Synchronized navigation of current and prior studies using image registration improves radiologist's efficiency.

PubMed

Forsberg, Daniel; Gupta, Amit; Mills, Christopher; MacAdam, Brett; Rosipko, Beverly; Bangert, Barbara A; Coffey, Michael D; Kosmas, Christos; Sunshine, Jeffrey L

2017-03-01

The purpose of this study was to investigate how the use of multi-modal rigid image registration integrated within a standard picture archiving and communication system affects the efficiency of a radiologist while performing routine interpretations of cases including prior examinations. Six radiologists were recruited to read a set of cases (either 16 neuroradiology or 14 musculoskeletal cases) during two crossover reading sessions. Each radiologist read each case twice, one time with synchronized navigation, which enables spatial synchronization across examinations from different study dates, and one time without. Efficiency was evaluated based upon time to read a case and amount of scrolling while browsing a case using Wilcoxon signed rank test. Significant improvements in efficiency were found considering either all radiologists simultaneously, the two sections separately and the majority of individual radiologists for time to read and for amount of scrolling. The relative improvement for each individual radiologist ranged from 4 to 32% for time to read and from 14 to 38% for amount of scrolling. Image registration providing synchronized navigation across examinations from different study dates provides a tool that enables radiologists to work more efficiently while reading cases with one or more prior examinations.

An Application of Six Sigma to Reduce Supplier Quality Cost

NASA Astrophysics Data System (ADS)

Gaikwad, Lokpriya Mohanrao; Teli, Shivagond Nagappa; Majali, Vijay Shashikant; Bhushi, Umesh Mahadevappa

2016-01-01

This article presents an application of Six Sigma to reduce supplier quality cost in manufacturing industry. Although there is a wider acceptance of Six Sigma in many organizations today, there is still a lack of in-depth case study of Six Sigma. For the present research the case study methodology was used. The company decided to reduce quality cost and improve selected processes using Six Sigma methodologies. Regarding the fact that there is a lack of case studies dealing with Six Sigma especially in individual manufacturing organization this article could be of great importance also for the practitioners. This paper discusses the quality and productivity improvement in a supplier enterprise through a case study. The paper deals with an application of Six Sigma define-measure-analyze-improve-control methodology in an industry which provides a framework to identify, quantify and eliminate sources of variation in an operational process in question, to optimize the operation variables, improve and sustain performance viz. process yield with well-executed control plans. Six Sigma improves the process performance (process yield) of the critical operational process, leading to better utilization of resources, decreases variations and maintains consistent quality of the process output.

Incorporating ITS into transportation improvement planning : the Seattle Case Study using PRUEVIIN

DOT National Transportation Integrated Search

1998-01-01

This project explored methods to analyze ITS strategies within Major Investment Study (MIS) studies and to apply them in a case study. The case study developed methods to define alternatives, and to estimate impacts and costs at the level required fo...

Report on Federal Productivity. Volume 2, Productivity Case Studies.

ERIC Educational Resources Information Center

Joint Financial Management Improvement Program, Washington, DC.

Volume 2 contains 15 productivity case studies which illustrate and expand on the causal factors mentioned in volume 1. The cases illustrate many different approaches to productivity measurement improvement. The case studies are: Development of an Output-Productivity Measure for the Air Force Medical Service; Measuring Effectiveness and Efficiency…

International benchmarking of specialty hospitals. A series of case studies on comprehensive cancer centres.

PubMed

van Lent, Wineke A M; de Beer, Relinde D; van Harten, Wim H

2010-08-31

Benchmarking is one of the methods used in business that is applied to hospitals to improve the management of their operations. International comparison between hospitals can explain performance differences. As there is a trend towards specialization of hospitals, this study examines the benchmarking process and the success factors of benchmarking in international specialized cancer centres. Three independent international benchmarking studies on operations management in cancer centres were conducted. The first study included three comprehensive cancer centres (CCC), three chemotherapy day units (CDU) were involved in the second study and four radiotherapy departments were included in the final study. Per multiple case study a research protocol was used to structure the benchmarking process. After reviewing the multiple case studies, the resulting description was used to study the research objectives. We adapted and evaluated existing benchmarking processes through formalizing stakeholder involvement and verifying the comparability of the partners. We also devised a framework to structure the indicators to produce a coherent indicator set and better improvement suggestions. Evaluating the feasibility of benchmarking as a tool to improve hospital processes led to mixed results. Case study 1 resulted in general recommendations for the organizations involved. In case study 2, the combination of benchmarking and lean management led in one CDU to a 24% increase in bed utilization and a 12% increase in productivity. Three radiotherapy departments of case study 3, were considering implementing the recommendations.Additionally, success factors, such as a well-defined and small project scope, partner selection based on clear criteria, stakeholder involvement, simple and well-structured indicators, analysis of both the process and its results and, adapt the identified better working methods to the own setting, were found. The improved benchmarking process and the success factors can produce relevant input to improve the operations management of specialty hospitals.

International benchmarking of specialty hospitals. A series of case studies on comprehensive cancer centres

PubMed Central

2010-01-01

Background Benchmarking is one of the methods used in business that is applied to hospitals to improve the management of their operations. International comparison between hospitals can explain performance differences. As there is a trend towards specialization of hospitals, this study examines the benchmarking process and the success factors of benchmarking in international specialized cancer centres. Methods Three independent international benchmarking studies on operations management in cancer centres were conducted. The first study included three comprehensive cancer centres (CCC), three chemotherapy day units (CDU) were involved in the second study and four radiotherapy departments were included in the final study. Per multiple case study a research protocol was used to structure the benchmarking process. After reviewing the multiple case studies, the resulting description was used to study the research objectives. Results We adapted and evaluated existing benchmarking processes through formalizing stakeholder involvement and verifying the comparability of the partners. We also devised a framework to structure the indicators to produce a coherent indicator set and better improvement suggestions. Evaluating the feasibility of benchmarking as a tool to improve hospital processes led to mixed results. Case study 1 resulted in general recommendations for the organizations involved. In case study 2, the combination of benchmarking and lean management led in one CDU to a 24% increase in bed utilization and a 12% increase in productivity. Three radiotherapy departments of case study 3, were considering implementing the recommendations. Additionally, success factors, such as a well-defined and small project scope, partner selection based on clear criteria, stakeholder involvement, simple and well-structured indicators, analysis of both the process and its results and, adapt the identified better working methods to the own setting, were found. Conclusions The improved benchmarking process and the success factors can produce relevant input to improve the operations management of specialty hospitals. PMID:20807408

A Comparison of Case Study and Traditional Teaching Methods for Improvement of Oral Communication and Critical-Thinking Skills

ERIC Educational Resources Information Center

Noblitt, Lynnette; Vance, Diane E.; Smith, Michelle L. DePoy

2010-01-01

This study compares a traditional paper presentation approach and a case study method for the development and improvement of oral communication skills and critical-thinking skills in a class of junior forensic science majors. A rubric for rating performance in these skills was designed on the basis of the oral communication competencies developed…

Promoting Student Achievement: A Case Study of Change Actions Employed by an Urban School Superintendent

ERIC Educational Resources Information Center

Bealer, David E.

2010-01-01

The purpose of this study was to examine the change strategies and actions taken by an urban district superintendent to improve student achievement. In a qualitative case study of a large urban school district, one research question and three subquestions focused on: 10 specific reform strategies to improve student achievement, how the quality and…

Ensuring Healthy Youth Development through Community Schools: A Case Study

ERIC Educational Resources Information Center

Anderson-Butcher, Dawn; Paluta, Lauren; Sterling, Karen; Anderson, Carol

2018-01-01

Using mixed methods, this case study explored outcomes associated with the adoption and implementation of a community schools approach in four Title I schools using the Community Collaboration Model for School Improvement. Trends in school data demonstrate academic achievement improvements in three of the four schools. Absenteeism and the number…

Problem-Based Learning in Online Environments

ERIC Educational Resources Information Center

An, Yun-Jo; Reigeluth, Charles M.

2008-01-01

This study examined 3 graduate-level online courses that utilized problem-based learning (PBL), considering each course as a case. Beyond describing how PBL was implemented in each case, this study identified what worked (strengths) and did not work (weaknesses) in the PBL and explored how the PBL could be improved (improvements) by collecting…

Creating quality improvement culture in public health agencies.

PubMed

Davis, Mary V; Mahanna, Elizabeth; Joly, Brenda; Zelek, Michael; Riley, William; Verma, Pooja; Fisher, Jessica Solomon

2014-01-01

We conducted case studies of 10 agencies that participated in early quality improvement efforts. The agencies participated in a project conducted by the National Association of County and City Health Officials (2007-2008). Case study participants included health directors and quality improvement team leaders and members. We implemented multiple qualitative analysis processes, including cross-case analysis and logic modeling. We categorized agencies according to the extent to which they had developed a quality improvement culture. Agencies were conducting informal quality improvement projects (n = 4), conducting formal quality improvement projects (n = 3), or creating a quality improvement culture (n = 4). Agencies conducting formal quality improvement and creating a quality improvement culture had leadership support for quality improvement, participated in national quality improvement initiatives, had a greater number of staff trained in quality improvement and quality improvement teams that met regularly with decision-making authority. Agencies conducting informal quality improvement were likely to report that accreditation is the major driver for quality improvement work. Agencies creating a quality improvement culture were more likely to have a history of evidence-based decision-making and use quality improvement to address emerging issues. Our findings support previous research and add the roles of national public health accreditation and emerging issues as factors in agencies' ability to create and sustain a quality improvement culture.

Extracting information from the text of electronic medical records to improve case detection: a systematic review

PubMed Central

Carroll, John A; Smith, Helen E; Scott, Donia; Cassell, Jackie A

2016-01-01

Background Electronic medical records (EMRs) are revolutionizing health-related research. One key issue for study quality is the accurate identification of patients with the condition of interest. Information in EMRs can be entered as structured codes or unstructured free text. The majority of research studies have used only coded parts of EMRs for case-detection, which may bias findings, miss cases, and reduce study quality. This review examines whether incorporating information from text into case-detection algorithms can improve research quality. Methods A systematic search returned 9659 papers, 67 of which reported on the extraction of information from free text of EMRs with the stated purpose of detecting cases of a named clinical condition. Methods for extracting information from text and the technical accuracy of case-detection algorithms were reviewed. Results Studies mainly used US hospital-based EMRs, and extracted information from text for 41 conditions using keyword searches, rule-based algorithms, and machine learning methods. There was no clear difference in case-detection algorithm accuracy between rule-based and machine learning methods of extraction. Inclusion of information from text resulted in a significant improvement in algorithm sensitivity and area under the receiver operating characteristic in comparison to codes alone (median sensitivity 78% (codes + text) vs 62% (codes), P = .03; median area under the receiver operating characteristic 95% (codes + text) vs 88% (codes), P = .025). Conclusions Text in EMRs is accessible, especially with open source information extraction algorithms, and significantly improves case detection when combined with codes. More harmonization of reporting within EMR studies is needed, particularly standardized reporting of algorithm accuracy metrics like positive predictive value (precision) and sensitivity (recall). PMID:26911811

Improving the Effectiveness of Professional Education: Learning Managerial Accounting via a Complex Case.

ERIC Educational Resources Information Center

Carter, Melissa; And Others

To give students more experience with real situations, many professional schools use case studies in their courses. Creating complex cases, case experiences that immerse students in complex problems, rather than mere case studies that require armchair analysis should help students gain better and more integrated knowledge. Designing, implementing,…

Technology-Based Programs to Promote Walking Fluency or Improve Foot-Ground Contact during Walking: Two Case Studies of Adults with Multiple Disabilities

ERIC Educational Resources Information Center

Lancioni, Giulio E.; Singh, Nirbhay N.; O'Reilly, Mark F.; Sigafoos, Jeff; La Martire, Maria L.; Oliva, Doretta; Groeneweg, Jop

2012-01-01

These two case studies assessed technology-based programs for promoting walking fluency and improving foot-ground contact during walking with a man and a woman with multiple disabilities, respectively. The man showed breaks during walking and the woman presented with toe walking. The technology used in the studies included a microprocessor with…

A Review of Differences in Clinical Characteristics between Tardive Syndrome Induced or Improved by Aripiprazole Treatment.

PubMed

Chen, Yen-Wen; Tseng, Ping-Tao

2016-09-15

Tardive syndrome is a troublesome complication secondary to the long-term usage of antipsychotic medication. At present, there is a lack of effective treatment for tardive syndrome. Aripiprazole has been used in the treatment of tardive syndrome, with some reports of a good response. However, other reports have suggested that tardive syndrome can actually be induced by aripiprazole. The aim of current study was to investigate whether aripiprazole is beneficial or harmful for the treatment of tardive syndrome in specific patients. We performed a thorough literature search via PubMed. We included all of the studies discussing the relationship between tardive syndrome and aripiprazole, either with regards to "inducing" or "improving" the disease. None of the included studies were well-designed clinical trials, and all were case reports or case series. A total of 26 articles were included in which aripiprazole induced tardive syndrome, and another 24 in which tardive syndrome was improved by aripiprazole treatment. In the "improved" group, there were significantly more cases of schizophrenia than in the "induced" group (p=0.002). However, there were significantly more cases with other miscellaneous diagnoses in the "induced" group than in the "improved" group (p=0.003). In addition, the cases in the "induced" group had a significantly longer duration of aripiprazole usage than those in the "improved" group (p=0.001). Current study is important for clinicians to pay attention to the risk of tardive syndrome when prescribing aripiprazole in patients with a diagnosis other than a psychiatric illness or in the long-term administration of aripiprazole.

The application of interactive worksheet to improve vocational students' ability to write financial statements

NASA Astrophysics Data System (ADS)

Larasati, Aisyah; Hajji, Apif Miftahul

2017-09-01

Vocational students in Culinary Department is required to mastering the ability on managing restaurant. One of the responsibility of the students while operating a training restaurant is writing financial statements. Most of the time, writing financial statements is the hardest part for students to be conducted in a training restaurant since the students have studied limited theory/courses on that topic. This research aims to explore the improvement of students' ability to write financial statements after the application of interactive worksheet by asking them to solve financial statements case study. This research is an experimental research. Three groups of samples are used in this research, in which each of the group consists of 74 students. The first group consists of the students who solve the case study without using any software/application, the second group solve the case study by using Microsoft excel, and the third group solve the case study by using the interactive worksheet application. The results show that the use of interactive worksheet significantly improve the students ability to solve the financial statement case study either in term of accuracy or time needed to write the financial statement.

A Case Study of Team-Initiated Problem Solving Addressing Student Behavior in One Elementary School

ERIC Educational Resources Information Center

Todd, Anne W.; Horner, Robert H.; Berry, Dorothy; Sanders, Carol; Bugni, Michelle; Currier, Allison; Potts, Nicky; Newton, J. Stephen; Algozzine, Bob; Algozzine, Kate

2012-01-01

Team-Initiated Problem Solving (TIPS) is an approach for organizing school team meetings to improve identification of targeted problems, use of data in the development of solutions, and development of implemented action plans. TIPS has been demonstrated in single-case and randomized controlled trial studies to improve the effectiveness of teams to…

Implementing a Portfolio Assessment System for Chapter 1 Program Improvement: A Case Study.

ERIC Educational Resources Information Center

Leitner, David; Trevisan, Mike

This paper presents findings of a case study that documented the implementation of a portfolio assessment system in response to mandated program improvement and assessed its impact on teacher and student behaviors. The sample included elementary and middle school teachers and students from three Chapter 1 schools in a rural California school…

The Impact of Management Decision-Making on Student Success in Community Colleges: A Case Study

ERIC Educational Resources Information Center

Alt, Albert G.

2012-01-01

This case study examined a multi-college community college district in northern California in a primarily rural area, to understand how their practices compared to management best practices designed to improve student success, barriers that may exist in implementing best practices, and how the institution may improve its own practices. The problem…

Lifelong Education and Community Learning: Three Case Studies in India. UIE Monographs, 7.

ERIC Educational Resources Information Center

Patel, V; Shukla, N. N.

Three case studies of educational practices in India illustrate that lifelong learning (1) is not confined to childhood; (2) encompasses a large number of sources outside formal education; and (3) can lead to improvement of everday life. These three educational activities, all at semi-rural institutions, and directed toward improving aborigines'…

[Teaching of clinical reasoning to medical students using prototypical clinical cases].

PubMed

Montaldo L, Gustavo; Herskovic L, Pedro

2013-07-01

Clinical reasoning is the most important competente in the training process of a physician. To develop a method for teaching clinical reasoning based on prototypes of clinical cases. The study was conducted on sixty-four third year medical students. The study and control groups attended lectures and tutorial sessions with patients. The study group attended additionally discussion seminars of prototypical clinical cases. A clinical reasoning test was applied at the start and end of the learning period to both groups. At the end of the study, the opinions of students of the study group were collected in a focus group. After the learning period, both groups significantly increased their clinical reasoning skills. However, the improvement in the study group was more than double than that of the control group. The absolute improvement in the study group was 30.9%. Students interviewed in the focus group were unanimous in expressing their satisfaction in each and every aspect discussed. The teaching of clinical reasoning to third year medical students by means of pattern recognition in seminars with clinical cases improved significantly their skills.

Improving ethical knowledge and sensemaking from cases through elaborative interrogation and outcome valence.

PubMed

Johnson, James F; Bagdasarov, Zhanna; MacDougall, Alexandra E; Steele, Logan; Connelly, Shane; Devenport, Lynn D; Mumford, Michael D

2014-01-01

The case-based approach to learning is popular among many applied fields. However, results of case-based education vary widely on case content and case presentation. This study examined two aspects of case-based education-outcome valence and case elaboration methods-in a two-day case-based Responsible Conduct of Research (RCR) ethics education program. Results suggest that outcome information is an integral part of a quality case. Furthermore, valence consistent outcomes may have certain advantages over mixed valence outcome information. Finally, students enjoy and excel working with case material, and the use of elaborative interrogation techniques can significantly improve internally-focused ethical sensemaking strategies associated with personal biases, constraints, and emotions.

The effect of a loss of model structural detail due to network skeletonization on contamination warning system design: case studies.

PubMed

Davis, Michael J; Janke, Robert

2018-01-04

The effect of limitations in the structural detail available in a network model on contamination warning system (CWS) design was examined in case studies using the original and skeletonized network models for two water distribution systems (WDSs). The skeletonized models were used as proxies for incomplete network models. CWS designs were developed by optimizing sensor placements for worst-case and mean-case contamination events. Designs developed using the skeletonized network models were transplanted into the original network model for evaluation. CWS performance was defined as the number of people who ingest more than some quantity of a contaminant in tap water before the CWS detects the presence of contamination. Lack of structural detail in a network model can result in CWS designs that (1) provide considerably less protection against worst-case contamination events than that obtained when a more complete network model is available and (2) yield substantial underestimates of the consequences associated with a contamination event. Nevertheless, CWSs developed using skeletonized network models can provide useful reductions in consequences for contaminants whose effects are not localized near the injection location. Mean-case designs can yield worst-case performances similar to those for worst-case designs when there is uncertainty in the network model. Improvements in network models for WDSs have the potential to yield significant improvements in CWS designs as well as more realistic evaluations of those designs. Although such improvements would be expected to yield improved CWS performance, the expected improvements in CWS performance have not been quantified previously. The results presented here should be useful to those responsible for the design or implementation of CWSs, particularly managers and engineers in water utilities, and encourage the development of improved network models.

The effect of a loss of model structural detail due to network skeletonization on contamination warning system design: case studies

NASA Astrophysics Data System (ADS)

Davis, Michael J.; Janke, Robert

2018-05-01

The effect of limitations in the structural detail available in a network model on contamination warning system (CWS) design was examined in case studies using the original and skeletonized network models for two water distribution systems (WDSs). The skeletonized models were used as proxies for incomplete network models. CWS designs were developed by optimizing sensor placements for worst-case and mean-case contamination events. Designs developed using the skeletonized network models were transplanted into the original network model for evaluation. CWS performance was defined as the number of people who ingest more than some quantity of a contaminant in tap water before the CWS detects the presence of contamination. Lack of structural detail in a network model can result in CWS designs that (1) provide considerably less protection against worst-case contamination events than that obtained when a more complete network model is available and (2) yield substantial underestimates of the consequences associated with a contamination event. Nevertheless, CWSs developed using skeletonized network models can provide useful reductions in consequences for contaminants whose effects are not localized near the injection location. Mean-case designs can yield worst-case performances similar to those for worst-case designs when there is uncertainty in the network model. Improvements in network models for WDSs have the potential to yield significant improvements in CWS designs as well as more realistic evaluations of those designs. Although such improvements would be expected to yield improved CWS performance, the expected improvements in CWS performance have not been quantified previously. The results presented here should be useful to those responsible for the design or implementation of CWSs, particularly managers and engineers in water utilities, and encourage the development of improved network models.

Increased capture of pediatric surgical complications utilizing a novel case-log web application to enhance quality improvement.

PubMed

Fisher, Jason C; Kuenzler, Keith A; Tomita, Sandra S; Sinha, Prashant; Shah, Paresh; Ginsburg, Howard B

2017-01-01

Documenting surgical complications is limited by multiple barriers and is not fostered in the electronic health record. Tracking complications is essential for quality improvement (QI) and required for board certification. Current registry platforms do not facilitate meaningful complication reporting. We developed a novel web application that improves accuracy and reduces barriers to documenting complications. We deployed a custom web application that allows pediatric surgeons to maintain case logs. The program includes a module for entering complication data in real time. Reminders to enter outcome data occur at key postoperative intervals to optimize recall of events. Between October 1, 2014, and March 31, 2015, frequencies of surgical complications captured by the existing hospital reporting system were compared with data aggregated by our application. 780 cases were captured by the web application, compared with 276 cases registered by the hospital system. We observed an increase in the capture of major complications when compared to the hospital dataset (14 events vs. 4 events). This web application improved real-time reporting of surgical complications, exceeding the accuracy of administrative datasets. Custom informatics solutions may help reduce barriers to self-reporting of adverse events and improve the data that presently inform pediatric surgical QI. Diagnostic study/Retrospective study. Level III - case control study. Copyright © 2017 Elsevier Inc. All rights reserved.

A Case Study of Change in the Teaching and Learning of Precalculus to Calculus 2: What We Are Doing with What We Have

ERIC Educational Resources Information Center

Apkarian, Naneh; Bowers, Janet; O'Sullivan, Michael E.; Rasmussen, Chris

2018-01-01

This article presents a case study that details the successes and lessons learned by faculty and administrators at San Diego State University (SDSU) who are in the process of implementing a substantial improvement to the Precalculus to Calculus 2 sequence. Improvement efforts have been informed by national studies of successful programs and center…

Assessment of a Learning Strategy among Spine Surgeons

PubMed Central

Gotfryd, Alberto Ofenhejm; Teixeira, William Jacobsen; Martins, Delio Eulálio; Milano, Jeronimo; Iutaka, Alexandre Sadao

2017-01-01

Study Design Pilot test, observational study. Objective To evaluate objectively the knowledge transfer provided by theoretical and practical activities during AOSpine courses for spine surgeons. Methods During two AOSpine principles courses, 62 participants underwent precourse assessment, which consisted of questions about their professional experience, preferences regarding adolescent idiopathic scoliosis (AIS) classification, and classifying the curves by means of the Lenke classification of two AIS clinical cases. Two learning strategies were used during the course. A postcourse questionnaire was applied to reclassify the same deformity cases. Differences in the correct answers of clinical cases between pre- and postcourse were analyzed, revealing the number of participants whose accuracy in classification improved after the course. Results Analysis showed a decrease in the number of participants with wrong answers in both cases after the course. In the first case, statistically significant differences were observed in both curve pattern (83.3%, p  =  0.005) and lumbar spine modifier (46.6%, p  =  0.049). No statistically significant improvement was seen in the sagittal thoracic modifier (33.3%, p  =  0.309). In the second case, statistical improvement was obtained in curve pattern (27.4%, p  =  0.018). No statistically significant improvement was seen regarding lumbar spine modifier (9.8%, p  =  0.121) and sagittal thoracic modifier (12.9%, p  =  0.081). Conclusion This pilot test showed objectively that learning strategies used during AOSpine courses improved the participants' knowledge. Teaching strategies must be continually improved to ensure an optimal level of knowledge transfer. PMID:28451507

Prospects and Problems of Transferring Quality-Improvement Methods from Health Care to Social Services: Two Case Studies

PubMed Central

Neubeck, Truls; Elg, Mattias; Schneider, Thomas; Andersson-Gäre, Boel

2014-01-01

Introduction: This study examines the use of quality-improvement (QI) methods in social services. Particularly the key aspects—generalizable knowledge, interprofessional teamwork, and measurements—are studied in projects from the QI program Forum for Values in Sweden. Methods: This is a mixed-method case study. Two projects using standard QI methods and tools as used in health care were chosen as critical cases to highlight some problems and prospects with the use of QI in social services. The cases were analyzed through documented results and qualitative interviews with participants one year after the QI projects ended. Results: The social service QI projects led to measurable improvements when they used standard methods and tools for QI in health care. One year after the projects, the improvements were either not continuously measured or not reported in any infrastructure for measurements. The study reveals that social services differ from health care regarding the availability and use of evidence, the role of professional expertise, and infrastructure for measurements. Conclusions: We argue that QI methods as used in health care are applicable in social services and can lead to measurable improvements. The study gives valuable insights for QI, not only in social services but also in health care, on how to assess and sustain improvements when infrastructures for measurements are lacking. In addition, when one forms QI teams, the focus should be on functions instead of professions, and QI methods can be used to support implementation of evidence-based practice. PMID:24867549

Key Strategies for Improving School Nutrition: A Case Study of Three School Nutrition Program Innovators

ERIC Educational Resources Information Center

Sacheck, Jennifer M.; Morgan, Emily H.; Wilde, Parke; Griffin, Timothy; Nahar, Elizabeth; Economos, Christina D.

2012-01-01

Purpose/Objective: This case study identified common elements of three diverse New England school districts that were real-world models of improving school meals. Methods: School districts that had greater than 1,000 students, [greater than or equal to]3 schools, and [greater than or equal to]40% of students who qualified for free- or…

Using a Client Survey to Support Continuous Improvement: An Australian Case Study in Managing Change

ERIC Educational Resources Information Center

Besch, Janice

2014-01-01

With the arrival of online survey tools that are low-cost, readily available and easy to administer, all organizations have access to one of the most effective mechanisms for determining quality improvement priorities and measuring progress towards achieving those priorities over time. This case study outlines the use made of this simple tool by a…

Creating Quality Improvement Culture in Public Health Agencies

PubMed Central

Mahanna, Elizabeth; Joly, Brenda; Zelek, Michael; Riley, William; Verma, Pooja; Fisher, Jessica Solomon

2014-01-01

Objectives. We conducted case studies of 10 agencies that participated in early quality improvement efforts. Methods. The agencies participated in a project conducted by the National Association of County and City Health Officials (2007–2008). Case study participants included health directors and quality improvement team leaders and members. We implemented multiple qualitative analysis processes, including cross-case analysis and logic modeling. We categorized agencies according to the extent to which they had developed a quality improvement culture. Results. Agencies were conducting informal quality improvement projects (n = 4), conducting formal quality improvement projects (n = 3), or creating a quality improvement culture (n = 4). Agencies conducting formal quality improvement and creating a quality improvement culture had leadership support for quality improvement, participated in national quality improvement initiatives, had a greater number of staff trained in quality improvement and quality improvement teams that met regularly with decision-making authority. Agencies conducting informal quality improvement were likely to report that accreditation is the major driver for quality improvement work. Agencies creating a quality improvement culture were more likely to have a history of evidence-based decision-making and use quality improvement to address emerging issues. Conclusions. Our findings support previous research and add the roles of national public health accreditation and emerging issues as factors in agencies’ ability to create and sustain a quality improvement culture. PMID:24228680

Use of Multiple Metabolic and Genetic Markers to Improve the Prediction of Type 2 Diabetes: the EPIC-Potsdam Study

PubMed Central

Schulze, Matthias B.; Weikert, Cornelia; Pischon, Tobias; Bergmann, Manuela M.; Al-Hasani, Hadi; Schleicher, Erwin; Fritsche, Andreas; Häring, Hans-Ulrich; Boeing, Heiner; Joost, Hans-Georg

2009-01-01

OBJECTIVE We investigated whether metabolic biomarkers and single nucleotide polymorphisms (SNPs) improve diabetes prediction beyond age, anthropometry, and lifestyle risk factors. RESEARCH DESIGN AND METHODS A case-cohort study within a prospective study was designed. We randomly selected a subcohort (n = 2,500) from 26,444 participants, of whom 1,962 were diabetes free at baseline. Of the 801 incident type 2 diabetes cases identified in the cohort during 7 years of follow-up, 579 remained for analyses after exclusions. Prediction models were compared by receiver operatoring characteristic (ROC) curve and integrated discrimination improvement. RESULTS Case-control discrimination by the lifestyle characteristics (ROC-AUC: 0.8465) improved with plasma glucose (ROC-AUC: 0.8672, P < 0.001) and A1C (ROC-AUC: 0.8859, P < 0.001). ROC-AUC further improved with HDL cholesterol, triglycerides, γ-glutamyltransferase, and alanine aminotransferase (0.9000, P = 0.002). Twenty SNPs did not improve discrimination beyond these characteristics (P = 0.69). CONCLUSIONS Metabolic markers, but not genotyping for 20 diabetogenic SNPs, improve discrimination of incident type 2 diabetes beyond lifestyle risk factors. PMID:19720844

Engaging Engineering Students in Geoscience through Case Studies and Active Learning

ERIC Educational Resources Information Center

Holley, Elizabeth A.

2017-01-01

This study reports on a case study-based curricular intervention designed to help undergraduate engineering students make connections between geoscience and its applications. Teaching through case studies resulted in a measurable and significant improvement in the confidence that students had in their ability to apply geoscience concepts in an…

Analysis of Alternatives (AoA) Process Improvement Study

DTIC Science & Technology

2016-12-01

stakeholders, and mapped the process activities and durations. We tasked the SAG members with providing the information required on case studies and...are the expected time saves/cost/risk of any changes? (3) Utilization of case studies for both “good” and “challenged” AoAs to identify lessons...16 4 CASE STUDIES

Case Study: Formulating Questions That Address Student Misconceptions in a Case Study

ERIC Educational Resources Information Center

Prud'homme-Généreux, Annie

2017-01-01

Misconceptions are sometimes called "alternative conceptions" in acknowledgement of the fact that although these concepts are inaccurate, they are congruent with prior experiences. The idea that misconceptions must be addressed to improve learning is helpful to remember when developing a case study. Students will bring their existing…

Corporate Energy Conservation Program for Alcoa North American Extrusions: Office of Industrial Technologies (OIT) Aluminum BestPractices Management Case Study

DOE Office of Scientific and Technical Information (OSTI.GOV)

U.S. Department of Energy

2001-08-06

This case study is the latest in a series on industrial firms who are implementing energy efficient technologies and system improvements into their manufacturing processes. The case studies document the activities, savings, and lessons learned on these projects.

A web-based endodontic case difficulty assessment tool.

PubMed

Shah, P K; Chong, B S

2018-07-01

To develop a web-based tool to facilitate identification, evaluation and management of teeth requiring endodontic treatment. Following a literature search and thorough analysis of existing case difficulty assessment forms, the web-based tool was developed using an online survey builder (Qualtrics, Qualtrics Lab, UT, USA). Following feedback from a pilot study, it was refined and improved. A study was performed, using the updated version (EndoApp) on a cohort (n = 53) of dental professionals and dental students. The participants were e-mailed instructions detailing the assessment of five test cases using EndoApp, followed by completion of a structured feedback form. Analysis of the EndoApp responses was used to evaluate usage times, whereas the results of the feedback forms were used to assess user experience and relevance, other potential applications and comments on further improvement/s. The average usage time was 2 min 7 s; the average times needed for the last three (Cases 3-5) were significantly less than the preceding two (Cases 1 & 2) test cases. An overwhelming majority of participants expressed favourable views on user experience and relevance of the web-based case difficulty assessment tool. Only two participants (4%) were unlikely or very unlikely to use EndoApp again. The potential application of EndoApp as an 'educational tool' and for 'primary care triage' was deemed the most popular features and of greater importance than the secondary options of 'fee setting' and as a 'dento-legal justification tool'. Within the study limitations, owing to its ability to quantify the level of difficulty and provide guidance, EndoApp was considered user-friendly and helped facilitate endodontic case difficulty assessment. From the feedback, further improvements and the development of a Smartphone App version are in progress. EndoApp may facilitate treatment planning, improve treatment cost-effectiveness and reduce frequency of procedural errors by providing appropriate guidance on endodontic case management.

The Improving Way of Logistics Management in Korean Army

DTIC Science & Technology

2011-03-01

case study , ethnography , phenomenological study , ground theory study and content 18 analysis. The case study deals with a...there are five kinds of qualitative research approaches. To decide which method to be chosen, one should consider the purpose, focus, method of data... qualitative research , case study is good to find the answer when the researcher has no

Beyond surgical care improvement program compliance: antibiotic prophylaxis implementation gaps.

PubMed

Hawkins, Russell B; Levy, Shauna M; Senter, Casey E; Zhao, Jane Y; Doody, Kaitlin; Kao, Lillian S; Lally, Kevin P; Tsao, KuoJen

2013-10-01

Despite increased compliance with Surgical Care Improvement Project infection measures, surgical-site infections are not decreasing. The aim of this study was to test the hypothesis that documented compliance with antibiotic prophylaxis guidelines on a pediatric surgery service does not reflect implementation fidelity or adherence to guidelines as intended. A 7-week observational study of elective pediatric surgical cases was conducted. Adherence was evaluated for appropriate administration, type, timing, weight-based dosing, and redosing of antibiotics. Prophylactic antibiotics were administered appropriately in 141 of 143 cases (99%). Of 100 cases (70%) in which antibiotic prophylaxis was indicated, compliance was documented in 100% cases in the electronic medical record, but only 48% of cases adhered to all 5 guidelines. Lack of adherence was due primarily to dosing or timing errors. Lack of implementation fidelity in antibiotic prophylaxis guidelines may partly explain the lack of expected reduction in surgical-site infections. Future studies of Surgical Care Improvement Project effectiveness should measure adherence and implementation fidelity rather than just documented compliance. Copyright © 2013 Elsevier Inc. All rights reserved.

SEASAT economic assessment. Volume 9: Ports and harbors case study and generalization. [economic benefits of SEASAT satellites to harbors and shipping industries through improved weather forecasting

NASA Technical Reports Server (NTRS)

1975-01-01

This case study and generalization quantify benefits made possible through improved weather forecasting resulting from the integration of SEASAT data into local weather forecasts. The major source of avoidable economic losses to shipping from inadequate weather forecasting data is shown to be dependent on local precipitation forecasting. The ports of Philadelphia and Boston were selected for study.

Achieving Dramatic School Improvement: An Exploratory Study. A Cross-Site Analysis from the Evaluation of Comprehensive School Reform Program Implementation and Outcomes Study

ERIC Educational Resources Information Center

Aladjem, Daniel K.; Birman, Beatrice F.; Orland, Martin; Harr-Robins, Jenifer; Heredia, Alberto; Parrish, Thomas B.; Ruffini, Stephen J.

2010-01-01

This exploratory study describes approaches to improving schools through retrospective, in-depth qualitative case studies. To select schools to be examined, the authors sought to identify Comprehensive School Reform (CSR) schools demonstrating two distinctive patterns of improved student achievement between 2000 and 2005, rapid-improvement (i.e.,…

Generating Academic Urgency through Improved Classroom Management: A Case Study of a University and Urban Charter High School Partnership

ERIC Educational Resources Information Center

Morales, Erik E.

2017-01-01

This case study documents a university and secondary school partnership designed to improve classroom management and student time on task at an urban charter high school. The initiative utilized the expertise and knowledge of college of education faculty to identify and ameliorate the high school's observed barriers to students' time on task, and…

The Assimilation of Beginning Teachers into an Established School Improvement Project: A Qualitative Case Study Examining Formats of Job-Embedded Professional Development

ERIC Educational Resources Information Center

Fuller, Lynn A.

2016-01-01

This dissertation examined formats of job-embedded professional development that were experienced by beginning teachers at a high-poverty, high-mobility elementary school in the third year of a School Improvement Grant. A qualitative case study was conducted to examine formats of job-embedded professional development that were most useful to help…

Alcoa North American Extrusions Implements Energy Use Assessments at Multiple Facilities: Office of Industrial Technologies (OIT) BestPractices Aluminum Assessment Case Study

DOE Office of Scientific and Technical Information (OSTI.GOV)

U.S. Department of Energy

2001-08-05

This case study is the latest in a series on industrial firms who are implementing energy efficient technologies and system improvements into their manufacturing processes. The case studies document the activities, savings, and lessons learned on these projects.

Lessons in Literacy: Case Studies of Successful Strategies for Raising Achievement in Multilingual Schools.

ERIC Educational Resources Information Center

Campbell, Bernard, Ed.

The group of case studies details ways in which elementary, middle, and secondary schools in Bradford (England) have responded to recent developments in literacy education and developed whole- school approaches to improving achievement in literacy within multilingual school populations. Case study titles include: "The Literacy Lesson: A…

Incorporating Case Studies into a World Food and Population Course

ERIC Educational Resources Information Center

Econopouly, Bethany F.; Byrne, Patrick F.; Johnson, Marc A.

2010-01-01

The use of case studies in college courses can increase student engagement with the subject matter and improve analytical, problem-solving, and communication skills. Case studies were introduced in a relatively large (54 students) undergraduate world food and population course at Colorado State University in the spring semester of 2008 and…

Management Design Theories

NASA Astrophysics Data System (ADS)

Pries-Heje, Jan; Baskerville, Richard L.

This paper elaborates a design science approach for management planning anchored to the concept of a management design theory. Unlike the notions of design theories arising from information systems, management design theories can appear as a system of technological rules, much as a system of hypotheses or propositions can embody scientific theories. The paper illus trates this form of management design theories with three grounded cases. These grounded cases include a software process improvement study, a user involvement study, and an organizational change study. Collectively these studies demonstrate how design theories founded on technological rules can not only improve the design of information systems, but that these concepts have great practical value for improving the framing of strategic organi zational design decisions about such systems. Each case is either grounded in an empirical sense, that is to say, actual practice, or it is grounded to practices described extensively in the practical literature. Such design theories will help managers more easily approach complex, strategic decisions.

Promoting the Use of Online Social Technology as a Case-Based Learning Tool

ERIC Educational Resources Information Center

Ractham, Peter; Chen, Charlie

2013-01-01

Social technology is proliferating and influencing different aspects of society. However, very few studies have examined the use of such a technology for a case-based learning pedagogy. This preliminary study investigates the use of social technology as a case-based learning tool to improve the effectiveness of case-based learning in the…

Case Study: Clinical Governance as an Approach to Improve Maternal and Newborn Health in 22 Hospitals in Indonesia.

PubMed

Amelia, Dwirani; Suhowatsky, Stephanie; Baharuddin, Mohammad; Tholandi, Maya; Hyre, Anne; Sethi, Reena

Clinical governance is a concept used to improve management, accountability and the provision of quality healthcare. An approach to strengthen clinical governance as a means to improve the quality of maternal and newborn care in Indonesia was developed by the Expanding Maternal and Neonatal Survival (EMAS) Program. This case study presents findings and lessons learned from EMAS program experience in 22 hospitals where peer-to-peer mentoring supported staff in strengthening clinical governance from 2012-2015. Efforts resulted in improved hospital preparedness and significantly increased the odds of facility-level coverage for three evidence-based maternal and newborn healthcare interventions.

An audit of inpatient case records and suggestions for improvements.

PubMed

Arshad, A R; Ganesananthan, S; Ajik, S

2000-09-01

A study was carried out in Kuala Lumpur Hospital to review the adequacy of documentation of bio-data and clinical data including clinical examination, progress review, discharge process and doctor's identification in ten of our clinical departments. Twenty criteria were assessed in a retrospective manner to scrutinize the contents of medical notes and subsequently two prospective evaluations were conducted to see improvement in case notes documentation. Deficiencies were revealed in all the criteria selected. However there was a statistically significant improvement in the eleven clinical data criteria in the subsequent two evaluations. Illegibility of case note entries and an excessive usage of abbreviations were noted during this audit. All clinical departments and hospitals should carry out detailed studies into the contents of their medical notes.

Improving safety culture through the health and safety organization: a case study.

PubMed

Nielsen, Kent J

2014-02-01

International research indicates that internal health and safety organizations (HSO) and health and safety committees (HSC) do not have the intended impact on companies' safety performance. The aim of this case study at an industrial plant was to test whether the HSO can improve company safety culture by creating more and better safety-related interactions both within the HSO and between HSO members and the shop-floor. A quasi-experimental single case study design based on action research with both quantitative and qualitative measures was used. Based on baseline mapping of safety culture and the efficiency of the HSO three developmental processes were started aimed at the HSC, the whole HSO, and the safety representatives, respectively. Results at follow-up indicated a marked improvement in HSO performance, interaction patterns concerning safety, safety culture indicators, and a changed trend in injury rates. These improvements are interpreted as cultural change because an organizational double-loop learning process leading to modification of the basic assumptions could be identified. The study provides evidence that the HSO can improve company safety culture by focusing on safety-related interactions. © 2013. Published by Elsevier Ltd and National Safety Council.

Using standardized nursing languages: a case study exemplar on management of diabetes mellitus.

PubMed

Fischetti, Natalie

2008-01-01

This case study illustrates the characteristics of the nursing diagnosis readiness for enhanced self health management. Published literature, experience, and expertise of the author were utilized as data sources. The standardized nursing languages of NANDA International, Nursing Outcomes Classification, Nursing Interventions Classification, and interventions related to the client's management of diabetes were derived for the case study. The use of standardized nursing languages with interventions related to the management of type 2 diabetes provided a framework for nurses to support clients with enhanced self-management to improve their outcomes. The use of standardized nursing language in the management of type 2 diabetes can improve client outcomes.

Do transportation subsidies and living allowances improve tuberculosis control outcomes among internal migrants in urban Shanghai, China?

PubMed

Lu, Hui; Yan, Fei; Wang, Wei; Wu, Laiwa; Ma, Weiping; Chen, Jing; Shen, Xin; Mei, Jian

2013-01-01

Tuberculosis (TB) in internal migrants is one of three threats for TB control in China. To address this threat, a project was launched in eight of the 19 districts of Shanghai in 2007 to provide transportation subsidies and living allowances for all migrant TB cases. This study aims to determine if this project contributed to improved TB control outcomes among migrants in urban Shanghai. This was a community intervention study. The data were derived from the TB Management Information System in three project districts and three non-project districts in Shanghai between 2006 and 2010. The impact of the project was estimated in a difference-in-difference (DID) analysis framework, and a multivariable binary logistic regression analysis. A total of 1872 pulmonary TB (PTB) cases in internal migrants were included in the study. The treatment success rate (TSR) for migrant smear-positive cases in project districts increased from 59.9% in 2006 to 87.6% in 2010 (P < 0.001). The crude DID improvement of TSR was 18.9%. There was an increased probability of TSR in the project group before and after the project intervention period (coefficient = 1.156, odds ratio = 3.178, 95% confidence interval: 1.305-7.736, P = 0.011). The study showed the project could improve treatment success in migrant PTB cases. This was a short-term programme using special financial subsidies for all migrant PTB cases. It is recommended that project funds be continuously invested by governments with particular focus on the more vulnerable PTB cases among migrants.

Staff Training for Business Process Improvement: The Benefit of Role-Plays in the Case of KreditSim

ERIC Educational Resources Information Center

Borner, Rene; Moormann, Jurgen; Wang, Minhong

2012-01-01

Purpose: The paper aims to explore staff's experience with role-plays using the example of training bank employees in Six Sigma as a major methodology for business process improvement. Design/methodology/approach: The research is based on a case study. A role-play, KreditSim, is used to simulate a loan approval process that has to be improved by…

Applying Process Improvement Methods to Clinical and Translational Research: Conceptual Framework and Case Examples

PubMed Central

Selker, Harry P.; Leslie, Laurel K.

2015-01-01

Abstract There is growing appreciation that process improvement holds promise for improving quality and efficiency across the translational research continuum but frameworks for such programs are not often described. The purpose of this paper is to present a framework and case examples of a Research Process Improvement Program implemented at Tufts CTSI. To promote research process improvement, we developed online training seminars, workshops, and in‐person consultation models to describe core process improvement principles and methods, demonstrate the use of improvement tools, and illustrate the application of these methods in case examples. We implemented these methods, as well as relational coordination theory, with junior researchers, pilot funding awardees, our CTRC, and CTSI resource and service providers. The program focuses on capacity building to address common process problems and quality gaps that threaten the efficient, timely and successful completion of clinical and translational studies. PMID:26332869

Long-term symptomatic, functional, and work outcomes of carpal tunnel syndrome among construction workers.

PubMed

Evanoff, Bradley; Gardner, Bethany T; Strickland, Jaime R; Buckner-Petty, Skye; Franzblau, Alfred; Dale, Ann Marie

2016-05-01

The long-term outcomes of carpal tunnel syndrome (CTS) including symptoms, functional status, work disability, and economic impact are unknown. We conducted a retrospective study of 234 active construction workers with medical claims for CTS and 249 workers without CTS claims; non-cases were matched on age, trade, and insurance eligibility. We conducted telephone interviews with cases and non-cases and collected administrative data on work hours. Compared to non-cases, CTS cases were more likely to report recurrent hand symptoms, decreased work productivity/quality, decreased performance of physical work demands, and greater functional limitations. Surgical cases showed larger improvements on multiple outcomes than non-surgical cases. Minimal differences in paid work hours were seen between cases and non-cases in the years preceding and following CTS claims. Persistent symptoms and functional impairments were present several years after CTS diagnosis. Long-term functional limitations shown by this and other studies indicate the need for improved prevention and treatment. © 2016 Wiley Periodicals, Inc.

[Case managers experience improved trajectories for cancer patients after implementation of the case manager function].

PubMed

Axelsen, Karina Rahbek; Nafei, Hanne; Jakobsen, Stine Finne; Gandrup, Per; Knudsen, Janne Lehmann

2014-10-13

Case managers are increasingly used to optimize trajectories for patients. This study is based on a questionnaire among case managers in cancer care, aiming at the clarification of the function and its impact on especially patient safety, when handing over the responsibility. The results show a major variation in how the function is organized, the level of competence and the task to be handled. The responsibility has in general been narrowed to department level. Overall, the case managers believe that the function has optimized pathways for cancer patients and improved safety, but barriers persist.

Corvallis case study : indirect land use and growth impacts of highway improvements.

DOT National Transportation Integrated Search

2001-06-01

To improve environmental analysis of indirect land use impacts of highway capacity improvements, this study analyzed the land use and growth patterns of 20 Oregon communities over 20 years. Using a Geographic Information System and aerial photos, gro...

Case Studies in Continuous Process Improvement

NASA Technical Reports Server (NTRS)

Mehta, A.

1997-01-01

This study focuses on improving the SMT assembly process in a low-volume, high-reliability environment with emphasis on fine pitch and BGA packages. Before a process improvement is carried out, it is important to evaluate where the process stands in terms of process capability.

The Development of Technical and Vocational Education in Malaysia--A Case Study in Quality Improvement. Case Studies on Technical and Vocational Education in Asia and the Pacific.

ERIC Educational Resources Information Center

Hee, Tieng Fok

The economic profile of Malaysia has changed from an economy mainly based on agriculture and the production of tin ore to a more balanced economy with continuing growth in the manufacturing and industrial sectors. Educational programs need to be upgraded and improved, particularly the direction and development of technical and vocational education…

Case Study: South Texas Veterans Health Care System’s Communication Center

DTIC Science & Technology

2008-07-14

appropriate access to health care; technical quality is providing world-class care to our veterans; customer satisfaction is ensuring the STVHCS patients and...were not called. These results not only improved access to health care, but also positively affected customer service. 111 Case Study: South Texas...increased waiting times for the patient . With current regulatory requirements calling for improved access to health care services, many hospital and

A Case Study: Testing in the Albuquerque Public Schools.

ERIC Educational Resources Information Center

Robinson, Carol

1983-01-01

This case study of testing in the Albuquerque public schools highlights improvement of test results dissemination and use through cooperative planning, integrated database development, and a partnership with public media. (Author)

A Case-Based Approach Improves Science Students' Experimental Variable Identification Skills

ERIC Educational Resources Information Center

Grunwald, Sandra; Hartman, Andrew

2010-01-01

Incorporation of experimental case studies into the laboratory curriculum increases students' abilities to identify experimental variables that affect the outcome of an experiment. Here the authors describe how such case studies were incorporated using an online course management system into a biochemistry laboratory curriculum and the assessment…

Defining the performance gap: Conducting a self-assessment

NASA Technical Reports Server (NTRS)

Braymer, Susan A.; Stoner, David L.; Powell, William C.

1992-01-01

This paper presents two different approaches to performing self-assessments of continuous improvement activities. Case Study 1 describes the activities performed by JSC to assess the implementation of continuous improvement efforts at the NASA Center. The JSC approach included surveys administered to randomly selected NASA personnel and personal interviews with NASA and contractor management personnel. Case Study 2 describes the continuous improvement survey performed by the JSC Safety, Reliability, and Quality Assurance (SR&QA) organization. This survey consisted of a short questionnaire (50 questions) administered to all NASA and contractor SR&QA personnel. The questionnaire is based on the eight categories of the President's Award for Quality and Productivity Improvement. It is designed to objectively determine placement on the TQ benchmark and identify a roadmap for improvement.

Faculty Workshops for Teaching Information Assurance through Hands-On Exercises and Case Studies

ERIC Educational Resources Information Center

Yuan, Xiaohong; Williams, Kenneth; Yu, Huiming; Rorrer, Audrey; Chu, Bei-Tseng; Yang, Li; Winters, Kathy; Kizza, Joseph

2017-01-01

Though many Information Assurance (IA) educators agree that hands-on exercises and case studies improve student learning, hands-on exercises and case studies are not widely adopted due to the time needed to develop them and integrate them into curricula. Under the support of the National Science Foundation (NSF) Scholarship for Service program, we…

School Is Your Job: A Case Study on School Leadership and Black Male Achievement

ERIC Educational Resources Information Center

Lee-Currie, Monica

2013-01-01

The purpose of this qualitative case study was to examine and report how four school leaders in a mid-sized, Mid-Atlantic high school created an environment that improved achievement levels, increased graduation rates, and reduced drop-out rates for Black male students. The researcher utilized a qualitative case study design which included…

Social Networking as a Platform for Role-Playing Scientific Case Studies

ERIC Educational Resources Information Center

Geyer, Andrea M.

2014-01-01

This work discusses the design and implementation of two online case studies in a face-to-face general chemistry course. The case studies were integrated into the course to emphasize the need for science literacy in general society, to enhance critical thinking, to introduce database searching, and to improve primary literature reading skills. An…

A parametric study of the value of hydrological information for irrigation and hydropower management of the Feather River

NASA Technical Reports Server (NTRS)

Wetzler, E.; Sand, F.; Stevenson, P.; Putnam, M.

1975-01-01

A case study analysis is presented of the relationships between improvements in the accuracy, frequency, and timeliness of information used in making hydrological forecasts and economic benefits in the areas of hydropower and irrigation. The area chosen for the case study is the Oroville Dam and Reservoir. Emphasis is placed on the use of timely and accurate mapping of the aerial extent of snow in the basin by earth resources survey systems such as LANDSAT. The subject of benefits resulting from improved runoff forecasts is treated in a generalized way without specifying the source of the improvements.

Case studies combined with or without concept maps improve critical thinking in hospital-based nurses: a randomized-controlled trial.

