec's broad wavelength tuning provides access to multiple trace gas species. The Aztec has a wide range of applications for both NASA and commercial users, from protecting astronauts in space to improving combustion processes on Earth. It may serve as a new tool for planetary exploration, as it can detect a wide range of multiple gas species in planetary atmospheres. The laser could optically detect gaseous indicators of incipient fires on the International Space Station and Space Shuttle, as well as detect low concentrations of potentially toxic gases in spacecraft crew habitats. The laser could also provide more accurate fire detection in aircraft cargo compartments. Since the Aztec can detect several gases that only evolve during an actual fire, its implementation could reduce the large number of commercial aircraft landings that currently occur due to false alarms. Other applications include environmental and industrial process monitoring.

  7. A first step toward understanding patient safety

    PubMed Central

    2016-01-01

    Patient safety has become an important policy agenda in healthcare systems since publication of the 1999 report entitled "To Err Is Human." The paradigm has changed from blaming the individual for the error to identifying the weakness in the system that led to the adverse events. Anesthesia is one of the first healthcare specialties to adopt techniques and lessons from the aviation industry. The widespread use of simulation programs and the application of human factors engineering to clinical practice are the influences of the aviation industry. Despite holding relatively advanced medical technology and comparable safety records, the Korean health industry has little understanding of the systems approach to patient safety. Because implementation of the existing system and program requires time, dedication, and financial support, the Korean healthcare industry is in urgent need of developing patient safety policies and putting them into practice to improve patient safety before it is too late. PMID:27703622

  8. Improving Student Understanding of Spatial Ecology Statistics

    ERIC Educational Resources Information Center

    Hopkins, Robert, II; Alberts, Halley

    2015-01-01

    This activity is designed as a primer to teaching population dispersion analysis. The aim is to help improve students' spatial thinking and their understanding of how spatial statistic equations work. Students use simulated data to develop their own statistic and apply that equation to experimental behavioral data for Gambusia affinis (western…

  9. Measuring improved patient choice.

    PubMed

    Holmes-Rovner, M; Rovner, D R

    2000-08-01

    Patient decision support (PDS) tools or decision aids have been developed as adjuncts to the clinical encounter. Their aim is to support evidence-based patient choice. Clinical trials of PDS tools have used an array of outcome measures to determine efficacy, including knowledge, satisfaction, health status and consistency between patient choice and values. This paper proposes that the correlation between 'subjective expected utility' (SEU) and decision may be the best primary endpoint for trials. SEU is a measure usually used in behavioural decision theory. The paper first describes how decision support tools may use decision analysis to structure the presentation of evidence and guide patient decision-making. Uses of expected utility (EU) are suggested for evaluating PDS tools when improving population health status is the objective. SEU is the theoretically better measure when internal consistency of patient choices is the objective. PMID:11083037

  10. Teleophthalmology: improving patient outcomes?

    PubMed

    Sreelatha, Omana Kesary; Ramesh, Sathyamangalam VenkataSubbu

    2016-01-01

    Teleophthalmology is gaining importance as an effective eye care delivery modality worldwide. In many developing countries, teleophthalmology is being utilized to provide quality eye care to the underserved urban population and the unserved remote rural population. Over the years, technological innovations have led to improvement in evidence and teleophthalmology has evolved from a research tool to a clinical tool. The majority of the current teleophthalmology services concentrate on patient screening and appropriate referral to experts. Specialty care using teleophthalmology services for the pediatric group includes screening as well as providing timely care for retinopathy of prematurity (ROP). Among geriatric eye diseases, specialty teleophthalmology care is focused toward screening and referral for diabetic retinopathy (DR), glaucoma, age-related macular degeneration (ARMD), and other sight-threatening conditions. Comprehensive vision screening and refractive error services are generally covered as part of most of the teleophthalmology methods. Over the past decades, outcome assessment of health care system includes patients' assessments on their health, care, and services they receive. Outcomes, by and large, remain the ultimate validators of the effectiveness and quality of medical care. Teleophthalmology produces the same desired clinical outcome as the traditional system. Remote portals allow specialists to provide care over a larger region, thereby improving health outcomes and increasing accessibility of specialty care to a larger population. A high satisfaction level and acceptance is reported in the majority of the studies because of increased accessibility and reduced traveling cost and time. Considering the improved quality of patient care and patient satisfaction reported for these telemedicine services, this review explores how teleophthalmology helps to improve patient outcomes. PMID:26929592

  11. Teleophthalmology: improving patient outcomes?

    PubMed Central

    Sreelatha, Omana Kesary; Ramesh, Sathyamangalam VenkataSubbu

    2016-01-01

    Teleophthalmology is gaining importance as an effective eye care delivery modality worldwide. In many developing countries, teleophthalmology is being utilized to provide quality eye care to the underserved urban population and the unserved remote rural population. Over the years, technological innovations have led to improvement in evidence and teleophthalmology has evolved from a research tool to a clinical tool. The majority of the current teleophthalmology services concentrate on patient screening and appropriate referral to experts. Specialty care using teleophthalmology services for the pediatric group includes screening as well as providing timely care for retinopathy of prematurity (ROP). Among geriatric eye diseases, specialty teleophthalmology care is focused toward screening and referral for diabetic retinopathy (DR), glaucoma, age-related macular degeneration (ARMD), and other sight-threatening conditions. Comprehensive vision screening and refractive error services are generally covered as part of most of the teleophthalmology methods. Over the past decades, outcome assessment of health care system includes patients’ assessments on their health, care, and services they receive. Outcomes, by and large, remain the ultimate validators of the effectiveness and quality of medical care. Teleophthalmology produces the same desired clinical outcome as the traditional system. Remote portals allow specialists to provide care over a larger region, thereby improving health outcomes and increasing accessibility of specialty care to a larger population. A high satisfaction level and acceptance is reported in the majority of the studies because of increased accessibility and reduced traveling cost and time. Considering the improved quality of patient care and patient satisfaction reported for these telemedicine services, this review explores how teleophthalmology helps to improve patient outcomes. PMID:26929592

  12. Improving student understanding of quantum mechanics

    NASA Astrophysics Data System (ADS)

    Singh, Chandralekha

    2015-04-01

    Learning quantum mechanics is challenging for many students. We are investigating the difficulties that upper-level students have in learning quantum mechanics. To help improve student understanding of quantum concepts, we are developing quantum interactive learning tutorials (QuILTs) and tools for peer-instruction. Many of the QuILTs employ computer simulations to help students visualize and develop better intuition about quantum phenomena. We will discuss the common students' difficulties and research-based tools we are developing to bridge the gap between quantitative and conceptual aspects of quantum mechanics and help students develop a solid grasp of quantum concepts. Support from the National Science Foundation is gratefully acknowledged.

  13. Improving students' understanding of quantum mechanics

    NASA Astrophysics Data System (ADS)

    Singh, Chandralekha; Zhu, Guangtian

    2010-02-01

    Learning quantum mechanics is challenging. We are investigating the difficulties that upper-level students have in learning quantum mechanics. To help improve student understanding of quantum concepts, we are developing quantum interactive learning tutorials (QuILTs) and tools for peer-instruction. Many of the QuILTs employ computer simulations to help students visualize and develop better intuition about quantum phenomena. We will discuss the common students' difficulties and research-based tools we are developing to bridge the gap between quantitative and conceptual aspects of quantum mechanics and help students develop a solid grasp of quantum concepts. Supported by the National Science Foundation. )

  14. Improving students' understanding of quantum mechanics

    NASA Astrophysics Data System (ADS)

    Singh, Chandralekha

    2011-03-01

    Learning quantum mechanics is especially challenging, in part due to the abstract nature of the subject. We have been conducting investigations of the difficulties that students have in learning quantum mechanics. To help improve student understanding of quantum concepts, we are developing quantum interactive learning tutorials (QuILTs) as well as tools for peer-instruction. The goal of QuILTs and peer-instruction tools is to actively engage students in the learning process and to help them build links between the formalism and the conceptual aspects of quantum physics without compromising the technical content. They focus on helping students integrate qualitative and quantitative understanding, confront and resolve their misconceptions and difficulties, and discriminate between concepts that are often confused. In this talk, I will give examples from my research in physics education of how students' prior knowledge relevant for quantum mechanics can be assessed, and how learning tools can be designed to help students develop a robust knowledge structure and critical thinking skills. Supported by the National Science Foundation.

  15. Simulation: improving patient outcomes.

    PubMed

    Smith, Abi; Siassakos, Dimitrios; Crofts, Joanna; Draycott, Tim

    2013-06-01

    Effective training has been shown to improve perinatal care and outcome, decrease litigation claims and reduce midwifery sick leave. To be effective, training should be incentivised, in a realistic context, and delivered to inter-professional teams similar to those delivering actual care. Teamwork training is a useful addition, but it should be based on the characteristics of effective teamwork as derived from the study of frontline teams. Implementation of simulation and teamwork training is challenging, with constraints on staff time, facilities and finances. Local adoption and adaptation of effective programmes can help keep costs down, and make them locally relevant whilst maintaining effectiveness. Training programmes need to evolve continually in line with new evidence. To do this, it is vital to monitor outcomes and robustly evaluate programmes for their impact on patient care and outcome, not just on participants. PMID:23721770

  16. Clinical research: what do patients understand?

    PubMed

    Erlen, J A

    2000-01-01

    An increasing amount of clinical research is being conducted to test the efficacy and effectiveness of new medications, therapies, and medical procedures. These studies often require that patients be invited to be subjects. However, what do patients really understand whenever they are asked to participate in clinical research? Are patients aware that research is clearly different from treatment? Are they aware that their participation in research is to benefit future patients? Despite the desire of clinical agencies to support research, there is the concern about how they can best protect the rights of patients who are subjects in this research. The author briefly discusses clinical research, patients as vulnerable subjects, the therapeutic misconception, and informed consent. In addition, recommendations are provided to help assure that the rights of patients who are research subjects are protected.

  17. Qualitative approaches to understanding patient preferences.

    PubMed

    Gooberman-Hill, Rachael

    2012-01-01

    Achieving patient-centered care depends on a thorough understanding of patient preferences at all stages of their journeys through healthcare. Qualitative research methods provide the means to systematically collect and analyze these preferences. Qualitative approaches to research are diverse in character, but many such approaches have a long history and strong disciplinary roots. Despite variation, most qualitative approaches work inductively from the 'ground up', and seek to build knowledge and understanding rather than test hypotheses. Their use to explore patient pathways through care has offered insight into reasons why people become patients in the first instance, their preferences for treatment options and degree of involvement in decisions, and their preferences for healthcare delivery. Qualitative approaches are sometimes used alongside 'quantitative' in mixed methods designs, requiring solid expertise and resourcing. Expertise is also crucial in the assessment of quality in qualitative research, and efforts to develop checklists to assess quality are challenged by evidence about the importance of expertise-based judgments. Recent developments in health research include an upsurge in patient involvement activities in design of research and healthcare services; these may seem similar to qualitative research, but are in fact very different. While an important part of the research landscape, patient involvement activities are not intended to provide robust research-based evidence about patients' preferences or experiences. There is pressing need to bridge the gap between qualitative research evidence and patient involvement in the design of research and services. Participatory research methods that harness qualitative approaches may be a way to achieve this.

  18. Evidence that patients can understand and use?

    PubMed

    Santesso, Nancy; Glenton, Claire; Lang, Britta

    2008-01-01

    The impact that research evidence can have on patients making decisions about their own care is often overlooked. Regardless of whether patients want to lead or fully participate in their care, it appears that patients still want to be informed. We have health information that patients could benefit from knowing, a growing body of evidence and experiences about how to translate this information to patients. The Cochrane Collaboration, an organisation that produces and disseminates systematic reviews of healthcare interventions, translates the evidence from their reviews into summaries for the public. Research is presently being conducted to test a format for the plain language summaries. Principles such as presenting evidence in standard qualitative statements, as relative and absolute risks, as natural frequencies, and in tables are being incorporated into the format. Groups within the Collaboration are also translating the evidence for use by patients and the public. Effective strategies are being used to target patients directly and via their physicians, such as dissemination on specific patient group websites and decision aids. Research evidence and experiences can feed into the creation of evidence that patients can understand and use. PMID:19216198

  19. Continuous Improvement in Schools: Understanding the Practice

    ERIC Educational Resources Information Center

    Anderson, Stephen; Kumari, Roshni

    2009-01-01

    This article investigates conceptually and practically what it means for schools to engage in the practice of continuous improvement. The analysis draws upon prior research and discussion to predict core elements of the practice of continuous improvement in schools. The predictions are then applied to a case study of continuous improvement efforts…

  20. Understanding the role of physician attire on patient perceptions: a systematic review of the literature— targeting attire to improve likelihood of rapport (TAILOR) investigators

    PubMed Central

    Petrilli, Christopher Michael; Mack, Megan; Petrilli, Jennifer Janowitz; Hickner, Andy; Saint, Sanjay; Chopra, Vineet

    2015-01-01

    Objectives Despite a growing body of literature, uncertainty regarding the influence of physician dress on patients’ perceptions exists. Therefore, we performed a systematic review to examine the influence of physician attire on patient perceptions including trust, satisfaction and confidence. Setting, participants, interventions and outcomes We searched MEDLINE, Embase, Biosis Previews and Conference Papers Index. Studies that: (1) involved participants ≥18 years of age; (2) evaluated physician attire; and (3) reported patient perceptions related to attire were included. Two authors determined study eligibility. Studies were categorised by country of origin, clinical discipline (eg, internal medicine, surgery), context (inpatient vs outpatient) and occurrence of a clinical encounter when soliciting opinions regarding attire. Studies were assessed using the Downs and Black Scale risk of bias scale. Owing to clinical and methodological heterogeneity, meta-analyses were not attempted. Results Of 1040 citations, 30 studies involving 11 533 patients met eligibility criteria. Included studies featured patients from 14 countries. General medicine, procedural (eg, general surgery and obstetrics), clinic, emergency departments and hospital settings were represented. Preferences or positive influence of physician attire on patient perceptions were reported in 21 of the 30 studies (70%). Formal attire and white coats with other attire not specified was preferred in 18 of 30 studies (60%). Preference for formal attire and white coats was more prevalent among older patients and studies conducted in Europe and Asia. Four of seven studies involving procedural specialties reported either no preference for attire or a preference for scrubs; four of five studies in intensive care and emergency settings also found no attire preference. Only 3 of 12 studies that surveyed patients after a clinical encounter concluded that attire influenced patient perceptions. Conclusions

  1. Improving weekend patient handover.

    PubMed

    Ashton, Catherine

    2014-01-01

    The Royal College of Physicians state that 'handover, particularly of temporary 'on-call' responsibility, has been identified as a point at which errors are likely to occur' [1]. Working a weekend on-call covering medical wards is often busy and stressful for all junior doctors, with added pressure in trying to identify patients and tasks amongst several different pieces of paper and making important care escalation. All handover sheets from a random weekend were collected and studied. Only 57% of patients listed had the minimum expected 3 patient identifiers [2] included and just 11% had any indication of escalation planning. They were also often written on scrap pieces of paper and included varying levels of relevant patient background and information. After liaison with junior doctors and the handover committee, involving senior medical clinicians, a new handover sheet was created and uploaded onto the trust intranet, to rectify some of the problems identified. Junior doctors were also educated about the changes to weekend handover. At 2 months post-introduction, another set of weekend handover sheets were collected. All medical wards used the handover sheets for documentation of patients and tasks at a weekend and inclusion of 3 patient identifiers rose to 80%. There was also a big increase noted in clinical information and background included at weekend handover and anecdotally made weekend handover easier and less stressful. There was also increased consideration of escalation planning. The handover sheet is now being rolled out trust-wide in medicine and introduced to surgical colleagues.

  2. Improving semantic scene understanding using prior information

    NASA Astrophysics Data System (ADS)

    Laddha, Ankit; Hebert, Martial

    2016-05-01

    Perception for ground robot mobility requires automatic generation of descriptions of the robot's surroundings from sensor input (cameras, LADARs, etc.). Effective techniques for scene understanding have been developed, but they are generally purely bottom-up in that they rely entirely on classifying features from the input data based on learned models. In fact, perception systems for ground robots have a lot of information at their disposal from knowledge about the domain and the task. For example, a robot in urban environments might have access to approximate maps that can guide the scene interpretation process. In this paper, we explore practical ways to combine such prior information with state of the art scene understanding approaches.

  3. Patients Provide Recommendations for Improving Patient Satisfaction.

    PubMed

    Moore, Angelo D; Hamilton, Jill B; Krusel, Jessica L; Moore, LeeAntoinette G; Pierre-Louis, Bosny J

    2016-04-01

    National Committee for Quality Assurance recommends patient-centered medical homes incorporate input from patient populations; however, many health care organizations do not. This qualitative study used two open-ended questions from 148 active duty Army Soldiers and their family members to illicit recommendations for primary care providers and clinic leadership that would improve their health care experiences. Content analysis and descriptive statistics were used to analyze responses. Participant responses were related to four major themes: Access to Care, Interpersonal Interaction, Satisfaction of Care, and Quality of Care. Participants were overall satisfied with their care; however, spending less time waiting for appointments and to see the provider or specialist were the most frequently requested improvements related to Access to Care. For Interpersonal Interaction, 82% of the responses recommended that providers be more attentive listeners, courteous, patient, caring, and respectful. Decreasing wait times and improving interpersonal skills would improve health care experiences and patient satisfaction. PMID:27046182

  4. Toward an improved understanding of MCS propagation

    NASA Astrophysics Data System (ADS)

    Peters, J. M.

    2015-12-01

    Processes that drive the propagation of elevated mesoscale convective systems (MCSs) have been the topic of a growing body of recent research. Elevated MCSs are responsible for a large percentage of warm season rainfall in the continental United States, and produce flash floods more frequently than other modes of convection. A comprehensive understanding of the dynamics of MCS propagation is important, since propagation sometimes opposes other environmental forces that influence MCS motion. This leads to nearly stationary MCSs that produce prolific local rainfall totals. The ingredients-based Propagation index (IPI) is introduced in this research. IPI is defined as the normalized product of horizontal warm thermal advection (a proxy for lifting), convective available potential energy (CAPE), and relative humidity. Horizontal plots of IPI are useful in identifying regions of probable convective initiation, including the intersections between potentially unstable flow and outflow boundaries, regions of mesoscale lift along the nose of the low-level jet, convectively induced gravity waves, and frontogenesis. Effective inflow-layer shear vectors are also introduced, and found to be useful for scenarios where IPI does yield predictive insight, such as the traditional "RKW" scenario where the forward propagation of an MCS is driven by thunderstorm outflow. It is argued that horizontal maps of IPI and EILS vectors will contribute significantly to short-term (e.g. 1-2 hr) predictions of the movement of MCSs, and to the subsequent assessment of their potential for flash flood production.

  5. Improving emergency department patient flow

    PubMed Central

    Jarvis, Paul Richard Edwin

    2016-01-01

    Emergency departments (ED) face significant challenges in delivering high quality and timely patient care on an ever-present background of increasing patient numbers and limited hospital resources. A mismatch between patient demand and the ED’s capacity to deliver care often leads to poor patient flow and departmental crowding. These are associated with reduction in the quality of the care delivered and poor patient outcomes. A literature review was performed to identify evidence-based strategies to reduce the amount of time patients spend in the ED in order to improve patient flow and reduce crowding in the ED. The use of doctor triage, rapid assessment, streaming and the co-location of a primary care clinician in the ED have all been shown to improve patient flow. In addition, when used effectively point of care testing has been shown to reduce patient time in the ED. Patient flow and departmental crowding can be improved by implementing new patterns of working and introducing new technologies such as point of care testing in the ED.

  6. What constitutes our understanding of a patient?

    PubMed

    Chessick, R D

    1993-01-01

    A number of approaches to the search for methodology in the human sciences are reviewed. Heidegger's use of Husserl's phenomenology led to his exploration of the background practices on which he believed all our understanding is based. This use of phenomenology was adopted by Sartre and R. D. Laing, and existential psychiatrists and psychoanalysts in their emphasis on the here-and-now encounter between the patient and the therapist, along with various embellishments and emendations on Heidegger's notion of what it meant to live authentically or inauthentically. Foucault maintained that there is a politics embedded in all the human sciences such as psychiatry and psychoanalysis, and this politics revolves around the use of power and its operations, including the actual use of the human sciences in the culture and what the different theories imply in the way of an ideology. Lacan emphasized this when he challenged the prevailing ideology of United States psychoanalysis, in which adaptation was seen as the crucial task of the ego. The existence of background practices and outer horizons required for any understanding in the human sciences leads to a situation that questions the use of empirical methods to establish what is accepted as "truth" in the human sciences. A predominant alternative, that of hermeneutics, has gained acceptance by eminent analysts such as Gill and certain interpersonal theorists. But the term hermeneutics is used in many ways by many authors and runs the danger of a relativism and a nihilism. This leads to a discussion of the value of various philosophical positions in throwing light on our search for a methodology in the human sciences. A review of arguments invoking the "end of philosophy" such as those of Rorty reveals that they are paradoxical and based on premises which in turn represent a philosophy. This debate remains unresolved. In general the postmodern view sees "truth" as more relative and emphasizes the role of social and cultural

  7. Patient Care Partnership: Understanding Expectations, Rights and Responsibilities

    MedlinePlus

    ` e Patient Care Partnership Understanding Expectations, Rights and Responsibilities What to expect during your hospital stay: • High ... e Patient Care Partnership Understanding Expectations, Rights and Responsibilities W hen you need hospital care, your doctor ...

  8. Improving Students' Understanding of Electricity and Magnetism

    ERIC Educational Resources Information Center

    Li, Jing

    2012-01-01

    Electricity and magnetism are important topics in physics. Research shows that students have many common difficulties in understanding concepts related to electricity and magnetism. However, research to improve students' understanding of electricity and magnetism is limited compared to introductory mechanics. This thesis explores issues…

  9. Orthogeriatric care: improving patient outcomes

    PubMed Central

    Tarazona-Santabalbina, Francisco José; Belenguer-Varea, Ángel; Rovira, Eduardo; Cuesta-Peredó, David

    2016-01-01

    Hip fractures are a very serious socio-economic problem in western countries. Since the 1950s, orthogeriatric units have introduced improvements in the care of geriatric patients admitted to hospital because of hip fractures. During this period, these units have reduced mean hospital stays, number of complications, and both in-hospital mortality and mortality over the middle term after hospital discharge, along with improvements in the quality of care and a reduction in costs. Likewise, a recent clinical trial has reported greater functional gains among the affected patients. Studies in this field have identified the prognostic factors present upon admission or manifesting themselves during admission and that increase the risk of patient mortality or disability. In addition, improved care afforded by orthogeriatric units has proved to reduce costs. Nevertheless, a number of management issues remain to be clarified, such as the optimum anesthetic, analgesic, and thromboprophylactic protocols; the type of diagnostic and therapeutic approach best suited to patients with cognitive problems; or the efficiency of the programs used in convalescence units or in home rehabilitation care. Randomized clinical trials are needed to consolidate the evidence in this regard. PMID:27445466

  10. How Well Do Patients Understand Written Instructions?

    PubMed Central

    Wong, Peter K.K.; Christie, Laura; Johnston, Jenny; Bowling, Alison; Freeman, Diane; Joshua, Fred; Bird, Paul; Chia, Karen; Bagga, Hanish

    2014-01-01

    Abstract The aim of this study was to assess health literacy (word recognition and comprehension) in patients at a rural rheumatology practice and to compare this to health literacy levels in patients from an urban rheumatology practice. Inclusion criteria for this cross-sectional study were as follows: ≥18-year-old patients at a rural rheumatology practice (Mid-North Coast Arthritis Clinic, Coffs Harbour, Australia) and an urban Sydney rheumatology practice (Combined Rheumatology Practice, Kogarah, Australia). Exclusion criteria were as follows: ill-health precluding participation; poor vision/hearing, non-English primary language. Word recognition was assessed using the Rapid Estimate of Adult Literacy in Medicine (REALM). Comprehension was assessed using the Test of Functional Health Literacy in Adults (TOFHLA). Practical comprehension and numeracy were assessed by asking patients to follow prescribing instructions for 5 common rheumatology medications. At the rural practice (Mid-North Coast Arthritis Clinic), 124/160 patients agreed to participate (F:M 83:41, mean age 60.3 ± 12.2) whereas the corresponding number at the urban practice (Combined Rheumatology Practice) was 99/119 (F:M 69:30, mean age 60.7 ± 17.5). Urban patients were more likely to be born overseas, speak another language at home, and be employed. There was no difference in REALM or TOFHLA scores between the 2 sites, and so data were pooled. REALM scores indicated 15% (33/223) of patients had a reading level ≤Grade 8 whereas 8% (18/223) had marginal or inadequate functional health literacy as assessed by the TOFHLA. Dosing instructions for ibuprofen and methotrexate were incorrectly understood by 32% (72/223) and 21% (46/223) of patients, respectively. Up to 15% of rural and urban patients had low health literacy and <1/3 of patients incorrectly followed dosing instructions for common rheumatology drugs. There was no significant difference in word recognition, functional health

  11. Understanding Dying Patients and Their Families

    PubMed Central

    Librach, S.L.; Talbot, Yves

    1991-01-01

    Caring for dying patients and their families presents unique opportunities and challenges for the family physician. The family FIRO model provides a simple way of assessing families and providing appropriate, individualized care. This article outlines the model, discusses the care of dying patients and their families from the FIRO perspective, and provides a guideline for the family physician. A framework is suggested for teaching residents to support families. PMID:21228989

  12. Improving Patient's Primary Medication Adherence

    PubMed Central

    Leguelinel-Blache, Géraldine; Dubois, Florent; Bouvet, Sophie; Roux-Marson, Clarisse; Arnaud, Fabrice; Castelli, Christel; Ray, Valérie; Kinowski, Jean-Marie; Sotto, Albert

    2015-01-01

    Abstract Quality of transitions of care is one of the first concerns in patient safety. Redesigning the discharge process to incorporate clinical pharmacy activities could reduce the incidence of postdischarge adverse events by improving medication adherence. The present study investigated the value of pharmacist counseling sessions on primary medication adherence after hospital discharge. This study was conducted in a 1844-bed hospital in France. It was divided in an observational period and an interventional period of 3 months each. In both periods, ward-based clinical pharmacists performed medication reconciliation and inpatient follow-up. In interventional period, initial counseling and discharge counseling sessions were added to pharmaceutical care. The primary medication adherence was assessed by calling community pharmacists 7 days after patient discharge. We compared the measure of adherence between the patients from the observational period (n = 201) and the interventional period (n = 193). The rate of patients who were adherent increased from 51.0% to 66.7% between both periods (P < 0.01). When discharge counseling was performed (n = 78), this rate rose to 79.7% (P < 0.001). The multivariate regression performed on data from both periods showed that age of at least 78 years old, and 3 or less new medications on discharge order were predictive factors of adherence. New medications ordered at discharge represented 42.0% (n = 1018/2426) of all medications on discharge order. The rate of unfilled new medications decreased from 50.2% in the observational period to 32.5% in the interventional period (P < 10−7). However, patients included in the observational period were not significantly more often readmitted or visited the emergency department than the patients who experienced discharge counseling during the interventional period (45.3% vs. 46.2%; P = 0.89). This study highlights that discharge counseling sessions are

  13. Labelling improves false belief understanding. A training study.

    PubMed

    Sellabona, Elisabet Serrat; Sánchez, Carles Rostan; Majoral, Eduard Vallès; Guitart, Moisès Esteban; Caballero, Francesc Sidera; Ortiz, Jèssica Serrano

    2013-01-01

    A total of 104 children aged between 41 and 47 months were selected to study the relationship between language and false belief understanding. Participants were assigned to four different training conditions: discourse, labelling, control (all with deceptive objects), and sentential complements (involving non-deceptive objects). Post-test results showed an improvement in children's false belief understanding in the discourse and the labelling conditions, but not in the sentential complements with non-deceptive objects or the control group. Furthermore, the most remarkable improvement in false belief understanding occurred in the labelling group. These results suggest that some types of linguistic experience promote the development of false belief understanding, provided that differing perspectives are confronted. PMID:23866253

  14. Understanding Fertility in Young Female Cancer Patients

    PubMed Central

    Waimey, Kate E.; Smith, Brigid M.; Confino, Rafael; Jeruss, Jacqueline S.

    2015-01-01

    Abstract Young women diagnosed with cancer today have a greater chance of long-term survival than ever before. Successful survivorship for this group of patients includes maintaining a high quality of life after a cancer diagnosis and treatment; however, lifesaving treatments such as chemotherapy, radiation, and surgery can impact survivors by impairing reproductive and endocrine health. Studies demonstrate that future fertility is a concern for many women diagnosed with cancer, but physician knowledge and attitudinal barriers can still prevent females from receiving care. Today, fertility preservation is an option for girls and women facing a cancer diagnosis, and emerging research is providing clinicians with an increasing number of reproductive and hormonal management tools. Physicians can play an important role in fertility by working closely with oncologists, providing patients with information about fertility preservation options prior to the start of cancer treatment, monitoring reproductive capacity after treatment, and working with cancer survivors to explore potential avenues to parenthood. PMID:26075731

  15. Understanding Patient Portal Use: Implications for Medication Management

    PubMed Central

    Mayberry, Lindsay Satterwhite; Wallston, Kenneth A; Johnson, Kevin B; Elasy, Tom A

    2013-01-01

    Background The Internet can be leveraged to provide disease management support, including medication adherence promotion that, when tailored, can effectively improve adherence to medications. The growing adoption of patient portals represents an opportunity to support medication management and adherence more broadly, but virtually no data exist about the real and potential impact of existing portals on these outcomes. Objective We sought to (1) understand who uses an existing patient portal and reasons for use and nonuse, (2) understand how portal users are using a portal to manage their medications, and (3) explore participants’ ideas for improving portal functionality for medication management and adherence support. Methods A total of 75 adults with type 2 diabetes participated in a mixed-methods study involving focus groups, a survey, and a medical chart review. We used quantitative data to identify differences between portal users and nonusers, and to test the relationship between the frequency of portal use and glycemic control among users. We used qualitative methods to understand how and why participants use a portal and their ideas for improving its medication management functionality. Results Of the enrolled participants, 81% (61/75) attended a focus group and/or completed a survey; portal users were more likely than nonusers to participate in that capacity (Fisher exact test; P=.01). Users were also more likely than nonusers to be Caucasian/white (Fisher exact test; P<.001), have higher incomes (Fisher exact test; P=.005), and be privately insured (Fisher exact test; P<.001). Users also tended to have more education than nonusers (Mann–Whitney U; P=.05), although this relationship was not significant at P<.05. Among users, more frequent use of a portal was associated with better A1C (Spearman rho =–0.30; P=.02). Reasons for nonuse included not knowing about the portal (n=3), not having access to a computer (n=3), or having a family member serve as

  16. Understanding the Change Styles of Teachers to Improve Student Achievement

    ERIC Educational Resources Information Center

    Bigby, Arlene May Green

    2009-01-01

    The topic of this dissertation is the understanding of teacher change styles to improve student achievement. Teachers from public schools in a state located in the northern plains were surveyed regarding their Change Styles (preferred approaches to change) and flexibility scores. The results were statistically analyzed to determine if there were…

  17. Can we improve patient safety?

    PubMed

    Corbally, Martin Thomas

    2014-01-01

    Despite greater awareness of patient safety issues especially in the operating room and the widespread implementation of surgical time out World Health Organization (WHO), errors, especially wrong site surgery, continue. Most such errors are due to lapses in communication where decision makers fail to consult or confirm operative findings but worryingly where parental concerns over the planned procedure are ignored or not followed through. The WHO Surgical Pause/Time Out aims to capture these errors and prevent them, but the combination of human error and complex hospital environments can overwhelm even robust safety structures and simple common sense. Parents are the ultimate repository of information on their child's condition and planned surgery but are traditionally excluded from the process of Surgical Pause and Time Out, perhaps to avoid additional stress. In addition, surgeons, like pilots, are subject to the phenomenon of "plan-continue-fail" with potentially disastrous outcomes. If we wish to improve patient safety during surgery and avoid wrong site errors then we must include parents in the Surgical Pause/Time Out. A recent pilot study has shown that neither staff nor parents found it added to their stress, but, moreover, 100% of parents considered that it should be a mandatory component of the Surgical Pause nor does it add to the stress of surgery. Surgeons should be required to confirm that the planned procedure is in keeping with the operative findings especially in extirpative surgery and this "step back" should be incorporated into the standard Surgical Pause. It is clear that we must improve patient safety further and these simple measures should add to that potential. PMID:25279366

  18. Understanding cognition in older patients with cancer

    PubMed Central

    Karuturi, Meghan; Wong, Melisa L.; Hsu, Tina; Kimmick, Gretchen G.; Lichtman, Stuart M.; Holmes, Holly M.; Inouye, Sharon K.; Dale, William; Loh, Kah P.; Whitehead, Mary I.; Magnuson, Allison; Hurria, Arti; Janelsins, Michelle C.; Mohile, Supriya

    2016-01-01

    Cancer and neurocognitive disorders, such as dementia and delirium, are common and serious diseases in the elderly that are accompanied by high degree of morbidity and mortality. Furthermore, evidence supports the under-diagnosis of both dementia and delirium in older adults. Complex questions exist regarding the interaction of dementia and delirium with cancer, beginning with guidelines on how best measure disease severity, the optimal screening test for either disorder, the appropriate level of intervention in the setting of abnormal findings, and strategies aimed at preventing the development or progression of either process. Ethical concerns emerge in the research setting, pertaining to the detection of cognitive dysfunction in participants, validity of consent, disclosure of abnormal results if screening is pursued, and recommended level of intervention by investigators. Furthermore, understanding the ways in which comorbid cognitive dysfunction and cancer impact both cancer and non-cancer-related outcomes is essential in guiding treatment decisions. In the following article, we will discuss what is presently known of the interactions of pre-existing cognitive impairment and delirium with cancer. We will also discuss identified deficits in our knowledge base, and propose ways in which innovative research may address these gaps. PMID:27282296

  19. Patient and parent understanding of informed consent in orthodontics.

    PubMed

    Mortensen, Micah G; Kiyak, H Asuman; Omnell, Lena

    2003-11-01

    In both medical and dental settings, researchers have found that patients do not adequately comprehend the information given during informed consent discussions, especially the less educated, low-income patients. Because of the importance of patient compliance with orthodontic treatment regimens, this study examined patient and parent understanding of the child's Phase I orthodontic treatment in a public dental clinic with ethnically diverse, low-income patients. Interviews were conducted with 29 children (ages 6-12) and their parents or guardians at the orthodontic case presentation appointment. The orthodontist explained the reasons for treatment, the orthodontic procedures to be used, the risks, the alternatives, and patient and parent responsibilities during treatment; the session was audiotaped. Interviews were conducted immediately after this discussion and the results compared with the orthodontists' presentations. In general, both children and parents recalled significantly fewer reasons for treatment (1.10, 1.66, and 2.34 items, respectively), procedures (1.55, 1.59, and 2.45, respectively), risks associated with treatment (0.66, 1.48, and 4.66, respectively), and responsibilities of the child during treatment (2.21, 2.07, and 3.38, respectively) than what the orthodontist had told them. They were also less likely to recall the reasons, procedures, and risks that were most frequently cited by the orthodontist. These findings raise concerns about the effectiveness of current informed consent techniques with public health populations, especially the low recall rates within 30 minutes of the case presentations. Low recall of risks by children and their parents, particularly for critical risks such as relapse, caries, and periodontal problems, raises concerns about treatment compliance, success, and more importantly, the effectiveness of the informed consent process itself. Future research should focus on methods to improve the informed consent process among

  20. Understanding minority patients' beliefs about hypertension to reduce gaps in communication between patients and clinicians.

    PubMed

    Kronish, Ian M; Leventhal, Howard; Horowitz, Carol R

    2012-01-01

    The authors' objective was to gain a better understanding of minority patients' beliefs about hypertension and to use this understanding to develop a model to explain gaps in communication between patients and clinicians. Eighty-eight hypertensive black and Latino adults from 4 inner-city primary care clinics participated in focus groups to elucidate views on hypertension. Participants believed that hypertension was a serious illness in need of treatment. Participants' diverged from the medical model in their beliefs about the time-course of hypertension (believed hypertension was intermittent); causes of hypertension (believed stress, racism, pollution, and poverty were the important causes); symptoms of hypertension (believed hypertension was primarily present when symptomatic); and treatments for hypertension (preferred alternative treatments that reduced stress over prescription medications). Participants distrusted clinicians who prioritized medications that did not directly address their understanding of the causes or symptoms of hypertension. Patients' models of understanding chronic asymptomatic illnesses such as hypertension challenge the legitimacy of lifelong, pill-centered treatment. Listening to patients' beliefs about hypertension may increase trust, improve communication, and encourage better self-management of hypertension.

  1. Examining patient comprehension of emergency department discharge instructions: Who says they understand when they do not?

    PubMed

    Lin, Margaret Jane; Tirosh, Adva Gutman; Landry, Alden

    2015-12-01

    Patient comprehension of emergency department (ED) discharge instructions is important for ensuring that patients understand their diagnosis, recommendations for treatment, appropriate follow-up, and reasons to return. However, many patients may not fully understand their instructions. Furthermore, some patients may state they understand their instructions even when they do not. We surveyed 75 patients on their perception of their understanding of their ED discharge instructions, and asked them specific questions about the instructions. We also performed a chart review, and examined patients' answers for correlation with the written instructions and medical chart. We then performed a statistical analysis evaluating which patients claimed understanding but who were found to have poor understanding on chart review. Overall, there was no significant correlation between patient self-reported understanding and physician evaluation of their understanding (ρ = 0.221, p = 0.08). However, among female patients and patients with less than 4 years of college, there was significant positive correlation between self-report and physician evaluation of comprehension (ρ = 0.326, p = 0.04 and ρ = 0.344, p = 0.04, respectively), whereas there was no correlation for male patients and those with more than 16 years of education (ρ = 0.008, p = 0.9, ρ = -0.041, p = 0.84, respectively). Patients' perception of their understanding may not be accurate, especially among men, and those with greater than college education. Identifying which patients say they understand their discharge instructions, but may actually have poor comprehension could help focus future interventions on improving comprehension.

  2. Investigators Share Improved Understanding of the North American Carbon Cycle

    SciTech Connect

    Birdsey, Richard A.; Cook, Robert B; Denning, Scott; Griffith, Peter; Law, Beverly E.; Masek, Jeffrey; Michalak, Anna; Ogle, Stephen; Ojima, Dennis; Pan, Yude; Sabine, Christopher; Sheffner, Edwin; Sundquist, Eric

    2007-06-01

    U.S. North American Carbon Program Investigators Meeting, Colorado Springs, Colorado, 22-25 January 2007. The U.S. North American Carbon Program (NACP) sponsored an "all-scientist" meeting to review progress in understanding the dynamics of the carbon cycle of North America and adjacent oceans, and to chart a course for improved integration across scientific disciplines, scales, and Earth system boundaries. The meeting participants also addressed the need for better decision support tools for managing the carbon cycle of North America, so that strong science can inform policy as interest in taking action increases across the nation.

  3. TRACE program: improving patient safety.

    PubMed

    Rinehart, Brenda

    2011-01-01

    The Tools for Radiation Awareness and Community Education (TRACE) program was designed as a two phase approach to radiation dose awareness and overall patient dose reduction achieved through patient and community education, physician awareness, staff training, and technological enhancements. It was made possible by the AHRA and Toshiba Putting Patients First grant program. Phase one of the program began by engaging radiation safety committee and management to address new radiation safety policy and procedures followed by patient and community education. Next, fluoroscopy dose reduction was addressed through physician awareness and dose notification. The final step was CT dose reduction through protocol changes. Phase two will contain three components: The implementation of software that will assist in recording and reporting dose; patient and referring physician notification for radiation dose >3 Gy; and CT dose reduction through technology and additional changes to protocols.

  4. Listening to native patients. Changes in physicians' understanding and behaviour.

    PubMed Central

    Kelly, Len; Brown, Judith Belle

    2002-01-01

    OBJECTIVE: To discover how physicians develop an understanding of Native patients and communities that enables them to communicate better with these patients. DESIGN: Qualitative method of in-depth interviews. SETTING: Native communities across Canada. PARTICIPANTS: Ten non-Native physicians providing primary care to Native patients and communities. METHOD: In-depth, semistructured interviews explored communication strategies developed by primary care physicians working with Native patients. The audiotaped and transcribed interviews were analyzed by the investigators using the phenomenologic approach of immersion and crystallization. MAIN FINDINGS: Three main themes emerged. First was elements of communication: during patient-physician communication, physicians speak less, take more time with patients, and become comfortable with silence. Second was community context: patients' illnesses are not distinct from their community context; patient care and community relations, culture, and values are often inseparable. Third was the process of change in physicians: over time, participants increased understanding of Native culture, ways of communicating, and behaviour. Change comes about through long service, listening well, and participating in community events. CONCLUSION: Developing cross-cultural communication was difficult and took years, if not forever. Understanding Native communities changed physicians. They described a journey of self-examination, development of personal relationships, and rewards and frustrations. PMID:12449549

  5. Improvements in Professional Development Program Participants' Understandings about Inclusive Teaching

    NASA Astrophysics Data System (ADS)

    Metevier, A. J.; Hunter, L.; Goza, B. K.; Raschke, L. M.; Seagroves, S.

    2010-12-01

    A major emphasis of the Center for Adaptive Optics Professional Development Program (PDP) is training early-career scientists and engineers to teach more inclusively as well as more effectively. To this end, the PDP includes workshops on diversity and equity, and PDP participants are explicitly encouraged to weave inclusive instructional strategies into the inquiry laboratory activities they design and teach. In an initial effort to gauge the effectiveness of the PDP's diversity and equity training, we have analyzed 2008 and 2009 PDP participants' responses to a survey knowledge question that asks them to briefly describe how they would engage a diverse undergraduate student population through their teaching and research. Each participant answered the survey question before any PDP training, as well as after a series of intensive PDP workshops. We developed a rubric to score and analyze participants' pre- and post-workshop responses, and have found that their response scores improve significantly after PDP training. This indicates that PDP training does improve participants' understandings about how to teach inclusively. Furthermore, survey respondents who participated in the PDP in both 2008 and 2009 showed little decrease in response scores between years, but continued increases with continued training. In this paper, we detail our rubric development, survey response scoring, analysis, and results, as well as the implications our results have had for refining our goals for PDP participants and for further improving PDP workshops.

  6. Patients' understanding of medical terminology used in the breast clinic.

    PubMed

    O'Connell, R L; Hartridge-Lambert, S K; Din, N; St John, E R; Hitchins, C; Johnson, T

    2013-10-01

    This study evaluated patients' understanding of common terms used by breast surgeons in order to identify words which may need to be defined and explained during a clinic consultation. 95 patients completed the survey. 87% defined 'Surgeon' correctly whereas 'Radiographer' and 'Radiologist' were correctly defined by only 19% and 28% respectively. 26% correctly defined 'Pathologist' and 43% 'Oncologist'. Two-thirds of patients correctly defined 'Benign' (66%) and 'Malignant' (65%). 'Mammogram' and 'Ultrasound' were correctly defined by 39% and 8% respectively. 21% of patients correctly defined 'Multi-Disciplinary Team Meeting'. 1 in 5 patients correctly defined 'Chemotherapy' (20%) and 'Radiotherapy' (19%). This study has identified that many of the medical terms used in a consultation are not understood by patients. Education must be incorporated as a routine part of the consultation to enhance the patient experience and ensure they can actively participate in making informed decisions about their care. PMID:23523178

  7. Developing Improved MD Codes for Understanding Processive Cellulases

    SciTech Connect

    Crowley, M. F.; Uberbacher, E. C.; Brooks III, C. L.; Walker, R.C.; Nimlos, M. R.; Himmel, M. E.

    2008-01-01

    The mechanism of action of cellulose-degrading enzymes is illuminated through a multidisciplinary collaboration that uses molecular dynamics (MD) simulations and expands the capabilities of MD codes to allow simulations of enzymes and substrates on petascale computational facilities. There is a class of glycoside hydrolase enzymes called cellulases that are thought to decrystallize and processively depolymerize cellulose using biochemical processes that are largely not understood. Understanding the mechanisms involved and improving the efficiency of this hydrolysis process through computational models and protein engineering presents a compelling grand challenge. A detailed understanding of cellulose structure, dynamics and enzyme function at the molecular level is required to direct protein engineers to the right modifications or to understand if natural thermodynamic or kinetic limits are in play. Much can be learned about processivity by conducting carefully designed molecular dynamics (MD) simulations of the binding and catalytic domains of cellulases with various substrate configurations, solvation models and thermodynamic protocols. Most of these numerical experiments, however, will require significant modification of existing code and algorithms in order to efficiently use current (terascale) and future (petascale) hardware to the degree of parallelism necessary to simulate a system of the size proposed here. This work will develop MD codes that can efficiently use terascale and petascale systems, not just for simple classical MD simulations, but also for more advanced methods, including umbrella sampling with complex restraints and reaction coordinates, transition path sampling, steered molecular dynamics, and quantum mechanical/molecular mechanical simulations of systems the size of cellulose degrading enzymes acting on cellulose.

  8. How community ecology can improve our understanding of cholera dynamics

    PubMed Central

    Constantin de Magny, Guillaume; Hasan, Nur A.; Roche, Benjamin

    2013-01-01

    Understanding the seasonal emergence and reemergence of cholera is challenging due to the complex dynamics of different protagonists. The abundance of Vibrio cholerae, the causative agent of cholera and a natural inhabitant of aquatic environments, fluctuates according to abiotic, and biotic factors. Among the biotic factors, the zooplankton community dynamics has been suggested to play a pivotal role in the survival, persistence, and natural competence of V. cholerae. However, factors regulating V. cholerae population structure and seasonal dynamics are still not fully understood. Investigation of the temporal shifts and variability in aquatic community composition in relation to the occurrence or abundance of V. cholerae appears very promising yet remained underexplored. Recent advances in metagenomics, facilitated by high-throughput ultra deep sequencing, have greatly improved our ability for a broader and deeper exploration of microbial communities including an understanding of community structure, function, as well as inter- and intra-specific competitions. Here, we discuss possible areas of research focusing how combination of community ecology and metagenomic approaches could be applied to study the cholera system. PMID:24765090

  9. Improvements to our Understanding of Toronto-Area Atmospheric Composition

    NASA Astrophysics Data System (ADS)

    Whaley, Cynthia

    Using eleven years of trace gas column measurements at the University of Toronto Atmospheric Observatory (TAO), along with data from complementary sources, such as satellites, surface in situ measurements, and nearby rural column measurements, this thesis aims to improve our understanding of the sources of air pollution and the causes of variability in atmospheric composition over the Toronto area. The relative influence of chemical production and direct emissions on Toronto-area O3 and CO were determined using GEOS-Chem model simulations. 28 pollution events (defined as enhanced O3 or CO lower-tropospheric (0-5 km) columns that coincided with surface O3 exceedances) were found in the TAO dataset between 2002 and 2010. O3 columns over Toronto during pollution events are influenced by urban and industrial anthropogenic NOx emissions, biogenic isoprene emissions from the eastern United States, and soil NOx emissions from the mid- and western United States. During pollution events, Toronto CO columns are greatly influenced by nearby fossil fuel emissions and isoprene oxidation. C2H6 columns are often enhanced during pollution events, as the sources of C2H6 are similar to those of O3 and CO. HCN columns are assumed to be enhanced in biomass burning plumes, and thus, aid in identifying transport of biomass burning emissions over Toronto. Sensitivity to meteorological conditions was examined as well, and five case studies were presented in detail. Passage of the polar vortex over the Toronto area was determined by increases in scaled potential vorticity (PV) that coincide with outliers in the HF stratospheric time series. Confirmed with polar PV maps and reductions in N2O stratospheric columns, 53 polar intrusion events were identified in the 2002 to 2013 TAO time series. The effect on HF, HCl, O3, and N 2O was studied, and we found these events caused a significant increase in HF-column winter/spring variability, and a small increase (on average) in stratospheric O3

  10. Understanding of evolution may be improved by thinking about people.

    PubMed

    Nettle, Daniel

    2010-05-20

    The theory of evolution is poorly understood in the population at large, even by those with some science education. The recurrent misunderstandings can be partly attributed to failure to distinguish between processes which individual organisms undergo and those which populations undergo. They may be so pervasive because we usually explain evolutionary ideas with examples from non-human animals, and our everyday cognition about animals does not track individuals as distinct from the species to which they belong. By contrast, everyday cognition about other people tracks unique individuals as well as general properties of humans. In Study 1, I present experimental evidence that categorization by species occurs more strongly for non-human animals than for other people in 50 British university students. In Study 2, I show, in the same population, that framing evolutionary scenarios in terms of people produces fewer conceptual errors than when logically identical scenarios are framed terms of non-human animals. I conclude that public understanding of evolution might be improved if we began instruction by considering the organisms which are most familiar to us.

  11. Understanding of carbonate fuel cell resistance issues for performance improvement

    SciTech Connect

    Yuh, C.Y.; Farooque, M.; Johnsen, R.

    1992-09-01

    The overall objective of the current Task 6 under Contract AC21-90MC27168 is to develop understanding as well as quantification of cell ohmic resistance in carbonate fuel cell. The important resistance-contributing interfaces and elements are being investigated in high-temperature out-of-cell resistance experiments, using an AC-impedance technique. Ohmic resistance loss in a state-of-the-art carbonate fuel cell contributes about 65 mV loss at BOL (beginning-of-life). It may increase to about as much as 145 mV after 40,000 hours. Its reduction will offer further improvement in fuel cell power plant efficiency. The important resistance contributing elements/interfaces are illustrated in Figure 1. The majority of the ohmic loss attributed to electrolyte matrix (ionic) and cathode-side hardware (electronic). The ohmic loss due to anode-side hardware can generally be neglected because the anode-side hardware is surface protected resulting in very little surface oxide formation. The ohmic resistance of the electrodes is also negligible. The matrix ionic resistance is influenced by many factors: electrolyte conductivity, matrix porosity, tortuosity, electrolyte fill level and matrix thickness. At present, matrix contributes to > 300 m{Omega}cm{sup 2} (>70% of the total cell ohmic resistance) and is the major resistance contributor.

  12. Understanding of carbonate fuel cell resistance issues for performance improvement

    SciTech Connect

    Yuh, C.Y.; Farooque, M.; Johnsen, R.

    1992-01-01

    The overall objective of the current Task 6 under Contract AC21-90MC27168 is to develop understanding as well as quantification of cell ohmic resistance in carbonate fuel cell. The important resistance-contributing interfaces and elements are being investigated in high-temperature out-of-cell resistance experiments, using an AC-impedance technique. Ohmic resistance loss in a state-of-the-art carbonate fuel cell contributes about 65 mV loss at BOL (beginning-of-life). It may increase to about as much as 145 mV after 40,000 hours. Its reduction will offer further improvement in fuel cell power plant efficiency. The important resistance contributing elements/interfaces are illustrated in Figure 1. The majority of the ohmic loss attributed to electrolyte matrix (ionic) and cathode-side hardware (electronic). The ohmic loss due to anode-side hardware can generally be neglected because the anode-side hardware is surface protected resulting in very little surface oxide formation. The ohmic resistance of the electrodes is also negligible. The matrix ionic resistance is influenced by many factors: electrolyte conductivity, matrix porosity, tortuosity, electrolyte fill level and matrix thickness. At present, matrix contributes to > 300 m{Omega}cm{sup 2} (>70% of the total cell ohmic resistance) and is the major resistance contributor.

  13. Toward an Improved Understanding of the Global Fresh Water Budget

    NASA Technical Reports Server (NTRS)

    Hildebrand, Peter H.

    2005-01-01

    priorities for future improvements in global fresh water budget monitoring. The priorities are based on the potential of new approaches to provide improved measurement and modeling systems, and on the need to measure and understand the potential for a speed-up of the global water cycle under the effects of climate change.

  14. Improving assessment with virtual patients.

    PubMed

    Round, Jonathan; Conradi, Emily; Poulton, Terry

    2009-08-01

    Assessments should accurately predict future performance in a wide variety of settings yet be feasible to conduct. In medical education a robust and comprehensive system of assessment is essential to protect the public from inadequate professionals. The parameters for devising such an assessment are well-defined, and good practice for writing examinations well-established. However even excellent written assessments are limited in their predictive validity, and limited in sampling, face and construct validity. The increasing availability and power of computing has led to growing interest in computer simulations for use in examinations, creating assessment virtual patients (AVPs). They can potentially test knowledge and data interpretation, incorporate images, sound or video and test decision making. Such AVPs could represent the most comprehensive, integrated assessment possible that is both objective and feasible. This article focuses on AVP design, distinguishing between linear and branched models, choice and consequence driven designs. It reviews the use of AVPs in the context of assessment theory. It presents different AVP designs discussing their benefits and problems. AVPs can become valuable components in high stakes medical exams, particularly in later years of courses. However this requires application of established assessment principles to AVP design. PMID:19811215

  15. Understanding and Improving High Voltage Vacuum Insulators for Microsecond Pulses

    SciTech Connect

    Javedani, J B; Goerz, D A; Houck, T L; Lauer, E J; Speer, R D; Tully, L K; Vogtlin, G E; White, A D

    2007-03-05

    High voltage insulation is one of the main areas of pulsed power research and development, and dielectric breakdown is usually the limiting factor in attaining the highest possible performance in pulsed power devices. For many applications the delivery of pulsed power into a vacuum region is the most critical aspect of operation. The surface of an insulator exposed to vacuum can fail electrically at an applied field more than an order or magnitude below the bulk dielectric strength of the insulator. This mode of breakdown, called surface flashover, imposes serious limitations on the power flow into a vacuum region. This is especially troublesome for applications where high voltage conditioning of the insulator and electrodes is not practical and for applications where relatively long pulses, on the order of several microseconds, are required. The goal of this project is to establish a sound fundamental understanding of the mechanisms that lead to surface flashover, and then evaluate the most promising techniques to improve vacuum insulators and enable high voltage operation at stress levels near the intrinsic bulk breakdown limits of the material. The approach we proposed and followed was to develop this understanding through a combination of theoretical and computation methods coupled with experiments to validate and quantify expected behaviors. In this report we summarize our modeling and simulation efforts, theoretical studies, and experimental investigations. The computational work began by exploring the limits of commercially available codes and demonstrating methods to examine field enhancements and defect mechanisms at microscopic levels. Plasma simulations with particle codes used in conjunction with circuit models of the experimental apparatus enabled comparisons with experimental measurements. The large scale plasma (LSP) particle-in-cell (PIC) code was run on multiprocessor platforms and used to simulate expanding plasma conditions in vacuum gap regions

  16. Patients' understanding of shared decision making in a mental health setting.

    PubMed

    Eliacin, Johanne; Salyers, Michelle P; Kukla, Marina; Matthias, Marianne S

    2015-05-01

    Shared decision making is a fundamental component of patient-centered care and has been linked to positive health outcomes. Increasingly, researchers are turning their attention to shared decision making in mental health; however, few studies have explored decision making in these settings from patients' perspectives. We examined patients' accounts and understanding of shared decision making. We analyzed interviews from 54 veterans receiving outpatient mental health care at a Department of Veterans Affairs Medical Center in the United States. Although patients' understanding of shared decision making was consistent with accounts published in the literature, participants reported that shared decision making goes well beyond these components. They identified the patient-provider relationship as the bedrock of shared decision making and highlighted several factors that interfere with shared decision making. Our findings highlight the importance of the patient-provider relationship as a fundamental element of shared decision making and point to areas for potential improvement.

  17. Performance improvement with patient service partners.

    PubMed

    Burns, J P

    1998-01-01

    Once the decision is made to use a patient-focused care delivery system, a variety of methods can be used to successfully design the model. The author describes the process used by a multilevel, multidisciplinary team at a community hospital to design and implement a Service Partner role that would meet and exceed customer expectations. Demonstrated performance improvements included increased patient satisfaction, productive labor dollar savings, and improvements in the work environment for staff members. PMID:9451381

  18. Prenatal Training Improves New Mothers’ Understanding of Jaundice

    PubMed Central

    Zhang, Ling; Hu, Peng; Wang, Jian; Zhang, Min; Zhang, Qing Ling; Hu, Bo

    2015-01-01

    Background Mothers’ knowledge of neonatal jaundice (NNJ) is grossly deficient or inaccurate, which may adversely affect the actions of mothers in the recognition of NNJ and cause a delay in seeking medical attention. Material/Methods A total of 1036 primiparas were separated randomly into the intervention group and the control group, with 518 primiparas in each group. Results All (100%) mothers in the intervention group understood that NNJ is a yellow discoloration of the skin and sclera; 94.19% of them considered that NNJ is a common problem in newborns; 82.80% and 95.27% replied that jaundice appearing within the first 36 hours and lasting more than 2 weeks usually indicates pathological NNJ; 96.34%, 80.86%, and 90.32% realized that premature newborns, low birth weight, and perinatal asphyxia, respectively, are more likely to be accompanied by NNJ; 97.41%, 78.71%, and 64.95% knew that maternal-fetal blood group incompatibility, infection, and glucose-6-phosphate dehydrogenase deficiency, respectively, are the common inducements to NNJ; 94.84% could associate NNJ with brain damage; 92.26%, 93.12%, and 74.62% agreed that phototherapy, strengthen feeding, and exchange blood transfusion, respectively, can greatly relieve NNJ. However, some respondents in the control group responded in other ways, such as stopping breastfeeding (9.19%), placing newborns in sunlight (10.24%) and traditional Chinese medicine (10.24%), which was significantly higher than that of the intervention group. There was also a significant delay for respondents in the control group in consulting a pediatrician, and 6.30% of them did not seek medical help until after the interview. Conclusions Prenatal training could significantly improve new mothers’ understanding of NNJ. PMID:26056164

  19. Understanding quality improvement at scale in general practice: a qualitative evaluation of a COPD improvement programme

    PubMed Central

    Marshall, Martin; Mountford, James; Gamet, Kirsten; Gungor, Gulsen; Burke, Conor; Hudson, Robyn; Morris, Steve; Patel, Nishma; Koczan, Phil; Meaker, Rob; Chantler, Cyril; Roberts, Christopher Michael

    2014-01-01

    Background A growing body of knowledge exists to guide efforts to improve the organisation and delivery of health care, most of which is based on work carried out in hospitals. It is uncertain how transferable this knowledge is to primary care. Aim To understand the enablers and constraints to implementing a large-scale quality improvement programme in general practice, designed to improve care for people with chronic obstructive pulmonary disease. Design and setting A qualitative study of 189 general practices in a socioeconomically and ethnically-mixed, urban area in east London, UK. Method Twelve semi-structured interviews were conducted with people leading the programme and 17 in-depth interviews with those participating in it. Participants were local health system leaders, clinicians, and managers. A theoretical framework derived from evidence-based guidance for improvement programmes was used to interpret the findings. A complex improvement intervention took place with social and technical elements including training and mentorship, guidance, analytical tools, and data feedback. Results Practice staff wanted to participate in and learn from well-designed collaborative improvement projects. Nevertheless, there were limitations in the capacities and capabilities of the workforce to undertake systematic improvement, significant problems with access to and the quality of data, and tensions between the narrative-based generalist orientation of many primary care clinicians and the quantitative single-disease orientation that has characterised much of the quality improvement movement to date. Conclusion Improvement guidance derived largely from hospital-based studies is, for the most part, applicable to improvement efforts in primary care settings, although large-scale change in general practice presents some particular challenges. These need to be better understood and addressed if improvement initiatives are to be effective. PMID:25452538

  20. Improving Patient Satisfaction with Waiting Time

    ERIC Educational Resources Information Center

    Eilers, Gayleen M.

    2004-01-01

    Waiting times are a significant component of patient satisfaction. A patient satisfaction survey performed in the author's health center showed that students rated waiting time lowest of the listed categories--A ratings of 58% overall, 63% for scheduled appointments, and 41% for the walk-in clinic. The center used a quality improvement process and…

  1. Communicating with Parents: Understanding the Process, Improving Your Skills

    ERIC Educational Resources Information Center

    American Federation of Teachers (NJ), 2007

    2007-01-01

    Communication is the exchange of information, ideas and/or feelings from one person to another. The goal of communication is understanding. Without understanding, there is no communication. The communication process consists of verbal and nonverbal communication and listening. The spoken word is self-explanatory. Communication problems between…

  2. Osteoporosis pharmacotherapy following bone densitometry: importance of patient beliefs and understanding of DXA results

    PubMed Central

    Cadarette, S. M.; Eskildsen, P.; Abrahamsen, B.

    2016-01-01

    Summary Persistence with osteoporosis therapy remains low and identification of factors associated with better persistence is essential in preventing osteoporosis and fractures. In this study, patient understanding of dual energy X-ray absorptiometry (DXA) results and beliefs in effects of treatment were associated with treatment initiation and persistence. Introduction The purpose of this study is to examine patient understanding of their DXA results and evaluate factors associated with initiation of and persistence with prescribed medication in first-time users of anti-osteoporotic agents. Self-reported DXA results reflect patient understanding of diagnosis and may influence acceptance of osteoporosis therapy. To improve patient understanding of DXA results, we provided written information to patients and their referring general practitioner (GP), and evaluated factors associated with osteoporosis treatment initiation and 1-year persistence. Methods Information on diagnosis was mailed to 1,000 consecutive patients and their GPs after DXA testing. One year after, a questionnaire was mailed to all patients to evaluate self-report of DXA results, drug initiation and 1-year persistence. Quadratic weighted kappa was used to estimate agreement between self-report and actual DXA results. Multivariable logistic regression was used to evaluate predictors of understanding of diagnosis, and correlates of treatment initiation and persistence. Results A total of 717 patients responded (72%). Overall, only 4% were unaware of DXA results. Agreement between self-reported and actual DXA results was very good (κ=0.83); younger age and glucocorticoid use were associated with better understanding. Correctly reported DXA results was associated with treatment initiation (OR 4.3, 95% CI 1.2–15.1, p=0.02), and greater beliefs in drug treatment benefits were associated with treatment initiation (OR 1.4, 95%CI 1.1–1.9, p=0.006) and persistence with therapy (OR 1.8, 95% CI 1.2–2

  3. Sound source information to improve cardiothoracic patients' comfort.

    PubMed

    Mackrill, Jamie; Cain, Rebecca; Jennings, Paul; England, Michelle

    Hospital sound has been well documented through acoustic measurement and the classification of its adverse effects on patients and nurses. However, little consideration has been given to how the perception of these unavoidable soundscapes can be improved. For instance, does a better understanding of the variety of sounds improve patients' feeling? This paper begins to answer this and documents a pilot questionnaire-based study looking at the effects and potential benefits of sound source information (SSI) on patients' subjective reactions to a ward soundscape. The study was carried out from July to September 2011 with 31 patients in a cardiothoracic ward. Although strong inferences were not made, it was found that this simple intervention created a 21-26% positive change perception (p<0.05). The paper discusses the results in relation to nursing practice, concluding that SSI could be beneficial in helping patients to feel more comfortable.

  4. A handoff is not a telegram: an understanding of the patient is co-constructed

    PubMed Central

    2012-01-01

    Hospital handoffs are believed to be a key locus of communication breakdown that can endanger patient safety and undermine quality of care. Substantial new efforts to better understand handoffs and to improve handoff practices are under way. Many such efforts appear to be seriously hampered, however, by an underlying presumption that the essential function of a handoff is one-way information transmission. Here, we examine social science literature that supports a richer framing of handoff conversations, one that characterizes them as co-constructions of an understanding of the patient. PMID:22316097

  5. A handoff is not a telegram: an understanding of the patient is co-constructed.

    PubMed

    Cohen, Michael D; Hilligoss, Brian; Kajdacsy-Balla Amaral, André Carlos

    2012-02-08

    Hospital handoffs are believed to be a key locus of communication breakdown that can endanger patient safety and undermine quality of care. Substantial new efforts to better understand handoffs and to improve handoff practices are under way. Many such efforts appear to be seriously hampered, however, by an underlying presumption that the essential function of a handoff is one-way information transmission. Here, we examine social science literature that supports a richer framing of handoff conversations, one that characterizes them as co-constructions of an understanding of the patient.

  6. Understanding the influence of educational attainment on kidney health and opportunities for improved care.

    PubMed

    Green, Jamie A; Cavanaugh, Kerri L

    2015-01-01

    Educational attainment is an important but often overlooked contributor to health outcomes in patients with kidney disease. Those with lower levels of education have an increased risk of ESRD, complications of peritoneal dialysis, worse transplant outcomes, and mortality. Mediators of these associations are poorly understood but involve a complex interplay between health knowledge, behaviors, and socioeconomic and psychosocial factors. Interventions targeting these aspects of care have the potential to reduce disparities related to educational attainment; however, few programs have been described that specifically address this issue. Future research efforts should not only systematically assess level of educational attainment but also report the differential impact of interventions across educational strata. In addition, routine measurement of health literacy may be useful to identify high-risk patients independent of years of schooling. A better understanding of the influence of educational attainment on kidney health provides an opportunity to improve the care and outcomes of vulnerable patients with kidney disease.

  7. Understanding the influence of educational attainment on kidney health and opportunities for improved care.

    PubMed

    Green, Jamie A; Cavanaugh, Kerri L

    2015-01-01

    Educational attainment is an important but often overlooked contributor to health outcomes in patients with kidney disease. Those with lower levels of education have an increased risk of ESRD, complications of peritoneal dialysis, worse transplant outcomes, and mortality. Mediators of these associations are poorly understood but involve a complex interplay between health knowledge, behaviors, and socioeconomic and psychosocial factors. Interventions targeting these aspects of care have the potential to reduce disparities related to educational attainment; however, few programs have been described that specifically address this issue. Future research efforts should not only systematically assess level of educational attainment but also report the differential impact of interventions across educational strata. In addition, routine measurement of health literacy may be useful to identify high-risk patients independent of years of schooling. A better understanding of the influence of educational attainment on kidney health provides an opportunity to improve the care and outcomes of vulnerable patients with kidney disease. PMID:25573509

  8. Understanding Synthesis Across Disciplines to Improve Nursing Education.

    PubMed

    Blondy, Laurie C; Blakeslee, Ann M; Scheffer, Barbara K; Rubenfeld, M Gaie; Cronin, Brenda M; Luster-Turner, Rose

    2016-06-01

    Nursing students must learn higher-order thinking skills of analysis and synthesis to manage complex data for decision making in healthcare. Teaching synthesis, however, is challenging and elusive due to lack of understanding of the concept and an explicit pedagogy for teaching it. A qualitative, multi-phased research project was designed to gain understanding of what synthesis is, how professionals acquire synthesis skills, and how to best teach synthesis. The first phase explored interdisciplinary descriptions of synthesis. Three focus groups were conducted, and interdisciplinary participants responded to several questions. Several themes emerged suggesting that synthesis depends on cognitive skills and competencies, situational and contextual factors, preparation and knowledge acquisition skills, interpersonal and interaction skills, and personal qualities. Participants also supported use of multi-modal teaching strategies to reinforce students' use of synthesis in learning. This project provided a beginning understanding of the synthesis process, revealing striking similarities in synthesis across professional disciplines. PMID:26689219

  9. Understanding Synthesis Across Disciplines to Improve Nursing Education.

    PubMed

    Blondy, Laurie C; Blakeslee, Ann M; Scheffer, Barbara K; Rubenfeld, M Gaie; Cronin, Brenda M; Luster-Turner, Rose

    2016-06-01

    Nursing students must learn higher-order thinking skills of analysis and synthesis to manage complex data for decision making in healthcare. Teaching synthesis, however, is challenging and elusive due to lack of understanding of the concept and an explicit pedagogy for teaching it. A qualitative, multi-phased research project was designed to gain understanding of what synthesis is, how professionals acquire synthesis skills, and how to best teach synthesis. The first phase explored interdisciplinary descriptions of synthesis. Three focus groups were conducted, and interdisciplinary participants responded to several questions. Several themes emerged suggesting that synthesis depends on cognitive skills and competencies, situational and contextual factors, preparation and knowledge acquisition skills, interpersonal and interaction skills, and personal qualities. Participants also supported use of multi-modal teaching strategies to reinforce students' use of synthesis in learning. This project provided a beginning understanding of the synthesis process, revealing striking similarities in synthesis across professional disciplines.

