Science.gov

Sample records for improve patient understanding

  1. Improving Health Care by Understanding Patient Preferences

    PubMed Central

    Brennan, Patricia Flatley; Strombom, Indiana

    1998-01-01

    If nurses, physicians, and health care planners knew more about patients' health-related preferences, care would most likely be cheaper, more effective, and closer to the individuals' desires. In order for patient preferences to be effectively used in the delivery of health care, it is important that patients be able to formulate and express preferences, that these judgments be made known to the clinician at the time of care, and that these statements meaningfully inform care activities. Decision theory and health informatics offer promising strategies for eliciting subjective values and making them accessible in a clinical encounter in a manner that drives health choices. Computer-based elicitation and reporting tools are proving acceptable to patients and clinicians alike. It is time for the informatics community to turn their attention toward building computer-based applications that support clinicians in the complex cognitive process of integrating patient preferences with scientific knowledge, clinical practice guidelines, and the realities of contemporary health care. PMID:9609495

  2. 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

  3. Tablets in trauma: using mobile computing platforms to improve patient understanding and experience.

    PubMed

    Furness, Nicholas D; Bradford, Oliver J; Paterson, Maurice P

    2013-03-01

    Tablets are becoming commonplace in the health care setting. Patients often request to view their radiographs after sustaining trauma. This can be challenging, especially if patients are immobile. The authors performed a prospective, questionnaire-based study to assess inpatient desire to view radiographs on tablets and whether viewing images affected patient-rated outcomes of understanding and satisfaction. Enabling trauma patients to view their images on a tablet is a worthwhile practice because it improves patient involvement in decision making, satisfaction, perceived understanding, and overall experience.

  4. Knowledge is Power. A quality improvement project to increase patient understanding of their hospital stay

    PubMed Central

    Nicholson Thomas, Eleanor; Edwards, Lloyd; McArdle, Paul

    2017-01-01

    Patients frequently leave hospital uninformed about the details of their hospital stay with studies showing that only 59.9% of patients are able to accurately state their diagnosis and ongoing management after discharge. 1 2 This places patients at a higher risk of complications. Educating patients by providing them with accurate and understandable information enables them to take greater control, potentially reducing readmission rates, and unplanned visits to secondary services whilst providing safer care and improving patient satisfaction. 3 4 We wished to investigate whether through a simple intervention, we could improve the understanding and retention of key pieces of clinical information in those patients recently admitted to hospital. A leaflet was designed to trigger patients to ask questions about key aspects of their stay. This was then given to inpatients who were interviewed two weeks later using telephone follow up to assess their understanding of their hospital admission. Patients were asked about their diagnosis, new medications, likely complications, follow up arrangements and recommended points of contact in case of difficulty. Sequential modifications were made using PDSA cycles to maximise the impact and benefit of the process. Baseline data revealed that only 77% of patients could describe their diagnosis and only 27% of patients knew details about their new medications. After the leaflet intervention these figures improved to 100% and 71% respectively. Too often patients are unaware about what happens to them whilst in hospital and are discharged unsafely and dissatisfied as a result. A simple intervention such as a leaflet prompting patients to ask questions and take responsibility for their health can make a difference in potentially increasing patient understanding and thereby reducing risk. PMID:28321297

  5. Using Patient Case Video Vignettes to Improve Students' Understanding of Cross-cultural Communication.

    PubMed

    Arif, Sally; Cryder, Brian; Mazan, Jennifer; Quiñones-Boex, Ana; Cyganska, Angelika

    2017-04-01

    Objective. To develop, implement, and assess whether simulated patient case videos improve students' understanding of and attitudes toward cross-cultural communication in health care. Design. Third-year pharmacy students (N=159) in a health care communications course participated in a one-hour lecture and two-hour workshop on the topic of cross-cultural communication. Three simulated pharmacist-patient case vignettes highlighting cross-cultural communication barriers, the role of active listening, appropriate use of medical interpreters, and useful models to overcome communication barriers were viewed and discussed in groups of 20 students during the workshop. Assessment. A pre-lecture and post-workshop assessed the effect on students' understanding of and attitudes toward cross-cultural communication. Understanding of cross-cultural communication concepts increased significantly, as did comfort level with providing cross-cultural care. Conclusion. Use of simulated patient case videos in conjunction with an interactive workshop improved pharmacy students' understanding of and comfort level with cross-cultural communication skills and can be useful tools for cultural competency training in the curriculum.

  6. Using Patient Case Video Vignettes to Improve Students’ Understanding of Cross-cultural Communication

    PubMed Central

    Cryder, Brian; Mazan, Jennifer; Quiñones-Boex, Ana; Cyganska, Angelika

    2017-01-01

    Objective. To develop, implement, and assess whether simulated patient case videos improve students’ understanding of and attitudes toward cross-cultural communication in health care. Design. Third-year pharmacy students (N=159) in a health care communications course participated in a one-hour lecture and two-hour workshop on the topic of cross-cultural communication. Three simulated pharmacist-patient case vignettes highlighting cross-cultural communication barriers, the role of active listening, appropriate use of medical interpreters, and useful models to overcome communication barriers were viewed and discussed in groups of 20 students during the workshop. Assessment. A pre-lecture and post-workshop assessed the effect on students’ understanding of and attitudes toward cross-cultural communication. Understanding of cross-cultural communication concepts increased significantly, as did comfort level with providing cross-cultural care. Conclusion. Use of simulated patient case videos in conjunction with an interactive workshop improved pharmacy students' understanding of and comfort level with cross-cultural communication skills and can be useful tools for cultural competency training in the curriculum. PMID:28496276

  7. Annotated Bibliography: Understanding Ambulatory Care Practices in the Context of Patient Safety and Quality Improvement.

    PubMed

    Montano, Maria F; Mehdi, Harshal; Nash, David B

    2016-11-01

    The ambulatory care setting is an increasingly important component of the patient safety conversation. Inpatient safety is the primary focus of the vast majority of safety research and interventions, but the ambulatory setting is actually where most medical care is administered. Recent attention has shifted toward examining ambulatory care in order to implement better health care quality and safety practices. This annotated bibliography was created to analyze and augment the current literature on ambulatory care practices with regard to patient safety and quality improvement. By providing a thorough examination of current practices, potential improvement strategies in ambulatory care health care settings can be suggested. A better understanding of the myriad factors that influence delivery of patient care will catalyze future health care system development and implementation in the ambulatory setting.

  8. Improving understanding and rigour through triangulation: an exemplar based on patient participation in interaction.

    PubMed

    Jones, Aled; Bugge, Carol

    2006-09-01

    In this paper, we aim to explore the benefits of triangulation and to expose the positive contribution of using 'triangulation for completeness' within a study of a complex concept, namely patient participation during healthcare interaction. Complex concepts, such as patient participation, are often the focus of nursing research. Triangulation has been proposed as a technique for studying complexity but, although debates about triangulation are becoming more prevalent in the literature, there is little deliberation about the process through which triangulation for completeness, with its claims of forming more comprehensive and rigorous descriptions of concepts through use of multiple data sources, yields it purported benefits. A seminar series, held between 2001 and 2003, brought together researchers actively involved in the study of patient participation in healthcare consultations. The group came from diverse methodological traditions and had undertaken research with a range of informants and a range of methods. The various studies used triangulation at different levels: within studies, across studies and across disciplines. Our examples support theoretical arguments that triangulation for completeness can lead to a more holistic understanding of a concept and can improve scientific rigour. Furthermore, we suggest that triangulation can improve research skills for individuals. Our examples suggest that the process through which understanding is enhanced is discursive and centres on discussions of convergent and unique findings; rigour is improved is through challenging findings, being encouraged to explain aspects of your research that may be taken for granted and improving transparency; and individual researcher's skills and abilities are improved is through a process of discussion and reflexivity. Triangulation for completeness, on various levels, can improve the quality and utility of research about complex concepts through a range of discursive processes

  9. Improving Pain Management Communication: How Patients Understand the Terms “Opioid” and “Narcotic”

    PubMed Central

    Crowley-Matoka, Megan

    2008-01-01

    Background/Objectives Pain specialists often advocate discontinuing use of the term “narcotic,” with the negative connotations it bears for many patients, in favor of the term “opioid.” To contribute empirical data to this argument, we elicited and compared patient understandings of the terms “narcotic” and “opioid.” Design/Participants Brief, anonymous surveys were administered to 100 outpatients. Respondents were asked to describe what a narcotic/opioid is, give example(s), explain why someone would take a narcotic/opioid and describe long term consequences of use. Results Of the 100 outpatients, 86% responded “don’t know” to all four opioid questions. Only 12% did not know what a narcotic was ( < 001). While 50% of patients related “narcotics” to pain management, more than a third cited addiction or abuse. Of the 100 outpatients, 78% feared an adverse outcome from long-term narcotic use, with 66% of those answers citing “addiction.” Conclusion Most patients were unfamiliar with the term opioid, while a substantial percentage identified a narcotic as an illegal drug and most reported adverse consequences as the outcome of long term use. Our findings, while preliminary, suggest that “opioid” is a more unfamiliar term, but raise questions about whether simply using different terminology would affect patient fears about this class of medications. PMID:18516649

  10. Using a supportive care framework to understand and improve palliative care among cancer patients in Africa.

    PubMed

    Busolo, David S; Woodgate, Roberta L

    2016-06-01

    Cancer incidence and mortality are increasing in Africa, which is leading to greater demands for palliative care. There has been little progress in terms of research, pain management, and policies related to palliative care. Palliative care in Africa is scarce and scattered, with most African nations lacking the basic services. To address these needs, a guiding framework that identifies care needs and directs palliative care services could be utilized. Therefore, using the supportive care framework developed by Fitch (Fitch, 2009), we here review the literature on palliative care for patients diagnosed with cancer in Africa and make recommendations for improvement. The PubMed, Scopus, CINAHL, Web of Science, Embase, PsycINFO, Social Sciences Citation Index, and Medline databases were searched. Some 25 English articles on research from African countries published between 2004 and 2014 were selected and reviewed. The reviewed literature was analyzed and presented using the domains of the supportive care framework. Palliative care patients with cancer in Africa, their families, and caregivers experience increasing psychological, physical, social, spiritual, emotional, informational, and practical needs. Care needs are often inadequately addressed because of a lack of awareness as well as deficient and scattered palliative care services and resources. In addition, there is sparse research, education, and policies that address the dire situation in palliative care. Our review findings add to the existing body of knowledge demonstrating that palliative care patients with cancer in Africa experience disturbing care needs in all domains of the supportive care framework. To better assess and address these needs, holistic palliative care that is multidomain and multi-professional could be utilized. This approach needs to be individualized and to offer better access to services and information. In addition, research, education, and policies around palliative care for cancer

  11. Improving student understanding and management of patients through role-playing and video taping.

    PubMed

    Levine, N R

    1976-02-01

    A teaching program that uses video tape and simulated patients assists the student in developing skills necessary for good professional relationships with patients and augments the student's ability in patient inverviewing and effective interview behavior. Role-playing by selected drama students and community theatre actors involves common problems encountered in the optometrist's office and management of problem patients (angry, aggressive, shy, withdrawn, talkative, flirt, hypocondriac, etc.).

  12. Implementation of educational video improves patient understanding of basic breast cancer concepts in an undereducated county hospital population.

    PubMed

    Bouton, Marcia E; Shirah, Gina R; Nodora, Jesse; Pond, Erika; Hsu, Chiu-Hsieh; Klemens, Anne E; Martinez, Maria Elena; Komenaka, Ian K

    2012-01-01

    The purpose of this study was to evaluate the effect of a video on patient understanding of basic breast cancer concepts. An 11 item tool of breast cancer concepts was devised. A previous study obtained baseline information on patient knowledge. Subsequently an 8 min video was designed to facilitate the understanding of these concepts. The next 40 consecutive patients who saw the video were then administered the same 11 item questionnaire. Eighty-one women agreed to participate in the study, 41 before and 40 after the implementation of the video. Fifty-one percent had less than a high school education. The group who saw the video had a higher mean number of questions correct (6.7 vs. 8.9, P = 0.0007). Interestingly 90% of all respondents correctly answered the question on the value of screening mammography, however, only 37% of these patients underwent screening mammograms. A multiple linear regression model adjusting for years of education, language, and seeing the video, revealed that having seen the video (P = 0.0029) and years of education (P = 0.0002) remained significantly associated with higher score. Implementation of an educational video significantly improved understanding of breast cancer concepts in an undereducated population. Copyright © 2011 Wiley Periodicals, Inc.

  13. Understanding patients' perspective in the use of generic antiepileptic drugs: compelling lessons for physicians to improve physician/patient communication

    PubMed Central

    Liow, Kore

    2009-01-01

    Background Epilepsy is a condition in which consistency of treatment is paramount to successful management and for most patients, effective seizure control can be achieved. Given the severe consequences of even a single breakthrough seizure, patients should be afforded every opportunity to succeed on their given regimens. Discussion Some experts argue that global policy on generic antiepileptic drug substitution in epilepsy should be limited – occurring at the discretion of and with careful monitoring by the physician. While the debate continues, physicians still have daily responsibilities to their patients to help them best manage their epilepsy within the context of the current environment – the reality of which may involve switching to a generic antiepileptic drug or navigating various formulations between generics. Summary To provide context, this paper first reviews the main "hot button" issues fueling the ongoing generic debate, including a broad overview of the current state of the literature. The main goal however is to provide physicians with a patient perspective on generic antiepileptic drug use in epilepsy as a source of clinically useful, everyday advice to improve communication and increase patient self-advocacy, both of which are necessary for optimal patient outcome. PMID:19292903

  14. A video to improve patient and surrogate understanding of cardiopulmonary resuscitation choices in the ICU: a randomized controlled trial.

    PubMed

    Wilson, Michael E; Krupa, Artur; Hinds, Richard F; Litell, John M; Swetz, Keith M; Akhoundi, Abbasali; Kashyap, Rahul; Gajic, Ognjen; Kashani, Kianoush

    2015-03-01

    To determine if a video depicting cardiopulmonary resuscitation and resuscitation preference options would improve knowledge and decision making among patients and surrogates in the ICU. Randomized, unblinded trial. Single medical ICU. Patients and surrogate decision makers in the ICU. The usual care group received a standard pamphlet about cardiopulmonary resuscitation and cardiopulmonary resuscitation preference options plus routine code status discussions with clinicians. The video group received usual care plus an 8-minute video that depicted cardiopulmonary resuscitation, showed a simulated hospital code, and explained resuscitation preference options. One hundred three patients and surrogates were randomized to usual care. One hundred five patients and surrogates were randomized to video plus usual care. Median total knowledge scores (0-15 points possible for correct answers) in the video group were 13 compared with 10 in the usual care group, p value of less than 0.0001. Video group participants had higher rates of understanding the purpose of cardiopulmonary resuscitation and resuscitation options and terminology and could correctly name components of cardiopulmonary resuscitation. No statistically significant differences in documented resuscitation preferences following the interventions were found between the two groups, although the trial was underpowered to detect such differences. A majority of participants felt that the video was helpful in cardiopulmonary resuscitation decision making (98%) and would recommend the video to others (99%). A video depicting cardiopulmonary resuscitation and explaining resuscitation preference options was associated with improved knowledge of in-hospital cardiopulmonary resuscitation options and cardiopulmonary resuscitation terminology among patients and surrogate decision makers in the ICU, compared with receiving a pamphlet on cardiopulmonary resuscitation. Patients and surrogates found the video helpful in decision

  15. Patients' understanding and participation in a trial designed to improve the management of anti-psychotic medication: a qualitative study.

    PubMed

    Rogers, Anne; Day, Jenny; Randall, Fiona; Bentall, Richard P

    2003-12-01

    Combining qualitative methods alongside randomised controlled trials in the health field has been advocated but has only been used rarely in mental health services research. The aim of this study was to illuminate patients' understanding of the nature and purpose and outcomes of a trial designed to improve the management of neuroleptic medication. Qualitative interviews were carried out with a group of patients participating in a trial comparing a psycho-educational and therapeutic alliance intervention in managing anti-psychotic medication. Our findings highlighted aspects of the experience, process and outcome of the trial, which remain latent in the quantitative assessment. The issue of enlarged selfefficacy emerging when patients were involved in communications with professionals in the trial was important. Whilst the participants provided positive feedback about their involvement in the trial, they struggled to recall the details of the intervention to which they had been exposed. Patients did not readily identify the content and concepts characterising each condition; rather they prioritised the opportunity for communication and contact with the researchers. Qualitative research accompanying trials illuminates and adds to the quantitative outcomes. The key to interpreting participants' accounts of the process and outcomes of this trial suggests the need to give greater emphasis to participants' past and current experience of service contact.

  16. Understanding the needs of relatives of patients within a special hospital for mentally disordered offenders: a basis for improved services.

    PubMed

    McCann, G; McKeown, M; Porter, I

    1996-02-01

    This paper outlines one component of a major research study, which will form the basis for a new service for relatives of schizophrenia sufferers within a special hospital. The aim of this initial component has been twofold: firstly to identify and understand the needs of relatives in terms of their present knowledge and understanding of schizophrenia; and secondly to establish what stress the relatives are presently experiencing in maintaining contact with patients and whether this stress may have an impact on the management of schizophrenia at the hospital. A purposive sample of 17 relatives were interviewed using two semi-structured interview protocols. All interviews were audio-taped and later transcribed for analysis. The data have provided an illuminating insight into the thoughts and feelings of relatives and indicate many ways in which a service for relatives could be tailored. It is apparent that many relatives are currently not being supported, involved or allowed to contribute to the care of their family member at Ashworth Hospital. This present situation is stressful for relatives and is likely to have a detrimental effect on the course of schizophrenia in patients at Ashworth Hospital.

  17. Improving understanding of trigger points and widespread pressure pain sensitivity in tension-type headache patients: clinical implications.

    PubMed

    Fernández-De-Las-Peñas, César; Arendt-Nielsen, Lars

    2017-09-01

    The underlying etiology of tension type headache (TTH) is not understood. The current paper highlights the etiologic role of muscle trigger points (TrPs) to the development and maintenance of central sensitization in TTH and its clinical repercussion for proper management of these patients. Areas covered: A literature search on Pub Med for English-language published papers between 1990 and May 2017 to provide the most updated data on the topic was conducted. Current literature suggests that the referred pain elicited by active trigger points (TrPs) contributes to the manifestations of TTH. There is also evidence supporting that TrPs represent a peripheral source of nociception and thereby a driver in the development of central sensitization. In fact, TrPs have been found to be associated with widespread pressure pain sensitivity in TTH. Temporal and spatial summation of TrP nociception suggests that inactivating TrP in the neck, head and shoulder muscles could help these patients; however, current evidence supporting the therapeutic role of TrPs in TTH is conflicting. Expert commentary: Understanding the role of TrPs in TTH in widespread pain sensitization may help to develop better management regimes and possibly prevent TTH from developing into more chronic conditions.

  18. Improving the delivery of care for patients with diabetes through understanding optimised team work and organisation in primary care.

    PubMed

    Eccles, Martin P; Hawthorne, Gillian; Johnston, Marie; Hunter, Margaret; Steen, Nick; Francis, Jill; Hrisos, Susan; Elovainio, Marko; Grimshaw, Jeremy M

    2009-04-27

    Type 2 diabetes is an increasingly prevalent chronic illness and is an important cause of avoidable mortality. Patients are managed by the integrated activities of clinical and non-clinical members of the primary care team. Studies of the quality of care for patients with diabetes suggest less than optimum care in a number of areas. The aim of this study is to improve the quality of care for patients with diabetes cared for in primary care in the UK by identifying individual, team, and organisational factors that predict the implementation of best practice. Participants will be clinical and non-clinical staff within 100 general practices sampled from practices who are members of the MRC General Practice Research Framework. Self-completion questionnaires will be developed to measure the attributes of individual health care professionals, primary care teams (including both clinical and non-clinical staff), and their organisation in primary care. Questionnaires will be administered using postal survey methods. A range of validated theories will be used as a framework for the questionnaire instruments. Data relating to a range of dimensions of the organisational structure of primary care will be collected via a telephone interview at each practice using a structured interview schedule. We will also collect data relating to the processes of care, markers of biochemical control, and relevant indicator scores from the quality and outcomes framework (QOF). Process data (as a proxy indicator of clinical behaviours) will be collected from practice databases and via a postal questionnaire survey of a random selection of patients from each practice. Levels of biochemical control will be extracted from practice databases. A series of analyses will be conducted to relate the individual, team, and organisational data to the process, control, and QOF data to identify configurations associated with high quality care. UKCRN ref:DRN120 (ICPD).

  19. Understanding and improving patient experience: a national survey of training courses provided by higher education providers and healthcare organizations in England.

    PubMed

    Robert, Glenn; Waite, Richard; Cornwell, Jocelyn; Morrow, Elizabeth; Maben, Jill

    2014-01-01

    Understanding and improving 'patient experience' is essential to delivering high quality healthcare. However, little is known about the provision of education and training to healthcare staff in this increasingly important area. This study aims to ascertain the extent and nature of such provision in England and to identify how it might be developed in the future. An on-line survey was designed to explore training provision relating to patient experiences. To ensure that respondents thought about patient experience in the same way we defined patient experience training as that which aims to teach staff: 'How to measure or monitor the experience, preferences and priorities of patients and use that knowledge to improve their experience'. Survey questions (n=15) were devised to cover nine consistently reported key aspects of patient experience; identified from the research literature and recommendations put forward by professional bodies. The survey was administered to (i) all 180 providers of Higher Education (HE) to student/qualified doctors, nurses and allied health professionals, and (ii) all 390 National Health Service (NHS) trusts in England. In addition, we added a single question to the NHS 2010 Staff Survey (n=306,000) relating to the training staff had received to deliver a good patient experience. Two hundred and sixty-five individuals responded to the on-line survey representing a total of 159 different organizations from the HE and healthcare sectors. Respondents most commonly identified 'relationships' as an 'essential' aspect of patient experience education and training. The biggest perceived gaps in current provision related to the 'physical' and 'measurement' aspects of our conceptualization of patient experience. Of the 148,657 staff who responded to the Staff Survey 41% said they had not received patient experience training and 22% said it was not applicable to them. While some relevant education courses are in place in England, the results suggest

  20. Improving Understanding of and Adherence to Pulmonary Rehabilitation in Patients with COPD: A Qualitative Inquiry of Patient and Health Professional Perspectives

    PubMed Central

    Guo, Su-Er; Bruce, Anne

    2014-01-01

    Objectives Although patients with Chronic Obstructive Pulmonary Disease (COPD) who adhere to a pulmonary rehabilitation program are better able to manage their illness and experience a better health-related quality of life, pulmonary rehabilitation remains underused. This study aims to describe the experiences of patients who are in a pulmonary rehabilitation program, and explore the perceptions of both patients and health professionals about what improves effective pulmonary rehabilitation. Methods A qualitative research design, including focus groups and individual interviews with 25 patients and 7 program health professionals, was used to obtain combined perspectives about the factors underpinning the COPD patient's reasons for participation in a rehabilitation program. Results Three themes were derived from the descriptive content analysis: (1) building confidence, (2) a perception of immediate tangible results, and (3) being ready and having access to the program. Conclusions and Practical Implications Qualitative findings from this study suggest that a patient's adherence to a COPD rehabilitation program can be improved by quickly building up the participant's confidence, promoting tangible results, and by timely recognizing and responding to the issues of readiness and access. Based on these findings, health care providers could develop strategies to better serve COPD patients who face multiple barriers to access and successfully complete a pulmonary rehabilitation program. PMID:25357128

  1. 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.

  2. Improving Students' Understanding of Quantum Measurement

    NASA Astrophysics Data System (ADS)

    Zhu, Guangtian; Singh, Chandralekha

    2010-10-01

    We describe the difficulties advanced undergraduate and graduate students have with quantum measurement. To reduce these difficulties, we have developed research-based learning tools such as the Quantum Interactive Learning Tutorial (QuILT) and peer instruction tools. A preliminary evaluation shows that these learning tools are effective in improving students' understanding of concepts related to quantum measurement.

  3. Improving Students' Understanding of Quantum Measurement

    SciTech Connect

    Zhu Guangtian; Singh, Chandralekha

    2010-10-24

    We describe the difficulties advanced undergraduate and graduate students have with quantum measurement. To reduce these difficulties, we have developed research-based learning tools such as the Quantum Interactive Learning Tutorial (QuILT) and peer instruction tools. A preliminary evaluation shows that these learning tools are effective in improving students' understanding of concepts related to quantum measurement.

  4. 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…

  5. 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…

  6. 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

  7. 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.

  8. Do Patients Understand Written Health Information?

    ERIC Educational Resources Information Center

    Dixon, Elizabeth; Park, Rosemarie

    1990-01-01

    Long sentences, medical terms, and small print make hospital information brochures and consent forms difficult for many patients to understand. Nurses can help patients by simplifying language, highlighting important information, and using lists. (JOW)

  9. Improving students' understanding of quantum mechanics

    NASA Astrophysics Data System (ADS)

    Zhu, Guangtian

    2011-12-01

    Learning physics is challenging at all levels. Students' difficulties in the introductory level physics courses have been widely studied and many instructional strategies have been developed to help students learn introductory physics. However, research shows that there is a large diversity in students' preparation and skills in the upper-level physics courses and it is necessary to provide scaffolding support to help students learn advanced physics. This thesis explores issues related to students' common difficulties in learning upper-level undergraduate quantum mechanics and how these difficulties can be reduced by research-based learning tutorials and peer instruction tools. We investigated students' difficulties in learning quantum mechanics by administering written tests and surveys to many classes and conducting individual interviews with a subset of students. Based on these investigations, we developed Quantum Interactive Learning Tutorials (QuILTs) and peer instruction tools to help students build a hierarchical knowledge structure of quantum mechanics through a guided approach. Preliminary assessments indicate that students' understanding of quantum mechanics is improved after using the research-based learning tools in the junior-senior level quantum mechanics courses. We also designed a standardized conceptual survey that can help instructors better probe students' understanding of quantum mechanics concepts in one spatial dimension. The validity and reliability of this quantum mechanics survey is discussed.

  10. Understanding nursing 'nous' in the context of service improvements.

    PubMed

    Price, Bob

    2013-07-01

    Nurse managers face the challenges of how best to improve healthcare services in ways that can be evaluated readily by patients and that engage nurses. They also need to demonstrate how staff resource has been successfully deployed. This article ventures that a better understanding of 'nous' - the organisational ability of nurses to combine skills to clear purpose and patient benefit - may assist nurse managers to achieve these aims. It explores what staff nous consists of and examines critically more traditional modes of thinking about staff as intellectual capital. The reader is shown how staff nous might feature in new patient evaluations of care, nursing staff appraisals and the design of care initiatives.

  11. Do patients understand how PHRs work?

    PubMed

    Zayas-Cabán, Teresa; Valdez, Rupa

    2007-10-11

    As Personal Health Records (PHRs) gain momentum, designers need to ensure that users understand the functions and benefits of PHRs. This study examines patients' readiness to use PHRs. Results show that although most participants envision themselves using the system, five areas of concern about the use of PHRs remain. The gap between current and ideal understanding highlights the need for formalized methods to help patients understand what PHRs are and how to use them.

  12. 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

  13. Improving Literary Understanding through Classroom Conversation.

    ERIC Educational Resources Information Center

    Langer, Judith A.; Close, Elizabeth

    Why is it important to teach literary understanding? It is through reading, thinking, and discussing literature that students find alternative ways to gain knowledge and solve problems. Through sharing of understandings, they learn not only important content but also cognitive, critical, and social strategies needed for success in academic…

  14. 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…

  15. Improving patient education for patients with low literacy skills.

    PubMed

    Mayeaux, E J; Murphy, P W; Arnold, C; Davis, T C; Jackson, R H; Sentell, T

    1996-01-01

    Patients who misunderstand their diagnosis and treatment plans usually exhibit poor compliance. The 90 million adult Americans with low literacy skills struggle to understand such essential health information as discharge instructions, consent forms, oral instructions and drug labels. The Joint Commission on Accreditation of Health Organizations (JCAHO) now requires that instructions be given on a level understandable to the patient. Most physicians tend to give too much information on too high a level for many patients to understand. Physicians who speak in simpler language, repeat their instructions and demonstrate key points, while avoiding too many directives, enhance their patients' understanding. Combining easy-to-read written patient education materials with oral instructions has been shown to greatly enhance patient understanding. To be effective with patients whose literacy skills are low, patient education materials should be short and simple, contain culturally sensitive graphics and encourage desired behavior. Compliance with therapy also may be improved by including family members in the patient education process.

  16. Investigating organizational quality improvement systems, patient empowerment, organizational culture, professional involvement and the quality of care in European hospitals: the 'Deepening our Understanding of Quality Improvement in Europe (DUQuE)' project.

    PubMed

    Groene, Oliver; Klazinga, Niek; Wagner, Cordula; Arah, Onyebuchi A; Thompson, Andrew; Bruneau, Charles; Suñol, Rosa

    2010-09-24

    Hospitals in European countries apply a wide range of quality improvement strategies. Knowledge of the effectiveness of these strategies, implemented as part of an overall hospital quality improvement system, is limited. We propose to study the relationships among organisational quality improvement systems, patient empowerment, organisational culture, professionals' involvement with the quality of hospital care, including clinical effectiveness, patient safety and patient involvement. We will employ a cross-sectional, multi-level study design in which patient-level measurements are nested in hospital departments, which are in turn nested in hospitals in different EU countries. Mixed methods will be used for data collection, measurement and analysis. Hospital/care pathway level constructs that will be assessed include external pressure, hospital governance, quality improvement system, patient empowerment in quality improvement, organisational culture and professional involvement. These constructs will be assessed using questionnaires. Patient-level constructs include clinical effectiveness, patient safety and patient involvement, and will be assessed using audit of patient records, routine data and patient surveys. For the assessment of hospital and pathway level constructs we will collect data from randomly selected hospitals in eight countries. For a sample of hospitals in each country we will carry out additional data collection at patient-level related to four conditions (stroke, acute myocardial infarction, hip fracture and delivery). In addition, structural components of quality improvement systems will be assessed using visits by experienced external assessors. Data analysis will include descriptive statistics and graphical representations and methods for data reduction, classification techniques and psychometric analysis, before moving to bi-variate and multivariate analysis. The latter will be conducted at hospital and multilevel. In addition, we will apply

  17. Understanding patient perceptions of shared decision making.

    PubMed

    Shay, L Aubree; Lafata, Jennifer Elston

    2014-09-01

    This study aims to develop a conceptual model of patient-defined SDM, and understand what leads patients to label a specific, decision-making process as shared. Qualitative interviews were conducted with 23 primary care patients following a recent appointment. Patients were asked about the meaning of SDM and about specific decisions that they labeled as shared. Interviews were coded using qualitative content analysis. Patients' conceptual definition of SDM included four components of an interactive exchange prior to making the decision: both doctor and patient share information, both are open-minded and respectful, patient self-advocacy, and a personalized physician recommendation. Additionally, a long-term trusting relationship helps foster SDM. In contrast, when asked about a specific decision labeled as shared, patients described a range of interactions with the only commonality being that the two parties came to a mutually agreed-upon decision. There is no one-size-fits all process that leads patients to label a decision as shared. Rather, the outcome of "agreement" may be more important than the actual decision-making process for patients to label a decision as shared. Studies are needed to better understand how longitudinal communication between patient and physicians and patient self-advocacy behaviors affect patient perceptions of SDM. Published by Elsevier Ireland Ltd.

  18. Developing An Analytic Approach to Understanding the Patient Care Experience

    PubMed Central

    Springman, Mary Kate; Bermeo, Yalissa; Limper, Heather M

    2016-01-01

    The amount of data available to health-care institutions regarding the patient care experience has grown tremendously. Purposeful approaches to condensing, interpreting, and disseminating these data are becoming necessary to further understand how clinical and operational constructs relate to patient satisfaction with their care, identify areas for improvement, and accurately measure the impact of initiatives designed to improve the patient experience. We set out to develop an analytic reporting tool deeply rooted in the patient voice that would compile patient experience data obtained throughout the medical center. PMID:28725852

  19. Patients' understanding and use of advance directives.

    PubMed Central

    Jacobson, J A; White, B E; Battin, M P; Francis, L P; Green, D J; Kasworm, E S

    1994-01-01

    The Patient Self-Determination Act was implemented in December 1991. Before and after its implementation, we used a structured interview of 302 randomly selected patients to determine their awareness, understanding, and use of advance directives. Implementation of the Act did not have a major effect on these. Although more than 90% of patients were aware of the living will, only about a third selected the correct definition or the correct circumstances in which it applied, and less than 20% of patients had completed one. About a third of patients were aware of a Durable Power of Attorney for Health Care and chose the correct definition, and about half identified the correct circumstances in which it applies; less than 10% had completed such a document. Surprisingly, patients who said they had completed advance directives did not demonstrate better understanding of these documents. Our results indicate that many patients, including some who have completed advance directives, do not fully understand them. It may be unwise to regard these documents as carefully considered, compelling statements of patients' preferences. Appropriate responses to our findings include increased public education, revising state statutes to bring them into congruence with public perception, and expanding the dialogue between physicians and patients. PMID:8191755

  20. Understanding Troubleshooting Styles To Improve Training Methods.

    ERIC Educational Resources Information Center

    Johnson, Scott D.; And Others

    An effective training program for preparing troubleshooters provides knowledge needed to understand the technology, teaches the process of troubleshooting, and provides the opportunity to practice using their knowledge and skill to diagnose faulty equipment. Recent research and common sense indicate many troubleshooting programs overemphasize…

  1. 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.

  2. Understanding Empathy Training with Virtual Patients.

    PubMed

    Kleinsmith, Andrea; Rivera-Gutierrez, Diego; Finney, Glen; Cendan, Juan; Lok, Benjamin

    2015-11-01

    While the use of virtual characters in medical education is becoming more and more commonplace, an understanding of the role they can play in empathetic communication skills training is still lacking. This paper presents a study aimed at building this understanding by determining if students can respond to a virtual patient's statement of concern with an empathetic response. A user study was conducted at the [blinded] College of Medicine in which early stage medical students interacted with virtual patients in one session and real humans trained to portray real patients (i.e., standardized patients) in a separate session about a week apart. During the interactions, the virtual and 'real' patients presented the students with empathetic opportunities which were later rated by outside observers. The results of pairwise comparisons indicate that empathetic responses made to virtual patients were rated as significantly more empathetic than responses made to standardized patients. Even though virtual patients may be perceived as artificial, the educational benefit of employing them for training medical students' empathetic communications skills is that virtual patients offer a low pressure interaction which allows students to reflect on their responses.

  3. Understanding Empathy Training with Virtual Patients

    PubMed Central

    Kleinsmith, Andrea; Rivera-Gutierrez, Diego; Finney, Glen; Cendan, Juan; Lok, Benjamin

    2015-01-01

    While the use of virtual characters in medical education is becoming more and more commonplace, an understanding of the role they can play in empathetic communication skills training is still lacking. This paper presents a study aimed at building this understanding by determining if students can respond to a virtual patient's statement of concern with an empathetic response. A user study was conducted at the [blinded] College of Medicine in which early stage medical students interacted with virtual patients in one session and real humans trained to portray real patients (i.e., standardized patients) in a separate session about a week apart. During the interactions, the virtual and ‘real' patients presented the students with empathetic opportunities which were later rated by outside observers. The results of pairwise comparisons indicate that empathetic responses made to virtual patients were rated as significantly more empathetic than responses made to standardized patients. Even though virtual patients may be perceived as artificial, the educational benefit of employing them for training medical students' empathetic communications skills is that virtual patients offer a low pressure interaction which allows students to reflect on their responses. PMID:26166942

  4. 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

  5. [Understanding my patient from the personalist bioethics].

    PubMed

    Cardona Vélez, Jonathan

    2014-01-01

    The role of ethics in our everyday life responds to the need to understand a decisive reality, especially for us as physicians, a reality that we know as the human person. So, a personalized bioethical approach plays an important role against the accelerated dehumanization that we are experiencing, because every one of our actions has a direct impact on our patients.

  6. Understanding Patient Satisfaction Ratings for Radiology Services

    PubMed Central

    Lang, Elvira V.; Yuh, William T.C.; Kelly, Ronda; Macadam, Luke; Potts, Richard; Mayr, Nina A.

    2015-01-01

    Under the Hospital Value-Based Purchasing Program of the Centers for Medicare & Medicaid Services patient satisfaction accounts for 30% of the measures of and payments for quality of care. Understanding what drives satisfaction data, how it is obtained, converted into scores, and formulated into rankings, is increasingly critical for imaging departments. PMID:24261356

  7. Understanding basic carbohydrate counting, glycemic index, and glycemic load for improved glycemic control in Hispanic patients with type 2 diabetes mellitus.

    PubMed

    Ortiz, Lidia Guadalupe Compeán; Berry, Diane C; Ruiz, Octelina Castillo; González, Eunice Reséndiz; Pérez, Paulina Aguilera; Rivas, Elva Del Ángel

    2014-01-01

    Hispanic patients with type 2 diabetes mellitus generally have poor glycemic control. Constant hyperglycemia in individuals with type 2 diabetes can cause microvascular and macrovascular complications that lead to early morbidity and mortality. Good glycemic control requires a balance between diet, exercise, and medication, but dietary balance is difficult to achieve for many patients. Of the macronutrients, carbohydrates mostly affect blood glucose levels. Basic carbohydrate counting, glycemic index, and glycemic load are important tools for patients to master to control their blood glucose levels.

  8. Understanding pharmacokinetics to improve tuberculosis treatment outcome

    PubMed Central

    Reynolds, Jonathan; Heysell, Scott K

    2014-01-01

    Introduction Tuberculosis (TB) remains the leading cause of death from a curable infectious disease; drug-resistant TB threatens to dismantle all prior gains in global control. Suboptimal circulating anti-TB drug concentrations can lead to lack of cure and acquired drug resistance. Areas covered This review will introduce pharmacokinetic parameters for key anti-TB drugs, as well as the indications and limitations of measuring these parameters in clinical practice. Current and novel methodologies for delivering anti-TB pharmacokinetic-pharmacodynamic data are highlighted and gaps in operational research described. Expert opinion Individual pharmacokinetic variability is commonplace, underappreciated and difficult to predict without therapeutic drug monitoring (TDM). Pharmacokinetic thresholds associated with poor TB treatment outcome in drug-susceptible TB have recently been described and may now guide the application of TDM, but require validation in a variety of settings and comorbidities. Dried blood spots for TDM and prepackaged multidrug plates for minimum inhibitory concentration testing will overcome barriers of accessibility and represent areas for innovation. Operationalizing pharmacokinetics has the potential to improve TB outcomes in the most difficult-to-treat forms of the disease such as multidrug resistance. Clinical studies in these areas are eagerly anticipated and we expect will better define the rational introduction of novel therapeutics. PMID:24597717

  9. A controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). The SUPPORT Principal Investigators.

    PubMed

    To improve end-of-life decision making and reduce the frequency of a mechanically supported, painful, and prolonged process of dying. A 2-year prospective observational study (phase I) with 4301 patients followed by a 2-year controlled clinical trial (phase II) with 4804 patients and their physicians randomized by specialty group to the intervention group (n = 2652) or control group (n = 2152). Five teaching hospitals in the United States. A total of 9105 adults hospitalized with one or more of nine life-threatening diagnoses; an overall 6-month mortality rate of 47%. Physicians in the intervention group received estimates of the likelihood of 6-month survival for every day up to 6 months, outcomes of cardiopulmonary resuscitation (CPR), and functional disability at 2 months. A specifically trained nurse had multiple contacts with the patient, family, physician, and hospital staff to elicit preferences, improve understanding of outcomes, encourage attention to pain control, and facilitate advance care planning and patient-physician communication. The phase I observation documented shortcomings in communication, frequency of aggressive treatment, and the characteristics of hospital death: only 47% of physicians knew when their patients preferred to avoid CPR: 46% of do-not-resuscitate (DNR) orders were written within 2 days of death; 38% of patients who died spent at least 10 days in an intensive care unit (ICU); and for 50% of conscious patients who died in the hospital, family members reported moderate to severe pain at least half the time. During the phase II intervention, patients experienced no improvement in patient-physician communication (eg, 37% of control patients and 40% of intervention patients discussed CPR preferences) or in the five targeted outcomes, ie, incidence or timing of written DNR orders (adjusted ratio, 1.02; 95% confidence interval [CI], 0.90 to 1.15), physicians' knowledge of their patients' preferences not to be resuscitated (adjusted

  10. Management for improving patients’ knowledge and understanding about drug allergy

    PubMed Central

    Jarernsiripornkul, Narumol; Chaipichit, Nataporn; Chumworathayi, Pansu; Krska, Janet

    2014-01-01

    Background: Drug allergy a serious adverse drug reaction commonly concerned in healthcare practice. Inadequate documentation and communication between health providers, and limited health literacy and knowledge in patients could contribute to the re-occurrence of allergic reactions. Objective: To evaluate the effectiveness of initiatives aiming to improve patients’ knowledge, understanding and behavior in preventing recurrent drug allergy. Methods: A before-and-after study was conducted at an 800-bed university teaching hospital, involving patients with a history of drug allergy. Questionnaires, completed at baseline and one month after receiving information were used to compare knowledge and understanding of drug allergy and behaviors in relation to drug allergy cards. Patients in Group 1 received a brochure only, but patients in Group 2 also received a pharmacist counseling intervention in addition to the brochure. Outcomes were evaluated within intervention group and between intervention groups. Results: The study included 299 (30.4%) and 100 patients (100.0%) in Groups 1 and 2 respectively who completed the baseline questionnaire, of whom 179 (59.8%) and 96 (96.0%) completed the follow-up questionnaire. At baseline, higher educational levels and possession of a drug allergy card were significantly associated with better knowledge about drug allergy. After intervention, Group 2 had significantly greater increases in mean overall knowledge scores than Group 1 (p<0.01) and also greater increases in the proportions self-reporting carrying and presenting drug allergy cards (p<0.05 and p<0.01). Conclusions: Pharmacist counseling plus brochure may be more effective than brochure alone in promoting patients’ knowledge of drug allergy and drug allergy card importance. PMID:25883688

  11. Understanding challenging behaviour in patients with dementia.

    PubMed

    Cunningham, C

    The fifth and final article in the series on patients with dementia in acute care examines challenging behaviour. Hospital admission, combined with unfamiliar surroundings and memory problems, can be frightening and disorientating for those with dementia. This can lead to behaviour which is perceived as 'disruptive' or 'difficult'. Aspects of the hospital environment or care practice can contribute to problems that may be misinterpreted and lead to challenging behaviour. Staff should seek to understand the cause of challenging behaviour, assess the possible causes and use strategies to reinforce familiarity and minimise distress for these patients.

  12. Guidelines for discharge: do standardized cards help in patient understanding?

    PubMed

    Reis, Phillipe Geraldo Teixeira de Abreu; Nakakogue, Camila; Nakakogue, Tabatha; Nasr, Adonis; Tomasich, Flávio Daniel Saavedra; Collaço, Iwan Augusto

    2013-01-01

    To determine whether the addition of discharge standard illustrated cards improves understanding of patients in the emergency room. We conducted a prospective, randomized, interventional study with 228 patients discharged from the emergency department. All patients were interviewed and tested for the level of understanding of discharge instructions. Some of them received the intervention, with the standard cards, and another did not, constituting the control group. The average of followed discharge guidelines of the group that received the cards was higher than the control group, with statistical significance (p=0.009). When segregated by age, the group between 16 and 35 years of both sexes had the best average of followed guidelines, statistically, than the average of the control group (p=0.01). The difference between the mean orientations between the control group and the card for patients undergoing procedures was statistically significant (p=0.02); as for the stratification according to the number of procedures, the significance increases when that is equal to 1 (p=0.001) and decreased the more procedures were carried out. The introduction of discharge standard orientation cards was associated with improvement in the understanding of patients. Without replacing the verbal directions, which establishes dialogue and doctor-patient bonding, cards appear as auxiliary elements, facilitating understanding and care guidelines.

  13. Memorandum of Understanding for Improving Environmental Management of Electronic Assets

    EPA Pesticide Factsheets

    This is a memorandum of understanding between the U.S. Postal Service, Department of Defense, Department of Energy, Department of Interior and EPA to improve the environmental management of the government's electronic assets.

  14. 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…

  15. 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…

  16. 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

  17. Strategies for improving patient compliance.

    PubMed

    Strand, J

    1994-01-01

    Achieving patient compliance in taking prescribed medications is a formidable challenge for all clinicians. As PAs, we have daily opportunities to communicate with patients and improve their compliance. An office-based compliance program, combining patient education and behavior-modification components, can be beneficial in this regard. Strategies for improving compliance include giving clear, concise, and logical instructions in familiar language, adapting drug regimens to daily routines, eliciting patient participation through self-monitoring, and providing educational materials that promote overall good health in connection with medical treatment.

  18. 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. PMID:27752619

  19. Improving emergency department patient flow.

    PubMed

    Jarvis, Paul Richard Edwin

    2016-06-01

    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.