PubMed

Huang, Yu-Chuan; Chen, Hsing-Hsia; Yeh, Mei-Ling; Chung, Yu-Chu

2012-06-01

Critical thinking (CT) is essential to the exercise of professional judgment. As nurses face increasingly complex health-care situations, critical thinking can promote appropriate clinical decision-making and improve the quality of nursing care. This study aimed to evaluate the effects of a program of case studies, alone (CS) or combined with concept maps (CSCM), on improving CT in clinical nurses. The study was a randomized controlled trial. The experimental group participated in a 16-week CSCM program, whereas the control group participated in a CS program of equal duration. A randomized-controlled trial with a multistage randomization process was used to select and to assign participants, ultimately resulting in 67 nurses in each group. Data were collected before and after the program using the California Critical Thinking Skill Test (CCTST) and the California Critical Thinking Disposition Inventory (CCTDI). After the programs, there were significant differences between the two groups in the critical thinking skills of analysis, evaluation, inference, deduction, and induction. There was also an overall significant difference, and a significant difference in the specific disposition of open-mindedness. This study supports the application of case studies combined with concept maps as a hospital-based teaching strategy to promote development of critical thinking skills and encourage dispositions for nurses. The CSCM resulted in greater improvements in all critical thinking skills of as well as the overall and open-minded affective dispositions toward critical thinking, compared with the case studies alone. An obvious improvement in the CSCM participants was the analytic skill and disposition. Further longitudinal studies and data collection from multisite evaluations in a range of geographic locales are warranted. Copyright © 2012 Elsevier Ltd. All rights reserved.

Vocal Fold Bowing in Elderly Male Monozygotic Twins: A Case Study

PubMed Central

Tanner, Kristine; Sauder, Cara; Thibeault, Susan L.; Dromey, Christopher; Smith, Marshall E.

2009-01-01

Objectives This study examined case histories, diagnostic features, and treatment response in two 79-year-old male monozygotic (identical) twins with vocal fold bowing, exploring both genetic and environmental factors. Study Design Case study. Methods DNA concordance was examined via cheek swab. Case histories, videostroboscopy, auditory- and visual-perceptual assessment, electromyography, acoustic measures, and Voice Handicap ratings were undertaken. Both twins underwent surgical intervention and subsequent voice therapy. Results Monozygosity was confirmed for DNA polymorphisms, with 10 of 10 concordance for STR DNA markers. For both twins, auditory and visual-perceptual assessments indicated severe bowing, hoarseness and breathiness, although Twin 1 was judged to be extremely severe. Differences in RMS amplitudes were observed for TA and LCA muscles, with smaller relative amplitudes observed for the Twin 1 versus Twin 2. No consistent voice improvement was observed following surgical intervention(s), despite improved mid-membranous vocal fold closure. Marked reductions in Voice Handicap Index total scores were observed following behavioral voice therapy, coinciding with increased mid-membranous and posterior laryngeal (interarytenoid) glottal closure. No substantive differences in acoustic measures were observed. Conclusions Vocal fold bowing was more severe for Twin 1 versus Twin 2 despite identical heritability factors. Overall voice improvement with treatment was greater for Twin 2 than Twin 1. Environmental factors might partially account for the differences observed between the twins, including variability in their responsiveness to behavioral voice therapy. Voice therapy was useful in improving mid-membranous and posterior laryngeal closure, although dysphonia remained severe in both cases. PMID:19664899

Nutritional and safety assessment of foods and feeds nutritionally improved through biotechnology--case studies by the International Food Biotechnology Committee of ILSI.

PubMed

Glenn, Kevin C

2008-01-01

During the last two decades, the public and private sectors have made substantial research progress internationally toward improving the nutritional value of a wide range of food and feed crops. Nevertheless, significant numbers of people still suffer from the effects of undernutrition. As newly developed crops with nutritionally improved traits come closer to being available to producers and consumers, scientifically sound and efficient processes are needed to assess the safety and nutritional quality of these crops. In 2004, a Task Force of international scientific experts, convened by the International Food Biotechnology Committee (IFBiC) of ILSI, published recommendations for the safety and nutritional assessment of foods and feeds nutritionally improved through modern biotechnology (J. Food Science, 2004, 69:CRH62-CRH68). The comparative safety assessment process is a basic principle in this publication and is the starting point, not the conclusion, of the analysis. Significant differences in composition are expected to be observed in the case of nutritionally enhanced crops and must be assessed on a case-by-case basis. The Golden Rice 2 case study will be presented as an example of a food crop nutritionally enhanced through the application of modern biotechnology (i.e., recombinant DNA techniques) to illustrate how the 2004 recommendations provide a robust paradigm for the safety assessment of "real world" examples of improved nutrition crops.

Rare variant association analysis in case-parents studies by allowing for missing parental genotypes.

PubMed

Li, Yumei; Xiang, Yang; Xu, Chao; Shen, Hui; Deng, Hongwen

2018-01-15

The development of next-generation sequencing technologies has facilitated the identification of rare variants. Family-based design is commonly used to effectively control for population admixture and substructure, which is more prominent for rare variants. Case-parents studies, as typical strategies in family-based design, are widely used in rare variant-disease association analysis. Current methods in case-parents studies are based on complete case-parents data; however, parental genotypes may be missing in case-parents trios, and removing these data may lead to a loss in statistical power. The present study focuses on testing for rare variant-disease association in case-parents study by allowing for missing parental genotypes. In this report, we extended the collapsing method for rare variant association analysis in case-parents studies to allow for missing parental genotypes, and investigated the performance of two methods by using the difference of genotypes between affected offspring and their corresponding "complements" in case-parent trios and TDT framework. Using simulations, we showed that, compared with the methods just only using complete case-parents data, the proposed strategy allowing for missing parental genotypes, or even adding unrelated affected individuals, can greatly improve the statistical power and meanwhile is not affected by population stratification. We conclude that adding case-parents data with missing parental genotypes to complete case-parents data set can greatly improve the power of our strategy for rare variant-disease association.

Systematic review of physiotherapy interventions to improve gross motor capacity and performance in children and adolescents with an acquired brain injury.

PubMed

Baque, Emmah; Sakzewski, Leanne; Barber, Lee; Boyd, Roslyn N

2016-01-01

To systematically review the efficacy of physiotherapy interventions to improve gross motor capacity, performance and societal participation in children aged 5-17 years with an acquired brain injury (ABI). Randomized and non-randomized controlled trials, cohort, case series, case-control and case studies were included and classified according to grades of evidence. Methodological quality of studies was assessed using the Downs and Black (D&B) scale and quantitative data was analysed using effect sizes. Two home-based studies investigated functional strength training (one randomized controlled trial, n = 20, level 2b, D&B = 16/32 and one non-randomized self-control study, n = 19, level 4, D&B = 15/32). Four studies evaluated virtual reality including: one pilot study, n = 50, level 4, D&B = 22/32; one single-subject, non-concurrent, randomized multiple baseline study, n = 3, level 4, D&B = 15/32; one case series study, n = 2, level 4, D&B = 15/32; one case study, n = 1, level 4, D&B = 15/32. Effect sizes for the randomized controlled trial ranged between 0.30-1.29 for the Functional Reach and Timed Up and Go outcome measures. There is preliminary evidence to support the efficacy of physiotherapy interventions to improve gross motor outcomes in children with an ABI. Both functional strength training and virtual-reality based therapy are potential treatment options for clinicians to prescribe in either home or clinical settings.

To study the effect of orbital sling on post operative vision in cases of maxillary carcinoma undergoing total maxillectomy.

PubMed

Shukla, Anirudh; Dudeja, Vivek

2014-06-01

To study effect of orbital sling on post operative vision in cases of maxillary carcinoma undergoing total maxillectomy. All patients with the principal procedure of "total maxillectomy" for histopathologically proven cases of carcinoma maxilla in department of otorhinolaryngology and head-neck surgery, N.S.C.B. medical college, Jabalapur, Madhya Pradesh, India from July 2011 to October 2013 were included. Out of the 20 patients irrespective of whether orbital sling was created or not, maximum number of patients 8 (40 %) showed a 3 step improvement, and maximum improvement seen was up to five steps. Out of the 14 patients in which orbital sling was created maximum number of patients 7 (50 %) showed a 3 step improvement, and maximum improvement seen was up to five steps. Out of the 6 patients in whom orbital sling was not created maximum number of patients 3 (50 %) showed a 2 step improvement, and maximum improvement seen was up to three steps. Infraorbital repair with the help of sling results in better improvement of vision as compared to those in whom sling was not or could not be made with no significant difference on eye movements.

Successful strategies for improving operating room efficiency at academic institutions.

PubMed

Overdyk, F J; Harvey, S C; Fishman, R L; Shippey, F

1998-04-01

In this prospective study, we evaluated the etiology of operating room (OR) delays in an academic institution, examined the impact of multidisciplinary strategies to improve OR efficiency, and established OR timing benchmarks for use in future OR efficiency studies. OR times and delay etiologies were collected for 94 cases during the initial phase of the study. Timing data and delay etiologies were analyzed, and 2 wk of multidisciplinary OR efficiency awareness education was conducted for the nursing, surgical, and anesthesia staff. After the education period, timing data were collected from 1787 cases, and monthly reports listing individual case delays and timing data were sent to the Chiefs of Service. For the first case of the day, patient in room, anesthesia ready, surgical preparation start, and procedure start time were significantly earlier (P < 0.01) in the posteducation period compared with the preeducation period, and the procedure start time for the first case of the day occurred, on average, 22 min earlier than all other procedures. For all cases combined, turnover time decreased, on average, by 16 min. Unavailability of surgeons, anesthesiologists, and residents decreased significantly (P < 0.05) as causes of OR delays. Anesthesia induction times were consistently longer for the vascular and cardiothoracic services, whereas surgical preparation time was increased for the neurosurgical and orthopedic services (P < 0.05). Identification of the etiology of OR inefficiency, combined with multidisciplinary awareness training and personal accountability, can improve OR efficiency. The time savings realized are probably most cost-effective when combined with more flexible OR staffing and improved OR scheduling. We achieved significant improvements in operating room efficiency by analyzing operating room data on causes of delays, devising strategies for minimizing the most common delays, and subsequently measuring delay data. Personal accountability, streamlining of procedures, interdisciplinary team work, and accurate data collection were all important contributors to improved efficiency.

Improving performance of breast cancer risk prediction using a new CAD-based region segmentation scheme

NASA Astrophysics Data System (ADS)

Heidari, Morteza; Zargari Khuzani, Abolfazl; Danala, Gopichandh; Qiu, Yuchen; Zheng, Bin

2018-02-01

Objective of this study is to develop and test a new computer-aided detection (CAD) scheme with improved region of interest (ROI) segmentation combined with an image feature extraction framework to improve performance in predicting short-term breast cancer risk. A dataset involving 570 sets of "prior" negative mammography screening cases was retrospectively assembled. In the next sequential "current" screening, 285 cases were positive and 285 cases remained negative. A CAD scheme was applied to all 570 "prior" negative images to stratify cases into the high and low risk case group of having cancer detected in the "current" screening. First, a new ROI segmentation algorithm was used to automatically remove useless area of mammograms. Second, from the matched bilateral craniocaudal view images, a set of 43 image features related to frequency characteristics of ROIs were initially computed from the discrete cosine transform and spatial domain of the images. Third, a support vector machine model based machine learning classifier was used to optimally classify the selected optimal image features to build a CAD-based risk prediction model. The classifier was trained using a leave-one-case-out based cross-validation method. Applying this improved CAD scheme to the testing dataset, an area under ROC curve, AUC = 0.70+/-0.04, which was significantly higher than using the extracting features directly from the dataset without the improved ROI segmentation step (AUC = 0.63+/-0.04). This study demonstrated that the proposed approach could improve accuracy on predicting short-term breast cancer risk, which may play an important role in helping eventually establish an optimal personalized breast cancer paradigm.

La Grande/Island City case study indirect land use and growth impacts of highway improvements : final report.

DOT National Transportation Integrated Search

2000-04-01

To improve environmental analysis of indirect land use impacts of highway capacity improvements, this study analyzed the land use and growth patterns of 20 Oregon communities over 20 years. Using a Geographic Information System and aerial photos, gro...

Random Versus Nonrandom Peer Review: A Case for More Meaningful Peer Review.

PubMed

Itri, Jason N; Donithan, Adam; Patel, Sohil H

2018-05-10

Random peer review programs are not optimized to discover cases with diagnostic error and thus have inherent limitations with respect to educational and quality improvement value. Nonrandom peer review offers an alternative approach in which diagnostic error cases are targeted for collection during routine clinical practice. The objective of this study was to compare error cases identified through random and nonrandom peer review approaches at an academic center. During the 1-year study period, the number of discrepancy cases and score of discrepancy were determined from each approach. The nonrandom peer review process collected 190 cases, of which 60 were scored as 2 (minor discrepancy), 94 as 3 (significant discrepancy), and 36 as 4 (major discrepancy). In the random peer review process, 1,690 cases were reviewed, of which 1,646 were scored as 1 (no discrepancy), 44 were scored as 2 (minor discrepancy), and none were scored as 3 or 4. Several teaching lessons and quality improvement measures were developed as a result of analysis of error cases collected through the nonrandom peer review process. Our experience supports the implementation of nonrandom peer review as a replacement to random peer review, with nonrandom peer review serving as a more effective method for collecting diagnostic error cases with educational and quality improvement value. Copyright © 2018 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Lean principles optimize on-time vascular surgery operating room starts and decrease resident work hours.

PubMed

Warner, Courtney J; Walsh, Daniel B; Horvath, Alexander J; Walsh, Teri R; Herrick, Daniel P; Prentiss, Steven J; Powell, Richard J

2013-11-01

Lean process improvement techniques are used in industry to improve efficiency and quality while controlling costs. These techniques are less commonly applied in health care. This study assessed the effectiveness of Lean principles on first case on-time operating room starts and quantified effects on resident work hours. Standard process improvement techniques (DMAIC methodology: define, measure, analyze, improve, control) were used to identify causes of delayed vascular surgery first case starts. Value stream maps and process flow diagrams were created. Process data were analyzed with Pareto and control charts. High-yield changes were identified and simulated in computer and live settings prior to implementation. The primary outcome measure was the proportion of on-time first case starts; secondary outcomes included hospital costs, resident rounding time, and work hours. Data were compared with existing benchmarks. Prior to implementation, 39% of first cases started on time. Process mapping identified late resident arrival in preoperative holding as a cause of delayed first case starts. Resident rounding process inefficiencies were identified and changed through the use of checklists, standardization, and elimination of nonvalue-added activity. Following implementation of process improvements, first case on-time starts improved to 71% at 6 weeks (P = .002). Improvement was sustained with an 86% on-time rate at 1 year (P < .001). Resident rounding time was reduced by 33% (from 70 to 47 minutes). At 9 weeks following implementation, these changes generated an opportunity cost potential of $12,582. Use of Lean principles allowed rapid identification and implementation of perioperative process changes that improved efficiency and resulted in significant cost savings. This improvement was sustained at 1 year. Downstream effects included improved resident efficiency with decreased work hours. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Testing the effectiveness of family therapeutic assessment: a case study using a time-series design.

PubMed

Smith, Justin D; Wolf, Nicole J; Handler, Leonard; Nash, Michael R

2009-11-01

We describe a family Therapeutic Assessment (TA) case study employing 2 assessors, 2 assessment rooms, and a video link. In the study, we employed a daily measures time-series design with a pretreatment baseline and follow-up period to examine the family TA treatment model. In addition to being an illustrative addition to a number of clinical reports suggesting the efficacy of family TA, this study is the first to apply a case-based time-series design to test whether family TA leads to clinical improvement and also illustrates when that improvement occurs. Results support the trajectory of change proposed by Finn (2007), the TA model's creator, who posits that benefits continue beyond the formal treatment itself.

Case Studies in Elementary and Secondary Curriculum

ERIC Educational Resources Information Center

Boboc, Marius; Nordgren, R. D.

2010-01-01

Practical and engaging, this book contains 21 case studies that help students apply curriculum theory to classroom reality. Each case is authored by an in-service teacher, reflecting on ways to improve instruction by making changes to various aspects of the curriculum. These real-life examples investigate up-to-date curricular issues ranging from…

Advances in malaria elimination in Botswana: a dramatic shift to parasitological diagnosis, 2008–2014

PubMed Central

Edwards, J. K.; Motlaleng, M.; Namboze, J.; Butt, W.; Obopile, M.; Mosweunyane, T.; Manzi, M.; Takarinda, K. C.; Owiti, P.

2018-01-01

Background: Malaria elimination requires infection detection using quality assured diagnostics and appropriate treatment regimens. Although Botswana is moving towards malaria elimination, reports of unconfirmed cases may jeopardise this effort. This study aimed to determine the proportion of cases treated for malaria that were confirmed by rapid diagnostic testing (RDT) and/or microscopy. Methods: This was a retrospective descriptive study using routine national data from the integrated disease surveillance and case-based surveillance systems from 2008 to 2014. The data were categorised into clinical and confirmed cases each year. An analysis of the data on cases registered in three districts that reported approximately 70% of all malaria cases was performed, stratified by year, type of reporting health facilities and diagnostic method. Results: During 2008–2014, 50 487 cases of malaria were reported in Botswana, and the proportion of RDT and/or blood microscopy confirmed cases improved from 6% in 2008 to 89% in 2013. The total number of malaria cases decreased by 97% in the same period, then increased by 41% in 2013. Conclusion: This study shows that malaria diagnostic tests dramatically improved malaria diagnosis and consequently reduced the malaria burden in Botswana. The study identified a need to build capacity on microscopy for species identification, parasite quantification and guiding treatment choices. PMID:29713592

Advances in malaria elimination in Botswana: a dramatic shift to parasitological diagnosis, 2008-2014.

PubMed

Moakofhi, K; Edwards, J K; Motlaleng, M; Namboze, J; Butt, W; Obopile, M; Mosweunyane, T; Manzi, M; Takarinda, K C; Owiti, P

2018-04-25

Background: Malaria elimination requires infection detection using quality assured diagnostics and appropriate treatment regimens. Although Botswana is moving towards malaria elimination, reports of unconfirmed cases may jeopardise this effort. This study aimed to determine the proportion of cases treated for malaria that were confirmed by rapid diagnostic testing (RDT) and/or microscopy. Methods: This was a retrospective descriptive study using routine national data from the integrated disease surveillance and case-based surveillance systems from 2008 to 2014. The data were categorised into clinical and confirmed cases each year. An analysis of the data on cases registered in three districts that reported approximately 70% of all malaria cases was performed, stratified by year, type of reporting health facilities and diagnostic method. Results: During 2008-2014, 50 487 cases of malaria were reported in Botswana, and the proportion of RDT and/or blood microscopy confirmed cases improved from 6% in 2008 to 89% in 2013. The total number of malaria cases decreased by 97% in the same period, then increased by 41% in 2013. Conclusion: This study shows that malaria diagnostic tests dramatically improved malaria diagnosis and consequently reduced the malaria burden in Botswana. The study identified a need to build capacity on microscopy for species identification, parasite quantification and guiding treatment choices.

Clinical Case Definitions for Classification of Intrathoracic Tuberculosis in Children: An Update

PubMed Central

Graham, Stephen M.; Cuevas, Luis E.; Jean-Philippe, Patrick; Browning, Renee; Casenghi, Martina; Detjen, Anne K.; Gnanashanmugam, Devasena; Hesseling, Anneke C.; Kampmann, Beate; Mandalakas, Anna; Marais, Ben J.; Schito, Marco; Spiegel, Hans M. L.; Starke, Jeffrey R.; Worrell, Carol; Zar, Heather J.

2015-01-01

Consensus case definitions for childhood tuberculosis have been proposed by an international expert panel, aiming to standardize the reporting of cases in research focusing on the diagnosis of intrathoracic tuberculosis in children. These definitions are intended for tuberculosis diagnostic evaluation studies of symptomatic children with clinical suspicion of intrathoracic tuberculosis, and were not intended to predefine inclusion criteria into such studies. Feedback from researchers suggested that further clarification was required and that these case definitions could be further improved. Particular concerns were the perceived complexity and overlap of some case definitions, as well as the potential exclusion of children with acute onset of symptoms or less severe disease. The updated case definitions proposed here incorporate a number of key changes that aim to reduce complexity and improve research performance, while maintaining the original focus on symptomatic children suspected of having intrathoracic tuberculosis. The changes proposed should enhance harmonized classification for intrathoracic tuberculosis disease in children across studies, resulting in greater comparability and the much-needed ability to pool study results. PMID:26409281

Educational Cost Analysis in Action: Case Studies for Planners -- I.

ERIC Educational Resources Information Center

Coombs, Philip H.; Hallak, Jacques

This document is the first in a series of three documents, which together contains 27 case studies on the uses of cost analysis in educational planning. The case studies have been presented to help planners and administrators see how cost analysis can be used to improve the efficiency of their educational systems, or how to get the best value from…

Educational Cost Analysis in Action: Case Studies for Planners -- III.

ERIC Educational Resources Information Center

Coombs, Philip H.; Hallak, Jacques

This document is the third in a series of three documents, which together contain 27 case studies on the uses of cost analysis in educational planning. The case studies have been presented to help planners and administrators see how cost analysis can be used to improve the efficiency of their educational systems, and to get the best value from…

Structured review: evaluating the effectiveness of nurse case managers in improving health outcomes in three major chronic diseases.

PubMed

Sutherland, Debbie; Hayter, Mark

2009-11-01

This paper presents the findings of a review and appraisal of the evidence for the effectiveness of nurse case management in improving health outcomes for patients living either with Diabetes, Chronic Obstructive Pulmonary Disease or Coronary Heart Disease. Long term chronic health conditions provide some of the greatest challenges to western health care systems. In the UK, three of the most significant chronic conditions are Diabetes, Chronic Obstructive Pulmonary Disease and Coronary Heart Disease. Patients with these long term conditions are high users of health services who often receive unplanned, poorly co-ordinated, ad-hoc care in response to an exacerbation or crisis. To counter this, the nurse case manager is identified as a central aspect of improving care for these patients. However, the evidence for the effectiveness of nurse case management in improving health outcomes for the chronically ill is scarce. A structured review of the literature. The review was undertaken focussing on studies that evaluated nurse case management with one or all of the three major long term chronic conditions. A total of 108 papers were initially reviewed and filtered to leave 75 citations that were appraised. About 18 papers were finally included in the review and subject to thematic analysis based on the health outcomes evaluated in the studies. Significantly positive results were reported for nurse case management impact on five health outcomes; 'objective clinical measurements', 'quality of life and functionality', 'patient satisfaction', 'adherence to treatment' and 'self care and service use'. The evidence generated in this review suggests that nurse case managers have the potential to achieve improved health outcomes for patients with long term conditions. Further research is required to support role development and create a more targeted approach to the intervention.

Electronic Freight Management Case Studies : a Summary of Results

DOT National Transportation Integrated Search

2012-04-01

The Electronic Freight Management (EFM) initiative is a USDOT-sponsored project that applies Web technologies that improve data and message transmissions between supply chain partners. The EFM implementation case studies contained in this document ex...

The Welfare of Bears in Zoos: A Case Study of Poland.

PubMed

Maślak, Robert; Sergiel, Agnieszka; Bowles, David; Paśko, Łukasz

2016-01-01

The welfare of captive bears became a big issue of concern in Poland when a case of a bear being ill-treated became a high-profile case in the media. This case created a challenge to verify, study, and understand the main problems associated with bear keeping so that zoos could significantly improve the conditions in which they keep bears or ensure they keep bears at the minimum required standards. The results presented here are from 1 of the few countrywide studies of captive bear conditions conducted in all the captive institutions in Poland that keep bears. Thirteen institutions kept bears at the time of the study (2007-2009), including 54 individuals of 5 species. Major welfare problems were identified, and the results have been used to challenge zoos to address the changes required and focus the government's attention on areas that require legislative improvement.

[Case managers experience improved trajectories for cancer patients after implementation of the case manager function].

PubMed

Axelsen, Karina Rahbek; Nafei, Hanne; Jakobsen, Stine Finne; Gandrup, Per; Knudsen, Janne Lehmann

2015-06-08

Case managers are increasingly used to optimize trajectories for patients. This study is based on a questionnaire among case managers in cancer care, aiming at the clarification of the func­tion and its impact on especially patient safety, when handing over the responsibility. The results show a major variation in how the function is organized, the level of competence and the task to be handled. The responsibility has in general been nar­rowed to department level. Overall, the case managers believe that the function has optimized pathways for cancer patients and improved safety, but barriers persist.

Digital enhancement of sub-quality bitemark photographs.

PubMed

Karazalus, C P; Palmbach, T T; Lee, H C

2001-07-01

Digital enhancement software was used to enhance bitemark photographs. This enhancement technique improved the resolution of the bitemark images. Lucis was the software program utilized in this study and case applications. First, this technique was applied on known bitemark images to evaluate the potential effectiveness of this digital enhancement method. Subsequently, Lucis was utilized on two separate unsolved cases involving enhancement of bitemark evidence. One case involved a severely beaten infant with a bitemark on the upper thigh. The second case involves a bitemark observed on the breast of a female sexual assault strangulation victim. In both cases, bitemark images were significantly improved after digital enhancement.

Improving Diabetes Care in the Military Primary Care Clinic: Case Study Review

DTIC Science & Technology

2016-03-23

This research study combines qualitative and quantitative methodology in reflectively exploring positive case studies to ascertain strategies that...enabled patients to engage in self-management. Moreover, this study seeks to better understand how applying the ADA Standards of Care in a military

Education research: a case-based bioethics curriculum for neurology residents.

PubMed

Tolchin, Benjamin; Willey, Joshua Z; Prager, Kenneth

2015-03-31

In 2012, the American Academy of Neurology (AAN) updated and expanded its ethics curriculum into Practical Ethics in Clinical Neurology, a case-based ethics curriculum for neurologists. We piloted a case-based bioethics curriculum for neurology residents using the framework and topics recommended by the AAN, matched to clinical cases drawn from Columbia's neurologic services. Our primary outcome was residents' ability to analyze and manage ethically complex cases as measured on precurriculum and postcurriculum multiple-choice quizzes. Secondary outcomes included precurriculum and postcurriculum self-assessed comfort in discussing and managing ethically complex cases, as well as attendance at ethics discussion sessions as compared to attendance at other didactic sessions. Resident performance on quizzes improved from 75.8% to 86.7% (p = 0.02). Comfort in discussing ethically complex cases improved from 6.4 to 7.4 on a 10-point scale (p = 0.03). Comfort in managing such cases trended toward improvement but did not reach statistical significance. Attendance was significantly better at ethics discussions (73.5%) than at other didactic sessions (61.7%, p = 0.04). Our formal case-based ethics curriculum for neurology residents, based on core topics drawn from the AAN's published curricula, was successfully piloted. Our study showed a statistically significant improvement in residents' ability to analyze and manage ethically complex cases as measured by multiple-choice tests and self-assessments. © 2015 American Academy of Neurology.

Variables affecting the financial viability of your practice: a case study.

PubMed

Binderman, J

2001-01-01

Utilizing the discussion of variables affecting practice financial viability, a case study is considered. The case study reveals the relative impact multiple variables have upon the bottom line, including: practice capacity, percentage of capitation, and fee-for-service in the practice, as well as patient visit rates and patient churning. This article presents basic financial information through a case study model, utilizing a series of worksheets that can be adapted to any practice situation to encourage improved financial viability.

Tuberculous meningitis: a uniform case definition for use in clinical research.

PubMed

Marais, Suzaan; Thwaites, Guy; Schoeman, Johan F; Török, M Estée; Misra, Usha K; Prasad, Kameshwar; Donald, Peter R; Wilkinson, Robert J; Marais, Ben J

2010-11-01

Tuberculous meningitis causes substantial mortality and morbidity in children and adults. More research is urgently needed to better understand the pathogenesis of disease and to improve its clinical management and outcome. A major stumbling block is the absence of standardised diagnostic criteria. The different case definitions used in various studies makes comparison of research findings difficult, prevents the best use of existing data, and limits the management of disease. To address this problem, a 3-day tuberculous meningitis workshop took place in Cape Town, South Africa, and was attended by 41 international participants experienced in the research or management of tuberculous meningitis. During the meeting, diagnostic criteria were assessed and discussed, after which a writing committee was appointed to finalise a consensus case definition for tuberculous meningitis for use in future clinical research. We present the consensus case definition together with the rationale behind the recommendations. This case definition is applicable irrespective of the patient's age, HIV infection status, or the resources available in the research setting. Consistent use of the proposed case definition will aid comparison of studies, improve scientific communication, and ultimately improve care. Copyright © 2010 Elsevier Ltd. All rights reserved.

Different paths to high-quality care: three archetypes of top-performing practice sites.

PubMed

Feifer, Chris; Nemeth, Lynne; Nietert, Paul J; Wessell, Andrea M; Jenkins, Ruth G; Roylance, Loraine; Ornstein, Steven M

2007-01-01

Primary care practices use different approaches in their quest for high-quality care. Previous work in the Practice Partner Research Network (PPRNet) found that improved outcomes are associated with strategies to prioritize performance, involve staff, redesign elements of the delivery system, make patients active partners in guideline adherence, and use tools embedded in the electronic medical record. The aim of this study was to examine variations in the adoption of improvements among sites achieving the best outcomes. This study used an observational case study design. A practice-level measure of adherence to clinical guidelines was used to identify the highest performing practices in a network of internal and family medicine practices participating in a national demonstration project. We analyzed qualitative and quantitative information derived from project documents, field notes, and evaluation questionnaires to develop and compare case studies. Nine cases are described. All use many of the same improvement strategies. Differences in the way improvements are organized define 3 distinct archetypes: the Technophiles, the Motivated Team, and the Care Enterprise. There is no single approach that explains the superior performance of high-performing practices, though each has adopted variations of PPRNet's improvement model. Practices will vary in their path to high-quality care. The archetypes could prove to be a useful guide to other practices selecting an overall quality improvement approach.

Preventing Delays in First-Case Starts on the Neurosurgery Service: A Resident-Led Initiative at an Academic Institution.

PubMed

Han, Seunggu J; Rolston, John D; Zygourakis, Corinna C; Sun, Matthew Z; McDermott, Michael W; Lau, Catherine Y; Aghi, Manish K

2016-01-01

On-time starts for the first case of the day are critical to maintaining efficiency in operating rooms (ORs). We studied whether a resident-led initiative to ensure on-time site marking and documentation of surgical consent could lead to improved first-case start time. In a resident-led initiative at a large 600-bed academic hospital with 25 ORs, we aimed to complete site marking and surgical consents half an hour before the scheduled start time for all first-case neurosurgical patients. We monitored the occurrence of delayed first starts and the length of delay during our initiative, and compared these cases to neurosurgical cases 3 months before the implementation of the initiative and to first-start nonneurosurgical cases. In the year of the initiative, both site marking and surgical consents were completed 30 minutes before the case start in 97% of neurosurgical cases. The average delay across all first-case starts was reduced to 7.17 minutes (N = 1271), compared with 9.67 minutes before the intervention (N = 345). During the study period, non-neurosurgical cases were delayed on average 10.3 minutes (N = 3592). There was a significant difference in latencies between the study period and the period before the initiative (p < 0.001), and also between neurosurgical cases and nonneurosurgical cases (p < 0.001). There was no reduction in delay times seen on the non-neurosurgical services in the study period when compared to the case 3 months before. Considering its effect across 1271 cases, this initiative over 1 year resulted in a total reduction of 52 hours and 57 minutes in delays. Through a resident-led quality improvement program, neurosurgical trainees successfully reduced delays in first-case starts on a surgical service. Engaging physician trainees in quality improvement and enhancing OR efficiency can be successfully achieved and can have a significant clinical and financial effect. Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Experiential Learning and Its Role in Training and Improved Practice in High Level Sports Officiating

ERIC Educational Resources Information Center

Grover, Kenda S.

2014-01-01

This qualitative study investigated how high level sports officials engage in experiential learning to improve their practice. Adult learning occurs in formal, nonformal and informal environments, and in some cases it is difficult to differentiate between these settings. In the case of cycling officials, learning begins in a nonformal environment…

Leading for Instructional Improvement in the Context of Accountability: Central Office Leadership

ERIC Educational Resources Information Center

Rigby, Jessica Goodman; Corriell, Rebecca; Kuhl, Katie J.

2018-01-01

This case was written to help prepare central office leaders who are expected to design systems and lead toward instructional improvement in the context of both educational accountability and implementation of standards with increased rigor. The intent of this case study is to encourage educators to examine the complex and multiple challenges of…

Research Challenges Inherent in Determining Improvement in University Teaching

ERIC Educational Resources Information Center

Devlin, Marcia

2008-01-01

Using a recent study that examined the effectiveness of a particular approach to improving individual university teaching as a case study, this paper examines some of the challenges inherent in educational research, particularly research examining the effects of interventions to improve teaching. Aspects of the research design and methodology and…

Strengthening Partnerships: How Communication and Collaboration Contribute to School Improvement

ERIC Educational Resources Information Center

Rubinstein, Saul A.

2014-01-01

For most of the past decade, this author has studied union-management efforts to improve public education, and has witnessed extraordinary examples of teachers, union leaders, and administrators working together to improve teaching and learning. In this article, seven case studies on collaborative partnerships between teachers' unions and…

Methodology or method? A critical review of qualitative case study reports.

PubMed

Hyett, Nerida; Kenny, Amanda; Dickson-Swift, Virginia

2014-01-01

Despite on-going debate about credibility, and reported limitations in comparison to other approaches, case study is an increasingly popular approach among qualitative researchers. We critically analysed the methodological descriptions of published case studies. Three high-impact qualitative methods journals were searched to locate case studies published in the past 5 years; 34 were selected for analysis. Articles were categorized as health and health services (n=12), social sciences and anthropology (n=7), or methods (n=15) case studies. The articles were reviewed using an adapted version of established criteria to determine whether adequate methodological justification was present, and if study aims, methods, and reported findings were consistent with a qualitative case study approach. Findings were grouped into five themes outlining key methodological issues: case study methodology or method, case of something particular and case selection, contextually bound case study, researcher and case interactions and triangulation, and study design inconsistent with methodology reported. Improved reporting of case studies by qualitative researchers will advance the methodology for the benefit of researchers and practitioners.

A role for social workers in improving care setting transitions: a case study.

PubMed

Barber, Ruth D; Coulourides Kogan, Alexis; Riffenburgh, Anne; Enguidanos, Susan

2015-01-01

High 30-day readmission rates are a major burden to the American medical system. Much attention is on transitional care to decrease financial costs and improve patient outcomes. Social workers may be uniquely qualified to improve care transitions and have not previously been used in this role. We present a case study of an older, dually eligible Latina woman who received a social work-driven transition intervention that included in-home and telephone contacts. The patient was not readmitted during the six-month study period, mitigated her high pain levels, and engaged in social outings once again. These findings suggest the value of a social worker in a transitional care role.

Current Status of Endovascular Treatment for Vasospasm following Subarachnoid Hemorrhage: Analysis of JR-NET2

PubMed Central

HAYASHI, Kentaro; HIRAO, Tomohito; SAKAI, Nobuyuki; NAGATA, Izumi

2014-01-01

Endovascular treatments are employed for cerebral vasospasm following subarachnoid hemorrhage, which is not responded to the medical treatments. However, the effect or complication of the treatments is not known well. Here, we analyzed the data of Japanese Registry of Neuroendovascular Therapy 2 (JRNET2) and revealed current status of the endovascular treatment for the cerebral vasospasm. JR-NET2 is conducted from January 1, 2007 to December 31, 2009. Information on the clinical status, imaging studies, treatment methods, the results of treatment, and status 30 days later were recorded. Totally 645 treatments for 480 patients (mean age, 59.4 years; 72.7% woman) were included. Factors related to the neurological improvement and treatment related complications were statistically analyzed. Treatments for ruptured cerebral aneurysm were direct surgery for 366 cases and endovascular treatment for 253 cases. The timing of the endovascular treatment for the cerebral vasospasm was within 3 hours in 209 cases, 3–6 hours in 158 cases, and more than 6 hours in 158 cases. Intra-arterial vasodilator was employed for the 495 cases and percutaneous transluminal angioplasty for 140 cases. Neurological improvement was observed in 372 cases and radiological improvement was seen in 623 cases. The treatment related complication occurred in 20 cases (3.1%), including 6 cases of intracranial hemorrhage, 5 cases of cerebral ischemia, a case of puncture site trouble, and 8 cases of others. Statistical analysis showed early treatment was related to the neurological improvement. Current status of endovascular treatment for cerebral vasospasm was revealed. Endovascular treatment was effective for vasospasm especially was performed early. PMID:24257541

Current status of endovascular treatment for vasospasm following subarachnoid hemorrhage: analysis of JR-NET2.

PubMed

Hayashi, Kentaro; Hirao, Tomohito; Sakai, Nobuyuki; Nagata, Izumi

2014-01-01

Endovascular treatments are employed for cerebral vasospasm following subarachnoid hemorrhage, which is not responded to the medical treatments. However, the effect or complication of the treatments is not known well. Here, we analyzed the data of Japanese Registry of Neuroendovascular Therapy 2 (JR-NET2) and revealed current status of the endovascular treatment for the cerebral vasospasm. JR-NET2 is conducted from January 1, 2007 to December 31, 2009. Information on the clinical status, imaging studies, treatment methods, the results of treatment, and status 30 days later were recorded. Totally 645 treatments for 480 patients (mean age, 59.4 years; 72.7% woman) were included. Factors related to the neurological improvement and treatment related complications were statistically analyzed. Treatments for ruptured cerebral aneurysm were direct surgery for 366 cases and endovascular treatment for 253 cases. The timing of the endovascular treatment for the cerebral vasospasm was within 3 hours in 209 cases, 3-6 hours in 158 cases, and more than 6 hours in 158 cases. Intra-arterial vasodilator was employed for the 495 cases and percutaneous transluminal angioplasty for 140 cases. Neurological improvement was observed in 372 cases and radiological improvement was seen in 623 cases. The treatment related complication occurred in 20 cases (3.1%), including 6 cases of intracranial hemorrhage, 5 cases of cerebral ischemia, a case of puncture site trouble, and 8 cases of others. Statistical analysis showed early treatment was related to the neurological improvement. Current status of endovascular treatment for cerebral vasospasm was revealed. Endovascular treatment was effective for vasospasm especially was performed early.

Current Status of Endovascular Treatment for Vasospasm following Subarachnoid Hemorrhage: Analysis of JR-NET2.

PubMed

Hayashi, Kentaro; Hirao, Tomohito; Sakai, Nobuyuki; Nagata, Izumi

2014-01-01

Endovascular treatments are employed for cerebral vasospasm following subarachnoid hemorrhage, which is not responded to the medical treatments. However, the effect or complication of the treatments is not known well. Here, we analyzed the data of Japanese Registry of Neuroendovascular Therapy 2 (JR-NET2) and revealed current status of the endovascular treatment for the cerebral vasospasm. JR-NET2 is conducted from January 1, 2007 to December 31, 2009. Information on the clinical status, imaging studies, treatment methods, the results of treatment, and status 30 days later were recorded. Totally 645 treatments for 480 patients (mean age, 59.4 years; 72.7% woman) were included. Factors related to the neurological improvement and treatment related complications were statistically analyzed. Treatments for ruptured cerebral aneurysm were direct surgery for 366 cases and endovascular treatment for 253 cases. The timing of the endovascular treatment for the cerebral vasospasm was within 3 hours in 209 cases, 3–6 hours in 158 cases, and more than 6 hours in 158 cases. Intra-arterial vasodilator was employed for the 495 cases and percutaneous transluminal angioplasty for 140 cases. Neurological improvement was observed in 372 cases and radiological improvement was seen in 623 cases. The treatment related complication occurred in 20 cases (3.1%), including 6 cases of intracranial hemorrhage, 5 cases of cerebral ischemia, a case of puncture site trouble, and 8 cases of others. Statistical analysis showed early treatment was related to the neurological improvement. Current status of endovascular treatment for cerebral vasospasm was revealed. Endovascular treatment was effective for vasospasm especially was performed early.

Does Lean healthcare improve patient satisfaction? A mixed-method investigation into primary care.

PubMed

Poksinska, Bozena Bonnie; Fialkowska-Filipek, Malgorzata; Engström, Jon

2017-02-01

Lean healthcare is claimed to contribute to improved patient satisfaction, but there is limited evidence to support this notion. This study investigates how primary-care centres working with Lean define and improve value from the patient's perspective, and how the application of Lean healthcare influences patient satisfaction. This paper contains two qualitative case studies and a quantitative study based on results from the Swedish National Patient Survey. Through the case studies, we investigated how primary-care organisations realised the principle of defining and improving value from the patient's perspective. In the quantitative study, we compared results from the patient satisfaction survey for 23 primary-care centres working with Lean with a control group of 23 care centres not working with Lean. We also analysed changes in patient satisfaction over time. Our case studies reveal that Lean healthcare implementations primarily target efficiency and little attention is paid to the patient's perspective. The quantitative study shows no significantly better results in patient satisfaction for primary-care centres working with Lean healthcare compared with those not working with Lean. Further, care centres working with Lean show no significant improvements in patient satisfaction over time. Lean healthcare implementations seem to have a limited impact on improving patient satisfaction. Care providers need to pay more attention to integrating the patient's perspective in the application of Lean healthcare. Value needs to be defined and value streams need to be improved based on both the knowledge and clinical expertise of care providers, and the preferences and needs of patients. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Critical challenges in ERP implementation: A qualitative case study in the Canadian oil and gas industry

NASA Astrophysics Data System (ADS)

Menon, Sreekumar A.

This exploratory qualitative single-case study examines critical challenges encountered during ERP implementation based on individual perspectives in four project roles: senior leaders, project managers, project team members, and business users, all specifically in Canadian oil and gas industry. Data was collected by interviewing participants belonging to these categories, and by analyzing project documentation about ERP implementation. The organization for the case study was a leading multinational oil and gas company having a substantial presence in the energy sector in Canada. The study results were aligned with the six management questions regarding critical challenges in ERP: (a) circumstances to implement ERP, (b) benefits and process improvements achieved, (c) best practices implemented, (d) critical challenges encountered, (e) strategies and mitigating actions used, and (f) recommendations to improve future ERP implementations. The study results highlight six key findings. First, the study provided valid circumstances for implementing ERP systems. Second, the study underscored the importance of benefits and process improvements in ERP implementation. Third, the study highlighted that adoption of best practices is crucial for ERP Implementation. Fourth, the study found that critical challenges are encountered in ERP Implementation and are significant during ERP implementation. Fifth, the study found that strategies and mitigating actions can overcome challenges in ERP implementation. Finally, the study provided ten major recommendations on how to improve future ERP implementations.

Power Factor Study Reduces Energy Costs at Aluminum Extrusion Plant (Alcoa North American Extrusions)

DOE Office of Scientific and Technical Information (OSTI.GOV)

None

2001-08-01

This case study is the latest in a series on industrial firms who are implementing energy efficient technologies and system improvements into their manufacturing processes. The case studies document the activities, savings, and lessons learned on these projects.

Insider Threat: Preventing Direct Action Attacks Within the United States Army

DTIC Science & Technology

2017-06-09

violence within the United States, this study focused solely on cases where a US Army Soldier attacked fellow Soldiers. For the purposes of this study ...chapters will examine Army doctrine and two case studies , in detail. The conclusion of this project will provide recommendations on improved... study specifically on insider threats pertaining to targeted violence, this literature review does not include information pertaining to cases

Corporate Energy Conservation Program for Alcoa North American Extrusions

DOE Office of Scientific and Technical Information (OSTI.GOV)

None

2001-08-01

This case study is the latest in a series on industrial firms who are implementing energy efficient technologies and system improvements into their manufacturing processes. The case studies document the activities, savings, and lessons learned on these projects.

Treatment of onychomycosis using a 1064nm Nd:YAG laser.

PubMed

Noguchi, Hiromitsu; Miyata, Keishi; Sugita, Takashi; Hiruma, Midori; Hiruma, Masataro

2013-01-01

We investigated the efficacy of 1064nm Nd:YAG laser for the treatment of onychomycosis caused by dermatophytes. The study population consisted of 12 patients (6 male, 6 female ; average age 53.5 years), with onychomycosis confirmed by fungal culture and/or real-time PCR identification of the pathogen. The causative agent was identified as Trichophyton rubrum in 11 cases and a mixture of T. rubrum and T. mentagrophytes in 1 case. For each patient, laser treatment was given to a single hallux nail, with turbidity at baseline affecting <75% of the nail surface and thickness at baseline <3mm. Treatment was given in 3 sessions at 4-week intervals, and nail turbidity was evaluated 3 and 6 months after the first laser treatment. After 6 months the efficacy results were as follows: 3 cases, turbidity significantly improved ( >70%) ; 2 cases, turbidity improved (50-70%), 1 case, turbidity slightly improved (30-50%) ; 5 cases, no change in turbidity (<30% improvement) ; and 1 case, turbidity worsened. Overall, the total lesion area with turbidity in 12 patients decreased from 664.4mm(2) to 481.0mm(2), corresponding to a 27.6% improvement after treatment. Pain during laser treatment was well tolerated, and all patients underwent all 3 treatments. These results suggest that the 1064nm Nd:YAG laser could be a useful treatment alternative for patients with mild onychomycosis.

Quality assurance in surgical practice through auditing.

PubMed

Wong, W T

1980-05-01

An efficient auditing method is presented which involves objective criteria-based numerical screening of medical process and treatment outcome by paramedical staff and detailed analysis of deviated cases by surgeons. If properly performed it requires the study of no more than 50 cases in a diagnostic category to provide sufficient information about the quality of care. Encouraging points as well as problems are communicated to the surgeons to induce the maintenance or improvement of the standard of care. Graphic documentation of case performance is possible, allowing surgeons to compare results with their colleagues. The general performance level of several consecutive studies can be compared at a glance. In addition, logical education programs to improve the medical process can be designed on the basis of the problems identified. As all the cases with an unacceptable outcome are traceable to inadequate medical process, improvement in this area will decrease outcome defects. With the use of auditing and the follow-up technique described, the quality of care in surgery may be assured.

Applying Process Improvement Methods to Clinical and Translational Research: Conceptual Framework and Case Examples.

PubMed

Daudelin, Denise H; Selker, Harry P; Leslie, Laurel K

2015-12-01

There is growing appreciation that process improvement holds promise for improving quality and efficiency across the translational research continuum but frameworks for such programs are not often described. The purpose of this paper is to present a framework and case examples of a Research Process Improvement Program implemented at Tufts CTSI. To promote research process improvement, we developed online training seminars, workshops, and in-person consultation models to describe core process improvement principles and methods, demonstrate the use of improvement tools, and illustrate the application of these methods in case examples. We implemented these methods, as well as relational coordination theory, with junior researchers, pilot funding awardees, our CTRC, and CTSI resource and service providers. The program focuses on capacity building to address common process problems and quality gaps that threaten the efficient, timely and successful completion of clinical and translational studies. © 2015 The Authors. Clinical and Translational Science published by Wiley Periodicals, Inc.

How to get the most out of your orthopaedic fellowship: thinking about practice-based learning.

PubMed

Templeman, David

2012-09-01

Practice-based learning and improvement is an important skill set to develop during an orthopaedic trauma fellowship and is 1 of the 6 core competencies stated by the ACGME. The review of clinic cases is best done using a few simple models to develop a structured approach for studying cases. Three common sense and easy-to-use strategies to improve clinical practice are as follows: performing each case three times, studying the 4 quadrants of patient outcomes, and the application of the Pareto 80/20 rule. These principles help to develop a structured approach for analyzing and thinking about practice-based experiences.

Implementation and evaluation of a dilation and evacuation simulation training curriculum.

PubMed

York, Sloane L; McGaghie, William C; Kiley, Jessica; Hammond, Cassing

2016-06-01

To evaluate obstetrics and gynecology resident physicians' performance following a simulation curriculum on dilation and evacuation (D&E) procedures. This study included two phases: simulation curriculum development and resident physician performance evaluation following training on a D&E simulator. Trainees participated in two evaluations. Simulation training evaluated participants performing six cases on a D&E simulator, measuring procedural time and a 26-step checklist of D&E steps. The operative training portion evaluated residents' performance after training on the simulator using mastery learning techniques. Intra-operative evaluation was based on a 21-step checklist score, Objective Structured Assessment of Technical Skills (OSATS), and percentage of cases completed. Twenty-two residents participated in simulation training, demonstrating improved performance from cases one and two to cases five and six, as measured by checklist score and procedural time (p<.001 and p=.001, respectively). Of 10 participants in the operative training, all performed at least three D&Es, while seven performed at least six cases. While checklist scores did not change significantly from the first to sixth case (mean for first case: 18.3; for sixth case: 19.6; p=.593), OSATS ratings improved from case one (19.7) to case three (23.5; p=.001) and to case six (26.8; p=.005). Trainees completed approximately 71.6% of their first case (range: 21.4-100%). By case six, the six participants performed 81.2% of the case (range: 14.3-100%). D&E simulation using a newly-developed uterine model and simulation curriculum improves resident technical skills. Simulation training with mastery learning techniques transferred to high level of performance in OR using checklist. The OSATS measured skills and showed improvement in performance with subsequent cases. Implementation of a D&E simulation curriculum offers potential for improved surgical training and abortion provision. Copyright © 2016 Elsevier Inc. All rights reserved.

Police Officer Schema of Sexual Assault Reports: Real Rape, Ambiguous Cases, and False Reports.

PubMed

Venema, Rachel M

2016-03-01

While extensive research has studied sexual assault reporting behaviors and described negative experiences with the criminal justice system among victim-survivors, fewer studies have explored police officer attitudes, knowledge, and thought processes that may affect victims' perceptions of negative interactions and unsatisfactory outcomes within reported sexual assault cases. This study explores police officer understanding of the definition of sexual assault and characteristics that influence their perceptions and response. Ten police officers were interviewed within one police department in a midsized city in the Great Lakes region. The study uses a modified grounded theory approach. Findings suggest that officers employ distinct schema of reported sexual assaults. Case characteristics, perceived credibility of the victim, and types of evidence formed categorizations of false reports, ambiguous cases, and legitimate sexual assaults. Police officers describe the ways in which perceptions of the case may or may not influence the response and point to areas for improvement within police procedure. The study findings provide insight into recommendations for improved police interviewing and response to reported sexual assaults. © The Author(s) 2014.

The Management of University-Industry Relations: Five Institutional Case Studies from Africa, Europe, Latin America, and the Pacific Region. Improving the Managerial Effectiveness of Higher Education Institutions.

ERIC Educational Resources Information Center

Martin, Michaela, Ed.

Five case studies were conducted to collect empirical evidence on innovative mechanisms through which universities worldwide manage their relations with industry. Cases were selected from institutions of higher education in Israel, Papua New Guinea, Turkey, Brazil, and Uganda. These studies were selected for their innovative approaches, but also…

Using Faculty Evaluation to Improve Teaching Quality: A Longitudinal Case Study of Higher Education in Southeast Asia

ERIC Educational Resources Information Center

Hallinger, Philip

2010-01-01

This paper presents a case study of implementation of a new system of faculty teaching evaluation at a graduate school of business in Thailand. The research employed a non-experimental, longitudinal case study design in the analysis of student course evaluation data gathered over a period of 21 terms during a seven-year period. The report…

The effect of a multidisciplinary obstetric emergency team training program, the In Time course, on diagnosis to delivery interval following umbilical cord prolapse - A retrospective cohort study.

PubMed

Copson, Sean; Calvert, Katrina; Raman, Puvaneswary; Nathan, Elizabeth; Epee, Mathias

2017-06-01

Cord prolapse is an uncommon obstetric emergency, with potentially fatal consequences for the baby if prompt action is not taken. Simulation training provides a means by which uncommon emergencies can be practised, with the aim of improving teamwork and clinical outcomes. This study aimed to determine if the introduction of a simulation-based training course was associated with an improvement in the management of cord prolapse, in particular the diagnosis to delivery interval. We also aimed to investigate if an improvement in perinatal outcomes could be demonstrated. A retrospective cohort study was performed. All cases of cord prolapse in the designated time period were identified and reviewed and a comparison of outcome measures pre- and post-training was undertaken. Thirty-one cases were identified in the pre-training period, and compared to 64 cases post-training. Documentation improved significantly post-training. There were non-significant improvements in use of spinal anaesthetic, and in the length of stay in the special care neonatal unit. There was a significant increase in the number of babies with Apgar scores less than seven at 5 min. There were no differences in the diagnosis to delivery interval, or in perinatal mortality rates. Obstetric emergency training was associated with improved teamwork, as evidenced by the improved documentation post-training in this study, but not with improved diagnosis to delivery interval. Long-term follow-up studies are required to ascertain whether training has an impact on longer-term paediatric outcomes, such as cerebral palsy rates. © 2016 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Undertaking Individual Transdisciplinary PhD Research for Sustainable Development: Case Studies from South Africa

ERIC Educational Resources Information Center

van Breda, John; Musango, Josephine; Brent, Alan

2016-01-01

Purpose: This paper aims to improve the understanding of individual transdisciplinary PhD research in a developing country context, focusing on three individual PhD case studies in South Africa. Design/Methodology/Approach: Multiple-case method was used, and three completed transdisciplinary PhD research efforts undertaken at the Stellenbosch…

Evolution and outcomes of a quality improvement program.