  10. Quality of life and disease understanding: impact of attending a patient-centered cancer symposium.

    PubMed

    Padrnos, Leslie; Dueck, Amylou C; Scherber, Robyn; Glassley, Pamela; Stigge, Rachel; Northfelt, Donald; Mikhael, Joseph; Aguirre, Annette; Bennett, Robert M; Mesa, Ruben A

    2015-06-01

    To evaluate the impact of a patient-centered symposium as an educational intervention on a broad population of cancer patients. We developed a comprehensive patient symposium. Through voluntary questionnaires, we studied the impact of this cancer symposium on quality of life, cancer-specific knowledge, and symptom management among cancer patients. Symposium attendees were provided surveys prior to and 3 months following the educational intervention. Surveys included (1) EORTC-QLQ-C30; (2) disease understanding tool developed for this conference; (3) validated disease-specific questionnaires. Changes over time were assessed using McNemar's tests and paired t-tests for categorical and continuous variables, respectively. A total of 158 attendees completed the pre-convention survey. Most respondents reported at least "quite a bit" of understanding regarding treatment options, screening modalities, symptomatology, and cancer-related side effects. Attendees endorsed the least understanding of disease-related stress, risk factors, fatigue management, and legal issues related to disease/treatment. At 3 months, there was improvement in understanding (12 of 14 areas of self-reported knowledge especially regarding nutrition, and stress/fatigue management). However, no significant change was seen in QLQ-C30 functioning, fatigue, pain, or insomnia. A patient symposium, as an educational intervention improves a solid knowledge base amongst attendees regarding their disease, increases knowledge in symptom management, but may be insufficient to impact QoL as a single intervention. PMID:25641947

  11. Understanding patient preferences and willingness to pay for hemophilia therapies

    PubMed Central

    Chaugule, Shraddha S; Hay, Joel W; Young, Guy

    2015-01-01

    Background Despite clearly improved clinical outcomes for prophylaxis compared to on-demand therapy, on average only 56% of patients diagnosed with severe hemophilia receive prophylactic factor replacement therapy in the US. Prophylaxis rates generally drop as patients transition from childhood to adulthood, partly due to patients becoming less adherent when they reach adulthood. Assessment of patient preferences is important because these are likely to translate into increased treatment satisfaction and adherence. In this study, we assessed preferences and willingness to pay (WTP) for on-demand, prophylaxis, and longer acting prophylaxis therapies in a sample of US hemophilia patients. Methods Adult US hemophilia patients and caregivers (N=79) completed a discrete-choice survey that presented a series of trade-off questions, each including a pair of hypothetical treatment profiles. Using a mixed logit model for analysis, we compared the relative importance of five treatment characteristics: 1) out-of-pocket treatment costs (paid by patients), 2) factor dose adjustment, 3) treatment side effects, 4) availability of premixed factor, and 5) treatment effectiveness and dosing frequency. Based on these attribute estimates, we calculated patients’ WTP. Results Out-of-pocket treatment costs (P<0.001), side effects (P<0.001), and treatment effectiveness and dosing frequency (P<0.001) were found to be statistically significant in the model. Patients were willing to pay US $410 (95% confidence interval: $164–$656) out of pocket per month for thrice-weekly prophylaxis therapy compared to on-demand therapy and $360 (95% confidence interval: $145–$575) for a switch from thrice-weekly to once-weekly prophylaxis therapy. Conclusion Improvements in treatment effectiveness and dosing frequency, treatment side effects, and out-of-pocket costs per month were the greatest determinants of hemophilia treatment choice and WTP. The positive preferences and WTP for longer acting

  12. Communicating the results of randomized clinical trials: do patients understand multidimensional patient-reported outcomes?

    PubMed

    McNair, Angus G K; Brookes, Sara T; Davis, Christopher R; Argyropoulos, Miltiadis; Blazeby, Jane M

    2010-02-10

    PURPOSE Evidence suggests that patient-reported outcomes (PROs) from randomized trials in oncology may not influence clinical decision making and patient choice. Reasons for this are currently unclear and little is known about patients' interpretation of PROs. This study assessed patients' understanding of multidimensional PROs in a graphical format. PATIENTS AND METHODS Semistructured interviews in which patients interpreted a series of graphs depicting simple, then multiple different hypothetical PROs associated with two treatments with identical chances of survival were audio recorded. The interviewer and a blinded observer (listening to audio recordings) scored patients' understanding of the graphs. Logistic regression examined the associations between patient understanding of the graphs and clinical and sociodemographic details. Results One hundred thirty-two patients with esophageal and gastric cancer were interviewed and 115 understood the first two graphs depicting different PROs of two treatments (87%; 95% CI,81 to 93). Simultaneous interpretation of adverse and beneficial treatment effects was achieved by 74 (66%; 95% CI, 57 to 75). Graphs showing complex, longitudinal data were correctly interpreted by 97 (73%; 95% CI, 66 to 81) and 108 (81%; 95% CI, 75 to 88), respectively. Univariable analyses demonstrated associations between patient understanding and patient age, educational level, and cancer site (P < or = .02 for all); however, in a multivariable model each of these associations was attenuated. CONCLUSION Most patients understand graphical multidimensional PROs, although a smaller majority were able to interpret more complex, or simultaneous, presentations. Additional work is needed to define methods for communicating clinical and PRO data from trials to allow patients to make informed treatment choices. PMID:20065187

  13. Applied Strategies for Improving Patient Safety: A Comprehensive Process To Improve Care in Rural and Frontier Communities

    ERIC Educational Resources Information Center

    Westfall, John M.; Fernald, Douglas H.; Staton, Elizabeth W.; VanVorst, Rebecca; West, David; Pace, Wilson D.

    2004-01-01

    Medical errors and patient safety have gained increasing attention throughout all areas of medical care. Understanding patient safety in rural settings is crucial for improving care in rural communities. To describe a system to decrease medical errors and improve care in rural and frontier primary care offices. Applied Strategies for Improving…

  14. Lectures and Simulation Laboratories to Improve Learners' Conceptual Understanding

    ERIC Educational Resources Information Center

    Brophy, Sean P.; Magana, Alejandra J.; Strachan, Alejandro

    2013-01-01

    We studied the use of online molecular dynamics simulations (MD) to enhance student abilities to understand the atomic processes governing plastic deformation in materials. The target population included a second-year undergraduate engineering course in the School of Materials Engineering at Purdue University. The objectives of the study were to…

  15. Improving Reading Strategies through an Understanding of Culture and Language.

    ERIC Educational Resources Information Center

    Wen, Xiaohong

    This paper contends that many of the difficulties students of Chinese have in reading comprehension are directly related to their level of understanding of Chinese language and culture, and that these difficulties could be alleviated by providing students with knowledge about the value system, social customs, formation of Chinese characters and…

  16. Standing in the Hallway Improves Students' Understanding of Conformity

    ERIC Educational Resources Information Center

    Lawson, Timothy J.; Haubner, Richard R.; Bodle, James H.

    2013-01-01

    To help beginning psychology students understand how they are influenced by social pressures to conform, we developed a demonstration designed to elicit their conformity to a small group of students standing in the hallway before class. Results showed the demonstration increased students' recognition of their own tendency to conform, knowledge of…

  17. Changing the Conversation: Messages for Improving Public Understanding of Engineering

    ERIC Educational Resources Information Center

    National Academies Press, 2008

    2008-01-01

    Can the United States continue to lead the world in innovation? The answer may hinge in part on how well the public understands engineering, a key component of the "innovation engine." A related concern is how to encourage young people--particularly girls and under-represented minorities--to consider engineering as a career option.…

  18. Patient care simulations: role playing to enhance clinical understanding.

    PubMed

    Comer, Shirley K

    2005-01-01

    Role-play techniques can serve as an effective substitute for, and supplement to, simulation technology when teaching clinical nursing skills. They provide risk-free opportunities to practice clinical skills and develop clinical judgment. A two-phase patient care simulation, performed in real time, is described. Students are presented with a scenario and work cooperatively in role-playing appropriate care, with one student using a prepared script to assume the role of patient. The class functions as a resource for four students who assume the nursing role. Students reported increased understanding of course material as a result of participation in the clinical simulation scenario. Faculty observed a decreased failure rate on the corresponding course examination.

  19. Understanding Emergency Department 72-Hour Revisits Among Medicaid Patients Using Electronic Healthcare Records.

    PubMed

    Ryan, James; Hendler, James; Bennett, Kristin P

    2015-12-01

    Electronic Healthcare Records (EHRs) have the potential to improve healthcare quality and to decrease costs by providing quality metrics, discovering actionable insights, and supporting decision-making to improve future outcomes. Within the United States Medicaid Program, rates of recidivism among emergency department (ED) patients serve as metrics of hospital performance that help ensure efficient and effective treatment within the ED. We analyze ED Medicaid patient data from 1,149,738 EHRs provided by a hospital over a 2-year period to understand the characteristics of the ED return visits within a 72-hour time frame. Frequent flyer patients with multiple revisits account for 47% of Medicaid patient revisits over this period. ED encounters by frequent flyer patients with prior 72-hour revisits in the last 6 months are thrice more likely to result in a readmit than those of infrequent patients. Statistical L1-logistic regression and random forest analyses reveal distinct patterns of ED usage and patient diagnoses between frequent and infrequent patient encounters, suggesting distinct opportunities for interventions to improve efficacy of care and streamline ED workflow. This work forms a foundation for future development of predictive models, which could flag patients at high risk of revisiting.

  20. Technology and simulation to improve patient safety.

    PubMed

    Ghobrial, George M; Hamade, Youssef J; Bendok, Bernard R; Harrop, James S

    2015-04-01

    Improving the quality and efficiency of surgical techniques, reducing technical errors in the operating suite, and ultimately improving patient safety and outcomes through education are common goals in all surgical specialties. Current surgical simulation programs represent an effort to enhance and optimize the training experience, to overcome the training limitations of a mandated 80-hour work week, and have the overall goal of providing a well-balanced resident education in a society with a decreasing level of tolerance for medical errors.

  1. Understanding quality patient care and the role of the practicing nurse.

    PubMed

    Owens, Laura D; Koch, Robert W

    2015-03-01

    Nurses play a vital role in improving the safety and quality of patient care. The authors provide the front-line nurse providers with an overview of critical concepts related to quality management of patient care. A historical approach provides the reader with an overview of the trajectory or the quality in health care movement. Furthermore, the article provides the nurse with a basic understanding of national and international organizations that focus on quality patient care. A brief introduction of measures of quality care is presented as well as implications for nursing practice.

  2. Understanding MWD data acquisition can improve log interpretation

    SciTech Connect

    Fagin, R.A. )

    1994-02-14

    By understanding how measurement-while-drilling (MWD) tools acquire data and how the data are processed, engineers and geologists can better interpret MWD logs. Wire line and MWD log data sometimes do not precisely match. If a discrepancy occurs between MWD and wire line logs run across the same interval, many log interpreters will condemn the MWD data. Recognizing the differences and the correct data requires a better understanding of the MWD tool operational principles. Because MWD logs are becoming more widely accepted as quantitative replacements for equivalent wire line logs, the differences between logs should be analyzed logically. This paper discusses these differences by describing the following: time-based acquisition, filtering, depth control, environmental variables, and quality control.

  3. Increasing Patient Activation Could Improve Outcomes for Patients with Inflammatory Bowel Disease.

    PubMed

    Shah, Shawn L; Siegel, Corey A

    2015-12-01

    Inflammatory bowel disease (IBD) is a complex disease process that often requires the integration of skills from various health care providers to adequately meet the needs of patients with IBD. The medical and surgical treatment options for IBD have become more complicated and are frequently a source of angst for both the patient and provider. However, it has become more important than ever to engage patients in navigating the treatment algorithm. Although novel in the IBD world, the concept of patients' becoming more active and effective managers of their care has been well studied in other disease processes such as diabetes mellitus and mental illness. This idea of patient activation refers to a patient understanding his or her role in the care process and having the skill sets and self-reliance necessary to manage his or her own health care. Over the past decade, evidence supporting the role of patient activation in chronic illness has grown, revealing improved health outcomes, enhanced patient experiences, and lower overall costs. Patient activation can be measured, and interventions have been shown to improve levels of activation over time and influence outcomes. A focus on patient activation is very appropriate for patients with IBD because this may potentially serve as a tool for IBD providers to not only improve patient outcomes and experience but also reduce health care costs.

  4. Improving Student Understanding of History Textbooks: A Practical Approach.

    ERIC Educational Resources Information Center

    Filner, Robert E.; Basile, Donald D.

    1980-01-01

    Noting that college history teachers must often contend with student reading problems, the article recommends ways of improving student comprehension of textbooks. Methods center on selecting a proper textbook and on having students preview, paraphrase, analyze, and review. Journal available from Loren E. Pennington, Division of Social Sciences,…

  5. Improving Access to and Understanding of Regulations through Taxonomies

    ERIC Educational Resources Information Center

    Cheng, Chin Pang; Lau. Gloria T.; Law, Kincho H.; Pan, Jiayi; Jones, Albert

    2009-01-01

    Industrial taxonomies have the potential to automate information retrieval, facilitate interoperability and, most importantly, improve decision making - decisions that must comply with existing government regulations and codes of practice. However, it is difficult to find those regulations and codes most relevant to a particular decision, even…

  6. Understanding Leadership Paradigms for Improvement in Higher Education

    ERIC Educational Resources Information Center

    Flumerfelt, Shannon; Banachowski, Michael

    2011-01-01

    Purpose: This research article is based on the Baldrige National Quality Program Education Criteria for Performance Excellence's conceptualization of improvement as a dual cycle/three element initiative of examining and bettering inputs, processes, and outputs as driven by measurement, analysis and knowledge management work. This study isolates a…

  7. Realising Our Potential: Understanding and Developing Capacity for Lasting Improvement.

    ERIC Educational Resources Information Center

    Stoll, Louise

    1999-01-01

    Drawing on research and development work in school effectiveness/improvement, this article argues that internal capacity is vital in developing and sustaining the teacher and organizational learning necessary to promote and enhance student learning. Organizational and external influences on internal capacity are discussed, along with…

  8. Working with industry for improved patient outcomes.

    PubMed

    Shorney, Richard

    Various codes of practice, guidelines and protocols exist that support the engagement between health professionals and industry. Of importance is how these engagements can be encouraged to support improved patient outcomes. This article reviews the policies that exist from both the perspective of the health professionals and that of industry within the wound-care market space. Health professionals' engagement with wound-care companies in various guises in practice, including advancement of medical technologies; education development; provision on the safe and effective use of products; and true, practical research and evaluations of products. Joint working initiatives do exist between the NHS and industry that are transparent, mutually beneficial, support patient safety, ensure improved patient experience, and drive clinical effectiveness.

  9. Improving utilisation of dental services by understanding cultural difference.

    PubMed

    Johnston, J A

    1993-10-01

    There is considerable health and medical research and anecdotal evidence showing that members of different cultural groups and people from lower socio-economic status and/or disadvantaged ethnic minority groups are prone to increased morbidity and early mortality. It is also clear that similar patterns are found in terms of dental health status and dental health morbidity. New Zealand data from the Second International Collaborative Study (ICSII) clearly illustrate that poorer health status overall and poorer dental health status are experienced by certain sections and groups within the population. Data from these studies suggest that members of lower socio-economic status groups, different ethnic groups and those with different cultural affiliations experience different health status and use the health services at differential rates. Some of the factors that appear to influence this are clearly related to cultural beliefs and attitudes. Future efforts by the New Zealand health services and in particular by the New Zealand dental health services to redress the situation need to be based on a clear understanding of the many factors that limit the availability and uptake of preventive and dental health care services by high risk groups. Understanding cultural difference is a key requirement.

  10. Exercise improves cognitive function in aging patients

    PubMed Central

    Hu, Jian-Ping; Guo, Yan-Hua; Wang, Feng; Zhao, Xin-Ping; Zhang, Quan-Hai; Song, Qing-Hua

    2014-01-01

    A decline in cognitive ability commonly occurs among older individuals. This study sought to explore the restorative effects of exercise in older patients with existing cognitive disabilities. Ninety-six patients with mild cognitive impairment were placed in an exercise program for six months. Following completion of the program, participants were assessed via the Chinese Mini Mental Status Examination (MMSE), Activity of Daily Living (ADL) assessment, and body movement testing and compared to a control group of patients with mild cognitive impairment who did not participate in the exercise program (N = 102). Statistical analyses were performed using the Student’s t-test and chi-square test to compare results between groups. Compared with control group, patients who exercised showed improved cognitive function in immediate memory (p < 0.001) and delayed recall (p = 0.004) function. In addition, activities associated with daily living showed improvement (p < 0.001), as did body movement (p < 0.05), arm stability (p < 0.001), and the appearance of rotation (p < 0.05). Based on these results, we conclude that participation in an exercise program can improve patients’ cognitive function, physical abilities, and body movement capacity. PMID:25419345

  11. Bootstrapping Q Methodology to Improve the Understanding of Human Perspectives.

    PubMed

    Zabala, Aiora; Pascual, Unai

    2016-01-01

    Q is a semi-qualitative methodology to identify typologies of perspectives. It is appropriate to address questions concerning diverse viewpoints, plurality of discourses, or participation processes across disciplines. Perspectives are interpreted based on rankings of a set of statements. These rankings are analysed using multivariate data reduction techniques in order to find similarities between respondents. Discussing the analytical process and looking for progress in Q methodology is becoming increasingly relevant. While its use is growing in social, health and environmental studies, the analytical process has received little attention in the last decades and it has not benefited from recent statistical and computational advances. Specifically, the standard procedure provides overall and arguably simplistic variability measures for perspectives and none of these measures are associated to individual statements, on which the interpretation is based. This paper presents an innovative approach of bootstrapping Q to obtain additional and more detailed measures of variability, which helps researchers understand better their data and the perspectives therein. This approach provides measures of variability that are specific to each statement and perspective, and additional measures that indicate the degree of certainty with which each respondent relates to each perspective. This supplementary information may add or subtract strength to particular arguments used to describe the perspectives. We illustrate and show the usefulness of this approach with an empirical example. The paper provides full details for other researchers to implement the bootstrap in Q studies with any data collection design.

  12. Concepts first, jargon second improves student articulation of understanding.

    PubMed

    McDonnell, Lisa; Barker, Megan K; Wieman, Carl

    2016-01-01

    In this experiment, students in a large undergraduate biology course were first exposed to the concepts without new technical vocabulary ("jargon") in a pre-class reading assignment. Their learning of the concepts and jargon was compared with that of an equivalent group of students in another section of the same course, whose pre-class reading presented both the jargon and concepts together in the traditional manner. Both groups had the same active-learning classes with the same instructor, and then completed the same post-test. Although the two groups performed the same on the multiple choice questions of the post-test, the group exposed to concepts first and jargon second included 1.5 times and 2.5 times more correct arguments on two free-response questions about the concepts. The correct use of jargon between the two groups was similar, with the exception of one jargon term that the control group used more often. These results suggest that modest instructional changes whereby new concepts are introduced in a concepts-first, jargon-second manner can increase student learning, as demonstrated by their ability to articulate their understanding of new concepts. PMID:26537537

  13. Understanding and working with the psychodynamics of practitioner-patient relationships in the manual therapies.

    PubMed

    Sher, Danny; Sher, Mannie

    2016-04-01

    In this paper, we argue that practitioner-patient relationships in the manual therapies would be strengthened by a deeper understanding of the psychodynamics and emotions of those relationships. We suggest that in many cases, a purely bio-mechanical approach may neglect underlying psychological and emotional reasons of the patient's presenting condition, and consequently, lead to a less than adequate outcome for the patient. We offer easily adopted suggestions that could enhance the practice of practitioners of manual therapies as well as other professions that rely on the application of physical methods of diagnosis and treatment. These suggestions could lead to improved prognosis and increased professional satisfaction for practitioners. This paper describes five key dynamics that characterize practitioner-patient relationships: (i) pain as a form of communication; (ii) the 'heart-sink' patient; (iii) dependency; (iv) the erotic transference; (v) endings and loss. PMID:27210846

  14. A Practical Approach to Improving Pain Control in Cancer Patients

    PubMed Central

    Brigden, Malcolm L.; Barnett, Jeffrey B.

    1987-01-01

    Despite a wealth of recent articles, many patients with cancer pain continue to suffer needlessly. The satisfactory treatment of cancer pain requires a variety of practical management strategies. Practicing physicians need a wider understanding of both the basic principles of analgesic therapy and the pharmacologic features of analgesics. Certain analgesics are best not used in cancer care. The use of pharmacologic adjuncts may lessen overall narcotic requirements and side effects. The appropriate use of alternative therapies can dramatically improve the quality of patients' overall survival. PMID:2884781

  15. Mechanistic Understanding of Microbial Plugging for Improved Sweep Efficiency

    SciTech Connect

    Steven Bryant; Larry Britton

    2008-09-30

    Microbial plugging has been proposed as an effective low cost method of permeability reduction. Yet there is a dearth of information on the fundamental processes of microbial growth in porous media, and there are no suitable data to model the process of microbial plugging as it relates to sweep efficiency. To optimize the field implementation, better mechanistic and volumetric understanding of biofilm growth within a porous medium is needed. In particular, the engineering design hinges upon a quantitative relationship between amount of nutrient consumption, amount of growth, and degree of permeability reduction. In this project experiments were conducted to obtain new data to elucidate this relationship. Experiments in heterogeneous (layered) beadpacks showed that microbes could grow preferentially in the high permeability layer. Ultimately this caused flow to be equally divided between high and low permeability layers, precisely the behavior needed for MEOR. Remarkably, classical models of microbial nutrient uptake in batch experiments do not explain the nutrient consumption by the same microbes in flow experiments. We propose a simple extension of classical kinetics to account for the self-limiting consumption of nutrient observed in our experiments, and we outline a modeling approach based on architecture and behavior of biofilms. Such a model would account for the changing trend of nutrient consumption by bacteria with the increasing biomass and the onset of biofilm formation. However no existing model can explain the microbial preference for growth in high permeability regions, nor is there any obvious extension of the model for this observation. An attractive conjecture is that quorum sensing is involved in the heterogeneous bead packs.

  16. Improving animal and human health through understanding liver fluke immunology.

    PubMed

    Piedrafita, D; Spithill, T W; Smith, R E; Raadsma, H W

    2010-08-01

    Sheep, goats and cattle represent the most numerous and economically important agricultural species worldwide used as sources for milk, fibre and red meat. In addition, in the developing world, these species often represent the sole asset base for small-holder livestock farmers and cattle/buffaloes often provide the majority of draught power for crop production. Production losses caused by helminth diseases of these animals are a major factor in extending the cycle of poverty in developing countries and a major food security issue for developed economies. Fasciola spp. are one of the most important zoonotic diseases with a global economic impact in livestock production systems and a poorly defined but direct effect on human health. Improvements in human and animal health will require a concerted research effort into the development of new accurate and simple diagnostic tests and increased vaccine and drug development against Fasciola infections. Here, the use of definitive natural host breeds with contrasting resistance to Fasciola infections is discussed as a resource to contrast parasite-host interactions and identify parasite immune evasion strategies. Such studies are likely to boost the discovery of new vaccine, drug and diagnostic candidates and provide the foundation for future genetic selection of resistant animals. PMID:20626812

  17. Vaccine adjuvants--understanding molecular mechanisms to improve vaccines.

    PubMed

    Egli, Adrian; Santer, Deanna; Barakat, Khaled; Zand, Martin; Levin, Aviad; Vollmer, Madeleine; Weisser, Maja; Khanna, Nina; Kumar, Deepali; Tyrrell, Lorne; Houghton, Michael; Battegay, Manuel; O'Shea, Daire

    2014-01-01

    Infectious pathogens are responsible for high utilisation of healthcare resources globally. Attributable morbidity and mortality remains exceptionally high. Vaccines offer the potential to prime a pathogen-specific immune response and subsequently reduce disease burden. Routine vaccination has fundamentally altered the natural history of many frequently observed and serious infections. Vaccination is also recommended for persons at increased risk of severe vaccine-preventable disease. Many current nonadjuvanted vaccines are poorly effective in the elderly and immunocompromised populations, resulting in nonprotective postvaccine antibody titres, which serve as surrogate markers for protection. The vaccine-induced immune response is influenced by: (i.) vaccine factors i.e., type and composition of the antigen(s), (ii.) host factors i.e., genetic differences in immune-signalling or senescence, and (iii.) external factors such as immunosuppressive drugs or diseases. Adjuvanted vaccines offer the potential to compensate for a lack of stimulation and improve pathogen-specific protection. In this review we use influenza vaccine as a model in a discussion of the different mechanisms of action of the available adjuvants. In addition, we will appraise new approaches using "vaccine-omics" to discover novel types of adjuvants.

  18. A systems approach to understanding and improving health systems.

    PubMed

    Erazo, Álvaro

    2015-09-01

    Health systems face the challenge of helping to improve health conditions. They occupy a priority place in middle- and lower-income countries, since the absence or fragility of health systems adversely impacts expected health outcomes. Thus, due to the direct relationship between programs and systems, the absence or weakness of either will result in a consequent deficiency in public health and the very execution of the programs. In the same vein, weakened health systems are one of the main bottlenecks to attaining the Millennium Development Goals. Systems thinking is one of the "four revolutions in progress" that are helping to transform health and health care systems. Within that framework, this article identifies conceptual and operational elements of systems applicable to health systems that contribute to overcoming the obstacles and inertia that hinder health activities and outcomes. It discusses relevant concepts characteristic of systems thinking, such as structural variables and dynamic complexity, the relationship between programs and health systems, and the monitoring and evaluation function, together with the role of innovation and systems integration as high-priority elements. This will aid in the development of designs that also stress the context of the components that guide management, identifying processes and outcomes in a health management continuum. PMID:26758004

  19. Vaccine adjuvants--understanding molecular mechanisms to improve vaccines.

    PubMed

    Egli, Adrian; Santer, Deanna; Barakat, Khaled; Zand, Martin; Levin, Aviad; Vollmer, Madeleine; Weisser, Maja; Khanna, Nina; Kumar, Deepali; Tyrrell, Lorne; Houghton, Michael; Battegay, Manuel; O'Shea, Daire

    2014-01-01

    Infectious pathogens are responsible for high utilisation of healthcare resources globally. Attributable morbidity and mortality remains exceptionally high. Vaccines offer the potential to prime a pathogen-specific immune response and subsequently reduce disease burden. Routine vaccination has fundamentally altered the natural history of many frequently observed and serious infections. Vaccination is also recommended for persons at increased risk of severe vaccine-preventable disease. Many current nonadjuvanted vaccines are poorly effective in the elderly and immunocompromised populations, resulting in nonprotective postvaccine antibody titres, which serve as surrogate markers for protection. The vaccine-induced immune response is influenced by: (i.) vaccine factors i.e., type and composition of the antigen(s), (ii.) host factors i.e., genetic differences in immune-signalling or senescence, and (iii.) external factors such as immunosuppressive drugs or diseases. Adjuvanted vaccines offer the potential to compensate for a lack of stimulation and improve pathogen-specific protection. In this review we use influenza vaccine as a model in a discussion of the different mechanisms of action of the available adjuvants. In addition, we will appraise new approaches using "vaccine-omics" to discover novel types of adjuvants. PMID:24844935

  20. 3D printing of patient-specific anatomy: A tool to improve patient consent and enhance imaging interpretation by trainees.

    PubMed

    Liew, Yaoren; Beveridge, Erin; Demetriades, Andreas K; Hughes, Mark A

    2015-01-01

    We report the use of three-dimensional or 3D printed, patient-specific anatomy as a tool to improve informed patient consent and patient understanding in a case of posterior lumbar fixation. Next, we discuss its utility as an educational tool to enhance imaging interpretation by neurosurgery trainees. PMID:25822093

  1. 3D printing of patient-specific anatomy: A tool to improve patient consent and enhance imaging interpretation by trainees.

    PubMed

    Liew, Yaoren; Beveridge, Erin; Demetriades, Andreas K; Hughes, Mark A

    2015-01-01

    We report the use of three-dimensional or 3D printed, patient-specific anatomy as a tool to improve informed patient consent and patient understanding in a case of posterior lumbar fixation. Next, we discuss its utility as an educational tool to enhance imaging interpretation by neurosurgery trainees.

  2. Improving patient safety in radiation oncology

    SciTech Connect

    Hendee, William R.; Herman, Michael G.

    2011-01-15

    Beginning in the 1990s, and emphasized in 2000 with the release of an Institute of Medicine report, healthcare providers and institutions have dedicated time and resources to reducing errors that impact the safety and well-being of patients. But in January 2010 the first of a series of articles appeared in the New York Times that described errors in radiation oncology that grievously impacted patients. In response, the American Association of Physicists in Medicine and the American Society of Radiation Oncology sponsored a working meeting entitled ''Safety in Radiation Therapy: A Call to Action''. The meeting attracted 400 attendees, including medical physicists, radiation oncologists, medical dosimetrists, radiation therapists, hospital administrators, regulators, and representatives of equipment manufacturers. The meeting was cohosted by 14 organizations in the United States and Canada. The meeting yielded 20 recommendations that provide a pathway to reducing errors and improving patient safety in radiation therapy facilities everywhere.

  3. Understanding

    ERIC Educational Resources Information Center

    Buxkemper, Andra C.; Hartfiel, D. J.

    2003-01-01

    There is no common agreement on the meaning of the word "understand". However, there is agreement on what students should be able to do with material they understand. Bloom et al. discuss kinds of tasks a student should be able to do, provided that the student understands. In a similar way, Biggs and Collis provide a taxonomy intended to evaluate…

  4. [Improving patient safety through voluntary peer review].

    PubMed

    Kluge, S; Bause, H

    2015-01-01

    The intensive care unit (ICU) is one area of the hospital in which processes and communication are of primary importance. Errors in intensive care units can lead to serious adverse events with significant consequences for patients. Therefore quality and risk-management are important measures when treating critically ill patients. A pragmatic approach to support quality and safety in intensive care is peer review. This approach has gained significant acceptance over the past years. It consists of mutual visits by colleagues who conduct standardised peer reviews. These reviews focus on the systematic evaluation of the quality of an ICU's structure, its processes and outcome. Together with different associations, the State Chambers of Physicians and the German Medical Association have developed peer review as a standardized tool for quality improvement. The common goal of all stakeholders is the continuous and sustainable improvement in intensive care with peer reviews significantly increasing and improving communication between professions and disciplines. Peer reviews secure the sustainability of planned change processes and consequently lead the way to an improved culture of quality and safety.

  5. Understanding context for quality improvement: artefacts, affordances and socio-material infrastructure.

    PubMed

    Allen, Davina

    2013-09-01

    Against a backdrop of growing concern for patient safety and service quality, modern health-care systems are witnessing a proliferation of improvement initiatives. The impact is often variable, however, and a key theme to emerge from evaluations of these efforts is a recognition of the effects of local context on the success or otherwise of an intervention. However, the 'context' tends to be understood in terms of higher order issues such as structure, culture and leadership. This article explores a dimension of context not typically taken into account in the health-care improvement literature: the infrastructural context. Many quality improvement interventions hinge on the introduction of artefacts to support behavioural change in the workplace. Despite calls from scholars of technology in practice for a greater acknowledgement of the role of such mundane artefacts in supporting the organisation of health-care work, they are rarely considered in these terms in evaluations of improvement efforts. In this article, I argue that understanding the potential generative effects of artefacts for quality improvement purposes requires an understanding of their 'affordances' and how these relate to the socio-material infrastructure into which they are to be introduced, and/or the technologies they are designed to replace. Integrated care pathway implementation is examined to illustrate this position. Drawing on qualitative case studies of integrated care pathway development processes undertaken in the UK National Health Service and ethnographic research on the international care pathway community, I consider the infrastructural reasons behind the challenges of making pathways work in organising health care, and why, contrary to the aspirations of their proponents, they often appear to increase rather than decrease paperwork.

  6. Caring for LGBTQ patients: Methods for improving physician cultural competence.

    PubMed

    Klein, Elizabeth W; Nakhai, Maliheh

    2016-05-01

    This article summarizes the components of a curriculum used to teach family medicine residents and faculty about LGBTQ patients' needs in a family medicine residency program in the Pacific Northwest region of the United States. This curriculum was developed to provide primary care physicians and physicians-in-training with skills to provide better health care for LGBTQ-identified patients. The curriculum covers topics that range from implicit and explicit bias and appropriate terminology to techniques for crafting patient-centered treatment plans. Additionally, focus is placed on improving the understanding of specific and unique barriers to competent health care encountered by LGBTQ patients. Through facilitated discussion, learners explore the health disparities that disproportionately affect LGBTQ individuals and develop skills that will improve their ability to care for LGBTQ patients. The goal of the curriculum is to teach family medicine faculty and physicians in training how to more effectively communicate with and treat LGBTQ patients in a safe, non-judgmental, and welcoming primary care environment. PMID:27497452

  7. Improving patient safety by instructional systems design

    PubMed Central

    Battles, J B

    2006-01-01

    Education and training are important elements in patient safety, both as a potential contributing factor to risks and hazards of healthcare associated injury or harm and as an intervention to be used in eliminating or preventing such harm. All too often we have relied on training as the only interventions for patient safety without examining other alternatives or realizing that, in some cases, the training systems themselves are part of the problem. One way to ensure safety by design is to apply established design principles to education and training. Instructional systems design (ISD) is a systematic method of development of education and training programs for improved learner performance. The ISD process involves five integrated steps: analysis, development, design, implementation, and evaluation (ADDIE). The application of ISD using the ADDIE approach can eliminate or prevent education and training from being a contributing factor of health associated injury or harm, and can also be effective in preventing injury or harm. PMID:17142604

  8. Improving communication among nurses and patients.

    PubMed

    Unluturk, Mehmet S; Ozcanhan, Mehmet H; Dalkilic, Gokhan

    2015-07-01

    Patients use nurse call systems to signal nurses for medical help. Traditional push button-flashing lamp call systems are not integrated with other hospital automation systems. Therefore, nurse response time becomes a matter of personal discretion. The improvement obtained by integrating a pager system into the nurse call systems does not increase care efficiency, because unnecessary visits are still not eliminated. To obtain an immediate response and a purposeful visit by a nurse; regardless of the location of nurse in hospital, traditional systems have to be improved by intelligent telephone system integration. The results of the developed Nurse Call System Software (NCSS), the Wireless Phone System Software (WPSS), the Location System Software (LSS) and the communication protocol are provided, together with detailed XML message structures. The benefits of the proposed system are also discussed and the direction of future work is presented.

  9. Improving communication among nurses and patients.

    PubMed

    Unluturk, Mehmet S; Ozcanhan, Mehmet H; Dalkilic, Gokhan

    2015-07-01

    Patients use nurse call systems to signal nurses for medical help. Traditional push button-flashing lamp call systems are not integrated with other hospital automation systems. Therefore, nurse response time becomes a matter of personal discretion. The improvement obtained by integrating a pager system into the nurse call systems does not increase care efficiency, because unnecessary visits are still not eliminated. To obtain an immediate response and a purposeful visit by a nurse; regardless of the location of nurse in hospital, traditional systems have to be improved by intelligent telephone system integration. The results of the developed Nurse Call System Software (NCSS), the Wireless Phone System Software (WPSS), the Location System Software (LSS) and the communication protocol are provided, together with detailed XML message structures. The benefits of the proposed system are also discussed and the direction of future work is presented. PMID:25935361

  10. An Evaluation of Understandability of Patient Journey Models in Mental Health

    PubMed Central

    2016-01-01

    Background There is a significant trend toward implementing health information technology to reduce administrative costs and improve patient care. Unfortunately, little awareness exists of the challenges of integrating information systems with existing clinical practice. The systematic integration of clinical processes with information system and health information technology can benefit the patients, staff, and the delivery of care. Objectives This paper presents a comparison of the degree of understandability of patient journey models. In particular, the authors demonstrate the value of a relatively new patient journey modeling technique called the Patient Journey Modeling Architecture (PaJMa) when compared with traditional manufacturing based process modeling tools. The paper also presents results from a small pilot case study that compared the usability of 5 modeling approaches in a mental health care environment. Method Five business process modeling techniques were used to represent a selected patient journey. A mix of both qualitative and quantitative methods was used to evaluate these models. Techniques included a focus group and survey to measure usability of the various models. Results The preliminary evaluation of the usability of the 5 modeling techniques has shown increased staff understanding of the representation of their processes and activities when presented with the models. Improved individual role identification throughout the models was also observed. The extended version of the PaJMa methodology provided the most clarity of information flows for clinicians. Conclusions The extended version of PaJMa provided a significant improvement in the ease of interpretation for clinicians and increased the engagement with the modeling process. The use of color and its effectiveness in distinguishing the representation of roles was a key feature of the framework not present in other modeling approaches. Future research should focus on extending the pilot

  11. Listening to patients with cancer: using a literary-based research method to understand patient-focused care

    PubMed Central

    Begley, Amanda; Pritchard-Jones, Kathy; Biriotti, Maurice; Kydd, Anna; Burdsey, Tim; Townsley, Emma

    2014-01-01

    Objective In spite of considerable attention, patients diagnosed with cancer continue to report poor experiences of care. The root causes of this remain unclear. This exploratory study aimed to investigate new ways of understanding the experience of patients with cancer, using a literary-based research approach. Design Interviews were undertaken with four patients diagnosed with high-grade brain cancers at least 6 months from diagnosis and with people (n=5) identified by the patients as important in their care pathway. Interview transcripts were analysed by humanities academics as pieces of literature, where each patient's story was told from more than one person's perspective. The academics then came together in a facilitated workshop to agree major themes within the patient experiences. The themes were presented at a patient and carer event involving 70 participants to test the validity of the insights. Results Insights into the key issues for patients with cancer could be grouped into six themes: accountability; identity; life context; time; language; rigour and emotion. Patients often held a different perspective to the traditionally held medical views of what constitutes good care. For example, patients did not see any conflict between a doctor having scientific rigour and portraying emotion. Conclusions One key feature of the approach was its comparative nature: patients often held different views from those traditionally held by physicians of what constitutes health and good outcomes. This revealed aspects that may be considered by healthcare professionals when designing improvements. Proposals for further testing are discussed, with a particular emphasis on the need for sensitivity to individual differences in experiences. PMID:25324319

  12. Health innovation for patient safety improvement.

    PubMed

    Sellappans, Renukha; Chua, Siew Siang; Tajuddin, Nur Amani Ahmad; Mei Lai, Pauline Siew

    2013-01-01

    Medication error has been identified as a major factor affecting patient safety. Many innovative efforts such as Computerised Physician Order Entry (CPOE), a Pharmacy Information System, automated dispensing machines and Point of Administration Systems have been carried out with the aim of improving medication safety. However, areas remain that require urgent attention. One main area will be the lack of continuity of care due to the breakdown of communication between multiple healthcare providers. Solutions may include consideration of "health smart cards" that carry vital patient medical information in the form of a "credit card" or use of the Malaysian identification card. However, costs and technical aspects associated with the implementation of this health smart card will be a significant barrier. Security and confidentiality, on the other hand, are expected to be of primary concern to patients. Challenges associated with the implementation of a health smart card might include physician buy-in for use in his or her everyday practice. Training and technical support should also be available to ensure the smooth implementation of this system. Despite these challenges, implementation of a health smart card moves us closer to seamless care in our country, thereby increasing the productivity and quality of healthcare.

  13. Health innovation for patient safety improvement.

    PubMed

    Sellappans, Renukha; Chua, Siew Siang; Tajuddin, Nur Amani Ahmad; Mei Lai, Pauline Siew

    2013-01-01

    Medication error has been identified as a major factor affecting patient safety. Many innovative efforts such as Computerised Physician Order Entry (CPOE), a Pharmacy Information System, automated dispensing machines and Point of Administration Systems have been carried out with the aim of improving medication safety. However, areas remain that require urgent attention. One main area will be the lack of continuity of care due to the breakdown of communication between multiple healthcare providers. Solutions may include consideration of "health smart cards" that carry vital patient medical information in the form of a "credit card" or use of the Malaysian identification card. However, costs and technical aspects associated with the implementation of this health smart card will be a significant barrier. Security and confidentiality, on the other hand, are expected to be of primary concern to patients. Challenges associated with the implementation of a health smart card might include physician buy-in for use in his or her everyday practice. Training and technical support should also be available to ensure the smooth implementation of this system. Despite these challenges, implementation of a health smart card moves us closer to seamless care in our country, thereby increasing the productivity and quality of healthcare. PMID:23423150

  14. Functional dysphonia: strategies to improve patient outcomes

    PubMed Central

    Behlau, Mara; Madazio, Glaucya; Oliveira, Gisele

    2015-01-01

    Functional dysphonia (FD) refers to a voice problem in the absence of a physical condition. It is a multifaceted voice disorder. There is no consensus with regard to its definition and inclusion criteria for diagnosis. FD has many predisposing and precipitating factors, which may include genetic susceptibility, psychological traits, and the vocal behavior itself. The assessment of voice disorders should be multidimensional. In addition to the clinical examination, auditory-perceptual, acoustic, and self-assessment analyses are very important. Self-assessment was introduced in the field of voice 25 years ago and has produced a major impact in the clinical and scientific scenario. The choice of treatment for FD is vocal rehabilitation by means of direct therapy; however, compliance has been an issue, except for cases of functional aphonia or when an intensive training is administered. Nevertheless, there are currently no controlled studies that have explored the different options of treatment regimens for these patients. Strategies to improve patient outcome involve proper multidisciplinary diagnosis in order to exclude neurological and psychiatric disorders, careful voice documentation with quantitative measurement and qualitative description of the vocal deviation for comparison after treatment, acoustic evaluation to gather data on the mechanism involved in voice production, self-assessment questionnaires to map the impact of the voice problem on the basis of the patient’s perspective, referral to psychological evaluation in cases of suspected clinical anxiety and/or depression, identification of dysfunctional coping strategies, self-regulation data to assist patients with their vocal load, and direct and intensive vocal rehabilitation to reduce psychological resistance and to reassure patient’s recovery. An international multicentric effort, involving a large population of voice-disordered patients with no physical pathology, could produce enough data for

  15. Early Palliative Care Improves Patients' Quality of Life

    MedlinePlus

    ... fullstory_160885.html Early Palliative Care Improves Patients' Quality of Life Also increases chances of having end-of-life ... incurable cancer helps patients cope and improves their quality of life, a new study shows. It also leads to ...

  16. Understanding the factors that influence patient satisfaction with ambulance services.

    PubMed

    Bogomolova, Svetlana; Tan, P J; Dunn, S P; Bizjak-Mikic, M

    2016-01-01

    The quality of ambulance services has an immense impact on patients' future well-being and quality of life. Patient satisfaction is one of the key metrics for evaluating the quality of this service. Yet, the patient satisfaction measurement may be limited in its ability to accurately reflect this service quality, and even reflect factors beyond the patient experiences. We analyze 10 years of survey data to reveal a number of factors that systematically bias ambulance satisfaction ratings. Taking into account these biases provides more robust comparison of ambulance performance over time or across different jurisdictions. PMID:27295008

  17. Understanding the Transformation of Compassion in Nurses Who Become Patients

    ERIC Educational Resources Information Center

    Pucino, Carrie L.

    2013-01-01

    The purpose of this study was to examine how nurses who become patients learn compassion toward patients in their professional practice, and examine the role of empathy in the process of learning compassion. The process of learning compassion represents a significant change in the way nurses perceive this aspect of practice. Therefore,…

  18. What is the impact of physician communication and patient understanding in the management of headache?

    PubMed Central

    Patwardhan, Meenal; Coeytaux, Remy R; Deshmukh, Rajeshwari; Samsa, Gregory

    2007-01-01

    Migraine is a common and debilitating condition. Despite the burden of disease and increasing availability of effective treatment, migraine management is unsatisfactory. Evidence in other chronic conditions indicates that effective physician communication results in better patient understanding and health outcomes. The current literature review was intended to evaluate evidence regarding the relationship of effective physician-provider communication to health outcomes and patient satisfaction among patients with migraine. The authors searched MEDLINE® (1966–June 2007) and the Cochrane Database of Systematic Reviews for relevant publications. The search strategy combined the concepts of “headache disorders” and “physician-patient relations”. 912 abstracts were identified, and 80 (9%) of them were included for data abstraction. There were no studies that met our eligibility criteria. Therefore we revised the eligibility criteria to allow for the inclusion of non-migraine primary headache disorders or the role of non-physician health care providers. Twelve published papers met the revised criteria. The findings from the limited evidence available suggests, but does not prove, that improvements in physician-patient communication could result in a significant decrease in the burden of suffering and health care resource utilization associated with migraine. More research is needed to assess the explicit role of physician-patient communication in the management of migraine. PMID:19300624

  19. Understanding and Utilizing Patient Preferences in Cancer Treatment Decisions.

    PubMed

    Ubel, Peter A

    2016-05-01

    Shared decision-making is a complex endeavor that should take into account the patient's personal preferences regarding treatment options. To truly empower patients to be partners in decision-making, especially in situations in which their preferences are important, physicians must learn to communicate better and to distinguish between what is "medical fact" versus a "value judgement." Knowing what are, when to ask, and how to ask the right questions will help physicians be effective in guiding patients toward the right treatments. PMID:27226516

  20. Educating patients: understanding barriers, learning styles, and teaching techniques.

    PubMed

    Beagley, Linda

    2011-10-01

    Health care delivery and education has become a challenge for providers. Nurses and other professionals are challenged daily to assure that the patient has the necessary information to make informed decisions. Patients and their families are given a multitude of information about their health and commonly must make important decisions from these facts. Obstacles that prevent easy delivery of health care information include literacy, culture, language, and physiological barriers. It is up to the nurse to assess and evaluate the patient's learning needs and readiness to learn because everyone learns differently. This article will examine how each of these barriers impact care delivery along with teaching and learning strategies will be examined.

  1. Understanding cultural difference in caring for dying patients.

    PubMed Central

    Koenig, B A; Gates-Williams, J

    1995-01-01

    Experiences of illness and death, as well as beliefs about the appropriate role of healers, are profoundly influenced by patients' cultural background. As the United States becomes increasingly diverse, cultural difference is a central feature of many clinical interactions. Knowledge about how patients experience and express pain, maintain hope in the face of a poor prognosis, and respond to grief and loss will aid health care professionals. Many patients' or families' beliefs about appropriate end-of-life care are easily accommodated in routine clinical practice. Desires about the care of the body after death, for example, generally do not threaten deeply held values of medical science. Because expected deaths are increasingly the result of explicit negotiation about limiting or discontinuing therapies, however, the likelihood of serious moral disputes and overt conflict increases. We suggest a way to assess cultural variation in end-of-life care, arguing that culture is only meaningful when interpreted in the context of a patient's unique history, family constellation, and socioeconomic status. Efforts to use racial or ethnic background as simplistic, straightforward predictors of beliefs or behavior will lead to harmful stereotyping of patients and culturally insensitive care for the dying. PMID:7571587

  2. Improving Marking Reliability of Scientific Writing with the Developing Understanding of Assessment for Learning Programme

    ERIC Educational Resources Information Center

    Bird, Fiona L.; Yucel, Robyn

    2013-01-01

    The Developing Understanding of Assessment for Learning (DUAL) programme was developed with the dual aims of improving both the quality and consistency of feedback students receive and the students' ability to use that feedback to improve. DUAL comprises a range of processes (including marking rubrics, sample reports, moderation discussions and…

  3. Understanding and coping with binge eating disorder: the patient's perspective.

    PubMed

    McElroy, Susan L; Guerdjikova, Anna I

    2015-08-01

    Binge eating disorder (BED) is the most common of the 6 feeding and eating disorders recognized by the DSM-5 and a significant public health problem that can be successfully managed with appropriate help. Many patients, however, are hesitant to discuss the symptoms of BED with their providers because of embarrassment or because they simply do not recognize the behavior as a problem behavior. Clinicians need to increase their awareness of BED, its warning signs, and how and why patients might try to hide it leading to increased BED recognition and timely diagnosis. Then, given the right tools, clinicians can help patients to not only accept the diagnosis and look into various treatment options but also to move beyond it to recognize if any comorbid disorders are present and in need of treatment.

  4. Understanding the will to live in patients nearing death.

    PubMed

    Chochinov, Harvey Max; Hack, Thomas; Hassard, Thomas; Kristjanson, Linda J; McClement, Susan; Harlos, Mike

    2005-01-01

    This study examined concurrent influences on the will to live in 189 patients with end-stage cancer The authors found significant correlations between the will to live and existential, psychological, social, and, to a lesser degree, physical sources of distress. Existential variables proved to have the most influence, with hopelessness, burden to others, and dignity entering into the final model. Health care providers must learn to appreciate the importance of existential issues and their ability to influence the will to live among patients nearing death.

  5. Value Driven Outcomes (VDO): a pragmatic, modular, and extensible software framework for understanding and improving health care costs and outcomes

    PubMed Central

    Kawamoto, Kensaku; Martin, Cary J; Williams, Kip; Tu, Ming-Chieh; Park, Charlton G; Hunter, Cheri; Staes, Catherine J; Bray, Bruce E; Deshmukh, Vikrant G; Holbrook, Reid A; Morris, Scott J; Fedderson, Matthew B; Sletta, Amy; Turnbull, James; Mulvihill, Sean J; Crabtree, Gordon L; Entwistle, David E; McKenna, Quinn L; Strong, Michael B; Pendleton, Robert C; Lee, Vivian S

    2015-01-01

    Objective To develop expeditiously a pragmatic, modular, and extensible software framework for understanding and improving healthcare value (costs relative to outcomes). Materials and methods In 2012, a multidisciplinary team was assembled by the leadership of the University of Utah Health Sciences Center and charged with rapidly developing a pragmatic and actionable analytics framework for understanding and enhancing healthcare value. Based on an analysis of relevant prior work, a value analytics framework known as Value Driven Outcomes (VDO) was developed using an agile methodology. Evaluation consisted of measurement against project objectives, including implementation timeliness, system performance, completeness, accuracy, extensibility, adoption, satisfaction, and the ability to support value improvement. Results A modular, extensible framework was developed to allocate clinical care costs to individual patient encounters. For example, labor costs in a hospital unit are allocated to patients based on the hours they spent in the unit; actual medication acquisition costs are allocated to patients based on utilization; and radiology costs are allocated based on the minutes required for study performance. Relevant process and outcome measures are also available. A visualization layer facilitates the identification of value improvement opportunities, such as high-volume, high-cost case types with high variability in costs across providers. Initial implementation was completed within 6 months, and all project objectives were fulfilled. The framework has been improved iteratively and is now a foundational tool for delivering high-value care. Conclusions The framework described can be expeditiously implemented to provide a pragmatic, modular, and extensible approach to understanding and improving healthcare value. PMID:25324556

  6. Understanding the current state of patient flow in a hospital.

    PubMed

    Allder, Steven; Silvester, Kate; Walley, Paul

    2010-10-01

    The challenge of generating bed availability is constant in most NHS acute trusts. Building on previous work applying queue theory, this paper now takes operational data from one NHS trust, collected over a period of more than a year, to provide an evidence base and to establish the practical challenges associated with demand variation and managing length of stay. The problem is split into three separate parts. Daily bed shortages are mostly influenced by the timing of arrival and discharge of patients with a short length of stay. Patients who stay for longer than one to two days contribute most significantly to the observed weekly bed availability problem. The problems associated with bed shortages around Christmas time and into the New Year are not simply issues of increased demand. A reduction in discharge capacity is a major contributory factor that results in unnecessary increases in length of stay. PMID:21117373

  7. Understanding the current state of patient flow in a hospital.

    PubMed

    Allder, Steven; Silvester, Kate; Walley, Paul

    2010-10-01

    The challenge of generating bed availability is constant in most NHS acute trusts. Building on previous work applying queue theory, this paper now takes operational data from one NHS trust, collected over a period of more than a year, to provide an evidence base and to establish the practical challenges associated with demand variation and managing length of stay. The problem is split into three separate parts. Daily bed shortages are mostly influenced by the timing of arrival and discharge of patients with a short length of stay. Patients who stay for longer than one to two days contribute most significantly to the observed weekly bed availability problem. The problems associated with bed shortages around Christmas time and into the New Year are not simply issues of increased demand. A reduction in discharge capacity is a major contributory factor that results in unnecessary increases in length of stay.

  8. Understanding minority patients’ beliefs about hypertension to reduce gaps in communication between patients and clinicians

    PubMed Central

    Kronish, Ian M; Leventhal, Howard; Horowitz, Carol R

    2011-01-01

    Our objective was to gain a better understanding of minority patients’ beliefs about hypertension and to use this understanding to develop a model to explain gaps in communication between patients and clinicians. Eighty-eight hypertensive Black and Latino adults from four inner-city primary care clinics participated in focus groups to elucidate views on hypertension. Participants believed that hypertension was a serious illness in need of treatment. Participants’ diverged from the medical model in their beliefs about the time-course of hypertension (believed hypertension was intermittent); causes of hypertension (believed stress, racism, pollution, and poverty were the important causes); symptoms of hypertension (believed hypertension was primarily present when symptomatic); and treatments for hypertension (preferred alternative treatments that reduced stress over prescription medications). Participants distrusted clinicians who prioritized medications that did not directly address their understanding of the causes or symptoms of hypertension. Patients’ models of understanding chronic asymptomatic illnesses such as hypertension challenge the legitimacy of lifelong, pill-centered treatment. Listening to patients’ beliefs about hypertension may increase trust, improve communication, and encourage better self-management of hypertension. PMID:22235822

  9. A survey of patients with haemophilia to understand how they track product used at home.

    PubMed

    Sholapur, N S; Barty, R; Wang, G; Almonte, T; Heddle, N M

    2013-09-01

    Record keeping among individuals who manage haemophilia at home is an essential tool of communication between patient and Haemophilia Treatment Center (HTC). Complete records help HTCs monitor patients, their use of factor and ensure treatment is optimal. HTCs provide patients with a number of methods to track infusion practices. The study objectives were to: [1] determine the current methods of record keeping; [2] identify previous methods of record keeping; [3] understand the strengths and weaknesses associated with each method; and [4] gather suggestions for improvement. Survey methods were used to address the research objectives. Of the 83 patients in the Hamilton-Niagara region who received the survey distributed through the local HTC, 51 returned surveys were included into the analysis. Descriptive statistics were used. Results indicate individuals with haemophilia record infusion practices using: paper diaries, excel spreadsheets, hand-held PDAs and/or the online EZ-Log Web Client. The most popular method of record keeping was EZ-Log (45.1%) followed by paper diaries (35.2%). Advantages to using paper methods include the visual tracking of information and retaining hardcopies. The disadvantage was the inconvenience of physically submitting the records monthly. Advantages to using the online EZ-Log Web Client included ease of use and improved accuracy. The primary disadvantage was technical errors that were difficult to troubleshoot. Record keeping practices among individuals with haemophilia seem to vary according to personal preference and convenience. Respondents suggested that saving infusion history, incorporating barcode scanners or a copy and paste function could improve electronic methods.

  10. A survey of patients with haemophilia to understand how they track product used at home.

    PubMed

    Sholapur, N S; Barty, R; Wang, G; Almonte, T; Heddle, N M

    2013-09-01

    Record keeping among individuals who manage haemophilia at home is an essential tool of communication between patient and Haemophilia Treatment Center (HTC). Complete records help HTCs monitor patients, their use of factor and ensure treatment is optimal. HTCs provide patients with a number of methods to track infusion practices. The study objectives were to: [1] determine the current methods of record keeping; [2] identify previous methods of record keeping; [3] understand the strengths and weaknesses associated with each method; and [4] gather suggestions for improvement. Survey methods were used to address the research objectives. Of the 83 patients in the Hamilton-Niagara region who received the survey distributed through the local HTC, 51 returned surveys were included into the analysis. Descriptive statistics were used. Results indicate individuals with haemophilia record infusion practices using: paper diaries, excel spreadsheets, hand-held PDAs and/or the online EZ-Log Web Client. The most popular method of record keeping was EZ-Log (45.1%) followed by paper diaries (35.2%). Advantages to using paper methods include the visual tracking of information and retaining hardcopies. The disadvantage was the inconvenience of physically submitting the records monthly. Advantages to using the online EZ-Log Web Client included ease of use and improved accuracy. The primary disadvantage was technical errors that were difficult to troubleshoot. Record keeping practices among individuals with haemophilia seem to vary according to personal preference and convenience. Respondents suggested that saving infusion history, incorporating barcode scanners or a copy and paste function could improve electronic methods. PMID:23672744

  11. Understanding situation awareness and its importance in patient safety.

    PubMed

    Gluyas, Heather; Harris, Sarah-Jane

    2016-04-20

    Situation awareness describes an individual's perception, comprehension and subsequent projection of what is going on in the environment around them. The concept of situation awareness sits within the group of non-technical skills that include teamwork, communication and managing hierarchical lines of communication. The importance of non-technical skills has been recognised in safety-critical industries such as aviation, the military, nuclear, and oil and gas. However, health care has been slow to embrace the role of non-technical skills such as situation awareness in improving outcomes and minimising the risk of error. This article explores the concept of situation awareness and the cognitive processes involved in maintaining it. In addition, factors that lead to a loss of situation awareness and strategies to improve situation awareness are discussed. PMID:27097212

  12. Understanding Why Patients Return to the Emergency Department after Mild Traumatic Brain Injury within 72 Hours

    PubMed Central

    Ganti, Latha; Conroy, Lauren M.; Bodhit, Aakash; Daneshvar, Yasamin; Patel, Pratik Shashikant; Ayala, Sarah; Kuchibhotla, Sudeep; Hatchitt, Kelsey; Pulvino, Christa; Peters, Keith R.; Lottenberg, Lawrence L.

    2015-01-01

    Introduction Although there are approximately 1.1 million case presentations of mild traumatic brain injury (mTBI) in the emergency department (ED) each year, little data is available to clinicians to identify patients who are at risk for poor outcomes, including 72-hour ED return after discharge. An understanding of patients at risk for ED return visits during the hyperacute phase following head injury would allow ED providers to develop clinical interventions that reduce its occurrence and improve outcomes. Methods This institutional review board-approved consecutive cohort study collected injury and outcome variables on adults with the purpose of identifying positive predictors for 72-hour ED return visits in mTBI patients. Results Of 2,787 mTBI patients, 145 (5%) returned unexpectedly to the ED within 72 hours of hospital discharge. Positive predictors for ED return visits included being male (p=0.0298), being black (p=0.0456), having a lower prehospital Glasgow Coma Score (p=0.0335), suffering the injury due to a motor vehicle collision (p=0.0065), or having a bleed on head computed tomography (CT) (p=0.0334). ED return visits were not significantly associated with age, fracture on head CT, or symptomology following head trauma. Patients with return visits most commonly reported post-concussion syndrome (43.1%), pain (18.7%), and recall for further clinical evaluation (14.6%) as the reason for return. Of the 124 patients who returned to the ED within 72 hours, one out of five were admitted to the hospital for further care, with five requiring intensive care unit stays and four undergoing neurosurgery. Conclusion Approximately 5% of adult patients who present to the ED for mTBI will return within 72 hours of discharge for further care. Clinicians should identify at-risk individuals during their initial visits and attempt to provide anticipatory guidance when possible. PMID:25987933

  13. Improving the revenue cycle by taking the patient's perspective.

    PubMed

    Langford, April; Dye, Lyda; Moresco, Jessica; Riefner, Donald C

    2010-09-01

    UPMC revenue cycle operations analyzed front-end processes to improve them, thereby also improving the patient experience. UPMC focused on scheduling, eligibility/insurance verification, and financial counseling to develop an integrated work flow ensuring data integrity and expediting account resolution. Automating the processes increased efficiency and reduced errors, while improving patient satisfaction.

  14. Improving the quality of patient handover on a surgical ward.

    PubMed

    Bradley, Alison

    2014-01-01

    The European Working Time Directive means safe patient hand over is imperative. It is the responsibility of every doctor and an issue of patient safety and clinical governance [1]. The aims of this project were to improve the quality of patient handover between combined assessment unit (CAU) and surgical ward FY1 doctors. The Royal College of Surgeons England (RCSEng) guidelines on surgical patient handover [1] were used as the standard. Data was collected throughout November 2013. A handover tool was then introduced and attached to the front of patient notes when a patient was transferred from CAU to the surgical ward. The doctor handing over the patient and the ward doctor receiving the handover signed this document. Policy was also changed so that handover should take place once the patient had received senior review on the CAU and was deemed appropriate for transfer to the surgical ward. Data from the handover tool was collated and checked against the list of surgical admission for February 2014. The number of patients handed over improved from 15 % to 45%. The quality of patient handover also improved. 0 patient handovers in November 2013 included all of the information recommended by the RCSEng guidelines. 100% of the patient handovers in February 2014 contained all the recommended information. Introduction of a handover tool and formalisation of timing of patient handover helped to improve quality and number of patients being handed over. Further work needs to be done to improve safe handover of surgical patients, particularly out of hours.

  15. Understanding the direct and indirect costs of patients with schizophrenia.

    PubMed

    Tajima-Pozo, Kazuhiro; de Castro Oller, María Jesús; Lewczuk, Adrian; Montañes-Rada, Francisco

    2015-01-01

    Background : Schizophrenia is a disabling mental disorder with high prevalence and that usually  requires long-term follow-up and expensive lifelong treatment. The cost of schizophrenia treatment consumes a significant amount of the health services' budget in western countries. Objective : The aim of the study was to find out about the costs related to schizophrenia across different european countries and compare them. Results : Schizophrenia treatment costs an estimated 18 billion euros annually worldwide. The direct costs associated with medical help are only part of the total expenditure. The indirect costs are an equally (or even more)important part of the total cost. These expenses are related to the lack of productivity of schizophrenic patients and the cost that relatives have to bear as a result of taking care of their affected relatives. Conclusions : Although data on the cost of schizophrenia may vary slightly between different european countries, the general conclusion that can be drawn is that schizophrenia is a very costly disorder. Not only because of direct costs related to medical procedures, but also due to the non-medical (indirect) costs. Together this suggests the need to investigate cost-efficient strategies that could provide a better outcome for schizophrenic patients, as well as the people who care for them. PMID:26339474

  16. How patients understand the term ‘nonmedical use’ of prescription drugs: insights from cognitive interviews

    PubMed Central

    Halkitis, Perry N.; Horton, Ariana; Khan, Rubina; Gourevitch, Marc N.

    2013-01-01

    Background With rising rates of prescription drug abuse and associated overdose deaths, there is great interest in having accurate and efficient screening tools that identify nonmedical use of prescription drugs in health care settings. We sought to gain a better understanding of how patients interpret questions about misuse of prescription drugs, with the goal of improving the accuracy and acceptability of instruments intended for use in primary care. Methods A total of 27 English speaking adult patients were recruited from an urban safety net primary care clinic to complete a cognitive interview about a four-item screening questionnaire for tobacco, alcohol, illicit drugs, and misuse of prescription drugs. Detailed field notes were analyzed for overall comprehension of the screening items on illicit drug use and prescription drug misuse, the accuracy with which participants classified drugs into these categories, and whether the screening response correctly captured the participant’s substance use behavior. Results Based on initial responses to the screening items, 6 (22%) participants screened positive for past year prescription drug misuse, and 8 (30%) for illicit drug use. The majority (26/27) of participants correctly interpreted the item on illicit drug use, and appropriately classified drugs in this category. Eleven (41%) participants had errors in their understanding of the prescription drug misuse item. The most common error was including use of medications without abuse potential as misuse. All cases of misunderstanding prescription drug misuse occurred among participants who screened negative for illicit drug use. Conclusions Our results suggest that terminology used to describe misuse of prescription medications may be misunderstood by many primary care patients, particularly those who do not use illicit drugs. Failure to improve upon the language used to describe prescription drug misuse in screening questionnaires intended for use in medical

  17. Understanding and Managing Erectile Dysfunction in Patients Treated for Cancer.

    PubMed

    Annam, Kiran; Voznesensky, Maria; Kreder, Karl J

    2016-04-01

    Cancer can cause sexual adverse effects by direct and indirect pathways. It can involve sexual organs, indirectly affect body image, or cause fatigue or depression with subsequent effects on libido. Erectile dysfunction (ED), the inability to obtain or maintain an erection firm enough for sexual intercourse, can also result from adverse effects of cancer treatment, such as fatigue, pain, or anxiety about therapy. In addition, depressed feelings about having cancer can affect sexuality, causing a range of signs and symptoms that can lead to ED. Chemotherapy, hormone therapy, surgery, and radiation can all cause sexual adverse effects. Additional factors that play a role include patient age and degree of ED before starting cancer treatment. In this article, we discuss how chemotherapy, hormone therapy, surgery, and radiation affect erectile function as well as possible treatment options for ED. PMID:27072383

  18. "Hello, hello--it's English I speak!": a qualitative exploration of patients' understanding of the science of clinical trials.

    PubMed

    Stead, M; Eadie, D; Gordon, D; Angus, K

    2005-11-01

    Informed consent may be seriously compromised if patients fail to understand the experimental nature of the trial in which they are participating. Using focus groups, the authors explored how prospective trial participants interpret and understand the science of clinical trials by using patient information sheets relative to their medical condition. An opportunity was provided to hear in the patients' own words how they interpret the information and why there is variable understanding. Respondents struggled to comprehend the meaning and purpose of concepts such as randomisation and double blinding, and found them threatening to their ideas of medical care. Suggestions are made about how to improve the national guidelines on written information for trial participants and pretesting of the information sheets is advocated.

  19. Look Through Patients' Eyes to Improve the Delivery of Care.

    PubMed

    2016-07-01

    By developing and implementing a method for seeing the healthcare experience from the standpoint of patients and family members, the University of Pittsburgh Medical Center has improved care delivery, lowered costs, and improved patient satisfaction. Cross-functional, multidisciplinary teams use a six-step patient and family-centered care methodology to identify gaps and develop changes that will improve the patient experience and clinical outcomes. Committee members shadow patients and family members to get firsthand knowledge about what they are going through and what goes wrong and what goes right. The teams proposed minor and major changes, but none involve adding more staff and few involve more expenditures. PMID:27434940

  20. Using the synergy model of patient care in understanding the lived emergency department experiences of patients, family members and their nurses during critical illness: a phenomenological study.

    PubMed

    Cypress, Brigitte S

    2013-01-01

    Despite many studies conducted aimed to understand and improve emergency care, research on the triad of nurses, patients, and family members looking at the lived emergency department experiences and their perspective of each from the other is notably absent. In a hermeneutic phenomenological study using van Manen's method, a sample of 10 patients, 5 family members, and 8 nurses of a nonprofit community hospital was recruited and interviewed in 2010 to 2011 to explore, understand, and describe their lived experiences during critical illness in the emergency department. The nurses perceived that addressing the patient's physiologic deficit promptly is vital in the emergency department as well as including family members as coparticipants in the care. Patients and family members perceived that communication, critical thinking, sensitivity, and caring are essential for emergency department nurses. The American Association of Critical-Care Nurses' Synergy Model for Patient Care was applied in conceptualizing the findings and served as a framework in recommending practices and interventions geared toward improving competencies required in caring for critically ill patients and their families in the emergency department. The study supports recognizing the patient and family as active participants in the patient's medical care; encouraging family-member presence and creating institutional policies for patient- and family-centered care, as well as encouraging the development of ongoing programs that will recognize, enhance, and support the psychological and emotional well-being of emergency department nurses.

  1. Understanding and Managing Pregnancy in Patients with Lupus

    PubMed Central

    de Jesus, Guilherme Ramires; Mendoza-Pinto, Claudia; de Jesus, Nilson Ramires; dos Santos, Flávia Cunha; Klumb, Evandro Mendes; Carrasco, Mario García; Levy, Roger Abramino

    2015-01-01

    Systemic lupus erythematosus (SLE) is a chronic, multisystemic autoimmune disease that occurs predominantly in women of fertile age. The association of SLE and pregnancy, mainly with active disease and especially with nephritis, has poorer pregnancy outcomes, with increased frequency of preeclampsia, fetal loss, prematurity, growth restriction, and newborns small for gestational age. Therefore, SLE pregnancies are considered high risk condition, should be monitored frequently during pregnancy and delivery should occur in a controlled setting. Pregnancy induces dramatic immune and neuroendocrine changes in the maternal body in order to protect the fetus from immunologic attack and these modifications can be affected by SLE. The risk of flares depends on the level of maternal disease activity in the 6–12 months before conception and is higher in women with repeated flares before conception, in those who discontinue useful medications and in women with active glomerulonephritis at conception. It is a challenge to differentiate lupus nephritis from preeclampsia and, in this context, the angiogenic and antiangiogenic cytokines are promising. Prenatal care of pregnant patients with SLE requires close collaboration between rheumatologist and obstetrician. Planning pregnancy is essential to increase the probability of successful pregnancies. PMID:26246905

  2. Improved patient pathways can prevent overcrowding.

    PubMed

    Emeny, Russell; Vincent, Connolly

    2013-03-01

    Emergency department (ED) crowding is a common problem throughout the western world. Not only does crowding create a miserable environment for patients, and to considerable stress and poor job satisfaction among staff, it can also lead EDs to breach the four-hour standard and other care quality indicators. In addition, crowding in EDs correlates with increases in patient mortality, rates of admission, lengths of inpatient stay and costs. This article argues that crowding is best tackled by the consistent application of eight principles, derived from various guidance, to emergency patient pathways, particularly those in acute settings. PMID:23586168

  3. Using Digital Multimedia to Improve Parents’ and Children’s Understanding of Clinical Trials

    PubMed Central

    Tait, Alan R.; Voepel-Lewis, Terri; Levine, Robert

    2015-01-01

    Objective Data show that many research subjects have difficulty understanding study information using traditional paper consent documents. This study, therefore, was designed to evaluate the effect of an interactive multimedia program on improving parents’ and children’s understanding of clinical trial concepts and participation. Methods Parents (n = 148) and children (n = 135) were each randomized to receive information regarding clinical trials using either a traditional paper format (TF) or an interactive iPad program (IP) with in-line exercises. Participants’ understanding of the information was assessed using semi-structured interviews prior to (pre-test) and after (post-test) receiving the information. Participants also completed a short survey to assess their perceptions of the information delivery and satisfaction with the process. Results Regardless of the mode of information delivery, all participants demonstrated improved pre- to post-test understanding. While there were no statistical differences in parents’ post-test understanding between the TF and IP groups, children in the IP group had significantly greater post-test understanding compared with children in the TF group (11.65(4.1) vs 8.85(4.1) [2.8, 1.4,4.2] 0–18 scale where 18 = complete understanding). Furthermore, the IP was found to be significantly “easier to follow” and “more effective” in presenting information compared with the TF. Conclusions Results demonstrated the importance of providing information regarding clinical trial concepts to parents and children. Importantly, the ability of interactive multimedia to improve understanding of clinical trial concepts and satisfaction with information delivery, particularly among children, supports this approach as a novel and effective vehicle for enhancing the informed consent process. PMID:25829422

  4. Improving the Quality and Scientific Understanding of Trophic Magnification Factors (TMFs)

    EPA Science Inventory

    This short 1000 word report presents a series of research needs for improving the measurement and understanding of trophic magnification factors (TMFs). TMFs are useful measures of trophic magnification and represent the diet-weighted average biomagnification factor (BMF) of che...

