PEPFAR/DOD/Pharmaccess/Tanzania Peoples Defence Forces HIV/AIDS Program

DTIC Science & Technology

2009-09-01

NACP National AIDS Control Program NGO Non Governmental Organization NLTP National Leprosy and TB Program NS National Service OIS...have an ongoing DOT-TB program monitored by the Regional Medical Officer, in line with the guidelines of the National Tuberculosis and Leprosy ...and treatment, according to the guidelines of the NACP TB Unit and the National TB and Leprosy Programme (NTLP). 48 48 C Train medical officers

Psychosocial Correlates of Clinicians' Prescription Drug Monitoring Program Utilization.

PubMed

Pugliese, John A; Wintemute, Garen J; Henry, Stephen G

2018-05-01

The purpose of this study is to extend prior research on barriers to use of a prescription drug monitoring program by examining psychosocial correlates of intended use among physicians and pharmacists. Overall, 1,904 California physicians and pharmacists responded to a statewide survey (24.1% response rate) from August 2016 to January 2017. Participants completed an online survey examining attitudes toward prescription drug misuse and abuse, prescribing practices, prescription drug monitoring program design and ease of use, professional obligations, and normative beliefs regarding prescription drug monitoring program use. Data were analyzed in 2017. Perceived prescription drug monitoring program usefulness and normative beliefs fully mediated the relationship between concern about prescription drug abuse and intentions to use the prescription drug monitoring program. Clinicians' sense of professional and moral obligation to use the prescription drug monitoring program was unrelated to intention to use the prescription drug monitoring program despite a positive relationship with concern about misuse and abuse. Compared with physicians, pharmacists reported greater concern about prescription drug misuse, greater professional and moral obligation to use prescription drug monitoring program, and greater rating of prescription drug monitoring program usefulness. Interventions that target normative beliefs surrounding prescription drug monitoring program use and how to use prescription drug monitoring programs effectively are likely to be more effective than those that target professional obligations or moralize to the medical community. Published by Elsevier Inc.

The "nuts and bolts" of implementing shared medical appointments: the Harvard Vanguard Medical Associates experience.

PubMed

Berger-Fiffy, Jill

2012-01-01

Harvard Vanguard Medical Associates (Harvard Vanguard) decided to develop a Shared Medical Appointment (SMA) program in 2007 for a variety of reasons. The program has launched 86 SMAs in 17 specialties at 12 sites and has exceeded 13 000 patient visits. Currently, the practice offers 54 SMAs and is believed to be the largest program in the country. This article provides an overview regarding staffing, space and equipment, project planning, promotional materials, training programs, workflow development, and the use of quality improvement (ie, LEAN) tools used to monitor the work to be completed and the metrics to date.

Training Medical Students for Rural, Underserved Areas: A Rural Medical Education Program in California.

PubMed

Eidson-Ton, W Suzanne; Rainwater, Julie; Hilty, Donald; Henderson, Stuart; Hancock, Christine; Nation, Cathryn L; Nesbitt, Thomas

2016-01-01

The Association of American Medical Colleges projects an increasing shortage of physicians in rural areas. Medical schools have developed specialty track programs to improve the recruitment and retention of physicians who can serve rural populations. One such program in California includes a variety of unique elements including outreach, admissions, rural clinical experiences, focused mentorship, scholarly and leadership opportunities, and engagement with rural communities. Preliminary outcomes demonstrate that this rural track program has achieved some success in the recruitment, retention, and training of students interested in future rural practice and in the placement of students in primary care residencies. Long-term outcomes, such as graduates entering rural practice, are still unknown, but will be monitored to assess the impact and sustainability of the rural program. This article illustrates the opportunities and challenges of training medical students for rural practice and provides lessons learned to inform newly-established and long standing rural medical education programs.

Interdisciplinary Medication Adherence Program: The Example of a University Community Pharmacy in Switzerland

PubMed Central

Lelubre, Mélanie; Kamal, Susan; Genre, Noëllie; Celio, Jennifer; Gorgerat, Séverine; Hugentobler Hampai, Denise; Bourdin, Aline; Berger, Jerôme; Bugnon, Olivier; Schneider, Marie

2015-01-01

The Community Pharmacy of the Department of Ambulatory Care and Community Medicine (Policlinique Médicale Universitaire, PMU), University of Lausanne, developed and implemented an interdisciplinary medication adherence program. The program aims to support and reinforce medication adherence through a multifactorial and interdisciplinary intervention. Motivational interviewing is combined with medication adherence electronic monitors (MEMS, Aardex MWV) and a report to patient, physician, nurse, and other pharmacists. This program has become a routine activity and was extended for use with all chronic diseases. From 2004 to 2014, there were 819 patient inclusions, and 268 patients were in follow-up in 2014. This paper aims to present the organization and program's context, statistical data, published research, and future perspectives. PMID:26839879

Interdisciplinary Medication Adherence Program: The Example of a University Community Pharmacy in Switzerland.

PubMed

Lelubre, Mélanie; Kamal, Susan; Genre, Noëllie; Celio, Jennifer; Gorgerat, Séverine; Hugentobler Hampai, Denise; Bourdin, Aline; Berger, Jerôme; Bugnon, Olivier; Schneider, Marie

2015-01-01

The Community Pharmacy of the Department of Ambulatory Care and Community Medicine (Policlinique Médicale Universitaire, PMU), University of Lausanne, developed and implemented an interdisciplinary medication adherence program. The program aims to support and reinforce medication adherence through a multifactorial and interdisciplinary intervention. Motivational interviewing is combined with medication adherence electronic monitors (MEMS, Aardex MWV) and a report to patient, physician, nurse, and other pharmacists. This program has become a routine activity and was extended for use with all chronic diseases. From 2004 to 2014, there were 819 patient inclusions, and 268 patients were in follow-up in 2014. This paper aims to present the organization and program's context, statistical data, published research, and future perspectives.

Administrative and Technical Support for the U.S. Army Medical Research and Development Command Joint Working Group on Medical Chemical Defense

DTIC Science & Technology

1989-08-01

microproces;qor databaAing systems for monitoring project and contract reports and program technology trans. fers, coordinating and providing administratIvo ...The JWGD 3 annual planning process generally included: - Program review by the JWGD’ membership at quarterly meetings, which consisted of the review...Office developed the program planning and budget documents associated with the planning process outlined above. Program project databases and

Medical Education and the Physician Workforce of Iraq

ERIC Educational Resources Information Center

Al Mosawi, Aamir Jalal

2008-01-01

The lack of resources in a country experiencing decades of successive wars, blockade, administrative corruption, and poor governance led to deteriorated standards throughout medical education. Although professional certification programs exist, continuing medical education accreditation and credit systems are required to monitor and certify the…

Reasons for misuse of prescription medication among physicians undergoing monitoring by a physician health program.

PubMed

Merlo, Lisa J; Singhakant, Supachoke; Cummings, Simone M; Cottler, Linda B

2013-01-01

Substance-related impairment of physicians is a small but serious problem, with significant consequences for patient safety and public health. The purpose of this study was to identify reasons for prescription drug misuse among physicians referred to a physician health program for monitoring because of substance-related impairment, to develop better mechanisms for prevention and intervention. A total of 55 physicians (94.5% male) who were being monitored by their State physician health program because of substance-related impairment participated in guided focus group discussions. Participation was anonymous. Discussions were transcribed from 9 separate focus groups, lasting 60 to 90 minutes each. Qualitative analyses were conducted to examine themes. All participants were diagnosed with substance dependence, and 69.1% of them endorsed a history of misusing prescription drugs. Participants documented the following 5 primary reasons for prescription drug misuse: (1) to manage physical pain, (2) to manage emotional/psychiatric distress, (3) to manage stressful situations, (4) to serve recreational purposes, and (5) to avoid withdrawal symptoms. Our results emphasize the importance of self-medication as a leading reason for misusing prescription medications, although recreational use was also an important factor. Prevention efforts targeting prescription drug misuse among physicians should be initiated during medical training, with continuing education requirements throughout the physicians' careers.

Medically related activities of application team program

NASA Technical Reports Server (NTRS)

1971-01-01

Application team methodology identifies and specifies problems in technology transfer programs to biomedical areas through direct contact with users of aerospace technology. The availability of reengineering sources increases impact of the program on the medical community and results in broad scale application of some bioinstrumentation systems. Examples are given that include devices adapted to the rehabilitation of neuromuscular disorders, power sources for artificial organs, and automated monitoring and detection equipment in clinical medicine.

[The training of medical and scientific manpower in the system of postgraduate medical education].

PubMed

Kabanova, S A; Lozhkevich, I Iu

2010-01-01

The research was held within Petrovsky National surgery center and revealed certain regularities and trends testifying the necessity of further strategic and tactic development of training of graduated specialists through the innovative optimization of effectiveness of post-graduate training of medical personnel. The inclusion of social psychological monitoring of educational process is obligatory. The implementation of sociological monitoring in any institution providing post-graduate training has to be a powerful tool for enhancing quality and efficiency of training of medical professionals. This approach presupposes modernization of training programs accounting the innovations and research data.

Construction of a smart medication dispenser with high degree of scalability and remote manageability.

PubMed

Pak, JuGeon; Park, KeeHyun

2012-01-01

We propose a smart medication dispenser having a high degree of scalability and remote manageability. We construct the dispenser to have extensible hardware architecture for achieving scalability, and we install an agent program in it for achieving remote manageability. The dispenser operates as follows: when the real-time clock reaches the predetermined medication time and the user presses the dispense button at that time, the predetermined medication is dispensed from the medication dispensing tray (MDT). In the proposed dispenser, the medication for each patient is stored in an MDT. One smart medication dispenser contains mainly one MDT; however, the dispenser can be extended to include more MDTs in order to support multiple users using one dispenser. For remote management, the proposed dispenser transmits the medication status and the system configurations to the monitoring server. In the case of a specific event such as a shortage of medication, memory overload, software error, or non-adherence, the event is transmitted immediately. All these operations are performed automatically without the intervention of patients, through the agent program installed in the dispenser. Results of implementation and verification show that the proposed dispenser operates normally and performs the management operations from the medication monitoring server suitably.

Medical research misconduct need regulatory reforms.

PubMed

Bedi, Neeraj

2014-10-01

The medical research misconduct has become a global problem. Except from countries like the USA, China, and Germany the exact figures of misconduct are not available. The research misconduct include fabricating the data, falsifying data, and plagiarism. The irresponsible research practices are publishing research data more than once, conflicts of interest is not declared, selective reporting of data and including an author who has not contributed at all and many more. About 2% of scientists have been found to admit the fabricating the data and 33% researchers were involved in irresponsible research practices. There is no formal regulatory programs available to monitor the research projects. Few developed countries like the USA, Germany, and China tried to develop programs which can monitor the medical research misconduct. There is a need to develop a regulatory system at national and institutional level to regulate the research activity to ensure that good ethical and scientific standards are practiced by medical researchers.

Medical education and the physician workforce of Iraq.

PubMed

Al Mosawi, Aamir Jalal

2008-01-01

The lack of resources in a country experiencing decades of successive wars, blockade, administrative corruption, and poor governance led to deteriorated standards throughout medical education. Although professional certification programs exist, continuing medical education accreditation and credit systems are required to monitor and certify the continuing professional development of physicians.

A call for a statewide medication reconciliation program.

PubMed

Askin, Elizabeth; Margolius, David

2016-10-01

In the outpatient setting, it is exceedingly difficult to know what medications our patients have been prescribed and are taking. Each encounter with a specialist, hospital, or pharmacy can generate a change to a patient's list of medications, and in most systems, this information is not communicated back to the primary care practice's electronic health record-the exception being opiate prescriptions. Prescription drug monitoring programs in 48 states list every opiate prescription, the name of the prescriber, and the date and location the prescription was picked up. We propose that policy makers act to expand these programs to all medications, thus improving the likelihood that any provider prescribing a new medication would know what medicines their patient is already taking.

A performance improvement plan to increase nurse adherence to use of medication safety software.

PubMed

Gavriloff, Carrie

2012-08-01

Nurses can protect patients receiving intravenous (IV) medication by using medication safety software to program "smart" pumps to administer IV medications. After a patient safety event identified inconsistent use of medication safety software by nurses, a performance improvement team implemented the Deming Cycle performance improvement methodology. The combined use of improved direct care nurse communication, programming strategies, staff education, medication safety champions, adherence monitoring, and technology acquisition resulted in a statistically significant (p < .001) increase in nurse adherence to using medication safety software from 28% to above 85%, exceeding national benchmark adherence rates (Cohen, Cooke, Husch & Woodley, 2007; Carefusion, 2011). Copyright © 2012 Elsevier Inc. All rights reserved.

National Antimicrobial Resistance Monitoring System (NARMS) Program

USDA-ARS?s Scientific Manuscript database

The National Antimicrobial Resistance Monitoring System (NARMS) – Enteric Bacteria is a national public health surveillance system in the United States that tracks changes in the susceptibility of certain enteric bacteria to antimicrobial agents of human and veterinary medical importance. The NARMS ...

A Remote Medication Monitoring System for Chronic Heart Failure Patients to Reduce Readmissions: A Two-Arm Randomized Pilot Study.

PubMed

Hale, Timothy M; Jethwani, Kamal; Kandola, Manjinder Singh; Saldana, Fidencio; Kvedar, Joseph C

2016-04-17

Heart failure (HF) is a chronic condition affecting nearly 5.7 million Americans and is a leading cause of morbidity and mortality. With an aging population, the cost associated with managing HF is expected to more than double from US $31 billion in 2012 to US $70 billion by 2030. Readmission rates for HF patients are high-25% are readmitted at 30 days and nearly 50% at 6 months. Low medication adherence contributes to poor HF management and higher readmission rates. Remote telehealth monitoring programs aimed at improved medication management and adherence may improve HF management and reduce readmissions. The primary goal of this randomized controlled pilot study is to compare the MedSentry remote medication monitoring system versus usual care in older HF adult patients who recently completed a HF telemonitoring program. We hypothesized that remote medication monitoring would be associated with fewer unplanned hospitalizations and emergency department (ED) visits, increased medication adherence, and improved health-related quality of life (HRQoL) compared to usual care. Participants were randomized to usual care or use of the remote medication monitoring system for 90 days. Twenty-nine participants were enrolled and the final analytic sample consisted of 25 participants. Participants completed questionnaires at enrollment and closeout to gather data on medication adherence, health status, and HRQoL. Electronic medical records were reviewed for data on baseline classification of heart function and the number of unplanned hospitalizations and ED visits during the study period. Use of the medication monitoring system was associated with an 80% reduction in the risk of all-cause hospitalization and a significant decrease in the number of all-cause hospitalization length of stay in the intervention arm compared to usual care. Objective device data indicated high adherence rates (95%-99%) among intervention group participants despite finding no significant difference in self-reported adherence between study arms. The intervention group had poorer heart function and HRQoL at baseline, and HRQoL declined significantly in the intervention group compared to controls. The MedSentry medication monitoring system is a promising technology that merits continued development and evaluation. The MedSentry medication monitoring system may be useful both as a standalone system for patients with complex medication regimens or used to complement existing HF telemonitoring interventions. We found significant reductions in risk of all-cause hospitalization and the number of all-cause length of stay in the intervention group compared to controls. Although HRQoL deteriorated significantly in the intervention group, this may have been due to the poorer HF-functioning at baseline in the intervention group compared to controls. Telehealth medication adherence technologies, such as the MedSentry medication monitoring system, are a promising method to improve patient self-management,the quality of patient care, and reduce health care utilization and expenditure for patients with HF and other chronic diseases that require complex medication regimens. ClinicalTrials.gov NCT01814696; https://clinicaltrials.gov/ct2/show/study/NCT01814696 (Archived by WebCite® at http://www.webcitation.org/6giqAVhno).

The Learning Environment Counts: Longitudinal Qualitative Analysis of Study Strategies Adopted by First-Year Medical Students in a Competency-Based Educational Program.

PubMed

Bierer, S Beth; Dannefer, Elaine F

2016-11-01

The move toward competency-based education will require medical schools and postgraduate training programs to restructure learning environments to motivate trainees to take personal ownership for learning. This qualitative study explores how medical students select and implement study strategies while enrolled in a unique, nontraditional program that emphasizes reflection on performance and competence rather than relying on high-stakes examinations or grades to motivate students to learn and excel. Fourteen first-year medical students volunteered to participate in three, 45-minute interviews (42 overall) scheduled three months apart during 2013-2014. Two medical educators used structured interview guides to solicit students' previous assessment experiences, preferred learning strategies, and performance monitoring processes. Interviews were digitally recorded and transcribed verbatim. Participants confirmed accuracy of transcripts. Researchers independently read transcripts and met regularly to discuss transcripts and judge when themes achieved saturation. Medical students can adopt an assessment for learning mind-set with faculty guidance and implement appropriate study strategies for mastery-learning demands. Though students developed new strategies at different rates during the year, they all eventually identified study and performance monitoring strategies to meet learning needs. Students who had diverse learning experiences in college embraced mastery-based study strategies sooner than peers after recognizing that the learning environment did not reward performance-based strategies. Medical students can take ownership for their learning and implement specific strategies to regulate behavior when learning environments contain building blocks emphasized in self-determination theory. Findings should generalize to educational programs seeking strategies to design learning environments that promote self-regulated learning.

Survey of Injuries and Injury Risk Factors in the 2nd Brigade Combat Team, 3rd Infantry Division, November 2014 - January 2015

DTIC Science & Technology

2017-07-10

physical training programs, health behaviors, and perceptions of leadership and medical support related to injury. Survey responses were received...illness, and health behavior data is recommended for monitoring of physical training program effects and collection of data necessary to inform future...calculated for demographics, personal characteristics, physical fitness and occupational demands, leadership and medical support, health behaviors

South Carolina Cancer Health Equity Consortium: HBCU Student Summer Training Program

DTIC Science & Technology

2017-08-01

TYPE OF REPORT: Annual PREPARED FOR: U.S. Army Medical Research and Materiel Command Fort Detrick, Maryland 21702-5012 DISTRIBUTION STATEMENT...SPONSORING / MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSOR/MONITOR’S ACRONYM(S) U.S. Army Medical Research and Materiel Command Fort Detrick...Carolina. The goal of the South Carolina Cancer Health Equity Consortium: HBCU Student Summer Training Program is to provide a biomedical research

Quality assurance for respiratory care services: a computer-assisted program.

PubMed

Elliott, C G

1993-01-01

At present, the principal advantage of computer-assisted quality assurance is the acquisition of quality assurance date without resource-consuming chart reviews. A surveillance program like the medical director's alert may reduce morbidity and mortality. Previous research suggests that inadequate oxygen therapy or failures in airway management are important causes of preventable deaths in hospitals. Furthermore, preventable deaths tend to occur among patients who have lower severity-of-illness scores and who are not in ICUs. Thus, surveillance of the entire hospital, as performed by the HIS medical director's alert, may significantly impact hospital mortality related to respiratory care. Future research should critically examine the potential of such computerized systems to favorably change the morbidity and mortality of hospitalized patients. The departments of respiratory care and medical informatics at LDS Hospital have developed a computer-assisted approach to quality assurance monitoring of respiratory care services. This system provides frequent and consistent samples of a variety of respiratory care data. The immediate needs of patients are addressed through a daily surveillance system (medical director's alert). The departmental quality assurance program utilizes a separate program that monitors clinical indicators of staff performance in terms of stated departmental policies and procedures (rate-based clinical indicators). The availability of an integrated patient database allows these functions to be performed without labor-intensive chart audits.

ASTRONAUT CONRAD, CHARLES (PETE), JR. - X-RAYS - MEDICAL TEAM MEMBERS - CAPE

NASA Image and Video Library

1965-08-17

S65-28699 (17 Aug. 1965) --- Astronaut Charles Conrad Jr. (dark shirt), pilot for the Gemini-5 spaceflight, discusses x-rays with members of the medical team at Cape Kennedy. Left to right are Dr. Eugene Tubbs; astronaut Conrad; Dr. Charles A. Berry, chief, Center Medical Programs, Manned Spacecraft Center; and Dr. Robert Moser (seated), Medical Monitor with the U.S. Army.

Preclinical Evaluation of a Decision Support Medical Monitoring System for Early Detection of Potential Hemodynamic Decompensation During Blood Loss in Humans

DTIC Science & Technology

2013-09-01

Hemodynamic Decompensation During Blood Loss in Humans PRINCIPAL INVESTIGATOR: Michael J. Joyner, M.D. CONTRACTING ORGANIZATION: Mayo Clinic...Medical Monitoring System for Early Detection of Potential Hemodynamic Decompensation During Blood Loss in Humans 5c. PROGRAM ELEMENT NUMBER 6...loss and hemorrhage in humans. The aim Is to be able to detect subtle changes in hemodynamic variables that provide prodromal clues to Impending

TBI Endpoints Development

DTIC Science & Technology

2015-10-01

Medical Research and Materiel Command Fort Detrick, Maryland 21702-5012 DISTRIBUTION STATEMENT: Approved for Public Release; Distribution Unlimited The...SPONSORING / MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSOR/MONITOR’S ACRONYM(S) U.S. Army Medical Resear ch and Materiel Command Fort Detrick...DDT) and Medical Device Development Tool (MDDT) programs with case study presentations and question and answer opportunities. Expert Working Groups

Development and Application of Direct Data Capture for Monitoring Medication Compliance in Clinical Trials.

PubMed

Kim, Eun-Young

2017-10-01

The monitoring of medication compliance in clinical trials is important but labor intensive. To check medication compliance in clinical trials, a system was developed, and its technical feasibility evaluated. The system consisted of three parts: a management part (clinical trial center database and a developed program), clinical trial investigator part (monitoring), and clinical trial participant part (personal digital assistant [PDA] with a barcode scanner). The system was tested with 20 participants for 2 weeks, and compliance was evaluated. This study developed a medication compliance monitoring system that used a PDA with a barcode scanner, which sent reminder/warning messages, logged medication barcode data, and provided compliance information to investigators. Registered participants received short message service (SMS) reminder/warning messages on their PDA and sent barcode data at the dosing time. The age range of the participants was 29 to 73 years. Five participants were <50 years old and 8 were ≥65 years old. The total mean compliance rate was 82.3%. The mean compliance rate was 83.1% in participants <65 years old and 81.1% in those ≥65 years old. The system was feasible, usable, and effective, even with elderly participants, for monitoring medication compliance in clinical trials using a PDA with a barcode scanner, and may improve the quality of clinical trials.

Meeting the Needs for Radiation Protection: Diagnostic Imaging.

PubMed

Frush, Donald P

2017-02-01

Radiation and potential risk during medical imaging is one of the foremost issues for the imaging community. Because of this, there are growing demands for accountability, including appropriate use of ionizing radiation in diagnostic and image-guided procedures. Factors contributing to this include increasing use of medical imaging; increased scrutiny (from awareness to alarm) by patients/caregivers and the public over radiation risk; and mounting calls for accountability from regulatory, accrediting, healthcare coverage (e.g., Centers for Medicare and Medicaid Services), and advisory agencies and organizations as well as industry (e.g., NEMA XR-29, Standard Attributes on CT Equipment Related to Dose Optimization and Management). Current challenges include debates over uncertainty with risks with low-level radiation; lack of fully developed and targeted products for diagnostic imaging and radiation dose monitoring; lack of resources for and clarity surrounding dose monitoring programs; inconsistencies across and between practices for design, implementation and audit of dose monitoring programs; lack of interdisciplinary programs for radiation protection of patients; potential shortages in personnel for these and other consensus efforts; and training concerns as well as inconsistencies for competencies throughout medical providers' careers for radiation protection of patients. Medical care providers are currently in a purgatory between quality- and value-based imaging paradigms, a state that has yet to mature to reward this move to quality-based performance. There are also deficits in radiation expertise personnel in medicine. For example, health physics academic programs and graduates have recently declined, and medical physics residency openings are currently at a third of the number of graduates. However, leveraging solutions to the medical needs will require money and resources, beyond personnel alone. Energy and capital will need to be directed to:• innovative and cooperative cross-disciplinary institutional/practice oversight of and guidance for the use of diagnostic imaging (e.g., radiology, surgical specialties, cardiologists, and intensivists);• initiatives providing practical benchmarks (e.g., dose index registries);• comprehensive (consisting of access, integrity, metrology, analytics, informatics) and effective and efficient dose monitoring programs;• collaboration with industry;• improved use of imaging, such as through decision support combined with evidence-based appropriateness for imaging use;• integration with e-health such as medical records;• education, including information extending beyond the medical imaging community that is relevant to patients, public, and providers and administration;• identification of opportunities for alignment with salient media and advocacy organizations to deliver balanced information regarding medical radiation and risk;• open lines of communication between medical radiation experts and appropriate bodies such as the U.S. Environmental Protection Agency, the U.S. Food and Drug Administration, and the Joint Commission to assure appropriate guidance on documents and actions originating from these organizations; and• increased grant funding to foster translational work that advances understanding of low-level radiation and biological effects.