PubMed

Thor, Johan; Herrlin, Bo; Wittlöv, Karin; Øvretveit, John; Brommels, Mats

2010-01-01

The purpose of this paper is to examine the outcomes and evolution over a five-year period of a Swedish university hospital quality improvement program in light of enduring uncertainty regarding the effectiveness of such programs in healthcare and how best to evaluate it. The paper takes the form of a case study, using data collected as part of the program, including quality indicators from clinical improvement projects and participants' program evaluations. Overall, 58 percent of the program's projects (39/67) demonstrated success. A greater proportion of projects led by female doctors demonstrated success (91 percent, n=11) than projects led by male doctors (51 percent, n=55). Facilitators at the hospital continuously adapted the improvement methods to the local context. A lack of dedicated time for improvement efforts was the participants' biggest difficulty. The dominant benefits included an increased ability to see the "bigger picture" and the improvements achieved for patients and employees. Quality measurement, which is important for conducting and evaluating improvement efforts, was weak with limited reliability. Nevertheless, the present study adds evidence about the effectiveness of healthcare improvement programs. Gender differences in improvement team leadership merit further study. Improvement program evaluation should assess the extent to which improvement methods are locally adapted and applied. This case study reports the outcomes of all improvement projects undertaken in one healthcare organization over a five-year period and provides in-depth insight into an improvement program's changeable nature.

Removing barriers to educating children in foster care through interagency collaboration: a seven county multiple-case study.

PubMed

Weinberg, Lois A; Zetlin, Andrea; Shea, Nancy M

2009-01-01

This multiple-case study examines interagency collaboration between child protective services (CPS), local education agencies (LEAs), and other public agencies in seven California counties. These agencies were provided technical assistance to remove barriers impeding the education of children in foster care and improve their educational outcomes. Results of this study suggest that making changes to remove educational barriers for foster children and improve their educational outcomes requires successful collaboration between CPS and LEAs and strong leadership within at least one of the agencies.

Improving Operating Room Efficiency: First Case On-Time Start Project.

PubMed

Phieffer, Laura; Hefner, Jennifer L; Rahmanian, Armin; Swartz, Jason; Ellison, Christopher E; Harter, Ronald; Lumbley, Joshua; Moffatt-Bruce, Susan D

Operating rooms (ORs) are costly to run, and multiple factors influence efficiency. The first case on-time start (FCOS) of an OR is viewed as a harbinger of efficiency for the daily schedule. Across 26 ORs of a large, academic medical center, only 49% of cases started on time in October 2011. The Perioperative Services Department engaged an interdisciplinary Operating Room Committee to apply Six Sigma tools to this problem. The steps of this project included (1) problem mapping, (2) process improvements to preoperative readiness, (3) informatics support improvements, and (4) continuous measurement and feedback. By June 2013, there was a peak of 92% first case on-time starts across service lines, decreasing to 78% through 2014, still significantly above the preintervention level of 49% (p = .000). Delay minutes also significantly decreased through the study period (p = .000). Across 2013, the most common delay owners were the patient, the surgeon, the facility, and the anesthesia department. Continuous and sustained improvement of first case on-time starts is attributed to tracking the FCOS metric, establishing embedded process improvement resources and creating transparency of data. This article highlights success factors and barriers to program success and sustainability.

Does surgical sympathectomy improve clinical outcomes in patients with refractory angina pectoris?

PubMed

Holland, Luke C; Navaratnarajah, Manoraj; Taggart, David P

2016-04-01

A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was: In patients with angina pectoris refractory to medical therapy, does surgical sympathectomy improve clinical outcomes? A total of 528 papers were identified using the search protocol described, of which 6 represented the best evidence to answer the clinical question. There were 5 case series and 1 prospective cohort study. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. All 5 of the case series demonstrated an improvement in symptoms, exercise tolerance or quality of life in patients undergoing surgical sympathectomy. An early case series investigating an open approach had a high morbidity and mortality rate, but the 4 other series used a minimally invasive technique and had low morbidity and zero perioperative mortality rates. The cohort study compared surgical sympathectomy with transmyocardial laser revascularization (TMR) and concluded TMR to be superior. However, this study looked only at unilateral sympathectomy, whereas all 5 case series focused on bilateral surgery. We conclude that the best currently available evidence does suggest that patients report an improvement in their symptoms and quality of life following surgical sympathectomy, but the low level of this evidence does not allow for a statistically proved recommendation. © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Organization of care for persons with HIV-infection: a systematic review.

PubMed

Handford, Curtis D; Tynan, Anne-Marie; Agha, Ayda; Rzeznikiewiz, Damian; Glazier, Richard H

2017-07-01

The objective of this systematic review was to examine the effectiveness of the organization of care: case management, multidisciplinary care, multi-faceted treatment, hours of service, outreach programs and health information systems on medical, immunological, virological, psychosocial and economic outcomes for persons living with HIV/AIDS. We searched PubMed (MEDLINE) and 10 other electronic databases from 1 January 1980 to April, 2012 for both experimental and controlled observational studies. Thirty-three studies met the inclusion criteria. Eleven studies were randomized controlled trials (RCTs), three of which were conducted in low-middle income settings. Patient characteristics, study design, organization measures and outcomes data were abstracted independently by two reviewers from all studies. A risk of bias tool was applied to RCTs and a separate tool was used to assess the quality of observational studies. This review concludes that case management interventions were most consistently associated with improvements in immunological outcomes but case management demonstrates no clear association with other outcome measures. The same mixed results were also identified for multidisciplinary and multi-faceted care interventions. Eight studies with an outreach intervention were identified and demonstrated improvements or non-inferiority with respect to mortality, receipt of antiretroviral medications, immunological outcomes, improvements in healthcare utilization and lower reported healthcare costs when compared to usual care. Of the interventions examined in this review, sustained in-person case management and outreach interventions were most consistently associated with improved medical and economic outcomes, in particular antiretroviral prescribing, immunological outcomes and healthcare utilization. No firm conclusions can be reached about the impact of any one intervention on patient mortality.

Drivers of routine immunization coverage improvement in Africa: findings from district-level case studies

PubMed Central

LaFond, Anne; Kanagat, Natasha; Steinglass, Robert; Fields, Rebecca; Sequeira, Jenny; Mookherji, Sangeeta

2015-01-01

There is limited understanding of why routine immunization (RI) coverage improves in some settings in Africa and not in others. Using a grounded theory approach, we conducted in-depth case studies to understand pathways to coverage improvement by comparing immunization programme experience in 12 districts in three countries (Ethiopia, Cameroon and Ghana). Drawing on positive deviance or assets model techniques we compared the experience of districts where diphtheria–tetanus–pertussis (DTP3)/pentavalent3 (Penta3) coverage improved with districts where DTP3/Penta3 coverage remained unchanged (or steady) over the same period, focusing on basic readiness to deliver immunization services and drivers of coverage improvement. The results informed a model for immunization coverage improvement that emphasizes the dynamics of immunization systems at district level. In all districts, whether improving or steady, we found that a set of basic RI system resources were in place from 2006 to 2010 and did not observe major differences in infrastructure. We found that the differences in coverage trends were due to factors other than basic RI system capacity or service readiness. We identified six common drivers of RI coverage performance improvement—four direct drivers and two enabling drivers—that were present in well-performing districts and weaker or absent in steady coverage districts, and map the pathways from driver to improved supply, demand and coverage. Findings emphasize the critical role of implementation strategies and the need for locally skilled managers that are capable of tailoring strategies to specific settings and community needs. The case studies are unique in their focus on the positive drivers of change and the identification of pathways to coverage improvement, an approach that should be considered in future studies and routine assessments of district-level immunization system performance. PMID:24615431

Perioperative Care and the Importance of Continuous Quality Improvement--A Controlled Intervention Study in Three Tanzanian Hospitals.

PubMed

Bosse, Goetz; Abels, Wiltrud; Mtatifikolo, Ferdinand; Ngoli, Baltazar; Neuner, Bruno; Wernecke, Klaus-Dieter; Spies, Claudia

2015-01-01

Surgical services are increasingly seen to reduce death and disability in Sub-Saharan Africa, where hospital-based mortality remains alarmingly high. This study explores two implementation approaches to improve the quality of perioperative care in a Tanzanian hospital. Effects were compared to a control group of two other hospitals in the region without intervention. All hospitals conducted quality assessments with a Hospital Performance Assessment Tool. Changes in immediate outcome indicators after one and two years were compared to final outcome indicators such as Anaesthetic Complication Rate and Surgical Case Fatality Rate. Immediate outcome indicators for Preoperative Care in the intervention hospital improved (52.5% in 2009; 84.2% in 2011, p<0.001). Postoperative Inpatient Care initially improved to then decline again (63.3% in 2009; 70% in 2010; 58.6% in 2011). In the control group, preoperative care declined from 50.8% (2009) to 32.8% (2011, p <0.001), while postoperative care did not significantly change. Anaesthetic Complication Rate in the intervention hospital declined (1.89% before intervention; 0.96% after intervention, p = 0.006). Surgical Case Fatality Rate in the intervention hospital declined from 5.67% before intervention to 2.93% after intervention (p<0.0010). Surgical Case Fatality Rate in the control group was 4% before intervention and 3.8% after intervention (p = 0.411). Anaesthetic Complication Rate in the control group was not available. Immediate outcome indicators initially improved, while at the same time final outcome declined (Surgical Case Fatality, Anaesthetic Complication Rate). Compared to the control group, final outcome improved more in the intervention hospital, although the effect was not significant over the whole study period. Documentation of final outcome indicators seemed inconsistent. Immediate outcome indicators seem more helpful to steer the Continuous Quality Improvement program. Specific interventions as part of Continuous Quality Improvement might lead to sustainable improvement of the quality of care, if embedded in a multi-faceted approach.

Alcoa North American Extrusions Implements Energy Use Assessments at Multiple Facilities

DOE Office of Scientific and Technical Information (OSTI.GOV)

None

2001-08-01

This case study is the latest in a series on industrial firms who are implementing energy efficient technologies and system improvements into their manufacturing processes. The case studies document the activities, savings, and lessons learned on these projects.

The Case of Web-Based Course on Taxation: Current Status, Problems and Future Improvement

NASA Astrophysics Data System (ADS)

Qin, Zhigang

This paper mainly introduces the case of the web-based course on taxation developed by Xiamen University. We analyze the current status, problems and future improvement of the web-based course. The web-based course has the basic contents and modules, but it has several problems including unclear object, lacking interaction, lacking examination module, lacking study management module, and the learning materials and the navigation are too simple. According to its problems, we put forward the measures to improve it.

A Case Study of Essential Components of School Success in a Turnaround School

ERIC Educational Resources Information Center

Cronin, Jodi Lynn

2016-01-01

School reform and turnaround efforts have been in the public eye since the signing of the Elementary and Secondary Act (ESEA) into law by President Lyndon Baines Johnson in 1965. Research has been focused on the School Improvement Grant, as well as the essential components that improve performance of schools. This qualitative case examines one…

Systems Thinking Tools for Improving Evidence-Based Practice: A Cross-Case Analysis of Two High School Leadership Teams

ERIC Educational Resources Information Center

Kensler, Lisa A. W.; Reames, Ellen; Murray, John; Patrick, Lynne

2012-01-01

Teachers and administrators have access to large volumes of data but research suggests that they lack the skills to use data effectively for continuous school improvement. This study involved a cross-case analysis of two high school leadership teams' early stages of evidence-based practice development; differing forms of external support were…

Thermal management improvement of an air-cooled high-power lithium-ion battery by embedding metal foam

NASA Astrophysics Data System (ADS)

Mohammadian, Shahabeddin K.; Rassoulinejad-Mousavi, Seyed Moein; Zhang, Yuwen

2015-11-01

Effect of embedding aluminum porous metal foam inside the flow channels of an air-cooled Li-ion battery module was studied to improve its thermal management. Four different cases of metal foam insert were examined using three-dimensional transient numerical simulations. The effects of permeability and porosity of the porous medium as well as state of charge were investigated on the standard deviation of the temperature field and maximum temperature inside the battery in all four cases. Compared to the case of no porous insert, embedding aluminum metal foam in the air flow channel significantly improved the thermal management of Li-ion battery cell. The results also indicated that, decreasing the porosity of the porous structure decreases both standard deviation of the temperature field and maximum temperature inside the battery. Moreover, increasing the permeability of the metal foam drops the maximum temperature inside the battery while decreasing this property leads to improving the temperature uniformity. Our results suggested that, among the all studied cases, desirable temperature uniformity and maximum temperature were achieved when two-third and the entire air flow channel is filled with aluminum metal foam, respectively.

Case Study IV: Carnegie Foundation for the Advancement of Teaching's Networked Improvement Communities (NICs)

ERIC Educational Resources Information Center

Coburn, Cynthia E.; Penuel, William R.; Geil, Kimberly E.

2015-01-01

The Carnegie Foundation for the Advancement of Teaching is a nonprofit, operating foundation with a long tradition of developing and studying ways to improve teaching practice. For the past three years, the Carnegie Foundation has initiated three different Networked Improvement Communities (NICs). The first, Quantway, is addressing the high…

Improving the Quality of Services in Residential Treatment Facilities: A Strength-Based Consultative Review Process

ERIC Educational Resources Information Center

Pavkov, Thomas W.; Lourie, Ira S.; Hug, Richard W.; Negash, Sesen

2010-01-01

This descriptive case study reports on the positive impact of a consultative review methodology used to conduct quality assurance reviews as part of the Residential Treatment Center Evaluation Project. The study details improvement in the quality of services provided to youth in unmonitored residential treatment facilities. Improvements were…

Improvement in Hemodynamics After Methylene Blue Administration in Drug-Induced Vasodilatory Shock: A Case Report.

PubMed

Laes, JoAn R; Williams, David M; Cole, Jon B

2015-12-01

The purpose of this study is to describe a case where methylene blue improved hemodynamics in a poisoned patient. This is a single case report where a poisoned patient developed vasodilatory shock following ingestion of atenolol, amlodipine, and valsartan. Shock persisted after multiple therapies including vasopressors, high-dose insulin, hemodialysis, and 20% intravenous fat emulsion. Methylene blue (2 mg/kg IV over 30 min) was administered in the ICU with temporal improvement as measured by pulmonary artery catheter hemodynamic data pre- and post-methylene blue administration. Within 1 h of methylene blue administration, systemic vascular resistance improved (240 dyn s/cm5 increased to 1204 dyn s/cm5), and vasopressor requirements decreased with maintenance of mean arterial pressure 60 mmHg. Methylene blue may improve hemodynamics in drug-induced vasodilatory shock and should be considered in critically ill patients poisoned with vasodilatory medications refractory to standard therapies.

SU-E-T-760: Tolerance Design for Site-Specific Range in Proton Patient QA Process Using the Six Sigma Model

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lah, J; Shin, D; Kim, G

Purpose: To show how tolerance design and tolerancing approaches can be used to predict and improve the site-specific range in patient QA process in implementing the Six Sigma. Methods: In this study, patient QA plans were selected according to 6 site-treatment groups: head &neck (94 cases), spine (76 cases), lung (89 cases), liver (53 cases), pancreas (55 cases), and prostate (121 cases), treated between 2007 and 2013. We evaluated a model of the Six Sigma that determines allowable deviations in design parameters and process variables in patient-specific QA, where possible, tolerance may be loosened, then customized if it necessary tomore » meet the functional requirements. A Six Sigma problem-solving methodology is known as DMAIC phases, which are used stand for: Define a problem or improvement opportunity, Measure process performance, Analyze the process to determine the root causes of poor performance, Improve the process by fixing root causes, Control the improved process to hold the gains. Results: The process capability for patient-specific range QA is 0.65 with only ±1 mm of tolerance criteria. Our results suggested the tolerance level of ±2–3 mm for prostate and liver cases and ±5 mm for lung cases. We found that customized tolerance between calculated and measured range reduce that patient QA plan failure and almost all sites had failure rates less than 1%. The average QA time also improved from 2 hr to less than 1 hr for all including planning and converting process, depth-dose measurement and evaluation. Conclusion: The objective of tolerance design is to achieve optimization beyond that obtained through QA process improvement and statistical analysis function detailing to implement a Six Sigma capable design.« less

Albany case study : indirect land use and growth impacts

DOT National Transportation Integrated Search

1999-02-01

To improve environmental analysis of indirect land use impacts of highway capacity improvements, this study analyzed the land use and growth patterns of 20 Oregon communities over 20 years. Using a Geographic Information System (GIS) and aerial photo...

Albany case study : indirect land use and growth impacts.

DOT National Transportation Integrated Search

1999-02-01

To improve environmental analysis of indirect land use impacts of highway capacity improvements, this study analyzed the land use and growth patterns of 20 Oregon communities over 20 years. Using a Geographic Information System and aerial photos, gro...

Bend case study : indirect land use and growth impacts.

DOT National Transportation Integrated Search

2000-01-01

To improve environmental analysis of indirect land use impacts of highway capacity improvements, this study analyzed the land use and growth patterns of 20 Oregon communities over 20 years. Using a Geographic Information System and aerial photos, gro...

Summary of Data from the Sixth AIAA CFD Drag Prediction Workshop: CRM Cases 2 to 5

NASA Technical Reports Server (NTRS)

Tinoco, Edward N.; Brodersen, Olaf P.; Keye, Stefan; Laflin, Kelly R.; Feltrop, Edward; Vassberg, John C.; Mani, Mori; Rider, Ben; Wahls, Richard A.; Morrison, Joseph H.;

Approaches to dog health education programs in Australian rural and remote Indigenous communities: four case studies.

PubMed

Constable, S E; Dixon, R M; Dixon, R J; Toribio, J-A

2013-09-01

Dog health in rural and remote Australian Indigenous communities is below urban averages in numerous respects. Many Indigenous communities have called for knowledge sharing in this area. However, dog health education programs are in their infancy, and lack data on effective practices. Without this core knowledge, health promotion efforts cannot progress effectively. This paper discusses a strategy that draws from successful approaches in human health and indigenous education, such as dadirri, and culturally respectful community engagement and development. Negotiating an appropriate education program is explored in its practical application through four case studies. Though each case was unique, the comparison of the four illustrated the importance of listening (community consultation), developing and maintaining relationships, community involvement and employment. The most successful case studies were those that could fully implement all four areas. Outcomes included improved local dog health capacity, local employment and engagement with the program and significantly improved dog health.

Framing quality improvement tools and techniques in healthcare the case of improvement leaders' guides.

PubMed

Millar, Ross

2013-01-01

The purpose of this paper is to present a study of how quality improvement tools and techniques are framed within healthcare settings. The paper employs an interpretive approach to understand how quality improvement tools and techniques are mobilised and legitimated. It does so using a case study of the NHS Modernisation Agency Improvement Leaders' Guides in England. Improvement Leaders' Guides were framed within a service improvement approach encouraging the use of quality improvement tools and techniques within healthcare settings. Their use formed part of enacting tools and techniques across different contexts. Whilst this enactment was believed to support the mobilisation of tools and techniques, the experience also illustrated the challenges in distributing such approaches. The paper provides an important contribution in furthering our understanding of framing the "social act" of quality improvement. Given the ongoing emphasis on quality improvement in health systems and the persistent challenges involved, it also provides important information for healthcare leaders globally in seeking to develop, implement or modify similar tools and distribute leadership within health and social care settings.

Integrating Educational Technologies into Teacher Education: A Case Study

ERIC Educational Resources Information Center

Rawlins, Peter; Kehrwald, Benjamin

2014-01-01

This article is a case study of an integrated, experiential approach to improving pre-service teachers' understanding and use of educational technologies in one New Zealand teacher education programme. The study examines the context, design and implementation of a learning activity which integrated student-centred approaches, experiential…

The CASE Project: Evaluation of Case-Based Approaches to Learning and Teaching in Statistics Service Courses

ERIC Educational Resources Information Center

Fawcett, Lee

2017-01-01

The CASE project (Case-based Approaches to Statistics Education; see www.mas.ncl.ac.uk/~nlf8/innovation) was established to investigate how the use of real-life, discipline-specific case study material in Statistics service courses could improve student engagement, motivation, and confidence. Ultimately, the project aims to promote deep learning…

The business case for quality improvement: oral anticoagulation for atrial fibrillation.

PubMed

Rose, Adam J; Berlowitz, Dan R; Ash, Arlene S; Ozonoff, Al; Hylek, Elaine M; Goldhaber-Fiebert, Jeremy D

2011-07-01

The potential to save money within a short time frame provides a more compelling "business case" for quality improvement than merely demonstrating cost-effectiveness. Our objective was to demonstrate the potential for cost savings from improved control in patients anticoagulated for atrial fibrillation. Our population consisted of 67 077 Veterans Health Administration patients anticoagulated for atrial fibrillation between October 1, 2006, and September 30, 2008. We simulated the number of adverse events and their associated costs and utilities, both before and after various degrees of improvement in percent time in therapeutic range (TTR). The simulation had a 2-year time horizon, and costs were calculated from the perspective of the payer. In the base-case analysis, improving TTR by 5% prevented 1114 adverse events, including 662 deaths; it gained 863 quality-adjusted life-years and saved $15.9 million compared with the status quo, not accounting for the cost of the quality improvement program. Improving TTR by 10% prevented 2087 events, gained 1606 quality-adjusted life-years, and saved $29.7 million. In sensitivity analyses, costs were most sensitive to the estimated risk of stroke and the expected stroke reduction from improved TTR. Utilities were most sensitive to the estimated risk of death and the expected mortality benefit from improved TTR. A quality improvement program to improve anticoagulation control probably would be cost-saving for the payer, even if it were only modestly effective in improving control and even without considering the value of improved health. This study demonstrates how to make a business case for a quality improvement initiative.

Impacts and limitations of medialization thyroplasty on swallowing function of patients with unilateral vocal fold paralysis.

PubMed

Tateya, Ichiro; Hirano, Shigeru; Kishimoto, Yo; Suehiro, Atsushi; Kojima, Tsuyohi; Ohno, Satoshi; Ito, Juichi

2010-11-01

Medialization thyroplasty was effective in improving swallowing function as well as vocal function in most cases with unilateral vocal fold paralysis. The impact of medialization thryoplasty was insufficient for the case with severe atrophy and that in which the vocal fold was fixed in the lateral position. To evaluate the impacts and limitations of medialization thyroplasty on swallowing function of the patients with unilateral vocal fold paralysis. Eight cases (mean age 68.5 years) with unilateral vocal fold paralysis chiefly complaining of swallowing disturbance were studied. All patients underwent thyroplasty type I. The causes of the paralysis were lung cancer in four cases, esophageal cancer in one case, aortic aneurysm in one case, subarachnoid hemorrhage in one case, and unknown in one case. Subjective swallowing function score, maximum phonation time (MPT), mean flow rate (MFR), amplitude perturbation quotient (APQ), and pitch perturbation quotient (PPQ) were examined pre- and postoperatively. The swallowing score improved in all except two cases. However, bilateral thryoplasty was necessary for the case with severe vocal fold atrophy and arytenoid adduction was needed for the case in which the vocal fold was fixed in the lateral position. The swallowing score, MPT, and MFR showed significant improvement after surgery.

Metropolitan transportation management center : a case study : Milwaukee MONITOR : addressing congestion while improving safety and air quality

DOT National Transportation Integrated Search

1999-10-01

The following case study provides a snapshot of Milwaukee's MONITOR transportation management center. It follows the outline provided in the companion document, Metropolitan Transportation Management Center Concepts of Operation - A Cross Cutting Stu...

The Development and Evaluation of Industrial Case Studies to Support a New Laboratory Course in Electrical Engineering.

ERIC Educational Resources Information Center

Bolton, B.; Adderley, K. J.

1978-01-01

After viewing videotaped case studies indicating the relevance of electrical laboratory work to professional engineers, student attitudes showed a positive improvement toward laboratory work. Semantic differential tests, questionnaires, and interviews were used. (Author/MH)

Metropolitan transportation management center : a case study : Michigan intelligent transportation system : improving safety and air quality while reducing stress for motorists

DOT National Transportation Integrated Search

1999-10-01

The following case study provides a snapshot of Michigan's Intelligent Transportation Systems transportation management center (MITSC). It follows the outline provided in the companion document, Metropolitan Transportation Management Center Concepts ...

Assessment of a Learning Strategy among Spine Surgeons.

PubMed

Gotfryd, Alberto Ofenhejm; Corredor, Jose Alfredo; Teixeira, William Jacobsen; Martins, Delio Eulálio; Milano, Jeronimo; Iutaka, Alexandre Sadao

2017-02-01

Pilot test, observational study. To evaluate objectively the knowledge transfer provided by theoretical and practical activities during AOSpine courses for spine surgeons. During two AOSpine principles courses, 62 participants underwent precourse assessment, which consisted of questions about their professional experience, preferences regarding adolescent idiopathic scoliosis (AIS) classification, and classifying the curves by means of the Lenke classification of two AIS clinical cases. Two learning strategies were used during the course. A postcourse questionnaire was applied to reclassify the same deformity cases. Differences in the correct answers of clinical cases between pre- and postcourse were analyzed, revealing the number of participants whose accuracy in classification improved after the course. Analysis showed a decrease in the number of participants with wrong answers in both cases after the course. In the first case, statistically significant differences were observed in both curve pattern (83.3%, p   =  0.005) and lumbar spine modifier (46.6%, p   =  0.049). No statistically significant improvement was seen in the sagittal thoracic modifier (33.3%, p   =  0.309). In the second case, statistical improvement was obtained in curve pattern (27.4%, p   =  0.018). No statistically significant improvement was seen regarding lumbar spine modifier (9.8%, p   =  0.121) and sagittal thoracic modifier (12.9%, p   =  0.081). This pilot test showed objectively that learning strategies used during AOSpine courses improved the participants' knowledge. Teaching strategies must be continually improved to ensure an optimal level of knowledge transfer.

Effects of a Case-Based Reasoning System on Student Performance in a Java Programming Course

ERIC Educational Resources Information Center

Schmidt, Cecil

2007-01-01

The purpose of this study was to determine if a case-based reasoning tool would improve a student's understanding of the complex concepts in a Java programming course. Subjects for the study were randomly assigned from two sections of an introductory Java programming course. Posttests were used to measure the effects of the case-based reasoning…

Teaching Literacy to English Language Learners in the Borderlands: A Case Study of A Sixth Grade Language Arts and Reading Teacher

ERIC Educational Resources Information Center

Smith, Ann Marie; Salgado, Yolanda

2018-01-01

The purpose of this case study was to investigate how an English language arts teacher used young adult literature to help English language learners improve English and literacy comprehension. Through the lens of Anzaldua's (2007) "borderlands", and Rolon-Dow's (2005) "critical care", the authors analyze the case study…

Project Career: A qualitative examination of five college students with traumatic brain injuries.

PubMed

Nardone, Amanda; Sampson, Elaine; Stauffer, Callista; Leopold, Anne; Jacobs, Karen; Hendricks, Deborah J; Elias, Eileen; Chen, Hui; Rumrill, Phillip

2015-01-01

Project Career is an interprofessional five-year development project designed to improve the employment success of undergraduate college and university students with traumatic brain injury (TBI). The case study information was collected and synthesized by the project's Technology and Employment Coordinators (TECs) at each of the project's three university sites. The project's evaluation is occurring independently through JBS International, Inc. Five case studies are presented to provide an understanding of student participants' experiences within Project Career. Each case study includes background on the student, engagement with technology, vocational supports, and interactions with his/her respective TEC. A qualitative analysis from the student's case notes is provided within each case study, along with a discussion of the overall qualitative analysis. Across all five students, the theme Positive Outcomes was mentioned most often in the case notes. Of all the different type of challenges, Cognitive Challenges were most often mentioned during meetings with the TECs, followed by Psychological Challenges, Physical Challenges, Other Challenges, and Academic Challenges, respectively. Project Career is providing academic enrichment and career enhancement that may substantially improve the unsatisfactory employment outcomes that presently await students with TBI following graduation.

A case report of evaluating a large-scale health systems improvement project in an uncontrolled setting: a quality improvement initiative in KwaZulu-Natal, South Africa.

PubMed

Mate, Kedar S; Ngidi, Wilbroda Hlolisile; Reddy, Jennifer; Mphatswe, Wendy; Rollins, Nigel; Barker, Pierre

2013-11-01

New approaches are needed to evaluate quality improvement (QI) within large-scale public health efforts. This case report details challenges to large-scale QI evaluation, and proposes solutions relying on adaptive study design. We used two sequential evaluative methods to study a QI effort to improve delivery of HIV preventive care in public health facilities in three districts in KwaZulu-Natal, South Africa, over a 3-year period. We initially used a cluster randomised controlled trial (RCT) design. During the RCT study period, tensions arose between intervention implementation and evaluation design due to loss of integrity of the randomisation unit over time, pressure to implement changes across the randomisation unit boundaries, and use of administrative rather than functional structures for the randomisation. In response to this loss of design integrity, we switched to a more flexible intervention design and a mixed-methods quasiexperimental evaluation relying on both a qualitative analysis and an interrupted time series quantitative analysis. Cluster RCT designs may not be optimal for evaluating complex interventions to improve implementation in uncontrolled 'real world' settings. More flexible, context-sensitive evaluation designs offer a better balance of the need to adjust the intervention during the evaluation to meet implementation challenges while providing the data required to evaluate effectiveness. Our case study involved HIV care in a resource-limited setting, but these issues likely apply to complex improvement interventions in other settings.

Factors associated with unreported tuberculosis cases in Spanish hospitals.

PubMed

Morales-García, Concepción; Rodrigo, Teresa; García-Clemente, Marta M; Muñoz, Ana; Bermúdez, Pilar; Casas, Francisco; Somoza, María; Milá, Celia; Penas, Antón; Hidalgo, Carmen; Casals, Martí; Caylá, Joan A

2015-07-29

Under-reporting of tuberculosis (TB) cases complicates disease control, hinders contact tracing and alters the accuracy of epidemiological data, including disease burden. The objective of the present study is to evaluate the proportion of unreported TB cases in Spanish healthcare facilities and to identify the associated factors. A multi-center retrospective study design was employed. The study included TB cases diagnosed in 16 facilities during 2011-2012. These cases were compared to those reported to the corresponding public health departments. Demographic, microbiological and clinical data were analyzed to determine the factors associated with unreported cases. Associated factors were analyzed on a bivariate level using the x(2) test and on a multivariate level using a logistic regression. Odds ratios (OR) and 95 % confidence intervals (CI) were calculated. Of the 592 TB cases included in the study, 85 (14.4 %) were not reported. The percentage of unreported cases per healthcare center ranged from 0-45.2 %. The following variables were associated to under-reporting at a multivariate level: smear-negative TB (OR = 1.87; CI:1.07-3.28), extrapulmonary disease (OR = 2.07; CI:1.05-4.09) and retired patients (OR = 3.04; CI:1.29-7.18). A nurse case manager was present in all of the centers with 100 % reporting. The percentage of reported cases among the smear-positive cases was 9.4 % and 19.4 % (p = 0.001) among the rest of the study population. Smear-positive TB was no associated to under-reporting. It is important that TB Control Programs encourage thorough case reporting to improve disease control, contact tracing and accuracy of epidemiological data. The help from a TB nurse case manager could improve the rate of under-reporting.

Increasing operating room productivity by duration categories and a newsvendor model.

PubMed

Lehtonen, Juha-Matti; Torkki, Paulus; Peltokorpi, Antti; Moilanen, Teemu

2013-01-01

Previous studies approach surgery scheduling mainly from the mathematical modeling perspective which is often hard to apply in a practical environment. The aim of this study is to develop a practical scheduling system that considers the advantages of both surgery categorization and newsvendor model to surgery scheduling. The research was carried out in a Finnish orthopaedic specialist centre that performs only joint replacement surgery. Four surgery categorization scenarios were defined and their productivity analyzed by simulation and newsvendor model. Detailed analyses of surgery durations and the use of more accurate case categories and their combinations in scheduling improved OR productivity 11.3 percent when compared to the base case. Planning to have one OR team to work longer led to remarkable decrease in scheduling inefficiency. In surgical services, productivity and cost-efficiency can be improved by utilizing historical data in case scheduling and by increasing flexibility in personnel management. The study increases the understanding of practical scheduling methods used to improve efficiency in surgical services.

How business intelligence can improve value.

PubMed

Moore, Keith D; Eyestone, Katie; Coddington, Dean C

2012-10-01

Case studies of three healthcare organizations reinforce the premise that business intelligence--the ability to convert data into actionable information for decision making--is critical to demonstrating improved value.

Methodology or method? A critical review of qualitative case study reports

PubMed Central

Hyett, Nerida; Kenny, Amanda; Dickson-Swift, Virginia

2014-01-01

Despite on-going debate about credibility, and reported limitations in comparison to other approaches, case study is an increasingly popular approach among qualitative researchers. We critically analysed the methodological descriptions of published case studies. Three high-impact qualitative methods journals were searched to locate case studies published in the past 5 years; 34 were selected for analysis. Articles were categorized as health and health services (n=12), social sciences and anthropology (n=7), or methods (n=15) case studies. The articles were reviewed using an adapted version of established criteria to determine whether adequate methodological justification was present, and if study aims, methods, and reported findings were consistent with a qualitative case study approach. Findings were grouped into five themes outlining key methodological issues: case study methodology or method, case of something particular and case selection, contextually bound case study, researcher and case interactions and triangulation, and study design inconsistent with methodology reported. Improved reporting of case studies by qualitative researchers will advance the methodology for the benefit of researchers and practitioners. PMID:24809980

Mid-term financial impact of animal welfare improvements in Dutch broiler production.

PubMed

Gocsik, E; Lansink, A G J M Oude; Saatkamp, H W

2013-12-01

This study used a stochastic bioeconomic simulation model to simulate the business and financial risk of different broiler production systems over a 5-yr period. Simulation analysis was conducted using the @Risk add-in in MS Excel. To compare the impact of different production systems on economic feasibility, 2 cases were considered. The first case focused on the economic feasibility of a completely new system, whereas the second examined economic feasibilities when a farm switches from a conventional to an animal welfare-improving production system. A sensitivity analysis was conducted to assess the key drivers of economic feasibility and to reveal systematic differences across production systems. The study shows that economic feasibility of systems with improved animal welfare predominantly depends on the price that farmers receive. Moreover, the study demonstrates the importance of the level and variation of the price premium for improved welfare, particularly in the first 5 yr after conversion. The economic feasibility of the production system increases with the level of welfare improvements for a sufficiently high price level for broiler meat and low volatility in producer prices. If this is not the case, however, risk attitudes of farmers become important as well as the use of potential risk management instruments.

Improving Parolees' Participation in Drug Treatment and Other Services through Strengths Case Management.

PubMed

Prendergast, Michael; Cartier, Jerome J

2008-01-01

In an effort to increase participation in community aftercare treatment for substance-abusing parolees, an intervention based on a transitional case management (TCM) model that focuses mainly on offenders' strengths has been developed and is under testing. This model consists of completion, by the inmate, of a self-assessment of strengths that informs the development of the continuing care plan, a case conference call shortly before release, and strengths case management for three months post-release to promote retention in substance abuse treatment and support the participant's access to designated services in the community. The post-release component consists of a minimum of one weekly client/case manager meeting (in person or by telephone) for 12 weeks. The intervention is intended to improve the transition process from prison to community at both the individual and systems level. Specifically, the intervention is designed to improve outcomes in parolee admission to, and retention in, community-based substance-abuse treatment, parolee access to other needed services, and recidivism rates during the first year of parole. On the systems level, the intervention is intended to improve the communication and collaboration between criminal justice agencies, community-based treatment organizations, and other social and governmental service providers. The TCM model is being tested in a multisite study through the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) research cooperative funded by the National Institute of Drug Abuse.

Bend case study : indirect land use and growth impacts : interim report

DOT National Transportation Integrated Search

2000-01-01

To improve environmental analysis of indirect land use impacts of highway capacity improvements, this study analyzed the land use and growth patterns of 20 Oregon communities over 20 years. Using a Geographic Information System and aerial photos, gro...

McMinnville case study : indirect land use and growth impacts : interim report

DOT National Transportation Integrated Search

1999-12-01

To improve environmental analysis of indirect land use impacts of highway capacity improvements, this study analyzed : the land use and growth patterns of 20 Oregon communities over 20 years. Using a Geographic Information System and : aerial photos,...

Differential diagnosis and treatment of bilateral facial pain after whiplash: a case report.

PubMed

Peterson, Seth

2015-01-01

Clinical case report. Symptoms in the face and jaw are common after whiplash. Few studies have reported cervicogenic headache in a trigeminal nerve distribution, and no published studies could be found describing such symptoms experienced bilaterally after whiplash. The objective of the current case report was to detail the clinical reasoning and management of an uncommon patient presentation. The 41-year-old female patient of the current case complained of shooting pain in the jaw, cheek and forehead beginning 7 days after her accident. No imaging was performed, and examination ruled out serious pathology. The patient was treated primarily with deep neck flexor (DNF) and proprioceptive training for 10 visits over an 8-week period. The Numeric Pain Rating Scale improved from 2/10 to 0/10, the Neck Disability Index improved from 17/50 to 1/50, and the Neck Flexor Muscle Endurance Test improved from 13 to 30 s. The patient remained symptom-free at 4-month follow-up. The current case report describes a patient presentation unique to the literature. Significant changes were seen by week 3 with DNF and proprioceptive training. Additional research is required to determine the effectiveness of this intervention in similar presentations.

Case Series of an Intraoral Balancing Appliance Therapy on Subjective Symptom Severity and Cervical Spine Alignment

PubMed Central

Lee, Young Jun; Lee, Joo Kang; Jung, Soo Chang; Lee, Hwang-woo; Yin, Chang Shik; Lee, Young Jin

2013-01-01

Objective. The objective of this study was to investigate the effect of a holistic intraoral appliance (OA) on cervical spine alignment and subjective symptom severity. Design. An observational study on case series with holistic OA therapy. Setting. An outpatient clinic for holistic temporomandibular joint (TMJ) therapy under the supervision of the Pain Center, CHA Biomedical center, CHA University. Subjects. Ambulatory patients presenting with diverse chief complaints in the holistic TMJ clinic. Main Measures. Any immediate change in the curvature of cervical spine and the degree of atlantoaxial rotation was investigated in the images of simple X-ray and computed tomography of cervical spine with or without OA. Changes of subjective symptom severity were also analyzed for the holistic OA therapy cases. Results. A total of 59 cases were reviewed. Alignment of upper cervical spine rotation showed an immediate improvement (P < 0.001). Changes of subjective symptom severity also showed significant improvement (P < 0.05). Conclusion. These cases revealed rudimentary clinical evidence that holistic OA therapy may be related to an alleviated symptom severity and an improved cervical spinal alignment. These results show that further researches may warrant for the holistic TMJ therapy. PMID:23935655

Improving the Effectiveness of Higher Education Institutions through Inter-University Co-Operation: The Case of Peking University. Improving the Managerial Effectiveness of Higher Education Institutions.

ERIC Educational Resources Information Center

Weifang, Min

This case study on the experience of the University of Peking, China, in inter-university cooperation describes the process of identifying appropriate partner institutions and implementing collaborative programs with them. It also highlights a number of lessons for those managing inter-university cooperation and shows how such initiatives can be…

Reverse shoulder arthroplasty for massive rotator cuff tear: risk factors for poor functional improvement.

PubMed

Hartzler, Robert U; Steen, Brandon M; Hussey, Michael M; Cusick, Michael C; Cottrell, Benjamin J; Clark, Rachel E; Frankle, Mark A

2015-11-01

Some patients unexpectedly have poor functional improvement after reverse shoulder arthroplasty (RSA) for massive rotator cuff tear without glenohumeral arthritis. Our aim was to identify risk factors for this outcome. We also assessed the value of RSA for cases with poor functional improvement vs. The study was a retrospective case-control analysis for primary RSA performed for massive rotator cuff tear without glenohumeral arthritis with minimum 2-year follow-up. Cases were defined as Simple Shoulder Test (SST) score improvement of ≤1, whereas controls improved SST score ≥2. Risk factors were chosen on the basis of previous association with poor outcomes after shoulder arthroplasty. Latissimus dorsi tendon transfer results were analyzed as a subgroup. Value was defined as improvement in American Shoulder and Elbow Surgeons (ASES) score per $10,000 hospital cost. In a multivariate binomial logistic regression analysis, neurologic dysfunction (P = .006), age <60 years (P = .02), and high preoperative SST score (P = .03) were independently associated with poor functional improvement. Latissimus dorsi tendon transfer patients significantly improved in active external rotation (-0.3° to 38.7°; P < .01). The value of RSA (ΔASES/$10,000 cost) for cases was 0.8 compared with 17.5 for controls (P < .0001). Young age, high preoperative function, and neurologic dysfunction were associated with poor functional improvement. Surgeons should consider these associations in counseling and selection of patients. Concurrent latissimus dorsi transfer was successful in restoring active external rotation in a subgroup of patients. The critical economic importance of improved patient selection is emphasized by the very low value of the procedure in the case group. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Efficacy of metacognitive therapy in improving mental health: A meta-analysis of single-case studies.

PubMed

Rochat, Lucien; Manolov, Rumen; Billieux, Joël

2018-06-01

Metacognitive therapy and one of its treatment components, the attention training technique, are increasingly being delivered to improve mental health. We examined the efficacy of metacognitive therapy and/or attention training technique on mental health outcomes from single-case studies. A total of 14 studies (53 patients) were included. We used the d-statistic for multiple baseline data and the percentage change index to compute the effect sizes. Metacognitive therapy has a large effect on depression, anxiety, other psychopathological symptoms, and all outcomes together. Effect sizes were significantly moderated by the number of sessions, the severity and duration of symptoms, and patient gender, but not by study quality or attention training technique when used as a stand-alone treatment. At the follow-up, 77.36% of the individuals were considered recovered or had maintained improvement. Metacognitive therapy and attention training technique strongly contribute to improving mental health outcomes. This study effectively informs evidence-based practice in the clinical milieu. © 2017 Wiley Periodicals, Inc.

Perioperative Care and the Importance of Continuous Quality Improvement—A Controlled Intervention Study in Three Tanzanian Hospitals

PubMed Central

Mtatifikolo, Ferdinand; Ngoli, Baltazar; Neuner, Bruno; Wernecke, Klaus–Dieter; Spies, Claudia

2015-01-01

Introduction Surgical services are increasingly seen to reduce death and disability in Sub-Saharan Africa, where hospital-based mortality remains alarmingly high. This study explores two implementation approaches to improve the quality of perioperative care in a Tanzanian hospital. Effects were compared to a control group of two other hospitals in the region without intervention. Methods All hospitals conducted quality assessments with a Hospital Performance Assessment Tool. Changes in immediate outcome indicators after one and two years were compared to final outcome indicators such as Anaesthetic Complication Rate and Surgical Case Fatality Rate. Results Immediate outcome indicators for Preoperative Care in the intervention hospital improved (52.5% in 2009; 84.2% in 2011, p<0.001). Postoperative Inpatient Care initially improved to then decline again (63.3% in 2009; 70% in 2010; 58.6% in 2011). In the control group, preoperative care declined from 50.8% (2009) to 32.8% (2011, p <0.001), while postoperative care did not significantly change. Anaesthetic Complication Rate in the intervention hospital declined (1.89% before intervention; 0.96% after intervention, p = 0.006). Surgical Case Fatality Rate in the intervention hospital declined from 5.67% before intervention to 2.93% after intervention (p<0.0010). Surgical Case Fatality Rate in the control group was 4% before intervention and 3.8% after intervention (p = 0.411). Anaesthetic Complication Rate in the control group was not available. Discussion Immediate outcome indicators initially improved, while at the same time final outcome declined (Surgical Case Fatality, Anaesthetic Complication Rate). Compared to the control group, final outcome improved more in the intervention hospital, although the effect was not significant over the whole study period. Documentation of final outcome indicators seemed inconsistent. Immediate outcome indicators seem more helpful to steer the Continuous Quality Improvement program. Conclusion Specific interventions as part of Continuous Quality Improvement might lead to sustainable improvement of the quality of care, if embedded in a multi-faceted approach. PMID:26327392

A Comparative Case Study of the Role of the School District in Influencing School Improvement: Supporting and Turning around Low-Performing Schools

ERIC Educational Resources Information Center

Kelly, Christopher

2016-01-01

The purpose of this study was to examine the efforts of school districts in developing and sustaining their capacity to improve student achievement in response to increased accountability. The study sought to confirm what the research says regarding the role of the school district in influencing school improvement. While there is a significant…

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.

California Community College Administrators' Use of Predictive Modeling to Improve Student Course Completions

ERIC Educational Resources Information Center

Grogan, Rita D.

2017-01-01

Purpose: The purpose of this case study was to determine the impact of utilizing predictive modeling to improve successful course completion rates for at-risk students at California community colleges. A secondary purpose of the study was to identify factors of predictive modeling that have the most importance for improving successful course…

A Case Study of High School Teachers' Technology Use through Social Studies Data Teams

ERIC Educational Resources Information Center

Wilson-Cortez, Lauretta

2013-01-01

Many schools placed under Program Improvement because they have not met the AYP requirements of the NCLB mandate are required to build in time during the school day for teachers' professional collaboration to improve their performance in the classrooms. A lack of research exists to explore how professional collaboration improves teaching and…

Exploring the Principal Perspective: Implications for Expanded School Improvement and School Mental Health

ERIC Educational Resources Information Center

Iachini, Aidyn L.; Pitner, Ronald O.; Morgan, Frank; Rhodes, Kevin

2016-01-01

Principals are critical to school improvement efforts, yet few studies aim to elicit their perspectives on what contributes to teaching, learning, and broader school improvement. The purpose of this mixed-methods case study was to elicit principals' perspectives on (a) teacher and school staff needs, and (b) student needs, in an effort to uncover…

[Navigated implantation of total knee endoprostheses--a comparative study with conventional instrumentation].

PubMed

Jenny, J Y; Boeri, C

2001-01-01

A navigation system should improve the quality of a total knee prosthesis implantation in comparison to the classical, surgeon-controlled operative technique. The authors have implanted 40 knee total prostheses with an optical infrared navigation system (Orthopilot AESCULAP, Tuttlingen--group A). The quality of implantation was studied on postoperative long leg AP and lateral X-rays, and compared to a control group of 40 computer-paired total knee prostheses o the same model (Search Prosthesis, AESCULAP, Tuttlingen) implanted with a classical, surgeon-controlled technique (group B). An optimal mechanical femorotibial angle (3 degrees valgus to 3 degrees varus) was obtained by 33 cases in group A and 31 cases in group B (p > 0.05). Better results were seen for the coronal and sagittal orientation of both tibial and femoral components in group A. Globally, 26 cases of the group A and 12 cases of the group B were implanted in an optimal manner for all studied criteria (p < 0.01). The used navigation system allows a significant improvement of the quality of implantation of a knee total prosthesis in comparison to a classical, surgeon-controlled instrumentation. Long-term outcome could be consequently improved.

Case-study experiments in the introductory physics curriculum

NASA Astrophysics Data System (ADS)

Arion, D. N.; Crosby, K. M.; Murphy, E. A.

2000-09-01

Carthage College added inquiry-based case study activities to the traditional introductory physics laboratory. Student teams designed, constructed, and executed their own experiments to study real-world phenomena, through which they gained understanding both of physic principles and methods of physics research. Assessment results and student feedback through teacher evaluations indicate that these activities improved student attitudes about physics as well as their ability to solve physics problems relative to previous course offerings that did not include case study.

Improving Assistive Technology Service by Using 3D Printing: Three Case Studies.

PubMed

Watanabe, Takashi; Hatakeyama, Takuro; Tomiita, Mitsuru

2015-01-01

Assistive technology services are essential for adapting assistive devices to the individual needs of users with disabilities. In this study, we attempted to apply three-dimensional (3D) printing technology to three actual cases, and to study its use, effectiveness, and future applications. We assessed the usefulness of 3D printing technology by categorizing its utilization after reviewing the outcomes of these case studies. In future work, we aim to gather additional case studies and derive information on using 3D printing technology that will enable its effective application in the process of assistive technology services.

Evaluation of the effect of erythropoietin + corticosteroid versus corticosteroid alone in methanol-induced optic nerve neuropathy.

PubMed

Zamani, Nasim; Hassanian-Moghaddam, Hossein; Shojaei, Maziar; Rahimian, Sara

2018-06-01

Following methanol intoxication, optic nerve neuropathy may occur, which is currently treated by different therapeutic regimens. Erythropoietin (EPO) has recently been introduced as a good therapeutic option in methanol-induced optic neuropathy. The aim of the current study was to evaluate the efficacy of EPO in improvement of the visual disturbances in methanol-intoxicated patients. In a case-control study, all patients who had referred to our toxicology centre with confirmed diagnosis of methanol toxicity were considered to be included. Of them, those who had referred with visual disturbances, survived, and their visual disturbances had not improved after haemodialysis were entered. Cases received EPO and corticosteroids while controls only received corticosteroids. They were then compared regarding their visual outcome. All five patients in the control group mentioned that after discharge, their visual acuity had improved while in the cases, three mentioned visual improvement, two mentioned their visual acuity had deteriorated after discharge, two mentioned no change in their visual acuity and three mentioned that their visual acuity had first improved but then deteriorated with a mean two-month interval period. In fundoscopic evaluations, two controls had normal fundospcopy while eight cases had abnormal fundoscopy (p = 0.055). Protective effect of EPO on methanol-induced optic nerve may be strong at the beginning of the intervention but is probably transient.

The CARE guidelines: consensus-based clinical case reporting guideline development

PubMed Central

Gagnier, Joel J; Kienle, Gunver; Altman, Douglas G; Moher, David; Sox, Harold; Riley, David

2013-01-01

A case report is a narrative that describes, for medical, scientific or educational purposes, a medical problem experienced by one or more patients. Case reports written without guidance from reporting standards are insufficiently rigorous to guide clinical practice or to inform clinical study design. Develop, disseminate and implement systematic reporting guidelines for case reports. We used a three-phase consensus process consisting of (1) premeeting literature review and interviews to generate items for the reporting guidelines, (2) a face-to-face consensus meeting to draft the reporting guidelines and (3) postmeeting feedback, review and pilot testing, followed by finalisation of the case report guidelines. This consensus process involved 27 participants and resulted in a 13-item checklist—a reporting guideline for case reports. The primary items of the checklist are title, key words, abstract, introduction, patient information, clinical findings, timeline, diagnostic assessment, therapeutic interventions, follow-up and outcomes, discussion, patient perspective and informed consent. We believe the implementation of the CARE (CAse REport) guidelines by medical journals will improve the completeness and transparency of published case reports and that the systematic aggregation of information from case reports will inform clinical study design, provide early signals of effectiveness and harms, and improve healthcare delivery. PMID:24155002

A Collection of Papers on Self-Study and Institutional Improvement 1995.

ERIC Educational Resources Information Center

North Central Association of Colleges and Schools, Chicago, IL. Commission on Institutions of Higher Education.