  5. Scaffolded Instruction Improves Student Understanding of the Scientific Method & Experimental Design

    ERIC Educational Resources Information Center

    D'Costa, Allison R.; Schlueter, Mark A.

    2013-01-01

    Implementation of a guided-inquiry lab in introductory biology classes, along with scaffolded instruction, improved students' understanding of the scientific method, their ability to design an experiment, and their identification of experimental variables. Pre- and postassessments from experimental versus control sections over three semesters…

  6. Social and Economic Benefits of Improved Adult Literacy: Towards a Better Understanding: Support Document

    ERIC Educational Resources Information Center

    Hartley, Robyn; Horne, Jackie

    2005-01-01

    This document was produced by the authors based on their research for the report, "Social and Economic Benefits of Improved Adult Literacy: Towards a Better Understanding," and is an added resource for further information. The original document is a feasibility study which explores the frameworks and methodologies available for determining and…

  7. A Review of Some Promising Approaches To Understanding and Improving Thinking Skills.

    ERIC Educational Resources Information Center

    Newsome, George L., III

    2000-01-01

    Examines the thinking and reasoning skills today's students need, reviewing promising approaches to understanding and improving these skills offered by cognitive psychologists and philosophers, evaluating the contributions of each approach, and suggesting how explanations offered by cognitive psychologists and criteria for evaluating students'…

  8. Water Literacy in College Freshmen: Could a Cognitive Imagery Strategy Improve Understanding?

    ERIC Educational Resources Information Center

    Ewing, Margaret S.; Mills, Terence J.

    1994-01-01

    Presents a study designed to determine whether levels of water literacy differed between (n=83) college freshman nonscience majors having one versus two years of high school science coursework, visual imagery exercises could improve understanding of the water cycle, and patterns exist in the concept of the water cycle. (Contains 23 references.)…

  9. Improving the Conceptual Understanding in Kinematics Subject Matter with Hypertext Media Learning and Formal Thinking

    ERIC Educational Resources Information Center

    Manurung, Sondang R.; Mihardi, Satria

    2016-01-01

    The purpose of this study was to determine the effectiveness of hypertext media based kinematic learning and formal thinking ability to improve the conceptual understanding of physic prospective students. The research design used is the one-group pretest-posttest experimental design is carried out in the research by taking 36 students on from…

  10. Book review: Darwinian agriculture: How understanding evolution can improve agriculture by R. Ford Dennison

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Agricultural research continually seeks to increase productivity while protecting soil, water and genetic resources. The book Darwinian Agriculture: How Understanding Evolution Can Improve Agriculture, by R. Ford Dennison, delivers a thought-provoking view of how principles of ecology and evolution ...

  11. Managing Resources and Relations in Higher Education Institutions: A Framework for Understanding Performance Improvement

    ERIC Educational Resources Information Center

    Ho, Sophia Shi-Huei; Peng, Michael Yao-Ping

    2016-01-01

    Changes in social systems demonstrate that various structural disadvantages have jointly led to increasing competition among higher education institutions (HEIs) in many countries, especially Taiwan. Institutional administrators must recognize the need to understand how to improve performance and consistently outperform other institutions.…

  12. Understanding the Evolving Roles of Improvement-Oriented High School Teachers in Gilgit-Baltistan

    ERIC Educational Resources Information Center

    Ali, Takbir

    2011-01-01

    In this paper the author presents a framework for understanding how improvement-oriented high school teachers' accounts of change experiences portray their evolving roles as change agents in school reform. The data on which this paper is based come from a one-year long in-depth study (doctoral thesis research project) in which the author set out…

  13. Improving patient safety: lessons from other disciplines.

    PubMed

    Golemboski, Karen

    2011-01-01

    Other industries and certain healthcare specialties have employed a variety of methods to improve safety and quality of services. Techniques such as industry-wide standardized collection and reporting of error data, standardization of practice through checklists, application of electronic health records, and simulator-based interdisciplinary training have improved outcomes in aviation, anesthesiology, and surgery. Although traditionally the clinical laboratory has concentrated on analytical performance, pre- and post-analytical aspects of laboratory services may also be improved through the application of these methods. PMID:21657145

  14. How patients understand depression associated with chronic physical disease – a systematic review

    PubMed Central

    2012-01-01

    Background Clinicians are encouraged to screen people with chronic physical illness for depression. Screening alone may not improve outcomes, especially if the process is incompatible with patient beliefs. The aim of this research is to understand people’s beliefs about depression, particularly in the presence of chronic physical disease. Methods A mixed method systematic review involving a thematic analysis of qualitative studies and quantitative studies of beliefs held by people with current depressive symptoms. MEDLINE, EMBASE, PSYCHINFO, CINAHL, BIOSIS, Web of Science, The Cochrane Library, UKCRN portfolio, National Research Register Archive, Clinicaltrials.gov and OpenSIGLE were searched from database inception to 31st December 2010. A narrative synthesis of qualitative and quantitative data, based initially upon illness representations and extended to include other themes not compatible with that framework. Results A range of clinically relevant beliefs was identified from 65 studies including the difficulty in labeling depression, complex causal factors instead of the biological model, the roles of different treatments and negative views about the consequences of depression. We found other important themes less related to ideas about illness: the existence of a self-sustaining ‘depression spiral’; depression as an existential state; the ambiguous status of suicidal thinking; and the role of stigma and blame in depression. Conclusions Approaches to detection of depression in physical illness need to be receptive to the range of beliefs held by patients. Patient beliefs have implications for engagement with depression screening. PMID:22640234

  15. Understanding the purpose of treatment and expectations in patients with inoperable lung cancer treated with palliative chemotherapy

    PubMed Central

    Woźniak, Karolina; Krajnik, Małgorzata

    2015-01-01

    Aim of the study Informing cancer patients about various types of treatment and their adverse effects and communicating negative information is an important element of diagnostic and therapeutic procedures. Understanding the purpose of treatment and expectations, and socio-demographic factors in patients undergoing palliative chemotherapy because of lung cancer. Material and methods The study included 100 patients with lung cancer at the age of 40–80 years (mean 63.1) in the Oncology Center in Bydgoszcz in 2013–2014. The diagnostic survey method with the author's questionnaire was used. Results Forty-one percent of patients were convinced that the purpose of chemotherapy is to cure the disease. Both inhabitants of small towns (population below 50 thousand) and large villages (p = 0.09) were similarly convinced about the effectiveness of chemotherapy. Seventy-three percent of inhabitants of small towns and 79% of country dwellers (p = 0.005) thought that chemotherapy is aimed at improving the quality of life. Patients with very good economic conditions responded that chemotherapy is designed to improve the quality of life more often than those with good and bad economic conditions, 90%, 88% and 60%, respectively (p = 0.001). With the increase in population the number of people who claimed that palliative chemotherapy prolongs their life increased, 71%, 77% and 90%, respectively (p = 0.03). Conclusions The knowledge of patients with lung cancer about palliative chemotherapy is insufficient. Almost half of them do not understand the purpose of treatment and hope that chemotherapy will cure them of the disease. Most patients know that the aim of chemotherapy is to alleviate symptoms and improve quality of life and prolong their life. Half of the patients want to obtain information on treatment and half of them about life expectancy. Almost half of the patients feel stress and anxiety towards chemotherapy. Most patients do not use the help of a psychologist and do

  16. Confirming delivery: understanding the role of the hospitalized patient in medication administration safety.

    PubMed

    Macdonald, Marilyn T; Heilemann, MarySue V; MacKinnon, Neil J; Lang, Ariella; Gregory, David; Gurnham, Mary Ellen; Fillatre, Theresa

    2014-04-01

    The purpose of our study was to gain an understanding of current patient involvement in medication administration safety from the perspectives of both patients and nursing staff members. Administering medication is taken for granted and therefore suited to the development of theory to enhance its understanding. We conducted a constructivist, grounded theory study involving 24 patients and 26 nursing staff members and found that patients had the role of confirming delivery in the administration of medication. Confirming delivery was characterized by three interdependent subprocesses: engaging in the medication administration process, being "half out of it" (patient mental status), and perceiving time. We believe that ours is one of the first qualitative studies on the role of hospitalized patients in administering medication. Medication administration and nursing care systems, as well as patient mental status, impose limitations on patient involvement in safe medication administration.

  17. Social simulation theory: a framework to explain nurses' understanding of patients' experiences of ill-health.

    PubMed

    Nordby, Halvor

    2016-09-01

    A fundamental aim in caring practice is to understand patients' experiences of ill-health. These experiences have a qualitative content and cannot, unlike thoughts and beliefs with conceptual content, directly be expressed in words. Nurses therefore face a variety of interpretive challenges when they aim to understand patients' subjective perspectives on disease and illness. The article argues that theories on social simulation can shed light on how nurses manage to meet these challenges. The core assumption of social simulationism is that we do not understand other people by forming mental representations of how they think, but by putting ourselves in their situation in a more imaginative way. According to simulationism, any attempt to understand a patient's behavior is made on the basis of simulating what it is like to be that patient in the given context. The article argues that this approach to social interpretation can clarify how nurses manage to achieve aims of patient understanding, even when they have limited time to communicate and incomplete knowledge of patients' perspectives. Furthermore, simulation theory provides a normative framework for interpretation, in the sense that its theoretical assumptions constitute ideals for how nurses should seek to understand patients' experiences of illness.

  18. Improving outcomes in patients with cystic fibrosis.

    PubMed

    Warwick, Geoffrey; Elston, Caroline

    2011-01-01

    Cystic fibrosis (CF) is the most common fatal inherited disease in Caucasian people. Inheritance follows an autosomal recessive pattern. Recent data indicate that there are more than 9,000 patients with CF in the UK. At a cellular level there is an abnormal CF transmembrane conductance regulator (CFTR), a protein essential for chloride and sodium homoeostasis, caused by a mutation in the CF gene. The consequence of this abnormal protein is thick, viscous secretions in the lungs and GI tract, which lead to recurrent lung infections and pancreatic insufficiency with intestinal malabsorption. Most patients present in early childhood with classic CF. They show one or more of the typical CF phenotypic characteristics (chronic pulmonary disease, GI symptoms and malabsorption, nutritional abnormalities and sinus disease). A minority of patients have atypical CF. They tend to present at an older age, often in adulthood, are mainly pancreatic sufficient, have milder disease and a better prognosis. When CF is suspected the diagnosis can be confirmed by measuring sweat chloride concentration and by looking for CFTR mutations. Immunoreactive trypsinogen is measured in blood taken from a heel prick in all neonates, and is a marker of pancreatic injury consistent with (but not specific for) CF. PMID:21932505

  19. Accelerating patient-care improvement in the ED.

    PubMed

    Forrester, Nancy E

    2003-08-01

    Quality improvement is always in the best interest of healthcare providers. One hospital examined the patient-care delivery process used in its emergency department to determine ways to improve patient satisfaction while increasing the effectiveness and efficiency of healthcare delivery. The hospital used activity-based costing (ABC) plus additional data related to rework, information opportunity costs, and other effectiveness measures to create a process map that helped it accelerate diagnosis and improve redesign of the care process. PMID:12938618

  20. Lean Manufacturing Improves Emergency Department Throughput and Patient Satisfaction.

    PubMed

    Kane, Marlena; Chui, Kristen; Rimicci, Janet; Callagy, Patrice; Hereford, James; Shen, Sam; Norris, Robert; Pickham, David

    2015-09-01

    A multidisciplinary team led by nursing leadership and physicians developed a plan to meet increasing demand and improve the patient experience in the ED without expanding the department's current resources. The approach included Lean tools and engaged frontline staff and physicians. Applying Lean management principles resulted in quicker service, improved patient satisfaction, increased capacity, and reduced resource utilization. Incorporating continuous daily management is necessary for sustainment of continuous improvement activities. PMID:26252725

  1. Lean Manufacturing Improves Emergency Department Throughput and Patient Satisfaction.

    PubMed

    Kane, Marlena; Chui, Kristen; Rimicci, Janet; Callagy, Patrice; Hereford, James; Shen, Sam; Norris, Robert; Pickham, David

    2015-09-01

    A multidisciplinary team led by nursing leadership and physicians developed a plan to meet increasing demand and improve the patient experience in the ED without expanding the department's current resources. The approach included Lean tools and engaged frontline staff and physicians. Applying Lean management principles resulted in quicker service, improved patient satisfaction, increased capacity, and reduced resource utilization. Incorporating continuous daily management is necessary for sustainment of continuous improvement activities.

  2. Regional anesthesia for the trauma patient: improving patient outcomes.

    PubMed

    Gadsden, Jeff; Warlick, Alicia

    2015-01-01

    Trauma is a significant health problem and a leading cause of death in all age groups. Pain related to trauma is frequently severe, but is often undertreated in the trauma population. Opioids are widely used to treat pain in injured patients but have a broad range of undesirable effects in a multitrauma patient such as neurologic and respiratory impairment and delirium. In contrast, regional analgesia confers excellent site-specific pain relief that is free from major side effects, reduces opioid requirement in trauma patients, and is safe and easy to perform. Specific populations that have shown benefits (including morbidity and mortality advantages) with regional analgesic techniques include those with fractured ribs, femur and hip fractures, and patients undergoing digital replantation. Acute compartment syndrome is a potentially devastating sequela of soft-tissue injury that complicates high-energy injuries such as proximal tibia fractures. The use of regional anesthesia in patients at risk for compartment syndrome is controversial; although the data is sparse, there is no evidence that peripheral nerve blocks delay the diagnosis, and these techniques may in fact facilitate the recognition of pathologic breakthrough pain. The benefits of regional analgesia are likely most influential when it is initiated as early as possible, and the performance of nerve blocks both in the emergency room and in the field has been shown to provide quality pain relief with an excellent safety profile. PMID:26316813

  3. Application of Bow-tie methodology to improve patient safety.

    PubMed

    Abdi, Zhaleh; Ravaghi, Hamid; Abbasi, Mohsen; Delgoshaei, Bahram; Esfandiari, Somayeh

    2016-05-01

    Purpose - The purpose of this paper is to apply Bow-tie methodology, a proactive risk assessment technique based on systemic approach, for prospective analysis of the risks threatening patient safety in intensive care unit (ICU). Design/methodology/approach - Bow-tie methodology was used to manage clinical risks threatening patient safety by a multidisciplinary team in the ICU. The Bow-tie analysis was conducted on incidents related to high-alert medications, ventilator associated pneumonia, catheter-related blood stream infection, urinary tract infection, and unwanted extubation. Findings - In total, 48 potential adverse events were analysed. The causal factors were identified and classified into relevant categories. The number and effectiveness of existing preventive and protective barriers were examined for each potential adverse event. The adverse events were evaluated according to the risk criteria and a set of interventions were proposed with the aim of improving the existing barriers or implementing new barriers. A number of recommendations were implemented in the ICU, while considering their feasibility. Originality/value - The application of Bow-tie methodology led to practical recommendations to eliminate or control the hazards identified. It also contributed to better understanding of hazard prevention and protection required for safe operations in clinical settings. PMID:27142951

  4. Application of Bow-tie methodology to improve patient safety.

    PubMed

    Abdi, Zhaleh; Ravaghi, Hamid; Abbasi, Mohsen; Delgoshaei, Bahram; Esfandiari, Somayeh

    2016-05-01

    Purpose - The purpose of this paper is to apply Bow-tie methodology, a proactive risk assessment technique based on systemic approach, for prospective analysis of the risks threatening patient safety in intensive care unit (ICU). Design/methodology/approach - Bow-tie methodology was used to manage clinical risks threatening patient safety by a multidisciplinary team in the ICU. The Bow-tie analysis was conducted on incidents related to high-alert medications, ventilator associated pneumonia, catheter-related blood stream infection, urinary tract infection, and unwanted extubation. Findings - In total, 48 potential adverse events were analysed. The causal factors were identified and classified into relevant categories. The number and effectiveness of existing preventive and protective barriers were examined for each potential adverse event. The adverse events were evaluated according to the risk criteria and a set of interventions were proposed with the aim of improving the existing barriers or implementing new barriers. A number of recommendations were implemented in the ICU, while considering their feasibility. Originality/value - The application of Bow-tie methodology led to practical recommendations to eliminate or control the hazards identified. It also contributed to better understanding of hazard prevention and protection required for safe operations in clinical settings.

  5. Being altered by the unexpected: understanding the perioperative patient's experience: a case study.

    PubMed

    Rudolfsson, Gudrun

    2014-08-01

    The present paper focuses on the process of understanding the patient in the context of perioperative caring and reports a story narrated by a perioperative nurse as well as her emerging understanding of the patient prior to surgery at an operating department. This qualitative case study had a dual purpose; firstly, to describe how the perioperative nurse's understanding of the patient emerged and, secondly, to establish how the researcher interpreted the situation. As a perioperative nurse and researcher, the author is both the narrator and interpreter. To date we have rarely discussed the fact that, in a perioperative context, the patient might feel ashamed of his/her body, even before arriving at the operating department. This new understanding emerged from the hermeneutical dialogue in the present study. PMID:24118543

  6. Saskatchewan: improving patient, nursing and organizational outcomes utilizing formal nurse-patient ratios.

    PubMed

    Rozdilsky, Janlyn; Alecxe, Amber

    2012-03-01

    The issue of nurse-to-patient ratios has been of significant interest to nurses in Saskatchewan. A commitment to a nurse-to-patient pilot project was articulated in a letter of understanding in the 2005 to 2008 contract between the Saskatchewan Union of Nurses (SUN) and the Saskatchewan Association of Health Organizations. The SUN, the Saskatoon Health Region and the Saskatchewan Ministry of Health formed a partnership to engage in the pilot project, which lasted from November 2008 to March 2011. The project involved the creation of a flexible, dynamic and real-time staffing tool to inform day-to-day nurse staffing decisions on a hospital unit and was based on an adaptation of Curley's Synergy Model. A medical unit at St. Paul's Hospital in Saskatoon was selected for implementation, and all front-line nursing staff as well as unit nursing leaders were involved. A project working group adapted the Synergy-based Patient Scoring Tool (PST), which had been utilized for a recent project in British Columbia, to its own patient population. In April 2010, nurses began assessing each patient on every shift with the goal of determining the most suitable care provider. Patient assignment became based on the holistic assessment of patient needs according to the PST results rather than "geography" (for example, one nurse assigned to a multi-bed unit regardless of the acuity/capability of patients in the unit). Whenever possible, staffing on the unit was increased according to tool calculations.Positive impacts in patient outcomes began to be noted during the final data collection period for the project – nosocomial infection rates showed improvement, and the number of falls per patient-days decreased. As well, patient needs were made more visible through use of the PST, which created non-threatening opportunities for dialogue related to legislated scopes of practice. While longer timelines and larger sample size are needed to measure impacts on retention and recruitment of

  7. "What We Breathe Impacts Our Health: Improving Understanding of the Link between Air Pollution and Health".

    PubMed

    West, J Jason; Cohen, Aaron; Dentener, Frank; Brunekreef, Bert; Zhu, Tong; Armstrong, Ben; Bell, Michelle L; Brauer, Michael; Carmichael, Gregory; Costa, Dan L; Dockery, Douglas W; Kleeman, Michael; Krzyzanowski, Michal; Künzli, Nino; Liousse, Catherine; Lung, Shih-Chun Candice; Martin, Randall V; Pöschl, Ulrich; Pope, C Arden; Roberts, James M; Russell, Armistead G; Wiedinmyer, Christine

    2016-05-17

    Air pollution contributes to the premature deaths of millions of people each year around the world, and air quality problems are growing in many developing nations. While past policy efforts have succeeded in reducing particulate matter and trace gases in North America and Europe, adverse health effects are found at even these lower levels of air pollution. Future policy actions will benefit from improved understanding of the interactions and health effects of different chemical species and source categories. Achieving this new understanding requires air pollution scientists and engineers to work increasingly closely with health scientists. In particular, research is needed to better understand the chemical and physical properties of complex air pollutant mixtures, and to use new observations provided by satellites, advanced in situ measurement techniques, and distributed micro monitoring networks, coupled with models, to better characterize air pollution exposure for epidemiological and toxicological research, and to better quantify the effects of specific source sectors and mitigation strategies. PMID:27010639

  8. "What We Breathe Impacts Our Health: Improving Understanding of the Link between Air Pollution and Health".

    PubMed

    West, J Jason; Cohen, Aaron; Dentener, Frank; Brunekreef, Bert; Zhu, Tong; Armstrong, Ben; Bell, Michelle L; Brauer, Michael; Carmichael, Gregory; Costa, Dan L; Dockery, Douglas W; Kleeman, Michael; Krzyzanowski, Michal; Künzli, Nino; Liousse, Catherine; Lung, Shih-Chun Candice; Martin, Randall V; Pöschl, Ulrich; Pope, C Arden; Roberts, James M; Russell, Armistead G; Wiedinmyer, Christine

    2016-05-17

    Air pollution contributes to the premature deaths of millions of people each year around the world, and air quality problems are growing in many developing nations. While past policy efforts have succeeded in reducing particulate matter and trace gases in North America and Europe, adverse health effects are found at even these lower levels of air pollution. Future policy actions will benefit from improved understanding of the interactions and health effects of different chemical species and source categories. Achieving this new understanding requires air pollution scientists and engineers to work increasingly closely with health scientists. In particular, research is needed to better understand the chemical and physical properties of complex air pollutant mixtures, and to use new observations provided by satellites, advanced in situ measurement techniques, and distributed micro monitoring networks, coupled with models, to better characterize air pollution exposure for epidemiological and toxicological research, and to better quantify the effects of specific source sectors and mitigation strategies.

  9. Analysis of drought characteristics for improved understanding of a water resource system

    NASA Astrophysics Data System (ADS)

    Lennard, A. T.; Macdonald, N.; Hooke, J.

    2014-09-01

    Droughts are a reoccurring feature of the UK climate; recent drought events (2004-2006 and 2010-2012) have highlighted the UK's continued vulnerability to this hazard. There is a need for further understanding of extreme events, particularly from a water resource perspective. A number of drought indices are available, which can help to improve our understanding of drought characteristics such as frequency, severity and duration. However, at present little of this is applied to water resource management in the water supply sector. Improved understanding of drought characteristics using indices can inform water resource management plans and enhance future drought resilience. This study applies the standardised precipitation index (SPI) to a series of rainfall records (1962-2012) across the water supply region of a single utility provider. Key droughts within this period are analysed to develop an understanding of the meteorological characteristics that lead to, exist during and terminate drought events. The results of this analysis highlight how drought severity and duration can vary across a small-scale water supply region, indicating that the spatial coherence of drought events cannot be assumed.

  10. Quality of discharge practices and patient understanding at an academic medical center

    PubMed Central

    Horwitz, Leora I.; Moriarty, John P.; Chen, Christine; Fogerty, Robert L.; Brewster, Ursula C.; Kanade, Sandhya; Ziaeian, Boback; Jenq, Grace Y.; Krumholz, Harlan M.

    2013-01-01

    Importance With growing national focus on reducing readmissions, there is a need to comprehensively assess the quality of transitional care, including discharge practices, patient perspectives, and patient understanding. Objective To conduct a multifaceted evaluation of transitional care from a patient-centered perspective. Design Prospective observational cohort study, May 2009-April, 2010 Setting Urban, academic medical center Participants Patients 65 and older discharged home after hospitalization for acute coronary syndrome, heart failure or pneumonia. Main outcome measures Discharge practices, including presence of follow-up appointment and patient-friendly discharge instructions; patient understanding of diagnosis and follow-up appointment; and patient perceptions of and satisfaction with discharge care. Results The 395 enrolled patients (66.7% of eligible) had a mean age of 77.2 years. Although 349 (95.6%) patients reported understanding the reason they had been in the hospital, only 218 (59.6%) patients were able to accurately describe their diagnosis in post-discharge interviews. Discharge instructions routinely included symptoms to watch out for (98.4%), activity instructions (97.3%) and diet advice (89.7%) in lay language; however, 99 (26.3%) written reasons for hospitalization did not use language likely to be intelligible to patients. Of the 123 (32.6%) patients discharged with a scheduled primary care or cardiology appointment, 54 (43.9%) accurately recalled details of either appointment. During post-discharge interviews, 118 (30.0%) of patients reported receiving less than one day’s advance notice of discharge, and 246 (66.1%) reported that staff asked if they would have the support they needed at home before discharge. Conclusions Patient perceptions of discharge care quality and self-rated understanding were high and written discharge instructions were generally comprehensive though not consistently clear. However, follow-up appointments and

  11. What Do We Need To Do To Improve Our Understanding of How Volcanoes Affect Stratospheric Ozone?

    NASA Astrophysics Data System (ADS)

    Solomon, S.

    2015-12-01

    This talk will briefly survey what is known and what is not known about stratospheric ozone depletion and volcanic events, and will describe some ways to improve our understanding. Observations of total ozone following the eruption of El Chichon in the 1980s provided some of the earliest and clearest indications of the importance of volcanic aerosol on ozone depletion. In subsequent decades, improved laboratory information, modeling studies, and observations showed how heterogeneous chemical processing on and in volcanic aerosols could enhance chlorine-catalyzed ozone loss in the lower stratosphere, while decreasing nitrogen-catalyzed ozone loss in the upper stratosphere. Recent satellite observations shed important light on this chemistry but major gaps in understanding remain, including for example a lack of knowledge of whether hydrochloric acid can be efficiently taken up in stratospheric particles under cold conditions, interactions and competition between volcanic aerosols and ice clouds, and the effects of volcanic aerosols on chemistry in the tropopause region. Effects of volcanic aerosols on Arctic and Antarctic ozone depletion are also subject to many certainties, owing in large part to observational deficiencies. Implications for gaining an improved understanding through both laboratory studies and new observations will be briefly described.

  12. Reducing PICC migrations and improving patient outcomes.

    PubMed

    Elen Hughes, Meinir

    Inadvertent migration of central venous catheters can lead to several issues including delayed therapy and clinical morbidities such as thrombosis. Peripherally inserted central catheters (PICCs) are particularly at risk of movement. An innovative new device which allows anchorage of the catheter has proved very successful in the minimisation of catheter migration. The SecurAcath device incorporates a small blunt anchor which lies beneath the skin in order to secure the catheter in place and prevent inadvertent movement. An evaluation of 31 patients with a SecurAcath device in situ to secure a PICC found only one case of insignificant catheter migration. Some initial problems with infection and pain were encountered and interventions were put in place to minimise their incidence. SecurAcath removal proved to be the most significant challenge but this can be overcome with suitable guidance and training.

  13. Applying Transactional Analysis and Personality Assessment to Improve Patient Counseling and Communication Skills

    PubMed Central

    Lawrence, Lesa

    2007-01-01

    Objective To teach pharmacy students how to apply transactional analysis and personality assessment to patient counseling to improve communication. Design A lecture series for a required pharmacy communications class was developed to teach pharmacy students how to apply transactional analysis and personality assessment to patient counseling. Students were asked to apply these techniques and to report their experiences. A personality self-assessment was also conducted. Assessment After attending the lecture series, students were able to apply the techniques and demonstrated an understanding of the psychological factors that may affect patient communication, an appreciation for the diversity created by different personality types, the ability to engage patients based on adult-to-adult interaction cues, and the ability to adapt the interactive patient counseling model to different personality traits. Conclusion Students gained a greater awareness of transactional analysis and personality assessment by applying these concepts. This understanding will help students communicate more effectively with patients. PMID:17786269

  14. Understanding of definition and safety of oral health products among patients, physicians and pharmacists.

    PubMed

    Asahina, Yasuko; Hori, Satoko; Sawada, Yasufumi

    2010-07-01

    Our objective was to clarify the current understanding of the definition and safety of oral health products among patients and health professionals, and patients' perception about their communication with physicians and pharmacists regarding those products. Self-administered questionnaires were completed by patients at 17 community pharmacies in 14 prefectures of Japan. For health professionals, we sent a questionnaire to pharmacists and physicians who were registered as members of the Internet-based Medical Doctor's and Pharmacist's Information-Sharing System. The respondents were 242 patients, 158 physicians and 407 pharmacists. Some patients did not categorize dietary supplements as health products, while they did so categorize conventional foods (e.g., fermented soybeans, yogurt). Their understanding of the definition of health products was different from that of health professionals. Less than half of the patients considered that health products might potentiate or attenuate the effects of concomitant drugs, and this view was especially common among the elderly. The percentage of patients who reported that they rarely or never asked for advice from a pharmacist about their use of health products was significantly higher among those who had an incorrect understanding about health products. In conclusion, some patients' recognition of oral health products was different from that of health professionals, and most patients do not discuss their use of such products unless they are asked. Therefore, it is important for health professionals to check a patient's use of health products and be sure what he or she means when using the term 'health product'.

  15. Using the Health Literacy Universal Precautions Toolkit to Improve the Quality of Patient Materials.

    PubMed

    Brega, Angela G; Freedman, Megan A G; LeBlanc, William G; Barnard, Juliana; Mabachi, Natabhona M; Cifuentes, Maribel; Albright, Karen; Weiss, Barry D; Brach, Cindy; West, David R

    2015-01-01

    Patient materials are often written above the reading level of most adults. Tool 11 of the Health Literacy Universal Precautions Toolkit ("Design Easy-to-Read Material") provides guidance on ensuring that written patient materials are easy to understand. As part of a pragmatic demonstration of the Toolkit, we examined how four primary care practices implemented Tool 11 and whether written materials improved as a result. We conducted interviews to learn about practices' implementation activities and assessed the readability, understandability, and actionability of patient education materials collected during pre- and postimplementation site visits. Interview data indicated that practices followed many action steps recommended in Tool 11, including training staff, assessing readability, and developing or revising materials, typically focusing on brief documents such as patient letters and information sheets. Many of the revised and newly developed documents had reading levels appropriate for most patients and--in the case of revised documents--better readability than the original materials. In contrast, the readability, understandability, and actionability of lengthier patient education materials were poor and did not improve over the 6-month implementation period. Findings guided revisions to Tool 11 and highlighted the importance of engaging multiple stakeholders in improving the quality of patient materials. PMID:26513033

  16. Improving Patient Flow Utilizing a Collaborative Learning Model.

    PubMed

    Tibor, Laura C; Schultz, Stacy R; Cravath, Julie L; Rein, Russell R; Krecke, Karl N

    2016-01-01

    This initiative utilized a collaborative learning approach to increase knowledge and experience in process improvement and systems thinking while targeting improved patient flow in seven radiology modalities. Teams showed improvements in their project metrics and collectively streamlined the flow for 530 patients per day by improving patient lead time, wait time, and first case on-time start rates. In a post-project survey of 50 project team members, 82% stated they had more effective solutions as a result of the process improvement methodology, 84% stated they will be able to utilize the process improvement tools again in the future, and 98% would recommend participating in another project to a colleague. PMID:27514106

  17. Quality Improvement Project to Improve Patient Satisfaction With Pain Management: Using Human-Centered Design.

    PubMed

    Trail-Mahan, Tracy; Heisler, Scott; Katica, Mary

    2016-01-01

    In this quality improvement project, our health system developed a comprehensive, patient-centered approach to improving inpatient pain management and assessed its impact on patient satisfaction across 21 medical centers. Using human-centered design principles, a bundle of 6 individual and team nursing practices was developed. Patient satisfaction with pain management, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems pain composite score, increased from the 25th to just under the 75th national percentile.

  18. Analysis of drought characteristics from 1900-2012 for improved understanding of a water resource system

    NASA Astrophysics Data System (ADS)

    Lennard, Amy; Macdonald, Neil; Hooke, Janet

    2014-05-01

    Droughts are a reoccurring feature of the European climate; recent drought events (2004-2006 & 2010-2012) in the UK have highlighted a continued vulnerability to this hazard. The period 2010-2012 was characterised by departures from typical seasonal climatic conditions, resulting in a severe drought which had a severe impact on water resources. This highlighted the need for further understanding of extreme drought events, particularly from a water resource perspective. A number of drought indices are available, which can help to improve our understanding of drought characteristics such as frequency, severity and duration. However, at present little of this is applied to water resource management in the water supply sector. Improved understanding of drought characteristics using indices can inform water resource management plans and enhance future drought resilience. The UK has a rich source of historical rainfall data that has been underutilised in the analysis of drought characteristics at a regional scale. This study applies the standardised precipitation index (SPI) to a series of rainfall records (1900-2012) across the water supply region of a single utility provider. Key multi-year droughts within this period are analysed to develop an understanding of the meteorological characteristics that lead to, exist during and terminate drought events. The results of this analysis highlight how drought severity and duration can vary across a small-scale water supply region, indicating that the spatial coherence of drought events cannot be assumed. Variations in drought duration and severity across a region may have significant implications for water resource management during and after a drought event. A better understanding of regional drought characteristics is achievable by using historical data providing insight for the prediction of future of drought events.

  19. Combining Chemotherapy with Bevacizumab Improves Outcomes for Ovarian Cancer Patients

    Cancer.gov

    Results from two phase III randomized clinical trials suggest that, at least for some patients with ovarian cancer, adding the antiangiogenesis agent bevacizumab to chemotherapy increases the time to disease progression and may improve survival.

  20. Practice improvement, part II: update on patient communication technologies.

    PubMed

    Roett, Michelle A; Coleman, Mary Thoesen

    2013-11-01

    Patient portals (ie, secure web-based services for patient health record access) and secure messaging to health care professionals are gaining popularity slowly. Advantages of web portals include timely communication and instruction, access to appointments and other services, and high patient satisfaction. Limitations include inappropriate use, security considerations, organizational costs, and exclusion of patients who are uncomfortable with or unable to use computers. Attention to the organization's strategic plan and office policies, patient and staff expectations, workflow and communication integration, training, marketing, and enrollment can facilitate optimal use of this technology. Other communication technologies that can enhance patient care include automated voice or text reminders and brief electronic communications. Social media provide another method of patient outreach, but privacy and access are concerns. Incorporating telehealthcare (health care provided via telephone or Internet), providing health coaching, and using interactive health communication applications can improve patient knowledge and clinical outcomes and provide social support. PMID:24261435

  1. Operative treatment improves patient function in recalcitrant medial epicondylitis.

    PubMed

    Shahid, M; Wu, F; Deshmukh, S C

    2013-10-01

    The purpose of this retrospective study was to assess the outcome of open surgery for patients with recalcitrant medial epicondylitis following failed conservative management. The clinical results are presented for 15 patients (17 elbows) who were reviewed at a mean follow-up of 66 months. Operative treatment improved patient function significantly with a mean increase in grip strength of 10kg and a mean decrease (improvement) in DASH (Disabilities of the Arm, Shoulder and Hand) score of 25.7. All but one patient experienced little or no residual elbow discomfort and had excellent Mayo elbow performance scores postoperatively. Eleven of the twelve patients who were previously in employment were able to return to work within eight weeks of surgery. This study demonstrates that operative treatment for recalcitrant medial epicondylitis is effective in restoring patient function and strength.

  2. [Strategies for improving care of oncologic patients: SHARE Project results].

    PubMed

    Reñones Crego, María de la Concepción; Fernández Pérez, Dolores; Vena Fernández, Carmen; Zamudio Sánchez, Antonio

    2016-01-01

    Cancer treatment is a major burden for the patient and its family that requires an individualized management by healthcare professionals. Nurses are in charge of coordinating care and are the closest healthcare professionals to patient and family; however, in Spain, there are not standard protocols yet for the management of oncology patients. The Spanish Oncology Nursing Society developed between 2012 and 2014 the SHARE project, with the aim of establishing strategies to improve quality of life and nursing care in oncology patients. It was developed in 3 phases. First, a literature search and review was performed to identify nursing strategies, interventions and tools to improve cancer patients' care. At the second stage, these interventions were agreed within a group of oncology nursing experts; and at the third phase, a different group of experts in oncology care categorized the interventions to identify the ones with highest priority and most feasible to be implemented. As a result, 3 strategic actions were identified to improve nursing care during cancer treatment: To provide a named nurse to carry out the follow up process by attending to the clinic or telephonic consultation, develop therapeutic education with adapted protocols for each tumor type and treatment and ensure specific training for nurses on the management of the cancer patients. Strategic actions proposed in this paper aim to improve cancer patients' healthcare and quality of life through the development of advanced nursing roles based on a higher level of autonomy, situating nurses as care coordinators to assure an holistic care in oncology patients.

  3. Agomelatine improves sleep in a patient with fatal familial insomnia.

    PubMed

    Froböse, T; Slawik, H; Schreiner, R; Veselý, Z; Wiegand, M; Bäuml, J; Förstl, H

    2012-01-01

    A young patient with FFI was started on agomelatine 25 mg to medicate nocturnal insomnia. Under this treatment sleep efficiency was improved, slow wave sleep was high and awakenings during sleep period time were far less than before. Clinically the patient was less restless during nighttime.

  4. A Cognitive Framework for Understanding and Improving Interference Resolution in the Brain

    PubMed Central

    Mishra, Jyoti; Anguera, Joaquin A.; Ziegler, David A.; Gazzaley, Adam

    2014-01-01

    All of us are familiar with the negative impact of interference on achieving our task goals. We are referring to interference by information, which either impinges on our senses from an external environmental source or is internally generated by our thoughts. Informed by more than a decade of research on the cognitive and neural processing of interference, we have developed a framework for understanding how interference impacts our neural systems and especially how it is regulated and suppressed during efficient on-task performance. Importantly, externally and internally generated interferences have distinct neural signatures, and further, distinct neural processing emerges depending on whether individuals must ignore and suppress the interference, as for distractions, or engage with them in a secondary task, as during multitasking. Here, we elaborate on this cognitive framework and how it changes throughout the human lifespan, focusing mostly on research evidence from younger adults and comparing these findings to data from older adults, children, and cognitively impaired populations. With insights gleaned from our growing understanding, we then describe three novel translational efforts in our lab directed at improving distinct aspects of interference resolution using cognitive training. Critically, these training approaches were specifically developed to target improved interference resolution based on neuroplasticity principles and have shown much success in randomized controlled first version evaluations in healthy aging. Our results show not only on-task training improvements but also robust generalization of benefit to other cognitive control abilities. This research showcases how an in-depth understanding of neural mechanisms can then inform the development of effective deficit-targeted interventions, which can in turn benefit both healthy and cognitively impaired populations. PMID:24309262

  5. Understanding the effects of nurses on the process by which patients develop hospital satisfaction.

    PubMed

    Gotlieb, Jerry B

    2002-10-01

    An understanding of the process by which hospital patients evaluate their nurses could be very useful. However, no theory-based model exists in the nursing literature to explain the relationship among patients' hospital rooms, locus of causality, patients' evaluation of nurses, and hospital satisfaction. This article proposes a model to help fill this void. It also presents empirical evidence supporting the model--a study finding that patients' evaluation of their hospital rooms and their perception of locus of causality affected their evaluations of nurses. The results suggest patients' evaluation of their nurses and rooms are two key variables that affect their overall hospital satisfaction. However, patients' evaluation of nurses appears to have a much greater influence on hospital satisfaction than does patients' evaluation of their rooms. PMID:12465218

  6. Improving Depression Care in Patients with Diabetes and Multiple Complications

    PubMed Central

    Kinder, Leslie S; Katon, Wayne J; Ludman, Evette; Russo, Joan; Simon, Greg; Lin, Elizabeth HB; Ciechanowski, Paul; Von Korff, Michael; Young, Bessie

    2006-01-01

    BACKGROUND Depression is common in patients with diabetes, but it is often inadequately treated within primary care. Competing clinical demands and treatment resistance may make it especially difficult to improve depressive symptoms in patients with diabetes who have multiple complications. OBJECTIVE To determine whether a collaborative care intervention for depression would be as effective in patients with diabetes who had 2 or more complications as in patients with diabetes who had fewer complications. DESIGN The Pathways Study was a randomized control trial comparing collaborative care case management for depression and usual primary care. This secondary analysis compared outcomes in patients with 2 or more complications to patients with fewer complications. PATIENTS Three hundred and twenty-nine patients with diabetes and comorbid depression were recruited through primary care clinics of a large prepaid health plan. MEASUREMENTS Depression was assessed at baseline, 3, 6, and 12 months with the 20-item depression scale from the Hopkins Symptom Checklist. Diabetes complications were determined from automated patient records. RESULTS The Pathways collaborative care intervention was significantly more successful at reducing depressive symptoms than usual primary care in patients with diabetes who had 2 or more complications. Patients with fewer than 2 complications experienced similar reductions in depressive symptoms in both intervention and usual care. CONCLUSION Patients with depression and diabetes who have multiple complications may benefit most from collaborative care for depression. These findings suggest that with appropriate intervention depression can be successfully treated in patients with diabetes who have the highest severity of medical problems. PMID:16836628

  7. Smoking cessation strategies for patients with asthma: improving patient outcomes.

    PubMed

    Perret, Jennifer L; Bonevski, Billie; McDonald, Christine F; Abramson, Michael J

    2016-01-01

    Smoking is common in adults with asthma, yet a paucity of literature exists on smoking cessation strategies specifically targeting this subgroup. Adverse respiratory effects from personal smoking include worse asthma control and a predisposition to lower lung function and chronic obstructive pulmonary disease. Some data suggest that individuals with asthma are more likely than their non-asthmatic peers to smoke regularly at an earlier age. While quit attempts can be more frequent in smokers with asthma, they are also of shorter duration than in non-asthmatics. Considering these asthma-specific characteristics is important in order to individualize smoking cessation strategies. In particular, asthma-specific information such as "lung age" should be provided and longer-term follow-up is advised. Promising emerging strategies include reminders by cellular phone and web-based interventions using consumer health informatics. For adolescents, training older peers to deliver asthma education is another promising strategy. For smokers who are hospitalized for asthma, inpatient nicotine replacement therapy and counseling are a priority. Overall, improving smoking cessation rates in smokers with asthma may rely on a more personalized approach, with the potential for substantial health benefits to individuals and the population at large. PMID:27445499

  8. Smoking cessation strategies for patients with asthma: improving patient outcomes

    PubMed Central

    Perret, Jennifer L; Bonevski, Billie; McDonald, Christine F; Abramson, Michael J

    2016-01-01

    Smoking is common in adults with asthma, yet a paucity of literature exists on smoking cessation strategies specifically targeting this subgroup. Adverse respiratory effects from personal smoking include worse asthma control and a predisposition to lower lung function and chronic obstructive pulmonary disease. Some data suggest that individuals with asthma are more likely than their non-asthmatic peers to smoke regularly at an earlier age. While quit attempts can be more frequent in smokers with asthma, they are also of shorter duration than in non-asthmatics. Considering these asthma-specific characteristics is important in order to individualize smoking cessation strategies. In particular, asthma-specific information such as “lung age” should be provided and longer-term follow-up is advised. Promising emerging strategies include reminders by cellular phone and web-based interventions using consumer health informatics. For adolescents, training older peers to deliver asthma education is another promising strategy. For smokers who are hospitalized for asthma, inpatient nicotine replacement therapy and counseling are a priority. Overall, improving smoking cessation rates in smokers with asthma may rely on a more personalized approach, with the potential for substantial health benefits to individuals and the population at large. PMID:27445499

  9. A web-based interactive tool to improve breast cancer patient centredness.

    PubMed

    Gorini, Alessandra; Mazzocco, Ketti; Kondylakis, Haridimos; McVie, Gordon; Pravettoni, Gabriella

    2016-01-01

    The uniqueness of a patient as determined by the integration of clinical data and psychological aspects should be the aspired aim of a personalized medicine approach. Nevertheless, given the time constraints usually imposed by the clinical setting, it is not easy for physicians to collect information about the patient's unique mental dimensions and needs related to her illness. Such information may be useful in tailoring patient-physician communication, improving the patient's understanding of provided information, her involvement in the treatment process, and in general her empowerment during and after the therapeutic journey. The primary objective of this study is to evaluate the effect of an interactive empowerment tool (IEm) on enhancing the breast cancer patient-physician experience, in terms of increasing empowerment, i.e. by providing physicians with a personalised patient's profile, accompanied by specific recommendations to advise them how to interact with each individual patient on the basis of her personal profile. The study will be implemented as a two-arm randomised controlled trial with 100 adult breast cancer patients who fill in the ALGA-BC questionnaire, a computerised validated instrument to evaluate the patient's physical and psychological characteristics following a breast cancer diagnosis. The IEm tool will collect and analyse the patient's answers in real time and send them, together with specific recommendations to the physician's computer immediately before physician's first encounter with the patient. Patients will be randomised to either the intervention group using the IEm tool or to a control group who will only fill in the questionnaire without taking advantage of the tool (physicians will not receive the patient's profile). The proposed approach is supposed to improve the patient-physician communication leading to increased patient participation in the therapeutic process as a consequence leading to improvement in patient empowerment

  10. The CONVEX project - Using Observational Evidence and Process Understanding to Improve Predictions of Extreme Rainfall Change

    NASA Astrophysics Data System (ADS)

    Fowler, Hayley; Kendon, Elizabeth; Blenkinsop, Stephen; Chan, Steven; Ferro, Christopher; Roberts, Nigel; Stephenson, David; Jones, Richard; Sessford, Pat

    2013-04-01

    During the last decade, widespread major flood events in the UK and across the rest of Europe have focussed attention on perceived increases in rainfall intensities. Whilst Regional Climate Models (RCMs) are able to simulate the magnitude and spatial pattern of observed daily extreme rainfall events more reliably than Global Circulation Models (GCMs), they still underestimate extreme rainfall in relation to observations. Particularly during the summer a large proportion of the precipitation comes from convective storms that are typically too small to be explicitly represented by climate models. Instead, convection parameterisation schemes are necessary to represent the larger-scale effect of unresolved convective cells. Given the deficiencies in the simulation of extreme rainfall by climate models, even in the current generation of high-resolution RCMs, the CONVEX project (CONVective EXtremes) argues that an integrated approach is needed that brings together observations, basic understanding and models. This should go hand in hand with a change from a focus on traditional validation exercises (comparing modelled and observed extremes) to an understanding and quantification of the causes of model deficiencies in the simulation of extreme rainfall processes on different spatial and temporal scales. It is particularly true for localised intense summer convection. CONVEX therefore aims to contribute to the goals of enabling society to respond to global climate change and predicting the regional and local impacts of environmental change. In addition to an improved understanding of the spatial-temporal characteristics of extreme rainfall processes (principally in the UK) the project is also assessing the influence of model parameterisations and resolution on the simulation of extreme rainfall events and processes. This includes the running of new RCM simulations undertaken by the UK Meteorological Office at 50km and 12km resolutions (parameterised convection) and

  11. How Patients Can Improve the Accuracy of their Medical Records

    PubMed Central

    Dullabh, Prashila M.; Sondheimer, Norman K.; Katsh, Ethan; Evans, Michael A.

    2014-01-01

    Objectives: Assess (1) if patients can improve their medical records’ accuracy if effectively engaged using a networked Personal Health Record; (2) workflow efficiency and reliability for receiving and processing patient feedback; and (3) patient feedback’s impact on medical record accuracy. Background: Improving medical record’ accuracy and associated challenges have been documented extensively. Providing patients with useful access to their records through information technology gives them new opportunities to improve their records’ accuracy and completeness. A new approach supporting online contributions to their medication lists by patients of Geisinger Health Systems, an online patient-engagement advocate, revealed this can be done successfully. In late 2011, Geisinger launched an online process for patients to provide electronic feedback on their medication lists’ accuracy before a doctor visit. Patient feedback was routed to a Geisinger pharmacist, who reviewed it and followed up with the patient before changing the medication list shared by the patient and the clinicians. Methods: The evaluation employed mixed methods and consisted of patient focus groups (users, nonusers, and partial users of the feedback form), semi structured interviews with providers and pharmacists, user observations with patients, and quantitative analysis of patient feedback data and pharmacists’ medication reconciliation logs. Findings/Discussion: (1) Patients were eager to provide feedback on their medications and saw numerous advantages. Thirty percent of patient feedback forms (457 of 1,500) were completed and submitted to Geisinger. Patients requested changes to the shared medication lists in 89 percent of cases (369 of 414 forms). These included frequency—or dosage changes to existing prescriptions and requests for new medications (prescriptions and over-the counter). (2) Patients provided useful and accurate online feedback. In a subsample of 107 forms

  12. Cross-Functional Team Processes and Patient Functional Improvement

    PubMed Central

    Alexander, Jeffrey A; Lichtenstein, Richard; Jinnett, Kimberly; Wells, Rebecca; Zazzali, James; Liu, Dawei

    2005-01-01

    Objective To test the hypothesis that higher levels of participation and functioning in cross-functional psychiatric treatment teams will be related to improved patient outcomes. Data Sources/Study Setting Primary data were collected during the period 1992–1999. The study was conducted in 40 teams within units treating seriously mentally ill patients in 16 Veterans Affairs hospitals across the U.S. Study Design A longitudinal, multilevel analysis assessed the relationship between individual- and team-level variables and patients' ability to perform activities of daily living (ADL) over time. Team data were collected in 1992, 1994, and 1995. The number of times patient data were collected was dependent on the length of time the patient was treated and varied from 1 to 14 between 1992 and 1999. Key variables included: patients' ADL scores (the dependent variable); measures of team participation and team functioning; the number of days from baseline on which a patient's ADLs were assessed; and several control variables. Data Collection Methods Team data were obtained via self-administered questionnaires distributed to staff on the study teams. Additional team data were obtained via questionnaires completed by unit directors contemporaneously with the staff survey. Patient data were collected by trained clinicians at regular intervals using a standard assessment instrument. Principal Findings Results indicated that patients treated in teams with higher levels of staff participation experienced greater improvement in ADL over time. No differences in ADL change were noted for patients treated in teams with higher levels of team functioning. Conclusions Findings support our premise that team process has important implications for patient outcomes. The results suggest that the level of participation by the team as a whole may be a more important process attribute, in terms of patient improvements in ADLs, than the team's smooth functioning. These findings indicate the

  13. Hypercapnia Improves Tissue Oxygenation in Morbidly Obese Surgical Patients

    PubMed Central

    Hager, Helmut; Reddy, Dayakar; Mandadi, Goutham; Pulley, Debra; Eagon, J Chris; Sessler, Daniel I; Kurz, Andrea

    2006-01-01

    Risk of wound infection is increased in morbidly obese surgical patients, in part because a major determinant of wound infection risk, tissue oxygenation, is marginal. Unlike in lean patients, supplemental inspired oxygen (FIO2) only slightly improves tissue oxygenation in obese patients. Mild hypercapnia improves tissue oxygenation in lean, but has not been evaluated in obese patients. We thus tested the hypothesis that mild hypercapnia markedly improves tissue oxygenation in morbidly obese patients given FIO2 80% during major abdominal surgery. Thirty obese patients (body mass index 61.5±17 kg/m2) scheduled for open gastric bypass were randomly assigned to normocapnia (n=15, end-tidal PCO2 35 mmHg) or hypercapnia (n=15, end-tidal PCO2 50 mmHg); FIO2 was 80%. Anesthetic management and other confounding factors were controlled. Tissue oxygen tension was measured subcutaneously at the upper arm using a polarographic probe in a silastic tonometer. Demographic characteristics, cardiovascular measurements, and PaO2 (222±48 versus 230±68 mmHg in normocapnic versus hypercapnic; mean±SD, P=0.705) were comparable in the groups. Tissue oxygen tension, however, was greater in hypercapnic than in normocapnic patients (78±31 versus 56±13 mmHg, P=0.029). Mild hypercapnia increased tissue oxygenation by an amount believed to be clinically important and could potentially reduce the risk of surgical wound infection in morbidly obese patients. PMID:16931680

  14. Kidney Function Can Improve in Patients with Hypertensive CKD

    PubMed Central

    Gadegbeku, Crystal; Lipkowitz, Michael S.; Rostand, Stephen; Lewis, Julia; Wright, Jackson T.; Appel, Lawrence J.; Greene, Tom; Gassman, Jennifer; Astor, Brad C.

    2012-01-01

    The typical assumption is that patients with CKD will have progressive nephropathy. Methodological issues, such as measurement error and regression to the mean, have made it difficult to document whether kidney function might improve in some patients. Here, we used data from 12 years of follow-up in the African American Study of Kidney Disease and Hypertension to determine whether some patients with CKD can experience a sustained improvement in GFR. We calculated estimated GFR (eGFR) based on serum creatinine measurements during both the trial and cohort phases. We defined clearly improved patients as those with positive eGFR slopes that we could not explain by random measurement variation under Bayesian mixed-effects models. Of 949 patients with at least three follow-up eGFR measurements, 31 (3.3%) demonstrated clearly positive eGFR slopes. The mean slope among these patients was +1.06 (0.12) ml/min per 1.73 m2 per yr, compared with −2.45 (0.07) ml/min per 1.73 m2 per yr among the remaining patients. During the trial phase, 24 (77%) of these 31 patients also had clearly positive slopes of 125I-iothalamate–measured GFR during the trial phase. Low levels of proteinuria at baseline and randomization to the lower BP goal (mean arterial pressure ≤92 mmHg) associated with improved eGFR. In conclusion, the extended follow-up from this study provides strong evidence that kidney function can improve in some patients with hypertensive CKD. PMID:22402803

  15. Process Improvements to Reform Patient Flow in the Emergency Department.

    PubMed

    Whatley, Shawn D; Leung, Alexander K; Duic, Marko

    2016-01-01

    Emergency departments (ED) function to diagnose, stabilize, manage and dispose patients as efficiently as possible. Although problems may be suspected at triage, ED physician input is required at each step of the patient journey through the ED, from diagnosis to disposition. If we want timely diagnosis, appropriate treatment and great outcomes, then ED processes should connect patients and physicians as quickly as possible. This article discusses the key concepts of ED patient flow, value and efficiency. Based on these fundamentals, it describes the significant impact of ED process improvements implemented on measures of ED efficiency at a large community ED in Ontario, Canada. PMID:27133605

  16. Process Improvements to Reform Patient Flow in the Emergency Department.

    PubMed

    Whatley, Shawn D; Leung, Alexander K; Duic, Marko

    2016-01-01

    Emergency departments (ED) function to diagnose, stabilize, manage and dispose patients as efficiently as possible. Although problems may be suspected at triage, ED physician input is required at each step of the patient journey through the ED, from diagnosis to disposition. If we want timely diagnosis, appropriate treatment and great outcomes, then ED processes should connect patients and physicians as quickly as possible. This article discusses the key concepts of ED patient flow, value and efficiency. Based on these fundamentals, it describes the significant impact of ED process improvements implemented on measures of ED efficiency at a large community ED in Ontario, Canada.

  17. Improving documentation of clinical care within a clinical information network: an essential initial step in efforts to understand and improve care in Kenyan hospitals

    PubMed Central

    Tuti, Timothy; Bitok, Michael; Malla, Lucas; Paton, Chris; Muinga, Naomi; Gathara, David; Gachau, Susan; Mbevi, George; Nyachiro, Wycliffe; Ogero, Morris; Julius, Thomas; Irimu, Grace; English, Mike

    2016-01-01

    In many low income countries health information systems are poorly equipped to provide detailed information on hospital care and outcomes. Information is thus rarely used to support practice improvement. We describe efforts to tackle this challenge and to foster learning concerning collection and use of information. This could improve hospital services in Kenya. We are developing a Clinical Information Network, a collaboration spanning 14 hospitals, policy makers and researchers with the goal of improving information available on the quality of inpatient paediatric care across common childhood illnesses in Kenya. Standardised data from hospitals’ paediatric wards are collected using non-commercial and open source tools. We have implemented procedures for promoting data quality which are performed prior to a process of semi-automated analysis and routine report generation for hospitals in the network. In the first phase of the Clinical Information Network, we collected data on over 65 000 admission episodes. Despite clinicians’ initial unfamiliarity with routine performance reporting, we found that, as an initial focus, both engaging with each hospital and providing them information helped improve the quality of data and therefore reports. The process has involved mutual learning and building of trust in the data and should provide the basis for collaborative efforts to improve care, to understand patient outcome, and to evaluate interventions through shared learning. We have found that hospitals are willing to support the development of a clinically focused but geographically dispersed Clinical Information Network in a low-income setting. Such networks show considerable promise as platforms for collaborative efforts to improve care, to provide better information for decision making, and to enable locally relevant research. PMID:27398232

  18. Improving haemophilia patient care through sharing best practice.

    PubMed

    de Moerloose, Philippe; Arnberg, Daniel; O'Mahony, Brian; Colvin, Brian

    2015-10-01

    At the 2014 Annual Congress of the European Haemophilia Consortium (EHC) held in Belfast, Northern Ireland, Pfizer initiated and funded a satellite symposium entitled: 'Improving Patient Care Through Sharing Best Practice'. Co-chaired by Brian Colvin (Pfizer Global Innovative Pharma Business, Rome, Italy) and Brian O'Mahony [President of the EHC, Brussels, Belgium], the symposium provided an opportunity to consider patient care across borders, to review how patient advocacy groups can successfully engage with policymakers in healthcare decision-making and to discuss the importance of patient involvement in data collection to help shape the future environment for people with haemophilia. Professor Philippe de Moerloose (University Hospitals and Faculty of Medicine of Geneva, Switzerland) opened the session by discussing the gap between the haemophilia management guidelines and the reality of care for many patients living in Europe, highlighting the importance of sharing of best practice and building a network of treaters and patient organisations to support the improvement of care across Europe. Daniel Arnberg (SCISS AB, Hägersten, Sweden) reviewed the health technology assessment process conducted in Sweden, the first for haemophilia products, as a case study, focusing on the role of the patient organisation. Finally, Brian O'Mahony reflected on the central role of patients as individuals and also within patient organisations in shaping the future of haemophilia care. PMID:26338268

  19. Improving haemophilia patient care through sharing best practice.

    PubMed

    de Moerloose, Philippe; Arnberg, Daniel; O'Mahony, Brian; Colvin, Brian

    2015-10-01

    At the 2014 Annual Congress of the European Haemophilia Consortium (EHC) held in Belfast, Northern Ireland, Pfizer initiated and funded a satellite symposium entitled: 'Improving Patient Care Through Sharing Best Practice'. Co-chaired by Brian Colvin (Pfizer Global Innovative Pharma Business, Rome, Italy) and Brian O'Mahony [President of the EHC, Brussels, Belgium], the symposium provided an opportunity to consider patient care across borders, to review how patient advocacy groups can successfully engage with policymakers in healthcare decision-making and to discuss the importance of patient involvement in data collection to help shape the future environment for people with haemophilia. Professor Philippe de Moerloose (University Hospitals and Faculty of Medicine of Geneva, Switzerland) opened the session by discussing the gap between the haemophilia management guidelines and the reality of care for many patients living in Europe, highlighting the importance of sharing of best practice and building a network of treaters and patient organisations to support the improvement of care across Europe. Daniel Arnberg (SCISS AB, Hägersten, Sweden) reviewed the health technology assessment process conducted in Sweden, the first for haemophilia products, as a case study, focusing on the role of the patient organisation. Finally, Brian O'Mahony reflected on the central role of patients as individuals and also within patient organisations in shaping the future of haemophilia care.

  20. Current advances in targeted therapies for metastatic gastric cancer: improving patient care.

    PubMed

    Aguiar, Pedro Nazareth; Muniz, Thiago Pimentel; Miranda, Raelson Rodrigues; Tadokoro, Hakaru; Forones, Nora Manoukian; Monteiro, Ines-de-Paula; Castelo-Branco, Pedro; Janjigian, Yelena Y; Mello, Ramon Andrade de

    2016-03-01

    In this article, we review the literature on the current advances in targeted therapies for metastatic gastric cancer aimed at improving patient care. We conclude that the key to guiding targeted therapy is individual biomarkers, which are not completely elucidated. HER2 overexpression is the only predictive biomarker currently in use. Furthermore, it is necessary to understand that gastric tumors are heterogeneous; therefore, is impossible to evaluate a novel biological compound without evaluating personal biomarkers. The selection of patients who are able to receive each treatment is paramount for improving advanced gastric cancer survival and reducing unnecessary costs.

  1. Understanding motivations to participate in an observational research study: Why do patients enroll?

    PubMed

    Soule, Michael C; Beale, Eleanor E; Suarez, Laura; Beach, Scott R; Mastromauro, Carol A; Celano, Christopher M; Moore, Shannon V; Huffman, Jeff C

    2016-01-01

    By understanding common motivations for participating in observational research studies, clinicians may better understand the perceived benefits of research participation from their clients' perspective. We enrolled 164 cardiac patients in a study about the effects of gratitude and optimism. Two weeks post-enrollment, participants completed a four-item questionnaire regarding motivations for study enrollment. Altruistic motivation ranked highest, while intellectual, health-related, and financial motivations rated lower. Four subgroups of participants emerged, each with distinct characteristics and different priorities for participating. These findings may help front-line clinicians to understand which motivations for participation apply to their clients who enroll in non-treatment-based research projects. PMID:26933943

  2. Ecosystem function in waste stabilisation ponds: Improving water quality through a better understanding of biophysical coupling

    NASA Astrophysics Data System (ADS)

    Ghadouani, Anas; Reichwaldt, Elke S.; Coggins, Liah X.; Ivey, Gregory N.; Ghisalberti, Marco; Zhou, Wenxu; Laurion, Isabelle; Chua, Andrew

    2014-05-01

    Wastewater stabilisation ponds (WSPs) are highly productive systems designed to treat wastewater using only natural biological and chemical processes. Phytoplankton, microbial communities and hydraulics play important roles for ecosystem functionality of these pond systems. Although WSPs have been used for many decades, they are still considered as 'black box' systems as very little is known about the fundamental ecological processes which occur within them. However, a better understanding of how these highly productive ecosystems function is particularly important for hydrological processes, as treated wastewater is commonly discharged into streams, rivers, and oceans, and subject to strict water quality guidelines. WSPs are known to operate at different levels of efficiency, and treatment efficiency of WSPs is dependent on physical (flow characteristics and sludge accumulation and distribution) and biological (microbial and phytoplankton communities) characteristics. Thus, it is important to gain a better understanding of the role and influence of pond hydraulics and vital microbial communities on pond performance and WSP functional stability. The main aim of this study is to investigate the processes leading to differences in treatment performance of WSPs. This study uses a novel and innovative approach to understand these factors by combining flow cytometry and metabolomics to investigate various biochemical characteristics, including the metabolite composition and microbial community within WSPs. The results of these analyses will then be combined with results from the characterisation of pond hydrodynamics and hydraulic performance, which will be performed using advanced hydrodynamic modelling and advanced sludge profiling technology. By understanding how hydrodynamic and biological processes influence each other and ecosystem function and stability in WSPs, we will be able to propose ways to improve the quality of the treatment using natural processes, with

  3. Implementing practice management strategies to improve patient care: the EPIC project.

    PubMed

    Attwell, David; Rogers-Warnock, Leslie; Nemis-White, Joanna

    2012-01-01

    Healthcare gaps, the difference between usual care and best care, are evident in Canada, particularly with respect to our aging, ailing population. Primary care practitioners are challenged to identify, prevent and close care gaps in their practice environment given the competing demands of informed, litigious patients with complex medical needs, ever-evolving scientific evidence with new treatment recommendations across many disciplines and an enhanced emphasis on quality and accountability in healthcare. Patient-centred health and disease management partnerships using measurement, feedback and communication of practice patterns and outcomes have been shown to narrow care gaps. Practice management strategies such as the use of patient registries and recall systems have also been used to help practitioners better understand, follow and proactively manage populations of patients in their practice. The Enhancing Practice to Improve Care project was initiated to determine the impact of a patient-centred health and disease management partnership using practice management strategies to improve patient care and outcomes for patients with chronic kidney disease (CKD). Forty-four general practices from four regions of British Columbia participated and, indeed, demonstrated that care and outcomes for patients with CKD could be improved via the implementation of practice management strategies in a patient-centred partnership measurement model of health and disease management.

  4. Understanding and Improving CRM and GCM Simulations of Cloud Systems with ARM Observations

    SciTech Connect

    Wu, Xiaoqing

    2014-02-25

    The works supported by this ASR project lay the solid foundation for improving the parameterization of convection and clouds in the NCAR CCSM and the climate simulations. We have made a significant use of CRM simulations and ARM observations to produce thermodynamically and dynamically consistent multi-year cloud and radiative properties; improve the GCM simulations of convection, clouds and radiative heating rate and fluxes using the ARM observations and CRM simulations; and understand the seasonal and annual variation of cloud systems and their impacts on climate mean state and variability. We conducted multi-year simulations over the ARM SGP site using the CRM with multi-year ARM forcing data. The statistics of cloud and radiative properties from the long-term CRM simulations were compared and validated with the ARM measurements and value added products (VAP). We evaluated the multi-year climate simulations produced by the GCM with the modified convection scheme. We used multi-year ARM observations and CRM simulations to validate and further improve the trigger condition and revised closure assumption in NCAR GCM simulations that demonstrate the improvement of climate mean state and variability. We combined the improved convection scheme with the mosaic treatment of subgrid cloud distributions in the radiation scheme of the GCM. The mosaic treatment of cloud distributions has been implemented in the GCM with the original convection scheme and enables the use of more realistic cloud amounts as well as cloud water contents in producing net radiative fluxes closer to observations. A physics-based latent heat (LH) retrieval algorithm was developed by parameterizing the physical linkages of observed hydrometeor profiles of cloud and precipitation to the major processes related to the phase change of atmospheric water.

  5. Improving patient comprehension and recall of discharge instructions by supplementing free texts with pictographs.

    PubMed

    Zeng-Treitler, Qing; Kim, Hyeoneui; Hunter, Martha

    2008-11-06

    Inpatient discharge instructions provide critical information for patients to manage their own care. These instructions are typically free-text and not easy for patients to understand and remember. In this pilot study, we developed a set of pictographs through a participatory design process and used them to enhance two mock-up discharge instructions. Tested on 13 healthy volunteers, the pictograph enhancement resulted in statistically significant better recall rates (p<0.001). This suggests that patient comprehension and recall of discharge instructions could be improved by supplementing free texts with pictographs.

  6. Improved understanding of factors driving methicillin-resistant Staphylococcus aureus epidemic waves

    PubMed Central

    Chatterjee, Som S; Otto, Michael

    2013-01-01

    Methicillin-resistant Staphylococcus aureus (MRSA) remains one of the most important causes of nosocomial infections worldwide. Since the global spread of MRSA in the 1960s, MRSA strains have evolved with increased pathogenic potential. Notably, some strains are now capable of causing persistent infections not only in hospitalized patients but also in healthy individuals in the community. Furthermore, MRSA is increasingly associated with infections among livestock-associated workers, primarily because of transmission from animals to humans. Moreover, many MRSA strains have gained resistance to most available antibiotics. In this review, we will present current knowledge on MRSA epidemiology and discuss new endeavors being undertaken to understand better the molecular and epidemiological underpinnings of MRSA outbreaks. PMID:23861600

  7. Understanding and Improving the Quality of Inter-Layer Interfaces in FDM 3-D Printing

    NASA Astrophysics Data System (ADS)

    Duranty, Edward; Spradlin, Brandon; Stark, Madeline; Dadmun, Mark

    We have studied the effect of thermal history and material diffusion on inter-filament bonding in FDM 3D printed parts and developed methods to improve interlayer adhesion in 3D printed samples. The available thermal energy during the FDM print environment was determined quantitatively by tracking the temperature of the bottom most printed layer using a thermocouple attached to the print bed. The role of the thermal history of the filaments during the deposition process on the quality of inter-layer bonding in an FDM ABS part was monitored using a T-peel test and an innovative sample design. Additionally, the interfacial adhesion between 3D printed layers was improved by the addition of a chemical cross-linking agent 4,4 '-diaminodiphenylmethane (DADPM). These studies have increased our understanding of the importance of the complex thermal history of a filament in the 3D printing process and its impact on the interfaces that form during the fused deposition modeling print process. Furthermore, the chemical crosslinking process demonstrates a potential method to covalently link layers in FDM printed parts, improving the bulk strength of the part. The insight provided in this work may aid in the development of techniques that can produce FDM parts that could be used as replacement parts in structural applications, or as completely standalone products.