Medication-use evaluation with a Web application.

PubMed

Burk, Muriel; Moore, Von; Glassman, Peter; Good, Chester B; Emmendorfer, Thomas; Leadholm, Thomas C; Cunningham, Francesca

2013-12-15

A Web-based application for coordinating medication-use evaluation (MUE) initiatives within the Veterans Affairs (VA) health care system is described. The MUE Tracker (MUET) software program was created to improve VA's ability to conduct national medication-related interventions throughout its network of 147 medical centers. MUET initiatives are centrally coordinated by the VA Center for Medication Safety (VAMedSAFE), which monitors the agency's integrated databases for indications of suboptimal prescribing or drug therapy monitoring and adverse treatment outcomes. When a pharmacovigilance signal is detected, VAMedSAFE identifies "trigger groups" of at-risk veterans and uploads patient lists to the secure MUET application, where locally designated personnel (typically pharmacists) can access and use the data to target risk-reduction efforts. Local data on patient-specific interventions are stored in a centralized database and regularly updated to enable tracking and reporting for surveillance and quality-improvement purposes; aggregated data can be further analyzed for provider education and benchmarking. In a three-year pilot project, the MUET program was found effective in promoting improved prescribing of erythropoiesis-stimulating agents (ESAs) and enhanced laboratory monitoring of ESA-treated patients in all specified trigger groups. The MUET initiative has since been expanded to target other high-risk drugs, and efforts are underway to refine the tool for broader utility. The MUET application has enabled the increased standardization of medication safety initiatives across the VA system and may serve as a useful model for the development of pharmacovigilance tools by other large integrated health care systems.

40 CFR 62.14453 - What must I monitor?

Code of Federal Regulations, 2011 CFR

2011-07-01

... 40 Protection of Environment 8 2011-07-01 2011-07-01 false What must I monitor? 62.14453 Section 62.14453 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) APPROVAL AND PROMULGATION OF STATE PLANS FOR DESIGNATED FACILITIES AND POLLUTANTS Federal Plan Requirements for Hospital/Medical/Infectious Waste...

Analysis of inflight sleep, experiment M008

NASA Technical Reports Server (NTRS)

Kellaway, P.

1971-01-01

The feasibility of recording the electroencephalogram during space flight is demonstrated. The precise information that is collected with the electroencephalograph regarding the duration, depth, and number of sleep periods implies that electroencephalogram monitoring should be considered for routine use in the long-duration space flights that are contemplated for the Apollo Program and other programs. The importance of such information in the direction and execution of the flight, both to the medical monitors and to the crewmembers, is obvious.

Effectiveness of the 3D Monitor System for Medical Education During Neurosurgical Operation.

PubMed

Wanibuchi, Masahiko; Komatsu, Katsuya; Akiyama, Yukinori; Mikami, Takeshi; Mikuni, Nobuhiro

2018-01-01

Three-dimensional (3D) graphics are used in the medical field, especially during surgery. Although 3D monitoring is useful for medical education, its effectiveness needs to be objectively evaluated. The aim of this study was to investigate the efficacy of 3D monitoring in the surgical education of medical students. A questionnaire on high-definition 3D monitoring was given to fifth-year medical students in a 6-year program. Sixty-four students wore polarized glasses and observed a microsurgical operation through a 3D monitor. The questionnaire contained questions on stereopsis, neurosurgical interest, visual impact, comprehension of surgical anatomy and procedures, optical sharpness, active learning enhancement, and eye exhaustion. These parameters were evaluated on a 5-point scale that spanned negative and positive scores. The average score of each parameter ranged from 3.13 to 3.78, except for eye exhaustion, which was 0.88. The items for which the students reported positive perceptions (scores of 4 or 5) were stereopsis (67.2% of students), neurosurgical interest (62.5%), visual impact and optical sharpness (60.9% for both), active learning enhancement (57.8%), and comprehension of surgical anatomy (50.0%) and procedures (42.2%). By contrast, only eye exhaustion was evaluated negatively (26.6%). The use of 3D monitoring systems in medical education offers the advantage of stereopsis and contributes to surgical training. However, improvements are required to decrease eye exhaustion. Copyright © 2017 Elsevier Inc. All rights reserved.

Chaplain Documentation and the Electronic Medical Record: A Survey of ACPE Residency Programs.

PubMed

Tartaglia, Alexander; Dodd-McCue, Diane; Ford, Timothy; Demm, Charles; Hassell, Alma

2016-01-01

This study explores the extent to which chaplaincy departments at ACPE-accredited residency programs make use of the electronic medical record (EMR) for documentation and training. Survey data solicited from 219 programs with a 45% response rate and interview findings from 11 centers demonstrate a high level of usage of the EMR as well as an expectation that CPE residents document each patient/family encounter. Centers provided considerable initial training, but less ongoing monitoring of chaplain documentation. Centers used multiple sources to develop documentation tools for the EMR. One center was verified as having created the spiritual assessment component of the documentation tool from a peer reviewed published model. Interviews found intermittent use of the student chart notes for educational purposes. One center verified a structured manner of monitoring chart notes as a performance improvement activity. Findings suggested potential for the development of a standard documentation tool for chaplain charting and training.

Clinician impression versus prescription drug monitoring program criteria in the assessment of drug-seeking behavior in the emergency department.

PubMed

Weiner, Scott G; Griggs, Christopher A; Mitchell, Patricia M; Langlois, Breanne K; Friedman, Franklin D; Moore, Rebecca L; Lin, Shuo Cheng; Nelson, Kerrie P; Feldman, James A

2013-10-01

We compare emergency provider impression of drug-seeking behavior with objective criteria from a state prescription drug monitoring program, assess change in opioid pain reliever prescribing after prescription drug monitoring program review, and examine clinical factors associated with suspected drug-seeking behavior. This was a prospective observational study of emergency providers assessing a convenience sample of patients aged 18 to 64 years who presented to either of 2 academic medical centers with chief complaint of back pain, dental pain, or headache. Drug-seeking behavior was objectively defined as present when a patient had greater than or equal to 4 opioid prescriptions by greater than or equal to 4 providers in the 12 months before emergency department evaluation. Emergency providers completed data forms recording their impression of the likelihood of drug-seeking behavior, patient characteristics, and plan for prescribing pre- and post-prescription drug monitoring program review. Descriptive statistics were generated. We calculated agreement between emergency provider impression of drug-seeking behavior and prescription drug monitoring program definition, and sensitivity, specificity, and positive predictive value of emergency provider impression, using prescription drug monitoring program criteria as the criterion standard. A multivariate logistic regression analysis was conducted to determine clinical factors associated with drug-seeking behavior. Thirty-eight emergency providers with prescription drug monitoring program access participated. There were 544 patient visits entered into the study from June 2011 to January 2013. There was fair agreement between emergency provider impression of drug-seeking behavior and prescription drug monitoring program (κ=0.30). Emergency providers had sensitivity 63.2% (95% confidence interval [CI] 54.8% to 71.7%), specificity 72.7% (95% CI 68.4% to 77.0%), and positive predictive value 41.2% (95% CI 34.4% to 48.2%) for identifying drug-seeking behavior. After exposure to prescription drug monitoring program data, emergency providers changed plans to prescribe opioids at discharge in 9.5% of cases (95% CI 7.3% to 12.2%), with 6.5% of patients (n=35) receiving opioids not previously planned and 3.0% (n=16) no longer receiving opioids. Predictors for drug-seeking behavior by prescription drug monitoring program criteria were patient requests opioid medications by name (odds ratio [OR] 1.91; 95% CI 1.13 to 3.23), multiple visits for same complaint (OR 2.5; 95% CI 1.49 to 4.18), suspicious history (OR 1.88; 95% CI 1.1 to 3.19), symptoms out of proportion to examination (OR 1.83; 95% CI 1.1 to 3.03), and hospital site (OR 3.1; 95% CI 1.76 to 5.44). Emergency providers had fair agreement with objective criteria from the prescription drug monitoring program in suspecting drug-seeking behavior. Program review changed management plans in a small number of cases. Multiple clinical factors were predictive of drug-seeking behavior. Copyright © 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

Workers Compensation Cost Containment

DTIC Science & Technology

1995-12-01

16 Return to Work Program Q1. Q2. Q3. Does your company have a modified work (light duty) program for industrial injured workers ? Yes - 14 No - 2...your Medical Department monitor the outside medical treatment of industrial injuries? Yes - 13 companies No - 3 companies On average how long does your...site - 6 On site - 10 b. Do you have a legal counsel on the claim staff to compensation claims? Yes - 4 No - 12 litigate workers ’ NSRB.SRB PAGE 18 DATE

Developing Memory Reconsolidation Blockers as Novel PTSD Treatments

DTIC Science & Technology

2011-06-01

REPORT DATE: June 20 TYPE OF REPORT: Annual PREPARED FOR: U.S. Army Medical Research and Materiel...MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSOR/MONITOR’S ACRONYM(S) U.S. Army Medical Research and Materiel Command Fort Detrick, Maryland...Diabetes Program.10 Given our duty as health care pro- viders to reduce the risk of our treat- ments (ie, psychiatric medications ) to our patients, we

Kennedy Space Center exercise program

NASA Technical Reports Server (NTRS)

Hoffman, Cristy

1993-01-01

The Kennedy Space Center (KSC) Fitness Program began in Feb. 1993. The program is managed by the Biomedical Operations and Research Office and operated by the Bionetics Corporation. The facilities and programs are offered to civil servants, all contractors, temporary duty assignment (TDY) participants, and retirees. All users must first have a medical clearance. A computer-generated check-in system is used to monitor participant usage. Various aspects of the program are discussed.

Achieving blood pressure control among renal transplant recipients by integrating electronic health technology and clinical pharmacy services.

PubMed

Migliozzi, Daniel R; Zullo, Andrew R; Collins, Christine; Elsaid, Khaled A

2015-11-15

The implementation and outcomes of a program combining electronic home blood pressure monitoring (HBPM) and pharmacist-provided medication therapy management (MTM) services in a renal transplantation clinic are described. Patients enrolled in the program were provided with a computer-enabled blood pressure monitor. A dedicated renal transplantation pharmacist was integrated into the renal transplantation team under a collaborative care practice agreement. The collaborative care agreement allowed the pharmacist to authorize medication additions, deletions, and dosage changes. Comprehensive disease and blood pressure education was provided by a clinical pharmacist. In the pretransplantation setting, the pharmacist interviewed the renal transplant candidate and documents allergies, verified the patient's medication profile, and identified and assessed barriers to medication adherence. A total of 50 renal transplant recipients with at least one recorded home blood pressure reading and at least one year of follow-up were included in our analysis. A significant reduction in mean systolic and diastolic blood pressure values were observed at 30, 90, 180, and 360 days after enrollment in the program (p < 0.05). Pharmacist interventions were documented for 37 patients. Medication-related problems accounted for 46% of these interventions and included dosage modifications, regimen changes, and mitigation of barriers to medication access and adherence. Implementation of electronic HBPM and pharmacist-provided MTM services implemented in a renal transplant clinic was associated with sustained improvements in blood pressure control. Incorporation of a pharmacist in the renal transplant clinic resulted in the detection and resolution of medication-related problems. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Evaluation of a Non-Invasive Alternative Glucose Monitor System in Patients with Diabetes Mellitus

DTIC Science & Technology

2008-01-07

Diabetes Mellitus New Protocol Title: Evaluation of a Non-Invasive Alternative Glucose Monitor System in Patients with Diabetes Mellitus PRINCIPAL...Invasive Alternative Glucose Monitor System in Patients with Diabetes Mellitus 5b. GRANT NUMBER Coop Agreement # 05216002 5c. PROGRAM ELEMENT NUMBER...Flexible Medical Systems was approved by the Department of Clinical Investigation at WRAMC in January 2008. FY08 AAMTI funding will support the

Safeguarding the Health of the NASA Astronaut Community: the Need for Expanded Medical Monitoring for Former NASA Astronauts Under the Astronaut Occupational Health Program

NASA Technical Reports Server (NTRS)

Rossi, Meredith; Lee, Lesley; Wear, Mary; Van Baalen, Mary; Rhodes, Bradley

2016-01-01

The astronaut community is unique, and may be disproportionately exposed to occupational hazards not commonly seen in other communities. The extent to which the demands of the astronaut occupation and exposure to spaceflight-related hazards affect the health of the astronaut population over the life course is not completely known. Provision of health screening services to active and former astronauts ensures individual, mission, and community health and safety. Currently, the NASA Johnson Space Center (JSC) Flight Medicine Clinic (FMC) provides extensive medical monitoring to active astronauts throughout their careers. Upon retirement, astronauts may voluntarily return to the JSC FMC for an annual preventive exam. However, current retiree monitoring includes only selected screening tests, representing an opportunity for augmentation. The potential latent health effects of spaceflight demand an expanded framework of testing for former astronauts. The need is two-fold: screening tests widely recommended for other aging communities are necessary for astronauts to rule out conditions resulting from the natural aging process (e.g., colonoscopy, mammography), as opposed to conditions resulting directly from the astronaut occupation; and increased breadth of monitoring services will improve the understanding of occupational health risks and longitudinal health of the astronaut community, past, present, and future. To meet this need, NASA has begun an extensive exploration of the overall approach, cost, and policy implications of expanding existing medical monitoring under the Astronaut Occupational Health program for former NASA astronauts.

42 CFR 460.200 - Maintenance of records and reporting of data.

Code of Federal Regulations, 2010 CFR

2010-10-01

... agency require to monitor the operation, cost, quality, and effectiveness of the program and establish... Federal and State laws regarding confidentiality and disclosure for mental health records, medical records... audit arising from the operation of the PACE program is started before the expiration of the retention...

Helmet Integrated Nanosensors, Signal Processing and Wireless Real Time Data Communication for Monitoring Blast Exposure to Battlefield Personnel

DTIC Science & Technology

2009-12-01

of the Congressionally Directed Medical Research Programs (CDMRP) # PT073804 II. BACKGROUND Unlike the painfully obvious losses seen in Alzheimer ...Medical Research and Materiel Command Fort Detrick, Maryland 21702-5012 DISTRIBUTION STATEMENT: Approved for...AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSOR/MONITOR’S ACRONYM(S) U.S. Army Medical Research and Materiel Command Fort Detrick, Maryland 21702

The efficacy of using self-monitoring diaries in a weight loss program for chronically ill obese adults in a rural area.

PubMed

Wang, Chi-Jane; Fetzer, Susan J; Yang, Yi-Ching; Wang, Wen-Ling

2012-09-01

Self-monitoring is part of many weight-loss programs and is widely accepted as effective. However, there is a lack of research related to the efficacy of various self-monitoring instruments in meeting the needs of individuals with limited mobility or access to healthcare providers, especially those with limited education living in rural settings. This study examined the efficacy of using self-monitoring diaries in a weight loss program targeting chronically ill and obese rural-dwelling adults. A community-based intervention program using a pretest and posttest design examined the effect of using self-monitoring diaries on weight loss. Fifty participants were enrolled from the chronic disease clinic of a district health center with limited medical resources in a remote village in southwestern Taiwan. All participants were diagnosed with diabetes and/or hypertension, had body mass indices between 27 and 32 kg/m, and had a minimum educational level of junior high school. Mean participant age was 43.7 years. Participants were randomly assigned to the intervention or control group. All attended a mandatory 12-week weight loss program. The intervention group received instructions on how to record diet and exercise details in a structured, graphics-based diary provided by the researchers. Body weight and percentage of body fat were measured before and after the program, and data were analyzed by chi-square and ANCOVA. The intervention group significantly lost more weight than the control group (5.7 kg vs. 2.1 kg; p < .05). The participants of 88% in the intervention group lost 5% or more of their baseline weight greater than the 23% in the control group. Both groups achieved the mean of body fat reductions by comparing pretest and posttest. Self-monitoring diaries can have a significant impact on weight loss in individuals living in rural communities. Healthcare providers and health promotion agencies can use the suggested checklist method to improve weight loss promotion programs in isolated rural communities with limited medical resources.

Quality management of Body Donation Program at the University of Padova.

PubMed

Porzionato, Andrea; Macchi, Veronica; Stecco, Carla; Mazzi, Anna; Rambaldo, Anna; Sarasin, Gloria; Parenti, Anna; Scipioni, Antonio; De Caro, Raffaele

2012-01-01

Quality management improvement has become a recent focus of attention in medical education. The program for the donation of bodies and body parts (Body Donation Program) at the University of Padova has recently been subjected to a global quality management standard, the ISO 9001:2008 certification. The aim of the present work is to show how the above standard is useful in enhancing the efficiency of body donation procedures and the quality and output of medical education. The program is managed by means of the following interlinked procedures: the collection of body donations, death certificates, data, and body parts from living donors; the transportation and identification of cadavers; the management of bodies, body parts, equipment, instruments, purchasing of necessary materials, and setting up anatomical training sessions; the management of preventive and corrective actions; the management of documents and registration; the management of internal and external quality audits; and the review of outcomes and improvement planning. Monitoring indicators are identified in the numbers of donors and of donated body parts per year, education sessions, and satisfaction of learners and donors, as evaluated by questionnaires. The process management approach, the integrated involvement of medical, technical, and administrative staff in defining procedures, and the application of monitoring indicators allow quality improvement in all aspects of the Body Donation Program. Copyright © 2012 American Association of Anatomists.

Assessment of medical occupational radiation doses in Costa Rica.

PubMed

Mora, P; Acuña, M

2011-09-01

Participation of the University of Costa Rica (UCR) in activities in an IAEA Regional Project RLA/9/066 through training, equipment and expert missions, has enabled to setting up of a national personal monitoring laboratory. Since 2007, the UCR has been in charge of monitoring around 1800 medical radiation workers of the Social Security System. Individual external doses are measured with thermoluminescent dosemeter using a Harshaw 6600 Plus reader. The service has accreditation with ISO/IEC 17025:2005. Distribution of monitored medical personnel is as follows: 83 % in diagnostic radiology, 6 % in nuclear medicine and 6 % in radiotherapy. Preliminary values for the 75 percentile of annual H(p)(10) in mSv are: radiology 0.37; interventional radiology 0.41; radiotherapy 0.53 and nuclear medicine 1.55. The service provided by the UCR in a steady and reliable way can help to implement actions to limit the doses received by the medical workers and optimise their radiation protection programs.

Adverse drug events and medication problems in "Hospital at Home" patients.

PubMed

Mann, Elizabeth; Zepeda, Orlando; Soones, Tacara; Federman, Alex; Leff, Bruce; Siu, Albert; Boockvar, Kenneth

2018-03-26

"Hospital at Home(HaH)" programs provide an alternative to traditional hospitalization. However, the incidence of adverse drug events in these programs is unknown. This study describes adverse drug events and potential adverse drug events in a new HaH program. We examined the charts of the first 50 patients admitted. We found 45 potential adverse drug events and 14 adverse drug events from admission to 30 days after HaH discharge. None of the adverse drug events were severe. Some events, like problems with medication administration, may be unique to the hospital at home setting. Monitoring for adverse drug events is feasible and important for hospital at home programs.

Biomedical Results of Apollo

NASA Technical Reports Server (NTRS)

Johnston, R. S. (Editor); Dietlein, L. F. (Editor); Berry, C. A. (Editor); Parker, James F. (Compiler); West, Vita (Compiler)

1975-01-01

The biomedical program developed for Apollo is described in detail. The findings are listed of those investigations which are conducted to assess the effects of space flight on man's physiological and functional capacities, and significant medical events in Apollo are documented. Topics discussed include crew health and inflight monitoring, preflight and postflight medical testing, inflight experiments, quarantine, and life support systems.

Is the public being protected? Prevention of suboptimal medical practice through training programs and credentialing examinations.

PubMed

Tamblyn, R

1994-06-01

Governments have traditionally looked to the medical profession for leadership in health planning and have charged the profession with the responsibility of establishing and monitoring standards of medical practice. Training program accreditation and licensure/certification exams have been used as the primary methods of preventing unqualified individuals from entering medical practice. Despite the critical nature of the decision made at the time of licensure/certification, there is no information about the validity of these examinations for predicting subsequent practice and health outcome. In this article, the assumptions implicit in the current use of licensing/certifying examinations are identified, the relevant evidence is reviewed, and the implications of this evidence for current methods of measurement are discussed.

Scaffold Attachment Factor B1: A Novel Chromatin Regulator of Prostate Cancer Metabolism

DTIC Science & Technology

2016-10-01

INVESTIGATOR: SUNGYONG YOU PhD CONTRACTING ORGANIZATION: Cedars-Sinai Medical Center Los Angeles, CA 90048 REPORT DATE: October 2016 TYPE OF REPORT...NUMBER CEDARS-SINAI MEDICAL CENTER 8700 BEVERLY BLVD LOS ANGELES CA 90048-1804 9. SPONSORING / MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSOR...Bioinformatics. The Urologic Oncology Program, held in Cedars- Sinai Medical Center, Los Angeles, California, March 10, 2015. Oral Presentation: 1. You S

Evaluation of an mHealth Medication Regimen Self-Management Program for African American and Hispanic Uncontrolled Hypertensives.

PubMed

Davidson, Tatiana M; McGillicuddy, John; Mueller, Martina; Brunner-Jackson, Brenda; Favella, April; Anderson, Ashley; Torres, Magaly; Ruggiero, Kenneth J; Treiber, Frank A

2015-11-17

African Americans and Hispanics have disproportionate rates of uncontrolled essential hypertension (EH) compared to Non-Hispanic Whites. Medication non-adherence (MNA) is the leading modifiable behavior to improved blood pressure (BP) control. The Smartphone Medication Adherence Stops Hypertension (SMASH) program was developed using a patient-centered, theory-guided, iterative design process. Electronic medication trays provided reminder signals, and Short Message Service [SMS] messaging reminded subjects to monitor BP with Bluetooth-enabled monitors. Motivational and reinforcement text messages were sent to participants based upon levels of adherence. Thirty-eight African-American (18) and Hispanic (20) uncontrolled hypertensives completed clinic-based anthropometric and resting BP evaluations prior to randomization, and again at months 1, 3 and 6. Generalized linear mixed modeling (GLMM) revealed statistically significant time-by-treatment interactions (p < 0.0001) indicating significant reductions in resting systolic blood pressure (SBP) and diastolic blood pressure (DBP) for the SMASH group vs. the standard care (SC) control group across all time points. 70.6% of SMASH subjects vs. 15.8% of the SC group reached BP control (< 140/90 mmH) at month 1 (p < 0.001). At month 6, 94.4% of the SMASH vs. 41.2% of the SC group exhibited controlled BP (p < 0.003). Our findings provide encouraging evidence that efficacious mHealth, chronic disease, medical regimen, self-management programs can be developed following principles of patient-centered, theory-guided design.

The role of providers in implementation of the National Kidney Foundation-Dialysis Outcomes Quality Initiative: Fresenius Medical Care North America perspective.

PubMed

Lazarus, J M; Wick, G; Borella, L

1999-01-01

This is a brief review of the history of utilization of quality indicators by a major dialysis provider and how those indicators have been modified in response to the National Kidney Foundation-Dialysis Outcomes Quality Initiative (NKF-DOQI). Fresenius Medical Care North America (FMCNA) has monitored adequacy of dialysis, anemia management, and nutrition therapy for a number of years, using a self-directed continuous quality improvement program. FMCNA supports the NKF-DOQI Guidelines and has used the DOQI as it continues to enhance its patient quality care program. Specific goals and action thresholds of that program are delineated.