This 11th publication of Annual Meeting papers presents 68 written materials related to invited speakers' oral presentations. The materials address issues of self-study and institutional improvement by institutions of higher education. Chapter 1, "From Self-Study to Site Visit: Case Studies," shares the experiences of a community college…

The effect of improving task representativeness on capturing nurses’ risk assessment judgements: a comparison of written case simulations and physical simulations

PubMed Central

2013-01-01

Background The validity of studies describing clinicians’ judgements based on their responses to paper cases is questionable, because - commonly used - paper case simulations only partly reflect real clinical environments. In this study we test whether paper case simulations evoke similar risk assessment judgements to the more realistic simulated patients used in high fidelity physical simulations. Methods 97 nurses (34 experienced nurses and 63 student nurses) made dichotomous assessments of risk of acute deterioration on the same 25 simulated scenarios in both paper case and physical simulation settings. Scenarios were generated from real patient cases. Measures of judgement ‘ecology’ were derived from the same case records. The relationship between nurses’ judgements, actual patient outcomes (i.e. ecological criteria), and patient characteristics were described using the methodology of judgement analysis. Logistic regression models were constructed to calculate Lens Model Equation parameters. Parameters were then compared between the modeled paper-case and physical-simulation judgements. Results Participants had significantly less achievement (ra) judging physical simulations than when judging paper cases. They used less modelable knowledge (G) with physical simulations than with paper cases, while retaining similar cognitive control and consistency on repeated patients. Respiration rate, the most important cue for predicting patient risk in the ecological model, was weighted most heavily by participants. Conclusions To the extent that accuracy in judgement analysis studies is a function of task representativeness, improving task representativeness via high fidelity physical simulations resulted in lower judgement performance in risk assessments amongst nurses when compared to paper case simulations. Lens Model statistics could prove useful when comparing different options for the design of simulations used in clinical judgement analysis. The approach outlined may be of value to those designing and evaluating clinical simulations as part of education and training strategies aimed at improving clinical judgement and reasoning. PMID:23718556

Service quality that improves customer satisfaction in a university: a case study in Institut Teknologi Indonesia

NASA Astrophysics Data System (ADS)

Theresia, L.; Bangun, R.

2017-12-01

Universities should provide better service quality to get more customers. The purpose of this study was to find service quality which has impact on the increasing of customer satisfaction in a university. This study is a case study in Institut Teknologi Indonesia (ITI). The result of the study will help ITI to improve its service quality to increase customer satisfaction. This study employs path analysis technique. The data were collected through questionnaires developed from the literature. Questionnaires have two parts namely 1) service quality and 2) customer satisfaction. Service quality is measured through 22 questions with five service quality dimensions: 1) Tangibles, 2) Reliability, 3) Responsiveness, 4) Assurance and 5) Empathy. Customer Satisfaction is measured through 4 questions. The data then are processed by SPSS. The results showed that the students preferred to tangible quality improvement than intangible aspect.

Effect of digital problem-based learning cases on student learning outcomes in ophthalmology courses.

PubMed

Kong, Jun; Li, Xiaoyan; Wang, Youdong; Sun, Wei; Zhang, Jinsong

2009-09-01

To assess the impact of digital problem-based learning (PBL) cases on student learning in ophthalmology courses. Ninety students were randomly divided into 3 classes (30 students per class). The first class studied under a didactic model. The other 2 classes were divided into 6 groups (10 students per group) and received PBL teaching; 3 groups studied via cases presented in digital form and the others studied via paper-form cases. The results of theoretical and case analysis examinations were analyzed using the chi(2) test. Student performance on the interval practice was analyzed using the Kruskal-Wallis test. Questionnaires were used to evaluate student and facilitator perceptions. Students in the digital groups exhibited better performance in the practice procedures according to tutorial evaluations compared with the other groups (P < .05). The 2 PBL classes had significantly higher mean results of theoretical and case analysis examinations (P < .001), but there was no significant difference between the 2 PBL classes. Ninety-three percent of students in the digital groups (vs 73% in the paper groups) noted that the cases greatly stimulated their interest. Introducing PBL into ophthalmology could improve educational quality and effectiveness. Digital PBL cases stimulate interest and motivate students to further improve diagnosis and problem-handling skills.

Benchmarking, benchmarks, or best practices? Applying quality improvement principles to decrease surgical turnaround time.

PubMed

Mitchell, L

1996-01-01

The processes of benchmarking, benchmark data comparative analysis, and study of best practices are distinctly different. The study of best practices is explained with an example based on the Arthur Andersen & Co. 1992 "Study of Best Practices in Ambulatory Surgery". The results of a national best practices study in ambulatory surgery were used to provide our quality improvement team with the goal of improving the turnaround time between surgical cases. The team used a seven-step quality improvement problem-solving process to improve the surgical turnaround time. The national benchmark for turnaround times between surgical cases in 1992 was 13.5 minutes. The initial turnaround time at St. Joseph's Medical Center was 19.9 minutes. After the team implemented solutions, the time was reduced to an average of 16.3 minutes, an 18% improvement. Cost-benefit analysis showed a potential enhanced revenue of approximately $300,000, or a potential savings of $10,119. Applying quality improvement principles to benchmarking, benchmarks, or best practices can improve process performance. Understanding which form of benchmarking the institution wishes to embark on will help focus a team and use appropriate resources. Communicating with professional organizations that have experience in benchmarking will save time and money and help achieve the desired results.

Improving ED specimen TAT using Lean Six Sigma.

PubMed

Sanders, Janet H; Karr, Tedd

2015-01-01

Lean and Six Sigma are continuous improvement methodologies that have garnered international fame for improving manufacturing and service processes. Increasingly these methodologies are demonstrating their power to also improve healthcare processes. The purpose of this paper is to discuss a case study for the application of Lean and Six Sigma tools in the reduction of turnaround time (TAT) for Emergency Department (ED) specimens. This application of the scientific methodologies uncovered opportunities to improve the entire ED to lab system for the specimens. This case study provides details on the completion of a Lean Six Sigma project in a 1,000 bed tertiary care teaching hospital. Six Sigma's Define, Measure, Analyze, Improve, and Control methodology is very similar to good medical practice: first, relevant information is obtained and assembled; second, a careful and thorough diagnosis is completed; third, a treatment is proposed and implemented; and fourth, checks are made to determine if the treatment was effective. Lean's primary goal is to do more with less work and waste. The Lean methodology was used to identify and eliminate waste through rapid implementation of change. The initial focus of this project was the reduction of turn-around-times for ED specimens. However, the results led to better processes for both the internal and external customers of this and other processes. The project results included: a 50 percent decrease in vials used for testing, a 50 percent decrease in unused or extra specimens, a 90 percent decrease in ED specimens without orders, a 30 percent decrease in complete blood count analysis (CBCA) Median TAT, a 50 percent decrease in CBCA TAT Variation, a 10 percent decrease in Troponin TAT Variation, a 18.2 percent decrease in URPN TAT Variation, and a 2-5 minute decrease in ED registered nurses rainbow draw time. This case study demonstrated how the quantitative power of Six Sigma and the speed of Lean worked in harmony to improve the blood draw process for a 1,000 bed tertiary care teaching hospital. The blood draw process is a standard process used in hospitals to collect blood chemistry and hematology information for clinicians. The methods used in this case study demonstrated valuable and practical applications of process improvement methodologies that can be used for any hospital process and/or service environment. While this is not the first case study that has demonstrated the use of continuous process improvement methodologies to improve a hospital process, it is unique in the way in which it utilizes the strength of the project focussed approach that adheres more to the structure and rigor of Six Sigma and relied less on the speed of lean. Additionally, the application of these methodologies in healthcare is emerging research.

Implementing service improvement projects within pre-registration nursing education: a multi-method case study evaluation.

PubMed

Baillie, Lesley; Bromley, Barbara; Walker, Moira; Jones, Rebecca; Mhlanga, Fortune

2014-01-01

Preparing healthcare students for quality and service improvement is important internationally. A United Kingdom (UK) initiative aims to embed service improvement in pre-registration education. A UK university implemented service improvement teaching for all nursing students. In addition, the degree pathway students conducted service improvement projects as the basis for their dissertations. The study aimed to evaluate the implementation of service improvement projects within a pre-registration nursing curriculum. A multi-method case study was conducted, using student questionnaires, focus groups with students and academic staff, and observation of action learning sets. Questionnaire data were analysed using SPSS v19. Qualitative data were analysed using Ritchie and Spencer's (1994) Framework Approach. Students were very positive about service improvement. The degree students, who conducted service improvement projects in practice, felt more knowledgeable than advanced diploma students. Selecting the project focus was a key issue and students encountered some challenges in practice. Support for student service improvement projects came from action learning sets, placement staff, and academic staff. Service improvement projects had a positive effect on students' learning. An effective partnership between the university and partner healthcare organisations, and support for students in practice, is essential. Copyright © 2013 Elsevier Ltd. All rights reserved.

A Case Study of the Partnership Schools Comprehensive School Reform (CSR) Model

ERIC Educational Resources Information Center

Epstein, Joyce L.

2005-01-01

This case study reports the feasibility of the Partnership Schools Comprehensive School Reform (CSR) model for school improvement in a Title I elementary school. Interviews were conducted and documents were collected for 3 years to study whether and how the school implemented key policy attributes--specificity, consistency, authority, power, and…

A Case Study on TRICARE Online Web-enabled Appointing: Improving Utilization Rates at Navy Medical Treatment Facilities

DTIC Science & Technology

2009-10-20

Low usage volume raised concerns about the effectiveness of TOL. In 2004, the eHealth Division of TMA Information Management conducted a study to...Case Study 31 (Version 15.8). Falls Church, VA: Department of Defense, TRICARE Management Activity, Information Management eHealth Division

Enabling Occupational Performance of Children through Coaching Parents: Three Case Reports

ERIC Educational Resources Information Center

Graham, Fiona; Rodger, Sylvia; Ziviani, Jenny

2010-01-01

This study explores the use of occupational performance coaching (OPC) with three parent-child dyads using descriptive case study methodology. OPC is a parent-directed intervention in which parents are coached to improve their own or their children's performance in home and community contexts. In this study, parent and child performance was…

Successful Leadership in Three High-Poverty Urban Elementary Schools

ERIC Educational Resources Information Center

Jacobson, Stephen L.; Brooks, Sharon; Giles, Corrie; Johnson, Lauri; Ylimaki, Rose

2007-01-01

This study examined the beliefs and practices of three principals during whose tenure their high-poverty urban elementary schools experienced improved student achievement. A two-stage, multiple case-study methodology was employed. First, New York State Education Department (NYSED) school report card data were analyzed to identify case-study sites.…

Grants Pass case study : indirect land use and growth impacts : interim report

DOT National Transportation Integrated Search

1999-08-01

To improve environmental analysis of indirect land use impacts of highway capacity improvements, this study analyzed the land use and growth patterns of 20 Oregon communities over 20 years. Using a Geographic Information System and aerial photos, gro...

An experiment in multispectral, multitemporal crop classification using relaxation techniques

NASA Technical Reports Server (NTRS)

Davis, L. S.; Wang, C.-Y.; Xie, H.-C

1983-01-01

The paper describes the result of an experimental study concerning the use of probabilistic relaxation for improving pixel classification rates. Two LACIE sites were used in the study and in both cases, relaxation resulted in a marked improvement in classification rates.

Improving adolescent pregnancy outcomes and maternal health:a case study of comprehensive case managed services.

PubMed

Bowman, Elizabeth K; Palley, Howard A

2003-01-01

Our findings indicate how health outcomes regarding adolescent pregnancy and maternal and infant health care are intertwined with a case management process that fosters measures that are social in nature-the provision of direct services, as well as the encouragement of informal social supports systems. They also show how case managed services in a small, nongovernmental organization (NGO) with a strong commitment to its clients may provide the spontaneity and caring which results in a "match" between client needs and the delivery of services-and positive outcomes for pregnant women, early maternal health and infant health. The delivery of such case managed services in a manner which is intensive, comprehensive, flexible and integrated contributes significantly to such improved health outcomes.

Into the development of a model to assess beam shaping and polarization control effects on laser cutting

NASA Astrophysics Data System (ADS)

Rodrigues, Gonçalo C.; Duflou, Joost R.

2018-02-01

This paper offers an in-depth look into beam shaping and polarization control as two of the most promising techniques for improving industrial laser cutting of metal sheets. An assessment model is developed for the study of such effects. It is built upon several modifications to models as available in literature in order to evaluate the potential of a wide range of considered concepts. This includes different kinds of beam shaping (achieved by extra-cavity optical elements or asymmetric diode staking) and polarization control techniques (linear, cross, radial, azimuthal). A fully mathematical description and solution procedure are provided. Three case studies for direct diode lasers follow, containing both experimental data and parametric studies. In the first case study, linear polarization is analyzed for any given angle between the cutting direction and the electrical field. In the second case several polarization strategies are compared for similar cut conditions, evaluating, for example, the minimum number of spatial divisions of a segmented polarized laser beam to achieve a target performance. A novel strategy, based on a 12-division linear-to-radial polarization converter with an axis misalignment and capable of improving cutting efficiency with more than 60%, is proposed. The last case study reveals different insights in beam shaping techniques, with an example of a beam shape optimization path for a 30% improvement in cutting efficiency. The proposed techniques are not limited to this type of laser source, neither is the model dedicated to these specific case studies. Limitations of the model and opportunities are further discussed.

The association between improved quality diabetes indicators, health outcomes and costs: towards constructing a "business case" for quality of diabetes care--a time series study.

PubMed

Wilf-Miron, Rachel; Bolotin, Arkadi; Gordon, Nesia; Porath, Avi; Peled, Ronit

2014-12-01

In primary health care systems where member's turnover is relatively low, the question, whether investment in quality of care improvement can make a business case, or is cost effective, has not been fully answered.The objectives of this study were: (1) to investigate the relationship between improvement in selected measures of diabetes (type 2) care and patients' health outcomes; and (2) to estimate the association between improvement in performance and direct medical costs. A time series study with three quality indicators - Hemoglobin A1c (HbA1c) testing, HbA1C and LDL- cholesterol (LDL-C) control - which were analyzed in patients with diabetes, insured by a large health fund. Health outcomes measures used: hospitalization days, Emergency Department (ED) visits and mortality. Poisson, GEE and Cox regression models were employed. Covariates: age, gender and socio-economic rank. 96,553 adult (age >18) patients with diabetes were analyzed. The performance of the study indicators, significantly and steadily improved during the study period (2003-2009). Poor HbA1C (>9%) and inappropriate LDL-C control (>100 mg/dl) were significantly associated with number of hospitalization days. ED visits did not achieve statistical significance. Improvement in HbA1C control was associated with an annual average of 2% reduction in hospitalization days, leading to substantial reduction in tertiary costs. The Hazard ratio for mortality, associated with poor HbA1C and LDL-C, control was 1.78 and 1.17, respectively. Our study demonstrates the effect of continuous improvement in quality care indicators, on health outcomes and resource utilization, among patients with diabetes. These findings support the business case for quality, especially in healthcare systems with relatively low enrollee turnover, where providers, in the long term, could "harvest" their investments in improving quality.

Effects of interactive metronome training on postural stability and upper extremity function in Parkinson's disease: a case study.

PubMed

Kim, Arim; Lee, Hye-Sun; Song, Chiang-Soon

2017-01-01

[Purpose] The purpose of this study was to examine the effects of interactive metronome training on the postural stability and upper extremity function of an individual with Parkinson's disease. [Subject and Methods] The participant of this case study was a 75-year-old female with Parkinson's disease diagnosed 7 years prior. This study was a single-subject research with an A-B-A design. She received IM training during the treatment phase (B phase) for 40 minutes per session. She was assessed pretest and posttest using the Berg balance scale and Wolf motor function test, and at baseline and the treatment phase using the measured box-and-block test and a Tetrax system. [Results] After training, the patient's static and dynamic balance, functional activity, and performance time of the upper extremity improved. Interactive metronome therapy improved the manual dexterity of both hands. Interactive metronome therapy also improved the limit of stability of the Parkinson's disease. [Conclusion] Though a case study, the results of this study suggest that IM therapy is effective at restoring the postural stability and upper extremity function of patients with Parkinson's disease.

Effects of interactive metronome training on postural stability and upper extremity function in Parkinson’s disease: a case study

PubMed Central

Kim, Arim; Lee, Hye-Sun; Song, Chiang-Soon

2017-01-01

[Purpose] The purpose of this study was to examine the effects of interactive metronome training on the postural stability and upper extremity function of an individual with Parkinson’s disease. [Subject and Methods] The participant of this case study was a 75-year-old female with Parkinson’s disease diagnosed 7 years prior. This study was a single-subject research with an A-B-A design. She received IM training during the treatment phase (B phase) for 40 minutes per session. She was assessed pretest and posttest using the Berg balance scale and Wolf motor function test, and at baseline and the treatment phase using the measured box-and-block test and a Tetrax system. [Results] After training, the patient’s static and dynamic balance, functional activity, and performance time of the upper extremity improved. Interactive metronome therapy improved the manual dexterity of both hands. Interactive metronome therapy also improved the limit of stability of the Parkinson’s disease. [Conclusion] Though a case study, the results of this study suggest that IM therapy is effective at restoring the postural stability and upper extremity function of patients with Parkinson’s disease. PMID:28210066

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.

Flexible Learning in Action: Case Studies in Higher Education. Staff and Educational Development Series.

ERIC Educational Resources Information Center

Hudson, Rachel, Ed.; Maslin-Prothero, Sian, Ed.; Oates, Lyn, Ed.

Following an introduction (Hudson, Maslin-Prothero, Oates), the following 31 case studies describe flexible learning developments in the United Kingdom, Australia, and the United States: "Teaching Business Writing Online" (Fulkerth); "Don't Lecture Me about Flexible Learning!" (Dunning); "Improving Independent Learning…

School Leadership and Administration: Important Concepts, Case Studies and Simulations

ERIC Educational Resources Information Center

Gorton, Richard; Alston, Judy; Snowden, Petra

2006-01-01

This text helps prospective and experienced principals, administrators, and supervisors increase their knowledge and skills through concepts, case-studies, and simulations. This book contains the following two parts and fifteen chapters. Part I presents important theoretical concepts and research findings that can improve educators'…

Creating a Learning Organization: A Case Study of Outcomes and Lessons Learned.

ERIC Educational Resources Information Center

Bierema, Laura L.; Berdish, David M.

1999-01-01

Discusses how organizations are gaining a competitive edge in a global business environment through learning and highlights a learning organization implementation case study of a division of Ford Motor Company. Examines the strategic initiative; performance improvement results; individual learning, including interpersonal development and…

Ninety to Nothing: a PDSA quality improvement project.

PubMed

Prybutok, Gayle Linda

2018-05-14

Purpose The purpose of this paper is to present a case study of a successful quality improvement project in an acute care hospital focused on reducing the time of the total patient visit in the emergency department. Design/methodology/approach A multidisciplinary quality improvement team, using the PDSA (Plan, Do, Study, Act) Cycle, analyzed the emergency department care delivery process and sequentially made process improvements that contributed to project success. Findings The average turnaround time goal of 90 minutes or less per visit was achieved in four months, and the organization enjoyed significant collateral benefits both internal to the organization and for its customers. Practical implications This successful PDSA process can be duplicated by healthcare organizations of all sizes seeking to improve a process related to timely, high-quality patient care delivery. Originality/value Extended wait time in hospital emergency departments is a universal problem in the USA that reduces the quality of the customer experience and that delays necessary patient care. This case study demonstrates that a structured quality improvement process implemented by a multidisciplinary team with the authority to make necessary process changes can successfully redefine the norm.

Comparison of the effectiveness of two styles of case-based learning implemented in lectures for developing nursing students' critical thinking ability: A randomized controlled trial.

PubMed

Hong, Shaohua; Yu, Ping

2017-03-01

To explore and compare the effectiveness of two styles of case-based learning methods, unfolding nursing case and usual nursing case, implemented in lectures for developing nursing students' critical thinking ability. 122 undergraduate nursing students in four classes were taught the subject of medical nursing for one year. Two classes were randomly assigned as the experimental group and the other two the control group. The experimental group received the lectures presenting unfolding nursing cases and the control group was taught the usual cases. Nineteen case-based lectures were provided in 8 months in two semesters to each group. The two groups started with a similar level of critical thinking ability as tested by the instrument of Critical Thinking Disposition Inventory-Chinese version (CTDI-CV). After receiving 19 case-based learning lectures for 8 months, both groups of students significantly improved their critical thinking ability. The improvement in the experimental group was significantly higher than that in the control group (with the average total score of 303.77±15.24 vs. 288.34±13.94, p<0.05). The experimental group also had significantly better improvement in six out of seven dimensions whereas the control group showed improvement in only three out of seven dimensions of CTDI-CV. The study suggests the feasibility of implementing case-based learning in lectures. Unfolding nursing cases appear to be significantly more effective than the usual nursing cases in developing undergraduate nursing students' critical thinking ability in the subject of medical nursing. Further research can implement the unfolding nursing cases in other nursing subjects. Copyright © 2016 Elsevier Ltd. All rights reserved.

Improving operating room productivity via parallel anesthesia processing.

PubMed

Brown, Michael J; Subramanian, Arun; Curry, Timothy B; Kor, Daryl J; Moran, Steven L; Rohleder, Thomas R

2014-01-01

Parallel processing of regional anesthesia may improve operating room (OR) efficiency in patients undergoes upper extremity surgical procedures. The purpose of this paper is to evaluate whether performing regional anesthesia outside the OR in parallel increases total cases per day, improve efficiency and productivity. Data from all adult patients who underwent regional anesthesia as their primary anesthetic for upper extremity surgery over a one-year period were used to develop a simulation model. The model evaluated pure operating modes of regional anesthesia performed within and outside the OR in a parallel manner. The scenarios were used to evaluate how many surgeries could be completed in a standard work day (555 minutes) and assuming a standard three cases per day, what was the predicted end-of-day time overtime. Modeling results show that parallel processing of regional anesthesia increases the average cases per day for all surgeons included in the study. The average increase was 0.42 surgeries per day. Where it was assumed that three cases per day would be performed by all surgeons, the days going to overtime was reduced by 43 percent with parallel block. The overtime with parallel anesthesia was also projected to be 40 minutes less per day per surgeon. Key limitations include the assumption that all cases used regional anesthesia in the comparisons. Many days may have both regional and general anesthesia. Also, as a case study, single-center research may limit generalizability. Perioperative care providers should consider parallel administration of regional anesthesia where there is a desire to increase daily upper extremity surgical case capacity. Where there are sufficient resources to do parallel anesthesia processing, efficiency and productivity can be significantly improved. Simulation modeling can be an effective tool to show practice change effects at a system-wide level.

COMPARATIVE EFFECTIVENESS OF AN ADJUSTABLE TRANSFEMORAL PROSTHETIC INTERFACE ACCOMMODATING VOLUME FLUCTUATION: CASE STUDY

PubMed Central

Kahle, Jason T.; Klenow, Tyler D.; Highsmith, M. Jason

2016-01-01

The socket-limb interface is vital for functionality and provides stability and mobility for the amputee. Volume fluctuation can lead to compromised fit and function. Current socket technology does not accommodate for volume fluctuation. An adjustable interface may improve function and comfort by filling this technology gap. The purpose of this study was to compare the effectiveness of the standard of care (SOC) ischial ramus containment to an adjustable transfemoral prosthetic interface socket in the accommodation of volume fluctuation. A prospective experimental case study using repeated measures of subjective and performance outcome measures between socket conditions was employed. In the baseline volume condition, the adjustable socket improved subjective and performance measures 19% to 37% over SOC, whereas the two-minute walk test demonstrated equivalence. In the volume loss condition, the adjustable socket improved all subjective and performance measures 22% to 93%. All aggregated data improved 16% to 50% compared with the SOC. In simulated volume gain, the SOC socket failed, while the subject was able to complete the protocol using the adjustable socket. In this case study, the SOC socket was inferior to the comparative adjustable transfemoral amputation interface in subjective and performance outcomes. There is a lack of clinical trials and evidence comparing socket functional outcomes related to volume fluctuation. PMID:28066526

School Technology Leadership: Artifacts in Systems of Practice

ERIC Educational Resources Information Center

Dexter, Sara

2011-01-01

A cross-case analysis of five case studies of team-based technology leadership in middle schools with laptop programs identifies systems of practice that organize teams' distributed leadership. These cases suggest that successfully implementing a complex improvement effort warrants a team-based leadership approach, especially for an improvement…

The Undergraduate Case Research Study Model

ERIC Educational Resources Information Center

Vega, Gina

2010-01-01

Student-written cases are powerful pedagogical tools that can lead to improved understanding of business situations, more informed analysis, emphasis on reflection, and clearer expository writing, all of which are critical skills for business students. Cases provide an opportunity for students to enjoy an active learning experience and derive the…

Technology Solutions Case Study: Cost Analysis of Roof-Only Air Sealing and Insulation Strategies on 1-1/2 Story Homes in Cold Climates, Minneapolis, MN

DOE Office of Scientific and Technical Information (OSTI.GOV)

None

This case study describes the External Thermal and Moisture Management System developed by the NorthernSTAR Building America Partnership. This system is typically used in deep energy retrofits and is a valuable approach for the roof-only portions of existing homes, particularly the 1 1/2-story home. It is effective in reducing energy loss through the building envelope, improving building durability, reducing ice dams, and providing opportunities to improve occupant comfort and health.

Improving the knowledge of labour and delivery nurses in India: a randomized controlled trial of mentoring and case sheets in primary care centres.

PubMed

Bradley, Janet; Jayanna, Krishnamurthy; Shaw, Souradet; Cunningham, Troy; Fischer, Elizabeth; Mony, Prem; Ramesh, B M; Moses, Stephen; Avery, Lisa; Crockett, Maryanne; Blanchard, James F

2017-01-07

Birthing in health facilities in India has increased over the last few years, yet maternal and neonatal mortality rates remain high. Clinical mentoring with case sheets or checklists for nurses is viewed as essential for on-going knowledge transfer, particularly where basic training is inadequate. This paper summarizes a study of the effect of such a programme on staff knowledge and skills in a randomized trial of 295 nurses working in 108 Primary Health Centres (PHCs) in Karnataka, India. Stratifying by district, half of the PHCs were randomly assigned to be intervention sites and provided with regular mentoring visits where case sheet/checklists were a central job and teaching aid, and half to be control sites, where no support was provided except provision of case sheets. Nurses' knowledge and skills around normal labour, labour complications and neonate issues were tested before the intervention began and again one year later. Univariate and multivariate analyses were conducted to examine the effect of mentoring and case sheets. Overall, on none of the 3 measures, did case sheet use without mentoring add anything to the basic nursing training when controlling for other factors. Only individuals who used both case-sheets and received mentoring scored significantly higher on the normal labour and neonate indices, scoring almost twice as high as those who only used case-sheets. This group was also associated with significantly higher scores on the complications of labour index, with their scores 2.3 times higher on average than the case sheet only control group. Individuals from facilities with 21 or more deliveries in a month tended to fare worse on all 3 indices. There were no differences in outcomes according to district or years of experience. This study demonstrates that provision of case sheets or checklists alone is insufficient to improve knowledge and practices. However, on-site mentoring in combination with case sheets can have a demonstrable effect on improving nurse knowledge and skills around essential obstetric and neonatal care in remote rural areas of India. We recommend scaling up of this mentoring model in order to improve staff knowledge and skills and reduce maternal and neonatal mortality in India. This study is registered at clinicaltrials.gov, Identifier No. NCT02004912 , November 27, 2013.

Interventions aimed at improving the ability to use everyday technology in work after brain injury.

PubMed

Kassberg, Ann-Charlotte; Prellwitz, Maria; Malinowsky, Camilla; Larsson-Lund, Maria

2016-01-01

The aim of this study was to explore and describe how client-centred occupational therapy interventions may support and improve the ability to use everyday technology (ET) in work tasks in people with acquired brain injury (ABI). A qualitative, descriptive multiple-case study was designed, and occupation-based interventions were provided to three working-age participants with ABI. Multiple sources were used to collect data throughout the three intervention processes, including assessments, field notes, and interviews. The Canadian Occupational Performance Measure and the Management of Everyday Technology Assessment were administered before the interventions, after the interventions and at a follow-up session 2-3 months subsequent to the interventions. The three intervention processes initially consisted of similar actions, but subsequently the actions took on a different focus and intensity for each case. All of the goals in each of the three case processes were achieved, and both perceived and observed abilities to use ET in work tasks improved. Client-centred occupational therapy interventions might have the potential to improve the ability to use ET in work tasks in people with ABI.

Improved survival after stroke: is admission to hospital the major explanation? Trend analyses of the Auckland Regional Community Stroke Studies.

PubMed

Carter, Kristie N; Anderson, Craig S; Hackett, Maree L; Barber, P Alan; Bonita, Ruth

2007-01-01

There is uncertainty regarding the impact of changes in stroke care and natural history of stroke in the community. We examined factors responsible for trends in survival after stroke in a series of population-based studies. We used statistical models to assess temporal trends in 28-day and 1-year case fatality after first-ever stroke cases registered in 3 stroke incidence studies undertaken in Auckland, New Zealand, over uniform 12-month calendar periods in 1981-1982 (n = 1,030), 1991-1992 (1,305) and 2001-2002 (1,423). Cox proportional hazards regression was used to evaluate the significance of pre-defined 'patient', 'disease' and 'service/care' factors on these trends. Overall, there was a 40% decline in 28-day case fatality after stroke over the study periods, from 32% (95% confidence interval, 29-35%) in 1981-1982 to 23% (21-25%) in 1991-1992 and then 19% (17-21%) in 2002-2003. Similar relative declines were seen in 1-year case fatality. In regression models, the trends were still significant after adjusting for patient and disease factors. However, further adjustment for care factors (higher hospital admission and neuroimaging) explained most of the improvement in survival. These data show significant downwards trends in case fatality after stroke in Auckland over 20 years, which can largely be attributed to improved stroke care associated with increases in hospital admission and brain imaging during the acute phase of the illness.

Let's Play: The Use of Improv Games in Change Management Training: A Case Study

ERIC Educational Resources Information Center

Rajeev, Priya Nair; Kalpathi, Subramanian

2016-01-01

This paper is based on the concept of Improv games as a promising mechanism and design principle for enhancing an organization's capacity for learning and adaptability. The study explores how Improv games can be used to create a mindset conducive to change, facilitate ideation and guide discussions on bringing about systemic change. In the case…

Critical Thinking in the Business Classroom

ERIC Educational Resources Information Center

Reid, Joanne R.; Anderson, Phyllis R.

2012-01-01

A minicourse in critical thinking was implemented to improve student outcomes in two sessions of a senior-level business course at a Midwestern university. Statistical analyses of two quantitative assessments revealed significant improvements in critical thinking skills. Improvements in student outcomes in case studies and computerized business…

Elective surgical case cancellation in the Veterans Health Administration system: identifying areas for improvement.

PubMed

Argo, Joshua L; Vick, Catherine C; Graham, Laura A; Itani, Kamal M F; Bishop, Michael J; Hawn, Mary T

2009-11-01

This study evaluated elective surgical case cancellation (CC) rates, reasons for these cancellations, and identified areas for improvement within the Veterans Health Administration (VA) system. CC data for 2006 were collected from the scheduling software for 123 VA facilities. Surveys were distributed to 40 facilities (10 highest and 10 lowest CC rates for high- and low-volume facilities). CC reasons were standardized and piloted at 5 facilities. Of 329,784 cases scheduled by 9 surgical specialties, 40,988 (12.4%) were cancelled. CC reasons (9,528) were placed into 6 broad categories: patient (35%), work-up/medical condition change (28%), facility (20%), surgeon (8%), anesthesia (1%), and miscellaneous (8%). Survey results show areas for improvement at the facility level and a standardized list of 28 CC reasons was comprehensive. Interventions that decrease cancellations caused by patient factors, inadequate work-up, and facility factors are needed to reduce overall elective surgical case cancellations.

Effects of case management in community aged care on client and carer outcomes: a systematic review of randomized trials and comparative observational studies

PubMed Central

2012-01-01

Background Case management has been applied in community aged care to meet frail older people’s holistic needs and promote cost-effectiveness. This systematic review aims to evaluate the effects of case management in community aged care on client and carer outcomes. Methods We searched Web of Science, Scopus, Medline, CINAHL (EBSCO) and PsycINFO (CSA) from inception to 2011 July. Inclusion criteria were: no restriction on date, English language, community-dwelling older people and/or carers, case management in community aged care, published in refereed journals, randomized control trials (RCTs) or comparative observational studies, examining client or carer outcomes. Quality of studies was assessed by using such indicators as quality control, randomization, comparability, follow-up rate, dropout, blinding assessors, and intention-to-treat analysis. Two reviewers independently screened potentially relevant studies, extracted information and assessed study quality. A narrative summary of findings were presented. Results Ten RCTs and five comparative observational studies were identified. One RCT was rated high quality. Client outcomes included mortality (7 studies), physical or cognitive functioning (6 studies), medical conditions (2 studies), behavioral problems (2 studies) , unmet service needs (3 studies), psychological health or well-being (7 studies) , and satisfaction with care (4 studies), while carer outcomes included stress or burden (6 studies), satisfaction with care (2 studies), psychological health or well-being (5 studies), and social consequences (such as social support and relationships with clients) (2 studies). Five of the seven studies reported that case management in community aged care interventions significantly improved psychological health or well-being in the intervention group, while all the three studies consistently reported fewer unmet service needs among the intervention participants. In contrast, available studies reported mixed results regarding client physical or cognitive functioning and carer stress or burden. There was also limited evidence indicating significant effects of the interventions on the other client and carer outcomes as described above. Conclusions Available evidence showed that case management in community aged care can improve client psychological health or well-being and unmet service needs. Future studies should investigate what specific components of case management are crucial in improving clients and their carers’ outcomes. PMID:23151143

Daylighting in Schools: Improving Student Performance and Health at a Price Schools Can Afford.

ERIC Educational Resources Information Center

Plympton, Patricia; Conway, Susan; Epstein, Kyra

This document discusses evidence regarding daylighting and student performance and development, and presents four case studies of schools that have cost effectively implemented daylighting into their buildings. Case studies reveal that design and construction strategies that incorporate daylighting do not significantly increase costs over…

Compressed Air System Redesign Results in Increased Production at a Fuel System Plant (Caterpillar Fuel Systems Pontiac Plant)

DOE Office of Scientific and Technical Information (OSTI.GOV)

None

2001-06-01

This case study is one in a series on industrial firms who are implementing energy efficient technologies and system improvements into their manufacturing processes. This case study documents the activities, savings, and lessons learned on the Caterpillar's Pontiac Plant project.

Relegation and Reversion: Longitudinal Analysis of School Turnaround and Decline

ERIC Educational Resources Information Center

Hochbein, Craig

2012-01-01

School turnaround has become a popular strategy for improvement of chronically low-performing schools. Research related to school turnaround has relied substantially upon case studies. These case studies often focus on successful turnarounds and report immediate outcomes, failing to provide information about the sustainability of the results. In…

Schools Where Parents Make A Difference.

ERIC Educational Resources Information Center

Davies, Don, Ed.

This book presents 11 case studies that demonstrate successful efforts to improve education through building new relationships between schools and communities. In addition to presenting the case studies, the book also contains an introductory chapter that discusses the potentials and pitfalls of local efforts at participatory democracy, as well as…

Empowering Students through Organizational Empathy: Multiple Case Study Methodology

ERIC Educational Resources Information Center

Williams, Daniel

2017-01-01

This dissertation in practice employed a multiple case study design to better understand how two executive directors within a national network of arts and technology educational organizations defined, nurtured, and measured empathy with in their students. Empathy can connect diverse people and improve relationships, and it has been proven to…

Exploring Professors' Engaging Instructional Practices: A Collective Case Study

ERIC Educational Resources Information Center

Arghode, Vishal; Wang, Jia; Lathan, Ann

2017-01-01

Professors use various strategies to improve learning. To explore what professors perceived as critical aspects of engaging instruction, we conducted a qualitative case study with seven professors in the United States. Data was collected through individual face-to-face interviews. The conversations were audio-taped and transcribed verbatim. The…

A New Lean Paradigm in Higher Education: A Case Study

ERIC Educational Resources Information Center

Doman, Mark S.

2011-01-01

Purpose: This case study aims to demonstrate that lean principles and practices utilized in industry can be successfully applied to improve higher education administrative processes through an innovative and engaging learning experience involving undergraduate students. Design/methodology/approach: This is a first-hand account by the instructor of…

Blended and Online Learning: Student Perceptions and Performance

ERIC Educational Resources Information Center

Adam, Stewart; Nel, Deon

2009-01-01

Purpose: The purpose of this paper is to improve educator knowledge of the antecedents and consequences of blended learning in higher education. Design/methodology/approach: A longitudinal case study approach is adopted. Three case studies each involve tracking a student evaluations of teaching (SET) measure (willingness to recommend) and grade…

Catching a Wave: An Australian Case Study on Building Competence in Search of Competitive Advantage.

ERIC Educational Resources Information Center

Kellie, Deborah

1998-01-01

A case study of an Australian road construction company's skill development project is an example of an attempt to increase competitive advantage through competency acquisition. It remains to be seen whether reconstruction of the company will result in improved productivity and financial performance. (SK)

A Recap of the 2011 ISPI University Case Study Competition

ERIC Educational Resources Information Center

Hicks, Karen; Blake, Anne

2012-01-01

In early 2011, the International Society for Performance Improvement (ISPI) invited three universities--University of North Carolina, Charlotte; Purdue University; and Wayne State University--to participate in the third annual University Human Performance Technology (HPT) Case Study Competition. Each university put together a team of three or four…

Relationship Enhancement Therapy: A Case Study for Treating Vaginismus.

ERIC Educational Resources Information Center

Harman, Marsha J.; And Others

1994-01-01

A case study of Relationship Enhancement (RE) therapy with a couple, in which the woman was identified as having vaginismus, is presented including excerpts of transcripts from the therapy sessions. RE's effectiveness at improving communication skills and providing structure in which the couple could discuss the intimate issues affecting the…

Air Quality Analysis of a Multilevel Complex Interchange : Case Study Using the Improved TSC/EPA Model

DOT National Transportation Integrated Search

1976-12-01

This report describes a case study of an air quality analysis prepared by the U.S. Department of Transportation (DOT), Transportation Systems Center (TSC). The site analyzed was the proposed I-83/I-95 interchange in Baltimore, Maryland. This intercha...

Case-Cohort Studies: Design and Applicability to Hand Surgery.

PubMed

Vojvodic, Miliana; Shafarenko, Mark; McCabe, Steven J

2018-04-24

Observational studies are common research strategies in hand surgery. The case-cohort design offers an efficient and resource-friendly method for risk assessment and outcomes analysis. Case-cohorts remain underrepresented in upper extremity research despite several practical and economic advantages over case-control studies. This report outlines the purpose, utility, and structure of the case-cohort design and offers a sample research question to demonstrate its value to risk estimation for adverse surgical outcomes. The application of well-designed case-cohort studies is advocated in an effort to improve the quality and quantity of observational research evidence in hand and upper extremity surgery. Copyright © 2018 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Lessons learned from measuring safety culture: an Australian case study.

PubMed

Allen, Suellen; Chiarella, Mary; Homer, Caroline S E

2010-10-01

adverse events in maternity care are relatively common but often avoidable. International patient safety strategies advocate measuring safety culture as a strategy to improve patient safety. Evidence suggests it is necessary to fully understand the safety culture of an organisation to make improvements to patient safety. this paper reports a case study examining the safety culture in one maternity service in Australia and considers the benefits of using surveys and interviews to understand safety culture as an approach to identify possible strategies to improve patient safety in this setting. the study took place in one maternity service in two public hospitals in NSW, Australia. Concurrently, both hospitals were undergoing an organisational restructure which was part of a major health reform agenda. The priorities of the reform included improving the quality of care and patient safety; and, creating a more efficient health system by reducing administration inefficiencies and duplication. a descriptive case study using three approaches: the safety culture was identified to warrant improvement across all six safety culture domains. There was reduced infrastructure and capacity to support incident management activities required to improve safety, which was influenced by instability from the organisational restructure. There was a perceived lack of leadership at all levels to drive safety and quality and improving the safety culture was neither a key priority nor was it valued by the organisation. the safety culture was complex as was undertaking this study. We were unable to achieve a desired 60% response rate highlighting the limitations of using safety culture surveys in isolation as a strategy to improve safety culture. Qualitative interviews provided greater insight into the factors influencing the safety culture. The findings of this study provide evidence of the benefits of including qualitative methods with quantitative surveys when examining safety culture. Undertaking research in this way requires local engagement, commitment and capacity from the study site. The absence of these factors is likely to limit the practicality of this approach in the clinical setting. the use of safety culture surveys as the only method of assessing safety culture is of limited value in identifying strategies to potentially improve the safety culture. Copyright © 2010 Elsevier Ltd. All rights reserved.

Does a Case-Based Online Group Project Increase Students' Satisfaction with Interaction in Online Courses?

ERIC Educational Resources Information Center

Lee, Sang Joon; Ngampornchai, Anchalee; Trail-Constant, Trudian; Abril, Andres; Srinivasan, Sandhya

2016-01-01

Due to the realistic, complex natures of authentic cases involved in case-based learning, the use of group work has been encouraged and expected to enhance the quality of interaction among participants and to improve students' learning experiences. The purpose of this study was to investigate whether the case-based online group work increased…

Improving first case start times using Lean in an academic medical center.

PubMed

Deldar, Romina; Soleimani, Tahereh; Harmon, Carol; Stevens, Larry H; Sood, Rajiv; Tholpady, Sunil S; Chu, Michael W

2017-06-01

Lean is a process improvement strategy that can improve efficiency of the perioperative process. The purpose of this study was to identify etiologies of late surgery start times, implement Lean interventions, and analyze their effects. A retrospective review of all first-start surgery cases was performed. Lean was implemented in May 2015, and cases 7 months before and after implementation were analyzed. A total of 4,492 first-start cases were included; 2,181 were pre-Lean and 2,311 were post-Lean. The post-Lean group had significantly higher on-time starts than the pre-Lean group (69.0% vs 57.0%, P < .01). The most common delay etiology was surgeon-related for both groups. Delayed post-Lean cases were significantly less likely to be due to preoperative assessment (14.9% vs 9.9%, P < .01) and more likely due to patient-related (16.5% vs 22.3%, P < .01) or chaplain (1.8% vs 4.0%, P < .01) factors. Delayed starts occurred more often on snowy and cold days, and less often on didactic days (P < .01). Modifying preoperative tasks using Lean methods can improve operating room efficiency and increase on-time starts. Copyright © 2016 Elsevier Inc. All rights reserved.

EMS Response to Mass Casualty Incidents: The Critical Importance of Automatic Statewide Mutual Aid and MCI Training

DTIC Science & Technology

2008-09-01

difficulty in implementation for each case study. After an overview, each case study is given a score against each of the criteria of “meets” or “exceeds...While expectations may be different for different individuals, the narrative section provides supporting information for the assigned score , with...decrease in response time will improve patient outcome? The narrative discussing the score will give information from the case study on the specific

Improving publicly funded substance abuse treatment: the value of case management.

PubMed Central

Shwartz, M; Baker, G; Mulvey, K P; Plough, A

1997-01-01

OBJECTIVES: This study evaluated the impact of case management on client retention in treatment and short-term relapse for clients in the publicly funded substance abuse treatment system. METHODS: A retrospective cohort design was used to study clients discharged from the following four modalities in 1993 and 1994: short-term residential (3112 clients), long-term residential (2888 clients), outpatient (7431 clients), and residential detox (7776 clients). Logistic regression models were used to analyze the impact of case management after controlling for baseline characteristics. RESULTS: The odds that case-managed clients reached a length of stay previously identified as associated with more successful treatment were 1.6 (outpatient programs) to 3.6 (short-term residential programs) times higher than the odds for non-case-managed clients. With the exception of outpatient clients, the odds of case-managed clients' being admitted to detox within 90 days after discharge (suggesting relapse) were about two thirds those of non-case-managed clients. The odds of case-managed detox clients' transitioning to post-detox treatment (a good outcome) were 1.7 times higher than the odds for non-case-managed clients. CONCLUSIONS: Case management is a low-cost enhancement that improves short-term outcomes of substance abuse treatment programs. PMID:9357349

Using iterative learning to improve understanding during the informed consent process in a South African psychiatric genomics study.

PubMed

Campbell, Megan M; Susser, Ezra; Mall, Sumaya; Mqulwana, Sibonile G; Mndini, Michael M; Ntola, Odwa A; Nagdee, Mohamed; Zingela, Zukiswa; Van Wyk, Stephanus; Stein, Dan J

2017-01-01

Obtaining informed consent is a great challenge in global health research. There is a need for tools that can screen for and improve potential research participants' understanding of the research study at the time of recruitment. Limited empirical research has been conducted in low and middle income countries, evaluating informed consent processes in genomics research. We sought to investigate the quality of informed consent obtained in a South African psychiatric genomics study. A Xhosa language version of the University of California, San Diego Brief Assessment of Capacity to Consent Questionnaire (UBACC) was used to screen for capacity to consent and improve understanding through iterative learning in a sample of 528 Xhosa people with schizophrenia and 528 controls. We address two questions: firstly, whether research participants' understanding of the research study improved through iterative learning; and secondly, what were predictors for better understanding of the research study at the initial screening? During screening 290 (55%) cases and 172 (33%) controls scored below the 14.5 cut-off for acceptable understanding of the research study elements, however after iterative learning only 38 (7%) cases and 13 (2.5%) controls continued to score below this cut-off. Significant variables associated with increased understanding of the consent included the psychiatric nurse recruiter conducting the consent screening, higher participant level of education, and being a control. The UBACC proved an effective tool to improve understanding of research study elements during consent, for both cases and controls. The tool holds utility for complex studies such as those involving genomics, where iterative learning can be used to make significant improvements in understanding of research study elements. The UBACC may be particularly important in groups with severe mental illness and lower education levels. Study recruiters play a significant role in managing the quality of the informed consent process.

A Case Study of the Impact of Guided Reading Groups in Second Grade on Comprehension Improvement

ERIC Educational Resources Information Center

Lorent Deegan, Chanin E.

2010-01-01

This study combined both qualitative and quantitative research to determine the impact of instructional practices on comprehension improvement in second grade Guided Reading groups. Four second grade teachers and their 73 students ages seven through eight years old participated in this study. Additionally, the study examined the effects of Guided…

Artifact reduction of different metallic implants in flat detector C-arm CT.

PubMed

Hung, S-C; Wu, C-C; Lin, C-J; Guo, W-Y; Luo, C-B; Chang, F-C; Chang, C-Y

2014-07-01

Flat detector CT has been increasingly used as a follow-up examination after endovascular intervention. Metal artifact reduction has been successfully demonstrated in coil mass cases, but only in a small series. We attempted to objectively and subjectively evaluate the feasibility of metal artifact reduction with various metallic objects and coil lengths. We retrospectively reprocessed the flat detector CT data of 28 patients (15 men, 13 women; mean age, 55.6 years) after they underwent endovascular treatment (20 coiling ± stent placement, 6 liquid embolizers) or shunt drainage (n = 2) between January 2009 and November 2011 by using a metal artifact reduction correction algorithm. We measured CT value ranges and noise by using region-of-interest methods, and 2 experienced neuroradiologists rated the degrees of improved imaging quality and artifact reduction by comparing uncorrected and corrected images. After we applied the metal artifact reduction algorithm, the CT value ranges and the noise were substantially reduced (1815.3 ± 793.7 versus 231.7 ± 95.9 and 319.9 ± 136.6 versus 45.9 ± 14.0; both P < .001) regardless of the types of metallic objects and various sizes of coil masses. The rater study achieved an overall improvement of imaging quality and artifact reduction (85.7% and 78.6% of cases by 2 raters, respectively), with the greatest improvement in the coiling group, moderate improvement in the liquid embolizers, and the smallest improvement in ventricular shunting (overall agreement, 0.857). The metal artifact reduction algorithm substantially reduced artifacts and improved the objective image quality in every studied case. It also allowed improved diagnostic confidence in most cases. © 2014 by American Journal of Neuroradiology.

Driving Performance Improvements by Integrating Competencies with Human Resource Practices

ERIC Educational Resources Information Center

Lee, Jin Gu; Park, Yongho; Yang, Gi Hun

2010-01-01

This study explores the issues in the development and application of a competency model and provides implications for more precise integration of competencies into human resource (HR) functions driving performance improvement. This research is based on a case study from a Korean consumer corporation. This study employed document reviews,…

Improving the Process of Career Decision Making: An Action Research Approach

ERIC Educational Resources Information Center

Greenbank, Paul

2011-01-01

Purpose: This study adopts an action research approach with the aim of improving the process of career decision making among undergraduates in a business school at a "new" university in the UK. Design/methodology/approach: The study utilised unfreezing techniques, multiple case studies in conjunction with the principle of analogical…

An Analysis of a Plan to Improve Graduation Rates in Johnston County Schools

ERIC Educational Resources Information Center

Renfrow, David Ross

2015-01-01

There have been limited qualitative case studies exploring effective strategies designed to improve graduation rates in rural school districts. Specifically, few studies have presented information based solely upon the voices of practitioners themselves in solving the graduation crisis in America's public schools. This study will add to the…

Improving the Textbook Selection Process: Case Studies of the Textbook Adoption Guidelines Project. Technical Report No. 478.

ERIC Educational Resources Information Center

Dole, Janice; And Others

A study followed three textbook adoption committees as they evaluated basal reading programs. The committees used "A Guide to Selecting Basal Reading Programs" (developed at the Center for the Study of Reading) to help them evaluate the quality of instruction in existing programs. Case studies of the three committees sought to address the…

Resource Allocation and Educational Adequacy: Case Studies of School-Level Resource Use in Southern California with Budget Reductions

ERIC Educational Resources Information Center

Hobbs, Alysia Jocelyn

2010-01-01

This study selected a purposeful sample of eight high performing southern California elementary schools which achieved API scores above 900 over a three year period. A review of instructional strategies for each study school during the improvement process and resource allocation patterns was determined. Case studies of each school include…

Improving the timeliness of procedures in a pediatric endoscopy suite.

PubMed

Tomer, Gitit; Choi, Steven; Montalvo, Andrea; Sutton, Sheila; Thompson, John; Rivas, Yolanda

2014-02-01

Pediatric endoscopic procedures are essential in the evaluation and treatment of gastrointestinal diseases in children. Although pediatric endoscopists are greatly interested in increasing efficiency and through-put in pediatric endoscopy units, there is scarcely any literature on this critical process. The goal of this study was to improve the timeliness of pediatric endoscopy procedures at Children's Hospital at Montefiore. In June 2010, a pediatric endoscopy quality improvement initiative was formed at Children's Hospital at Montefiore. We identified patient-, equipment-, and physician-related causes for case delays. Pareto charts, cause and effect diagrams, process flow mapping, and statistical process control charts were used for analysis. From June 2010 to December 2012, we were able to significantly decrease the first case endoscopy delay from an average of 17 to 10 minutes (P < .001), second case delay from 39 to 25 minutes (P = .01), third case delay from 61 to 45 minutes (P = .05), and fourth case delay from 79 to 51 minutes (P = .05). Total delay time decreased from 196 to 131 minutes, resulting in a reduction of 65 minutes (P = .02). From June 2010 to August 2011 (preintervention period), an average of 36% of first endoscopy cases started within 5 minutes, 51% within 10 minutes, and 61% within 15 minutes of the scheduled time. From September 2011 to December 2012 (postintervention period), the percentage of cases starting within 5 minutes, 10 minutes, and 15 minutes increased to 47% (P = .07), 61% (P = .04), and 79% (P = .01), respectively. Applying quality improvement methods and tools helped improve pediatric endoscopy timeliness and significantly decreased total delays.

The impact of protocol on nurses' role stress: a longitudinal perspective.

PubMed

Dodd-McCue, Diane; Tartaglia, Alexander; Veazey, Kenneth W; Streetman, Pamela S

2005-04-01

The study examined the impact of a protocol directed at increasing organ donation on the role stress and work attitudes of critical care nurses involved in potential organ donation cases. The research examined whether the protocol could positively affect nurses' perceptions of role stress, and if so, could the work environment improvements be sustained over time. The Family Communication Coordinator (FCC) protocol promotes effective communication during potential organ donation cases using a multidisciplinary team approach. Previous research found it associated with improved donation outcomes and with improved perceptions of role stress by critical care nurses. However, the previous study lacked methodological rigor necessary to determine causality and sustainability over time. The study used a quasi-experimental prospective longitudinal design. The sample included critical care nurses who had experience with potential organ donation cases with the protocol. Survey data were collected at 4 points over 2 years. Surveys used previously validated and reliable measures of role stress (role ambiguity, role conflict, role overload) and work attitudes (commitment, satisfaction). Interviews supplemented these data. The nurses' perceptions of role stress associated with potential organ donation cases dramatically dropped after the protocol was implemented. All measures of role stress, particularly role ambiguity and role conflict, showed statistically significant and sustained improvement. Nurses' professional, unit, and hospital commitment and satisfaction reflect an increasingly positive workplace. The results demonstrate that the FCC protocol positively influenced the workplace through its impact on role stress over the first 2 years following its implementation. The findings suggest that similar protocols may be appropriate in improving the critical care environment by reducing the stress and uncertainty of professionals involved in other end-of-life situations. However, the most striking implication relates to the reality of the workplace: meeting the goals of improved patient care outcomes and those of improving the healthcare work environment are not mutually exclusive and may be mutually essential.