  20. Understanding Preprocedure Patient Flow in IR.

    PubMed

    Zafar, Abdul Mueed; Suri, Rajeev; Nguyen, Tran Khanh; Petrash, Carson Cope; Fazal, Zanira

    2016-08-01

    To quantify preprocedural patient flow in interventional radiology (IR) and to identify potential contributors to preprocedural delays. An administrative dataset was used to compute time intervals required for various preprocedural patient-flow processes. These time intervals were compared across on-time/delayed cases and inpatient/outpatient cases by Mann-Whitney U test. Spearman ρ was used to assess any correlation of the rank of a procedure on a given day and the procedure duration to the preprocedure time. A linear-regression model of preprocedure time was used to further explore potential contributing factors. Any identified reason(s) for delay were collated. P < .05 was considered statistically significant. Of the total 1,091 cases, 65.8% (n = 718) were delayed. Significantly more outpatient cases started late compared with inpatient cases (81.4% vs 45.0%; P < .001, χ(2) test). The multivariate linear regression model showed outpatient status, length of delay in arrival, and longer procedure times to be significantly associated with longer preprocedure times. Late arrival of patients (65.9%), unavailability of physicians (18.4%), and unavailability of procedure room (13.0%) were the three most frequently identified reasons for delay. The delay was multifactorial in 29.6% of cases (n = 213). Objective measurement of preprocedural IR patient flow demonstrated considerable waste and highlighted high-yield areas of possible improvement. A data-driven approach may aid efficient delivery of IR care. Copyright © 2016 SIR. Published by Elsevier Inc. All rights reserved.

  1. An initiative to improve patient discharge satisfaction.

    PubMed

    Strong, Sally; Bettin, Arlene

    2015-01-01

    To provide patients with knowledge needed to make a smoother transition from inpatient rehabilitation to the community or another level of care. The Journey to Discharge concept developed from efforts to clearly communicate the stages a patient travels through on the path to discharge from inpatient rehabilitation. The creation and implementation of this concept led to marked improvement in patient satisfaction scores as measured by Press Ganey Associates. Specifically, measures of discharge-specific questions increased from the 39th percentile in fiscal year (FY) 2009 to the 84th percentile in FY 2011 and gains were maintained through FY 2012 and into this year. The Journey to Discharge guides Marianjoy Rehabilitation Hospital associates in helping patients understand expectations for their inpatient rehabilitation stay. This patient-centered initiative demonstrates an innovate approach to better understanding of the rehabilitation process and to easing the patient's transition across the continuum of care (Brady, 2013). The concept includes a post discharge follow-up component designed to ensure patients are following instructions, thereby potentially lowering the incidence of readmission following discharge. Optimizing patient discharge preparation can lead to improvement in satisfaction scores. Discharging well-prepared patients, coupled with proactive post discharge follow-up has the potential to lower the incidence of readmissions. © 2014 Association of Rehabilitation Nurses.

  2. Improving our understanding of the remote sensing process

    NASA Technical Reports Server (NTRS)

    Calabrese, M. A.; Murphy, R. E.; Heydorn, R. P.

    1983-01-01

    Plans for two fundamental research programs aimed at improving an understanding of the physics and mathematics of remote sensing are discussed. The first program, Scene Radiation and Atmospheric Research Program, is concerned with developing the capability to determine biophysical attributes of terrestrial scenes through an improved understanding of the relationships between those properties and remotely sensed radiation. The research issues in the second program, Mathematical Pattern Recognition and Image Analysis, are discussed with reference to the following five categories: preprocessing, digital image representation, object scene inference, computational structures, and continuing studies.

  3. 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 ...

  4. Can an understanding of transactional analysis improve postgraduate clinical supervision?

    PubMed

    Sivan, Manoj; McKimm, Judy; Held, Sam

    2011-01-01

    Clinical supervision in postgraduate medical training is vital in producing competent and safe health-care practitioners. Effective communication between supervisors and trainees at an interpersonal and professional level determines the quality of the supervision process. Transactional analysis, a theory of personality, can be used to enhance understanding of interpersonal interactions and improve the outcomes of clinical training.

  5. Investigators share improved understanding of the North American carbon cycle

    Treesearch

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

    2007-01-01

    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 American and adjacent oceans, and to chart a course for improved integration across scientifi c disciplines, scales, and Earth system boundaries. The meeting participants also addressed the need for...

  6. Improving At-Risk Learners' Understanding of Fractions

    ERIC Educational Resources Information Center

    Fuchs, Lynn S.; Schumacher, Robin F.; Long, Jessica; Namkung, Jessica; Hamlett, Carol L.; Cirino, Paul T.; Jordan, Nancy C.; Siegler, Robert; Gersten, Russell; Changas, Paul

    2013-01-01

    The purposes of this study were to investigate the effects of an intervention designed to improve at-risk 4th graders' understanding of fractions and to examine the processes by which effects occurred. The intervention focused more on the measurement interpretation of fractions; the control condition focused more on the part-whole interpretation…

  7. Using Science Notebooks to Improve Writing Skills and Conceptual Understanding

    ERIC Educational Resources Information Center

    Butler, Malcolm B.; Nesbit, Catherine

    2008-01-01

    The purpose of this article is to provide teachers with strategies for improving students' writing and deepening their conceptual understanding through the use of science notebooks. The strategies include using various resources and providing a variety of feedback opportunities for students. A sample science investigation and an accompanying…

  8. Improving the public understanding of science: New initiatives.

    PubMed

    Scotchmoor, Judy; Thanukos, Anastasia; Potter, Sheri

    2009-10-01

    The United States may be on the brink of losing its global edge in science. Many American students are underprepared for and uninterested in the scientific and technical careers they may be asked to take on. Furthermore, these students, their teachers, and the broader public lack basic understandings of what science is and how it works, which may negatively impact their ability to make reasoned and informed decisions about science-related issues. We describe two unique and recently developed projects designed to help tackle these problems by improving public understanding of and interest in science. The Coalition on the Public Understanding of Science is a grassroots effort to lower the barriers between the scientific community and the public. It aims to inspire broad appreciation of science, inform the public about the nature and process of science, and make science accessible to everyone. Understanding Science is a web-based project that aims to improve teacher understanding of the nature of the scientific enterprise, to provide resources that encourage and enable kindergarten through undergraduate (K-16) teachers to reinforce the nature of science throughout their teaching, and to serve as a clear and accessible reference that accurately portrays the scientific endeavor. The botanical and broader scientific communities are invited to participate in these efforts.

  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. Understanding confidentiality and disclosure of patient information.

    PubMed

    Griffith, Richard

    2007-11-01

    The need to share information about patients is vital to effective care and protection, especially where it relates to children or vulnerable adults. District nurses in common with other health professionals are often reluctant to share information because of a misunderstanding over the extent of their duty of confidence to patients. This has resulted in the needs of patients being unmet and in some cases tragic deaths have occurred. In this article Richard Griffith outlines the extent of the district nurses duty of confidence and considers when sharing patient information is lawful.

  11. A model for improving cancer patient education.

    PubMed

    Fredette, S L

    1990-08-01

    Adjustment to cancer requires modification of behavior that may be aided through patient education. Numerous programs have been developed to meet this need; however, studies show that even after being taught, patients are not well informed. It seems that the process of educating cancer patients needs to be improved. Authors suggest a progression of psychosocial stages of adjustment to serious illness during which specific behaviors are exhibited and coping mechanisms utilized. Understanding the nature of this process forms the basis for effective patient education since theories of adaptation describe behaviors that impact on motivation to learn, information required, and teaching methodology. Failure to attend to this variable of emotional response to the disease can prevent learning. This article integrates the theories of Weisman, Crate, Engle, and Kubler-Ross into an educational model for the cancer patient consisting of six periods. The model suggests nursing approaches, educational topics, and teaching strategies based on the patient's behavioral responses. Use of this model can improve teaching effectiveness in clinical practice by ensuring that the patient is ready to learn prior to teaching and by utilizing teaching strategies appropriate to the educational period. It can further be used as a tool to teach students of nursing how to use the stages of adjustment to chronic illness when planning patient teaching.

  12. Understanding and Improving Knowledge Transactions in Command and Control

    DTIC Science & Technology

    2003-06-01

    6310 Greenwich Dr., Suite 200, San Diego, CA 92122 Fax: (858) 535-1665 ramoore@pacific-science.com hors: ald A. Moore1, Janel H. Schermerhorn ...Understanding and Improving K ald A. Moore, Janel H. Schermerhorn , Heath 6310 Greenwich Dr., Suite 200, San Diego, CA 92 Phone: (858) 535 , jscherm@pacific...Naval Research (ONR Introduction For example, sources must ions must be quickly and fully support als and teams produced and ent tasks and

  13. Toward understanding the patient's perception of quality.

    PubMed

    Carson, P P; Carson, K D; Roe, C W

    1998-03-01

    Patients often don't have the technical competence to judge the quality of medical care. Therefore, they rely on different criteria than do professionals in assessing quality. They perceive quality as a gestalt of experiences influenced by such issues as empathy, integrity, and appearance of competency. Patients do not complain about service quality when it is appropriately provided. But to satisfy the consumer, providers must go beyond being reliable, polite, and honest. They must provide prompt services, be approachable, and provide individualized attention. To ultimately delight consumers, however, providers must meet the unarticulated needs of the patient.

  14. Understanding and managing patients with chronic pain.

    PubMed

    Szumita, Richard P; Szumita, Paul M; Just, Nancy

    2010-11-01

    The specialty of oral and maxillofacial surgery has had at its core the foundations of anesthesia and pain and anxiety control. This article attempts to refamiliarize the reader with clinical pearls helpful in the management of patients with chronic pain conditions. The authors also hope to highlight the interplay of chronic pain and psychology as it relates to the oral and maxillofacial surgery patient. To that end, the article outlines and reviews the neurophysiology of pain, the definitions of pain, conditions encountered by the oral and maxillofacial surgeon that produce chronic pain, the psychological impact and comorbidities associated with patients experiencing chronic pain conditions, and concepts of multimodal treatment for patients experiencing chronic pain conditions.

  15. Understanding taste dysfunction in patients with cancer.

    PubMed

    McLaughlin, Laura; Mahon, Suzanne M

    2012-04-01

    Taste dysfunction is a significant but underestimated issue for patients with cancer. Impaired taste results in changes in diet and appetite, early satiety, and impaired social interactions. Nurses can play a key role in educating patients and families on the pathophysiology of taste dysfunction by suggesting interventions to treat the consequences of taste dysfunction, when available, and offering psychosocial support as patients cope with this often devastating consequence of treatment. Taste recognition helps humans identify the nutritional quality of food and signals the digestive tract to begin secreting enzymes. Spoiled or tainted foods typically are recognized by their bad taste. Along with the other sensory systems, taste is crucial for helping patients treated for cancer feel normal. This article will review the anatomy and physiology of taste; define the different types of taste dysfunction, including the underlying pathophysiologic basis related to cancer treatment; and discuss potential nursing interventions to manage the consequences of taste dysfunction.

  16. 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

  17. 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

  18. Understanding and improving global crop response to ozone pollution.

    PubMed

    Ainsworth, Elizabeth A

    2017-06-01

    Concentrations of ground-level ozone ([O3 ]) over much of the Earth's land surface have more than doubled since pre-industrial times. The air pollutant is highly variable over time and space, which makes it difficult to assess the average agronomic and economic impacts of the pollutant as well as to breed crops for O3 tolerance. Recent modeling efforts have improved quantitative understanding of the effects of current and future [O3 ] on global crop productivity, and experimental advances have improved understanding of the cellular O3 sensing, signaling and response mechanisms. This work provides the fundamental background and justification for breeding and biotechnological approaches for improving O3 tolerance in crops. There is considerable within-species variation in O3 tolerance in crops, which has been used to create mapping populations for screening. Quantitative trait loci (QTL) for O3 tolerance have been identified in model and crop species, and although none has been cloned to date, transcript profiling experiments have identified candidate genes associated with QTL. Biotechnological strategies for improving O3 tolerance are also being tested, although there is considerable research to be done before O3 -tolerant germplasm is available to growers for most crops. Strategies to improve O3 tolerance in crops have been hampered by the lack of translation of laboratory experiments to the field, and the lack of correlation between visual leaf-level O3 damage and yield loss to O3 stress. Future efforts to screen mapping populations in the field and to identify more promising phenotypes for O3 tolerance are needed. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

  19. 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.

  20. Improving patient safety: just do it!

    PubMed

    Etchells, E; Bernstein, M

    2001-01-01

    Clinicians must celebrate and study medical errors. The dark culture of blame must be replaced by a scholarly culture of safety. This commentary presents six cases that show what we can learn from errors. The first step to identifying and understanding patient safety problems is to develop a common language for discussing patient safety. Latent unsafe conditions are ongoing circumstances of daily practice that reduce the safety of patients. An error is the failure ofa planned action to be completed as intended (error of execution), or the use of a wrong plan to achieve an aim (error of planning). Errors can be intercepted by appropriate action that minimizes the threat to patient safety. An adverse event is any unintended result of medical treatment that results in prolonged hospital stay, morbidity or mortality. If an adverse event is caused by an error, or series of errors, then it is a preventable adverse event. The teaching hospital is the first place where students (physicians, nurses, pharmacists and all other disciplines) are exposed to the culture of healthcare. It is essential to expose students to a culture of safety early in their training. Clinicians can make safety an academically important activity. Clinicians will find it difficult to undertake major safety initiatives given the existing constraints on time and energy. Although clinicians can identify the safety problems,there must also be a commitment to understand safety problems and make improvements. It is strongly recommended that hospitals train, implement and support Patient Safety Consultation Teams.

  1. Understanding motivation to enhance patient compliance.

    PubMed

    Wilkinson, J

    Motivation as a psychological concept is important in health care because frequently good care is dependent on the motivation of the patient, his/her family and the practitioners within the healthcare team. In addition, nurses need to be motivated to keep up to date with professional developments. This article describes George Kelly's framework of motivation and suggests recommendations to enhance practice in this area. The main conclusion is that although external determinants can encourage a person to engage in a particular activity the most effective kind of motivation is that which is internally mediated.

  2. 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

  3. Incongruence between nurses' and patients' understandings and expectations of rehabilitation.

    PubMed

    Pryor, Julie; O'Connell, Beverly

    2009-06-01

    To explore nurses' understandings and expectations of rehabilitation and nurses' perceptions of patients' understandings and expectations of rehabilitation. Within the context of a broadening appreciation of the benefits of rehabilitation, interest in the nature of rehabilitation is growing. Some believe that rehabilitation services do not adequately meet the needs of patients. Others are interested in the readiness of patients to participate in rehabilitation. Qualitative. Grounded theory using data collected during interviews with nurses in five inpatient rehabilitation units and during observation of the nurses' everyday practice. According to nurses working in inpatient rehabilitation units, there is a marked incongruence between nurses' understandings and expectations of rehabilitation and what they perceive patients to understand and expect. Given these different understandings, an important nursing role is the education of patients about the nature of rehabilitation and how to optimise their rehabilitation. Before patients are transferred to rehabilitation, the purpose and nature of rehabilitation, in particular the roles of patients and nurses, needs to be explained to them. The understandings of rehabilitation that nurses in this study possessed provide a framework for the design of education materials and orientation programmes that inform patients (and their families) about rehabilitation. In addition, reinforcement of the differences between acute care and rehabilitation will assist patients new to rehabilitation to understand the central role that they themselves can play in their recovery.

  4. Assessing and Improving Student Understanding of Tree-Thinking

    NASA Astrophysics Data System (ADS)

    Kummer, Tyler A.

    Evolution is the unifying theory of biology. The importance of understanding evolution by those who study the origins, diversification and diversity life cannot be overstated. Because of its importance, in addition to a scientific study of evolution, many researchers have spent time studying the acceptance and the teaching of evolution. Phylogenetic Systematics is the field of study developed to understand the evolutionary history of organisms, traits, and genes. Tree-thinking is the term by which we identify concepts related to the evolutionary history of organisms. It is vital that those who undertake a study of biology be able to understand and interpret what information these phylogenies are meant to convey. In this project, we evaluated the current impact a traditional study of biology has on the misconceptions students hold by assessing tree-thinking in freshman biology students to those nearing the end of their studies. We found that the impact of studying biology was varied with some misconceptions changing significantly while others persisted. Despite the importance of tree-thinking no appropriately developed concept inventory exists to measure student understanding of these important concepts. We developed a concept inventory capable of filling this important need and provide evidence to support its use among undergraduate students. Finally, we developed and modified activities as well as courses based on best practices to improve teaching and learning of tree-thinking and organismal diversity. We accomplished this by focusing on two key questions. First, how do we best introduce students to tree-thinking and second does tree-thinking as a course theme enhance student understanding of not only tree-thinking but also organismal diversity. We found important evidence suggesting that introducing students to tree-thinking via building evolutionary trees was less successful than introducing the concept via tree interpretation and may have in fact introduced or

  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. An evaluation of a training placement in general practice for paramedic practitioner students: improving patient-centred care through greater interprofessional understanding and supporting the development of autonomous practitioners.

    PubMed

    Ruston, Annmarie; Tavabie, Abdol

    2011-01-01

    To report the extent to which the placement of paramedic practitioner students (PPSs) in accredited general practice (GP) training practices supported their development as autonomous, patient-centred practitioners and fostered interprofessional learning. A case study method was used. Sources of data included semi-structured telephone interviews (eight PPSs, eight GP trainers), an online end of placement survey and placement and assessment documentation. Interview data were transcribed and analysed using the constant comparative method. Accredited training practices in South East England. All respondents were positive that the placement provided a high-quality interprofessional learning environment which provided PPSs with learning opportunities based on assessed need, the support of experienced trainers and access to a wide range of patients and learning situations. The placement enabled PPSs to acquire the appropriate skills, knowledge and understanding to act as autonomous, patient-centred practitioners. The placement provides a sound model for expanding the skills of paramedic practitioners in order to meet the increasing demands for patient-centred, community based health care. It provided them with the skills to treat patients closer to home rather than automatically transporting them to hospital.

  7. Improving patient safety in haemodialysis

    PubMed Central

    Bray, Benjamin D.; Metcalfe, Wendy

    2015-01-01

    Thomas Inman (1820–76) wrote ‘Practice two things in your dealings with disease: either help or do not harm the patient’, echoing writings from the Hippocratic school. The challenge of practicing safely with the avoidance of complications or harm is perhaps only heightened in the context of modern medical settings such as the haemodialysis unit where complex interventions and treatment are routine. The current issue of CKJ reports two studies aimed at improving the care of haemodialysis patients targeting early use of arteriovenous grafts as access for haemodialysis and the implementation of a dialysis checklist to ensure the prescribed dialysis treatment is delivered. The further challenge of ensuring that such evidence-based tools are used appropriately and consistently falls to all members of the clinical team. PMID:26034585

  8. Multivariate analyses to improve understanding of NAPL pollutant sources

    SciTech Connect

    Powers, S.E.; Villaume, J.F.; Ripp, J.A.

    1997-09-01

    Current site assessment techniques do not always generate adequate information regarding the presence, type, or distribution of nonaqueous phase liquids (NAPLs) at sites with ground water contamination. Without this information, however, the design of remediation methods is uncertain, often resulting in costly and/or failed attempts to minimize risks associated with the contamination. In this work, it is proposed that a thorough multivariate analysis of data from ground water sampling efforts could improve one`s overall understanding of these sites. Multivariate analyses can provide considerable insight into the contaminant source characteristics by elucidating correlations in ground water concentrations that identify recurring chemical patterns or signatures. These correlations are related to the type of NAPL and proximity to the contaminant source. Multivariate plots and a principal components analysis (PCA) are used to interpret ground water data from a manufactured gas plant site in Iowa contaminated with both gasoline and coal tar.

  9. 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

  10. Improving Students' Understanding of Lock-In Amplifiers

    NASA Astrophysics Data System (ADS)

    DeVore, Seth; Gauthier, Alexandre; Levy, Jeremy; Chandralekha, Singh

    2014-03-01

    A lock-in amplifier is a versatile instrument frequently used in physics research. However, many students struggle with the basic operating principles of a lock-in amplifier which can lead to a variety of difficulties. To improve students' understanding, we have been developing and evaluating a research-based tutorial which makes use of a computer simulation of a lock-in amplifier. The tutorial is based on a field-tested approach in which students realize their difficulties after predicting the outcome of simulated experiments involving a lock-in amplifier and check their predictions using the simulated lock-in amplifier. Then, the tutorial guides and helps students develop a coherent understanding of the basics of a lock-in amplifier. The tutorial development involved interviews with physics faculty members and graduate students and iteration of many versions of the tutorial with professors and graduate students. The student difficulties and the development and assessment of the research-based tutorial are discussed. We thank National Science Foundation for award NSF-1124131.

  11. Patient adherence improves glycemic control.

    PubMed

    Rhee, Mary K; Slocum, Wrenn; Ziemer, David C; Culler, Steven D; Cook, Curtiss B; El-Kebbi, Imad M; Gallina, Daniel L; Barnes, Catherine; Phillips, Lawrence S

    2005-01-01

    The purpose of this study was to assess the influence of appointment keeping and medication adherence on HbA1c. A retrospective evaluation was performed in 1560 patients with type 2 diabetes who presented for a new visit to the Grady Diabetes Clinic between 1991 and 2001 and returned for a follow-up visit and HbA1c after 1 year of care. Appointment keeping was assessed by the number of scheduled intervening visits that were kept, and medication adherence was assessed by the percentage of visits in which self-reported diabetes medication use was as recommended at the preceding visit. The patients had an average age of 55 years, body mass index (BMI) of 32 kg/m2, diabetes duration of 4.6 years, and baseline HbA1c of 9.1%. Ninety percent were African American, and 63% were female. Those who kept more intervening appointments had lower HbA1c levels after 12 months of care (7.6% with 6-7 intervening visits vs 9.7% with 0 intervening visits). Better medication adherence was also associated with lower HbA1c levels after 12 months of care (7.8% with 76%-100% adherence). After adjusting for age, gender, race, BMI, diabetes duration, and diabetes therapy in multivariate linear regression analysis, the benefits of appointment keeping and medication adherence remained significant and contributed independently; the HbA1c was 0.12% lower for every additional intervening appointment that was kept (P = .0001) and 0.34% lower for each quartile of better medication adherence (P = .0009). Keeping more appointments and taking diabetes medications as directed were associated with substantial improvements in HbA1c. Efforts to enhance glycemic outcomes should include emphasis on these simple but critically important aspects of patient adherence.

  12. Combinatorial mutagenesis and selection to understand and improve yeast promoters.

    PubMed

    Berg, Laila; Strand, Trine Aakvik; Valla, Svein; Brautaset, Trygve

    2013-01-01

    Microbial promoters are important targets both for understanding the global gene expression and developing genetic tools for heterologous expression of proteins and complex biosynthetic pathways. Previously, we have developed and used combinatorial mutagenesis methods to analyse and improve bacterial expression systems. Here, we present for the first time an analogous strategy for yeast. Our model promoter is the strong and inducible P AOX1 promoter in methylotrophic Pichia pastoris. The Zeocin resistance gene was applied as a valuable reporter for mutant P AOX1 promoter activity, and we used an episomal plasmid vector to ensure a constant reporter gene dosage in the yeast host cells. This novel design enabled direct selection for colonies of recombinant cells with altered Zeocin tolerance levels originating solely from randomly introduced point mutations in the P AOX1 promoter DNA sequence. We demonstrate that this approach can be used to select for P AOX1 promoter variants with abolished glucose repression in large mutant libraries. We also selected P AOX1 promoter variants with elevated expression level under induced conditions. The properties of the selected P AOX1 promoter variants were confirmed by expressing luciferase as an alternative reporter gene. The tools developed here should be useful for effective screening, characterization, and improvement of any yeast promoters.

  13. Understanding Why Rheumatoid Arthritis Patient Treatment Preferences Differ by Race

    PubMed Central

    Constantinescu, Florina; Goucher, Suzanne; Weinstein, Arthur; Smith, Wally; Fraenkel, Liana

    2014-01-01

    Background Rheumatoid arthritis (RA) patient preferences may account for some of the variability in treatment amongst different racial groups. How and why treatment preferences differ by race is not well understood. We sought to determine whether Black and White RA patients differ in how they evaluate the specific risks and benefits related to medications. Methods 136 RA patients completed a conjoint analysis interactive computer survey to determine how they valued the specific risks and benefits related to treatment characteristics. We calculated the importance that respondents assigned to each characteristic and the ratio of the importance that patients attached to overall benefit versus overall risk. Subjects having a risk ratio of less than one were classified as being risk averse. Results The mean age of the study sample was 55 years (range 22–84), 49% were Black and 51% were White. Black subjects assigned the greatest importance to the risk of cancer, whereas White subjects were most concerned with the likelihood of remission and halting radiographic progression. Fifty-two percent of Black subjects were found to be risk averse compared to 12% of the White subjects (p<0.0001). Race remained strongly associated with risk aversion [adjusted odds ratio (95% CI) = 8.4 (3.1 – 23.1)] after adjusting for relevant covariates. Conclusions Black patients attach greater importance to the risks of toxicity and less importance to the likelihood of benefit than their White counterparts. Effective risk communication and improved understanding of expected benefits may help decrease unwanted variability in healthcare. PMID:19333986

  14. Understanding Patient, Provider, and System Factors Related to Medicaid Readmissions.

    PubMed

    Jiang, H Joanna; Boutwell, Amy E; Maxwell, James; Bourgoin, Angel; Regenstein, Marsha; Andres, Ellie

    2016-03-01

    Efforts on reducing hospital readmissions, which are intended to improve quality and reduce costs, tend to focus on elderly Medicare beneficiaries without recognition of another high-risk population--adult nonmaternal Medicaid patients. This study was undertaken to understand the complexity of Medicaid readmission issues at the patient, provider, and system levels. Multiple qualitative methods, including site visits to nine safety-net hospitals, patient/family/caregiver inter views, and semistructured interviews with health plans and state Medicaid agencies, were used in 2012 and 2013 to obtain information on patient, provider, and system issues related to Medicaid readmissions; strategies considered or currently used to address those issues; and any perceived financial, regulatory or, other policy factors inhibiting or facilitating readmission reduction efforts. Significant risk factors for Medicaid readmissions included financial stress, high prevalence of mental health and substance abuse disorders, medication nonadherence, and housing instability. Lacking awareness on Medicaid patients' high risk, a sufficient business case, and proven strategies for reducing readmissions were primary barriers for providers. Major hurdles at the system level included shortage of primary care and mental health providers, lack of coordination among providers, lack of partnerships between health plans and providers, and limited data capacity for realtime monitoring of readmissions. The intertwining of behavioral, socioeconomic, and health factors; the difficulty of accessing appropriate care in the outpatient setting; the lack of clear financial incentives for health care providers to reduce readmissions; and the fragmentation of the current health care system warrant greater attention and more concerted efforts from all stakeholders to reduce Medicaid readmissions.

  15. Assessing Community Leadership: Understanding Community Capacity for Health Improvement.

    PubMed

    Castle, Billie; Wendel, Monica; Kelly Pryor, Brandy N; Ingram, Monique

    The purpose of this study was to pilot a quantitative instrument to measure aspects of community leadership within an assessment framework. The instrument includes 14 Likert-type questions asking residents how they perceive leaders within 5 sectors: Louisville Metro Council/Mayor's Office, the faith community, education, business, and the civic sector. Louisville/Jefferson County, Kentucky, has a population of about 743 000 residents. Respondents were asked to examine leadership within West Louisville, an economically deprived area of the city made up of 9 contiguous neighborhoods. This area is predominantly African American (78% compared with 22% in Louisville Metro), with an overall poverty rate of 43% (compared with 18% in Louisville Metro), and unemployment rate of 23% (compared with 8% in Louisville Metro). Residents of West Louisville are looking to leadership to address many of the inequities. Twenty-seven participants representing 7 community sectors completed the survey, of whom 90% work in West Louisville. The instrument measured local perceptions of leadership strength, effectiveness, trust, communication, community building, and leadership development. The majority of respondents agree that strong leadership exists across the 5 sectors, with variation regarding perceptions of the quality of that leadership. City leadership within the Mayor's Office and Metro Council is largely viewed positively, while the growing tensions within the education sector were reflected in the survey results. The perception of community leadership is important to understanding local community capacity to improve health and also inclusivity of community voice in the assessment and community improvement processes. Results from such assessments can offer useful information for strengthening community capacity and sustaining relationships needed to enact progressive and equitable solutions to address local issues. Leaders in a variety of settings can utilize this instrument to

  16. Understanding the distributed cognitive processes of intensive care patient discharge.

    PubMed

    Lin, Frances; Chaboyer, Wendy; Wallis, Marianne

    2014-03-01

    To better understand and identify vulnerabilities and risks in the ICU patient discharge process, which provides evidence for service improvement. Previous studies have identified that 'after hours' discharge and 'premature' discharge from ICU are associated with increased mortality. However, some of these studies have largely been retrospective reviews of various administrative databases, while others have focused on specific aspects of the process, which may miss crucial components of the discharge process. This is an ethnographic exploratory study. Distributed cognition and activity theory were used as theoretical frameworks. Ethnographic data collection techniques including informal interviews, direct observations and collecting existing documents were used. A total of 56 one-to-one interviews were conducted with 46 participants; 28 discharges were observed; and numerous documents were collected during a five-month period. A triangulated technique was used in both data collection and data analysis to ensure the research rigour. Under the guidance of activity theory and distributed cognition theoretical frameworks, five themes emerged: hierarchical power and authority, competing priorities, ineffective communication, failing to enact the organisational processes and working collaboratively to optimise the discharge process. Issues with teamwork, cognitive processes and team members' interaction with cognitive artefacts influenced the discharge process. Strategies to improve shared situational awareness are needed to improve teamwork, patient flow and resource efficiency. Tools need to be evaluated regularly to ensure their continuous usefulness. Health care professionals need to be aware of the impact of their competing priorities and ensure discharges occur in a timely manner. Activity theory and distributed cognition are useful theoretical frameworks to support healthcare organisational research. © 2013 John Wiley & Sons Ltd.

  17. Using Quality Improvement Methods to Improve Patient Experience.

    PubMed

    Jensen, Jeff D; Allen, Lisa; Blasko, Robert; Nagy, Paul

    2016-12-01

    Patient experience is an important component of the overall medical encounter. This paper explores how patient experience is measured and its role in radiology, including its impact on clinical outcomes and reimbursement. Although typically applied to safety and clinical outcomes, quality improvement methodology can also be used to drive improvement efforts centered on patient experience. Applying an established framework for patient-centered care to radiology, this paper provides a number of examples of projects that are likely to yield significant improvement in patient satisfaction measures. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  18. Terminology matters: patient understanding of "opioids" and "narcotics".

    PubMed

    Wallace, Lorraine S; Keenum, Amy J; Abdurraqeeb, Obaydah; Miser, William F; Wexler, Randy K

    2013-02-01

     The terms "opioid" and "narcotic" are often used interchangeably by healthcare providers. The purpose of this study was to compare understanding "narcotics" vs. "opioids."  A convenience sample of English-speaking women (n = 188), aged 21-45 years, seeking care at a primary care clinic were asked (1) "What is an opioid/narcotic?" (2) "Give an example of an opioid/narcotic?" (3) "Why does someone take an opioid/narcotic?" and (4) "What happens when someone takes an opioid/narcotic for a long time?" Responses were recorded verbatim by a research assistant and then coded independently by two investigators.  More than half of respondents (55.9%) responded "don't know" to all 4 opioid questions, while just 3.2% responded "don't know" to all 4 narcotic questions (P < 0.01). Most women were unfamiliar with the term opioid (76.3%) and did not know why someone would take an opioid (68.8%). About two-thirds of respondents were able to give an example of a narcotic (64.2%) and knew the consequences of long-term narcotic use (63.2%).  While more women were more familiar with narcotic, many identified negative connotations with this term. Future research should explore how to improve patient understanding and attitudes regarding both the terms opioids and narcotics. © 2012 The Authors. Pain Practice © 2012 World Institute of Pain.

  19. Myelodysplastic syndromes: challenges to improving patient and caregiver satisfaction.

    PubMed

    Smith, B Douglas

    2012-07-01

    The task of improving patient and caregiver satisfaction in the management of myelodysplastic syndromes (MDS) poses many challenges for physicians and patient care teams. Advances in the understanding of MDS biology have resulted in the approval of 3 agents for the treatment of MDS by the US Food and Drug Administration (FDA) in the past decade. However, according to a retrospective physician survey, the majority of recently diagnosed patients with MDS still receive supportive care only. Interestingly, a survey performed in patients with MDS suggests that patient understanding of treatment goals and prognosis is often limited, with a third of patients reporting that prognosis was not discussed with their physician. Efforts to improve patient awareness of their disease severity and establishing clear treatment goals are crucial for setting up an individualized treatment plan and ensuring optimal patient and caregiver satisfaction.

  20. 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.

  1. 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.

  2. Researchers' Roles in Patient Safety Improvement.

    PubMed

    Pietikäinen, Elina; Reiman, Teemu; Heikkilä, Jouko; Macchi, Luigi

    2016-03-01

    In this article, we explore how researchers can contribute to patient safety improvement. We aim to expand the instrumental role researchers have often occupied in relation to patient safety improvement. We reflect on our own improvement model and experiences as patient safety researchers in an ongoing Finnish multi-actor innovation project through self-reflective narration. Our own patient safety improvement model can be described as systemic. Based on the purpose of the innovation project, our improvement model, and the improvement models of the other actors in the project, we have carried out a wide range of activities. Our activities can be summarized in 8 overlapping patient safety improvement roles: modeler, influencer, supplier, producer, ideator, reflector, facilitator, and negotiator. When working side by side with "practice," researchers are offered and engage in several different activities. The way researchers contribute to patient safety improvement and balance between different roles depends on the purpose of the study, as well as on the underlying patient safety improvement models. Different patient safety research paradigms seem to emphasize different improvement roles, and thus, they also face different challenges. Open reflection on the underlying improvement models and roles can help researchers with different backgrounds-as well as other actors involved in patient safety improvement-in structuring their work and collaborating productively.

  3. 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

  4. Geophysical Methods for Improved Understanding of Managed Aquifer Recharge (Invited)

    NASA Astrophysics Data System (ADS)

    Pidlisecky, A.; Nenna, V.; Knight, R. J.

    2013-12-01

    Managed aquifer recharge is increasingly being used as a means of augmenting groundwater supplies. With the increased use, questions arise regarding the suitability of sites for such operations, as well as the operational efficiency of these systems. In this work we specifically look at MAR using an artificial recharge pond. There are two operational challenges commonly faced in artificial recharge ponds: 1) A decrease in infiltration rate of water into the subsurface during operating; this limits the amount of stored water. 2) Low recovery rates of the stored water. Addressing both of these challenges requires sufficient information about the spatial and temporal variation in governing hydrologic properties and processes. Geophysical methods provide a novel way of obtaining such information from the region beneath a recharge pond. A study of the Harkins Slough Recharge Pond, near Watsonville California, presented a unique opportunity to develop and test geophysical methods, specifically for improved understanding off MAR. At this site we deployed a series of geophysical sensors aimed at addressing the two operational challenges at the site. We first addressed the question: What is controlling the decrease in filtration rate? The development and installation of electrical conductivity probes beneath the pond allowed us to monitor changes in the top ~1 m over a 4-month period. This dataset revealed that clogging in the top ~10 cm was responsible for the decreased infiltration rate. These 1D data were augmented by a time-lapse 2D ERT dataset that shows significant lateral variability in infiltration at the site. The second question we addressed was: Why is the recovery rate so low? Using a combination of cone-penetrometer testing and seismic reflection data, we developed a subsurface model that suggested there was a thin clay layer that may be impeding the flow of water to the recovery wells. To further understand this, we developed electrical conductivity probes

  5. Self-care instructions: do patients understand educational materials?

    PubMed

    Wong, M

    1992-02-01

    As health care providers we are not in a position to teach reading. We do, however, have a legal and an ethical obligation to provide patients with self-care instructions they can understand. Because the methods presented for enhancing patient understanding of self-care instructions are relatively new, and because nurses are just beginning to be aware of the need for such interventions, it will be a while before the ideal situation exists. Ideally, each pamphlet or set of instructions would be coded with the reading grade level needed to understand it and each patient's reading level would be recorded in the chart. Under such "perfect" circumstances it would be easy for nurses to provide patients with instructions at the appropriate reading level. For now, any step that nurses take toward making self-care a reality for patients who read poorly is a step in the right direction. People with poor reading skills are less adept at formulating questions than good readers because they lack vocabulary and the ability to analyze written material. Rather than be regarded as stupid, many choose not to verbalize their lack of understanding. This phenomenon puts a large group of patients at risk for health complications related to inadequate understanding of self-care directions.

  6. Understanding and projecting sea level change: improvements and uncertainties (Invited)

    NASA Astrophysics Data System (ADS)

    Church, J. A.; Clark, P. U.; Cazenave, A. A.; Gregory, J. M.; Jevrejeva, S.; Merrifield, M. A.; Milne, G. A.; Nerem, R.; Payne, A. J.; Pfeffer, W. T.; Stammer, D.; Levermann, A.; Nunn, P.; Unnikrishnan, A. S.

    2013-12-01

    The rate of global mean sea level rise (GMSLR) has accelerated during the last two centuries, from a rate of order tenths of mm yr-1 during the late Holocene, to about 1.7 mm yr-1 since 1901. Ocean thermal expansion and glacier melting were the dominant contributors to 20th century GMSLR, with relatively small contributions from the Greenland and Antarctic ice sheets. Process-based models suggest that the larger rate of rise since 1990 results from increased radiative forcing (both natural and anthropogenic) and increased ice-sheet outflow, induced by warming of the immediately adjacent ocean. Confidence in projections of global mean sea level rise has increased since the AR4 because of improved physical process-based understanding of observed sea level change, especially in recent decades, and the inclusion of future rapid ice-sheet dynamical changes, for which a quantitative assessment could not be made on the basis of scientific knowledge available at the time of the AR4. By 2100, the rate of GMSLR for a scenario of high emissions (RCP8.5) could approach the average rates that occurred during the last deglaciation, whereas for a strong emissions mitigation scenario (RCP2.6) it could stabilise at rates similar to those of the early 21st century. In either case, GMSLR will continue for many subsequent centuries. Although there has been much recent progress, projections of ice-sheet change are still uncertain, especially beyond 2100. Future sea level change will not be globally uniform, but models still exhibit substantial disagreement in projections of ice mass loss and ocean dynamics, which are the main influences on the pattern. Uncertainty in projections of future storminess is a further obstacle to confident projection of changes in sea level extremes.

  7. Improving predictive certainty and system understanding with watershed hydrology models

    NASA Astrophysics Data System (ADS)

    Kelleher, C.; McGlynn, B. L.; Wagener, T.

    2015-12-01

    Modeling at the intersection of climate variability and hydrology is complicated by uncertainties that make predicting physical behavior a challenge. Environmental models used to simulate how climate will impact hydrology are typically complex, demand many spatial and temporal data inputs, contain numerous parameters, and can be computationally expensive. Distributed models in particular complicate the assessment of how uncertainty in the model framework, inputs, parameters, and observations impact predictive uncertainty. In addition, future climate perturbations may alter the magnitude of these uncertainties. Here, we focus on model parameters as a key source of uncertainty. Identifying those model parameters that most influence the predictions at a particular place can reduce a complex, multidimensional problem to a simpler form. We demonstrate how sensitivity analysis in the absence of observational streamflow can be used to identify sensitive model parameters by conditioning a model on climate data and a priori parameter ranges. We apply this approach to five headwater catchments in the Tenderfoot Creek Experimental Forest located in central Montana using the Distributed Hydrology-Soil-Vegetation Model. Across these five sub-catchments, climate clearly organizes parameter sensitivities. To further explore the relationship between parameter sensitivities and climate, we assess how parameter sensitivities change when meteorological forcing data is perturbed to reflect natural variability at the site. This general approach can support uncertainty reduction. However, parameter equifinality will still impact finer scale predictions of any environmental variable in space and time. As such, improving our certainty in environmental predictions should evaluate point predictions as well as simulations of internal catchment behavior, and must not only rely on our use of computational methods but on our basic understanding of system functioning.

  8. Nurses' understanding influences comprehension of patients admitted in the observation unit.

    PubMed

    Desme, Aline; Mendes, Nathalie; Perruche, Franck; Veillard, Elsa; Elie, Caroline; Moulinet, Françoise; Sanson, Fabienne; Georget, Jean-Michel; Tissier, Anne; Pourriat, Jean-Louis; Claessens, Yann-Erick

    2013-01-01

    Comprehension is poor in patients admitted in the emergency observation unit. Teamwork communication gaps could contribute to patients' misunderstanding of their health condition. To determine in patients admitted in the emergency observation unit whether comprehension of diagnosis, prognosis, and management depended on nurses' comprehension, the authors conducted a prospective observational study in a busy adult emergency department of a tertiary teaching hospital in Paris over 2 months. Consecutive patients admitted in the emergency observation unit were included. Patients' and nurses' comprehension of diagnosis, prognosis, and management was compared with the statements of the emergency department attending physicians for these items. The authors observed whether patients' misunderstanding was associated with nurses' misunderstanding. A total of 544 patients were evaluated. For each patient, nurses' and patients' comprehension was available. Patients understood severity in 40%, organ involved in 69%, medical wording in 57%, reason for admission in 48%, and discharge instruction in 67%. In comparison with patients, nurses better understood each item except for discharge instruction. The authors observed that patients' comprehension was better when nurses understood diagnosis (p <.0001), reasons for admission (p =.032) and discharge instructions (p =.002). Nurses' understanding of severity did not modify patients' comprehension. These results support the conclusions that communication gaps in teamwork alter patients' comprehension and that nurses' and patients' misunderstandings are associated. Therefore, improving communication by nurses and physicians to patients may improve patients' understanding.

  9. 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…

  10. The extent of patients' understanding of the risk of treatments

    PubMed Central

    Lloyd, A

    2001-01-01

    The scientific understanding of how people perceive and code risks and then use this information in decision making has progressed greatly in the last 20 years. There is considerable evidence that people employ simplifying heuristics in judgement and decision making. These heuristics may lead to bias in how people interpret information. However, much of our understanding of risk perception is based on laboratory studies. It is much less clear whether risk perception in the real world (as in the case of medical treatments) exhibits the same patterns and biases. This paper reviews the published literature on risk perception in patients who face substantial treatment risks. It examines how accurate patients' perception of risk is, what factors affect the perception of risk, and several possible explanations for why patients' risk perception is not always accurate. Key Words: patient preference; risk; informed choice; decision making; patient-caregiver communication PMID:11533432

  11. Improving oral hygiene for patients.

    PubMed

    Bonetti, Debbie; Hampson, Victoria; Queen, Kerry; Kirk, Donna; Clarkson, Jan; Young, Linda

    2015-01-13

    Systematic reviews and patient safety initiatives recommend that oral hygiene should be part of routine patient care. However, evidence suggests it is often neglected in hospitals and care homes. Research recommends encouraging beliefs that support oral hygiene, and teaching nurses appropriate skills, as necessary prerequisites to implementing best practice in hospital wards. This article describes a pilot study of an educational workshop on oral hygiene. Results from the pilot study suggest that this workshop is a feasible intervention for a service-wide trial. The literature suggests that other interventions are required to complement this approach if nurses are to make oral hygiene a priority in daily patient care.

  12. Understanding and improving the toughening mechanisms in silicon carbide ceramics

    NASA Astrophysics Data System (ADS)

    Kueck, Aaron Michael

    In order to enhance the utility of advanced silicon carbide materials for use in mechanically demanding environments, this study was conducted to understand the underlying mechanisms of fracture toughness and methods that promise to improve the toughness to acceptable levels. Silicon carbide was sintered using both pressureless and hot pressing methods, with an additive system consisting of 3 wt% Al, 0.6 wt% B, 2 wt% C (designated 3ABC-SiC), with some materials also using the rare earth (RE) additives La, Y, or Yb. The RE dopants were used to decorate the grain boundary phases typically found in liquid-phase-sintered ceramics such as SiC in order to evaluate both the mechanism of crack deflection and the role of these additives in determining the fracture behavior. Using a two-step process to create high density in pressureless-sintered 3ABC-SiC, it was found that the action of nitrogen and the necessarily long sintering times altered both the morphology of the grains and the nature of the grain boundary phase. These changes did not create a favorable situation for crack deflection and enhanced fracture toughness; therefore the pressureless-sintered 3ABC-SiC maintained a low value of toughness. Using hot-pressed 3ABC-SiC with RE additives, it was found that cracks are deflected along the interface between the grain boundary phase and the SiC grains. This process can be described by the He & Hutchinson model for crack deflection at an interface, and is dependent on several important mechanical parameters of the grain boundary phase: the stiffness of the phase and the toughness of its interface with the matrix grains. It was shown that these parameters change with the size of the RE ion added in such a way that large ions favor crack deflection---high toughness---and small ions favor crack penetration through the interface---low toughness. This behavior is seen empirically over many studies. It was also found that the yttrium additive system could display extensive

  13. Improving Spiritual Well-Being in Patients with Lung Cancers

    PubMed Central

    Piderman, Katherine M.; Euerle, Terin T.; Frost, Marlene H.; Novotny, Paul J.; Rausch Osian, Sarah M.; Nes, Lise Solberg; Patten, Christi A.; Sloan, Jeff A.; Rummans, Teresa A.; Bronars, Carrie A.; Yang, Ping; Clark, Matthew M.