Integration of remote blood glucose meter upload technology into a clinical pharmacist medication therapy management service.

PubMed

Schenk, Robert J; Schenk, Jenna

2011-01-01

A pharmacist-delivered, outpatient-focused medication therapy management (MTM) program is using a remote blood glucose (BG) meter upload device to provide better care and to improve outcomes for its patients with diabetes. Sharing uploaded BG meter data, presented in easily comprehensible graphs and charts, enables patients, caregivers, and the medical team to better understand how the patients' diabetes care is progressing. Pharmacists are becoming increasingly more active in helping to manage patients' complex medication regimens in an effort to help detect and avoid medication-related problems. Working together with patients and their physicians as part of an interdisciplinary health care team, pharmacists are helping to improve medication outcomes. This article focuses on two case studies highlighting the Diabetes Monitoring Program, one component of the Meridian Pharmacology Institute MTM service, and discusses the clinical application of a unique BG meter upload device. © 2010 Diabetes Technology Society.

Study of Development for RFID System to Hospital Environment.

PubMed

Hong, Seung Kwon; Sung, Myung-Whun

2015-01-01

RFID/USN develops information systems for anytime, anywhere to anybody access Electronic Medical Records (EMR). The goal of the present study is to develop a RFID/USN-based information system for the hospital environment. First, unable to recognize, second, able to recognize as a pursuit of place and suppose the time of medical examination. A retrospective analysis of 235 RFID monitoring results, from four ENT ambulatory clinics of Seoul National University Hospital were extracted by a reader program and monitoring of RFID tag (2006.11.16~2006.12.16). RFID detection for sensing reader of this study has been put into representing "place" and "spending time" of patients for medical history taking and examination. Through the RFID of detection for specific place and spending time of medical examination, RFID/USN develops information system progressing in the EMR of hospital system.

Fusion Genes Predict Prostate Cancer Recurrence

DTIC Science & Technology

2017-10-01

we will develop a training program centered on genomics and cell culturing methods to train new investigators to carry out research in benign urologic...Medical Research and Materiel Command Fort Detrick, Maryland 21702-5012 DISTRIBUTION STATEMENT: Approved for Public Release; Distribution...MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSOR/MONITOR’S ACRONYM(S) U.S. Army Medical Research and Materiel Command Fort Detrick, Maryland

[Regulatory Program for Medical Devices in Cuba: experiences and current challenges].

PubMed

Pereira, Dulce María Martínez; Rodríguez, Yadira Álvarez; Valdés, Yamila Cedeño; Ribas, Silvia Delgado

2016-05-01

Regulatory control of medical devices in Cuba is conducted through a system based on the Regulatory Program for Medical Devices as a way to ensure the safety, efficacy, and effectiveness of these technologies, which are in use by the National Health System. This program was launched in 1992, when the Regulations for State Evaluation and Registration of Medical Devices were approved. Its successive stages and the merging of regulatory activities for drugs and medical equipment have meant progress toward stronger, more transparent strategies and greater control of industry and the National Health System. Throughout its course the Cuban program has met with challenges and difficulties that it has addressed by drawing on its own experiences. During the new period, the greatest challenges revolve around ensuring that regulatory systems incorporate scientific evaluation, risk levels, maximum rigor through the use of technical standards, and the implementation of international recommendations, together with the application of the ISO 13485 certification scheme, enhanced market monitoring, and classification of medical devices in accordance with their relevance to the country's national health policies. From the regional standpoint, the greatest challenge lies in working toward regulatory convergence. The Collaborating Centre for the Regulation of Health Technologies will support the proposed regulatory strategy and established regional priorities, in particular in connection with the implementation of actions involving medical devices.

The dilemma and reality of transplant tourism: an ethical perspective for liver transplant programs.

PubMed

Schiano, Thomas D; Rhodes, Rosamond

2010-02-01

Transplant programs are likely to encounter increasing numbers of patients who return after receiving an organ transplant abroad. These patients will require ongoing medical care to monitor their immunosuppression and to provide treatment when the need arises. Transplant societies have condemned transplantation with organs purchased abroad and with organs procured from executed prisoners in China. Nevertheless, transplant programs require guidance on how to respond to the needs of returning transplant tourists and to the needs of patients who may choose to become transplant tourists. This discussion presents a case that raised such issues in our program. It goes on to offer reasons for considering a program's responses in terms of the most relevant principles of medical ethics, namely beneficence and nonjudgmental regard.

Cost-benefit and cost-savings analyses of antiarrhythmic medication monitoring.

PubMed

Snider, Melissa; Carnes, Cynthia; Grover, Janel; Davis, Rich; Kalbfleisch, Steven

2012-09-15

The economic impact of pharmacist-managed antiarrhythmic drug therapy monitoring on an academic medical center's electrophysiology (EP) program was investigated. Data were collected for the initial two years of patient visits (n = 816) to a pharmacist-run clinic for antiarrhythmic drug therapy monitoring. A retrospective cost analysis was conducted to assess the direct costs associated with three appointment models: (1) a clinic office visit only, (2) a clinic visit involving electrocardiography and basic laboratory tests, and (3) a clinic visit including pulmonary function testing and chest x-rays in addition to electrocardiography and laboratory testing. A subset of patient cases (n = 18) were included in a crossover analysis comparing pharmacist clinic care and usual care in an EP physician clinic. The primary endpoints were the cost benefits and cost savings associated with pharmacy-clinic care versus usual care. A secondary endpoint was improvement of overall EP program efficiency. The payer mix was 61.6% (n = 498) Medicare, 33.2% (n = 268) managed care, and 5.2% (n = 42) other. Positive contribution margins were demonstrated for all appointment models. The pharmacist-managed clinic also yielded cost savings by reducing overall patient care charges by 21% relative to usual care. By the second year, the pharmacy clinic improved EP program efficiency by scheduling an average of 24 patients per week, in effect freeing up one day per week of EP physician time to spend on other clinical activities. Pharmacist monitoring of antiarrhythmic drug therapy in an out-patient clinic provided cost benefits, cost savings, and improved overall EP program efficiency.

Medical Care Provided Under California's Workers' Compensation Program: Effects of the Reforms and Additional Opportunities to Improve the Quality and Efficiency of Care.

PubMed

Wynn, Barbara O; Timbie, Justin W; Sorbero, Melony E

2011-01-01

Since 2004, significant changes have been made to the California workers' compensation (WC) system. The Commission on Health and Safety and Workers' Compensation (CHSWC) asked the RAND Corporation to examine the impact that these changes have on the medical care provided to injured workers. This study synthesizes findings from interviews and available information regarding the implementation of the changes affecting WC medical care and identifies areas in which additional changes might increase the quality and efficiency of care delivered under the WC system. To improve incentives for efficiently providing medically appropriate care, California should revise its fee schedule allowances for services provided by hospitals to inpatients, freestanding ambulatory surgery centers, and physicians, create nonmonetary incentives for providing medically appropriate care in the medical provider network (MPN) context through more-selective contracting with providers and reducing medical review requirements for high-performing physicians; reduce incentives for inappropriate prescribing practices by curtailing in-office physician dispensing; and implement pharmacy benefit network regulations. To increase accountability for performance, California should revise the MPN certification process to place accountability for meeting MPN standards on the entity contracting with the physician network; strengthen Division of Workers' Compensation (DWC) authorities to provide intermediate sanctions for failure to comply with MPN requirements; and modify the Labor Code to remove payers and MPNs from the definition of individually identifiable data so that performance on key measures can be publicly available. To facilitate monitoring and oversight, California should provide DWC with more flexibility to add needed data elements to medical data reporting and provide penalties for a claim administrator failing to comply with the data-reporting requirements; require that medical cost-containment expenses be reported by category of cost; compile information on the types of medical services that are subject to UR denials and expedited hearings; and expand ongoing monitoring of system performance. Finally, to increase administrative efficiency, California should use an external medical review organization to review medical-necessity determinations, and it should explore best practices of other WC programs and health programs in carrying out medical cost-containment activities.

Inside Maine’s Medicine Cabinet: Findings From the Drug Enforcement Administration's Medication Take-Back Events

PubMed Central

Malinowski, Alexandra; Ochs, Leslie; Jaramillo, Jeanie; McCall, Kenneth; Sullivan, Meghan

2015-01-01

Objectives. We evaluated the quantity and type of medications obtained in unused-medications return programs and the proportion of medication waste. Methods. We analyzed data collected in 11 Maine cities in 2011 to 2013 during 6 Drug Enforcement Administration (DEA) national medication take-back events. Pharmacy doctoral student volunteers collected data under the supervision of law enforcement, independent of the DEA. Data entry into the Pharmaceutical Collection Monitoring System, through its interface with Micromedex, allowed for analysis of medication classification, controlled substance category, therapeutic class, and percentage of medication waste (units returned/units dispensed). Results. Medication take-back events resulted in return of 13 599 individual medications from 1049 participants. We cataloged 553 019 units (capsules, tablets, milliliters, patches, or grams), representing 69.7% medication waste. Noncontrolled prescription medications accounted for 56.4% of returns, followed by over-the-counter medications (31.4%) and controlled prescription medications (9.1%). Conclusions. The significant quantities of medications, including controlled substances, returned and high degree of medication waste emphasize the need for medication collection programs to further public health research and improve health in our communities. PMID:25393189

76 FR 4120 - The National Antimicrobial Resistance Monitoring System Strategic Plan 2011-2015; Request for...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-24

... susceptibility of enteric bacteria to antimicrobial agents of medical importance. The NARMS program, established... infected with these bacteria, resulting in tens of thousands of hospitalizations and hundreds of deaths...

Haditha General Hospital Under the Economic Support Fund Program Haditha, Iraq

DTIC Science & Technology

2009-06-23

disease from the use of the restrooms. Photos 10 and 11. Heart monitors and defibrillator machines (left) and standing...350 kilometers west of Baghdad, Haditha is a river-side community with an estimated population of 150,000. The hospital, located in the heart of...medical equipment requiring electricity; specifically, several heart monitors and defibrillator machines (Site Photo 10). This equipment appeared

Medical care delivery in the US space program

NASA Technical Reports Server (NTRS)

Stewart, Donald F.

1991-01-01

The stated goal of this meeting is to examine the use of telemedicine in disaster management, public health, and remote health care. NASA has a vested interest in providing health care to crews in remote environments. NASA has unique requirements for telemedicine support, in that our flight crews conduct their job in the most remote of all work environments. Compounding the degree of remoteness are other environmental concerns, including confinement, lack of atmosphere, spaceflight physiological deconditioning, and radiation exposure, to name a few. In-flight medical care is a key component in the overall support for missions, which also includes extensive medical screening during selection, preventive medical programs for astronauts, and in-flight medical monitoring and consultation. This latter element constitutes the telemedicine aspect of crew health care. The level of in-flight resources dedicated to medical care is determined by the perceived risk of a given mission, which in turn is related to mission duration, planned crew activities, and length of time required for return to definitive medical care facilities.

Occupational health surveillance strategies for an ethnically diverse Asian employee population.

PubMed

Sakamoto, M; Vaughan, J; Tobias, B

2001-05-01

1. Implementation of a medical/health surveillance program can prevent the damaging effects of lead toxicity. Lead toxicity may be a result of acute or chronic exposure and can affect the hematopoietic, nervous, renal, and reproductive systems. 2. Minority groups tend to be overrepresented in lead industries. Further, an increase in high lead levels can be compounded by cultural influences. Education must be geared toward the specific employee populations. 3. Successful programs require assistance from all team members--occupational health nurse, safety engineer, industrial hygienist, and environmental engineer. Occupational health nurses play an important role in implementation of medical/health surveillance programs by scheduling regular blood testing, monitoring results, and educating employees.

Tumor Registry Follow-Up at Army Medical Centers.

DTIC Science & Technology

1983-06-03

7a. NAME OF MONITORING ORGANIZATION U.S. AIW-BAYL) R UNIVERSITY (If applicable) GRAD PGM4 IN HEALTH CARE ADMIN HSHA-IHC 6c. ADDRESS (City, State, and...Cancer Program," The Hospital Medical Staff 11, No. 2 (February 1982): 12. 3Charles R . Smart, "The Commission on Cancer," Bulletin, American College of...Mq. 5- a- _ , . . . . - -, uo-----. *_ . . < -% - ’ . ’.- ."-. b-" -" ... ." .. .- r ’° ... V .r’v" - 36 Tumor Registry Letterman Army Medical Center

["Soiuz-Apollo" experimental flight. Preliminary results of medicobiological studies, carried out during the flight of "Soiuz-19" spaceship].

PubMed

Vorob'ev, E I; Gazenko, O G; Gurovskiĭ, N N; Nefedov, Iu G; Egorov, B B

1976-01-01

The paper presents brief information on the Apollo-Soyuz test mission, its program biomedical investigations to be carried out in flight and specific medical aspects. It discusses the main tasks of the joint US-USSR experiments and Soviet experiments. It gives and analyzes preliminary results of medical monitoring and postflight examinations of the crew members.

Prevalence of Substance Misuse in New Patients in an Outpatient Psychiatry Clinic Using a Prescription Monitoring Program

PubMed Central

Fellers, Jonathan C.; Raisinghani, Rachna S.; Santa Cruz, Maria R.; Hidalgo, Priscilla C.; Lee, Meredith S.; Martinez, Lady A.; Keller, Adrienne E.; Clayton, Anita H.

2014-01-01

Objective: To investigate the value of a prescription monitoring program in identifying prescription drug misuse among patients presenting to a resident physician outpatient psychiatry clinic at an academic medical center. Method: Participants were 314 new patients aged 18 years or older presenting to the clinic from October 2011 to June 2012. Resident physicians completed a data collection form for each participant using information from the patient interview and from the prescription monitoring program report. Prescription drug misuse was defined as having any 1 of the following 5 criteria in the prescription monitoring program report: (1) filled prescriptions for 2 or more controlled substances, (2) obtained prescriptions from 2 or more providers, (3) obtained early refills, (4) used 3 or more pharmacies, and (5) the prescription monitoring program report conflicted with the patient’s report. Results: At least 1 indicator of prescription drug misuse was found in 41.7% of patients. Over 69% of the patients that the residents believed were misusing prescription drugs actually met 1 of the criteria for prescription drug misuse. The prescription monitoring program report changed the management only 2.2% of the time. Patients with prior benzodiazepine use (χ21 = 17.68, P < .001), prior opioid use (χ21 = 19.98, P < .001), a personality disorder (χ21 = 7.22, P < .001), and chronic pain (χ21 = 14.31, P < .001) had a higher percentage of prescription drug misuse compared to patients without these factors. Conclusion: Using the prescription monitoring program to screen patients with prior benzodiazepine and opioid use, with a personality disorder, and/or with chronic pain may be useful in confirming the suspicion of prescription drug misuse identified at the initial evaluation. PMID:24940523

Biomedical research, development, and engineering at the Johns Hopkins University Applied Physics Laboratory. Annual report 1 October 1978-30 September 1979

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

Not Available

The Medical Institutions of The Johns Hopkins University and The Johns Hopkins University Applied Physics Laboratory have developed a vigorous collaborative program of biomedical research, development, and systems engineering. An important objective of the program is to apply the expertise in engineering, the physical sciences, and systems analysis acquired by APL in defense and space research and development to problems of medical research and health care delivery. This program has grown to include collaboration with many of the clinical and basic science departments of the medical divisions. Active collaborative projects exist in ophthalmology, neurosensory research and instrumentation development, cardiovascular systems,more » patient monitoring, therapeutic and rehabilitation systems, clinical information systems, and clinical engineering. This application of state-of-the-art technology has contributed to advances in many areas of basic medical research and in clinical diagnosis and therapy through improvement of instrumentation, techniques, and basic understanding.« less

Adherence to HAART therapy measured by electronic monitoring in newly diagnosed HIV patients in Botswana.

PubMed

Vriesendorp, Reinout; Cohen, Adam; Kristanto, Paulus; Vrijens, Bernard; Rakesh, Pande; Anand, Bene; Iwebor, Henry Uchechukwaka; Stiekema, Jacobus

2007-12-01

This pilot study was designed to evaluate the feasibility and benefits of electronic adherence monitoring of antiretroviral medications in HIV patients who recently started Highly Active Anti Retroviral Therapy (HAART) in Francistown, Botswana and to compare this with self-reporting. Dosing histories were compiled electronically using Micro Electro Mechanical Systems (MEMS) monitors to evaluate adherence to prescribed therapies. Thirty patients enrolled in the antiretroviral treatment program were monitored over 6 weeks. These patients were all antiretroviral (ARV) naïve. After each visit (mean three times) to the pharmacy, the data compiled by the monitors were downloaded. Electronic monitoring of adherence was compared to patient self-reports of adherence. The mean individual medication adherence level measured with the electronic device was 85% (range 21-100%). The mean adherence level measured by means of self-reporting was 98% (range 70-100%). Medication prescribed on a once-a-day dose base was associated with a higher adherence level (97.9% for efavirenz) compared with a twice-a-day regimen (88.4% for Lamivudine/Zidovudine). It is feasible to assess treatment adherence of patients living in a low resource setting on HAART by using electronic monitors. Adherence, even in the early stages of treatment, appears to be insufficient in some patients and may be below the level required for continuous inhibition of viral replication. This approach may lead to improved targeting of counselling about their medication intake of such patients in order to prevent occurrence of resistant viral strains due to inadequate inhibition of viral replication. In this pilot study a significant difference between the data recorded through the electronic monitors and those provided by self-reporting was observed.

The evolution of a health hazard assessment database management system for military weapons, equipment, and materiel.

PubMed

Murnyak, George R; Spencer, Clark O; Chaney, Ann E; Roberts, Welford C

2002-04-01

During the 1970s, the Army health hazard assessment (HHA) process developed as a medical program to minimize hazards in military materiel during the development process. The HHA Program characterizes health hazards that soldiers and civilians may encounter as they interact with military weapons and equipment. Thus, it is a resource for medical planners and advisors to use that can identify and estimate potential hazards that soldiers may encounter as they train and conduct missions. The U.S. Army Center for Health Promotion and Preventive Medicine administers the program, which is integrated with the Army's Manpower and Personnel Integration program. As the HHA Program has matured, an electronic database has been developed to record and monitor the health hazards associated with military equipment and systems. The current database tracks the results of HHAs and provides reporting designed to assist the HHA Program manager in daily activities.

Opportunities for Enhanced Strategic Use of Surveys, Medical Records, and Program Data for HIV Surveillance of Key Populations: Scoping Review

PubMed Central

Baral, Stefan D; Edwards, Jessie K; Zadrozny, Sabrina; Hargreaves, James; Zhao, Jinkou; Sabin, Keith

2018-01-01

Background Normative guidelines from the World Health Organization recommend tracking strategic information indicators among key populations. Monitoring progress in the global response to the HIV epidemic uses indicators put forward by the Joint United Nations Programme on HIV/AIDS. These include the 90-90-90 targets that require a realignment of surveillance data, routinely collected program data, and medical record data, which historically have developed separately. Objective The aim of this study was to describe current challenges for monitoring HIV-related strategic information indicators among key populations ((men who have sex with men [MSM], people in prisons and other closed settings, people who inject drugs, sex workers, and transgender people) and identify future opportunities to enhance the use of surveillance data, programmatic data, and medical record data to describe the HIV epidemic among key populations and measure the coverage of HIV prevention, care, and treatment programs. Methods To provide a historical perspective, we completed a scoping review of the expansion of HIV surveillance among key populations over the past three decades. To describe current efforts, we conducted a review of the literature to identify published examples of SI indicator estimates among key populations. To describe anticipated challenges and future opportunities to improve measurement of strategic information indicators, particularly from routine program and health data, we consulted participants of the Third Global HIV Surveillance Meeting in Bangkok, where the 2015 World Health Organization strategic information guidelines were launched. Results There remains suboptimal alignment of surveillance and programmatic data, as well as routinely collected medical records to facilitate the reporting of the 90-90-90 indicators for HIV among key populations. Studies (n=3) with estimates of all three 90-90-90 indicators rely on cross-sectional survey data. Programmatic data and medical record data continue to be insufficiently robust to provide estimates of the 90-90-90 targets for key populations. Conclusions Current reliance on more active data collection processes, including key population-specific surveys, remains warranted until the quality and validity of passively collected routine program and medical record data for key populations is optimized. PMID:29789279

A mental health program for ground zero rescue and recovery workers: cases and observations.

PubMed

Katz, Craig L; Smith, Rebecca; Silverton, Marsha; Holmes, Anastasia; Bravo, Carlos; Jones, Kristina; Kiliman, Marta; Lopez, Norma; Malkoff, Laurie; Marrone, Kathryn; Neuman, Alla; Stephens, Tricia; Tavarez, Wendy; Yarowsky, Anne; Levin, Stephen; Herbert, Robin

2006-09-01

Clinical vignettes from the World Trade Center Worker and Volunteer Mental Health Monitoring and Treatment Program at the Mount Sinai Medical Center in New York City are presented. The hospital-based program pairs mental health screenings with federally funded occupational medical screenings to identify persons with mental health problems related to their rescue and recovery roles. The program also provides on-site mental health treatment. The cases illustrate the diverse mental health needs of the rescue and recovery workers, some of whom initially sought treatment years after September 11, 2001. The cases show that in addition to symptoms of posttraumatic stress disorder, workers experienced survivor guilt, distressing memories of childhood trauma, shame associated with intense feelings, substance abuse relapse, psychosis, and problems with family relationships.

Electromagnetic Interference of Wireless Local Area Network on Electrocardiogram Monitoring System: A Case Report

PubMed Central

Chung, Seungmin; Yi, Joohee

2013-01-01

Electromagnetic interference (EMI) can affect various medical devices. Herein, we report the case of EMI from wireless local area network (WLAN) on an electrocardiogram (ECG) monitoring system. A patient who had a prior myocardial infarction participated in the cardiac rehabilitation program in the sports medicine center of our hospital under the wireless ECG monitoring system. After WLAN was installed, wireless ECG monitoring system failed to show a proper ECG signal. ECG signal was distorted when WLAN was turned on, but it was normalized after turning off the WLAN. PMID:23613696

New Direction for Enhancing Quality in Diabetes Care: Utilizing Telecommunications and Paraprofessional Outreach Workers Backed by an Expert Medical Team

PubMed Central

Ann Mayes, Penelope; Silvers, Abraham

2010-01-01

Abstract This article assesses the value of using telecommunications with Promatoras (paraprofessional outreach workers) and an expert medical team of registered nurses (RNs) and endocrinologists in an at-risk type 2 diabetic Hispanic population recruited for a telemedicine feasibility project from a free clinic. Nineteen patients agreed to enter the program and 16 completed the program in 3.5 years of study. A Promatoras is the primary educator and the point of communication to patient or medical personnel overseeing each patient's home glucose monitoring, medical records, and medications, regularly communicating by telephone and e-mail with patients and diabetes specialists. Between clinic visits, all routine care, including body weight, blood glucose, and blood pressure monitoring, was shared over the Internet, and each patient was interviewed by audio and camera. The endocrinologist was in his office, while the primary care physician, patient, and Promotora volunteers were at the free clinic. Four variables were considered in this longitudinal study: weight, systolic blood pressure, diastolic blood pressure, and HbA1c. Estimates of means, correlations, t-tests, and slopes of the repeated measures were obtained, and comparisons were made between first and last values. The most important sign of improvement in the patients' situation was the significant decrease in HbA1c to 7.2% from 9.6% (p = 0.001). PMID:20406123

New direction for enhancing quality in diabetes care: utilizing telecommunications and paraprofessional outreach workers backed by an expert medical team.