Comparative analysis of maize (Zea mays) crop performance: natural variation, incremental improvements and economic impacts.

PubMed

Leibman, Mark; Shryock, Jereme J; Clements, Michael J; Hall, Michael A; Loida, Paul J; McClerren, Amanda L; McKiness, Zoe P; Phillips, Jonathan R; Rice, Elena A; Stark, Steven B

2014-09-01

Grain yield from maize hybrids continues to improve through advances in breeding and biotechnology. Despite genetic improvements to hybrid maize, grain yield from distinct maize hybrids is expected to vary across growing locations due to numerous environmental factors. In this study, we examine across-location variation in grain yield among maize hybrids in three case studies. The three case studies examine hybrid improvement through breeding, introduction of an insect protection trait or introduction of a transcription factor trait associated with increased yield. In all cases, grain yield from each hybrid population had a Gaussian distribution. Across-location distributions of grain yield from each hybrid partially overlapped. The hybrid with a higher mean grain yield typically outperformed its comparator at most, but not all, of the growing locations (a 'win rate'). These results suggest that a broad set of environmental factors similarly impacts grain yields from both conventional- and biotechnology-derived maize hybrids and that grain yields among two or more hybrids should be compared with consideration given to both mean yield performance and the frequency of locations at which each hybrid 'wins' against its comparators. From an economic standpoint, growers recognize the value of genetically improved maize hybrids that outperform comparators in the majority of locations. Grower adoption of improved maize hybrids drives increases in average U.S. maize grain yields and contributes significant value to the economy. © 2014 Society for Experimental Biology, Association of Applied Biologists and John Wiley & Sons Ltd.

Case Study: Fort Mill High School--A Culture of Continuous Improvement

ERIC Educational Resources Information Center

Southern Regional Education Board (SREB), 2014

2014-01-01

This is the latest in a series of case studies highlighting best practices High Schools That Work (HSTW) network schools and districts are implementing to prepare students better for further studies and careers. Fort Mill High School is in Fort Mill, South Carolina, an outlying suburb of Charlotte, North Carolina. Fort Mill links high quality…

A Qualitative Evaluation of the Use of Multimedia Case Studies in an Introductory Engineering Course at Two Southeastern Universities

ERIC Educational Resources Information Center

Huett, Kim C.; Kawulich, Barbara

2015-01-01

Collaborating at two universities to improve teaching and learning in undergraduate engineering, an interdisciplinary team of researchers, instructors, and evaluators planned and implemented the use of multimedia case studies with students enrolled in an introductory engineering course. This qualitative action evaluation study focuses on results…

Social Skills Training for Adolescents with Asperger's Syndrome Using a Consultation Model

ERIC Educational Resources Information Center

Minihan, Aileen; Kinsella, William; Honan, Rita

2011-01-01

A case study design was used to evaluate the effectiveness of behavioural consultation as a method for improving the social skills of adolescents with Asperger's syndrome. Two case studies were conducted. In each study, two teachers implemented a social skills programme with two to three adolescents with Asperger's syndrome in a group setting with…

The Heart of School Improvement: A Multi-Site Case Study of Leadership for Teacher Learning in Vietnam

ERIC Educational Resources Information Center

Tran, Ngoc H.; Hallinger, Philip; Truong, Thang

2018-01-01

This study addressed the research question: How do Vietnamese principals lead the professional learning of teachers? The research was comprised of a multiple-site case study of leadership and teacher learning in four Vietnamese schools. Qualitative data analysis aimed at identifying modal practices adopted by these Vietnamese principals to lead…

Student's Plagiarisms in Higher Learning Institutions in the Era of Improved Internet Access: Case Study of Developing Countries

ERIC Educational Resources Information Center

Anney, Vicent Naano; Mosha, Mary Atanas

2015-01-01

This study investigated students' plagiarism practices in Tanzania higher learning institutions by involving two universities-one public and one private university as a case study. The universities involved have honour code and policies for plagiarism detection however they do not employ software for checking students' plagiarism. The study…

The Effect of Tomatis Therapy on Children with Autism: Eleven Case Studies

ERIC Educational Resources Information Center

Gerritsen, Jan

2010-01-01

This article presents a reanalysis of a previously reported study on the impact of the Tomatis Method of auditory stimulation on subjects with autism. When analyzed as individual case studies, the data showed that six of the 11 subjects with autism demonstrated significant improvement from 90 hours of Tomatis Therapy. Five subjects did not benefit…

Making School Work in a Changing World: Tatitlek Community School. Case Study.

ERIC Educational Resources Information Center

Landis, Sarah

As part of a larger study of systemic educational reform in rural Alaska, this case study examines the implementation of the Alaska Onward to Excellence (AOTE) improvement process in the village of Tatitlek in south-central Alaska. The village has about 100 residents, mostly of Alutiiq heritage (Native peoples of Prince William Sound). A…

Evaluating the Effects of Medical Explorers a Case Study Curriculum on Critical Thinking, Attitude toward Life Science, and Motivational Learning Strategies in Rural High School Students

ERIC Educational Resources Information Center

Brand, Lance G.

2011-01-01

The purpose of this study was three-fold: to measure the ability of the "Medical Explorers" case-based curriculum to improve higher order thinking skills; to evaluate the impact of the "Medical Explorers" case-based curriculum to help students be self directed learners; and to investigate the impact of the "Medical…

Improving Initiation and Tracking of Research Projects at an Academic Health Center: A Case Study.

PubMed

Schmidt, Susanne; Goros, Martin; Parsons, Helen M; Saygin, Can; Wan, Hung-Da; Shireman, Paula K; Gelfond, Jonathan A L

2017-09-01

Research service cores at academic health centers are important in driving translational advancements. Specifically, biostatistics and research design units provide services and training in data analytics, biostatistics, and study design. However, the increasing demand and complexity of assigning appropriate personnel to time-sensitive projects strains existing resources, potentially decreasing productivity and increasing costs. Improving processes for project initiation, assigning appropriate personnel, and tracking time-sensitive projects can eliminate bottlenecks and utilize resources more efficiently. In this case study, we describe our application of lean six sigma principles to our biostatistics unit to establish a systematic continual process improvement cycle for intake, allocation, and tracking of research design and data analysis projects. The define, measure, analyze, improve, and control methodology was used to guide the process improvement. Our goal was to assess and improve the efficiency and effectiveness of operations by objectively measuring outcomes, automating processes, and reducing bottlenecks. As a result, we developed a web-based dashboard application to capture, track, categorize, streamline, and automate project flow. Our workflow system resulted in improved transparency, efficiency, and workload allocation. Using the dashboard application, we reduced the average study intake time from 18 to 6 days, a 66.7% reduction over 12 months (January to December 2015).

Countdown to 2015 country case studies: what can analysis of national health financing contribute to understanding MDG 4 and 5 progress?

PubMed

Mann, Carlyn; Ng, Courtney; Akseer, Nadia; Bhutta, Zulfiqar A; Borghi, Josephine; Colbourn, Tim; Hernández-Peña, Patricia; Huicho, Luis; Malik, Muhammad Ashar; Martinez-Alvarez, Melisa; Munthali, Spy; Salehi, Ahmad Shah; Tadesse, Mekonnen; Yassin, Mohammed; Berman, Peter

2016-09-12

Countdown to 2015 (Countdown) supported countries to produce case studies that examine how and why progress was made toward the Millennium Development Goals (MDGs) 4 and 5. Analysing how health-financing data explains improvements in RMNCH outcomes was one of the components to the case studies. This paper presents a descriptive analysis on health financing from six Countdown case studies (Afghanistan, Ethiopia, Malawi, Pakistan, Peru, and Tanzania), supplemented by additional data from global databases and country reports on macroeconomic, health financing, demographic, and RMNCH outcome data as needed. It also examines the effect of other contextual factors presented in the case studies to help interpret health-financing data. Dramatic increases in health funding occurred since 2000, where the MDG agenda encouraged countries and donors to invest more resources on health. Most low-income countries relied on external support to increase health spending, with an average 20-64 % of total health spending from 2000 onwards. Middle-income countries relied more on government and household spending. RMNCH funding also increased since 2000, with an average increase of 119 % (2005-2010) for RMNH expenditures (2005-2010) and 165 % for CH expenditures (2005-2011). Progress was made, especially achieving MDG 4, even with low per capita spending; ranging from US$16 to US$44 per child under 5 years among low-income countries. Improvements in distal factors were noted during the time frame of the analysis, including rapid economic growth in Ethiopia, Peru, and Tanzania and improvements in female literacy as documented in Malawi, which are also likely to have contributed to MDG progress and achievements. Increases in health and RMNCH funding accompanied improvements in outcomes, though low-income countries are still very reliant on external financing, and out-of-pocket comprising a growing share of funds in middle-income settings. Enhancements in tracking RMNCH expenditures across countries are still needed to better understand whether domestic and global health financing initiatives lead to improved outcomes as RMNCH continues to be a priority under the Sustainable Development Goals.

Effectiveness of case management for homeless persons: a systematic review.

PubMed

de Vet, Renée; van Luijtelaar, Maurice J A; Brilleslijper-Kater, Sonja N; Vanderplasschen, Wouter; Beijersbergen, Mariëlle D; Wolf, Judith R L M

2013-10-01

We reviewed the literature on standard case management (SCM), intensive case management (ICM), assertive community treatment (ACT), and critical time intervention (CTI) for homeless adults. We searched databases for peer-reviewed English articles published from 1985 to 2011 and found 21 randomized controlled trials or quasi-experimental studies comparing case management to other services. We found little evidence for the effectiveness of ICM. SCM improved housing stability, reduced substance use, and removed employment barriers for substance users. ACT improved housing stability and was cost-effective for mentally ill and dually diagnosed persons. CTI showed promise for housing, psychopathology, and substance use and was cost-effective for mentally ill persons. More research is needed on how case management can most effectively support rapid-rehousing approaches to homelessness.

Effectiveness of Case Management for Homeless Persons: A Systematic Review

PubMed Central

de Vet, Renée; van Luijtelaar, Maurice J. A.; Brilleslijper-Kater, Sonja N.; Vanderplasschen, Wouter; Beijersbergen, Mariëlle D.

2013-01-01

We reviewed the literature on standard case management (SCM), intensive case management (ICM), assertive community treatment (ACT), and critical time intervention (CTI) for homeless adults. We searched databases for peer-reviewed English articles published from 1985 to 2011 and found 21 randomized controlled trials or quasi-experimental studies comparing case management to other services. We found little evidence for the effectiveness of ICM. SCM improved housing stability, reduced substance use, and removed employment barriers for substance users. ACT improved housing stability and was cost-effective for mentally ill and dually diagnosed persons. CTI showed promise for housing, psychopathology, and substance use and was cost-effective for mentally ill persons. More research is needed on how case management can most effectively support rapid-rehousing approaches to homelessness. PMID:23947309

Evaluation and perceived results of moral case deliberation: A mixed methods study.

PubMed

Janssens, Rien M J P A; van Zadelhoff, Ezra; van Loo, Ger; Widdershoven, Guy A M; Molewijk, Bert A C

2015-12-01

Moral case deliberation is increasingly becoming part of various Dutch healthcare organizations. Although some evaluation studies of moral case deliberation have been carried out, research into the results of moral case deliberation within aged care is scarce. How did participants evaluate moral case deliberation? What has moral case deliberation brought to them? What has moral case deliberation contributed to care practice? Should moral case deliberation be further implemented and, if so, how? Quantitative analysis of a questionnaire study among participants of moral case deliberation, both caregivers and team leaders. Qualitative analysis of written answers to open questions, interview study and focus group meetings among caregivers and team leaders. Caregivers and team leaders in a large organization for aged care in the Netherlands. A total of 61 moral case deliberation sessions, carried out on 16 care locations belonging to the organization, were evaluated and perceived results were assessed. Participants gave informed consent and anonymity was guaranteed. In the Netherlands, the law does not prescribe independent ethical review by an Institutional Review Board for this kind of research among healthcare professionals. Moral case deliberation was evaluated positively by the participants. Content and atmosphere of moral case deliberation received high scores, while organizational issues regarding the moral case deliberation sessions scored lower and merit further attention. Respondents indicated that moral case deliberation has the potential to contribute to care practice as relationships among team members improve, more openness is experienced and more understanding for different perspectives is fostered. If moral case deliberation is to be successfully implemented, top-down approaches should go hand in hand with bottom-up approaches. The relevance of moral case deliberation for care practice received wide acknowledgement from the respondents. It can contribute to the team's cohesion as mutual understanding for one another's views is fostered. If implemented well, moral case deliberation has the potential to improve care, according to the respondents. © The Author(s) 2014.

Systems-Oriented Workplace Learning Experiences for Early Learners: Three Models.

PubMed

O'Brien, Bridget C; Bachhuber, Melissa R; Teherani, Arianne; Iker, Theresa M; Batt, Joanne; O'Sullivan, Patricia S

2017-05-01

Early workplace learning experiences may be effective for learning systems-based practice. This study explores systems-oriented workplace learning experiences (SOWLEs) for early learners to suggest a framework for their development. The authors used a two-phase qualitative case study design. In Phase 1 (spring 2014), they prepared case write-ups based on transcribed interviews from 10 SOWLE leaders at the authors' institution and, through comparative analysis of cases, identified three SOWLE models. In Phase 2 (summer 2014), studying seven 8-week SOWLE pilots, the authors used interview and observational data collected from the seven participating medical students, two pharmacy students, and site leaders to construct case write-ups of each pilot and to verify and elaborate the models. In Model 1, students performed specific patient care activities that addressed a system gap. Some site leaders helped students connect the activities to larger systems problems and potential improvements. In Model 2, students participated in predetermined systems improvement (SI) projects, gaining experience in the improvement process. Site leaders had experience in SI and often had significant roles in the projects. In Model 3, students worked with key stakeholders to develop a project and conduct a small test of change. They experienced most elements of an improvement cycle. Site leaders often had experience with SI and knew how to guide and support students' learning. Each model could offer systems-oriented learning opportunities provided that key elements are in place including site leaders facile in SI concepts and able to guide students in SOWLE activities.

Strategy for the Management of Macular Edema in Retinal Vein Occlusion: The European VitreoRetinal Society Macular Edema Study

PubMed Central

Adelman, Ron A.; Parnes, Aaron J.; Bopp, Silvia; Saad Othman, Ihab; Ducournau, Didier

2015-01-01

Objective. To compare the efficacy of different therapies in the treatment of macular edema associated with retinal vein occlusion (RVO). Design. This is a nonrandomized, multicenter collaborative study. Participants. 86 retina specialists from 29 countries provided clinical information, including choice of treatment and outcome, on 2,603 patients with macular edema including 738 cases of RVO. Methods. Reported data included the type and number of treatments performed, visual acuities, and other clinical and diagnostic findings. Main Outcome Measures. The mean increase in visual acuity and mean number of treatments performed. Results. 358 cases of central retinal vein occlusion (CRVO) and 380 cases of branch retinal vein occlusion (BRVO) were included in this investigation. Taking all RVO cases together, pars plana vitrectomy with internal limiting membrane (ILM) peeling alone resulted in an improvement in vision greater than other therapies. Those treated with intravitreal antivascular endothelial growth factor (anti-VEGF) injection alone showed the second greatest improvement in vision. Dexamethasone intravitreal implant alone and intravitreal triamcinolone alone both resulted in modest visual gains. Conclusions. In the treatment of macular edema in RVO, vitrectomy with ILM peeling may achieve visual improvement and may be a good option for certain cases. Anti-VEGF injection is the most effective of the nonsurgical treatments. PMID:25705695

Strategy for the management of macular edema in retinal vein occlusion: the European VitreoRetinal Society macular edema study.

PubMed

Adelman, Ron A; Parnes, Aaron J; Bopp, Silvia; Saad Othman, Ihab; Ducournau, Didier

2015-01-01

To compare the efficacy of different therapies in the treatment of macular edema associated with retinal vein occlusion (RVO). This is a nonrandomized, multicenter collaborative study. 86 retina specialists from 29 countries provided clinical information, including choice of treatment and outcome, on 2,603 patients with macular edema including 738 cases of RVO. Reported data included the type and number of treatments performed, visual acuities, and other clinical and diagnostic findings. The mean increase in visual acuity and mean number of treatments performed. 358 cases of central retinal vein occlusion (CRVO) and 380 cases of branch retinal vein occlusion (BRVO) were included in this investigation. Taking all RVO cases together, pars plana vitrectomy with internal limiting membrane (ILM) peeling alone resulted in an improvement in vision greater than other therapies. Those treated with intravitreal antivascular endothelial growth factor (anti-VEGF) injection alone showed the second greatest improvement in vision. Dexamethasone intravitreal implant alone and intravitreal triamcinolone alone both resulted in modest visual gains. In the treatment of macular edema in RVO, vitrectomy with ILM peeling may achieve visual improvement and may be a good option for certain cases. Anti-VEGF injection is the most effective of the nonsurgical treatments.

Continuous Quality Improvement: A Roadmap for Rural School Improvement.

ERIC Educational Resources Information Center

Kilmer, Lloyd C.

A case study documented a continuous quality improvement approach to school improvement in a rural Nebraska high school over a 2-year period. Data gathered from surveys, portfolios, pilot results, and test scores indicated that the changes during the 2-year period were not dramatic, but significant and consistent with the Total Quality literature.…

Training to Improve New Product Sales Performance: The Case of Samsung in China

ERIC Educational Resources Information Center

Fu, Frank Q.; Yi, Hong; Zhai, Nanji

2013-01-01

The authors report a case study conducted with over 8,000 Samsung salespeople in the Chinese market. Using research-oriented, evidence-based, and systematic approaches, training professionals contributed to Samsung's business outcomes at multiple levels. The case highlights the valuable impacts of training on salespeople's behaviors and new…

Priority-setting and hospital strategic planning: a qualitative case study.

PubMed

Martin, Douglas; Shulman, Ken; Santiago-Sorrell, Patricia; Singer, Peter

2003-10-01

To describe and evaluate the priority-setting element of a hospital's strategic planning process. Qualitative case study and evaluation against the conditions of 'accountability for reasonableness' of a strategic planning process at a large urban university-affiliated hospital. The hospital's strategic planning process met the conditions of 'accountability for reasonableness' in large part. Specifically: the hospital based its decisions on reasons (both information and criteria) that the participants felt were relevant to the hospital; the number and type of participants were very extensive; the process, decisions and reasons were well communicated throughout the organization, using multiple communication vehicles; and the process included an ethical framework linked to an effort to evaluate and improve the process. However, there were opportunities to improve the process, particularly by giving participants more time to absorb the information relevant to priority-setting decisions, more time to take difficult decisions and some means to appeal or revise decisions. A case study linked to an evaluation using 'accountability for reasonableness' can serve to improve priority-setting in the context of hospital strategic planning.

Two-Step Optimization for Spatial Accessibility Improvement: A Case Study of Health Care Planning in Rural China

PubMed Central

Luo, Jing; Tian, Lingling; Luo, Lei; Yi, Hong

2017-01-01

A recent advancement in location-allocation modeling formulates a two-step approach to a new problem of minimizing disparity of spatial accessibility. Our field work in a health care planning project in a rural county in China indicated that residents valued distance or travel time from the nearest hospital foremost and then considered quality of care including less waiting time as a secondary desirability. Based on the case study, this paper further clarifies the sequential decision-making approach, termed “two-step optimization for spatial accessibility improvement (2SO4SAI).” The first step is to find the best locations to site new facilities by emphasizing accessibility as proximity to the nearest facilities with several alternative objectives under consideration. The second step adjusts the capacities of facilities for minimal inequality in accessibility, where the measure of accessibility accounts for the match ratio of supply and demand and complex spatial interaction between them. The case study illustrates how the two-step optimization method improves both aspects of spatial accessibility for health care access in rural China. PMID:28484707

Two-Step Optimization for Spatial Accessibility Improvement: A Case Study of Health Care Planning in Rural China.

PubMed

Luo, Jing; Tian, Lingling; Luo, Lei; Yi, Hong; Wang, Fahui

2017-01-01

A recent advancement in location-allocation modeling formulates a two-step approach to a new problem of minimizing disparity of spatial accessibility. Our field work in a health care planning project in a rural county in China indicated that residents valued distance or travel time from the nearest hospital foremost and then considered quality of care including less waiting time as a secondary desirability. Based on the case study, this paper further clarifies the sequential decision-making approach, termed "two-step optimization for spatial accessibility improvement (2SO4SAI)." The first step is to find the best locations to site new facilities by emphasizing accessibility as proximity to the nearest facilities with several alternative objectives under consideration. The second step adjusts the capacities of facilities for minimal inequality in accessibility, where the measure of accessibility accounts for the match ratio of supply and demand and complex spatial interaction between them. The case study illustrates how the two-step optimization method improves both aspects of spatial accessibility for health care access in rural China.

FSH treatment in infertile males candidate to assisted reproduction improved sperm DNA fragmentation and pregnancy rate.

PubMed

Garolla, Andrea; Ghezzi, Marco; Cosci, Ilaria; Sartini, Barbara; Bottacin, Alberto; Engl, Bruno; Di Nisio, Andrea; Foresta, Carlo

2017-05-01

The purpose of this study is to evaluate whether follicle-stimulating hormone treatment improves sperm DNA parameters and pregnancy outcome in infertile male candidates to in-vitro fertilization.Observational study in 166 infertile male partners of couples undergoing in-vitro fertilization. Eighty-four patients were receiving follicle-stimulating hormone treatment (cases) and 82 refused treatment (controls). Semen parameters, sexual hormones, and sperm nucleus (fluorescence in-situ hybridization, acridine orange, TUNEL, and γH2AX) were evaluated at baseline (T0) and after 3 months (T1), when all subjects underwent assisted reproduction techniques. Statistical analysis was performed by analysis of variance.Compared to baseline, cases showed significant improvements in seminal parameters and DNA fragmentation indexes after follicle-stimulating hormone therapy (all P < 0.05), whereas no changes were observed in controls. Within cases, follicle-stimulating hormone treatment allowed to perform intrauterine insemination in 35 patients with a pregnancy rate of 23.2 %. Intracytoplasmic sperm injection was performed in all controls and in 49 patients from cases, with pregnancy rates of 23.2 and 40.8 %, respectively (P < 0.05). After 3 months (T0 vs. T1) of follicle-stimulating hormone therapy, cases with positive outcome had reduced DNA fragmentation index and lower double strand breaks (P < 0.05 and P < 0.001 vs. negative outcome, respectively).In this observational study, we showed that follicle-stimulating hormone treatment improves sperm DNA fragmentation, which in turn leads to increased pregnancy rates in infertile males undergoing in-vitro fertilization. In particular, double strand breaks (measured with γH2AX test) emerged as the most sensible parameter to follicle-stimulating hormone treatment in predicting reproductive outcome.

A STUDY ON A COOPERATIVE RELATIONSHIP TO THE IMPROVEMENT OF THE REGIONAL FIRE FIGHTING VALIDITY -Case Study in Bangkok, Thailand-

NASA Astrophysics Data System (ADS)

Sripramai, Keerati; Oikawa, Yasushi; Watanabe, Hiroshi; Katada, Toshitaka

Generally, in order to improve some regional fire fighting validity, indispensable strategies are not only a reinforcement of the governmental fire fighting ability, but also a strengthening of the cooperative relationship between governmental and non-governmental fire fighting ability. However, for practical purposes, the effective strategy should be different depending on the actual situationin the subject area. So, in this study, we grasp the actual state and background of the problems that need to be solved for the improvement of the regional fire fighting validity in Bangkok as a case study, and examine the appropriate solution focusing on the relationship between official and voluntary fire fighting. Through some practicable activities such as interviews, investigati ons, and making the regional fire fighting validity map, it became clear that the problems of uncooperative relationship and the lack of trust between stakeholders should be solved first and foremost.

A multicentre case control study on complicated coeliac disease: two different patterns of natural history, two different prognoses.

PubMed

Biagi, Federico; Marchese, Alessandra; Ferretti, Francesca; Ciccocioppo, Rachele; Schiepatti, Annalisa; Volta, Umberto; Caio, Giacomo; Ciacci, Carolina; Zingone, Fabiana; D'Odorico, Anna; Carroccio, Antonio; Ambrosiano, Giuseppe; Mansueto, Pasquale; Gasbarrini, Antonio; Piscaglia, Anna Chiara; Andrealli, Alida; Astegiano, Marco; Segato, Sergio; Neri, Matteo; Meggio, Alberto; de Pretis, Giovanni; De Vitis, Italo; Gobbi, Paolo; Corazza, Gino Roberto

2014-08-07

Coeliac disease is a common enteropathy characterized by an increased mortality mainly due to its complications. The natural history of complicated coeliac disease is characterised by two different types of course: patients with a new diagnosis of coeliac disease that do not improve despite a strict gluten-free diet (type A cases) and previously diagnosed coeliac patients that initially improved on a gluten-free diet but then relapsed despite a strict diet (type B cases). Our aim was to study the prognosis and survival of A and B cases. Clinical and laboratory data from coeliac patients who later developed complications (A and B cases) and sex- and age-matched coeliac patients who normally responded to a gluten-free diet (controls) were collected among 11 Italian centres. 87 cases and 136 controls were enrolled. Complications tended to occur rapidly after the diagnosis of coeliac disease and cumulative survival dropped in the first months after diagnosis of complicated coeliac disease. Thirty-seven cases died (30/59 in group A, 7/28 in group B). Type B cases presented an increased survival rate compared to A cases. Complicated coeliac disease is an extremely serious condition with a high mortality and a short survival. Survival depends on the type of natural history.

Student learning outcomes associated with video vs. paper cases in a public health dentistry course.

PubMed

Chi, Donald L; Pickrell, Jacqueline E; Riedy, Christine A

2014-01-01

Educational technologies such as video cases can improve health professions student learning outcomes, but few studies in dentistry have evaluated video-based technologies. The goal of this study was to compare outcomes associated with video and paper cases used in an introductory public health dentistry course. This was a retrospective cohort study with a historical control group. Based on dual coding theory, the authors tested the hypotheses that dental students who received a video case (n=37) would report better affective, cognitive, and overall learning outcomes than students who received a paper case (n=75). One-way ANOVA was used to test the hypotheses across ten cognitive, two affective, and one general assessment measures (α=0.05). Students in the video group reported a significantly higher overall mean effectiveness score than students in the paper group (4.2 and 3.3, respectively; p<0.001). Video cases were also associated with significantly higher mean scores across the remaining twelve measures and were effective in helping students achieve cognitive (e.g., facilitating good discussions, identifying public health problems, realizing how health disparities might impact their future role as dentists) and affective (e.g., empathizing with vulnerable individuals, appreciating how health disparities impact real people) goals. Compared to paper cases, video cases significantly improved cognitive, affective, and overall learning outcomes for dental students.

Mind the Gap: Organizational Learning and Improvement in an Underperforming Urban System

ERIC Educational Resources Information Center

Finnigan, Kara S.; Daly, Alan J.

2012-01-01

Drawing on the theoretical lens of organizational learning, and utilizing the methodological approaches of social network and case-study analyses, our exploratory study examines whether schools under sanction exhibit the necessary processes, relationships, and social climates that support organizational learning and improvement. We also…

Job Rotation at Cardiff University Library Service: A Pilot Study

ERIC Educational Resources Information Center

Earney, Sally; Martins, Ana

2009-01-01

This paper presents case study research of a job rotation pilot involving six library assistants in Cardiff University Library Service (ULS). Firstly, it investigates whether job rotation improves motivation and secondly, whether there is an improvement in skills, both technical and "soft". Following a review of the literature,…

Improving Group Processes in Transdisciplinary Case Studies for Sustainability Learning

ERIC Educational Resources Information Center

Hansmann, Ralf; Crott, Helmut W.; Mieg, Harald A.; Scholz, Roland W.

2009-01-01

Purpose: Deficient group processes such as conformity pressure can lead to inadequate group decisions with negative social, economic, or environmental consequences. The study aims to investigate how a group technique (called INFO) improves students' handling of conformity pressure and their collective judgments in the context of a…

A real time biofeedback using Kinect and Wii to improve gait for post-total knee replacement rehabilitation: a case study report.

PubMed

Levinger, Pazit; Zeina, Daniel; Teshome, Assefa K; Skinner, Elizabeth; Begg, Rezaul; Abbott, John Haxby

2016-01-01

This study aimed to develop a low-cost real-time biofeedback system to assist with rehabilitation for patients following total knee replacement (TKR) and to assess its feasibility of use in a post-TKR patient case study design with a comparison group. The biofeedback system consisted of Microsoft Kinect(TM) and Nintendo Wii balance board with a dedicated software. A six-week inpatient rehabilitation program was augmented by biofeedback and tested in a single patient following TKR. Three patients underwent a six weeks standard rehabilitation with no biofeedback and served as a control group. Gait, function and pain were assessed and compared before and after the rehabilitation. The biofeedback software incorporated real time visual feedback to correct limb alignment, movement pattern and weight distribution. Improvements in pain, function and quality of life were observed in both groups. The strong improvement in the knee moment pattern demonstrated in the case study indicates feasibility of the biofeedback-augmented intervention. This novel biofeedback software has used simple commercially accessible equipment that can be feasibly incorporated to augment a post-TKR rehabilitation program. Our preliminary results indicate the potential of this biofeedback-assisted rehabilitation to improve knee function during gait. Research is required to test this hypothesis. Implications for Rehabilitation The real-time biofeedback system developed integrated custom-made software and simple low-cost commercially accessible equipment such as Kinect and Wii board to provide augmented information during rehabilitation following TKR. The software incorporated key rehabilitation principles and visual feedback to correct alignment of the lower legs, pelvic and trunk as well as providing feedback on limbs weight distribution. The case study patient demonstrated greater improvement in their knee function where a more normal biphasic knee moment was achieved following the six-week biofeedback intervention.

Strategy, leadership and change: the North York General Hospital transformation journey.

PubMed

Adamson, Bonnie; Kwolek, Susan

2008-01-01

Improvements in the emergency department and general internal medicine will serve as a case study to examine how North York General Hospital cultural transformation efforts led to improvements in these departments, and why we believe this approach will enable the organization to sustain these improvements over time.

Lean Thinking in Libraries: A Case Study on Improving Shelving Turnaround

ERIC Educational Resources Information Center

Kress, Nancy J.

2007-01-01

The University of Chicago's Joseph Regenstein Library Bookstacks Department has used process mapping and continuous improvement to successfully improve its overall operations. The most recent efforts focus on Lean manufacturing, an initiative centered on eliminating waste in manufacturing processes. The conversion of the Bookstacks Department from…

Creating a Cycle of Continuous Improvement through Instructional Rounds

ERIC Educational Resources Information Center

Meyer-Looze, Catherine L.

2015-01-01

Instructional Rounds is a continuous improvement strategy that focuses on the technical core of educational systems as well as educators collaborating side-by-side. Concentrating on collective learning, this process only makes sense within an overall strategy of improvement. This case study examined the Instructional Rounds process in a northern…

Learning to Collaborate: A Case Study of Performance Improvement CME

ERIC Educational Resources Information Center

Shershneva, Marianna B.; Mullikin, Elizabeth A.; Loose, Anne-Sophie; Olson, Curtis A.

2008-01-01

Introduction: Performance Improvement Continuing Medical Education (PI CME) is a mechanism for joining quality improvement (QI) in health care to continuing medical education (CME) systems together. Although QI practices and CME approaches have been recognized for years, what emerges from their integration is largely unfamiliar, because it…

Child protective services utilization of child abuse pediatricians: A mixed methods study.

PubMed

Girardet, Rebecca; Bolton, Kelly; Hashmi, Syed; Sedlock, Emily; Khatri, Rachna; Lahoti, Nina; Lukefahr, James

2018-02-01

Several children's hospitals and medical schools across Texas have child abuse pediatricians (CAPs) who work closely with child protection workers to help ensure accurate assessments of the likelihood of maltreatment in cases of suspected abuse and neglect. Since the state does not mandate which cases should be referred to a CAP center, we were interested in studying factors that may influence workers' decisions to consult a CAP. We used a mixed methods study design consisting of a focus group followed by a survey. The focus group identified multiple factors that impact workers' decision-making, including several that involve medical providers. Responses from 436 completed surveys were compared to employees' number of years of employment and to the state region in which they worked. Focus group findings and survey responses revealed frustration among many workers when dealing with medical providers, and moderate levels of confidence in workers' abilities to make accurate determinations in cases involving medical information. Workers were more likely to refer cases involving serious physical injury than other types of cases. Among workers who reported prior interactions with a CAP, experiences and attitudes regarding CAPs were typically positive. The survey also revealed significant variability in referral practices by state region. Our results suggest that standard guidelines regarding CAP referrals may help workers who deal with cases involving medical information. Future research and quality improvement efforts to improve transfers of information and to better understand the qualities that CPS workers appreciate in CAP teams should improve CAP-CPS coordination. Copyright © 2017 Elsevier Ltd. All rights reserved.

Applying Lean principles and Kaizen rapid improvement events in public health practice.

PubMed

Smith, Gene; Poteat-Godwin, Annah; Harrison, Lisa Macon; Randolph, Greg D

2012-01-01

This case study describes a local home health and hospice agency's effort to implement Lean principles and Kaizen methodology as a rapid improvement approach to quality improvement. The agency created a cross-functional team, followed Lean Kaizen methodology, and made significant improvements in scheduling time for home health nurses that resulted in reduced operational costs, improved working conditions, and multiple organizational efficiencies.

Improving rational thermal comfort prediction by using subpopulation characteristics: A case study at Hermitage Amsterdam

PubMed Central

Kramer, Rick; Schellen, Lisje; Schellen, Henk; Kingma, Boris

2017-01-01

ABSTRACT This study aims to improve the prediction accuracy of the rational standard thermal comfort model, known as the Predicted Mean Vote (PMV) model, by (1) calibrating one of its input variables “metabolic rate,” and (2) extending it by explicitly incorporating the variable running mean outdoor temperature (RMOT) that relates to adaptive thermal comfort. The analysis was performed with survey data (n = 1121) and climate measurements of the indoor and outdoor environment from a one year-long case study undertaken at Hermitage Amsterdam museum in the Netherlands. The PMVs were calculated for 35 survey days using (1) an a priori assumed metabolic rate, (2) a calibrated metabolic rate found by fitting the PMVs to the thermal sensation votes (TSVs) of each respondent using an optimization routine, and (3) extending the PMV model by including the RMOT. The results show that the calibrated metabolic rate is estimated to be 1.5 Met for this case study that was predominantly visited by elderly females. However, significant differences in metabolic rates have been revealed between adults and elderly showing the importance of differentiating between subpopulations. Hence, the standard tabular values, which only differentiate between various activities, may be oversimplified for many cases. Moreover, extending the PMV model with the RMOT substantially improves the thermal sensation prediction, but thermal sensation toward extreme cool and warm sensations remains partly underestimated. PMID:28680934

Improving rational thermal comfort prediction by using subpopulation characteristics: A case study at Hermitage Amsterdam.

PubMed

Kramer, Rick; Schellen, Lisje; Schellen, Henk; Kingma, Boris

2017-01-01

This study aims to improve the prediction accuracy of the rational standard thermal comfort model, known as the Predicted Mean Vote (PMV) model, by (1) calibrating one of its input variables "metabolic rate," and (2) extending it by explicitly incorporating the variable running mean outdoor temperature (RMOT) that relates to adaptive thermal comfort. The analysis was performed with survey data ( n = 1121) and climate measurements of the indoor and outdoor environment from a one year-long case study undertaken at Hermitage Amsterdam museum in the Netherlands. The PMVs were calculated for 35 survey days using (1) an a priori assumed metabolic rate, (2) a calibrated metabolic rate found by fitting the PMVs to the thermal sensation votes (TSVs) of each respondent using an optimization routine, and (3) extending the PMV model by including the RMOT. The results show that the calibrated metabolic rate is estimated to be 1.5 Met for this case study that was predominantly visited by elderly females. However, significant differences in metabolic rates have been revealed between adults and elderly showing the importance of differentiating between subpopulations. Hence, the standard tabular values, which only differentiate between various activities, may be oversimplified for many cases. Moreover, extending the PMV model with the RMOT substantially improves the thermal sensation prediction, but thermal sensation toward extreme cool and warm sensations remains partly underestimated.

Honey as a dressing for chronic wounds in adults.

PubMed

Fox, Carolyn

2002-10-01

The aim of this review was to identify whether in adults with chronic wounds the use of honey as a wound dressing improves wound management outcomes. As no randomized controlled trials or comparative studies comparing the use of honey as a chronic wound dressing with usual treatment could be found, the review is based on case studies and serial case studies. These were reviewed using a framework broadly based on wound care case study guidelines (Nelson, 2000) and cohort study guidelines (Greenhalgh and Donald, 2000). Based on the case studies reviewed, honey appears to be a useful dressing in adults with chronic wounds, but the available evidence is weak and therefore must be interpreted with caution.

Clinical Results of Platelet-Rich Plasma for Partial Thickness Rotator Cuff Tears: A Case Series.

PubMed

Zafarani, Zohreh; Mirzaee, Fateme; Guity, Mohamadreza; Aslani, Hamidreza

2017-09-01

Partial thickness rotator cuff tears (PTRCTs) are a common pathology among shoulder disorders in people over 50 years. Treatment of PTRCTs remains controversial. Most studies on the treatment of PTRCTs have explained surgical techniques or outcomes; few studies have centralized on the conservative and new management of PTRCTs, like treatment with Platelet-rich plasma (PRP). These case series study have been conducted on Platelet-rich plasma (PRP) injection, as a concentrated source of cytokines that can stimulate healing of soft tissue. PRP injection showed positive effect on improving PTRCTs complains. This method improved pain, function, DASH score and shoulder joint range motion in. Because of PRP products are safe and easy to prepare and apply, and also according to improving patient's condition, this method can be used to treat PTRCTs.

MO-F-16A-04: Case Study: Estimation of Peak Skin Dose Following a Physician Reported “High Dose” Case and Sentinel Event Considerations

DOE Office of Scientific and Technical Information (OSTI.GOV)

Supanich, M; Chu, J; Wehmeyer, A

2014-06-15

Purpose: This work offers as a teaching example a reported high dose fluoroscopy case and the workflow the institution followed to self-report a radiation overdose sentinel event to the Joint Commission. Methods: Following the completion of a clinical case in a hybrid OR room with a reported air kerma of >18 Gy at the Interventional Reference Point (IRP) the physicians involved in the case referred study to the institution's Radiation Safety Committee (RSC) for review. The RSC assigned a Diagnostic Medical Physicist (DMP) to estimate the patient's Peak Skin Dose (PSD) and analyze the case. Following the DMP's analysis andmore » estimate of a PSD of >15 Gy the institution's adverse event committee was convened to discuss the case and to self-report the case as a radiation overdose sentinel event to the Joint Commission. The committee assigned a subgroup to perform the root cause analysis and develop institutional responses to the event. Results: The self-reporting of the sentinel event and the associated root cause analysis resulted in several institutional action items that are designed to improve process and safety. A formal reporting and analysis mechanism was adopted to review fluoroscopy cases with air kerma greater than 6 Gy at the IRP. An improved and formalized radiation safety training program for physicians using fluoroscopy equipment was implemented. Additionally efforts already under way to monitor radiation exposure in the Radiology department were expanded to include all fluoroscopy equipment capable of automated dose reporting. Conclusion: The adverse event review process and the root cause analysis following the self-reporting of the sentinel event resulted in policies and procedures that are expected to improve the quality and safe usage of fluoroscopy throughout the institution.« less

Developing a new case based computer-aided detection scheme and an adaptive cueing method to improve performance in detecting mammographic lesions

PubMed Central

Tan, Maxine; Aghaei, Faranak; Wang, Yunzhi; Zheng, Bin

2017-01-01

The purpose of this study is to evaluate a new method to improve performance of computer-aided detection (CAD) schemes of screening mammograms with two approaches. In the first approach, we developed a new case based CAD scheme using a set of optimally selected global mammographic density, texture, spiculation, and structural similarity features computed from all four full-field digital mammography (FFDM) images of the craniocaudal (CC) and mediolateral oblique (MLO) views by using a modified fast and accurate sequential floating forward selection feature selection algorithm. Selected features were then applied to a “scoring fusion” artificial neural network (ANN) classification scheme to produce a final case based risk score. In the second approach, we combined the case based risk score with the conventional lesion based scores of a conventional lesion based CAD scheme using a new adaptive cueing method that is integrated with the case based risk scores. We evaluated our methods using a ten-fold cross-validation scheme on 924 cases (476 cancer and 448 recalled or negative), whereby each case had all four images from the CC and MLO views. The area under the receiver operating characteristic curve was AUC = 0.793±0.015 and the odds ratio monotonically increased from 1 to 37.21 as CAD-generated case based detection scores increased. Using the new adaptive cueing method, the region based and case based sensitivities of the conventional CAD scheme at a false positive rate of 0.71 per image increased by 2.4% and 0.8%, respectively. The study demonstrated that supplementary information can be derived by computing global mammographic density image features to improve CAD-cueing performance on the suspicious mammographic lesions. PMID:27997380

Meta-Analysis of Interventions for Basic Mathematics Computation in Single-Case Research

ERIC Educational Resources Information Center

Methe, Scott A.; Kilgus, Stephen P.; Neiman, Cheryl; Riley-Tillman, T. Chris

2012-01-01

This study examined interventions for addition and subtraction that were implemented through single-case design (SCD) research studies. We attempted to extend prior SCD meta-analyses by examining differences in effect sizes across several moderating variables and by including a novel index of effect, improvement rate difference (IRD). We also…

Recruiting Young Volunteers in an Area of Selective Education: A Qualitative Case Study

ERIC Educational Resources Information Center

Dean, Jon

2016-01-01

This article presents findings from a small qualitative case study of a youth volunteering brokerage organisation in England, operating in an area of selective state education. Data show how brokerage workers felt grammar schools managed their students in a concerted way to improve students' chances of attending university. Conversely, workers…

Application of a Novel Collaboration Engineering Method for Learning Design: A Case Study

ERIC Educational Resources Information Center

Cheng, Xusen; Li, Yuanyuan; Sun, Jianshan; Huang, Jianqing

2016-01-01

Collaborative case studies and computer-supported collaborative learning (CSCL) play an important role in the modern education environment. A number of researchers have given significant attention to learning design in order to improve the satisfaction of collaborative learning. Although collaboration engineering (CE) is a mature method widely…

Teaching Biotechnology through Case Studies--Can We Improve Higher Order Thinking Skills of Nonscience Majors?

ERIC Educational Resources Information Center

Dori, Yehudit J.; Tal, Revital T.; Tsaushu, Masha

2003-01-01

Teaching nonscience majors topics in biotechnology through case studies is the focus of this research. Our "Biotechnology, Environment, and Related Issues" module, developed within the "Science for All" framework, is aimed at elevating the level of students' scientific and technological literacy and their higher order thinking…

The Efficacy of Math Coaching: An Evaluative Case Study

ERIC Educational Resources Information Center

Dobbins, C. Neelie

2010-01-01

There is a lack of implementation of instructional strategies to assist middle school teachers in improving mathematics education for their students. Coaching is one solution to this problem, but its impact on student achievement is unclear. This case study evaluated the relationship between coaching and teacher efficacy and the impact of these…

Emotional and Social Competencies of a Principal School Leader

ERIC Educational Resources Information Center

Williams, Angelina M.

2017-01-01

Emotional and Social Competencies (ESCs) are considered important to school leadership because it is believed that they can help to build trusting relationships with staff and improve organizational capacity within the school. Limited case study research has been conducted on how ESCs are manifested in principal practice. This case study is…

Teaching Information Security with Workflow Technology--A Case Study Approach

ERIC Educational Resources Information Center

He, Wu; Kshirsagar, Ashish; Nwala, Alexander; Li, Yaohang

2014-01-01

In recent years, there has been a significant increase in the demand from professionals in different areas for improving the curricula regarding information security. The use of authentic case studies in teaching information security offers the potential to effectively engage students in active learning. In this paper, the authors introduce the…

Improving In Vitro to In Vivo Extrapolation by Incorporating Toxicokinetic Measurements: A Case Study of Lindane-Induced Neurotoxicity

EPA Science Inventory

Approaches for extrapolating in vitro toxicity testing results for prediction of human in vivo outcomes are needed. The purpose of this case study was to employ in vitro toxicokinetics and PBPK modeling to perform in vitro to in vivo extrapolation (IVIVE) of lindane neurotoxicit...

Critical Evaluation as an Aid to Improved Report Writing: A Case Study

ERIC Educational Resources Information Center

Walker, Mirabelle; Williams, Judith

2014-01-01

Report writing is an important employability skill for Engineers and Technologists, and this case study describes how a Technology degree module took a novel approach to developing students' report writing skills. Students learned how to use a criterion-referenced critical evaluation framework for reports and other technological documents. They…

Improving the Quality of Teaching in a State-Owned, Regional University

ERIC Educational Resources Information Center

Ballerini, Aldo A.; Albarran, Manuel I.

2013-01-01

The authors present a case study discussing student-oriented initiatives to enhance academic achievement. They focus on the academic, psychosocial and motivational weaknesses of students showing how these can be overcome with strategic projects to aid students in their first year of higher education. The case study, a multi-million US dollar…

Implementing RTI in a High School: A Case Study

ERIC Educational Resources Information Center

Fisher, Douglas; Frey, Nancy

2013-01-01

This case study chronicles the efforts of a small high school over a 2-year period as it designed and implemented a response to intervention (RTI) program for students at the school. Their efforts were largely successful, with improved achievement, attendance, and grade point averages and a decrease in special education referrals. Major themes…

An Approach to Meeting the Needs of Medical Students with Learning Disabilities.

ERIC Educational Resources Information Center

Walters, Janice A.; Croen, Lila G.

1993-01-01

A study at the Albert Einstein College of Medicine (Yeshiva University, New York) has identified students from each medical class with previously unidentified learning disabilities. In three case studies, the importance of early identification and support is illustrated. In each case, dramatic improvement occurred with student awareness and…

Therapeutic effects of saireito (chai-ling-tang), a traditional Japanese herbal medicine, on lymphedema caused by radiotherapy: a case series study.

PubMed

Nagai, Aiko; Shibamoto, Yuta; Ogawa, Keiko

2013-01-01

Despite the development of radiotherapy machines and technologies, a proportion of patients suffer from radiation-induced lymphedema. Saireito (SRT) is a traditional Japanese herbal medicine that has been used for treating edema and inflammation in conditions such as nephritic disease. This study investigated the effect of SRT on lymphedema caused by radiotherapy. Four patients were treated with SRT at a dose of 9 g/day. The severity of lymphedema was evaluated using the Common Terminology Criteria for Adverse Events version 4 and Numerical Rating Scale before and after SRT treatment. After the treatment with SRT, 2 of 4 patients (50%) showed apparent improvement in lymphedema. One of the cases had difficulty in wearing the custom-made thermoplastic cast, but after SRT administration, he could wear the mask easily. One case decided to stop taking SRT 3 days after initiation because cough and fever appeared. In conclusion, it is important to control the side effects of radiotherapy, which leads to improved tumor control rates. Prospective randomized studies are necessary to confirm the findings of this case series study.

Studying Relational Spaces in Secondary School: Applying a Spatial Framework for the Study of Borderlands and Relational Work in School Improvement Processes

ERIC Educational Resources Information Center

Frelin, Anneli; Grannäs, Jan

2014-01-01

This article introduces a theoretical framework for studying school improvement processes such as making school environments safer. Using concepts from spatial theory, in which distinctions between mental, social and physical space are applied makes for a multidimensional analysis of processes of change. In a multilevel case study, these were…

Aquatic therapy for a child with type III spinal muscular atrophy: a case report.

PubMed

Salem, Yasser; Gropack, Stacy Jaffee

2010-11-01

Spinal muscular atrophy (SMA) is a neuromuscular disorder characterized by degeneration of alpha motor neurons. This case report describes an aquatic therapy program and the outcomes for a 3-year-old girl with type III SMA. Motor skills were examined using the 88-item Gross Motor Function Measure (GMFM), the Peabody Developmental Motor Scales (PDMS-2), and the GAITRite system. The child received aquatic therapy twice per week for 45-min sessions, for 14 weeks. The intervention included aquatic activities designed to improve gross motor skills and age-appropriate functional mobility. The GMFM total score improved by 11% following the intervention. The Standing Dimension score improved by 28% and the Walking, Running, and Jumping Dimension score improved by 18%. The gross motor quotient for the PDMS-2 improved from 66 to 74. The child's gait showed improvement in walking velocity, stride length, and single-limb support time as a percentage of the gait cycle. The outcomes of this case report demonstrate the successful improvement of gross motor function and gait in a 3-year-old child with SMA. This study provides clinical information for therapists utilizing aquatic therapy as a modality for children with neuromuscular disorders.

CASE STUDY RESEARCH: THE VIEW FROM COMPLEXITY SCIENCE

PubMed Central

Anderson, Ruth; Crabtree, Benjamin F.; Steele, David J.; McDaniel, Reuben R.

2005-01-01

Many wonder why there has been so little change in care quality, despite substantial quality improvement efforts. Questioning why current approaches are not making true changes draws attention to the organization as a source of answers. We bring together the case study method and complexity science to suggest new ways to study health care organizations. The case study provides a method for studying systems. Complexity theory suggests that keys to understanding the system are contained in patterns of relationships and interactions among the system’s agents. We propose some of the “objects” of study that are implicated by complexity theory and discuss how studying these using case methods may provide useful maps of the system. We offer complexity theory, partnered with case study method, as a place to begin the daunting task of studying a system as an integrated whole. PMID:15802542

Nutritional and safety assessments of foods and feeds nutritionally improved through biotechnology: lysine maize as a case study.

PubMed

Glenn, Kevin C

2007-01-01

During the last decade, the area of biotech crops modified for agronomic input traits (e.g., herbicide tolerance and insect protection) has increased to 90 million halyear, grown by over 8 million farmers in a total of 17 countries. As adoption of these improved agronomic trait biotech crops has grown, so has interest in biotech crops that have improved nutritional characteristics for use as feed and food. A previous publication by the International Life Sciences Institute (ILSI) reported on the principles and concepts proposed for the nutritional and safety assessments of foods and feeds nutritionally improved through biotechnology. In this paper, the guidelines and principles recommended in the earlier publication are discussed relative to a specific case study, Lysine maize. Lysine maize is a feed ingredient with enhanced nutritional characteristics for poultry and swine and provides an alternative to the need for addition of supplemental lysine to some diets for these animals. The 2004 Task Force of the ILSI has also applied the concepts from that report to 4 other case studies: sweet potato enriched in provitamin A (2 examples, one using biotechnology and one using conventional breeding); Golden Rice 2; double-embryo maize; and ASP-1 enhanced protein sweet potato.

Improvement of Coordination in the Multi-National Military Coordination Center of the Nepal Army in Respond to Disasters

DTIC Science & Technology

2017-06-09

primary question. This thesis has used the case study research methodology with Capability-Based Assessment (CBA) approach. My engagement in this...protected by more restrictions in their home countries, in which case further publication or sale of copyrighted images is not permissible...effective coordinating mechanism. The research follows the case study method utilizing the Capability Based Analysis (CBA) approach to scrutinize the

Post-Arab Spring Governments in North Africa: Identifying Focus Areas for Economic Advancement

DTIC Science & Technology

2012-09-01

Areas in which improvement is required to create positive change that are specific to the country being studied are thereby determined. The cases ...being studied are thereby determined. The cases of pre-Arab Spring Libya, Tunisia and Egypt were examined in an attempt to provide guidance and focus...to occur in countries wherein authoritarian regimes appear to have, in many cases , stifled economic advancement through corruption, power-hoarding

The Practicality of Poetry: Using Sonnets to Improve Reading Ability

ERIC Educational Resources Information Center

Vallicelli, Arthur E.