  8. Understanding side reactions in K-O2 batteries for improved cycle life.

    PubMed

    Ren, Xiaodi; Lau, Kah Chun; Yu, Mingzhe; Bi, Xuanxuan; Kreidler, Eric; Curtiss, Larry A; Wu, Yiying

    2014-11-12

    Superoxide based metal-air (or metal-oxygen) batteries, including potassium and sodium-oxygen batteries, have emerged as promising alternative chemistries in the metal-air battery family because of much improved round-trip efficiencies (>90%). In order to improve the cycle life of these batteries, it is crucial to understand and control the side reactions between the electrodes and the electrolyte. For potassium-oxygen batteries using ether-based electrolytes, the side reactions on the potassium anode have been identified as the main cause of battery failure. The composition of the side products formed on the anode, including some reaction intermediates, have been identified and quantified. Combined experimental studies and density functional theory (DFT) calculations show the side reactions are likely driven by the interaction of potassium with ether molecules and the crossover of oxygen from the cathode. To inhibit these side reactions, the incorporation of a polymeric potassium ion selective membrane (Nafion-K(+)) as a battery separator is demonstrated that significantly improves the battery cycle life. The K-O2 battery with the Nafion-K(+) separator can be discharged and charged for more than 40 cycles without increases in charging overpotential. PMID:25295518

  9. Understanding side reactions in K-O2 batteries for improved cycle life.

    PubMed

    Ren, Xiaodi; Lau, Kah Chun; Yu, Mingzhe; Bi, Xuanxuan; Kreidler, Eric; Curtiss, Larry A; Wu, Yiying

    2014-11-12

    Superoxide based metal-air (or metal-oxygen) batteries, including potassium and sodium-oxygen batteries, have emerged as promising alternative chemistries in the metal-air battery family because of much improved round-trip efficiencies (>90%). In order to improve the cycle life of these batteries, it is crucial to understand and control the side reactions between the electrodes and the electrolyte. For potassium-oxygen batteries using ether-based electrolytes, the side reactions on the potassium anode have been identified as the main cause of battery failure. The composition of the side products formed on the anode, including some reaction intermediates, have been identified and quantified. Combined experimental studies and density functional theory (DFT) calculations show the side reactions are likely driven by the interaction of potassium with ether molecules and the crossover of oxygen from the cathode. To inhibit these side reactions, the incorporation of a polymeric potassium ion selective membrane (Nafion-K(+)) as a battery separator is demonstrated that significantly improves the battery cycle life. The K-O2 battery with the Nafion-K(+) separator can be discharged and charged for more than 40 cycles without increases in charging overpotential.

  10. Understanding unexpected courses of multiple sclerosis among patients using complementary and alternative medicine: A travel from recipient to explorer

    PubMed Central

    Salamonsen, Anita; Launsø, Laila; Kruse, Tove E.; Eriksen, Sissel H.

    2010-01-01

    Complementary and alternative medicine (CAM) is frequently used by patients with multiple sclerosis (MS). Some MS patients experience unexpected improvements of symptoms, which they relate to their use of CAM. The aim of this study was to obtain knowledge and develop understandings of such self-defined unexpected improvement of MS symptoms. Two cases were constructed based on documents and 12 qualitative interviews. Our aim was not to make generalisations from the cases, but to transfer knowledge as working hypotheses. We identified four health-related change processes: the process of losing bodily competence; the process of developing responsibility; the process of taking control; and the process of choosing CAM. The patients explained unexpected improvements in their MS symptoms as results of their own efforts including their choice and use of CAM. In our theoretical interpretations, we found the patients’ redefinition of history, the concept of treatment and the importance of conventional health care to be essential, and leading to a change of patients’ position towards conventional health care from recipients to explorers. The explorers can be perceived as boundary walkers reflecting limitations within the conventional health care system and as initiators regarding what MS patients find useful in CAM. PMID:20616888

  11. Understanding and improving lithium ion batteries through mathematical modeling and experiments

    NASA Astrophysics Data System (ADS)

    Deshpande, Rutooj D.

    There is an intense, worldwide effort to develop durable lithium ion batteries with high energy and power densities for a wide range of applications, including electric and hybrid electric vehicles. For improvement of battery technology understanding the capacity fading mechanism in batteries is of utmost importance. Novel electrode material and improved electrode designs are needed for high energy- high power batteries with less capacity fading. Furthermore, for applications such as automotive applications, precise cycle-life prediction of batteries is necessary. One of the critical challenges in advancing lithium ion battery technologies is fracture and decrepitation of the electrodes as a result of lithium diffusion during charging and discharging operations. When lithium is inserted in either the positive or negative electrode, there is a volume change associated with insertion or de-insertion. Diffusion-induced stresses (DISs) can therefore cause the nucleation and growth of cracks, leading to mechanical degradation of the batteries. With different mathematical models we studied the behavior of diffusion induces stresses and effects of electrode shape, size, concentration dependent material properties, pre-existing cracks, phase transformations, operating conditions etc. on the diffusion induced stresses. Thus we develop tools to guide the design of the electrode material with better mechanical stability for durable batteries. Along with mechanical degradation, chemical degradation of batteries also plays an important role in deciding battery cycle life. The instability of commonly employed electrolytes results in solid electrolyte interphase (SEI) formation. Although SEI formation contributes to irreversible capacity loss, the SEI layer is necessary, as it passivates the electrode-electrolyte interface from further solvent decomposition. SEI layer and diffusion induced stresses are inter-dependent and affect each-other. We study coupled chemical

  12. Patient and clinician's ratings of improvement in methadone-maintained patients: Differing perspectives?

    PubMed Central

    2011-01-01

    Background In the last few years there seems to be an emerging interest for including the patients' perspective in assessing methadone maintenance treatment (MMT), with treatment satisfaction surveys being the most commonly-used method of incorporating this point of view. The present study considers the perspective of patients on MMT when assessing the outcomes of this treatment, acknowledging the validity of this approach as an indicator. The primary aim of this study is to evaluate the concordance between improvement assessment performed by two members of the clinical staff (a psychiatrist and a nurse) and assessment carried out by MMT patients themselves. Method Patients (n = 110) and their respective psychiatrist (n = 5) and nurse (n = 1) completed a scale for assessing how the patient's condition had changed from the beginning of MMT, using the Patient Global Impression of Improvement scale (PGI-I) and the Clinical Global Impression of Improvement scale (CGI-I), respectively. Results The global improvement assessed by patients showed weak concordance with the assessments made by nurses (Quadratic-weighted kappa = 0.13, p > 0.05) and by psychiatrists (Quadratic-weighted kappa = 0.19, p = 0.0086), although in the latter, concordance was statistically significant. The percentage of improved patients was significantly higher in the case of the assessments made by patients, compared with those made by nurses (90.9% vs. 80%, Z-statistic = 2.10, p = 0.0354) and by psychiatrists (90.9% vs. 50%, Z-statistic = 6.48, p < 0.0001). Conclusions MMT patients' perception of improvement shows low concordance with the clinical staff's perspective. Assessment of MMT effectiveness should also focus on patient's evaluation of the outcomes or changes achieved, thus including indicators based on the patient's experiences, provided that MMT aim is to be more patient centred and to cover different needs of patients themselves. PMID:21871064

  13. Commentary: quality improvement projects: how do we protect patients' rights?

    PubMed

    Diamond, Louis H; Kliger, Alan S; Goldman, Richard S; Palevsky, Paul M

    2004-01-01

    A recent ruling by the Office of Human Research Protection (OHRP) has renewed an ongoing debate over whether Institutional Review Boards (IRBs) should have oversight not only over clinical research but also over quality improvement projects (QIPs). The authors discussed the similarities and differences among clinical practice, QIPs, and clinical research, pointing out issues to consider when identifying the most appropriate method for QIP oversight and accountability. They note that potential solutions must address ethical issues (eg, patient safety, privacy, and self-determination) and weigh the effect of the underlying QIP goal (administrative versus clinical improvement) on an individual patient and patient populations. They conclude that because QIPs are an extension of clinical practice and have elements of clinical research, it too should have an oversight system. Institutional or regional quality improvement boards, operating parallel to current IRBs, are suggested as 1 means of ensuring that QIP participants are offered the same protections as those who take part in clinical research.

  14. I can't read that! Improving perioperative literacy for ambulatory surgical patients.

    PubMed

    Liebner, Laura Traylor

    2015-04-01

    Low literacy and low health literacy are surprisingly rampant problems facing health care providers. Patient educators in all settings should consider the need for improved patient education materials that are easy to read and understand for the majority of patients. In the ambulatory surgery setting, patients often have time to prepare for scheduled outpatient surgery, yet education is provided primarily in the postoperative period. This article highlights the need for incorporating education into all phases of the perioperative process, beginning in the preoperative period. Perioperative educators should address all learning styles that provide education in a simple and cost-effective way to appeal to all patients and help to reduce postoperative complications and increase patient satisfaction in the ambulatory surgery setting.

  15. Health professionals' knowledge and understanding about Listeria monocytogenes indicates a need for improved professional training.

    PubMed

    Buffer, Janet L; Medeiros, Lydia C; Kendall, Patricia; Schroeder, Mary; Sofos, John

    2012-07-01

    Listeria monocytogenes causes listeriosis, an uncommon but potentially fatal disease in immunocompromised persons, with a public health burden of approximately $2 billion annually. Those consumers most at risk are the highly susceptible populations otherwise known as the immunocompromised. Health professionals have a considerable amount of interaction with the immunocompromised and are therefore a valuable resource for providing appropriate safe food handling information. To determine how knowledgeable health professionals are about Listeria monocytogenes, a nationwide Web-based survey was distributed targeting registered nurses (RNs) and registered dietitians (RDs) who work with highly susceptible populations. Responses were received from 499 health professionals. Knowledge and understanding of Listeria monocytogenes was assessed descriptively. Parametric and nonparametric analyses were used to detect differences between RNs and RDs. The major finding is that there are gaps in knowledge and a self-declared lack of understanding by both groups, but especially RNs, about Listeria monocytogenes. RDs were more likely than RNs to provide information about specific foods and food storage behaviors to prevent a Listeria infection. Notably, neither group of health professionals consistently provided Listeria prevention messages to their immunocompromised patients. Pathogens will continue to emerge as food production, climate, water, and waste management systems change. Health professionals, represented by RNs and RDs, need resources and training to ensure that they are providing the most progressive information about various harmful pathogens; in this instance, Listeria monocytogenes.

  16. Different Approaches to Understanding Patients in General Practice in Denmark: A Qualitative Study

    ERIC Educational Resources Information Center

    Davidsen, Annette Sofie; Reventlow, Susanne

    2011-01-01

    General practitioners (GPs) treat more than 90% of common mental disorders. Their approaches to psychological interventions have been little studied and their process of understanding patients remains unexplored. This qualitative interview and observation study aimed to explore Danish GPs' approaches to emotional problems and mental disorders in…

  17. Understanding the outcomes of a home nursing programme for patients with epidermolysis bullosa: an Australian perspective.

    PubMed

    Stevens, Louise J; McKenna, Sue; Marty, Jennifer; Cowin, Allison J; Kopecki, Zlatko

    2016-10-01

    Epidermolysis bullosa (EB) consists of a spectrum of genodermatoses characterised by skin fragility and various degrees of skin and mucous membrane blistering. Minimal trauma and friction can cause extensive blistering in patients with EB, resulting in a number of complications. However, wound management is the main challenge for these patients because of a high risk of infection, fluid loss and potential development of aggressive squamous cell carcinoma (SCC). Indeed, patients with EB have an increased risk for developing skin cancers compared to the general population. In 2012, a home nursing programme was established in Australia to provide assistance to families or patients with severe forms of EB. Nursing care was provided to patients with severe EB during dressing changes in their homes over a period of 2 years. Both families of patients and nurses were surveyed periodically using a developed questionnaire to assess the benefits of this home nursing and its impact on the patients, their families and the nurses. Key findings included a perceived improvement in quality of life, a better provision of support and improved family life management. These findings are the first to highlight the benefits of this national home nursing programme for EB patients within Australia and demonstrate the continued need and benefit of home nursing for patients with severe skin blistering disorders.

  18. What Is in a Name? How Biomedical Language May Derail Patient Understanding of Hypertension.

    PubMed

    Bokhour, Barbara G; Kressin, Nancy R

    2015-07-01

    Despite major advances in treating hypertension, >50% of all individuals diagnosed with the condition remain in poor control. A fundamental issue may be that patients may not fully understand the meaning of the term hypertension or its cause, leading to poor adherence to medications and limiting other effective self-management behaviors. We posit that the word hypertension itself may contribute to these misunderstandings, particularly in regards to the role of stress in causing hypertension, which thus suggests stress management as a primary strategy for control. The word hypertension is often interpreted by patients to mean too much tension. In conjunction with cultural framings of stress causing high blood pressure, many patients turn to stress management to control their hypertension. The word hypertension can thus cause patients to think of it as more of a psychological than physiological condition, thus discounting the value of antihypertensive medications and interfering with medication adherence. We therefore suggest that clinicians reconsider the use of the term hypertension and the ways in which they explain the condition to patients. Reorienting the language to the more patient-centered term of high blood pressure may help patients better understand the condition and to more readily embrace the available efficacious therapies. PMID:26152679

  19. Improving organizational climate for excellence in patient care.

    PubMed

    Arnold, Edwin

    2013-01-01

    Managers in health care organizations today are expected to achieve higher-quality patient care at a lower cost. Developing and maintaining a positive organizational climate can help improve motivation and foster higher employee performance. In turn, this will help the organization deliver better patient care at a lower cost. This article offers metrics for assessing organizational climate, analyzes barriers to a positive climate, and explores strategies that managers can use to build the type of climate that fosters high performance. PMID:23903945

  20. [Strategies for improving care of oncologic patients: SHARE Project results].

    PubMed

    Reñones Crego, María de la Concepción; Fernández Pérez, Dolores; Vena Fernández, Carmen; Zamudio Sánchez, Antonio

    2016-01-01

    Cancer treatment is a major burden for the patient and its family that requires an individualized management by healthcare professionals. Nurses are in charge of coordinating care and are the closest healthcare professionals to patient and family; however, in Spain, there are not standard protocols yet for the management of oncology patients. The Spanish Oncology Nursing Society developed between 2012 and 2014 the SHARE project, with the aim of establishing strategies to improve quality of life and nursing care in oncology patients. It was developed in 3 phases. First, a literature search and review was performed to identify nursing strategies, interventions and tools to improve cancer patients' care. At the second stage, these interventions were agreed within a group of oncology nursing experts; and at the third phase, a different group of experts in oncology care categorized the interventions to identify the ones with highest priority and most feasible to be implemented. As a result, 3 strategic actions were identified to improve nursing care during cancer treatment: To provide a named nurse to carry out the follow up process by attending to the clinic or telephonic consultation, develop therapeutic education with adapted protocols for each tumor type and treatment and ensure specific training for nurses on the management of the cancer patients. Strategic actions proposed in this paper aim to improve cancer patients' healthcare and quality of life through the development of advanced nursing roles based on a higher level of autonomy, situating nurses as care coordinators to assure an holistic care in oncology patients. PMID:27237729

  1. Improving organizational climate for excellence in patient care.

    PubMed

    Arnold, Edwin

    2013-01-01

    Managers in health care organizations today are expected to achieve higher-quality patient care at a lower cost. Developing and maintaining a positive organizational climate can help improve motivation and foster higher employee performance. In turn, this will help the organization deliver better patient care at a lower cost. This article offers metrics for assessing organizational climate, analyzes barriers to a positive climate, and explores strategies that managers can use to build the type of climate that fosters high performance.

  2. Patient-Provider Communication: Understanding the Role of Patient Activation for Latinos in Mental Health Treatment

    ERIC Educational Resources Information Center

    Cortes, Dharma E.; Mulvaney-Day, Norah; Fortuna, Lisa; Reinfeld, Sarah; Alegria, Margarita

    2009-01-01

    This article highlights results from the Right Question Project-Mental Health (RQP-MH), an intervention designed to teach skills in question formulation and to increase patients' participation in decisions about mental health treatment. Of participants in the RQP-MH intervention, 83% were from a Latino background, and 75% of the interviews were…

  3. Step Into Patients' Shoes: How to Understand and Apply a Patient-Centered Perspective.

    PubMed

    Rowell, Liz Webler

    2015-01-01

    Is your health plan truly encouraging employees to be health care consumers? Research in health literacy and patient health engagement may unlock new solutions. This article offers concrete ways employers can shift their frame when designing and communicating health plans, empowering employees to be better self-advocates. PMID:26666090

  4. The CONVEX project - Using Observational Evidence and Process Understanding to Improve Projections of Extreme Rainfall Change

    NASA Astrophysics Data System (ADS)

    Blenkinsop, Stephen; Fowler, Hayley; Kendon, Elizabeth; Chan, Steven; Ferro, Chris; Roberts, Nigel; Sessford, Pat

    2014-05-01

    During the last decade, widespread major flood events in the UK and across Europe have focussed attention on perceived increases in rainfall intensities. Whilst Regional Climate Models (RCMs) are able to simulate the magnitude and spatial pattern of observed daily extreme rainfall events more reliably than Global Circulation Models (GCMs), they still underestimate extreme rainfall in relation to observations and do not capture the properties of sub-daily events that may lead to flooding in urban areas. In the UK and Europe, particularly during the summer, a large proportion of precipitation comes from convective storms that are typically too small to be explicitly represented by climate models. Instead, convection parameterisation schemes are necessary to represent the larger-scale effect of unresolved convective cells. The CONVEX project (CONVective EXtremes) argues that an integrated approach is needed to provide improvements in estimates of change in extreme rainfall, particularly for summer convective events. As usable predictions require the synthesis of observations, understanding of atmospheric processes and models, a change in focus from traditional validation exercises (comparing modelled and observed extremes) to an understanding and quantification of the causes for model deficiencies in the simulation of extreme rainfall processes on different spatial and temporal scales is needed. By adopting this new focus CONVEX aims to contribute to the goals of enabling society to respond to global climate change and predicting the regional and local impacts of environmental change on timescales from days to decades. In addition to an improved understanding of the spatial-temporal characteristics of extreme rainfall processes (principally in the UK) the project is also assessing the influence of model parameterisations and resolution on the simulation of extreme rainfall events and processes. Under the project the UK Meteorological Office has run new RCM simulations

  5. Understanding and Improving High-Temperature Structural Properties of Metal-Silicide Intermetallics

    SciTech Connect

    Bruce S. Kang

    2005-10-10

    The objective of this project was to understand and improve high-temperature structural properties of metal-silicide intermetallic alloys. Through research collaboration between the research team at West Virginia University (WVU) and Dr. J.H. Schneibel at Oak Ridge National Laboratory (ORNL), molybdenum silicide alloys were developed at ORNL and evaluated at WVU through atomistic modeling analyses, thermo-mechanical tests, and metallurgical studies. In this study, molybdenum-based alloys were ductilized by dispersing MgAl2O4 or MgO spinel particles. The addition of spinel particles is hypothesized to getter impurities such as oxygen and nitrogen from the alloy matrix with the result of ductility improvement. The introduction of fine dispersions has also been postulated to improve ductility by acting as a dislocation source or reducing dislocation pile-ups at grain boundaries. The spinel particles, on the other hand, can also act as local notches or crack initiation sites, which is detrimental to the alloy mechanical properties. Optimization of material processing condition is important to develop the desirable molybdenum alloys with sufficient room-temperature ductility. Atomistic analyses were conducted to further understand the mechanism of ductility improvement of the molybdenum alloys and the results showed that trace amount of residual oxygen may be responsible for the brittle behavior of the as-cast Mo alloys. For the alloys studied, uniaxial tensile tests were conducted at different loading rates, and at room and elevated temperatures. Thermal cycling effect on the mechanical properties was also studied. Tensile tests for specimens subjected to either ten or twenty thermal cycles were conducted. For each test, a follow-up detailed fractography and microstructural analysis were carried out. The test results were correlated to the size, density, distribution of the spinel particles and processing time. Thermal expansion tests were carried out using thermo

  6. Toward Improved Understanding of Food Security: A Methodological Examination Based in Rural South Africa

    PubMed Central

    Kirkland, Tracy; Kemp, Robert S.; Hunter, Lori M.; Twine, Wayne S.

    2014-01-01

    Accurate measurement of household food security is essential to generate adequate information on the proportion of households experiencing food insecurity, especially in areas or regions vulnerable to food shortages and famine. This manuscript offers a methodological examination of three commonly used indicators of household food security – experience of hunger, dietary diversity, and coping strategies. Making use of data from the Agincourt Health and Demographic Surveillance Site in rural South Africa, we examine the association between the indicators themselves to improve understanding of the different insight offered by each food security “lens.” We also examine how the choice of indicator shapes the profile of vulnerable households, with results suggesting that dietary diversity scores may not adequately capture broader food insecurity. Concluding discussion explores programmatic and policy implications as related to methodological choices. PMID:25414598

  7. Sexual dimorphism in immunity: improving our understanding of vaccine immune responses in men.

    PubMed

    Furman, David

    2015-03-01

    Weaker immune responses are often observed in males compared to females. Since female hormones have proinflammatory properties and androgens have potent immunomodulatory effects, this sexual dimorphism in the immune response seems to be hormone dependent. Despite our current knowledge about the effect of sex hormones on immune cells, definition of the factors driving the sex differences in immunoclinical outcomes, such as the diminished response to infection and vaccination observed in men or the higher rates of autoimmunity observed in females, remains elusive. Recently, systems approaches to immune function have started to suggest a way toward establishing this connection. Such studies promise to improve our understanding of the mechanisms underlying the sexual dimorphism observed in the human immune system.

  8. Improved understanding of geologic CO{sub 2} storage processes requires risk-driven field experiments

    SciTech Connect

    Oldenburg, C.M.

    2011-06-01

    The need for risk-driven field experiments for CO{sub 2} geologic storage processes to complement ongoing pilot-scale demonstrations is discussed. These risk-driven field experiments would be aimed at understanding the circumstances under which things can go wrong with a CO{sub 2} capture and storage (CCS) project and cause it to fail, as distinguished from accomplishing this end using demonstration and industrial scale sites. Such risk-driven tests would complement risk-assessment efforts that have already been carried out by providing opportunities to validate risk models. In addition to experimenting with high-risk scenarios, these controlled field experiments could help validate monitoring approaches to improve performance assessment and guide development of mitigation strategies.

  9. Animal virus discovery: improving animal health, understanding zoonoses, and opportunities for vaccine development

    PubMed Central

    Delwart, Eric

    2012-01-01

    The characterization of viral genomes has accelerated due to improvement in DNA sequencing technology. Sources of animal samples and molecular methods for the identification of novel viral pathogens and steps to determine their pathogenicity are listed. The difficulties for predicting future cross-species transmissions are highlighted by the wide diversity of known viral zoonoses. Recent surveys of viruses in wild and domesticated animals have characterized numerous viruses including some closely related to those infecting humans. The detection of multiple genetic lineages within viral families infecting a single host species, phylogenetically interspersed with viruses found in other host species, reflects frequent past cross-species transmissions. Numerous opportunities for the generation of novel vaccines will arise from a better understanding of animal viromes. PMID:22463981

  10. Toward Improved Understanding of Food Security: A Methodological Examination Based in Rural South Africa.

    PubMed

    Kirkland, Tracy; Kemp, Robert S; Hunter, Lori M; Twine, Wayne S

    2013-03-01

    Accurate measurement of household food security is essential to generate adequate information on the proportion of households experiencing food insecurity, especially in areas or regions vulnerable to food shortages and famine. This manuscript offers a methodological examination of three commonly used indicators of household food security - experience of hunger, dietary diversity, and coping strategies. Making use of data from the Agincourt Health and Demographic Surveillance Site in rural South Africa, we examine the association between the indicators themselves to improve understanding of the different insight offered by each food security "lens." We also examine how the choice of indicator shapes the profile of vulnerable households, with results suggesting that dietary diversity scores may not adequately capture broader food insecurity. Concluding discussion explores programmatic and policy implications as related to methodological choices.

  11. Informed consent in clinical research; Do patients understand what they have signed?

    PubMed

    Villamañán, Elena; Ruano, Margarita; Fernández-de Uzquiano, Enma; Lavilla, Paz; González, Diana; Freire, Mercedes; Sobrino, Carmen; Herrero, Alicia

    2016-05-01

    Informed consent is an essential element of research, and signing this document is required to conduct most clinical trials. Its aim is to inform patients what their participation in the study will involve. However, increasingly, their complexity and length are making them difficult to understand, which might lead patients to give their authorization without having read them previously or without having understood what is stated. In this sense, the Ethics Committees for Clinical Research, and Pharmacists specialized in Hospital Pharmacy and Primary Care in their capacity as members of said committees, play an important and difficult role in defending the rights of patients. These Committees will review thoroughly these documents to guarantee that all legal requirements have been met and, at the same time, that they are easy to understand by the potential participants in a clinical trial.

  12. Informed consent in clinical research; Do patients understand what they have signed?

    PubMed

    Villamañán, Elena; Ruano, Margarita; Fernández-de Uzquiano, Enma; Lavilla, Paz; González, Diana; Freire, Mercedes; Sobrino, Carmen; Herrero, Alicia

    2016-01-01

    Informed consent is an essential element of research, and signing this document is required to conduct most clinical trials. Its aim is to inform patients what their participation in the study will involve. However, increasingly, their complexity and length are making them difficult to understand, which might lead patients to give their authorization without having read them previously or without having understood what is stated. In this sense, the Ethics Committees for Clinical Research, and Pharmacists specialized in Hospital Pharmacy and Primary Care in their capacity as members of said committees, play an important and difficult role in defending the rights of patients. These Committees will review thoroughly these documents to guarantee that all legal requirements have been met and, at the same time, that they are easy to understand by the potential participants in a clinical trial. PMID:27145389

  13. An improved conceptual understanding of snowmelt and groundwater dynamics in the semi-arid Andes

    NASA Astrophysics Data System (ADS)

    Sproles, Eric; Hevia, Andres; Soulsby, Chris; Tetzlaff, Doerthe

    2016-04-01

    The contribution of snowmelt to groundwater has long been recognized as an important component of the hydrological cycle in semi-arid northern central Chile (29°-32°S). Despite its importance as a water resource, this transition to groundwater remains poorly understood. Climatically, the High Cordillera in northern central Chile receives approximately 10 times as much annual precipitation as the valley bottoms, falling almost exclusively as snow above 3500 m during the winter months. Geologically, the High Cordillera is characterized by steep topography and a highly dissected landscape underlain by bedrock. Groundwater stores in the mountain headwaters are assumed to be constrained to the valley bottoms. The current working hypothesis of watershed processes in the High Cordillera describes fluxes of spring melt moving through the hillslope via local flowpaths to valley aquifers that recharge streams throughout the headwater reaches. Previous studies in the region indicate Pre-Cordilleran aquifers, located in lower elevation dry ephemeral valleys, are hydrologically disconnected from the High Cordillera. These watersheds have no seasonal snowpack, and recharge occurs primarily during infrequent rain events. These isolated Pre-Cordilleran aquifers serve as an important water resource for rural residents and infrastructure. We present stable isotope, geochemical, and groundwater level data from the wet El Niño winter of 2015 that suggests a topographically disconnected aquifer in the Pre-Cordillera received considerable recharge from High Cordillera snowmelt. These novel findings are indicative of deep groundwater flow paths between the Pre- and High Cordillera during the wet winter and spring of 2015, and improve the conceptual understanding of hydrological processes in the region. Additionally, these results will directly benefit groundwater management in the Pre-Cordillera and better inform modeling efforts in the High Cordillera. While this study is limited to

  14. Improving Understanding of the Agulhas Current and Its Global Climate Impacts

    NASA Astrophysics Data System (ADS)

    Beal, Lisa; Biastoch, Arne

    2010-05-01

    Working Group on the Climatic Importance of the Greater Agulhas System; Portland, Oregon, 20-21 February 2010; The first meeting of the new Scientific Committee on Oceanic Research (SCOR) Working Group 136 was held to discuss recent developments in understanding the greater Agulhas Current system and future research directions. The overarching goal of the working group is to improve understanding and awareness of the regional and global climate impacts of the Agulhas Current, a major western boundary current that flows along the east coast of Africa, and its interocean leakage. In addition to studying modern circulation, the working group is motivated by recent paleodata that suggest that through the currents' southern influence on the Atlantic meridional overturning circulation (AMOC), changes in the leakage of warm and salty Agulhas waters into the Atlantic may have triggered the end of ice ages. In terms of global climate, this arguably puts the importance of the greater Agulhas system on a par with Heinrich (land-ice release) events and high-latitude deepwater formation.

  15. Improving conservation outcomes with a new paradigm for understanding species’ fundamental and realized adaptive capacity

    USGS Publications Warehouse

    Beever, Erik; O’Leary, John; Mengelt, Claudia; West, Jordan M.; Julius, Susan; Green, Nancy; Magness, Dawn; Petes, Laura E.; Stein, Bruce A.; Nicotra, Adrienne B; Hellmann, Jessica J; Robertson, Amanda L; Staudinger, Michelle D.; Rosenberg, Andrew A.; Babij, Eleanora; Brennan, Jean; Schuurman, Gregor W; Hofmann, Gretchen E

    2016-01-01

    Worldwide, many species are responding to ongoing climate change with shifts in distribution, abundance, phenology, or behavior. Consequently, natural-resource managers face increasingly urgent conservation questions related to biodiversity loss, expansion of invasive species, and deteriorating ecosystem services. We argue that our ability to address these questions is hampered by the lack of explicit consideration of species’ adaptive capacity (AC). AC is the ability of a species or population to cope with climatic changes and is characterized by three fundamental components: phenotypic plasticity, dispersal ability, and genetic diversity. However, few studies simultaneously address all elements; often, AC is confused with sensitivity or omitted altogether from climate-change vulnerability assessments. Improved understanding, consistent definition, and comprehensive evaluations of AC are needed. Using classic ecological-niche theory as an analogy, we propose a new paradigm that considers fundamental and realized AC: the former reflects aspects inherent to species, whereas the latter denotes how extrinsic factors constrain AC to what is actually expressed or observed. Through this conceptualization, we identify ecological attributes contributing to AC, outline areas of research necessary to advance understanding of AC, and provide examples demonstrating how the inclusion of AC can better inform conservation and natural-resource management.

  16. Redefining fine roots improves understanding of below-ground contributions to terrestrial biosphere processes.

    PubMed

    McCormack, M Luke; Dickie, Ian A; Eissenstat, David M; Fahey, Timothy J; Fernandez, Christopher W; Guo, Dali; Helmisaari, Heljä-Sisko; Hobbie, Erik A; Iversen, Colleen M; Jackson, Robert B; Leppälammi-Kujansuu, Jaana; Norby, Richard J; Phillips, Richard P; Pregitzer, Kurt S; Pritchard, Seth G; Rewald, Boris; Zadworny, Marcin

    2015-08-01

    Fine roots acquire essential soil resources and mediate biogeochemical cycling in terrestrial ecosystems. Estimates of carbon and nutrient allocation to build and maintain these structures remain uncertain because of the challenges of consistently measuring and interpreting fine-root systems. Traditionally, fine roots have been defined as all roots ≤ 2 mm in diameter, yet it is now recognized that this approach fails to capture the diversity of form and function observed among fine-root orders. Here, we demonstrate how order-based and functional classification frameworks improve our understanding of dynamic root processes in ecosystems dominated by perennial plants. In these frameworks, fine roots are either separated into individual root orders or functionally defined into a shorter-lived absorptive pool and a longer-lived transport fine-root pool. Using these frameworks, we estimate that fine-root production and turnover represent 22% of terrestrial net primary production globally - a c. 30% reduction from previous estimates assuming a single fine-root pool. Future work developing tools to rapidly differentiate functional fine-root classes, explicit incorporation of mycorrhizal fungi into fine-root studies, and wider adoption of a two-pool approach to model fine roots provide opportunities to better understand below-ground processes in the terrestrial biosphere.

  17. Using Computer-Based Visualization Strategies to Improve Students' Understanding of Molecular Polarity and Miscibility

    NASA Astrophysics Data System (ADS)

    Sanger, Michael J.; Badger, Steven M., II

    2001-10-01

    This study reports how instruction including visualization strategies associated with computer animations and electron density plots affected students' conceptual understanding of two chemistry topics. Two sets of students responded to several conceptual questions about molecular polarities and miscibilities and these responses were compared. One group received instruction including the use of wooden model kits and physical demonstrations; the other received similar instruction with the additional use of computer animations and electron-density plots. Students who viewed electron-density plots were more likely to identify symmetric molecules with polar bonds as being nonpolar and provided more complete descriptions of how soap molecules help remove grease from an object. Students who viewed computer animations and electron density plots were also more likely to explain that the intermolecular attractions among water molecules are responsible for the immiscibility of oil and water, and were more likely to recognize that water molecules are attracted to each other and to sodium and chloride ions but are not strongly attracted to hydrogen molecules. Although other studies have shown that computer animations can improve students' conceptual understanding of chemistry, this is the first to demonstrate that electron-density plots mapped with electrostatic potentials can also be an effective visualization strategy.

  18. Engaging Students Through Classroom Connection Webinars to Improve Their Understanding of the Mars Science Laboratory Mission

    NASA Technical Reports Server (NTRS)

    Graff, Paige V.; Achilles, Cherie

    2013-01-01

    Planetary exploration missions to other worlds, like Mars, can generate a lot of excitement and wonder for the public. The Mars Science Laboratory Mission is one of the latest planetary missions that has intrigued the public perhaps more than most. How can scientists and educational specialists capitalize on the allure of this mission and involve students and teachers in a way that not only shares the story of the mission, but actively engages classrooms with scientists and improves their understanding of the science? The Expedition Earth and Beyond (EEAB) Program [1], facilitated by the Astromaterials Research and Exploration Science (ARES) Directorate Education Program at the NASA Johnson Space Center achieves this by facilitating MSL mission focused classroom connection webinars. Five MSL-focused webinars facilitated through EEAB during the 2012 fall semester engaged almost 3000 students and teachers. Involved STEM experts/role models helped translate the science behind the Mars Science Laboratory mission in a comprehensive, exciting, and engaging manner. These virtual events captured participants attention while increasing their science awareness and understanding of the MSL mission.

  19. Active learning to understand infectious disease models and improve policy making.

    PubMed

    Willem, Lander; Stijven, Sean; Vladislavleva, Ekaterina; Broeckhove, Jan; Beutels, Philippe; Hens, Niel

    2014-04-01

    Modeling plays a major role in policy making, especially for infectious disease interventions but such models can be complex and computationally intensive. A more systematic exploration is needed to gain a thorough systems understanding. We present an active learning approach based on machine learning techniques as iterative surrogate modeling and model-guided experimentation to systematically analyze both common and edge manifestations of complex model runs. Symbolic regression is used for nonlinear response surface modeling with automatic feature selection. First, we illustrate our approach using an individual-based model for influenza vaccination. After optimizing the parameter space, we observe an inverse relationship between vaccination coverage and cumulative attack rate reinforced by herd immunity. Second, we demonstrate the use of surrogate modeling techniques on input-response data from a deterministic dynamic model, which was designed to explore the cost-effectiveness of varicella-zoster virus vaccination. We use symbolic regression to handle high dimensionality and correlated inputs and to identify the most influential variables. Provided insight is used to focus research, reduce dimensionality and decrease decision uncertainty. We conclude that active learning is needed to fully understand complex systems behavior. Surrogate models can be readily explored at no computational expense, and can also be used as emulator to improve rapid policy making in various settings.

  20. Active Learning to Understand Infectious Disease Models and Improve Policy Making

    PubMed Central

    Vladislavleva, Ekaterina; Broeckhove, Jan; Beutels, Philippe; Hens, Niel

    2014-01-01

    Modeling plays a major role in policy making, especially for infectious disease interventions but such models can be complex and computationally intensive. A more systematic exploration is needed to gain a thorough systems understanding. We present an active learning approach based on machine learning techniques as iterative surrogate modeling and model-guided experimentation to systematically analyze both common and edge manifestations of complex model runs. Symbolic regression is used for nonlinear response surface modeling with automatic feature selection. First, we illustrate our approach using an individual-based model for influenza vaccination. After optimizing the parameter space, we observe an inverse relationship between vaccination coverage and cumulative attack rate reinforced by herd immunity. Second, we demonstrate the use of surrogate modeling techniques on input-response data from a deterministic dynamic model, which was designed to explore the cost-effectiveness of varicella-zoster virus vaccination. We use symbolic regression to handle high dimensionality and correlated inputs and to identify the most influential variables. Provided insight is used to focus research, reduce dimensionality and decrease decision uncertainty. We conclude that active learning is needed to fully understand complex systems behavior. Surrogate models can be readily explored at no computational expense, and can also be used as emulator to improve rapid policy making in various settings. PMID:24743387

  1. Redefining fine roots improves understanding of belowground contributions to terrestrial biosphere processes

    SciTech Connect

    McCormack, M. Luke; Dickie, Ian A.; Eissenstat, David M.; Fahey, Timothy J.; Fernandez, Christopher W.; Guo, Dali; Helmisaari, Helja -Sisko; Hobbie, Erik A.; Iversen, Colleen M.; Jackson, Robert B.; Leppälammi-Kujansuu, Jaana; Norby, Richard J.; Phillips, Richard P.; Pregitzer, Kurt S.; Pritchard, Seth G.; Rewald, Boris; Zadworny, Marcin

    2015-03-10

    Fine roots acquire essential soil resources and mediate biogeochemical cycling in terrestrial ecosystems. Estimates of carbon and nutrient allocation to build and maintain these structures remain uncertain due to challenges in consistent measurement and interpretation of fine-root systems. We define fine roots as all roots less than or equal to 2 mm in diameter, yet it is now recognized that this approach fails to capture the diversity of form and function observed among fine-root orders. We demonstrate how order-based and functional classification frameworks improve our understanding of dynamic root processes in ecosystems dominated by perennial plants. In these frameworks, fine roots are separated into either individual root orders or functionally defined into a shorter-lived absorptive pool and a longer-lived transport fine root pool. Furthermore, using these frameworks, we estimate that fine-root production and turnover represent 22% of terrestrial net primary production globally a ca. 30% reduction from previous estimates assuming a single fine-root pool. In the future we hope to develop tools to rapidly differentiate functional fine-root classes, explicit incorporation of mycorrhizal fungi in fine-root studies, and wider adoption of a two-pool approach to model fine roots provide opportunities to better understand belowground processes in the terrestrial biosphere.

  2. Redefining fine roots improves understanding of belowground contributions to terrestrial biosphere processes

    DOE PAGES

    McCormack, M. Luke; Dickie, Ian A.; Eissenstat, David M.; Fahey, Timothy J.; Fernandez, Christopher W.; Guo, Dali; Helmisaari, Helja -Sisko; Hobbie, Erik A.; Iversen, Colleen M.; Jackson, Robert B.; et al

    2015-03-10

    Fine roots acquire essential soil resources and mediate biogeochemical cycling in terrestrial ecosystems. Estimates of carbon and nutrient allocation to build and maintain these structures remain uncertain due to challenges in consistent measurement and interpretation of fine-root systems. We define fine roots as all roots less than or equal to 2 mm in diameter, yet it is now recognized that this approach fails to capture the diversity of form and function observed among fine-root orders. We demonstrate how order-based and functional classification frameworks improve our understanding of dynamic root processes in ecosystems dominated by perennial plants. In these frameworks, finemore » roots are separated into either individual root orders or functionally defined into a shorter-lived absorptive pool and a longer-lived transport fine root pool. Furthermore, using these frameworks, we estimate that fine-root production and turnover represent 22% of terrestrial net primary production globally a ca. 30% reduction from previous estimates assuming a single fine-root pool. In the future we hope to develop tools to rapidly differentiate functional fine-root classes, explicit incorporation of mycorrhizal fungi in fine-root studies, and wider adoption of a two-pool approach to model fine roots provide opportunities to better understand belowground processes in the terrestrial biosphere.« less

  3. Doctors and their patients: a context for understanding the wish to hasten death.

    PubMed

    Kelly, Brian; Burnett, Paul; Badger, Shirlene; Pelusi, Dan; Varghese, Francis T; Robertson, Marguerite

    2003-06-01

    There is a paucity of research that has directly examined the role of the health professional in dealing with a terminally ill patient's wish to hasten death (WTHD) and the implications of this for the support and services needed in the care for a dying patient. Themes to emerge from a qualitative analysis of interviews conducted on doctors (n=24) involved in the treatment and care of terminally ill patients were (i). the doctors' experiences in caring for their patients (including themes of emotional demands/expectations, the duration of illness, and the availability of palliative care services); (ii). the doctors' perception of the care provided to their respective patients (comprising themes concerning satisfaction with the care for physical symptoms, for emotional symptoms, or overall care); (iii). the doctors' attitudes to euthanasia and (iv). the doctors' perception of their patients' views/beliefs regarding euthanasia and hastened death. When responses were categorised according to the patients' level of a WTHD, the theme concerning the prolonged nature of the patients' illnesses was prominent in the doctor group who had patients with the highest WTHD, whereas there was only a minority of responses concerning support from palliative care services and satisfaction with the level of emotional care in this group.This exploratory study presents a set of descriptive findings identifying themes among a small group of doctors who have been involved in the care of terminally ill cancer patients, to investigate factors that may be associated with the WTHD among these patients. The pattern of findings suggest that research investigating the doctor-patient interaction in this setting may add to our understanding of the problems (for patients and their doctors) that underpins the wish to hasten death in the terminally ill. PMID:12748974

  4. Collaborating With Music Therapists to Improve Patient Care.

    PubMed

    Palmer, Jaclyn Bradley; Lane, Deforia; Mayo, Diane

    2016-09-01

    Collaboration between perioperative nurses and music therapists can be beneficial in providing a safe, cost-effective means of managing patients' anxiety and pain and reducing the need for pharmacologic intervention in the perioperative setting. The use of a board-certified music therapist may help to improve patient outcomes, ease nurse workload, and serve as an adjunct therapeutic modality that is enjoyable for both patients and staff members. We conducted a two-year, randomized controlled trial to determine how to best implement a music therapy program, navigate its challenges, and collaborate with nurse colleagues to bring its benefits to surgical patients. This article offers suggestions for alliances between perioperative nursing and music therapy staff members and describes the potential of music therapists to help provide optimal patient care. PMID:27568531

  5. Interventions to Improve Care for Patients with Limited Health Literacy

    PubMed Central

    Sudore, Rebecca L.; Schillinger, Dean

    2009-01-01

    Objective To propose a framework and describe best practices for improving care for patients with limited health literacy (LHL). Methods Review of the literature. Results Approximately half of the U.S. adult population has LHL. Because LHL is associated with poor health outcomes and contributes to health disparities, the adoption of evidence-based best practices is imperative. Feasible interventions at the clinician-patient level (eg, patient-centered communication, clear communication techniques, teach-to-goal methods, and reinforcement), at the system-patient level (eg, clear health education materials, visual aids, clear medication labeling, self-management support programs, and shame-free clinical environments), and at the community-patient level (eg, adult education referrals, lay health educators, and harnessing the mass media) can improve health outcomes for patients with LHL. Conclusion Because LHL is prevalent, and because the recommended communication strategies can benefit patients of all literacy levels, clinicians, health system planners, and health policy leaders should promote the uptake of these strategies into routine care. PMID:20046798

  6. Improving Outcomes for ESRD Patients: Shifting the Quality Paradigm

    PubMed Central

    2014-01-01

    Summary The availability of life-saving dialysis therapy has been one of the great successes of medicine in the past four decades. Over this time period, despite treatment of hundreds of thousands of patients, the overall quality of life for patients with ESRD has not substantially improved. A narrow focus by clinicians and regulators on basic indicators of care, like dialysis adequacy and anemia, has consumed time and resources but not resulted in significantly improved survival; also, frequent hospitalizations and dissatisfaction with the care experience continue to be seen. A new quality paradigm is needed to help guide clinicians, providers, and regulators to ensure that patients’ lives are improved by the technically complex and costly therapy that they are receiving. This paradigm can be envisioned as a quality pyramid: the foundation is the basic indicators (outstanding performance on these indicators is necessary but not sufficient to drive the primary outcomes). Overall, these basics are being well managed currently, but there remains an excessive focus on them, largely because of publically reported data and regulatory requirements. With a strong foundation, it is now time to focus on the more complex intermediate clinical outcomes—fluid management, infection control, diabetes management, medication management, and end-of-life care among others. Successfully addressing these intermediate outcomes will drive improvements in the primary outcomes, better survival, fewer hospitalizations, better patient experience with the treatment, and ultimately, improved quality of life. By articulating this view of quality in the ESRD program (pushing up the quality pyramid), the discussion about quality is reframed, and also, clinicians can better target their facilities in the direction of regulatory oversight and requirements about quality. Clinicians owe it to their patients, as the ESRD program celebrates its 40th anniversary, to rekindle the aspirations of the

  7. Bovine brucellosis in wildlife: using adaptive management to improve understanding, technology and suppression.

    PubMed

    White, P J; Treanor, J J; Geremia, C; Wallen, R L; Blanton, D W; Hallac, D E

    2013-04-01

    Eradication of brucellosis from bison (Bison bison) and elk (Cervus elaphus) populations in the Greater Yellowstone Area is not possible with current technology. There are considerable uncertainties regarding the effectiveness of management techniques and unintended effects on wildlife behaviour and demography. However, adaptive management provides a framework for learning about the disease, improving suppression techniques, and lowering brucellosis transmission among wildlife and to cattle. Since it takes approximately three years after birth for female bison to become reproductively active and contribute to brucellosis transmission, there is an opportunity to implement actions such as vaccination and the selective removal of infectious bison based on age and assay results to reduce the potential for transmission. Older adult bison that have been exposed to the bacteria, but recovered from acute infection, could be retained in the population to provide some immunity (resistance) against future transmission. Through careful predictions, research, and monitoring, our understanding and technology will be improved and management actions can be adjusted to better achieve desired outcomes. PMID:23837383

  8. Nourishing Our Understanding of Role Modeling to Improve Support and Health (NOURISH): Design and Methods

    PubMed Central

    Mazzeo, Suzanne E.; Kelly, Nichole R.; Stern, Marilyn; Gow, Rachel W.; Serdar, Kasey; Evans, Ronald K.; Jones, Resa M.; Bulik, Cynthia M.

    2012-01-01

    Pediatric overweight is associated with numerous physical and psychological health risks, and overweight children are at significant risk for obesity in adulthood. African-American children are at particularly high risk for obesity and related health complications. However, this racial group has traditionally had limited access to obesity treatment and relatively few studies have included sufficient numbers of lower-SES, African American participants. Further, although parental involvement in treatment for pediatric overweight has been found to be beneficial, few studies have examined the efficacy of offering treatment exclusively to parents, a potentially cost-effective approach which could benefit the entire family. This pilot project will evaluate the efficacy of an intensive parenting intervention, (NOURISH; Nourishing Our Understanding of Role modeling to Improve Support and Health), targeting racially diverse parents of overweight children (ages 6–11). NOURISH addresses several urgent research priorities by targeting the underserved and addressing the significant disparity in obesity treatment services. Parents meeting study criteria (having a child between the ages of 6 and 11 with a BMI ≥ the 85th percentile) will be offered participation in the randomized trial comparing NOURISH with a control group. We hypothesize that children whose parents participate in NOURISH will manifest greater decreases in BMI, and greater improvements in dietary intake, and quality of life compared to children whose parents do not participate. This study is designed explicitly to gather preliminary feasibility, acceptability, and effectiveness data to inform a subsequent larger randomized controlled trial. PMID:22273843

  9. Jatropha curcas, a biofuel crop: Functional genomics for understanding metabolic pathways and genetic improvement

    PubMed Central

    Maghuly, Fatemeh; Laimer, Margit

    2013-01-01

    Jatropha curcas is currently attracting much attention as an oilseed crop for biofuel, as Jatropha can grow under climate and soil conditions that are unsuitable for food production. However, little is known about Jatropha, and there are a number of challenges to be overcome. In fact, Jatropha has not really been domesticated; most of the Jatropha accessions are toxic, which renders the seedcake unsuitable for use as animal feed. The seeds of Jatropha contain high levels of polyunsaturated fatty acids, which negatively impact the biofuel quality. Fruiting of Jatropha is fairly continuous, thus increasing costs of harvesting. Therefore, before starting any improvement program using conventional or molecular breeding techniques, understanding gene function and the genome scale of Jatropha are prerequisites. This review presents currently available and relevant information on the latest technologies (genomics, transcriptomics, proteomics and metabolomics) to decipher important metabolic pathways within Jatropha, such as oil and toxin synthesis. Further, it discusses future directions for biotechnological approaches in Jatropha breeding and improvement. PMID:24092674

  10. Air pollution and public health: emerging hazards and improved understanding of risk.

    PubMed

    Kelly, Frank J; Fussell, Julia C

    2015-08-01

    Despite past improvements in air quality, very large parts of the population in urban areas breathe air that does not meet European standards let alone the health-based World Health Organisation Air Quality Guidelines. Over the last 10 years, there has been a substantial increase in findings that particulate matter (PM) air pollution is not only exerting a greater impact on established health endpoints, but is also associated with a broader number of disease outcomes. Data strongly suggest that effects have no threshold within the studied range of ambient concentrations, can occur at levels close to PM2.5 background concentrations and that they follow a mostly linear concentration-response function. Having firmly established this significant public health problem, there has been an enormous effort to identify what it is in ambient PM that affects health and to understand the underlying biological basis of toxicity by identifying mechanistic pathways-information that in turn will inform policy makers how best to legislate for cleaner air. Another intervention in moving towards a healthier environment depends upon the achieving the right public attitude and behaviour by the use of optimal air pollution monitoring, forecasting and reporting that exploits increasingly sophisticated information systems. Improving air quality is a considerable but not an intractable challenge. Translating the correct scientific evidence into bold, realistic and effective policies undisputedly has the potential to reduce air pollution so that it no longer poses a damaging and costly toll on public health.

  11. Improving our understanding of papillary renal cell carcinoma with integrative genomic analysis

    PubMed Central

    Modi, Parth K.

    2016-01-01

    Papillary renal cell carcinoma (pRCC) is a heterogeneous and incompletely understood histologic subtype of kidney cancer. Recently, authors from The Cancer Genome Atlas Research Network performed a comprehensive molecular characterization of pRCC. Using multiple analytic methods, they identified 4 subgroups of pRCC with varied genotypic anomalies and probabilities of overall survival. This analysis elucidated the differences between type 1 and type 2 pRCC. Furthermore, type 2 pRCC was found to be heterogeneous itself, with at least 3 subtypes with distinct molecular features. This improved characterization and insight about potential driver mutations and altered pathways may lead to the development of more targeted agents and better patient stratification in clinical trials for pRCC. PMID:27162793

  12. Improving the acute care of COPD patients across Gloucestershire: a quality improvement project.

    PubMed

    Miller, Craig; Cushley, Claire; Redler, Kasey; Mitchell, Claire; Aynsley Day, Elizabeth; Mansfield, Helen; Nye, Abigail

    2015-01-01

    Admissions for exacerbations of chronic obstructive pulmonary disease (COPD) present a significant proportion of patients in the acute medical take. The British Thoracic Society (BTS) provides guidelines for time specific interventions, that should be delivered to those with an acute exacerbation of COPD through the admission care bundle. These include correct diagnosis, correct assessment of oxygenation, early administration of treatment, recognition of respiratory failure, and specialist review. Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT) chose improvement in acute COPD care to be a local Commissioning for Quality and Innovation (CQUIN) scheme, which enables commissioners to reward excellence by linking a proportion of English healthcare providers' income to the achievement of local quality improvement goals. The effects of initiatives put in place by senior clinicians had waned, and further improvements were required to meet the CQUIN target. The aim of the scheme was to improve compliance with the BTS guidelines and CQUIN scheme for patients admitted with an exacerbation of COPD. Specific bundle paperwork to be used for all patients admitted to the Trust with an exacerbation of COPD was introduced to the Trust in June 2014, with training and education of medical staff at that time. This had improved compliance rates from 10% to 63% by September 2014. Compliance with each intervention was audited through the examination of notes of patients admitted with an exacerbation of COPD. Compliance rates had plateaued over the last three months, and so a focus group involving junior medical staff met in September 2014 to try to increase awareness further, in order to drive greater improvements in care, and meet the CQUIN requirements. Their strategies were implemented, and then compliance with the CQUIN requirements was reaudited as described above. The December 2014 audit results showed a further improvement in overall COPD care, with 73% of patients

  13. Galantamine improves sleep quality in patients with dementia.

    PubMed

    Naharci, Mehmet Ilkin; Ozturk, Ahmet; Yasar, Halit; Cintosun, Umit; Kocak, Necmettin; Bozoglu, Ergun; Tasci, Ilker; Doruk, Huseyin

    2015-12-01

    The purpose of the study was to evaluate the influences of cholinesterase inhibitors on sleep pattern and sleep disturbance. A total of 87 mild to moderate stage dementia patients who were not on cholinesterase enzyme inhibitor and memantine treatment were included in the study. The dementia patients were treated with donepezil, galantamine or rivastigmine, depending on the preference of the clinician. Fifty-five dementia patients (63.2 %) completed the study. Twenty-three elderly subjects, who had normal cognitive functions, were included in the study as the control group. The Pittsburgh Sleep Quality Index was used for evaluating the sleep quality at the beginning and at the final assessment. The improvement in sleep quality was better with regard to changes in Pittsburgh Sleep Quality Index scores with galantamine treatment compared to the donepezil and the control groups. A significant decrease in Pittsburgh Sleep Quality Index scores was detected in the galantamine group after treatment. Although statistically not significant, rivastigmine decreased and donepezil increased the Pittsburgh Sleep Quality Index scores after treatment. Dementia patients who had a poor sleep quality (n: 36), the rate of improvement in sleep disturbance was 81.8 % in the galantamine group, 75 % in the rivastigmine, and 50 % in the donepezil group. Galantamine may be the first choice of cholinesterase inhibitor in mild to moderate dementia patients in terms of improving sleep quality.

  14. Galantamine improves sleep quality in patients with dementia.

    PubMed

    Naharci, Mehmet Ilkin; Ozturk, Ahmet; Yasar, Halit; Cintosun, Umit; Kocak, Necmettin; Bozoglu, Ergun; Tasci, Ilker; Doruk, Huseyin

    2015-12-01

    The purpose of the study was to evaluate the influences of cholinesterase inhibitors on sleep pattern and sleep disturbance. A total of 87 mild to moderate stage dementia patients who were not on cholinesterase enzyme inhibitor and memantine treatment were included in the study. The dementia patients were treated with donepezil, galantamine or rivastigmine, depending on the preference of the clinician. Fifty-five dementia patients (63.2 %) completed the study. Twenty-three elderly subjects, who had normal cognitive functions, were included in the study as the control group. The Pittsburgh Sleep Quality Index was used for evaluating the sleep quality at the beginning and at the final assessment. The improvement in sleep quality was better with regard to changes in Pittsburgh Sleep Quality Index scores with galantamine treatment compared to the donepezil and the control groups. A significant decrease in Pittsburgh Sleep Quality Index scores was detected in the galantamine group after treatment. Although statistically not significant, rivastigmine decreased and donepezil increased the Pittsburgh Sleep Quality Index scores after treatment. Dementia patients who had a poor sleep quality (n: 36), the rate of improvement in sleep disturbance was 81.8 % in the galantamine group, 75 % in the rivastigmine, and 50 % in the donepezil group. Galantamine may be the first choice of cholinesterase inhibitor in mild to moderate dementia patients in terms of improving sleep quality. PMID:25777522

  15. Understanding The Role Played By Medicare's Patient Experience Points System In Hospital Reimbursement.

    PubMed

    Elliott, Marc N; Beckett, Megan K; Lehrman, William G; Cleary, Paul; Cohea, Christopher W; Giordano, Laura A; Goldstein, Elizabeth H; Damberg, Cheryl L

    2016-09-01

    In 2015 the Medicare Hospital Value-Based Purchasing (VBP) program paid hospitals $1.4 billion in performance-based incentives; 30 percent of a hospital's VBP Total Performance Score was based on performance on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) measures of the patient experience of care. Hospitals receive patient experience points based on three components: achievement, improvement, and consistency. For 2015 we examined how the three components affected reimbursement for 3,152 hospitals, including their impact on low-performing and high-minority hospitals. Achievement accounted for 96 percent of the differences among hospitals in total HCAHPS points. Although achievement had the biggest influence on payments, payments related to improvement and consistency were more beneficial for low-performing hospitals that disproportionately served minority patients. The findings highlight the important inducement that paying for improvement provides to initially low-performing hospitals to improve care and the role this incentive structure plays in minimizing resource redistributions away from hospitals serving minority populations. Additional emphasis on improvement points could benefit hospitals serving disadvantaged patients. PMID:27605650

  16. Improving Patients Experience in Peadiatric Emergency Waiting Room.

    PubMed

    Ehrler, Frederic; Siebert, Johan; Wipfli, Rolf; Duret, Cyrille; Gervaix, Alain; Lovis, Christian

    2016-01-01

    When visiting the emergency department, the perception of the time spent in the waiting room before the beginning of the care, may influence patients' experience. Based on models of service evaluation, highlighting the importance of informing people about their waiting process and their place in the queue, we have developed an innovative information screen aiming at improving perception of time by patients. Following an iterative process, a group of experts including computer scientists, ergonomists and caregivers designed a solution adapted to the pediatric context. The solution includes a screen displaying five lanes representing triage levels. Patients are represented by individual avatars, drawn sequentially in the appropriate line. The interface has been designed using gamification principle, aiming at increasing acceptance, lowering learning curve and improving satisfaction. Questionnaire based evaluation results revealed high satisfaction from the 278 respondents even if the informative content was not always completely clear. PMID:27332258

  17. Improving outpatient services for elderly patients in Taiwan: a qualitative study.

    PubMed

    Kuo, Ren-Jieh; Wu, Yung-Hung; Hsu, Tsung-Shin; Chen, Liang-Kung

    2011-01-01

    The rapid pace of population aging poses significant importance of establishing an age-friendly health care system, including outpatient, inpatient, intermediate, and long-term care. The main purpose of this study is to evaluate the quality of outpatient services for elderly patients in Taiwan. Quality function deployment (QFD) is a tool effectively shortening the research-and-development period, reducing costs, and fulfilling customer needs (CNs). This study applied Kano's model and the analytic network process (ANP) to improve the basic framework of QFD. Kano's model enables a thorough understanding of elderly patients' needs and problems with regard to medical care services, so that appropriate outpatient services can be offered to them from the outset. In addition, adapting the supermatrix of ANP to the calculation of the house of quality (HoQ) will reduce subjective judgments. Using Kano's model and an integrated ANP-QFD approach, we extracted five needs of elderly patients and calculated their priorities: 'Professional medical care services convincing patients' (27%), 'With sufficient knowledge to answer patients' questions' (23.5%), 'Providing fast services to solve patients' problems' (19.3%), 'Voluntarily serving patients' (19.1%), and 'Providing proper medical equipment to patients' (11.1%). We then identified six outpatient service attributes deserving of improvement and their priorities: 'Physician with a high level of professionalism and giving clear interpretation of patient's condition' (25%), 'Staff with good communication skills and assistance to patients' (22%), 'High standardization of operating procedures' (18%), 'Staff getting on-the-job training periodically' (15%), 'Facilities sufficient and fitting for elderly patients' (10%), and 'Applying IT (internet) to help patients to receive medical care' (10%). In conclusion, we reconstructed an integrated QFD model which will not only reduce costs but also reveal the crucial outpatient service items

  18. Improving outpatient services for elderly patients in Taiwan: a qualitative study.

    PubMed

    Kuo, Ren-Jieh; Wu, Yung-Hung; Hsu, Tsung-Shin; Chen, Liang-Kung

    2011-01-01

    The rapid pace of population aging poses significant importance of establishing an age-friendly health care system, including outpatient, inpatient, intermediate, and long-term care. The main purpose of this study is to evaluate the quality of outpatient services for elderly patients in Taiwan. Quality function deployment (QFD) is a tool effectively shortening the research-and-development period, reducing costs, and fulfilling customer needs (CNs). This study applied Kano's model and the analytic network process (ANP) to improve the basic framework of QFD. Kano's model enables a thorough understanding of elderly patients' needs and problems with regard to medical care services, so that appropriate outpatient services can be offered to them from the outset. In addition, adapting the supermatrix of ANP to the calculation of the house of quality (HoQ) will reduce subjective judgments. Using Kano's model and an integrated ANP-QFD approach, we extracted five needs of elderly patients and calculated their priorities: 'Professional medical care services convincing patients' (27%), 'With sufficient knowledge to answer patients' questions' (23.5%), 'Providing fast services to solve patients' problems' (19.3%), 'Voluntarily serving patients' (19.1%), and 'Providing proper medical equipment to patients' (11.1%). We then identified six outpatient service attributes deserving of improvement and their priorities: 'Physician with a high level of professionalism and giving clear interpretation of patient's condition' (25%), 'Staff with good communication skills and assistance to patients' (22%), 'High standardization of operating procedures' (18%), 'Staff getting on-the-job training periodically' (15%), 'Facilities sufficient and fitting for elderly patients' (10%), and 'Applying IT (internet) to help patients to receive medical care' (10%). In conclusion, we reconstructed an integrated QFD model which will not only reduce costs but also reveal the crucial outpatient service items

  19. Does L-carnitine improve endothelial function in hemodialysis patients?

    PubMed Central

    Sabri, Mohammad Reza; Fahimi, Farnaz; Hajialiasgar, Soheila; Etminan, Abbas; Nazemi, Sarir; Salehi, Farzaneh

    2012-01-01

    Background: Atherosclerosis is the leading cause of death in hemodialysis patients. These patients are also very prone to L-carnitine deficiency due to kidney disease. In this clinical trial, we investigated the effect of oral L-carnitine on endothelial function of these patients. Materials ans Methods: We studied 31 adult chronic hemodialysis patients in our center and divided them into two groups. The first group (n = 20) received 1500 mg/dialysis interval (every other day) oral L-carnitine. The control group (n = 11) received placebo for one month. Ultrasonographic measurements of flow mediated dilation and carotid intima-media thickness were performed before and after one month of L-carnitine and placebo therapy. Results: This study showed that after one month of L-carnitine or placebo therapy there was no significant improvement in flow mediated dilation (p = 0.80 and p = 0.59, respectively) or decrease in carotid intima-media thickness (p = 0.12 and p = 0.50, respectively). Conclusions: Our study revealed that one month of oral L-carnitine therapy did not improve endothelial function in hemodialysis patients. Long-term studies with large sample size using intravenous form and higher doses of the drug are required to clarify the questionable role of L-carnitine in hemodialysis patients. PMID:23626603

  20. Topical Therapies for Psoriasis: Improving Management Strategies and Patient Adherence.

    PubMed

    Stein Gold, Linda F

    2016-03-01

    Psoriasis is a chronic disease that has a substantial effect on quality of life of patients and often needs long-term treatment. Topical treatments for psoriasis include corticosteroids, vitamin D derivatives, tazarotene, anthralin, tacrolimus, pimecrolimus, and newer formulations of tar. Although many of these treatments are effective, they must be prescribed appropriately and used consistently for a period of weeks to months before clinical evidence of improvement can be seen and patients perceive that the treatment is working. As such, medication dosage/schedule, choice of vehicle, and especially patient adherence to medication are key factors for a treatment to be effective. Addressing patient preferences about treatments and concerns about treatment-related toxicities and managing their expectations represent additional aspects of patient care. Therapies such as calcipotriene and betamethasone dipropionate (Cal/BD) fixed combination foam and new drugs and vehicles continuously enhance the treatment landscape for psoriasis. Because adherence to topical treatment can be a major difficulty, keeping the treatment regimen simple and using new and sophisticated treatment vehicles that are acceptable to patients can likely improve treatment outcomes. PMID:27074696

  1. Need for improved monitoring in patients with acromegaly

    PubMed Central

    Silverstein, Julie M

    2015-01-01

    Acromegaly is a rare and insidious disease characterized by the overproduction of growth hormone (GH) and insulin-like growth factor 1 (IGF1) and is most commonly due to a pituitary adenoma. Patients with acromegaly who experience prolonged exposure to elevated levels of GH and IGF1 have an increased mortality risk and progressive worsening of disease-related comorbidities. Multimodal treatment with surgery, medical therapy, and radiotherapy provides biochemical control, defined by recent acromegaly clinical guidelines from the Endocrine Society as a reduction of GH levels to <1.0 ng/ml and normalization of IGF1 levels, to a substantial proportion of patients and is associated with improved clinical outcomes. Patients with acromegaly, even those without clinical symptoms of disease, require long-term monitoring of GH and IGF1 levels if the benefits associated with biochemical control are to be maintained and the risk of developing recurrent disease is to be abated. However, suboptimal monitoring is common in patients with acromegaly, and this can have negative health effects due to delays in detection of recurrent disease and implementation of appropriate treatment. Because of the significant health consequences associated with prolonged exposure to elevated levels of GH and IGF1, optimal monitoring in patients with acromegaly is needed. This review article will discuss the biochemical assessments used for therapeutic monitoring in acromegaly, the importance of monitoring after surgery and medical therapy or radiotherapy, the consequences of suboptimal monitoring, and the need for improved monitoring algorithms for patients with acromegaly. PMID:26381160

  2. Topical Therapies for Psoriasis: Improving Management Strategies and Patient Adherence.

    PubMed

    Stein Gold, Linda F

    2016-03-01

    Psoriasis is a chronic disease that has a substantial effect on quality of life of patients and often needs long-term treatment. Topical treatments for psoriasis include corticosteroids, vitamin D derivatives, tazarotene, anthralin, tacrolimus, pimecrolimus, and newer formulations of tar. Although many of these treatments are effective, they must be prescribed appropriately and used consistently for a period of weeks to months before clinical evidence of improvement can be seen and patients perceive that the treatment is working. As such, medication dosage/schedule, choice of vehicle, and especially patient adherence to medication are key factors for a treatment to be effective. Addressing patient preferences about treatments and concerns about treatment-related toxicities and managing their expectations represent additional aspects of patient care. Therapies such as calcipotriene and betamethasone dipropionate (Cal/BD) fixed combination foam and new drugs and vehicles continuously enhance the treatment landscape for psoriasis. Because adherence to topical treatment can be a major difficulty, keeping the treatment regimen simple and using new and sophisticated treatment vehicles that are acceptable to patients can likely improve treatment outcomes.

  3. The loss of homeostasis in hemostasis: new approaches in treating and understanding acute disseminated intravascular coagulation in critically ill patients.

    PubMed

    Hook, Karen M; Abrams, Charles S

    2012-02-01

    Disseminated intravascular coagulation (DIC) profoundly increases the morbidity and mortality of patients who have sepsis. Both laboratory and clinical research advanced the understanding of the biology and pathophysiology of DIC. This, in turn, gave rise to improved therapies and patient outcomes. Beginning with a stimulus causing disruption of vascular integrity, cytokines and chemokines cause activation of systemic coagulation and inflammation. Seemingly paradoxically, the interplay between coagulation and inflammation also inhibits endogenous anticoagulants, fibrinolytics, and antiinflammatory pathways. The earliest documented and best-studied microbial cause of DIC is the lipopolysaccharide endotoxin of Gram-negative bacteria. Extensive microvascular thrombi emerge in the systemic vasculature due to dysregulation of coagulation. The result of this unrestrained, widespread small vessel thromboses multiorgan system failure. Consumption of platelets and coagulation factors during this process can lead to an elevated risk of hemorrhage. The management of these patients with simultaneous hemorrhage and thrombosis is complex and challenging. Definitive treatment of DIC, and attenuation of end-organ damage, requires control of the inciting cause. Currently, activated protein C is the only approved therapy in the United States for sepsis complicated by DIC. Further research is needed in this area to improve clinical outcomes for patients with sepsis.