PubMed

Mayes, Penelope Ann; Silvers, Abraham; Prendergast, J Joseph

2010-04-01

Abstract This article assesses the value of using telecommunications with Promatoras (paraprofessional outreach workers) and an expert medical team of registered nurses (RNs) and endocrinologists in an at-risk type 2 diabetic Hispanic population recruited for a telemedicine feasibility project from a free clinic. Nineteen patients agreed to enter the program and 16 completed the program in 3.5 years of study. A Promatoras is the primary educator and the point of communication to patient or medical personnel overseeing each patient's home glucose monitoring, medical records, and medications, regularly communicating by telephone and e-mail with patients and diabetes specialists. Between clinic visits, all routine care, including body weight, blood glucose, and blood pressure monitoring, was shared over the Internet, and each patient was interviewed by audio and camera. The endocrinologist was in his office, while the primary care physician, patient, and Promotora volunteers were at the free clinic. Four variables were considered in this longitudinal study: weight, systolic blood pressure, diastolic blood pressure, and HbA1c. Estimates of means, correlations, t-tests, and slopes of the repeated measures were obtained, and comparisons were made between first and last values. The most important sign of improvement in the patients' situation was the significant decrease in HbA1c to 7.2% from 9.6% (p = 0.001).

Medical Gas Analyzer

NASA Technical Reports Server (NTRS)

1983-01-01

The Remote Monitoring System (RMS) is manufactured by Perkin Elmer Corporation. The principal component of the RMS was originally developed for spacecraft use to monitor astronaut's respiratory gases in NASA's Gemini and Apollo program. At Wishard Memorial Hospital in Indianapolis, IN, the RMS is used in operating rooms for analysis of anesthetic gases and measurement of oxygen, carbon dioxide and nitrogen concentrations. It assures that the patient undergoing surgery has the proper breathing environment.

Skylab

NASA Image and Video Library

1970-01-01

This 1970 photograph shows equipment for the Skylab's Sleep Monitoring Experiment (M133), a medical evaluation designed to objectively determine the amount and quality of crewmembers' inflight sleep. The experiment monitored and recorded electroencephalographic (EEG) and electrooculographic (EOG) activity during astronauts' sleep periods. One of the astronauts was selected for this experiment and wore a fitted cap during his sleep periods. The Marshall Space Flight Center had program management responsibility for the development of Skylab hardware and experiments.

Trained standardized patients can train their peers to provide well-rated, cost-effective physical exam skills training to first-year medical students.

PubMed

Aamodt, Carla B; Virtue, David W; Dobbie, Alison E

2006-05-01

Teaching physical examination skills effectively, consistently, and cost-effectively is challenging. Faculty time is the most expensive resource. One solution is to train medical students using lay physical examination teaching associates. In this study, we investigated the feasibility, acceptability, and cost-effectiveness of training medical students using teaching associates trained by a lay expert instead of a clinician. We used teaching associates to instruct students about techniques of physical examination. We measured students' satisfaction with this teaching approach. We also monitored the financial cost of this approach compared to the previously used approach in which faculty physicians taught physical examination skills. Our program proved practical to accomplish and acceptable to students. Students rated the program highly, and we saved approximately $9,100, compared with our previous faculty-intensive teaching program. We believe that our program is popular with students, cost-effective, and generalizable to other institutions.

Atypical antipsychotics and metabolic syndrome in patients with schizophrenia: risk factors, monitoring, and healthcare implications.

PubMed

Riordan, Henry J; Antonini, Paola; Murphy, Michael F

2011-09-01

Metabolic syndrome is a leading cause of morbidity and mortality in patients with schizophrenia, with a prevalence rate double that of nonpsychiatric populations. Given the amount of evidence suggesting a link between atypical antipsychotic medications and metabolic syndrome, several agencies have recommended regular clinical monitoring of weight, symptoms of hyperglycemia, and glucose in chronically medicated patients with schizophrenia. To summarize the current literature on atypical antipsychotic-induced metabolic syndrome in patients with schizophrenia, outline some of the molecular mechanisms behind this syndrome, identify demographic and disease-related risk factors, and describe cost-effective methods for surveillance. The differential prevalence of metabolic syndrome associated with various atypical antipsychotic medications has been evidenced across numerous studies, with higher effects seen for certain antipsychotic medications on weight gain, waist circumference, fasting triglyceride level, and glucose levels. Given the association of these symptoms, all atypical antipsychotic medications currently include a warning about the risk of hyperglycemia and diabetes, as well as suggestions for regular monitoring. Despite this, very little data are available to support adherence to these monitoring recommendations. Lack of awareness and resources, diffusion of responsibility, policy implementation, and organizational structure have all been implicated. The treatment of schizophrenia involves a balance in terms of risks and benefits. Failing to treat because of risk for complications from metabolic syndrome may place the patient at a higher risk for more serious health outcomes. Supporting programs aimed at increasing monitoring of simple laboratory and clinical measures associated with metabolic syndrome may decrease important risk factors, improve patients' quality of life, and reduce healthcare costs.

Foreign Medical Schools: Education Should Improve Monitoring of Schools That Participate in the Federal Student Loan Program. Report to Congressional Committees. GAO-10-412

ERIC Educational Resources Information Center

Scott, George A.

2010-01-01

Each year, the federal government makes a significant financial investment in the education and training of the U.S. physician workforce. A quarter of that physician workforce is composed of international medical graduates (IMG) and they include both U.S. citizens and foreign nationals. Little is known about IMGs with respect to how much they…

Gaining Control of Occupational Injury and Illness in the U.S. Navy Civilian Work Force

DTIC Science & Technology

1990-01-16

caring for the back. Also monitored by the supervisor is a work -hardening program developed by the clinic physical therapist and physician that... development of a work -hardening program for the returning injured employee to ensure a safe re-entry to the workplace. e. "Green Table" and Medical...physical therapist work closely in developing effective programs for the treatment of occupational injuries. Having an onsite physical therapist available

Implementing OpenMRS for patient monitoring in an HIV/AIDS care and treatment program in rural Mozambique.

PubMed

Manders, Eric-Jan; José, Eurico; Solis, Manuel; Burlison, Janeen; Nhampossa, José Leopoldo; Moon, Troy

2010-01-01

We have adopted the Open Medical Record System (OpenMRS) framework to implement an electronic patient monitoring system for an HIV care and treatment program in Mozambique. The program provides technical assistance to the Ministry of Health supporting the scale up of integrated HIV care and support services in health facilities in rural resource limited settings. The implementation is in use for adult and pediatric programs, with ongoing roll-out to cover all supported sites. We describe early experiences in adapting the system to the program needs, addressing infrastructure challenges, creating a regional support team, training data entry staff, migrating a legacy database, deployment, and current use. We find that OpenMRS offers excellent prospects for in-country development of health information systems, even in severely resource limited settings. However, it also requires considerable organizational infrastructure investment and technical capacity building to ensure continued local support.

Local health care system utilizing the LPG (liquid propane gas) network.

PubMed

Umemoto, T; Hoshi, H; Tsuda, M; Horio, S; Itou, N; Neriki, T

1998-07-01

JAC's LPG monitoring network system is mainly provided in mountain villages. However, by using this system, it will be possible to start a Digital Network Program for the Elderly while maintaining superior economic feasibility and public benefit using existing information infrastructures. This project also has the capabilities for the creation of a fire/disaster monitoring system, as well as a health care system by using conventional LPG monitoring systems. Telemedicine is an option for the future, as well, by connecting medical equipment and a tele-conferencing system.

PUPTH Prehospital Air Medical Plasma (PAMP) Trial

DTIC Science & Technology

2014-07-01

collection of information, including suggestions for reducing this burden to Department of Defense, Washington Headquarters Services, Directorate for...projects. Scott Gunn, MD, is an Associate Professor of CCM and Emergency Medicine and Director , Combined Emergency Medicine/Internal Medicine/CCM...Residency Program. Dr. Gunn is also Director of the CCM Clinical Trials Program. As such, he is experienced in the design and monitoring of clinical trials

Scalable decision support at the point of care: a substitutable electronic health record app for monitoring medication adherence.

PubMed

Bosl, William; Mandel, Joshua; Jonikas, Magdalena; Ramoni, Rachel Badovinac; Kohane, Isaac S; Mandl, Kenneth D

2013-07-22

Non-adherence to prescribed medications is a serious health problem in the United States, costing an estimated $100 billion per year. While poor adherence should be addressable with point of care health information technology, integrating new solutions with existing electronic health records (EHR) systems require customization within each organization, which is difficult because of the monolithic software design of most EHR products. The objective of this study was to create a published algorithm for predicting medication adherence problems easily accessible at the point of care through a Web application that runs on the Substitutable Medical Apps, Reusuable Technologies (SMART) platform. The SMART platform is an emerging framework that enables EHR systems to behave as "iPhone like platforms" by exhibiting an application programming interface for easy addition and deletion of third party apps. The app is presented as a point of care solution to monitoring medication adherence as well as a sufficiently general, modular application that may serve as an example and template for other SMART apps. The widely used, open source Django framework was used together with the SMART platform to create the interoperable components of this app. Django uses Python as its core programming language. This allows statistical and mathematical modules to be created from a large array of Python numerical libraries and assembled together with the core app to create flexible and sophisticated EHR functionality. Algorithms that predict individual adherence are derived from a retrospective study of dispensed medication claims from a large private insurance plan. Patients' prescription fill information is accessed through the SMART framework and the embedded algorithms compute adherence information, including predicted adherence one year after the first prescription fill. Open source graphing software is used to display patient medication information and the results of statistical prediction of future adherence on a clinician-facing Web interface. The user interface allows the physician to quickly review all medications in a patient record for potential non-adherence problems. A gap-check and current medication possession ratio (MPR) threshold test are applied to all medications in the record to test for current non-adherence. Predictions of 1-year non-adherence are made for certain drug classes for which external data was available. Information is presented graphically to indicate present non-adherence, or predicted non-adherence at one year, based on early prescription fulfillment patterns. The MPR Monitor app is installed in the SMART reference container as the "MPR Monitor", where it is publically available for use and testing. MPR is an acronym for Medication Possession Ratio, a commonly used measure of adherence to a prescribed medication regime. This app may be used as an example for creating additional functionality by replacing statistical and display algorithms with new code in a cycle of rapid prototyping and implementation or as a framework for a new SMART app. The MPR Monitor app is a useful pilot project for monitoring medication adherence. It also provides an example that integrates several open source software components, including the Python-based Django Web framework and python-based graphics, to build a SMART app that allows complex decision support methods to be encapsulated to enhance EHR functionality.

Best Practices for Robotic Surgery Programs

PubMed Central

Goldenberg, David; Winder, Joshua S.; Juza, Ryan M.; Lyn-Sue, Jerome R.

2017-01-01

Background and Objectives: Robotic surgical programs are increasing in number. Efficient methods by which to monitor and evaluate robotic surgery teams are needed. Methods: Best practices for an academic university medical center were created and instituted in 2009 and continue to the present. These practices have led to programmatic development that has resulted in a process that effectively monitors leadership team members; attending, resident, fellow, and staff training; credentialing; safety metrics; efficiency; and case volume recommendations. Results: Guidelines for hospitals and robotic directors that can be applied to one's own robotic surgical services are included with examples of management of all aspects of a multispecialty robotic surgery program. Conclusion: The use of these best practices will ensure a robotic surgery program that is successful and well positioned for a safe and productive environment for current clinical practice. PMID:28729780

77 FR 65414 - Agency Information Collection Activities; Submission for OMB Review; Comment Request; 1,3...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-26

... collection requirements is to protect employees from the adverse health effects associated with occupational... respirator; establish medical surveillance programs to monitor employee health; and to provide employees with... Labor (DOL) is submitting the Occupational [[Page 65415

A day in the life of a monitor!

PubMed

Shah, Kunal

2012-01-01

When at a site, the monitor will meet with the Study Coordinator, review the hospital medical records, use the internet database or paper to 'monitor' their data versus their medical records, issue queries, check master files, count tablets or vials, provide the update to the doctor, and so on. When not traveling, the monitor will work in the office, printing letters, filing documents collected from sites, writing reports and follow-up letters, responding to e-mails, calling sites, to follow-up on the pending action items, in addition to calling sites not visited recently, attending study teleconferences, attending study and company training programs, reading standard operating procedures, completing excel spreadsheets or company specific software systems, and so on. The monitor is loaded with all these different types of work requirements and most importantly each and every task is important and time bound. Different skill sets are required for different tasks and the monitor plays different roles, while doing different tasks. This article enlists the tasks that are required to be done by the monitor, the different roles played by the monitor while doing these tasks, analyze which is the most important day for a monitor, what are the tasks performed during this day, and what knowledge and skills are required for performing these tasks.

Linezolid Surveillance Results for the United States: LEADER Surveillance Program 2011

PubMed Central

Mendes, Rodrigo E.; Ross, James E.; Sader, Helio S.; Jones, Ronald N.

2013-01-01

The LEADER surveillance program monitors the in vitro activity of linezolid and comparator agents against Gram-positive bacteria in the United States. In its eighth consecutive year (2011), a total of 60 medical centers from the United States, including seven medical centers specializing in children's health care contributed a total of 7,303 Gram-positive pathogens. The MIC90 value for Staphylococcus aureus was 2 μg/ml, and for coagulase-negative staphylococci, enterococci, Streptococcus pneumoniae, β-hemolytic streptococci, and viridans group streptococci, the MIC90 was 1 μg/ml. The “all organism” linezolid-resistant and nonsusceptible rate was only 0.19%. PMID:23254424

Medical-device risk management and public safety: using cost-benefit as a measurement of effectiveness

NASA Astrophysics Data System (ADS)

Hughes, Allen A.

1994-12-01

Public safety can be enhanced through the development of a comprehensive medical device risk management. This can be accomplished through case studies using a framework that incorporates cost-benefit analysis in the evaluation of risk management attributes. This paper presents a framework for evaluating the risk management system for regulatory Class III medical devices. The framework consists of the following sixteen attributes of a comprehensive medical device risk management system: fault/failure analysis, premarket testing/clinical trials, post-approval studies, manufacturer sponsored hospital studies, product labeling, establishment inspections, problem reporting program, mandatory hospital reporting, medical literature surveillance, device/patient registries, device performance monitoring, returned product analysis, autopsy program, emergency treatment funds/interim compensation, product liability, and alternative compensation mechanisms. Review of performance histories for several medical devices can reveal the value of information for many attributes, and also the inter-dependencies of the attributes in generating risk information flow. Such an information flow network is presented as a starting point for enhancing medical device risk management by focusing on attributes with high net benefit values and potential to spur information dissemination.

Diversion of prescription drugs to the black market: what the states are doing to curb the tide.

PubMed

Forgione, D A; Neuenschwander, P; Vermeer, T E

2001-01-01

The diversion of legitimate controlled substances to the black market is a major cause of medical emergencies, fatalities, and drug-related dependencies. The effects harm not only the illegal user, but also the legitimate patient who may be getting shorted on treatments and innocent medical providers who may be charged with false claim offenses or other professional failures because of diversions that take place during their watch. The dollar magnitude of this crime is estimated to rival the black markets for both crack cocaine and heroine combined. This article addresses the various ways prescription drugs are diverted to the black market, some monitoring programs employed by the states, and guidelines that doctors, pharmacists, and other providers can use to protect themselves against possible liabilities arising from the diversion of prescription drugs. We will also address some of the oppositions to monitoring programs that have been asserted and replies to these oppositions.

Desktop publishing and medical imaging: paper as hardcopy medium for digital images.

PubMed

Denslow, S

1994-08-01

Desktop-publishing software and hardware has progressed to the point that many widely used word-processing programs are capable of printing high-quality digital images with many shades of gray from black to white. Accordingly, it should be relatively easy to print digital medical images on paper for reports, instructional materials, and in research notes. Components were assembled that were necessary for extracting image data from medical imaging devices and converting the data to a form usable by word-processing software. A system incorporating these components was implemented in a medical setting and has been operating for 18 months. The use of this system by medical staff has been monitored.

Challenges Facing Medical Residents' Satisfaction in the Middle East: A Report From United Arab Emirates.

PubMed

Abdulrahman, Mahera; Qayed, Khalil I; AlHammadi, Hisham H; Julfar, Adnan; Griffiths, Jane L; Carrick, Frederick R

2015-01-01

PHENOMENON: Medical residents' satisfaction with the quality of training for medical residency training specialists is one of the core measures of training program success. It will also therefore contribute to the integrity of healthcare in the long run. Yet there is a paucity of research describing medical residents' satisfaction in the Middle East, and there are no published studies that measure the satisfaction of medical residents trained within the United Arab Emirates (UAE). This makes it difficult to develop a quality residency training program that might meet the needs of both physicians and society. The authors designed a questionnaire to assess medical residents' satisfaction with the Dubai residency training program in order to identify insufficiencies in the training, clinical, and educational aspects. The survey was a self-report questionnaire composed of different subscales covering sociodemographic and educational/academic profile of the residents along with their overall satisfaction of their training, curriculum, work environment, peer teamwork, and their personal opinion on their medical career. Respondents showed a substantial level of satisfaction with the residency training. The vast majority of residents (80%, N = 88) believe that their residency program curriculum and rotation was "good," "very good," or "excellent." Areas of dissatisfaction included salary, excessive paperwork during rotations, and harassment. INSIGHTS: This is the first report that studies the satisfaction of medical residents in all specialties in Dubai, UAE. Our findings provide preliminary evidence on the efficiency of different modifications applied to the residency program in UAE. To our knowledge, there has not been any previous study in the Middle East that has analyzed this aspect of medical residents from different specialties. The authors believe that this report can be used as a baseline to monitor the effectiveness of interventions applied in the future toward improving residency training programs in this region.

[Implementation of a remote oncology-monitoring program for cancer patients in outpatient care unit: A major challenge for the different actors].

PubMed

Peyrilles, Elodie; Lepage-Seydoux, Coralie; Sejean, Karine; Bonan, Brigitte

2018-04-01

The development of outpatient departments requires health professionals to reorganize practices for a better patient monitoring and a better patient care pathway. To evaluate, using indicators, the impact of an oncology-monitoring program on activity and organizational fluidity in a Cytotoxic Preparation Unit and clinical departments. Method the clinical and biological data are collected between two injections by calling the patient two days prior chemotherapy is performed by a specialist nurse of an outsourced medical call center. After medical and pharmaceutical validation, early preparations (D-1) for expensive and non-expensive molecules are performed. The program is started in February 2016. After 3 months, 382 patients were included into the program. Twenty-three patients on average are called per day related to 1162 completed clinical questionnaires (87%). Among the files, 47% are complete at D-2 (biological and clinical data). The early preparation rate of expensive drugs, zero before the program for financial reasons, has reached 40% at 3 months. The destroyed preparation rate because of non-administration decreased from 5 to 2%. Preliminary results show a significant patient compliance, feasibility of early preparation of expensive and non-expensive chemotherapy. These are preliminary results of a one-year study. They will be completed by an evaluation of patients' and health professionals' satisfaction, evaluation of length of stay, optimization of operations for clinical departments and CPU. The D-2 biological data collection must be improved. A strong doctor/pharmacist collaboration is essential for better patient care pathway. Copyright © 2018 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.

Human Research Program (HRP) Exploration Medical Capability (ExMC) Standing Review Panel (SRP)

NASA Technical Reports Server (NTRS)

Cintron, Nitza; Dutson, Eric; Friedl, Karl; Hyman, William; Jemison, Mae; Klonoff, David

2009-01-01

The SRP believes strongly that regularly performed in-flight crew assessments are needed in order to identify a change in health status before a medical condition becomes clinically apparent. It is this early recognition in change that constitutes the foundation of the "occupational health model" expounded in the HRP Requirements Document as a key component of the HRP risk mitigation strategy that will enable its objective of "prevention and mitigation of human health and performance risks". A regular crew status examination of physiological and clinical performance is needed. This can be accomplished through instrumented monitoring of routine embedded tasks. The SRP recommends addition of a new gap to address this action under Category 3.0 Mitigate the Risk. This new gap is closely associated with Task 4.19 which addresses the lack of adequate biomedical monitoring capabilities for performing periodic clinical status evaluations and contingency medical monitoring. A corollary to these gaps is the critical emphasis on preventive medicine, not only during pre- and post-flight phases of a mission as is the current practice, but continued into the in-flight phases of exploration class missions.

Mentoring programs for medical students--a review of the PubMed literature 2000-2008.

PubMed

Frei, Esther; Stamm, Martina; Buddeberg-Fischer, Barbara

2010-04-30

Although mentoring is acknowledged as a key to successful and satisfying careers in medicine, formal mentoring programs for medical students are lacking in most countries. Within the framework of planning a mentoring program for medical students at Zurich University, an investigation was carried out into what types of programs exist, what the objectives pursued by such programs are, and what effects are reported. A PubMed literature search was conducted for 2000 - 2008 using the following keywords or their combinations: mentoring, mentoring program, medical student, mentor, mentee, protégé, mentorship. Although a total of 438 publications were identified, only 25 papers met the selection criteria for structured programs and student mentoring surveys. The mentoring programs reported in 14 papers aim to provide career counseling, develop professionalism, increase students' interest in research, and support them in their personal growth. There are both one-to-one and group mentorships, established in the first two years of medical school and continuing through graduation. The personal student-faculty relationship is important in that it helps students to feel that they are benefiting from individual advice and encourages them to give more thought to their career choices. Other benefits are an increase in research productivity and improved medical school performance in general. Mentored students also rate their overall well-being as higher. - The 11 surveys address the requirements for being an effective mentor as well as a successful mentee. A mentor should empower and encourage the mentee, be a role model, build a professional network, and assist in the mentee's personal development. A mentee should set agendas, follow through, accept criticism, and be able to assess performance and the benefits derived from the mentoring relationship. Mentoring is obviously an important career advancement tool for medical students. In Europe, more mentoring programs should be developed, but would need to be rigorously assessed based on evidence of their value in terms of both their impact on the career paths of juniors and their benefit for the mentors. Medical schools could then be monitored with respect to the provision of mentorships as a quality characteristic.

Mentoring programs for medical students - a review of the PubMed literature 2000 - 2008

PubMed Central

2010-01-01

Background Although mentoring is acknowledged as a key to successful and satisfying careers in medicine, formal mentoring programs for medical students are lacking in most countries. Within the framework of planning a mentoring program for medical students at Zurich University, an investigation was carried out into what types of programs exist, what the objectives pursued by such programs are, and what effects are reported. Methods A PubMed literature search was conducted for 2000 - 2008 using the following keywords or their combinations: mentoring, mentoring program, medical student, mentor, mentee, protégé, mentorship. Although a total of 438 publications were identified, only 25 papers met the selection criteria for structured programs and student mentoring surveys. Results The mentoring programs reported in 14 papers aim to provide career counseling, develop professionalism, increase students' interest in research, and support them in their personal growth. There are both one-to-one and group mentorships, established in the first two years of medical school and continuing through graduation. The personal student-faculty relationship is important in that it helps students to feel that they are benefiting from individual advice and encourages them to give more thought to their career choices. Other benefits are an increase in research productivity and improved medical school performance in general. Mentored students also rate their overall well-being as higher. - The 11 surveys address the requirements for being an effective mentor as well as a successful mentee. A mentor should empower and encourage the mentee, be a role model, build a professional network, and assist in the mentee's personal development. A mentee should set agendas, follow through, accept criticism, and be able to assess performance and the benefits derived from the mentoring relationship. Conclusion Mentoring is obviously an important career advancement tool for medical students. In Europe, more mentoring programs should be developed, but would need to be rigorously assessed based on evidence of their value in terms of both their impact on the career paths of juniors and their benefit for the mentors. Medical schools could then be monitored with respect to the provision of mentorships as a quality characteristic. PMID:20433727

Foundation for Integrating Employee Health Activities for Active Duty Personnel in the Department of Defense

DTIC Science & Technology

2009-01-01

the intent of DoD’s electronic health record, AHLTA, which will eventually contain all health uti - lization information in a single record. However...service) Health monitoring Serum sample Prescription medications Immunizations Pregnancy test Health monitoring Required (varies by service) Periodic...FedEx in 2002, but it should be noted that these are unpublished. FedEx reports that the HCM program has reduced costs and uti - lization of heath-care

42 CFR 88.1 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... RELATED ACTIVITIES WORLD TRADE CENTER HEALTH PROGRAM § 88.1 Definitions. Link to an amendment published at... screening-eligible survivor as eligible for monitoring and treatment, or a WTC-related health condition or a health condition medically associated with a WTC-related health condition in a particular WTC responder...