2012-01-01

This dissertation examines the way in which sonnets improved reading comprehension through a case study. The study was conceptually framed around the ideas of the New Critics, who employed two particular fallacies to ensure the most accurate reading of literature. The purpose of the study was to see the potential benefits that could come from…

Rotational Flap to Enhance Buccal Gingival Thickness and Implant Emergence Profile in the Esthetic Zone: Two Cases Reports

PubMed Central

AL-Juboori, Mohammed Jasim

2017-01-01

Objective: Many techniques have been developed to enhance the gingival thickness, gingival level and emergence profile around the implant in the esthetic zone. Introduction: In this study, a buccal rotational flap was used to improve the implant site in the esthetic zone and increase gingival tissue thickness. Methods: Two cases involved the use of a rotational flap during second-stage implant surgery, one case involved the use of a temporary crown with a healing abutment, and another case involved the use of a healing abutment. Result: The cases were followed up until the final crown was placed. The implant site was improved in 2 cases; the gingival thickness increased, the gingival level was enhanced and the emergence profile was developed. Conclusion: Many factors affect the results of a rotational flap; some factors are surgical, while others are prosthetic, biological and anatomical. PMID:28839477

A Case Study of the Implementation of Conflict Resolution in a Second Grade Classroom.

ERIC Educational Resources Information Center

LeBlanc, Patrice R.; Lacey, Candace; Adler, Alison

This case study evaluated a second grade teacher and her students and the implementation of a conflict resolution program in the classroom; the goals of the evaluation were to provide descriptive data on the success or failure of the program and why those results occurred, and to make recommendations for program improvement. The study used…

A Case Study on the Professional Development of Elementary Teachers Related to Brain Research and the Strategies Used to Help Struggling Readers

ERIC Educational Resources Information Center

Denton, Valerie R.

2010-01-01

This case study examined the impact of classroom interventions for struggling readers as changed/improved by teachers who participated in ongoing professional development on brain research studies. It investigated how teachers' knowledge of brain research impacted their instruction and the interventions they implemented in elementary classrooms.…

A Case Study of E-Tutors' Teaching Practice: Does Technology Drive Pedagogy?

ERIC Educational Resources Information Center

Chuang, Hsueh-Hua

2013-01-01

This article presents a case study of e-tutoring teaching practice during a 20-week e-tutoring program aimed at improving the English proficiency of targeted students. The study revealed what and why certain online tools were used by e-tutors and investigated how different technological proficiency and face-to-face (f2f) teaching experience shaped…

The Views of International Students Regarding University Support Services in Australia: A Case Study

ERIC Educational Resources Information Center

Roberts, Pam; Boldy, Duncan; Dunworth, Katie

2015-01-01

This paper reports on a study aimed at developing an improved understanding of the support needs of international students. Using a case study approach at one Australian university, a three stage data collection process was adopted: interviews with key support service providers in the university, student focus groups, and a large-scale survey.…

The Use of Interrupted Case Studies to Enhance Critical Thinking Skills in Biology

PubMed Central

White, Tracy K.; Whitaker, Paul; Gonya, Terri; Hein, Richard; Kroening, Dubear; Lee, Kevin; Lee, Laura; Lukowiak, Andrea; Hayes, Elizabeth

2009-01-01

There has been a dramatic increase in the availability of case studies for use in the biology classroom, and perceptions of the effectiveness of case-study-based learning are overwhelmingly positive. Here we report the results of a study in which we evaluated the ability of interrupted case studies to improve critical thinking in the context of experimental design and the conventions of data interpretation. Students were assessed using further case studies designed to evaluate their ability to recognize and articulate problematic approaches to these elements of experimentation. Our work reveals that case studies have broad utility in the classroom. In addition to demonstrating a small but statistically significant increase in the number of students capable of critically evaluating selected aspects of experimental design, we also observed increased student engagement and documented widespread misconceptions regarding the conventions of data acquisition and analysis. PMID:23653687

Hybrid-Wing-Body Vehicle Composite Fuselage Analysis and Case Study

NASA Technical Reports Server (NTRS)

Mukhopadhyay, Vivek

2014-01-01

Recent progress in the structural analysis of a Hybrid Wing-Body (HWB) fuselage concept is presented with the objective of structural weight reduction under a set of critical design loads. This pressurized efficient HWB fuselage design is presently being investigated by the NASA Environmentally Responsible Aviation (ERA) project in collaboration with the Boeing Company, Huntington Beach. The Pultruded Rod-Stiffened Efficient Unitized Structure (PRSEUS) composite concept, developed at the Boeing Company, is approximately modeled for an analytical study and finite element analysis. Stiffened plate linear theories are employed for a parametric case study. Maximum deflection and stress levels are obtained with appropriate assumptions for a set of feasible stiffened panel configurations. An analytical parametric case study is presented to examine the effects of discrete stiffener spacing and skin thickness on structural weight, deflection and stress. A finite-element model (FEM) of an integrated fuselage section with bulkhead is developed for an independent assessment. Stress analysis and scenario based case studies are conducted for design improvement. The FEM model specific weight of the improved fuselage concept is computed and compared to previous studies, in order to assess the relative weight/strength advantages of this advanced composite airframe technology

Focal high-concentration trichloroacetic acid peeling for treatment of atrophic facial chickenpox scar: an open-label study.

PubMed

Barikbin, Behrooz; Saadat, Nelda; Akbari, Zahra; Yousefi, Maryam; Toossi, Parviz

2012-10-01

Despite their prevalence, there is a paucity of information in the medical literature on the treatment of atrophic chickenpox scars. To evaluate the efficacy and safety of using the chemical reconstruction of skin scar technique for the treatment of atrophic facial chickenpox scars. One hundred patients (mean age 23 years; Fitzpatrick skin types II-IV) were treated with focal chemical peeling with 70% trichloroacetic acid (TCA) for a maximum of six sessions. Improvement rate, frequency of adverse events and patient satisfaction were assessed. Five hundred thirty-three peeling sessions in 100 consecutive patients were performed. Final assessment at 12-week follow-up visit after the last treatment revealed improvement in 95% of patients: mild improvement in 12 cases, moderate improvement in 42 cases, and marked improvement in 41 cases. The appearance of scars did not change in five patients. Seventy-nine patients expressed moderate to high satisfaction with the results. Post-treatment side effects were mild and transient, resolving gradually within the study period. Focal peeling with high-concentration TCA appears to be a safe and effective alternative in the treatment of atrophic facial chickenpox scars. © 2012 by the American Society for Dermatologic Surgery, Inc. Published by Wiley Periodicals, Inc.

Histological Stains: A Literature Review and Case Study

PubMed Central

Alturkistani, Hani A; Tashkandi, Faris M; Mohammedsaleh, Zuhair M

2016-01-01

The history of histology indicates that there have been significant changes in the techniques used for histological staining through chemical, molecular biology assays and immunological techniques, collectively referred to as histochemistry. Early histologists used the readily available chemicals to prepare tissues for microscopic studies; these laboratory chemicals were potassium dichromate, alcohol and the mercuric chloride to harden cellular tissues. Staining techniques used were carmine, silver nitrate, Giemsa, Trichrome Stains, Gram Stain and Hematoxylin among others. The purpose of this research was to assess past and current literature reviews, as well as case studies, with the aim of informing ways in which histological stains have been improved in the modern age. Results from the literature review has indicated that there has been an improvement in histopathology and histotechnology in stains used. There has been a rising need for efficient, accurate and less complex staining procedures. Many stain procedures are still in use today, and many others have been replaced with new immunostaining, molecular, non-culture and other advanced staining techniques. Some staining methods have been abandoned because the chemicals required have been medically proven to be toxic. The case studies indicated that in modern histology a combination of different stain techniques are used to enhance the effectiveness of the staining process. Currently, improved histological stains, have been modified and combined with other stains to improve their effectiveness. PMID:26493433

Histological Stains: A Literature Review and Case Study.

PubMed

Alturkistani, Hani A; Tashkandi, Faris M; Mohammedsaleh, Zuhair M

2015-06-25

The history of histology indicates that there have been significant changes in the techniques used for histological staining through chemical, molecular biology assays and immunological techniques, collectively referred to as histochemistry. Early histologists used the readily available chemicals to prepare tissues for microscopic studies; these laboratory chemicals were potassium dichromate, alcohol and the mercuric chloride to harden cellular tissues. Staining techniques used were carmine, silver nitrate, Giemsa, Trichrome Stains, Gram Stain and Hematoxylin among others. The purpose of this research was to assess past and current literature reviews, as well as case studies, with the aim of informing ways in which histological stains have been improved in the modern age. Results from the literature review has indicated that there has been an improvement in histopathology and histotechnology in stains used. There has been a rising need for efficient, accurate and less complex staining procedures. Many stain procedures are still in use today, and many others have been replaced with new immunostaining, molecular, non-culture and other advanced staining techniques. Some staining methods have been abandoned because the chemicals required have been medically proven to be toxic. The case studies indicated that in modern histology a combination of different stain techniques are used to enhance the effectiveness of the staining process. Currently, improved histological stains, have been modified and combined with other stains to improve their effectiveness.

Comparative Case Studies Of Corridor Safety Improvement Efforts

DOT National Transportation Integrated Search

1999-12-01

In 1988, following a series of fatal crashes on U.S. Route 322, Pennsylvania's governor directed Pennsylvania's secretary of transportation to develop immediate, short-term measures to improve safety on the roadway. In response, the Pennsylvania Depa...

Indian reservation safety improvement program : a methodology and case study.

DOT National Transportation Integrated Search

2015-11-01

Improving roadway safety on Indian reservations requires a comprehensive approach. Limited : resources, lack of crash data, and few cross-jurisdictions coordination has made it difficult for : Native American communities to address their roadway safe...

Impact of interdisciplinary learning on critical thinking using case study method in allied health care graduate students.

PubMed

Zimmerman, Scott D; Lester Short, Glenda F; Hendrix, E Michael

2011-01-01

It remains unclear which classroom experiences, if any, foster critical think ability. We measured the effectiveness of interdisciplinary, case-based learning on the critical-thinking ability of graduate students enrolled in allied health care programs. We designed a voluntary classroom experience to examine the effectiveness of case studies used in an interdisciplinary setting to increase critical-thinking ability. Two groups of students were measured for their critical thinking ability using an online assessment both before and after their respective classroom experiences. One group of 14 graduate students from 4 different allied health care programs (interdisciplinary, ID) discussed complex interdisciplinary case studies and answered multiple-choice type questions formed around the cases. The second group was composed of graduate students (n = 28) from a single disciple enrolled in a clinical anatomy course (discipline specific, DS). They discussed complex case studies specific to their discipline and answered multiple-choice questions formed around the cases. There was no overall change in critical-thinking scores from the pre- to post-test in either group (delta scores: ID 1.5 ± 5.3, DS -1.7 ± 5.7). However, ID students scoring below the median on the pretest improved significantly (paired t-test, pre 50.7 ± 3.8, post 54.2 ± 1.7, p = 0.02). The interdisciplinary learning experience improved critical-thinking ability in students with the least proficiency. As case studies have long been used to advance deeper learning, these data provide evidence for a broader impact of cases when used in an interdisciplinary setting, especially for those students coming in with the least ability.

Autism training in pediatric residency: evaluation of a case-based curriculum.

PubMed

Major, Nili E; Peacock, Georgina; Ruben, Wendy; Thomas, Jana; Weitzman, Carol C

2013-05-01

Despite recent studies indicating the high prevalence of autism spectrum disorders (ASDs), there has been little focus on improving ASD education during pediatric residency training. The objective of this study was to evaluate a new curriculum developed in partnership with the Centers for Disease Control and Prevention and the Maternal and Child Health Bureau about ASDs. "Autism Case Training (ACT): A Developmental-Behavioral Pediatrics Curriculum" consists of 7 case-based teaching modules. Modules were facilitated by faculty at 26 pediatric residency programs and data were obtained on 114 residents. Pre- and post-test data revealed significant short-term improvements in residents' knowledge and self-assessed competence regarding ASDs. Findings suggest that the ACT curriculum is effective in enhancing training about ASDs in pediatric residency programs.

Lean healthcare in developing countries: evidence from Brazilian hospitals.

PubMed

Costa, Luana Bonome Message; Filho, Moacir Godinho; Rentes, Antonio Freitas; Bertani, Thiago Moreno; Mardegan, Ronaldo

2017-01-01

The present study evaluates how five sectors of two Brazilian hospitals have implemented lean healthcare concepts in their operations. The main characteristics of the implementation process are analyzed in the present study: the motivational factor for implementation, implementation time, form (consultancy or internal), team (hospital and consultants), lean implementation continuity/sustainability, lean healthcare tools and methods implemented, problems/improvement opportunities, lean healthcare barriers faced during the implementation process, and critical factors that affected the implementation and the results obtained in each case. The case studies indicate that reducing patient lead times and costs and making financial improvements were the primary factors that motivated lean healthcare implementation in the hospitals studied. Several tools and methods were used in the cases studied, especially value stream mapping and DMAIC. The barriers found in both hospitals are primarily associated with the human factor. Additionally, the results obtained after implementation were analyzed and improvements in financial aspects, productivity and capacity, and lead time reduction of the analyzed sectors were observed. Further, this study also exhibited four propositions elaborated from the results obtained from the cases that highlighted barriers and challenges to lean healthcare implementation in developing countries. Two of these barriers are hospital organizational structure (and, consequently, how the senior management works with medical staff), and outsourcing hospital activities. This study also concluded that the initialization and maintenance of lean healthcare implementation rely heavily on external support because lean healthcare subject knowledge is not yet available in the healthcare organization, which represents a challenge. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

A Picture of Burnout: Case Studies and Solutions Toward Improving Radiologists' Well-being.

PubMed

Restauri, Nicole; Flug, Jonathan A; Mcarthur, Tatum A

This article uses case fictional case vignettes as a vehicle to discuss the complex way organizational and individual factors contribute to physician burnout. The article incorporates a review of the current literature on physician burnout focusing on work place inefficiency and ineffective leadership. Copyright © 2017 Elsevier Inc. All rights reserved.

Effects of Interspersed versus Summary Feedback on the Quality of Students' Case Report Revisions

ERIC Educational Resources Information Center

Phillips, Fred; Wolcott, Susan

2014-01-01

This study examines whether students show greater improvement in written case analyses when given feedback that is either interspersed throughout their written case analyses or presented only as a summary, and whether the benefits of these placements vary across differing levels of student performance in the course. Results from an exploratory…

SEASAT economic assessment. Volume 5: Coastal zones case study and generalization. [economic benefits of weather forecasting by SEASAT satellites to the coastal plains of the United States

NASA Technical Reports Server (NTRS)

1975-01-01

The economic losses sustained in the U.S. coastal zones were studied for the purpose of quantitatively establishing economic benefits as a consequence of improving the predictive quality of destructive phenomena in U.S. coastal zones. Improved prediction of hurricane landfall and improved experimental knowledge of hurricane seeding are discussed.

Building Teacher Capacity to Support English Language Learners in Schools Receiving School Improvement Grants. NCEE Evaluation Brief. NCEE 2015-4004

ERIC Educational Resources Information Center

Boyle, Andrea; Golden, Laura; Le Floch, Kerstin Carlson; O'Day, Jennifer; Harris, Barbara; Wissel, Sarah

2014-01-01

The Study of School Turnaround examines the improvement process in a purposive sample of 35 case study schools receiving federal funds through the School Improvement Grants (SIG) program over a three-year period (2010-11 to 2012-13 school years). This brief focuses on 11 of these SIG schools with high proportions of English Language Learner (ELL)…

A Focused Look at Schools Receiving School Improvement Grants That Have Percentages of English Language Learner Students. NCEE Evaluation Brief. NCEE 2014-4014

ERIC Educational Resources Information Center

Golden, Laura; Harris, Barbara; Mercado-Garcia, Diana; Boyle, Andrea; Le Floch, Kerstin Carlson; O'Day, Jennifer

2014-01-01

The Study of School Turnaround examines the improvement process in a purposive sample of 35 case study schools receiving federal funds through the School Improvement Grants (SIG) program over a three-year period (2010-11 to 2012-13 school years). This evaluation brief focuses on 11 of these SIG schools with high proportions of English Language…

A Focused Look at Rural Schools Receiving School Improvement Grants. NCEE Evaluation Brief. NCEE 2014-4013

ERIC Educational Resources Information Center

Rosenberg, Linda; Christianson, Megan Davis; Angus, Megan Hague; Rosenthal, Emily

2014-01-01

The Study of School Turnaround is a set of case studies of the school improvement process in a purposive sample of 35 schools receiving federal funds through the School Improvement Grants (SIG) program over a three-year period (school years 2010-11 to 2012-13). This evaluation brief focuses on the nine SIG schools that were in rural areas and how…

Case management redesign in an urban facility.

PubMed

Almaden, Stefany; Freshman, Brenda; Quaye, Beverly

2011-01-01

To explore strategies for improving patient throughput and to redesign case management processes to facilitate level of care transitions and safe discharges. Large Urban Medical Center in South Los Angeles County, with 384 licensed beds that services poor, underserved communities. Both qualitative and quantitative methods were applied. Combined theoretical frameworks were used for needs assessment, intervention strategies, and change management. Observations, interviews, surveys, and database extraction methods were used. The sample consisted of case management staff members and several other staff from nursing, social work, and emergency department staff. Postintervention measures indicated improvement in reimbursements for services, reduction in length of stay, increased productivity, improved patients' access to care, and avoiding unnecessary readmission or emergency department visits. Effective change management strategies must consider multiple factors that influence daily operations and service delivery. Creating accountability by using performance measures associated with patient transitions is highlighted by the case study results. The authors developed a process model to assist in identifying and tracking outcome measures related to patient throughput, front-end assessments, and effective patient care transitions. This model can be used in future research to further investigate best case management practices.

Neurofeedback as an adjunct therapy for treatment of chronic posttraumatic stress disorder related to refugee trauma and torture experiences: two case studies.

PubMed

Askovic, Mirjana; Watters, Anna J; Aroche, Jorge; Harris, Anthony W F

2017-08-01

The objective of this study was to describe the use of neurofeedback for refugee-related chronic posttraumatic stress disorder (PTSD) in two case studies. We describe the assessment and application of neurofeedback integrated into the treatment of two clients with chronic PTSD. We include details of our treatment schedule, symptoms and quantitative electrophysiological data for each case. Results All clients achieved significant reduction in symptoms of PTSD and improvement in daily functioning post-neurofeedback therapy. Quantitative electroencephalogric (EEG) measures indicate a normalisation of EEG markers relating to trauma, including overarousal at rest and working memory function. Conclusions Neurofeedback as an adjunct to trauma-informed therapy may help to remediate chronic PTSD relating to refugee experiences. If replicated then improvements demonstrated in this population would be generalisable to all chronic PTSD.

Re-defining one's occupational self 2 years after breast cancer: a case study.

PubMed

Newman, Robin M

2013-01-01

Margaret*, a 56 year-old Caucasian Stage III breast cancer survivor, participated in a 5 week occupational therapy pilot program, called Take Action. This program was designed for breast cancer survivors who self-reported changes in cognitive function following completion of chemotherapy. The goals of the program were to improve participants' knowledge and use of strategies to enhance occupational performance and to improve satisfaction and performance of meaningful daily activities or occupations. Through a client-centered and evidence-based approach, this case study highlights the importance of incorporating the survivors' sense of self into an occupation-based intervention. Occupational therapists play an important role in facilitating exploration of sense of self in the survivorship phase of care to support occupational performance in self care, productivity, work, leisure and social participation. This case study highlights the important work of redefining oneself in the survivorship phase of care. (*denotes name change).

Electronic Sentinel Surveillance of Influenza-like Illness. Experience from a pilot study in New Zealand.

PubMed

Adnan, Mehnaz; Peterkin, Donald; Lopez, Liza; Mackereth, Graham

2017-02-01

Electronic reporting of Influenza-like illness (eILI) from primary care was implemented and evaluated in three general medical practices in New Zealand during May to September 2015. To measure the uptake of eILI and to identify the system's strength and limitations. Analysis of transactional data from the eILI system; comparative study of influenza-like illness cases reported using manual methods and eILI; questionnaire administered to clinical and operational stakeholders. Over the study period 66% of total ILI cases were reported using eILI. Reporting timeliness improved significantly compared to manual reporting with an average of 24 minutes from submission by the clinician to processing in the national database. Users found the system to be user-friendly. eILI assists clinicians to report ILI cases to public health authorities within a stipulated time period and is associated with faster, more reliable and improved information transfer.

The contribution of a non-governmental organisation's Community Based Tuberculosis Care Programme to case finding in Myanmar: trend over time.

PubMed

Maung, Htet Myet Win; Saw, Saw; Isaakidis, Petros; Khogali, Mohammed; Reid, Anthony; Hoa, Nguyen Binh; Zaw, Ko Ko; Thein, Saw; Aung, Si Thu

2017-04-03

It is estimated that the standard, passive case finding (PCF) strategy for detecting cases of tuberculosis (TB) in Myanmar has not been successful: 26% of cases are missing. Therefore, alternative strategies, such as active case finding (ACF) by community volunteers, have been initiated since 2011. This study aimed to assess the contribution of a Community Based TB Care Programme (CBTC) by local non-government organizations (NGOs) to TB case finding in Myanmar over 4 years. This was a descriptive study using routine, monitoring data. Original data from the NGOs were sent to a central registry within the National TB Programme and data for this study were extracted from that database. Data from all 84 project townships in five regions and three states in Myanmar were used. The project was launched in 2011. Over time, the number of presumptive TB cases that were referred decreased, except in the Yangon Region, although in some areas, the numbers fluctuated. At the same time, there was a trend for the proportion of cases treated, compared to those referred, that decreased over time (P = 0.051). Overall, among 84 townships, the contribution of CBTC to total case detection deceased from 6% to 4% over time (P < 0.001). Contrary to expectations and evidence from previous studies in other countries, a concerning reduction in TB case finding by local NGO volunteer networks in several areas in Myanmar was recorded over 4 years. This suggests that measures to support the volunteer network and improve its performance are needed. They may include discussion with local NGOs human resources personnel, incentives for the volunteers, closer supervision of volunteers and improved monitoring and evaluation tools.

Theory-based and evidence-based design of audit and feedback programmes: examples from two clinical intervention studies.

PubMed

Hysong, Sylvia J; Kell, Harrison J; Petersen, Laura A; Campbell, Bryan A; Trautner, Barbara W

2017-04-01

Audit and feedback (A&F) is a common intervention used to change healthcare provider behaviour and, thus, improve healthcare quality. Although A&F can be effective its effectiveness varies, often due to the details of how A&F interventions are implemented. Some have suggested that a suitable conceptual framework is needed to organise the elements of A&F and also explain any observed differences in effectiveness. Through two examples from applied research studies, this article demonstrates how a suitable explanatory theory (in this case Kluger & DeNisi's Feedback Intervention Theory (FIT)) can be systematically applied to design better feedback interventions in healthcare settings. Case 1: this study's objective was to reduce inappropriate diagnosis of catheter-associated urinary tract infections (CAUTI) in inpatient wards. Learning to identify the correct clinical course of action from the case details was central to this study; consequently, the feedback intervention featured feedback elements that FIT predicts would best activate learning processes (framing feedback in terms of group performance and providing of correct solution information). We designed a highly personalised, interactive, one-on-one intervention with healthcare providers to improve their capacity to distinguish between CAUTI and asymptomatic bacteruria (ASB) and treat ASB appropriately. Case 2: Simplicity and scalability drove this study's intervention design, employing elements that FIT predicted positively impacted effectiveness yet still facilitated deployment and scalability (eg, delivered via computer, delivered in writing). We designed a web-based, report-style feedback intervention to help primary care physicians improve their care of patients with hypertension. Both studies exhibited significant improvements in their desired outcome and in both cases interventions were received positively by feedback recipients. A&F has been a popular, yet inconsistently implemented and variably effective tool for changing healthcare provider behaviour and, improving healthcare quality. Through the systematic use of theory such as FIT, robust feedback interventions can be designed that yield greater effectiveness. Future work should look to comparative effectiveness of specific design elements and contextual factors that identify A&F as the optimal intervention to effectuate healthcare provider behaviour change. NCT01052545, NCT00302718; post-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Using Hyaluronic Acid for Improving Vocal Function in a Prepubescent Boy With an Atrophied Right Vocal Fold.

PubMed

Cohen, Wendy; Wynne, David McGregor

2015-07-01

A single case study is reported of a child who underwent several surgical procedures as result of congenital grade III subglottic stenosis. The anterior aspect of the right vocal cord was damaged and underwent atrophy during one of these procedures. Now, an active 10-year-old, the patient has become increasingly aware of his vocal limitations on functional activities. Injection of hyaluronic acid into the vocal folds has been known to provide improved voice quality in adults although there are no known cases reported of this procedure in children. This article reports voice outcomes after injection of hyaluronic acid into the Reinke's space in a single case study. Voice recordings were made before, after, and 1 month after injection. The voice recordings were subject to acoustic and perceptual analysis. Post and follow-up voice recordings demonstrate decreased jitter, shimmer, and harmonics-to-noise ratio. Perceptual evaluation indicates improved voice quality. Injection of hyaluronic acid in children who require voice augmentation is possible and may contribute to increased vocal function and improved voice outcomes. Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

TBDQ: A Pragmatic Task-Based Method to Data Quality Assessment and Improvement

PubMed Central

Vaziri, Reza; Mohsenzadeh, Mehran; Habibi, Jafar

2016-01-01

Organizations are increasingly accepting data quality (DQ) as a major key to their success. In order to assess and improve DQ, methods have been devised. Many of these methods attempt to raise DQ by directly manipulating low quality data. Such methods operate reactively and are suitable for organizations with highly developed integrated systems. However, there is a lack of a proactive DQ method for businesses with weak IT infrastructure where data quality is largely affected by tasks that are performed by human agents. This study aims to develop and evaluate a new method for structured data, which is simple and practical so that it can easily be applied to real world situations. The new method detects the potentially risky tasks within a process, and adds new improving tasks to counter them. To achieve continuous improvement, an award system is also developed to help with the better selection of the proposed improving tasks. The task-based DQ method (TBDQ) is most appropriate for small and medium organizations, and simplicity in implementation is one of its most prominent features. TBDQ is case studied in an international trade company. The case study shows that TBDQ is effective in selecting optimal activities for DQ improvement in terms of cost and improvement. PMID:27192547

Inquiry-based Science Instruction in High School Biology Courses: A Multiple Case Study

NASA Astrophysics Data System (ADS)

Aso, Eze

A lack of research exists about how secondary school science teachers use inquiry-based instruction to improve student learning. The purpose of this qualitative study was to explore how science teachers used inquiry-based instruction to improve student learning in high school biology courses. The conceptual framework was based on Banchi and Bell's model of increasing levels of complexity for inquiry-based instruction. A multiple case study research design was conducted of biology programs at 3 high schools in an urban school district in the northeastern region of the United States. Participants included 2 biology teachers from each of the 3 high schools. Data were collected from individual interviews with biology teachers, observations of lessons in biology, and documents related to state standards, assessments, and professional development. The first level of data analysis involved coding and categorizing the interview and observation data. A content analysis was used for the documents. The second level of data analysis involved examining data across all sources and all cases for themes and discrepancies. According to study findings, biology teachers used confirmation, structure, and guided inquiry to improve student learning. However, they found open inquiry challenging and frustrating to implement because professional development about scaffolding of instruction over time was needed, and students' reading and writing skills needed to improve. This study contributes to positive social change by providing educators and researchers with a deeper understanding about how to scaffold levels of inquiry-based science instruction in order to help students become scientifically literate citizens.

Expectation-Based Efficiency and Quality Improvements in Research Administration: Multi-Institutional Case Studies

ERIC Educational Resources Information Center

Saha, Dhanonjoy C.; Ahmed, Abrar; Hanumandla, Shailaja

2011-01-01

Conventional wisdom may support the presumed notion that higher expectations increase efficiency and improve quality. However, this claim may only be validated when workers are equipped with appropriate tools, training, and a conducive work environment. This study implements various interventions, observes outcomes, and analyzes data collected in…

Using Formative Student Feedback: A Continuous Quality Improvement Approach for Online Course Development

ERIC Educational Resources Information Center

Bloxham, Kristy Taylor

2010-01-01

The objective of this study was to examine the use of frequent, anonymous student course surveys as a tool in supporting continuous quality improvement (CQI) principles in online instruction. The study used a qualitative, multiple-case design involving four separate online courses. Analysis methods included pattern matching/explanation building,…

Improving Learning Performance in Laboratory Instruction by Means of SMS Messaging

ERIC Educational Resources Information Center

Martinez-Torres, M. R.; Toral, S. L.; Barrero, F.; Gallardo, S.

2007-01-01

The study described in this paper outlines an attempt to explore those factors that contribute to learning performance improvement in laboratory instruction. As a case study, the educational methodology involved in a basic microcontroller course was analyzed. Traditional lab sessions based on the control of peripherals with low interactivity have…

Using Mobile Learning to Improve the Reflection: A Case Study of Traffic Violation

ERIC Educational Resources Information Center

Lan, Yu-Feng; Huang, Shin-Ming

2012-01-01

The purpose of this study was to integrate mobile communication technologies and a global positioning system (GPS) to construct an instant, convenient report of the mobile network service system named the Mobile Traffic Violation Reporting System (MTVRS), to improve learners' traffic violation reflection level. Data were collected using a…

An Urban School Leader's Approach to School Improvement: Toward Contextually Responsive Leadership

ERIC Educational Resources Information Center

Reed, Latish C.; Swaminathan, Raji

2016-01-01

This case study examines the leadership practices and actions of an urban high school principal who faced many challenges, but worked diligently to improve student achievement and school climate over a 3-year period. Significant improvements were made by using elements of Distributed Leadership, Professional Learning Communities, and Social…

Pennsylvania School Improvement Program. Linkage Case Study. Intermediate Unit A.

ERIC Educational Resources Information Center

Barnette, J. Jackson

The Pennsylvania School Improvement Program (PSIP) was created to assist local schools and school districts in the development of curriculum improvement strategies. The process involves the use of "linkers," curriculum specialists who work with teams from the local level to ascertain needs, then connect the local teams with the research…

Large-Scale High School Reform through School Improvement Networks: Exploring Possibilities for "Developmental Evaluation"

ERIC Educational Resources Information Center

Peurach, Donald J.; Lenhoff, Sarah Winchell; Glazer, Joshua L.

2016-01-01

Recognizing school improvement networks as a leading strategy for large-scale high school reform, this analysis examines developmental evaluation as an approach to examining school improvement networks as "learning systems" able to produce, use, and refine practical knowledge in large numbers of schools. Through a case study of one…

Homeopathic approach in the treatment of patients with mental disability.

PubMed

Dolce Filho, R

2006-01-01

The author describes his experience assisting mentally disabled patients with homeopathy. In these patients' anamneses, common traits shared by some syndromes, pathologies and behaviour, were taken into consideration, mainly to choose the most characteristic symptoms in each case. The study includes 58 cases of patients suffering from this pathology: 28 females and 30 males, ages ranging from 1 to 49 years (mean 20). Forty-seven had some improvement. Homeopathy is a useful alternative to relieve pathologies associated with mental disability. In those cases in which there were similarities between remedy and whole symptomatology, improvements in adaptation skills and in overall health were observed.

Building an outpatient imaging center: A case study at genesis healthcare system, part 2.

PubMed

Yanci, Jim

2006-01-01

In the second of 2 parts, this article will focus on process improvement projects utilizing a case study at Genesis HealthCare System located in Zanesville, OH. Operational efficiency is a key step in developing a freestanding diagnostic imaging center. The process improvement projects began with an Expert Improvement Session (EIS) on the scheduling process. An EIS session is a facilitated meeting that can last anywhere from 3 hours to 2 days. Its intention is to take a group of people involved with the problem or operational process and work to understand current failures or breakdowns in the process. Recommendations are jointly developed to overcome any current deficiencies, and a work plan is structured to create ownership over the changes. A total of 11 EIS sessions occurred over the course of this project, covering 5 sections: Scheduling/telephone call process, Pre-registration, Verification/pre-certification, MRI throughput, CT throughput. Following is a single example of a project focused on the process improvement efforts. All of the process improvement projects utilized a quasi methodology of "DMAIC" (Define, Measure, Analyze, Improve, and Control).

[A comparative study on treating femal stress urinary incontinence with TVT-Abbrevo and TVT-Obturator].

PubMed

Li, W L; Lu, Z W; Li, F P; Yu, H Y

2016-07-26

To compare the effectiveness and complications of TVT-Abbrevo (tension-free vaginal tape-Abbrevo) and TVT-Obturator (tension-free vaginal tape-obturator) for the treatment of female stress urinary incontinence (SUI). From Nov.2012 to Nov.2013, 117 patients suffering from SUI were treated with TVT-Abbrebo (n=79) or TVT-Obturator (n=38) procedure, the clinical efficacy and operation-correlated complications were observed. A total of 117 cases, 107 cases of urinary incontinence symptoms disappeared completely, 10 cases were improved. 72 cases (91.1%) were cured and 7 cases (8.9%) were improved in TVT-Abbrevo group; 35 cases (92.1%) were cured and 3 cases (7.9%) were improved in TVT-Obturator group. No significant differences could be found for the curing rates between two groups (P>0.05). Compared with the TVT-Obturator group, the TVT-Abbrevo group had less patients complaining of inner thigh pain at 24 h and 1 w after surgery (P<0.05). No significant differences were observed for the incidence of inner thigh pain at 1m and 1y after surgery between TVT-Abbrevo and TVT-Obturator group (P>0.05). No intraoperative complications such as blood vessel, nerve, bladder damage were recorded and no postoperative retropubic hematoma, tape adjustment and other complications occurred in two goups. No recurrence after 1 year follow-up. The study shows that TVT-Abbrevo procedure is safe and efficacy in treatment of SUI, and associated with low incidence of recent postoperative inner thigh pain.

Can computer-aided diagnosis (CAD) help radiologists find mammographically missed screening cancers?

NASA Astrophysics Data System (ADS)

Nishikawa, Robert M.; Giger, Maryellen L.; Schmidt, Robert A.; Papaioannou, John

2001-06-01

We present data from a pilot observer study whose goal is design a study to test the hypothesis that computer-aided diagnosis (CAD) can improve radiologists' performance in reading screening mammograms. In a prospective evaluation of our computer detection schemes, we have analyzed over 12,000 clinical exams. Retrospective review of the negative screening mammograms for all cancer cases found an indication of the cancer in 23 of these negative cases. The computer found 54% of these in our prospective testing. We added to these cases normal exams to create a dataset of 75 cases. Four radiologists experienced in mammography read the cases and gave their BI-RADS assessment and their confidence that the patient should be called back for diagnostic mammography. They did so once reading the films only and a second time reading with the computer aid. Three radiologists had no change in area under the ROC curve (mean Az of 0.73) and one improved from 0.73 to 0.78, but this difference failed to reach statistical significance (p equals 0.23). These data are being used to plan a larger more powerful study.

Rapid Operational Access and Maneuver Support (ROAMS) Platform for Improved Military Logistics Lines of Communication and Operational Vessel Routing

DTIC Science & Technology

2017-06-01

case study in a northeastern American metropolitan area. METHODOLOGY : The ROAMS platform provides expanded analysis, model automation, and enhanced...shoals. An initial route for such operations is selected much like the military logistics case . Subsequent adjustments to routes may be done on an ad...IX-45 June 2017 8 CASE STUDY: The ROAMS platform was applied to a large, northeast American metropolitan region to demonstrate the capability of

Comparison of three problem-based learning conditions (real patients, digital and paper) with lecture-based learning in a dermatology course: a prospective randomized study from China.

PubMed

Li, Jie; Li, Qing Ling; Li, Ji; Chen, Ming Liang; Xie, Hong Fu; Li, Ya Ping; Chen, Xiang

2013-01-01

The precise effect and the quality of different cases used in dermatology problem-based learning (PBL) curricula are yet unclear. To prospectively compare the impact of real patients, digital, paper PBL (PPBL) and traditional lecture-based learning (LBL) on academic results and student perceptions. A total of 120 students were randomly allocated into either real-patients PBL (RPBL) group studied via real-patient cases, digital PBL (DPBL) group studied via digital-form cases, PPBL group studied via paper-form cases, or conventional group who received didactic lectures. Academic results were assessed through review of written examination, objective structured clinical examination and student performance scores. A five-point Likert scale questionnaire was used to evaluate student perceptions. Compared to those receiving lectures only, all PBL participants had better results for written examination, clinical examination and overall performance. Students in RPBL group exhibited better overall performance than those in the other two PBL groups. Real-patient cases were more effective in helping develop students' self-directed learning skills, improving their confidence in future patient encounters and encouraging them to learn more about the discussed condition, compared to digital and paper cases. Both real patient and digital triggers are helpful in improving students' clinical problem-handling skills. However, real patients provide greater benefits to students.

Effects of Diabetic Case Management on Knowledge, Self-Management Abilities, Health Behaviors, and Health Service Utilization for Diabetes in Korea

PubMed Central

Shin, Soon Ae; Lee, Kunsei; Lin, Vivian; Liu, George; Shin, Eunyoung

2015-01-01

Purpose This study aimed to evaluate the effects of a case management program for diabetics, using a pre-post comparison design. Materials and Methods The study population comprised 6007 diabetics who received case management intervention in 2006 and were sampled nationwide in Korea. Before and after the intervention, the study population answered questions regarding their knowledge of diabetes, self-management ability, and health behaviors. Body mass index (BMI) was also calculated. Healthcare service utilization for diabetes was extracted from health insurance claim data from 2005 to 2007. Results The case management program significantly improved the study population's knowledge of diabetes and ability to self-manage nutrition, blood glucose monitoring, foot and oral care, and medications. This program also significantly changed the study population's health behaviors regarding smoking, alcohol drinking, and exercise, and BMI was positively affected. In the over-serviced subgroup, there was a significant decrease in the number of consultations (mean=7.0; SD=19.5) after intervention. Conversely, in the under-serviced subgroup, there was a significant increase in the number of consultations (mean=3.2; SD=7.9) and the days of prescribed medication (mean=66.4; SD=120.3) after intervention. Conclusion This study showed that the case management program led the study population to improve their knowledge, self-management ability, health behaviors, and utilization of health care. It is necessary in future studies to evaluate the appropriateness of healthcare usage and clinical outcome by using a control group to determine the direct effectiveness of this case management program. PMID:25510771

Effects of diabetic case management on knowledge, self-management abilities, health behaviors, and health service utilization for diabetes in Korea.

PubMed

Shin, Soon Ae; Kim, Hyeongsu; Lee, Kunsei; Lin, Vivian; Liu, George; Shin, Eunyoung

2015-01-01

This study aimed to evaluate the effects of a case management program for diabetics, using a pre-post comparison design. The study population comprised 6007 diabetics who received case management intervention in 2006 and were sampled nationwide in Korea. Before and after the intervention, the study population answered questions regarding their knowledge of diabetes, self-management ability, and health behaviors. Body mass index (BMI) was also calculated. Healthcare service utilization for diabetes was extracted from health insurance claim data from 2005 to 2007. The case management program significantly improved the study population's knowledge of diabetes and ability to self-manage nutrition, blood glucose monitoring, foot and oral care, and medications. This program also significantly changed the study population's health behaviors regarding smoking, alcohol drinking, and exercise, and BMI was positively affected. In the over-serviced subgroup, there was a significant decrease in the number of consultations (mean=7.0; SD=19.5) after intervention. Conversely, in the under-serviced subgroup, there was a significant increase in the number of consultations (mean=3.2; SD=7.9) and the days of prescribed medication (mean=66.4; SD=120.3) after intervention. This study showed that the case management program led the study population to improve their knowledge, self-management ability, health behaviors, and utilization of health care. It is necessary in future studies to evaluate the appropriateness of healthcare usage and clinical outcome by using a control group to determine the direct effectiveness of this case management program.

Outcomes of cataract surgery with residents as primary surgeons in the Veterans Affairs Healthcare System.

PubMed

Payal, Abhishek R; Gonzalez-Gonzalez, Luis A; Chen, Xi; Cakiner-Egilmez, Tulay; Chomsky, Amy; Baze, Elizabeth; Vollman, David; Lawrence, Mary G; Daly, Mary K

2016-03-01

To explore visual outcomes, functional visual improvement, and events in resident-operated cataract surgery cases. Veterans Affairs Ophthalmic Surgery Outcomes Database Project across 5 Veterans Affairs Medical Centers. Retrospective data analysis of deidentified data. Cataract surgery cases with residents as primary surgeons were analyzed for logMAR corrected distance visual acuity (CDVA) and vision-related quality of life (VRQL) measured by the modified National Eye Institute Vision Function Questionnaire and 30 intraoperative and postoperative events. In some analyses, cases without events (Group A) were compared with cases with events (Group B). The study included 4221 cataract surgery cases. Preoperative to postoperative CDVA improved significantly in both groups (P < .0001), although the level of improvement was less in Group B (P = .03). A CDVA of 20/40 or better was achieved in 96.64% in Group A and 88.25% in Group B (P < .0001); however, Group B had a higher prevalence of preoperative ocular comorbidities (P < .0001). Cases with 1 or more events were associated with a higher likelihood of a postoperative CDVA worse than 20/40 (odds ratio, 3.82; 95% confidence interval, 2.92-5.05; P < .0001) than those who did not experience an event. Both groups had a significant increase in VRQL from preoperative levels (both P < .0001); however, the level of preoperative to postoperative VRQL improvement was significantly less in Group B (P < .0001). Resident-operated cases with and without events had an overall significant improvement in visual acuity and visual function compared with preoperatively, although this improvement was less marked in those that had an event. None of the authors has a financial or proprietary interest in any material or method mentioned. Copyright © 2016 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

Development and Evaluation of a Pilot Nurse Case Management Model to Address Multidrug-Resistant Tuberculosis (MDR-TB) and HIV in South Africa

PubMed Central

Farley, Jason E.; Kelly, Ana M.; Reiser, Katrina; Brown, Maria; Kub, Joan; Davis, Jeane G.; Walshe, Louise; Van der Walt, Martie

2014-01-01

Setting Multidrug-resistant tuberculosis (MDR-TB) unit in KwaZulu-Natal, South Africa. Objective To develop and evaluate a nurse case management model and intervention using the tenets of the Chronic Care Model to manage treatment for MDR-TB patients with a high prevalence of human immunodeficiency virus (HIV) co-infection. Design A quasi-experimental pilot programme utilizing a nurse case manager to manage care for 40 hospitalized MDR-TB patients, 70% HIV co-infected, during the intensive phase of MDR-TB treatment. Patients were followed for six months to compare proximal outcomes identified in the model between the pre- and post-intervention period. Results The greatest percent differences between baseline and six-month MDR-TB proximal outcomes were seen in the following three areas: baseline symptom evaluation on treatment initiation (95% improvement), baseline and monthly laboratory evaluations completed per guidelines (75% improvement), and adverse drug reactions acted upon by medical and/or nursing intervention (75% improvement). Conclusion Improvements were identified in guideline-based treatment and monitoring of adverse drug reactions following implementation of the nurse case management intervention. Further study is required to determine if the intervention introduced in this model will ultimately result in improvements in final MDR-TB treatment outcomes. PMID:25405988

The Effect of Scaffolding Students' Context-Generating Cognitive Activity in Technology-Enhanced Case-Based Learning

ERIC Educational Resources Information Center

Demetriadis, S. N.; Papadopoulos, P. M.; Stamelos, I. G.; Fischer, F.

2008-01-01

This study investigates the hypothesis that students' learning and problem-solving performance in ill-structured domains can be improved, if elaborative question prompts are used to activate students' context-generating cognitive processes, during case study. Two groups of students used a web-based learning environment to criss-cross and study…

Using a Facebook Closed Group to Improve EFL Students' Writing

ERIC Educational Resources Information Center

Rodliyah, Rojab Siti

2016-01-01

This study investigates how social media, in this case Facebook, can be incorporated in ELT through e-dialogue journal writing shared in a Facebook closed group. Fifteen EFL students participated in this case study. They were second, third, and fourth year students of English Education Department of a university in Bandung, who voluntarily joined…

Task-Based Interaction and Incidental Vocabulary Learning: A Case Study.

ERIC Educational Resources Information Center

Newton, Jonathan

1995-01-01

This case study examined the vocabulary gains made by an adult learner of English as a Second Language as a result of performing four communication tasks. It found that explicit negotiation of word meaning appeared less deterministic of posttest improvements than use of words in the process of completing the task. (13 references) (MDM)

Developing and Using a Logic Model for Evaluation and Assessment of University Student Affairs Programming: A Case Study

ERIC Educational Resources Information Center

Cooper, Jeff

2009-01-01

This dissertation addresses theory and practice of evaluation and assessment in university student affairs, by applying logic modeling/program theory to a case study. I intend to add knowledge to ongoing dialogue among evaluation scholars and practitioners on student affairs program planning and improvement as integral considerations that serve…

Lecturing: Case Studies, Experience and Practice. Case Studies of Teaching in Higher Education.

ERIC Educational Resources Information Center

Edwards, Helen, Ed.; Smith, Brenda, Ed.; Webb, Graham, Ed.

The essays in this collection explore how different lecturing situations can be handled and how lecturing confidence and techniques can be improved. The book covers a wide range of scenarios in these chapters: (1) "Learning from Objectives" (Stanley Yeo); (2) "New at This" (Sally Brown); (3) "The Smart Student" (Marilyn Baird); (4) "The Mobile…

Case studies in corporate compliance: putting the rubber to the road.

PubMed

Shah, Udayan K; Schmidt, Richard J; Hussain, S S Musheer; Cook, Steven P; Smith, Gina M; Ziv, Barbara E; Reilly, James S

2009-08-01

An interdisciplinary, proactive perspective allows providers to engage in productive, long-term collaborative relationships with corporations, while 1) maintaining patient care improvements; 2) maintaining legality; 3) enhancing technical and clinical innovation; and 4) providing fair compensation for work done. The case study approach is used to demonstrate an effective approach to compliant behavior.

Merging Regular and Special Education Teacher Preparation Programs: The Integrated Special Education-English Project (ISEP).

ERIC Educational Resources Information Center

Miller, Darcy E.

1991-01-01

Describes the Integrated Special Education-English Project (ISEP) which facilitated the gradual integration of special education and English teacher preparation programs. A description of the ISEP model and a case study are included. The case study indicated student teachers who participated in the ISEP improved special education and English…

Year One of School Improvement: Examples from Nine Schools

ERIC Educational Resources Information Center

Gordon, Stephen P.; Stiegelbauer, Suzanne; Diehl. Julie

2006-01-01

This study reports on the process and outcomes of schoolwide action research by nine schools in their first year as Network members. The participants were a blend of urban, suburban, small town, and rural schools in Central Texas. Focal points of the case studies and cross-case comparison included: (1) how the schools organized for action…

A Case Study in Market Transformation for Residential Energy Efficiency Programs

DOE Office of Scientific and Technical Information (OSTI.GOV)

Building Technologies Office

This case study describes how the Midwest Energy Efficiency Alliance (MEEA) partnered with gas and electric utilities in Iowa to establish the Iowa residential heating, ventilation, and air conditioning System Adjustment and Verified Efficiency (HVAC SAVE) program, taking it to scale improving the performance and energy efficiency of HVAC systems, growing businesses, and gaining consumer trust.

Using Portfolios to Improve Teaching Quality: The Case of a Small Business School

ERIC Educational Resources Information Center

Stewart, Ian

2004-01-01

In this study, the author applies B. K. Curry's (1992) model of organizational institutionalization to a case study involving efforts to implement course and teaching portfolios in a small business school. This article is based on the personal observations of those involved and the published literature on the subject. Both teaching and course…

Front-End and Back-End Database Design and Development: Scholar's Academy Case Study

ERIC Educational Resources Information Center

Parks, Rachida F.; Hall, Chelsea A.

2016-01-01

This case study consists of a real database project for a charter school--Scholar's Academy--and provides background information on the school and its cafeteria processing system. Also included are functional requirements and some illustrative data. Students are tasked with the design and development of a database for the purpose of improving the…

Repairing Discordant Student--Teacher Relationships: A Case Study Using Emotion-Focused Therapy

ERIC Educational Resources Information Center

Lander, Itzhak

2009-01-01

This article describes the use of emotion-focused therapy (EFT) to reduce conflict in the student-teacher relationship. A case study of a homeroom teacher and a sixth-grade student is presented. This innovative family treatment model is demonstrated to be a useful tool for improving the student-teacher relational system, resulting in amelioration…

System Learning in an Urban School District: A Case Study of Intra-District Learning

ERIC Educational Resources Information Center

Redding, Christopher; Cannata, Marisa; Miller, Jason

2017-01-01

This paper presents evidence from a unique reform model that allowed teachers and other educators in a large urban district to collaborate with one another in the development of an innovation meant to improve student ownership and responsibility. In this longitudinal case study, we describe school stakeholders' learning about the design, the…

Improved Attitude and Achievement: A Case Study of an Elementary School Academic Advisement Intervention

ERIC Educational Resources Information Center

Kamrath, Barry; Brooker, Teresa

2018-01-01

School counselors are often called upon to develop and implement academic interventions. In this case study of one urban elementary school, a school counselor conducted a small group academic advisement intervention. The results suggest that integrating the activities into the elementary school counseling program can be an effective Response to…

System Learning in an Urban School District: A Case Study of Intra-District Learning

ERIC Educational Resources Information Center

Redding, Christopher; Cannata, Marisa; Miller, Jason M.

2018-01-01

This paper presents evidence from a unique reform model that allowed teachers and other educators in a large urban district to collaborate with one another in the development of an innovation meant to improve student ownership and responsibility. In this longitudinal case study, we describe school stakeholders' learning about the design, the…

High-Intensity Strength Training Improves Function of Chronically Painful Muscles: Case-Control and RCT Studies

PubMed Central

Andersen, Christoffer H.; Skotte, Jørgen H.; Suetta, Charlotte; Søgaard, Karen; Saltin, Bengt; Sjøgaard, Gisela

2014-01-01

Aim. This study investigates consequences of chronic neck pain on muscle function and the rehabilitating effects of contrasting interventions. Methods. Women with trapezius myalgia (MYA, n = 42) and healthy controls (CON, n = 20) participated in a case-control study. Subsequently MYA were randomized to 10 weeks of specific strength training (SST, n = 18), general fitness training (GFT, n = 16), or a reference group without physical training (REF, n = 8). Participants performed tests of 100 consecutive cycles of 2 s isometric maximal voluntary contractions (MVC) of shoulder elevation followed by 2 s relaxation at baseline and 10-week follow-up. Results. In the case-control study, peak force, rate of force development, and rate of force relaxation as well as EMG amplitude were lower in MYA than CON throughout all 100 MVC. Muscle fiber capillarization was not significantly different between MYA and CON. In the intervention study, SST improved all force parameters significantly more than the two other groups, to levels comparable to that of CON. This was seen along with muscle fiber hypertrophy and increased capillarization. Conclusion. Women with trapezius myalgia have lower strength capacity during repetitive MVC of the trapezius muscle than healthy controls. High-intensity strength training effectively improves strength capacity during repetitive MVC of the painful trapezius muscle. PMID:24707475

A patient with Cotard syndrome who showed an improvement in single photon emission computed tomography findings after successful treatment with antidepressants.

PubMed

Hashioka, Sadayuki; Monji, Akira; Sasaki, Masayuki; Yoshida, Ichiro; Baba, Kanji; Tashiro, Nobutada

2002-01-01

We report the case of a presenile woman with Cotard syndrome, in the context of major depression, who showed an improvement in bilateral frontal hypoperfusion in a SPECT study using 99mTc-HMPAO after undergoing successful treatment with antidepressant therapy. We also retrospectively evaluated her clinical course based on the clinical stages. The symptoms of Cotard syndrome have been reported to change dramatically according to the stages. This peculiarity made it difficult for us to rapidly diagnose Cotard syndrome in the context of major depression, and not dementia, and thereby adequately treat the patient in our case. Differences in the reduced blood flow regions and a time lag from psychiatric remission were observed before the improvement in the SPECT findings when comparing our case with a previously reported case of Cotard syndrome. These differences suggest that the mechanism of Cotard syndrome is still not well understood at the present time.