    2016-01-01

    Patients with lung cancer report more disease burden and lower spiritual well-being (SWB) compared with other cancer patients. Understanding variables that lessen disease burden and improve SWB is essential. The aim of this study was to explore the relationship between motivational level for physical activity and SWB in patients with lung cancer. Linear regression showed increased SWB as stage of change for physical activity increased (p<0.0001), even after adjusting for multiple demographic variables. PMID:26463853

  14. Bedside Reporting: Protocols for Improving Patient Care.

    PubMed

    Ferguson, Teresa D; Howell, Teresa L

    2015-12-01

    Bedside reporting continues to gain much attention and is being investigated to support the premise that "hand-off" communications enhance efficacy in delivery of patient care. Patient inclusion in shift reports enhances good patient outcomes, increased satisfaction with care delivery, enhanced accountability for nursing professionals, and improved communications between patients and their direct care providers. This article discusses the multiple benefits of dynamic dialogue between patients and the health care team, challenges often associated with bedside reporting, and protocols for managing bedside reporting with the major aim of improving patient care. Nursing research supporting the concept of bedside reporting is examined.

  15. 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. © The Author(s) 2015.

  16. Giving Doctors' Daily Progress Notes to Hospitalized Patients and Families to Improve Patient Experience.

    PubMed

    Weinert, Craig

    Hospital quality includes excellent physician-patient communication. The objective was to determine effects of distributing physicians' notes to patients. Hospitalized patients or family members on 6 wards at a university hospital received daily a printed copy of their medical team's progress note. Surveys were completed about the benefits and adverse effects of reading the physician notes. In all, 74% to 86% of patients or family members responded favorably that receiving doctors' notes improved understanding of their health condition or gave them more control over their hospital course. Patient concerns about privacy or offense were uncommon, although 16% thought notes were confusing or caused worry. Note distribution had minor effects on physician note writing practice. Having patients and family members read their physicians' progress notes is feasible and enhances patients' understanding of their diagnostic and treatment plan. Notes supplement traditional physician-patient verbal communication practice and have the potential to improve the hospitalized patient experience.

  17. What do patients want from their endoscopy experience? The importance of measuring and understanding patient attitudes to their care

    PubMed Central

    Tierney, M; Bevan, R; Rees, C J; Trebble, T M

    2016-01-01

    Understanding and addressing patient attitudes to their care facilitates their engagement and attendance, improves the quality of their experience and the appropriate utilisation of resources. Gastrointestinal endoscopy is a commonly performed medical procedure that can be associated with patient anxiety and apprehension. Measuring patient attitudes to endoscopy can be undertaken through a number of approaches with contrasting benefits and limitations. Methodological validation is necessary for accurate interpretation of results and avoiding bias. Retrospective post-procedure questionnaires measuring satisfaction are easily undertaken but have limited value, particularly in directing service improvements. Patient experience questionnaires indicate areas of poor care but may reflect the clinician's not the patient's perspective. Directly assessing patient priorities and expectations identifies what is important to patients in their healthcare experience (patient-reported value) that can also provide a basis for other forms of evaluation. Published studies of patient attitudes to their endoscopy procedure indicate the importance of ensuring that endoscopists and their staff control patient discomfort, have adequate technical skill and effectively communicate with their patient relating to the procedure and results. Environmental factors, including noise, privacy and the single-sex environment, are considered to have less value. There are contrasting views on patient attitudes to waiting times for the procedure. Implementing patient-centred care in endoscopy requires an understanding of what patients want from their healthcare experience. The results from available studies suggest implications for current practice that relate to the training and practice of the endoscopist and their staff. PMID:27429733

  18. Improving Patient Safety Event Reporting Among Residents and Teaching Faculty

    PubMed Central

    Louis, Michelle Y.; Hussain, Lala R.; Dhanraj, David N.; Khan, Bilal S.; Jung, Steven R.; Quiles, Wendy R.; Stephens, Lorraine A.; Broering, Mark J.; Schrand, Kevin V.; Klarquist, Lori J.

    2016-01-01

    Background: A June 2012 site visit report from the Accreditation Council for Graduate Medical Education Clinical Learning Environment Review revealed that residents and physicians at TriHealth, Inc., a large, nonprofit independent academic medical center serving the Greater Cincinnati area in Ohio, had an opportunity to improve their awareness and understanding of the hospital's system for reporting patient safety concerns in 3 areas: (1) what constitutes a reportable patient safety event, (2) who is responsible for reporting, and (3) how to use the hospital's current reporting system. Methods: To improve the culture of patient safety, we designed a quality improvement project with the goal to increase patient safety event reporting among residents and teaching faculty. An anonymous questionnaire assessed physicians' and residents' attitudes and experience regarding patient safety event reporting. An educational intervention was provided in each graduate medical education program to improve knowledge and skills related to patient safety event reporting, and the anonymous questionnaire was distributed after the intervention. We compared the responses to the preintervention and postintervention questionnaires and tracked monthly patient safety event reports for 1 year postintervention. Results: The number of patient safety event reports increased following the educational intervention; however, we saw wide variability in reporting per month. On the postintervention questionnaire, participants demonstrated improved knowledge and attitudes toward patient safety event reporting. Conclusion: The goal of this unique project was to increase patient safety event reporting by both residents and teaching faculty in 6 residency programs through education. We achieved this goal through an educational intervention tailored to the institution's new event reporting system delivered to each residency program. We clearly understand that improvements in quality and patient safety

  19. 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…

  20. 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…

  1. 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.…

  2. 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…

  3. Optimizing patient involvement in quality improvement.

    PubMed

    Armstrong, Natalie; Herbert, Georgia; Aveling, Emma-Louise; Dixon-Woods, Mary; Martin, Graham

    2013-09-01

    Patient and public involvement in healthcare planning, service development and health-related research has received significant attention. However, evidence about the role of patient involvement in quality improvement work is more limited. We aimed to characterize patient involvement in three improvement projects and to identify strengths and weaknesses of contrasting approaches. Three case study quality improvement projects were purposively sampled from a broader programme. We used an ethnographic approach involving 126 in-depth interviews, 12 weeks of non-participant observations and documentary analysis. Data analysis was based on the constant comparative method. The three projects differed in the ways they involved patients in their quality improvement work, including their rationales for including patients. We characterized three very different models of patient involvement, which were each influenced by project context. Patients played distinctive roles across the three projects, acting in some cases as intermediaries between the wider patient community and clinicians, and sometimes undertaking persuasive work to convince clinicians of the need for change. We identified specific strategies that can be used to help ensure that patient involvement works most effectively and that the enthusiasm of patients to make a difference is not dissipated. Patient involvement in quality improvement work needs careful management to realize its full potential. © 2013 John Wiley & Sons Ltd.

  4. Understanding depression in medical patients. Part I: Diagnostic considerations.

    PubMed

    Wool, M S

    1990-01-01

    Little attention has been devoted to integrating theoretical conceptions of depression when considering patients with medical illness. This is more true of the social work literature than the psychiatric, in which medical formulations and treatment of depression gain primary focus. This paper presents an approach for understanding the phenomenon of depression in medical patients. It incorporates a theoretical perspective on the mechanism of depression relevant to social work intervention. Topics reviewed include diagnostic criteria for depression in the medically ill, organic factors in depression, and psychosocial theory of depression applied to medical patients. A second part of this paper will provide case examples and recommendations for social work intervention.

  5. Understanding patients' preferences for treatment: the need for innovative methodologies

    PubMed Central

    Frewer, L; Salter, B; Lambert, N

    2001-01-01

    Treatment selection is now much more consumer driven than in the past. However, there is a need to develop investigative methodological approaches that are sensitive to differences in patient preferences if full account is to be taken of what the patient sees as the best option in terms of different possible treatments available for a particular condition. Previous attitude research has been criticised because it does not provide insight into reasons why people hold different preferences or beliefs. A methodology is described which allows people to describe their concerns and values associated with different treatment options in their own words. This is the repertory grid method of eliciting personal constructs used in conjunction with generalised Procrustes analysis (GPA). An example of the use of this methodology is provided, drawn from research directed towards understanding people's beliefs about genetic technologies. A possible application of the method to understanding treatment preferences related to type 2 diabetes is also discussed. It is concluded that the use of innovative methodologies is essential if our understanding of patient preferences regarding treatment options is to have a significant impact on patient quality of life. Key Words: patient preference; repertory grid method; diabetes PMID:11533439

  6. Ways to optimize understanding health related information: the patients' perspective.

    PubMed

    Heinrich, Carol; Karner, Karen

    2011-01-01

    Self-management of chronic illness is a high priority health care need of community dwelling elderly. Effective patient provider health communication related to health promotion, disease prevention, and disease management is a key intervention necessary to achieve optimal health outcomes. Little is known about the methods elderly patients actually use to help understand health related teaching by their health care providers. Focus groups were held to describe these ways from a patient's perspective. Facilitators of understanding were identified as persevere in getting questions answered, come prepared to office visit, and work to develop a good relationship with health care providers. Barriers were identified as not having questions answered lack of time with provider, hearing difficulty, and fragmented care. Copyright © 2011 Mosby, Inc. All rights reserved.

  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.

  8. 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,…

  9. 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…

  10. 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…

  11. 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…

  12. 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…

  13. Prognostic Understanding, Quality of Life, and Mood in Patients Undergoing Hematopoietic Stem Cell Transplantation

    PubMed Central

    El-Jawahri, Areej; Traeger, Lara; Kuzmuk, Kailyn; Eusebio, Justin; Vandusen, Harry; Keenan, Tanya; Shin, Jennifer; Gallagher, Emily R.; Greer, Joseph A.; Pirl, William F.; Jackson, Vicki A.; Ballen, Karen K; Spitzer, Thomas R.; Graubert, Timothy A.; McAfee, Steven; Dey, Bimalangshu; Chen, Yi-Bin A.; Temel, Jennifer S.

    2015-01-01

    Little is known about how patients undergoing stem cell transplantation (HCT) and their family caregivers (FC) perceive their prognosis. We examined prognostic understanding in patients undergoing HCT and their FC and its relationship with quality of life (QOL) and mood. We conducted a longitudinal study of patients (and FC) hospitalized for HCT. We used a questionnaire to measure participants’ prognostic understanding and asked the oncologists to estimate patients’ prognosis prior to HCT. We assessed QOL and mood weekly and evaluated the relationship between prognostic understanding and QOL and mood using multivariable linear mixed models. We enrolled 90 patients undergoing (autologous n=30); myeloablative (n=30) or reduced intensity allogeneic (n=30)) HCT. 88.9% of patients and 87.1% of FC reported it is ‘extremely’ or ‘very’ important to know about prognosis. However, 77.6% of patients and 71.7% of FC reported a discordance and more optimistic prognostic perception compared to the oncologist (P’s < 0.0001). Patients with a concordant prognostic understanding with their oncologists reported worse QOL (β = −9.4, P = 0.01) and greater depression at baseline (β = 1.7, P = 0.02) and over time ((β = 1.2, P < 0.0001). Therefore, Interventions are needed to improve prognostic understanding, while providing patients with adequate psychological support. PMID:25961772

  14. Understanding the advances in biology of orthodontic tooth movement for improved ortho-perio interdisciplinary approach

    PubMed Central

    Patil, Anand K.; Shetty, Adarsh S.; Setty, Swati; Thakur, Srinath

    2013-01-01

    This article provides an insight on detailed current advances in molecular understandings of periodontal ligament cells and the influence of orthodontic force on them in the light of recent advances in molecular and genetic sciences. It sequentially unfolds the cellular events beginning from the mechanical force initiated events of cellular responses to bone remodeling. It also highlights the risks and limitations of orthodontic treatment in certain periodontal conditions, the important areas of team work, orthodontic expectations from periodontal treatment and the possibility of much more future combined research to improve the best possible periodontal health and esthetic outcome of the patient. PMID:24049330

  15. Understanding how information and ICTs can improve health.

    PubMed

    Bath, Peter A; Sen, Barbara A; Raptis, Dimitri A; Mettler, Tobias

    2012-02-01

    The 15th International Symposium for Health Information Management Research (ISHIMR) was organized jointly by University Hospital Zurich (Switzerland), the University of St Gallen (St Gallen, Switzerland) and the University of Sheffield (Sheffield, UK). Participants included researchers, healthcare professionals, health service managers and planners. The aim of the ISHIMR series of conferences is to bring together researchers and practitioners to disseminate, share and discuss research into how information and communication technologies can improve the management of information with the health sector.

  16. Understanding "revolving door" patients in general practice: a qualitative study.

    PubMed

    Williamson, Andrea E; Mullen, Kenneth; Wilson, Philip

    2014-02-13

    'Revolving door' patients in general practice are repeatedly removed from general practitioners' (GP) lists. This paper reports a qualitative portion of the first mixed methods study of these marginalised patients. We conducted qualitative semi-structured interviews with six practitioner services staff and six GPs in Scotland, utilizing Charmazian grounded theory to characterise 'revolving door' patients and their impact from professionals' perspectives. 'Revolving door' patients were reported as having three necessary characteristics; they had unreasonable expectations, exhibited inappropriate behaviours and had unmet health needs. A range of boundary breaches were reported too when 'revolving door' patients interacted with NHS staff. We utilise the 'sensitising concepts' of legitimacy by drawing on literature about 'good and bad' patients and 'dirty work designations.' We relate these to the core work of general practice and explore the role that medical and moral schemas have in how health service professionals understand and work with 'revolving door' patients. We suggest this may have wider relevance for the problem doctor patient relationship literature.

  17. Understanding risk communication through patient narratives about complex antithrombotic therapies.

    PubMed

    Andreas, Dorothy C; Abraham, Neena S; Naik, Aanand D; Street, Richard L; Sharf, Barbara F

    2010-08-01

    The purpose of this study was to explore how patients use narratives to create coherent understandings of risks associated with complex antithrombotic therapies. We led four focus groups consisting of patients older than 65 years of age who had a diagnosis of cardiovascular disease and were using a prescription for cardioprotective agents, such as aspirin, anticoagulants, and/or antiplatelets. The participants' stories were retrospective accounts about physician and patient interactions and adverse events organized in the plot structure of a trial-and-error story. The trial-and-error narrative structure emphasizes patients' idiosyncrasies and reasons why they expect to experience adverse events from changes in treatment. Any fears that they might have had about these risks were mitigated by physician expertise, patient responsibility, and medical technology. Patients who expressed concern about not having sufficient access to medical expertise (e.g., physicians, laboratory tests) seemed less willing to accept risks. The trial-and-error risk narratives helped patients deal with ambiguity and uncertainty about the outcomes of their therapies, and revealed patients' orientations to the risks they faced.

  18. Does improving patient-practitioner communication improve clinical outcomes in patients with cardiovascular diseases? A systematic review of the evidence.

    PubMed

    Schoenthaler, Antoinette; Kalet, Adina; Nicholson, Joseph; Lipkin, Mack

    2014-07-01

    To conduct a systematic literature review appraising the effects of interventions to improve patient-practitioner communication on cardiovascular-related clinical outcomes. Databases were searched up to March 27, 2013 to identify eligible studies that included interventions to improve patient and/or practitioner communication skills and assessment of a cardiovascular-related clinical outcome in adults ≥18 years of age. Fifteen papers were reviewed: the primary focus in seven studies was the patient; seven included a practitioner-focused intervention and one targeted both. Two patient-focused and two practitioner-focused studies demonstrated a beneficial effect of the intervention compared to a control group. Patient-focused studies were designed to improve patients' information-seeking and question-asking skills with their practitioner. Practitioner-focused studies were designed to either improve practitioner's general patient-centered communication or risk communication skills. Few interventions targeting patient-practitioner communication have assessed the impact on cardiovascular-related clinical outcomes, limiting the ability to determine effectiveness. Additional rigorous research supported by theoretical frameworks and validated measurement is needed to understand the potential of patient-practitioner communication to improve cardiovascular-related clinical outcomes. Investments in communication skills trainings in medical education and practice are needed in order to attain the full potential of patient-centered care on cardiovascular-related clinical outcomes. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  19. Understanding respiratory syncytial virus infection to improve treatment and immunity.

    PubMed

    González, P A; Carreño, L J; Bueno, S M; Riedel, C A; Kalergis, A M

    2013-08-01

    Despite significant research since it was discovered more than 50 years ago, respiratory syncytial virus (RSV) continues to be the leading agent causing infant hospitalization and respiratory distress worldwide. Although RSV normally does not cause mortality, this virus is recognized as a major public health and economic burden around the globe. RSV can modulate host immunity leading to an inflammatory response that produces lung damage and virus dissemination in the host airways. Remarkably, infection with the virus elicits poor immunity that in most cases fails to protect against subsequent exposures. Here, we review advances made on the understanding of the lifecycle of the virus, some of the molecular mechanisms it has evolved to cause pathology and ineffective immunity during infection. Hopefully, ongoing research will contribute to developing new drugs and candidate vaccines that will decrease the health burden caused by this virus.

  20. 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. © The Author(s) 2014.

  1. Improved performance of polybenzoxazines through a mechanistic understanding of polymerization

    NASA Astrophysics Data System (ADS)

    Wang, Yong-Xia

    A class of phenolic resins, polybenzoxazines, is described. Benzoxazine resins have a wide range of mechanical and physical properties that can be tailored to various needs. Good thermal, chemical, electrical, mechanical, and physical properties make polybenzoxazines attractive alternatives to existing materials. Effective initiators/catalysts aimed at lowering the polymerization temperature and reducing the product cycle time have been examined. The benzoxazine-initiator systems exhibit new polymerization mechanisms and kinetics, leading to polybenzoxazines with highly improved properties. By tailoring the benzoxazine chemistry and utilizing a new synthetic route, both hydrophilic and hydrophobic thermoplastic polybenzoxazines with high molecular weight are synthesized for the first time. A novel type of low cost yet high performance benzoxazine resins, mono-oxazine-based low viscosity benzoxazines, has been developed. Various characterization techniques including proton (1H) and carbon (13C) nuclear magnetic resonance spectroscopy (NMR), Fourier transform infrared spectroscopy (FT-IR), pyrolytic gas chromatography/mass spectrometry (GC/MS), size exclusion chromatography (SEC), static light scattering (SLS), wide angle X-ray diffraction (WAXD), differential scanning calorimetry (DSC), thermogravimetric analysis (TGA), and dynamic mechanical analysis (DMA) have been used to determine the polymer structures and demonstrate their improved properties.

  2. How well do doctors know their patients? Factors affecting physician understanding of patients' health beliefs.

    PubMed

    Street, Richard L; Haidet, Paul

    2011-01-01

    An important feature of patient-centered care is physician understanding of their patients' health beliefs and values. Determine physicians' awareness of patients' health beliefs as well as communication, relationship, and demographic factors associated with better physician understanding of patients' illness perspectives. Cross-sectional, observational study. RESEARCH PARTICIPANTS: A convenience sample of 207 patients and 29 primary care physicians from 10 outpatient clinics. APPROACH AND MEASURES: After their consultation, patients and physicians independently completed the CONNECT instrument, a measure that assesses beliefs about the degree to which the patient's condition has a biological cause, is the patient's fault, is one the patient can control, has meaning for the patient, can be treated with natural remedies, and patient preferences for a partnership with the physician. Physicians completed the measure again on how they thought the patient responded. Active patient participation (frequency of questions, concerns, acts of assertiveness) was coded from audio-recordings of the consultations. Physicians' answers for how they thought the patient responded to the health belief measure were compared to their patients' actual responses. Degree of physician understanding of patients' health beliefs was computed as the absolute difference between patients' health beliefs and physicians' perception of patients' health beliefs. Physicians' perceptions of their patients' health beliefs differed significantly (P<0.001) from patients' actual beliefs. Physicians also thought patients' beliefs were more aligned with their own. Physicians had a better understanding of the degree to which patients believed their health conditions had personal meaning (p=0.001), would benefit from natural remedies (p=0.049), were conditions the patient could control (p=0.001), and wanted a partnership with the doctor (p=0.014) when patients more often asked questions, expressed concerns

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

    PubMed Central

    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. PMID:26845694

  4. 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.

  5. Understanding the role of opinion leaders in improving clinical effectiveness.

    PubMed

    Locock, L; Dopson, S; Chambers, D; Gabbay, J

    2001-09-01

    We present findings from evaluations of two government-funded initiatives exploring the transfer of research evidence into clinical practice--the PACE Programme (Promoting Action on Clinical Effectiveness), and the Welsh Clinical Effectiveness Initiative National Demonstration Projects. We situate the findings within the context of available research evidence from healthcare and other settings on the role of opinion leaders or product champions in innovation and change--evidence which leaves a number of problems and unanswered questions. A major concern is the difficulty of achieving a single replicable description of what opinion leaders are and what they do--subjective understandings of their role differ from one setting to another, and we identify a range of very different types of opinion leadership. What makes someone a credible and influential authority is derived not just from their own personality and skills and the dynamic of their relationship with other individuals, but also from other context-specific factors. We examine the question of expert versus peer opinion leaders, and the potential for these different categories to be more or less influential at different stages in the innovation process. An often neglected area is the impact of opinion leaders who are ambivalent or hostile to an innovation. Finally, we note that the interaction between individual opinion leaders and the collective process of negotiating a change and reorienting professional norms remains poorly understood. This raises a number of methodological concerns which need to be considered in further research in this area.

  6. Improving Climate Projections by Understanding How Cloud Phase affects Radiation

    NASA Technical Reports Server (NTRS)

    Cesana, Gregory; Storelvmo, Trude

    2017-01-01

    Whether a cloud is predominantly water or ice strongly influences interactions between clouds and radiation coming down from the Sun or up from the Earth. Being able to simulate cloud phase transitions accurately in climate models based on observational data sets is critical in order to improve confidence in climate projections, because this uncertainty contributes greatly to the overall uncertainty associated with cloud-climate feedbacks. Ultimately, it translates into uncertainties in Earth's sensitivity to higher CO2 levels. While a lot of effort has recently been made toward constraining cloud phase in climate models, more remains to be done to document the radiative properties of clouds according to their phase. Here we discuss the added value of a new satellite data set that advances the field by providing estimates of the cloud radiative effect as a function of cloud phase and the implications for climate projections.

  7. Improving climate projections by understanding how cloud phase affects radiation

    NASA Astrophysics Data System (ADS)

    Cesana, Gregory; Storelvmo, Trude

    2017-04-01

    Whether a cloud is predominantly water or ice strongly influences interactions between clouds and radiation coming down from the Sun or up from the Earth. Being able to simulate cloud phase transitions accurately in climate models based on observational data sets is critical in order to improve confidence in climate projections, because this uncertainty contributes greatly to the overall uncertainty associated with cloud-climate feedbacks. Ultimately, it translates into uncertainties in Earth's sensitivity to higher CO2 levels. While a lot of effort has recently been made toward constraining cloud phase in climate models, more remains to be done to document the radiative properties of clouds according to their phase. Here we discuss the added value of a new satellite data set that advances the field by providing estimates of the cloud radiative effect as a function of cloud phase and the implications for climate projections.

  8. Improved understanding of pathogenesis from protein interactions in Mycobacterium tuberculosis.

    PubMed

    Cui, Tao; He, Zheng-Guo

    2014-12-01

    Comprehensive mapping and analysis of protein-protein interactions provide not only systematic approaches for dissecting the infection and survival mechanisms of pathogens but also clues for discovering new antibacterial drug targets. Protein interaction data on Mycobacterium tuberculosis have rapidly accumulated over the past several years. This review summarizes the current progress of protein interaction studies on M. tuberculosis, the causative agent of tuberculosis. These efforts improve our knowledge on the stress response, signaling regulation, protein secretion and drug resistance of the bacteria. M. tuberculosis-host protein interaction studies, although still limited, have recently opened a new door for investigating the pathogenesis of the bacteria. Finally, this review discusses the importance of protein interaction data on identifying and screening new anti-tuberculosis targets and drugs, respectively.

  9. 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.

  10. 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…

  11. Understanding improved osteoblast behavior on select nanoporous anodic alumina

    PubMed Central

    Ni, Siyu; Li, Changyan; Ni, Shirong; Chen, Ting; Webster, Thomas J

    2014-01-01

    The aim of this study was to prepare different sized porous anodic alumina (PAA) and examine preosteoblast (MC3T3-E1) attachment and proliferation on such nanoporous surfaces. In this study, PAA with tunable pore sizes (25 nm, 50 nm, and 75 nm) were fabricated by a two-step anodizing procedure in oxalic acid. The surface morphology and elemental composition of PAA were characterized by field emission scanning electron microscopy and X-ray photoelectron spectroscopy analysis. The nanopore arrays on all of the PAA samples were highly regular. X-ray photoelectron spectroscopy analysis suggested that the chemistry of PAA and flat aluminum surfaces were similar. However, contact angles were significantly greater on all of the PAA compared to flat aluminum substrates, which consequently altered protein adsorption profiles. The attachment and proliferation of preosteoblasts were determined for up to 7 days in culture using field emission scanning electron microscopy and a Cell Counting Kit-8. Results showed that nanoporous surfaces did not enhance initial preosteoblast attachment, whereas preosteoblast proliferation dramatically increased when the PAA pore size was either 50 nm or 75 nm compared to all other samples (P<0.05). Thus, this study showed that one can alter surface energy of aluminum by modifying surface nano-roughness alone (and not changing chemistry) through an anodization process to improve osteoblast density, and, thus, should be further studied as a bioactive interface for orthopedic applications. PMID:25045263

  12. Developing patient-friendly genetic and genomic test reports: formats to promote patient engagement and understanding.

    PubMed

    Haga, Susanne B; Mills, Rachel; Pollak, Kathryn I; Rehder, Catherine; Buchanan, Adam H; Lipkus, Isaac M; Crow, Jennifer H; Datto, Michael

    2014-01-01

    With the emergence of electronic medical records and patient portals, patients are increasingly able to access their health records, including laboratory reports. However, laboratory reports are usually written for clinicians rather than patients, who may not understand much of the information in the report. While several professional guidelines define the content of test reports, there are no guidelines to inform the development of a patient-friendly laboratory report. In this Opinion, we consider patient barriers to comprehension of lab results and suggest several options to reformat the lab report to promote understanding of test results and their significance to patient care, and to reduce patient anxiety and confusion. In particular, patients' health literacy, genetic literacy, e-health literacy and risk perception may influence their overall understanding of lab results and affect patient care. We propose four options to reformat lab reports: 1) inclusion of an interpretive summary section, 2) a summary letter to accompany the lab report, 3) development of a patient user guide to be provided with the report, and 4) a completely revised patient-friendly report. The complexity of genetic and genomic test reports poses a major challenge to patient understanding that warrants the development of a report more appropriate for patients.

  13. Improved understanding of hyperaccumulation yields commercial phytoextraction and phytomining technologies.

    PubMed

    Chaney, Rufus L; Angle, J Scott; Broadhurst, C Leigh; Peters, Carinne A; Tappero, Ryan V; Sparks, Donald L

    2007-01-01

    This paper reviews progress in phytoextraction of soil elements and illustrates the key role of hyperaccumulator plant species in useful phytoextraction technologies. Much research has focused on elements which are not practically phytoextracted (Pb); on addition of chelating agents which cause unacceptable contaminant leaching and are cost prohibitive; and on plant species which offer no useful phytoextraction capability (e.g., Brassica juncea Czern). Nickel phytoextraction by Alyssum hyperaccumulator species, which have been developed into a commercial phytomining technology, is discussed in more detail. Nickel is ultimately accumulated in vacuoles of leaf epidermal cells which prevents metal toxicity and provides defense against some insect predators and plant diseases. Constitutive up-regulation of trans-membrane element transporters appears to be the key process that allows these plants to achieve hyperaccumulation. Cadmium phytoextraction is needed for rice soils contaminated by mine wastes and smelter emissions with 100-fold more soil Zn than Cd. Although many plant species can accumulate high levels of Cd in the absence of Zn, when Cd/Zn>100, only Thlaspi caerulescens from southern France has demonstrated the ability to phytoextract useful amounts of Cd. Production of element-enriched biomass with value as ore or fertilizer or improved food (Se) or feed supplement may offset costs of phytoextraction crop production. Transgenic phytoextraction plants have been achieved for Hg, but not for other elements. Although several researchers have been attempting to clone all genes required for effective hyperaccumulation of several elements, success appears years away; such demonstrations will be needed to prove we have identified all necessary processes in hyperaccumulation.

  14. Soliciting the patient's agenda: have we improved?

    PubMed

    Marvel, M K; Epstein, R M; Flowers, K; Beckman, H B

    1999-01-20

    Previous research indicates physicians frequently choose a patient problem to explore before determining the patient's full spectrum of concerns. To examine the extent to which experienced family physicians in various practice settings elicit the agenda of concerns patients bring to the office. A cross-sectional survey using linguistic analysis of a convenience sample of 264 patient-physician interviews. Primary care offices of 29 board-certified family physicians practicing in rural Washington (n = 1; 3%), semirural Colorado (n = 20; 69%), and urban settings in the United States and Canada (n = 8; 27%). Nine participants had fellowship training in communication skills and family counseling. Patient-physician verbal interactions, including physician solicitations of patient concerns, rate of completion of patient responses, length of time for patient responses, and frequency of late-arising patient concerns. Physicians solicited patient concerns in 199 interviews (75.4%). Patients' initial statements of concerns were completed in 74 interviews (28.0%). Physicians redirected the patient's opening statement after a mean of 23.1 seconds. Patients allowed to complete their statement of concerns used only 6 seconds more on average than those who were redirected before completion of concerns. Late-arising concerns were more common when physicians did not solicit patient concerns during the interview (34.9% vs 14.9%). Fellowship-trained physicians were more likely to solicit patient concerns and allow patients to complete their initial statement of concerns (44% vs 22%). Physicians often redirect patients' initial descriptions of their concerns. Once redirected, the descriptions are rarely completed. Consequences of incomplete initial descriptions include late-arising concerns and missed opportunities to gather potentially important patient data. Soliciting the patient's agenda takes little time and can improve interview efficiency and yield increased data.

  15. 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…

  16. [Improved treatment options for a short bowel syndrome patient].

    PubMed

    Pakarinen, Mikko

    2014-01-01

    Short bowel syndrome necessitates long-term parenteral nutrition, which exposes to decreased quality of life and increased morbidity. In recent years the understanding of short bowel pathophysiology and related complications has expanded, forming the basis for improved treatment options. In addition to evolving nutritional therapy, new pharmacological and surgical therapies have emerged, enhancing the patients' possibilities to achieve intestinal autonomy. Increasingly efficient prevention of intestinal failure-associated liver disease and central line-associated septic episodes improves patient survival. Bowel function can be restored by intestinal transplantation in those developing life-threatening complications.

  17. [Preoperative patient education: can we improve satisfaction and reduce anxiety?].

    PubMed

    Ortiz, Jaime; Wang, Suwei; Elayda, MacArthur A; Tolpin, Daniel A

    2015-01-01

    Patients' knowledge deficits concerning anesthesia and the anesthesiologist's role in their care may contribute to anxiety. The objective of this study was to develop anesthesia patient education materials that would help improve patient's satisfaction regarding their knowledge of the perioperative process and decrease anxiety in a community hospital with a large Spanish-speaking population. A survey (Survey A) in English and Spanish was administered to all adult anesthesiology preoperative clinic patients during a 4-week period. The data were analyzed and then a patient education handout was developed in both English and Spanish to assist with our patients' major concerns. A second survey (Survey B) was administered that was completed after the education handout had been put into use at the clinic. The survey asked for basic demographic information and included questions on satisfaction with regard to understanding of anesthesia as well as worries regarding surgery and pain. In the patients who received the handout, statistically significant improvement was found in the questions that asked about satisfaction with regard to understanding of type of anesthesia, options for pain control, what patients are supposed to do on the day of surgery, and the amount of information given with regard to anesthetic plan. There was no difference in anxiety related to surgery in patients who received the educational handout compared to those patients who did not. Patient education handouts improved patient's satisfaction regarding their knowledge of the perioperative process but did not reduce anxiety related to surgery. Copyright © 2013 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  18. 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.

  19. An organizational approach to understanding patient safety and medical errors.

    PubMed

    Kaissi, Amer

    2006-01-01

    Progress in patient safety, or lack thereof, is a cause for great concern. In this article, we argue that the patient safety movement has failed to reach its goals of eradicating or, at least, significantly reducing errors because of an inappropriate focus on provider and patient-level factors with no real attention to the organizational factors that affect patient safety. We describe an organizational approach to patient safety using different organizational theory perspectives and make several propositions to push patient safety research and practice in a direction that is more likely to improve care processes and outcomes. From a Contingency Theory perspective, we suggest that health care organizations, in general, operate under a misfit between contingencies and structures. This misfit is mainly due to lack of flexibility, cost containment, and lack of regulations, thus explaining the high level of errors committed in these organizations. From an organizational culture perspective, we argue that health care organizations must change their assumptions, beliefs, values, and artifacts to change their culture from a culture of blame to a culture of safety and thus reduce medical errors. From an organizational learning perspective, we discuss how reporting, analyzing, and acting on error information can result in reduced errors in health care organizations.

  20. 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.

  1. The effects of language concordant care on patient satisfaction and clinical understanding for Hispanic pediatric surgery patients.

    PubMed

    Dunlap, Jonathan L; Jaramillo, Joshua D; Koppolu, Raji; Wright, Robert; Mendoza, Fernando; Bruzoni, Matias

    2015-09-01

    Hispanics account for over 60% of the U.S. population growth and 25% speak little-to-no English. This language barrier adversely affects both access to and quality of care. Surgical specialties trail other medical fields in assessing the effects of language barriers to surgical clinical care and patient satisfaction. This study was designed to assess the effects of patient-provider language concordance on a pediatric surgery practice. A surgery-specific, 7-point Likert scale questionnaire was designed with 14 questions modeled after validated patient satisfaction surveys from the literature. Questions concerning provider-patient language concordance, quality of understanding, and general satisfaction were included. Surveys were administered to families of patients in the General Pediatric Surgery Clinic at our institution. Families were categorized into three groups: English-speaking, regardless of race/ethnicity; Spanish-speaking using interpreter services with an English-speaking medical team; and Spanish-speaking communicating directly with a Spanish-speaking medical team (Hispanic Center for Pediatric Surgery, HCPS). One-way analysis of variance was used to test for group differences. We administered 226 surveys; 49 were removed due to lack literacy proficiency. Families in the HCPS group reported a higher level of satisfaction than the interpreter and English groups (p<0.01). The HCPS group also indicated improved understanding of the information from the visit (p<0.001). Spanish-speaking only families felt that communicating directly with their health care team in their primary language was more important than their English-speaking counterparts (p<0.001). In a pediatric surgery clinic, language concordant care improves patient satisfaction and understanding for Hispanic families in comparison to language discordant care. Other clinics in other surgery sub-specialties may consider using this model to eliminate language barriers and improve patient

  2. Understanding Muslim patients: cross-cultural dental hygiene care.

    PubMed

    Sirois, M L; Darby, M; Tolle, S

    2013-05-01

    Healthcare providers who understand the basic pillars of Islamic beliefs and common religious practices can apply these concepts, anticipate the needs of the Muslim patient and family, and attract Muslim patients to the practice. Cross cultural knowledge can motivate dental hygienists to adopt culturally acceptable behaviors, strengthen patient-provider relationships and optimize therapeutic outcomes. Trends in Muslim population growth, Islamic history and beliefs, modesty practices, healthcare beliefs, contraception, childbearing, childrearing, pilgrimage, dietary practices, dental care considerations and communication are explained. This paper reviews traditional Muslim beliefs and practices regarding lifestyle, customs, healthcare and religion as derived from the literature and study abroad experiences. Recommendations are offered on how to blend western healthcare with Islamic practices when making introductions, appointments, eye contact, and selecting a practitioner. The significance of fasting and how dental hygiene care can invalidate the fast are also discussed. The ultimate goal is for practitioners to be culturally competent in providing care to Muslim patients, while keeping in mind that beliefs and practices can vary widely within a culture. © 2012 John Wiley & Sons A/S.

  3. Assessing Resilience: How Plans, Strategies, and After Action Reports Can Improve Our Understanding of Organizational Preparedness

    DTIC Science & Technology

    2016-09-01

    CAN IMPROVE OUR UNDERSTANDING OF ORGANIZATIONAL PREPAREDNESS 5. FUNDING NUMBERS 6. AUTHOR(S) Melissa Nussbaum 7. PERFORMING ORGANIZATION NAME(S...task could be performed ). Two specific components of resources to which the resilience management framework calls attention— human resources and...STRATEGIES, AND AFTER ACTION REPORTS CAN IMPROVE OUR UNDERSTANDING OF ORGANIZATIONAL PREPAREDNESS by Melissa Nussbaum September 2016 Thesis Co

  4. Measuring and improving ambulatory surgery patients' satisfaction.

    PubMed

    Farber, Janice

    2010-09-01

    The pressure on perioperative services to improve quality for health care consumers creates both challenges and opportunities. To make positive changes, many health care organizations contract with Press Ganey (PG), which processes an extensive database of more than 9.5 million surveys annually and provides benchmark reports to same-type organizations. To measure and improve ambulatory surgery patient satisfaction at one health care network in northeastern Pennsylvania, the nursing leaders in the ambulatory surgery center and OR undertook a quality improvement project focused on educating perioperative nurses on the use of PG reports. After we reviewed the PG reports and implemented changes with nursing staff members in perioperative areas, PG patient satisfaction scores improved regarding information about delays (4.1%) and center attractiveness (0.2%).

  5. Understanding the meaning of medications for patients: The medication experience

    PubMed Central

    Ramalho de Oliveira, Djenane

    2007-01-01

    Objective: To understand and describe the meaning of medications for patients. Methods: A metasynthesis of three different, yet complementary qualitative research studies, was conducted by two researchers. The first study was a phenomenological study of patients’ medication experiences that used unstructured interviews. The second study was an ethnographic study of pharmaceutical care practice, which included participant observation, in-depth interviews and focus groups with patients of pharmaceutical care. The third was a phenomenological study of the chronic illness experience of medically uninsured individuals in the United States and included an explicit aim to understand the medication experience within that context. The two researchers who conducted these three qualitative studies that examined the medication experience performed the meta-synthesis. The process began with the researchers reviewing the themes of the medication experience for each study. The researchers then aggregated the themes to identify the overlapping and similar themes of the medication experience and which themes are sub-themes within another theme versus a unique theme of the medication experience. The researchers then used the analytic technique, “free imaginative variation” to determine the essential, structural themes of the medication experience. Results: The meaning of medications for patients was captured as four themes of the medication experience: a meaningful encounter; bodily effects; unremitting nature; and exerting control. The medication experience is an individual’s subjective experience of taking a medication in his daily life. It begins as an encounter with a medication. It is an encounter that is given meaning before it occurs. The experience may include positive or negative bodily effects. The unremitting nature of a chronic medication often causes an individual to question the need for the medication. Subsequently, the individual may exert control by altering

  6. Melatonin improves sleep quality in hemodialysis patients

    PubMed Central

    Edalat-Nejad, M.; Haqhverdi, F.; Hossein-Tabar, T.; Ahmadian, M.

    2013-01-01

    Disturbed sleep is common in end-stage renal disease (ESRD). Exogenous melatonin has somniferous properties in normal subjects and can improve sleep quality (SQ) in several clinical conditions. Recent studies have shown that melatonin may play a role in improving sleep in patients undergoing dialysis. The goal of the present study was to assess the effect of exogenous melatonin administration on SQ improvement in daytime hemodialysis patients. Lipid profile and the required dose of erythropoietin (EPO) are also reported as secondary outcomes. In a 6-week randomized, double-blind cross-over clinical trial, 3 mg melatonin or placebo was administered to 68 patients at bedtime. A 72-h washout preceded the switch from melatonin to placebo, or vice versa. SQ was assessed by the Pittsburgh sleep quality index (PSQI). Sixty-eight patients completed the study protocol and were included in the final analysis. Melatonin treatment significantly improved the global PSQI scores (P < 0.001), particularly subjective SQ (P < 0.001), sleep efficiency (P = 0.005) and sleep duration (P < 0.001). No differences in sleep latency and daytime sleepiness were observed. Melatonin also increased the high-density lipoprotein (HDL) cholesterol (P = 0.003). The need for EPO prescription decreased after melatonin treatment (P < 0.001). We conclude that melatonin can improve sleep in ESRD. The modest increase in HDL cholesterol and decrease in the EPO requirement are other benefits associated with this treatment PMID:23960341

  7. 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.

  8. Health care and social media: What patients really understand.

    PubMed

    Hoedebecke, Kyle; Beaman, Lindsey; Mugambi, Joy; Shah, Sanam; Mohasseb, Marwa; Vetter, Cheyanne; Yu, Kim; Gergianaki, Irini; Couvillon, Emily

    2017-01-01

    Background: Low health literacy is associated with decreased patient compliance and worse outcomes - with clinicians increasingly relying on printed materials to lower such risks. Yet, many of these documents exceed recommended comprehension levels. Furthermore, patients look increasingly to social media (SoMe) to answer healthcare questions. The character limits built into Twitter encourage users to publish small quantities of text, which are more accessible to patients with low health literacy. The present authors hypothesize that SoMe posts are written at lower grade levels than traditional medical sources, improving patient health literacy. Methods: The data sample consisted of the first 100 original tweets from three trending medical hashtags, leading to a total of 300 tweets. The Flesch-Kincaid Readability Formula (FKRF) was used to derive grade level of the tweets. Data was analyzed via descriptive and inferential statistics. Results: The readability scores for the data sample had a mean grade level of 9.45. A notable 47.6% of tweets were above ninth grade reading level. An independent-sample t-test comparing FKRF mean scores of different hashtags found differences between the means of the following: #hearthealth versus #diabetes (t = 3.15, p = 0.002); #hearthealth versus #migraine (t = 0.09, p = 0.9); and #diabetes versus #migraine (t = 3.4, p = 0.001). Conclusions: Tweets from this data sample were written at a mean grade level of 9.45, signifying a level between the ninth and tenth grades. This is higher than desired, yet still better than traditional sources, which have been previously analyzed. Ultimately, those responsible for health care SoMe posts must continue to improve efforts to reach the recommended reading level (between the sixth and eighth grade), so as to ensure optimal comprehension of patients.

  9. NCCN: 20 Years of Improving Patients' Lives.

    PubMed

    Carlson, Robert W

    2015-05-01

    In his Keynote Address at the NCCN 20th Annual Conference, Robert W. Carlson, MD, reflected on the achievements of NCCN and described how the organization will continue to grow under his leadership. Recognizing that the founding of NCCN was by a group of visionary leaders who came together 20 years ago to assure access of patients to high-quality cancer care, Dr. Carlson said "All our efforts within NCCN are focused on improving the quality, effectiveness, and efficiency of patient care, so that our patients can live better lives."

  10. Toward a better understanding of patient-reported outcomes in clinical practice.

    PubMed

    Bitton, Asaf; Onega, Tracy; Tosteson, Anna N A; Haas, Jennifer S

    2014-04-01

    Current shifts toward patient-centered healthcare and accountable payment options point to the more personalized production of better health, not just healthcare, as a next organizational paradigm. Transformation to a system geared toward promoting health requires us to think broadly about what it means to engage patients meaningfully, to give them a voice in their health and care, and to capture more of their varied experience and attitudes beyond the provider visit. The collection and use of patient-reported outcome data into electronic health records represents an important step forward for the transition to a more patient-centered health system. We set out an agenda for better understanding how and when patient-reported outcomes may improve patient health and care experience.