  4. Another dimension of patient-centered care delivery: understanding the nature of demand.

    PubMed

    Weber, D

    1997-06-01

    In designing effective and efficient care delivery systems, health care practitioners should address two major perspectives to patient-focused care--the micro approach, relating to the transaction between providers and health care consumers, and the macro approach, which focuses on understanding the nature of demand, as groups of consumers collectively select and use health care services. By better understanding the nature of demand, health care providers hold the key to designing more effective delivery systems and also the power to manage the demand for services, which may result in highly efficient care delivery. PMID:10167449

  5. Rethinking the patient: using Burden of Treatment Theory to understand the changing dynamics of illness

    PubMed Central

    2014-01-01

    Background In this article we outline Burden of Treatment Theory, a new model of the relationship between sick people, their social networks, and healthcare services. Health services face the challenge of growing populations with long-term and life-limiting conditions, they have responded to this by delegating to sick people and their networks routine work aimed at managing symptoms, and at retarding – and sometimes preventing – disease progression. This is the new proactive work of patient-hood for which patients are increasingly accountable: founded on ideas about self-care, self-empowerment, and self-actualization, and on new technologies and treatment modalities which can be shifted from the clinic into the community. These place new demands on sick people, which they may experience as burdens of treatment. Discussion As the burdens accumulate some patients are overwhelmed, and the consequences are likely to be poor healthcare outcomes for individual patients, increasing strain on caregivers, and rising demand and costs of healthcare services. In the face of these challenges we need to better understand the resources that patients draw upon as they respond to the demands of both burdens of illness and burdens of treatment, and the ways that resources interact with healthcare utilization. Summary Burden of Treatment Theory is oriented to understanding how capacity for action interacts with the work that stems from healthcare. Burden of Treatment Theory is a structural model that focuses on the work that patients and their networks do. It thus helps us understand variations in healthcare utilization and adherence in different healthcare settings and clinical contexts. PMID:24969758

  6. Evaluating, understanding and improving the quality of clinical placements for undergraduate nurses: A practice development approach.

    PubMed

    Courtney-Pratt, Helen; Ford, Karen; Marlow, Annette

    2015-11-01

    Supervision and support is central to sustainability of clinical placement experiences of undergraduate nurses, but open to influences that impact nurses' capacity to undertake the role. Whilst supervision of learners is integral to the role of health care professionals, the primary responsibility is to deliver safe and effective care. Supervision of learners in practice is impacted by low levels of organisational support, variable individual preparedness, and lack of feedback and recognition for the role from education and industry partners. Over a period of five years the Quality Clinical Placement Evaluation research team, consisting of a partnership between health care and tertiary sectors have developed, and utilised a practice development approach to understand and support the quality of clinical placement for undergraduates and supervising ward nurses involved in Tasmanian clinical placement programs. Importantly, the approach evolved over time to be a flexible three step program supporting the translation of findings to practice, comprised of an education session related to supervision support; survey distribution to undergraduates and supervising ward nurses following clinical placement; and workshops where stakeholders come together to consider findings of the survey, their experience and the local context, with resultant actions for change. This paper reports on findings from the program after successful implementation in urban tertiary hospitals as it was implemented in non-traditional clinical placement settings, including community, aged care and rural settings. Feedback from clinicians identifies the utility of the three step program across these settings. The unique partnerships and approach to evaluating, understanding and improving quality of clinical placements has potential for transferability to other areas, with the value of findings established for all stakeholders. PMID:26256817

  7. Evaluating, understanding and improving the quality of clinical placements for undergraduate nurses: A practice development approach.

    PubMed

    Courtney-Pratt, Helen; Ford, Karen; Marlow, Annette

    2015-11-01

    Supervision and support is central to sustainability of clinical placement experiences of undergraduate nurses, but open to influences that impact nurses' capacity to undertake the role. Whilst supervision of learners is integral to the role of health care professionals, the primary responsibility is to deliver safe and effective care. Supervision of learners in practice is impacted by low levels of organisational support, variable individual preparedness, and lack of feedback and recognition for the role from education and industry partners. Over a period of five years the Quality Clinical Placement Evaluation research team, consisting of a partnership between health care and tertiary sectors have developed, and utilised a practice development approach to understand and support the quality of clinical placement for undergraduates and supervising ward nurses involved in Tasmanian clinical placement programs. Importantly, the approach evolved over time to be a flexible three step program supporting the translation of findings to practice, comprised of an education session related to supervision support; survey distribution to undergraduates and supervising ward nurses following clinical placement; and workshops where stakeholders come together to consider findings of the survey, their experience and the local context, with resultant actions for change. This paper reports on findings from the program after successful implementation in urban tertiary hospitals as it was implemented in non-traditional clinical placement settings, including community, aged care and rural settings. Feedback from clinicians identifies the utility of the three step program across these settings. The unique partnerships and approach to evaluating, understanding and improving quality of clinical placements has potential for transferability to other areas, with the value of findings established for all stakeholders.

  8. Can spectroscopic analysis improve our understanding of biogeochemical processes in agricultural streams?

    NASA Astrophysics Data System (ADS)

    Bieroza, Magdalena; Heathwaite, Ann Louise

    2015-04-01

    In agricultural catchments diffuse fluxes of nutrients, mainly nitrogen (N) and phosphorus (P) from arable land and livestock are responsible for pollution of receiving waters and their eutrophication. Organic matter (OM) can play an important role in mediating a range of biogeochemical processes controlling diffuse pollution in streams and at their interface with surrounding land in the riparian and hyporheic zones. Thus, a holistic and simultaneous monitoring of N, P and OM fractions can help to improve our understanding of biogeochemical functioning of agricultural streams. In this study we build on intensive in situ monitoring of diffuse pollution in a small agricultural groundwater-fed stream in NW England carried out since 2009. The in situ monitoring unit captures high-frequency (15 minutes to hourly) responses of water quality parameters including total phosphorus, total reactive phosphorus and nitrate-nitrogen to changing flow conditions. For two consecutive hydrological years we have carried out additional spectroscopic water analyses to characterise organic matter components and their interactions with nutrient fractions. Automated and grab water samples have been analysed using ultraviolet-visible (UV-Vis) absorbance and excitation-emission (EEM) fluorescence spectroscopy. In addition, a tryptophan sensor was trialled to capture in situ fluorescence dynamics. Our paper evaluates patterns in nutrient and OM responses to baseflow and storm flow conditions and provides an assessment of storage-related changes of automated samples and temperature and turbidity effects on in situ tryptophan measurements. The paper shows the value of spectroscopic measurements to understand biogeochemical and hydrological nutrient dynamics and quantifies analytical uncertainty associated with both laboratory-based and in situ spectroscopic measurements.

  9. Parathyroidectomy Improves Restless Leg Syndrome in Patients on Hemodialysis

    PubMed Central

    Santos, Roberto Sávio Silva; Coelho, Fernando Morgadinho Santos; da Silva, Bruno Caldin; Graciolli, Fabiana Giorgeti; Dominguez, Wagner Velasquez; de Menezes Montenegro, Fabio Luiz; Jorgetti, Vanda; Moysés, Rosa Maria Affonso; Elias, Rosilene Motta

    2016-01-01

    Background Restless leg syndrome (RLS) is a sleep disorder with high prevalence among patients on hemodialysis. It has been postulated that high phosphate and high parathyroid hormone may be implicated in its pathogenesis. Standard international criteria and face-to-face interview are not always applied. Methods this was an interventional prospective study in which 19 patients (6 men, aged 48±11 years) with severe hyperparathyroidism were evaluated. RLS diagnosis and rating scale were accessed based on the International RLS Study Group pre- and post-parathyroidectomy. Patients also underwent standard polysomnography. Results At baseline, RLS was present in 10 patients (52.6%), and pain was the most reported symptom associated with the diagnosis. Patients with RLS had higher serum phosphate (p = 0.008) that remained independently associated with RLS in a logistic regression model, adjusted for hemoglobin, age and gender (HR = 7.28;CI = 1.14–46.3, p = 0.035). After parathyroidectomy, there was a reduction of serum parathyroid hormone, phosphate, calcium and alkaline phosphatase, and an increase of 25(OH)-vitamin D, and Fetuin-A. Parathyroidectomy alleviated RLS (from 52% to 21%; p = 0.04), which was accompanied by a decrease in severity scale, in association with relief of pain and pruritus. Polysomnography in these patients showed an improvement of sleep parameters as measured by sleep efficiency, sleep latency and percentage of REM sleep. Conclusion RLS is associated with high levels of phosphate in patients with severe secondary hyperparathyroidism on hemodialysis. Pain is most reported complain in these patients. Parathyroidectomy provided an opportunity to relief RLS. Whether the reduction of serum phosphorus or parathyroid hormone contributed to this improvement merits further investigation. PMID:27196740

  10. Understanding and Predicting Social Media Use Among Community Health Center Patients: A Cross-Sectional Survey

    PubMed Central

    2014-01-01

    Background The use of social media by health care organizations is growing and provides Web-based tools to connect patients, caregivers, and providers. Objective The aim was to determine the use and factors predicting the use of social media for health care–related purposes among medically underserved primary care patients. Methods A cross-sectional survey was administered to 444 patients of a federally qualified community health center. Results Community health center patients preferred that their providers use email, cell phones for texting, and Facebook and cell phone apps for sharing health information. Significantly more Hispanic than white patients believed their providers should use Facebook (P=.001), YouTube (P=.01), and Twitter (P=.04) for sharing health information. Use and intentions to use social media for health-related purposes were significantly higher for those patients with higher subjective norm scores. Conclusions Understanding use and factors predicting use can increase adoption and utilization of social media for health care–related purposes among underserved patients in community health centers. PMID:25427823

  11. Patient-centered transfer process for patients admitted through the ED boosts satisfaction, improves safety.

    PubMed

    2013-02-01

    To improve safety and patient flow, administrators at Hallmark Health System, based in Melrose, MA, implemented a new patient-centered transfer process for patients admitted through the ED at the health system's two hospitals. Under the new approach, inpatient nurses come down to the ED to take reports on new patients in a process that includes the ED care team as well as family members. The inpatient nurses then accompany the patients up to their designated floors. Since the new patient-transfer process was implemented in June 2012, patient satisfaction has increased by at least one point on patient satisfaction surveys. Administrators anticipate that medical errors or omissions related to the handoff process will show a drop of at least 50%, when data is tabulated.

  12. Brain metastasis in lung cancer: Building a molecular and systems-level understanding to improve outcomes.

    PubMed

    Ebben, Johnathan D; You, Ming

    2016-09-01

    metastasis over the course of their disease, while 18% of small cell lung cancer patients without previous metastasis went on to develop brain metastasis as their disease progressed (Goncalves et al., 2016).The reasons underlying this predilection for the central nervous system, as well as the recent increase in the frequency of brain metastasis identified in patients remain important questions for both clinicians and basic scientists. More than ever, the question of how brain metastasis develop and how they can be treated and managed requires the involvement of interdisciplinary teams-and more importantly-scientists who are capable of thinking like clinicians and clinicians who are capable of thinking like scientists. This review aims to present a translational perspective on brain metastasis. We will investigate the scope of the problem of brain metastasis and the current management of the metastatic disease process in lung cancer. From this clinical starting point, we will investigate the literature surrounding the molecular underpinnings of lung tumor metastasis and seek to understand the process from a biological perspective to generate new hypotheses.

  13. Development and Evaluation of an Intervention to Improve Further Education Students' Understanding of Higher Education Assessment Criteria: Three Studies

    ERIC Educational Resources Information Center

    Jessen, Anna; Elander, James

    2009-01-01

    This paper reports three studies about preparing Further Education (FE) students for the transition to Higher Education (HE) by improving their understanding of HE assessment criteria. In study 1, students and tutors in both FE and HE were interviewed for a qualitative analysis of their understandings and expectations about assessment criteria. In…

  14. Does using active learning in thermodynamics lectures improve students’ conceptual understanding and learning experiences?

    NASA Astrophysics Data System (ADS)

    Georgiou, H.; Sharma, M. D.

    2015-01-01

    Encouraging ‘active learning’ in the large lecture theatre emerges as a credible recommendation for improving university courses, with reports often showing significant improvements in learning outcomes. However, the recommendations are based predominantly on studies undertaken in mechanics. We set out to examine those claims in the thermodynamics module of a large first year physics course with an established technique, called interactive lecture demonstrations (ILDs). The study took place at The University of Sydney, where four parallel streams of the thermodynamics module were divided into two streams that experienced the ILDs and two streams that did not. The programme was first implemented in 2011 to gain experience and refine logistical matters and repeated in 2012 with approximately 500 students. A validated survey, the thermal concepts survey, was used as pre-test and post-test to measure learning gains while surveys and interviews provided insights into what the ‘active learning’ meant from student experiences. We analysed lecture recordings to capture the time devoted to different activities in a lecture, including interactivity. The learning gains were in the ‘high gain’ range for the ILD streams and ‘medium gain’ for the other streams. The analysis of the lecture recordings showed that the ILD streams devoted significantly more time to interactivity while surveys and interviews showed that students in the ILD streams were thinking in deep ways. Our study shows that ILDs can make a difference in students’ conceptual understanding as well as their experiences, demonstrating the potential value-add that can be provided by investing in active learning to enhance lectures.

  15. Understanding Variability in Beach Slope to Improve Forecasts of Storm-induced Water Levels

    NASA Astrophysics Data System (ADS)

    Doran, K. S.; Stockdon, H. F.; Long, J.

    2014-12-01

    The National Assessment of Hurricane-Induced Coastal Erosion Hazards combines measurements of beach morphology with storm hydrodynamics to produce forecasts of coastal change during storms for the Gulf of Mexico and Atlantic coastlines of the United States. Wave-induced water levels are estimated using modeled offshore wave height and period and measured beach slope (from dune toe to shoreline) through the empirical parameterization of Stockdon et al. (2006). Spatial and temporal variability in beach slope leads to corresponding variability in predicted wave setup and swash. Seasonal and storm-induced changes in beach slope can lead to differences on the order of a meter in wave runup elevation, making accurate specification of this parameter essential to skillful forecasts of coastal change. Spatial variation in beach slope is accounted for through alongshore averaging, but temporal variability in beach slope is not included in the final computation of the likelihood of coastal change. Additionally, input morphology may be years old and potentially very different than the conditions present during forecast storm. In order to improve our forecasts of hurricane-induced coastal erosion hazards, the temporal variability of beach slope must be included in the final uncertainty of modeled wave-induced water levels. Frequently collected field measurements of lidar-based beach morphology are examined for study sites in Duck, North Carolina, Treasure Island, Florida, Assateague Island, Virginia, and Dauphin Island, Alabama, with some records extending over a period of 15 years. Understanding the variability of slopes at these sites will help provide estimates of associated water level uncertainty which can then be applied to other areas where lidar observations are infrequent, and improve the overall skill of future forecasts of storm-induced coastal change. Stockdon, H. F., Holman, R. A., Howd, P. A., and Sallenger Jr, A. H. (2006). Empirical parameterization of setup

  16. Optimizing hemodialysis practices in Canada could improve patient survival.

    PubMed

    Yeates, Karen E; Mendelssohn, David C; Ethier, Jean; Trpeski, Lilyanna; Na, Jingbo; Bragg-Gresham, Jennifer L; Eichleay, Margaret A; Pisoni, Ronald L; Port, Fritz K

    2007-01-01

    Data from the Canadian Organ Replacement Registry (CORR) and the Dialysis Outcomes and Practice Patterns Study (DOPPS) were used to determine whether practice patterns have changed in Canada since the introduction of the Canadian Society of Nephrology (CSN) Guidelines in 1999. DOPPS data were then used to calculate the impact of not meeting the proposed guideline targets and to estimate the potential life years gained if all Canadian hemodialysis patients achieved guideline targets. For dialysis dose and hemoglobin targets, Canadian facility performance has significantly improved over time. The vascular access use patterns show trends toward a worse pattern with increased catheter use. A calculation of the percentage of attributable risk suggests that 49% of deaths could possibly be averted if all patients currently outside the guidelines achieved them over the next five years. This corresponds to a decrease in the annual death rate from 18 to 10.1 per hundred patient years. These data support the need for improved adherence to guidelines. If Canadian caregivers were to optimize practice patterns, patient outcomes could be improved. PMID:17691708

  17. Improving personal health records for patient-centered care

    PubMed Central

    Feldman, Henry J; Ross, Stephen E; Safran, Charles

    2010-01-01

    Objective To assess the patient-centeredness of personal health records (PHR) and offer recommendations for best practice guidelines. Design Semi-structured interviews were conducted in seven large early PHR adopter organizations in 2007. Organizations were purposively selected to represent a variety of US settings, including medium and large hospitals, ambulatory care facilities, insurers and health plans, government departments, and commercial sectors. Measurements Patient-centeredness was assessed against a framework of care that includes: (1) respect for patient values, preferences, and expressed needs; (2) information and education; (3) access to care; (4) emotional support to relieve fear and anxiety; (5) involvement of family and friends; (6) continuity and secure transition between healthcare providers; (7) physical comfort; (8) coordination of care. Within this framework we used evidence for patient preferences (where it exists) to compare existing PHR policies, and propose a best practice model. Results Most organizations enable many patient-centered functions such as data access for proxies and minors. No organization allows patient views of clinical progress notes, and turnaround times for PHR reporting of normal laboratory results can be up to 7 days. Conclusion Findings suggest patient-centeredness for personal health records can be improved, and recommendations are made for best practice guidelines. PMID:20190063

  18. Improving patient care through student leadership in team quality improvement projects.

    PubMed

    Tschannen, Dana; Aebersold, Michelle; Kocan, Mary Jo; Lundy, Francene; Potempa, Kathleen

    2015-01-01

    In partnership with a major medical center, senior-level nursing students completed a root cause analysis and implementation plan to address a unit-specific quality issue. To evaluate the project, unit leaders were asked their perceptions of the value of the projects and impact on patient care, as well as to provide exemplars depicting how the student root cause analysis work resulted in improved patient outcome and/or unit processes. Liaisons noted benefits of having an RCA team, with positive impact on patient outcomes and care processes.

  19. Understanding the effects of nurses, patients' hospital rooms, and patients' perception of control on the perceived quality of a hospital.

    PubMed

    Gotlieb, J B

    2000-01-01

    Service marketing researchers suggest that the physical environment, the people, and the process strongly affect consumers' judgements when they evaluate services. Previous research has rarely applied this general framework to help identify specific hospital variables that affect the perceived quality of a hospital. This article presents a proposed model and empirical evidence that is based upon this general framework. That is, this article reports the results of a study which found that the physical environment (i.e., patients' perception of their hospital rooms) and people (i.e., patients' perception of nurses) affected patients' perception of hospital quality. The process (i.e., patients' perception of control over the process) did not directly affect their perception of hospital quality. However, patients' perception of control over the process and their perception of their hospital rooms affected their perception of their nurses. Consequently, this research suggests that the general framework identified by service marketing researchers can be applied to help understand how patients develop their perception of hospital quality. PMID:11184431

  20. Understanding the effects of nurses, patients' hospital rooms, and patients' perception of control on the perceived quality of a hospital.

    PubMed

    Gotlieb, J B

    2000-01-01

    Service marketing researchers suggest that the physical environment, the people, and the process strongly affect consumers' judgements when they evaluate services. Previous research has rarely applied this general framework to help identify specific hospital variables that affect the perceived quality of a hospital. This article presents a proposed model and empirical evidence that is based upon this general framework. That is, this article reports the results of a study which found that the physical environment (i.e., patients' perception of their hospital rooms) and people (i.e., patients' perception of nurses) affected patients' perception of hospital quality. The process (i.e., patients' perception of control over the process) did not directly affect their perception of hospital quality. However, patients' perception of control over the process and their perception of their hospital rooms affected their perception of their nurses. Consequently, this research suggests that the general framework identified by service marketing researchers can be applied to help understand how patients develop their perception of hospital quality.

  1. Commentary on the article 'Understanding Muslim patients: cross-sectional dental hygiene care'.

    PubMed

    Musrati, Ahmed Ali

    2015-08-01

    I have read with interest the article ''Understanding Muslim patients: cross-sectional dental hygiene care'' by ML Sirois et al. In the time that I see their article as a faithful, unbiased image showing a Muslim's religious life and conduct from the oral and systemic health perspective, I still have two main concerns about certain facts which were denoted with imprecise connotations. These are related to food and Ramadan fasting.

  2. [Patient education and treatment documentation - Law to Improve the Rights of Patients].

    PubMed

    Meltendorf, G; Meltendorf, C

    2013-07-01

    The Law to Improve the Rights of Patients came into force with the promulgation in the (German) Federal Law Gazette on February 25, 2013. Thus administrations of medical institutions and doctors of all disciplines should themselves acquaint with the statutory regulations and their impact on the daily practice. The present article describes and explains the statutory regulations concerning patient education and treatment documentation.

  3. [Patient education and treatment documentation - law to improve the rights of patients].

    PubMed

    Meltendorf, Gerhard; Meltendorf, Christian

    2013-07-01

    The Law to Improve the Rights of Patients came into force with the promulgation in the German Federal Law Gazette on February 25, 2013. Thus administrations of medical institutions and doctors of all disciplines should acquaint themselves with the statutory regulations and their impact on the daily practice. The present article describes and explains the statutory regulations concerning patient education and treatment documentation.

  4. Improving Door to Needle time in Patients for Thrombolysis

    PubMed Central

    Fernandes, Darren; Umasankar, Udayaraj

    2016-01-01

    Ischaemic stroke can result in approximately 2 million brain neurones being damaged for each minute that it is left untreated. Various trials and studies such as the National Institute of Neurologic Disorders (NINDS) trial, the European Cooperative Acute Stroke Study (ECASS), ECASS II, and the Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke (ATLANTIS) study have clearly demonstrated the beneficial effects of intravenous tissue plasminogen activator (tPA) for treatment of acute stroke. Therefore to minimise damage and improve clinical outcome, we need to identify patients who present within 4.5 hours of symptom onset and reduce the time taken to adminster a thrombolytic agent. This time is commonly referred to as the ‘door to needle’ (DTN) time. Our standard, set by the Clinical Commissioning Group (CCG) is to achieve a median time of scanning and thrombolysis within 55 minutes from the time that the patient enters the hospital. The aim of our QIP was to collect data on what the DTN time was during November 2015, December 2015, and January 2016 and to evaluate how this can be improved after each month. This Quality Improvement Project in the DTN time in patients for thrombolysis has identified areas in the pathway that leads to delays. One major contributing factor is the time for a doctor to come and assess and administer the thrombolytic agent to the patient. Change was implemented by ensuring that the core medical trainee on call is allocated to respond as a priority to all possible thrombolysis calls. This has resulted in a reduction of mean DTN time, from 74 minutes in November to 43 minutes in January. As well as improving patient outcomes, it is proposed that the implementation of change has benefitted the training experience and development of key skills of the core medical trainees. PMID:27559475

  5. Improving Door to Needle time in Patients for Thrombolysis.

    PubMed

    Fernandes, Darren; Umasankar, Udayaraj

    2016-01-01

    Ischaemic stroke can result in approximately 2 million brain neurones being damaged for each minute that it is left untreated. Various trials and studies such as the National Institute of Neurologic Disorders (NINDS) trial, the European Cooperative Acute Stroke Study (ECASS), ECASS II, and the Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke (ATLANTIS) study have clearly demonstrated the beneficial effects of intravenous tissue plasminogen activator (tPA) for treatment of acute stroke. Therefore to minimise damage and improve clinical outcome, we need to identify patients who present within 4.5 hours of symptom onset and reduce the time taken to adminster a thrombolytic agent. This time is commonly referred to as the 'door to needle' (DTN) time. Our standard, set by the Clinical Commissioning Group (CCG) is to achieve a median time of scanning and thrombolysis within 55 minutes from the time that the patient enters the hospital. The aim of our QIP was to collect data on what the DTN time was during November 2015, December 2015, and January 2016 and to evaluate how this can be improved after each month. This Quality Improvement Project in the DTN time in patients for thrombolysis has identified areas in the pathway that leads to delays. One major contributing factor is the time for a doctor to come and assess and administer the thrombolytic agent to the patient. Change was implemented by ensuring that the core medical trainee on call is allocated to respond as a priority to all possible thrombolysis calls. This has resulted in a reduction of mean DTN time, from 74 minutes in November to 43 minutes in January. As well as improving patient outcomes, it is proposed that the implementation of change has benefitted the training experience and development of key skills of the core medical trainees. PMID:27559475

  6. Effectiveness of Surgical Safety Checklists in Improving Patient Safety.

    PubMed

    Ragusa, Paul S; Bitterman, Adam; Auerbach, Brett; Healy, William A

    2016-01-01

    Wrong-site surgery is all too common. Despite more than a decade of campaigns by major organizations to prevent these events, there are still reports of such mistakes. This article reviews the recent literature on surgical safety checklists and other tools designed to prevent wrong-site surgery and improve patient safety in the operating room. Emphasis is placed on how well institutions comply with these guidelines, the perceptions and attitudes of those who are asked to implement them, and their effectiveness. The literature shows that the implementation of such protocols has improved patient safety. In general, these efforts are viewed favorably by operating room personnel. However, the role of these checklists and other tools in reducing wrong-sided surgeries has not been proven. The goal of the health care profession should be to continue to improve on the advances that have been made in implementing surgical checklists and preventing wrong-site surgery. Practitioners at the authors' institution are continuously searching for ways to improve on the current protocols to prevent wrong-site surgeries. The authors recently employed a protocol in which surgical instruments are kept in the back of the room, away from the patient, until completion of the surgical time-out. This practice helps to ensure that team members are not distracted or preoccupied with setting up equipment during the time-out. This approach also helps to mitigate the hierarchal style in the operating room. PMID:26942472

  7. Understanding remission in real-world lupus patients across five European countries.

    PubMed

    Schneider, M; Mosca, M; Pego-Reigosa, J M; Hachulla, E; Teh, L-S; Perna, A; Koscielny, V; Pike, J; Lobosco, S; Apolone, G

    2016-04-01

    Systemic lupus erythematosus (SLE) is a chronic autoimmune disease associated with increased mortality and significant personal, psychological and socioeconomic consequences. An agreed definition of remission is needed and lacking. We sought to visualize 'remission in SLE' in European patients considered by their physicians to be 'in remission' by comparing the reported symptom burden as reported by treating physicians for patients considered to be 'in remission' and those not considered to be 'in remission'. Data for 1227 patients drawn from a multinational, real-world survey of patients with SLE consulting practising rheumatologists and nephrologists in France, Germany, Italy, Spain, and the UK show that physicians classed their patients as 'in remission' despite a considerable ongoing symptom burden and intensive immunosuppressive medication. Patients considered to be 'in remission' still had a mean of 2.68 current symptoms vs 5.48 for those considered to be not 'in remission' (p < 0.0001). The most common symptoms among those seen to be 'in remission' were joint symptoms, fatigue, pain, mucocutaneous involvement, haematological manifestations and kidney abnormalities. The current analysis highlights important ongoing disease activity, symptom burden and immunosuppressive medication in European patients with SLE considered by their treating physician to be 'in remission'. For a further improvement of outcome, there is an urgent need for an international consensus on the definitions for remission among patients with SLE.

  8. End-of-Life Discussion, Patient Understanding and Determinants of Preferences in Very Severe COPD Patients: A Multicentric Study.

    PubMed

    Carlucci, Annalisa; Vitacca, Michele; Malovini, Alberto; Pierucci, Paola; Guerrieri, Aldo; Barbano, Luca; Ceriana, Piero; Balestrino, Antonella; Santoro, Carmen; Pisani, Lara; Corcione, Nadia; Nava, Stefano

    2016-10-01

    Discussion about patients' end-of-life (E-o-L) preferences should be part of the routine practice. Using a semi-structured interview with a scenario-based decision, we performed a prospective multicentre study to elicit the patients' E-o-L preferences in very severe chronic obstructive pulmonary disease (COPD). We also checked their ability to retain this information and the respect of their decisions when they die. Forty-three out of ninety-one of the eligible patients completed the study. The choice of E-o-L practice was equally distributed among the three proposed options: endotracheal intubation (ETI), 'ceiling' non-invasive ventilation (NIV), and palliation of symptoms with oxygen and morphine. NIV and ETI were more frequently chosen by patients who already experienced them. ETI preference was also associated with the use of anti-depressant drugs and a low educational level, while a higher educational level and a previous discussion with a pneumologist significantly correlated with the preference for oxygen and morphine. Less than 50% of the patients retained a full comprehension of the options at 24 hours. About half of the patients who died in the follow-up period were not treated according to their wishes. In conclusion, in end-stage COPD more efforts are needed to improve communication, patients' knowledge of the disease and E-o-L practice.

  9. Improving the Understanding of Pathogenesis of Human Papillomavirus 16 via Mapping Protein-Protein Interaction Network

    PubMed Central

    Dong, Yongcheng; Kuang, Qifan; Dai, Xu; Li, Rong; Wu, Yiming; Leng, Weijia; Li, Yizhou; Li, Menglong

    2015-01-01

    The human papillomavirus 16 (HPV16) has high risk to lead various cancers and afflictions, especially, the cervical cancer. Therefore, investigating the pathogenesis of HPV16 is very important for public health. Protein-protein interaction (PPI) network between HPV16 and human was used as a measure to improve our understanding of its pathogenesis. By adopting sequence and topological features, a support vector machine (SVM) model was built to predict new interactions between HPV16 and human proteins. All interactions were comprehensively investigated and analyzed. The analysis indicated that HPV16 enlarged its scope of influence by interacting with human proteins as much as possible. These interactions alter a broad array of cell cycle progression. Furthermore, not only was HPV16 highly prone to interact with hub proteins and bottleneck proteins, but also it could effectively affect a breadth of signaling pathways. In addition, we found that the HPV16 evolved into high carcinogenicity on the condition that its own reproduction had been ensured. Meanwhile, this work will contribute to providing potential new targets for antiviral therapeutics and help experimental research in the future. PMID:25961044

  10. A belowground perspective on the drought sensitivity of forests: Towards improved understanding and simulation

    DOE PAGES

    Phillips, Richard P.; Ibanez, Ines; D’Orangeville, Loic; Hanson, Paul J.; Ryan, Michael G.; McDowell, Nathan G.

    2016-09-13

    Predicted increases in the frequency and intensity of droughts across the temperate biome have highlighted the need to examine the extent to which forests may differ in their sensitivity to water stress. At present, a rich body of literature exists on how leaf- and stem-level physiology influence tree drought responses; however, less is known regarding the dynamic interactions that occur below ground between roots and soil physical and biological factors. Hence, there is a need to better understand how and why processes occurring below ground influence forest sensitivity to drought. Here, we review what is known about tree species’ belowmore » ground strategies for dealing with drought, and how physical and biological characteristics of soils interact with rooting strategies to influence forest sensitivity to drought. Then, we highlight how a below ground perspective of drought can be used in models to reduce uncertainty in predicting the ecosystem consequences of droughts in forests. Lastly, we describe the challenges and opportunities associated with managing forests under conditions of increasing drought frequency and intensity, and explain how a below ground perspective on drought may facilitate improved forest management.« less

  11. Long-range correlations improve understanding of the influence of network structure on contact dynamics.

    PubMed

    Peyrard, N; Dieckmann, U; Franc, A

    2008-05-01

    Models of infectious diseases are characterized by a phase transition between extinction and persistence. A challenge in contemporary epidemiology is to understand how the geometry of a host's interaction network influences disease dynamics close to the critical point of such a transition. Here we address this challenge with the help of moment closures. Traditional moment closures, however, do not provide satisfactory predictions close to such critical points. We therefore introduce a new method for incorporating longer-range correlations into existing closures. Our method is technically simple, remains computationally tractable and significantly improves the approximation's performance. Our extended closures thus provide an innovative tool for quantifying the influence of interaction networks on spatially or socially structured disease dynamics. In particular, we examine the effects of a network's clustering coefficient, as well as of new geometrical measures, such as a network's square clustering coefficients. We compare the relative performance of different closures from the literature, with or without our long-range extension. In this way, we demonstrate that the normalized version of the Bethe approximation-extended to incorporate long-range correlations according to our method-is an especially good candidate for studying influences of network structure. Our numerical results highlight the importance of the clustering coefficient and the square clustering coefficient for predicting disease dynamics at low and intermediate values of transmission rate, and demonstrate the significance of path redundancy for disease persistence. PMID:18262579

  12. Improving our understanding of clouds in the Earth's climate using polarimetry (Invited)

    NASA Astrophysics Data System (ADS)

    Knobelspiesse, K. D.; Dunagan, S.; van Diedenhoven, B.; Marshak, A.; Holben, B. N.

    2013-12-01

    Water and ice clouds play a fundamental role in the radiative balance (and therefore climate) of the Earth, so understanding their distribution and optical properties is crucial. Recently, new data products from the ground-based NASA Aerosol Robotic Network (AERONET) have been created. These products expand the scope of AERONET to provide data about clouds in addition to atmospheric aerosols for which the network was originally designed. The main AERONET cloud data product is the Cloud Optical Depth (COD), which describes the amount of light extinction due to clouds in a vertical atmospheric column. AERONET measurements of COD must rely, however, on assumptions about the cloud thermodynamic phase. If the thermodynamic phase can be identified, AERONET COD errors can be significantly reduced. AERONET sun photometers determine aerosol and cloud optical properties by observing both the direct solar beam and sky scattered radiation at a variety of wavelengths. Newer instruments are also sensitive to light polarization, which we show can be used to determine cloud thermodynamic phase and therefore improve AERONET cloud data products. This work has two components. First, we performed atmospheric radiative transfer simulations to verify that polarization does contain information about cloud phase, and how to best exploit this in an algorithm. Observations were then compared to theoretical simulations. The second component of this research is to build our own polarization sensitive radiometer that is optimized for cloud observations. Initial results from both of these efforts will be presented.

  13. Improving Outcomes in the Patient with Polytrauma: A Review of the Role of Whole-Body Computed Tomography.

    PubMed

    Gunn, Martin L; Kool, Digna R; Lehnert, Bruce E

    2015-07-01

    Whole-body computed tomography (WBCT) is used for the workup of the patient with blunt polytrauma. WBCT is associated with improved patient survival and reduces the emergency department length of stay. However, randomized studies are needed to determine whether early WBCT improves survival, to clarify which patients benefit the most, and to model the costs of this technique compared with traditional workup. Advancements in modern multidetector computed tomography technology and an improved understanding of optimal protocols have enabled one to scan the entire body and achieve adequate image quality for a comprehensive trauma assessment in a short period. PMID:26046503

  14. Triheptanoin improves brain energy metabolism in patients with Huntington disease

    PubMed Central

    Adanyeguh, Isaac Mawusi; Rinaldi, Daisy; Henry, Pierre-Gilles; Caillet, Samantha; Valabregue, Romain; Durr, Alexandra

    2015-01-01

    Objective: Based on our previous work in Huntington disease (HD) showing improved energy metabolism in muscle by providing substrates to the Krebs cycle, we wished to obtain a proof-of-concept of the therapeutic benefit of triheptanoin using a functional biomarker of brain energy metabolism validated in HD. Methods: We performed an open-label study using 31P brain magnetic resonance spectroscopy (MRS) to measure the levels of phosphocreatine (PCr) and inorganic phosphate (Pi) before (rest), during (activation), and after (recovery) a visual stimulus. We performed 31P brain MRS in 10 patients at an early stage of HD and 13 controls. Patients with HD were then treated for 1 month with triheptanoin after which they returned for follow-up including 31P brain MRS scan. Results: At baseline, we confirmed an increase in Pi/PCr ratio during brain activation in controls—reflecting increased adenosine triphosphate synthesis—followed by a return to baseline levels during recovery (p = 0.013). In patients with HD, we validated the existence of an abnormal brain energy profile as previously reported. After 1 month, this profile remained abnormal in patients with HD who did not receive treatment. Conversely, the MRS profile was improved in patients with HD treated with triheptanoin for 1 month with the restoration of an increased Pi/PCr ratio during visual stimulation (p = 0.005). Conclusion: This study suggests that triheptanoin is able to correct the bioenergetic profile in the brain of patients with HD at an early stage of the disease. Classification of evidence: This study provides Class III evidence that, for patients with HD, treatment with triheptanoin for 1 month restores an increased MRS Pi/PCr ratio during visual stimulation. PMID:25568297

  15. Understanding the characteristics of patient presentations of young people at outdoor music festivals.

    PubMed

    Hutton, Alison; Ranse, Jamie; Verdonk, Naomi; Ullah, Shahid; Arbon, Paul

    2014-04-01

    Outdoor music festivals are unique events given that they are, for the most part, bounded and ticketed, and alcohol is served. They frequently have a higher incidence of patient presentations when compared with similar types of mass gatherings. Often, however, single events are reported in the literature, making it difficult to generalize the findings across multiple events and limiting the understanding of the "typical" patient presentations at these mass gatherings. The aim of this paper was to understand the characteristics of young people who have presented as patients to on-site health care at outdoor music festivals in Australia, and the relative proportion and type of injury and illness presentations at these events. This research used a nonexperimental design, utilizing a retrospective review of patient report forms from outdoor music festivals. Data were collected from 26 outdoor music festivals across four States of Australia during the year 2010. Females presented at greater numbers than males, and over two-thirds presented with minor illnesses, such as headaches. Males presented with injuries, in particular lacerations to their face and their hands, and alcohol and substance use made up 15% of all presentations. PMID:24555927

  16. Understanding the suffering of a patient with an illness: signs, context and strategies.

    PubMed

    Hueso Montoro, César; Siles González, José; Amezcua, Manuel; Bonill de Las Nieves, Candela; Pastor Montero, Sonia; Celdrán Mañas, Miriam

    2012-01-01

    The aim of this study is to understand the suffering of a patient with an illness, by using a secondary research method, that is, a qualitative meta-study. The primary data source of the meta-study includes "biographical reports". This project is based on a case study, in which the first-hand experiences of a patient with an illness were collected. The findings of the reports were compiled using the Archivos de la Memoria collection of the Index Foundation (Granada, Spain) and journals specialized in editing these materials. A selection of 20 biographical reports was targeted. The results of the meta-study show that suffering is a multidimensional process within a framework of ambiguous feelings. The suffering involves family and social network participation. Patients develop a range of strategies to overcome the illness. One of the effects is the fear of illness relapse or worsening.

  17. Understanding the suffering of a patient with an illness: signs, context and strategies.

    PubMed

    Hueso Montoro, César; Siles González, José; Amezcua, Manuel; Bonill de Las Nieves, Candela; Pastor Montero, Sonia; Celdrán Mañas, Miriam

    2012-01-01

    The aim of this study is to understand the suffering of a patient with an illness, by using a secondary research method, that is, a qualitative meta-study. The primary data source of the meta-study includes "biographical reports". This project is based on a case study, in which the first-hand experiences of a patient with an illness were collected. The findings of the reports were compiled using the Archivos de la Memoria collection of the Index Foundation (Granada, Spain) and journals specialized in editing these materials. A selection of 20 biographical reports was targeted. The results of the meta-study show that suffering is a multidimensional process within a framework of ambiguous feelings. The suffering involves family and social network participation. Patients develop a range of strategies to overcome the illness. One of the effects is the fear of illness relapse or worsening. PMID:22991127

  18. Does adherence therapy improve medication adherence among patients with schizophrenia? A systematic review.

    PubMed

    Hegedüs, Anna; Kozel, Bernd

    2014-12-01

    Non-adherence to medication is highly prevalent in patients with schizophrenia. Adherence therapy aims to improve medication adherence of these patients by applying techniques of cognitive behavioural therapy, psycho-education, and motivational interviewing. Even though adherence therapy is frequently discussed and researched, its effectiveness is still uncertain. This paper aims to review the effectiveness of adherence therapy on the medication adherence of patients with schizophrenia. To this end, six electronic databases were systematically searched for randomized, controlled trials on adherence therapy from January 2002 to March 2013. Four trials met the inclusion criteria and were incorporated into the review. The findings suggest that adherence therapy does not improve patients' medication adherence in comparison to treatment as usual or a control intervention. However, all the studies reviewed showed high-adherence ratings at baseline. Thus, further well-designed studies that target adherence therapy to patients who are non-adherent to their medication are needed for a more profound understanding of its effectiveness. In addition, if adherence therapy is aimed not only at improving medication adherence, but also to reach an agreement whereby the patient's decision not to take his medication is accepted, the shared decision-making process needs to be assessed as well.

  19. Improving service quality by understanding emergency department flow: a White Paper and position statement prepared for the American Academy of Emergency Medicine.

    PubMed

    Eitel, Dave R; Rudkin, Scott E; Malvehy, M Albert; Killeen, James P; Pines, Jesse M

    2010-01-01

    Emergency Department (ED) crowding is a common problem in the United States and around the world. Process reengineering methods can be used to understand factors that contribute to crowding and provide tools to help alleviate crowding by improving service quality and patient flow. In this article, we describe the ED as a service business and then discuss specific methods to improve the ED quality and flow. Methods discussed include demand management, critical pathways, process-mapping, Emergency Severity Index triage, bedside registration, Lean and Six Sigma management methods, statistical forecasting, queuing systems, discrete event simulation modeling and balanced scorecards. The purpose of this review is to serve as a background for emergency physicians and managers interested in applying process reengineering methods to improving ED flow, reducing waiting times, and maximizing patient satisfaction. Finally, we present a position statement on behalf of the American Academy of Emergency Medicine addressing these issues.

  20. What Do Children Learn about Biology from Factual Information? A Comparison of Interventions to Improve Understanding of Contagious Illnesses

    ERIC Educational Resources Information Center

    Myant, Katherine A.; Williams, Joanne M.

    2008-01-01

    Background: Children have been shown to hold misconceptions about illness, and previous work has indicated that their knowledge can be improved through the use of interventions. Aims: This study aims to evaluate interventions based on the provision of factual information for improving understanding of contagious illness. Sample: The participants…

  1. Understanding Teacher Effectiveness: Significant State Data Capacity Is Required to Measure and Improve Teacher Effectiveness. Data for Action 2012

    ERIC Educational Resources Information Center

    Data Quality Campaign, 2012

    2012-01-01

    States are increasingly focused on understanding and improving teacher effectiveness. There are several funding opportunities that incentivize states to use data to inform measurements of teacher effectiveness. Local, state, and federal efforts support using data to improve teacher preparation programs. Preparation programs seek "access to data…

  2. Accurate Accumulation of Dose for Improved Understanding of Radiation Effects in Normal Tissue

    SciTech Connect

    Jaffray, David A.; Lindsay, Patricia E.; Brock, Kristy K.; Deasy, Joseph O.; Tome, W.A.

    2010-03-01

    The actual distribution of radiation dose accumulated in normal tissues over the complete course of radiation therapy is, in general, poorly quantified. Differences in the patient anatomy between planning and treatment can occur gradually (e.g., tumor regression, resolution of edema) or relatively rapidly (e.g., bladder filling, breathing motion) and these undermine the accuracy of the planned dose distribution. Current efforts to maximize the therapeutic ratio require models that relate the true accumulated dose to clinical outcome. The needed accuracy can only be achieved through the development of robust methods that track the accumulation of dose within the various tissues in the body. Specific needs include the development of segmentation methods, tissue-mapping algorithms, uncertainty estimation, optimal schedules for image-based monitoring, and the development of informatics tools to support subsequent analysis. These developments will not only improve radiation outcomes modeling but will address the technical demands of the adaptive radiotherapy paradigm. The next 5 years need to see academia and industry bring these tools into the hands of the clinician and the clinical scientist.

  3. Improving Patient Safety in Anesthesia: A Success Story?

    SciTech Connect

    Botney, Richard

    2008-05-01

    Anesthesia is necessary for surgery; however, it does not deliver any direct therapeutic benefit. The risks of anesthesia must therefore be as low as possible. Anesthesiology has been identified as a leader in improving patient safety. Anesthetic mortality has decreased, and in healthy patients can be as low as 1:250,000. Trends in anesthetic morbidity have not been as well defined, but it appears that the risk of injury is decreasing. Studies of error during anesthesia and Closed Claims studies have identified sources of risk and methods to reduce the risks associated with anesthesia. These include changes in technology, such as anesthetic delivery systems and monitors, the application of human factors, the use of simulation, and the establishment of reporting systems. A review of the important events in the past 50 years illustrates the many steps that have contributed to the improvements in anesthesia safety.

  4. Understanding HIV-positive patients' preferences for healthcare services: a protocol for a discrete choice experiment

    PubMed Central

    Youssef, Elaney; Cooper, Vanessa; Miners, Alec; Llewellyn, Carrie; Pollard, Alex; Lagarde, Mylene; Sachikonye, Memory; Sabin, Caroline; Foreman, Claire; Perry, Nicky; Nixon, Eileen; Fisher, Martin

    2016-01-01

    Introduction While the care of HIV-positive patients, including the detection and management of comorbidities, has historically been provided in HIV specialist outpatient clinics, recent years have seen a greater involvement of non-HIV specialists and general practitioners (GPs). The aim of this study is to determine whether patients would prefer to see their GP or HIV physician given general symptoms, and to understand what aspects of care influence their preferences. Methods/analysis We have developed and piloted a discrete choice experiment (DCE) to better understand patients' preferences for care of non-HIV-related acute symptoms. The design of the DCE was informed by our exploratory research, including the findings of a systematic literature review and a qualitative study. Additional questionnaire items have been included to measure demographics, service use and experience of non-HIV illnesses and quality of life (EQ5D). We plan to recruit 1000 patients from 14 HIV clinics across South East England. Data will be analysed using random-effects logistic regression and latent class analysis. ORs and 95% CIs will be used to estimate the relative importance of each of the attribute levels. Latent class analysis will identify whether particular groups of people value the service attribute levels differently. Ethics/dissemination Ethical approval for this study was obtained from the Newcastle and North Tyneside Research Ethics Committee (reference number 14/NE/1193). The results will be disseminated at national and international conferences and peer-reviewed publications. A study report, written in plain English, will be made available to all participants. The Patient Advisory Group will develop a strategy for wider dissemination of the findings to patients and the public. PMID:27431895

  5. Involvement of a Surgical Service Improves Patient Satisfaction in Patients Admitted with Small Bowel Obstruction

    PubMed Central

    Schmocker, Ryan K.; Vang, Xia; Cherney Stafford, Linda M.; Leverson, Glen E.; Winslow, Emily R.

    2015-01-01

    Background For patients with small bowel obstruction (SBO), surgical care has been associated with improved outcomes; however it remains unknown how it impacts satisfaction. Methods Patients admitted for SBO who completed the hospital satisfaction survey were eligible. Only those with adhesions or hernias were included. Chart review extracted structural characteristics and outcomes. Results 47 patients were included; 74% (n=35) were admitted to a surgical service. 26% (n=12) were admitted to medicine, and 50% of those (n=6) had surgical consultation. Patients with surgical involvement as the consulting or primary service (SURG) had higher satisfaction with the hospital than those cared for by the medical service (80% SURG; 33% MED, p=0.015). SURG patients also had higher satisfaction with physicians (74% SURG; 44% MED; p=0.015). Conclusions Surgical involvement during SBO admissions is associated with increased patient satisfaction, and adds further weight to the recommendation that these patients be cared for by surgeons. PMID:25886702

  6. Heliophysics 2009 Roadmap and Global Change: Possibilities for Improved Understanding of the Connection

    NASA Technical Reports Server (NTRS)

    Spann, Jim

    2010-01-01

    Heliophysics is the science that includes all aspects of the research needed to understand the Sun and its effects on the Earth and the solar system. Six science targets: 1. Origins of Near-Earth Plasma - to understand the origin and transport of terrestrial plasma from its source to the magnetosphere and solar wind. 2. Solar Energetic Particle Acceleration and Transport - to understand how and where solar eruptions accelerate energetic particles that reach Earth. 3. Ion-Neutral Coupling in the Atmosphere - to understand how neutral winds control ionospheric variability. 4. Climate Impacts of Space Radiation - to understand our atmosphere s response to auroral, radiation belt, and solar energetic particles, and the associated effects on nitric oxide (NO) and ozone. 5. Dynamic Geospace Coupling - to understand how magnetospheric dynamics provides energy into the coupled ionosphere-magnetosphere system. 6. Heliospheric Magnetics - to understand the flow and dynamics of transient magnetic structures form the solar interior to Earth.

  7. Bridging the gap between anatomy and molecular genetics for an improved understanding of congenital heart disease.

    PubMed

    Reamon-Buettner, Stella Marie; Spanel-Borowski, Katharina; Borlak, Jürgen

    2006-05-01

    Birth defects are the leading cause of infant mortality and malformations in congenital heart disease (CHD) are among the most prevalent and fatal of all birth defects. Yet the molecular mechanisms leading to CHD are complex and the causes of the cardiac malformations observed in humans are still unclear. In recent years, the pivotal role of certain transcription factors in heart development has been demonstrated, and gene targeting of cardiac-specific transcription factor genes in animal models has provided valuable insights into heart anomalies. Nonetheless results in these models can be species specific, and in humans, germline mutations in transcription factor genes can only account for some cases of CHD. Furthermore, most patients do not have family history of CHD. There is, therefore, a need for a better understanding of the mechanisms in both normal cardiac development and the formation of malformations. The combining of expertise in cardiac anatomy, pathology, and molecular genetics is essential to adequately comprehend developmental abnormalities associated with CHD. To help elucidate genetic alterations in affected tissues of malformed hearts, we carried out genetic analysis of cardiac-specific transcription factor genes from the Leipzig collection of formalin-fixed malformed hearts. Working with this morphologically well-characterized archival material not only provided valuable genetic information associated with disease, but enabled us to put forward a hypothesis of somatic mutations as a novel molecular cause of CHD. Knowledge of cause and disease mechanism may allow for intervention that could modify the degree of cardiac malformations or development of new approaches for prevention of CHD. PMID:16711160

  8. Understanding and improving the mechanical stability of semiconducting polymers for flexible and stretchable electronics

    NASA Astrophysics Data System (ADS)

    Printz, Adam David

    Polymeric semiconductors offer the promise of low-cost, printable, and mechanically robust electronic devices for use in outdoor, portable, and wearable applications such as organic photovoltaics, biosensors, and electronic skins. However, many organic semiconductors are unable to accommodate the mechanical stresses these applications require, and it is therefore important to understand the factors and parameters that govern the mechanical stability of these materials. Chapter 1 provides a gentle introduction to the electronic and mechanical properties relevant to flexible and stretchable organic semiconductor devices. The idea of inherent competition between electronic performance and mechanical robustness is explored. Chapter 2 investigates the inherent competition between good electronic performance and mechanical robustness in poly(3-alkylthiophene)s. A key finding is a critical alkyl side-chain length that allows for good electronic performance and mechanical compliance. Chapter 3 and Appendix A are further studies on the properties of poly(3-alkylthiophene)s with side-chains close to the critical length to gain better understanding of the transition from good electronic properties and poor mechanical properties to poor electronic properties and good mechanical properties. Chapter 4 and Appendix B detail the effects on mechanical and electronic properties of statistical incorporation of unlike monomer into a low-bandgap polymer backbone in an effort to disrupt aggregation and improve mechanical compliance. Chapter 5 explores how the extent of molecular mixing of polythiophenes and fullerenes---materials common in organic photovoltaics---affects their mechanical properties. Chapter 6 describes the invention of a new technique to determine the yield point of thin films. A dependence on the alkyl-side chain length is observed, as well as a critical film thickness below which the yield point increases substantially. In Chapter 7, the weakly interacting H

  9. Periglacial process research for improved understanding of climate change in periglacial environments

    NASA Astrophysics Data System (ADS)

    Hvidtfeldt Christiansen, Hanne

    2010-05-01

    Periglacial landscapes extend widely outside the glaciated areas and the areas underlain by permafrost and with seasonal frost. Yet recently significant attention has in cryosphere research, related to periglacial geomorphology, been given to a direct climate permafrost relationship. The focus is on the permafrost thermal state including the thickness of the active layer, and often simplifying how these two key conditions are directly climatically controlled. There has been less focus on the understanding and quantification of the different periglacial processes, which largely control the consequences of changing climatic conditions on the permafrost and on seasonal frost all over the periglacial environments. It is the complex relationship between climate, micro-climate and local geomorphological, geological and ecological conditions, which controls periglacial processes. In several cases local erosion or deposition will affect the rates of landform change significantly more than any climate change. Thus detailed periglacial process studies will sophisticate the predictions of how periglacial landscapes can be expected to respond to climatic changes, and be built into Earth System Modelling. Particularly combining direct field observations and measurements with remote sensing and geochronological studies of periglacial landforms, enables a significantly improved understanding of periglacial process rates. An overview of the state of research in key periglacial processes are given focusing on ice-wedges and solifluction landforms, and seasonal ground thermal dynamics, all with examples from the high Arctic in Svalbard. Thermal contraction cracking and its seasonal meteorological control is presented, and potential thermal erosion of ice-wedges leading to development of thermokarst is discussed. Local and meteorological controls on solifluction rates are presented and their climatic control indicated. Seasonal ground thermal processes and their dependence on local

  10. Improving care in patients with acute coronary syndromes: the Erlanger quality improvement initiative.

    PubMed

    Fesmire, Francis M

    2004-09-01

    Quality improvement (QI) in emergency department (ED) patients with acute coronary syndromes (ACS) is a complex and dynamic phenomenon. ED physicians are faced with the challenge of multitasking a variety of patient complaints. This chaotic environment frequently hampers the ED physician's ability to properly evaluate and treat chest pain patients. Just as an airplane pilot would never take off without performing the comprehensive preflight operational checklist, the ED physician should have a standardized protocol for the evaluation and treatment of chest pain patients. In this report, we describe Erlanger Medical Center's 10-year QI initiative in developing a successful chest pain protocol for the rapid evaluation and treatment of patients with suspected ACS. Our initiative resulted from a collaborative effort among emergency physicians, cardiologists, nuclear radiologists, nursing staff, and administration. The systematic step-wise approach we utilized at our institution consisted of identification of the problem, development of standardized protocols, hospital-based QI initiatives, and continuation of QI efforts through national initiatives. Through this "building of bridges" among physicians, nursing, and administration, we hope that other institutions will modify our protocols to assist them in the development of their own successful QI program for improving the evaluation, treatment, and disposition of patients with suspected ACS.

  11. Music as intervention: a notable endeavor to improve patient outcomes.

    PubMed

    White, J M

    2001-03-01

    Music interventions have been used in medicine and nursing throughout history. Music therapy is an easy-to-administer, relatively inexpensive, noninvasive intervention that has been used to reduce heart rate, blood pressure, myocardial oxygen consumption, gastrointestinal function, anxiety, and pain. A review of theoretic and empirical base for the use of music therapy to improve patient outcomes in a variety of areas of clinical practice is presented. Implications for practice and future research are suggested. PMID:11342404

  12. Improving patient access and streamlining processes through enterprise intelligence systems.

    PubMed

    Dunn, Ronald L

    2014-01-01

    This article demonstrates how enterprise intelligence systems can be used to improve operational efficiency in hospitals. Enterprise intelligence systems mine raw data from disparate systems and transform the data into actionable information, which when used appropriately, support streamlined processes, optimize resources, and positively affect staff efficiency and the quality of patient care. Case studies on the implementation of McKesson Performance Visibility and Capacity Planner enterprise intelligence solutions at the Southlake Regional Health Centre and Lions Gate and Richmond Hospitals are provided.

  13. Breast cancer center: improving access to patient care.

    PubMed

    Singh, Jatinder; Edge, Stephen B; Bonaccio, Ermelinda; Schwert, Kathleen Trapp; Braun, Brian

    2014-02-01

    To improve access for patients to the Breast Cancer Center at Roswell Park Cancer Institute, the Opportunities for Improvement Project team defined 3 goals: reduce the delay to initial appointment, reduce delays in treatment at the Breast Cancer Center, and reduce delays in the start of endocrine therapy. The team developed a set of tools using Lean methodology that helped to address variables contributing to inefficiencies that result in delays. The idea behind these tools was to integrate all the business variables, such as volume, clinical space, physician availability, services offered in the Breast Program, and patient types, to produce a system or schedule that is more predictable. A new schedule for physicians, independent mid-level clinics, a survivorship program, a primary nursing model, and new roles and responsibilities were defined and implemented. Mean scores in a Press Ganey survey for wait-time questions improved by 10 points, and patient complaints decreased by almost 40%. The team concluded that delays in the Breast Program were symptoms of a larger dysfunction in systems. Fixing the problems required a comprehensive approach to review all the variables that resulted in delays. PMID:24614049

  14. Towards an Enhanced Understanding of Plant-Microbiome Interactions to Improve Phytoremediation: Engineering the Metaorganism.

    PubMed

    Thijs, Sofie; Sillen, Wouter; Rineau, Francois; Weyens, Nele; Vangronsveld, Jaco

    2016-01-01

    Phytoremediation is a promising technology to clean-up contaminated soils based on the synergistic actions of plants and microorganisms. However, to become a widely accepted, and predictable remediation alternative, a deeper understanding of the plant-microbe interactions is needed. A number of studies link the success of phytoremediation to the plant-associated microbiome functioning, though whether the microbiome can exist in alternative, functional states for soil remediation, is incompletely understood. Moreover, current approaches that target the plant host, and environment separately to improve phytoremediation, potentially overlook microbial functions and properties that are part of the multiscale complexity of the plant-environment wherein biodegradation takes place. In contrast, in situ studies of phytoremediation research at the metaorganism level (host and microbiome together) are lacking. Here, we discuss a competition-driven model, based on recent evidence from the metagenomics level, and hypotheses generated by microbial community ecology, to explain the establishment of a catabolic rhizosphere microbiome in a contaminated soil. There is evidence to ground that if the host provides the right level and mix of resources (exudates) over which the microbes can compete, then a competitive catabolic and plant-growth promoting (PGP) microbiome can be selected for as long as it provides a competitive superiority in the niche. The competition-driven model indicates four strategies to interfere with the microbiome. Specifically, the rhizosphere microbiome community can be shifted using treatments that alter the host, resources, environment, and that take advantage of prioritization in inoculation. Our model and suggestions, considering the metaorganism in its natural context, would allow to gain further knowledge on the plant-microbial functions, and facilitate translation to more effective, and predictable phytotechnologies. PMID:27014254

  15. Towards an Enhanced Understanding of Plant–Microbiome Interactions to Improve Phytoremediation: Engineering the Metaorganism

    PubMed Central

    Thijs, Sofie; Sillen, Wouter; Rineau, Francois; Weyens, Nele; Vangronsveld, Jaco

    2016-01-01

    Phytoremediation is a promising technology to clean-up contaminated soils based on the synergistic actions of plants and microorganisms. However, to become a widely accepted, and predictable remediation alternative, a deeper understanding of the plant–microbe interactions is needed. A number of studies link the success of phytoremediation to the plant-associated microbiome functioning, though whether the microbiome can exist in alternative, functional states for soil remediation, is incompletely understood. Moreover, current approaches that target the plant host, and environment separately to improve phytoremediation, potentially overlook microbial functions and properties that are part of the multiscale complexity of the plant-environment wherein biodegradation takes place. In contrast, in situ studies of phytoremediation research at the metaorganism level (host and microbiome together) are lacking. Here, we discuss a competition-driven model, based on recent evidence from the metagenomics level, and hypotheses generated by microbial community ecology, to explain the establishment of a catabolic rhizosphere microbiome in a contaminated soil. There is evidence to ground that if the host provides the right level and mix of resources (exudates) over which the microbes can compete, then a competitive catabolic and plant-growth promoting (PGP) microbiome can be selected for as long as it provides a competitive superiority in the niche. The competition-driven model indicates four strategies to interfere with the microbiome. Specifically, the rhizosphere microbiome community can be shifted using treatments that alter the host, resources, environment, and that take advantage of prioritization in inoculation. Our model and suggestions, considering the metaorganism in its natural context, would allow to gain further knowledge on the plant–microbial functions, and facilitate translation to more effective, and predictable phytotechnologies. PMID:27014254

  16. Towards an Enhanced Understanding of Plant-Microbiome Interactions to Improve Phytoremediation: Engineering the Metaorganism.

    PubMed

    Thijs, Sofie; Sillen, Wouter; Rineau, Francois; Weyens, Nele; Vangronsveld, Jaco

    2016-01-01

    Phytoremediation is a promising technology to clean-up contaminated soils based on the synergistic actions of plants and microorganisms. However, to become a widely accepted, and predictable remediation alternative, a deeper understanding of the plant-microbe interactions is needed. A number of studies link the success of phytoremediation to the plant-associated microbiome functioning, though whether the microbiome can exist in alternative, functional states for soil remediation, is incompletely understood. Moreover, current approaches that target the plant host, and environment separately to improve phytoremediation, potentially overlook microbial functions and properties that are part of the multiscale complexity of the plant-environment wherein biodegradation takes place. In contrast, in situ studies of phytoremediation research at the metaorganism level (host and microbiome together) are lacking. Here, we discuss a competition-driven model, based on recent evidence from the metagenomics level, and hypotheses generated by microbial community ecology, to explain the establishment of a catabolic rhizosphere microbiome in a contaminated soil. There is evidence to ground that if the host provides the right level and mix of resources (exudates) over which the microbes can compete, then a competitive catabolic and plant-growth promoting (PGP) microbiome can be selected for as long as it provides a competitive superiority in the niche. The competition-driven model indicates four strategies to interfere with the microbiome. Specifically, the rhizosphere microbiome community can be shifted using treatments that alter the host, resources, environment, and that take advantage of prioritization in inoculation. Our model and suggestions, considering the metaorganism in its natural context, would allow to gain further knowledge on the plant-microbial functions, and facilitate translation to more effective, and predictable phytotechnologies.

  17. Improving patient flow in pre-operative assessment

    PubMed Central

    Stark, Cameron; Gent, Anne; Kirkland, Linda

    2015-01-01

    Annual patient attendances at a pre-operative assessment department increased by 24.8% from 5659 in 2009, to 7062 in 2012. The unit was staffed by administrative staff, nurses, and health care assistants (HCA). Medical review was accessed via on call medical staff, or notes were sent to anaesthetists for further review. With rising demand, patient waits increased. The average lead time for a patient (time from entering the department to leaving) was 79 minutes. 9.3% of patients attended within two weeks of their scheduled surgery date. 10% of patients were asked to return on a later day, as there was not sufficient capacity to undertake their assessment. There were nine routes of referral in to the department. Patients moved between different clinic rooms and the waiting area several times. Work patterns were uneven, as many attendances were from out-patient clinics which meant peak attendance times were linked to clinic times. There were substantial differences in the approaches of different nurses, making the HCA role difficult. Patients reported dissatisfaction with waits. Using a Lean quality improvement process with rapid PDSA cycles, the service changed to one in which patients were placed in a room, and remained there for the duration of their assessment. Standard work was developed for HCWs and nurses. Rooms were standardised using 5S processes, and set up improved to reduce time spent looking for supplies. A co-ordinator role was introduced using existing staff to monitor flow and to organise the required medical assessments and ECGs. Timing of booked appointments were altered to take account of clinic times. Routes in to the department were reduced from nine to one. Ten months after the work began, the average lead time had reduced to 59 minutes. The proportion of people attending within two weeks of their surgery decreased from 9.3% to 5.3%. Referrals for an anaesthetic opinion decreased from 30% to 20%, and in the month reviewed no one had to return to

  18. Improving patient flow in pre-operative assessment.

    PubMed

    Stark, Cameron; Gent, Anne; Kirkland, Linda

    2015-01-01

    Annual patient attendances at a pre-operative assessment department increased by 24.8% from 5659 in 2009, to 7062 in 2012. The unit was staffed by administrative staff, nurses, and health care assistants (HCA). Medical review was accessed via on call medical staff, or notes were sent to anaesthetists for further review. With rising demand, patient waits increased. The average lead time for a patient (time from entering the department to leaving) was 79 minutes. 9.3% of patients attended within two weeks of their scheduled surgery date. 10% of patients were asked to return on a later day, as there was not sufficient capacity to undertake their assessment. There were nine routes of referral in to the department. Patients moved between different clinic rooms and the waiting area several times. Work patterns were uneven, as many attendances were from out-patient clinics which meant peak attendance times were linked to clinic times. There were substantial differences in the approaches of different nurses, making the HCA role difficult. Patients reported dissatisfaction with waits. Using a Lean quality improvement process with rapid PDSA cycles, the service changed to one in which patients were placed in a room, and remained there for the duration of their assessment. Standard work was developed for HCWs and nurses. Rooms were standardised using 5S processes, and set up improved to reduce time spent looking for supplies. A co-ordinator role was introduced using existing staff to monitor flow and to organise the required medical assessments and ECGs. Timing of booked appointments were altered to take account of clinic times. Routes in to the department were reduced from nine to one. Ten months after the work began, the average lead time had reduced to 59 minutes. The proportion of people attending within two weeks of their surgery decreased from 9.3% to 5.3%. Referrals for an anaesthetic opinion decreased from 30% to 20%, and in the month reviewed no one had to return to

  19. Talking about your health to strangers: understanding the use of online social networks by patients

    NASA Astrophysics Data System (ADS)

    Colineau, Nathalie; Paris, Cécile

    2010-04-01

    The internet has become a participatory place where everyone can contribute and interact with others. In health in particular, social media have changed traditional patient-physician relationships. Patients are organising themselves in groups, sharing observations and helping each other, although there is still little evidence of the effectiveness of these online communities on people's health. To understand why and how people use health-related sites, we studied these sites and identified three dimensions characterising most of them: informational/supportive; general/focused; and new relationships/existing ones. We conducted an online survey about the use of health-related social networking (SN) sites and learnt that, consistent with previous research, most patients were seeking information about their medical condition online, while, at the same time, still interacting with health professionals to talk about sensitive information and complex issues. We also found that, while people's natural social network played an important role for emotional support, sometimes, people chose to not involve their family, but instead interact with peers online because of their perceived support and ability to understand someone's experience, and also to maintain a comfortable emotional distance. Finally, our results show that people using general SN sites do not necessarily use health-related sites and vice versa.

  20. Understanding reasons for treatment interruption amongst patients on antiretroviral therapy – A qualitative study at the Lighthouse Clinic, Lilongwe, Malawi

    PubMed Central

    Tabatabai, Julia; Namakhoma, Ireen; Tweya, Hannock; Phiri, Sam; Schnitzler, Paul; Neuhann, Florian

    2014-01-01

    Background In recent years, scaling up of antiretroviral therapy (ART) in resource-limited settings moved impressively towards universal access. Along with these achievements, public health HIV programs are facing a number of challenges including the support of patients on lifelong therapy and the prevention of temporary/permanent loss of patients in care. Understanding reasons for treatment interruption (TI) can inform strategies for improving drug adherence and retention in care. Objective To evaluate key characteristics of patients resuming ART after TI at the Lighthouse Clinic in Lilongwe, Malawi, and to identify their reasons for interrupting ART. Design This study uses a mixed methods design to evaluate patients resuming ART after TI. We analysed an assessment form for patients with TI using pre-defined categories and a comments field to identify frequently stated reasons for TI. Additionally, we conducted 26 in-depth interviews to deepen our understanding of common reasons for TI. In-depth interviews also included the patients’ knowledge about ART and presence of social support systems. Qualitative data analysis was based on a thematic framework approach. Results A total of 347 patients (58.2% female, average age 35.1±11.3 years) with TI were identified. Despite the presence of social support and sufficient knowledge of possible consequences of TI, all patients experienced situations that resulted in TI. Analysis of in-depth interviews led to new and distinct categories for TI. The most common reason for TI was travel (54.5%, n=80/147), which further differentiated into work- or family-related travel. Patients also stated transport costs and health-care-provider-related reasons, which included perceived/enacted discrimination by health care workers. Other drivers of TI were treatment fatigue/forgetfulness, the patients’ health status, adverse drug effects, pregnancy/delivery, religious belief or perceived/enacted stigma. Conclusions To adequately

  1. An Integrated Care Initiative to Improve Patient Outcome in Schizophrenia

    PubMed Central

    Mayer-Amberg, Norbert; Woltmann, Rainer; Walther, Stefanie

    2016-01-01

    The optimal treatment of schizophrenia patients requires integration of medical and psychosocial inputs. In Germany, various health-care service providers and institutions are involved in the treatment process. Early and continuous treatment is important but often not possible because of the fragmented medical care system in Germany. The Integrated Care Initiative Schizophrenia has implemented a networked care concept in the German federal state of Lower Saxony that integrates various stakeholders of the health care system. In this initiative, office-based psychiatrists, specialized nursing staff, psychologists, social workers, hospitals, psychiatric institutional outpatient’s departments, and other community-based mental health services work together in an interdisciplinary approach. Much emphasis is placed on psychoeducation. Additional efforts cover socio-therapy, visiting care, and family support. During the period from October 2010 (start of the initiative) to December 2012, first experiences and results of quality indicators were collected of 713 registered patients and summarized in a quality monitoring report. In addition, standardized patient interviews were conducted, and duration of hospital days was recorded in 2013. By the end of 2012, patients had been enrolled for an average of 18.7 months. The overall patient satisfaction measured in a patient survey in June 2013 was high and the duration of hospital days measured in a pre–post analysis in July 2013 was reduced by 44%. Two years earlier than planned, the insurance fund will continue the successfully implemented Integrated Care Initiative and adopt it in the regular care setting. This initiative can serve as a learning case for how to set up and measure integrated care systems that may improve outcomes for patients suffering from schizophrenia. PMID:26779043

  2. An Integrated Care Initiative to Improve Patient Outcome in Schizophrenia.

    PubMed

    Mayer-Amberg, Norbert; Woltmann, Rainer; Walther, Stefanie

    2015-01-01

    The optimal treatment of schizophrenia patients requires integration of medical and psychosocial inputs. In Germany, various health-care service providers and institutions are involved in the treatment process. Early and continuous treatment is important but often not possible because of the fragmented medical care system in Germany. The Integrated Care Initiative Schizophrenia has implemented a networked care concept in the German federal state of Lower Saxony that integrates various stakeholders of the health care system. In this initiative, office-based psychiatrists, specialized nursing staff, psychologists, social workers, hospitals, psychiatric institutional outpatient's departments, and other community-based mental health services work together in an interdisciplinary approach. Much emphasis is placed on psychoeducation. Additional efforts cover socio-therapy, visiting care, and family support. During the period from October 2010 (start of the initiative) to December 2012, first experiences and results of quality indicators were collected of 713 registered patients and summarized in a quality monitoring report. In addition, standardized patient interviews were conducted, and duration of hospital days was recorded in 2013. By the end of 2012, patients had been enrolled for an average of 18.7 months. The overall patient satisfaction measured in a patient survey in June 2013 was high and the duration of hospital days measured in a pre-post analysis in July 2013 was reduced by 44%. Two years earlier than planned, the insurance fund will continue the successfully implemented Integrated Care Initiative and adopt it in the regular care setting. This initiative can serve as a learning case for how to set up and measure integrated care systems that may improve outcomes for patients suffering from schizophrenia. PMID:26779043

  3. Spectral analysis of left ventricular area variability as a tool to improve the understanding of cardiac autonomic control.