A Case Study on the Implementation of Reflective Development Model in Improving Intercultural Competence among Business Student in Stamford College

ERIC Educational Resources Information Center

Gowindasamy, Maniyarasi

2017-01-01

This study was conducted to evaluate the implementation of reflective development model in improving the intercultural competence among business student in Stamford College. This study will be focus on the local and international students in terms of their cultural competencies through the globalization subjects. An embedded design of mixed…

Using Wikipedia to Enhance Student Learning: A Case Study in Economics

ERIC Educational Resources Information Center

Freire, Tiago; Li, Jingping

2016-01-01

Currently, there is widespread interest in how Web 2.0 tools can be used to improve students' learning experiences. Previous studies have focused either on the advantages of wikis or on concerns over the use of Wikipedia. In this study, we propose to use Wikipedia as a classroom wiki. In doing so, we discuss how students can improve their standard…

Cingulate Epilepsy

PubMed Central

Alkawadri, Rafeed; So, Norman K.; Van Ness, Paul C.; Alexopoulos, Andreas V.

2016-01-01

IMPORTANCE The literature on cingulate gyrus epilepsy in the magnetic resonance imaging era is limited to case reports and small case series. To our knowledge, this is the largest study of surgically confirmed epilepsy arising from the anterior or posterior cingulate region. OBJECTIVE To characterize the clinical and electrophysiological findings of epilepsies arising from the anterior and posterior cingulate gyrus. DESIGN, SETTING, AND PARTICIPANTS We studied consecutive cingulate gyrus epilepsy cases identified retrospectively from the Cleveland Clinic and University of Texas Southwestern Medical Center epilepsy databases from 1992 to 2009. Participants included 14 consecutive cases of cingulate gyrus epilepsies confirmed by restricted magnetic resonance image lesions and seizure freedom or marked improvement following lesionectomy. MAIN OUTCOMES AND MEASURES The main outcome measure was improvement in seizure frequency following surgery. The clinical, video electroencephalography, neuroimaging, pathology, and surgical outcome data were reviewed. RESULTS All 14 patients had cingulate epilepsy confirmed by restricted magnetic resonance image lesions and seizure freedom or marked improvement following lesionectomy. They were divided into 3 groups based on anatomical location of the lesion and corresponding seizure semiology. In the posterior cingulate group, all 4 patients had electroclinical findings suggestive of temporal origin of the epilepsy. The anterior cingulate cases were divided into a typical (Bancaud) group (6 cases with hypermotor seizures and infrequent generalization with the presence of fear, laughter, or severe interictal personality changes) and an atypical group (4 cases presenting with simple motor seizures and a tendency for more frequent generalization and less-favorable long-term surgical outcome). All atypical cases were associated with an underlying infiltrative astrocytoma. CONCLUSIONS AND RELEVANCE Posterior cingulate gyrus epilepsy may present with electroclinical findings that are suggestive of temporal lobe epilepsy and can be considered as another example of pseudotemporal epilepsies. The electroclinical presentation and surgical outcome of lesional anterior cingulate epilepsy is possibly influenced by the underlying pathology. This study highlights the difficulty in localizing seizures arising from the cingulate gyrus in the absence of a magnetic resonance image lesion. PMID:23753910

Development of a Reality-Based Multimedia Case Study Teaching Method and Its Effect on Students' Planned Food Safety Behaviors

ERIC Educational Resources Information Center

Alberts, Caitlin M.; Stevenson, Clinton D.

2017-01-01

There is opportunity to decrease the frequency of foodborne illnesses by improving food safety competencies and planned behaviors of college students before they begin careers in the food industry. The objectives of this study were to (1) develop a multimedia case study teaching method that provides real world context for food science education;…

Case management.

PubMed

Woodward, Judy; Rice, Eve

2015-03-01

Health care in the United States is changing rapidly under pressure from both political and professional stakeholders, and one area on the front line of required change is the discipline of case management. Historically, case management has worked to defragment the health care delivery system for clients and increase access to health care. Case management will have an expanded role resulting from Affordable Care Act initiatives to improve health care. This article includes definitions of case management, current issues related to case management, case management standards of practice, and a case study of the management of pediatric chronic disease. Copyright © 2015 Elsevier Inc. All rights reserved.

Analysing organisational context: case studies on the contribution of absorptive capacity theory to understanding inter-organisational variation in performance improvement.

PubMed

Harvey, Gill; Jas, Pauline; Walshe, Kieran

2015-01-01

Organisational context is frequently cited as an important consideration when implementing and evaluating quality improvement interventions in healthcare, but limited guidance is available on which aspects of context are most influential or modifiable. This paper examines how internal and external contextual factors mediate organisational-level performance improvement through applying the knowledge-based theory of absorptive capacity (AC). Three healthcare case studies are presented. Each case is a UK National Health Service organisation that had been identified as having performance problems. Qualitative data were collected through semi-structured interviews with general and clinical managers within the organisation and members of external teams supporting or overseeing performance improvement (n=22). Interview data were analysed using an existing AC framework from the literature. The organisation with the highest AC showed the quickest and most comprehensive performance improvement. Internal characteristics including strategic priorities, processes for managing information, communication and orientation to learning and development impacted on the organisation's ability to engage successfully with external stakeholders and make use of available knowledge. This enabled the organisation to thrive despite the challenging external environment. Lower levels of AC appeared to delay or limit the improvement trajectory. Developing a more detailed and nuanced understanding of how context influences improvement is an important step towards achieving more effective and sustainable quality improvement programmes in healthcare. AC, with its focus on knowledge and organisational learning, provides a useful way to explore the relationship between context and quality improvement and represents a potentially valuable area for future research and development. 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.

Cross-system effects of dysphagia treatment on dysphonia: a case report

PubMed Central

LaGorio, Lisa A; Carnaby-Mann, Giselle D; Crary, Michael A

2008-01-01

Traditionally, treatment of dysphagia and dysphonia has followed a specificity approach whereby treatment plans have focused on each dysfunction individually. Recently however, a therapeutic cross-system effect has been proposed between these two dysfunctions. At least one study has demonstrated swallowing improvement in subjects who completed a dysphonia treatment program. However, we are unaware of any evidence demonstrating the converse effect. In this paper, we present a case-report of a 74 year old male who demonstrated improvement in selected vocal parameters after completion of a dysphagia therapy program. Dysphagia therapy resulted in improved laryngeal function in this subject. Results implicate improved vocal fold tension with increased glottal closure. Further investigation into the potential for this cross-system effect is warranted. PMID:18667069

Improving the implementation of health workforce policies through governance: a review of case studies

PubMed Central

2011-01-01

Introduction Responsible governance is crucial to national development and a catalyst for achieving the Millennium Development Goals. To date, governance seems to have been a neglected issue in the field of human resources for health (HRH), which could be an important reason why HRH policy formulation and implementation is often poor. This article aims to describe how governance issues have influenced HRH policy development and to identify governance strategies that have been used, successfully or not, to improve HRH policy implementation in low- and middle-income countries (LMIC). Methods We performed a descriptive literature review of HRH case studies which describe or evaluate a governance-related intervention at country or district level in LMIC. In order to systematically address the term 'governance' a framework was developed and governance aspects were regrouped into four dimensions: 'performance', 'equity and equality', 'partnership and participation' and 'oversight'. Results and discussion In total 16 case studies were included in the review and most of the selected studies covered several governance dimensions. The dimension 'performance' covered several elements at the core of governance of HRH, decentralization being particularly prominent. Although improved equity and/or equality was, in a number of interventions, a goal, inclusiveness in policy development and fairness and transparency in policy implementation did often not seem adequate to guarantee the corresponding desirable health workforce scenario. Forms of partnership and participation described in the case studies are numerous and offer different lessons. Strikingly, in none of the articles was 'partnerships' a core focus. A common theme in the dimension of 'oversight' is local-level corruption, affecting, amongst other things, accountability and local-level trust in governance, and its cultural guises. Experiences with accountability mechanisms for HRH policy development and implementation were lacking. Conclusion This review shows that the term 'governance' is neither prominent nor frequent in recent HRH literature. It provides initial lessons regarding the influence of governance on HRH policy development and implementation. The review also shows that the evidence base needs to be improved in this field in order to better understand how governance influences HRH policy development and implementation. Tentative lessons are discussed, based on the case studies. PMID:21486438

Improving the implementation of health workforce policies through governance: a review of case studies.

PubMed

Dieleman, Marjolein; Shaw, Daniel Mp; Zwanikken, Prisca

2011-04-12

Responsible governance is crucial to national development and a catalyst for achieving the Millennium Development Goals. To date, governance seems to have been a neglected issue in the field of human resources for health (HRH), which could be an important reason why HRH policy formulation and implementation is often poor. This article aims to describe how governance issues have influenced HRH policy development and to identify governance strategies that have been used, successfully or not, to improve HRH policy implementation in low- and middle-income countries (LMIC). We performed a descriptive literature review of HRH case studies which describe or evaluate a governance-related intervention at country or district level in LMIC. In order to systematically address the term 'governance' a framework was developed and governance aspects were regrouped into four dimensions: 'performance', 'equity and equality', 'partnership and participation' and 'oversight'. In total 16 case studies were included in the review and most of the selected studies covered several governance dimensions. The dimension 'performance' covered several elements at the core of governance of HRH, decentralization being particularly prominent. Although improved equity and/or equality was, in a number of interventions, a goal, inclusiveness in policy development and fairness and transparency in policy implementation did often not seem adequate to guarantee the corresponding desirable health workforce scenario. Forms of partnership and participation described in the case studies are numerous and offer different lessons. Strikingly, in none of the articles was 'partnerships' a core focus. A common theme in the dimension of 'oversight' is local-level corruption, affecting, amongst other things, accountability and local-level trust in governance, and its cultural guises. Experiences with accountability mechanisms for HRH policy development and implementation were lacking. This review shows that the term 'governance' is neither prominent nor frequent in recent HRH literature. It provides initial lessons regarding the influence of governance on HRH policy development and implementation. The review also shows that the evidence base needs to be improved in this field in order to better understand how governance influences HRH policy development and implementation. Tentative lessons are discussed, based on the case studies.

Intravitreal dobesilate in the treatment of choroidal neovascularisation associated with age-related macular degeneration: report of two cases

PubMed Central

Cuevas, Pedro; Outeiriño, Luis; Azanza, Carlos; Giménez-Gallego, Guillermo

2012-01-01

This case report presents the effectiveness of intravitreal administration of dobesilate, a synthetic fibroblast growth factor inhibitor, in two patients showing neovascular age-related macular degeneration of the classic, and of the occult choroidal neovascularisation types, respectively. Our study demonstrates that the treatment induces the regression of both forms of this pathology, as assessed by spectral optical coherence tomography. Improvement of the lesions was accompanied of visual acuity improvement. PMID:22948997

Ulnar nerve injury associated with trampoline injuries.

PubMed

Maclin, Melvin M; Novak, Christine B; Mackinnon, Susan E

2004-08-01

This study reports three cases of ulnar neuropathy after trampoline injuries in children. A chart review was performed on children who sustained an ulnar nerve injury from a trampoline accident. In all cases, surgical intervention was required. Injuries included upper-extremity fractures in two cases and an upper-extremity laceration in one case. All cases required surgical exploration with internal neurolysis and ulnar nerve transposition. Nerve grafts were used in two cases and an additional nerve transfer was used in one case. All patients had return of intrinsic hand function and sensation after surgery. Children should be followed for evolution of ulnar nerve neuropathy after upper-extremity injury with consideration for electrical studies and surgical exploration if there is no improvement after 3 months.

Clinical Case Studies in Psychoanalytic and Psychodynamic Treatment

PubMed Central

Willemsen, Jochem; Della Rosa, Elena; Kegerreis, Sue

2017-01-01

This manuscript provides a review of the clinical case study within the field of psychoanalytic and psychodynamic treatment. The method has been contested for methodological reasons and because it would contribute to theoretical pluralism in the field. We summarize how the case study method is being applied in different schools of psychoanalysis, and we clarify the unique strengths of this method and areas for improvement. Finally, based on the literature and on our own experience with case study research, we come to formulate nine guidelines for future case study authors: (1) basic information to include, (2) clarification of the motivation to select a particular patient, (3) information about informed consent and disguise, (4) patient background and context of referral or self-referral, (5) patient's narrative, therapist's observations and interpretations, (6) interpretative heuristics, (7) reflexivity and counter-transference, (8) leaving room for interpretation, and (9) answering the research question, and comparison with other cases. PMID:28210235

Comparison of 2 resident learning tools-interactive screen-based simulated case scenarios versus problem-based learning discussions: a prospective quasi-crossover cohort study.

PubMed

Rajan, Shobana; Khanna, Ashish; Argalious, Maged; Kimatian, Stephen J; Mascha, Edward J; Makarova, Natalya; Nada, Eman M; Elsharkawy, Hesham; Firoozbakhsh, Farhad; Avitsian, Rafi

2016-02-01

Simulation-based learning is emerging as an alternative educational tool in this era of a relative shortfall of teaching anesthesiologists. The objective of the study is to assess whether screen-based (interactive computer simulated) case scenarios are more effective than problem-based learning discussions (PBLDs) in improving test scores 4 and 8 weeks after these interventions in anesthesia residents during their first neuroanesthesia rotation. Prospective, nonblinded quasi-crossover study. Cleveland Clinic. Anesthesiology residents. Two case scenarios were delivered from the Anesoft software as screen-based sessions, and parallel scripts were developed for 2 PBLDs. Each resident underwent both types of training sessions, starting with the PBLD session, and the 2 cases were alternated each month (ie, in 1 month, the screen-based intervention used case 1 and the PBLD used case 2, and vice versa for the next month). Test scores before the rotation (baseline), immediately after the rotation (4 weeks after the start of the rotation), and 8 weeks after the start of rotation were collected on each topic from each resident. The effect of training method on improvement in test scores was assessed using a linear mixed-effects model. Compared to the departmental standard of PBLD, the simulation method did not improve either the 4- or 8-week mean test scores (P = .41 and P = .40 for training method effect on 4- and 8-week scores, respectively). Resident satisfaction with the simulation module on a 5-point Likert scale showed subjective evidence of a positive impact on resident education. Screen-based simulators were not more effective than PBLD for education during the neuroanesthesia rotation in anesthesia residency. Copyright © 2016 Elsevier Inc. All rights reserved.

A multicentre case control study on complicated coeliac disease: two different patterns of natural history, two different prognoses

PubMed Central

2014-01-01

Background Coeliac disease is a common enteropathy characterized by an increased mortality mainly due to its complications. The natural history of complicated coeliac disease is characterised by two different types of course: patients with a new diagnosis of coeliac disease that do not improve despite a strict gluten-free diet (type A cases) and previously diagnosed coeliac patients that initially improved on a gluten-free diet but then relapsed despite a strict diet (type B cases). Our aim was to study the prognosis and survival of A and B cases. Methods Clinical and laboratory data from coeliac patients who later developed complications (A and B cases) and sex- and age-matched coeliac patients who normally responded to a gluten-free diet (controls) were collected among 11 Italian centres. Results 87 cases and 136 controls were enrolled. Complications tended to occur rapidly after the diagnosis of coeliac disease and cumulative survival dropped in the first months after diagnosis of complicated coeliac disease. Thirty-seven cases died (30/59 in group A, 7/28 in group B). Type B cases presented an increased survival rate compared to A cases. Conclusions Complicated coeliac disease is an extremely serious condition with a high mortality and a short survival. Survival depends on the type of natural history. PMID:25103857

The CARE guidelines: consensus-based clinical case report guideline development.

PubMed

Gagnier, Joel J; Kienle, Gunver; Altman, Douglas G; Moher, David; Sox, Harold; Riley, David

2014-01-01

A case report is a narrative that describes, for medical, scientific, or educational purposes, a medical problem experienced by one or more patients. Case reports written without guidance from reporting standards are insufficiently rigorous to guide clinical practice or to inform clinical study design. Develop, disseminate, and implement systematic reporting guidelines for case reports. We used a three-phase consensus process consisting of (1) pre-meeting literature review and interviews to generate items for the reporting guidelines, (2) a face-to-face consensus meeting to draft the reporting guidelines, and (3) post-meeting feedback, review, and pilot testing, followed by finalization of the case report guidelines. This consensus process involved 27 participants and resulted in a 13-item checklist-a reporting guideline for case reports. The primary items of the checklist are title, key words, abstract, introduction, patient information, clinical findings, timeline, diagnostic assessment, therapeutic interventions, follow-up and outcomes, discussion, patient perspective, and informed consent. We believe the implementation of the CARE (CAse REport) guidelines by medical journals will improve the completeness and transparency of published case reports and that the systematic aggregation of information from case reports will inform clinical study design, provide early signals of effectiveness and harms, and improve healthcare delivery. Copyright © 2014 Reproduced with permission of Global Advances in Health and Medicine. Published by Elsevier Inc. All rights reserved.

Improved minimum cost and maximum power two stage genome-wide association study designs.

PubMed

Stanhope, Stephen A; Skol, Andrew D

2012-01-01

In a two stage genome-wide association study (2S-GWAS), a sample of cases and controls is allocated into two groups, and genetic markers are analyzed sequentially with respect to these groups. For such studies, experimental design considerations have primarily focused on minimizing study cost as a function of the allocation of cases and controls to stages, subject to a constraint on the power to detect an associated marker. However, most treatments of this problem implicitly restrict the set of feasible designs to only those that allocate the same proportions of cases and controls to each stage. In this paper, we demonstrate that removing this restriction can improve the cost advantages demonstrated by previous 2S-GWAS designs by up to 40%. Additionally, we consider designs that maximize study power with respect to a cost constraint, and show that recalculated power maximizing designs can recover a substantial amount of the planned study power that might otherwise be lost if study funding is reduced. We provide open source software for calculating cost minimizing or power maximizing 2S-GWAS designs.

Nurse case-manager vs multifaceted intervention to improve quality of osteoporosis care after wrist fracture: randomized controlled pilot study.

PubMed

Majumdar, S R; Johnson, J A; Bellerose, D; McAlister, F A; Russell, A S; Hanley, D A; Garg, S; Lier, D A; Maksymowych, W P; Morrish, D W; Rowe, B H

2011-01-01

Few outpatients with fractures are treated for osteoporosis in the years following fracture. In a randomized pilot study, we found a nurse case-manager could double rates of osteoporosis testing and treatment compared with a proven efficacious quality improvement strategy directed at patients and physicians (57% vs 28% rates of appropriate care). Few patients with fractures are treated for osteoporosis. An intervention directed at wrist fracture patients (education) and physicians (guidelines, reminders) tripled osteoporosis treatment rates compared to controls (22% vs 7% within 6 months of fracture). More effective strategies are needed. We undertook a pilot study that compared a nurse case-manager to the multifaceted intervention using a randomized trial design. The case-manager counseled patients, arranged bone mineral density (BMD) tests, and prescribed treatments. We included controls from our first trial who remained untreated for osteoporosis 1-year post-fracture. Primary outcome was bisphosphonate treatment and secondary outcomes were BMD testing, appropriate care (BMD test-treatment if bone mass low), and costs. Forty six patients untreated 1-year after wrist fracture were randomized to case-manager (n = 21) or multifaceted intervention (n = 25). Median age was 60 years and 68% were female. Six months post-randomization, 9 (43%) case-managed patients were treated with bisphosphonates compared with 3 (12%) multifaceted intervention patients (relative risk [RR] 3.6, 95% confidence intervals [CI] 1.1-11.5, p = 0.019). Case-managed patients were more likely than multifaceted intervention patients to undergo BMD tests (81% vs 52%, RR 1.6, 95%CI 1.1-2.4, p = 0.042) and receive appropriate care (57% vs 28%, RR 2.0, 95%CI 1.0-4.2, p = 0.048). Case-management cost was $44 (CDN) per patient vs $12 for the multifaceted intervention. A nurse case-manager substantially increased rates of appropriate testing and treatment for osteoporosis in patients at high-risk of future fracture when compared with a multifaceted quality improvement intervention aimed at patients and physicians. Even with case-management, nearly half of patients did not receive appropriate care. clinicaltrials.gov identifier: NCT00152321.

Distinguishing and Improving Mouse Behavior with Educational Computer Games in Young Children with Autistic Spectrum Disorder or Attention Deficit/Hyperactivity Disorder: An Executive Function-Based Interpretation

ERIC Educational Resources Information Center

Veenstra, Baukje; van Geert, Paul L. C.; van der Meulen, Bieuwe F.

2012-01-01

In this exploratory multiple case study, it is examined how a computer game focused on improving ineffective learning behavior can be used as a tool to assess, improve, and study real-time mouse behavior (MB) in different types of children: 18 children (3.8-6.3 years) with Autistic Spectrum Disorder (ASD), Attention Deficit/Hyperactivity Disorder…

Good Effective School Improvement Practices in Spain.

ERIC Educational Resources Information Center

Murillo, F. Javier

2002-01-01

Presents case studies of five effective school improvement (ESI) programs developed in Spain. Identified characteristics of the Spanish education system that affect the way ESI programs are carried out and developed descriptions of the five programs and lessons learned from them. (SLD)

Wooden beverage cases cause little damage to bottle caps

Treesearch

R. Bruce Anderson; William C. Miller

1973-01-01

Wooden beverage cases cause little damage to aluminum resealable caps during distribution. A study at bottling plants and distribution warehouses showed that an average of 1 bottle out of 4,000 has cap damage. Most of the damage was attributed to handling at the warehouse and in transit. Some recommendations are given for improvement of wooden beverage cases to prevent...

Application of Case-Task Based Approach in Business English Teaching--A Case Study of the Marketing Course in SEIB of GDUFS

ERIC Educational Resources Information Center

Guiyu, Dai; Yi, Cai

2017-01-01

Business English Teaching aims at cultivating students' ability to analyze and solve problems, improving students' comprehensive language competence and honing their business practical skills. Adhering to the principle of learning by doing and learning by teaching others, Case-Task Based Approach emphasizes students' ability of language use in…

Complex adaptive systems: a tool for interpreting responses and behaviours.

PubMed

Ellis, Beverley

2011-01-01

Quality improvement is a priority for health services worldwide. There are many barriers to implementing change at the locality level and misinterpreting responses and behaviours can effectively block change. Electronic health records will influence the means by which knowledge and information are generated and sustained among those operating quality improvement programmes. To explain how complex adaptive system (CAS) theory provides a useful tool and new insight into the responses and behaviours that relate to quality improvement programmes in primary care enabled by informatics. Case studies in two English localities who participated in the implementation and development of quality improvement programmes. The research strategy included purposefully sampled case studies, conducted within a social constructionist ontological perspective. Responses and behaviours of quality improvement programmes in the two localities include both positive and negative influences associated with a networked model of governance. Pressures of time, resources and workload are common issues, along with the need for education and training about capturing, coding, recording and sharing information held within electronic health records to support various information requirements. Primary care informatics enables information symmetry among those operating quality improvement programmes by making some aspects of care explicit, allowing consensus about quality improvement priorities and implementable solutions.

Abused women's experiences of a primary care identification and referral intervention: a case study analysis.

PubMed

Bradbury-Jones, Caroline; Clark, Maria; Taylor, Julie

2017-12-01

The aim of this study was to report the findings of a qualitative case study that investigated abused women's experiences of an identification and referral intervention and to discuss the implications for nurses, specifically those working in primary and community care. Domestic violence and abuse is a significant public health issue globally but it is a hidden problem that is under-reported. In the UK, Identification and Referral to Improve Safety is a primary care-based intervention that has been found to increase referral rates of abused women to support and safety services. This paper reports on the findings of an evaluation study of two sites in England. Qualitative study with a case study design. In line with case study design, the entire evaluation study employed multiple data collection methods. We report on the qualitative interviews with women referred through the programme. The aim was to elicit their experiences of the three aspects of the intervention: identification; referral; safety. Data collection took place March 2016. Ten women took part. Eight had exited the abusive relationship but two remained with the partner who had perpetrated the abuse. Women were overwhelmingly positive about the programme and irrespective of whether they had remained or exited the relationship all reported perceptions of increased safety and improved health. Nurses have an important role to play in identifying domestic violence and abuse and in referral and safety planning. As part of a portfolio of domestic violence and abuse interventions, those that empower women to take control of their safety (such as Identification and Referral to Improve Safety) are important. © 2017 John Wiley & Sons Ltd.

WE-AB-209-09: Optimization of Rotational Arc Station Parameter Optimized Radiation Therapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dong, P; Xing, L; Ungun, B

Purpose: To develop a fast optimization method for station parameter optimized radiation therapy (SPORT) and show that SPORT is capable of improving VMAT in both plan quality and delivery efficiency. Methods: The angular space from 0° to 360° was divided into 180 station points (SPs). A candidate aperture was assigned to each of the SPs based on the calculation results using a column generation algorithm. The weights of the apertures were then obtained by optimizing the objective function using a state-of-the-art GPU based Proximal Operator Graph Solver (POGS) within seconds. Apertures with zero or low weight were thrown out. Tomore » avoid being trapped in a local minimum, a stochastic gradient descent method was employed which also greatly increased the convergence rate of the objective function. The above procedure repeated until the plan could not be improved any further. A weighting factor associated with the total plan MU also indirectly controlled the complexities of aperture shapes. The number of apertures for VMAT and SPORT was confined to 180. The SPORT allowed the coexistence of multiple apertures in a single SP. The optimization technique was assessed by using three clinical cases (prostate, H&N and brain). Results: Marked dosimetric quality improvement was demonstrated in the SPORT plans for all three studied cases. Prostate case: the volume of the 50% prescription dose was decreased by 22% for the rectum. H&N case: SPORT improved the mean dose for the left and right parotids by 15% each. Brain case: the doses to the eyes, chiasm and inner ears were all improved. SPORT shortened the treatment time by ∼1 min for the prostate case, ∼0.5 min for brain case, and ∼0.2 min for the H&N case. Conclusion: The superior dosimetric quality and delivery efficiency presented here indicates that SPORT is an intriguing alternative treatment modality.« less

Collaborating for care: initial experience of embedded case managers across five medical homes.

PubMed

Treadwell, Janet; Giardino, Angelo

2014-01-01

The purpose of this intervention was to answer the following question: Does an embedded nurse case manager from a health plan performing embedded care coordination and supporting a quality improvement project impact medical home service use, role satisfaction, and per member per month expense? The setting for this study was primary care medical home practices with a minimum of 1,000 lives, contracted with a health plan delivering Medicaid and Children's Health Insurance coverage. Five medical home practice sites were selected for the intervention. The study began with case manager training and project permission in 5 medical homes, followed by implementation of care coordination with health plan clients. The nurse case manager performed care coordination functions for clients and initiated a Lean Six Sigma quality improvement project at the medical home site. The analysis strategy was to compare each medical home with itself before and after the intervention, as well as to obtain satisfaction information from medical home staff and care coordinators. Reductions in expense, as demonstrated by decreased per member per month claim cost, admissions per thousand, and reduced variation in days per thousand, were documented. Quality projects attained significant improvements in 4 out of 5 sites, and practice staff as well as case managers described satisfaction with the embedded nurse case manager role. These findings support medical homes as being an effective delivery model of the Affordable Care Act. Case managers who practice in primary care sites can make a significant difference in patient outcomes and practice efficiencies. Embedded case managers have the ability to impact the population being served through modeling and supporting interprofessional relationships and case management expertise. Use of motivational interviewing, assessment skills, advocacy, and joint care planning engage patients in their own care, whereas quality initiatives bring efficiencies and effectiveness to overall operations. There is need for research to be conducted across a larger number of practice sites and diverse populations to substantiate the effect of embedded case management in medical home.

Strategies for waste management in small and medium towns of developing countries: a case study of India.

PubMed

Sundaravadivel, M; Vigneswaran, S

2003-01-01

This paper evaluates the issues of waste management in small and medium towns (SMTs) (with population in the range of 10,000-100,000) of India, and identifies the need for a multi-disciplinary approach encompassing technological, economic and financial aspects of the issues to effect improvements. A comprehensive set of cross-disciplinary strategies is suggested to improve the prevailing conditions with environmentally appropriate, economically efficient and financially self-sustaining waste management services. Based on a case study of four SMTs in the State of Tamil Nadu in India, this paper evaluates the application of the suggested strategies and offers policy recommendations.

Improving the quality of the ECG signal by filtering in wavelet transform domain

NASA Astrophysics Data System (ADS)

DzierŻak, RóŻa; Surtel, Wojciech; Dzida, Grzegorz; Maciejewski, Marcin

2016-09-01

The article concerns the research methods of noise reduction occurring in the ECG signals. The method is based on the use of filtration in wavelet transform domain. The study was conducted on two types of signal - received during the rest of the patient and obtained during physical activity. For each of the signals 3 types of filtration were used. The study was designed to determine the effectiveness of various wavelets for de-noising signals obtained in both cases. The results confirm the suitability of the method for improving the quality of the electrocardiogram in case of both types of signals.

Models of community care for severe mental illness: a review of research on case management.

PubMed

Mueser, K T; Bond, G R; Drake, R E; Resnick, S G

1998-01-01

We describe different models of community care for persons with severe mental illness and review the research literature on case management, including the results of 75 studies. Most research has been conducted on the assertive community treatment (ACT) or intensive case management (ICM) models. Controlled research on ACT and ICM indicates that these models reduce time in the hospital and improve housing stability, especially among patients who are high service users. ACT and ICM appear to have moderate effects on improving symptomatology and quality of life. Most studies suggest little effect of ACT and ICM on social functioning, arrests and time spent in jail, or vocational functioning. Studies on reducing or withdrawing ACT or ICM services suggest some deterioration in gains. Research on other models of community care is inconclusive. We discuss the implications of the findings in terms of the need for specialization of ACT or ICM teams to address social and vocational functioning and substance abuse. We suggest directions for future research on models of community care, including evaluating implementation fidelity, exploring patient predictors of improvement, and evaluating the role of the helping alliance in mediating outcome.

In vitro performance of ceramic coatings obtained by high velocity oxy-fuel spray.

PubMed

Melero, H; Garcia-Giralt, N; Fernández, J; Díez-Pérez, A; Guilemany, J M

2014-01-01

Hydroxyapatite coatings obtained by plasma-spraying have been used for many years to improve biological performance of bone implants, but several studies have drawn attention to the problems arising from high temperatures and the lack of mechanical properties. In this study, plasma-spraying is substituted by high velocity oxy-fuel (HVOF) spray, with lower temperatures reached, and TiO2 is added in low amounts to hydroxyapatite in order to improve the mechanical properties. Four conditions have been tested to evaluate which are those with better biological properties. Viability and proliferation tests, as well as differentiation assays and morphology observation, are performed with human osteoblast cultures onto the studied coatings. The hydroxyapatite-TiO2 coatings maintain good cell viability and proliferation, especially the cases with higher amorphous phase amount and specific surface, and promote excellent differentiation, with a higher ALP amount for these cases than for polystyrene controls. Observation by SEM corroborates this excellent behaviour. In conclusion, these coatings are a good alternative to those used industrially, and an interesting issue would be improving biological behaviour of the worst cases, which in turn show the better mechanical properties.

Self-reports of induced abortion: an empathetic setting can improve the quality of data.

PubMed Central

Rasch, V; Muhammad, H; Urassa, E; Bergström, S

2000-01-01

OBJECTIVES: This study estimated the proportion of incomplete abortions that are induced in hospital-based settings in Tanzania. METHODS: A cross-sectional questionnaire study was conducted in 2 phases at 3 hospitals in Tanzania. Phase 1 included 302 patients with a diagnosis of incomplete abortion, and phase 2 included 823 such patients. RESULTS: In phase 1, in which cases were classified by clinical criteria and information from the patient, 3.9% to 16.1% of the cases were classified as induced abortion. In phase 2, in which the structured interview was changed to an empathetic dialogue and previously used clinical criteria were omitted, 30.9% to 60.0% of the cases were classified as induced abortion. CONCLUSIONS: An empathetic dialogue improves the quality of data collected among women with induced abortion. PMID:10897196

Are Two Voices Better Than One? Predicting Permanency for Minority Youth Using Multi-Informant Mental Health and Strength Data

PubMed Central

Toche-Manley, Linda L.; Dietzen, Laura; Nankin, Jesse; Beigel, Astrid

2013-01-01

Among youth in child welfare ages 6 to 17, 40% meet criteria for one or more DSM diagnoses. For minority youth in child welfare, poor mental health is compounded by limited access to care and racial disparity bias, leading to poorer outcomes. This paper uses data collected and analyzed by an automated behavioral health assessment system for a multi-year study that focused on ways to improve case planning in child welfare. Youth, their caseworkers and, in some cases, parents completed assessments that measured and monitored the youths’ needs and strengths. More than 60% of youth participating in the study were African American; permanency rates after six months of case planning were found to be only one-third. Predictive factors related to better behavioral health and permanency outcomes are identified and discussed, as well as the implications for improving case planning by incorporating the views of multiple informants, including the youth. PMID:22566058

Generic project definitions for improvement of health care delivery: a case-based approach.

PubMed

Niemeijer, Gerard C; Does, Ronald J M M; de Mast, Jeroen; Trip, Albert; van den Heuvel, Jaap

2011-01-01

The purpose of this article is to create actionable knowledge, making the definition of process improvement projects in health care delivery more effective. This study is a retrospective analysis of process improvement projects in hospitals, facilitating a case-based reasoning approach to project definition. Data sources were project documentation and hospital-performance statistics of 271 Lean Six Sigma health care projects from 2002 to 2009 of general, teaching, and academic hospitals in the Netherlands and Belgium. Objectives and operational definitions of improvement projects in the sample, analyzed and structured in a uniform format and terminology. Extraction of reusable elements of earlier project definitions, presented in the form of 9 templates called generic project definitions. These templates function as exemplars for future process improvement projects, making the selection, definition, and operationalization of similar projects more efficient. Each template includes an explicated rationale, an operationalization in the form of metrics, and a prototypical example. Thus, a process of incremental and sustained learning based on case-based reasoning is facilitated. The quality of project definitions is a crucial success factor in pursuits to improve health care delivery. We offer 9 tried and tested improvement themes related to patient safety, patient satisfaction, and business-economic performance of hospitals.

The Students Satisfaction Oriented: Academic Service Improvement Strategy, Department of Aquatic Resources Management, Bogor Agricultural University, Indonesia

ERIC Educational Resources Information Center

Widaryanti; Daryanto, Arief; Fauzi, Anas Miftah

2016-01-01

Higher education institutions must have a strategy change management in the increasingly competitive business environment. A continous performance improvement should be made accordingly. This study was conducted with the case of MSP-IPB, to analyze the priority of academic services improvement which were oriented in student satisfaction. This…

Designing Temporary Systems: Exploring Local School Improvement Intentions in the Swedish Context

ERIC Educational Resources Information Center

Nordholm, Daniel; Blossing, Ulf

2014-01-01

This article targets local school improvement in Sweden and temporary systems as a model to organize improvement work. These data are based on a qualitative case study of teacher groups constituting a temporary system representing the different subjects in comprehensive school in a medium-sized urban municipality. A total of eight interviews were…

Reading Teachers' Beliefs and Utilization of Computer and Technology: A Case Study

ERIC Educational Resources Information Center

Remetio, Jessica Espinas

2014-01-01

Many researchers believe that computers have the ability to help improve the reading skills of students. In an effort to improve the poor reading scores of students on state tests, as well as improve students' overall academic performance, computers and other technologies have been installed in Frozen Bay School classrooms. As the success of these…

Improving Information Extraction and Translation Using Component Interactions

DTIC Science & Technology

2008-01-01

74 7. CASE STUDY ON MONOLINGUAL INTERACTION.....................................................................76 7.1 IMPROVING NAME TAGGING BY...interactions described above focused on the monolingual analysis pipeline. (Huang and Vogel, 2002) presented a cross-lingual joint inference example to...improve the extracted named entity translation dictionary and the entity annotation in a bilingual 22 training corpus. They used a more

Inquiry-Based Science Instruction in High School Biology Courses: A Multiple Case Study

ERIC Educational Resources Information Center

Aso, Eze

2014-01-01

A lack of research exists about how secondary school science teachers use inquiry-based instruction to improve student learning. The purpose of this qualitative study was to explore how science teachers used inquiry-based instruction to improve student learning in high school biology courses. The conceptual framework was based on Banchi and Bell's…

Does Private Tutoring Improve Students' National College Entrance Exam Performance?--A Case Study from Jinan, China

ERIC Educational Resources Information Center

Zhang, Yu

2013-01-01

With the increasing attention on improving student achievement, private tutoring has been expanding rapidly worldwide. However, the evidence on the effect of private tutoring is inconclusive for education researchers and policy makers. Employing a comprehensive dataset collected from China in 2010, this study tries to identify the effect of…

Improving Teacher Education in the Netherlands: Data Team as Learning Team?

ERIC Educational Resources Information Center

Bolhuis, E. D.; Schildkamp, K.; Voogt, J. M.

2016-01-01

Using data in a professional learning community is a promising form of professional development. In this study, we followed a data team of teacher educators, who systematically tried to improve the education of student teachers (by decreasing first year drop-out). By conducting a single case study, we investigated the data team participants'…

Improving Students' Conceptual Understanding of a Specific Content Learning: A Designed Teaching Sequence

ERIC Educational Resources Information Center

Ahmad, N. J.; Lah, Y. Che

2012-01-01

The efficacy of a teaching sequence designed for a specific content of learning of electrochemistry is described in this paper. The design of the teaching draws upon theoretical insights into perspectives on learning and empirical studies to improve the teaching of this topic. A case study involving two classes, the experimental and baseline…

Using Learning Strategies to Improve the Academic Performance of University Students on Academic Probation

ERIC Educational Resources Information Center

Renzulli, Sara J.

2015-01-01

One half of all students who begin college fail to complete their degrees, resulting in wasted talents, time, and resources. Through use of mixed methods, but primarily qualitative, comparative case studies, this research reveals ways a 3-week course in study strategies improved the performance of students placed on academic probation. The…

Incidence of flare-ups and evaluation of quality after retreatment of resorcinol-formaldehyde resin ("Russian Red Cement") endodontic therapy.

PubMed

Gound, Tom G; Marx, David; Schwandt, Nathan A

2003-10-01

The purpose of this retrospective study was to evaluate the quality of treatment and incidence of flare-ups when teeth with resorcinol-formaldehyde resin are retreated in a postgraduate endodontic clinic. Fifty-eight cases were included in this study. Obturated and unfilled canal space was measured on radiographs. Forty-eight percent of the total canal space was filled before retreatment; 90% was filled after retreatment. After retreatment, obturations were rated as optimal in 59%, improved in 33%, unchanged in 6%, and worse in 2%. Seven patients (12%) had postretreatment flare-ups. Data were statistically analyzed using the Cochran-Armitage Test for Discrete Variables. No statistical difference in the incidence of flare-ups was found in teeth that before treatment had more than half the canal space filled compared to teeth with less than half, cases with pre-existing periradicular radiolucencies compared to cases with normal periradicular appearance, symptomatic cases compared to asymptomatic cases, or cases with optimal fillings after retreatment compared to less than optimal cases. It was concluded that teeth with resorcinol-formaldehyde fillings might be retreated with a good prognosis for improving the radiographic quality, but a higher than normal incidence of flare-ups may occur.

Disability assessment: the efficacy of multimedia interactive nurse education.

PubMed

Chiang, Hui-Chaun; Lin, Feng-Yu; Hwu, Yueh-Juen

2013-06-01

Nearly 3% of the population in Taiwan is classified as disabled. Disability assessment directly relates to long-term care quality and resource allocation. The purpose of this study was to explore the effects of a multimedia interactive DVD on enhancing nurse knowledgeand disability assessment skills. The study was a quasi-experimental design. The experimental group received multimedia interactive DVD, and the control group received conventional classroom education. The study gathered data using scales assessing knowledge related to disability assessment and case studies. Scales were implemented before and after multimedia interactive DVD interventions at weeks 2 and 4. In-depth interviews with voice recording were used to collect qualitative data to elicit differences in perception between the experimental and control groups. This study found significant improvements in the experimental group in terms of disability assessment knowledge and case study assessment skills. These improvements lasted through at least 1-month posttest. Analysis of interview data for the experimental group showed that the multimedia interactive DVD provided a more flexible approach to learning than classroom education and improved participant self-confidence to conduct disability assessments. The study showed the effectiveness of the developed multimedia interactive DVD in significantly improving the disability assessment confidences of nurses. Study findings can be used as a reference guide for continuing educational efforts in long-term care settings.

[Effects of a cultural competence promotion program for multicultural maternity nursing care: case-based small group learning].

PubMed

Park, Myung-Sook; Kweon, Young-Ran

2013-10-01

The purpose of this study was to examine the effects of a cultural competence improvement program for maternity nurses. A quasi-experimental study using a non-equivalent control group pre and posttest design was used. Participants were 67 maternity nurses caring for multicultural pregnant women in G city. The cultural competence improvement program was developed based on the 3-D Puzzle Model and was provided using case-based small group learning methods for the experimental group (n=31). The control group (n=36) did not receive any intervention. Data were collected using self-report structured questionnaires at two time points: prior to the intervention and after the intervention and were analyzed with descriptive statistics, χ²-test, and t-test. Compared to the control group, the experimental group reported significant positive changes for cultural knowledge (t=6.39, p<.001), cultural awareness (t=3.50, p<.001), and cultural acceptance (t=4.08, p<.001). However, change in cultural nursing behaviors (t=0.92, p=.067) was not significantly different between the two groups. Findings from this study indicate that a cultural competence improvement program with case-based small group learning is a useful intervention strategy to promote multicultural maternity care. Further, strategies to improve cultural nursing behavior should be developed to promote culturally congruent nursing care.

Lean Participative Process Improvement: Outcomes and Obstacles in Trauma Orthopaedics

PubMed Central

New, Steve; Hadi, Mohammed; Pickering, Sharon; Robertson, Eleanor; Morgan, Lauren; Griffin, Damian; Collins, Gary; Rivero-Arias, Oliver; Catchpole, Ken; McCulloch, Peter

2016-01-01

Objectives To examine the effectiveness of a “systems” approach using Lean methodology to improve surgical care, as part of a programme of studies investigating possible synergy between improvement approaches. Setting A controlled before-after study using the orthopaedic trauma theatre of a UK Trust hospital as the active site and an elective orthopaedic theatre in the same Trust as control. Participants All staff involved in surgical procedures in both theatres. Interventions A one-day “lean” training course delivered by an experienced specialist team was followed by support and assistance in developing a 6 month improvement project. Clinical staff selected the subjects for improvement and designed the improvements. Outcome Measures We compared technical and non-technical team performance in theatre using WHO checklist compliance evaluation, “glitch count” and Oxford NOTECHS II in a sample of directly observed operations, and patient outcome (length of stay, complications and readmissions) for all patients. We collected observational data for 3 months and clinical data for 6 months before and after the intervention period. We compared changes in measures using 2-way analysis of variance. Results We studied 576 cases before and 465 after intervention, observing the operation in 38 and 41 cases respectively. We found no significant changes in team performance or patient outcome measures. The intervention theatre staff focused their efforts on improving first patient arrival time, which improved by 20 minutes after intervention. Conclusions This version of “lean” system improvement did not improve measured safety processes or outcomes. The study highlighted an important tension between promoting staff ownership and providing direction, which needs to be managed in “lean” projects. Space and time for staff to conduct improvement activities are important for success. PMID:27124012

Mining Temporal Patterns to Improve Agents Behavior: Two Case Studies

NASA Astrophysics Data System (ADS)

Fournier-Viger, Philippe; Nkambou, Roger; Faghihi, Usef; Nguifo, Engelbert Mephu

We propose two mechanisms for agent learning based on the idea of mining temporal patterns from agent behavior. The first one consists of extracting temporal patterns from the perceived behavior of other agents accomplishing a task, to learn the task. The second learning mechanism consists in extracting temporal patterns from an agent's own behavior. In this case, the agent then reuses patterns that brought self-satisfaction. In both cases, no assumption is made on how the observed agents' behavior is internally generated. A case study with a real application is presented to illustrate each learning mechanism.

Communication and Collaboration in Library Technical Services: A Case Study of New York University in Abu Dhabi

ERIC Educational Resources Information Center

Parrott, Justin

2016-01-01

New York University Abu Dhabi Library has developed new strategies to increase efficiency in technical services processing between units based in New York and Abu Dhabi. This case study discusses the challenges specific to the international context and the methods used to overcome them, increase speed processing, and ultimately improve patron…

Engaging Literacy: A Case Study in the Use of e-Reader Devices

ERIC Educational Resources Information Center

Lettenmaier, Kris

2013-01-01

The purpose of this case study was to determine to what extent e-readers affected struggling readers as a part of reading instruction at the middle school level to improve students' literacy skills of comprehension, fluency, and vocabulary, and to show how e-readers affected engagement and self-efficacy of struggling readers to read and use…

A Rural School/Community: A Case Study of a Dramatic Turnaround & Its Implications for School Improvement.

ERIC Educational Resources Information Center

Carlson, Robert V.

This paper presents a case study of a rural community exhibiting a dramatic turnaround in community support for a new school bond issue. Demographic change was partly responsible for the change in community attitudes, with two waves of immigration altering the long-term conservative orientation of this community. After a series of failed…

Another Look at the Fizz Keeper: A Case-Study Laboratory Exercise for High School Students

ERIC Educational Resources Information Center

Mekelburg, Christopher R.; Szczepankiewicz, Steven H.; Hellerer, Matthew

2010-01-01

This case study places the high school student as a researcher for Carbonation Creators (fictional entity), a company responsible for making the Fizzy Forcer (a device to improve carbonation in previously opened bottles of soft drinks). The company faces a class-action lawsuit claiming that the Fizzy Forcer does not retain carbonation levels in…

Instructional Strategies and Best Practices for Improving the Achievement Gap in Mathematics: An Exploratory Case Study

ERIC Educational Resources Information Center

Lord, Joey

2017-01-01

This qualitative exploratory case study focused on the achievement gap in mathematics that exists in one urban North Carolina middle school and the strategies used by school personnel to narrow this gap. The goal of this research was to determine effective instructional strategies and best practices used to engage students in learning that will…

HEFCE's People Management Self-Assessment Tool: Ticking Boxes or Adding Value? A Case Study

ERIC Educational Resources Information Center

McDonald, Claire

2009-01-01

This article examines one specific organisational development tool in depth and uses a case study to investigate whether using the tool is more than a tick-box exercise and really can add value and help organisations to develop and improve. The People Management Self-Assessment Tool (SAT) is used to examine higher education institutions' (HEIs)…

All Students Are Not Equal: A Case Study of Geometry Teachers' Instructional Strategies When Trained in Multiple-Intelligence-Based Practices in Secondary Classrooms

ERIC Educational Resources Information Center

Davis, Cassandre Y.

2017-01-01

Over 50% of secondary students failed the geometry end-of-course test in a Florida school district, indicating a need to improve academic performance. Secondary school students' learning characteristics and the effectiveness of teachers' instructional strategies are imperative to educational success. In this qualitative case study, geometry…

On the Diverse Outcome of Communication Partner Training of Significant Others of People with Aphasia: An Experimental Study of Six Cases

ERIC Educational Resources Information Center

Eriksson, Karin; Hartelius, Lena; Saldert, Charlotta

2016-01-01

Background: Communication partner training (CPT) has been shown to improve the communicative environment of people with aphasia. Interaction-focused training is one type of training that provides an individualized intervention to participants. Although shown to be effective, outcomes have mostly been evaluated in non-experimental case studies.…

Improving Music Teaching and Learning through Online Service: A Case Study of a Synchronous Online Teaching Internship

ERIC Educational Resources Information Center

Pike, Pamela D.

2017-01-01

This case study explored the potential for using a synchronous online piano teaching internship as a service-learning project for graduate pedagogy interns. In partnership with the university, a local music retailer, and a local middle school, three pedagogy interns taught beginning piano to underprivileged teenaged students for 8 weeks. All…

Qzone Weblog for Critical Peer Feedback to Improve Business English Writing: A Case of Chinese Undergraduates

ERIC Educational Resources Information Center

Xianwei, Gao; Samuel, Moses; Asmawi, Adelina

2016-01-01

This study explores Qzone weblog for critical peer feedback (CPF) in Business English writing (BEW) among the Chinese undergraduates. A qualitative case study is conducted by Nvivo 8 to analyze the three research data of semi-structured interviews, BEW writing assignments, and CPF artifacts on Qzone weblog. Three research questions are focused to…

Developing Student Voice and Participatory Pedagogy: A Case Study in a Spanish Primary School

ERIC Educational Resources Information Center

Susinos, Teresa; Haya, Ignacio

2014-01-01

This article describes a case study that is part of a broader research project in which schools set up processes of school improvement inspired by the proposals put forward by students. The project furthers the initiatives of the student voice movement and seeks to implement more participative pedagogical models. This as a whole represents a novel…

Improving Learning Outcomes, Persistence, and Graduation Rates of Academically Underprepared Students: a Case Study of Alexander Community College and Its Developmental Education Effort

ERIC Educational Resources Information Center

Marchione, Susan M.

2012-01-01

This case study describes how Alexander Community College (ACC), a two-year State University of New York (SUNY) institution is addressing challenges associated with its developmental education effort--primarily high costs for repeated developmental (assumed by the institution and students) and low persistence and graduation rates for developmental…

Metaphor Comprehension in Autistic Spectrum Disorders: Case Studies of Two High-Functioning Children

ERIC Educational Resources Information Center

Melogno, Sergio; D'Ardia, Caterina; Pinto, Maria Antonietta; Levi, Gabriel

2012-01-01

This article presents case studies on metaphor comprehension in two boys with high-functioning autistic spectrum disorder, aged 9;1 (9 years, 1 month) and 8;11. The participants were assessed twice, before and after an intervention program aimed at improving their social skills. The focus of the article is on the specific patterns exhibited by…

A Case Study: The Implementation of a Problem-Solving Model with a Student with Reading Difficulties in Turkey

ERIC Educational Resources Information Center

Ozmen, E. Ruya; Doganay-Bilgi, Arzu

2016-01-01

The purpose of this case study was to improve the reading accuracy and reading comprehension of a 10-year-old fourth-grade female student with reading difficulties. For that purpose, the problem- solving model was implemented in four stages. These stages included problem identification, problem analysis, intervention, and evaluation. During the…

Effective Learning: A Case Study of the Learning Strategies Used by a Gifted High Achiever in Learning Science

ERIC Educational Resources Information Center

Stott, Angela; Hobden, Paul A.

2016-01-01

This article describes a case study of a gifted high achiever in learning science. This learner was selected on the assumption that drawing attention to the characteristics of a successful learner may improve learning effectiveness of less successful learners. The first author taught the gifted learner and collected data through participant…

A National Study of the Validity and Utility of the Comprehensive Assessment of School Environment (CASE) Survey

ERIC Educational Resources Information Center

McGuffey, Amy R.

2016-01-01

A healthy school climate is necessary for improvement. The purpose of this study was to evaluate the construct validity and usability of the Comprehensive Assessment of School Environment (CASE) as it was purportedly realigned to the three dimensions of the Breaking Ranks Framework developed by the National Association of Secondary School…

Exploring Self-Regulation through a Reflective Practicum: A Case Study of Improvement through Mindful Piano Practice

ERIC Educational Resources Information Center

Pike, Pamela D.

2017-01-01

Learning to self-regulate during practice is one of the most important skills that music majors must learn. Yet, because practising tends to occur mostly in private, there can be a disconnect between instructors' approaches to teaching practice skills in the lesson and students' actual behaviour in the practice room. This case study explored the…

Fostering Habib's Engagement and Self-Regulation: A Case Study of a Child from a Refugee Family at Home and Preschool

ERIC Educational Resources Information Center

Haines, Shana J.; Summers, Jean Ann; Turnbull, Ann P.; Turnbull, H. Rutherford, III.; Palmer, Susan

2015-01-01

Developing children's self-regulation and engagement skills are primary goals of early childhood education. These skills are fostered in both home and preschool environments and can lead to improved educational outcomes. This qualitative case study investigated how a refugee family and Head Start teachers fostered the self-regulation and…

Effective Schooling in Rural Africa Report 3: Case Study Briefs on Rural Schooling.

ERIC Educational Resources Information Center

World Bank, Washington, DC. Human Development Network.

This document contains 20 case study briefs about efforts to improve rural schools and teachers in Africa, Latin America, and Asia. Some reforms focus on a part of the education system or a particular population; others attempt to change the national education system. At least seven programs were begun as an alternative to government schools. Most…

Youth empowerment solutions for violence prevention.