  11. Improving management of patients with advanced cancer

    PubMed Central

    Drudge-Coates, Lawrence

    2010-01-01

    Development of bone metastases in patients with advanced cancer is associated with skeletal-related events (SREs) such as pathologic fractures, spinal cord compression, the requirement for surgery or palliative radiotherapy to bone, and hypercalcemia of malignancy. Skeletal morbidity may reduce patient mobility, limit functional independence, and impair quality of life (QOL). Proactive management of new or worsening bone pain or motor impairment is crucial because of the potential for rapid progression of symptoms. Administration of bisphosphonate therapy as a monthly infusion to patients with bone metastases prevents or delays the onset and reduces the frequency of SREs and provides clinically meaningful improvements in bone pain and QOL. In addition to administration of therapy, the monthly infusion visit allows a dedicated team of healthcare professionals to regularly assess SREs, response to therapy, adverse events (AEs), QOL, and adherence to oral medications and supplements. The continuity of care that occurs during the monthly infusion visit provides oncology nurses with an opportunity to educate patients about effective strategies to manage SREs and AEs. In addition, regular interaction provides oncology nurses with an opportunity to recognize and proactively address subtle changes in the patients’ medical condition. Using a multidisciplinary medical team also eliminates barriers between the various healthcare professionals involved in patient management. Consequently, the monthly infusion visit can result in effective patient management and improved clinical outcomes in patients with malignant bone disease. PMID:21206517

  12. Changing education to improve patient care

    PubMed Central

    Leach, D

    2001-01-01

    Health professionals need competencies in improvement skills if they are to contribute usefully to improving patient care. Medical education programmes in the USA have not systematically taught improvement skills to residents (registrars in the UK). The Accreditation Council for Graduate Medical Education (ACGME) has recently developed and begun to deploy a competency based model for accreditation that may encourage the development of improvement skills by the 100 000 residents in accredited programmes. Six competencies have been identified for all physicians, independent of specialty, and measurement tools for these competencies have been described. This model may be applicable to other healthcare professions. This paper explores patterns that inhibit efforts to change practice and proposes an educational model to provide changes in management skills based on trainees' analysis of their own work. Key Words: physician education; improvement skills; accreditation; competency PMID:11700380

  13. Modeling Patient Treatment With Medical Records: An Abstraction Hierarchy to Understand User Competencies and Needs.

    PubMed

    St-Maurice, Justin D; Burns, Catherine M

    2017-07-28

    Health care is a complex sociotechnical system. Patient treatment is evolving and needs to incorporate the use of technology and new patient-centered treatment paradigms. Cognitive work analysis (CWA) is an effective framework for understanding complex systems, and work domain analysis (WDA) is useful for understanding complex ecologies. Although previous applications of CWA have described patient treatment, due to their scope of work patients were previously characterized as biomedical machines, rather than patient actors involved in their own care. An abstraction hierarchy that characterizes patients as beings with complex social values and priorities is needed. This can help better understand treatment in a modern approach to care. The purpose of this study was to perform a WDA to represent the treatment of patients with medical records. The methods to develop this model included the analysis of written texts and collaboration with subject matter experts. Our WDA represents the ecology through its functional purposes, abstract functions, generalized functions, physical functions, and physical forms. Compared with other work domain models, this model is able to articulate the nuanced balance between medical treatment, patient education, and limited health care resources. Concepts in the analysis were similar to the modeling choices of other WDAs but combined them in as a comprehensive, systematic, and contextual overview. The model is helpful to understand user competencies and needs. Future models could be developed to model the patient's domain and enable the exploration of the shared decision-making (SDM) paradigm. Our work domain model links treatment goals, decision-making constraints, and task workflows. This model can be used by system developers who would like to use ecological interface design (EID) to improve systems. Our hierarchy is the first in a future set that could explore new treatment paradigms. Future hierarchies could model the patient as a

  14. Understanding the cost of dermatologic care: A survey study of dermatology providers, residents, and patients.

    PubMed

    Steen, Aaron J; Mann, Julianne A; Carlberg, Valerie M; Kimball, Alexa B; Musty, Michael J; Simpson, Eric L

    2017-04-01

    The American Academy of Dermatology recommends dermatologists understand the costs of dermatologic care. This study sought to measure dermatology providers' understanding of the cost of dermatologic care and how those costs are communicated to patients. We also aimed to understand the perspectives of patients and dermatological trainees on how cost information enters into the care they receive or provide. Surveys were systematically developed and distributed to 3 study populations: dermatology providers, residents, and patients. Response rates were over 95% in all 3 populations. Dermatology providers and residents consistently underestimated the costs of commonly recommended dermatologic medications but accurately predicted the cost of common dermatologic procedures. Dermatology patients preferred to know the cost of procedures and medications, even when covered by insurance. In this population, the costs of dermatologic medications frequently interfered with patients' ability to properly adhere to prescribed regimens. The surveyed population was limited to the northwestern United States and findings may not be generalizable. Cost estimations were based on average reimbursement rates, which vary by insurer. Improving dermatology providers' awareness and communication of the costs of dermatologic care might enhance medical decision-making, improve adherence and outcomes, and potentially reduce overall health care expenditures. Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  15. Understanding middle managers' influence in implementing patient safety culture.

    PubMed

    Gutberg, Jennifer; Berta, Whitney

    2017-08-22

    The past fifteen years have been marked by large-scale change efforts undertaken by healthcare organizations to improve patient safety and patient-centered care. Despite substantial investment of effort and resources, many of these large-scale or "radical change" initiatives, like those in other industries, have enjoyed limited success - with practice and behavioural changes neither fully adopted nor ultimately sustained - which has in large part been ascribed to inadequate implementation efforts. Culture change to "patient safety culture" (PSC) is among these radical change initiatives, where results to date have been mixed at best. This paper responds to calls for research that focus on explicating factors that affect efforts to implement radical change in healthcare contexts, and focuses on PSC as the radical change implementation. Specifically, this paper offers a novel conceptual model based on Organizational Learning Theory to explain the ability of middle managers in healthcare organizations to influence patient safety culture change. We propose that middle managers can capitalize on their unique position between upper and lower levels in the organization and engage in 'ambidextrous' learning that is critical to implementing and sustaining radical change. This organizational learning perspective offers an innovative way of framing the mid-level managers' role, through both explorative and exploitative activities, which further considers the necessary organizational context in which they operate.

  16. Medical Interpreting: Improving Communication with Your Patients.

    ERIC Educational Resources Information Center

    Tebble, Helen

    The guide is designed for physicians and other medical practitioners who need to work with medical interpreters to improve communication with patients. Special attention is given to the Australian context. An introductory section discusses the need for medical interpreters and explains the guide's organization. Subsequent sections address these…

  17. Improving health IT through understanding the cultural production of safety in clinical settings.

    PubMed

    Novak, Laurie Lovett

    2010-01-01

    Health IT is said to have the potential to improve the safety and effectiveness of care. However, it is known that the implementation of health IT can introduce new risks into the environment of care as a result of design failures, implementation failures, and unintended consequences. The design and implementation of health IT systems reflect explicit or implicit assumptions about what constitutes safe practice. These assumptions may clash with those held by patients and clinicians who are the intended users and subjects of the technology. Current perspectives on risk are discussed and an anthropological approach to understanding the construction of safe practices in the clinical setting is explored using research in barcode medication administration.

  18. Pilot study demonstrating effectiveness of targeted education to improve informed consent understanding in AIDS clinical trials.

    PubMed

    Sengupta, Sohini; Lo, Bernard; Strauss, Ronald P; Eron, Joseph; Gifford, Allen L

    2011-11-01

    Assessing and improving informed consent understanding is equally important as obtaining consent from participants in clinical trial research, but developing interventions to target gaps in participants' informed consent understanding remains a challenge. We used a randomized controlled study design to pilot test an educational intervention to improve actual informed consent understanding of new enrollees in the Adult AIDS Clinical Trial Group (AACTG). Questionnaires were administered to 24 enrollees to assess their baseline understanding on eight elements of informed consent associated with AIDS clinical trials. Enrollees who scored 18/21(85%) or less were randomly assigned to in-person, targeted education (intervention), or delayed education (control). Two follow-up assessments were administered. Repeated measures ANOVA was performed to determine intervention effectiveness in improving actual informed consent understanding over time. Actual understanding improved at the immediate post-intervention time point with a significant score difference of 2.5 when comparing the intervention and delayed groups. In addition, there was a significant score difference of 3.2 when comparing baseline to three-month follow-up for the two groups, suggesting a statistically significant intervention effect to improve actual understanding of the basic elements of informed consent. The findings demonstrated that one-time targeted education can improve actual informed consent understanding one week after the intervention, but retention of these concepts may require periodic monitoring to ensure comprehension throughout the course of a clinical trial.

  19. Developing patient-centred care: an ethnographic study of patient perceptions and influence on quality improvement.

    PubMed

    Renedo, Alicia; Marston, Cicely

    2015-04-23

    Understanding quality improvement from a patient perspective is important for delivering patient-centred care. Yet the ways patients define quality improvement remains unexplored with patients often excluded from improvement work. We examine how patients construct ideas of 'quality improvement' when collaborating with healthcare professionals in improvement work, and how they use these understandings when attempting to improve the quality of their local services. We used in-depth interviews with 23 'patient participants' (patients involved in quality improvement work) and observations in several sites in London as part of a four-year ethnographic study of patient and public involvement (PPI) activities run by Collaborations for Leadership in Applied Health Research and Care for Northwest London. We took an iterative, thematic and discursive analytical approach. When patient participants tried to influence quality improvement or discussed different dimensions of quality improvement their accounts and actions frequently started with talk about improvement as dependent on collective action (e.g. multidisciplinary healthcare professionals and the public), but usually quickly shifted away from that towards a neoliberal discourse emphasising the role of individual patients. Neoliberal ideals about individual responsibility were taken up in their accounts moving them away from the idea of state and healthcare providers being held accountable for upholding patients' rights to quality care, and towards the idea of citizens needing to work on self-improvement. Participants portrayed themselves as governed by self-discipline and personal effort in their PPI work, and in doing so provided examples of how neoliberal appeals for self-regulation and self-determination also permeated their own identity positions. When including patient voices in measuring and defining 'quality', governments and public health practitioners should be aware of how neoliberal rationalities at the

  20. Caregivers' understanding of dementia predicts patients' comfort at death: a prospective observational study.

    PubMed

    van der Steen, Jenny T; Onwuteaka-Philipsen, Bregje D; Knol, Dirk L; Ribbe, Miel W; Deliens, Luc

    2013-04-11

    Patients with dementia frequently do not receive adequate palliative care which may relate to poor understanding of the natural course of dementia. We hypothesized that understanding that dementia is a progressive and terminal disease is fundamental to a focus on comfort in dementia, and examined how family and professional caregivers' understanding of the nature of the disease was associated with patients' comfort during the dying process. We enrolled 372 nursing home patients from 28 facilities in The Netherlands in a prospective observational study (2007 to 2010). We studied both the families and the physicians (73) of 161 patients. Understanding referred to families' comprehension of complications, prognosis, having been counseled on these, and perception of dementia as "a disease you can die from" (5-point agreement scale) at baseline. Physicians reported on this perception, prognosis and having counseled on this. Staff-assessed comfort with the End-of-Life in Dementia - Comfort Assessment in Dying (EOLD-CAD) scale. Associations between understanding and comfort were assessed with generalized estimating equations, structural equation modeling, and mediator analyses. A family's perception of dementia as "a disease you can die from" predicted higher patient comfort during the dying process (adjusted coefficient -0.8, 95% confidence interval (CI): -1.5; -0.06 point increment disagreement). Family and physician combined perceptions (-0.9, CI: -1.5; -0.2; 9-point scale) were also predictive, including in less advanced dementia. Forty-three percent of the families perceived dementia as a disease you can die from (agreed completely, partly); 94% of physicians did. The association between combined perception and higher comfort was mediated by the families' reporting of a good relationship with the patient and physicians' perception that good care was provided in the last week. Awareness of the terminal nature of dementia may improve patient comfort at the end of life

  1. The patient with cold hands: understanding Raynaud's disease.

    PubMed

    Jackson, Carol Mackenzie

    2006-11-01

    The availability of new treatments for Raynaud's disease, as with any medical condition, depends on how convincing the results of clinical research prove to be. The validity and reliability of research in Raynaud's disease is subject to two major constraints: the seasonal and intermittent nature of the condition limits the amount of time patients can be studied continuously, and researchers have failed to agree on objective outcome measures. Vascular physiology is, and no doubt is destined to remain, a dynamic and technology-driven clinical realm. Despite the wide array of promising treatments, the best and most basic management of Raynaud's disease seems to be behavioral and at least partly pharmaceutical. The two biggest behavioral factors are nicotine use and exposure to cold environments. Giving up nicotine can be a daunting challenge for long-term smokers and chewing-tobacco users. Avoiding cold environments may be easier said than done, especially for patients who work outdoors or in air-conditioned spaces. Perhaps the best treatment for Raynaud's disease is a reliable diagnosis and the positive prognosis that comes with it. Most patients have a stable course, and nearly half will actually improve with time and steady reassurance.

  2. Lynch Syndrome Limbo: Patient Understanding of Variants of Uncertain Significance.

    PubMed

    Solomon, Ilana; Harrington, Elizabeth; Hooker, Gillian; Erby, Lori; Axilbund, Jennifer; Hampel, Heather; Semotiuk, Kara; Blanco, Amie; Klein, William M P; Giardiello, Francis; Leonard, Lori

    2017-01-26

    Providers and patients encounter challenges related to the management of Variants of Unknown Significance (VUS). A VUS introduces new counseling dilemmas for the understanding and psychosocial impact of uncertain genetic test results. This descriptive study uses Mishel's theory of uncertainty in illness to explore the experience of individuals who have received a VUS as part of the genetic testing process. Semi-structured interviews were conducted with 27 adult individuals who received a VUS for Lynch syndrome mismatch repair genes between 2002 and 2013. The interviews were transcribed and analyzed. Most individuals recalled their result and perceived various types of uncertainty associated with their VUS. Half of the participants appraised their variant as a danger and implemented coping strategies to reduce the threat of developing cancer. Mobilizing strategies to reduce their risk included vigilant cancer surveillance, information seeking and notifying relatives. The majority of participants were unaware of the possibility of a VUS before receiving their result and expected reclassification over time. These results provide insight into the ways healthcare providers can support patients who receive VUS for Lynch syndrome. Findings also provide direction for future work that can further explicate the impact of receiving a VUS.

  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. Dissatisfied patients: improving general practitioners' initial reactions.

    PubMed

    Bareman, F P; Nijenhuis, E M; Dokter, H J; Trijsburg, W; Out, J; Braams, F M

    1993-07-01

    General practitioners often have difficulty in dealing with dissatisfied patients. One underlying reason could be the disturbed relationship between the doctor and the dissatisfied patient. A training course has been developed taking the relationship as a starting-point. Based on Watzlawick et al.'s theory on communication GPs have been trained to react to a dissatisfied patient on a relational level ('Are you dissatisfied with my treatment?') rather than on a contents level ('How long have you been suffering from this?'). This method seeks to improve the relationship and the satisfaction of both doctor and patient. Three types of initial reaction to dissatisfied patients were offered to four groups of GPs (19 trainees in general practice and 19 trainers in general practice). Pre- and post-measurement were executed by means of registering the initial reactions on videorecorded vignettes of re-enacted dissatisfied patients. Subsequently the reactions were categorized blind by two judges. The 12 possible categories can be subdivided into categories primarily aimed at the contents or primarily aimed at the relationship. The results show that, as compared to the pre-measurements, GPs more frequently use empathic reactions and reactions in which they bring their own actions up for discussion. The number of responses in which doctors ask a further clinical question or in which GPs expect a solution whether from themselves or from others, decrease. It is concluded that the course appears to change for the better the GPs' initial reaction to dissatisfied patients.

  5. Surgical Baseball Cards: Improving Patient- and Family-Centered Care.

    PubMed

    Demehri, Farokh R; Claflin, Jake; Alameddine, Mitchell; Sandhu, Gurjit; Magas, Christopher P; Virgin, Kristen; Gauger, Paul G

    2015-01-01

    % of controls); 8% of SBC recipients commented positively on coordination of care (vs 1% of controls), whereas 5% commented negatively on coordination of care (vs 24% of controls). SBCs provide reasonable value by improving patient recognition of healthcare team members and understanding of team member roles, and they are associated with positive patient feedback regarding coordination of care and patient-centered care. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

  6. 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. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Patient understanding of the importance of statin use in the perioperative period.

    PubMed

    Cubillo, Efrain I; Rosenfeld, David M; Hagstrom, Susan G; Hu, Francis L; Demenkoff, John H; Cheng, Meng-Ru; Trentman, Terrence L

    2015-01-01

    Perioperative hydroxy-3-methyl glutaryl coenzyme A reductase inhibitors (statins) have been shown to decrease morbidity and mortality after noncardiac surgery. The objective of this study was to assess patient understanding of the potential benefits of perioperative statins in a select population already on chronic therapy. A secondary aim was to determine the frequency with which patients recalled having a discussion with their provider regarding perioperative statins. Survey. Teaching hospital. Patients taking daily statins presenting to a preoperative medical evaluation clinic were offered a 12-question survey that assessed their understanding of the potential benefit of taking the medication in the perioperative period. None. One hundred thirty-two patients completed the questionnaire. The mean age was 68.3 years (standard deviation, 9.0); 42% were female. The most frequent surgical referral to the clinic was orthopedics, at 36%. The most common statin prescribed was atorvastatin, in 35% of patients. Twenty-seven percent of patients (n = 36) recognized that perioperative statins are beneficial; 44% of these patients (n = 14) cited decreased cholesterol during the procedure as the reason, representing 12% of the total sampled population. Twenty-two percent (n = 8) of those recognizing the benefit of perioperative statins identified a decrease in the risk of heart attack or death as the reason. This represented only 6% of the total sample. One percent of surgeons mentioned statins in relation to the planned surgery; 2% of primary or prescribing physicians mentioned the medication in relation to surgery. This study suggested low patient understanding of the potential importance and reasons for perioperative statins. In addition, this study also suggested that the information regarding the importance of perioperative statins is not being relayed to the patient at the level of the surgeon or primary care physician. All physicians involved in perioperative care can

  8. Hearing the patient's voice? Factors affecting the use of patient survey data in quality improvement

    PubMed Central

    Davies, E; Cleary, P

    2005-01-01

    Objective: To develop a framework for understanding factors affecting the use of patient survey data in quality improvement. Design: Qualitative interviews with senior health professionals and managers and a review of the literature. Setting: A quality improvement collaborative in Minnesota, USA involving teams from eight medical groups, focusing on how to use patient survey data to improve patient centred care. Participants: Eight team leaders (medical, clinical improvement or service quality directors) and six team members (clinical improvement coordinators and managers). Results: Respondents reported three types of barriers before the collaborative: organisational, professional and data related. Organisational barriers included lack of supporting values for patient centred care, competing priorities, and lack of an effective quality improvement infrastructure. Professional barriers included clinicians and staff not being used to focusing on patient interaction as a quality issue, individuals not necessarily having been selected, trained or supported to provide patient centred care, and scepticism, defensiveness or resistance to change following feedback. Data related barriers included lack of expertise with survey data, lack of timely and specific results, uncertainty over the effective interventions or time frames for improvement, and consequent risk of perceived low cost effectiveness of data collection. Factors that appeared to have promoted data use included board led strategies to change culture and create quality improvement forums, leadership from senior physicians and managers, and the persistence of quality improvement staff over several years in demonstrating change in other areas. Conclusion: Using patient survey data may require a more concerted effort than for other clinical data. Organisations may need to develop cultures that support patient centred care, quality improvement capacity, and to align professional receptiveness and leadership with

  9. Creating effective leadership for improving patient safety.

    PubMed

    Mohr, Julie J; Abelson, Herbert T; Barach, Paul

    2002-01-01

    Leadership has emerged as a key theme in the rapidly growing movement to improve patient safety. Leading an organization that is committed to providing safer care requires overcoming the common traps in thinking about error, such as blaming individuals, ignoring the underlying systems factors, and blaming the bureaucracy of the organization. Leaders must address the system issues that are at work within their organizations to allow individual and organizational learning to occur.

  10. Improving adherence and outcomes in diabetic patients

    PubMed Central

    Joshi, Renu; Joshi, Disha; Cheriyath, Pramil

    2017-01-01

    Objective Nonadherence in diabetes is a problem leading to wasted resources and preventable deaths each year. Remedies for diminishing nonadherence are many but marginally effective, and outcomes remain suboptimal. Aim The aim of this study was to test a new iOS “app”, PatientPartner. Derived from complexity theory, this novel technology has been extensively used in other fields; this is the first trial in a patient population. Methods Physicians referred patients who were “severely non-adherent” with HbA1c levels >8. After consent and random assignment (n=107), subjects in the intervention group were immersed in the 12-min PatientPartner game, which assesses and trains subjects on parameters of thinking that are critical for good decision making in health care: information management, stress coping, and health strategies. The control group did not play PatientPartner. All subjects were called each week for 3 weeks and self-reported on their medication adherence, diet, and exercise. Baseline and 3-month post-intervention HbA1c levels were recorded for the intervention group. Results Although the control group showed no difference on any measures at 3 weeks, the intervention group reported significant mean percentage improvements on all measures: medication adherence (57%, standard deviation [SD] 18%–96%, SD 9), diet (50%, SD 33%–75%, SD 28), and exercise (29%, SD 31%–43%, SD 33). At 3 months, the mean HbA1c levels in the intervention group were significantly lower (9.6) than baseline (10.7). Conclusion Many programs to improve adherence have been proved to be expensive and marginally effective. Therefore, improvements from the single use of a 12-min-long “app” are noteworthy. This is the first ever randomized, controlled trial to demonstrate that an “app” can impact the gold standard biological marker, HbA1c, in diabetes. PMID:28243070

  11. Towards better understanding of patient centric drug product development in an increasingly older patient population.

    PubMed

    Stegemann, Sven

    2016-10-30

    The substantial reduction in premature death and longevity is an achievement of modern societies and advances in technology, medical and pharmaceutical sciences. Derived from the effective management of acute and chronic diseases throughout the lifetime the typical age related, later life stage diseases will become more dominant characteristics in future patients as well as other age related impairments or life conditions. Naturally, this leads to patients with complex clinical and functional patterns that are accompanied by the necessity of therapeutic interventions and polypharmacy. With the increasing number of older people and especially those with very high age in the society, new distinct older patient populations are evolving that require patient centered therapies and drug products to maintain safety and efficacy as well as effectiveness. Understanding how the patient populations and their characteristics change from a clinical, daily functioning and a patient perspective is crucial to move towards patient centric drug products. Copyright © 2016 Elsevier B.V. All rights reserved.

  12. Improving Student Depth of Understanding through the Use of Alternative Assessment.

    ERIC Educational Resources Information Center

    Campbell, Dirk; DeWall, Lora; Roth, Trenton; Stevens, Sharon

    This report describes a program for improving students' depth of understanding through the use of alternative assessment. The targeted population consisted of students at one elementary, one junior high, and two high schools in two growing middle class communities in northern Illinois. Lack of student understanding was documented through teacher…

  13. [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.

  14. Patient activation and improved outcomes in HIV-infected patients.

    PubMed

    Marshall, Rebecca; Beach, Mary Catherine; Saha, Somnath; Mori, Tomi; Loveless, Mark O; Hibbard, Judith H; Cohn, Jonathan A; Sharp, Victoria L; Korthuis, P Todd

    2013-05-01

    The Patient Activation Measure (PAM) assesses several important concepts in chronic care management, including self-efficacy for positive health behaviors. In HIV-infected populations, better self-efficacy for medication management is associated with improved adherence to antiretroviral medications (ARVs), which is critically important for controlling symptoms and slowing disease progression. To determine 1) characteristics associated with patient activation and 2) associations between patient activation and outcomes in HIV-infected patients. Cross-sectional survey. 433 patients receiving care in four HIV clinics. An interviewer conducted face-to-face interviews with patients following their HIV clinic visit. Survey data were supplemented with medical record abstraction to obtain most recent CD4 counts, HIV viral load and antiretroviral medications. Patient activation was measured using the 13-item PAM (possible range 0-100). Outcomes included CD4 cell count > 200 cells/mL(3), HIV-1 RNA < 400 copies/mL (viral suppression), and patient-reported adherence. Overall, patient activation was high (mean PAM = 72.3 [SD 16.5, range 34.7-100]). Activation was lower among those without vs. with a high school degree (68.0 vs. 74.0, p < .001), and greater depression (77.6 lowest, 70.2 middle, 68.1 highest tertile, p < .001). There was no association between patient activation and age, race, gender, problematic alcohol use, illicit drug use, or social status. In multivariable models, every 5-point increase in PAM was associated with greater odds of CD4 count > 200 cells/mL(3) (aOR 1.10 [95 % CI 1.01, 1.21]), adherence (aOR 1.18 [95 % CI 1.09, 1.29]) and viral suppression (aOR 1.08 [95 % CI 1.00, 1.17]). The association between PAM and viral suppression was mediated through adherence. Higher patient activation was associated with more favorable HIV outcomes. Interventions to improve patient activation should be developed and tested for their ability to

  15. Creating an improvement culture for enhanced patient safety: service improvement learning in pre-registration education.

    PubMed

    Christiansen, Angela; Robson, Linda; Griffith-Evans, Christine

    2010-10-01

    The present study reports a descriptive survey of nursing students' experience of service improvement learning in the university and practice setting. Opportunities to develop service improvement capabilities were embedded into pre-registration programmes at a university in the Northwest of England to ensure future nurses have key skills for the workplace. A cross-sectional survey designed to capture key aspects of students' experience was completed by nursing students (n = 148) who had undertaken a service improvement project in the practice setting. Work organizations in which a service improvement project was undertaken were receptive to students' efforts. Students reported increased confidence to undertake service improvement and service improvement capabilities were perceived to be important to future career development and employment prospects. Service improvement learning in pre-registration education appears to be acceptable, effective and valued by students. Further research to identify the impact upon future professional practice and patient outcomes would enhance understanding of this developing area. Nurse Managers can play an active role in creating a service culture in which innovation and improvement can flourish to enhance patient outcomes, experience and safety. © 2010 The Authors. Journal compilation © 2010 Blackwell Publishing Ltd.

  16. Quality improvement initiative to reduce serious safety events and improve patient safety culture.

    PubMed

    Muething, Stephen E; Goudie, Anthony; Schoettker, Pamela J; Donnelly, Lane F; Goodfriend, Martha A; Bracke, Tracey M; Brady, Patrick W; Wheeler, Derek S; Anderson, James M; Kotagal, Uma R

    2012-08-01

    Many thousands of patients die every year in the United States as a result of serious and largely preventable safety events or medical errors. Safety events are common in hospitalized children. We conducted a quality improvement initiative to implement cultural and system changes with the goal of reducing serious safety events (SSEs) by 80% within 4 years at our large, urban pediatric hospital. A multidisciplinary SSE reduction team reviewed the safety literature, examined recent SSEs, interviewed internal leaders, and visited other leading organizations. Senior hospital leaders provided oversight, monitored progress, and helped to overcome barriers. Interventions focused on: (1) error prevention; (2) restructuring patient safety governance; (3) a new root cause analysis process and a common cause database; (4) a highly visible lessons learned program; and (5) specific tactical interventions for high-risk areas. Our outcome measures were the rate of SSEs and the change in patient safety culture. SSEs per 10000 adjusted patient-days decreased from a mean of 0.9 at baseline to 0.3 (P < .0001). The days between SSEs increased from a mean of 19.4 at baseline to 55.2 (P < .0001). After a worsening of patient safety culture outcomes in the first year of intervention, significant improvements were observed between 2007 and 2009. Our multifaceted approach was associated with a significant and sustained reduction of SSEs and improvements in patient safety culture. Multisite studies are needed to better understand contextual factors and the significance of specific interventions.

  17. A survey of how patient-perceived empathy affects the relationship between health literacy and the understanding of information by orthopedic patients?

    PubMed

    Chu, Cheng-I; Tseng, Chia-Chih Alex

    2013-02-19

    There is a lack of research examining patient-perceived empathy and its effect on low-literacy patients' understanding of health information. This study investigated the moderating effect of patient-perceived empathy on the relationship between health literacy and understanding of preoperative information. During a 2-month period, a total of 144 patients took a survey that included the Chinese-edition Rapid Estimate of Adult Literacy in Medicine, the Barrett-Lennard Relationship Inventory and the Preoperative Information Understanding Scale. Hierarchical multiple regression analysis provided a test of moderator effects. All Cronbach's alphas exceeded 0.6, with REALM at 0.91, BLRI at 0.67, and PIUS at 0.77.The finding that the interaction term was significant suggests perceived empathy is a relevant factor when considering the relationship between health literacy and the understanding of information by patients. The relationship between the health literacy and understanding of information was stronger and positive among patients who perceived greater empathy from their physicians. Our study demonstrates that a focus on improving physician-patient empathy skills could be beneficial in helping to overcome the negative consequences associated with limited health-literacy capabilities. Healthcare providers who wish to improve the understanding of information by low health-literacy patients should first identify components of their empathic communication mechanisms, and then try to refine these skills to better serve their patients.

  18. 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…

  19. Improving Outcomes in Patients With Sepsis.

    PubMed

    Armen, Scott B; Freer, Carol V; Showalter, John W; Crook, Tonya; Whitener, Cynthia J; West, Cheri; Terndrup, Thomas E; Grifasi, Marissa; DeFlitch, Christopher J; Hollenbeak, Christopher S

    2016-01-01

    Sepsis mortality may be improved by early recognition and appropriate treatment based on evidence-based guidelines. An intervention was developed that focused on earlier identification of sepsis, early antimicrobial administration, and an educational program that was disseminated throughout all hospital units and services. There were 1331 patients with sepsis during the intervention period and 1401 patients with sepsis during the control period. After controlling for expected mortality, patients in the intervention period had 30% lower odds of dying (odds ratio = 0.70, 95% confidence interval [CI] = 0.57 to 0.84). They also had 1.07 fewer days on average in the intensive care unit (95% CI = -1.98 to -0.16), 2.15 fewer hospital days (95% CI = -3.45 to -0.86), and incurred on average $1949 less in hospital costs, although the effect on costs was not statistically significant. Continued incremental improvement and sustainment is anticipated through organizational oversight, continued education, and initiation of an automated electronic sepsis alert function. © The Author(s) 2014.

  20. Improving patient safety culture in general practice: an interview study

    PubMed Central

    Verbakel, Natasha J; de Bont, Antoinette A; Verheij, Theo JM; Wagner, Cordula; Zwart, Dorien LM

    2015-01-01

    Background When improving patient safety a positive safety culture is key. As little is known about improving patient safety culture in primary care, this study examined whether administering a culture questionnaire with or without a complementary workshop could be used as an intervention for improving safety culture. Aim To gain insight into how two interventions affected patient safety culture in everyday practice. Design and setting After conducting a randomised control trial of two interventions, this was a qualitative study conducted in 30 general practices to aid interpretation of the previous quantitative findings. Method Interviews were conducted at practice locations (n = 27) with 24 GPs and 24 practice nurses. The theory of communities of practice — in particular, its concepts of a domain, a community, and a practice — was used to interpret the findings by examining which elements were or were not present in the participating practices. Results Communal awareness of the problem was only raised after getting together and discussing patient safety. The combination of a questionnaire and workshop enhanced the interaction of team members and nourished team feelings. This shared experience also helped them to understand and develop tools and language for daily practice. Conclusion In order for patient safety culture to improve, the safety culture questionnaire was more successful when accompanied by a practice workshop. Initial discussion and negotiation of shared goals during the workshop fuelled feelings of coherence and belonging to a community wishing to learn about enhancing patient safety. Team meetings and day-to-day interactions enhanced further liaison and sharing, making patient safety a common and conscious goal. PMID:26622035

  1. Using relationship styles based on attachment theory to improve understanding of specialty choice in medicine

    PubMed Central

    Ciechanowski, Paul S; Worley, Linda LM; Russo, Joan E; Katon, Wayne J

    2006-01-01

    Background Patient-provider relationships in primary care are characterized by greater continuity and depth than in non-primary care specialties. We hypothesized that relationship styles of medical students based on attachment theory are associated with specialty choice factors and that such factors will mediate the association between relationship style and ultimately matching in a primary care specialty. Methods We determined the relationship styles, demographic characteristics and resident specialty match of 106 fourth-year medical students. We assessed the associations between 1) relationship style and specialty choice factors; 2) specialty choice factors and specialty match, and 3) relationship style and specialty match. We also conducted mediation analyses to determine if factors examined in a specialty choice questionnaire mediate the association between relationship style and ultimately matching in a primary care specialty. Results Prevalence of attachment styles was similar to that found in the general population and other medical school settings with 59% of students rating themselves as having a secure relationship style. Patient centeredness was directly associated, and career rewards inversely associated with matching in a primary care specialty. Students with a self-reliant relationship style were significantly more likely to match in a non-primary care specialty as compared to students with secure relationship style (OR = 5.3, 95% CI 1.8, 15.6). There was full mediation of the association between relationship style and specialty match by the specialty choice factor characterized by patient centeredness. Conclusion Assessing relationship styles based on attachment theory may be a potentially useful way to improve understanding and counsel medical students about specialty choice. PMID:16405723

  2. 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

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

    PubMed

    Percival, Jennifer; McGregor, Carolyn

    2016-07-28

    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. 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. 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. 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. 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 case study to a more diversified group of

  4. 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.

  5. Herceptin resistance database for understanding mechanism of resistance in breast cancer patients.

    PubMed

    Ahmad, Sahil; Gupta, Sudheer; Kumar, Rahul; Varshney, Grish C; Raghava, Gajendra P S

    2014-03-27

    Monoclonal antibody Trastuzumab/Herceptin is considered as frontline therapy for Her2-positive breast cancer patients. However, it is not effective against several patients due to acquired or de novo resistance. In last one decade, several assays have been performed to understand the mechanism of Herceptin resistance with/without supplementary drugs. This manuscript describes a database HerceptinR, developed for understanding the mechanism of resistance at genetic level. HerceptinR maintains information about 2500 assays performed against various breast cancer cell lines (BCCs), for improving sensitivity of Herceptin with or without supplementary drugs. In order to understand Herceptin resistance at genetic level, we integrated genomic data of BCCs that include expression, mutations and copy number variations in different cell lines. HerceptinR will play a vital role in i) designing biomarkers to identify patients eligible for Herceptin treatment and ii) identification of appropriate supplementary drug for a particular patient. HerceptinR is available at http://crdd.osdd.net/raghava/herceptinr/.

  6. Understanding and Improving Recruitment to Randomised Controlled Trials: Qualitative Research Approaches.

    PubMed

    Elliott, Daisy; Husbands, Samantha; Hamdy, Freddie C; Holmberg, Lars; Donovan, Jenny L

    2017-05-31

    The importance of evidence from randomised trials is now widely recognised, although recruitment is often difficult. Qualitative research has shown promise in identifying the key barriers to recruitment, and interventions have been developed to reduce organisational difficulties and support clinicians undertaking recruitment. This article provides an introduction to qualitative research techniques and explains how this approach can be used to understand-and subsequently improve-recruitment and informed consent within a range of clinical trials. A literature search was performed using Medline, Embase, and CINAHL. All studies with qualitative research methods that focused on the recruitment activity of clinicians were included in the review. The majority of studies reported that organisational difficulties and lack of time for clinical staff were key barriers to recruitment. However, a synthesis of qualitative studies highlighted the intellectual and emotional challenges that arise when combining research with clinical roles, particularly in relation to equipoise and patient eligibility. To support recruiters to become more comfortable with the design and principles of randomised controlled trials, interventions have been developed, including the QuinteT Recruitment Intervention, which comprises in-depth investigation of recruitment obstacles in real time, followed by implementation of tailored strategies to address these challenges as the trial proceeds. Qualitative research can provide important insights into the complexities of recruitment to trials and inform the development of interventions, and provide support and training initiatives as required. Investigators should consider implementing such methods in trials expected to be challenging or recruiting below target. Qualitative research is a term used to describe a range of methods that can be implemented to understand participants' perspectives and behaviours. Data are gathered from interviews, focus groups

  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. A survey of how patient-perceived empathy affects the relationship between health literacy and the understanding of information by orthopedic patients?

    PubMed Central

    2013-01-01

    Background There is a lack of research examining patient-perceived empathy and its effect on low-literacy patients’ understanding of health information. This study investigated the moderating effect of patient-perceived empathy on the relationship between health literacy and understanding of preoperative information. Methods During a 2-month period, a total of 144 patients took a survey that included the Chinese-edition Rapid Estimate of Adult Literacy in Medicine, the Barrett-Lennard Relationship Inventory and the Preoperative Information Understanding Scale. Hierarchical multiple regression analysis provided a test of moderator effects. Results All Cronbach’s alphas exceeded 0.6, with REALM at 0.91, BLRI at 0.67, and PIUS at 0.77.The finding that the interaction term was significant suggests perceived empathy is a relevant factor when considering the relationship between health literacy and the understanding of information by patients. The relationship between the health literacy and understanding of information was stronger and positive among patients who perceived greater empathy from their physicians. Conclusion Our study demonstrates that a focus on improving physician–patient empathy skills could be beneficial in helping to overcome the negative consequences associated with limited health-literacy capabilities. Healthcare providers who wish to improve the understanding of information by low health-literacy patients should first identify components of their empathic communication mechanisms, and then try to refine these skills to better serve their patients. PMID:23421348

  9. Medication understanding among patients living with multiple chronic conditions: Implications for patient-reported measures of adherence.

    PubMed

    Fredericksen, R J; Gibbons, L; Brown, S; Edwards, T C; Yang, F M; Fitzsimmons, E; Alperovitz-Bichell, K; Godfrey, M; Wang, A; Church, A; Gutierrez, C; Paez, E; Dant, L; Loo, S; Walcott, M; Mugavero, M J; Mayer, K; Mathews, W C; Patrick, D L; Crane, P K; Crane, H M

    2017-06-20

    Low health literacy is associated with poor medication adherence and poor health outcomes. Limited understanding of prescribed medications may decrease validity of patient-reported adherence measures. To assess knowledge of names and purposes of prescribed medications among patients with multiple chronic conditions. Individual interviews were conducted with a convenience sample of patients from six U.S. primary care clinics. Participants (n = 57) were English and/or Spanish-speaking patients prescribed 3+ medications for chronic conditions, for which non-adherence may lead to disability or death. In individual interviews, patients were asked to name their medications, explain the purpose of each, and to explain how they distinguish them from one another. Interviews were audio recorded, transcribed, and coded; coded content was quantified by 1) whether or not the patient could name medications; 2) method of categorizing medications; 3) whether or not the purpose of the medication was understood. Descriptive statistics were compiled using Fisher's exact test to determine the relationship between patient knowledge and medication characteristics. Thirty percent of patients could not name at least one of their medications; 19% did not know their purpose; 30% held misconceptions about the purpose of one or more medications. There was no significant difference in ability to name medications or state their medication's purpose between patients using medi-sets, pre-packaged rolls, or blister packs, and patients who stored pills in their original containers (p = 0.56 and p = 0.73, respectively), or across demographic groups (p = 0.085 to 0.767). Many patients demonstrated difficulty identifying the name and purpose of prescribed medications; this did not differ by demographic group or medication storage type. Patients may benefit from routine review of medications with their provider in order to improve health literacy, outcomes, and patient-reported adherence

  10. Understanding polycystic ovary syndrome from the patient perspective: a concept elicitation patient interview study.

    PubMed

    Martin, Mona L; Halling, Katarina; Eek, Daniel; Krohe, Meaghan; Paty, Jean

    2017-08-18

    The aim of this study was to explore the need for a new disease-specific patient reported outcome (PRO) measure for use in clinical trials of drugs designed to target the underlying causes of polycystic ovary syndrome (PCOS), and in the process contribute to our understanding of the symptoms and impacts that define the patient experience with PCOS. Semi-structured interviews were conducted in 20 women diagnosed with PCOS according to the Rotterdam criteria who had not menstruated in the previous month. The relative importance of PCOS symptoms and impact concepts to patients was determined by analyzing the frequency of their expression in the interview transcripts. These insights were compared to clinicians' perceptions of PCOS. Pain- and discomfort-related symptoms accounted for the highest proportion (27.6%) of the 735 patient expressions, although clinicians did not consider pain to be important to patients with PCOS. The most frequently expressed individual symptoms were cramping (70% of patients; 14.7% of concepts), irregular menstruation (95% of patients; 12.2% of concepts), facial hair growth (75% of patients; 10.6% of concepts), heavy bleeding (70% of patients; 8.8% of concepts), infertility (70% of patients; 5.4% of concepts), and bloating (60% of patients; 5.2% of concepts). Cramping, heavy bleeding, and bloating were not identified by clinicians as being important to patients with PCOS. The impacts most frequently reported by patients with PCOS related to emotional well-being (e.g. anxiety/stress) and coping behaviors (e.g. acne medication, hair removal). The only validated PCOS-specific PRO, the PCOSQ, does not capture some key PCOS symptoms and impacts expressed by patients with PCOS, most notably those related to pain and discomfort, bleeding intensity and coping behaviours. Furthermore, some key PCOS symptoms may be under-recognized in the clinic.

  11. Improving clinical care for patients with irritable bowel syndrome.

    PubMed

    Thompson, Julie

    2017-01-26

    Progress has been made in the past year in the guidance available for health professionals caring for patients with irritable bowel syndrome (IBS). In April 2016, the first National Institute for Health and Care Excellence (NICE) quality standard on IBS in adults was published and new dietary guidelines were developed. Nurses are at the forefront of caring for people with IBS across all healthcare sectors and may have more time to understand the patient's perspective and advise on lifestyle changes than a general practitioner in the average 10-minute consultation. Rapid diagnosis and evidence-based treatments using treatment pathways significantly reduces healthcare costs in primary care and improves quality of life. First-line treatment modalities remain a combination of lifestyle factors, diet and medications, but for persistent refractory symptoms, referral to specialist practitioners should be considered. This article aims to update nurses on new practice guidance and provide information on when it is appropriate to refer patients for specialist care.

  12. Consent for biobanking: assessing the understanding and views of cancer patients.

    PubMed

    Mancini, Julien; Pellegrini, Isabelle; Viret, Frédéric; Vey, Norbert; Daufresne, Lise-Marie; Chabannon, Christian; Julian-Reynier, Claire

    2011-01-19

    Cancer patients were questioned about the consent process in a context in which they were routinely requested to donate tumor samples to research. After in-depth interviews of 19 patients, a 12-page questionnaire was designed and mailed to 745 patients who had been recently treated for colorectal cancer, breast cancer, or a hematological malignancy at a French Regional Cancer Center at which an opt-in biobanking system has existed since 2002. The response rate was 77.0% (N = 574). Among responding patients, 349 (60.8%) of the 574 were in favor of a formal and signed consent. Concordance was low (kappa = 0.23) between the number of patients who declared in the survey that they had given consent (213 of 574 [37.1%]) vs the number for whom registered consent had been recorded (267 of 574 [46.5%]). Only 2 (0.3%) of the 574 patients stated that they had signed a refusal, and only 88 (41.3%) of the 213 patients who remembered giving consent understood that their consent for biobanking also covered authorization to use their clinical data. We conclude that the opt-in consent procedure is positively perceived by most patients but should be improved for a better understanding and possibly an even better adherence to the consent process.

  13. Conferences, tablecloths and cupboards: how to understand the situatedness of quality improvements in long-term care.

    PubMed

    Stoopendaal, Annemiek; Bal, Roland

    2013-02-01

    Long term care needs improvement, but still little is known how quality improvement works in practice. A better, in-depth, understanding of the content and complexities of quality improvement is necessary because of the still limited theoretical and empirical grounds underlying its approach. This article draws on empirical material from Care for Better, a national quality improvement collaborative (QIC) for the long-term care sector in the Netherlands that took place from 2005 until 2012. Following a project on prevention of malnutrition, we analyzed the complex and ongoing processes of embedding improvements. The guiding question for our research was: what must be accomplished to enable and sustain improvements to occur in the everyday life of care organizations? In our analysis, we linked ethnographic findings to Actor Network Theory. We found that different kinds of work had to be done by both human and non-human actors to displace improvements into specific organizational situations. We conceptualized this work as the activity of translation. Moreover, the concept of inscription offers a perspective to reveal how improvements are made durable. Inscriptions are translations of values into texts, behavior or materialities that steer action in a specific way. We analyzed three different modes of inscription: gathering, materializing and training. We analyzed how one specific value, patient choice, became inscribed in different ways, configuring the actors in specific ways, with diverging consequences for how patient choice comes about.

  14. Improving patient care. My right knee.

    PubMed

    Berwick, Donald M

    2005-01-18

    Despite some impressive recent gains, improving the glaring deficiencies in health care quality is proving to be very hard. Improvement is local, rather than system-wide, and is sustained with difficulty, rather than becoming an intrinsic feature of care. My right knee will probably need to be replaced soon. This has given me the opportunity to define, in very personal terms, 5 specific dimensions of "total quality" that I will require from the medical institution that does my surgery and that every patient has the right to require of their encounters with the health care system. Don't kill me (no needless deaths). Do help me, and don't hurt me (no needless pain). Don't make me feel helpless. Don't keep me waiting. And don't waste resources, mine or anyone else's. Given my requirements, it is not clear that any health care institution in the United States will want to take me on as a patient. Although at this point individual institutions can meet some of these requirements, no single institution can deliver on all of them. Generating the energy, insight, and courage we need to get to "total quality" may require those of us who work in health care to get much better at seeing images of ourselves in the people we help. As Gandhi said, "You must be the change you wish to see in the world."