    PubMed

    Akselrod, S; Amitayt, Y; Lang, R M; Mor-Avi, V; Keselbrener, L

    2000-05-01

    Spectral analysis of the fluctuations in heart rate (HR) or blood pressure (BP) has been extensively used as a tool for the noninvasive assessment of autonomic control of the heart. The recently developed echocardiographic acoustic quantification allows noninvasive continuous measurement of the left ventricular cross-sectional area (LVA) signal. In this study, we investigated whether the LVA signal, and more specifically its fluctuations, can be reliably subjected to spectral analysis, and whether the results of such analysis may improve the understanding of the cardiovascular control mechanisms. Our results show that the general pattern of power spectra of LVA fluctuations, as well as their reproducibility, is similar to the power spectra of HR and BP fluctuations. Analysis of LVA signals obtained in normal subjects at rest as well as under vagal blockade and under held respiration, and in patients with known autonomic dysfunction, showed significant differences between groups and states. The effects of age, related to the reduction in parasympathetic activity, were not evident in the spectral content of the LVA and BP signals. The high frequency LVA fluctuations are mainly of mechanical origin, since they were eliminated by breath-holding. We observed an increase in the high frequency LVA fluctuations under vagal blockade, indicating that under normal (control) conditions, these high frequency fluctuations are attenuated by parasympathetic activity. The enhancement in high frequency fluctuations in LVA observed in diabetic patients can thus be attributed to reduced parasympathetic activity. The analysis of LVA variability may be used as a tool for basic research and, possibly, as a quantitative clinical measure for specific disease states.

  4. Donepezil Improved Cognitive Deficits in a Patient With Neurosyphilis.

    PubMed

    Wu, Yi-Shan; Lane, Hsien-Yuan; Lin, Chieh-Hsin

    2015-01-01

    A large number of patients with neurosyphilis present dementia with a progressive course and psychiatric symptoms such as depression, mania, and psychosis. Despite prompt and proper antibiotic treatment, the recovery is often incomplete, especially when tissue damage has occurred. We reported a patient with persisted cognitive decline associated with neurosyphilis that improved substantially after donepezil therapy. A 43-year-old man manifested significant psychiatric symptoms such as mania, psychosis, and cognitive impairment due to neurosyphilis. Subsequently, the patient was treated with antipsychotics and donepezil concurrent with an adequate antibiotic treatment for neurosyphilis. During the 1-year follow-up, his rapid plasma reagin titer approached from 1:256 to 1:64. His Mini-Mental State Examination (MMSE) and Alzheimer's Disease Assessment Scale-cognitive subscale scores improved from 12 to 25 and 42.3 to 6.3, respectively, after a 6-month donepezil treatment. Donepezil was discontinued. Three months later, worsening of cognitive impairment (MMSE score, 23) was noted. After donepezil was started again for 3 months, his MMSE score improved to 26. Persistent cognitive impairment is commonly associated with neurosyphilis despite adequate penicillin treatment. Treatment of the cognitive impairment is important but difficult. Cholinergic pathways are considered as involving in the cognitive deficit induced by neurosyphilis and donepezil, a cholinesterase inhibitor, which may be useful for the improvement of cognition. In this case report, we described for the first time the successful use of donepezil in treating cognitive impairment associated with neurosyphilis. The role of cholinesterase inhibitors in the treatment of cognitive impairments caused by neurosyphilis needs further studies.

  5. Understanding CAM Natural Health Products: Implications of Use Among Cancer Patients and Survivors.

    PubMed

    Fouladbakhsh, Judith M; Balneaves, Lynda; Jenuwine, Elizabeth

    2013-09-01

    Herbs, vitamins, and other natural health products are being used by cancer patients and survivors with increasing prevalence in the United States. These complementary and alternative medicine (CAM) products, which are also referred to as natural health products in Canada and abroad, are used during cancer treatment and the survivorship period to ease the burden of symptoms such as pain, fatigue, insomnia, anxiety, and depression and hence improve overall quality of life. Data indicate that while patients choose these products for self-treatment, they often do not inform their health-care providers, thereby presenting the potential for negative interactions. This article gives an overview of CAM natural health products, including discussion of herbs, vitamins, and other supplements such as minerals, enzymes, and more. Related research is presented, and implications for advanced practitioners are discussed. Insights into guiding safe and effective use among patients as well as appropriate decision-making strategies are explored. PMID:25032009

  6. Understanding CAM Natural Health Products: Implications of Use Among Cancer Patients and Survivors

    PubMed Central

    Fouladbakhsh, Judith M.; Balneaves, Lynda; Jenuwine, Elizabeth

    2013-01-01

    Herbs, vitamins, and other natural health products are being used by cancer patients and survivors with increasing prevalence in the United States. These complementary and alternative medicine (CAM) products, which are also referred to as natural health products in Canada and abroad, are used during cancer treatment and the survivorship period to ease the burden of symptoms such as pain, fatigue, insomnia, anxiety, and depression and hence improve overall quality of life. Data indicate that while patients choose these products for self-treatment, they often do not inform their health-care providers, thereby presenting the potential for negative interactions. This article gives an overview of CAM natural health products, including discussion of herbs, vitamins, and other supplements such as minerals, enzymes, and more. Related research is presented, and implications for advanced practitioners are discussed. Insights into guiding safe and effective use among patients as well as appropriate decision-making strategies are explored. PMID:25032009

  7. Toward a Research Agenda for Understanding and Improving the Use of Research Evidence

    ERIC Educational Resources Information Center

    Nelson, Steven R.; Leffler, James C.; Hansen, Barbara A.

    2009-01-01

    Many researchers and research funders want their work to be influential in educational policy and practice, but there is little systematic understanding of how policymakers and practitioners use research evidence, much less how they acquire or interpret it. By understanding what does shape policymakers' and practitioners' decision making and the…

  8. Improving Students' Understanding of Waves by Plotting a Displacement-Time Graph in Class

    ERIC Educational Resources Information Center

    Wei, Yajun

    2012-01-01

    The topic of waves is one that many high school physics students find difficult to understand. This is especially true when using some A-level textbooks used in the U.K., where the concept of waves is introduced prior to the concept of simple harmonic oscillations. One of the challenges my students encounter is understanding the difference between…

  9. Improving Social Understanding of Preschool Children: Evaluation of a Training Program

    ERIC Educational Resources Information Center

    Esteban, Moises; Sidera, Francesc; Serrano, Jessica; Amado, Anna; Rostan, Carles

    2010-01-01

    Introduction: This study tested the effects of a training program intending to foster social understanding or the capacity which enables them to understand themselves and others in terms of intentions, beliefs, desires, and emotions in children at preschool age. A number of studies have shown that in the context of shared narratives, children are…

  10. Improving Students' Understanding of, and Ability to Identify Independent and Dependent Variables

    ERIC Educational Resources Information Center

    Aldrich, Rosalie S.

    2015-01-01

    Students need to have a basic understanding of research methods before obtaining a communication degree in order to become an intelligent consumer of research--someone who is able to read, understand, explain, and critically evaluate communication and other research reported in scholarly journals as well as in the popular press. These skills are…

  11. A Versatile Module to Improve Understanding of Scientific Literature through Peer Instruction

    ERIC Educational Resources Information Center

    Jacques-Fricke, Bridget T.; Hubert, Amy; Miller, Sarah

    2009-01-01

    Using primary literature in undergraduate science classes helps teach students both scientific information and process. However, students' lack of understanding of scientific techniques can hinder their understanding of the papers. This article describes a "technique module" that uses peer teaching and active learning to facilitate integration of…

  12. A Pilot Program: Using Text Messaging to Improve Timely Communication to Tonsillectomy Patients.

    PubMed

    Newton, Laurie; Sulman, Cecille

    2016-01-01

    Approximately 1,500 tonsillectomies are performed annually at a large pediatric academic medical center each year. Families need to be educated on how to care for their child after this surgery. Most tonsillectomy patients are discharged home either the same day as surgery or after one night of observation, resulting in post-operative tonsillectomy recovery and care falling upon the patient's family. Multiple quality improvement efforts to improve family education post tonsillectomy surgery have been performed over the last several years at a large pediatric academic medical center. None of these efforts, however, have focused on the use of technology to provide innovative patient education. The purpose of this project is to provide information to parents via text messages and videos to improve patient experience and outcomes following tonsillectomy. Families provided positive feedback, including that the texts were helpful, easy to understand, and reduced pre-operative and recovery anxiety. Also, none of these families needed to call the ENT clinic for any other questions or concerns. The recovery from tonsillectomy is not easy and this pediatric otolaryngology practice is always searching for new ways to improve care and education. Use of technology is an innovative approach and likely one that will be used more often in the future.

  13. A Pilot Program: Using Text Messaging to Improve Timely Communication to Tonsillectomy Patients.

    PubMed

    Newton, Laurie; Sulman, Cecille

    2016-01-01

    Approximately 1,500 tonsillectomies are performed annually at a large pediatric academic medical center each year. Families need to be educated on how to care for their child after this surgery. Most tonsillectomy patients are discharged home either the same day as surgery or after one night of observation, resulting in post-operative tonsillectomy recovery and care falling upon the patient's family. Multiple quality improvement efforts to improve family education post tonsillectomy surgery have been performed over the last several years at a large pediatric academic medical center. None of these efforts, however, have focused on the use of technology to provide innovative patient education. The purpose of this project is to provide information to parents via text messages and videos to improve patient experience and outcomes following tonsillectomy. Families provided positive feedback, including that the texts were helpful, easy to understand, and reduced pre-operative and recovery anxiety. Also, none of these families needed to call the ENT clinic for any other questions or concerns. The recovery from tonsillectomy is not easy and this pediatric otolaryngology practice is always searching for new ways to improve care and education. Use of technology is an innovative approach and likely one that will be used more often in the future. PMID:27305731

  14. Lower extremity amputation in peripheral artery disease: improving patient outcomes

    PubMed Central

    Swaminathan, Aparna; Vemulapalli, Sreekanth; Patel, Manesh R; Jones, W Schuyler

    2014-01-01

    Peripheral artery disease affects over eight million Americans and is associated with an increased risk of mortality, cardiovascular disease, functional limitation, and limb loss. In its most severe form, critical limb ischemia, patients are often treated with lower extremity (LE) amputation (LEA), although the overall incidence of LEA is declining. In the US, there is significant geographic variation in the performing of major LEA. The rate of death after major LEA in the US is approximately 48% at 1 year and 71% at 3 years. Despite this significant morbidity and mortality, the use of diagnostic testing (both noninvasive and invasive testing) in the year prior to LEA is low and varies based on patient, provider, and regional factors. In this review we discuss the significance of LEA and methods to reduce its occurrence. These methods include improved recognition of the risk factors for LEA by clinicians and patients, strong advocacy for noninvasive and/or invasive imaging prior to LEA, improved endovascular revascularization techniques, and novel therapies. PMID:25075192

  15. Improving Patient Access to an Interventional US Clinic

    PubMed Central

    Clarke, Ryan K.; Terrell, John A.; Brightmon, Tonya R.

    2014-01-01

    A continuous quality improvement project was conducted to increase patient access to a neurointerventional ultrasonography (US) clinic. The clinic was experiencing major scheduling delays because of an increasing patient volume. A multidisciplinary team was formed that included schedulers, medical assistants, nurses, technologists, and physicians. The team created an Ishikawa diagram of the possible causes of the long wait time to the next available appointment and developed a flowchart of the steps involved in scheduling and completing a diagnostic US examination and biopsy. The team then implemented a staged intervention that included adjustments to staffing and room use (stage 1); new procedures for scheduling same-day add-on appointments (stage 2); and a lead technician rotation to optimize patient flow, staffing, and workflow (stage 3). Six months after initiation of the intervention, the mean time to the next available appointment had decreased from 25 days at baseline to 1 day, and the number of available daily appointments had increased from 38 to 55. These improvements resulted from a coordinated provider effort and had a net present value of more than $275,000. This project demonstrates that structural changes in staffing, workflow, and room use can substantially reduce scheduling delays for critical imaging procedures. © RSNA, 2014 PMID:24428301

  16. Improving patient access to an interventional US clinic.

    PubMed

    Steele, Joseph R; Clarke, Ryan K; Terrell, John A; Brightmon, Tonya R

    2014-01-01

    A continuous quality improvement project was conducted to increase patient access to a neurointerventional ultrasonography (US) clinic. The clinic was experiencing major scheduling delays because of an increasing patient volume. A multidisciplinary team was formed that included schedulers, medical assistants, nurses, technologists, and physicians. The team created an Ishikawa diagram of the possible causes of the long wait time to the next available appointment and developed a flowchart of the steps involved in scheduling and completing a diagnostic US examination and biopsy. The team then implemented a staged intervention that included adjustments to staffing and room use (stage 1); new procedures for scheduling same-day add-on appointments (stage 2); and a lead technician rotation to optimize patient flow, staffing, and workflow (stage 3). Six months after initiation of the intervention, the mean time to the next available appointment had decreased from 25 days at baseline to 1 day, and the number of available daily appointments had increased from 38 to 55. These improvements resulted from a coordinated provider effort and had a net present value of more than $275,000. This project demonstrates that structural changes in staffing, workflow, and room use can substantially reduce scheduling delays for critical imaging procedures.

  17. Obstacles to the dynamic understanding of therapist-patient sexual relations.

    PubMed

    Gutheil, T G; Gabbard, G O

    1992-10-01

    Several dynamic resistances appear to interfere with rational and empirically based discourse about therapist-patient sexual misconduct. These resistances include the lure of reductionism and a longing for simplicity; wishes for "political correctness"; gender bias; and confusion about the nature of the trauma in sexual misconduct. We conclude that (1) empirical study may produce unpleasant results; (2) "politically incorrect" models of misconduct merit study with care equal to "politically correct" ones; and (3) those reenactments we call transference-countertransference should be viewed in all their human complexity. Only then will our increased understanding of misconduct offer hope of prevention.

  18. Understanding the patient's use of the method of free association: an ego psychological approach.

    PubMed

    Busch, F

    1997-01-01

    While most of our methods of listening have been geared toward unearthing unconscious fantasies, those directed toward the ego's all-inclusive role in effecting the associative process have lagged far behind. It is the thesis of this paper that listening from the perspective of the ego allows the analyst to work more closely with what the patient is ready to understand. Clinical technique, using an ego psychological view, is elaborated, demonstrated, and compared to technique dependent on the reading of signs and symbols of the unconscious.

  19. Patient-Reported Use of Personalized Video Recordings to Improve Neurosurgical Patient-Provider Communication

    PubMed Central

    Porter, Randall

    2015-01-01

    Background: Providing patients with a video recording of their visit with a medical professional is a common-sense method for improving patient-provider communication. Objective: To describe the patient and provider experiences to video recording clinical medical encounters and providing the patient with a copy of the video for informational purposes. Methods: Since 2009, over 2,800 patients of eight different neurosurgeons chose to be video recorded during their encounter with the doctor and were provided access to the recording to watch over again as a way to recall what the doctor had said. The video system was set up as a handheld video camera, and video files were downloaded and made accessible to patients via a secure Internet patient portal. Between 2012 and 2014, patients who participated were surveyed regarding their use of the video and what was recorded on the video. The experience of the providers from a clinical and medico-legal standpoint was also reviewed. Results: Three hundred and thirty-three responses to the survey were received (39.2% response rate). More than half of patients (N=333; 56.2%) watched their video more than once, and over two-thirds (N=333; 68.6%) shared their video with a family member, friend, or another physician. Patients self-reported improved memory after watching their videos (N=299; 73.6% could remember more) and 50.2% responded that having the video made them feel more “at ease” with their medical problem (N=299). Overall, 88.0% of respondents indicated that their video had been helpful to them, and 98.5% would recommend having future visits video recorded. No patient made a comment that the video was intrusive or had prevented them from being open with their doctor. Finally, in the high-risk specialty of neurosurgery, none of the 2,807 patients who have been recorded since 2009 have used a video in a medico-legal action. Conclusions: Patient responses to the recording system and having a copy of their video

  20. Improved understanding of Diatom stratigraphy in a varved sediment through lake monitoring and sediment trap data

    NASA Astrophysics Data System (ADS)

    Maier, Dominique Beatrice; Bigler, Christian

    2016-04-01

    Biological remains in lake sediments reflect past conditions in the lake itself and within its catchment. However, it is difficult to disentangle to which extent the environmental drivers are natural (e.g. population dynamics, climate) or human-induced (e.g. agriculture, forestry). Therefore, comprehensive lake monitoring is crucial to understand taphonomy and sediment formation, and enhances the value of the paleolimnological archive. In this study, we analyze survey data of a varved lake in northern Sweden (Nylandssjön, Nordingrå) with special focus on the diatom record. Different monitoring components are combined, i.e. (1) bi-weekly data of chemical parameters (chlorophyll a, nutrients) covering the period from 2012 to 2015, (2) physical parameters (temperature, oxygen, ice-cover) covering the period from 2000-2015, (3) high-resolution data from a sequential sediment trap covering the period from 2000-2015 and (4) annually resolved diatom data from the sediment varves. Early and intense spring mixing in 2012 translates into a short but vertically pervasive chlorophyll a band which is simultaneously recorded in the sequential trap with a high diatom peak (500 000 valves cm2 d-1). The years 2013 and 2014 show higher chlorophyll a concentrations in the water column, but diatoms do not form a peak flux (>100 000 diatoms cm2 d-1) at any time in the sediment trap, probably due to stratification patterns. The trap record from 2012 indicates a spring bloom dominating the sediment signal, but this is not repeated in 2013 and 2014. Future analyses will be directed towards linking the monitored in-lake processes to annually or even seasonally resolved environmental characteristics. The multiplicity of potential ecological and environmental drivers led us to reverse our analytical view by starting with the diatom stratigraphy in the varved sediment, continuing through the data from sediment trap and water column into the lake catchment to identify deviations (timing

  1. Patient safety in plastic surgery: identifying areas for quality improvement efforts.

    PubMed

    Hernandez-Boussard, Tina; McDonald, Kathryn M; Rhoads, Kim F; Curtin, Catherine M

    2015-05-01

    Improving quality of health care is a global priority. Before quality benchmarks are established, we first must understand rates of adverse events (AEs). This project assessed risk-adjusted rates of inpatient AEs for soft tissue reconstructive procedures.Patients receiving soft tissue reconstructive procedures from 2005 to 2010 were extracted from the Nationwide Inpatient Sample. Inpatient AEs were identified using patient safety indicators (PSIs), established measures developed by Agency for Healthcare Research and Quality.We identified 409,991 patients with soft tissue reconstruction and 16,635 (4.06%) had a PSI during their hospital stay. Patient safety indicators were associated with increased risk-adjusted mortality, longer length of stay, and decreased routine disposition (P < 0.01). Patient characteristics associated with a higher risk-adjusted rate per 1000 patients at risk included older age, men, nonwhite, and public payer (P < 0.05). Overall, plastic surgery patients had significantly lower risk-adjusted rate compared to other surgical inpatients for all events evaluated except for failure to rescue and postoperative hemorrhage or hematoma, which were not statistically different. Risk-adjusted rates of hematoma hemorrhage were significantly higher in patients receiving size-reduction surgery, and these rates were further accentuated when broken down by sex and payer. In general, plastic surgery patients had lower rates of in-hospital AEs than other surgical disciplines, but PSIs were not uncommon. With the establishment of national basal PSI rates in plastic surgery patients, benchmarks can be devised and target areas for quality improvement efforts identified. Further prospective studies should be designed to elucidate the drivers of AEs identified in this population.

  2. [Patient education and treatment documentation - Law to Improve the Rights of Patients].

    PubMed

    Meltendorf, G; Meltendorf, C

    2013-07-01

    The Law to Improve the Rights of Patients came into force with the promulgation in the (German) Federal Law Gazette on February 25, 2013. Thus administrations of medical institutions and doctors of all disciplines should themselves acquaint with the statutory regulations and their impact on the daily practice. The present article describes and explains the statutory regulations concerning patient education and treatment documentation. PMID:23824480

  3. [Patient education and treatment documentation - law to improve the rights of patients].

    PubMed

    Meltendorf, Gerhard; Meltendorf, Christian

    2013-07-01

    The Law to Improve the Rights of Patients came into force with the promulgation in the German Federal Law Gazette on February 25, 2013. Thus administrations of medical institutions and doctors of all disciplines should acquaint themselves with the statutory regulations and their impact on the daily practice. The present article describes and explains the statutory regulations concerning patient education and treatment documentation. PMID:23888409

  4. Nasal highflow improves ventilation in patients with COPD

    PubMed Central

    Bräunlich, Jens; Köhler, Marcus; Wirtz, Hubert

    2016-01-01

    Background Nasal highflow (NHF) provides a warmed and humidified air stream up to 60 L/min. Recent data demonstrated a positive effect in patients with acute hypoxemic respiratory failure, especially when caused by pneumonia. Preliminary data show a decrease in hypercapnia in patients with COPD. Therefore, NHF should be evaluated as a new ventilatory support device. This study was conducted to assess the impact of different flow rates on ventilatory parameters in patients with COPD. Materials and methods This interventional clinical study was performed with patients suffering from severe COPD. The aim was to characterize flow-dependent changes in mean airway pressure, breathing volumes, breathing frequency, and decrease in partial pressure of CO2 (pCO2). Mean airway pressure was measured in the nasopharyngeal space (19 patients). To evaluate breathing volumes, we used a polysomnographic device (18 patients). All patients received 20 L/min, 30 L/min, 40 L/min, and 50 L/min and – to illustrate the effects – nasal continuous positive airway pressure and nasal bilevel positive airway pressure. Capillary blood gas analyses were performed in 54 patients with hypercapnic COPD before and two hours after the use of NHF. We compared the extent of decrease in pCO2 when using 20 L/min and 30 L/min. Additionally, comfort and dyspnea during the use of NHF were surveyed. Results NHF resulted in a minor flow dependent increase in mean airway pressure. Tidal volume increased, and breathing rate decreased. The calculated minute volume decreased under NHF breathing. In spite of this fact, hypercapnia decreased with increasing flow (20 L/min vs 30 L/min). Additionally, an improvement in dyspnea was observed. The rapid shallow breathing index shows a decrease when using NHF. Conclusion NHF leads to a flow-dependent reduction in pCO2. This is most likely achieved by a washout of the respiratory tract and a functional reduction in dead space. In summary, NHF enhances effectiveness of

  5. Improving the likelihood of neurology patients being examined using patient feedback

    PubMed Central

    Appleton, Jason Philip; Ilinca, Andreea; Lindgren, Arne; Puschmann, Andreas; Hbahbih, Majed; A. Siddiqui, Khurram; de Silva, Rajith; Jones, Matthew; Butterworth, Richard; willmot, mark; Hayton, Tom; Lunn, Michael; Nicholl, David

    2015-01-01

    We aimed to establish whether recall of elements of the neurological examination can be improved by use of a simple patient assessment score. In a previous study we demonstrated that in-patients referred to neurology at two United Kingdom (UK) hospitals were not fully examined prior to referral; we therefore designed a larger quality improvement report with 80% power to detect a 10% increase in tendon hammer or ophthalmoscope use following an educational intervention. In-patients referred to neurology over a four month period (in hospitals in the UK (10), Jordan (1), Sweden (2), and the United Arab Emirates (1)) were asked whether they recalled being examined with a tendon hammer (T), ophthalmoscope (O), and stethoscope (S) since admission. The results were disseminated to local medical teams using various techniques (including Grand Round presentations, email, posters, discounted equipment). Data were then collected for a further four month period post-intervention. Pre-intervention and post-intervention data were available for 11 centres with 407 & 391 patients in each arm respectively. Median age of patients was 51 (range 13-100) and 49 (range 16-95) years respectively, with 44.72% and 44.76% being male in each group. 264 patients (64.86%) recalled being examined with a tendon hammer in the pre-intervention arm, which significantly improved to 298 (76.21%) (p<0.001). Only 119 patients (29.24%) recollected examination with an ophthalmoscope pre-intervention, which significantly improved to 149 (38.11%)(p=0.009). The majority of patients (321 (78.87%)) pre-intervention recalled examination with a stethoscope, which significantly improved to 330 (84.4%) to a lesser extent (p=0.045). Results indicate that most patients are not fully examined prior to neurology referral yet a simple assessment score and educational intervention can improve recall of elements of the neurological examination and thus the likelihood of patients being examined neurologically. This is the

  6. Understanding Statin Non-Adherence: Knowing Which Perceptions and Experiences Matter to Different Patients

    PubMed Central

    Wouters, Hans; Van Dijk, Liset; Geers, Harm C. J.; Winters, Nina A.; Van Geffen, Erica C. G.; Stiggelbout, Anne M.; Bouvy, Marcel L.

    2016-01-01

    Background Non-adherence to statins is substantial and is associated with numerous perceptions and experiences. However, time limits in clinical practice constrain in depth explorations of these perceptions and experiences. Objectives To propose and examine a strategy aimed at an efficient assessment of a wide array of perceptions and experiences regarding the efficacy, side effects, and practical problems of statins. Furthermore, to assess associations between this wide array of experiences and perceptions and non-adherence and to examine whether patients' 'perceived self-efficacy' moderated these associations. Methods Patients were recruited through community pharmacies. A wide array of specific patient perceptions and experiences was efficiently assessed using the electronic Tailored Medicine Inventory that allows people to skip irrelevant questions. Adherence was measured through self-report and pharmacy refill data. Results Of the two-hundred twenty-nine patients who participated (mean age 63.9, standard deviation 10.2), 40%-70% doubted the necessity of or lacked knowledge about the efficacy of statins, 20%-35% of the patients were worried about joint and muscle side effects or had experienced these, and 23% had encountered practical problems regarding information about statins, intake of tablets, the package, or the blister. Experiencing more practical problems was associated with increased unintentional non-adherence (Odds ratio 1.54, 95%CI:1.13–2.10, P < 0.01), whereas worrying about side effects was associated with increased intentional non-adherence (Odds ratio 1.90, 95%CI:1.17–3.08, P < 0.01). Higher 'perceived self-efficacy' did not moderate these associations. Conclusions Insight into patients' specific barriers with regard to appropriate statin use may reveal personal reasons for being non-adherent. The Tailored Medicine Inventory is a promising tool to devise individualized intervention strategies aimed at improving adherence by the clinician-patient

  7. Preparing the patient for surgery to improve outcomes.

    PubMed

    Levett, Denny Z H; Edwards, Mark; Grocott, Mike; Mythen, Monty

    2016-06-01

    The time between contemplation of surgery and the procedure offers a window of opportunity to optimize patients' nutritional, functional and psychological state prior to surgery. Traditionally, preoperative pathways have focused on the underlying disease process and 'fitness for surgery' with physical pre-assessment and risk counselling late in the pathway when little time is available to intervene. With an increasingly elderly and co-morbid surgical population, early physiological assessment and multidisciplinary collaborative decision-making is increasingly important. Multimodal prehabilitation programmes may improve surgical outcome, facilitating rapid recovery from surgery and limiting post-operative functional dependence. Patient education and engagement is important if compliance with behavioural change is to be achieved and maintained. To date, there has been evidence supporting preoperative exercise training, smoking cessation, reduction in alcohol intake, anaemia management and psychosocial support. Further research is needed to identify the most effective elements of these complex preoperative interventions, as well as their optimum timing and duration.

  8. Computerized decision support systems: improving patient safety in nephrology

    PubMed Central

    Chang, Jamison; Ronco, Claudio; Rosner, Mitchell H.

    2016-01-01

    Incorrect prescription and administration of medications account for a substantial proportion of medical errors in the USA, causing adverse drug events (ADEs) that result in considerable patient morbidity and enormous costs to the health-care system. Patients with chronic kidney disease or acute kidney injury often have impaired drug clearance as well as polypharmacy, and are therefore at increased risk of experiencing ADEs. Studies have demonstrated that recognition of these conditions is not uniform among treating physicians, and prescribed drug doses are often incorrect. Early interventions that ensure appropriate drug dosing in this group of patients have shown encouraging results. Both computerized physician order entry and clinical decision support systems have been shown to reduce the rate of ADEs. Nevertheless, these systems have been implemented at surprisingly few institutions. Economic stimulus and health-care reform legislation present a rare opportunity to refine these systems and understand how they could be implemented more widely. Failure to explore this technology could mean that the opportunity to reduce the morbidity associated with ADEs is missed. PMID:21502973

  9. Improving patient and staff outcomes using practice development.

    PubMed

    Hennessey, Catherine Elizabeth; Fry, Margaret

    2016-10-10

    Purpose The purpose of this paper is to examine the impact of a practice development program, "Essentials of Care" (EOC), on patient and staff outcomes, workplace culture and service delivery. Design/methodology/approach A descriptive study design was used to explore the impact of EOC in a district hospital rehabilitation ward. EOC focuses on embedding a person-centered culture within clinical areas and is structured from practice development methodologies. EOC was implemented in a metropolitan district hospital rehabilitation, older person 20-bed, ward. Findings Two projects were implemented during EOC. These projects led to nine significant patient and staff outcomes for medication and continence care practices. Outcomes included a reduction in older person complaints by 80 percent, pressure injuries by 62 percent, ward multi resistant staphylococcus aureus infection rates by 50 percent, clinical incidents by 22 percent, older person falls by 14 percent (per 1,000 bed days) and nursing sick leave by 10 percent. There was also a 13 percent improvement in the post nursing workplace satisfaction survey. Research limitations/implications This is a single site study and findings may not be suitable for generalizing across ward settings and broader population groups. Originality/value The EOC program led to significant improvements for and in clinical practices, staff satisfaction and ward culture. Specifically, the EOC program also identified significant cost savings and brought together the healthcare team in a cohesive and integrated way not previously experienced by staff. Practice development strategies can champion service quality improvement, optimal patient outcomes and consistency within healthcare. PMID:27671421

  10. Improving handwashing in hospitals: a patient education and empowerment program.

    PubMed

    McGuckin, M

    2001-11-01

    Each year, about 5% of people admitted to U.S. hospitals (about 2 million people) acquire an infection there. These infections cause nearly 20,000 deaths each year, and cost an estimated $4.5 billion to treat. Handwashing is the single most effective measure for preventing hospital-acquired infections. Despite widespread knowledge of the importance of handwashing, health care workers wash their hands far less often than is indicated. This Issue Brief describes a novel strategy to improve handwashing among hospital personnel, by involving the people with the most to gain--the patients themselves.

  11. Improving psychosocial health in hemodialysis patients after a disaster.

    PubMed

    Weiner, Sheila; Kutner, Nancy G; Bowles, Tess; Johnstone, Stephanie

    2010-01-01

    Twenty-two social workers implemented a cognitive-behavioral intervention with 69 patients in 22 dialysis units in Louisiana to improve psychosocial health following Hurricanes Katrina and Rita. Pre- and post-intervention questionnaires measured psychosocial status domains (general health status, social functioning, burden of kidney disease, depressed mood, anxiety, and mastery). Participants rated their general health status (p < .05) and social functioning (p < .05) significantly higher after the intervention. Participants who listened to the class Managing stress through communication and problem solving and discussed it with their social worker, had significant improvement in depressed mood score (p < .05) after completing the program, compared to participants who did not discuss this material with their social worker. Sixty-five percent had scores indicating depressed mood before the program, compared with 56% following. The more positive participants' program evaluation, the higher their quality of life (lower perceived burden of kidney disease [p = .05]).

  12. Improving service provision for patients who are prescribed continence products.

    PubMed

    Mangnall, Joanne; Midgley, Kate; Lakin, Stuart; Beckitt, Liz; Shepherd, Laura

    2010-04-01

    It is estimated that 14 million people experience problems with bladder control and 6.5 million people have a bowel control problem (Bladder and Bowel Foundation, 2008). Many will rely on continence products to manage their problem and as such require products which ensure user dignity and discretion is maintained. Locally, an ever-increasing spend on prescribed continence products promoted a review of current service delivery. The combined results of a clinical audit and patient satisfaction survey highlighted areas in which service delivery needed immediate improvement. Significant service re-design has been undertaken with prescribing responsibility for continence-related products being transferred from GP practices to specialist nurses working within the continence service. Improvements in clinical care have been achieved and cost savings have been re-invested in the service. PMID:20559160

  13. [Prevention and Information for Patients Undergoing Periodontal Treatment: Potentials for Improvement from the Patients' Perspective].

    PubMed

    Klingenberg, A; Walther, W; Dörfer, C E; Szecsenyi, J

    2016-05-01

    2 334 patients from 29 dental practices took part in a written survey on their experiences with dental treatment in general as well as treatment of periodontal disease (response rate 80.8%). 72.6% of all participating patients fully agreed that they could recommend their dentist to their friends. 63.6% of patients undergoing treatment of periodontitis (N=328) rated this treatment as "excellent". However, for important aspects (prevention, patient information, treatment) potentials for improvement became obvious. 43.7% of patients treated for periodontitis were not completely satisfied with information on how this disease develops; 40.7% saw potentials for better information on preventive care (dental-hygiene, nutrition). An even higher percentage of patients actually not treated for periodontitis was interested in more information on prevention (51.4%). The results of the survey show that dentists should offer information and exercise on how to prevent periodontal desease more actively. There is a lack of research on the present state of affairs and potentials for improvement concerning treatment and prevention of periodontitis including the patients' perspective. PMID:26086539

  14. Improving outpatient access and patient experiences in academic ambulatory care.

    PubMed

    O'Neill, Sarah; Calderon, Sherry; Casella, Joanne; Wood, Elizabeth; Carvelli-Sheehan, Jayne; Zeidel, Mark L

    2012-02-01

    Effective scheduling of and ready access to doctor appointments affect ambulatory patient care quality, but these are often sacrificed by patients seeking care from physicians at academic medical centers. At one center, Beth Israel Deaconess Medical Center, the authors developed interventions to improve the scheduling of appointments and to reduce the access time between telephone call and first offered appointment. Improvements to scheduling included no redirection to voicemail, prompt telephone pickup, courteous service, complete registration, and effective scheduling. Reduced access time meant being offered an appointment with a physician in the appropriate specialty within three working days of the telephone call. Scheduling and access were assessed using monthly "mystery shopper" calls. Mystery shoppers collected data using standardized forms, rated the quality of service, and transcribed their interactions with schedulers. Monthly results were tabulated and discussed with clinical leaders; leaders and frontline staff then developed solutions to detected problems. Eighteen months after the beginning of the intervention (in June 2007), which is ongoing, schedulers had gone from using 60% of their registration skills to over 90%, customer service scores had risen from 2.6 to 4.9 (on a 5-point scale), and average access time had fallen from 12 days to 6 days. The program costs $50,000 per year and has been associated with a 35% increase in ambulatory volume across three years. The authors conclude that academic medical centers can markedly improve the scheduling process and access to care and that these improvements may result in increased ambulatory care volume. PMID:22193182

  15. Improving the provision of meals in hospital. The patients' viewpoint.

    PubMed

    Johns, Nick; Hartwell, Heather; Morgan, Michael

    2010-02-01

    This study examines the provision of hospital meals from the patients' viewpoint, with the aim of improving hospital food service. Patients were approached in early 2008 in a National Health Service hospital in the South of England and invited to comment on the good and bad aspects of eating in hospital. Comments were collected in an abbreviated "key word" format which incurred the minimum of bias and allowed emergent themes to be analysed both quantitatively and qualitatively. Seven main themes emerged, of which "food" and "choice" were mentioned most frequently, but had a low ratio (1.8 and 1.7, respectively) of approving over disapproving comments. The next most mentioned theme, "service staff", showed the highest approving/disapproving ratio (4.8) overall. Less frequent themes were: "meals and lifestyle", "timing and routine", "service quality" and "food quantity". These data, together with qualitative analysis of the responses showed patients' views of hospital food to be positive, on the whole meeting or surpassing their expectations. However, these expectations were low, the experience of eating in hospital contrasted unfavourably with home, and the meals were at best a distraction from the rigours of hospital treatment. Service staff were positively regarded because they offered an important opportunity for "normal" discourse with a non-medical person. On the basis of the findings, changes are recommended in the management of service staff, menus, food presentation, nutritional intake and patients' lifestyle. Of these, the first is likely to have most impact on the experience and viewpoint of hospital patients. PMID:19857535

  16. Community pharmacist–administered influenza immunization improves patient access to vaccination

    PubMed Central

    Folkins, Chris; Li, Wilson; Zervas, John

    2014-01-01

    Objectives: To describe the demographic characteristics and risk factors of patients receiving influenza vaccination in community pharmacies and to understand patient experiences and perceptions surrounding being vaccinated by a pharmacist. Methods: Survey data were collected by research pharmacists at 4 different community pharmacy locations in Toronto throughout a period of 8 weeks during October and November 2013. Participation in the survey was voluntary, and all patients vaccinated by pharmacists were invited to complete a survey following immunization. Results: During the course of the study, 2498 vaccine doses were administered among all study sites, and 1502 surveys were completed. Our data showed a high degree of patient satisfaction, with 92% of patients indicating they were very satisfied with the pharmacist’s injection technique and the services they received. Furthermore, 86% of patients were very comfortable with being vaccinated by a pharmacist, and 99% of patients reported they would recommend that friends and family be vaccinated by a pharmacist. Convenience and accessibility were major determinants of patient satisfaction, as shown by 46% of all written comments specifically addressing these factors. Of the patients surveyed, 25% were not regular annual vaccine recipients, and 47% were classified as being at high risk for influenza complications according to Public Health Agency of Canada criteria. Notably, 28% of total patients and 21% of high-risk patients reported that they would not have been immunized this year if pharmacy-based vaccination were not available. Conclusions: Our findings suggest that pharmacists provide a highly convenient and accessible option for seasonal flu vaccination that is viewed favourably by patients. Administration of the flu vaccine by pharmacists has the potential to positively affect public health by improving vaccination rates among high-risk patients, first-time or occasional vaccine recipients, and patients

  17. Structured nursing communication on interdisciplinary acute care teams improves perceptions of safety, efficiency, understanding of care plan and teamwork as well as job satisfaction.

    PubMed

    Gausvik, Christian; Lautar, Ashley; Miller, Lisa; Pallerla, Harini; Schlaudecker, Jeffrey

    2015-01-01

    Efficient, accurate, and timely communication is required for quality health care and is strongly linked to health care staff job satisfaction. Developing ways to improve communication is key to increasing quality of care, and interdisciplinary care teams allow for improved communication among health care professionals. This study examines the patient- and family-centered use of structured interdisciplinary bedside rounds (SIBR) on an acute care for the elderly (ACE) unit in a 555-bed metropolitan community hospital. This mixed methods study surveyed 24 nurses, therapists, patient care assistants, and social workers to measure perceptions of teamwork, communication, understanding of the plan for the day, safety, efficiency, and job satisfaction. A similar survey was administered to a control group of 38 of the same staff categories on different units in the same hospital. The control group units utilized traditional physician-centric rounding. Significant differences were found in each category between the SIBR staff on the ACE unit and the control staff. Nurse job satisfaction is an important marker of retention and recruitment, and improved communication may be an important aspect of increasing this satisfaction. Furthermore, improved communication is key to maintaining a safe hospital environment with quality patient care. Interdisciplinary team rounds that take place at the bedside improve both nursing satisfaction and related communication markers of quality and safety, and may help to achieve higher nurse retention and safer patient care. These results point to the interconnectedness and dual benefit to both job satisfaction and patient quality of care that can come from enhancements to team communication.

  18. Understanding predictors of prolonged hospitalizations among general medicine patients: A guide and preliminary analysis.

    PubMed

    Anderson, Mary E; Glasheen, Jeffrey J; Anoff, Debra; Pierce, Read; Capp, Roberta; Jones, Christine D

    2015-09-01

    Targeting patients with prolonged hospitalizations may represent an effective strategy for reducing average hospital length of stay (LOS). We sought to characterize predictors of prolonged hospitalizations among general medicine patients to guide future improvement efforts. We conducted a retrospective cohort study using administrative data of general medicine patients discharged from inpatient status from our academic medical center between 2012 and 2014. Multivariable logistic regression was performed to assess the association between sociodemographic and clinical variables with prolonged LOS, defined as >21 days. Of 18,363 discharges, 416 (2.3%) demonstrated prolonged LOS. Prolonged hospitalizations accounted for 18.6% of total inpatient days and contributed 0.8 days to an average LOS of 4.8 days during the study period. Prolonged hospitalizations were associated with younger age (odds ratio [OR]: 0.80 per 10-year increase in age, 95% confidence interval [CI]: 0.73-0.87) and Medicaid insurance (OR: 1.99, 95% CI: 1.29-3.05, REF = Medicare). Compared to patients without prolonged LOS, prolonged LOS patients were more likely to have methicillin-resistant Staphylococcus aureus septicemia (OR: 8.83, 95% CI: 1.72-45.36); require a palliative care consult (OR: 4.63, 95% CI: 2.86-7.49), ICU stay (OR: 6.66, 95% CI: 5.22-8.50), or surgery (OR: 5.04, 95% CI: 3.90-6.52); and be discharged to a post-acute-care facility (OR: 10.37, 95% CI: 6.92-15.56). Prolonged hospitalizations in a small proportion of patients were an important contributor to overall LOS and particularly affected Medicaid enrollees with complex hospital stays who were not discharged home. Further studies are needed to determine the reasons for discharge delays in this population.

  19. Understanding Course Content through Letter Writing: Do Informal Writing Assignments Improve Grades?

    ERIC Educational Resources Information Center

    Bersamin, Melina; Zamboanga, Byron L.; Orsak-Neff, Natalie

    2013-01-01

    Using an experimental study design (N = 41), we examined whether participation in an informal writing assignment, specifically writing a letter to a friend about course content, improved exam scores in an undergraduate child development course. Findings indicated that participating in the writing assignment significantly improved scores on an exam…

  20. Training and Action for Patient Safety: Embedding Interprofessional Education for Patient Safety within an Improvement Methodology

    ERIC Educational Resources Information Center

    Slater, Beverley L.; Lawton, Rebecca; Armitage, Gerry; Bibby, John; Wright, John

    2012-01-01

    Introduction: Despite an explosion of interest in improving safety and reducing error in health care, one important aspect of patient safety that has received little attention is a systematic approach to education and training for the whole health care workforce. This article describes an evaluation of an innovative multiprofessional, team-based…

  1. Longterm oral cisapride improves interdigestive antroduodenal motility in dyspeptic patients.

    PubMed Central

    Testoni, P A; Bagnolo, F; Fanti, L; Passaretti, S; Tittobello, A

    1990-01-01

    We have evaluated the effect of cisapride on interdigestive antroduodenal motility during a prolonged oral therapy in 20 consecutive dyspeptic subjects. Individuals with less than two migrating motor complexes (MMCs) starting from the antral region in 240 minutes and without evidence of upper gastrointestinal tract diseases were randomly treated with either cisapride (10 cases), or placebo (10 cases) for 15 days. Computerised manometry of antroduodenal region was performed for 240 minutes, in basal conditions and on the 15th day of therapy. Symptomatic evaluation of patients was also performed before and after treatment. After cisapride administration, a significant increase in the incidence of antral migrating motor complexes was noticed (p = 0.022); likewise, the motility index, calculated for phase-2 periods, appeared to be significantly higher both in the antrum and in the duodenum (p less than 0.001). Symptomatic improvement was observed in both groups, with a hardly significant (p = 0.049) reduction of dyspeptic symptoms severity only but not of frequency in cisapride treated patients v controls. We conclude that longterm oral therapy with cisapride improves interdigestive antroduodenal motor activity. PMID:2323591

  2. Success of patient training in improving proficiency of eyedrop administration among various ophthalmic patient populations

    PubMed Central

    Feng, Alexander; O’Neill, John; Holt, Mitchell; Georgiadis, Catherine; Wright, Martha M; Montezuma, Sandra R

    2016-01-01

    Purpose The purpose of this study is to evaluate the success and usefulness of patient education in eyedrop self-administration technique via an educational handout and a short instructional video. Patients and methods We conducted a prospective study that included 34 patients who were self-administering ophthalmic drops. Of the total patients included, 12% had used drops for <12 months, and 88% had used drops for >12 months. Average age of patients in the study was 67 years, with an age range of 19–91 years. Of the total patients included, 82% had glaucoma, 6% had dry eyes, and 12% did not have a specific diagnosis. Subjects were video recorded and assessed by a trained observer on two occasions: at baseline and after they viewed a demonstrational video and handout. A maximum score of 15 points was awarded based on 15 criteria. A written self-assessment was administered at the end of each study. Results Pre- and post-teaching assessment scores improved significantly with education. Patients initially scored an average 2.53 points compared to a post-education score of 6.15 out of 15 points, demonstrating a 2.43 (P=0.008) factor of improvement. After education, 94% of patients versus 47% pre-teaching (P=0.0001) pulled down their lower eyelids. A total of 91% pre-teaching versus 59% post-teaching (P=0.0042) patients squeezed one drop into the lower fornix, 74% pre-teaching versus 26% post-teaching (P=0.0002) patients released the eyelid and closed the eye for 1 minute, and 56% pre-teaching versus 3% post-teaching (P=0.0001) patients applied nasal digital pressure on each eye. We found no significant difference in score changes between those who previously received education and those who had not (P=0.37). A total of 91% patients responded in a postassessment survey that they now feel more confident of their ability to self-administer eyedrops as their doctor prescribed and that the educational materials were responsible. Conclusion Participants demonstrated an

  3. A web-based interactive tool to improve breast cancer patient centredness

    PubMed Central

    Gorini, Alessandra; Mazzocco, Ketti; Kondylakis, Haridimos; McVie, Gordon; Pravettoni, Gabriella

    2016-01-01

    The uniqueness of a patient as determined by the integration of clinical data and psychological aspects should be the aspired aim of a personalized medicine approach. Nevertheless, given the time constraints usually imposed by the clinical setting, it is not easy for physicians to collect information about the patient’s unique mental dimensions and needs related to her illness. Such information may be useful in tailoring patient–physician communication, improving the patient’s understanding of provided information, her involvement in the treatment process, and in general her empowerment during and after the therapeutic journey. The primary objective of this study is to evaluate the effect of an interactive empowerment tool (IEm) on enhancing the breast cancer patient–physician experience, in terms of increasing empowerment, i.e. by providing physicians with a personalised patient’s profile, accompanied by specific recommendations to advise them how to interact with each individual patient on the basis of her personal profile. The study will be implemented as a two-arm randomised controlled trial with 100 adult breast cancer patients who fill in the ALGA-BC questionnaire, a computerised validated instrument to evaluate the patient’s physical and psychological characteristics following a breast cancer diagnosis. The IEm tool will collect and analyse the patient’s answers in real time and send them, together with specific recommendations to the physician’s computer immediately before physician’s first encounter with the patient. Patients will be randomised to either the intervention group using the IEm tool or to a control group who will only fill in the questionnaire without taking advantage of the tool (physicians will not receive the patient’s profile). The proposed approach is supposed to improve the patient–physician communication leading to increased patient participation in the therapeutic process as a consequence leading to improvement in

  4. Improving Students' Understanding of Waves by Plotting a Displacement-Time Graph in Class

    NASA Astrophysics Data System (ADS)

    Wei, Yajun

    2012-04-01

    The topic of waves is one that many high school physics students find difficult to understand. This is especially true when using some A-level textbooks1,2used in the U.K., where the concept of waves is introduced prior to the concept of simple harmonic oscillations. One of the challenges my students encounter is understanding the difference between displacement-time graphs and displacement-position graphs. Many students wonder why these two graphs have the same sinusoidal shape. Having the students use multimedia simulations allows them to see, in a hands-on fashion, the relationship between the two graphs.

  5. Strategies to reduce patient harm: understanding the role of design and the built environment.

    PubMed

    Barach, Paul

    2008-01-01

    One of the great ironies of modern medicine is that the very environments created to heal are the cause of countless injuries, illnesses and death to the vulnerable population they were created to serve. Not since Florence Nightingale visited the pestholes in which wounded and sick British soldiers were housed in the Crimea, has there been a growing international awareness of the harm caused by the healing environment. There is growing recognition that risks and hazards of health care associated injury and harm are a result of systemic design problems rather than poor performance by individual providers. The evidence is overwhelming that current hospital design is not sufficient to prevent medical errors, rates of infection and injuries from falls, and even contributes to slow patient recovery and high nurse turnover.Today's challenges are even steeper than a half-century ago due to: a) Rising concern and demand about health care costs and quality, b) Large population increase with an exponentially growing elderly proportion, c) A proliferation of complex and confusing local, state and federal regulations, d) A dramatically evolving technological environment, e) A sicker, more debilitated and compromised patient population, and f) A workforce with higher expectations of the work environment should be like. The present hospital construction boom provides an opportunity to rethink hospital design, and especially to consider how improved hospital design can help reduce staff stress and fatigue, reduce patient and family stress and improve patient outcomes and quality of care. A key challenge remains how to incorporate technology into the local learning environment and culture in ways that optimize its implementation and use.

  6. Patient-powered research networks aim to improve patient care and health research.

    PubMed

    Fleurence, Rachael L; Beal, Anne C; Sheridan, Susan E; Johnson, Lorraine B; Selby, Joe V

    2014-07-01

    The era of big data, loosely defined as the development and analysis of large or complex data sets, brings new opportunities to empower patients and their families to generate, collect, and use their health information for both clinical and research purposes. In 2013 the Patient-Centered Outcomes Research Institute launched a large national research network, PCORnet, that includes both clinical and patient-powered research networks. This article describes these networks, their potential uses, and the challenges they face. The networks are engaging patients, family members, and caregivers in four key ways: contributing data securely, with privacy protected; including diverse and representative groups of patients in research; prioritizing research questions, participating in research, and disseminating results; and participating in the leadership and governance of patient-powered research networks. If technical, regulatory, and organizational challenges can be overcome, PCORnet will allow research to be conducted more efficiently and cost-effectively and results to be disseminated quickly back to patients, clinicians, and delivery systems to improve patient health. PMID:25006148

  7. Patient-powered research networks aim to improve patient care and health research.

    PubMed

    Fleurence, Rachael L; Beal, Anne C; Sheridan, Susan E; Johnson, Lorraine B; Selby, Joe V

    2014-07-01

    The era of big data, loosely defined as the development and analysis of large or complex data sets, brings new opportunities to empower patients and their families to generate, collect, and use their health information for both clinical and research purposes. In 2013 the Patient-Centered Outcomes Research Institute launched a large national research network, PCORnet, that includes both clinical and patient-powered research networks. This article describes these networks, their potential uses, and the challenges they face. The networks are engaging patients, family members, and caregivers in four key ways: contributing data securely, with privacy protected; including diverse and representative groups of patients in research; prioritizing research questions, participating in research, and disseminating results; and participating in the leadership and governance of patient-powered research networks. If technical, regulatory, and organizational challenges can be overcome, PCORnet will allow research to be conducted more efficiently and cost-effectively and results to be disseminated quickly back to patients, clinicians, and delivery systems to improve patient health.

  8. Using Public Reports of Patient Satisfaction for Hospital Quality Improvement

    PubMed Central

    Barr, Judith K; Giannotti, Tierney E; Sofaer, Shoshanna; Duquette, Cathy E; Waters, William J; Petrillo, Marcia K

    2006-01-01

    Objective To explore the impact of statewide public reporting of hospital patient satisfaction on hospital quality improvement (QI), using Rhode Island (RI) as a case example. Data Source Primary data collected through semi-structured interviews between September 2002 and January 2003. Study Design The design is a retrospective study of hospital executives at all 11 general and two specialty hospitals in RI. Respondents were asked about hospital QI activities at several points throughout the public reporting process, as well as about hospital structure and processes to accomplish QI. Qualitative analysis of the interview data proceeded through an iterative process to identify themes and categories in the data. Principal Findings Data from the standardized statewide patient satisfaction survey process were used by hospitals to identify and target new QI initiatives, evaluate performance, and monitor progress. While all hospitals fully participated in the public reporting process, they varied in the stage of development of their QI activities and adoption of the statewide standardized survey for ongoing monitoring of their QI programs. Most hospitals placed responsibility for QI within each department, with results reported to top management, who were perceived as giving strong support for QI. The external environment facilitated QI efforts. Conclusion Public reporting of comparative data on patient views can enhance and reinforce QI efforts in hospitals. The participation of key stakeholders facilitated successful implementation of statewide public reporting. This experience in RI offers lessons for other states or regions as they move to public reporting of hospital quality data. PMID:16704506

  9. A Real-Time Screening Alert Improves Patient Recruitment Efficiency

    PubMed Central

    Weng, Chunhua; Batres, Candido; Borda, Tomas; Weiskopf, Nicole G.; Wilcox, Adam B.; Bigger, J Thomas; Davidson, Karina W.

    2011-01-01

    The scarcity of cost-effective patient identification methods represents a significant barrier to clinical research. Research recruitment alerts have been designed to facilitate physician referrals but limited support is available to clinical researchers. We conducted a retrospective data analysis to evaluate the efficacy of a real-time patient identification alert delivered to clinical research coordinators recruiting for a clinical prospective cohort study. Data from log analysis and informal interviews with coordinators were triangulated. Over a 12-month period, 11,295 were screened electronically, 1,449 were interviewed, and 282 were enrolled. The enrollment rates for the alert and two other conventional methods were 4.65%, 2.01%, and 1.34% respectively. A taxonomy of eligibility status was proposed to precisely categorize research patients. Practical ineligibility factors were identified and their correlation with age and gender were analyzed. We conclude that the automatic prescreening alert improves screening efficiency and is an effective aid to clinical research coordinators. PMID:22195213

  10. A Positive Deviance Approach to Understanding Key Features to Improving Diabetes Care in the Medical Home

    PubMed Central

    Gabbay, Robert A.; Friedberg, Mark W.; Miller-Day, Michelle; Cronholm, Peter F.; Adelman, Alan; Schneider, Eric C.

    2013-01-01

    PURPOSE The medical home has gained national attention as a model to reorganize primary care to improve health outcomes. Pennsylvania has undertaken one of the largest state-based, multipayer medical home pilot projects. We used a positive deviance approach to identify and compare factors driving the care models of practices showing the greatest and least improvement in diabetes care in a sample of 25 primary care practices in southeast Pennsylvania. METHODS We ranked practices into improvement quintiles on the basis of the average absolute percentage point improvement from baseline to 18 months in 3 registry-based measures of performance related to diabetes care: glycated hemoglobin concentration, blood pressure, and low-density lipoprotein cholesterol level. We then conducted surveys and key informant interviews with leaders and staff in the 5 most and least improved practices, and compared their responses. RESULTS The most improved/higher-performing practices tended to have greater structural capabilities (eg, electronic health records) than the least improved/lower-performing practices at baseline. Interviews revealed striking differences between the groups in terms of leadership styles and shared vision; sense, use, and development of teams; processes for monitoring progress and obtaining feedback; and presence of technologic and financial distractions. CONCLUSIONS Positive deviance analysis suggests that primary care practices’ baseline structural capabilities and abilities to buffer the stresses of change may be key facilitators of performance improvement in medical home transformations. Attention to the practices’ structural capabilities and factors shaping successful change, especially early in the process, will be necessary to improve the likelihood of successful medical home transformation and better care. PMID:23690393

  11. Understanding the priorities for women diagnosed with lymphangioleiomyomatosis: a patient perspective

    PubMed Central

    Bassi, Iris; Hollis, Gill; Cottin, Vincent; Harari, Sergio; Zwanenburg, Elma; Veltkamp, Marcel; Casanova, Alvaro; Fletcher, Monica; Masefield, Sarah; Powell, Pippa

    2016-01-01

    Lymphangioleiomyomatosis (LAM) is a rare lung disease that almost exclusively affects women and develops in about one in 400 000 adult females. The European Lung Foundation worked closely with one of the patient organisations within its network, the European LAM Federation, to raise awareness of LAM at the 2014 European Respiratory Society International Congress in Munich, Germany. In addition, an invitation-only workshop with 45 individuals from 13 countries was held to discuss the priorities for women in Europe living with the disease. The need for ongoing collaboration to improve knowledge of this rare lung condition with healthcare professionals across Europe was highlighted. PMID:27730199

  12. WWC Review of the Report "Improving At-Risk Learners' Understanding of Fractions." What Works Clearinghouse Single Study Review

    ERIC Educational Resources Information Center

    What Works Clearinghouse, 2013

    2013-01-01

    The study examined the effects of "Fraction Challenge," a supplemental small-group tutoring math program that focuses on improving student understanding of fractions. Study authors randomly assigned fourth grade "at-risk" students in 53 classrooms in 13 schools to either an intervention group that received "Fraction Challenge" or to a comparison…

  13. Ofqual's Reliability Programme: A Case Study Exploring the Potential to Improve Public Understanding and Confidence

    ERIC Educational Resources Information Center

    Newton, Paul E.

    2013-01-01

    In May 2008, Ofqual established a two-year programme of research to investigate the nature and extent of (un)reliability within the qualifications, examinations and assessments that it regulated. It was particularly concerned to improve understanding of, and confidence in, this technically complex and politically sensitive phenomenon. The…

  14. Using Targeted Active-Learning Exercises and Diagnostic Question Clusters to Improve Students' Understanding of Carbon Cycling in Ecosystems

    ERIC Educational Resources Information Center

    Maskiewicz, April Cordero; Griscom, Heather Peckham; Welch, Nicole Turrill

    2012-01-01

    In this study, we used targeted active-learning activities to help students improve their ways of reasoning about carbon flow in ecosystems. The results of a validated ecology conceptual inventory (diagnostic question clusters [DQCs]) provided us with information about students' understanding of and reasoning about transformation of inorganic and…

  15. Research Plans for Improving Understanding of Effects of Very Low-Frequency Noise of Heavy Lift Rotorcraft

    NASA Technical Reports Server (NTRS)

    Fidell, Sanford; Horonieff, Richard D.; Schmitz, Fredric H.

    2010-01-01

    This report reviews the English-language technical literature on infrasonic and low-frequency noise effects; identifies the most salient effects of noise produced by a future large civil tiltrotor aircraft on crew, passengers, and communities near landing areas; and recommends research needed to improve understanding of the effects of such noise on passengers, crew, and residents of areas near landing pads.

  16. An information theory application to improve understanding of subsurface flow and transport conditions at the BARC OPE3 site

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Improving understanding of subsurface conditions includes comparison and discrimination of concurrent models. Additional observations can be useful for that purpose. The objective of this work was to implement and test a novel method for optimization of selecting locations for additional observation...

  17. An Exercise To Improve Career Understanding of Commencing Engineering and Technology Students.

    ERIC Educational Resources Information Center

    Palmer, Stuart R.; Bray, Sharyn L.

    2002-01-01

    Undergraduate engineering students (n=123) collected and analyzed engineering job ads from newspapers and the Internet and prepared reports. Many began with inaccurate conceptions; 86.2% reported change in their understanding of engineering. Some learned how to increase their employability. Initial concepts of engineering as focused on technology…

  18. Improved understanding and testing for salinity tolerance in cool-season turfgrasses

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Utah State University and the USDA-ARS in Logan, Utah, were funded to conduct research towards understanding how cool season turf specied tolerate salt stress. Salt tolerant and salt susceptible varieties of Kentucky bluegrass, perennial ryegrass, and the check alkaligrass were planted in a replica...

  19. Improving Children's Understanding of Emotions: The Effects of the PATHS Curriculum.

    ERIC Educational Resources Information Center

    Greenberg, Mark T.; And Others

    This study examines the effects of the Promoting Alternative Thinking Strategies (PATHS) Curriculum, which provided children with instruction on a variety of issues involved with the expression, understanding, and control of emotions. Participants were 308 first and second graders. PATHS lessons were given about three days a week from October…

  20. Drafting Exercises to Improve Understanding. Industrial Arts Series No. 10,007.

    ERIC Educational Resources Information Center

    Hinrichs, Roy S., Comp.

    These materials, which can be used to supplement a drafting program, are designed to assist the instructor in helping students develop a better understanding of certain areas of drafting. The materials are divided into exercises that allow the student to devote full attention to one aspect of drafting at a time, and tests, which can be used either…

  1. An Integrated Academic Literacy Approach to Improving Students' Understanding of Plagiarism in an Accounting Course

    ERIC Educational Resources Information Center

    Powell, Lisa; Singh, Nishani

    2016-01-01

    Plagiarism in higher education is a widespread and complex issue. Students' understanding of plagiarism differs as a result of combining their prior learning about referencing with their current experience of institutional policies and generic resources. Plagiarism was identified as a major learning issue in a core second-year undergraduate…

  2. The Director's Cut: Toward an Improved Understanding of Learning from Museums

    ERIC Educational Resources Information Center

    Falk, John

    2004-01-01

    This paper presents two perspectives that the author believes will contribute to an enhanced ability to describe and understand learning from museums. Arguably, a major strength of the past decade of research on learning from museums has been the description and investigation of many of the myriad factors that appear to influence learning from…

  3. Understanding Change for Effective School Improvement Initiatives: Critical Elements of School Reform

    ERIC Educational Resources Information Center

    Schnautz, Dee Ann Piercy

    2012-01-01

    With the historical political and social changes, which ultimately affect education, it is easy to see why teachers sometimes balk at new initiatives and perceived new best practices. For change to occur it is important to understand how perception of critical elements of change impact student academic growth. It is also important to have a…

  4. Improving Students' Understanding and Explanation Skills through the Use of a Knowledge Building Forum

    ERIC Educational Resources Information Center

    Hamel, Christine; Turcotte, Sandrine; Laferriere, Therese; Bisson, Nicolas

    2015-01-01

    Education research has shown the importance of helping students develop comprehension skills. Explanation-seeking rather than fact-seeking pedagogies have been shown to warrant deeper student understanding. This study investigates the use of Knowledge Forum (KF) in K-6 classrooms (n = 251) to develop students' explanation skills. To this end, we…

  5. Improving High School Students' Understanding of Potential Difference in Simple Electric Circuits

    ERIC Educational Resources Information Center

    Liegeois, Laurent; Chasseigne, G'erard; Papin, Sophie; Mullet, Etienne

    2003-01-01

    This paper reports two studies into the understanding of the concept of potential difference in the current-potential difference-resistance context among 8th-12th graders (Study 1), and the efficiency of a learning device derived from Social Judgment Theory (Study 2). These two studies showed that: (a) when asked to infer potential difference from…

  6. Effective Use of Discovery Learning to Improve Understanding of Factors That Affect Quality

    ERIC Educational Resources Information Center

    Mukherjee, Arup

    2015-01-01

    Undergraduate business majors are required to take a course in operations management. In this course, a great deal of emphasis is put on developing a good understanding of quality because this is likely to be the only required course that covers this important topic. Quality of output exhibits a great deal of variation. To produce high quality on…

  7. Using Art-Based Chemistry Activities to Improve Students' Conceptual Understanding in Chemistry

    ERIC Educational Resources Information Center

    Danipog, Dennis L.; Ferido, Marlene B.

    2011-01-01

    This study aimed to determine the effects of art-based chemistry activities (ABCA) on high school students' conceptual understanding in chemistry. The study used the pretest-posttest control group design. A total of 64 third-year high school students from two different chemistry classes participated in the study. One class was exposed to art-based…

  8. Teachers and Game-Based Learning: Improving Understanding of How to Increase Efficacy of Adoption

    ERIC Educational Resources Information Center

    Ketelhut, Diane Jass; Schifter, Catherine C.

    2011-01-01

    Interest in game-based learning for K-12 is growing. Thus, helping teachers understand how to use these new pedagogies is important. This paper presents a cross-case study of the development of teacher professional development for the River City project, a games-based multi-user virtual environment science curriculum project for middle school…

  9. Can Dynamic Visualizations Improve Middle School Students' Understanding of Energy in Photosynthesis?

    ERIC Educational Resources Information Center

    Ryoo, Kihyun; Linn, Marcia C.

    2012-01-01

    Dynamic visualizations have the potential to make abstract scientific phenomena more accessible and visible to students, but they can also be confusing and difficult to comprehend. This research investigates how dynamic visualizations, compared to static illustrations, can support middle school students in developing an integrated understanding of…

  10. Blending Physical and Virtual Manipulatives: An Effort to Improve Students' Conceptual Understanding through Science Laboratory Experimentation

    ERIC Educational Resources Information Center

    Olympiou, Georgios; Zacharia, Zacharias C.

    2012-01-01

    This study aimed to investigate the effect of experimenting with physical manipulatives (PM), virtual manipulatives (VM), and a blended combination of PM and VM on undergraduate students' understanding of concepts in the domain of "Light and Color." A pre-post comparison study design was used for the purposes of this study that involved 70…

  11. Patient counseling program to improve the compliance to imatinib in chronic myeloid leukemia patients.

    PubMed

    Moon, Joon Ho; Sohn, Sang Kyun; Kim, Shi Nae; Park, Seon Yang; Yoon, Sung Soo; Kim, In Ho; Kim, Hyeoung Joon; Kim, Yeo Kyeoung; Min, Yoo Hong; Cheong, June Won; Kim, Jin Seok; Jung, Chul Won; Kim, Dong Hwan

    2012-06-01

    To achieve successful therapeutic outcomes in chronic myeloid leukemia (CML), continuous and adequate imatinib (Gleevec(®), Glivec(®), Novartis Pharmaceuticals, Basel, Switzerland) dosing is essential. Here, we report a patient counseling program ("Care club", "Happy club" in Korea) performed to improve patient compliance with imatinib. From January 2006 to December 2008, patients diagnosed with chronic phase CML and taking imatinb were eligible for this retrospective study. A total of 114 patients from 4 centers in Korea were recruited at a 50:50 ratio for Happy club group versus non-Happy club group at each center. During 36-month follow-up, persistency (the number of days of imatinib prescribed versus 1 year) was higher in the Happy club group (98.2 ± 0.03%) than in the non-Happy club group (79.3 ± 0.16%, P = 0.001), whereas dose compliance (miligrams of imatinib that were actually taken versus miligrams that should have been taken) was not different between two groups; 96.5 ± 0.6% and 96.6 ± 0.7% in the Happy club and non-Happy club (P = 0.958). Overall compliance (the product of persistency and dose compliance) improved in the Happy club group (93.0 ± 2.3%) compared with the non-Happy club group (76.2 ± 7.4%, P = 0.001). The patient counseling program was efficient especially in patients who needed high-dose imatinib (>400 mg/day), and overall compliance was 87.8 ± 6.0% in the Happy club group versus 65.5 ± 16.1% in the non-Happy club group (P = 0.017). In conclusion, the patient counseling program was effective in persisting imatinib medication, resulting in the improvement of overall compliance.

  12. Improving efficacy of landscape interventions in the (sub) humid Ethiopian highlands by improved understanding of runoff processes

    NASA Astrophysics Data System (ADS)

    Tebebu, Tigist; Steenhuis, Tammo; Dagnew, Dessalegn; Guzman, Christian; Bayabil, Haimanote; Zegeye, Assefa; Collick, Amy; Langan, Simon; MacAlister, Charlotte; Langendoen, Eddy; Yitaferu, Birru; Tilahun, Seifu

    2015-09-01

    Despite millions of dollars invested in soil and water conservation practices in the (sub) humid Ethiopian highlands and billions of hours of food-for-work farm labor, sediment concentration in rivers is increasing. This paper reports on the research to reverse the current trend. Based on the understanding of the hydrology of highlands, we provide evidence on sources of surface runoff and sediment and on mechanisms that govern the erosion processes and approaches and how they affect soil and water conservation practices. We suggest that priority in landscape interventions should be given to re-vegetation of the degraded areas so as to reduce the sediment concentration contributions originating from these areas. Additionally, efforts should be directed to gully rehabilitation in the saturated bottom landscape that may consist of vegetating shallow gullies and stabilizing head cuts of deeper gullies Finally, rehabilitation efforts should be directed to increase the rain water infiltration in the upland areas through the hard pan layer by connecting the land surface to the original deep flow paths that exist below about 60 cm. It will reduce the direct runoff during the rainy season and increase baseflow during the dry season.