PubMed

Reischl, Thomas M; Zimmerman, Marc A; Morrel-Samuels, Susan; Franzen, Susan P; Faulk, Monique; Eisman, Andria B; Roberts, Everett

2011-12-01

The limited success of youth violence prevention interventions suggests that effective prevention needs to address causes at multiple levels of analysis and empower youth in developing and implementing prevention programs. In this article, we review published studies of youth violence prevention efforts that engage youth in developing or implementing violence prevention activities. The reviewed studies suggest the promise of youth empowerment strategies and the need for systematic outcome studies of empowerment programs. After reviewing empowerment theory applied to youth violence prevention programs, we present a case study of the Youth Empowerment Solutions (YES) for Peaceful Communities program. YES engages middle-school youth in an after-school and summer program that includes a culturally tailored character development curriculum and empowers the youth to plan and implement community improvement projects with assistance from adult neighborhood advocates. The case study focuses on outcome evaluation results and presents evidence of the YES program effects on community-level outcomes (eg, property improvements, violent crime incidents) and on individual-level outcomes (eg, conflict avoidance, victimization). The literature review and the case study suggest the promise of engaging and empowering youth to plan and implement youth violence prevention programs.

[Acquiring skills in malignant hyperthermia crisis management: comparison of high-fidelity simulation versus computer-based case study].

PubMed

Mejía, Vilma; Gonzalez, Carlos; Delfino, Alejandro E; Altermatt, Fernando R; Corvetto, Marcia A

The primary purpose of this study was to compare the effect of high fidelity simulation versus a computer-based case solving self-study, in skills acquisition about malignant hyperthermia on first year anesthesiology residents. After institutional ethical committee approval, 31 first year anesthesiology residents were enrolled in this prospective randomized single-blinded study. Participants were randomized to either a High Fidelity Simulation Scenario or a computer-based Case Study about malignant hyperthermia. After the intervention, all subjects' performance in was assessed through a high fidelity simulation scenario using a previously validated assessment rubric. Additionally, knowledge tests and a satisfaction survey were applied. Finally, a semi-structured interview was done to assess self-perception of reasoning process and decision-making. 28 first year residents finished successfully the study. Resident's management skill scores were globally higher in High Fidelity Simulation versus Case Study, however they were significant in 4 of the 8 performance rubric elements: recognize signs and symptoms (p = 0.025), prioritization of initial actions of management (p = 0.003), recognize complications (p = 0.025) and communication (p = 0.025). Average scores from pre- and post-test knowledge questionnaires improved from 74% to 85% in the High Fidelity Simulation group, and decreased from 78% to 75% in the Case Study group (p = 0.032). Regarding the qualitative analysis, there was no difference in factors influencing the student's process of reasoning and decision-making with both teaching strategies. Simulation-based training with a malignant hyperthermia high-fidelity scenario was superior to computer-based case study, improving knowledge and skills in malignant hyperthermia crisis management, with a very good satisfaction level in anesthesia residents. Copyright © 2018 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

Case study: the Argentina Road Safety Project: lessons learned for the decade of action for road safety, 2011-2020.

PubMed

Raffo, Veronica; Bliss, Tony; Shotten, Marc; Sleet, David; Blanchard, Claire

2013-12-01

This case study of the Argentina Road Safety Project demonstrates how the application of World Bank road safety project guidelines focused on institution building can accelerate knowledge transfer, scale up investment and improve the focus on results. The case study highlights road safety as a development priority and outlines World Bank initiatives addressing the implementation of the World Report on Road Traffic Injury's recommendations and the subsequent launch of the Decade of Action for Road Safety, from 2011-2020. The case study emphasizes the vital role played by the lead agency in ensuring sustainable road safety improvements and promoting the shift to a 'Safe System' approach, which necessitated the strengthening of all elements of the road safety management system. It summarizes road safety performance and institutional initiatives in Argentina leading up to the preparation and implementation of the project. We describe the project's development objectives, financing arrangements, specific components and investment staging. Finally, we discuss its innovative features and lessons learned, and present a set of supplementary guidelines, both to assist multilateral development banks and their clients with future road safety initiatives, and to encourage better linkages between the health and transportation sectors supporting them.

The Development of Technical and Vocational Education in Indonesia--A Case Study in Quality Improvement. Case Studies on Technical and Vocational Education in Asia and the Pacific.

ERIC Educational Resources Information Center

Bakri, Mohamad

After its independence in 1969, Indonesia studied and analyzed its previous colonial system of technical and vocational education (TVE) and took steps to overcome the shortcomings. TVE was required to provide expansion of work opportunities and industrial development to promote national development. Until 1989, attention was given to further…

The Survival of Arts Education in the NCLB Era: A Case Study of One K-8th Grade Arts-Focused Charter School in a California Program Improvement School District

ERIC Educational Resources Information Center

Kratochvil, Kathie R.

2009-01-01

This research study presents one in-depth case study that investigates the successes, challenges, and processes of developing and enacting arts education programming at the elementary school level given the time limitations and other constraints associated with the high stakes testing environment that currently characterizes many of California's…

How School Leaders Prioritize and Allocate Resources to Improve Teacher Quality through Teacher Professional Development: A Multiple Case Study in Suburban North Carolina

ERIC Educational Resources Information Center

Tyson, Deonte Rashawn

2017-01-01

This multiple case study examined the methods by which school leaders determined and planned teacher professional development, as well as what teachers perceived as their professional development needs and how they believe school leaders take those needs into account. The study took place at two suburban elementary schools (1 traditional public, 1…

Compiling an Evidence-Based Improvement Plan for the Support of Distance-Education Students at a Southern African University

ERIC Educational Resources Information Center

Makhakhane, Bothephana; Wilkinson, Annette C.; Ndeya-Ndereya, Charity N.

2016-01-01

This article illustrates how an event guide can be used to organise, systematise and prioritise the large amount of findings from an extensive study. The study aimed to enhance student support at a distance-education institute in a Southern African country (Lesotho). In this case study an improvement-oriented evaluation of the strengths,…

Electronic case report forms and electronic data capture within clinical trials and pharmacoepidemiology.

PubMed

Rorie, David A; Flynn, Robert W V; Grieve, Kerr; Doney, Alexander; Mackenzie, Isla; MacDonald, Thomas M; Rogers, Amy

2017-09-01

Researchers in clinical and pharmacoepidemiology fields have adopted information technology (IT) and electronic data capture, but these remain underused despite the benefits. This review discusses electronic case report forms and electronic data capture, specifically within pharmacoepidemiology and clinical research. The review used PubMed and the Institute of Electrical and Electronic Engineers library. Search terms used were agreed by the authors and documented. PubMed is medical and health based, whereas Institute of Electrical and Electronic Engineers is technology based. The review focuses on electronic case report forms and electronic data capture, but briefly considers other relevant topics; consent, ethics and security. There were 1126 papers found using the search terms. Manual filtering and reviewing of abstracts further condensed this number to 136 relevant manuscripts. The papers were further categorized: 17 contained study data; 40 observational data; 27 anecdotal data; 47 covering methodology or design of systems; one case study; one literature review; two feasibility studies; and one cost analysis. Electronic case report forms, electronic data capture and IT in general are viewed with enthusiasm and are seen as a cost-effective means of improving research efficiency, educating participants and improving trial recruitment, provided concerns about how data will be protected from misuse can be addressed. Clear operational guidelines and best practises are key for healthcare providers, and researchers adopting IT, and further work is needed on improving integration of new technologies with current systems. A robust method of evaluation for technical innovation is required. © 2017 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.

Electronic case report forms and electronic data capture within clinical trials and pharmacoepidemiology

PubMed Central

Flynn, Robert W. V.; Grieve, Kerr; Doney, Alexander; Mackenzie, Isla; MacDonald, Thomas M.; Rogers, Amy

2017-01-01

Aims Researchers in clinical and pharmacoepidemiology fields have adopted information technology (IT) and electronic data capture, but these remain underused despite the benefits. This review discusses electronic case report forms and electronic data capture, specifically within pharmacoepidemiology and clinical research. Methods The review used PubMed and the Institute of Electrical and Electronic Engineers library. Search terms used were agreed by the authors and documented. PubMed is medical and health based, whereas Institute of Electrical and Electronic Engineers is technology based. The review focuses on electronic case report forms and electronic data capture, but briefly considers other relevant topics; consent, ethics and security. Results There were 1126 papers found using the search terms. Manual filtering and reviewing of abstracts further condensed this number to 136 relevant manuscripts. The papers were further categorized: 17 contained study data; 40 observational data; 27 anecdotal data; 47 covering methodology or design of systems; one case study; one literature review; two feasibility studies; and one cost analysis. Conclusion Electronic case report forms, electronic data capture and IT in general are viewed with enthusiasm and are seen as a cost‐effective means of improving research efficiency, educating participants and improving trial recruitment, provided concerns about how data will be protected from misuse can be addressed. Clear operational guidelines and best practises are key for healthcare providers, and researchers adopting IT, and further work is needed on improving integration of new technologies with current systems. A robust method of evaluation for technical innovation is required. PMID:28276585

[Barriers and facilitators to health care coordination in two integrated health care organizations in Catalonia (Spain)].

PubMed

Vargas Lorenzo, Ingrid; Vázquez Navarrete, M Luisa

2007-01-01

To analyze 2 integrated delivery systems (IDS) in Catalonia and identify areas for future development to improve their effectiveness. An exploratory, descriptive, qualitative study was carried out based on case studies by means of document analysis and semi-structured individual interviews. A criterion sample of cases and, for each case, of documents and informants was selected. Study cases consisted of the Consorci Sanitari del Maresme (CSdM) and the Consorci Sanitari de Terrassa/Fundació Hospital Sant Llàtzer (FHSLL). A total of 127 documents were analyzed and 29 informants were interviewed: IDS managers (n = 10), technical staff (n = 5), operational unit managers (n = 5) and health professionals (n = 9). Content analysis was conducted, with mixed generation of categories and segmentation by cases and subjects. CSdM and CSdT/FHSLL are health care organizations with backward vertical integration, total services production, and real (CSdM) and virtual (CSdT/FHSLL) ownership. Funds are allocated by care level. The governing body is centralized in CSdM and decentralized in CSdT/FHSLL. In both organizations, the global objectives are oriented toward improving coordination and efficiency but are not in line with those of the operational units. Both organizations present a functional structure with integration of support functions and utilize mechanisms for collaboration between care levels based on work processes standardization. Both IDS present facilitators and barriers to health care coordination. To improve coordination, changes in external elements (payment mechanism) and in internal elements (governing body role, organizational structure and coordination mechanisms) are required.

IMPROVING EMISSIONS ESTIMATES WITH COMPUTATIONAL INTELLIGENCE, DATABASE EXPANSION, AND COMPREHENSIVE VALIDATION

EPA Science Inventory

The report discusses an EPA investigation of techniques to improve methods for estimating volatile organic compound (VOC) emissions from area sources. Using the automobile refinishing industry for a detailed area source case study, an emission estimation method is being developed...

Effect of Weight Losing on the Improving Clinical Statement of Patients With Knee Osteoarthritis.

PubMed

Sadeghi, Alireza; Rad, Zahra Abbaspour; Sajedi, Behnam; Heydari, Amir Hossein; Akbarieh, Samira; Jafari, Behzad

2017-11-01

Osteoarthritis causes severe pain and disability in joints, one of the most prevalent involved joints is the knee joint. There are several therapeutics ways to control pain and disability, but almost none of them are definite treatment. In this article, we tried to reveal the effect of weight loss on improving symptoms of knee osteoarthritis as an effective and permanent therapeutic approach. We chose 62 patients with grade 1-2 (mild to moderate) knee osteoarthritis and divided them equally into case and control groups. Patients should not had used NSAIDs at least for 6 months before study initiation. Symptoms severity was measured by WOMAC and VAS questionnaires before and after 3 months follow up. Weight and BMI were recorded too. Case group was suggested to have weight loss diet of less fat and carbohydrates and control group did not have any limitation. Comparison of variables' average of case and control groups was not logistically meaningful at the initiation and after the end of the study. But there was a meaningful correlation between variables' changes and lifestyle change in both groups, especially in WOMAC and VAS scores. All variables in case group had statistically meaningful differences between their amounts at the beginning and after the end of the study, on the contrary of the control group. In the comparison of our study with similar studies in the world. We deduced that weight loss can improve symptoms of knee osteoarthritis even in short time weight loss diet (3 months). ZUMS.REC.1394.94. Copyright © 2017. Publicado por Elsevier España, S.L.U.

Using uterine activity to improve fetal heart rate variability analysis for detection of asphyxia during labor.

PubMed

Warmerdam, G J J; Vullings, R; Van Laar, J O E H; Van der Hout-Van der Jagt, M B; Bergmans, J W M; Schmitt, L; Oei, S G

2016-03-01

During labor, uterine contractions can cause temporary oxygen deficiency for the fetus. In case of severe and prolonged oxygen deficiency this can lead to asphyxia. The currently used technique for detection of asphyxia, cardiotocography (CTG), suffers from a low specificity. Recent studies suggest that analysis of fetal heart rate variability (HRV) in addition to CTG can provide information on fetal distress. However, interpretation of fetal HRV during labor is difficult due to the influence of uterine contractions on fetal HRV. The aim of this study is therefore to investigate whether HRV features differ during contraction and rest periods, and whether these differences can improve the detection of asphyxia. To this end, a case-control study was performed, using 14 cases with asphyxia that were matched with 14 healthy fetuses. We did not find significant differences for individual HRV features when calculated over the fetal heart rate without separating contractions and rest periods (p  >  0.30 for all HRV features). Separating contractions from rest periods did result in a significant difference. In particular the ratio between HRV features calculated during and outside contractions can improve discrimination between fetuses with and without asphyxia (p  <  0.04 for three out of four ratio HRV features that were studied in this paper).

The application of the Practitioners in Applied Practice Model during breaking bad news communication training for medical students: a case study.

PubMed

Dunning, Rose; Laidlaw, Anita

2015-11-01

Breaking bad news is a key skill within clinical communication and one which can impact outcomes for both the patient and practitioner. The evidence base for effective clinical communication training in breaking bad news is scarce. Frameworks have been found to assist the practitioner, such as SPIKES; however, the pedagogical approach used alongside such frameworks can vary. This study sought to examine the impact of utilising the Practitioners in Applied Practice Model (PAPM) alongside the SPIKES framework for training undergraduate medical students in breaking bad news. A case study approach is used to highlight the impact of training based on the PAPM and SPIKES on patient-centred communication and simulated patient satisfaction with the clinical communication behaviour. Results showed that following training, both patient-centred behaviour and patient satisfaction improved. With detailed communication behaviour changes, a balance was established between rapport building behaviour, lifestyle and psychosocial talk alongside biomedical information. This case study shows how the PAPM could be utilised alongside the SPIKES framework to improve breaking bad news communication in medical undergraduate students and describes the behavioural basis of the improvement. Further research is required to show the generalisability of this training intervention. © The Author(s) 2015.

Using discordance to improve classification in narrative clinical databases: an application to community-acquired pneumonia.

PubMed

Hripcsak, George; Knirsch, Charles; Zhou, Li; Wilcox, Adam; Melton, Genevieve B

2007-03-01

Data mining in electronic medical records may facilitate clinical research, but much of the structured data may be miscoded, incomplete, or non-specific. The exploitation of narrative data using natural language processing may help, although nesting, varying granularity, and repetition remain challenges. In a study of community-acquired pneumonia using electronic records, these issues led to poor classification. Limiting queries to accurate, complete records led to vastly reduced, possibly biased samples. We exploited knowledge latent in the electronic records to improve classification. A similarity metric was used to cluster cases. We defined discordance as the degree to which cases within a cluster give different answers for some query that addresses a classification task of interest. Cases with higher discordance are more likely to be incorrectly classified, and can be reviewed manually to adjust the classification, improve the query, or estimate the likely accuracy of the query. In a study of pneumonia--in which the ICD9-CM coding was found to be very poor--the discordance measure was statistically significantly correlated with classification correctness (.45; 95% CI .15-.62).

Patient engagement: four case studies that highlight the potential for improved health outcomes and reduced costs.

PubMed

Laurance, Jeremy; Henderson, Sarah; Howitt, Peter J; Matar, Mariam; Al Kuwari, Hanan; Edgman-Levitan, Susan; Darzi, Ara

2014-09-01

The energy of patients and members of the public worldwide who care about improving health is a huge, but still largely unrecognized and untapped, resource. The aim of patient engagement is to shift the clinical paradigm from determining "what is the matter?" to discovering "what matters to you?" This article presents four case studies from around the world that highlight the proven and potential abilities of increased patient engagement to improve health outcomes and reduce costs, while extending the reach of treatment and diagnostic programs into the community. The cases are an online mental health community in the United Kingdom, a genetic screening program in the United Arab Emirates, a World Health Organization checklist for new mothers, and a hospital-based patient engagement initiative in the United States. Evidence from these and similar endeavors suggests that closer collaboration on the part of patients, families, health care providers, health care systems, and policy makers at multiple levels could help diverse nations provide more effective and population-appropriate health care with fewer resources. Project HOPE—The People-to-People Health Foundation, Inc.

Mobile phones improve case detection and management of malaria in rural Bangladesh

PubMed Central

2013-01-01

Background The recent introduction of mobile phones into the rural Bandarban district of Bangladesh provided a resource to improve case detection and treatment of patients with malaria. Methods During studies to define the epidemiology of malaria in villages in south-eastern Bangladesh, an area with hypoendemic malaria, the project recorded 986 mobile phone calls from families because of illness suspected to be malaria between June 2010 and June 2012. Results Based on phone calls, field workers visited the homes with ill persons, and collected blood samples for malaria on 1,046 people. 265 (25%) of the patients tested were positive for malaria. Of the 509 symptomatic malaria cases diagnosed during this study period, 265 (52%) were detected because of an initial mobile phone call. Conclusion Mobile phone technology was found to be an efficient and effective method for rapidly detecting and treating patients with malaria in this remote area. This technology, when combined with local knowledge and field support, may be applicable to other hard-to-reach areas to improve malaria control. PMID:23374585

Systematic Review of Programs Treating High-Need and High-Cost People With Multiple Chronic Diseases or Disabilities in the United States, 2008–2014

PubMed Central

Bleich, Sara N.; Sherrod, Cheryl; Chiang, Anne; Boyd, Cynthia; Wolff, Jennifer; DuGoff, Eva; Salzberg, Claudia; Anderson, Keely; Leff, Bruce

2015-01-01

Introduction Finding ways to provide better and less expensive health care for people with multiple chronic conditions or disability is a pressing concern. The purpose of this systematic review was to evaluate different approaches for caring for this high-need and high-cost population. Methods We searched Medline for articles published from May 31, 2008, through June 10, 2014, for relevant studies. Articles were considered eligible for this review if they met the following criteria: included people with multiple chronic conditions (behavioral or mental health) or disabilities (2 or more); addressed 1 or more of clinical outcomes, health care use and spending, or patient satisfaction; and compared results from an intervention group with a comparison group or baseline measurements. We extracted information on program characteristics, participant characteristics, and significant (positive and negative) clinical findings, patient satisfaction, and health care use outcomes. For each outcome, the number of significant and positive results was tabulated. Results Twenty-seven studies were included across 5 models of care. Of the 3 studies reporting patient satisfaction outcomes, 2 reported significant improvements; both were randomized controlled trials (RCTs). Of the 14 studies reporting clinical outcomes, 12 reported improvements (8 were RCTs). Of the 13 studies reporting health care use and spending outcomes, 12 reported significant improvements (2 were RCTs). Two models of care — care and case management and disease management — reported improvements in all 3 outcomes. For care and case management models, most improvements were related to health care use. For the disease management models, most improvements were related to clinical outcomes. Conclusions Care and case management as well as disease management may be promising models of care for people with multiple chronic conditions or disabilities. More research and consistent methods are needed to understand the most appropriate care for these high-need and high-cost patients. PMID:26564013

Systematic Review of Programs Treating High-Need and High-Cost People With Multiple Chronic Diseases or Disabilities in the United States, 2008-2014.

PubMed

Bleich, Sara N; Sherrod, Cheryl; Chiang, Anne; Boyd, Cynthia; Wolff, Jennifer; DuGoff, Eva; Chang, Eva; Salzberg, Claudia; Anderson, Keely; Leff, Bruce; Anderson, Gerard

2015-11-12

Finding ways to provide better and less expensive health care for people with multiple chronic conditions or disability is a pressing concern. The purpose of this systematic review was to evaluate different approaches for caring for this high-need and high-cost population. We searched Medline for articles published from May 31, 2008, through June 10, 2014, for relevant studies. Articles were considered eligible for this review if they met the following criteria: included people with multiple chronic conditions (behavioral or mental health) or disabilities (2 or more); addressed 1 or more of clinical outcomes, health care use and spending, or patient satisfaction; and compared results from an intervention group with a comparison group or baseline measurements. We extracted information on program characteristics, participant characteristics, and significant (positive and negative) clinical findings, patient satisfaction, and health care use outcomes. For each outcome, the number of significant and positive results was tabulated. Twenty-seven studies were included across 5 models of care. Of the 3 studies reporting patient satisfaction outcomes, 2 reported significant improvements; both were randomized controlled trials (RCTs). Of the 14 studies reporting clinical outcomes, 12 reported improvements (8 were RCTs). Of the 13 studies reporting health care use and spending outcomes, 12 reported significant improvements (2 were RCTs). Two models of care - care and case management and disease management - reported improvements in all 3 outcomes. For care and case management models, most improvements were related to health care use. For the disease management models, most improvements were related to clinical outcomes. Care and case management as well as disease management may be promising models of care for people with multiple chronic conditions or disabilities. More research and consistent methods are needed to understand the most appropriate care for these high-need and high-cost patients.

Characteristics of the group of radiologists that benefits the most using Breast Screen Reader Assessment Strategy (BREAST)

NASA Astrophysics Data System (ADS)

Ganesan, A.; Alakhras, M.; Brennan, P. C.; Lee, W.; Tapia, K.; Mello-Thoms, C.

2018-03-01

Purpose: To determine the impact of Breast Screen Reader Assessment Strategy (BREAST) over time in improving radiologists' breast cancer detection performance, and to identify the group of radiologists that benefit the most by using BREAST as a training tool. Materials and Methods: Thirty-six radiologists who completed three case-sets offered by BREAST were included in this study. The case-sets were arranged in radiologists' chronological order of completion and five performance measures (sensitivity, specificity, location sensitivity, receiver operating characteristics area under the curve (ROC AUC) and jackknife alternative free-response receiver operating characteristic (JAFROC) figure-of-merit (FOM)), available from BREAST, were compared between case-sets to determine the level of improvement achieved. The radiologists were then grouped based on their characteristics and the above performance measures between the case-sets were compared. Paired t-tests or Wilcoxon signed-rank tests with statistical significance set at p < 0.05 were used to compare the performance measures. Results: Significant improvement was demonstrated in radiologists' case-set performance in terms of location sensitivity and JAFROC FOM over the years, and radiologists' location sensitivity and JAFROC FOM showed significant improvement irrespective of their characteristics. In terms of ROC AUC, significant improvement was shown for radiologists who were reading screen mammograms for more than 7 years and spent more than 9 hours per week reading mammograms. Conclusion: Engaging with case-sets appears to enhance radiologists' performance suggesting the important value of initiatives such as BREAST. However, such performance enhancement was not shown for everyone, highlighting the need to tailor the BREAST platform to benefit all radiologists.

Clinical Utility of a Coronary Heart Disease Risk Prediction Gene Score in UK Healthy Middle Aged Men and in the Pakistani Population

PubMed Central

Beaney, Katherine E.; Cooper, Jackie A.; Ullah Shahid, Saleem; Ahmed, Waqas; Qamar, Raheel; Drenos, Fotios; Crockard, Martin A.; Humphries, Steve E.

2015-01-01

Background Numerous risk prediction algorithms based on conventional risk factors for Coronary Heart Disease (CHD) are available but provide only modest discrimination. The inclusion of genetic information may improve clinical utility. Methods We tested the use of two gene scores (GS) in the prospective second Northwick Park Heart Study (NPHSII) of 2775 healthy UK men (284 cases), and Pakistani case-control studies from Islamabad/Rawalpindi (321 cases/228 controls) and Lahore (414 cases/219 controls). The 19-SNP GS included SNPs in loci identified by GWAS and candidate gene studies, while the 13-SNP GS only included SNPs in loci identified by the CARDIoGRAMplusC4D consortium. Results In NPHSII, the mean of both gene scores was higher in those who went on to develop CHD over 13.5 years of follow-up (19-SNP p=0.01, 13-SNP p=7x10-3). In combination with the Framingham algorithm the GSs appeared to show improvement in discrimination (increase in area under the ROC curve, 19-SNP p=0.48, 13-SNP p=0.82) and risk classification (net reclassification improvement (NRI), 19-SNP p=0.28, 13-SNP p=0.42) compared to the Framingham algorithm alone, but these were not statistically significant. When considering only individuals who moved up a risk category with inclusion of the GS, the improvement in risk classification was statistically significant (19-SNP p=0.01, 13-SNP p=0.04). In the Pakistani samples, risk allele frequencies were significantly lower compared to NPHSII for 13/19 SNPs. In the Islamabad study, the mean gene score was higher in cases than controls only for the 13-SNP GS (2.24 v 2.34, p=0.04). There was no association with CHD and either score in the Lahore study. Conclusion The performance of both GSs showed potential clinical utility in European men but much less utility in subjects from Pakistan, suggesting that a different set of risk loci or SNPs may be required for risk prediction in the South Asian population. PMID:26133560

Navigation-guided optic canal decompression for traumatic optic neuropathy: Two case reports.

PubMed

Bhattacharjee, Kasturi; Serasiya, Samir; Kapoor, Deepika; Bhattacharjee, Harsha

2018-06-01

Two cases of traumatic optic neuropathy presented with profound loss of vision. Both cases received a course of intravenous corticosteroids elsewhere but did not improve. They underwent Navigation guided optic canal decompression via external transcaruncular approach, following which both cases showed visual improvement. Postoperative Visual Evoked Potential and optical coherence technology of Retinal nerve fibre layer showed improvement. These case reports emphasize on the role of stereotactic navigation technology for optic canal decompression in cases of traumatic optic neuropathy.

Using information technology for an improved pharmaceutical care delivery in developing countries. Study case: Benin.

PubMed

Edoh, Thierry Oscar; Teege, Gunnar

2011-10-01

One of the problems in health care in developing countries is the bad accessibility of medicine in pharmacies for patients. Since this is mainly due to a lack of organization and information, it should be possible to improve the situation by introducing information and communication technology. However, for several reasons, standard solutions are not applicable here. In this paper, we describe a case study in Benin, a West African developing country. We identify the problem and the existing obstacles for applying standard ECommerce solutions. We develop an adapted system approach and describe a practical test which has shown that the approach has the potential of actually improving the pharmaceutical care delivery. Finally, we consider the security aspects of the system and propose an organizational solution for some specific security problems.

A novel approach of magnetorheological abrasive fluid finishing with swirling-assisted inlet flow

NASA Astrophysics Data System (ADS)

Kheradmand, Saeid; Esmailian, Mojtaba; Fatahy, A.

Abrasive flow machining has been the pioneer of new finishing processes. Rotating workpiece and imposing a magnetic field using magnetorheological working medium are some assisting manipulations to improve surface finishing, because they can increase the forces on the workpiece surface. Similarly, swirling the inlet flow using stationary swirler vanes, as a novel idea, may also increase forces on the surface, and then raise the material removal, with a lower expense and energy consumption compared with the case of workpiece rotation. Thus, in this paper, surface roughness improvement is studied in a pipe with rotating inlet flow of a magnetorheological finishing medium under imposing a magnetic field. The results are compared with the case of rotating workpiece, using 3D numerical simulation. The governing hydrodynamic parameters are investigated in both cases to monitor the flow variations. It is shown that surface roughness is improved by rotating inlet flow. However, it is found that finishing in the entrance length of swirling-assisted inlet flow can be so economical for short length workpieces, compared with the case of rotating workpiece, with very near Ra values. By comparison of the numerical results and published experimental data, current study also shows the ability of the numerical simulation, as an inexpensive and efficient tool, to predict the surface roughness changes in finishing processes.

Evaluating the effectiveness of case method instruction in technical communication

NASA Technical Reports Server (NTRS)

Feinberg, S. G.

1981-01-01

The effectiveness of the case method as an instructional technique in improving technical writing was evaluated. The development of a self-report instrument that attempts to measure changes in attitude toward technical communication and the presentation results change are the purpose of this paper. Standards for developing a case set forth by Goldstein and Couture, were used to design an evaluation instrument to measure the effect instruction on student attitude toward technical communication. This self-report instrument is based on model developed and tested by Daly and Miller who studied writer attitude and apprehension toward writing. It was the most important objective of any evaluation is to provide information for improving the program.

Case Studies Illustrating Focal Alzheimer's, Fluent Aphasia, Late-Onset Memory Loss, and Rapid Dementia.

PubMed

Camsari, Gamze Balci; Murray, Melissa E; Graff-Radford, Neill R

2016-08-01

Many dementia subtypes have more shared signs and symptoms than defining ones. We review 8 cases with 4 overlapping syndromes and demonstrate how to distinguish the cases. These include focal cortical presentations of Alzheimer's disease (AD; posterior cortical atrophy and corticobasal syndrome [CBS]), fluent aphasia (semantic dementia and logopenic aphasia), late-onset slowly progressive dementia (hippocampal sclerosis and limbic predominant AD) and rapidly progressive dementia (Creutzfeldt-Jakob disease and limbic encephalitis). Recognizing the different syndromes can help the clinician to improve their diagnostic skills, leading to improved patient outcomes by early and accurate diagnosis, prompt treatment, and appropriate counseling and guidance. Copyright © 2016 Elsevier Inc. All rights reserved.

Video Cases. [SITE 2002 Section].

ERIC Educational Resources Information Center

Talley, Sue, Ed.

This document contains the following papers on video case studies from the SITE (Society for Information Technology & Teacher Education) 2002 conference: (1) "Developing Digital Video Resources To Improve Teaching with Technology: The PT3--'Best Practices' Project"; (2) "Portraits of Three Schools from the U.S.A. Exemplary Technology-Supported…

Improving Operational Readiness through Total Quality Management

DTIC Science & Technology

1991-06-21

DTIC AD-A236 611 EL CT F NAVAL WAR COLL GE C Newport, R. I. IMPROVING OPERATIONAL READINESS THROUGH TOTAL QUALITY MANAGEMENT by Herb Westphal Defense...IMPROVING OPERATIONAL READINESS THROUGH TOTAL QUALITY MANAGEMENT (TQM) A Case Study: The Defense Mapping Agency Combat Support Center (DMACSC) initiated a...of the Defense Mapping Agency Combat Support Center’s (DMACSC) Total Quality Management (TQM) improvement methodology. This allows the reader to

Piloting case-based instruction in a didactic clinical immunology course.

PubMed

Hoag, Kathleen; Lillie, Janet; Hoppe, Ruth

2005-01-01

To assess (1) the effect of case-based instructional modules on student critical thinking, class attendance, and satisfaction and (2) student opinion of case formats. University-based upper division course in clinical immunology and serology. The course was taught by the same instructor for two consecutive semesters with the intervention introduced in the second semester. Sixty-seven students experienced the intervention and 56 students were in the baseline cohort. Nine cases were interspersed between lectures during the semester. Each case took one 50-minute class in which students worked in groups of five or six. Student performance on five critical thinking multiple-choice examination questions and percent student attendance on case days versus lecture days were analyzed using the Mann-Whitney test. Student ratings on course evaluations were analyzed using t-test comparing semesters with and without intervention. Student opinion of cases was obtained through surveys and a focus group. Student performance on critical thinking exam questions was similar in the two groups. Student attendance was significantly higher on case days (95.6%) versus lecture days (80.3%; p < 0.0001). Only composite ratings for instructor involvement, student-instructor interaction, and course organization were significantly improved in the semester with cases compared to the semester with lecture only (p < 0.0001 for all indices). Although case studies did not significantly improve student performance on critical thinking questions, they still proved to be a valuable instructional method. Student attendance, student-instructor interaction, and instructor involvement in the course were all positively affected by incorporation of case studies. Discussion of cases also helped to uncover student misconceptions of course material.

Evidence-Based Advances in Reptile Medicine.

PubMed

Mitchell, Mark A; Perry, Sean M

2017-09-01

Evidence-based medicine allows veterinarians to practice high-quality medicine, because the basis for all decision making is quantitative, objective, and reproducible. Case reports and case series are limited in their scope and application. Cross-sectional studies, likewise, cannot provide answers to specific variable testing with a temporal application. It is essential for the reptile specialty to expand into case-control studies, cohort studies, and experimental/intervention studies. Unfortunately, much of the reptile literature remains limited to descriptive studies. This article reviews current evidence-based topics in reptile medicine and shares how everyone practicing in the field can contribute to improving this specialty. Copyright © 2017 Elsevier Inc. All rights reserved.

Case Studies in Exercise and Sport Sciences: A Powerful Tool to Bridge the Science-Practice Gap.

PubMed

Halperin, Israel

2018-03-27

Despite the progress made by the scientific exercise community in collaborating and communicating with non-scientist coaches, there is room for improvement. Coaches find research difficult to understand, feel that their interests are not being addressed by exercise research, and rely on peer-discussion to further their coaching knowledge base while consuming little peer-reviewed articles. One useful strategy to bridge the science-practice gap is with case-studies. In addition to furthering our understanding of the physiology, psychology, and training schedules of elite athletes, case studies can serve 1) as a useful communication channel with coaches if presented as narratives and 2) to establish and strengthen relationships between scientists and coaches leading to fruitful research collaborations. The purpose of this invited commentary is to discuss these two less-recognized benefits of case-studies, and propose a way to incorporate case-studies more frequently alongside group-based studies.

Case Studies in Exercise and Sport Sciences: A Powerful Tool to Bridge the Science-Practice Gap.

PubMed

Halperin, Israel

2018-06-21

Despite the progress made by the scientific exercise community in collaborating and communicating with nonscientist coaches, there is room for improvement. Coaches find research difficult to understand, feel that their interests are not being addressed by exercise research, and rely on peer discussion to further their coaching knowledge base while consuming few peer-reviewed articles. One useful strategy to bridge the science-practice gap is with case studies. In addition to furthering our understanding of the physiology, psychology, and training schedules of elite athletes, case studies can serve (1) as a useful communication channel with coaches if presented as narratives and (2) to establish and strengthen relationships between scientists and coaches, leading to fruitful research collaborations. The purpose of this invited commentary is to discuss these 2 less-recognized benefits of case studies and propose a way to incorporate case studies more frequently alongside group-based studies.

Feasibility of energy medicine in a community teaching hospital: an exploratory case series.

PubMed

Dufresne, Francois; Simmons, Bonnie; Vlachostergios, Panagiotis J; Fleischner, Zachary; Joudeh, Ramsey; Blakeway, Jill; Julliard, Kell

2015-06-01

Energy medicine (EM) derives from the theory that a subtle biologic energy can be influenced for therapeutic effect. EM practitioners may be trained within a specific tradition or work solo. Few studies have investigated the feasibility of solo-practitioner EM in hospitals. This study investigated the feasibility of EM as provided by a solo practitioner in inpatient and emergent settings. Feasibility study, including a prospective case series. Inpatient units and emergency department. To investigate the feasibility of EM, acceptability, demand, implementation, and practicality were assessed. Short-term clinical changes were documented by treating physicians. Patients, employees, and family members were enrolled in the study only if study physicians expected no or slow improvement in specific symptoms. Those with secondary gains or who could not communicate perception of symptom change were excluded. EM was found to have acceptability and demand, and implementation was smooth because study procedures dovetailed with conventional clinical practice. Practicality was acceptable within the study but was low upon further application of EM because of cost of program administration. Twenty-four of 32 patients requested relief from pain. Of 50 reports of pain, 5 (10%) showed no improvement; 4 (8%), slight improvement; 3 (6%), moderate improvement; and 38 (76%), marked improvement. Twenty-one patients had issues other than pain. Of 29 non-pain-related problems, 3 (10%) showed no, 2 (7%) showed slight, 1 (4%) showed moderate, and 23 (79%) showed marked improvement. Changes during EM sessions were usually immediate. This study successfully implemented EM provided by a solo practitioner in inpatient and emergent hospital settings and found that acceptability and demand justified its presence. Most patients experienced marked, immediate improvement of symptoms associated with their chief complaint. Substantial practicality issues must be addressed to implement EM clinically in a hospital, however.

Effect of using an audience response system on learning environment, motivation and long-term retention, during case-discussions in a large group of undergraduate veterinary clinical pharmacology students.

PubMed

Doucet, Michèle; Vrins, André; Harvey, Denis

2009-12-01

Teaching methods that provide an opportunity for individual engagement and focussed feedback are required to create an active learning environment for case-based teaching in large groups. A prospective observational controlled study was conducted to evaluate whether the use of an audience response system (ARS) would promote an active learning environment during case-based discussions in large groups, have an impact on student motivation and improve long-term retention. Group A (N = 83) participated in large group case discussions where student participation was voluntary, while for group B (N = 86) an ARS was used. Data collection methods included student and teacher surveys, student focus group interviews, independent observations and 1-year post-course testing. Results indicated that the use of an ARS provided an active learning environment during case-based discussions in large groups by favouring engagement, observation and critical reflection and by increasing student and teacher motivation. Although final exam results were significantly improved in group B, long-term retention was not significantly different between groups. It was concluded that ARS use significantly improved the learning experience associated with case-based discussions in a large group of undergraduate students.

A Clinical Study of Autologous Bone Marrow Mononuclear Cells for Cerebral Palsy Patients: A New Frontier

PubMed Central

Sharma, Alok; Sane, Hemangi; Gokulchandran, Nandini; Kulkarni, Pooja; Sundaram, Jyothi; Paranjape, Amruta; Shetty, Akshata; Bhagwanani, Khushboo; Biju, Hema; Badhe, Prerna

2015-01-01

Cerebral palsy is a nonprogressive heterogeneous group of neurological disorders with a growing rate of prevalence. Recently, cellular therapy is emerging as a potential novel treatment strategy for cerebral palsy. The various mechanisms by which cellular therapy works include neuroprotection, immunomodulation, neurorestoration, and neurogenesis. We conducted an open label, nonrandomized study on 40 cases of cerebral palsy with an aim of evaluating the benefit of cellular therapy in combination with rehabilitation. These cases were administered autologous bone marrow mononuclear cells intrathecally. The follow-up was carried out at 1 week, 3 months, and 6 months after the intervention. Adverse events of the treatment were also monitored in this duration. Overall, at six months, 95% of patients showed improvements. The study population was further divided into diplegic, quadriplegic, and miscellaneous group of cerebral palsy. On statistical analysis, a significant association was established between the symptomatic improvements and cell therapy in diplegic and quadriplegic cerebral palsy. PET-CT scan done in 6 patients showed metabolic improvements in areas of the brain correlating to clinical improvements. The results of this study demonstrate that cellular therapy may accelerate the development, reduce disability, and improve the quality of life of patients with cerebral palsy. PMID:25788947

Impact of Case Mix Severity on Quality Improvement in a Patient-centered Medical Home (PCMH) in the Maryland Multi-Payor Program.

PubMed

Khanna, Niharika; Shaya, Fadia T; Chirikov, Viktor V; Sharp, David; Steffen, Ben

2016-01-01

We present data on quality of care (QC) improvement in 35 of 45 National Quality Forum metrics reported annually by 52 primary care practices recognized as patient-centered medical homes (PCMHs) that participated in the Maryland Multi-Payor Program from 2011 to 2013. We assigned QC metrics to (1) chronic, (2) preventive, and (3) mental health care domains. The study used a panel data design with no control group. Using longitudinal fixed-effects regressions, we modeled QC and case mix severity in a PCMH. Overall, 35 of 45 quality metrics reported by 52 PCMHs demonstrated improvement over 3 years, and case mix severity did not affect the achievement of quality improvement. From 2011 to 2012, QC increased by 0.14 (P < .01) for chronic, 0.15 (P < .01) for preventive, and 0.34 (P < .01) for mental health care domains; from 2012 to 2013 these domains increased by 0.03 (P = .06), 0.04 (P = .05), and 0.07 (P = .12), respectively. In univariate analyses, lower National Commission on Quality Assurance PCMH level was associated with higher QC for the mental health care domain, whereas case mix severity did not correlate with QC. In multivariate analyses, higher QC correlated with larger practices, greater proportion of older patients, and readmission visits. Rural practices had higher proportions of Medicaid patients, lower QC, and higher QC improvement in interaction analyses with time. The gains in QC in the chronic disease domain, the preventive care domain, and, most significantly, the mental health care domain were observed over time regardless of patient case mix severity. QC improvement was generally not modified by practice characteristics, except for rurality. © Copyright 2016 by the American Board of Family Medicine.

Sjögren's syndrome - not just Sicca: renal involvement in Sjögren's syndrome.

PubMed

Kaufman, I; Schwartz, D; Caspi, D; Paran, D

2008-01-01

To present a case of severe interstitial nephritis with proteinuria in primary Sjögren's syndrome (pSS) and review the literature regarding renal disease and its management in pSS, aiming to suggest recommendations for treatment. A search of MEDLINE (PubMed) was performed for review articles and case reports using the MESH terms: Sjögren syndrome; renal disease; interstitial nephritis (IN); glomerulonephritis (GN). We describe a rare case of pSS presenting with hypokalaemic tetraparesis and proteinuria due to severe IN, successfully treated with high-dose steroids and azathioprine. Reviewing the literature, we identified 180 reported cases of renal involvement in pSS (selected based on the European criteria for pSS), 89 of which underwent renal biopsies revealing IN in 49 cases, GN in 33 samples, and both IN and GN in seven. Eighteen studies reported treatment experience of renal disease in 32 pSS cases. Seventeen patients were treated with corticosteroids and cyclophosphamide, and 15 patients received only steroids with improvement in the majority of cases. The present case, as well as the limited number of reports in the literature, suggest that renal involvement, including IN, in pSS may improve with immunosuppressive therapy. Further studies are required to determine indications for and dosages of immunosuppressive treatment in patients with renal involvement of pSS.

Improved malaria case management in formal private sector through public private partnership in Ethiopia: retrospective descriptive study.

PubMed

Argaw, Mesele D; Woldegiorgis, Asfawesen Gy; Abate, Derebe T; Abebe, Mesfin E

2016-07-11

Malaria is a major public health problem and still reported among the 10 top causes of morbidity and mortality in Ethiopia. More than one-third of the people sought treatment from the private health sector. Evaluating adherences of health care providers to standards are paramount importance to determine the quality and the effectiveness of service delivery. Therefore, the aim of this study was to evaluate the contribution of public private mix (PPM) approach in improving quality of malaria case management among formal private providers. A retrospective data analysis was conducted using 2959 facility-months data collected from 110 PPM for malaria care facilities located in Amhara, Dire Dawa, Hareri, Oromia, Southern Nation Nationalities and Peoples and Tigray regions. Data abstraction formats were used to collect and collate the data on quarterly bases. The data were manually cleaned and analysed using Microsoft Office Excel 2010. To claim statistical significance non-parametric McNemar test was done and decision accepted at P < 0.05. From April 2012-September 2015, a total of 873,707 malaria suspected patients were identified, of which one-fourth (25.6 %) were treated as malaria cases. Among malaria suspected cases the proportion of malaria investigation improved from recorded in first quarter 87.7-100.0 % in last quarter (X(2) = 66.84, P < 0.001). The majority (96.0 %) were parasitologically-confirmed cases either by using microscopy or rapid diagnostic tests. The overall slid positivity rate was 25.1 % of which half (50.7 %) were positive for Plasmodium falciparum and slightly lower than half (45.2 %) for Plasmodium vivax; the remaining 8790 (4.1 %) showed mixed infections of P. falciparum and P. vivax. Adherence to appropriate treatment using artemether-lumefantrine (AL) was improved from 47.8 % in the first quarter to 95.7 % in the last quarter (X(2) = 12.89, P < 0.001). Similarly, proper patient management using chloroquine (CQ) was improved from 44.1 % in the first quarter to 98.12 % in the last quarter (X(2) = 11.62, P < 0.001). This study documented the chronological changes of adherence of health care providers with the national recommended standards to treat malaria. The PPM for malaria care services significantly improved the malaria case management practice of health care providers at the formal private health facilities. Therefore, regional health bureaus and partners shall closely work to scale up the initiated PPM for malaria care service.

Adding a Time-Series Design Element to the Success Case Method to Improve Methodological Rigor: An Application for Nonprofit Program Evaluation

ERIC Educational Resources Information Center

Coryn, Chris L. S.; Schroter, Daniela C.; Hanssen, Carl E.

2009-01-01

Brinkerhoff's Success Case Method (SCM) was developed with the specific purpose of assessing the impact of organizational interventions (e.g., training and coaching) on business goals by analyzing extreme groups using case study techniques and storytelling. As an efficient and cost-effective method of evaluative inquiry, SCM is attractive in other…

Analytical study of effect of casing treatment on performance of a multistage compressor

NASA Technical Reports Server (NTRS)

Snyder, R. W.; Blade, R. J.

1972-01-01

The simulation was based on individual stage pressure and efficiency maps. These maps were modified to account for casing treatment effects on the individual stage characteristics. The individual stage maps effects on overall compressor performance were observed. The results show that to improve the performance of the compressor in its normal operating range, casing treatment of the rear stages is required.

Strontium-90 Biokinetics from Simulated Wound Intakes in Non-human Primates Compared with Combined Model Predictions from National Council on Radiation Protection and Measurements Report 156 and International Commission on Radiological Protection Publication 67.

PubMed

Allen, Mark B; Brey, Richard R; Gesell, Thomas; Derryberry, Dewayne; Poudel, Deepesh

2016-01-01

This study had a goal to evaluate the predictive capabilities of the National Council on Radiation Protection and Measurements (NCRP) wound model coupled to the International Commission on Radiological Protection (ICRP) systemic model for 90Sr-contaminated wounds using non-human primate data. Studies were conducted on 13 macaque (Macaca mulatta) monkeys, each receiving one-time intramuscular injections of 90Sr solution. Urine and feces samples were collected up to 28 d post-injection and analyzed for 90Sr activity. Integrated Modules for Bioassay Analysis (IMBA) software was configured with default NCRP and ICRP model transfer coefficients to calculate predicted 90Sr intake via the wound based on the radioactivity measured in bioassay samples. The default parameters of the combined models produced adequate fits of the bioassay data, but maximum likelihood predictions of intake were overestimated by a factor of 1.0 to 2.9 when bioassay data were used as predictors. Skeletal retention was also over-predicted, suggesting an underestimation of the excretion fraction. Bayesian statistics and Monte Carlo sampling were applied using IMBA to vary the default parameters, producing updated transfer coefficients for individual monkeys that improved model fit and predicted intake and skeletal retention. The geometric means of the optimized transfer rates for the 11 cases were computed, and these optimized sample population parameters were tested on two independent monkey cases and on the 11 monkeys from which the optimized parameters were derived. The optimized model parameters did not improve the model fit in most cases, and the predicted skeletal activity produced improvements in three of the 11 cases. The optimized parameters improved the predicted intake in all cases but still over-predicted the intake by an average of 50%. The results suggest that the modified transfer rates were not always an improvement over the default NCRP and ICRP model values.

A Systematic Review of Diuretics in the Medical Management of Ménière's Disease.

PubMed

Crowson, Matthew G; Patki, Aniruddha; Tucci, Debara L

2016-05-01

(1) Review evidence for the use of oral diuretic medications in the management of Ménière's disease. (2) Analyze therapy-related hearing and vertigo outcomes. Literature was obtained through directed searches of MEDLINE, EMBASE, Web of Science, EBSCO Host, Cochrane Reviews, and linked citations through seminal papers. We searched independent electronic databases for articles that reported the use of diuretics in patients with Ménière's disease. All articles of level 4 evidence or higher, per the Oxford Centre for Evidence-Based Medicine, were included with no limit for number of patients, duration of therapy, or follow-up period. Two independent investigators reviewed the articles for inclusion eligibility. Outcomes were tabulated, including subjective or quantitative measures of hearing, tinnitus, vertigo episode frequency, and medication adverse effects. Nineteen articles were included from 1962 to 2012 from 11 countries. Twelve retrospective case series, 4 randomized controlled trials, 2 case-control trials, and 1 prospective case series were identified. Six studies investigated isosorbide; 5, hydrochlorothiazide; 2, acetazolamide; 2, chlorthalidone; and 1 each of betahistine, hydrochlorothiazide, chlorthalidone, acetazolamide, hydrochlorothiazide-triamterene, and nimodipine. Eight (42.1%) studies reported hearing outcomes improvement. Fifteen (79.0%) studies reported vertigo outcomes improvement. Ten (52.6%) studies reported no side effects, and 4 studies (21.1%) reported abdominal discomfort. No significant morbidity or mortality was reported in any study. Multiple low evidence-level studies report that oral diuretic therapy may be beneficial in the medical management of Ménière's disease. Improvement in vertigo episode frequency was consistently reported, with less convincing evidence for improvement in hearing outcomes. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

Ten tools of continuous quality improvement: a review and case example of hospital discharge.

PubMed

Ziegenfuss, J T; McKenna, C K

1995-01-01

Concepts and methods of continuous quality improvement have been endorsed by quality specialists in American Health care, and their use has convinced CEOs that industrial methods can make a contribution to health and medical care. For all the quality improvement publications, there are still few that offer a clear, concise definition and an explanation of the primary tools for teaching purposes. This report reviews ten continuous quality improvement methods including: problem solving cycle, affinity diagrams, cause and effect diagrams, Pareto diagrams, histograms, bar charts, control charts, scatter diagrams, checklists, and a process decision program chart. These do not represent an exhaustive list, but a set of commonly used tools. They are applied to a case study of bed utilization in a university hospital.

Improving proprioceptive deficits after stroke through robot-assisted training of the upper limb: a pilot case report study.

PubMed

Colombo, R; Sterpi, I; Mazzone, A; Delconte, C; Pisano, F

2016-01-01

The purpose of this study was to determine whether a conventional robot-assisted therapy of the upper limb was able to improve proprioception and motor recovery of an individual after stroke who exhibited proprioceptive deficits. After robotic sensorimotor training, significant changes were observed in kinematic performance variables. Two quantitative parameters evaluating position sense improved after training. Range of motion during shoulder and wrist flexion improved, but only wrist flexion remained improved at 3-month follow-up. These preliminary results suggest that intensive robot-aided rehabilitation may play an important role in the recovery of sensory function. However, further studies are required to confirm these data.

Chronic idiopathic anal pain. Results of a diagnostic-therapeutic protocol in a colorectal referral unit.

PubMed

Armañanzas, Laura; Arroyo, Antonio; Ruiz-Tovar, Jaime; López, Alberto; Santos, Jair; Moya, Pedro; Gómez, María Amparo; Candela, Fernando; Calpena, Rafael

2015-01-01

Chronic idiopathic anal pain (CIAP) remains a diagnosis of exclusion. Its study and management still lack a standardized protocol. The aim of this study is to evaluate the results obtained with the diagnostic-therapeutic protocol established in our service. We performed a retrospective study of patients diagnosed with CIAP at the Colorectal Unit of the General University Hospital of Elche, between 2005 and 2011. We evaluated 57 patients with a diagnosis of chronic anal pain for functional anorectal disease (FAD). After the application of our diagnostic protocol, final diagnosis of chronic anal pain (CAP) was achieved in 43 cases (75%), including 22 cases of descending perineum syndrome, 12 of proctalgia fugax, 2 of pudendal neuritis and 7 of coccydynia. In 14 patients exclusion diagnosis of CIAP was established. Among the therapies used on patients with CIAP, biofeedback combined with conservative measures improved symptoms in 43% of the cases. Sacral nerve stimulation was assessed in patients who did not respond to other treatments. Through proper anamnesis, physical examination and complementary tests, a specific diagnosis of the cause of CAP by FAD can be achieved, reducing exclusion diagnosis of CIAP to 25% of cases. Conservative measures combined with biofeedback achieved an improvement in pain in more than 40% of the cases of CIAP in our study. Sacral nerve stimulation can be considered as a treatment option in refractory cases. Copyright © 2013 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

The Case for Evaluating Student Outcomes and Equity Gaps to Improve Pathways and Programs of Study

ERIC Educational Resources Information Center

Bragg, Debra D.

2017-01-01

When linked to program review and improvement, program evaluation can help practitioners to ensure that career-technical education (CTE) and science, technology, engineering, and mathematics (STEM) programs offer equitable access and outcomes for underserved student groups.