  15. Health literacy in patients referred for transplant: do patients have the capacity to understand?

    PubMed

    Miller-Matero, Lisa R; Hyde-Nolan, Maren E; Eshelman, Anne; Abouljoud, Marwan

    2015-04-01

    Adequate levels of health literacy are needed for transplant recipients to be able to understand and comply with medical recommendations. However, little is known about health literacy among transplant candidates. Therefore, the purpose of this study was to examine the levels of health literacy and cognitive functioning among patients being evaluated for various types of transplantation. There were 398 patients who completed a required psychological evaluation prior to being listed for transplant. This included a screen for cognitive impairment and limited reading and math ability. The prevalence of limited reading ability was 27.5%, limited math ability was 42.8%, and 30.7% had probable cognitive impairment. Rates of limited reading and math ability and cognitive impairment varied for each type of end-stage disease. Limited reading ability was related to poorer cognitive functioning. Those with a higher likelihood of limited reading ability included blacks and males. Those more likely to have cognitive impairment included blacks and patients who are older. Results from this study suggest that patients should be regularly screened for health literacy and cognitive impairment. Once patients with difficulties are identified, recommendations can be provided to these patients at a level that they are able to understand. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  16. Improved informed consent documents for biomedical research do not increase patients’ understanding but reduce enrolment: a study in real settings

    PubMed Central

    Paris, Adeline; Deygas, Béatrice; Cornu, Catherine; Thalamas, Claire; Maison, Patrick; Duale, Christian; Kane, Maty; Hodaj, Enkelejda; Cracowski, Jean-Luc

    2015-01-01

    Aims The aim was to evaluate the comprehension of participants of an improved informed consent document (ICD). Method This was a randomized controlled French multicentre study performed in real conditions. Participants were adult patients undergoing screening for enrolment in biomedical research studies, who agreed to answer a validated questionnaire evaluating objective and subjective comprehension scored from 0 (no comprehension) to 100 (excellent comprehension). Patients were provided either the original ICD or an ICD modified in terms of structure and readability. The primary end point was the score of objective comprehension. The secondary end-points were the enrolment rate in the clinical study and patient characteristics associated with the score of objective comprehension. Results Four hundred and eighty-one patients were included, 241 patients in the original ICD group and 240 patients in the modified ICD group. There was no difference between the two groups for the score of objective comprehension (original ICD 72.7 (95% CI 71.3, 74.1) vs. modified ICD 72.5 (95% CI 71.0, 74.0); P = 0.81). However, the rate of enrolment in the clinical study was lower in the group who received the modified ICD (64.4% (95% CI 58.3, 70.5)) than for the original ICD (73.0% (95% CI 67.4, 78.7)) (P = 0.042). Only female gender and high educational level were associated with a better objective comprehension. Conclusions Improving ICDs had no effect on participants’ understanding, whereas the rate of enrolment was lower in this group. In attempts at improving potential participants’ understanding of clinical research information, efforts and future trials should focus on other ways to improve comprehension. PMID:26147763

  17. Teaching genetics prior to teaching evolution improves evolution understanding but not acceptance.

    PubMed

    Mead, Rebecca; Hejmadi, Momna; Hurst, Laurence D

    2017-05-01

    What is the best way to teach evolution? As microevolution may be configured as a branch of genetics, it being a short conceptual leap from understanding the concepts of mutation and alleles (i.e., genetics) to allele frequency change (i.e., evolution), we hypothesised that learning genetics prior to evolution might improve student understanding of evolution. In the UK, genetics and evolution are typically taught to 14- to 16-y-old secondary school students as separate topics with few links, in no particular order and sometimes with a large time span between. Here, then, we report the results of a large trial into teaching order of evolution and genetics. We modified extant questionnaires to ascertain students' understanding of evolution and genetics along with acceptance of evolution. Students were assessed prior to teaching, immediately post teaching and again after several months. Teachers were not instructed what to teach, just to teach in a given order. Regardless of order, teaching increased understanding and acceptance, with robust signs of longer-term retention. Importantly, teaching genetics before teaching evolution has a significant (p < 0.001) impact on improving evolution understanding by 7% in questionnaire scores beyond the increase seen for those taught in the inverse order. For lower ability students, an improvement in evolution understanding was seen only if genetics was taught first. Teaching genetics first additionally had positive effects on genetics understanding, by increasing knowledge. These results suggest a simple, minimally disruptive, zero-cost intervention to improve evolution understanding: teach genetics first. This same alteration does not, however, result in a significantly increased acceptance of evolution, which reflects a weak correlation between knowledge and acceptance of evolution. Qualitative focus group data highlights the role of authority figures in determination of acceptance.

  18. Teaching genetics prior to teaching evolution improves evolution understanding but not acceptance

    PubMed Central

    Mead, Rebecca; Hejmadi, Momna

    2017-01-01

    What is the best way to teach evolution? As microevolution may be configured as a branch of genetics, it being a short conceptual leap from understanding the concepts of mutation and alleles (i.e., genetics) to allele frequency change (i.e., evolution), we hypothesised that learning genetics prior to evolution might improve student understanding of evolution. In the UK, genetics and evolution are typically taught to 14- to 16-y-old secondary school students as separate topics with few links, in no particular order and sometimes with a large time span between. Here, then, we report the results of a large trial into teaching order of evolution and genetics. We modified extant questionnaires to ascertain students’ understanding of evolution and genetics along with acceptance of evolution. Students were assessed prior to teaching, immediately post teaching and again after several months. Teachers were not instructed what to teach, just to teach in a given order. Regardless of order, teaching increased understanding and acceptance, with robust signs of longer-term retention. Importantly, teaching genetics before teaching evolution has a significant (p < 0.001) impact on improving evolution understanding by 7% in questionnaire scores beyond the increase seen for those taught in the inverse order. For lower ability students, an improvement in evolution understanding was seen only if genetics was taught first. Teaching genetics first additionally had positive effects on genetics understanding, by increasing knowledge. These results suggest a simple, minimally disruptive, zero-cost intervention to improve evolution understanding: teach genetics first. This same alteration does not, however, result in a significantly increased acceptance of evolution, which reflects a weak correlation between knowledge and acceptance of evolution. Qualitative focus group data highlights the role of authority figures in determination of acceptance. PMID:28542179

  19. 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.

  20. Toward a Better Understanding of Patient Health Literacy: A Focus on the Skills Patients Need to Find Health Information.

    PubMed

    Champlin, Sara; Mackert, Michael; Glowacki, Elizabeth M; Donovan, Erin E

    2016-05-12

    While many health literacy assessments exist, this area of research lacks an instrument that isolates and reflects the four components driving this concept (abilities to find, understand, use, and communicate about health information). The purpose of this study was to determine what abilities comprise the first component, how a patient finds health information. Low (n = 13) and adequate (n = 14) health literacy patients, and health professionals (n = 10) described their experiences when looking for health information and the skills they employed to complete these tasks. Major skills/themes elicited included knowing when to search, credibility assessments, finding text and numerical information, interpersonal seeking, technology and online search, and spatial navigation. Findings from this study suggest that each of the dimensions included in the definition of health literacy warrants specific attention and assessment. Given identification of the skills comprising each dimension, interventions targeting deficits across health literacy dimensions could be developed to improve patient health.

  1. 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

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

    PubMed

    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

    To develop expeditiously a pragmatic, modular, and extensible software framework for understanding and improving healthcare value (costs relative to outcomes). 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. 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. The framework described can be expeditiously implemented to provide a pragmatic, modular, and extensible approach to understanding and improving healthcare value. © The Author 2014. Published by Oxford University Press on behalf of the American Medical Informatics Association.

  3. Understanding patient satisfaction, trust, and loyalty to primary care physicians.

    PubMed

    Platonova, Elena A; Kennedy, Karen Norman; Shewchuk, Richard M

    2008-12-01

    The authors developed and empirically tested a model reflecting a system of interrelations among patient loyalty, trust, and satisfaction as they are related to patients' intentions to stay with a primary care physician (PCP) and recommend the doctor to other people. They used a structural equation modeling approach. The fit statistics indicate a well-fitting model: root mean square error of approximation = .022, goodness-of-fit index = .99, adjusted goodness-of-fit index = .96, and comparative fit index = 1.00. The authors found that patient trust and good interpersonal relationships with the PCP are major predictors of patient satisfaction and loyalty to the physician. Patients need to trust the PCP to be satisfied and loyal to the physician. The authors also found that patient trust, satisfaction, and loyalty are strong and significant predictors of patients' intentions to stay with the doctor and to recommend the PCP to others.

  4. Understanding and improving low bystander CPR rates: a systematic review of the literature.

    PubMed

    Vaillancourt, Christian; Stiell, Ian G; Wells, George A

    2008-01-01

    Cardiopulmonary resuscitation (CPR) is a crucial yet weak link in the chain of survival for out-of-hospital cardiac arrest. We sought to understand the determinants of bystander CPR and the factors associated with successful training. For this systematic review, we searched 11 electronic databases, 1 trial registry and 9 scientific websites. We performed hand searches and contacted 6 content experts. We reviewed without restriction all communications pertaining to who should learn CPR, what should be taught, when to repeat training, where to give CPR instructions and why people lack the motivation to learn and perform CPR. We used standardized forms to review papers for inclusion, quality and data extraction. We grouped publications by category and classified recommendations using a standardized classification system that was based on level of evidence. We reviewed 2409 articles and selected 411 for complete evaluation. We included 252 of the 411 papers in this systematic review. Differences in their study design precluded a meta-analysis. We classified 22 recommendations; those with the highest scores were 1) 9-1-1 dispatch- assisted CPR instructions, 2) teaching CPR to family members of cardiac patients, 3) Braslow's self-training video, 4) maximizing time spent using manikins and 5) teaching the concepts of ambiguity and diffusion of responsibility. Recommendations not supported by evidence include mass training events, pulse taking prior to CPR by laymen and CPR using chest compressions alone. We evaluated and classified the potential impact of interventions that have been proposed to improve bystander CPR rates. Our results may help communities design interventions to improve their bystander CPR rates.

  5. 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

  6. Understanding the experience of care managers and relationship with patient outcomes: the COMPASS initiative.

    PubMed

    Coleman, Karen J; Hemmila, Tani; Valenti, Mark D; Smith, Nasya; Quarrell, Rachel; Ruona, Lynnice K; Brandenfels, Emily; Hann, Barbara; Hinnenkamp, Todd; Parra, Margarita D; Monkman, Jeyn; Vos, Sue; Rossom, Rebecca C

    To understand how care managers implemented COMPASS and if this was related to patient health outcomes. A total of 96 COMPASS care managers were approached to participate in the online survey and 93 (97%) provided responses. Correlations were generated between key survey responses and the average number of care management contacts, patient depression, blood pressure and glycosylated hemoglobin outcomes. Patients of care managers who reported spending more time on COMPASS-related tasks had higher rates of depression improvement (r=0.34; P=.002) and remission (r=0.27; P=.02) as well as higher rates of blood pressure control (r=0.29; P=.03). To improve the effectiveness of care management in collaborative care models, particularly for patients with comorbid conditions and complex nonmedical needs, care managers need the support of social work and administrative support staff. Care managers for this patient population would also benefit from more intensive training in nonpharmacological depression treatment, such as motivational interviewing and behavioral activation. Additionally, systems support is needed such as education for primary care teams and psychiatry on the value of collaborative care models and integration of population management tools into electronic medical records. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Understanding plant response to nitrogen limitation for the improvement of crop nitrogen use efficiency.

    PubMed

    Kant, Surya; Bi, Yong-Mei; Rothstein, Steven J

    2011-02-01

    Development of genetic varieties with improved nitrogen use efficiency (NUE) is essential for sustainable agriculture. Generally, NUE can be divided into two parts. First, assimilation efficiency involves nitrogen (N) uptake and assimilation and second utilization efficiency involves N remobilization. Understanding the mechanisms regulating these processes is crucial for the improvement of NUE in crop plants. One important approach is to develop an understanding of the plant response to different N regimes, especially to N limitation, using various methods including transcription profiling, analysing mutants defective in their normal response to N limitation, and studying plants that show better growth under N-limiting conditions. One can then attempt to improve NUE in crop plants using the knowledge gained from these studies. There are several potential genetic and molecular approaches for the improvement of crop NUE discussed in this review. Increased knowledge of how plants respond to different N levels as well as to other environmental conditions is required to achieve this.

  8. The AMA clinical quality improvement forum on addressing patient safety.

    PubMed

    Berman, S

    2000-07-01

    More than 200 health care policy makers and researchers, clinicians, quality professionals, and other representatives of health care organizations, government, and academia attended the Division of American Medical Association Clinical Quality Improvement's conference, "Addressing Patient Safety," April 28, 2000, in Chicago--the first national conference to respond to the recent Institute of Medicine (IOM) report, To Err Is Human: Building a Safer Health System. ADDRESSING PATIENT SAFETY--PUBLIC AND PRIVATE PERSPECTIVES: John M. Eisenberg, MD, stated that research on errors is needed to describe the scope and nature of the problem, understand the barriers to and benefits of improvement, and develop and test strategies for improvement. Kenneth W. Kizer, MD, MPH, stated that the National Quality Forum will develop a compendium of best practices and will develop core measures for serious adverse events, and health care organizations and government health programs should act now to make a clear organizational commitment to patient safety, create a nonpunitive health care culture of safety, and implement known safe medication practices. Alan R. Nelson, MD, stated that the IOM report places its emphasis on continuous quality improvement and technology that can be used to mitigate the risks in a complex health system. Donald M. Nielsen, MD, discussed the American Hospital Association's (AHA's) Medication Safety Initiative, which promised to provide its members with successful practices, tools, and resources and to track progress of implementation of the recommended successful practices. Dennis S. O'Leary, MD, stated that when a hospital reports a sentinel event, the hospital is expected to implement improvements to reduce risk and monitor their effectiveness. The National Committee for Quality Assurance is considering changes to its accreditation standards to further address patient safety.

  9. 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

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

    PubMed

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

    2014-10-16

    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. 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. 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. 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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  11. Don't assume the patient understands: Qualitative analysis of the challenges low health literate patients face in the pharmacy.

    PubMed

    Wali, Huda; Grindrod, Kelly

    Low health literacy populations have difficulty understanding health information and making appropriate health decisions. Pharmacists need to ensure patients have a basic understanding of how to take their medications and understand the risks and benefits of their prescriptions. To explore the major challenges low health literate adults face when trying to understand their medication therapy. One-on-one semi-structured interviews were used to gather data on the major challenges low health literate adults face regarding their medication. Each interview began with a verbal health literacy assessment, followed by open-ended questions focused on medication information. After each interview was complete, a written health literacy assessment was given in English, which was later used to compare self-assessed health literacy to written health literacy scores. All interviews were audio-recorded, transcribed and analyzed using thematic analysis. The population sample had an average age of 67 years old and 90% had been education outside of North America. Low health literacy levels were found in 75% of participants based on the S-TOFHLA and demonstrated a generally over estimated self-assessed health literacy levels. After thematic analysis, a flow chart that describes the low health literate population's pharmacy experience with medication information was developed to explain the cause and effect of challenges faced with current pharmacy medication information. Also, the major challenges patients with low health literacy face with current medication information from the pharmacy were limited time with pharmacists, understanding medication information, forgetting to take medication, side effects and food-drug interactions. Future interventions targeted to improving pharmacy medication information for the low health literate population should focus on addressing the challenges with limited time with pharmacists, poor understanding of medication information, forgetting to take

  12. 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

  13. Using digital multimedia to improve parents' and children's understanding of clinical trials.

    PubMed

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

    2015-06-01

    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. Parents (n=148) and children (n=135) were each randomised to receive information regarding clinical trials using either a traditional paper format (TF) or an interactive iPad program (IP) with inline exercises. Participants' understanding of the information was assessed using semistructured interviews prior to (pretest) and after (post-test) receiving the information. Participants also completed a short survey to assess their perceptions of information delivery and satisfaction with the process. Regardless of the mode of information delivery, all participants demonstrated improved pretest 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. 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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  14. Patient perspectives of patient-controlled analgesia (PCA) and methods for improving pain control and patient satisfaction.

    PubMed

    Patak, Lance S; Tait, Alan R; Mirafzali, Leela; Morris, Michelle; Dasgupta, Sunavo; Brummett, Chad M

    2013-01-01

    This study aimed to (1) identify patient-controlled analgesia (PCA) attributes that negatively impact patient satisfaction and ability to control pain while using PCA and (2) obtain data on patient perceptions of new PCA design features. We conducted a prospective survey study of postoperative pain control among patients using a PCA device. The survey was designed to evaluate patient satisfaction with pain control, understanding of PCA, difficulties using PCA, lockout-period management, and evaluation of new PCA design features. A total of 350 eligible patients completed the survey (91%). Patients who had difficulties using PCA were less satisfied (P < 0.001) and were more likely to feel unable to control their pain (P < 0.001). Satisfaction and self-reported ability to control pain were not affected by patient education about the PCA. Forty-nine percent of patients reported not knowing if they would receive medicine when they pushed the PCA button, and of these, 22% believed that this uncertainty made their pain worse. The majority of patients preferred the proposed PCA design features for easier use, including a light on the button, making it easier to find (57%), and a PCA button that vibrates (55%) or lights up (70%), alerting the patient that the PCA pump is able to deliver more medicine. A majority of patients, irrespective of their satisfaction with PCA, preferred a new PCA design. Certain attributes of current PCA technology may negatively impact patient experience, and modifications could potentially address these concerns and improve patient outcomes.

  15. 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.

  16. Improving management of patients with hyperemesis

    PubMed Central

    Lloyd, Jilly; Ramskill, Nikki; Sharma, Bhavna

    2014-01-01

    Hyperemesis gravidarum (HG), defined as severe nausea and vomiting resulting in dehydration, is a common reason for emergency admission in gynaecology (1). The management of HG is supportive, including the correction of dehydration and electrolyte disturbances and use of antiemetics. An audit in our unit identified that women with HG were not receiving appropriate fluid resuscitation and in particular inadequate potassium replacement. A proforma was developed by a multidiscplinary team to prompt appropriate investigations, medications, and fluid resuscitation. The proforma was introduced in paper format and electronically, accompanied by an education programme for junior doctors. This intervention has improved prescribing practice and fluid resuscitation for these patients. Length of admission has reduced. Efforts have been made to ensure this change is sustainable in the long term, through involvement of the junior doctors using the proforma at all stages of the project. PMID:26734219

  17. Understanding the Code: exceptions to the duty of patient confidentiality.

    PubMed

    Griffith, Richard

    2015-07-01

    Last month's article considered the scope of a district nurse's duty to maintain the confidentiality of patient information under the Nursing and Midwifery Council (NMC) Code, their contract of employment, and the law. This month, Richard Griffith considers the exceptions to these duties and sets out when a district nurse would be justified in disclosing patient information.

  18. 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,…

  19. 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,…

  20. Understanding diabetes in patients with HIV/AIDS

    PubMed Central

    2011-01-01

    This paper reviews the incidence, pathogenetic mechanisms and management strategies of diabetes mellitus in patients with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). It classifies patients based on the aetiopathogenetic mechanisms, and proposes rational methods of management of the condition, based on aetiopathogenesis and concomitant pharmacotherapy. PMID:21232158

  1. 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…

  2. 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.)…

  3. Development and Evaluation of a Tutorial to Improve Students' Understanding of a Lock-in Amplifier

    ERIC Educational Resources Information Center

    DeVore, Seth; Gauthier, Alexandre; Levy, Jeremy; Singh, Chandralekha

    2016-01-01

    A lock-in amplifier is a versatile instrument frequently used in physics research. However, many students struggle with the basic operating principles of a lock-in amplifier which can lead to a variety of difficulties. To improve students' understanding, we have been developing and evaluating a research-based tutorial which makes use of a computer…

  4. Improving Evaluation Programs Through Better Understanding of the College Student and His Professor.

    ERIC Educational Resources Information Center

    Hutchison, Jerry E.

    A successful evaluation or improvement of teaching program ought to develop after a careful consideration of the attitudes and perceptions of those most directly affected--namely students and faculty members. An understanding and awareness of the forces which control their actions on the intellectual-social-cultural environment of the university…

  5. Improving Economic Understanding of Students in Junior College Economic Principles Courses.

    ERIC Educational Resources Information Center

    Barr, Saul Zusman; Carr, Glenna D.

    1980-01-01

    Describes a study comparing a conventional textbook/lecture teaching method and a teaching method based on current event readings with lectures and class discussions. The study sought to show whether improvement in students' understanding of economics was influenced by teaching method and selected characteristics of students and teachers. (AYC)

  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…

  7. Improving Food Safety by Understanding the Evolution of Egg-contaminating Salmonella Enteritidis

    USDA-ARS?s Scientific Manuscript database

    Improving Food Safety by Understanding the Evolution of Egg-contaminating Salmonella Enteritidis Jean Guard, Veterinary Medical Officer U. S. Department of Agriculture, Athens, GA USA (jean.guard@ars.usda.gov) The curious case of egg contamination by Salmonella enterica serovar Enteritidis S. ...

  8. Using Drama To Improve Student Teachers' Understanding in the Physical Sciences.

    ERIC Educational Resources Information Center

    Braund, M. R.

    One way of making scientific concepts more accessible to students is to use active approaches, such as drama, in the classroom. The study reported in this paper evaluates the use of three dramatic improvisations performed by second year undergraduate students to improve their understanding of the generation and supply of electricity. Student…

  9. 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.…

  10. 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...

  11. Development and Evaluation of a Tutorial to Improve Students' Understanding of a Lock-in Amplifier

    ERIC Educational Resources Information Center

    DeVore, Seth; Gauthier, Alexandre; Levy, Jeremy; Singh, Chandralekha

    2016-01-01

    A lock-in amplifier is a versatile instrument frequently used in physics research. However, many students struggle with the basic operating principles of a lock-in amplifier which can lead to a variety of difficulties. To improve students' understanding, we have been developing and evaluating a research-based tutorial which makes use of a computer…

  12. 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…

  13. Improved understanding of moisture effects on outdoor wood–adhesive bondlines

    Treesearch

    Joseph E. Jakes; Nayomi Z. Plaza; Xavier Arzola Villegas; Charles R. Frihart

    2017-01-01

    The development of improved moisture-durable wood adhesives for outdoor applications, such as repairing historic covered bridges, is hindered by an incomplete mechanistic understanding of what makes a wood–adhesive bond moisture-durable. The wood–adhesive bondline is extraordinarily difficult to study because of the chemical, structural, and mechanical complexities and...

  14. 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…

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

    USDA-ARS?s Scientific Manuscript database

    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 ...

  16. Improving Design Understandings and Skills through Enhanced Metacognition: Reflective Design Journals

    ERIC Educational Resources Information Center

    Kurt, Mustafa; Kurt, Sevinc

    2017-01-01

    The main aim of this study was to investigate and discover whether going through the process of reflection by keeping reflective design journals (RDJ) enhances architecture students' metacognition and whether this enhanced metacognition improves their design understandings and skills. The study was a mixed-methods design and utilised content…

  17. 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...

  18. 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.)…

  19. A Hands-On Exercise Improves Understanding of the Standard Error of the Mean

    ERIC Educational Resources Information Center

    Ryan, Robert S.

    2006-01-01

    One of the most difficult concepts for statistics students is the standard error of the mean. To improve understanding of this concept, 1 group of students used a hands-on procedure to sample from small populations representing either a true or false null hypothesis. The distribution of 120 sample means (n = 3) from each population had standard…

  20. Patient understanding of the importance of beta-blocker use in the perioperative period.

    PubMed

    Rosenfeld, David M; Trentman, Terrence L; Hentz, Joseph G; Hagstrom, Susan G; Demenkoff, John H

    2007-06-01

    Perioperative beta-adrenergic blockade has been shown to decrease morbidity and mortality after noncardiac surgery. The objective of this study was to determine patient knowledge of the importance of perioperative beta-blockade in a population already taking chronic therapy and to assess the effectiveness of medical and surgical providers in patient education regarding these benefits. Survey. Teaching hospital. One hundred twenty-six patients taking daily beta-blockers presenting to a preoperative medical evaluation clinic completed a 12-question survey that assessed their understanding of the potential benefit of taking the medication in the perioperative period. None. Mean coronary artery disease risk factors per individual were 3.2 (standard deviation, 1.5). Forty-nine percent indicated that beta-blockers are beneficial in the perioperative period. Of those identifying benefit, 8% recognized decrease in myocardial infarction or decrease in mortality as the reason. Sixty-nine percent of patients who identified perioperative benefit cited blood pressure control as the reason. This correlated to the 67% of the total sample who identified their indication for the medication as antihypertensive. Only 7% recalled their prescribing physician ever mentioning the beta-blocker in relation to surgery. The same percentage recalled their surgeon mentioning it in relation to the planned procedure. This study suggests low patient understanding of the potential importance and reasons for perioperative beta-blockade. Patients who recognized perioperative benefit identified antihypertensive versus cardioprotective effects. Clinicians can improve education of patients already taking daily beta-blockers regarding these potential benefits.

  1. Understanding Facial Expressions of Pain in Patients With Depression.

    PubMed

    Lautenbacher, Stefan; Bär, Karl-Juergen; Eisold, Patricia; Kunz, Miriam

    2016-12-02

    Although depression is associated with more clinical pain complaints, psychophysical data sometimes point to hypoalgesic alterations. Studying the more reflex-like facial expression of pain in patients with depression may offer a new perspective. Facial and psychophysical responses to nonpainful and painful heat stimuli were studied in 23 patients with major depressive disorder (MDD) and 23 matched control participants. As psychophysical data, pain thresholds, tolerance thresholds, and self-report were assessed. Facial responses were videotaped and subjected offline to Facial Action Coding System analysis. One of the key facial responses of pain, which is a known facial signal of negative affect (contraction of the eyebrows), was significantly increased in MDD patients. Moreover, facial expressions and pain ratings were strongly correlated in MDD patients, whereas these 2 response systems were-in line with established findings-only weakly related in healthy participants. Pain psychophysics was unaltered in MDD patients compared with healthy control participants. In conclusion, the facial expression of pain in MDD patients indicates rather hyper- than hypoalgesia, with enhanced affective pain processing. Moreover, the linkage between subjective and facial responses was much stronger in MDD patients, which may be due to a reduced influence of social display rules, which normally complicate this relationship.

  2. Understanding the interplay of cancer patients' instrumental concerns and emotions.

    PubMed

    Brandes, Kim; van der Goot, Margot J; Smit, Edith G; van Weert, Julia C M; Linn, Annemiek J

    2017-05-01

    1) to assess patients' descriptions of concerns, and 2) to inform a conceptual framework in which the impact of the nature of concerns on doctor-patient communication is specified. Six focus groups were conducted with 39 cancer patients and survivors. In these focus groups participants were asked to describe their concerns during and after their illness. Concerns were described as instrumental concerns (e.g., receiving insufficient information) and emotions (e.g., sadness). Patients frequently explained their concerns as an interplay of instrumental concerns and emotions. Examples of the interplay were "receiving incorrect information" and "frustration", and "difficulties with searching, finding and judging of information" and "fear". Instrumental concerns need to be taken into account in the operationalization of concerns in research. Based on the interplay, the conceptual framework suggests that patients can express instrumental concerns as emotions and emotions as instrumental concerns. Consequently, providers can respond with instrumental and emotional communication when patients express an interplay of concerns. The results of this study can be used to support providers in recognizing concerns that are expressed by patients in consultations. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. Patient understanding of oral contraceptive pill instructions related to missed pills: a systematic review.

    PubMed

    Zapata, Lauren B; Steenland, Maria W; Brahmi, Dalia; Marchbanks, Polly A; Curtis, Kathryn M

    2013-05-01

    Instructions on what to do after pills are missed are critical to reducing unintended pregnancies resulting from patient non-adherence to oral contraceptive (OC) regimens. Missed pill instructions have previously been criticized for being too complex, lacking a definition of what is meant by "missed pills," and for being confusing to women who may not know the estrogen content of their formulation. To help inform the development of missed pill guidance to be included in the forthcoming US Selected Practice Recommendations, the objective of this systematic review was to evaluate the evidence on patient understanding of missed pill instructions. We searched the PubMed database for peer-reviewed articles that examined patient understanding of OC pill instructions that were published in any language from inception of the database through March 2012. We included studies that examined women's knowledge and understanding of missed pill instructions after exposure to some written material (e.g., patient package insert, brochure), as well as studies that compared different types of missed pill instructions on women's comprehension. We used standard abstract forms and grading systems to summarize and assess the quality of the evidence. From 1620 articles, nine studies met our inclusion criteria. Evidence from one randomized controlled trial (RCT) and two descriptive studies found that more women knew what to do after missing 1 pill than after missing 2 or 3 pills (Level I, good, to Level II-3, poor), and two descriptive studies found that more women knew what to do after missing 2 pills than after missing 3 pills (Level II-3, fair). Data from two descriptive studies documented the difficulty women have understanding missed pill instructions contained in patient package inserts (Level II-3, poor), and evidence from two RCTs found that providing written brochures with information on missed pill instructions in addition to contraceptive counseling significantly improved

  4. The mediatory role of medication adherence in improving patients' medication experience through patient-physician communication among older hypertensive patients.

    PubMed

    Lee, Woojung; Noh, Youran; Kang, Hyeonjin; Hong, Song Hee

    2017-01-01

    Understanding how patient-physician communication affects patients' medication experience would help hypertensive patients maintain their regular long-term medication therapy. This study aimed to examine whether patient-physician communication (information and interpersonal treatment) affects patients' medication experience directly or indirectly through changing medication adherence for each of the two communication domains. A self-administered cross-sectional survey was conducted for older patients who had visited a community senior center as a member. Two communication domains were assessed using two subscales of the Primary Care Assessment Survey. Medication adherence and experience were measured using the Morisky Medication Adherence Scale and a five-point Likert scale, respectively. Mediatory effects were assessed via Baron and Kenny's procedure and a Sobel test. Patient-physician communication had a positive prediction on patients' medication experience (β=0.25, P=0.03), and this was fully mediated by medication adherence (z=3.62, P<0.001). Of the two components of patient-physician communication, only informative communication showed a mediatory effect (z=2.21, P=0.03). Patient-physician communication, specifically informative communication, had the potential to improve patients' medication experience via changes in medication adherence. This finding can inform health care stakeholders of the mediatory role of medication adherence in ensuring favorable medication experience for older hypertensive patients by fostering informative patient-physician communication.

  5. Understanding the impact of pulmonary arterial hypertension on patients' and carers' lives.

    PubMed

    Guillevin, Loïc; Armstrong, Iain; Aldrighetti, Rino; Howard, Luke S; Ryftenius, Henrik; Fischer, Aryeh; Lombardi, Sandra; Studer, Sean; Ferrari, Pisana

    2013-12-01

    Pulmonary arterial hypertension (PAH) is a rare, debilitating and rapidly progressive disease. Although there have been important medical advances in PAH management, the search for a cure continues. Despite an increased understanding of the disease, data on the wider effect of PAH on patients and carers, beyond the clinical symptoms, are still limited. In order to explore this, a large-scale international survey investigated four key areas affected by PAH (physical and practical, emotional, social, and information needs) and provides new insight into patients' and carers' experiences of living with the disease. The results from the survey highlight not only the limited ability of patients to carry out everyday tasks, but also the financial impact and social isolation experienced by both patients and carers. The study confirmed that a decline in a patient's World Health Organization functional class, which indicates an increase in clinical severity of the disease, is associated with greater limitations. Results from the survey demonstrate the need for multidisciplinary PAH management and a comprehensive standard of care to assess and improve all aspects of well-being for both patients and carers. In addition, they underline the need for updated PAH guidelines that address these needs.

  6. Negative communication in psychosis: understanding pathways to poorer patient outcomes.

    PubMed

    Finnegan, Deirdre; Onwumere, Juliana; Green, Catherine; Freeman, Daniel; Garety, Philippa; Kuipers, Elizabeth

    2014-11-01

    High expressed emotion (EE) is a robust predictor of elevated rates of relapse and readmission in schizophrenia. However, far less is known about how high EE leads to poorer patient outcomes. This study was designed to examine links between high EE (criticism), affect, and multidimensional aspects of positive symptoms in patients with psychosis. Thirty-eight individuals with nonaffective psychosis were randomly exposed to proxy high-EE or neutral speech samples and completed self-report measures of affect and psychosis symptoms. Patients reported significant increases in anxiety, anger, and distress after exposure to the proxy high-EE speech sample as well as increases in their appraisals of psychosis symptoms: voice controllability, delusional preoccupation, and conviction. These findings offer further evidence of the potential deleterious impact of a negative interpersonal environment on patient symptoms in psychosis.

  7. Sildenafil improves exercise hemodynamics in Fontan patients.

    PubMed

    Van De Bruaene, Alexander; La Gerche, Andre; Claessen, Guido; De Meester, Pieter; Devroe, Sarah; Gillijns, Hilde; Bogaert, Jan; Claus, Piet; Heidbuchel, Hein; Gewillig, Marc; Budts, Werner

    2014-03-01

    Patients with Fontan circulation have reduced exercise capacity. The absence of a presystemic pump may limit flow through the pulmonary circulation, restricting ventricular filling and cardiac output. We evaluated exercise hemodynamics and the effect of sildenafil on exercise hemodynamics in Fontan patients. Ten Fontan patients (6 men, 20±4 years) underwent cardiac magnetic resonance imaging at rest and during supine bicycle exercise before and after sildenafil. Systemic ventricular volumes were obtained at rest and during low- (34±15 W), moderate- (69±29 W), and high-intensity (97±36 W) exercise using an ungated, free-breathing cardiac magnetic resonance sequence and analyzed correcting for cardiac phase and respiratory translation. Radial and pulmonary artery pressures and cGMP were measured. Before sildenafil, cardiac index increased throughout exercise (4.0±0.9, 5.9±1.1, 7.0±1.6, 7.4±1.7 L/(min·m(2)); P<0.0001) with 106±49% increase in heart rate. Stroke volume index (P=0.015) and end-diastolic volume index (P=0.001) decreased during exercise. End-systolic volume index remained unchanged (P=0.8). Total pulmonary resistance index (P=0.005) increased, whereas systemic vascular resistance index decreased during exercise (P<0.0001). Sildenafil increased cardiac index (P<0.0001) and stroke volume index (P=0.003), especially at high-intensity exercise (interaction P=0.004 and P=0.003, respectively). Systemic vascular resistance index was reduced (P<0.0001-interaction P=0.1), whereas total pulmonary resistance index was reduced at rest and reduced further during exercise (P=0.008-interaction P=0.029). cGMP remained unchanged before sildenafil (P=0.9), whereas it increased significantly after sildenafil (P=0.019). In Fontan patients, sildenafil improved cardiac index during exercise with a decrease in total pulmonary resistance index and an increase in stroke volume index. This implies that pulmonary vasculature represents a physiological limitation, which

  8. Quality Improvement Initiative to Reduce Serious Safety Events and Improve Patient Safety Culture

    PubMed Central

    Goudie, Anthony; Schoettker, Pamela J.; Donnelly, Lane F.; Goodfriend, Martha A.; Bracke, Tracey M.; Brady, Patrick W.; Wheeler, Derek S.; Kotagal, Uma R.

    2012-01-01

    BACKGROUND AND OBJECTIVE: Many thousands of patients die every year in the United States as a result of serious and largely preventable safety events or medical errors. Safety events are common in hospitalized children. We conducted a quality improvement initiative to implement cultural and system changes with the goal of reducing serious safety events (SSEs) by 80% within 4 years at our large, urban pediatric hospital. METHODS: A multidisciplinary SSE reduction team reviewed the safety literature, examined recent SSEs, interviewed internal leaders, and visited other leading organizations. Senior hospital leaders provided oversight, monitored progress, and helped to overcome barriers. Interventions focused on: (1) error prevention; (2) restructuring patient safety governance; (3) a new root cause analysis process and a common cause database; (4) a highly visible lessons learned program; and (5) specific tactical interventions for high-risk areas. Our outcome measures were the rate of SSEs and the change in patient safety culture. RESULTS: SSEs per 10 000 adjusted patient-days decreased from a mean of 0.9 at baseline to 0.3 (P < .0001). The days between SSEs increased from a mean of 19.4 at baseline to 55.2 (P < .0001). After a worsening of patient safety culture outcomes in the first year of intervention, significant improvements were observed between 2007 and 2009. CONCLUSIONS: Our multifaceted approach was associated with a significant and sustained reduction of SSEs and improvements in patient safety culture. Multisite studies are needed to better understand contextual factors and the significance of specific interventions. PMID:22802607

  9. Understanding patient e-loyalty toward online health care services.

    PubMed

    Martínez-Caro, Eva; Cegarra-Navarro, Juan Gabriel; Solano-Lorente, Marcelina

    2013-01-01

    Public health institutions are making a great effort to develop patient-targeted online services in an attempt to enhance their effectiveness and reduce expenses. However, if patients do not use those services regularly, public health institutions will have wasted their limited resources. Hence, patients' electronic loyalty (e-loyalty) is essential for the success of online health care services. In this research, an extended Technology Acceptance Model was developed to test e-loyalty intent toward online health care services offered by public health institutions. Data from a survey of 256 users of online health care services provided by the public sanitary system of a region in Spain were analyzed. The research model was tested by using the structural equation modeling approach. The results obtained suggest that the core constructs of the Technology Acceptance Model (perceived usefulness, ease of use, and attitude) significantly affected users' behavioral intentions (i.e., e-loyalty intent), with perceived usefulness being the most decisive antecedent of affective variables (i.e., attitude and satisfaction). This study also reveals a general support for patient satisfaction as a determinant of e-loyalty intent in online health care services. Policy makers should focus on striving to get the highest positive attitude in users by enhancing easiness of use and, mainly, perceived usefulness. Because through satisfaction of patients, public hospitals will enlarge their patient e-loyalty intent, health care providers must always work at obtaining satisfied users and to encourage them to continue using the online services.

  10. Understanding patients' behavioral intentions: evidence from Iran's private hospitals industry.

    PubMed

    Zarei, Ehsan; Arab, Mohammad; Tabatabaei, Seyed Mahmoud Ghazi; Rashidian, Arash; Forushani, Abbas Rahimi; Khabiri, Roghayeh

    2014-01-01

    In the ever-increasing competitive market of private hospital industry, creating a strong relationship with the customers that shapes patients' loyalty has been considered a key factor in obtaining market share. The purpose of this paper is to test a model of customer loyalty among patients of private hospitals in Iran. This cross-sectional study was carried out in Tehran, the capital of the Islamic Republic of Iran in 2010. The study samples composed of 969 patients who were consecutively selected from eight private hospitals. The survey instrument was designed based on a review of the related literature and included 36 items. Data analysis was performed using structural equation modeling. For the service quality construct, three dimensions extracted: Process, interaction, and environment. Both process and interaction quality had significant effects on perceived value. Perceived value along with the process and interaction quality were the most important antecedents of patient overall satisfaction. The direct effect of the process and interaction quality on behavioral intentions was insignificant. Perceived value and patient overall satisfaction were the direct antecedents of patient behavioral intentions and the mediators between service quality and behavioral intentions. Environment quality of service delivery had no significant effect on perceived value, overall satisfaction, and behavioral intentions. Contrary to previous similar studies, the role of service quality was investigated not in a general sense, but in the form of three types of qualities including quality of environment, quality of process, and quality of interaction.

  11. What Do Patients Prefer? Understanding Patient Perspectives on Receiving a New Breast Cancer Diagnosis.

    PubMed

    Attai, Deanna J; Hampton, Regina; Staley, Alicia C; Borgert, Andrew; Landercasper, Jeffrey

    2016-10-01

    There is variability in physician practice regarding delivery method and timeliness of test results to cancer patients. Our aim was to survey patients to determine if there was a difference between actual and preferred care for disclosure of test results. A de-identified survey was distributed to online cancer support groups to query patients about their experience regarding communication of cancer testing and timeliness. Analyses of the differences between actual and preferred communication and wait times were performed. Overall, 1000 patients completed the survey. The analysis herein was restricted to 784 breast cancer survivors. Survey responders were predominately White (non-Hispanic; 89 %), college educated (78 %), and media 'savvy' (online medical media usage; 97 %). Differences between actual and preferred care were identified for the domains of mode of communication and wait times for initial breast cancer diagnostic biopsies and other tests. A total of 309 (39 %) of 784 patients received face-to-face communication for a new cancer diagnosis, with 394 (50 %) patients preferring this option (p < 0.0001). In addition, 315 (40 %) of 784 patients received their cancer biopsy result within 2 days, with 646 (82 %) patients preferring this option (p < 0.0001). Differences were also identified between actual and preferred care for multiple other test types. Actual care for timeliness and modes of communication did not reflect patient-desired care. National and local initiatives to improve performance are needed. As a first step, we recommend that each patient be queried about their preference for mode of communication and timeliness, and efforts made to comply.

  12. 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

  13. Improving our understanding of the use of traditional complementary/alternative medicine in children with cancer.

    PubMed

    Ladas, Elena J; Lin, Meiko; Antillion, Federico; Rivas, Silvia; Chantada, Guillermo; Cacciavillano, Walter; Ortiz, Roberta; Stein, Katja; Castillo, Luis; Rocha, Valeria; Fu, Ligia; Rodriquez, Hilze; Kelly, Kara M

    2015-05-01

    Children with cancer in high-income and low-income countries often use traditional complementary/alternative medicine (TCAM). With efforts by the World Health Organization and international twinning programs improving access to conventional care for patients with childhood cancer, understanding the global use of TCAM is important because reliance on TCAM may affect time to presentation, adherence, and abandonment of care. In the current study, the authors describe the process and validation of an international survey documenting the use of TCAM among children with cancer. The survey was designed to collect information on TCAM use and associated factors through both open-ended and close-ended questions. During the period between June 2012 and December 2013, the survey was administered to 300 children and adolescents (or their parents) who were undergoing treatment for cancer at a collaborating institution located in Mexico, Uruguay, and Nicaragua. For the majority of constructs, the survey demonstrated strong test-retest reliability as evidenced by an intraclass correlation of at least ≥0.79 in each of the participating countries. The survey demonstrated good internal consistency and reliability across countries (α range from. 77 to. 85 for the belief scale; and an α range from. 60 to. 86 for the cause scale) and convergent validity between TCAM beliefs and behavior constructs (adjusted correlation range, 0.35-0.60). The results of the current study demonstrate the successful development of a cross-cultural survey that produced results that were reliable and valid. These findings will aid investigators in providing guidelines concerning TCAM, support the development of education and research priorities, and identify variables associated with TCAM that are region-specific. © 2014 American Cancer Society.

  14. Understanding the gut microbiome of dairy calves: Opportunities to improve early-life gut health.

    PubMed

    Malmuthuge, Nilusha; Guan, Le Luo

    2017-07-01

    Early gut microbiota plays a vital role in the long-term health of the host. However, understanding of these microbiota is very limited in livestock species, especially in dairy calves. Neonatal calves are highly susceptible to enteric infections, one of the major causes of calf death, so approaches to improving gut health and overall calf health are needed. An increasing number of studies are exploring the microbial composition of the gut, the mucosal immune system, and early dietary interventions to improve the health of dairy calves, revealing possibilities for effectively reducing the susceptibility of calves to enteric infections while promoting growth. Still, comprehensive understanding of the effect of dietary interventions on gut microbiota-one of the key aspects of gut health-is lacking. Such knowledge may provide in-depth understanding of the mechanisms behind functional changes in response to dietary interventions. Understanding of host-microbial interactions with dietary interventions and the role of the gut microbiota during pathogenesis at the site of infection in early life is vital for designing effective tools and techniques to improve calf gut health. Copyright © 2017 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

  15. 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. Copyright © 2011 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

  16. 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.

  17. 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.

  18. The effectiveness of orthopedic patient education in improving patient outcomes: a systematic review protocol.

    PubMed

    Majid, Norhaini; Lee, Susan; Plummer, Virginia

    2015-01-01

    The objective of this review is to identify the effectiveness of patient education for orthopedic surgery patients. More specifically, the objectives are to identify the effectiveness of patient education on:length of staysatisfactionpain levelcost of carefunctional abilitiesknowledgeanxietyquality of life in orthopedic settings. Patient education is an essential part of practice for all healthcare professionals. In the orthopedic setting, effective patient education contributes to positive patient outcomes. Patient education is critical to ensure that patients receive appropriate information to assist in the pre-admission, peri-operative treatment and rehabilitation process for the patient. The process of patient education is essentially one where the patient comes to understand his or her physical condition and self-care using the experience and guidance of the multidisciplinary team.With an effective and well-structured patient education program, the cost benefit for health care provider and patient includes a shortened length of stay, and reduced cost of care. According to Huang et al. a simplified pre-operative education program reduced the length of stay and cost of care. Similarly, Jones et al. found that length of stay of a patient who received pre-operative education was reduced. In that study, the mean length of stay was significantly reduced from seven days in patients who did not received pre-operative education to five days in patients who received pre-operative education. These results suggest that pre-operative education programs are an effective method in reducing the length of stay of orthopedic patients.Johansson et al. also described pre-operative education for orthopedic patients in a systematic review published in 2005. They discussed the effect of patient education on the orthopedic patient and found that knowledge, anxiety, pain, length of hospital stay, performance of exercise and mobilization, self-efficacy, patient compliance, adherence

  19. Understanding the Need for Obesity Prevention Counseling among Homeless Patients

    ERIC Educational Resources Information Center

    Peart, Tasha; de Leon Siantz, MaryLou

    2017-01-01

    Though many studies have examined the level of physician obesity prevention counseling among the general population, little is known about how homeless patients are advised about healthy eating and physical activity by their health care provider. The homeless are an at-risk population with whom physicians and other health professionals can play a…

  20. Effect of a Disease-Specific Planning Intervention on Surrogate Understanding of Patient Goals for Future Medical Treatment

    PubMed Central

    Kirchhoff, Karin T.; Hammes, Bernard J.; Kehl, Karen A.; Briggs, Linda A.; Brown, Roger L.