  13. How can we improve our understanding of cardiovascular safety liabilities to develop safer medicines?

    PubMed Central

    Laverty, HG; Benson, C; Cartwright, EJ; Cross, MJ; Garland, C; Hammond, T; Holloway, C; McMahon, N; Milligan, J; Park, BK; Pirmohamed, M; Pollard, C; Radford, J; Roome, N; Sager, P; Singh, S; Suter, T; Suter, W; Trafford, A; Volders, PGA; Wallis, R; Weaver, R; York, M; Valentin, JP

    2011-01-01

    Given that cardiovascular safety liabilities remain a major cause of drug attrition during preclinical and clinical development, adverse drug reactions, and post-approval withdrawal of medicines, the Medical Research Council Centre for Drug Safety Science hosted a workshop to discuss current challenges in determining, understanding and addressing ‘Cardiovascular Toxicity of Medicines’. This article summarizes the key discussions from the workshop that aimed to address three major questions: (i) what are the key cardiovascular safety liabilities in drug discovery, drug development and clinical practice? (ii) how good are preclinical and clinical strategies for detecting cardiovascular liabilities? and (iii) do we have a mechanistic understanding of these liabilities? It was concluded that in order to understand, address and ultimately reduce cardiovascular safety liabilities of new therapeutic agents there is an urgent need to: Fully characterize the incidence, prevalence and impact of drug-induced cardiovascular issues at all stages of the drug development process. Ascertain the predictive value of existing non-clinical models and assays towards the clinical outcome. Understand the mechanistic basis of cardiovascular liabilities; by addressing areas where it is currently not possible to predict clinical outcome based on preclinical safety data. Provide scientists in all disciplines with additional skills to enable them to better integrate preclinical and clinical data and to better understand the biological and clinical significance of observed changes. Develop more appropriate, highly relevant and predictive tools and assays to identify and wherever feasible to eliminate cardiovascular safety liabilities from molecules and wherever appropriate to develop clinically relevant and reliable safety biomarkers. PMID:21306581

  14. Deepening our understanding of quality improvement in Europe (DUQuE): overview of a study of hospital quality management in seven countries

    PubMed Central

    Secanell, Mariona; Groene, Oliver; Arah, Onyebuchi A.; Lopez, Maria Andrée; Kutryba, Basia; Pfaff, Holger; Klazinga, Niek; Wagner, Cordula; Kristensen, Solvejg; Bartels, Paul Daniel; Garel, Pascal; Bruneau, Charles; Escoval, Ana; França, Margarida; Mora, Nuria; Suñol, Rosa; Klazinga, N; Kringos, DS; Lopez, MA; Secanell, M; Sunol, R; Vallejo, P; Bartels, P; Kristensen, S; Michel, P; Saillour-Glenisson, F; Vlcek, F; Car, M; Jones, S; Klaus, E; Bottaro, S; Garel, P; Saluvan, M; Bruneau, C; Depaigne-Loth, A; Shaw, C; Hammer, A; Ommen, O; Pfaff, H; Groene, O; Botje, D; Wagner, C; Kutaj-Wasikowska, H; Kutryba, B; Escoval, A; Lívio, A; Eiras, M; Franca, M; Leite, I; Almeman, F; Kus, H; Ozturk, K; Mannion, R; Arah, OA; Chow, A; DerSarkissian, M; Thompson, CA; Wang, A; Thompson, A

    2014-01-01

    Introduction and Objective This paper provides an overview of the DUQuE (Deepening our Understanding of Quality Improvement in Europe) project, the first study across multiple countries of the European Union (EU) to assess relationships between quality management and patient outcomes at EU level. The paper describes the conceptual framework and methods applied, highlighting the novel features of this study. Design DUQuE was designed as a multi-level cross-sectional study with data collection at hospital, pathway, professional and patient level in eight countries. Setting and Participants We aimed to collect data for the assessment of hospital-wide constructs from up to 30 randomly selected hospitals in each country, and additional data at pathway and patient level in 12 of these 30. Main outcome measures A comprehensive conceptual framework was developed to account for the multiple levels that influence hospital performance and patient outcomes. We assessed hospital-specific constructs (organizational culture and professional involvement), clinical pathway constructs (the organization of care processes for acute myocardial infarction, stroke, hip fracture and deliveries), patient-specific processes and outcomes (clinical effectiveness, patient safety and patient experience) and external constructs that could modify hospital quality (external assessment and perceived external pressure). Results Data was gathered from 188 hospitals in 7 participating countries. The overall participation and response rate were between 75% and 100% for the assessed measures. Conclusions This is the first study assessing relation between quality management and patient outcomes at EU level. The study involved a large number of respondents and achieved high response rates. This work will serve to develop guidance in how to assess quality management and makes recommendations on the best ways to improve quality in healthcare for hospital stakeholders, payers, researchers, and policy makers

  15. Understanding the Population Structure of North American Patients with Cystic Fibrosis

    PubMed Central

    Li, Weili; Sun, Lei; Corey, Mary; Zou, Fei; Lee, Seunggeun; Cojocaru, Andreea L; Taylor, Chelsea; Blackman, Scott M; Stephenson, Anne; Sandford, Andrew J; Dorfman, Ruslan; Drumm, Mitchell L; Cutting, Garry R; Knowles, Michael R; Durie, Peter; Wright, Fred A; Strug, Lisa J

    2010-01-01

    Rationale It is generally presumed that the Cystic Fibrosis (CF) population is relatively homogeneous, and predominantly of European origin. The complex ethnic make-up observed in the CF patients collected by the North American CF Modifier Gene Consortium has brought this assumption into question, and suggested the potential for population substructure in the three CF study samples collected from North America. It is well appreciated that population substructure can result in spurious genetic associations. Objectives To understand the ethnic composition of the North American CF population, and to assess the need for population structure adjustment in genetic association studies with North American CF patients. Methods Genome-wide single-nucleotide polymorphisms on 3076 unrelated North American CF patients were used to perform population structure analyses. We compared self-reported ethnicity to genotype-inferred ancestry, and also examined whether geographic distribution and CFTR mutation type could explain the structure observed. Main Results Although largely Caucasian, our analyses identified a considerable number of CF patients with admixed African-Caucasian, Mexican-Caucasian and Indian-Caucasian ancestries. Population substructure was present and comparable across the three studies of the consortium. Neither geographic distribution nor mutation type explained the population structure. Conclusion Given the ethnic diversity of the North American CF population, it is essential to carefully detect, estimate and adjust for population substructure to guard against potential spurious findings in CF genetic association studies. Other Mendelian diseases that are presumed to predominantly affect single ethnic groups may also benefit from careful analysis of population structure. PMID:20681990

  16. Patient attitudes and understanding about biosimilars: an international cross-sectional survey

    PubMed Central

    Jacobs, Ira; Singh, Ena; Sewell, K Lea; AL-Sabbagh, Ahmad; Shane, Lesley G

    2016-01-01

    Objective To understand the levels of awareness, usage, and knowledge of biosimilars among patients, caregivers, and the general population in the US and the European Union; perceptions of biosimilars compared to originator biologics; perceived benefits and drawbacks of clinical trials; and whether advocacy groups impact patients’ willingness to try a biosimilar. Methods An international survey was conducted which contained up to 56 closed-ended (requiring yes/no or ranking answers) and open-ended questions, depending on the population assigned. The survey was divided into distinct sections, including medication-class awareness, usage, and knowledge about biologic and biosimilar therapies; perceptions of clinical trials; and involvement in advocacy groups. Interviews were conducted in adults categorized as: 1) diagnosed: patients with inflammatory bowel disease including Crohn’s disease and ulcerative colitis, rheumatoid arthritis, psoriasis, breast cancer, lung cancer, colorectal cancer, or non-Hodgkin’s lymphoma; 2) diagnosed advocacy: individuals with these diseases who participated in patient support groups; 3) caregiver: has a loved one with these conditions and is involved in medical decisions; 4) general population: aged 18–64 years, without these conditions. Statistical analyses among groups within a region (US or EU) used column proportions test with a 95% confidence interval. Results In all, 3,198 individuals responded. Awareness about biologic therapies was significantly higher in diagnosed, diagnosed advocacy, and caregiver groups (45%–78%) versus general population (27%; P<0.05). Across all groups, awareness of biosimilars was low; only 6% of the general population reported at least a general impression of biosimilars. Awareness was significantly higher in the diagnosed advocacy group (20%–30%; P<0.05). Gaps in knowledge about biosimilars included safety, efficacy, and access to these agents. Respondents had generally positive perceptions

  17. How do cancer patients navigate the public information environment? Understanding patterns and motivations for movement among information sources.

    PubMed

    Nagler, Rebekah H; Romantan, Anca; Kelly, Bridget J; Stevens, Robin S; Gray, Stacy W; Hull, Shawnika J; Ramirez, A Susana; Hornik, Robert C

    2010-09-01

    Little is known about how patients move among information sources to fulfill unmet needs. We interviewed 43 breast, prostate, and colorectal cancer patients. Using a grounded theory approach, we identified patterns and motivations for movement among information sources. Overall, patients reported using one source (e.g., newspaper) followed by the use of another source (e.g., Internet), and five key motivations for such cross-source movement emerged. Patients' social networks often played a central role in this movement. Understanding how patients navigate an increasingly complex information environment may help clinicians and educators to guide patients to appropriate, high-quality sources.

  18. Patient engagement and patient support programs in allergy immunotherapy: a call to action for improving long-term adherence.

    PubMed

    Demoly, Pascal; Passalacqua, Giovanni; Pfaar, Oliver; Sastre, Joaquin; Wahn, Ulrich

    2016-01-01

    Allergy immunotherapy (AIT) is acknowledged to produce beneficial mid- and long-term clinical and immunologic effects and increased quality of life in patients with allergic respiratory diseases (such as allergic rhinoconjunctivitis and allergic asthma). However, poor adherence to AIT (due to intentional and/or non-intentional factors) is still a barrier to achieving these benefits. There is an urgent need for patient support programs (PSPs) that encompass communication, educational and motivational components. In the field of AIT, a PSP should be capable of (1) improving adherence, (2) boosting patient engagement, (3) explaining how AIT differs from pharmacological allergy treatments; (4) increasing health literacy about chronic, progressive, immunoglobulin-E-mediated immune diseases, (5) helping the patient to understand and manage local or systemic adverse events, and (6) providing and/or predicting local data on aeroallergen levels. We reviewed the literature in this field and have identified a number of practical issues to be addressed when implementing a PSP for AIT: the measurement of adherence, the choice of technologies, reminders, communication channels and content, the use of "push" messaging and social networks, interactivity, and the involvement of caregivers and patient leaders. A key issue is "hi-tech" (i.e. approaches based mainly on information technology) vs. "hi-touch" (based mainly on interaction with humans, i.e. family members, patient mentors and healthcare professionals). We conclude that multistakeholder PSPs (combining patient-, provider and society-based actions) must now be developed and tested with a view to increasing adherence, efficacy and safety in the field of AIT. PMID:27478445

  19. Museum Monsters and Victorious Viruses: Improving Public Understanding of Emerging Biomedical Research

    PubMed Central

    Diamond, Judy; Jee, Benjamin; Matuk, Camilla; McQuillan, Julia; Spiegel, Amy N.; Uttal, David

    2015-01-01

    Although microbes directly impact everyone's health, most people have limited knowledge about them. In this article, we describe a museum and media public education campaign aimed at helping diverse audiences better understand emerging knowledge about microbes and infectious disease. Funded primarily by the Science Education Partnership (SEPA) program of the National Institutes of Health, this campaign involved crosscutting programs designed to extend impacts throughout a broad public audience. PMID:26392634

  20. Using pitch accenting to improve Japanese text-to-speech understanding.

    PubMed

    Yu, Wenwei; Yokoi, Hiroshi; Kakazu, Yukinori; Tamura, Toshiyo

    2004-01-01

    In order to develop an assistive technology that can increase computer accessibility for visually impaired people, we investigated the effect of pitch accenting on Japanese text-to-speech understanding. The effect was confirmed when a training procedure was introduced. Besides, we proposed an individual-adaptive pitching accenting method to explore the optimal pitch accents for individual users. The exploration process of one subject in a verification experiment was analyzed. PMID:17271320

  1. The solar activity measurements experiments (SAMEX) for improved scientific understanding of solar activity

    NASA Technical Reports Server (NTRS)

    1989-01-01

    The Solar Activity Measurements Experiments (SAMEX) mission is described. It is designed to provide a look at the interactions of magnetic fields and plasmas that create flares and other explosive events on the sun in an effort to understand solar activity and the nature of the solar magnetic field. The need for this mission, the instruments to be used, and the expected benefits of SAMEX are discussed.

  2. Data-model fusion to better understand emerging pathogens and improve infectious disease forecasting.

    PubMed

    LaDeau, Shannon L; Glass, Gregory E; Hobbs, N Thompson; Latimer, Andrew; Ostfeld, Richard S

    2011-07-01

    Ecologists worldwide are challenged to contribute solutions to urgent and pressing environmental problems by forecasting how populations, communities, and ecosystems will respond to global change. Rising to this challenge requires organizing ecological information derived from diverse sources and formally assimilating data with models of ecological processes. The study of infectious disease has depended on strategies for integrating patterns of observed disease incidence with mechanistic process models since John Snow first mapped cholera cases around a London water pump in 1854. Still, zoonotic and vector-borne diseases increasingly affect human populations, and methods used to successfully characterize directly transmitted diseases are often insufficient. We use four case studies to demonstrate that advances in disease forecasting require better understanding of zoonotic host and vector populations, as well of the dynamics that facilitate pathogen amplification and disease spillover into humans. In each case study, this goal is complicated by limited data, spatiotemporal variability in pathogen transmission and impact, and often, insufficient biological understanding. We present a conceptual framework for data-model fusion in infectious disease research that addresses these fundamental challenges using a hierarchical state-space structure to (1) integrate multiple data sources and spatial scales to inform latent parameters, (2) partition uncertainty in process and observation models, and (3) explicitly build upon existing ecological and epidemiological understanding. Given the constraints inherent in the study of infectious disease and the urgent need for progress, fusion of data and expertise via this type of conceptual framework should prove an indispensable tool.

  3. Educational Intervention Improves Anticoagulation Control in Atrial Fibrillation Patients: The TREAT Randomised Trial

    PubMed Central

    Clarkesmith, Danielle E.; Pattison, Helen M.; Lip, Gregory Y. H.; Lane, Deirdre A.

    2013-01-01

    Background Stroke prevention in atrial fibrillation (AF), most commonly with warfarin, requires maintenance of a narrow therapeutic target (INR 2.0 to 3.0) and is often poorly controlled in practice. Poor patient-understanding surrounding AF and its treatment may contribute to the patient’s willingness to adhere to recommendations. Method A theory-driven intervention, developed using patient interviews and focus groups, consisting of a one-off group session (1–6 patients) utilising an “expert-patient” focussed DVD, educational booklet, self-monitoring diary and worksheet, was compared in a randomised controlled trial (ISRCTN93952605) against usual care, with patient postal follow-ups at 1, 2, 6, and 12-months. Ninety-seven warfarin-naïve AF patients were randomised to intervention (n=46, mean age (SD) 72.0 (8.2), 67.4% men), or usual care (n=51, mean age (SD) 73.7 (8.1), 62.7% men), stratified by age, sex, and recruitment centre. Primary endpoint was time within therapeutic range (TTR); secondary endpoints included knowledge, quality of life, anxiety/depression, beliefs about medication, and illness perceptions. Main Findings Intervention patients had significantly higher TTR than usual care at 6-months (76.2% vs. 71.3%; p=0.035); at 12-months these differences were not significant (76.0% vs. 70.0%; p=0.44). Knowledge increased significantly across time (F (3, 47) = 6.4; p<0.01), but there were no differences between groups (F (1, 47) = 3.3; p = 0.07). At 6-months, knowledge scores predicted TTR (r=0.245; p=0.04). Patients’ scores on subscales representing their perception of the general harm and overuse of medication, as well as the perceived necessity of their AF specific medications predicted TTR at 6- and 12-months. Conclusions A theory-driven educational intervention significantly improves TTR in AF patients initiating warfarin during the first 6-months. Adverse clinical outcomes may potentially be reduced by improving patients’ understanding of

  4. [Errors in medicine. Causes, impact and improvement measures to improve patient safety].

    PubMed

    Waeschle, R M; Bauer, M; Schmidt, C E

    2015-09-01

    The guarantee of quality of care and patient safety is of major importance in hospitals even though increased economic pressure and work intensification are ubiquitously present. Nevertheless, adverse events still occur in 3-4 % of hospital stays and of these 25-50 % are estimated to be avoidable. The identification of possible causes of error and the development of measures for the prevention of medical errors are essential for patient safety. The implementation and continuous development of a constructive culture of error tolerance are fundamental.The origins of errors can be differentiated into systemic latent and individual active causes and components of both categories are typically involved when an error occurs. Systemic causes are, for example out of date structural environments, lack of clinical standards and low personnel density. These causes arise far away from the patient, e.g. management decisions and can remain unrecognized for a long time. Individual causes involve, e.g. confirmation bias, error of fixation and prospective memory failure. These causes have a direct impact on patient care and can result in immediate injury to patients. Stress, unclear information, complex systems and a lack of professional experience can promote individual causes. Awareness of possible causes of error is a fundamental precondition to establishing appropriate countermeasures.Error prevention should include actions directly affecting the causes of error and includes checklists and standard operating procedures (SOP) to avoid fixation and prospective memory failure and team resource management to improve communication and the generation of collective mental models. Critical incident reporting systems (CIRS) provide the opportunity to learn from previous incidents without resulting in injury to patients. Information technology (IT) support systems, such as the computerized physician order entry system, assist in the prevention of medication errors by providing

  5. [Errors in medicine. Causes, impact and improvement measures to improve patient safety].

    PubMed

    Waeschle, R M; Bauer, M; Schmidt, C E

    2015-09-01

    The guarantee of quality of care and patient safety is of major importance in hospitals even though increased economic pressure and work intensification are ubiquitously present. Nevertheless, adverse events still occur in 3-4 % of hospital stays and of these 25-50 % are estimated to be avoidable. The identification of possible causes of error and the development of measures for the prevention of medical errors are essential for patient safety. The implementation and continuous development of a constructive culture of error tolerance are fundamental.The origins of errors can be differentiated into systemic latent and individual active causes and components of both categories are typically involved when an error occurs. Systemic causes are, for example out of date structural environments, lack of clinical standards and low personnel density. These causes arise far away from the patient, e.g. management decisions and can remain unrecognized for a long time. Individual causes involve, e.g. confirmation bias, error of fixation and prospective memory failure. These causes have a direct impact on patient care and can result in immediate injury to patients. Stress, unclear information, complex systems and a lack of professional experience can promote individual causes. Awareness of possible causes of error is a fundamental precondition to establishing appropriate countermeasures.Error prevention should include actions directly affecting the causes of error and includes checklists and standard operating procedures (SOP) to avoid fixation and prospective memory failure and team resource management to improve communication and the generation of collective mental models. Critical incident reporting systems (CIRS) provide the opportunity to learn from previous incidents without resulting in injury to patients. Information technology (IT) support systems, such as the computerized physician order entry system, assist in the prevention of medication errors by providing

  6. Socioscientific Issues: A Path Towards Advanced Scientific Literacy and Improved Conceptual Understanding of Socially Controversial Scientific Theories

    NASA Astrophysics Data System (ADS)

    Pinzino, Dean William

    This thesis investigates the use of socioscientific issues (SSI) in the high school science classroom as an introduction to argumentation and socioscientific reasoning, with the goal of improving students' scientific literacy (SL). Current research is reviewed that supports the likelihood of students developing a greater conceptual understanding of scientific theories as well as a deeper understanding of the nature of science (NOS), through participation in informal and formal forms of argumentation in the context of SSI. Significant gains in such understanding may improve a student's ability to recognize the rigor, legitimacy, and veracity of scientific claims and better discern science from pseudoscience. Furthermore, students that participate in significant SSI instruction by negotiating a range of science-related social issues can make significant gains in content knowledge and develop the life-long skills of argumentation and evidence-based reasoning, goals not possible in traditional lecture-based science instruction. SSI-based instruction may therefore help students become responsible citizens. This synthesis also suggests that that the improvements in science literacy and NOS understanding that develop from sustained engagement in SSI-based instruction will better prepare students to examine and scrutinize socially controversial scientific theories (i.e., evolution, global warming, and the Big Bang).

  7. Understanding Effective Program Improvement Schools through a Distributed Leadership Task Context Model

    ERIC Educational Resources Information Center

    Gipson, Frances Marie

    2012-01-01

    Federal, state, and local agencies face challenges organizing resources that create the conditions necessary to create, sustain, and replicate effective high performing schools. Knowing that leadership does impact achievement outcomes and that school districts tackle growing numbers of sanctioned Program Improvement schools, a distributed…

  8. Semantics of Learning Transactions: Intelligent Tutoring Systems for Improving the Understanding of Linguistic Representations.

    ERIC Educational Resources Information Center

    Fomichova, Olga S.; Fomichov, Vladimir A.

    1999-01-01

    Discusses the need to improve the design of intelligent tutoring systems for young children and teenagers so they will develop information-processing skills and enrich their cognitive-emotional sphere. Gives an example of an experimental group in Moscow studying English as a second language. (LRW)

  9. Using Sap Flow Monitoring for Improved Process-based Ecohydrologic Understanding 2022

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Sap flow measurements can be an important tool for unraveling the complex web of ecosystem fluxes, especially when it is combined with other measurements like eddy covariance, isotopes, remote sensing, etc. In this talk, we will demonstrate how sap flow measurements have improved our process-level u...

  10. Improving Students' Conceptual Understanding of a Specific Content Learning: A Designed Teaching Sequence

    ERIC Educational Resources Information Center

    Ahmad, N. J.; Lah, Y. Che

    2012-01-01

    The efficacy of a teaching sequence designed for a specific content of learning of electrochemistry is described in this paper. The design of the teaching draws upon theoretical insights into perspectives on learning and empirical studies to improve the teaching of this topic. A case study involving two classes, the experimental and baseline…

  11. Understanding Team-based Quality Improvement for Depression in Primary Care

    PubMed Central

    Rubenstein, Lisa V; Parker, Louise E; Meredith, Lisa S; Altschuler, Andrea; DePillis, Emmeline; Hernandez, John; Gordon, Nancy P

    2002-01-01

    Objective To assess the impacts of the characteristics of quality improvement (QI) teams and their environments on team success in designing and implementing highquality, enduring depression care improvement programs in primary care (PC) practices. Study Setting/Data Sources Two nonprofit managed care organizations sponsored five QI teams tasked with improving care for depression in large PC practices. Data on characteristics of the teams and their environments is from observer process notes, national expert ratings, administrative data, and interviews. Study Design Comparative formative evaluation of the quality and duration of implementation of the depression improvement programs developed by Central Teams (CTs) emphasizing expert design and Local Teams (LTs) emphasizing participatory local clinician design, and of the effects of additional team and environmental factors oneach type of team. Both types of teams depended upon local clinicians for implementation. Principal Findings The CT intervention program designs were more evidence-based than those of LTs. Expert team leadership, support from local practice management, and support from local mental health specialists strongly influenced the development of successful team programs. The CTs and LTs were equally successful when these conditions could be met, but CTs were more successful than LTs in less supportive environments. Conclusions The LT approach to QI for depression requires high local support and expertise from primary care and mental health clinicians. The CT approach is more likely to succeed than the LT approach when local practice conditions are not optimal. PMID:12236381

  12. Understanding the "How" of Quality Improvement: Lessons from the Rhode Island Program Quality Intervention

    ERIC Educational Resources Information Center

    Devaney, Elizabeth; Smith, Charles; Wong, Kenneth

    2012-01-01

    Over the past 10 years, afterschool and youth development programming has moved from providing childcare for working parents to being an integral component of the learning day, supporting the academic, social, and emotional development of young people. An important part of that transition has been a growing emphasis on improving program quality.…

  13. Improving Students' Understanding of Quantum Measurement. II. Development of Research-Based Learning Tools

    ERIC Educational Resources Information Center

    Zhu, Guangtian; Singh, Chandralekha

    2012-01-01

    We describe the development and implementation of research-based learning tools such as the Quantum Interactive Learning Tutorials and peer-instruction tools to reduce students' common difficulties with issues related to measurement in quantum mechanics. A preliminary evaluation shows that these learning tools are effective in improving students'…

  14. The Limits of Tutor Intervention: Understanding Improvement in a Cultural View of FE Learning and Teaching

    ERIC Educational Resources Information Center

    James, David; Wahlberg, Madeleine

    2007-01-01

    From its inception, the Transforming Learning Cultures in Further Education (TLC) project included an explicit intention to identify some principles for the enhancement of learning cultures in order to improve student and teacher learning, and a wish to see how effective different strategies could be in this endeavour. The project showed that both…

  15. Using Technology and Inquiry to Improve Student Understanding of Watershed Concepts

    ERIC Educational Resources Information Center

    Smith, Julie M.; Edwards, Patrick M.; Raschke, Jason

    2006-01-01

    This paper presents the design, implementation and assessment of the Columbia River Basin Environmental Research Project (CERP) curriculum. CERP is an online inquiry-based, regional geographic curriculum designed to improve technology skills and content knowledge about water quality and watershed-level processes. Student attitudes and knowledge…

  16. Inspiratory muscle training improves antireflux barrier in GERD patients.

    PubMed

    Nobre e Souza, Miguel Ângelo; Lima, Maria Josire Vitorino; Martins, Giovanni Bezerra; Nobre, Rivianny Arrais; Souza, Marcellus Henrique Loiola Ponte; de Oliveira, Ricardo Brandt; dos Santos, Armênio Aguiar

    2013-12-01

    The crural diaphragm (CD) is an essential component of the esophagogastric junction (EGJ), and inspiratory exercises may modify its function. This study's goal is to verify if inspiratory muscle training (IMT) improves EGJ motility and gastroesophageal reflux (GER). Twelve GER disease [GERD; 7 males, 20-47 yr, 9 esophagitis, and 3 nonerosive reflex disease (NERD)] and 7 healthy volunteers (3 males, 20-41 yr) performed esophageal pH monitoring, manometry, and heart rate variability (HRV) studies. A 6-cm sleeve catheter measured average EGJ pressure during resting, peak inspiratory EGJ pressures during sinus arrhythmia maneuver (SAM) and inhalations under 17-, 35-, and 70-cmH2O loads (TH maneuvers), and along 1 h after a meal. GERD patients entered a 5-days-a-week IMT program. One author scored heartburn and regurgitation before and after IMT. IMT increased average EGJ pressure (19.7 ± 2.4 vs. 29.5 ± 2.1 mmHg; P < 0.001) and inspiratory EGJ pressure during SAM (89.6 ± 7.6 vs. 125.6 ± 13.3 mmHg; P = 0.001) and during TH maneuvers. The EGJ-pressure gain across 35- and 70-cmH2O loads was lower for GERD volunteers. The number and cumulative duration of the transient lower esophageal sphincter relaxations decreased after IMT. Proximal progression of GER decreased after IMT but not the distal acid exposure. Low-frequency power increased after IMT and the higher its increment the lower the increment of supine acid exposure. IMT decreased heartburn and regurgitation scores. In conclusion, IMT improved EGJ pressure, reduced GER proximal progression, and reduced GERD symptoms. Some GERD patients have a CD failure, and IMT may prove beneficial as a GERD add-on treatment.

  17. [Radiographic contrast media hypersensitivity. New understanding of pathophysiology with implications for patient management].

    PubMed

    Brockow, K; Ring, J

    2005-01-01

    There has been a remarkable progress in our understanding of the pathophysiology of hypersensitivity to contrast media (CM). Immediate reactions develop within one hour after application of CM under the clinical picture of anaphylaxis. Pruritic exanthems appearing several days afterwards account for the majority of non-immediate reactions. Current evidence indicates an allergic basis of severe immediate as well as of non-immediate reactions involving CM-reactive IgE-antibodies and T-lymphocytes, respectively. Skin tests are helpful to establish the diagnosis of these reactions. The use of skin tests to predict tolerability of CM in patients with previous hypersensitivity reaction to CM is controversial. The value of cellular in-vitro tests is unknown. In patients with previous hypersensitivity to CM, premedication with antihistamins and/or corticosteroids is recommended, but current premedication protocols do not suppress all repeat reactions. European multicenter studies addressing sensitivity, specificity and predictive value of test procedures as well as prophylaxis and risk factors of CM hypersensitivity are currently ongoing.

  18. Recent advances in understanding the pathogenesis of atherosclerosis in CKD patients.

    PubMed

    Shah, Sudhir V; Shukla, Ashutosh M; Bose, Chhanda; Basnakian, Alexei G; Rajapurkar, Mohan

    2015-03-01

    A need exists for developing new therapies to improve cardiovascular outcomes in end-stage kidney disease. Three new areas that address novel pathophysiological mechanisms and/or therapeutic approaches toward cardiovascular events in chronic kidney disease patients include the use of an anti-inflammatory agent, the role of catalytic iron, and protein carbamylation. In preliminary studies, hydroxychloroquine, which has multiple anti-inflammatory properties, preserved vascular compliance for the aorta and major vessels, as well as reduced the extent of severity of atherosclerosis in ApoE-/- mice. The ability of iron to rapidly and reversibly cycle between 2 oxidation states makes iron potentially hazardous by enabling it to participate in the generation of powerful oxidant species. We have shown that high catalytic iron in the general population is associated with a 4-fold increase in prevalent cardiovascular disease (CVD), even after accounting for traditional risk factors. In addition, the highest levels of catalytic iron are present in dialysis patients and, more specifically, patients with prevalent CVD have several-fold higher catalytic iron levels compared with controls without CVD. These data suggest the utility of iron chelators for preventing and treating CVD in patients with chronic kidney disease and should be further investigated. Carbamylation of proteins results from nonenzymatic chemical modification by isocyanic acid derived from urea and an alternative route, the myeloperoxidase-catalyzed oxidation of thiocyanate. We have shown carbamylated low-density lipoprotein to have all the major biological effects relevant to atherosclerosis including endothelial cell injury, increased expression of cell adhesion molecules, and vascular smooth muscle cell proliferation. In 2 separate clinical studies, plasma levels of carbamylated protein independently predicted an increased risk of CVD and death. PMID:25556310

  19. Recent advances in understanding the pathogenesis of atherosclerosis in CKD patients.

    PubMed

    Shah, Sudhir V; Shukla, Ashutosh M; Bose, Chhanda; Basnakian, Alexei G; Rajapurkar, Mohan

    2015-03-01

    A need exists for developing new therapies to improve cardiovascular outcomes in end-stage kidney disease. Three new areas that address novel pathophysiological mechanisms and/or therapeutic approaches toward cardiovascular events in chronic kidney disease patients include the use of an anti-inflammatory agent, the role of catalytic iron, and protein carbamylation. In preliminary studies, hydroxychloroquine, which has multiple anti-inflammatory properties, preserved vascular compliance for the aorta and major vessels, as well as reduced the extent of severity of atherosclerosis in ApoE-/- mice. The ability of iron to rapidly and reversibly cycle between 2 oxidation states makes iron potentially hazardous by enabling it to participate in the generation of powerful oxidant species. We have shown that high catalytic iron in the general population is associated with a 4-fold increase in prevalent cardiovascular disease (CVD), even after accounting for traditional risk factors. In addition, the highest levels of catalytic iron are present in dialysis patients and, more specifically, patients with prevalent CVD have several-fold higher catalytic iron levels compared with controls without CVD. These data suggest the utility of iron chelators for preventing and treating CVD in patients with chronic kidney disease and should be further investigated. Carbamylation of proteins results from nonenzymatic chemical modification by isocyanic acid derived from urea and an alternative route, the myeloperoxidase-catalyzed oxidation of thiocyanate. We have shown carbamylated low-density lipoprotein to have all the major biological effects relevant to atherosclerosis including endothelial cell injury, increased expression of cell adhesion molecules, and vascular smooth muscle cell proliferation. In 2 separate clinical studies, plasma levels of carbamylated protein independently predicted an increased risk of CVD and death.

  20. Using Scientific Argumentation in a Science Methods Course to Improve Preservice Teachers' Understanding of Climate Change

    NASA Astrophysics Data System (ADS)

    Lambert, J. L.; Bleicher, R. E.; Soden, B. J.

    2014-12-01

    Given that K-12 students have numerous alternative conceptions, it is critical that teachers have an understanding of the fundamental science underlying climate change (Feldman et al., 2010). Many teachers, however, do not demonstrate adequate understanding of these concepts (Daskolia et al., 2006). Argumentation has been identified as a mechanism for conceptual change (Mercer et al., 2004). Even with several educational initiatives promoting and supporting the use of argumentation as an instructional practice, teachers often struggle to implement argumentation in the classroom (Sampson & Blanchard, 2012). To remedy both issues above, we have designed an innovative methods course to provide background in climate change knowledge and argumentation instruction. In our methods course, we utilize Climate Science Investigations (CSI), an online, interactive series of modules and teaching resources funded by a NASA grant to support teachers learning about the basic science concepts underlying climate change. A key assignment is to develop and present an evidence-based scientific argument. The teachers were assigned a typical question and claim of climate skeptics and asked to conduct research on the scientific findings to prepare a counter-argument (rebuttal). This study examined changes in 60 preservice teachers' knowledge and perceptions about climate change after participation in the course. The teachers' understanding of fundamental concepts increased significantly. Their perceptions about climate change became more aligned to those of climate scientists. Findings suggest that scientific argumentation can play an effective role in the preparation of science educators. In addition to reporting findings in more detail, methods course activities, particularly in argumentation, will be shared in our presentation.

  1. Understanding and improving acoustic to seismic coupling as it pertains to Sandia's helicopter detector

    SciTech Connect

    Elliott, G.; Fogler, R.J.

    1985-03-18

    This report covers results to date of an ongoing study undertaken in mid 1984 for the purpose of understanding the basic physics of the acoustic-to-seismic coupling phenomenon involved in the operation of a helicopter detector under development at Sandia National Laboratories. This study has been recently expanded to include assistance from the US Army Waterways Experiment Station and the University of Mississippi. A series of tests were conducted near Albuquerque, New Mexico USA, for the purpose of investigating the coupling phenomenon using an impulsive noise source and two different helicopters. Results of these tests including the evaluation of a new microphone windscreen design are reported.

  2. Improving pharmacy students' understanding and long-term retention of acid-base chemistry.

    PubMed

    Roche, Victoria F

    2007-12-15

    Despite repeated exposure to the principles underlying the behavior of organic acids and bases in aqueous solution, some pharmacy students remain confused about the topic of acid-base chemistry. Since a majority of organic drug molecules have acid-base character, the ability to predict their reactivity and the extent to which they will ionize in a given medium is paramount to students' understanding of essentially all aspects of drug action in vivo and in vitro. This manuscript presents a medicinal chemistry lesson in the fundamentals of acid-base chemistry that many pharmacy students have found enlightening and clarifying.

  3. Driving improvement in patient care: lessons from Toyota.

    PubMed

    Thompson, Debra N; Wolf, Gail A; Spear, Steven J

    2003-11-01

    Nurses today are attempting to do more with less while grappling with faulty error-prone systems that do not focus on patients at the point of care. This struggle occurs against a backdrop of rising national concern over the incidence of medical errors in healthcare. In an effort to create greater value with scarce resources and fix broken systems that compromise quality care, UPMC Health System is beginning to master and implement the Toyota Production System (TPS)--a method of managing people engaged in work that emphasizes frequent rapid problem solving and work redesign that has become the global archetype for productivity and performance. The authors discuss the rationale for applying TPS to healthcare and implementation of the system through the development of "learning unit" model lines and initial outcomes, such as dramatic reductions in the number of missing medications and thousands of hours and dollars saved as a result of TPS-driven changes. Tracking data further suggest that TPS, with sufficient staff preparation and involvement, has the potential for continuous, lasting, and accelerated improvement in patient care. PMID:14608217

  4. Neurostimulation to improve level of consciousness in patients with epilepsy.

    PubMed

    Gummadavelli, Abhijeet; Kundishora, Adam J; Willie, Jon T; Andrews, John P; Gerrard, Jason L; Spencer, Dennis D; Blumenfeld, Hal

    2015-06-01

    When drug-resistant epilepsy is poorly localized or surgical resection is contraindicated, current neurostimulation strategies such as deep brain stimulation and vagal nerve stimulation can palliate the frequency or severity of seizures. However, despite medical and neuromodulatory therapy, a significant proportion of patients continue to experience disabling seizures that impair awareness, causing disability and risking injury or sudden unexplained death. We propose a novel strategy in which neuromodulation is used not only to reduce seizures but also to ameliorate impaired consciousness when the patient is in the ictal and postictal states. Improving or preventing alterations in level of consciousness may have an effect on morbidity (e.g., accidents, drownings, falls), risk for death, and quality of life. Recent studies may have elucidated underlying networks and mechanisms of impaired consciousness and yield potential novel targets for neuromodulation. The feasibility, benefits, and pitfalls of potential deep brain stimulation targets are illustrated in human and animal studies involving minimally conscious/vegetative states, movement disorders, depth of anesthesia, sleep-wake regulation, and epilepsy. We review evidence that viable therapeutic targets for impaired consciousness associated with seizures may be provided by key nodes of the consciousness system in the brainstem reticular activating system, hypothalamus, basal ganglia, thalamus, and basal forebrain.

  5. Download Alert: Understanding Gastroenterology Patients' Perspectives on Health-Related Smartphone Apps

    PubMed Central

    Zia, Jasmine K; Le, Thai; Munson, Sean; Heitkemper, Margaret M; Demiris, George

    2015-01-01

    Objectives: The aims of this study were to understand patients' willingness to use different types of health-related smartphone apps and to explore their attitudes on the overall value, usability, feasibility, credibility, intrusiveness, and obtrusiveness of these apps. Methods: Questionnaires were distributed to adult patients presenting to gastroenterology clinics at an academic medical center. The 25-question survey consisted of 5-point Likert-type scale statements, multiple-choice questions, and open-ended questions. Results: Participants were mainly White (N=94, 78%) and smartphone owners (N=125, 93%). The mean age was 40.8 years (N=121, s.d.=13.2). Participants were willing to use most types of apps unless it monitored their location or social networking activity. Half were less willing to use an app if it required a visible accessory. Most participants were willing to use a health-related app up to 5 min a day indefinitely but unwilling to pay out-of-pocket for it. Participants generally disagreed that an app would be hard to learn how to use, interfere with their daily routine, or be embarrassing to use in public. Overall, participants felt that health-related apps could help them and their doctors better manage their medical problems, but were neutral in trusting their quality. Most worried that personal information used for an app would fall into the wrong hands. Conclusion: Gastroenterology patients were willing to use and valued most types of health-related apps. They perceived this technology as feasible, usable, and relatively unobtrusive unless a visible accessory was required. However, many were concerned about their privacy. PMID:26133109

  6. Interferon-Gamma Improves Macrophages Function against M. tuberculosis in Multidrug-Resistant Tuberculosis Patients.

    PubMed

    Khan, Taj Ali; Mazhar, Humaira; Saleha, Shamim; Tipu, Hamid Nawaz; Muhammad, Niaz; Abbas, Muhammad Nasser

    2016-01-01

    Background. Mycobacterium tuberculosis (M. tuberculosis) that causes tuberculosis (TB) kills millions of infected people annually especially multidrug-resistant tuberculosis (MDR-TB). On infection, macrophages recognize the mycobacteria by toll-like receptor (TLR) followed by phagocytosis and control of mycobacteria. In addition, macrophages also secrete IL-12 to induce IFN-γ production by T, which, in turn, increases the phagocytosis and oxidative burst. Individuals with defects in innate or adaptive immunity exhibit increased susceptibility to M. tuberculosis. Understanding these immunologic mechanisms will help in TB control. We aimed to investigate the immunopathologic mechanisms in MDR-TB and role of recombinant human interferon-gamma (rhIFN-γ). Study Design and Methods. Monocyte-derived macrophages (MDMs) were generated from peripheral blood mononuclear cells of MDR-TB patients and healthy subjects and were investigated for immunologic response by ELISA and flow cytometry. Results. Different functional and molecular anomalies were observed in macrophages. In addition, a defective immune response to M. tuberculosis from the patient's MDMs was characterized, which in turn improved by pretreatment with rhIFN-γ. Conclusion. This work highlights the fact that rhIFN-γ improves macrophages function against M. tuberculosis and treatment of patients with poor responsiveness to TB therapy may be needed in future to include IFN-γ as adjuvant therapy after the full characterization of pathological and molecular mechanisms in these and in other more multidrug-resistant TB patients. PMID:27478636

  7. Interferon-Gamma Improves Macrophages Function against M. tuberculosis in Multidrug-Resistant Tuberculosis Patients

    PubMed Central

    Mazhar, Humaira; Muhammad, Niaz; Abbas, Muhammad Nasser

    2016-01-01

    Background. Mycobacterium tuberculosis (M. tuberculosis) that causes tuberculosis (TB) kills millions of infected people annually especially multidrug-resistant tuberculosis (MDR-TB). On infection, macrophages recognize the mycobacteria by toll-like receptor (TLR) followed by phagocytosis and control of mycobacteria. In addition, macrophages also secrete IL-12 to induce IFN-γ production by T, which, in turn, increases the phagocytosis and oxidative burst. Individuals with defects in innate or adaptive immunity exhibit increased susceptibility to M. tuberculosis. Understanding these immunologic mechanisms will help in TB control. We aimed to investigate the immunopathologic mechanisms in MDR-TB and role of recombinant human interferon-gamma (rhIFN-γ). Study Design and Methods. Monocyte-derived macrophages (MDMs) were generated from peripheral blood mononuclear cells of MDR-TB patients and healthy subjects and were investigated for immunologic response by ELISA and flow cytometry. Results. Different functional and molecular anomalies were observed in macrophages. In addition, a defective immune response to M. tuberculosis from the patient's MDMs was characterized, which in turn improved by pretreatment with rhIFN-γ. Conclusion. This work highlights the fact that rhIFN-γ improves macrophages function against M. tuberculosis and treatment of patients with poor responsiveness to TB therapy may be needed in future to include IFN-γ as adjuvant therapy after the full characterization of pathological and molecular mechanisms in these and in other more multidrug-resistant TB patients. PMID:27478636

  8. Interprofessional Workshop to Improve Mutual Understanding Between Pharmacy and Medical Students

    PubMed Central

    Bjork, Bryan C.; Chandar, Nalini; Cornell, Susan; Fjortoft, Nancy; Green, Jacalyn M.; La Salle, Sophie; Lynch, Sean M.; Viselli, Susan M.; Burdick, Paulette

    2012-01-01

    Objective. To measure changes in pharmacy and medical students’ physician-pharmacist collaboration scores resulting from a workshop designed to promote understanding of the others’ roles in health care. Methods. More than 88% of first-year pharmacy (n = 215) and medical (n = 205) students completed the Scale of Attitudes Toward Physician-Pharmacist Collaboration on 3 occasions in order to establish a baseline of median scores and to determine whether the scores were influenced by an interprofessional workshop. Results. Participation in the interprofessional workshop increased pharmacy students’ collaboration scores above baseline (p=0.02) and raised the scores of medical students on the education component of the collaboration survey instrument (p=0.015). The collaboration scores of pharmacy students greatly exceeded those of medical students (p<0.0001). Conclusion. A workshop designed to foster interprofessional understanding between pharmacy and medical students raised the physician-pharmacist collaboration scores of both. Crucial practical goals for the future include raising the collaboration scores of medical students to those of pharmacy students. PMID:23129849

  9. Anatomy of Teaching Anatomy: Do Prosected Cross Sections Improve Students Understanding of Spatial and Radiological Anatomy?

    PubMed Central

    Vithoosan, S.; Kokulan, S.; Dissanayake, M. M.; Dissanayake, Vajira; Jayasekara, Rohan

    2016-01-01

    Introduction. Cadaveric dissections and prosections have traditionally been part of undergraduate medical teaching. Materials and Methods. Hundred and fifty-nine first-year students in the Faculty of Medicine, University of Colombo, were invited to participate in the above study. Students were randomly allocated to two age and gender matched groups. Both groups were exposed to identical series of lectures regarding anatomy of the abdomen and conventional cadaveric prosections of the abdomen. The test group (n = 77, 48.4%) was also exposed to cadaveric cross-sectional slices of the abdomen to which the control group (n = 82, 51.6%) was blinded. At the end of the teaching session both groups were assessed by using their performance in a timed multiple choice question paper as well as ability to identify structures in abdominal CT films. Results. Scores for spatial and radiological anatomy were significantly higher among the test group when compared with the control group (P < 0.05, CI 95%). Majority of the students in both control and test groups agreed that cadaveric cross section may be useful for them to understand spatial and radiological anatomy. Conclusion. Introduction of cadaveric cross-sectional prosections may help students to understand spatial and radiological anatomy better. PMID:27579181

  10. How evolutionary principles improve the understanding of human health and disease

    PubMed Central

    Gluckman, Peter D; Low, Felicia M; Buklijas, Tatjana; Hanson, Mark A; Beedle, Alan S

    2011-01-01

    An appreciation of the fundamental principles of evolutionary biology provides new insights into major diseases and enables an integrated understanding of human biology and medicine. However, there is a lack of awareness of their importance amongst physicians, medical researchers, and educators, all of whom tend to focus on the mechanistic (proximate) basis for disease, excluding consideration of evolutionary (ultimate) reasons. The key principles of evolutionary medicine are that selection acts on fitness, not health or longevity; that our evolutionary history does not cause disease, but rather impacts on our risk of disease in particular environments; and that we are now living in novel environments compared to those in which we evolved. We consider these evolutionary principles in conjunction with population genetics and describe several pathways by which evolutionary processes can affect disease risk. These perspectives provide a more cohesive framework for gaining insights into the determinants of health and disease. Coupled with complementary insights offered by advances in genomic, epigenetic, and developmental biology research, evolutionary perspectives offer an important addition to understanding disease. Further, there are a number of aspects of evolutionary medicine that can add considerably to studies in other domains of contemporary evolutionary studies. PMID:25567971

  11. Effective colonoscopy training techniques: strategies to improve patient outcomes

    PubMed Central

    Papanikolaou, Ioannis S; Karatzas, Pantelis S; Varytimiadis, Lazaros T; Tsigaridas, Athanasios; Galanopoulos, Michail; Viazis, Nikos; Karamanolis, Dimitrios G

    2016-01-01

    Colonoscopy has substantially evolved during the last 20 years and many different training techniques have been developed in order to improve the performance of endoscopists. The most known are mechanical simulators, virtual reality simulators, computer-simulating endoscopy, magnetic endoscopic imaging, and composite and explanted animal organ simulators. Current literature generally indicates that the use of simulators improves performance of endoscopists and enhances safety of patients, especially during the initial phase of training. Moreover, newer endoscopes and imaging techniques such as high-definition colonoscopes, chromocolonoscopy with dyes spraying, and third-eye retroscope have been incorporated in everyday practice, offering better visualization of the colon and detection of polyps. Despite the abundance of these different technological features, training devices are not widely used and no official guideline or specified training algorithm or technique for lower gastrointestinal endoscopy has been evolved. In this review, we present the most important training methods currently available and evaluate these using existing literature. We also try to propose a training algorithm for novice endoscopists. PMID:27099542

  12. Understanding how adherence goals promote adherence behaviours: a repeated measure observational study with HIV seropositive patients

    PubMed Central

    2012-01-01

    Background The extent to which patients follow treatments as prescribed is pivotal to treatment success. An exceptionally high level (> 95%) of HIV medication adherence is required to suppress viral replication and protect the immune system and a similarly high level (> 80%) of adherence has also been suggested in order to benefit from prescribed exercise programmes. However, in clinical practice, adherence to both often falls below the desirable level. This project aims to investigate a wide range of psychological and personality factors that may lead to adherence/non-adherence to medical treatment and exercise programmes. Methods HIV positive patients who are referred to the physiotherapist-led 10-week exercise programme as part of the standard care are continuously recruited. Data on social cognitive variables (attitude, intention, subjective norms, self-efficacy, and outcome beliefs) about the goal and specific behaviours, selected personality factors, perceived quality of life, physical activity, self-reported adherence and physical assessment are collected at baseline, at the end of the exercise programme and again 3 months later. The project incorporates objective measures of both exercise (attendance log and improvement in physical measures such as improved fitness level, weight loss, improved circumferential anthropometric measures) and medication adherence (verified by non-invasive hair analysis). Discussion The novelty of this project comes from two key aspects, complemented with objective information on exercise and medication adherence. The project assesses beliefs about both the underlying goal such as following prescribed treatment; and about the specific behaviours such as undertaking the exercise or taking the medication, using both implicit and explicit assessments of patients’ beliefs and attitudes. We predict that i) the way people think about the underlying goal of their treatments explains medication and exercise behaviours over and above

  13. Understanding and Improving Cardiovascular Health: An Update on the American Heart Association's Concept of Cardiovascular Health.

    PubMed

    Shay, Christina M; Gooding, Holly S; Murillo, Rosenda; Foraker, Randi

    2015-01-01

    The American Heart Association's 2020 Strategic Impact Goal is "By 2020, to improve the cardiovascular health of all Americans by 20% while reducing deaths from cardiovascular diseases and stroke by 20%." To monitor progress towards this goal, a new construct "ideal cardiovascular health" (iCVH) was defined that includes the simultaneous presence of optimal levels of seven health behaviors (physical activity, smoking, dietary intake, and body mass index) and factors (total cholesterol, blood pressure and fasting blood glucose). In this review, we present a summary of major concepts related to the concept of iCVH and an update of the literature in this area since publication of the 2020 Strategic Impact Goal, including trends in iCVH prevalence, new determinants and outcomes related to iCVH, strategies for maintaining or improving iCVH, policy implications of the iCVH model, and the remaining challenges to reaching the 2020 Strategic Impact Goal. PMID:25958016

  14. Understanding How the "Open" of Open Source Software (OSS) Will Improve Global Health Security.

    PubMed

    Hahn, Erin; Blazes, David; Lewis, Sheri

    2016-01-01

    Improving global health security will require bold action in all corners of the world, particularly in developing settings, where poverty often contributes to an increase in emerging infectious diseases. In order to mitigate the impact of emerging pandemic threats, enhanced disease surveillance is needed to improve early detection and rapid response to outbreaks. However, the technology to facilitate this surveillance is often unattainable because of high costs, software and hardware maintenance needs, limited technical competence among public health officials, and internet connectivity challenges experienced in the field. One potential solution is to leverage open source software, a concept that is unfortunately often misunderstood. This article describes the principles and characteristics of open source software and how it may be applied to solve global health security challenges. PMID:26889576

  15. Shared Medical Appointments: A Promising Innovation to Improve Patient Engagement and Ease the Primary Care Provider Shortage.

    PubMed

    Stults, Cheryl D; McCuistion, Mary H; Frosch, Dominick L; Hung, Dorothy Y; Cheng, Peter H; Tai-Seale, Ming

    2016-02-01

    The Affordable Care Act has extended coverage for uninsured and underinsured Americans, but it could exacerbate existing problems of access to primary care. Shared medical appointments (SMAs) are one way to improve access and increase practice productivity, but few studies have examined the patient's perspective on participation in SMAs. To understand patient experiences, 5 focus group sessions were conducted with a total of 30 people in the San Francisco Bay Area. The sessions revealed that most participants felt that they received numerous tangible and intangible benefits from SMAs, particularly enhanced engagement with other patients and physicians, learning, and motivation for health behavior change. Most importantly, participants noted changes in the power dynamic during SMA visits as they increasingly saw themselves empowered to impart information to the physician. Although SMAs improve access, engagement with physicians and other patients, and knowledge of patients' health, they also help to ease the workload for physicians.

  16. a Radiocarbon Database for Improved Understanding of Global Soil Carbon Dynamics: Part II

    NASA Astrophysics Data System (ADS)

    Trumbore, S.; Torn, M. S.; Sierra, C. A.; Smith, L. J.; Nave, L. E.; Workshop Paritipants, R.

    2011-12-01

    We report results of a workshop to initiate a global database of radiocarbon measurements in soil and other ecosystem compartments. Radiocarbon provides critical information for understanding the rate of exchange of soil carbon with the atmosphere and hydrosphere. For example, radiocarbon has been used to demonstrate the importance of short range order minerals in stabilizing organic carbon on millennial timescales in some soils. On decadal to centennial timescales, the infiltration of 'bomb' radiocarbon provides a measure of the amount and nature of soil carbon that responds on the timescale of most human impacts. The radiocarbon sigature of chemically or physically fractionated soil, or even in specific organic compounds, can yield clues as to controls on organic matter cycling on a range of timescales. Radiocarbon in microbial biomass or respiration can be a sensitive indicator of shifts in substrate use with vegetation, nutrient availability or temperature change. Taken toghether, such measurements can provide critical tests for models of soil carbon dynamics, while patterns in soil C dynamics with edaphic factors can be used to help parameterize models at spatial scales ranging from profile to landscape to global. The advent and proliferation of accelerator mass spectrometry since the early 1990s has vastly increased the number of radiocarbon analyses carried out in soils. However, these studies have usually been carried out by individual investigators within specific sites or regions, and to date the results have not been assembled, interpreted or compared at larger spatial scales. Given the expense of radiocarbon measurements, and the need for global synthesis products to evaluate and/or develop models of soil carbon response to climate and land use changes across a range of spatial scales, our goals are to: (1) bring together in one place existing radiocarbon measurements and provide a continuing common repository for new analyses; (2) supply ancillary

  17. Goal-Driven Development of a Patient Surveillance Application for Improving Patient Safety

    NASA Astrophysics Data System (ADS)

    Behnam, Saeed Ahmadi; Amyot, Daniel; Forster, Alan J.; Peyton, Liam; Shamsaei, Azalia

    Hospitals strive to improve the safety of their patients. Yet, every year, thousands of patients suffer from adverse events, which are defined as undesirable outcomes caused by health care business processes. There are few tools supporting adverse event detection and these are ineffective. There is hence some urgency in developing such a tool in a way that complies with the organizations goals and privacy legislation. In addition, governments will soon require hospitals to report on adverse events. In this paper, we will show how a pilot application we developed contributes to the patient safety goals of a major teaching hospital and how our goal-driven approach supported the collaboration between the university researchers and hospital decision makers involved. Benefits and challenges related to the modeling of requirements, goals, and processes, and to the development of the application itself, are also discussed.

  18. Anticipated Improvements in Precipitation Physics and Understanding of Water Cycle from GPM Mission

    NASA Technical Reports Server (NTRS)

    Smith, Eric A.

    2003-01-01

    The GPM mission is currently planned for start in the late-2007 to early-2008 time frame. Its main scientific goal is to help answer pressing scientific problems arising within the context of global and regional water cycles. These problems cut across a hierarchy of scales and include climate-water cycle interactions, techniques for improving weather and climate predictions, and better methods for combining observed precipitation with hydrometeorological prediction models for applications to hazardous flood-producing storms, seasonal flood/draught conditions, and fresh water resource assessments. The GPM mission will expand the scope of precipitation measurement through the use of a constellation of some 9 satellites, one of which will be an advanced TRMM-like core satellite carrying a dual-frequency Ku-Ka band precipitation radar and an advanced, multifrequency passive microwave radiometer with vertical-horizontal polarization discrimination. The other constellation members will include new dedicated satellites and co-existing operational/research satellites carrying similar (but not identical) passive microwave radiometers. The goal of the constellation is to achieve approximately 3-hour sampling at any spot on the globe -- continuously. The constellation s orbit architecture will consist of a mix of sun-synchronous and non-sun-synchronous satellites with the core satellite providing measurements of cloud-precipitation microphysical processes plus calibration-quality rainrate retrievals to be used with the other retrieval information to ensure bias-free constellation coverage. GPM is organized internationally, involving existing, pending, projected, and under-study partnerships which will link NASA and NOAA in the US, NASDA in Japan, ESA in Europe, ISRO in India, CNES in France, and possibly AS1 in Italy, KARI in South Korea, CSA in Canada, and AEB in Brazil. Additionally, the program is actively pursuing agreements with other international collaborators and

  19. Using epigenomic studies in monozygotic twins to improve our understanding of cancer.

    PubMed

    Roos, Leonie; Spector, Timothy D; Bell, Christopher G

    2014-06-01

    Cancer is a set of diseases that exhibit not only genetic mutations but also a profoundly distorted epigenetic landscape. Over the last two decades, great advances have been made in identifying these alterations and their importance in the initiation and progression of cancer. Epigenetic changes can be seen from the very early stages in tumorigenesis and dysregulation of the epigenome has an increasingly acknowledged pathogenic role. Epigenomic twin studies have great potential to contribute to our understanding of complex diseases, such as cancer. This is because the use of monozygotic twins discordant for cancer enables epigenetic variation analysis without the confounding influence of the constitutive genetic background, age or cohort effects. It therefore allows the identification of susceptibility loci that may be sensitive to modification by the environment. These studies into cancer etiology will potentially lead to robust epigenetic markers for the detection and risk assessment of cancer.

  20. On the Concept of Force: How Understanding its History can Improve Physics Teaching

    NASA Astrophysics Data System (ADS)

    Coelho, Ricardo Lopes

    2010-01-01

    Some physicists have pointed out that we do not know what force is. The most common definition of force in textbooks has been criticized for more than two centuries. Many studies have shown that the concept of force is a problem for teaching. How to conceive force on the basis of the concepts and criticism of force in the works of Newton, Euler, d’Alembert, Lagrange, Lazare Carnot, Saint-Venant, Reech, Kirchhoff, Mach, Hertz and Poincaré is the question of the present article. This part of the article is followed by an overview of definitions of force in contemporary textbooks. In the next part, an answer to the question is given: how to understand force within the framework of the laws of motion and in applications. Finally, some educational implications are considered.

  1. The Law of Inertia: How Understanding its History can Improve Physics Teaching

    NASA Astrophysics Data System (ADS)

    Coelho, Ricardo Lopes

    2007-10-01

    The law of inertia is a problem in teaching due to the impossibility of showing the proposition experimentally. As we cannot do an experiment to verify the law, we cannot know if it is correct. On the other hand, we know that the science based upon it is successful. A study in the history of mechanics has shown that there are different foundations for the law but also that the law plays the same role in the science since Newton. To avoid a statement of which we cannot be sure, the present paper proposes to understand the law through its function in the theory. In this case, we do not have to say how a free body moves, but rather that the rectilinear and uniform motion is the motion of reference in Newtonian mechanics.

  2. Interactive tutorial to improve student understanding of single photon experiments involving a Mach-Zehnder interferometer

    NASA Astrophysics Data System (ADS)

    Marshman, Emily; Singh, Chandralekha

    2016-03-01

    We have developed and evaluated a quantum interactive learning tutorial (QuILT) on a Mach-Zehnder interferometer with single photons to expose upper-level students in quantum mechanics courses to contemporary quantum optics applications. The QuILT strives to help students develop the ability to apply fundamental quantum principles to physical situations in quantum optics and explore the differences between classical and quantum ideas. The QuILT adapts visualization tools to help students build physical intuition about counter-intuitive quantum optics phenomena with single photons including a quantum eraser setup and focuses on helping them integrate qualitative and quantitative understanding. We discuss findings from in-class evaluations.

  3. MoFlow: visualizing conformational changes in molecules as molecular flow improves understanding

    PubMed Central

    2015-01-01

    Background Current visualizations of molecular motion use a Timeline-analogous representation that conveys "first the molecule was shaped like this, then like this...". This scheme is orthogonal to the Pathline-like human understanding of motion "this part of the molecule moved from here to here along this path". We present MoFlow, a system for visualizing molecular motion using a Pathline-analogous representation. Results The MoFlow system produces high-quality renderings of molecular motion as atom pathlines, as well as interactive WebGL visualizations, and 3D printable models. In a preliminary user study, MoFlow representations are shown to be superior to canonical representations for conveying molecular motion. Conclusions Pathline-based representations of molecular motion are more easily understood than timeline representations. Pathline representations provide other advantages because they represent motion directly, rather than representing structure with inferred motion. PMID:26361501

  4. Novel treatment strategies for schizophrenia from improved understanding of genetic risk.

    PubMed

    Morris, B J; Pratt, J A

    2014-11-01

    Recent years have seen significant advances in our understanding of the genetic basis of schizophrenia. In particular, genome-wide approaches have suggested the involvement of many common genetic variants of small effect, together with a few rare variants exerting relatively large effects. While unequivocal identification of the relevant genes has, for the most part, remained elusive, the genes revealed as potential candidates can in many cases be clustered into functionally related groups which are potentially open to therapeutic intervention. In this review, we summarise this information, focusing on the accumulating evidence that genetic dysfunction at glutamatergic synapses and post-synaptic signalling complexes contributes to the aetiology of the disease. In particular, there is converging support for involvement of post-synaptic JNK pathways in disease aetiology. An expansion of our neurobiological knowledge of the basis of schizophrenia is urgently needed, yet some promising novel pharmacological targets can already be discerned.

  5. Exploiting new electrochemical understanding of niobium electropolishing for improved performance of SRF cavities for CEBAF

    SciTech Connect

    Reece, Charles E.; Tian, Hui

    2010-09-01

    Recent incorporation of analytic electrochemistry into the development of protocols for electropolishing niobium SRF cavities has yielded new insights for optimizing this process for consistent, high-performance results. Use of reference electrodes in the electrolyte, electrochemical impedance spectroscopy (EIS), rotating disk electrodes (RDE), and controlled sample temperatures has greatly clarified the process dynamics over the empirical understanding developed via years of practice. Minimizing RF losses at high operational gradients is very valuable for CW linacs. Jefferson Lab is applying these new insights to the low-loss 7-cell cavity design developed for the CEBAF 12 GeV Upgrade. Together with controlled cleaning and assembly techniques to guard against field-emission-causing particulates, the resulting process is yielding consistent cavity performance that exceeds project requirements. Cavity tests show BCS-limited Q well above 30 MV/m. Detailed process data, interpretation, and resulting rf performance data will be presented.

  6. Integrating flux, satellite, and proximal optical data for an improved understanding of ecosystem carbon uptake

    NASA Astrophysics Data System (ADS)

    Gamon, J. A.; Huemmrich, K. F.; Garrity, S. R.

    2015-12-01

    The different scales and methods of satellite observations and flux measurements present challenges for data integration that can be partly addressed by the addition of scale-appropriate optical sampling. Proximal optical measurement facilitates experimental approaches that can inform upscaling, satellite validation, and lead to better understanding of controls on carbon fluxes and other ecosystem processes. Using the framework of the light-use efficiency model, this presentation will review efforts to explore the controls on ecosystem-atmosphere carbon fluxes using a variety of novel optical sensors and platforms. Topics of appropriate sampling methodology, scaling and data aggregation will also be considered, with examples of how information content and interpretation of optical data can be scale-dependent. Key challenges include informatics solutions that handle large, multi-dimensional data volumes and contextual information, including information about sampling protocols and scale. Key opportunities include the assessment of vegetation functional diversity with optical sensors.

  7. How online learning modules can improve the representational fluency and conceptual understanding of university physics students

    NASA Astrophysics Data System (ADS)

    Hill, M.; Sharma, M. D.; Johnston, H.

    2015-07-01

    The use of online learning resources as core components of university science courses is increasing. Learning resources range from summaries, videos, and simulations, to question banks. Our study set out to develop, implement, and evaluate research-based online learning resources in the form of pre-lecture online learning modules (OLMs). The aim of this paper is to share our experiences with those using, or considering implementing, online learning resources. Our first task was to identify student learning issues in physics to base the learning resources on. One issue with substantial research is conceptual understanding, the other with comparatively less research is scientific representations (graphs, words, equations, and diagrams). We developed learning resources on both these issues and measured their impact. We created weekly OLMs which were delivered to first year physics students at The University of Sydney prior to their first lecture of the week. Students were randomly allocated to either a concepts stream or a representations stream of online modules. The programme was first implemented in 2013 to trial module content, gain experience and process logistical matters and repeated in 2014 with approximately 400 students. Two validated surveys, the Force and Motion Concept Evaluation (FMCE) and the Representational Fluency Survey (RFS) were used as pre-tests and post-tests to measure learning gains while surveys and interviews provided further insights. While both streams of OLMs produced similar positive learning gains on the FMCE, the representations-focussed OLMs produced higher gains on the RFS. Conclusions were triangulated with student responses which indicated that they have recognized the benefit of the OLMs for their learning of physics. Our study shows that carefully designed online resources used as pre-instruction can make a difference in students’ conceptual understanding and representational fluency in physics, as well as make them more aware

  8. Understanding the systemic nature of cities to improve health and climate change mitigation.

    PubMed

    Chapman, Ralph; Howden-Chapman, Philippa; Capon, Anthony

    2016-09-01

    Understanding cities comprehensively as systems is a costly challenge and is typically not feasible for policy makers. Nevertheless, focusing on some key systemic characteristics of cities can give useful insights for policy to advance health and well-being outcomes. Moreover, if we take a coevolutionary systems view of cities, some conventional assumptions about the nature of urban development (e.g. the growth in private vehicle use with income) may not stand up. We illustrate this by examining the coevolution of urban transport and land use systems, and institutional change, giving examples of policy implications. At a high level, our concern derives from the need to better understand the dynamics of urban change, and its implications for health and well-being. At a practical level, we see opportunities to use stylised findings about urban systems to underpin policy experiments. While it is now not uncommon to view cities as systems, policy makers appear to have made little use so far of a systems approach to inform choice of policies with consequences for health and well-being. System insights can be applied to intelligently anticipate change - for example, as cities are subjected to increasing natural system reactions to climate change, they must find ways to mitigate and adapt to it. Secondly, systems insights around policy cobenefits are vital for better informing horizontal policy integration. Lastly, an implication of system complexity is that rather than seeking detailed, 'full' knowledge about urban issues and policies, cities would be well advised to engage in policy experimentation to address increasingly urgent health and climate change issues. PMID:27126780

  9. Understanding the systemic nature of cities to improve health and climate change mitigation.

    PubMed

    Chapman, Ralph; Howden-Chapman, Philippa; Capon, Anthony

    2016-09-01

    Understanding cities comprehensively as systems is a costly challenge and is typically not feasible for policy makers. Nevertheless, focusing on some key systemic characteristics of cities can give useful insights for policy to advance health and well-being outcomes. Moreover, if we take a coevolutionary systems view of cities, some conventional assumptions about the nature of urban development (e.g. the growth in private vehicle use with income) may not stand up. We illustrate this by examining the coevolution of urban transport and land use systems, and institutional change, giving examples of policy implications. At a high level, our concern derives from the need to better understand the dynamics of urban change, and its implications for health and well-being. At a practical level, we see opportunities to use stylised findings about urban systems to underpin policy experiments. While it is now not uncommon to view cities as systems, policy makers appear to have made little use so far of a systems approach to inform choice of policies with consequences for health and well-being. System insights can be applied to intelligently anticipate change - for example, as cities are subjected to increasing natural system reactions to climate change, they must find ways to mitigate and adapt to it. Secondly, systems insights around policy cobenefits are vital for better informing horizontal policy integration. Lastly, an implication of system complexity is that rather than seeking detailed, 'full' knowledge about urban issues and policies, cities would be well advised to engage in policy experimentation to address increasingly urgent health and climate change issues.

  10. How Kaiser Permanente uses video ethnography of patients for quality improvement, such as in shaping better care transitions.

    PubMed

    Neuwirth, Esther B; Bellows, Jim; Jackson, Ana H; Price, Patricia M

    2012-06-01

    Keeping patients and caregivers at the center of quality improvement is critical. Kaiser Permanente's Care Management Institute adapted video ethnography to achieve this aim, using video to capture interviews with-and observations of-patients and caregivers, identify patient-centered improvement opportunities, and communicate them effectively to clinical and administrative leaders and front-line staff. This method is particularly effective for helping understand the needs of frail elders, patients nearing the end of life, those with multiple chronic conditions, and other vulnerable people who are not well represented in focus groups and patient advisory councils. As part of an initiative to improve care transitions for elders with heart failure, video ethnography contributed to greatly reduced thirty-day hospital readmission rates, helping reduce readmissions at one medical center from 13.6 percent to 9 percent in six months. It also helped improve the reliability of the readmissions reduction program. When embedded within an established quality improvement framework, video ethnography can be an effective tool for innovating new solutions, improving existing processes, and spreading knowledge about how best to meet patient needs.