Home blood pressure monitoring and self-titration of antihypertensive medications: Proposed patient selection criteria.

PubMed

Hill, James R

2016-05-01

Recent studies have demonstrated that home blood pressure monitoring (HBPM), coupled with self-titration of medications is a viable intervention to control hypertension. There are currently no established criteria to evaluate patients for inclusion in such a program. The purpose of this discussion is to propose criteria for determining if a patient is appropriate to participate in a program of HBPM and self-titration. Inclusion criteria for two self-titration trials were examined, and additional factors in clinical practice were identified and discussed. Additional selection criteria were proposed to support the decision to enroll a patient in an antihypertensive self-titration program. Inclusion criteria from self-titration trials provide a reasonable starting point for choosing appropriate patients in clinical practice, but additional research is necessary. Adaptation of these criteria and consideration of the identified factors can be used to develop decision support instruments. Such instruments should be evaluated for effectiveness and reliability prior to use in clinical practice. HBPM combined with self-titration is an effective patient-centered approach for hypertension management. Decision support instruments to determine appropriate patients are necessary for safe and effective use in clinical practice. ©2015 American Association of Nurse Practitioners.

Accreditation of undergraduate medical education in the Caribbean: report on the Caribbean accreditation authority for education in medicine and other health professions.

PubMed

van Zanten, Marta; Parkins, Lorna M; Karle, Hans; Hallock, James A

2009-06-01

Medical education in the Caribbean has undergone significant change and growth in the past decades. Currently, approximately 60 medical schools in the Caribbean provide medical training to a combination of domestic and international students. External quality assurance of these institutions has varied in effectiveness and scope throughout the region. The Caribbean Accreditation Authority for Education in Medicine and Other Health Professions (CAAM-HP) was established by governments of the Caribbean Community as a way to fulfill regional and local needs for a governmentally recognized quality assurance agency. To examine efficient and effective options for maintaining and improving established accreditation systems such as CAAM-HP, the Invitational Conference on Accreditation of Medical Education Programs in the Caribbean took place in May 2007 in Jamaica. The conference was hosted by CAAM-HP and the World Federation for Medical Education, with assistance from the Educational Commission for Foreign Medical Graduates. The evaluation and monitoring of undergraduate medical education programs in the Caribbean by a regional accrediting system such as CAAM-HP can help ensure the quality of the education delivered at these diverse institutions.

Enacting Pedagogy in Curricula: On the Vital Role of Governance in Medical Education.

PubMed

Casiro, Oscar; Regehr, Glenn

2018-02-01

Managing curricula and curricular change involves both a complex set of decisions and effective enactment of those decisions. The means by which decisions are made, implemented, and monitored constitute the governance of a program. Thus, effective academic governance is critical to effective curriculum delivery. Medical educators and medical education researchers have been invested heavily in issues of educational content, pedagogy, and design. However, relatively little consideration has been paid to the governance processes that ensure fidelity of implementation and ongoing refinements that will bring curricular practices increasingly in line with the pedagogical intent. In this article, the authors reflect on the importance of governance in medical schools and argue that, in an age of rapid advances in knowledge and medical practices, educational renewal will be inhibited if discussions of content and pedagogy are not complemented by consideration of a governance framework capable of enabling change. They explore the unique properties of medical curricula that complicate academic governance, review the definition and properties of good governance, offer mechanisms to evaluate the extent to which governance is operating effectively within a medical program, and put forward a potential research agenda for increasing the collective understanding of effective governance in medical education.

Health and Fitness Evaluations for Long Duration Microgravity Exposure

NASA Technical Reports Server (NTRS)

Roden, Sean Kevin; Ewert, Patricia

2006-01-01

The current health maintenance program for ISS is adequate; however the future of medical care and research in space requires a change where crew time efficiency and autonomy are emphasized. NASA s medical personnel are currently refining their ability to monitor and provide remote health care in such a manner. The proposed plan would evaluate health and fitness of the on orbit crew to; perform on orbit operations, and readiness to return to a terrestrial environment. A two tiered approach will utilize exercise and medical equipment, as well as periodic medical conferences with the flight surgeon, to provide a quantitative and clinical picture of the crew s health and fitness. Any off nominal health and fitness issues that could arise will be evaluated by providing an "armamentarium" of devices both medical and exercise specific to the on orbit crew to use. The ability for the crew to provide autonomous health care, with decreasing earth support, will become increasingly more important for exploration missions. This new plan of health care and maintenance will allow us to, development such efforts while continuing to monitor and provide the best possible health, care and medical research through the microgravity environment on board ISS.

Perceived Exertion: An Old Exercise Tool Finds New Applications.

ERIC Educational Resources Information Center

Monahan, Terry

1988-01-01

Perceived exertion scales, based on subjective perception of energy output, are gaining respect as prescribing and monitoring tools for individual exercise programs. A review of recent literature indicates growing research interest in applications for individuals who are elderly, inactive, or subject to medical conditions such as angina. (IAH)

Medical surveillance and programs on industrial hygiene at RCRA facilities

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

Murphy, T.E.

1994-12-31

Some special areas where much progress in industrial hygiene and safety has been made in the past few years are; training, personal protective equipment, uniforms, personal monitoring, area monitoring, and medical surveillance. Before one can begin to construct programs for worker protection, some knowledge of potential exposures must be gained. The best place to start is the Waste Analysis Plan, and the list of wastes that a particular site is authorized to receive. Waste Codes are listed within a facility`s Part A and Part B permits. Actual facility receipt of wastes are well documented within Load Records and other documentation.more » A facility`s training program forms the heart of a health and safety program. Every TSD facility should have developed a matrix of job titles and required training. Every facility must also make a commitment to providing a wide range of personal protective equipment, including a wide array of disposables. Some facilities will benefit from the occasional use of the newer respirator quantitative fit-testing devices. All facilities are urged to rent or borrow this type of equipment periodically. Quantitative respirator fit-testers are capable of revealing important deficiencies in a respirator program. Providing uniforms is a newer means of protecting workers. The use of uniforms is an effective means for addressing the idea of carry-home-waste. The use of disposables including boots, must be integrated into a Uniform Program if the program is to be effective. In addition, employees must strictly understand that uniforms must not leave the facility at any time, including lunch time.« less

The importance of continuing education for transplant coordination staff.

PubMed

Tokalak, Ibrahim; Emiroğlu, Remzi; Karakayali, Hamdi; Bilgin, Nevzat; Haberal, Mehmet

2005-06-01

Continuous quality improvement activities are necessary to achieve excellence at any institution. The Başkent University Hospitals have implemented continuous in-service training programs to improve all health services provided. Also, continuing medical education programs are being instituted in organ procurement and transplantation centers. In addition to receiving basic orientation and training upon hiring, transplant coordination staff complete forms that detail their current training status, further job training needed, and other courses of interest. The information is used to monitor skill levels, to determine the success of educational programs, and to identify further education that is needed. Our aim is to improve the quality of transplant coordination activities and increase organ donation at the hospitals in our network through effective monitoring and evaluation of continuous in-service training. These training programs enhance staff members' understanding of and participation in procedures related to transplantation and improves the total quality of the transplantation process. In the near future, this training model may be used to improve the donor hospital education program in Turkey.

Scalable Decision Support at the Point of Care: A Substitutable Electronic Health Record App for Monitoring Medication Adherence

PubMed Central

Mandel, Joshua; Jonikas, Magdalena; Ramoni, Rachel Badovinac; Kohane, Isaac S; Mandl, Kenneth D

2013-01-01

Background Non-adherence to prescribed medications is a serious health problem in the United States, costing an estimated $100 billion per year. While poor adherence should be addressable with point of care health information technology, integrating new solutions with existing electronic health records (EHR) systems require customization within each organization, which is difficult because of the monolithic software design of most EHR products. Objective The objective of this study was to create a published algorithm for predicting medication adherence problems easily accessible at the point of care through a Web application that runs on the Substitutable Medical Apps, Reusuable Technologies (SMART) platform. The SMART platform is an emerging framework that enables EHR systems to behave as “iPhone like platforms” by exhibiting an application programming interface for easy addition and deletion of third party apps. The app is presented as a point of care solution to monitoring medication adherence as well as a sufficiently general, modular application that may serve as an example and template for other SMART apps. Methods The widely used, open source Django framework was used together with the SMART platform to create the interoperable components of this app. Django uses Python as its core programming language. This allows statistical and mathematical modules to be created from a large array of Python numerical libraries and assembled together with the core app to create flexible and sophisticated EHR functionality. Algorithms that predict individual adherence are derived from a retrospective study of dispensed medication claims from a large private insurance plan. Patients’ prescription fill information is accessed through the SMART framework and the embedded algorithms compute adherence information, including predicted adherence one year after the first prescription fill. Open source graphing software is used to display patient medication information and the results of statistical prediction of future adherence on a clinician-facing Web interface. Results The user interface allows the physician to quickly review all medications in a patient record for potential non-adherence problems. A gap-check and current medication possession ratio (MPR) threshold test are applied to all medications in the record to test for current non-adherence. Predictions of 1-year non-adherence are made for certain drug classes for which external data was available. Information is presented graphically to indicate present non-adherence, or predicted non-adherence at one year, based on early prescription fulfillment patterns. The MPR Monitor app is installed in the SMART reference container as the “MPR Monitor”, where it is publically available for use and testing. MPR is an acronym for Medication Possession Ratio, a commonly used measure of adherence to a prescribed medication regime. This app may be used as an example for creating additional functionality by replacing statistical and display algorithms with new code in a cycle of rapid prototyping and implementation or as a framework for a new SMART app. Conclusions The MPR Monitor app is a useful pilot project for monitoring medication adherence. It also provides an example that integrates several open source software components, including the Python-based Django Web framework and python-based graphics, to build a SMART app that allows complex decision support methods to be encapsulated to enhance EHR functionality. PMID:23876796

LEADER Program Results for 2009: an Activity and Spectrum Analysis of Linezolid Using 6,414 Clinical Isolates from 56 Medical Centers in the United States▿†

PubMed Central

Farrell, David J.; Mendes, Rodrigo E.; Ross, James E.; Sader, Helio S.; Jones, Ronald N.

2011-01-01

The LEADER Program monitors the in vitro activity of linezolid in sampled U.S. medical centers using reference broth microdilution methods with supporting molecular investigations in a central laboratory design. This report summarizes data obtained in 2009, the 6th consecutive year of this longitudinal study. A total of 6,414 isolates from 56 medical centers in all nine Census regions across the United States participated in 2009. For the six leading species/groups, the following linezolid MIC90 values were observed: Staphylococcus aureus, 2 μg/ml; coagulase-negative staphylococci (CoNS), 1 μg/ml; Enterococcus spp., 2 μg/ml; Streptococcus pneumoniae, 1 μg/ml; viridans group streptococci, 1 μg/ml; and beta-hemolytic streptococci, 1 μg/ml. Linezolid resistance was only 0.34% overall, with no evidence of significant increase in the LEADER Program since 2006. The predominant linezolid resistant mechanism found was a G2576T mutation in the 23S rRNA. L3/L4 riboprotein mutations were also found. The mobile multidrug-resistant cfr gene was found in four strains (two S. aureus strains and one strain each of S. epidermidis and S. capitis) from four different states, suggesting persistence but a lack of dissemination. Linezolid continues to exhibit excellent activity and spectrum, and this study documents the need for continued monitoring of emerging mechanisms of resistance over a wide geographic area. PMID:21670176

Impact of a pharmaceutical care program on liver transplant patients' compliance with immunosuppressive medication: a prospective, randomized, controlled trial using electronic monitoring.

PubMed

Klein, Anja; Otto, Gerd; Krämer, Irene

2009-03-27

Compliance with immunosuppressive therapy plays a major role in the long-term success of organ transplantation. Thus, strategies to promote compliance in posttransplant care are of particular interest. At the pharmacy department of the University Hospital Mainz, a program for pharmaceutical care of organ transplant patients has been developed for the first time ever. The main objective of the presented study was to examine the influence of this program on liver transplant patients' compliance with immunosuppressive therapy. To measure compliance, medication event monitoring systems were used. Dosing compliance (DC) was calculated for each patient and the mean DC was compared between the two groups. Further direct and indirect methods of measuring compliance served to confirm the electronic compliance data. Pharmaceutical care of liver transplant patients led to a significant increase in compliance with the immunosuppressive therapy. The mean DC of the intervention group was 90%+/-6% compared with 81%+/-12% in the control group (P=0.015). Only two patients (10%) in the intervention group and nine patients (43%) in the control group showed a DC less than 80% (P=0.032). Furthermore, patients in the intervention group were more likely to achieve target blood levels. Patients who received pharmaceutical care with traditional patient care showed significantly better compliance with their immunosuppressive medication than patients who received only traditional patient care. Pharmaceutical care proved to be an effective intervention that should be implemented in posttransplant care.

The Business of Bronchoscopy: How to Set up an Interventional Pulmonology Program.

PubMed

Kessler, Edward; Wahidi, Momen M

2018-03-01

Interventional pulmonology has advanced rapidly over the last decade and continues to evolve with new medical advances and changes in the health care landscape. Establishing and developing a new interventional pulmonology program entails careful planning, including a needs assessment, a business plan with financial and marketing considerations, and outcomes monitoring. Addressing these aspects will provide a framework to ensure the success of a new interventional pulmonology program that can provide valuable services to the local practice and community. Copyright © 2017 Elsevier Inc. All rights reserved.

Secure Authentication for Remote Patient Monitoring with Wireless Medical Sensor Networks †

PubMed Central

Hayajneh, Thaier; Mohd, Bassam J; Imran, Muhammad; Almashaqbeh, Ghada; Vasilakos, Athanasios V.

2016-01-01

There is broad consensus that remote health monitoring will benefit all stakeholders in the healthcare system and that it has the potential to save billions of dollars. Among the major concerns that are preventing the patients from widely adopting this technology are data privacy and security. Wireless Medical Sensor Networks (MSNs) are the building blocks for remote health monitoring systems. This paper helps to identify the most challenging security issues in the existing authentication protocols for remote patient monitoring and presents a lightweight public-key-based authentication protocol for MSNs. In MSNs, the nodes are classified into sensors that report measurements about the human body and actuators that receive commands from the medical staff and perform actions. Authenticating these commands is a critical security issue, as any alteration may lead to serious consequences. The proposed protocol is based on the Rabin authentication algorithm, which is modified in this paper to improve its signature signing process, making it suitable for delay-sensitive MSN applications. To prove the efficiency of the Rabin algorithm, we implemented the algorithm with different hardware settings using Tmote Sky motes and also programmed the algorithm on an FPGA to evaluate its design and performance. Furthermore, the proposed protocol is implemented and tested using the MIRACL (Multiprecision Integer and Rational Arithmetic C/C++) library. The results show that secure, direct, instant and authenticated commands can be delivered from the medical staff to the MSN nodes. PMID:27023540

Secure Authentication for Remote Patient Monitoring with Wireless Medical Sensor Networks.

PubMed

Hayajneh, Thaier; Mohd, Bassam J; Imran, Muhammad; Almashaqbeh, Ghada; Vasilakos, Athanasios V

2016-03-24

There is broad consensus that remote health monitoring will benefit all stakeholders in the healthcare system and that it has the potential to save billions of dollars. Among the major concerns that are preventing the patients from widely adopting this technology are data privacy and security. Wireless Medical Sensor Networks (MSNs) are the building blocks for remote health monitoring systems. This paper helps to identify the most challenging security issues in the existing authentication protocols for remote patient monitoring and presents a lightweight public-key-based authentication protocol for MSNs. In MSNs, the nodes are classified into sensors that report measurements about the human body and actuators that receive commands from the medical staff and perform actions. Authenticating these commands is a critical security issue, as any alteration may lead to serious consequences. The proposed protocol is based on the Rabin authentication algorithm, which is modified in this paper to improve its signature signing process, making it suitable for delay-sensitive MSN applications. To prove the efficiency of the Rabin algorithm, we implemented the algorithm with different hardware settings using Tmote Sky motes and also programmed the algorithm on an FPGA to evaluate its design and performance. Furthermore, the proposed protocol is implemented and tested using the MIRACL (Multiprecision Integer and Rational Arithmetic C/C++) library. The results show that secure, direct, instant and authenticated commands can be delivered from the medical staff to the MSN nodes.

The Texas Medication Algorithm Project Patient and Family Education Program: a consumer-guided initiative.

PubMed

Toprac, M G; Rush, A J; Conner, T M; Crismon, M L; Dees, M; Hopkins, C; Rowe, V; Shon, S P

2000-07-01

Educating patients with mental illness and their families about the illness and its treatment is essential to successful medication (disease) management. Specifically, education provides patients and families with the background they need to participate in treatment planning and implementation as full "partners" with clinicians. Thus, education increases the probability that appropriate and accurate treatment decisions will be made and that a treatment regimen will be followed. The Texas Medication Algorithm Project (TMAP) has incorporated these concepts into its philosophy of care and accordingly created a Patient and Family Education Program (PFEP) to complement the utilization of medication algorithms for the treatment of schizophrenic, bipolar, and major depressive disorders. This article describes how a team of mental health consumers, advocates, and professionals developed and implemented the PFEP. In keeping with the TMAP philosophy of care, consumers were true partners in the program's development and implementation. They not only created several components of the program and incorporated the consumer perspective, but they also served as program trainers and advocates. Initially, PFEP provides basic and subsequently more in-depth information about the illness and its treatment, including such topics as symptom monitoring and management and self-advocacy with one's treatment team. It includes written, pictorial, videotaped, and other media used in a phased manner by clinicians and consumer educators, in either individual or group formats.

Outsourcing an Effective Postdischarge Call Program

PubMed Central

Meek, Kevin L.; Williams, Paula; Unterschuetz, Caryn J.

2018-01-01

To improve patient satisfaction ratings and decrease readmissions, many organizations utilize internal staff to complete postdischarge calls to recently released patients. Developing, implementing, monitoring, and sustaining an effective call program can be challenging and have eluded some of the renowned medical centers in the country. Using collaboration with an outsourced vendor to bring state-of-the-art call technology and staffed with specially trained callers, health systems can achieve elevated levels of engagement and satisfaction for their patients postdischarge. PMID:29494453

KSC-94PC-0901

NASA Image and Video Library

1994-07-20

KENNEDY SPACE CENTER, FLA. -- Dr. Irene Duhart Long is the director, Biomedical Operations and Research Office, at the Kennedy Space Center effective July 24, 1994. She is responsible for the program management of the center's aerospace and occupational medicine, life sciences research, environmental health programs and the operations management of the life sciences support facilities. Dr. Long also is responsible for providing the coordinating medical, environmental monitoring and environmental health support to launch and landing activities and day-to-day institutional functions.

Cardiac rehabilitation after myocardial infarction.

PubMed

Contractor, Aashish S

2011-12-01

Cardiac rehabilitation/secondary prevention programs are recognized as integral to the comprehensive care of patients with coronary heart disease (CHD), and as such are recommended as useful and effective (Class I) by the American Heart Association and the American College of Cardiology in the treatment of patients with CHD. The term cardiac rehabilitation refers to coordinated, multifaceted interventions designed to optimize a cardiac patient's physical, psychological, and social functioning, in addition to stabilizing, slowing, or even reversing the progression of the underlying atherosclerotic processes, thereby reducing morbidity and mortality. Cardiac rehabilitation, aims at returning the patient back to normal functioning in a safe and effective manner and to enhance the psychosocial and vocational state of the patient. The program involves education, exercise, risk factor modification and counselling. A meta-analysis based on a review of 48 randomized trials that compared outcomes of exercise-based rehabilitation with usual medical care, showed a reduction of 20% in total mortality and 26% in cardiac mortality rates, with exercise-based rehabilitation compared with usual medical care. Risk stratification helps identify patients who are at increased risk for exercise-related cardiovascular events and who may require more intensive cardiac monitoring in addition to the medical supervision provided for all cardiac rehabilitation program participants. During exercise, the patients' ECG is continuously monitored through telemetry, which serves to optimize the exercise prescription and enhance safety. The safety of cardiac rehabilitation exercise programs is well established, and the occurrence of major cardiovascular events during supervised exercise is extremely low. As hospital stays decrease, cardiac rehabilitation is assuming an increasingly important role in secondary prevention. In contrast with its growing importance internationally, there are very few cardiac rehabilitation centers in India at the present moment.

Monitoring Compliance to Promote Quality Assurance: Development of a Mental Health Clinical Chart Audit Tool in Belize, 2013.

PubMed

Winer, Rachel A; Bennett, Eleanor; Murillo, Illouise; Schuetz-Mueller, Jan; Katz, Craig L

2015-09-01

Belize trained psychiatric nurse practitioners (PNPs) in the early 1990s to provide mental health services throughout the country. Despite overwhelming success, the program is limited by lack of monitoring, evaluation, and surveillance. To promote quality assurance, we developed a chart audit tool to monitor mental healthcare delivery compliance for initial psychiatric assessment notes completed by PNPs. After reviewing the Belize Health Information System electronic medical record system, we developed a clinical audit tool to capture 20 essential components for initial assessment clinical notes. The audit tool was then piloted for initial assessment notes completed during July through September of 2013. One hundred and thirty-four initial psychiatric interviews were audited. The average chart score among all PNPs was 9.57, ranging from 3 to 15. Twenty-three charts-or 17.2%-had a score of 14 or higher and met a 70% compliance benchmark goal. Among indicators most frequently omitted included labs ordered and named (15.7%) and psychiatric diagnosis (21.6%). Explicit statement of medications initiated with dose and frequency occurred in 47.0% of charts. Our findings provide direction for training and improvement, such as emphasizing the importance of naming labs ordered, medications and doses prescribed, and psychiatric diagnoses in initial assessment clinical notes. We hope this initial assessment helps enhance mental health delivery compliance by prompting creation of BHIS templates, development of audits tools for revisit follow-up visits, and establishment of corrective actions for low-scoring practitioners. These efforts may serve as a model for implementing quality assurance programming in other low resource settings.

[Drug-drug interactions: interactions between xenobiotics].

PubMed

Haen, E

2014-04-01

Drug-drug interactions (DDI) are a major topic in programs for continuous medical education (CME). Many physicians are afraid of being trapped into charges of malpractice; however, DDI cannot be avoided in many cases. They belong to routine medical practice and it is often impossible to avoid them. Moreover, they do not just occur between drugs but between any kind of foreign substance (xenobiotica), such as food (e.g. grapefruit juice, broccoli, barbecue) as well as legal (e.g. tobacco smoke, caffeine and alcohol) and illegal drugs. Therefore, the medical challenge is not just to avoid any interaction. Instead the physician faces the question of how to proceed with drug treatment in the presence of such interactions. Based on the medical education a physician has to judge first of all whether there is a risk for interactions in the prescription being planned for an individual patient. The classification of interactions proposed in this article (PD1-PD4, PK1-PK3) might help as a sort of check list. For more detailed information the physician can then consult one of the many databases available on the internet, such as PSIAConline (http://www.psiac.de) and MediQ (http://www.mediq.ch). Pharmacokinetic interactions can be easily assessed, monitored and controlled by therapeutic drug monitoring (TDM). Besides these tools it is important to keep in mind that nobody knows everything; even physicians do not know everything. So take pride in asking someone who might help and for this purpose AGATE offers a drug information service AID (http://www.amuep-agate.de). Just good for nothing, without being based on any kind of medical approach are computer programs that judge prescriptions without taking into account a patient's individual peculiarities. In case these types of programs produce red exclamation marks or traffic lights to underline their judgment, they might even work in a contrapuntal way by just eliciting insecurity and fear.

Assuring Quality Control of Clinical Education in Multiple Clinical Affiliates.

ERIC Educational Resources Information Center

Davis, Judith A.