    2010-01-01

    Context Patients with life-limiting illnesses, and their families, struggle with complex treatment decisions as these patients approach the last few years of life. Surrogates often do not clearly understand the patient's goals for future medical treatments. Objectives To determine if a disease-specific planning process can improve surrogate understanding of such patient goals for future, medical treatments. Design, Setting, and Participants A multisite randomized controlled trial conducted between January 1, 2004 and July 31, 2007 in 6 outpatient clinics of large community or university health systems in 3 Wisconsin cities. Subjects were patients with either chronic congestive heart failure or chronic renal disease and their surrogate decision makers. Participants had to be competent, English-speaking adults at least 18 years of age. Intervention Trained health professionals conducted a structured, patient-centered interview intended to promote informed decision making and to result in the completion of a document clarifying the goals of the patient with regard to four disease-specific health outcome situations and to the degree of decision-making latitude granted to the surrogate. Measurements Surrogate understanding of patient goals for care with regard to four expected, disease-specific outcomes situations and of the degree of surrogate latitude in decision making. Results Three hundred thirteen patient-surrogate pairs completed the study. As measured by Kappa (κ) scores and in all four situations and in the degree of latitude, intervention group surrogates demonstrated a significantly higher degree of understanding of patient goals than control group surrogates. Intervention group κ scores ranged from 0.61 to 0.78, while control group κ scores ranged from 0.07 to 0.28. Conclusion Surrogates in the intervention group had a significantly better understanding of patient goals and preferences than surrogates in the control group. This finding is the first step

  1. [Temporal trend in understanding of and attitudes to advance directives in patients with chronic diseases].

    PubMed

    Antolín, Albert; Sánchez, Miquel; Miró, Oscar

    2011-01-01

    To describe patients' degree of knowledge about their diseases and advance directives, as well as their willingness to write these documents, among patients with chronic diseases seen in the emergency department. We performed a prospective, comparative, cross-sectional study, without intervention and with consecutive patient inclusion in two periods (2003 and 2008). Demographic and clinical data were recorded. An anonymous interview about patients' knowledge and opinions about their illness and their awareness of advance directives was performed. Previous awareness of advance directives and the predisposition to write these documents were taken as dependent variables, and factors associated with these variables were analyzed. In both periods, 381 patients with similar characteristics were included (191 in 2003 and 190 in 2008). Patients showed greater knowledge of their disease (74% vs 55%, p<0,001), a greater predisposition to take part in medical decisions (62% vs 42%, p<0,001), and higher participation in such decisions (48% vs 35%, p=0.01) in 2008 than in 2003. However, awareness of advance directives was slightly lower (18% vs 23%, p=NS), and willingness to write these documents was unchanged (50% vs 50%, p=NS). Awareness of advance directives was associated with age less than 75 years and having completed secondary school. The predisposition to write advance directives was associated with previous awareness of these documents, considering oneself to be well informed, and wanting greater participation in medical decisions. Patients with chronic diseases showed greater understanding of their disease in the second period but awareness of advance directives and willingness to write these documents remained low. Information on these issues should be improved as an essential part of the physician-patient relationship. 2010 SESPAS. Published by Elsevier Espana. All rights reserved.

  2. Understanding how patients (vs physicians) approach the decision to escalate treatment: a proposed conceptual model.

    PubMed

    Fraenkel, Liana; Seng, Elizabeth K; Cunningham, Meaghan; Mattocks, Kristin

    2015-02-01

    We performed a qualitative study to better understand how patients with RA approach risk-benefit trade-offs inherent in the choice of remaining with their current treatment vs escalating care. We used a think-aloud protocol to examine how patients with RA approach risk-benefit trade-offs inherent in the choice of remaining with their current treatment vs adding a biologic. The data emerging from the protocols were used to develop a conceptual model describing how patients approach the decision to escalate care. Participants who were strongly impacted by their disease were not open to considering alternative options. For some patients, being highly impacted by their disease results in a strong preference to escalate care. For others, the same level of distress is reason to unconditionally refuse additional medications. In contrast, those who were moderately impacted were more open to consider treatment options. Among these participants, however, subjects' risk-benefit trade-offs were consistently modified by factors unrelated to medication, including sociodemographic characteristics, role responsibilities and the quality of the patient-physician relationship. The conceptual model indicates that patients approach the decision to escalate care differently from physicians. In order to improve care in RA, it is important to recognize that many patients with moderate to high disease activity are not open to alternative treatments, which is a prerequisite to engaging in decision making. Routine clinical encounters should enable health care providers to identify these patients in order to tailor education prior to recommending treatment escalation. © The Author 2014. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  3. 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.

  4. A synthesis of research needs for improving the understanding of atmospheric mercury cycling

    NASA Astrophysics Data System (ADS)

    Zhang, Leiming; Lyman, Seth; Mao, Huiting; Lin, Che-Jen; Gay, David A.; Wang, Shuxiao; Sexauer Gustin, Mae; Feng, Xinbin; Wania, Frank

    2017-07-01

    This synthesis identifies future research needs in atmospheric mercury science, based on a series of review papers, as well as recent developments in field data collection, modeling analysis, and emission assessments of speciated atmospheric mercury. Research activities are proposed that focus on areas that we consider important. These include refinement of mercury emission estimations, quantification of dry deposition and air-surface exchange, improvement of the treatment of chemical mechanisms in chemical transport models, increase in the accuracy of oxidized mercury measurements, better interpretation of atmospheric mercury chemistry data, and harmonization of network operation. Knowledge gained in these research areas will significantly improve our understanding of atmospheric cycling from local to global scales.

  5. Improved understanding of the Earth`s radiation belts from the CRRES satellite

    SciTech Connect

    Gussenhoven, M.S.; Mullen, E.G.; Brautigam, D.H.

    1996-04-01

    Energetic particle data gathered on the CRRES spacecraft have been used to produce new and more accurate models of high-energy electron and proton fluxes as well as total dose models out to geosynchronous altitude. In addition to providing the information necessary to improve designs and operations of near-Earth space systems, the models also give insight into the dynamic behavior of the radiation belts not considered in previous models. Sample orbit runs are compared to the earlier NASA models to elucidate their weaknesses. Areas of improved understanding in the radiation environment, gained from CRRES, and how they impact systems are summarized.

  6. "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.

  7. Improved understanding of atmospheric organic aerosols via innovations in soft ionization aerosol mass spectrometry.

    PubMed

    Zahardis, James; Geddes, Scott; Petrucci, Giuseppe A

    2011-04-01

    Organic molecules are a significant and highly varied component of atmospheric aerosols. Measurement of aerosol composition and improvements in our understanding of the complex chemistry involved in their formation and aging are being aided by innovations in soft ionization aerosol MS. (To listen to a podcast about this feature, please go to the Analytical Chemistry multimedia page at pubs.acs.org/page/ancham/audio/index.html.).

  8. Recent advances in improvement of forecast skill and understanding climate processes using AIRS Version-5 products

    NASA Astrophysics Data System (ADS)

    Susskind, Joel; Molnar, Gyula; Iredell, Lena; Rosenberg, Robert

    2012-10-01

    The NASA Goddard Earth Sciences (GES) Data and Information Services Center (DISC) generates products derived from AIRS/AMSU-A observations, starting from September 2002 when the AIRS instrument became stable, using the AIRS Science Team Version-5 retrieval algorithm. This paper shows results of some of our research using Version-5 products from the points of view of improving forecast skill as well as aiding in the understanding of climate processes.

  9. Big Data and the Atmospheric Science Data Center: Improving Access and Understanding of Data Products

    NASA Astrophysics Data System (ADS)

    Mathews, T. J.; Little, M. M.; Huffer, E.

    2013-12-01

    Working from an Enterprise Architecture, the ASDC has implemented a suite of new tools to provide improved access and understanding of data products related to the Earth's radiation budget, clouds, aerosols and tropospheric chemistry. This poster describes the overall architecture and the capabilities that have been implemented within the past twelve months. Further insight is offered into the issues and constraints of those tools, as well as lessons learned in their implementation.

  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.

  11. The Crucible simulation: Behavioral simulation improves clinical leadership skills and understanding of complex health policy change.

    PubMed

    Cohen, Daniel; Vlaev, Ivo; McMahon, Laurie; Harvey, Sarah; Mitchell, Andy; Borovoi, Leah; Darzi, Ara

    2017-05-11

    The Health and Social Care Act 2012 represents the most complex National Health Service reforms in history. High-quality clinical leadership is important for successful implementation of health service reform. However, little is known about the effectiveness of current leadership training. This study describes the use of a behavioral simulation to improve the knowledge and leadership of a cohort of medical doctors expected to take leadership roles in the National Health Service. A day-long behavioral simulation (The Crucible) was developed and run based on a fictitious but realistic health economy. Participants completed pre- and postsimulation questionnaires generating qualitative and quantitative data. Leadership skills, knowledge, and behavior change processes described by the "theory of planned behavior" were self-assessed pre- and postsimulation. Sixty-nine medical doctors attended. Participants deemed the simulation immersive and relevant. Significant improvements were shown in perceived knowledge, capability, attitudes, subjective norms, intentions, and leadership competency following the program. Nearly one third of participants reported that they had implemented knowledge and skills from the simulation into practice within 4 weeks. This study systematically demonstrates the effectiveness of behavioral simulation for clinical management training and understanding of health policy reform. Potential future uses and strategies for analysis are discussed. High-quality care requires understanding of health systems and strong leadership. Policymakers should consider the use of behavioral simulation to improve understanding of health service reform and development of leadership skills in clinicians, who readily adopt skills from simulation into everyday practice.

  12. How patients understand the term "nonmedical use" of prescription drugs: insights from cognitive interviews.

    PubMed

    McNeely, Jennifer; Halkitis, Perry N; Horton, Ariana; Khan, Rubina; Gourevitch, Marc N

    2014-01-01

    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. The authors 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. 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 4-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. 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 classifying use of medications without abuse potential as nonmedical use. All cases of misunderstanding the prescription drug misuse item occurred among participants who screened negative for illicit drug use. The 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 settings could

  13. Disclosure of financial conflicts of interest: an evaluation of orthopaedic surgery patients' understanding.

    PubMed

    Lieberman, Jay R; Pensak, Michael J; Kelleher, Michael S; Leger, Robin R; Polkowski, Gregory G

    2013-02-01

    Industry and orthopaedic surgeons often partner to develop new technology, which can lead to orthopaedic surgeons having financial conflicts of interest (FCOI). It is essential these FCOI be conveyed clearly to patients. It is unclear, however, whether and to what degree patients understand the ramifications of physician FCOI. We evaluated (1) patients' concerns regarding their surgeon having FCOI or the presence of institutional FCOI, (2) the effect of surgeon FCOI on patients' willingness to have surgery, and (3) patients' understanding of FCOI. We asked 101 patients (66% female) receiving total joint arthroplasty from the orthopaedic practices of two surgeons at an academic health center to complete a descriptive, correlational designed survey at their 6-week followup appointment. The data collected included patient demographics, knowledge of FCOI, and the influence of FCOI on patient attitudes toward surgery and their surgeon. A minority of patients (13%) reported discussing FCOI with prior physicians and only 55% agreed or strongly agreed a surgeon should disclose FCOI. Only 15% of patients believed such conflicts would make them less likely to have their surgeon operate on them. Level of education was weakly correlated (Spearman's rho = 0.29) with patient understanding of FCOI. Overall, patients had a poor understanding of FCOI. Both level of education and previous discussions of FCOI predicted better understanding. This study emphasizes communication of FCOI with patients needs to be enhanced.

  14. Improving physician-patient interactions: a review.

    PubMed

    Strecher, V J

    1983-01-01

    The interaction between physician and patient comprises aspects of communication common to any two human beings and other aspects peculiar to the roles exclusively adopted by physicians and patients. In this review, nonverbal and verbal elements of general communication are discussed, detailing important aspects of vocal tone, body postures, appearance, and verbal cues that may influence attributions made of physicians by patients. Role-related elements of physician-patient interactions are discussed in light of findings from research on interactions between physicians and patients. Developmental elements of general communication are discussed, relating stages tht evolve in interactions to physician-patient interactions. Finally, an examination is made of how interpersonal skills are taught to physicians and medical students. Discussion of what skills are specified for teaching, whether they are effectively taught, and whether the learning of these skills produces desired patient health-related outcomes is presented.

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

    PubMed

    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

    2015-05-01

    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. 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. 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. 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.

  16. 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

  17. Right hemisphere dominance for understanding the intentions of others: evidence from a split-brain patient.

    PubMed

    Ortigue, Stephanie; King, Danielle; Gazzaniga, Michael; Miller, Michael; Grafton, Scott

    2009-01-01

    Understanding the actions performed by other people is a key aspect of social interaction, including in clinical settings where patients are learning from therapists and caregivers. While lesions of the left cerebral hemisphere induce praxic disorders, the hemispheric specialisation of intention understanding remains unclear. Do patients with a right hemispheric lesion understand the intentions of other people properly? The present study investigates how a split-brain patient understands the means (what) and intentions (why) of the actions of other people. Results show a significant left hemispheric dominance for understanding what is done, and a significant right hemispheric dominance for understanding why an action is carried out. This discovery might have important clinical implications in neurological patients, especially when those with right hemisphere lesions are faced with important decisions related to the interpretation of other's intentions.

  18. Right hemisphere dominance for understanding the intentions of others: evidence from a split-brain patient

    PubMed Central

    Ortigue, Stephanie; King, Danielle; Gazzaniga, Michael; Miller, Michael; Grafton, Scott

    2009-01-01

    Understanding the actions performed by other people is a key aspect of social interaction, including in clinical settings where patients are learning from therapists and caregivers. While lesions of the left cerebral hemisphere induce praxic disorders, the hemispheric specialisation of intention understanding remains unclear. Do patients with a right hemispheric lesion understand the intentions of other people properly? The present study investigates how a split-brain patient understands the means (what) and intentions (why) of the actions of other people. Results show a significant left hemispheric dominance for understanding what is done, and a significant right hemispheric dominance for understanding why an action is carried out. This discovery might have important clinical implications in neurological patients, especially when those with right hemisphere lesions are faced with important decisions related to the interpretation of other’s intentions. PMID:21686731

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

    PubMed Central

    Voznesensky, Maria; Annam, Kiran

    2016-01-01

    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

  20. Rapid response teams: a proactive strategy for improving patient care.

    PubMed

    Garretson, Sharon; Rauzi, Mary Beth; Meister, Janice; Schuster, Janet

    Cardiopulmonary resuscitation success rates have not changed in 30 years. Patient outcomes may improve if changes in a patient's condition are addressed at the onset of subtle deteriorations, rather than at the point of cardiac arrest. The rapid response team involves early intervention that demonstrates the ability to decrease cardiac arrest rates and improve patient mortality.

  1. 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.

  2. "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.

  3. 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.

  4. Understanding nitrate uptake, signaling and remobilisation for improving plant nitrogen use efficiency.

    PubMed

    Kant, Surya

    2017-08-28

    The majority of terrestrial plants use nitrate as their main source of nitrogen. Nitrate also acts as an important signalling molecule in vital physiological processes required for optimum plant growth and development. Improving nitrate uptake and transport, through activation by nitrate sensing, signalling and regulatory processes, would enhance plant growth, resulting in improved crop yields. The increased remobilisation of nitrate, and assimilated nitrogenous compounds, from source to sink tissues further ensures higher yields and quality. An updated knowledge of various transporters, genes, activators, and microRNAs, involved in nitrate uptake, transport, remobilisation, and nitrate-mediated root growth, is presented. An enhanced understanding of these components will allow for their orchestrated fine tuning in efforts to improving nitrogen use efficiency in plants. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

  5. Improving patient care after stoma reversal.

    PubMed

    Taylor, Claire

    This article will examine the current service provision for patients who have had a temporary stoma reversal. Findings of a patient survey will be presented, highlighting the support and information received by 27 patients following a stoma reversal operation. Associated literature (Camilleri-Brennan and Steele, 2000; Sailer at al, 2000; Desnoo and Faithfull, 2006; Siassi et al, 2008; Chow et al, 2009) has confirmed a high likelihood of altered bowel function after stoma reversal, but makes less reference to the care that these patients require during the follow-up period. It is recommended that colorectal teams discuss the care implications for patients requiring stoma reversal, and appraise their care delivery to ensure patient needs are met.

  6. The National Kidney Disease Education Program: improving understanding, detection, and management of CKD.

    PubMed

    Narva, Andrew S; Briggs, Michael

    2009-03-01

    The National Kidney Disease Education Program (NKDEP), an initiative of the National Institute of Diabetes and Digestive and Kidney Diseases, works to reduce the morbidity and mortality caused by chronic kidney disease (CKD) and its complications. Established in 2000, the NKDEP initially focused on increasing awareness in at-risk populations and helping the laboratory community recalibrate serum creatinine measurement methods and begin using a revised equation to estimate glomerular filtration rate. Expanding its focus in recent years, the NKDEP now works to improve provider practices by collaborating with health systems, community health centers, and professional associations to encourage testing and treatment of patients. Among its top priorities is to develop such resources as clinical encounter tools, patient education aids, and training programs that help primary care professionals better identify and care for patients with CKD. Other priorities include improving the coordination of federal responses to CKD and addressing the standardization of measurement and reporting of urine albumin. Improving CKD detection and management is an important challenge. To succeed, the NKDEP must work in close partnership with the renal community, public health agencies, professional associations, and voluntary organizations that serve at-risk and patient communities.

  7. 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

  8. Understanding and Managing Pregnancy in Patients with Lupus.

    PubMed

    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.

  9. Digit training in noise can improve cochlear implant users' speech understanding in noise.

    PubMed

    Oba, Sandra I; Fu, Qian-Jie; Galvin, John J

    2011-01-01

    While auditory training in quiet has been shown to improve cochlear implant (CI) users' speech understanding in quiet, it is unclear whether training in noise will benefit speech understanding in noise. The present study investigated whether auditory training could improve CI users' speech recognition in noise and whether training with familiar stimuli in an easy listening task (closed-set digit recognition) would improve recognition of unfamiliar stimuli in a more difficult task (open-set sentence recognition). CI users' speech understanding in noise was assessed before, during, and after auditory training with a closed-set recognition task (digits identification) in speech babble. Before training was begun, recognition of digits, Hearing in Noise Test (HINT) sentences, and IEEE sentences presented in steady speech-shaped noise or multitalker speech babble was repeatedly measured to establish a stable estimate of baseline performance. After completing baseline measures, participants trained at home on their personal computers using custom software for approximately 30 mins/day, 5 days/wk, for 4 wks, for a total of 10 hrs of training. Participants were trained only to identify random sequences of three digits presented in speech babble, using a closed-set task. During training, the signal-to-noise ratio was adjusted according to subject performance; auditory and visual feedback was provided. Recognition of digits, HINT sentences, and IEEE sentences in steady noise and speech babble was remeasured after the second and fourth week of training. Training was stopped after the fourth week, and subjects returned to the laboratory 1 mo later for follow-up testing to see whether any training benefits had been retained. Mean results showed that the digit training in babble significantly improved digit recognition in babble (which was trained) and in steady noise (which was not trained). The training benefit generalized to improved HINT and IEEE sentence recognition in both

  10. 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.

  11. Vaginal pessaries: can an educational brochure help patients to better understand their care?

    PubMed

    Murray, Christine; Thomas, Elizabeth; Pollock, Wendy

    2017-01-01

    Pelvic organ prolapse is a common condition, with reported incidence of up to 50%. We aimed to assess whether written information, in addition to face-to-face consultation, improved happiness with information, confidence to self-manage and prolapse knowledge in women attending a pessary clinic. Little is known about the effect of adding a written information brochure on clinical outcomes of patients using pessaries. This prospective study used a pretest-posttest method, conducted following Ethical approval. Between February-December 2013, all women attending Pessary Clinic were eligible for participation. A questionnaire was developed to assess happiness with information, confidence regarding self-management (using a visual analogue scale, 1-10) and prolapse knowledge (using eight multiple-choice questions). Data were collected in person at baseline prior to distribution of a patient brochure and thereafter by telephone at one week and three months. Paired analysis was conducted using the McNemar test and related samples Wilcoxon signed-rank test for VAS items with p < 0.05 significant. Sixty women were recruited. Fifty-eight completed all questionnaires. Improvement in happiness with information, confidence regarding self-management and knowledge scores occurred at one week (p < 0.05) and were maintained at three months (p < 0.05). Changes were unrelated to age (p > 0.05), education level (p > 0.05), first language (p > 0.05) or previous clinic visits (p > 0.05). A written information brochure, in addition to face-to-face consultation, improves happiness with information, confidence to self-manage and knowledge about pessaries compared to verbal instruction alone and helps patients better understand their care. The written brochure was equally effective in women with low education and advanced age, and occurred regardless of the number of clinic visits. © 2016 John Wiley & Sons Ltd.

  12. Attaching a new understanding to the patient-physician relationship in family practice.

    PubMed

    Thompson, Darren; Ciechanowski, Paul S

    2003-01-01

    As a result of continuity of care with patients and their families, family physicians are uniquely poised to form enduring clinical relationships with their patients. The degree of collaboration in and satisfaction with the patient-provider alliance has been shown to have important implications for treatment outcomes across a range of medical problems. Providing optimal care can require family physicians to appreciate the sequelae of having clinically relevant aspects of past relationships emerge in the health care relationship, both in their patients and in themselves. A conceptual model is essential to assist in recognizing these key aspects. A literature search was conducted using MEDLINE. Key words entered were "illness" and "attachment theory." Thirty-five English-only articles appeared from which further relevant references were gathered. Attachment theory serves as a useful model for highlighting important features of physician-patient relationships, which can affect treatment outcome in the family practice setting. It posits that everyone has an innate need to form strong attachment bonds to their earliest caregivers. To ensure survival, the child adapts its bonding to the caregiver's attachment style. With time, the maturing person develops a style of relating in subsequent caregiving relationships based on these early, and to some extent later, close relationships. Insecure attachment styles that can develop--dismissing, preoccupied, and fearful--have been shown to affect the clinical relationship and medical treatment outcomes often in important and predictable ways. Family physicians can more easily adopt an understanding, compassionate, and flexible treatment stance by recognizing patients' unique attachment relationship patterns, thereby improving medical treatment outcome.

  13. Sitting at patients' bedsides may improve patients' perceptions of physician communication skills.

    PubMed

    Merel, Susan E; McKinney, Christy M; Ufkes, Patrick; Kwan, Alan C; White, Andrew A

    2016-12-01

    Sitting at a patient's bedside in the inpatient setting is recommended as a best practice but has not been widely adopted. Previous studies suggest that a physician's seated posture may increase the patient's perception of time spent in the room but have not included hospitalists. We performed a cluster-randomized trial of seated versus standing physician posture during inpatient rounds on a hospitalist service at an academic medical center. Patients whose physician sat were significantly more likely to rate their physician highly on measures of listening carefully and explaining things in a way that was easy to understand. The average time spent in the patient's room was approximately 12 minutes and was not affected by physician posture. Patients' perception of the time their physician spent in their room was not affected by physician posture. Sitting at the bedside during rounds does not increase the amount of time spent with the patient but may improve patient-physician communication. Journal of Hospital Medicine 2015;11:865-868. © 2015 Society of Hospital Medicine.

  14. Can cone-beam computed tomography superimposition help orthodontists better understand relapse in surgical patients?

    PubMed

    Porciúncula, Guilherme Machado; Koerich, Leonardo; Eidson, Lindsey; Gandini Junior, Luiz Gonzaga; Gonçalves, João Roberto

    2014-11-01

    This case report describes the interdisciplinary treatment of a 19-year-old Brazilian man with a Class I malocclusion, a hyperdivergent profile, an anterior open bite, and signs of temporomandibular joint internal derangement. The treatment plan included evaluation with a temporomandibular joint specialist and a rheumatologist, orthodontic appliances, and maxillomandibular surgical advancement with counterclockwise rotation. Cone-beam computed tomography images were taken before and after surgery at different times and superimposed at the cranial base to assess the changes after orthognathic surgery and to monitor quantitatively the internal derangement of the temporomandibular joints and surgical relapse. Our protocol can improve the orthodontist's understanding of surgical instability, demonstrate the clinical value of cone-beam computed tomography analysis beyond the multiplanar reconstruction, and guide patient management for the best outcome possible.

  15. Understanding latent tuberculosis: the key to improved diagnostic and novel treatment strategies

    PubMed Central

    Esmail, Hanif; Barry, Clifton E; Wilkinson, Robert J

    2012-01-01

    Treatment of latent tuberculosis (LTBI) is a vital component of tuberculosis elimination but is not efficiently implemented with available diagnostics and therapeutics. The tuberculin skin test and interferon gamma release assays can inform that infection has occurred but do not prove that it persists. Treatment of LTBI with isoniazid targets actively replicating bacilli but not non-replicating populations, prolonging treatment duration. Developing more predictive diagnostic tests and treatments of shorter duration requires a greater understanding of the biology of latent tuberculosis, from both host and bacillary perspectives. In this article we discuss the basis of current diagnosis and treatment of LTBI and review recent developments in understanding the biology of latency that may enable future improved diagnostic and treatment strategies. PMID:22198298

  16. 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

  17. 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.

  18. Understanding the Dreyfus model of skill acquisition to improve ultrasound training for obstetrics and gynaecology trainees.

    PubMed

    Field, Alexander

    2014-05-01

    There have been significant problems in ultrasound training since the introduction of the new postgraduate curriculum for obstetrics and gynaecology. It is therefore important to understand how the skill of ultrasound is acquired in order to be able to improve the training program. Here, the potential application of the Dreyfus model of skill acquisition has been analysed to map the progression from novice to master and the progressions between each stage analysed. Although the Dreyfus model is not a perfect match for ultrasound scanning, it provides us with a theoretical framework on which to underpin educational practice in this field.

  19. 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

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

    PubMed

    Maghuly, Fatemeh; Laimer, Margit

    2013-10-01

    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.

  1. Discussions of Life Expectancy and Changes in Illness Understanding in Patients With Advanced Cancer.

    PubMed

    Epstein, Andrew S; Prigerson, Holly G; O'Reilly, Eileen M; Maciejewski, Paul K

    2016-07-10

    Accurate illness understanding enables patients to make informed decisions. Evidence of the influence of prognostic discussions on the accuracy of illness understanding by patients would demonstrate the value of discussions. Recent and past oncology provider-patient discussions about prognosis/life expectancy were examined for their association with changes in illness understanding by patients. Patients (N = 178) with advanced cancers refractory to prior chemotherapy whom oncologists expected to die within 6 months were interviewed before and after a visit in which cancer restaging scan results were discussed. Illness understanding scores were the sum of four indicator variables: patient terminal illness acknowledgment, recognition of incurable disease status, knowledge of the advanced stage of the disease, and expectation to live months as opposed to years. Before the restaging scan visit, nine (5%) of 178 patients had completely accurate illness understanding (ie, correctly answered each of the four illness understanding questions). Eighteen patients (10%) reported only recent discussions of prognosis/life expectancy with their oncologists; 68 (38%) reported only past discussions; 24 (13%) reported both recent and past discussions; and 68 (38%) reported that they never had discussions of prognosis/life expectancy with their oncologists. After adjustment for potential confounders (ie, education and race/ethnicity), analysis identified significant, positive changes in illness understanding scores for patients in groups that reported recent only (least-squares mean change score, 0.62; 95% CI, 0.23 to 1.01; P = .002) and both recent and past (least-squares mean change score, 0.37; 95% CI, 0.04 to 0.70; P = 0.028) discussions of prognosis/life expectancy with their oncologists. Patients with advanced cancer who report recent discussions of prognosis/life expectancy with their oncologists come to have a better understanding of the terminal nature of their illnesses.

  2. Understanding the full breadth of cancer-related patient costs in Ontario: a qualitative exploration.

    PubMed

    Longo, Christopher J; Fitch, Margaret; Grignon, Michel; McAndrew, Alison

    2016-11-01

    This research informs existing work by examining the full scope of out-of-pocket costs and lost income, patients' private insurance behaviors, and their overall management of finances during their cancer treatment. The intent was to gain a deeper understanding of patient circumstances and the related costs. Participant qualitative interviews were conducted in person during outpatient clinic visits or by telephone and were recorded between June 2011 and July 2012. Interviews were transcribed verbatim and subjected to a descriptive qualitative analysis. The research team collaborated early in the process (after three subjects were enrolled) to develop a preliminary coding framework. The coding framework was modified to incorporate additional emerging content until saturation of data was evident. Transcripts were coded using the qualitative software NVivo version 9.0. Fifteen patients agreed to participate in the study and 14 completed the interview (seven breast, three colorectal, two lung, and two prostate). Consistent with existing published work, participants expressed concerns regarding expenses related to medications, complementary/alternative medicines, devices, parking and travel. These concerns were exacerbated if patients did not have insurance or lost insurance coverage due to loss of work. Although many acknowledged in hindsight that additional insurance would have helped, they also recognized that at the time of their diagnoses, it was not a viable option. Previously unidentified categorical costs identified in this study included modifications to housing arrangements or renovations, special clothing, fitness costs and the impact of an altered diet. We confirmed the results of earlier Canadian quantitative work. Additionally, cost categories not previously explored were identified, which will facilitate the development of an improved and more comprehensive quantitative questionnaire for future research. Many patients indicated that supplemental health

  3. 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

  4. Improving understanding of adjuvant therapy options by using simpler risk graphics.

    PubMed

    Zikmund-Fisher, Brian J; Fagerlin, Angela; Ubel, Peter A

    2008-12-15

    To help oncologists and breast cancer patients make informed decisions about adjuvant therapies, online tools such as Adjuvant! provide tailored estimates of mortality and recurrence risks. However, the graphical format used to display these results (a set of 4 horizontal stacked bars) may be suboptimal. The authors tested whether using simpler formats would improve comprehension of the relevant risk statistics. A total of 1,619 women, aged 40-74 years, completed an Internet-administered survey vignette about adjuvant therapy decisions for a patient with an estrogen receptor-positive tumor. Participants were randomized to view 1 of 4 risk graphics, a base version that mirrored the Adjuvant! format, an alternate graph that showed only 2 options (those that included hormonal therapy), a graph that used a pictograph format, or a graph that included both changes. Outcome measures included comprehension of key statistics, time required to complete the task, and graph-perception ratings. The simplifying format changes significantly improved comprehension, especially when both changes were implemented together. Compared with participants who viewed the base 4-option bar graph, respondents who, instead, viewed a 2-option pictograph version were more accurate when they reported the incremental risk reduction achievable from adding chemotherapy to hormonal therapy (77% vs 51%; P< .001), answered that question more quickly (median time, 28 seconds vs 42 seconds; P< .001), and liked the graph more (mean, 7.67 vs 6.88; P< .001). Although most patients will only view risk calculators such as Adjuvant! in consultation with their clinicians, simplifying design graphics could significantly improve patients' comprehension of statistics essential for informed decision making about adjuvant therapies.

  5. CBT for culture change: formulating teams to improve patient care.

    PubMed

    Taylor, Katherine Newman; Sambrook, Suzanne

    2012-07-01

    Increasingly, clinical psychologists and CBT trained clinicians work with and within teams. The cognitive model enables us to formulate the processes maintaining distress, and work with people to effect change. The model tends to be used to understand individuals' difficulties, but may be effective in making sense of problems within teams. This study aimed to (i) explore the value of the cognitive model in formulating key staff-service user relationships; and (ii) determine whether such an approach would yield useful team based interventions. The cognitive interpersonal model was used to develop an idiosyncratic conceptualization of key staff-service user interactions in an in-patient setting. This then informed management team planning aimed at improving provision for service users, and staff experience. Additionally, frequency of challenging behaviours and levels of staff burnout were assessed before and after service changes, as preliminary outcome data. The team formulation was effective in (i) making sense of interactions contributing to the maintenance of service users' challenging behaviours and staff burnout, and (ii) deriving systemic interventions likely to effect change. This was then used to guide service development planning. In support of a CBT approach to understanding and intervening with teams, preliminary data indicate that staff burnout and incidents of challenging behaviours reduced over time. The cognitive interpersonal model can be used to formulate relationships within teams and guide systemic change. This is likely to have a beneficial impact for both service users and staff.

  6. Environmental justice at school: understanding research, policy, and practice to improve our children's health.

    PubMed

    Sampson, Natalie

    2012-05-01

    No overarching federal agencies or policies are responsible for ensuring environmental health at schools in the United States, potentially allowing many inequities for low-income and minority communities to persist. This article examines emergent research, policy, and practice-based efforts that may be used to identify and address environmental justice at school. A brief literature review was conducted to understand (1) major mental, behavioral, and physical outcomes associated with environmental risk for school-aged children and (2) current research methods for assessing these relationships. Documents prepared by government agencies, school districts, and advocacy groups were also collected and synthesized to improve understanding of the state of planning and policies for maintaining or improving school environments. Environmental risk can manifest in diverse ways such as mold, poor air quality, poor community design, or contaminated playgrounds. Deeply rooted in national and state structures of school funding and planning, such risks can lead to outcomes including respiratory illness, poor performance in school, and reduced levels of physical activity. With growing attention to these concerns, methods for measuring environmental risks and underlying disparities have advanced tremendously in the last few decades, yet development of innovative research approaches may be necessary to further advance and evaluate appropriate interventions. Environmental injustice is generally unacknowledged during decision-making in US school districts. Continued dialogue reflective of translatable science is necessary to support school districts with limited funding in ensuring safe, healthy environments for learning. © 2012, American School Health Association.

  7. Learning from Our Evolving Understanding of Biophysical Interactions to Improve River Restoration Practice.

    NASA Astrophysics Data System (ADS)

    Sear, D. A.

    2014-12-01

    Restoration of riverine habitats has largely proceeded on the assumption that by improving physical habitat, and more latterly processes, biophysical interactions will reassemble to a state similar to that prior to the disturbance event. Whilst there had been little monitoring to support this view, there is increasing evidence that the complexity of ecological systems demands a greater understanding of these biophysical interactions before we can state that a restoration has succeeded. In this paper I will draw on two examples to demonstrate the importance of understanding the spatial as well as the temporal scale of biophysical interactions. In the first example, field and modelling was used to demonstrate how different location of large wood and forest restoration can result in different hydrological outcomes. Similarly, as the forest matures it is possible to see change in restoration outcomes, extending beyond the lifetime of the project. In the second example I demonstrate how climate and land use drive the biophysical interactions within spawning salmonid habitats, research that questions accepted models used in the restoration of salmonid spawning habitat. Finally the paper reflects on the problems of restoring complex ecosystems; and points towards the need for improvements in how we research and communicate with stakeholders who ultimately live by the streams we restore.

  8. Development and evaluation of a tutorial to improve students' understanding of a lock-in amplifier

    NASA Astrophysics Data System (ADS)

    DeVore, Seth; Gauthier, Alexandre; Levy, Jeremy; Singh, Chandralekha

    2016-12-01

    A lock-in amplifier is a versatile instrument frequently used in physics research. However, many students struggle with the basic operating principles of a lock-in amplifier which can lead to a variety of difficulties. To improve students' understanding, we have been developing and evaluating a research-based tutorial which makes use of a computer simulation of a lock-in amplifier. The tutorial is based on a field-tested approach in which students realize their difficulties after predicting the outcome of simulated experiments involving a lock-in amplifier and check their predictions using the simulated lock-in amplifier. Then, the tutorial provides guidance and strives to help students develop a coherent understanding of the basics of a lock-in amplifier. The tutorial development involved interviews with physics faculty members and graduate students and iteration of many versions of the tutorial with professors and graduate students. The student difficulties with lock-in amplifiers and the development and evaluation of the research-based tutorial to help students develop a functional understanding of this device are discussed.

  9. 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.

  10. Illness as a social construct: understanding what asthma means to the patient to better treat the disease.

    PubMed

    Rich, M; Taylor, S A; Chalfen, R

    2000-05-01

    Improved medical outcomes and patient satisfaction with health care may not always result from effective interventions on disease. Asthma is increasing in prevalence, morbidity, and mortality, despite a revolution in medical technology. Patient-created illness narratives were used to move beyond the biomedical model of disease to understand the social forces at work on the patient's experience of illness and his or her responses to it. Children and adolescents with moderate to severe asthma used Video Intervention/Prevention Assessment (VIA) to create visual narratives of their experiences living with and managing asthma. The illness narratives included documentation of the patients' day-to-day lives and medical management, interviews of family and friends, and personal monologues of their thoughts and feelings. Narratives were coded for illness-related attitudes and behaviors. Emerging themes were identified using grounded theory and analyzed through the theoretical frameworks of medicine, psychology, clinical social work, and anthropology. Visual narratives were created by 20 participants from 8 to 25 years of age and of diverse racial and ethnic backgrounds. The patients' illness responses varied, presenting in one or more psychological categories-disability, denial, self-comforting, and "specialness"--and in three distinct social domains-family/home, friends/school or work, and patient-clinician encounters. Participants' visual narratives yielded a unique understanding of illness as a social construct. Patients with comparable disease states had different illness experiences, sometimes motivating health-related behaviors that appeared inconsistent with the management needs of the disease. Improvement in outcomes and patient satisfaction may be achieved through a broader understanding of illness in the social context of patients' lives.

  11. 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

  12. Interventions to Improve Patient Comprehension in Informed Consent for Medical and Surgical Procedures: A Systematic Review

    PubMed Central

    Schenker, Yael; Fernandez, Alicia; Sudore, Rebecca; Schillinger, Dean

    2017-01-01

    Background Patient understanding in clinical informed consent is often poor. Little is known about the effectiveness of interventions to improve comprehension or the extent to which such interventions address different elements of understanding in informed consent. Purpose To systematically review communication interventions to improve patient comprehension in informed consent for medical and surgical procedures. Data Sources A systematic literature search of English-language articles in MEDLINE (1949–2008) and EMBASE (1974–2008) was performed. In addition, a published bibliography of empirical research on informed consent and the reference lists of all eligible studies were reviewed. Study Selection Randomized controlled trials and controlled trials with non-random allocation were included if they compared comprehension in informed consent for a medical or surgical procedure. Only studies that used a quantitative, objective measure of understanding were included. All studies addressed informed consent for a needed or recommended procedure in actual patients. Data Extraction Reviewers independently extracted data using a standardized form. All results were compared, and disagreements were resolved by consensus. Data Synthesis Forty-four studies were eligible. Intervention categories included written information, audiovisual/multimedia, extended discussions, and test/feedback techniques. The majority of studies assessed patient understanding of procedural risks; other elements included benefits, alternatives, and general knowledge about the procedure. Only 6 of 44 studies assessed all 4 elements of understanding. Interventions were generally effective in improving patient comprehension, especially regarding risks and general knowledge. Limitations Many studies failed to include adequate description of the study population, and outcome measures varied widely. Conclusions A wide range of communication interventions improve comprehension in clinical informed

  13. Patients' understanding of technical terms used during the pre-anaesthetic consultation.

    PubMed

    Babitu, U Q; Cyna, A M

    2010-03-01

    Communication between patients and anaesthetists is being recognised as an increasingly important aspect of clinical care. Patients need to understand the nature and consequences of any proposed procedure prior to giving informed consent. In this regard, anaesthetists have a responsibility to provide adequate information about anaesthesia and related procedures in a form that patients are likely to understand. We investigated whether patients understood the technical terms used by the anaesthetist. We observed 68 obstetric and gynaecological pre-anaesthesia consultations at two tertiary hospitals in South Australia. These pre-anaesthesia consultations were conducted by consultant anaesthetists on 46 occasions (68%) and by anaesthesia trainees (nine registrars and one resident medical officer) on 22 occasions (32%). Approximately half of the patients participating in the study (45%) failed to understand one or more of the terms used during their consultation. Of the technical terms used more than once, "reflux" was the most poorly understood, with seven of 36 patients (19%) having either poor or no understanding. The next five most commonly misunderstood technical terms were "aspiration", "allergy", "anaphylaxis", "local anaesthetic" and "sedation". We have identified many technical terms that may not be understood by patients presenting for anaesthesia care. An awareness of commonly misunderstood words may facilitate better transfer of information during pre-anaesthesia consultations. Our study findings should remind doctors that patients frequently fail to understand or take in what we tell them.

  14. 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.

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

    PubMed

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

    2016-05-09

    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.

  16. 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

  17. Understanding side reactions in K-O-2 batteries for improved cycle life.

    SciTech Connect

    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-O-2 battery with the Nafion-K+ separator can be discharged and charged for more than 40 cycles without increases in charging overpotential.

  18. 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.

  19. 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.

  20. From loquacious to reticent: understanding patient health information communication to guide consumer health IT design.

    PubMed

    Valdez, Rupa S; Guterbock, Thomas M; Fitzgibbon, Kara; Williams, Ishan C; Wellbeloved-Stone, Claire A; Bears, Jaime E; Menefee, Hannah K

    2017-07-01

    It is increasingly recognized that some patients self-manage in the context of social networks rather than alone. Consumer health information technology (IT) designed to support socially embedded self-management must be responsive to patients' everyday communication practices. There is an opportunity to improve consumer health IT design by explicating how patients currently leverage social media to support health information communication. The objective of this study was to determine types of health information communication patterns that typify Facebook users with chronic health conditions to guide consumer health IT design. Seven hundred participants with type 2 diabetes were recruited through a commercial survey access panel. Cluster analysis was used to identify distinct approaches to health information communication both on and off Facebook. Analysis of variance (ANOVA) methods were used to identify demographic and behavioral differences among profiles. Secondary analysis of qualitative interviews ( n  = 25) and analysis of open-ended survey questions were conducted to understand participant rationales for each profile. Our analysis yielded 7 distinct health information communication profiles. Five of 7 profiles had consistent patterns both on and off Facebook, while the remaining 2 demonstrated distinct practices, with no health information communication on Facebook but some off Facebook. One profile was distinct from all others in both health information communication practices and demographic composition. Rationales for following specific health information communication practices were categorized under 6 themes: altruism, instrumental support, social support, privacy and stigma, convenience, and Facebook knowledge. Facebook has been widely adopted for health information communication; This study demonstrates that Facebook has been widely adopted for health information communication. It also shows that the ways in which patients communicate health

  1. The Relative Importance of Physician Communication, Participatory Decision Making, and Patient Understanding in Diabetes Self-management

    PubMed Central

    Heisler, Michele; Bouknight, Reynard R; Hayward, Rodney A; Smith, Dylan M; Kerr, Eve A

    2002-01-01

    OBJECTIVE Patients' self-management practices have substantial consequences on morbidity and mortality in diabetes. While the quality of patient-physician relations has been associated with improved health outcomes and functional status, little is known about the impact of different patient-physician interaction styles on patients' diabetes self-management. This study assessed the influence of patients' evaluation of their physicians' participatory decision-making style, rating of physician communication, and reported understanding of diabetes self-care on their self-reported diabetes management. DESIGN We surveyed 2,000 patients receiving diabetes care across 25 Veterans' Affairs facilities. We measured patients' evaluation of provider participatory decision making with a 4-item scale (Provider Participatory Decision-making Style [PDMstyle]; α = 0.96), rating of providers' communication with a 5-item scale (Provider Communication [PCOM]; α = 0.93), understanding of diabetes self-care with an 8-item scale (α = 0.90), and patients' completion of diabetes self-care activities (self-management) in 5 domains (α = 0.68). Using multivariable linear regression, we examined self-management with the independent associations of PDMstyle, PCOM, and Understanding. RESULTS Sixty-six percent of the sample completed the surveys (N = 1,314). Higher ratings in PDMstyle and PCOM were each associated with higher self-management assessments (P < .01 in all models). When modeled together, PCOM remained a significant independent predictor of self-management (standardized β: 0.18; P < .001), but PDMstyle became nonsignificant. Adding Understanding to the model diminished the unique effect of PCOM in predicting self-management (standardized β: 0.10; P = .004). Understanding was strongly and independently associated with self-management (standardized β: 0.25; P < .001). CONCLUSION For these patients, ratings of providers' communication effectiveness were more important than a

  2. 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

  3. Involving patients in care decisions improves satisfaction: an outcomes-based quality improvement project.

    PubMed

    Leff, Ellen W

    2004-05-01

    A home care agency used quality improvement processes to improve patient satisfaction survey ratings. The focus was on involving patients in decisions about their care. A multidisciplinary team developed creative strategies to increase staff awareness and enhance customer service skills, which had dramatic results.

  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. 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

  6. 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

  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. Improving understanding of the functional diversity of fisheries by exploring the influence of global catch reconstruction.