  11. Interventions to improve long-term weight loss in patients following bariatric surgery: challenges and solutions

    PubMed Central

    McGrice, Melanie; Don Paul, Kathlene

    2015-01-01

    Bariatric surgery aims to provide long-term weight loss and improvement in weight-related comorbidities. Unfortunately, some patients do not achieve predicted weight loss targets and many regain a portion of their lost weight within 2–10 years postsurgery. A review of the literature found that behavioral, dietary, psychological, physical, and medical considerations can all play a role in suboptimal long-term weight loss. Recommendations to optimize long-term weight loss include ensuring that the patient understands how the procedure works, preoperative and postoperative education sessions, tailored nutritional supplements, restraint with liquid kilojoules, pureed foods, grazing and eating out of the home, an average of 60 minutes of physical activity per day, and lifelong annual medical, psychological, and dietary assessments. PMID:26150731

  12. Understanding Low-cycle Fatigue Life Improvement Mechanisms in a Pre-twinned Magnesium Alloy

    SciTech Connect

    Wu, Wei; An, Ke

    2015-10-03

    The mechanisms of fatigue life improvement by pre-twinning process in a commercial rolled magnesium (Mg) alloy have been investigated using real-time in situ neutron diffraction under a continuous-loading condition. It is found that by introducing the excess twinned grains through pre-compression along the rolling direction the fatigue life was enhanced approximately 50%, mainly resulting from the prolonged detwinning process and inhibited dislocation slip during reverse tension. Moreover, after pre-twinning process, the removal of the rapid strain hardening during reverse tension leads to a compressive mean stress value and more symmetric shape of stress-strain hysteresis loop. The pre-twinning has significant impacts on the twinning-detwinning characteristics and deformation modes during cyclic loading and greatly facilitates the twinning-detwinning activities in plastic deformation. The cyclic straining leads to the increase of contribution of tensile twinning deformation in overall plastic deformation in both the as-received and pre-deformed sample. The mechanisms of load partitioning in different groups of grains are closely related to the deformation modes in each deformation stage, while the fatigue cycling has little influence on the load sharing. The pre-twinning process provides an easy and cost-effective route to improve the low-cycle fatigue life through manufacturing and processing, which would advance the wide application of light-weight wrought Mg alloys as structural materials.

  13. Understanding Low-cycle Fatigue Life Improvement Mechanisms in a Pre-twinned Magnesium Alloy

    DOE PAGES

    Wu, Wei; An, Ke

    2015-10-03

    The mechanisms of fatigue life improvement by pre-twinning process in a commercial rolled magnesium (Mg) alloy have been investigated using real-time in situ neutron diffraction under a continuous-loading condition. It is found that by introducing the excess twinned grains through pre-compression along the rolling direction the fatigue life was enhanced approximately 50%, mainly resulting from the prolonged detwinning process and inhibited dislocation slip during reverse tension. Moreover, after pre-twinning process, the removal of the rapid strain hardening during reverse tension leads to a compressive mean stress value and more symmetric shape of stress-strain hysteresis loop. The pre-twinning has significant impactsmore » on the twinning-detwinning characteristics and deformation modes during cyclic loading and greatly facilitates the twinning-detwinning activities in plastic deformation. The cyclic straining leads to the increase of contribution of tensile twinning deformation in overall plastic deformation in both the as-received and pre-deformed sample. The mechanisms of load partitioning in different groups of grains are closely related to the deformation modes in each deformation stage, while the fatigue cycling has little influence on the load sharing. The pre-twinning process provides an easy and cost-effective route to improve the low-cycle fatigue life through manufacturing and processing, which would advance the wide application of light-weight wrought Mg alloys as structural materials.« less

  14. Manipulating Light to Understand and Improve Solar Cells (494th Brookhaven Lecture)

    SciTech Connect

    Eisaman, Matthew

    2014-04-16

    Energy consumption around the world is projected to approximately triple by the end of the century, according to the 2005 Report from the U.S. Department of Energy's Basic Energy Sciences Workshop on Solar Energy Utilization. Much will change in those next 86 years, but for all the power the world needs—for everything from manufacturing and transportation to air conditioning and charging cell phone batteries—improved solar cells will be crucial to meet this future energy demand with renewable energy sources. At Brookhaven Lab, scientists are probing solar cells and exploring variations within the cells—variations that are so small they are measured in billionths of a meter—in order to make increasingly efficient solar cells and ultimately help reduce the overall costs of deploying solar power plants. Dr. Eisaman will discuss DOE's Sunshot Initiative, which aims to reduce the cost of solar cell-generated electricity by 2020. He will also discuss how he and collaborators at Brookhaven Lab are probing different material compositions within solar cells, measuring how efficiently they collect electrical charge, helping to develop a new class of solar cells, and improving solar-cell manufacturing processes.

  15. Improving the understanding and diagnosis of Earth system changes in cold regions

    NASA Astrophysics Data System (ADS)

    Lettenmaier, D. P.

    2015-12-01

    I review key hydrological state variables and fluxes relevant to cold regions, specifically snow, permafrost and seasonally frozen soils, lakes, and wetlands, and comment on the ability of current models to represent the associated processes, and the quality of the data sets upon which model development and diagnosis efforts rest. Although snow processes are relatively well represented in current generation land surface models, at least at large scales for deep mountain snowpacks, the representation of high latitude snow processes remain complicated by the role of snow redistribution, and of sublimation during the shoulder (especially spring) season. Most credible land surface models now include representations of permafrost, some of which perform well when forced with local climate data; however their performance over large areas is limited by spatial variability of key processes, including soil thermal characteristics. Likewise, many land surface models now represent the hydrology and energetics of lakes, which cover a substantial portion of the landscape in many high latitude environs. However, accurate representation of lakes requires knowledge of certain characteristics of their bathymetry and hydrological connectivity, information which is not always available. Likewise, the representation of wetlands in models, although improved in many cases, is limited by topography (and the role of microtopography, even at large scales). Nonetheless, increased attention to high latitude hydrological processes has demonstrably improved the fidelity of land surface representations over the last decade or so.

  16. Improving the understanding and diagnosis of Earth system changes in cold regions

    NASA Astrophysics Data System (ADS)

    Lane, C.; D'Amico, E.

    2014-12-01

    I review key hydrological state variables and fluxes relevant to cold regions, specifically snow, permafrost and seasonally frozen soils, lakes, and wetlands, and comment on the ability of current models to represent the associated processes, and the quality of the data sets upon which model development and diagnosis efforts rest. Although snow processes are relatively well represented in current generation land surface models, at least at large scales for deep mountain snowpacks, the representation of high latitude snow processes remain complicated by the role of snow redistribution, and of sublimation during the shoulder (especially spring) season. Most credible land surface models now include representations of permafrost, some of which perform well when forced with local climate data; however their performance over large areas is limited by spatial variability of key processes, including soil thermal characteristics. Likewise, many land surface models now represent the hydrology and energetics of lakes, which cover a substantial portion of the landscape in many high latitude environs. However, accurate representation of lakes requires knowledge of certain characteristics of their bathymetry and hydrological connectivity, information which is not always available. Likewise, the representation of wetlands in models, although improved in many cases, is limited by topography (and the role of microtopography, even at large scales). Nonetheless, increased attention to high latitude hydrological processes has demonstrably improved the fidelity of land surface representations over the last decade or so.

  17. It Takes Two to Tango: Improving Patient Referrals from the Emergency Department to Inpatient Clinicians

    PubMed Central

    Lawrence, Sean; Spencer, Lyndall M.; Sinnott, Michael; Eley, Robert

    2015-01-01

    Background The transfer of responsibility for patient care across clinical specialties is a complex process. Published and anecdotal data suggest that referrals often fail to meet the needs of one or both parties and that patient focus can be lost during the process. Little is known about the Australian situation. Methods To obtain a more complete understanding of the referral process, including the nature of communication in an Australian context, we conducted semistructured interviews in a convenience sample of 25 volunteers. Two established strategies for analyzing qualitative data were used. Results All respondents considered the following information essential components of a referral: an account of the patient's current condition, a working diagnosis or problem statement and history of the presenting concern, key test results or tests awaiting results, a potential management plan, and any special characteristics of the patient. Respondents acknowledged implied, if not literal, power to accept or reject an emergency department (ED) referral and said the imbalance of power was reinforced when the ED physician was junior to the inpatient clinician. Respondents also noted that in addition to the predominant organizational culture, an independent culture is associated with specific shifts. Foremost among the nonclinical aspects of a referral considered to be important was the timeliness of the contact made to achieve the transition. Respondents also said the success of a referral depended on the speaking and listening abilities of all parties. The individual's motivation to accept or reject a referral can also have an impact on communication. Conclusion Respondents attributed the difficulty of negotiating the transfer of a patient's care across the ED and inpatient interface to three distinct factors: variations in the clinical information required, the culture of the organization and of the clinical team in which the transaction takes place, and the

  18. Communicating environmental health issues using GIS or improving response to citizens with understandable maps and data

    SciTech Connect

    Mann, J.H.

    1998-07-01

    People living near a Superfund site are understandably concerned about the effects of hazardous waste releases on the health of their families and themselves. These concerns often turn to anger if the residents believe investigators and public health officials are withholding critical details. In many communities with Superfund sites, residents are demanding detailed information on site investigations and public health assessments, even before such activities are completed. Investigators and public health officials can provide on-going public briefings using a geographic information system (GIS) as part of an interactive public presentation. A GIS is an excellent tool to answer questions about locations of multi-media site investigations and the analytical results because it combines computer mapping and graphics with a database. Rather than incorporate a multitude of slides and overheads into a detailed public presentation that too often never addresses the citizen concerns, a GIS can be used as a query system to answer citizen's questions. The GIS can be incorporated into a laptop or desktop computer for a one-on-one session with a resident or can be plugged into a computer projector to answer questions at public meetings.

  19. Understanding the improved sensitivity of spectral library searching over sequence database searching in proteomics data analysis.

    PubMed

    Zhang, Xin; Li, Yunzi; Shao, Wenguang; Lam, Henry

    2011-03-01

    Spectral library searching has been recently proposed as an alternative to sequence database searching for peptide identification from MS/MS. We performed a systematic comparison between spectral library searching and sequence database searching using a wide variety of data to better demonstrate, and understand, the superior sensitivity of the former observed in preliminary studies. By decoupling the effect of search space, we demonstrated that the success of spectral library searching is primarily attributable to the use of real library spectra for matching, without which the sensitivity advantage largely disappears. We further determined the extent to which the use of real peak intensities and non-canonical fragments, both under-utilized information in sequence database searching, contributes to the sensitivity advantage. Lastly, we showed that spectral library searching is disproportionately more successful in identifying low-quality spectra, and complex spectra of higher- charged precursors, both important frontiers in peptide sequencing. Our results answered important outstanding questions about this promising yet unproven method using well-controlled computational experiments and sound statistical approaches.

  20. An Overview on Recent Improvements in Understanding Snow Metamorphism and Vapor Transport (Invited)

    NASA Astrophysics Data System (ADS)

    Schneebeli, M.

    2013-12-01

    Undisturbed direct observation of metamorphic processes in snow was impossible for a long time: the observation through a hole created severe changes in the thermal environment. Time-lapse micro-CT using miniaturized "snow breeders" made possible direct and instant observation of crystal growth.In comparison to other natural rocks, snow is monomineralic, consisting only of ice, which makes segmentation precise and determination of the geometry unique. Based on this information, relevant physical properties of the sample can be calculated using direct numerical simulation, as thermal conductivty, permeability or tortuosity. The developments during the the past ten years show that dry snow metamorphism is dominated by vapor transport. The pressure gradient is either caused by differences between variably curved surfaces in the case of isothermal conditions, and, in most cases, by temperature gradients, even well below the "threshold" of about 10 K m-1. The direct observations show that the direction and stability of the gradient is very important in understanding recrystallization. The formation of anisotropy under temperature gradient conditions can be readily observed, and is caused by preferential disappearence of snow structures with high sublimation rate. Facet formation is a consequence of the diffusing vapor, and can lead even under isothermal conditions to the formation of facets under suitable geometric conditons. The tomographic time-lapse observations allow a consistent physical interpretation, and even "exotic" phenomena can now be interpreted, although not yet in every case in a quantitative way.

  1. Leveraging Conceptual Frameworks to Improve Students' Mental Organization of Astronomy Understanding

    NASA Astrophysics Data System (ADS)

    Slater, Timothy F.; Lee, K. M.

    2006-06-01

    Many different types of schematic diagrams are useful in helping students organize and internalize their developing understanding in introductory astronomy courses. These include Venn Diagrams, Flowcharts, Concept Maps, among others, which illustrate the relationships between astronomical objects and dynamic concepts. These conceptual framework diagrams have been incorporated into the NSF-funded ClassAction project. ClassAction is a collection of electronic materials designed to enhance the metacognitive skills of college and university introductory astronomy survey students by promoting interactive engagement and providing rapid feedback in a highly visual setting. The main effort is targeted at creating dynamic think-pair-share questions supported by simulations, animations, and visualizations to be projected in the lecture classroom. The infrastructure allows instructors to recast these questions into alternative forms based on their own pedagogical preferences and feedback from the class. The recourses can be easily selected from a FLASH computer database and are accompanied by outlines, graphics, and numerous simulations which the instructor can use to provide student feedback and, when necessary, remediation. ClassAction materials are publicly available online at URL: http://astro.unl.edu and is funded by NSF Grant #0404988.

  2. Improvements in Students' Understanding from Increased Implementation of Active Learning Strategies

    NASA Astrophysics Data System (ADS)

    Hayes-Gehrke, Melissa N.; Prather, E. E.; Rudolph, A. L.; Collaboration of Astronomy Teaching Scholars CATS

    2011-01-01

    Many instructors are hesitant to implement active learning strategies in their introductory astronomy classrooms because they are not sure which techniques they should use, how to implement those techniques, and question whether the investment in changing their course will really bring the advertised learning gains. We present an example illustrating how thoughtful and systematic implementation of active learning strategies into a traditionally taught Astro 101 class can translate into significant increases in students' understanding. We detail the journey of one instructor, over several years, as she changes the instruction and design of her course from one that focuses almost exclusively on lecture to a course that provides an integrated use of several active learning techniques such as Lecture-Tutorials and Think-Pair-Share questions. The students in the initial lecture-only course achieved a low normalized gain score of only 0.2 on the Light and Spectroscopy Concept Inventory (LSCI), while the students in the re-designed learner-centered course achieved a significantly better normalized gain of 0.43. This material is based upon work supported by the National Science Foundation under Grant No. 0715517, a CCLI Phase III Grant for the Collaboration of Astronomy Teaching Scholars (CATS), and Grant No. 0847170, a PAARE Grant for the Calfornia-Arizona Minority Partnership for Astronomy Research and Education (CAMPARE). Any opinions, findings, and conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the views of the National Science Foundation.

  3. Fundamentals of Melt-Water Interfacial Transport Phenomena: Improved Understanding for Innovative Safety Technologies in ALWRs

    SciTech Connect

    M. Anderson; M. Corradini; K.Y. Bank; R. Bonazza; D. Cho

    2005-04-26

    The interaction and mixing of high-temperature melt and water is the important technical issue in the safety assessment of water-cooled reactors to achieve ultimate core coolability. For specific advanced light water reactor (ALWR) designs, deliberate mixing of the core-melt and water is being considered as a mitigative measure, to assure ex-vessel core coolability. The goal of this work is to provide the fundamental understanding needed for melt-water interfacial transport phenomena, thus enabling the development of innovative safety technologies for advanced LWRs that will assure ex-vessel core coolability. The work considers the ex-vessel coolability phenomena in two stages. The first stage is the melt quenching process and is being addressed by Argonne National Lab and University of Wisconsin in modified test facilities. Given a quenched melt in the form of solidified debris, the second stage is to characterize the long-term debris cooling process and is being addressed by Korean Maritime University in via test and analyses. We then address the appropriate scaling and design methodologies for reactor applications.

  4. Use of Airport Noise Complaint Files to Improve Understanding of Community Response to Aircraft Noise

    NASA Technical Reports Server (NTRS)

    Fidell, Sanford; Howe, Richard

    1998-01-01

    This study assessed the feasibility of using complaint information archived by modem airport monitoring systems to conduct quantitative analyses of the causes of aircraft noise complaints and their relationship to noise- induced annoyance. It was found that all computer-based airport monitoring systems provide at least rudimentary tools for performing data base searches by complainant name, address, date, time of day, and types of aircraft and complaints. Analyses of such information can provide useful information about longstanding concerns, such as the extent to which complaint rates are driven by objectively measurable aspects of aircraft operations; the degree to which changes in complaint rates can be predicted prior to implementation of noise mitigation measures; and the degree to which aircraft complaint information can be used to simplify and otherwise improve prediction of the prevalence of noise-induced annoyance in communities.

  5. Understanding Interactions between Cellular Matrices and Metal Complexes: Methods To Improve Silver Nanodot-Specific Staining.

    PubMed

    Choi, Sungmoon; Yu, Junhua

    2016-08-26

    Metal complexes are frequently used for biological applications due to their special photophysical and chemical characteristics. Due to strong interactions between metals and biomacromolecules, a random staining of cytoplasm or nucleoplasm by the complexes results in a low signal-to-background ratio. In this study, we used luminescent silver nanodots as a model to investigate the major driving force for non-specific staining in cellular matrices. Even though some silver nanodot emitters exhibited excellent specific staining of nucleoli, labeling with nanodots was problematic owing to severe non-specific staining. Binding between silver and sulfhydryl group of proteins appeared to be the major factor that enforced the silver staining. The oxidation of thiol groups in cells with hexacyanoferrate(III) dramatically weakened the silver-cell interaction and consequently significantly improved the efficiency of targeted staining. PMID:27380586

  6. Improving Physician-Patient Communication through Coaching of Simulated Encounters

    ERIC Educational Resources Information Center

    Ravitz, Paula; Lancee, William J.; Lawson, Andrea; Maunder, Robert; Hunter, Jonathan J.; Leszcz, Molyn; McNaughton, Nancy; Pain, Clare

    2013-01-01

    Objective: Effective communication between physicians and their patients is important in optimizing patient care. This project tested a brief, intensive, interactive medical education intervention using coaching and standardized psychiatric patients to teach physician-patient communication to family medicine trainees. Methods: Twenty-six family…

  7. The Cryogenic Dark Matter Search: First 5-Tower Data and Improved Understanding of Ionization Collection

    SciTech Connect

    Bailey, Catherine N.

    2010-01-01

    The Cryogenic Dark Matter Search (CDMS) is searching for Weakly Interacting Massive Particles (WIMPs) with cryogenic particle detectors. These detectors have the ability to discriminate between nuclear recoil candidate and electron recoil background events by collecting both phonon and ionization energy from recoils in the detector crystals. The CDMS-II experiment has completed analysis of the first data runs with 30 semiconductor detectors at the Soudan Underground Laboratory, resulting in a world leading WIMP-nucleon spin-independent cross section limit for WIMP masses above 44 GeV/c2. As CDMS aims to achieve greater WIMP sensitivity, it is necessary to increase the detector mass and discrimination between signal and background events. Incomplete ionization collection results in the largest background in the CDMS detectors as this causes electron recoil background interactions to appear as false candidate events. Two primary causes of incomplete ionization collection are surface and bulk trapping. Recent work has been focused on reducing surface trapping through the modification of fabrication methods for future detectors. Analyzing data taken with test devices has shown that hydrogen passivation of the amorphous silicon blocking layer worsens surface trapping. Additional data has shown that the iron-ion implantation used to lower the critical temperature of the tungsten transition-edge sensors causes a degradation of the ionization collection. Using selective implantation on future detectors may improve ionization collection for events near the phonon side detector surface. Bulk trapping is minimized by neutralizing ionized lattice impurities. Detector investigations at testing facilities and in situ at the experimental site have provided methods to optimize the neutralization process and monitor running conditions to maintain full ionization collection. This work details my contribution to the 5-tower data taking, monitoring, and analysis effort as

  8. The emergence of hydrogeophysics for improved understanding of subsurface processes over multiple scales

    SciTech Connect

    Binley, Andrew; Hubbard, Susan S.; Huisman, Johan A.; Revil, André; Robinson, David A.; Singha, Kamini; Slater, Lee D.

    2015-06-15

    Geophysics provides a multidimensional suite of investigative methods that are transforming our ability to see into the very fabric of the subsurface environment, and monitor the dynamics of its fluids and the biogeochemical reactions that occur within it. Here we document how geophysical methods have emerged as valuable tools for investigating shallow subsurface processes over the past two decades and offer a vision for future developments relevant to hydrology and also ecosystem science. The field of “hydrogeophysics” arose in the late 1990s, prompted, in part, by the wealth of studies on stochastic subsurface hydrology that argued for better field-based investigative techniques. These new hydrogeophysical approaches benefited from the emergence of practical and robust data inversion techniques, in many cases with a view to quantify shallow subsurface heterogeneity and the associated dynamics of subsurface fluids. Furthermore, the need for quantitative characterization stimulated a wealth of new investigations into petrophysical relationships that link hydrologically relevant properties to measurable geophysical parameters. Development of time-lapse approaches provided a new suite of tools for hydrological investigation, enhanced further with the realization that some geophysical properties may be sensitive to biogeochemical transformations in the subsurface environment, thus opening up the new field of “biogeophysics.” Early hydrogeophysical studies often concentrated on relatively small “plot-scale” experiments. More recently, however, the translation to larger-scale characterization has been the focus of a number of studies. In conclusion, geophysical technologies continue to develop, driven, in part, by the increasing need to understand and quantify key processes controlling sustainable water resources and ecosystem services.

  9. The emergence of hydrogeophysics for improved understanding of subsurface processes over multiple scales

    PubMed Central

    Hubbard, Susan S.; Huisman, Johan A.; Revil, André; Robinson, David A.; Singha, Kamini; Slater, Lee D.

    2015-01-01

    Abstract Geophysics provides a multidimensional suite of investigative methods that are transforming our ability to see into the very fabric of the subsurface environment, and monitor the dynamics of its fluids and the biogeochemical reactions that occur within it. Here we document how geophysical methods have emerged as valuable tools for investigating shallow subsurface processes over the past two decades and offer a vision for future developments relevant to hydrology and also ecosystem science. The field of “hydrogeophysics” arose in the late 1990s, prompted, in part, by the wealth of studies on stochastic subsurface hydrology that argued for better field‐based investigative techniques. These new hydrogeophysical approaches benefited from the emergence of practical and robust data inversion techniques, in many cases with a view to quantify shallow subsurface heterogeneity and the associated dynamics of subsurface fluids. Furthermore, the need for quantitative characterization stimulated a wealth of new investigations into petrophysical relationships that link hydrologically relevant properties to measurable geophysical parameters. Development of time‐lapse approaches provided a new suite of tools for hydrological investigation, enhanced further with the realization that some geophysical properties may be sensitive to biogeochemical transformations in the subsurface environment, thus opening up the new field of “biogeophysics.” Early hydrogeophysical studies often concentrated on relatively small “plot‐scale” experiments. More recently, however, the translation to larger‐scale characterization has been the focus of a number of studies. Geophysical technologies continue to develop, driven, in part, by the increasing need to understand and quantify key processes controlling sustainable water resources and ecosystem services. PMID:26900183

  10. The emergence of hydrogeophysics for improved understanding of subsurface processes over multiple scales

    NASA Astrophysics Data System (ADS)

    Binley, Andrew; Hubbard, Susan S.; Huisman, Johan A.; Revil, André; Robinson, David A.; Singha, Kamini; Slater, Lee D.

    2015-06-01

    Geophysics provides a multidimensional suite of investigative methods that are transforming our ability to see into the very fabric of the subsurface environment, and monitor the dynamics of its fluids and the biogeochemical reactions that occur within it. Here we document how geophysical methods have emerged as valuable tools for investigating shallow subsurface processes over the past two decades and offer a vision for future developments relevant to hydrology and also ecosystem science. The field of "hydrogeophysics" arose in the late 1990s, prompted, in part, by the wealth of studies on stochastic subsurface hydrology that argued for better field-based investigative techniques. These new hydrogeophysical approaches benefited from the emergence of practical and robust data inversion techniques, in many cases with a view to quantify shallow subsurface heterogeneity and the associated dynamics of subsurface fluids. Furthermore, the need for quantitative characterization stimulated a wealth of new investigations into petrophysical relationships that link hydrologically relevant properties to measurable geophysical parameters. Development of time-lapse approaches provided a new suite of tools for hydrological investigation, enhanced further with the realization that some geophysical properties may be sensitive to biogeochemical transformations in the subsurface environment, thus opening up the new field of "biogeophysics." Early hydrogeophysical studies often concentrated on relatively small "plot-scale" experiments. More recently, however, the translation to larger-scale characterization has been the focus of a number of studies. Geophysical technologies continue to develop, driven, in part, by the increasing need to understand and quantify key processes controlling sustainable water resources and ecosystem services.

  11. The emergence of hydrogeophysics for improved understanding of subsurface processes over multiple scales

    DOE PAGES

    Binley, Andrew; Hubbard, Susan S.; Huisman, Johan A.; Revil, André; Robinson, David A.; Singha, Kamini; Slater, Lee D.

    2015-06-15

    Geophysics provides a multidimensional suite of investigative methods that are transforming our ability to see into the very fabric of the subsurface environment, and monitor the dynamics of its fluids and the biogeochemical reactions that occur within it. Here we document how geophysical methods have emerged as valuable tools for investigating shallow subsurface processes over the past two decades and offer a vision for future developments relevant to hydrology and also ecosystem science. The field of “hydrogeophysics” arose in the late 1990s, prompted, in part, by the wealth of studies on stochastic subsurface hydrology that argued for better field-based investigativemore » techniques. These new hydrogeophysical approaches benefited from the emergence of practical and robust data inversion techniques, in many cases with a view to quantify shallow subsurface heterogeneity and the associated dynamics of subsurface fluids. Furthermore, the need for quantitative characterization stimulated a wealth of new investigations into petrophysical relationships that link hydrologically relevant properties to measurable geophysical parameters. Development of time-lapse approaches provided a new suite of tools for hydrological investigation, enhanced further with the realization that some geophysical properties may be sensitive to biogeochemical transformations in the subsurface environment, thus opening up the new field of “biogeophysics.” Early hydrogeophysical studies often concentrated on relatively small “plot-scale” experiments. More recently, however, the translation to larger-scale characterization has been the focus of a number of studies. In conclusion, geophysical technologies continue to develop, driven, in part, by the increasing need to understand and quantify key processes controlling sustainable water resources and ecosystem services.« less

  12. Toward Better Understanding and Improved Performance of Silicon Heterojunction Solar Cells: Preprint

    SciTech Connect

    Wang, T. H.; Page, M. R.; Iwaniczko, E.; Levi, D. H.; Yan, Y.; Branz, H. M.; Yelundur, V.; Rohatgi, A.; Bunea, G.; Terao, A.; Wang, Q.

    2004-08-01

    The double-sided silicon heterojunction (SHJ) solar cell is more appropriate for n-type crystal silicon (c-Si) wafers than for p-type c-Si wafers because there is a larger band offset to the valence band edge of hydrogenated amorphous silicon than to the conduction band edge. Thin intrinsic and doped hydrogenated amorphous silicon (a Si:H) double layers by hot-wire chemical vapor deposition (HWCVD) are investigated as passivation layers, emitters, and back-surface-field (BSF) contacts to both p- and n-type wafers. Passivation quality is studied by characterizing the SHJ solar cells and by photoconductive decay (PCD) minority-carrier lifetime measurements. The crystal-amorphous heterointerface is studied with real-time spectroscopic ellipsometry (RTSE) and high-resolution transmission electron microscopy (HRTEM) to detect phase change and material evolution, with a focus on better understanding the factors determining passivation effectiveness. A common feature in effective passivation, emitter, and BSF layers is immediate a-Si:H deposition and an abrupt and flat interface to the c-Si substrate. In this case, good wafer passivation or an excellent heterojunction is obtained, with a low interface recombination velocity (S) or a high open-circuit voltage (Voc). Voc greater than 640 mV, S less than 15 cm/sec, and efficiency of 14.8% have been achieved on polished p type Czochralski-grown (CZ) Si wafers. Collaboration between NREL and Georgia Tech resulted in a 15.7%-efficient HWCVD-deposited SHJ cell on non-textured FZ-Si with a screen-printed Al back surface field (BSF), the highest reported HWCVD SHJ cell. Collaboration between NREL and SunPower demonstrated that HWCVD a-Si:H passivation can be better than the conventional oxides, with a low surface recombination velocity of 42 cm/sec on textured n-type FZ-Si.

  13. Integrating Empirical-Modeling Approaches to Improve Understanding of Terrestrial Ecology Processes

    SciTech Connect

    McCarthy, Heather; Luo, Yiqi; Wullschleger, Stan D

    2012-01-01

    Recent decades have seen tremendous increases in the quantity of empirical ecological data collected by individual investigators, as well as through research networks such as FLUXNET (Baldocchi et al., 2001). At the same time, advances in computer technology have facilitated the development and implementation of large and complex land surface and ecological process models. Separately, each of these information streams provides useful, but imperfect information about ecosystems. To develop the best scientific understanding of ecological processes, and most accurately predict how ecosystems may cope with global change, integration of empirical and modeling approaches is necessary. However, true integration - in which models inform empirical research, which in turn informs models (Fig. 1) - is not yet common in ecological research (Luo et al., 2011). The goal of this workshop, sponsored by the Department of Energy, Office of Science, Biological and Environmental Research (BER) program, was to bring together members of the empirical and modeling communities to exchange ideas and discuss scientific practices for increasing empirical - model integration, and to explore infrastructure and/or virtual network needs for institutionalizing empirical - model integration (Yiqi Luo, University of Oklahoma, Norman, OK, USA). The workshop included presentations and small group discussions that covered topics ranging from model-assisted experimental design to data driven modeling (e.g. benchmarking and data assimilation) to infrastructure needs for empirical - model integration. Ultimately, three central questions emerged. How can models be used to inform experiments and observations? How can experimental and observational results be used to inform models? What are effective strategies to promote empirical - model integration?

  14. Improving healthy behaviors in type 1 diabetic patients by interactive frameworks.

    PubMed

    Kharrazi, Hadi

    2009-11-14

    Patient empowerment is considered to be one of the key factors in improving and maintaining a patient's health status. Patient empowerment in chronic illnesses involves educating the patient after the initial diagnosis and then keeping the patient motivated to adhere to the treatment in the follow up period. The aim of this research is creating an interactive framework to improve adherence to treatment in type 1 diabetic (T1D) patients based on an existing theoretical behavioral change model. The proposed framework learns from the patient's situation based on the patient's adherence to treatment and the patient's personal profile; and then the framework adapts itself to the new situation and creates new strategies to motivate the patient in order to reinforce positive behavior on the part of the patient. Thus, the embedded self-care interactive framework empowers T1D patients in achieving improved health outcomes by adhering to long term treatments.

  15. A New and Improved Carbon Dioxide Isotope Analyzer for Understanding Soil-Plant-Atmosphere Interactions

    NASA Astrophysics Data System (ADS)

    Huang, Y. W.; Berman, E. S.; Owano, T. G.; Verfaillie, J. G.; Oikawa, P. Y.; Baldocchi, D. D.; Still, C. J.; Gardner, A.; Baer, D. S.; Rastogi, B.

    2015-12-01

    Stable CO2 isotopes provide information on biogeochemical processes that occur at the soil-plant-atmosphere interface. While δ13C measurement can provide information on the sources of the CO2, be it photosynthesis, natural gas combustion, other fossil fuel sources, landfills or other sources, δ18O, and δ17O are thought to be determined by the hydrological cycling of the CO2. Though researchers have called for analytical tools for CO2 isotope measurements that are reliable and field-deployable, developing such instrument remains a challenge. The carbon dioxide isotope analyzer developed by Los Gatos Research (LGR) uses LGR's patented Off-Axis ICOS (Integrated Cavity Output Spectroscopy) technology and incorporates proprietary internal thermal control for high sensitivity and optimal instrument stability. This new and improved analyzer measures CO2 concentration as well as δ13C, δ18O, and δ17O from CO2 at natural abundance (150-2500 ppm). The laboratory precision is ±200 ppb (1σ) in CO2 at 1 s, with a long-term (2 min) precision of ±20 ppb. The 1-second precision for both δ13C and δ18O is 0.7 ‰, and for δ17O is 1.8 ‰. The long-term (2 min) precision for both δ13C and δ18O is 0.08 ‰, and for δ17O is 0.18 ‰. The instrument has improved precision, stability and user interface over previous LGR CO2 isotope instruments and can be easily programmed for periodic referencing and sampling from different sources when coupled with LGR's multiport inlet unit (MIU). We have deployed two of these instruments at two different field sites, one at Twitchell Island in Sacramento County, CA to monitor the CO2 isotopic fluxes from an alfalfa field from 6/29/2015-7/13/2015, and the other at the Wind River Experimental Forest in Washington to monitor primarily the oxygen isotopes of CO2 within the canopy from 8/4/2015 through mid-November 2015. Methodology, laboratory development and testing and field performance are presented.

  16. Developing an in vitro understanding of patient experience with hydrofluoroalkane-metered dose inhalers.

    PubMed

    Doub, William H; Shah, Vibhakar; Limb, Susan; Guo, Changning; Liu, Xiaofei; Ngo, Diem

    2014-11-01

    As a result of the Montreal Protocol on Substances that Deplete the Ozone Layer, manufacturers of metered dose inhalers began reformulating their products to use hydrofluoroalkanes (HFAs) as propellants in place of chlorofluorocarbons (CFCs). Although the new products are considered safe and efficacious by the US Food and Drug Administration (FDA), a large number of complaints have been registered via the FDA's Adverse Events Reporting System (FAERS)-more than 7000 as of May 2013. To develop a better understanding of the measurable parameters that may, in part, determine in vitro performance and thus patient compliance, we compared several CFC- and HFA-based products with respect to their aerodynamic performance in response to changes in actuator cleaning interval and interactuation delay interval. Comparison metrics examined in this study were: total drug delivered ex-actuator, fine particle dose (<5 μm), mass median aerodynamic diameter, plume width, plume temperature, plume impaction force, and actuator orifice diameter. Overall, no single metric or test condition distinguishes HFA products from CFC products, but, for individual products tested, there were a combination of metrics that differentiated one from another. PMID:25228114

  17. Moving research to patient applications through commercialization: understanding and evaluating the role of intellectual property.

    PubMed

    Patino, Robert M

    2010-03-01

    The advancement of research from discovery to the delivery of medical care can be limited without the support of industry to sponsor its continued development. Federal government financial support is generally crucial in early-stage development through funding from the NIH, National Science Foundation, and other federal agencies; however, government support generally stops shortly after basic research discoveries have been reported. Much of the cessation of financial support derives from the government's regulatory responsibilities, as sponsoring the commercialization of a product conflicts with regulation of the approval for clinical use of a drug or device. Furthermore, differences in goals, resources, and flexibility render government, as compared with private industry, inefficient and less responsive to market demands with regard to stream-lining the development of and enhancing the quality of products and services offered. Thus, industry and private investment provide the bridge that converts new discoveries into healthcare products that are available to consumers and patients. This conversion occurs through commercialization, which involves both high risks and high rewards. Taking advantage of the commercialization option for research development requires an understanding of the technology transfer process. This article reviews 5 topics: 1) industry motivation to invest in academic research; 2) institutional considerations in partnering with industry; 3) academia's interactions with inventors in the commercialization process; 4) the research institution's route to commercialization, and 5) the role of intellectual property and commercialization in the advancement of healthcare. PMID:20353687

  18. Moving Research to Patient Applications through Commercialization: Understanding and Evaluating the Role of Intellectual Property

    PubMed Central

    2010-01-01

    The advancement of research from discovery to the delivery of medical care can be limited without the support of industry to sponsor its continued development. Federal government financial support is generally crucial in early-stage development through funding from the NIH, National Science Foundation, and other federal agencies; however, government support generally stops shortly after basic research discoveries have been reported. Much of the cessation of financial support derives from the government's regulatory responsibilities, as sponsoring the commercialization of a product conflicts with regulation of the approval for clinical use of a drug or device. Furthermore, differences in goals, resources, and flexibility render government, as compared with private industry, inefficient and less responsive to market demands with regard to stream-lining the development of and enhancing the quality of products and services offered. Thus, industry and private investment provide the bridge that converts new discoveries into healthcare products that are available to consumers and patients. This conversion occurs through commercialization, which involves both high risks and high rewards. Taking advantage of the commercialization option for research development requires an understanding of the technology transfer process. This article reviews 5 topics: 1) industry motivation to invest in academic research; 2) institutional considerations in partnering with industry; 3) academia's interactions with inventors in the commercialization process; 4) the research institution's route to commercialization, and 5) the role of intellectual property and commercialization in the advancement of healthcare. PMID:20353687

  19. Developing an in vitro understanding of patient experience with hydrofluoroalkane-metered dose inhalers.

    PubMed

    Doub, William H; Shah, Vibhakar; Limb, Susan; Guo, Changning; Liu, Xiaofei; Ngo, Diem

    2014-11-01

    As a result of the Montreal Protocol on Substances that Deplete the Ozone Layer, manufacturers of metered dose inhalers began reformulating their products to use hydrofluoroalkanes (HFAs) as propellants in place of chlorofluorocarbons (CFCs). Although the new products are considered safe and efficacious by the US Food and Drug Administration (FDA), a large number of complaints have been registered via the FDA's Adverse Events Reporting System (FAERS)-more than 7000 as of May 2013. To develop a better understanding of the measurable parameters that may, in part, determine in vitro performance and thus patient compliance, we compared several CFC- and HFA-based products with respect to their aerodynamic performance in response to changes in actuator cleaning interval and interactuation delay interval. Comparison metrics examined in this study were: total drug delivered ex-actuator, fine particle dose (<5 μm), mass median aerodynamic diameter, plume width, plume temperature, plume impaction force, and actuator orifice diameter. Overall, no single metric or test condition distinguishes HFA products from CFC products, but, for individual products tested, there were a combination of metrics that differentiated one from another.

  20. Improving recreational, residential, and vocational outcomes for patients with schizophrenia.

    PubMed

    Roder, V; Zorn, P; Müller, D; Brenner, H D

    2001-11-01

    As Roder and colleagues propose, we have seen three eras in the development and refinement of social skills training for individuals with schizophrenia. In the 1960s, skills training relied on the use of operant conditioning, as exemplified by the token economy. Reinforcement contingencies succeeded in activating patients with negative symptoms and in improving their social behavior. Contemporary psychiatric rehabilitation can profit from the identification and use of reinforcers to motivate anergic individuals who lack insight to participate actively in community-based programs. During the second era, in the 1970s, social learning through modeling, coaching, role playing, and behavioral assignments was introduced into skills training. These techniques were used to improve nonverbal skills, such as eye contact, fluency of speech, gestures, and facial expression, as well as conversational skills, assertiveness, and emotional expressiveness. Intervention programs of the third and current era are incorporating cognitive methods into the skills training enterprise. For example, in the modules for training social and independent living skills developed and validated by Liberman and his colleagues at the University of California at Los Angeles (1), the deficits in attention, memory, and verbal learning often experienced by persons with schizophrenia are overcome by repetition, shaping of incremental behavioral improvements, video modeling, and feedback for galvanizing attention. Procedural learning techniques that do not rely on the brain capacities that mediate verbal awareness and insight are also used. In this month's Rehab Rounds column, Roder and his colleagues present another example of a skills training approach of the third era that includes elements of cognitive remediation. As autonomous offsprings of integrated psychological therapy (IPT), which was originally developed by Hans Brenner and Volker Roder and their colleagues at the University of Bern in

  1. Understanding Sarason's concepts of school cultures and change: joining a community in school improvement efforts.

    PubMed

    Lorion, Raymond P

    2011-12-01

    This paper describes an evolving transformative partnership between a large comprehensive university, an urban school system and a predominantly African-American, low-income neighborhood. The partnership's originating intent was to apply an array of university, civic and local resources to improve the academic performance of a neighborhood's schools and the health, welfare and economic well-being of its residents. The extent to which that partnership would precipitate transactional (Sameroff and Fiese, Handbook of early childhood intervention, Cambridge University Press, Cambridge, pp. 119-149 in 1990) synergies among the partners was unanticipated; the long-term implications for each of the partners of such unfamiliar interactional processes remain unclear but are being systematically monitored over time. Evident at this point, however, it that a process has been initiated that has impacted how the university community, the local public school system, city government and the target neighborhood relate to each other, collaborate with each other and are changing each other. The pace of that process has varied over the years and challenged each partners' expectations and assumptions about the nature and consequences of their involvement. With time and perseverance, however, it appears that all are moving toward a sense of mutual learning and trust and toward extending to each other the benefit of the doubt. This paper discusses the evolution of that process and its implications for university-school-community collaborations. PMID:20857327

  2. NASA Contributions to Improve Understanding of Extreme Events in the Global Energy and Water Cycle

    NASA Technical Reports Server (NTRS)

    Lapenta, William M.

    2008-01-01

    The U.S. Climate Change Science Program (CCSP) has established the water cycle goals of the Nation's climate change program. Accomplishing these goals will require, in part, an accurate accounting of the key reservoirs and fluxes associated with the global water and energy cycle, including their spatial and temporal variability. through integration of all necessary observations and research tools, To this end, in conjunction with NASA's Earth science research strategy, the overarching long-term NASA Energy and Water Cycle Study (NEWS) grand challenge can he summarized as documenting and enabling improved, observationally based, predictions of water and energy cycle consequences of Earth system variability and change. This challenge requires documenting and predicting trends in the rate of the Earth's water and energy cycling that corresponds to climate change and changes in the frequency and intensity of naturally occurring related meteorological and hydrologic events, which may vary as climate may vary in the future. The cycling of water and energy has obvious and significant implications for the health and prosperity of our society. The importance of documenting and predicting water and energy cycle variations and extremes is necessary to accomplish this benefit to society.

  3. Improving our fundamental understanding of the role of aerosol-cloud interactions in the climate system.

    PubMed

    Seinfeld, John H; Bretherton, Christopher; Carslaw, Kenneth S; Coe, Hugh; DeMott, Paul J; Dunlea, Edward J; Feingold, Graham; Ghan, Steven; Guenther, Alex B; Kahn, Ralph; Kraucunas, Ian; Kreidenweis, Sonia M; Molina, Mario J; Nenes, Athanasios; Penner, Joyce E; Prather, Kimberly A; Ramanathan, V; Ramaswamy, Venkatachalam; Rasch, Philip J; Ravishankara, A R; Rosenfeld, Daniel; Stephens, Graeme; Wood, Robert

    2016-05-24

    The effect of an increase in atmospheric aerosol concentrations on the distribution and radiative properties of Earth's clouds is the most uncertain component of the overall global radiative forcing from preindustrial time. General circulation models (GCMs) are the tool for predicting future climate, but the treatment of aerosols, clouds, and aerosol-cloud radiative effects carries large uncertainties that directly affect GCM predictions, such as climate sensitivity. Predictions are hampered by the large range of scales of interaction between various components that need to be captured. Observation systems (remote sensing, in situ) are increasingly being used to constrain predictions, but significant challenges exist, to some extent because of the large range of scales and the fact that the various measuring systems tend to address different scales. Fine-scale models represent clouds, aerosols, and aerosol-cloud interactions with high fidelity but do not include interactions with the larger scale and are therefore limited from a climatic point of view. We suggest strategies for improving estimates of aerosol-cloud relationships in climate models, for new remote sensing and in situ measurements, and for quantifying and reducing model uncertainty.

  4. Can Simulation Credibility Be Improved Using Sensitivity Analysis to Understand Input Data Effects on Model Outcome?

    NASA Technical Reports Server (NTRS)

    Myers, Jerry G.; Young, M.; Goodenow, Debra A.; Keenan, A.; Walton, M.; Boley, L.

    2015-01-01

    Model and simulation (MS) credibility is defined as, the quality to elicit belief or trust in MS results. NASA-STD-7009 [1] delineates eight components (Verification, Validation, Input Pedigree, Results Uncertainty, Results Robustness, Use History, MS Management, People Qualifications) that address quantifying model credibility, and provides guidance to the model developers, analysts, and end users for assessing the MS credibility. Of the eight characteristics, input pedigree, or the quality of the data used to develop model input parameters, governing functions, or initial conditions, can vary significantly. These data quality differences have varying consequences across the range of MS application. NASA-STD-7009 requires that the lowest input data quality be used to represent the entire set of input data when scoring the input pedigree credibility of the model. This requirement provides a conservative assessment of model inputs, and maximizes the communication of the potential level of risk of using model outputs. Unfortunately, in practice, this may result in overly pessimistic communication of the MS output, undermining the credibility of simulation predictions to decision makers. This presentation proposes an alternative assessment mechanism, utilizing results parameter robustness, also known as model input sensitivity, to improve the credibility scoring process for specific simulations.

  5. Improving our fundamental understanding of the role of aerosol−cloud interactions in the climate system

    PubMed Central

    Seinfeld, John H.; Bretherton, Christopher; Carslaw, Kenneth S.; Coe, Hugh; DeMott, Paul J.; Dunlea, Edward J.; Feingold, Graham; Ghan, Steven; Guenther, Alex B.; Kraucunas, Ian; Molina, Mario J.; Nenes, Athanasios; Penner, Joyce E.; Prather, Kimberly A.; Ramanathan, V.; Ramaswamy, Venkatachalam; Rasch, Philip J.; Ravishankara, A. R.; Rosenfeld, Daniel; Stephens, Graeme; Wood, Robert

    2016-01-01

    The effect of an increase in atmospheric aerosol concentrations on the distribution and radiative properties of Earth’s clouds is the most uncertain component of the overall global radiative forcing from preindustrial time. General circulation models (GCMs) are the tool for predicting future climate, but the treatment of aerosols, clouds, and aerosol−cloud radiative effects carries large uncertainties that directly affect GCM predictions, such as climate sensitivity. Predictions are hampered by the large range of scales of interaction between various components that need to be captured. Observation systems (remote sensing, in situ) are increasingly being used to constrain predictions, but significant challenges exist, to some extent because of the large range of scales and the fact that the various measuring systems tend to address different scales. Fine-scale models represent clouds, aerosols, and aerosol−cloud interactions with high fidelity but do not include interactions with the larger scale and are therefore limited from a climatic point of view. We suggest strategies for improving estimates of aerosol−cloud relationships in climate models, for new remote sensing and in situ measurements, and for quantifying and reducing model uncertainty. PMID:27222566

  6. Improving our fundamental understanding of the role of aerosol-cloud interactions in the climate system.

    PubMed

    Seinfeld, John H; Bretherton, Christopher; Carslaw, Kenneth S; Coe, Hugh; DeMott, Paul J; Dunlea, Edward J; Feingold, Graham; Ghan, Steven; Guenther, Alex B; Kahn, Ralph; Kraucunas, Ian; Kreidenweis, Sonia M; Molina, Mario J; Nenes, Athanasios; Penner, Joyce E; Prather, Kimberly A; Ramanathan, V; Ramaswamy, Venkatachalam; Rasch, Philip J; Ravishankara, A R; Rosenfeld, Daniel; Stephens, Graeme; Wood, Robert

    2016-05-24

    The effect of an increase in atmospheric aerosol concentrations on the distribution and radiative properties of Earth's clouds is the most uncertain component of the overall global radiative forcing from preindustrial time. General circulation models (GCMs) are the tool for predicting future climate, but the treatment of aerosols, clouds, and aerosol-cloud radiative effects carries large uncertainties that directly affect GCM predictions, such as climate sensitivity. Predictions are hampered by the large range of scales of interaction between various components that need to be captured. Observation systems (remote sensing, in situ) are increasingly being used to constrain predictions, but significant challenges exist, to some extent because of the large range of scales and the fact that the various measuring systems tend to address different scales. Fine-scale models represent clouds, aerosols, and aerosol-cloud interactions with high fidelity but do not include interactions with the larger scale and are therefore limited from a climatic point of view. We suggest strategies for improving estimates of aerosol-cloud relationships in climate models, for new remote sensing and in situ measurements, and for quantifying and reducing model uncertainty. PMID:27222566

  7. Recent Advances in Improvement of Forecast Skill and Understanding Climate Processes Using AIRS Version-5 Products

    NASA Technical Reports Server (NTRS)

    Susskind, Joel; Molnar, Gyula; Iredell, Lena; Rosenberg, Robert

    2012-01-01

    AIRS/AMSU is the state of the art infrared and microwave atmospheric sounding system flying aboard EOS Aqua. These observations, covering the period September 2002 until the present, have been analyzed using the AIRS Science Team Version-5 retrieval algorithm. AIRS is a high spectral resolution infrared grating spectrometer with spect,ral coverage from 650 per centimeter extending to 2660 per centimeter, with low noise and a spectral resolving power of 2400. A brief overview of the AIRS Version-5 retrieval procedure will be presented, including the AIRS channels used in different steps in the retrieval process. Many researchers have used these products to make significant advances in both climate and weather applications. Recent significant results of these experiments will be presented, including results showing that 1) assimilation of AIRS Quality Controlled temperature profiles into a General Circulation Model (GCM) significantly improves the ability to predict storm tracks of intense precipitation events; and 2) anomaly time-series of Outgoing Longwave Radiation (OLR) computed using AIRS sounding products closely match those determined from the CERES instrument, and furthermore explain that the phenomenon that global and especially tropical mean OLR have been decreasing since September 2002 is a result of El Nino/La Nina oscillations during this period.

  8. Understanding pain and improving management of sickle cell disease: the PiSCES study.

    PubMed Central

    Smith, Wally R.; Bovbjerg, Viktor E.; Penberthy, Lynne T.; McClish, Donna K.; Levenson, James L.; Roberts, John D.; Gil, Karen; Roseff, Susan D.; Aisiku, Imoigele P.

    2005-01-01

    Until recent decades, sickle cell disease (SCD) was associated with recurrent, disabling pain, organ failure and death in childhood or early adulthood. SCD treatment advances have now decreased pain and prolonged survival, but episodic or chronic pain may still require substantial analgesic use and frequent hospitalization for pain episodes. This pain is poorly characterized and often poorly treated. Adult patients may face barriers to comprehensive SCD care, stigmatization of their care-seeking behavior by providers and lack of family support, forcing them into maladaptive coping strategies. The Pain in Sickle Cell Epidemiology Study (PiSCES) attempts to develop and validate a biopsychosocial model of SCD pain, pain response and healthcare utilization in a large, multisite adult cohort. PiSCES participants complete a baseline survey and six months of daily pain diaries in which they record levels of SCD-related pain and related disability and distress as well as responses to pain (e.g., medication use, hospital visits). PiSCES will advance methods of measuring pain and pain response in SCD by better describing home-managed as well as provider-managed pain. PiSCES will assess the relative contributions of biological (disease-related), psychosocial and environmental (readiness to utilize) factors to overall pain and pain response in SCD, suggesting targets for biobehavioral interventions over time. Importantly, PiSCES will also identify "triggers" of SCD pain episodes and healthcare utilization in the moment of pain, suggesting targets for timely care that mutes pain episodes. Images Figure 1 Figure 2 PMID:15712781

  9. Walking improvements with nabiximols in patients with multiple sclerosis.

    PubMed

    Coghe, G; Pau, M; Corona, F; Frau, J; Lorefice, L; Fenu, G; Spinicci, G; Mamusa, E; Musu, L; Massole, S; Massa, R; Marrosu, M G; Cocco, E

    2015-11-01

    Recently, nabiximols was approved as a treatment in MS spasticity. Data leading to approval and clinical use of nabiximols, although widely recognised, are based on subjective scales. Movement analysis procedures would obtain more detailed data about the impact on mobility. The aim of the study was to quantitatively assess the functional modification of gait patterns induced by nabiximols in MS. We evaluated three-dimensional gait analysis (spatial-temporal and kinematic) variation by means of one-way ANOVA. Twenty patients were enrolled-9 male and 11 female-with mean EDSS of 5.3 (SD ± 0.81) and mean reduction of numerical rating scale during nabiximols treatment of 1.88. The spatial-temporal parameters of gait revealed an increased speed (+15 %, p < 0.001), cadence (+6 %, p < 0.001) and stride length (+10 %, p < 0.001) after treatment. Regarding the kinematics data, the Gait Profile Score after treatment was reduced by 10 % (p < 0.001): Significant changes involved the pelvic area, hip rotation and knee flexion-extension. We found that nabiximols is able to improve the speed, cadence and stride length. Furthermore, the dynamics of the proximal segment of the legs and the knee movement results after treatment are closer to the physiologic values. PMID:26239223

  10. An improved understanding of the lifecycle of mixed-phase stratiform clouds through observations and simulation

    NASA Astrophysics Data System (ADS)

    de Boer, Gijs

    This work explores links between ice crystal nucleation in the immersion mode and the lifecycle of mixed-phase stratiform clouds. A background discussion is included on the general properties of mixed-phase clouds, their influence on climate, observational techniques and numerical studies used to better understand them. Also, an overview of ice nucleation principles and Arctic aerosol characteristics is provided. An observational analysis including thousands of half hour cases of single layer mixed-phase clouds measured using remote sensors at Barrow, Alaska and Eureka, Canada is reviewed. An overview of the techniques used in this effort is provided, including information on the instruments and all implemented retrieval algorithms. These observations show distinct differences between cloud properties at the two locations, as well as clear seasonal patterns in cloud macro and microphysical properties. This dataset is compared with those obtained in previous studies, and implications of the measurements on numerical simulation and cloud detection using other observational platforms are discussed. Utilizing results from these observations, as well as those from the work of others, a hypothesis on ice nucleation in these clouds via immersion freezing is formed, in which the concentration of soluble aerosol mass within liquid droplets results in a freezing point depression. Subsequent growth of these droplets dilutes the concentration of soluble mass, and the droplet can freeze. In order to test this hypothesis, an advanced numerical model is utilized. Simulation results show that immersion freezing does contribute significantly to ice production within mixed-phase clouds. Additionally, the soluble mass fraction assumed for the aerosol particles impacts simulated clouds via the effect discussed above. However, unlike suggested in the presented hypothesis, nucleation through the immersion mode was not limited to the regions above updrafts in the completed simulations

  11. Integrated stratigraphy of the Cenomanian-Turonian boundary interval: improving understanding of Oceanic Anoxic Events

    NASA Astrophysics Data System (ADS)

    Jarvis, Ian

    2014-05-01

    The Cenomanian-Turonian boundary (CTB) interval ~ 94 Ma represented a period of major global palaeoenvironmental change. Increasingly detailed multidisciplinary studies integrating sedimentological, palaeontological and geochemical data from multiple basins, are enabling the development of refined but complex models that aid understanding of the mechanisms driving changes in ocean productivity and climate. This paper reviews some of the exciting new developments in this field. Facies change characterizes the CTB interval in most areas. In the Chalk seas of northern Europe, a widespead hiatus was followed by the deposition of clay-rich organic-lean beds of the Plenus Marl and its equivalents, and then nodular chalks. In the North Sea basin and its onshore extension in eastern England and northern Germany, black shales of the Black Band (Blodøks Formation, Hasseltal Formation) occur. Similarly, in northern Tethys, a brief interval of black shale accumulation within a predominantly carbonate succession, is exemplified by the Niveau Thomel in the Vocontian Basin (SE France), and the Livello Bonarelli in Italy. Widespread deposition of organic-rich marine sediments during CTB times led to 12C depletion in surface carbon reservoirs (oceans, atmosphere, biosphere), and a large positive global δ13C excursion preserved in marine carbonates and both marine and terrestrial organic matter (Oceanic Anoxic Event 2). Significant biotic turnover characterises the boundary interval, and inter-regional correlation may be achieved at high resolution using integrated biostratigraphy employing macrofossils (ammonites, inoceramid bivalves), microfossils (planktonic foraminifera, dinoflagellate cysts) and calcareous nannofossils. Correlations can be tested against those based on comparison of δ13C profiles - carbon isotope chemostratigraphy, supplemented by oxygen isotope and elemental data. Interpretation of paired carbonate - organic matter δ13C data from multiple CTB sections

  12. Towards an improved understanding of strength and anisotropy of cold compacted powder

    NASA Astrophysics Data System (ADS)

    Wang, Wenhai

    enough. These results, which are in agreement with recent strength anisotropy data for cold compaction, bring a new perspective on understanding the interparticle behavior and the origin of the strength and failure of cold compacts.

  13. Improved Understanding of Carbon Storage Risk Via Controlled-Release Experiments

    NASA Astrophysics Data System (ADS)

    Birkholzer, J. T.; Guglielmi, Y.; Rutqvist, J.; Zheng, L.; Spycher, N.

    2014-12-01

    Two issues are often recognized as main risk drivers for carbon storage projects. The first is the possibility of pressure-induced slip of pre-existing faults, which can lead to breaching of seals to CO2 storage reservoirs. Although the mechanics of induced seismicity are well known, the characteristics of such slip events are poorly constrained and significant questions remain. The second is the potential impact of leaking CO2 on the quality of shallow potable groundwater. While several studies have been conducted using laboratory tests, natural analogues, and numerical models to evaluate the water quality changes induced by elevated CO2 concentrations, predictive understanding of these coupled processes remains limited in realistic field settings. We discuss in this invited contribution two controlled-release field experiments targeting remaining science gaps associated with induced seismicity and groundwater chemistry. The first experiment is a planned active fault slip experiment conducted in an underground research laboratory (URL) in a hardened shale formation that serves as a caprock analog. The critically stressed fault will be perturbed by the injection of fluid under pressure to simulate the influence of CO2 overpressure. The in situ reactivation experiment will use a novel borehole deformation tool that assesses the magnitude of overpressure required to cause slip, defines the mode of this slip as creeping (aseismic) or rapid (seismic), and measures the evolution of permeability on the fault. The second controlled-release field experiment was conducted in 2011/2012 to simulate the release of CO2 from a geologic storage site and study the transport as well as the chemical mechanisms leading to the CO2-induced mobilization of trace elements in a shallow aquifer. The field test involved a dipole system in which the shallow groundwater was pumped from one well, saturated with CO2 at the pressure corresponding to the hydraulic pressure of the aquifer, and

  14. Atmospheric Extremes in a Changing Climate: A Strategy for Improved Understanding Driven by International Security Concerns

    NASA Astrophysics Data System (ADS)

    Davis, A. B.; Kao, C. J.

    2001-05-01

    critical threshold crossing. So extreme atmospheric phenomena are of the essence yet they are poorly understood, even in a steady climate, because they challenge both dynamical modelers and statisticians. The authors will describe a preliminary proposal to harness some of the unique human, computational and observational resources at LANL that could lead to a significant breakthrough in our understanding of extreme weather mechanisms and how they relate to climate and climate change. If implemented, this program could open new relationships between the laboratory and presently unsuspecting client-agencies such as FEMA, CDC, EPA, State Department, and so on.

  15. A Hands-on Exercise in Building Darcy Tubes to Improve Student Understanding of Groundwater Flow

    NASA Astrophysics Data System (ADS)

    Smith, J. A.

    2012-12-01

    Teaching undergraduate students about sustainability typically includes discussions of water resources and the flow of groundwater in aquifers. Understanding the flow of groundwater is a fundamental step for students, but one that can easily get mired in equations (e.g., Darcy's Law). In an effort to transform Darcy's Law, which describes flow of fluid through a porous medium, from an abstract concept to a hands-on experiment, I had undergraduate students build working "Darcy tubes" and calculate hydraulic conductivity during a three-hour lab period. At the beginning of the lab period, I presented the students with the materials: three pairs of plastic soda bottles with straight sides, glass tubing, pantyhose (for screens), rubber hosing, sieved sand in three grain sizes (1-2 mm, 0.5-1.0 mm, and 0.25-0.5 mm), and various types of tape and adhesive. After we discussed the basic design of a Darcy tube (inlet and outlet, with two piezometers), the students went to work. Real-time problem-solving was an integral (and exciting) part of the exercise. Within two hours, they had built three Darcy tubes, each filled with a different sand size. The students determined the cross-sectional area of each tube (A) and the distance between the two piezometers (L). We then ran the experiments, using tinted water so that we could more easily tell when the sand in the tubes was saturated. We measured discharge (Q) through the tube and marked the height of the water in each piezometer to calculate difference in hydraulic head (Δh). With the data we had collected, the students were able to calculate hydraulic conductivity (K) using a simple form of Darcy's Law: Q = -KA (Δh/L). Despite the simplicity of the Darcy tubes, the students' K values were reasonable for the sediment types that we used. Student comments on the Darcy tube exercise were overwhelmingly positive. The Darcy tubes could be used in a subsequent lab period for exploration of more advanced concepts, such as

  16. Novel 3D imaging techniques for improved understanding of planetary surface geomorphology.

    NASA Astrophysics Data System (ADS)

    Muller, Jan-Peter

    2015-04-01

    Understanding the role of different planetary surface formation processes within our Solar System is one of the fundamental goals of planetary science research. There has been a revolution in planetary surface observations over the past decade for Mars and the Moon, especially in 3D imaging of surface shape (down to resolutions of 75cm) and subsequent correction for terrain relief of imagery from orbiting and co-registration of lander and rover robotic images. We present some of the recent highlights including 3D modelling of surface shape from the ESA Mars Express HRSC (High Resolution Stereo Camera), see [1], [2] at 30-100m grid-spacing; and then co-registered to HRSC using a resolution cascade of 20m DTMs from NASA MRO stereo-CTX and 0.75m DTMs from MRO stereo-HiRISE [3]. This has opened our eyes to the formation mechanisms of megaflooding events, such as the formation of Iani Vallis and the upstream blocky terrain, to crater lakes and receding valley cuts [4]. A comparable set of products is now available for the Moon from LROC-WA at 100m [5] and LROC-NA at 1m [6]. Recently, a very novel technique for the super-resolution restoration (SRR) of stacks of images has been developed at UCL [7]. First examples shown will be of the entire MER-A Spirit rover traverse taking a stack of 25cm HiRISE to generate a corridor of SRR images along the rover traverse of 5cm imagery of unresolved features such as rocks, created as a consequence of meteoritic bombardment, ridge and valley features. This SRR technique will allow us for ˜400 areas on Mars (where 5 or more HiRISE images have been captured) and similar numbers on the Moon to resolve sub-pixel features. Examples will be shown of how these SRR images can be employed to assist with the better understanding of surface geomorphology. Acknowledgements: The research leading to these results has received funding from the European Union's Seventh Framework Programme (FP7/2007-2013) under PRoViDE grant agreement n° 312377

  17. Understanding and Improving the Elastic Compressive Modulus of Fibre Reinforced Soy-Based Polyurethane Foams

    NASA Astrophysics Data System (ADS)

    Hussain, Sadakat

    Soy-based polyurethane foams (PUFs) were reinforced with fibres of different aspect ratios to improve the compressive modulus. Each of the three fibre types reinforced PUF differently. Shorter micro-crystalline cellulose fibres were found embedded inside the cell struts of PUF and reinforced them. The reinforcement was attributed to be stress transfer from the matrix to the fibre by comparing the experimental results to those predicted by micro-mechanical models for short fibre reinforced composites. The reinforced cell struts increased the overall compressive modulus of the foam. Longer glass fibres (470 microns, length) provided the best reinforcement. These fibres were found to be larger than the cell diameters. The micro-mechanical models could not predict the reinforcement provided by the longer glass fibres. The models predicted negligible reinforcement because the very low modulus PUF should not transfer load to the higher modulus fibres. However, using a finite element model, it was determined that the fibres were providing reinforcement through direct fibre interaction with each other. Intermediate length glass fibres (260 microns, length) were found to poorly reinforce the PUF and should be avoided. These fibres were too short to interact with each other and were on average too large to embed and reinforce cell struts. In order to produce natural fibre reinforced PUFs in the future, a novel device was invented. The purpose of the device is to deliver natural fibres at a constant mass flow rate. The device was found to consistently meter individual loose natural fibre tufts at a mass flow rate of 2 grams per second. However, the device is not robust and requires further development to deliver a fine stream of natural fibre that can mix and interact with the curing polymeric components of PUF. A design plan was proposed to address the remaining issues with the device.

  18. Improved understanding of aftershock triggering by waveform detection of aftershocks with GPU computing

    NASA Astrophysics Data System (ADS)

    Peng, Z.; Meng, X.; Hong, B.; Yu, X.

    2012-12-01

    Large shallow earthquakes are generally followed by increased seismic activities around the mainshock rupture zone, known as "aftershocks". Whether static or dynamic triggering is responsible for triggering aftershocks is still in debate. However, aftershocks listed in standard earthquake catalogs are generally incomplete immediately after the mainshock, which may result in inaccurate estimation of seismic rate changes. Recent studies have used waveforms of existing earthquakes as templates to scan through continuous waveforms to detect potential missing aftershocks, which is termed 'matched filter technique'. However, this kind of data mining is computationally intensive, which raises new challenges when applying to large data sets with tens of thousands of templates, hundreds of seismic stations and years of continuous waveforms. The waveform matched filter technique exhibits parallelism at multiple levels, which allows us to use GPU-based computation to achieve significant acceleration. By dividing the procedure into several routines and processing them in parallel, we have achieved ~40 times speedup for one Nvidia GPU card compared to sequential CPU code, and further scaled the code to multiple GPUs. We apply this paralleled code to detect potential missing aftershocks around the 2003 Mw 6.5 San Simeon and 2004 Mw6.0 Parkfield earthquakes in Central California, and around the 2010 Mw 7.2 El Mayor-Cucapah earthquake in southern California. In all these cases, we can detect several tens of times more earthquakes immediately after the mainshocks as compared with those listed in the catalogs. These newly identified earthquakes are revealing new information about the physical mechanisms responsible for triggering aftershocks in the near field. We plan to improve our code so that it can be executed in large-scale GPU clusters. Our work has the long-term goal of developing scalable methods for seismic data analysis in the context of "Big Data" challenges.

  19. Development of remote sensing products to improve understanding of land surface disturbance and altered watershed behavior

    NASA Astrophysics Data System (ADS)

    Hogue, T. S.; Kinoshita, A. M.; Kim, J.

    2012-12-01

    Disturbances such as wildfire, urbanization and climate change alter landscapes, land-atmosphere interactions and hydrologic behavior. Remote sensing can provide key information about environments both pre- and post-disturbance and is useful for monitoring watershed longer-term response. Numerous algorithms have been developed that improve the spatial and temporal resolution of otherwise difficult to retrieve characteristics and variables, such as vegetation biomass, soil moisture, potential evapotranspiration (PET) and evapotranspiration (ET). The current presentation will focus on multi-platform algorithms that have been developed in the Hogue research group for estimating these key hydrologic products. Moderate Resolution Imaging Spectroradiometer (MODIS), AMSR-E, and Landsat products have been used to develop independent, stand-alone algorithms for net radiation, soil moisture, and PET/ET at high spatial and temporal resolutions. The algorithms have been applied to both natural and urban areas to evaluate hydrologic fluxes and their response to disturbance or landscape change. This presentation will highlight application of developed products in evaluating short- and long-term impacts of wildfire on watershed behavior across a range of affected systems. Previous work in southern California has shown that hydrologic recovery is controlled by slope aspect, initial vegetation biomass levels, and burn severity and that discharge is altered up to eight years post-fire. Remote sensing products were used to provide key information on the corresponding spatial recovery patterns and influence on recovery length. Our work has also focused on integration of remote sensing products to better inform mitigation efforts and resource management in agencies responsible for life and property protection after wildfire.

  20. Developing Vocabularies to Improve Understanding and Use of NOAA Observing Systems

    NASA Astrophysics Data System (ADS)

    Austin, M.

    2014-12-01

    The NOAA Observing System Integrated Analysis project (NOSIA II), is an attempt to capture and tell the story of how valuable observing systems are in producing products and services that are required to fulfill the NOAA's diverse mission. NOAA's goals and mission areas cover a broad range of environmental data; a complexity exists in terms and vocabulary as applied to the creation of observing system derived products. The NOSIA data collection focused first on decomposing NOAA's goals in the creation and acceptance of Mission Service Areas (MSAs) by NOAA senior leadership. Products and services that supported the MSAs were then identified through the process of interviewing product producers across NOAA organization. Product Data inputs including models, databases and observing system were also identified. The NOSIA model contains over 20,000 nodes each representing levels in a network connecting products, datasources, users and desired outcomes. An immediate need became apparent that the complexity and variety of the data collected required data management to mature the quality and the content of the NOSIA model. The NOSIA Analysis Database (ADB) was developed initially to improve consistency of terms and data types to allow for the linkage of observing systems, products and NOAA's Goals and mission. The ADB also allowed for the prototyping of reports and product generation in an easily accessible and comprehensive format for the first time. Web based visualization of relationships between products, datasources, users, producers were generated to make the information easily understood This includes developing ontologies/vocabularies that are used for the development of users type specific products for NOAA leadership, Observing System Portfolio mangers and the users of NOAA data.