A plan was developed to assure equivalency of clinical education among the medical laboratory technician (MLT) programs affiliated with Sandhills Community College. The plan was designed by faculty to monitor the quality of clinical courses offered by the clinical affiliates. The major strategies were to develop competencies, slide/tape modules, a…

Using the School Nurse to Support Your Elementary Physical Education Program

ERIC Educational Resources Information Center

Kozub, Mary L.; Kozub, Francis M.

2012-01-01

The roles of teachers, nurses, and other educational personnel are changing. In the case of the school nurse, the responsibilities have expanded to include health promotion and various other roles outside of the traditional duties of providing first aid, administrating medications, and monitoring the daily health status of students (Broussard,…

An analysis of moderate sedation protocols used in dental specialty programs: a retrospective observational study.

PubMed

Setty, Madhavi; Montagnese, Thomas A; Baur, Dale; Aminoshariae, Anita; Mickel, Andre

2014-09-01

Pain and anxiety control is critical in dental practice. Moderate sedation is a useful adjunct in managing a variety of conditions that make it difficult or impossible for some people to undergo certain dental procedures. The purpose of this study was to analyze the sedation protocols used in 3 dental specialty programs at the Case Western Reserve University School of Dental Medicine, Cleveland, OH. A retrospective analysis was performed using dental school records of patients receiving moderate sedation in the graduate endodontic, periodontic, and oral surgery programs from January 1, 2010, to December 31, 2012. Information was gathered and the data compiled regarding the reasons for sedation, age, sex, pertinent medical conditions, American Society of Anesthesiologists physical status classifications, routes of administration, drugs, dosages, failures, complications, and other information that was recorded. The reasons for the use of moderate sedation were anxiety (54%), local anesthesia failures (15%), fear of needles (15%), severe gag reflex (8%), and claustrophobia with the rubber dam (8%). The most common medical conditions were hypertension (17%), asthma (15%), and bipolar disorder (8%). Most patients were classified as American Society of Anesthesiologists class II. More women (63.1%) were treated than men (36.9%). The mean age was 45 years. Monitoring and drugs varied among the programs. The most common tooth treated in the endodontic program was the mandibular molar. There are differences in the moderate sedation protocols used in the endodontic, periodontic, and oral surgery programs regarding monitoring, drugs used, and record keeping. Copyright © 2014 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Residency Programs' Evaluations of the Competencies: Data Provided to the ACGME About Types of Assessments Used by Programs

PubMed Central

Holt, Kathleen D.; Miller, Rebecca S.; Nasca, Thomas J.

2010-01-01

Background In 1999, the Accreditation Council for Graduate Medical Education (ACGME) Outcome Project began to focus on resident performance in the 6 competencies of patient care, medical knowledge, professionalism, practice-based learning and improvement, interpersonal communication skills, and professionalism. Beginning in 2007, the ACGME began collecting information on how programs assess these competencies. This report provides information on the nature and extent of those assessments. Methods Using data collected by the ACGME for site visits, we use descriptive statistics and percentages to describe the number and type of methods and assessors accredited programs (n  =  4417) report using to assess the competencies. Observed differences among specialties, methodologies, and assessors are tested with analysis of variance procedures. Results Almost all (>97%) of programs report assessing all of the competencies and using multiple methods and multiple assessors. Similar assessment methods and evaluator types were consistently used across the 6 competencies. However, there were some differences in the use of patient and family as assessors: Primary care and ambulatory specialties used these to a greater extent than other specialties. Conclusion Residency programs are emphasizing the competencies in their evaluation of residents. Understanding the scope of evaluation methodologies that programs use in resident assessment is important for both the profession and the public, so that together we may monitor continuing improvement in US graduate medical education. PMID:22132294

Caregivers Create a Veteran-Centric Community in VHA Medical Foster Homes.

PubMed

Haverhals, Leah M; Manheim, Chelsea E; Gilman, Carrie V; Jones, Jacqueline; Levy, Cari

2016-01-01

The Veteran's Health Administration's Medical Foster Home program offers a unique long-term care option for veterans who require nursing-home- or assisted-living-level care. Veterans in a medical foster home reside with community-based caregivers who provide 24-hr-a-day care and monitoring. The veterans often remain in the medical foster home until end of life. Support and oversight is provided to the caregiver from the Veteran's Health Administration's community-based medical team. This qualitative descriptive study is based on secondary analysis of interviews with 20 medical foster home caregivers from 7 programs across the United States. The study's research aims are to describe and explain (a) the type of care backgrounds and skills these caregivers possess, (b) caregivers' primary motivations to open their homes to veterans who often have complex medical and social needs, and (c) how caregivers function in their role as primary caregiver for veterans. Findings indicated that caregivers interviewed had worked in long-term care settings and/or cared for family members. A strong desire to serve veterans was a primary motivation for caregivers, rather than financial gain. The caregivers' long-term care skills aided them in building and sustaining the unique medical foster home family-like community.

Implementation of medical monitor system based on networks

NASA Astrophysics Data System (ADS)

Yu, Hui; Cao, Yuzhen; Zhang, Lixin; Ding, Mingshi

2006-11-01

In this paper, the development trend of medical monitor system is analyzed and portable trend and network function become more and more popular among all kinds of medical monitor devices. The architecture of medical network monitor system solution is provided and design and implementation details of medical monitor terminal, monitor center software, distributed medical database and two kind of medical information terminal are especially discussed. Rabbit3000 system is used in medical monitor terminal to implement security administration of data transfer on network, human-machine interface, power management and DSP interface while DSP chip TMS5402 is used in signal analysis and data compression. Distributed medical database is designed for hospital center according to DICOM information model and HL7 standard. Pocket medical information terminal based on ARM9 embedded platform is also developed to interactive with center database on networks. Two kernels based on WINCE are customized and corresponding terminal software are developed for nurse's routine care and doctor's auxiliary diagnosis. Now invention patent of the monitor terminal is approved and manufacture and clinic test plans are scheduled. Applications for invention patent are also arranged for two medical information terminals.

Management of Pregnant Women with Type 2 Diabetes Mellitus and the Consequences of Fetal Programming in Their Offspring.

PubMed

Berry, Diane C; Boggess, Kim; Johnson, Quinetta B

2016-05-01

The obesity epidemic has fueled an epidemic of prediabetes and type 2 diabetes mellitus in women of childbearing age. This paper examines the state of the science on preconception and pregnancy management of women with type 2 diabetes to optimize outcomes for the women and their infants. In addition, the consequence of fetal programming as a result of suboptimal maternal glycemic control is discussed. The paper focuses on type 2 diabetes, not type 1 diabetes or gestational diabetes. Management of women with type 2 diabetes includes preconception counseling, preconception weight management and weight loss, proper weight gain during pregnancy, self-monitoring of blood glucose levels, medication, medical nutrition therapy, and exercise.

Mechanisms of Prescription Drug Diversion Among Impaired Physicians

PubMed Central

Cummings, Simone Marie; Merlo, Lisa; Cottler, Linda B.

2014-01-01

The diversion of medications by physicians is a seldom discussed problem in the United States. A better understanding of the mechanisms of diversion could assist decision-makers as they seek to develop preventive. To identify these mechanisms, nine focus groups of physicians undergoing monitoring for substance abuse by a state-based physician health program (PHP) were conducted. The content analysis revealed that physicians divert medications by stealing from the office or hospital, by defrauding patients and insurers, by using medication samples, and by misusing valid prescriptions. The implementation of policy interventions targeting these mechanisms has the potential to mitigate the amount of physician diversion that occurs. PMID:21745042

Use of a Relational Database to Support Clinical Research: Application in a Diabetes Program

PubMed Central

Lomatch, Diane; Truax, Terry; Savage, Peter

1981-01-01

A database has been established to support conduct of clinical research and monitor delivery of medical care for 1200 diabetic patients as part of the Michigan Diabetes Research and Training Center (MDRTC). Use of an intelligent microcomputer to enter and retrieve the data and use of a relational database management system (DBMS) to store and manage data have provided a flexible, efficient method of achieving both support of small projects and monitoring overall activity of the Diabetes Center Unit (DCU). Simplicity of access to data, efficiency in providing data for unanticipated requests, ease of manipulations of relations, security and “logical data independence” were important factors in choosing a relational DBMS. The ability to interface with an interactive statistical program and a graphics program is a major advantage of this system. Out database currently provides support for the operation and analysis of several ongoing research projects.

[Contribution of medical technologists in team medical care of diabetics].

PubMed

Sato, Itsuko; Jikimoto, Takumi; Ooyabu, Chinami; Kusuki, Mari; Okano, Yosie; Mukai, Masahiko; Kawano, Seiji; Kumagai, Shunichi

2006-08-01

For the effective treatment of diabetic mellitus (DM), patients are encouraged to self-manage their disease according to the doctor's instructions and advice from certified diabetes educators (CDE) and other comedical staff. Therefore, the cooperation of medical staff consisting of a doctor, CDE, nurse, pharmacist, dietitian, and medical technologist is important for DM education. Medical technologists licensed for CDE (MT-CDE) have been participating in the DM education team in Kobe University Hospital since 2000. MT-CDE are in charge of classes for medical tests, guidance for self-monitoring of blood glucose and teaching how to read the fluctuation graph of the blood glucose level in the education program for hospitalized DM patients. MT-CDEs teach at the bedside how to read the results of medical tests during the first few days of hospitalization using pamphlets for medical tests. The pamphlets are made comprehensible for patients by using graphics and photographs as much as possible. It is important to create a friendly atmosphere and answer frank questions from patients, since they often feel stress when having medical tests at the early stage of hospitalization. This process of questions and answers promotes their understanding of medical tests, and seems to reduce their anxiety about having tests. We repeatedly evaluate their level of understanding during hospitalization. By showing them the fluctuation graph of the glucose level, patients can easily understand the status of their DM. When prescriptions are written on the graph, their therapeutic effects are more comprehensible for the patients. The items written on the graph are chosen to meet the level of understanding of each patient to promote their motivation. In summary, the introduction of MT-CDE has been successful in the education program for DM patients in our hospital. We plan to utilize the skills and knowledge of MT-CDE more in our program so that our DM education program will help patients cope with life with DM.

Engagement of National Board of Examinations in strengthening public health education in India: present landscape, opportunities and future directions.

PubMed

Sharma, Anjali; Zodpey, Sanjay; Batra, Bipin

2014-01-01

A trained and adequate heath workforce forms the crux in designing, implementing and monitoring health programs and delivering quality health services. Education is recognized as a critical instrument for creating such trained health professionals who can effectively address the 21 st century health challenges. At present, the Public Health Education in India is offered through medical colleges and also outside the corridors of medical colleges which was not the scenario earlier. Traditionally, Public Health Education has been a domain of medical colleges and was open for medical graduates only. In order to standardize the Postgraduate Medical Education in India, the National Board of Examinations (NBE) was set up as an independent autonomous body of its kind in the country in the field of medical sciences with the prime objective of improving the quality of the medical education. NBE has also played a significant role in enhancing Public Health Education in India through its Diplomat of National Board (DNB) Programs in Social and Preventive Medicine, Health and Hospital Administration, Maternal and Child Health, Family Medicine and Field Epidemiology. It envisions creating a cadre of skilled and motivated public health professionals and also developing a roadmap for postgraduate career pathways. However, there still exists gamut of opportunities for it to engage in expanding the scope of Public Health Education. It can play a key role in accreditation of public health programs and institutions which can transform the present landscape of education of health professionals. It also needs to revisit and re-initiate programs like DNB in Tropical Medicine and Occupational Health which were discontinued. The time is imperative for NBE to seize these opportunities and take necessary actions in strengthening and expanding the scope of Public Health Education in India.

Outsourcing an Effective Postdischarge Call Program: A Collaborative Approach.

PubMed

Meek, Kevin L; Williams, Paula; Unterschuetz, Caryn J

To improve patient satisfaction ratings and decrease readmissions, many organizations utilize internal staff to complete postdischarge calls to recently released patients. Developing, implementing, monitoring, and sustaining an effective call program can be challenging and have eluded some of the renowned medical centers in the country. Using collaboration with an outsourced vendor to bring state-of-the-art call technology and staffed with specially trained callers, health systems can achieve elevated levels of engagement and satisfaction for their patients postdischarge.

Development of Medical Technology for Contingency Response to Marrow Toxic Agents

DTIC Science & Technology

2013-10-30

NUMBER N/A 5b. GRANT NUMBER N00014-12-1-0142 5c. PROGRAM ELEMENT NUMBER N/A 6. AUTHOR( S ) Spellman, Stephen 5d. PROJECT NUMBER N/A 5e. TASK...NUMBER Project 1, 2, 3, 4 5f. WORK UNIT NUMBER N/A 7. PERFORMING ORGANIZATION NAME( S ) AND ADDRESS(ES) National Marrow Donor Program 3001 Broadway...St., N.E., Ste. 500 Minneapolis, MN 55413 8. PERFORMING ORGANIZATION REPORT NUMBER N/A 9. SPONSORING/MONITORING AGENCY NAME( S ) AND ADDRESS(ES

Medical surveillance and biological monitoring of lead exposed employees

NASA Technical Reports Server (NTRS)

Ferguson, E. B.

1993-01-01

Employee health protection is an employer responsibility. The multi-faceted aspects of employee protection from the potentially harmful effects of inorganic lead sometimes stress the relationships of several employer units. These include supervision and management, safety, operations and maintenance, engineering, environmental health, environmental management, and occupational medicine. The administrative aspects of program development are discussed. The purpose is to emphasize the opportunity for cooperation by all of the employee health components in developing an optimum surveillance and protection program.

76 FR 38913 - World Trade Center Health Program Requirements for Enrollment, Appeals, Certification of Health...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-01

...Title I of the James Zadroga Health and Compensation Act of 2010 amended the Public Health Service Act (PHS Act) by adding Title XXXIII, which establishes the World Trade Center (WTC) Health Program. Sections 3311, 3312, and 3321 of Title XXXIII of the PHS Act require that the WTC Program Administrator develop regulations to implement portions of the WTC Health Program established within the Department of Health and Human Services (HHS). The WTC Health Program, which will be administered in part by the Director of the National Institute for Occupational Safety and Health (NIOSH), within the Centers for Disease Control and Prevention (CDC), will provide medical monitoring and treatment to eligible firefighters and related personnel, law enforcement officers, and rescue, recovery and cleanup workers who responded to the September 11, 2001, terrorist attacks in New York City, Shanksville, PA, and at the Pentagon, and to eligible survivors of the New York City attacks. This interim final rule establishes the processes by which eligible responders and survivors may apply for enrollment in the WTC Health Program, obtain health monitoring and treatment for WTC-related health conditions, and appeal enrollment and treatment decisions. This interim final rule also establishes a process for the certification of health conditions, and reimbursement rates for providers who provide initial health evaluations, treatment, and health monitoring.

Quarterly Program Progress Report April 1, 2002-June 30, 2002

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

Palafox, Neal A., MD, MPH

2002-07-31

DOE B188 DOE/PHRI Special Medical Care Program in the Republic of the Marshall Islands (RMI)Quarterly Program Progress Report The DOE/PHRI Special Medical Care Program continues to provide, on a year round basis, a broad spectrum of medical care to the DOE patient population. During the fourth quarter of Year 4, the following medical services were provided: (1) Annual medical examinations for the DOE patient population (see Exhibit 1 for details). (2) Medications for the DOE patient population. (3) Preventive and primary medical care to the DOE patient population in the RMI as time and resources permit. (4) Additional manpower formore » the outpatient clinics at Ebeye and Majuro Hospitals (see Exhibit 2 for details). (5) Ancillary services such as labs, radiology and pharmacy in coordination with Kwajalein Hospital, Majuro Hospital and the 177 Health Care Program (177 HCP). (6) Referrals to Ebeye Hospital, Majuro Hospital and Kwajalein Hospital as necessary. (7) Referrals to Straub Clinic and Hospital in Honolulu as necessary (for details see Exhibit 1). (8) Monitored and adjusted monthly annual examination schedules based on equipment failure at Kwajalein. In addition to the above, the program was also involved in the following activities during this quarter: (1) Organized and conducted continuing medical education (CME) talks for the program's RMI staff and other RMI healthcare workers. (2) Held meetings with RMI government officials and Local Atoll government officials. (3) Input past medical records into the Electronic Medical Record (EMR) system. (4) Made adjustments to and created more templates for the EMR system. (5) Coordinated with the Public Health Departments on Majuro and Ebeye. (6) Met with PEACESAT to discuss possible collaboration on high speed Internet access. (7) Looked for opportunities to expand the program's telehealth capabilities. (8) Participated in the DOE-RMI Meeting in Honolulu. (9) Finalized the agreement with the RMI Ministry of Health and Environment (MOHE) and Majuro Hospital to hire Dr. Marie Lanwi on a part-time basis. (10) Held a Community Advisory Group (CAG) Meeting and Community Meeting on Majuro. (11) Negotiated with Kwajalein with regards to the increase in laboratory and procedure costs and continuing Mammography services for the DOE patient population. (12) Met with DOE in Honolulu to discuss the next year's program and budget. (13) Trained new residents in the use of the electronic medical record system. (14) Conducted electronic medical record audits. (15) Participated in a training session for the appointment scheduler module by Physician Micro System, Inc. on the EMR system. (16) Worked on the Year 5 Continuation Application and Budget. (17) Finalized the Memorandum of Understanding (MOU) with 177. (18) Worked with DOE and Bechtel Nevada (BN) to reduce PHRI program costs to meet an increase in referral costs paid by Bechtel. This report details the additions and changes to the program for the April 1, 2002-June 30, 2002 period.« less

Development of Medical Technology for Contingency Response to Marrow Toxic Agents

DTIC Science & Technology

2013-04-29

Period 1 5a. CONTRACT NUMBER N/A 5b. GRANT NUMBER N00014-13-1-0039 5c. PROGRAM ELEMENT NUMBER N/A 6. AUTHOR( S ) Spellman, Stephen 5d. PROJECT...NUMBER N/A 5e. TASK NUMBER Project 1, 2, 3, 4 5f. WORK UNIT NUMBER N/A 7. PERFORMING ORGANIZATION NAME( S ) AND ADDRESS(ES) National Marrow Donor... S ) AND ADDRESS(ES) Office of Naval Research 875 N. Randolph St. Arlington, VA 22203 10. SPONSOR/MONITOR’S ACRONYM( S ) ONR 11. SPONSORING/MONITORING

Optimizing Antibiotic Use in Nursing Homes Through Antibiotic Stewardship.

PubMed

Sloane, Philip D; Huslage, Kirk; Kistler, Christine E; Zimmerman, Sheryl

2016-01-01

Antibiotic stewardship is becoming a requirement for nursing homes. Programs should be interdisciplinary and multifaceted; should have support from nursing home administrators; and should aim to promote antibiotics only when needed, not just in case. Recommended components include use of evidence-based guidelines; ongoing monitoring of antibiotic prescriptions, cultures, and study results; monitoring of health outcomes; use of nursing home-specific antibiograms; regular reporting and feedback to medical providers and nurses; and education of residents and families. ©2016 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.

Automated biowaste sampling system feces monitoring system

NASA Technical Reports Server (NTRS)

Hunt, S. R.; Glanfield, E. J.

1979-01-01

The Feces Monitoring System (FMS) Program designed, fabricated, assembled and tested an engineering model waste collector system (WCS) to be used in support of life science and medical experiments related to Shuttle missions. The FMS design was patterned closely after the Shuttle WCS, including: interface provisions; mounting; configuration; and operating procedures. These similarities make it possible to eventually substitute an FMS for the Shuttle WCS of Orbiter. In addition, several advanced waste collection features, including the capability of real-time inertial fecal separation and fecal mass measurement and sampling were incorporated into the FMS design.

Clinical services provided by staff pharmacists in a community hospital.

PubMed

Garrelts, J C; Smith, D F

1990-09-01

A program for developing staff pharmacists' clinical skills and documenting pharmacists' clinical interventions in a large community teaching hospital is described. A coordinator hired in 1984 to develop clinical pharmacy services began a didactic and experiential program for baccalaureate-level staff pharmacists. Fourteen educational modules are supplemented by journal and textbook articles and small-group discussions of clinical cases, and the clinical coordinator provides individual training on the patient-care units for each pharmacist. Monitoring of clinical pharmacy services began in June 1987; each intervention provided by a pharmacist is recorded on a specially designed form. A target-drug program is used to document cost avoidance achieved through clinical services. Information collected through these monitoring activities is used to educate the pharmacy staff, shared with the pharmacy and therapeutics committee, and used to monitor prescribing patterns of individual physicians. The data are used in the hospital's productivity-monitoring system. All pharmacists who were on staff in 1984 have completed the educational modules, and all new employees are in the process. Since monitoring began, the number of clinical interventions has averaged 2098 per month. Cost avoidance has averaged $9306 per month. Over a five-year period, the development of staff pharmacists' clinical services raised the level of professional practice, produced substantial cost avoidance, and increased the number of pharmacist interventions in medication use.

Integrating an internet-mediated walking program into family medicine clinical practice: a pilot feasibility study.

PubMed

Goodrich, David E; Buis, Lorraine R; Janney, Adrienne W; Ditty, Megan D; Krause, Christine W; Zheng, Kai; Sen, Ananda; Strecher, Victor J; Hess, Michael L; Piette, John D; Richardson, Caroline R

2011-06-24

Regular participation in physical activity can prevent many chronic health conditions. Computerized self-management programs are effective clinical tools to support patient participation in physical activity. This pilot study sought to develop and evaluate an online interface for primary care providers to refer patients to an Internet-mediated walking program called Stepping Up to Health (SUH) and to monitor participant progress in the program. In Phase I of the study, we recruited six pairs of physicians and medical assistants from two family practice clinics to assist with the design of a clinical interface. During Phase II, providers used the developed interface to refer patients to a six-week pilot intervention. Provider perspectives were assessed regarding the feasibility of integrating the program into routine care. Assessment tools included quantitative and qualitative data gathered from semi-structured interviews, surveys, and online usage logs. In Phase I, 13 providers used SUH and participated in two interviews. Providers emphasized the need for alerts flagging patients who were not doing well and the ability to review participant progress. Additionally, providers asked for summary views of data across all enrolled clinic patients as well as advertising materials for intervention recruitment. In response to this input, an interface was developed containing three pages: 1) a recruitment page, 2) a summary page, and 3) a detailed patient page. In Phase II, providers used the interface to refer 139 patients to SUH and 37 (27%) enrolled in the intervention. Providers rarely used the interface to monitor enrolled patients. Barriers to regular use of the intervention included lack of integration with the medical record system, competing priorities, patient disinterest, and physician unease with exercise referrals. Intention-to-treat analyses showed that patients increased walking by an average of 1493 steps/day from pre- to post-intervention (t = (36) = 4.13, p < 0.01). Providers successfully referred patients using the SUH provider interface, but were less willing to monitor patient compliance in the program. Patients who completed the program significantly increased their step counts. Future research is needed to test the effectiveness of integrating SUH with clinical information systems over a longer evaluation period.

C-B3-03: Development and Pilot Testing of Guidelines to Monitor High-Risk Medications in the Ambulatory Setting

PubMed Central

Tjia, Jennifer; Field, Terry; Garber, Lawrence; Raebel, Marsha; Donovan, Jennifer; Kanaan, Abir; Fischer, Shira; Gagne, Shawn; Zhao, Yanfang; Fuller, Jackie; Gurwitz, Jerry

2010-01-01

Background: Inadequate laboratory monitoring of high-risk medications contributes to preventable adverse drug events. One barrier to appropriate monitoring is lack of standardized monitoring guidelines. The study aims were to develop guidelines to monitor high-risk medications and to assess the prevalence of laboratory testing for these medications in a multispecialty group practice. Methods: We developed guidelines for laboratory monitoring of high-risk medications as part of a patient safety intervention trial. An advisory committee of national experts and local leaders (clinicians, pharmacists, pharmacoepidemiologists, and patient safety experts) used a two-round, internet-based Delphi process to select guideline medications based on the importance of monitoring for efficacy, safety, and drug-drug interactions. Test frequency recommendations were developed by academic pharmacists based on literature review and local interdisciplinary consensus. To estimate the potential impact of the intervention, we determined the prevalence of high-risk drug dispensings and laboratory testing for guideline medications between January 1, 2008 and July 31, 2008. Results: Consensus on medications to include in the guidelines was achieved in two rounds. Final guidelines included 35 drugs/drug classes and 61 laboratory tests. The prevalence of monitoring ranged from <50% to >90%, with infrequently prescribed drugs having a lower prevalence of recommended testing. When more than one test was recommended for a selected medication, monitoring within a medication sometimes differed by > 50%. Conclusions: Even among drugs where there is general consensus that laboratory monitoring is important, prevalence of monitoring is highly variable. Further, infrequently prescribed medications are at higher risk for poor monitoring.