    PubMed

    Nash, Kirsty L; Watson, Reg A; Halpern, Benjamin S; Fulton, Elizabeth A; Blanchard, Julia L

    2017-09-06

    Functional diversity is thought to enhance ecosystem resilience, driving research focused on trends in the functional composition of fisheries, most recently with new reconstructions of global catch data. However, there is currently little understanding of how accounting for unreported catches (e.g. small-scale and illegal fisheries, bycatch and discards) influences functional diversity trends in global fisheries. We explored how diversity estimates varied among reported and unreported components of catch in 2010, and found these components had distinct functional fingerprints. Incorporating unreported catches had little impact on global-scale functional diversity patterns. However, at smaller, management-relevant scales, the effects of incorporating unreported catches were large (changes in functional diversity of up to 46%). Our results suggest there is greater uncertainty about the risks to ecosystem integrity and resilience from current fishing patterns than previously recognized. We provide recommendations and suggest a research agenda to improve future assessments of functional diversity of global fisheries.

  9. 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.

  10. SOCRATE: an optical bench dedicated to the understanding and improvement of a laser conditioning process

    SciTech Connect

    Bertussi, Bertrand; Piombini, Herve; Damiani, David; Pommies, Matthieu; Le Borgne, Xavier; Plessis, Daniel

    2006-11-20

    We present an automatic excimer laser bench (SOCRATE) allowing for the treatment of optical components by laser conditioning. This apparatus, developed at the Commissariat a l'Energie Atomique-Le Ripault, has been designed to add to this conditioning process an in situ, accurate laser-induced damage threshold (LIDT) measurement and different nondestructive optical techniques for the characterization of the component during treatment. Through different examples, we demonstrate the importance of these characterizations to improve the understanding of the laser conditioning.The role of an in situ adapted metrology associated in real time with a laser conditioning bench offers new opportunities to analyze laser-induced damage mechanisms and subsequently to increase the LIDT of optical components.

  11. 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

  12. 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

  13. 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

  14. 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.

  15. Improving patient satisfaction with nursing communication using bedside shift report.

    PubMed

    Radtke, Kimberly

    2013-01-01

    The objective of this study was to determine if standardizing shift report improves patient satisfaction with nursing communication. Patient surveys taken after discharge from the hospital show that patients perceive nursing communication during their stay could be improved. Standardizing bedside reporting is one step toward improving communication between nurses, patients, and their families. A pilot bedside shift report process was developed on a medical/surgical intermediate care unit to improve patient satisfaction scores in the area of "nurse communicated well," with the goal of reaching 90% satisfaction rates, which increased from 76% and 78%. Peplau's interpersonal relations theory was used in the adoption of this practice. This theory is based on the idea that the nurse-patient relationship is therapeutic and that it is crucial for nurses to assess, plan, and put context behind the care delivered to their patients. Lewin's Change Theory and the tenets of unfreezing, moving, and refreezing were crucial to the implementation of this practice change. Monitoring of patient satisfaction was continued for 3 months. There was a rise in patient satisfaction in nursing communication to 87.6%, an increase from 75% in the previous 6 months. This score did not meet the goal of 90%, but did show that this practice change did impact this particular area of patient satisfaction. This process was instituted organization-wide. Reaching the goal of 90% satisfaction in the area of patient perceptions of nursing communication is the overall goal of this program.

  16. 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

  17. Understanding and influencing behaviour change by farmers to improve water quality.

    PubMed

    Blackstock, K L; Ingram, J; Burton, R; Brown, K M; Slee, B

    2010-11-01

    Diffuse pollution from agriculture remains a significant challenge to many countries seeking to improve and protect their water environments. This paper reviews literature relating to the provision of information and advice as a mechanism to encourage farmers to mitigate diffuse pollution. The paper presents findings from a literature review on influencing farmer behaviour and synthesizes three main areas of literature: psychological and institutional theories of behaviour; shifts in the approach to delivery of advice (from knowledge transfer to knowledge exchange); and the increased interest in heterogeneous farming cultures. These three areas interconnect in helping to understand how best to influence farmer behaviour in order to mitigate diffuse pollution. They are, however, literatures that are rarely cited in the water management arena. The paper highlights the contribution of the 'cultural turn' taken by rural social scientists in helping to understand collective and individual voluntary behaviour. The paper explores how these literatures can contribute to the existing understanding of water management in the agricultural context, particularly: when farmers question the scientific evidence; when there are increased calls for collaborative planning and management; and when there is increased value placed on information as a business commodity. The paper also highlights where there are still gaps in knowledge that need to be filled by future research - possibly in partnership with farmers themselves. Whilst information and advice has long been seen as an important part of diffuse pollution control, increasing climate variability that will require farmers to practice adaptive management is likely to make these mechanisms even more important. Copyright © 2009 Elsevier B.V. All rights reserved.

  18. POST-TRAUMATIC OSTEOARTHRITIS: IMPROVED UNDERSTANDING AND OPPORTUNITIES FOR EARLY INTERVENTION†

    PubMed Central

    Anderson, Donald D.; Chubinskaya, Susan; Guilak, Farshid; Martin, James A.; Oegema, Theodore R.; Olson, Steven A.; Buckwalter, Joseph A.

    2011-01-01

    Even with current treatments of acute joint injuries, more than 40% of people who suffer significant ligament or meniscus tears, or articular surface injuries, will develop osteoarthritis. Correspondingly, 12% or more of all patients with lower extremity osteoarthritis have a history of joint injury. Recent research suggests that acute joint damage that occurs at the time of an injury initiates a sequence of events that can lead to progressive articular surface damage. New molecular interventions, combined with evolving surgical methods, aim to minimize or prevent progressive tissue damage triggered by joint injury. Seizing the potential for progress in the treatment of joint injuries to forestall OA will depend on advances in: (1) quantitative methods of assessing the injury severity, including both structural damage and biologic responses, (2) understanding of the pathogenesis of post-traumatic OA, taking into account potential interactions among the different tissues and the role of post-traumatic incongruity and instability, and (3) application of engineering and molecular research to develop new methods of treating injured joints. This paper highlights recent advances in understanding of the structural damage and the acute biological response following joint injury, and it identifies important directions for future research. PMID:21520254

  19. 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.

  20. 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.

  1. Improved Mechanistic Understanding of Natural Gas Methane Emissions from Spatially Resolved Aircraft Measurements

    DOE PAGES

    Schwietzke, Stefan; Pétron, Gabrielle; Conley, Stephen; ...

    2017-06-05

    Divergence in recent oil and gas related methane emission estimates between aircraft studies (basin total for a midday window) and emissions inventories (annualized regional and national statistics) indicate the need for better understanding the experimental design, including temporal and spatial alignment and interpretation of results. In our aircraft-based methane emission estimates in a major U.S. shale gas basin resolved from west to east show (i) similar spatial distributions for 2 days, (ii) strong spatial correlations with reported NG production (R2 = 0.75) and active gas well pad count (R2 = 0.81), and (iii) 2× higher emissions in the western halfmore » (normalized by gas production) despite relatively homogeneous dry gas and well characteristics. Operator reported hourly activity data show that midday episodic emissions from manual liquid unloadings (a routine operation in this basin and elsewhere) could explain ~1/3 of the total emissions detected midday by the aircraft and ~2/3 of the west–east difference in emissions. The 22% emission difference between both days further emphasizes that episodic sources can substantially impact midday methane emissions and that aircraft may detect daily peak emissions rather than daily averages that are generally employed in emissions inventories. And while the aircraft approach is valid, quantitative, and independent, this study sheds new light on the interpretation of previous basin scale aircraft studies, and provides an improved mechanistic understanding of oil and gas related methane emissions.« less

  2. 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

  3. How does sport psychology actually improve athletic performance? A framework to facilitate athletes' and coaches' understanding.

    PubMed

    Gee, Chris J

    2010-09-01

    The popularity of sport psychology, both as an academic discipline and an applied practice, has grown substantially over the past two decades. Few within the realm of competitive athletics would argue with the importance of being mentally prepared prior to an athletic competition as well as the need to maintain that particular mindset during a competitive contest. Nevertheless, recent research has shown that many athletes, coaches, and sporting administrators are still quite reluctant to seek out the services of a qualified sport psychologist, even if they believe it could help. One of the primary reasons for this hesitation appears to be a lack of understanding about the process and the mechanisms by which these mental skills affect performance. Unlike the "harder sciences" of sport physiology and biochemistry where athletes can see the tangible results in themselves or other athletes (e.g., he or she lifted weights, developed larger muscles, and is now stronger/faster as a result), the unfamiliar and often esoteric nature of sport psychology appears to be impeding a large number of athletes from soliciting these important services. As such, the purpose of this article is to provide the reader with a simple framework depicting how mental skills training translates into improved within-competition performance. This framework is intended to help bridge the general "understanding gap" that is currently being reported by a large number of athletes and coaches, while also helping sport psychology practitioners sell their valuable services to individual athletes and teams.

  4. 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.

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

    DOE PAGES

    McCormack, M. Luke; Dickie, Ian A.; Eissenstat, David M.; ...

    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

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. [Strategies for patient participation in continuing improvement of clinical safety].

    PubMed

    Saturno, Pedro J

    2009-06-01

    Strategies for patient participation in quality improvement, as an active part of processes or providing relevant information when asked, have progressed to a great extent for the last few years, influenced by the emphasis on patient-focused care as a key dimension for quality and, lately, by the emphasis on patient safety -a dimension for which the patient contribution can not be ignored. However, these strategies have not been fully implemented and used in most quality management systems. This article aims to make it easier to select the appropriate strategies for a given context, by describing them, grouped in three main themes (mobilising patients for patient safety; promoting active participation of patients in the prevention of safety incidents; requesting and using the relevant information for quality improvement that patients can provide), illustrating them with examples, and pointing out some of the obstacles for implementing them.

  11. Integrating Customer Intimacy Into Radiology to Improve the Patient Perspective: The Case of Breast Cancer Screening.

    PubMed

    Chhor, Chloe M; Mercado, Cecilia L

    2016-02-01

    The customer intimacy business model has emerged as a key operational approach for health care organizations as they move toward patient-centered care. The question arises how the customer intimacy approach can be implemented in the clinical setting and whether it can help practitioners address problems and improve quality of care. Breast cancer screening and its emphasis on the patient perspective provides an interesting case study for understanding how the customer intimacy approach can be integrated into radiologic practice to improve the patient experience.

  12. Utilizing a disease management approach to improve ESRD patient outcomes.

    PubMed

    Anand, Shaan; Nissenson, Allen R

    2002-01-01

    In this era of processes and systems to improve quality, disease management is one methodology to improve care delivery and outcomes for patients with chronic kidney disease (CKD). In most disease management systems a senior renal nurse coordinates all aspects of the patient's care and ensures that the prescribed and necessary care is delivered for both CKD-related and comorbid conditions. The nurse also continually monitors outcomes on quality indicators and key performance measures. These outcome data are then aggregated and analyzed, are compared with local and national benchmarks, and drive the continuous quality improvement (CQI) process. Such a system attempts to centralize the currently fragmented care delivery system, continually improve patient outcomes, and conserve scarce economic resources. Early data suggest a disease management approach may improve both the morbidity and mortality of CKD patients.

  13. 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'.

  14. 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.

  15. Has growth mixture modeling improved our understanding of how early change predicts psychotherapy outcome?

    PubMed

    Koffmann, Andrew

    2017-03-02

    Early change in psychotherapy predicts outcome. Seven studies have used growth mixture modeling [GMM; Muthén, B. (2001). Second-generation structural equation modeling with a combination of categorical and continuous latent variables: New opportunities for latent class-latent growth modeling. In L. M. Collins & A. G. Sawyers (Eds.), New methods for the analysis of change (pp. 291-322). Washington, DC: American Psychological Association] to identify patient classes based on early change but have yielded conflicting results. Here, we review the earlier studies and apply GMM to a new data set. In a university-based training clinic, 251 patients were administered the Outcome Questionnaire-45 [Lambert, M. J., Hansen, N. B., Umphress, V., Lunnen, K., Okiishi, J., Burlingame, G., … Reisinger, C. W. (1996). Administration and scoring manual for the Outcome Questionnaire (OQ 45.2). Wilmington, DE: American Professional Credentialing Services] at each psychotherapy session. We used GMM to identify class structure based on change in the first six sessions and examined trajectories as predictors of outcome. The sample was best described as a single class. There was no evidence of autoregressive trends in the data. We achieved better fit to the data by permitting latent variables some degree of kurtosis, rather than to assume multivariate normality. Treatment outcome was predicted by the amount of early improvement, regardless of initial level of distress. The presence of sudden early gains or losses did not further improve outcome prediction. Early improvement is an easily computed, powerful predictor of psychotherapy outcome. The use of GMM to investigate the relationship between change and outcome is technically complex and computationally intensive. To date, it has not been particularly informative.

  16. 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

  17. Patient Web Portals to Improve Diabetes Outcomes: A Systematic Review

    PubMed Central

    Mayberry, Lindsay Satterwhite; Mulvaney, Shelagh A.; Hess, Rachel

    2011-01-01

    Patient web portals (PWPs), defined as the integration of electronic medical records and patient health records, have been related to enhanced patient outcomes. A literature review was conducted to characterize the design and evaluation of PWPs to improve health care processes and outcomes in diabetes. A summary of 26 articles revealed the positive impact PWPs have on patient outcomes, patient-provider communication, disease management, and access to and patient satisfaction with health care. Innovative and useful approaches included the evaluation of specific components of the PWPs, assessing the impact of PWPs on mediators of health behaviors, such as patient distress, identification of barriers to use, and patient willingness to pay for access. Future research should focus on relevant processes that mediate patient and provider use, impact on health care utilization, and a patient-centered approach to the design and integration of educational opportunities afforded through PWPs. PMID:20890688

  18. Patient Satisfaction Survey as a Tool Towards Quality Improvement

    PubMed Central

    Al-Abri, Rashid; Al-Balushi, Amina

    2014-01-01

    Over the past 20 years, patient satisfaction surveys have gained increasing attention as meaningful and essential sources of information for identifying gaps and developing an effective action plan for quality improvement in healthcare organizations. However, there are very few published studies reporting of the improvements resulting from feedback information of patient satisfaction surveys, and in most cases, these studies are contradictory in their findings. This article investigates in-depth a number of research studies that critically discuss the relationship of dependent and independent influential attributes towards overall patient satisfaction in addition to its impact on the quality improvement process of healthcare organizations. PMID:24501659

  19. 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.

  20. Progress in Understanding Degradation Mechanisms and Improving Stability in Organic Photovoltaics.

    PubMed

    Mateker, William R; McGehee, Michael D

    2017-03-01

    Understanding the degradation mechanisms of organic photovoltaics is particularly important, as they tend to degrade faster than their inorganic counterparts, such as silicon and cadmium telluride. An overview is provided here of the main degradation mechanisms that researchers have identified so far that cause extrinsic degradation from oxygen and water, intrinsic degradation in the dark, and photo-induced burn-in. In addition, it provides methods for researchers to identify these mechanisms in new materials and device structures to screen them more quickly for promising long-term performance. These general strategies will likely be helpful in other photovoltaic technologies that suffer from insufficient stability, such as perovskite solar cells. Finally, the most promising lifetime results are highlighted and recommendations to improve long-term performance are made. To prevent degradation from oxygen and water for sufficiently long time periods, OPVs will likely need to be encapsulated by barrier materials with lower permeation rates of oxygen and water than typical flexible substrate materials. To improve stability at operating temperatures, materials will likely require glass transition temperatures above 100 °C. Methods to prevent photo-induced burn-in are least understood, but recent research indicates that using pure materials with dense and ordered film morphologies can reduce the burn-in effect.

  1. Understanding and improving the one and three times GDP per capita cost-effectiveness thresholds.

    PubMed

    Robinson, Lisa A; Hammitt, James K; Chang, Angela Y; Resch, Stephen

    2017-02-01

    Researchers and policymakers have long been interested in developing simple decision rules to aid in determining whether an intervention is, or is not, cost-effective. In global health, interventions that impose costs per disability-adjusted life year averted less than three and one times gross domestic product per capita are often considered cost-effective and very cost-effective, respectively. This article explores the conceptual foundation and derivation of these thresholds. Its goal is to promote understanding of how these thresholds were derived and their implications, as well as to suggest options for improvement. These thresholds are intended to reflect the monetary value of the benefits to affected individuals, based on their preferences for spending on health vs spending on other goods and services. However, the current values were not rigorously derived, which means that their application may lead to inappropriate conclusions regarding which interventions should be adopted as well as misallocation of resources across health and other investments. Improving the basis for these cost-effectiveness thresholds is of particular importance in low- and middle-income countries, given the limited resources available and the significant needs of their populations. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  2. 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.

  3. 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

  4. [Diabetes passport--understanding and use among different ethnic groups of diabetes patients. Interviews with Turkish, Pakistani and Danish patients].

    PubMed

    Nørgaard, Kirsten; Vibe-Petersen, Jette; Røjen, Dorrit; Mølvig, Jens C

    2007-11-12

    Diabetes passports for patients have been used for years in hospitals in our region. Since 2004 data have been printed from the electronic database DiabetesRASK and a new edition of the passport is given to patients at each visit. One of the objectives of the passport is to serve as a pedagogic tool. However, patients' understanding and use of the passport has never been studied. Inclusion criteria for patients: type 2 diabetes, born in Turkey (T) or Pakistan (P), regular attendees at the outpatient clinics at Hvidovre Hospital or Amager Hospital and their personal diabetes data in the database DiabetesRASK. A comparable group of Danish diabetes patients was selected. All were invited to participate in a semi-structured interview. 14 T, 11 P and 10 D patients participated in the study. 53% T and 73% P had the ability to read in their own language while 15% T and 55% P were able to read in Danish. In the groups fewer than 25% had ever shown their passport to the GP. Between 0% and 36% of any of the given questions were understood or identified correctly by T patients. Similar figures for the P and D patients were 0-55% and 30-100%. It is demonstrated that the diabetes passport is not widely used by patients. Furthermore, we found poor understanding of information on the passport in general but with great individual variability. The poorest understanding was found among immigrants, which might be the result of language problems. However, Danish patients also had insufficient understanding of the information. We recommend that the diabetes passport be rewritten so that it is more easily understood by patients and that outpatient clinics also allocate more resources to the guidance of patients concerning the passport.

  5. Leadership, safety climate, and continuous quality improvement: impact on process quality and patient safety.

    PubMed

    McFadden, Kathleen L; Stock, Gregory N; Gowen, Charles R

    2015-01-01

    Successful amelioration of medical errors represents a significant problem in the health care industry. There is a need for greater understanding of the factors that lead to improved process quality and patient safety outcomes in hospitals. We present a research model that shows how transformational leadership, safety climate, and continuous quality improvement (CQI) initiatives are related to objective quality and patient safety outcome measures. The proposed framework is tested using structural equation modeling, based on data collected for 204 hospitals, and supplemented with objective outcome data from the Centers for Medicare and Medicaid Services. The results provide empirical evidence that a safety climate, which is connected to the chief executive officer's transformational leadership style, is related to CQI initiatives, which are linked to improved process quality. A unique finding of this study is that, although CQI initiatives are positively associated with improved process quality, they are also associated with higher hospital-acquired condition rates, a measure of patient safety. Likewise, safety climate is directly related to improved patient safety outcomes. The notion that patient safety climate and CQI initiatives are not interchangeable or universally beneficial is an important contribution to the literature. The results confirm the importance of using CQI to effectively enhance process quality in hospitals, and patient safety climate to improve patient safety outcomes. The overall pattern of findings suggests that simultaneous implementation of CQI initiatives and patient safety climate produces greater combined benefits.

  6. Leadership, safety climate, and continuous quality improvement: impact on process quality and patient safety.

    PubMed

    McFadden, Kathleen L; Stock, Gregory N; Gowen, Charles R

    2014-10-01

    Successful amelioration of medical errors represents a significant problem in the health care industry. There is a need for greater understanding of the factors that lead to improved process quality and patient safety outcomes in hospitals. We present a research model that shows how transformational leadership, safety climate, and continuous quality improvement (CQI) initiatives are related to objective quality and patient safety outcome measures. The proposed framework is tested using structural equation modeling, based on data collected for 204 hospitals, and supplemented with objective outcome data from the Centers for Medicare and Medicaid Services. The results provide empirical evidence that a safety climate, which is connected to the chief executive officer's transformational leadership style, is related to CQI initiatives, which are linked to improved process quality. A unique finding of this study is that, although CQI initiatives are positively associated with improved process quality, they are also associated with higher hospital-acquired condition rates, a measure of patient safety. Likewise, safety climate is directly related to improved patient safety outcomes. The notion that patient safety climate and CQI initiatives are not interchangeable or universally beneficial is an important contribution to the literature. The results confirm the importance of using CQI to effectively enhance process quality in hospitals, and patient safety climate to improve patient safety outcomes. The overall pattern of findings suggests that simultaneous implementation of CQI initiatives and patient safety climate produces greater combined benefits.

  7. Understanding older patients' self-management abilities: functional loss, self-management, and well-being.

    PubMed

    Cramm, J M; Hartgerink, J M; Steyerberg, E W; Bakker, T J; Mackenbach, J P; Nieboer, A P

    2013-02-01

    This study aimed to increase our understanding of self-management abilities and identify better self-managers among older individuals. Our cross-sectional research was based on a pilot study of older people who had recently been admitted to a hospital. In the pilot study, all patients (>65 years of age) who were admitted to the Vlietland hospital between June and October 2010 were asked to participate, which led to the inclusion of 456 older patients at baseline. A total of 296 patients (65% response rate) were interviewed in their homes 3 months after admission. Measures included social, cognitive, and physical functioning, self-management abilities, and well-being. We used descriptive, correlations, and multiple regression analyses. In addition, we evaluated the mediation effect of self-management abilities on well-being. Social, cognitive, and physical functioning significantly correlated with self-management abilities and well-being (all p ≤ 0.001). After controlling for background characteristics, multiple regression analysis indicated that social, cognitive, and physical functioning still related to self-management abilities (β = 0.17-0.25; all p ≤ 0.001). Older people with low levels of social, cognitive, and physical functioning were worse self-managers than were those with higher levels of functioning. Self-management abilities mediate the relationship between social, cognitive, and physical functioning and well-being. Interventions to improve self-management abilities may help older people better deal with function losses as they age further.

  8. 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

  9. An Educational Intervention to Improve Nurses' Understanding of Pain in Children in Western India.

    PubMed

    Dongara, Ashish R; Nimbalkar, Somashekhar M; Phatak, Ajay G; Patel, Dipen V; Nimbalkar, Archana S

    2017-02-01

    Accurate assessment of pain and its management is a challenging aspect of pediatric care. Nurses, usually the primary caregivers, showed inadequate knowledge and restrictive attitudes toward pain assessment. We evaluated an educational intervention to improve nurses' assessment of pain in a teaching hospital in India. A convenient sample of nurses working in the neonatal intensive care unit, pediatric ward, pediatric intensive care unit, and pediatric cardiac intensive care unit were included in the study. Workshops to improve understanding of pain, its assessment, and management strategies were conducted. A modified and consensually validated Knowledge and Attitudes Survey Regarding Pain questionnaire-2008 consisting of 25 true/false questions, eight multiple choice questions, and two case scenarios was administered before, immediately after, and 3 months after the workshops to evaluate impact of the intervention. Eighty-seven nurses participated. Mean (standard deviation) experience was 4.04 (5.9) years. Thirty-seven percent felt that they could assess pain without pain scales. About half (49.4%) of the nurses had not previously heard of pain scales, while 47.1% reported using a pain scale in their routine practice. Significant improvement was observed between pretest and post-test total scores (15.69 [2.94] vs. 17.51 [3.47], p < .001) as well as the pretest and retention score (15.69 [2.94] vs. 19.40 [4.6], p < .001). Albeit the study site and sampling frame may limit the reliability of the findings, the educational intervention was successful, and better retention test scores suggest a cascading effect. Pain assessment and management education of children should be incorporated in the nursing curriculum and should be reinforced in all pediatric units. Copyright © 2016 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

  10. Medical Observation Units and Emergency Department Collaboration: Improving Patient Throughput.

    PubMed

    Gabele, Danielle; Bugais, Charlene; Laguna, Joanne

    2016-01-01

    The aim of this study was to identify whether observation status patients placed in a dedicated unit would decompress the emergency department (ED) more than observation patients who were admitted to other available beds. An urban quaternary hospital has a high volume of patients with average daily census of 95% capacity. A medical observation unit (MOU) was created to improve patient throughput. In phase 1, the MOU charge nurse reviewed the ED patients to be admitted and selected appropriate patients based on unit inclusion criteria. In phase 2, the MOU charge nurse did rounds with the ED charge nurse once per shift. MOU observation patients demonstrated a 53-minute (16%) reduction in average overall ED length of stay compared with observation patients admitted to other units. Inclusion criteria, a rounding checklist, and engagement of MOU and ED nurses helped the MOU and ED with patient throughput.

  11. Improving the uptake of pulmonary rehabilitation in patients with COPD:

    PubMed Central

    Harris, David; Hayter, Mark; Allender, Steven

    2008-01-01

    Background Pulmonary rehabilitation can improve the quality of life and ability to function of patients with chronic obstructive pulmonary disease (COPD). It may also reduce hospital admission and inpatient stay with exacerbations of COPD. Some patients who are eligible for pulmonary rehabilitation may not accept an offer of it, thereby missing an opportunity to improve their health status. Aim To identify a strategy for improving the uptake of pulmonary rehabilitation. Design of study Qualitative interviews with patients. Setting Patients with COPD were recruited from a suburban general practice in north-east Derbyshire, UK. Method In-depth interviews were conducted on a purposive sample of 16 patients with COPD to assess their concerns about accepting an offer of pulmonary rehabilitation. Interviews were analysed using grounded theory. Results Fear of breathlessness and exercise, and the effect of pulmonary rehabilitation on coexisting medical problems were the most common concerns patients had about taking part in the rehabilitation. The possibility of reducing the sensation of breathlessness and regaining the ability to do things, such as play with their grandchildren, were motivators to participating. Conclusion A model is proposed where patients who feel a loss of control as their disease advances may find that pulmonary rehabilitation offers them the opportunity to regain control. Acknowledging patients' fears and framing pulmonary rehabilitation as a way of ‘regaining control’ may improve patient uptake. PMID:18826782

  12. 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.

  13. Facilitating communication with patients for improved migraine outcomes.

    PubMed

    Buse, Dawn C; Lipton, Richard B

    2008-06-01

    Effective communication is integral to good medical care. Medical professional groups, regulatory agencies, educators, researchers, and patients recognize its importance. Quality of medical communication is directly related to patient satisfaction, improvement in medication adherence, treatment compliance, other outcomes, decreased risk of malpractice, and increase in health care providers' levels of satisfaction. However, skill level and training remain problematic in this area. Fortunately, research has shown that medical communication skills can be successfully taught and acquired, and that improvement in communication skills improves outcomes. The American Migraine Communication Studies I and II evaluated the current state of health care provider-patient communication in headache care and tested a simple educational intervention. They found problematic issues but demonstrated that these areas could be improved. We review theoretical models of effective communication and discuss strategies for improving communication, including active listening, interviewing strategies, and methods for gathering information about headache-related impairment, mood, and quality of life.

  14. 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. Copyright © 2015 Elsevier Ltd. All rights reserved.

  15. Improving our understanding of flood forecasting using earlier hydro-meteorological intelligence

    NASA Astrophysics Data System (ADS)

    Shih, Dong-Sin; Chen, Cheng-Hsin; Yeh, Gour-Tsyh

    2014-05-01

    In recent decades, Taiwan has suffered from severe bouts of torrential rain, and typhoon induced floods have become the major natural threat to Taiwan. In order to warn the public of potential risks, authorities are considering establishing an early warning system derived from an integrated hydro-meteorological estimation process. This study aims at the development and accuracy of such a warning system. So it is first necessary to understand the distinctive features of flood forecasting in integrated rainfall-runoff simulations. Additionally the adequacies of a warning system that is based on extracting useful intelligence from earlier, possibly faulty numerical simulation results are discussed. In order to precisely model flooding, hydrological simulations based upon spot measured rainfall data have been utilized in prior studies to calibrate model parameters. Here, precipitation inputs from an ensemble of almost 20 different realizations of rainfall fields have been used to derive flood forecasts. The flood warning system therefore integrates rainfall-runoff calculations, field observations and data assimilations. Simulation results indicate that the ensemble precipitation estimates generated by a Weather Research Forecasting (WRF) mesoscale model produce divergent estimates. Considerable flooding is often shown in the simulated hydrographs, but the results as to the peak time and peak stage are not always in agreement with the observations. In brief, such forecasts can be good for warning against potential damaging floods in the near future, but the meteorological inputs are not good enough to forecast the time and magnitude of the peaks. The key for such warning system is not to expect highly accurate rainfall predictions, but to improve our understanding from individual ensemble flood forecasts.

  16. Improvements and limitations on understanding of atmospheric processes of Fukushima Daiichi NPS radioactivity

    NASA Astrophysics Data System (ADS)

    Yamazawa, Hiromi; Terasaka, Yuta; Mizutani, Kenta; Sugiura, Hiroki; Hirao, Shigekazu

    2017-04-01

    Understanding on the release of radioactivity into the atmosphere from the accidental units of Fukushima Daiichi Nuclear Power Station have been improved owing to recent analyses of atmospheric concentrations of radionuclide. Our analysis of gamma-ray spectra from monitoring posts located about 100 km to the south of the site revealed temporal changes of atmospheric concentrations of several key nuclides including noble gas Xe-133 in addition to radio-iodine and cesium nuclides, including I-131 and Cs-137, at a 10 minute interval. By using the atmospheric concentration data, in combination with an inverse atmospheric transport modelling with a Bayesian statistical method, a modification was proposed for the widely used Katata's source term. A source term for Xe-133 was also proposed. Although the atmospheric concentration data and the source terms help us understand the atmospheric transport processes of radionuclides, they still have significant uncertainty due to limitations in availability of the concentration data. There still remain limitations in the atmospheric transport modeling. The largest uncertainty in the model is in the deposition processes. It had been pointed out that, in the 100 km range from the accidental site, there were locations at which the ambient dose rate significantly increased a few hours before precipitation detectors recorded the start of rain. According to our analysis, the dose rate increase was not directly caused by the air-borne radioactivity but by deposition. This phenomenon can be attributed to a deposition process in which evaporating precipitation enhances efficiency of deposition even in a case where no precipitation is observed at ground level.

  17. Assessment of mutual understanding of physician patient encounters: development and validation of a Mutual Understanding Scale (MUS) in a multicultural general practice setting.

    PubMed

    Harmsen, J A M; Bernsen, R M D; Meeuwesen, L; Pinto, D; Bruijnzeels, M A

    2005-11-01

    Mutual understanding between physician and patient is essential for good quality of care; however, both parties have different views on health complaints and treatment. This study aimed to develop and validate a measure of mutual understanding (MU) in a multicultural setting. The study included 986 patients from 38 general practices. GPs completed a questionnaire and patients were interviewed after the consultation. To assess mutual understanding the answers from GP and patient to questions about different consultation aspects were compared. An expert panel, using nominal group technique, developed criteria for mutual understanding on consultation aspects and secondly, established a ranking to combine all aspects into an overall consultation judgement. Regarding construct validity, patients' ethnicity, age and language proficiency were the most important predictors for MU. Regarding criterion validity, all GP-related criteria (the GPs perception of his ability to explain to the patient, the patient's ability to explain to the GP, and the patient's understanding of consultation aspects), were well-related to MU. The same can be said of patient's consultation satisfaction and feeling that the GP was considerate. We conclude that the Mutual Understanding Scale is regarded a reliable and valid measure to be used in large-scale quantitative studies.

  18. Identifying patients at high risk of breast cancer recurrence: strategies to improve patient outcomes

    PubMed Central

    Martei, Yehoda M; Matro, Jennifer M

    2015-01-01

    Identifying patients at high risk of breast cancer recurrence has important implications not only for enabling the ability to provide accurate information to patients but also the potential to improve patient outcomes. Patients at high recurrence risk can be offered appropriate treatment to improve the overall survival. However, the major challenge is identifying patients with early-stage breast cancer at lower risk who may be spared potentially toxic therapy. The successful integration of molecular assays into clinical practice may address the problem of overtreatment and improve overall patient outcomes. PMID:26504408

  19. Toward an improved understanding of the role of transpiration in critical zone dynamics

    NASA Astrophysics Data System (ADS)

    Mitra, B.; Papuga, S. A.

    2012-12-01

    Evapotranspiration (ET) is an important component of the total water balance across any ecosystem. In subalpine mixed-conifer ecosystems, transpiration (T) often dominates the total water flux and therefore improved understanding of T is critical for accurate assessment of catchment water balance and for understanding of the processes that governs the complex dynamics across critical zone (CZ). The interaction between T and plant vegetation not only modulates soil water balance but also influences water transit time and hydrochemical flux - key factors in our understanding of how the CZ evolves and responds. Unlike an eddy covariance system which provides only an integrated ET flux from an ecosystem, a sap flow system can provide an estimate of the T flux from the ecosystem. By isolating T, the ecohydrological drivers of this major water loss from the CZ can be identified. Still, the species composition of mixed-conifer ecosystems vary and the drivers of T associated with each species are expected to be different. Therefore, accurate quantification of T from a mixed-conifer requires knowledge of the unique transpiration dynamics of each of the tree species. Here, we installed a sap flow system within two mixed-conifer study sites of the Jemez River Basin - Santa Catalina Mountains Critical Zone Observatory (JRB - SCM CZO). At both sites, we identified the dominant tree species and installed sap flow sensors on healthy representatives for each of those species. At the JRB CZO site, sap sensors were installed in fir (4) and spruce (4) trees; at the SCM CZO site, sap sensors were installed at white fir (4) and maple (4) and one dead tree. Meteorological data as well as soil temperature (Ts) and soil moisture (θ) at multiple depths were also collected from each of the two sites. Preliminary analysis of two years of sap flux rate at JRB - SCM CZO shows that the environmental drivers of fir, spruce, and maple are different and also vary throughout the year. For JRB fir

  20. Improving patient satisfaction with pain management using Six Sigma tools.

    PubMed

    DuPree, Erin; Martin, Lisa; Anderson, Rebecca; Kathuria, Navneet; Reich, David; Porter, Carol; Chassin, Mark R

    2009-07-01

    Patient satisfaction as a direct and public measure of quality of care is changing the way hospitals address quality improvement. The feasibility of using the Six Sigma DMAIC (Define, Measure, Analyze, Improve, Control) methodology to improve patient satisfaction as it relates to pain management was evaluated. This project used the DMAIC methodology to improve patients' overall satisfaction with pain management on two inpatient units in an urban academic medical center. Pre- and postintervention patient surveys were conducted. The DMAIC methodology provided a data-driven structure to determine the optimal improvement strategies, as well as a long-term plan for maintaining any improvements. In addition, the Change Acceleration Process (CAP) was used throughout the project's various DMAIC stages to further the work of the team by creating a shared need to meet the objectives of the project. Overall satisfaction with pain management "excellent" ratings increased from 37% to 54%. Both units surpassed the goal of at least 50% of responses in the "excellent" category. Several key drivers of satisfaction with pain management were uncovered in the Analyze phase of the project, and each saw rating increases from the pre-intervention to postintervention surveys. Ongoing monitoring by the hospital inpatient satisfaction survey showed that the pain satisfaction score improved in subsequent quarters as compared with the pre-intervention period. The Six Sigma DMAIC methodology can be used successfully to improve patient satisfaction. The project led to measurable improvements in patient satisfaction with pain management, which have endured past the duration of the Six Sigma project. The Control phase of DMAIC allows the improvements to be incorporated into daily operations.

  1. The impact of an immersive elective on learners' understanding of lifestyle medicine and its role in patients' lives.

    PubMed

    Mattison, Melissa J; Nemec, Eric C

    2014-10-15

    To design an immersive, active learning, lifestyle medicine (LM) elective and evaluate its impact on a pharmacy learners' ability to understand the challenges of implementing lifestyle changes. A 3-credit elective was developed that incorporated goal setting and immersion into the realm of LM as experienced by both the patient and the practitioner. Learners were assessed via a survey instrument, formal assignments, reflections, and the Presidential Fitness Challenge. Learners reported that their ability to initiate LM as a primary intervention within a care plan significantly increased after taking this course. They also improved their overall health. By identifying and implementing self-identified lifestyle modifications, learners increased confidence in their abilities to produce evidence-based outcomes for patients. Learners were able to understand the challenges of trying to change their daily habits as they undertook their own personal goals.

  2. 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…

  3. Enhancing Nurses' Pain Assessment to Improve Patient Satisfaction.

    PubMed

    Schroeder, Diana L; Hoffman, Leslie A; Fioravanti, Marie; Medley, Deborah Poskus; Zullo, Thomas G; Tuite, Patricia K

    2016-01-01

    Patient satisfaction with pain management has increasing importance with Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores tied to reimbursement. Previous studies indicate patient satisfaction is influenced by staff interactions. This single-group pre/post design study aimed to improve satisfaction with pain management in older adults undergoing total joint replacement. This was a single-group pre-/posttest design. Nurse (knowledge assessment) and patient (American Pain Society Patient Outcomes Questionnaire Revised [APS-POQ-R], HCAHPS) responses evaluated pre- and postimplementation of the online educational program. Nurse focus group followed intervention. Nurses' knowledge improved significantly (p < .006) postintervention. HCAHPS scores (3-month average) for items reflecting patient satisfaction improved from 70.2 ± 9.5 to 73.9 ± 6.0. APS-POQ-R scores did not change. Focus group comments indicated need for education regarding linkages between pain management and patient satisfaction. Education on linkages between patient satisfaction and pain management can improve outcomes; education on strategies to further improve practice may enhance ability to achieve benchmarks.

  4. Use of a simplified consent form to facilitate patient understanding of informed consent for laparoscopic cholecystectomy

    PubMed Central

    Borello, Alessandro; Passera, Roberto; Surace, Alessandra; Marola, Silvia; Buccelli, Claudio; Niola, Massimo; Di Lorenzo, Pierpaolo; Amato, Maurizio; Di Domenico, Lorenza; Solej, Mario; Martino, Valter

    2016-01-01

    Abstract Background Surgical informed consent forms can be complicated for patients to read and understand. We created a consent form with key information presented in bulleted texts and diagrams combined in a graphical format to facilitate the understanding of information during the verbal consent discussion. Methods This prospective, randomized study involved 70 adult patients awaiting cholecystectomy for gallstones. Consent was obtained after standard verbal explanation using either a graphically formatted (study group, n=33) or a standard text document (control group, n=37). Comprehension was evaluated with a 9-item multiple-choice questionnaire administered before surgery and factors affecting comprehension were analyzed. Results Comparison of questionnaire scores showed no effect of age, sex, time between consent and surgery, or document format on understanding of informed consent. Educational level was the only predictor of comprehension. Conclusions Simplified surgical consent documents meet the goals of health literacy and informed consent. Educational level appears to be a strong predictor of understanding. PMID:28352847

  5. Using qualitative methods to understand factors contributing to patient satisfaction among dermatology patients: a systematic review.

    PubMed

    Gibbons, Caitlin; Singh, Sanminder; Gibbons, Brittany; Clark, Caitlin; Torres, Josefina; Cheng, Michelle Y; Wang, Elizabeth A; Armstrong, April W

    2017-09-11

    In this systematic review, we aimed to synthesize data that identify factors contributing to patient satisfaction in dermatology care using qualitative methods. We performed a comprehensive search of the literature using the PubMed database for articles published between January 1, 2000 and February 9, 2015. The initial search yielded 186 articles, of which 13 were included after applying inclusion and exclusion criteria. The systematic review of 13 articles included a total of 330 patients. Using in-field observations and semistructured interviews, studies found that qualitative methods and analysis increased the provider's sensitivity to patient needs and enhanced patient care. Analyses using qualitative methods found increased patient satisfaction in their healthcare provider is associated with (1) confidence in the provider's diagnosis, (2) perception of patient-centered, individualized recommendations and (3) quality of patient education and provider explanation during a visit. Patient satisfaction is measured using either quantitative or qualitative methods. Quantitative methods result in standardized data that often does not capture the nuances of patient experience. In contrast, qualitative methodology is integral to gathering patient perspectives on patient care and satisfaction and should be included in future research models.

  6. Taking your medicine: relational steps to improving patient compliance.

    PubMed

    Hausman, A

    2001-01-01

    Patient non-compliance with physicians' instructions is a major problem that costs billions of dollars each year. This study supports a significant role for communication, both as a form of information exchange and social support, and participative decision-making in improving patient compliance. These results, based on structural equation modeling, also support the interaction of communication and participative decision-making positively affecting compliance. Results suggest that one-way communication from physician to patient and patient education will not solve compliance problems by themselves. Instead the solution revolves around open, bi-directional information exchange, active listening by both parties, and truly informed consent on the part of patients.

  7. 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

  8. Improving Our Understanding of the 3D Coronal Evolution of CME Propagation

    NASA Astrophysics Data System (ADS)

    Hess Webber, Shea A.; Thompson, Barbara J.; Ireland, Jack; Kwon, Ryun Young

    2017-08-01

    An improved understanding of the kinematic properties of CMEs and CME-associated phenomena has several impacts: 1) a less ambiguous method of mapping propagating structures into their inner coronal manifestations, 2) a clearer view of the relationship between the “main” CME and CME-associated brightenings, and 3) an improved identification of the heliospheric sources of shocks, Type II bursts, and SEPs. We present the results of a mapping technique that facilitates the separation of CMEs and CME-associated brightenings (such as shocks) from background corona. The Time Convolution Mapping Method (TCMM) segments coronagraph data to identify the time history of coronal evolution, the advantage being that the spatiotemporal evolution profiles allow users to separate features with different propagation characteristics. For example, separating “main” CME mass from CME-associated brightenings or shocks is a well-known obstacle, which the TCMM aids in differentiating. A TCMM CME map is made by first recording the maximum value each individual pixel in the image reaches during the traversal of the CME. Then the maximum value is convolved with an index to indicate the time that the pixel reached that value. The TCMM user is then able to identify continuous “kinematic profiles,” indicating related kinematic behavior, and also identify breaks in the profiles that indicate a discontinuity in kinematic history (i.e. different structures or different propagation characteristics). The maps obtained from multiple spacecraft viewpoints (i.e., STEREO and SOHO) can then be fit with advanced structural models to obtain the 3D properties of the evolving phenomena.

  9. Doctor Who? A Quality Improvement Project to Assess and Improve Patients' Knowledge of Their Inpatient Physicians.

    PubMed

    Broderick-Forsgren, Kathleen; Hunter, Wynn G; Schulteis, Ryan D; Liu, Wen-Wei; Boggan, Joel C; Sharma, Poonam; Thomas, Steven; Zaas, Aimee; Bae, Jonathan

    2016-05-01

    Background Patient-physician communication is an integral part of high-quality patient care and an expectation of the Clinical Learning Environment Review program. Objective This quality improvement initiative evaluated the impact of an educational audit and feedback intervention on the frequency of use of 2 tools-business cards and white boards-to improve provider identification. Methods This before-after study utilized patient surveys to determine the ability of those patients to name and recognize their physicians. The before phase began in July 2013. From September 2013 to May 2014, physicians received education on business card and white board use. Results We surveyed 378 patients. Our intervention improved white board utilization (72.2% postintervention versus 54.5% preintervention, P < .01) and slightly improved business card use (44.4% versus 33.7%, P = .07), but did not improve physician recognition. Only 20.3% (14 of 69) of patients could name their physician without use of the business card or white board. Data from all study phases showed the use of both tools improved patients' ability to name physicians (OR = 1.72 and OR = 2.12, respectively; OR = 3.68 for both; P < .05 for all), but had no effect on photograph recognition. Conclusions Our educational intervention improved white board use, but did not result in improved patient ability to recognize physicians. Pooled data of business cards and white boards, alone or combined, improved name recognition, suggesting better use of these tools may increase identification. Future initiatives should target other barriers to usage of these types of tools.

  10. [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.

  11. Assessing understanding of individual risk and symptoms of progressive multifocal leukoencephalopathy in patients prescribed natalizumab for multiple sclerosis.