Advancements in medicine from aerospace research

NASA Technical Reports Server (NTRS)

Wooten, F. T.

1972-01-01

A program designed to find second applications for space technology in the medical field is described. Illustrative examples and clinical test results are included for prosthetic urethral devices, ear oximeter for monitoring leukemia patients, devices for measuring low level CO effects on automobile drivers, radiation dosimeter probe for detecting radiation levels in cancerous areas, and electromyographic muscle trainer.

A method for estimating cost savings for population health management programs.

PubMed

Murphy, Shannon M E; McGready, John; Griswold, Michael E; Sylvia, Martha L

2013-04-01

To develop a quasi-experimental method for estimating Population Health Management (PHM) program savings that mitigates common sources of confounding, supports regular updates for continued program monitoring, and estimates model precision. Administrative, program, and claims records from January 2005 through June 2009. Data are aggregated by member and month. Study participants include chronically ill adult commercial health plan members. The intervention group consists of members currently enrolled in PHM, stratified by intensity level. Comparison groups include (1) members never enrolled, and (2) PHM participants not currently enrolled. Mixed model smoothing is employed to regress monthly medical costs on time (in months), a history of PHM enrollment, and monthly program enrollment by intensity level. Comparison group trends are used to estimate expected costs for intervention members. Savings are realized when PHM participants' costs are lower than expected. This method mitigates many of the limitations faced using traditional pre-post models for estimating PHM savings in an observational setting, supports replication for ongoing monitoring, and performs basic statistical inference. This method provides payers with a confident basis for making investment decisions. © Health Research and Educational Trust.

Post-licensure rapid immunization safety monitoring program (PRISM) data characterization.

PubMed

Baker, Meghan A; Nguyen, Michael; Cole, David V; Lee, Grace M; Lieu, Tracy A

2013-12-30

The Post-Licensure Rapid Immunization Safety Monitoring (PRISM) program is the immunization safety monitoring component of FDA's Mini-Sentinel project, a program to actively monitor the safety of medical products using electronic health information. FDA sought to assess the surveillance capabilities of this large claims-based distributed database for vaccine safety surveillance by characterizing the underlying data. We characterized data available on vaccine exposures in PRISM, estimated how much additional data was gained by matching with select state and local immunization registries, and compared vaccination coverage estimates based on PRISM data with other available data sources. We generated rates of computerized codes representing potential health outcomes relevant to vaccine safety monitoring. Standardized algorithms including ICD-9 codes, number of codes required, exclusion criteria and location of the encounter were used to obtain the background rates. The majority of the vaccines routinely administered to infants, children, adolescents and adults were well captured by claims data. Immunization registry data in up to seven states comprised between 5% and 9% of data for all vaccine categories with the exception of 10% for hepatitis B and 3% and 4% for rotavirus and zoster respectively. Vaccination coverage estimates based on PRISM's computerized data were similar to but lower than coverage estimates from the National Immunization Survey and Healthcare Effectiveness Data and Information Set. For the 25 health outcomes of interest studied, the rates of potential outcomes based on ICD-9 codes were generally higher than rates described in the literature, which are typically clinically confirmed cases. PRISM program's data on vaccine exposures and health outcomes appear complete enough to support robust safety monitoring. Copyright © 2013 Elsevier Ltd. All rights reserved.

NASA Johnson Space Center SBIR STTR Program Technology Innovations

NASA Technical Reports Server (NTRS)

Krishen, Kumar

2007-01-01

The Small Business Innovation Research (SBIR) Program increases opportunities for small businesses to participate in research and development (R&D), increases employment, and improves U.S. competitiveness. Specifically the program stimulates U.S. technological innovation by using small businesses to meet federal R&D needs, increasing private-sector commercialization of innovations derived from federal R&D, and fostering and encouraging the participation of socially disadvantaged businesses. In 2000, the Small Business Technology Transfer (STTR) Program extended and strengthened the SBIR Program, increasing its emphasis on pursuing commercial applications by awarding contracts to small business concerns for cooperative R&D with a nonprofit research institution. Modeled after the SBIR Program, STTR is nevertheless a separately funded activity. Technologies that have resulted from the Johnson Space Center SBIR STTR Program include: a device for regenerating iodinated resin beds; laser-assisted in-situ keratomileusis or LASIK; a miniature physiological monitoring device capable of collecting and analyzing a multitude of real-time signals to transmit medical data from remote locations to medical centers for diagnosis and intervention; a new thermal management system for fibers and fabrics giving rise to new line of garments and thermal-enhancing environments; and a highly electropositive material that attracts and retains electronegative particles in water.

Mystery behind the match: an undergraduate medical education–graduate medical education collaborative approach to understanding match goals and outcomes

PubMed Central

Nagler, Alisa; Engle, Deborah L.; Rudd, Mariah; Chudgar, Saumil M.; Weinerth, John L.; Kuhn, Catherine M.; Buckley, Edward; Grochowski, Colleen O’Connor

2016-01-01

Background There is a paucity of information regarding institutional targets for the number of undergraduate medical education (UME) graduates being matched to graduate medical education (GME) programs at their home institutions. At our institution, the Duke University, the number of UME graduates matched to GME programs declined dramatically in 2011. To better understand why this decline may have happened, we sought to identify perceived quality metrics for UME and GME learners, evaluate trends in match outcomes and educational program characteristics, and explore whether there is an ideal retention rate for UME graduates in their home institutions’ GME programs. Methods We analyzed the number of Duke University UME graduates remaining at Duke for GME training over the past 5 years. We collected data to assess for changing characteristics of UME and GME, and performed descriptive analysis of trends over time to investigate the potential impact on match outcomes. Results A one-sample t-test analysis showed no statistically significant difference in the number of Duke UME graduates who stayed for GME training. For both UME and GME, no significant changes in the characteristics of either program were found. Discussion We created a process for monitoring data related to the characteristics or perceived quality of UME and GME programs and developed a shared understanding of what may impact match lists for both UME graduates and GME programs, leaving the Match somewhat less mysterious. While we understand the trend of graduates remaining at their home institutions for GME training, we are uncertain whether setting a goal for retention is reasonable, and so some mystery remains. We believe there is an invaluable opportunity for collaboration between UME and GME stakeholders to facilitate discussion about setting shared institutional goals. PMID:27702432

Mystery behind the match: an undergraduate medical education-graduate medical education collaborative approach to understanding match goals and outcomes.

PubMed

Nagler, Alisa; Engle, Deborah L; Rudd, Mariah; Chudgar, Saumil M; Weinerth, John L; Kuhn, Catherine M; Buckley, Edward; Grochowski, Colleen O'Connor

2016-01-01

There is a paucity of information regarding institutional targets for the number of undergraduate medical education (UME) graduates being matched to graduate medical education (GME) programs at their home institutions. At our institution, the Duke University, the number of UME graduates matched to GME programs declined dramatically in 2011. To better understand why this decline may have happened, we sought to identify perceived quality metrics for UME and GME learners, evaluate trends in match outcomes and educational program characteristics, and explore whether there is an ideal retention rate for UME graduates in their home institutions' GME programs. We analyzed the number of Duke University UME graduates remaining at Duke for GME training over the past 5 years. We collected data to assess for changing characteristics of UME and GME, and performed descriptive analysis of trends over time to investigate the potential impact on match outcomes. A one-sample t -test analysis showed no statistically significant difference in the number of Duke UME graduates who stayed for GME training. For both UME and GME, no significant changes in the characteristics of either program were found. We created a process for monitoring data related to the characteristics or perceived quality of UME and GME programs and developed a shared understanding of what may impact match lists for both UME graduates and GME programs, leaving the Match somewhat less mysterious. While we understand the trend of graduates remaining at their home institutions for GME training, we are uncertain whether setting a goal for retention is reasonable, and so some mystery remains. We believe there is an invaluable opportunity for collaboration between UME and GME stakeholders to facilitate discussion about setting shared institutional goals.

Overview of Pre-Flight Physical Training, In-Flight Exercise Countermeasures and the Post-Flight Reconditioning Program for International Space Station Astronauts

NASA Technical Reports Server (NTRS)

Kerstman, Eric

2011-01-01

International Space Station (ISS) astronauts receive supervised physical training pre-flight, utilize exercise countermeasures in-flight, and participate in a structured reconditioning program post-flight. Despite recent advances in exercise hardware and prescribed exercise countermeasures, ISS crewmembers are still found to have variable levels of deconditioning post-flight. This presentation provides an overview of the astronaut medical certification requirements, pre-flight physical training, in-flight exercise countermeasures, and the post-flight reconditioning program. Astronauts must meet medical certification requirements on selection, annually, and prior to ISS missions. In addition, extensive physical fitness testing and standardized medical assessments are performed on long duration crewmembers pre-flight. Limited physical fitness assessments and medical examinations are performed in-flight to develop exercise countermeasure prescriptions, ensure that the crewmembers are physically capable of performing mission tasks, and monitor astronaut health. Upon mission completion, long duration astronauts must re-adapt to the 1 G environment, and be certified as fit to return to space flight training and active duty. A structured, supervised postflight reconditioning program has been developed to prevent injuries, facilitate re-adaptation to the 1 G environment, and subsequently return astronauts to training and space flight. The NASA reconditioning program is implemented by the Astronaut Strength, Conditioning, and Rehabilitation (ASCR) team and supervised by NASA flight surgeons. This program has evolved over the past 10 years of the International Space Station (ISS) program and has been successful in ensuring that long duration astronauts safely re-adapt to the 1 g environment and return to active duty. Lessons learned from this approach to managing deconditioning can be applied to terrestrial medicine and future exploration space flight missions.

Undergraduate GPAs, MCAT scores, and academic performance the first 2 years in podiatric medical school at Des Moines University.

PubMed

Yoho, Robert M; Antonopoulos, Kosta; Vardaxis, Vassilios

2012-01-01

This study was performed to determine the relationship between undergraduate academic performance and total Medical College Admission Test score and academic performance in the podiatric medical program at Des Moines University. The allopathic and osteopathic medical professions have published educational research examining this relationship. To our knowledge, no such educational research has been published for podiatric medical education. The undergraduate cumulative and science grade point averages and total Medical College Admission Test scores of four podiatric medical classes (2007-2010, N = 169) were compared with their academic performance in the first 2 years of podiatric medical school using pairwise Pearson product moment correlations and multiple regression analysis. Significant low to moderate positive correlations were identified between undergraduate cumulative and science grade point averages and student academic performance in years 1 and 2 of podiatric medical school for each of the four classes (except one) and the pooled data. There was no significant correlation between Medical College Admission Test score and academic performance in years 1 and 2 (except one) and the pooled data. These results identify undergraduate cumulative grade point average as the strongest cognitive admissions variable in predicting academic performance in the podiatric medicine program at Des Moines University, followed by undergraduate science grade point average. These results also suggest limitations of the total Medical College Admission Test score in predicting academic performance. Information from this study can be used in the admissions process and to monitor student progress.

Alcohol use in Polish 9/11 responders: implications for cross-cultural treatment.

PubMed

Katz, Craig L; Jutras-Aswad, Didier; Kiliman, Marta; Pilatowicz, Iwona; Akerele, Evaristo; Marrone, Kathryn; Ozbay, Fatih

2012-01-01

More than 35,000 individuals are estimated to have responded to the World Trade Center (WTC) site following the terrorist attacks of September 11, 2001. The federally funded WTC Medical Monitoring and Treatment Program (WTCMMTP) provides medical monitoring and occupational medicine treatment as well as counseling regarding entitlements and benefits to the workers and volunteers who participated in the WTC response. A major component of the WTCMMTP is the WTC Mental Health Program (WTCMHP), which offers annual mental health assessments and ongoing treatment for those found to have 9/11 associated mental health problems. In the program's 9.5 years of evaluating and treating mental health problems in thousands of Ground Zero responders, diversity in multiple domains (e.g., gender, family, profession and employment status, state of physical health, cultural identity, and immigration status) has been a hallmark of the population served by the program. To illustrate the types of issues that arise in treating this diverse patient population, the authors first present a representative case involving a Polish asbestos worker with an alcohol use disorder. They then discuss how accepted alcohol treatment modalities can and often must be modified in providing psychiatric treatment to Polish responders, in particular, and to foreign-born patients in general. Treatment modalities discussed include cognitive and behavioral therapy, relapse prevention strategies, psychodynamic therapy, motivational approaches, family therapy, group peer support, and pharmacotherapy. Implications for the practice of addiction psychiatry, cultural psychiatry, and disaster psychiatry are discussed.

Utilization of the Arkansas Prescription Monitoring Program to combat prescription drug abuse

PubMed Central

Rittenhouse, Rebecca; Wei, Feifei; Robertson, Denise; Ryan, Kevin

2015-01-01

Objective The Arkansas Prescription Monitoring Program (AR PMP) was implemented in 2013 to combat prescription drug abuse. All enrollees were invited to participate in a user survey available in February 2014, to identify makeup of users, utilization of the program, and changes made to health care practices after implementation of the program. Methods Of the 3694 individual enrollees invited to participate, 1541 (41.7%) completed the survey. Data collected were analyzed to identify changes in health care practices by program frequency of use and user profession. Results Medical doctors, advanced practice nurses, and pharmacists are the professions who use the program most frequently. Daily AR PMP users are considerably more likely than infrequent users to be prompted to access the program by the involvement of a controlled substance (CS) prescription or by office/facility policy requirements. Increased frequency of use of the AR PMP results in positive impacts on CS prescribing and dispensing practices. Conclusion Compelling more users of the AR PMP to be prompted to access the program by the involvement of a CS prescription or by requirements per office/facility policy may increase frequency of use of the program and thereby changes in health care practices to combat prescription drug abuse. PMID:26191489

Hospital Guidelines for Diabetes Management and the Joint Commission-American Diabetes Association Inpatient Diabetes Certification.

PubMed

Arnold, Pamela; Scheurer, Danielle; Dake, Andrew W; Hedgpeth, Angela; Hutto, Amy; Colquitt, Caroline; Hermayer, Kathie L

2016-04-01

The Joint Commission Advanced Inpatient Diabetes Certification Program is founded on the American Diabetes Association's Clinical Practice Recommendations and is linked to the Joint Commission Standards. Diabetes currently affects 29.1 million people in the USA and another 86 million Americans are estimated to have pre-diabetes. On a daily basis at the Medical University of South Carolina (MUSC) Medical Center, there are approximately 130-150 inpatients with a diagnosis of diabetes. The program encompasses all service lines at MUSC. Some important features of the program include: a program champion or champion team, written blood glucose monitoring protocols, staff education in diabetes management, medical record identification of diabetes, a plan coordinating insulin and meal delivery, plans for treatment of hypoglycemia and hyperglycemia, data collection for incidence of hypoglycemia, and patient education on self-management of diabetes. The major clinical components to develop, implement, and evaluate an inpatient diabetes care program are: I. Program management, II. Delivering or facilitating clinical care, III. Supporting self-management, IV. Clinical information management and V. performance measurement. The standards receive guidance from a Disease-Specific Care Certification Advisory Committee, and the Standards and Survey Procedures Committee of the Joint Commission Board of Commissioners. The Joint Commission-ADA Advanced Inpatient Diabetes Certification represents a clinical program of excellence, improved processes of care, means to enhance contract negotiations with providers, ability to create an environment of teamwork, and heightened communication within the organization. Published by Elsevier Inc.

A New Approach to Identify High Burnout Medical Staffs by Kernel K-Means Cluster Analysis in a Regional Teaching Hospital in Taiwan

PubMed Central

Lee, Yii-Ching; Huang, Shian-Chang; Huang, Chih-Hsuan; Wu, Hsin-Hung

2016-01-01

This study uses kernel k-means cluster analysis to identify medical staffs with high burnout. The data collected in October to November 2014 are from the emotional exhaustion dimension of the Chinese version of Safety Attitudes Questionnaire in a regional teaching hospital in Taiwan. The number of effective questionnaires including the entire staffs such as physicians, nurses, technicians, pharmacists, medical administrators, and respiratory therapists is 680. The results show that 8 clusters are generated by kernel k-means method. Employees in clusters 1, 4, and 5 are relatively in good conditions, whereas employees in clusters 2, 3, 6, 7, and 8 need to be closely monitored from time to time because they have relatively higher degree of burnout. When employees with higher degree of burnout are identified, the hospital management can take actions to improve the resilience, reduce the potential medical errors, and, eventually, enhance the patient safety. This study also suggests that the hospital management needs to keep track of medical staffs’ fatigue conditions and provide timely assistance for burnout recovery through employee assistance programs, mindfulness-based stress reduction programs, positivity currency buildup, and forming appreciative inquiry groups. PMID:27895218

Dialectics of a medical provision policy in priority areas in Brazil.

PubMed

Weber, César Augusto Trinta

2017-03-01

The people living in vulnerable areas that are difficult to access in Brazil represent a portion of the population that has proven very sensitive to lack of medical and health services. The government, seeking to solve the situation urgently, implemented the More Doctors Program [Programa Mais Médicos, in the Portuguese original] in 2013. To discuss the More Doctors Program, with the purpose of contributing to the debate on the provision of medical policies in Brazil. Study based on the review of official documents: Programa Mais Médicos - dois anos: mais saúde para os brasileiros, 2015 [More Doctors Program - two years: more health for Brazilians, 2015]; Operational Audit Report, TC Nº 005391/2014-8, the Court of Auditors of Brazil; and Medical Demography in Brazil 2015. The import of exchange physicians without diploma revalidation has cast a shadow on the technical quality of services offered to the population. In terms of infrastructure, the reduction of resources paralyzed works and made the care network maintenance projects impossible. The creation of new medical schools has created uncertainty about the possibility of quality education being offered, with minimum and sufficient structure including laboratories, clinics and teaching hospitals indispensable to medical training. The regional inequalities of concentration and dispersion of physicians, showed by studies on medical demography in Brazil, stem from several factors, including the lack of a career path and working conditions. There is no point in having physicians if they do not have safe and ethical conditions to establish the diagnosis and a treatment plan, as well as to monitor the rehabilitation of the patient.

Evolution of telemedicine in the space program and earth applications.

PubMed

Nicogossian, A E; Pober, D F; Roy, S A

2001-01-01

Remote monitoring of crew, spacecraft, and environmental health has always been an integral part of the National Aeronautics and Space Administration's (NASA's) operations. Crew safety and mission success face a number of challenges in outerspace, including physiological adaptations to microgravity, radiation exposure, extreme temperatures and vacuum, and psychosocial reactions to space flight. The NASA effort to monitor and maintain crew health, system performance, and environmental integrity in space flight is a sophisticated and coordinated program of telemedicine combining cutting-edge engineering with medical expertise. As missions have increased in complexity, NASA telemedicine capabilities have grown apace, underlying its role in the field. At the same time, the terrestrial validation of telemedicine technologies to bring healthcare to remote locations provides feedback, improvement, and enhancement of the space program. As NASA progresses in its space exploration program, astronauts will join missions lasting months, even years, that take them millions of miles from home. These long-duration missions necessitate further technological breakthroughs in tele-operations and autonomous technology. Earth-based monitoring will no longer be real-time, requiring telemedicine capabilities to advance with future explorers as they travel deeper into space. The International Space Station will serve as a testbed for the telemedicine technologies to enable future missions as well as improve the quality of healthcare delivery on Earth.

Evolution of telemedicine in the space program and earth applications

NASA Technical Reports Server (NTRS)

Nicogossian, A. E.; Pober, D. F.; Roy, S. A.

2001-01-01

Remote monitoring of crew, spacecraft, and environmental health has always been an integral part of the National Aeronautics and Space Administration's (NASA's) operations. Crew safety and mission success face a number of challenges in outerspace, including physiological adaptations to microgravity, radiation exposure, extreme temperatures and vacuum, and psychosocial reactions to space flight. The NASA effort to monitor and maintain crew health, system performance, and environmental integrity in space flight is a sophisticated and coordinated program of telemedicine combining cutting-edge engineering with medical expertise. As missions have increased in complexity, NASA telemedicine capabilities have grown apace, underlying its role in the field. At the same time, the terrestrial validation of telemedicine technologies to bring healthcare to remote locations provides feedback, improvement, and enhancement of the space program. As NASA progresses in its space exploration program, astronauts will join missions lasting months, even years, that take them millions of miles from home. These long-duration missions necessitate further technological breakthroughs in tele-operations and autonomous technology. Earth-based monitoring will no longer be real-time, requiring telemedicine capabilities to advance with future explorers as they travel deeper into space. The International Space Station will serve as a testbed for the telemedicine technologies to enable future missions as well as improve the quality of healthcare delivery on Earth.

Pain management and opioid risk mitigation in the military.

PubMed

Sharpe Potter, Jennifer; Bebarta, Vikhyat S; Marino, Elise N; Ramos, Rosemarie G; Turner, Barbara J

2014-05-01

Opioid analgesics misuse is a significant military health concern recognized as a priority issue by military leadership. Opioids are among those most commonly prescribed medications in the military for pain management. The military has implemented opioid risk mitigation strategies, including the Sole Provider Program and the Controlled Drug Management Analysis and Reporting Tool, which are used to identify and monitor for risk and misuse. However, there are substantial opportunities to build on these existing systems to better ensure safer opioid prescribing and monitor for misuse. Opioid risk mitigation strategies implemented by the civilian sector include establishing clinical guidelines for opioid prescribing and prescription monitoring programs. These strategies may help to inform opioid risk mitigation in the military health system. Reducing the risk of opioid misuse and improving quality of care for our Warfighters is necessary. This must be done through evidence-based approaches with an investment in research to improve patient care and prevent opioid misuse as well as its sequelae. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

Medication monitoring attitudes and perceived determinants to offering medication adherence advice to older hypertensive adults: a factorial survey of community pharmacy interns.

PubMed

Dillon, Paul; Smith, Susan M; Gallagher, Paul; Cousins, Gráinne

2018-06-13

Community pharmacy is an ideal setting to monitor medication adherence, however, barriers to pharmacist-led interventions exist. Preparing future pharmacists for enhanced roles may overcome such barriers. Our objective was to identify medication monitoring attitudes and contextual factors that influence adherence monitoring by pharmacy interns to inform educational activities on medication adherence. An online factorial survey of all pharmacy interns (N = 123) in the Republic of Ireland, completing advanced community pharmacy experiential learning in May 2016 was undertaken to evaluate attitudes to medication monitoring and to identify respondent characteristics and contextual factors which influence adherence monitoring of older hypertensive adults during repeat dispensing. The medication monitoring attitude measure (MMAM) was used to evaluate interns' attitudes, and factorial vignette analysis was performed to identify factors influencing behavioural intention to offer adherence advice. There were 121 completed online surveys. Half of interns reported they felt uncomfortable and confrontational discussing adherence with patients. In factorial vignette analysis, higher medication monitoring attitudes resulted in higher likelihood to offer adherence advice; experiential-learning characteristics such as pharmacy ownership-type (nonchain store) and contextual factors including patients being treated for longer and time-pressures had a significant negative influence on pharmacy interns' likelihood to offer adherence advice. Medication monitoring attitudes and contextual factors influenced responses to offer adherence advice in hypothetical scenarios. Ensuring pharmacy students are educated on patterns of adherence and appropriate skills to address nonadherence, and engage in structured programmes to facilitate patient interactions during experiential learning, may improve medication monitoring attitudes and adherence monitoring. © 2018 Royal Pharmaceutical Society.