    PubMed

    Rath, Louise; Vijiaratnam, Nirosen; Skibina, Olga

    2017-02-01

    Natalizumab, a monoclonal antibody directed against α4 integrin, is a highly efficacious treatment commonly used in relapsing remitting multiple sclerosis. Natalizumab is associated with the potentially fatal, rare, demyelinating, opportunistic brain infection, progressive multifocal leukoencephalopathy (PML). Prognosis and disability from PML are determined by early diagnosis. Written tools are mandated in Australia and other prescribing countries with the aim to help patients understand the risks associated with treatment and ensure familiarity with the early symptoms of PML. We aimed to assess if these tools achieve such an outcome. A cross-sectional survey was conducted using a convenience sample of multiple sclerosis patients prescribed natalizumab presenting to the infusion centre at a major tertiary hospital. Patients were offered a multi-choice questionnaire to assess their knowledge on the treatment risks and surveillance requirements of their therapy. Three specific questions were highlighted by the researchers as crucial to patient understanding of PML and defined as basic knowledge. A total of 48 patients in our hospital was prescribed natalizumab; 37 responded. A total of 16 (43.2%) patients answered all three basic knowledge questions correctly. There was no difference in the ability to answer these questions based on length of treatment or co-ownership knowledge between patients with base knowledge and without. Natalizumab is associated with an increased risk of PML. Early detection and treatment of PML results in improved patient outcomes. Patient knowledge and co-partnership in the utilisation of PML risk tools is relevant in ensuring early detection. Our findings question the ability of currently sanctioned tools to inform patients of basic knowledge of PML and their risk of developing PML. A future study with a repetitive education approach and repeating the questionnaire at multiple time points would be of interest. © 2016 Royal Australasian

  12. How to help patients understand and conquer grief. Avoiding depression in the midst of sadness.

    PubMed

    Crow, H E

    1991-06-01

    Grief is a painful yet normal process that many patients do not fully understand or appreciate. Any person may be at risk for depression as a result of grief-inducing events. Early, organized intervention by primary care physicians can help patients return to full emotional health and maintain self-esteem. When the behavioral markers that measure the intensity of grief are named and used as a scale by which to measure progress, grief reactions can be jointly managed by patient and physician in brief counseling sessions over a reasonable period of time. I believe this is an efficient, effective, and valuable service to patients.

  13. Understanding Patient Experience Using Internet-based Email Surveys: A Feasibility Study at Mount Sinai Hospital.

    PubMed

    Morgan, Matthew; Lau, Davina; Jivraj, Tanaz; Principi, Tania; Dietrich, Sandra; Bell, Chaim M

    2015-01-01

    Email is becoming a widely accepted communication tool in healthcare settings. This study sought to test the feasibility of Internet-based email surveys of patient experience in the ambulatory setting. We conducted a study of email Internet-based surveys sent to patients in selected ambulatory clinics at Mount Sinai Hospital in Toronto, Canada. Our findings suggest that email links to Internet surveys are a feasible, timely and efficient method to solicit patient feedback about their experience. Further research is required to optimally leverage Internet-based email surveys as a tool to better understand the patient experience.

  14. Patient safety and quality improvement in rehabilitation medicine.

    PubMed

    Cristian, Adrian; Green, Jonah

    2012-05-01

    Patient safety in medical settings has become a major concern. As more and more individuals seek rehabilitative care for their medical conditions or are referred to rehabilitation specialists with increasingly complex medical conditions, the issue of patient safety in the rehabilitation setting takes on added importance. This article introduces the concepts of patient safety, cognitive biases, systems thinking, and quality improvement as they apply to the rehabilitation medicine.

  15. Current multiple sclerosis treatments have improved our understanding of MS autoimmune pathogenesis.

    PubMed

    Martin, Roland; Sospedra, Mireia; Rosito, Maria; Engelhardt, Britta

    2016-09-01

    Multiple sclerosis (MS) is the most common inflammatory disorder of the central nervous system (CNS) in young adults. When MS is not treated, it leads to irreversible and severe disability. The etiology of MS and its pathogenesis are not fully understood. The recent discovery that MS-associated genetic variants code for molecules related to the function of specific immune cell subsets is consistent with the concept of MS as a prototypic, T-cell-mediated autoimmune disease targeting the CNS. While the therapeutic efficacy of the currently available immunomodulatory therapies further strengthen this concept, differences observed in responses to MS treatment as well as additional clinical and imaging observations have also shown that the autoimmune pathogenesis underlying MS is much more complex than previously thought. There is therefore an unmet need for continued detailed phenotypic and functional analysis of disease-relevant adaptive immune cells and tissues directly derived from MS patients to unravel the immune etiology of MS in its entire complexity. In this review, we will discuss the currently available MS treatment options and approved drugs, including how they have contributed to the understanding of the immune pathology of this autoimmune disease.

  16. The Promise and Limitations of Using Analogies to Improve Decision-Relevant Understanding of Climate Change.

    PubMed

    Raimi, Kaitlin T; Stern, Paul C; Maki, Alexander

    2017-01-01

    To make informed choices about how to address climate change, members of the public must develop ways to consider established facts of climate science and the uncertainties about its future trajectories, in addition to the risks attendant to various responses, including non-response, to climate change. One method suggested for educating the public about these issues is the use of simple mental models, or analogies comparing climate change to familiar domains such as medical decision making, disaster preparedness, or courtroom trials. Two studies were conducted using online participants in the U.S.A. to test the use of analogies to highlight seven key decision-relevant elements of climate change, including uncertainties about when and where serious damage may occur, its unprecedented and progressive nature, and tradeoffs in limiting climate change. An internal meta-analysis was then conducted to estimate overall effect sizes across the two studies. Analogies were not found to inform knowledge about climate literacy facts. However, results suggested that people found the medical analogy helpful and that it led people-especially political conservatives-to better recognize several decision-relevant attributes of climate change. These effects were weak, perhaps reflecting a well-documented and overwhelming effect of political ideology on climate change communication and education efforts in the U.S.A. The potential of analogies and similar education tools to improve understanding and communication in a polarized political environment are discussed.

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

    DOE PAGES

    Phillips, Richard P.; Ibanez, Ines; D’Orangeville, Loic; ...

    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

  18. The Promise and Limitations of Using Analogies to Improve Decision-Relevant Understanding of Climate Change

    PubMed Central

    Stern, Paul C.; Maki, Alexander

    2017-01-01

    To make informed choices about how to address climate change, members of the public must develop ways to consider established facts of climate science and the uncertainties about its future trajectories, in addition to the risks attendant to various responses, including non-response, to climate change. One method suggested for educating the public about these issues is the use of simple mental models, or analogies comparing climate change to familiar domains such as medical decision making, disaster preparedness, or courtroom trials. Two studies were conducted using online participants in the U.S.A. to test the use of analogies to highlight seven key decision-relevant elements of climate change, including uncertainties about when and where serious damage may occur, its unprecedented and progressive nature, and tradeoffs in limiting climate change. An internal meta-analysis was then conducted to estimate overall effect sizes across the two studies. Analogies were not found to inform knowledge about climate literacy facts. However, results suggested that people found the medical analogy helpful and that it led people—especially political conservatives—to better recognize several decision-relevant attributes of climate change. These effects were weak, perhaps reflecting a well-documented and overwhelming effect of political ideology on climate change communication and education efforts in the U.S.A. The potential of analogies and similar education tools to improve understanding and communication in a polarized political environment are discussed. PMID:28135337

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

    SciTech Connect

    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’ below 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.

  20. 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.

  1. Improve Student Understanding Ability Through Gamification in Instructional Media Based Explicit Instruction

    NASA Astrophysics Data System (ADS)

    Firdausi, N.; Prabawa, H. W.; Sutarno, H.

    2017-02-01

    In an effort to maximize a student’s academic growth, one of the tools available to educators is the explicit instruction. Explicit instruction is marked by a series of support or scaffold, where the students will be guided through the learning process with a clear statement of purpose and a reason for learning new skills, a clear explanation and demonstration of learning targets, supported and practiced with independent feedback until mastery has been achieved. The technology development trend of todays, requires an adjustment in the development of learning object that supports the achievement of explicit instruction targets. This is where the gamification position is. In the role as a pedagogical strategy, the use of gamification preformance study class is still relatively new. Gamification not only use the game elements and game design techniques in non-game contexts, but also to empower and engage learners with the ability of motivation on learning approach and maintains a relaxed atmosphere. With using Reseach and Development methods, this paper presents the integration of technology (which in this case using the concept of gamification) in explicit instruction settings and the impact on the improvement of students’ understanding.

  2. Using process elicitation and validation to understand and improve chemotherapy ordering and delivery.

    PubMed

    Mertens, Wilson C; Christov, Stefan C; Avrunin, George S; Clarke, Lori A; Osterweil, Leon J; Cassells, Lucinda J; Marquard, Jenna L

    2012-11-01

    Chemotherapy ordering and administration, in which errors have potentially severe consequences, was quantitatively and qualitatively evaluated by employing process formalism (or formal process definition), a technique derived from software engineering, to elicit and rigorously describe the process, after which validation techniques were applied to confirm the accuracy of the described process. The chemotherapy ordering and administration process, including exceptional situations and individuals' recognition of and responses to those situations, was elicited through informal, unstructured interviews with members of an interdisciplinary team. The process description (or process definition), written in a notation developed for software quality assessment purposes, guided process validation (which consisted of direct observations and semistructured interviews to confirm the elicited details for the treatment plan portion of the process). The overall process definition yielded 467 steps; 207 steps (44%) were dedicated to handling 59 exceptional situations. Validation yielded 82 unique process events (35 new expected but not yet described steps, 16 new exceptional situations, and 31 new steps in response to exceptional situations). Process participants actively altered the process as ambiguities and conflicts were discovered by the elicitation and validation components of the study. Chemotherapy error rates declined significantly during and after the project, which was conducted from October 2007 through August 2008. Each elicitation method and the subsequent validation discussions contributed uniquely to understanding the chemotherapy treatment plan review process, supporting rapid adoption of changes, improved communication regarding the process, and ensuing error reduction.

  3. Improvements to the Interpretation and Understanding of SXR Tomography Measurements on MST

    NASA Astrophysics Data System (ADS)

    Vanmeter, Patrick; Franz, Paolo; Reusch, Lisa; Goetz, John; den Hartog, Daniel

    2016-10-01

    The soft x-ray (SXR) tomography system on MST uses four cameras in a double foil configuration to determine the emissivity and temperature structures of the plasma. The emissivity is due to a combination of bremsstrahlung, recombination, and line radiation due to impurities in the plasma. At higher energies recombination steps and line radiation are no longer present and can therefore be removed using thick filters. However, this limits the range of measurements to high temperature, high performance plasmas. Recent analysis focuses on including these additional sources of radiation in order to extend the effective range of SXR measurements and to explore the agreement of SXR measurements with other diagnostics like the external magnetic sensing coils. The SXR emissivity structure should directly correspond to the structure of the magnetic field; however, there is a discrepancy between the phase of the emissivity reconstructions and magnetic field reconstructions when using a cylindrical approximation to interpret the magnetic signals. This discrepancy was measured for each SXR camera viewing angle and for two distinct plasma conditions, with results supporting the interpretation that it emerges from physical effects of the toroidal geometry. Improving the understanding of these toroidal effects and the effects of radiation from impurity ions will aid in the interpretation of all SXR measurements. Supported by the US DOE.

  4. 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.

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

    SciTech Connect

    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’ below 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.

  6. Advanced MRI techniques to improve our understanding of experience-induced neuroplasticity.

    PubMed

    Tardif, Christine Lucas; Gauthier, Claudine Joëlle; Steele, Christopher John; Bazin, Pierre-Louis; Schäfer, Andreas; Schaefer, Alexander; Turner, Robert; Villringer, Arno

    2016-05-01

    Over the last two decades, numerous human MRI studies of neuroplasticity have shown compelling evidence for extensive and rapid experience-induced brain plasticity in vivo. To date, most of these studies have consisted of simply detecting a difference in structural or functional images with little concern for their lack of biological specificity. Recent reviews and public debates have stressed the need for advanced imaging techniques to gain a better understanding of the nature of these differences - characterizing their extent in time and space, their underlying biological and network dynamics. The purpose of this article is to give an overview of advanced imaging techniques for an audience of cognitive neuroscientists that can assist them in the design and interpretation of future MRI studies of neuroplasticity. The review encompasses MRI methods that probe the morphology, microstructure, function, and connectivity of the brain with improved specificity. We underline the possible physiological underpinnings of these techniques and their recent applications within the framework of learning- and experience-induced plasticity in healthy adults. Finally, we discuss the advantages of a multi-modal approach to gain a more nuanced and comprehensive description of the process of learning. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Beneficent persuasion: techniques and ethical guidelines to improve patients' decisions.

    PubMed

    Swindell, J S; McGuire, Amy L; Halpern, Scott D

    2010-01-01

    Physicians frequently encounter patients who make decisions that contravene their long-term goals. Behavioral economists have shown that irrationalities and self-thwarting tendencies pervade human decision making, and they have identified a number of specific heuristics (rules of thumb) and biases that help explain why patients sometimes make such counterproductive decisions. In this essay, we use clinical examples to describe the many ways in which these heuristics and biases influence patients' decisions. We argue that physicians should develop their understanding of these potentially counterproductive decisional biases and, in many cases, use this knowledge to rebias their patients in ways that promote patients' health or other values. Using knowledge of decision-making psychology to persuade patients to engage in healthy behaviors or to make treatment decisions that foster their long-term goals is ethically justified by physicians' duties to promote their patients' interests and will often enhance, rather than limit, their patients' autonomy. We describe techniques that physicians may use to frame health decisions to patients in ways that are more likely to motivate patients to make choices that are less biased and more conducive to their long-term goals. Marketers have been using these methods for decades to get patients to engage in unhealthy behaviors; employers and policy makers are beginning to consider the use of similar approaches to influence healthy choices. It is time for clinicians also to make use of behavioral psychology in their interactions with patients.

  8. Improved understanding and control of magnesium-doped gallium nitride by plasma assisted molecular beam epitaxy

    NASA Astrophysics Data System (ADS)

    Burnham, Shawn D.

    By an improved understanding of Mg-doped GaN through an exhaustive review of current limitations, increased control over the material was achieved by addressing several of these issues. To address the issues of the memory effect, low sticking coefficient and high vapor pressure of Mg, a new Mg dopant source was implemented, characterized and modeled for p-type doping of GaN. The device enhanced the sticking coefficient of Mg by energizing the outgoing Mg flux, and also allowed the first reported demonstration of an abrupt junction between two non-zero Mg concentrations and a graded Mg-doped GaN film. The significant compensation of Mg acceptors at high dopant concentrations was used advantageously to develop a new ex situ resistivity analysis technique using the energy distributions of SIMS to characterize doping of buried layers. The new technique was used to identify the barrier between conductive and resistive Mg doping for increased Mg concentration, which was then used to optimize Mg-doped GaN. Because Mg doping exhibits a dependence upon the growth regime, a new growth and regime characterization technique was developed using specific RHEED intensity responses to repeat growth conditions. During the development of this technique, a new surface kinetics growth model for III-nitrides was discovered based on DMS observations, which suggests preferential buildup of the metal bilayer before growth begins with an unfamiliar cation-anion exchange process initially upon metal shutter opening. Using the new RHEED growth and regime characterization technique, a new growth technique called metal modulated epitaxy (MME) was developed to increase repeatability, uniformity and smoothness. The MME technique was enhanced with a closed-loop control using real-time feedback from RHEED transients to control shutter transitions. This enhancement, called "smart shuttering," led to improved growth rate and further improvement of surface roughness and grain size, which were

  9. Using Informatics to Improve the Care of Patients Susceptible to Malignant Hyperthermia.

    PubMed

    Denholm, Bonnie G

    2016-04-01

    Perioperative nurses and nurse leaders should understand how to apply a nursing informatics framework and informatics concepts to strengthen data interpretation, transitions in care, and engagement with patients susceptible to malignant hyperthermia (MH) and their family members. Patient outcomes can be improved when informatics solutions facilitate identifying risks, clinical decision making in a crisis situation, retrieving priority information during transitions of care, and involving patients in planning care. Incorporating informatics solutions into existing quality improvement processes can help evaluate knowledge and preparedness related to managing care for a patient in an MH crisis. Informatics solutions can also help enhance interoperability by evaluating workflow related to transitions in care. Perioperative nurses and nurse leaders should advocate for diligence in submitting reports of MH-suspected events to databases. Improved data collection and data sharing enhance aggregated standardized data sets, which can advance research and increase the quality of evidence available with which to guide practice.

  10. What is the business case for improving care for patients with complex conditions?

    PubMed

    Luck, Jeff; Parkerton, Patricia; Hagigi, Fred

    2007-12-01

    Patients with complex conditions account for a disproportionate share of health care spending. Although evidence indicates that care for these patients could be provided more efficiently, the financial impact of mechanisms to improve the care they receive is unclear. Numerous mechanisms-emphasizing patient self-management, care coordination, and evidence-based guidelines-aim to improve the quality of care and outcomes for patients with complex conditions. Assessing the overall "business case" for these mechanisms requires carefully estimating all relevant costs and financial benefits, then comparing them in present value terms. Mechanisms that are not cost-saving may still be implemented if they are cost-effective. We reviewed articles in peer-reviewed journals, as well as reports available on publicly accessible websites, which contained data about the business case for mechanisms to improve care for patients with complex conditions. Published studies do not provide clear evidence that current mechanisms are cost saving. This literature also has several major methodological shortcomings with respect to providing an understanding of the business case for these mechanisms. Further research using standardized methodologies is needed to understand the business case for mechanisms to improve care for patients with complex conditions. Implications for VA business case analyses include the necessity of establishing appropriate time horizons, scope of services, and target populations, as well as considering the impact of existing VA systems.

  11. Understanding Motivations to Participate in an Observational Research Study: Why do Patients Enroll?

    PubMed Central

    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

  12. 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.

  13. The Alberta Cardiac Access Collaborative: improving the cardiac patient journey.

    PubMed

    Blackadar, Robyn; Houle, Mishaela

    2009-01-01

    The Alberta Cardiac Access Collaborative (ACAC) is a joint initiative of Alberta's health system to improve access to adult cardiac services across the patient journey. ACAC has created new care delivery models and implemented best practices across Alberta in four streams across the continuum: heart attack, patient navigation, heart failure and arrhythmia. Emergency medical providers, nurses, primary care physicians, hospitals, cardiac specialists and clinicians are all working together to integrate services, bridge jurisdictions and geography with one aim--improving the patient journey for adults in need of cardiac care.

  14. Polymer Solar Cells: Understanding Solvent Interactions and Morphology, and Strategies for Efficiency Improvements

    NASA Astrophysics Data System (ADS)

    Chang, Lilian

    Organic solar cells have the potential to be unrivaled in terms of processing cost, speed, and simplicity. The simplest of such devices consists of a single bulk-heterojunction (BHJ) active layer, in which the electron donor (conjugated polymer) and electron acceptor (fullerene) are deposited from a common solvent. The performance of BHJ solar cells is strongly correlated with the nanoscale structure of the active layer. Various processing techniques have been explored to improve the nanoscale morphology of the BHJ layer, e.g. by varying the casting solvent, thermal annealing, solvent annealing, and solvent additives. An understanding of the role of residual solvent in the BHJ layer is imperative in order to develop strategies for morphology stabilization and preserve the longevity of the device. This work highlights the effect of residual solvents on acceptor, (6,6)-phenyl-C61-butyric acid methyl ester (PCBM) diffusion and ultimately the stability of the morphology. We first show that solvent is retained within the BHJ film despite prolonged heat treatment, leading to extensive phase separation between poly(3-hexylthiophene) (P3HT) and PCBM. We then show that the addition of a small volume fraction of nitrobenzene to the casting solution inhibits the diffusion of PCBM in the film and improves the fill factor of the BHJ device without further tempering. Other commonly used additives for morphology improvement were also investigated, i.e. 1,8-diiodooctane and 1-chloronaphthalene. We show that the choice of solvent additives has direct implications on morphological evolution, i.e. P3HT:PCBM BHJ films processed with a small amount of 1,8-diiodooctane or 1-chloronaphthalene have more crystalline PCBM domains compared to crystalline P3HT domains, while the opposite is true for films cast with nitrobenzene additive and films cast purely from chlorobenzene. The BHJ film cross-links when annealed at 300°C in the presence of 1,8-diiodooctane. Cross-linking is found to

  15. Partnering With a Patient and Family Advisory Council to Improve Patient Care Experiences With Pain Management.

    PubMed

    Bookout, Michelle L; Staffileno, Beth A; Budzinsky, Christine M

    2016-04-01

    Patient-centered care is a key driver for the nation's health system, yet patient experience surveys indicate that hospitals are far from achieving favorable outcomes. Partnering with patients and families through a patient and family advisory council (PFAC) advances the practice of patient-centered care to improve outcomes and experiences. This article describes the process of implementing a PFAC and presents outcomes related to patients' perception of pain management in the acute care hospital setting.

  16. Cognitive Predictors of Understanding Treatment Decisions in Patients with Newly Diagnosed Brain Metastases

    PubMed Central

    Gerstenecker, Adam; Meneses, Karen; Duff, Kevin; Fiveash, John B.; Marson, Daniel C.; Triebel, Kristen L.

    2015-01-01

    Background Medical decision-making capacity is a higher-order functional skill that refers to a patient’s ability to make informed, sound decisions related to care and treatment. In a medical context, understanding is the most cognitively demanding consent standard and refers to a patient’s ability to comprehend information to the extent that informed decisions can be made. Methods The association between reasoning and cognition was examined using data from 41 patients with diagnosed brain metastasis. All diagnoses were made by a board-certified radiation oncologist and were verified histologically. In total, 41 demographically-matched, cognitively healthy controls were also included to aid in classifying patients with brain metastasis according to reasoning status (i.e., intact or impaired). Results Results indicate that measures of simple attention, verbal fluency, verbal memory, processing speed, and executive functioning were all associated with understanding, and that verbal memory and phonemic fluency were the primary cognitive predictors. Using these two primary predictors, equations can be constructed to predict the ability to understand treatment decisions in patients with brain metastasis. Conclusions Although preliminary, these data demonstrate how cognitive measures can estimate understanding as it relates to medical decision-making capacities in these patients. Clinically, these findings suggest that poor verbal memory and expressive language function could serve as “red flags” for reduced consent capacity in this patient population, and, thus, signal that a more comprehensive medical decision-making capacity evaluation is warranted. PMID:25735262

  17. 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

  18. Improved quality of life in hyperthyroidism patients after surgery.

    PubMed

    Bukvic, Branka; Zivaljevic, Vladan; Sipetic, Sandra; Diklic, Aleksandar; Tausanovic, Katarina; Stojanovic, Dragos; Stevanovic, Dejan; Paunovic, Ivan

    2015-02-01

    The most common causes of hyperthyroidism are Graves disease (GD) and toxic nodular goiter (TNG). GD and TNG might influence patients' quality of life (QoL). The aim of our study was to analyze and compare the QoL of patients with GD with that of TNG patients and to evaluate the influence of surgical treatment on their QoL. A prospective case-control study was conducted at the Center for Endocrine surgery in Belgrade, Serbia. The ThyPRO questionnaire was used in the QoL assessment of the GD and TNG patients (31 and 28, respectively) pre- and post-operatively. All patients were receiving antithyroid drugs, and none of the patients were overtly hyperthyroid at the time of completing the preoperative questionnaire. The QoL of the GD patients was worse than that of the TNG patients, with significant differences in eye symptoms, anxiety, and sex life domains (P < 0.001, P = 0.005, and P = 0.004, respectively), preoperatively, and in eye symptoms, anxiety, emotional susceptibility, and overall QoL (P = 0.001, P = 0.027, P = 0.005 and P = 0.013, respectively), postoperatively. The improvement in QoL in the GD patients was significant after surgical treatment in all ThyPRO domains. In the TNG patients, the improvement was significant in all but one ThyPRO domain, sex life (P = 0.066). The QoL of GD patients is worse than those of TNG patients. Surgery may improve QoL in patients with GD and TNG even if they have achieved satisfying thyroid status with medication treatment, preoperatively. Copyright © 2015 Elsevier Inc. All rights reserved.

  19. The Patient Passport Program: An Intervention to Improve Patient-Provider Communication for Hospitalized Minority Children and Their Families.

    PubMed

    Lee, Lois K; Mulvaney-Day, Norah; Berger, Anne M; Bhaumik, Urmi; Nguyen, Hiep T; Ward, Valerie L

    2016-07-01

    Effective patient-provider communication is essential to improve health care delivery and satisfaction and to minimize disparities in care for minorities. The objective of our study was to evaluate the impact of a patient-provider communication program, the Patient Passport Program, to improve communication and satisfaction for hospitalized minority children. This was a qualitative evaluation of a communication project for families with hospitalized children. Families were assigned to either the Patient Passport Program or to usual care. The Passport Program consisted of a personalized Passport book and additional medical rounds with medical providers. Semistructured interviews at the time of patient discharge were conducted with all participants to measure communication quality and patient/family satisfaction. Inductive qualitative methods were used to identify common themes. Of the 40 children enrolled in the Passport Program, 60% were boys; the mean age was 9.7 years (range, 0.16-19 years). The most common themes in the qualitative analysis of the interviews were: 1) organization of medical care; 2) emotional expressions about the hospitalization experience; and 3) overall understanding of the process of care. Spanish- and English-speaking families had similar patient satisfaction experiences, but the Passport families reported improved quality of communication with the medical care team. The Patient Passport Program enhanced the quality of communication among minority families of hospitalized children with some common themes around the medical care expressed in the Passport book. Copyright © 2016 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  20. Improving hospital care of patients with intellectual and developmental disabilities.

    PubMed

    Ailey, Sarah H; Brown, Paula J; Ridge, Caitlin M

    2017-04-01

    People with intellectual disabilities and developmental disabilities (IDD) face poorer care and outcomes when hospitalized than patients without IDD. A panel discussion Hospital care for individuals with IDD: The Issues and Challenges was held at the Annual Conference of the American Academy of Developmental Medicine and Dentistry, held in Chicago July 8-10, 2016. Among the panelists were representatives from Rush University Medical Center in Chicago, IL and Saint Barnabas Medical Center in Livingston, NJ who discussed efforts to improve hospital care of patients with IDD at their institutions. Systemic changes are needed to improve care, however, programs that target improving care for patients with IDD are possible within current systems and with current staff who are empowered to make changes that improve the quality of care. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. 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…

  2. 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…

  3. [Perception and understanding chronic heart failure by the patient. The impact of therapeutic education on the level of knowledge of patients. About 350 cases].

    PubMed

    Jourdain, P; Funck, F; Bellorini, M; Tessier, S; Lejeune, N; Loiret, J; Thebault, B; Elhallak, A; Guillard, N; Abiaad, J; Genevelle, S; Delattre, A

    2007-03-01

    Heart failure is a severe disease with a poor prognosis despite major therapeutic progresses achieved recently. A key factor is the high number of hospitalizations for heart failure, considered as being avoidable, since they are related to a lack of adequate management of the patients. Several therapeutic education programs focused on heart failure are in progress. Even though these programs aim at making patients an active agent managing the disease, data on patient's level of knowledge and experience regarding heart failure are scarce. The aim of our study was to analyze the patient's perception of the disease and his/her practices about this disease, as well as the treatments used. we included 350 consecutive patients and analyzed their level of knowledge and experience using a questionnaire, as well as interviews performed by nurses and physicians. This initial assessment was followed by a second assessment after an 8-hours course in 2 days, made by the multidisciplinary education team of R. Dubos hospital (including physicians, nurses, physiotherapists, dietician). in contrast to tests assessing the knowledge on the disease, which were in overall satisfactory, the results on the level of knowledge on treatments and heart failure pathways were poor. The courses improve significantly the level of knowledge in all domains, whatever would the age and the level of patient's demand for information be. The analysis of the patient's conception of his/her own disease reveals the lack of knowledge on the severity of heart failure. Frequently, the effect of treatments is considered as poorly efficient, and a substantial fraction of these patients have underlying depressive moods. the understanding of the level of knowledge and the perception of the patient regarding his/her disease is primordial for setting educational structures and programs. However, the patient's conception of the disease is different from care providers. It is therefore essential to assess the

  4. Readability of Patient Education Materials in Hand Surgery and Health Literacy Best Practices for Improvement.

    PubMed

    Hadden, Kristie; Prince, Latrina Y; Schnaekel, Asa; Couch, Cory G; Stephenson, John M; Wyrick, Theresa O

    2016-08-01

    This study aimed to update a portion of a 2008 study of patient education materials from the American Society for Surgery of the Hand Web site with new readability results, to compare the results to health literacy best practices, and to make recommendations to the field for improvement. A sample of 77 patient education documents were downloaded from the American Society for Surgery of the Hand Web site, handcare.org, and assessed for readability using 4 readability tools. Mean readability grade-level scores were derived. Best practices for plain language for written health materials were compiled from 3 government agency sources. The mean readability of the 77 patient education documents in the study was 9.3 grade level. This reading level is reduced from the previous study in 2008 in which the overall mean was 10.6; however, the current sample grade level still exceeds recommended readability according to best practices. Despite a small body of literature on the readability of patient education materials related to hand surgery and other orthopedic issues over the last 7 years, readability was not dramatically improved in our current sample. Using health literacy as a framework, improvements in hand surgery patient education may result in better understanding and better outcomes for patients seeing hand surgeons. Improved understanding of patient education materials related to hand surgery may improve preventable negative outcomes that are clinically significant as well as contribute to improved quality of life for patients. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  5. 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.

  6. 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

  7. 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

  8. Towards an improved mechanistic understanding of major saltwater inflows into the Baltic Sea

    NASA Astrophysics Data System (ADS)

    Höflich, Katharina; Lehmann, Andreas; Myrberg, Kai

    2017-04-01

    area are investigated in more detail. Finally, insights into the ingredients to effective major Baltic inflows are synthesized into a flow-chart diagram in which an improved mechanistic understanding of major Baltic inflows is outlined.

  9. Written Information Improves Patient Knowledge About Implanted Ports.

    PubMed

    Piredda, Michela; Migliozzi, Amelia; Biagioli, Valentina; Carassiti, Massimiliano; De Marinis, Maria Grazia

    2016-04-01

    Implanted ports are frequently used for patients with cancer who require IV chemotherapy. In addition to verbal communication with healthcare providers, patients with cancer may benefit from written information. This pre/post study evaluated the effectiveness of an informational booklet by improving knowledge about ports and assessed the history, need, and preferences for information. Patients with cancer who had an implanted port for at least six months were provided with an informational booklet about ports. Knowledge about ports was tested before (T0) and after (T1) patients read the booklet. Information needs and preferred sources of information were also assessed at T0. Patients reported their opinions of the booklet at T1. The sample included 129 patients; 49% were male, with a mean age of 59 years. Most patients want to receive as much information as possible, preferably before the port is implanted. However, 43% of patients reported they had received little information about ports. After reading the booklet, patients' knowledge, which was measured with a validated seven-item instrument, improved from T0 to T1 (p < 0.001, effect size = 0.689). Oncology nurses, by providing written and verbal information, can increase patients' knowledge about implanted ports and their confidence in caring for their ports.

  10. Grid Patient Appointment Template Design to Improve Scheduling Effectiveness.

    PubMed

    Huang, Yu-Li; Marcak, Justin

    2015-01-01

    Current outpatient delivery systems have been problematic in their ability to effectively schedule appointments and grant patients access to care. A better appointment system has demonstrated improvement on these issues. The objective of this study is to develop a grid appointment system to further improve the scheduling flexibility by determining the minimum length of appointment slots that optimizes the total costs of patient waiting, physician idling, and overtime. This minimum length is used for the patient type requiring the least amount of treatment time such as return visit (RV), and multiplications of the minimum length are for patient types with longer treatment such as new patients (NP). The results indicated that the proposed grid system adjusts to demand changes at least 15% more cost-effective when grouping two RVs into an NP or dividing an NP into two RVs compared to the base-line scheduling approaches that build around the mean treatment time.

  11. Educate patients on billing policies to improve your bottom line.

    PubMed

    May, Jonathan

    2006-01-01

    In no other industry are the consumers of goods or services so unaware and uninvolved in the reimbursement for the goods or services received. The United States healthcare industry has created and allowed to perpetuate a "hands-off" compensation approach that has created a consumer mentality proving quite difficult to change. In this article, the author describes the origin of this outdated approach and suggests a restructured office and clear communication with patients as starting points to change this deep-rooted mind-set. He describes how an up-front approach to patients' financial responsibilities and proactive staff can help reduce miscommunication between provider, patient, and insurance carrier and improve your practice's cash flow. The author also suggests that the patient's financial burden will continue to increase and offers tips to maintain positive patient relationships, improve your accounts receivable management, and protect you financially.

  12. [Methods used in the hospital for patients' sleep improvement].

    PubMed

    Ryhänen, A; Kuivalainen, L; Meriläinen, P; Isola, A

    1998-01-01

    The purpose of this article is to describe methods used in the hospital for sleep improvement. The article is based on a study of patients' sleep in a Finnish hospital's medical or surgical ward. The patients of the Central Hospital of Northern Carelia's two medical and two surgical wards took part in the research. The data were collected by a structured questionnaire in May-June 1996. Of the replies of 181 patients, the results of 177 were taken to the final analysis. The data were analysed by statistical methods. The data and the results are presented in frequency and percent distributions. The most common method used by the patients to improve their sleep was to choose a good sleeping position. Other methods, which were often used, were reading, watching TV, having a snack, taking a warm shower or praying. The nurses were versatile in using the available methods of nursing for helping the patients to sleep. They informed the patients about their illnesses, nursing regime and the forthcoming operations, consoling and giving support to them. The nurses also organised sleep-supporting environment and gave painkillers and sleeping pills. About 60% of the researched patients were of the opinion, that sleeping tablets were prescribed too often. The patients themselves regarded the information and knowledge about their own treatment as the best way to improve their sleep.

  13. 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

  14. Communicating bodily changes: physicians' ways of enabling patient understanding in gastrointestinal cancer consultations.

    PubMed

    Friberg, Febe; Lidén, Eva; Håkanson, Cecilia; Öhlén, Joakim

    2015-06-01

    To explore how physicians communicatively enable patients' understanding of bodily changes in gastrointestinal cancer care consultations. Two datasets were used. The first consisted of transcribed video-recorded palliative care consultations with three oncologists and six patients diagnosed with advanced gastrointestinal cancer, in the context of outpatient palliative care. The second dataset was audio-recorded transcriptions from diagnostic consultations with six surgeons and seven patients diagnosed with colorectal cancer, in the context of cancer surgery. An inductively driven and iterative analysis of interaction was performed, guided by Wetherell et al. (2001). Two overarching communicative strategies were identified: (1) "visualizing strategies," with the dimensions: visible strategies (visualizing with what you actually or potentially can see), sensory strategies (visualizing with what is possible to feel), and imaginative strategies; and (2) "contrasting strategies," with the dimensions: contrasting subjective experiences and contrasting between the patient and other people. The visualizing and contrasting communicative strategies form parts of physicians' tacit and experience-based knowledge. The strategies employed by physicians reveal clear potentials to enable patients' understanding and sense making of bodily changes. However, these strategies need to be explicated and problematized as parts of both consultation practice and basic medical education. By means of increased awareness, physicians can more easily identify turning points in patients' levels of understanding, thereby enriching ordinary medical consultations with reflected pedagogical strategies and skills in how to dialogue in a person-centered manner.

  15. 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

  16. Improving discharge planning communication between hospitals and patients.

    PubMed

    New, P W; McDougall, K E; Scroggie, C P R

    2016-01-01

    A potential barrier to patient discharge from hospital is communication problems between the treating team and the patient or family regarding discharge planning. To determine if a bedside 'Leaving Hospital Information Sheet' increases patient and family's knowledge of discharge date and destination and the name of the key clinician primarily responsible for team-patient communication. This article is a 'before-after' study of patients, their families and the interdisciplinary ward-based clinical team. Outcomes assessed pre-implementation and post-implementation of a bedside 'Leaving Hospital Information Sheet' containing discharge information for patients and families. Patients and families were asked if they knew the key clinician for team-patient communication and the proposed discharge date and discharge destination. Responses were compared with those set by the team. Staff were surveyed regarding their perceptions of patient awareness of discharge plans and the benefit of the 'Leaving Hospital Information Sheet'. Significant improvement occurred regarding patients' knowledge of their key clinician for team-patient communication (31% vs 75%; P = 0.0001), correctly identifying who they were (47% vs 79%; P = 0.02), and correctly reporting their anticipated discharge date (54% vs 86%; P = 0.004). There was significant improvement in the family's knowledge of the anticipated discharge date (78% vs 96%; P = 0.04). Staff reported the 'Leaving Hospital Information Sheet' assisted with communication regarding anticipated discharge date and destination (very helpful n = 11, 39%; a little bit helpful n = 11, 39%). A bedside 'Leaving Hospital Information Sheet' can potentially improve communication between patients, families and their treating team. © 2016 Royal Australasian College of Physicians.

  17. Cross-functional team processes and patient functional improvement.

    PubMed

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

    2005-10-01

    To test the hypothesis that higher levels of participation and functioning in cross-functional psychiatric treatment teams will be related to improved patient outcomes. 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. 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. 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. 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. 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 potential appropriateness of managerial interventions to encourage member investment in team processes.

  18. Lost in Translation: Helping patients understand the risks of inflammatory bowel disease therapy

    PubMed Central

    Siegel, Corey A.

    2010-01-01

    Patients with inflammatory bowel disease are commonly treated with immunomodulators and biologic therapy. These treatments can be very effective, but are associated with risks of adverse events that need to be discussed with patients. Effectively communicating risks of therapy can be challenging based on time constraints, misinformation available on the Internet and from others, and the lack of tools to efficiently share accurate data with patients and their families. Providers need to acknowledge the emotional aspect involved in the perception of risk, and be aware of mistakes that can easily be made in communicating with patients. Tools are available to make medical data easier to understand, and these techniques have been adapted for patients with inflammatory bowel disease. By more clearly communicating with patients, we can ensure that they are making informed medical decisions that fit with their personal preferences for treatment. PMID:20848508

  19. Patient Understanding of Pelvic Floor Disorders: What Women Want to Know

    PubMed Central

    Kiyosaki, Krista; Ackerman, A. Lenore; Histed, Stephanie; Sevilla, Claudia; Eilber, Karyn; Maliski, Sally; Anger, Jennifer

    2013-01-01

    Objective To assess the effect of initial visit with a specialist on disease understanding in women with pelvic floor disorders. Methods Women with referrals or chief complaints suggestive of urinary incontinence (UI) or pelvic organ prolapse (POP) were recruited from an academic urology clinic. Patients completed a Test of Functional Health Literacy in Adults (TOFHLA) and scripted interview sessions before and after the physician encounter. Physician treatment plans were standardized based on diagnosis and were explained using models. Interview transcripts were analyzed using qualitative grounded theory methodology. Results Twenty women with pelvic floor disorders (UI or POP) were recruited and enrolled in this pilot study. The mean age was 60.5 years (range 31–87 years) and the majority of women were Caucasian with a college degree or beyond. TOFHLA scores indicated adequate to high levels of health literacy. Preliminary themes before and after the physician encounter were extracted from interviews, and two main concepts emerged: 1) After the initial physician visit, knowledge of their diagnosis and the ability to treat their symptoms relieved patient concerns related to misunderstandings of the severity of their disease 2) Patients tended to focus on treatment and had difficulty grasping certain diagnostic terms. This resulted in good understanding of treatment plans despite an inconsistent understanding of diagnosis. Conclusion Our findings demonstrated a significant effect of the initial physician visit on patient understanding of her pelvic floor disorder. Despite the variation in diagnostic recall after the physician encounter, patients had good understanding of treatment plans. This served to increase perceived control and adequately relieve patient fears. PMID:22543763

  20. Patients' understanding of pelvic floor disorders: what women want to know.

    PubMed

    Kiyosaki, Krista; Ackerman, A Lenore; Histed, Stephanie; Sevilla, Claudia; Eilber, Karyn; Maliski, Sally; Rogers, Rebecca G; Anger, Jennifer

    2012-01-01

    To assess the effect of initial visit with a specialist on disease understanding in women with pelvic floor disorders. Women with referrals or chief complaints suggestive of urinary incontinence or pelvic organ prolapse were recruited from an academic urology clinic. The patients completed a Test of Functional Health Literacy in Adults and scripted interview sessions before and after a physician encounter. Physician's treatment plans were standardized based on diagnosis and were explained using models. Interview transcripts were analyzed using qualitative grounded theory methodology. Twenty women with pelvic floor disorders (urinary incontinence or pelvic organ prolapse) were recruited and enrolled in this pilot study. The mean age was 60.5 years (range, 31-87 years) and most of the women were white, with a college degree or beyond. Test of Functional Health Literacy in Adults scores indicated adequate to high levels of health literacy. Preliminary themes before and after the physician encounter were extracted from interviews, and 2 main concepts emerged. First, after the initial physician's visit, knowledge of their diagnosis and the ability to treat their symptoms relieved the patients' concerns related to misunderstandings of the severity of their disease, Second, the patients tended to focus on treatment and had difficulty grasping certain diagnostic terms. This resulted in good understanding of treatment plans despite an inconsistent understanding of diagnosis. Our findings demonstrated a significant effect of the initial physician's visit on the patients' understanding of their pelvic floor disorder. Despite the variation in diagnostic recall after the physician encounter, the patients had a good understanding of treatment plans. This served to increase perceived control and adequately relieve patients' fears.

  1. Understanding Non-Adherence From the Inside: Hypertensive Patients' Motivations for Adhering and Not Adhering.

    PubMed

    Herrera, Pablo A; Moncada, Laura; Defey, Denise

    2017-06-01

    Patients' low adherence to medical treatment in chronic illnesses is one of the biggest public health problems. Numerous studies attend to the diverse factors associated with patient adherence. However, little research has been done to explore patients' reasons for non-compliance from their own point of view. In this article, we aim to understand patient non-adherence using dialogical self-theory and qualitative research methods. We interviewed 51 hypertensive patients to explore their anti- and pro-adherence motivations. Results show that most patients adhere and non-adhere to different aspects of treatment programs (medication, exercise, diet) according to the way they construct meaning to those activities. Also, our findings support the notion that patients' non-adherent behavior aims to preserve important values such as self-esteem, autonomy, affiliation, well-being, freedom, and health (or that more adherence is not worth the extra effort). We discuss the therapeutic relevance of empathically understanding patients' worldview and implicit beliefs.

  2. Improving learning outcomes: integration of standardized patients & telemedicine technology.

    PubMed

    Seibert, Diane C; Guthrie, John T; Adamo, Graceanne

    2004-01-01

    Innovative use of standardized patients (SPs) in a telemedicine environment can improve learning outcomes and clinical competencies. This randomized, cross-over study examined the relationship of technology-based strategies and the improvement of knowledge outcomes and competencies. Results showed that the innovative use of SPs and telemedicine, compared to a traditional distance learning teaching methodology, significantly improved learning outcomes. In addition, there was a significant increase in performance motivation and an interesting decrease in student satisfaction that may be linked to the pressure of performance-based learning. This article addresses knowledge improvement only.

  3. Informed consent in trauma: does written information improve patient recall of risks? A prospective randomised study.

    PubMed

    Smith, Hannah K; Manjaly, Joseph G; Yousri, Taher; Upadhyay, Neil; Taylor, Hazel; Nicol, Stephen G; Livingstone, James A

    2012-09-01

    Informed consent is vital to good surgical practice. Pain, sedative medication and psychological distress resulting from trauma are likely to adversely affect a patient's ability to understand and retain information thus impairing the quality of the consent process. This study aims to assess whether provision of written information improves trauma patient's recall of the risks associated with their surgery. 121 consecutive trauma patients were randomised to receive structured verbal information or structured verbal information with the addition of supplementary written information at the time of obtaining consent for their surgery. Patients were followed up post-operatively (mean 3.2 days) with a questionnaire to assess recall of risks discussed during the consent interview and satisfaction with the consent process. Recall of risks discussed in the consent interview was found to be significantly improved in the group receiving written and verbal information compared to verbal information alone (mean questionnaire score 41% vs. 64%), p=0.0014 using the Mann-Whitney U test. Patient satisfaction with the consent process was improved in the group receiving written and verbal information and 90% of patients in both groups expressed a preference for both written and verbal information compared to verbal information alone. Patients awaiting surgery following trauma can pose a challenge to adequately inform about benefits conferred, the likely post operative course and potential risks. Written information is a simple and cost-effective means to improve the consent process and was popular with patients. Copyright © 2011 Elsevier Ltd. All rights reserved.

  4. The Geophysical Kitchen Sink Approach to Improving our Understanding of Volcano-Tectonic Interactions

    NASA Astrophysics Data System (ADS)

    George, Ophelia A.

    A multi-prong approach was taken in this dissertation to understand volcanic processes from both a long-term and more immediate hazard perspective. In the long-term, magma sources within the crust may produce measurable surficial response and long-wavelength gravity anomalies that provide information about the extent and depth of this magma. Long-term volcanic hazard forecasting is also improved by developing as complete a record as possible of past events. In the short-term, a long-standing question has been on the casting of precursory volcanic activity in terms of future volcanic hazards. Three studies are presented in this dissertation to address these issues. Inversion of high-resolution ground magnetic data in Amargosa Valley, NV indicates that anomaly B could be generated by a buried shield volcano. This new information changes the event count in this region which in turn affects the overall volcanic hazard estimation. Through the use of Finite Element Models (FEM) an in-depth characterization of the surficial response to magma underplating is provided for the Tohoku Volcanic Arc, Japan. These models indicate that surficial uplift was dominantly driven by mid-crustal intrusions and the magnitude and wavelength of this uplift was mainly controlled by the elastic layer thickness. In Dominica, seismic data were used as weights in spatial intensity maps to generate dynamic volcanic hazard maps influenced by changes in seismicity. These maps show an increasing trend in the north that may be indicative of an increase in earthquake and volcanic hazards.

  5. 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

  6. 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.

  7. 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

  8. 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-mappin