[Results of Monitoring of the Plan of Measures Directed to Reduction of Ischemic Heart Disease in North Caucasus Republics. Analysis of Dynamics of Cardio-Vascular Mortality].

PubMed

Mamedov, M N

2016-05-01

Comparative analysis of dynamics of cardiovascular mortality in Russia and foreign countries as well as main directions of development of cardiological service in Russia are presented in this review article. Plan of measures for reduction of mortality from ischemic heart disease (IHD) was created in 2015. This plan comprises 4 blocks of assessment of the following measures: directed at improvement of primary IHD prevention (1), directed at secondary prevention of complications of IHD (2); directed at improvement of efficacy of medical care of patients with IHD (3), and directed at monitoring of some demographic parameters (4). The article also contains results of monitoring of realization of the plan of IHD reduction in republics of North Caucasus. Realization of the program on healthy life style (HLS) lacks coordination between ministries. Mass information media are not sufficiently involved in propaganda of HLS. Mean achievement of target levels of main risk factors does not exceed 30-35%. First stage of prophylactic medical examination (dispanserization) has been fulfilled in 65%. High technology care is available both in federal and regional centers. Organization of effective urgent medical service, drug supply, and rehabilitation of patients with IHD are important aspects of improvement of secondary prevention in the region.

[Current status of the development of wireless sensors for medical applications].

PubMed

Moor, C; Braecklein, M; Jörns, N

2005-01-01

Wireless near-field transmission has been a challenge for scientists developing medical sensors for a long time. Here, instruments which measure a patient's ECG, oxygen saturation, blood pressure, peak flow, weight, blood glucose etc. are to be equipped with suitable transmission technology. Application scenarios for these sensors can be found in all medical areas where cable connections are irritating for the doctor, patient and other care personnel. This problem is especially common in sport medicine, sleep medicine, emergency medicine and intensive care. Based on its beneficial properties with regard to power consumption, range, data security and network capability, the worldwide standard radio technology Bluetooth was selected to transmit measurements. Since digital data is sent to a receiving station via Bluetooth, the measurement pre-processing now takes place in the patient sensor itself, instead of being processed by the monitor. In this article, a Bluetooth ECG, Bluetooth pulse oximeter, Bluetooth peak flow meter and Bluetooth event recorder will be introduced. On the one hand, systems can be realized with these devices, which allow patients to be monitored online (ECG, pulse oximeter). These devices can also be integrated in disease management programs (peak flow meter) and can be used to monitor high-risk patients in their home environment (event recorder).

A framework for improving resident research participation and scholarly output.

PubMed

Manring, M M; Panzo, Julia A; Mayerson, Joel L

2014-01-01

The Accreditation Council for Graduate Medical Education requires that "faculty should encourage and support residents in scholarly activities." There are no guidelines, however, to illustrate how this should be done, and only a small number of published reports offer examples of successful efforts to spur resident research. We sought to improve our residents' participation in scholarly activities. We describe a multifaceted program to quickly build resident scholarship at an orthopaedic department. Large academic medical center in the Midwestern United States. An experienced medical editor was recruited to assist faculty and mentor residents in coordinating research projects and to direct publishing activity. Additional publishing requirements were added to the resident curriculum beyond those already required by the Accreditation Council for Graduate Medical Education. Residents were required to select a faculty research mentor to guide all research projects toward a manuscript suitable for submission to a peer-reviewed journal. Activities were monitored by the editor and the resident coordinator. Over 4 years, total department peer-reviewed publications increased from 33 to 163 annually. Despite a decrease in resident complement, the number of peer-reviewed publications with a resident author increased from 6 in 2009 to 53 in 2012. The addition of an experienced medical editor, changes in program requirements, and an increased commitment to promotion of resident research across the faculty led to a dramatic increase in resident publications. Our changes may be a model for other programs that have the financial resources and faculty commitment necessary to achieve a rapid turnaround. Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

A mobile phone application for the assessment and management of youth mental health problems in primary care: health service outcomes from a randomised controlled trial of mobiletype.

PubMed

Reid, Sophie C; Kauer, Sylvia D; Hearps, Stephen J C; Crooke, Alexander H D; Khor, Angela S; Sanci, Lena A; Patton, George C

2013-06-19

GPs detect at best 50c of mental health problems in young people. Barriers to detecting mental health problems include lack of screening tools, limited appointment times and young people's reluctance to report mental health symptoms to GPs. The mobiletype program is a mobile phone mental health assessment and management application which monitors mood, stress and everyday activities then transmits this information to general practitioners (GPs) via a secure website in summary format for medical review. The current aims were to examine: (i) mobiletype as a clinical assistance tool, ii) doctor-patient rapport and, iii) pathways to care. We conducted a randomised controlled trial in primary care with patients aged 14 to 24 years recruited from rural and metropolitan general practices. GPs identified and referred eligible participants (those with mild or more mental health concerns) who were randomly assigned to either the intervention group (where mood, stress and daily activities were monitored) or the attention-comparison group (where only daily activities were monitored). Both groups self-monitored for 2 to 4 weeks and reviewed the monitoring data with their GP. GPs, participants and researchers were blind to group allocation at randomisation. GPs assessed the mobiletype program as a clinical assistant tool. Doctor-patient rapport was assessed using the General Practice Assessment Questionnaire Communication and Enablement subscales, and the Trust in Physician Scale (TPS). Pathways to care was measured using The Party Project's Exit Interview. Of the 163 participants assessed for eligibility, 118 were randomised and 114 participants were included in analyses (intervention n = 68, attention-comparison n = 46). T-tests showed that the intervention program increased understanding of patient mental health, assisted in decisions about medication/referral and helped in diagnosis when compared to the attention-comparison program. Mixed model analysis showed no differences in GP-patient rapport nor in pathways to care. We conducted the first RCT of a mobile phone application in the mental health assessment and management of youth mental health in primary care. This study suggests that mobiletype has much to offer GPs in the often difficult and time-consuming task of assessment and management of youth mental health problems in primary care. ClinicalTrials.gov NCT00794222.

Medication Safety Systems and the Important Role of Pharmacists.

PubMed

Mansur, Jeannell M

2016-03-01

Preventable medication-related adverse events continue to occur in the healthcare setting. While the Institute of Medicine's To Err is Human, published in 2000, highlighted the prevalence of medical and medication-related errors in patient morbidity and mortality, there has not been significant documented progress in addressing system contributors to medication errors. The lack of progress may be related to the myriad of pharmaceutical options now available and the nuances of optimizing drug therapy to achieve desired outcomes and prevent undesirable outcomes. However, on a broader scale, there may be opportunities to focus on the design and performance of the many processes that are part of the medication system. Errors may occur in the storage, prescribing, transcription, preparation and dispensing, or administration and monitoring of medications. Each of these nodes of the medication system, with its many components, is prone to failure, resulting in harm to patients. The pharmacist is uniquely trained to be able to impact medication safety at the individual patient level through medication management skills that are part of the clinical pharmacist's role, but also to analyze the performance of medication processes and to lead redesign efforts to mitigate drug-related outcomes that may cause harm. One population that can benefit from a focus on medication safety through clinical pharmacy services and medication safety programs is the elderly, who are at risk for adverse drug events due to their many co-morbidities and the number of medications often used. This article describes the medication safety systems and provides a blueprint for creating a foundation for medication safety programs within healthcare organizations. The specific role of pharmacists and clinical pharmacy services in medication safety is also discussed here and in other articles in this Theme Issue.

The United States Army Medical Department Journal. October - December 2012

DTIC Science & Technology

2012-12-01

assess effect on weight change following injury. Nutritional programs aimed at smaller meal consumption , inclusion of breakfast, making healthier...electrocardiography, blood pres- sure, oxygen saturation, end-tidal carbon dioxide, and rectal temperatures were continuously monitored for the...blood pressure, oxygen saturation, end-tidal carbon dioxide, and rectal temperatures . Body temperature was maintained greater than 36.0°C. When

NRC/AMRMC Resident Research Associateship Program

DTIC Science & Technology

2016-03-01

Washington, DC 20001 8. PERFORMING ORGANIZATION REPORT NUMBER 9. SPONSORING / MONITORING AGENCY NAME(S) AND ADDRESS(ES) U.S. Army Medical Research and...9) PUBLICATIONS AND PAPERS RESULTING FROM NRC ASSOCIATESHIP RESEARCH Provide complete citations: author(s), title, full name of journal , volume...PUBLICATIONS AND PAPERS RESULTING FROM NRC ASSOCIATESHIP RESEARCH Provide complete citations: author(s), title, full name of journal , volume number, page

Physical exercise program for children with bronchial asthma.

PubMed

Szentágothai, K; Gyene, I; Szócska, M; Osváth, P

1987-01-01

A long-term physical exercise program was established for a large number of children with bronchial asthma. Asthmatic children were first taught to swim on their backs to prevent breathing problems customary for beginners using other strokes. They concurrently participated in gymnasium exercises, and the program was later completed with outdoor running. Program effectiveness was evaluated by monitoring asthmatic symptoms, changes in medication, and changes in the activity and physical fitness of the children. Data collected from 121 children showed that during the first year in the program the number of days with asthmatic symptoms decreased in a large majority of the patients while medication was decreased. School absenteeism and hospitalization dropped markedly. Parental evaluation of the children indicated much improvement in 51.2%, improvement in 40.5%, unchanged condition in 7.4%, and deterioration of general health was only reported in one child (0.8%). The same extent of improvement continued during the second year. The Cooper test was applied for the first time to such an exercise program and indicated that the participating asthmatic children performed as well as a control group of nonasthmatic children, and the cardiovascular efficiency of the asthmatics was actually better.

Pediatric medical device development by surgeons via capstone engineering design programs.

PubMed

Sack, Bryan S; Elizondo, Rodolfo A; Huang, Gene O; Janzen, Nicolette; Espinoza, Jimmy; Sanz-Cortes, Magdalena; Dietrich, Jennifer E; Hakim, Julie; Richardson, Eric S; Oden, Maria; Hanks, John; Haridas, Balakrishna; Hury, James F; Koh, Chester J

2018-03-01

There is a need for pediatric medical devices that accommodate the unique physiology and anatomy of pediatric patients that is increasingly receiving more attention. However, there is limited literature on the programs within children's hospitals and academia that can support pediatric device development. We describe our experience with pediatric device design utilizing collaborations between a children's hospital and two engineering schools. Utilizing the academic year as a timeline, unmet pediatric device needs were identified by surgical faculty and matched with an engineering mentor and a team of students within the Capstone Engineering Design programs at two universities. The final prototypes were showcased at the end of the academic year and if appropriate, provisional patent applications were filed. All twelve teams successfully developed device prototypes, and five teams obtained provisional patents. The prototypes that obtained provisional patents included a non-operative ureteral stent removal system, an evacuation device for small kidney stone fragments, a mechanical leech, an anchoring system of the chorio-amniotic membranes during fetal surgery, and a fetal oxygenation monitor during fetoscopic procedures. Capstone Engineering Design programs in partnership with surgical faculty at children's hospitals can play an effective role in the prototype development of novel pediatric medical devices. N/A - No clinical subjects or human testing was performed. Copyright © 2017 Elsevier Inc. All rights reserved.

Diabetes is a community issue: the critical elements of a successful outreach and education model on the U.S.-Mexico border.

PubMed

Ingram, Maia; Gallegos, Gwen; Elenes, JoJean

2005-01-01

Diabetes is reaching epidemic proportions on the U.S.-Mexico Border, and culturally competent diabetes education is not available in many communities. People with diabetes often do not have access to regular medical care, cannot afford medication, and lack the community infrastructure that supports self-management practices. Self-management education and support have great potential to impact diabetes control in this environment. To address this need, partners of the Border Health Strategic Initiative (Border Health iSI!) collaboratively developed a culturally relevant diabetes outreach and education program. The model included a five-week series of free diabetes education classes that assisted participants in gaining the knowledge and skills necessary to be physically active, control diet, monitor blood sugar, take medications, and be aware of complications. Central to the model was the use of community health workers - or promotores de salud - to conduct outreach, participate in patient education, and provide individual support. Program participants achieved significant improvements in self-management behaviors and HbA1c, random blood glucose, and blood pressure levels. Quantitative and qualitative evaluation helped to identify the essential elements of a successful program, including partnership of providers, community diabetes classes, promotores outreach and support, linkage between diabetes education and clinical care, and program evaluation.

Heart failure remote monitoring: evidence from the retrospective evaluation of a real-world remote monitoring program.

PubMed

Agboola, Stephen; Jethwani, Kamal; Khateeb, Kholoud; Moore, Stephanie; Kvedar, Joseph

2015-04-22

Given the magnitude of increasing heart failure mortality, multidisciplinary approaches, in the form of disease management programs and other integrative models of care, are recommended to optimize treatment outcomes. Remote monitoring, either as structured telephone support or telemonitoring or a combination of both, is fast becoming an integral part of many disease management programs. However, studies reporting on the evaluation of real-world heart failure remote monitoring programs are scarce. This study aims to evaluate the effect of a heart failure telemonitoring program, Connected Cardiac Care Program (CCCP), on hospitalization and mortality in a retrospective database review of medical records of patients with heart failure receiving care at the Massachusetts General Hospital. Patients enrolled in the CCCP heart failure monitoring program at the Massachusetts General Hospital were matched 1:1 with usual care patients. Control patients received care from similar clinical settings as CCCP patients and were identified from a large clinical data registry. The primary endpoint was all-cause mortality and hospitalizations assessed during the 4-month program duration. Secondary outcomes included hospitalization and mortality rates (obtained by following up on patients over an additional 8 months after program completion for a total duration of 1 year), risk for multiple hospitalizations and length of stay. The Cox proportional hazard model, stratified on the matched pairs, was used to assess primary outcomes. A total of 348 patients were included in the time-to-event analyses. The baseline rates of hospitalizations prior to program enrollment did not differ significantly by group. Compared with controls, hospitalization rates decreased within the first 30 days of program enrollment: hazard ratio (HR)=0.52, 95% CI 0.31-0.86, P=.01). The differential effect on hospitalization rates remained consistent until the end of the 4-month program (HR=0.74, 95% CI 0.54-1.02, P=.06). The program was also associated with lower mortality rates at the end of the 4-month program: relative risk (RR)=0.33, 95% 0.11-0.97, P=.04). Additional 8-months follow-up following program completion did not show residual beneficial effects of the CCCP program on mortality (HR=0.64, 95% 0.34-1.21, P=.17) or hospitalizations (HR=1.12, 95% 0.90-1.41, P=.31). CCCP was associated with significantly lower hospitalization rates up to 90 days and significantly lower mortality rates over 120 days of the program. However, these effects did not persist beyond the 120-day program duration.

Clinical validation of a medical grade color monitor for chest radiology

NASA Astrophysics Data System (ADS)

Jacobs, J.; Zanca, F.; Verschakelen, J.; Marchal, G.; Bosmans, H.

2009-02-01

Until recently, the specifications of medical grade monochrome LCD monitors outperformed those of color LCD monitors. New generations of color LCD monitors, however, show specifications that are in many respects similar to those of monochrome monitors typically used in diagnostic workstations. The aim of present study was to evaluate the impact of different medical grade monitors in terms of detection of simulated lung nodules in chest x-ray images. Specifically, we wanted to compare a new medical grade color monitor (Barco Coronis 6MP color) to a medical grade grayscale monitor (Barco Coronis 3MP monochrome) and a consumer color monitor (Philips 200VW 1.7MP color) by means of an observer performance experiment. Using the free-response acquisition data paradigm, seven radiologists were asked to detect and locate lung nodules (170 in total), simulated in half of the 200 chest X-ray images used in the experiment. The jackknife free-response receiver operating characteristic (JAFROC) analysis of the data showed a statistically significant difference between at least two monitors, F-value=3.77 and p-value =0.0481. The different Figure of Merit values were 0.727, 0.723 and 0.697 for the new color LCD monitor, the medical grade monitor and the consumer color monitor respectively. There was no difference between the needed reading times but there was a difference between the mean calculated Euclidian distances between the position marked by the observers and the center of the simulated nodule, indicating a better accuracy with both medical grade monitors. Present data suggests that the new generation of medical grade color monitors could be used as diagnostic workstations.

A SOA-Based Solution to Monitor Vaccination Coverage Among HIV-Infected Patients in Liguria.

PubMed

Giannini, Barbara; Gazzarata, Roberta; Sticchi, Laura; Giacomini, Mauro

2016-01-01

Vaccination in HIV-infected patients constitutes an essential tool in the prevention of the most common infectious diseases. The Ligurian Vaccination in HIV Program is a proposed vaccination schedule specifically dedicated to this risk group. Selective strategies are proposed within this program, employing ICT (Information and Communication) tools to identify this susceptible target group, to monitor immunization coverage over time and to manage failures and defaulting. The proposal is to connect an immunization registry system to an existing regional platform that allows clinical data re-use among several medical structures, to completely manage the vaccination process. This architecture will adopt a Service Oriented Architecture (SOA) approach and standard HSSP (Health Services Specification Program) interfaces to support interoperability. According to the presented solution, vaccination administration information retrieved from the immunization registry will be structured according to the specifications within the immunization section of the HL7 (Health Level 7) CCD (Continuity of Care Document) document. Immunization coverage will be evaluated through the continuous monitoring of serology and antibody titers gathered from the hospital LIS (Laboratory Information System) structured into a HL7 Version 3 (v3) Clinical Document Architecture Release 2 (CDA R2).

Germany's Disease Management Program: Improving Outcomes in Congestive Heart Failure

PubMed Central

Kottmair, Stefan; Frye, Christian; Ziegenhagen, Dieter J.

2005-01-01

Hospital admissions among patients with congestive heart failure (CHF) are a major contributor to health care costs. A comprehensive disease management program for CHF was developed for private and statutory health insurance companies in order to improve health outcomes and reduce rehospitalization rates and costs. The program comprises care calls, written training material, telemetric monitoring, and health reports. Currently, 909 members from six insurance companies are enrolled. Routine evaluation, based on medical data warehouse software, demonstrates benefits in terms of improved health outcomes and processes of care. Economical evaluation of claims data indicates significant cost savings in a pre/post study design. PMID:17288080

Resident away rotations allow adaptive neurosurgical training.

PubMed

Gephart, Melanie Hayden; Derstine, Pamela; Oyesiku, Nelson M; Grady, M Sean; Burchiel, Kim; Batjer, H Hunt; Popp, A John; Barbaro, Nicholas M

2015-04-01

Subspecialization of physicians and regional centers concentrate the volume of certain rare cases into fewer hospitals. Consequently, the primary institution of a neurological surgery training program may not have sufficient case volume to meet the current Residency Review Committee case minimum requirements in some areas. To ensure the competency of graduating residents through a comprehensive neurosurgical education, programs may need for residents to travel to outside institutions for exposure to cases that are either less common or more regionally focused. We sought to evaluate off-site rotations to better understand the changing demographics and needs of resident education. This would also allow prospective monitoring of modifications to the neurosurgery training landscape. We completed a survey of neurosurgery program directors and query of data from the Accreditation Council of Graduate Medical Education to characterize the current use of away rotations in neurosurgical education of residents. We found that 20% of programs have mandatory away rotations, most commonly for exposure to pediatric, functional, peripheral nerve, or trauma cases. Most of these rotations are done during postgraduate year 3 to 6, lasting 1 to 15 months. Twenty-six programs have 2 to 3 participating sites and 41 have 4 to 6 sites distinct from the host program. Programs frequently offset potential financial harm to residents rotating at a distant site by support of housing and transportation costs. As medical systems experience fluctuating treatment paradigms and demographics, over time, more residency programs may adapt to meet the Accreditation Council of Graduate Medical Education case minimum requirements through the implementation of away rotations.

Reaching the Unreachable: Novel Approaches to Telemedicine Screening of Underserved Populations for Vitreoretinal Disease.

PubMed

Murchison, Ann P; Haller, Julia A; Mayro, Eileen; Hark, Lisa; Gower, Emily; Huisingh, Carrie; Rhodes, Lindsay; Friedman, David S; Lee, David J; Lam, Byron L

2017-07-01

Telemedicine involves electronic communication between a physician in one location and a patient in another location to provide remote medical care. Ophthalmologists are increasingly employing telemedicine, particularly in retinal disease screening and monitoring. Telemedicine has been utilized to decrease barriers to care and yield greater patient satisfaction and lower costs, while maintaining high sensitivity and specificity. This review discusses common patient barriers to eye care, innovative approaches to retinal disease screening and monitoring using telemedicine, and eye care policy initiatives needed to enact large-scale telemedicine eye disease screening programs.

Cost-benefit analysis on the use of telemedicine program of Kosova for continuous medical education: a sustainable and efficient model to rebuild medical systems in developing countries.

PubMed

Latifi, Kalterina; Lecaj, Ismet; Bekteshi, Flamur; Dasho, Erion; Doarn, Charles R; Merrell, Ronald C; Latifi, Rifat

2011-12-01

The Ministry of Health of Kosova has recently announced the Telemedicine Program of Kosova (TMPK) as the official institution responsible for managing and coordinating the nation's Long-Distance Continuous Medical Education (CME) program. There are a lack of studies on cost-benefit analysis (CBA) and other economic evaluations of telemedicine programs (TMP), in particular the financial value of CME offered through such a service. In addition, there is lack of prospective studies on Monitoring & Evaluation (M&E) of TMP. The goal of this study was to conduct a retrospective CBA of prospective data collected at TMPK over a 5-year period (2005-2010) in order to determine the cost benefit as opposed to the alternative method of delivery of this model for developing countries whose healthcare systems are in disarray. We reviewed data on the number of participants in virtual lectures both at the Telemedicine Center of Kosova (TCK) as well as the number of participants at six Regional Telemedicine Centers throughout Kosova, the number of lectures broadcasted, the clinical cases reviewed and transmitted for international consultation, and other quantitative data. Only in 2009, approximately 2,000 CME certificates were awarded to physicians and nurses of Kosova, 18 international teleconsultations were conducted, 138 videoconferences, lectures, and seminars were held, and there were over 9,000 visitors at the TCK e-library. Data analysis shows that the TMPK has been an efficient mechanism for CME and sustainable model for rebuilding the medical system. TMPK has been successful in offering physicians, nurses, and other medical professions access to electronic information. TMP is an efficient mechanism to ensure CME and rebuilding medical systems in developing countries. There is a need for prospective CBA of any TMP and the establishment of M&E programs in any future telemedicine initiatives in developing countries.

TU-F-CAMPUS-I-05: Semi-Automated, Open Source MRI Quality Assurance and Quality Control Program for Multi-Unit Institution

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

Yung, J; Stefan, W; Reeve, D

2015-06-15

Purpose: Phantom measurements allow for the performance of magnetic resonance (MR) systems to be evaluated. Association of Physicists in Medicine (AAPM) Report No. 100 Acceptance Testing and Quality Assurance Procedures for MR Imaging Facilities, American College of Radiology (ACR) MR Accreditation Program MR phantom testing, and ACR MRI quality control (QC) program documents help to outline specific tests for establishing system performance baselines as well as system stability over time. Analyzing and processing tests from multiple systems can be time-consuming for medical physicists. Besides determining whether tests are within predetermined limits or criteria, monitoring longitudinal trends can also help preventmore » costly downtime of systems during clinical operation. In this work, a semi-automated QC program was developed to analyze and record measurements in a database that allowed for easy access to historical data. Methods: Image analysis was performed on 27 different MR systems of 1.5T and 3.0T field strengths from GE and Siemens manufacturers. Recommended measurements involved the ACR MRI Accreditation Phantom, spherical homogenous phantoms, and a phantom with an uniform hole pattern. Measurements assessed geometric accuracy and linearity, position accuracy, image uniformity, signal, noise, ghosting, transmit gain, center frequency, and magnetic field drift. The program was designed with open source tools, employing Linux, Apache, MySQL database and Python programming language for the front and backend. Results: Processing time for each image is <2 seconds. Figures are produced to show regions of interests (ROIs) for analysis. Historical data can be reviewed to compare previous year data and to inspect for trends. Conclusion: A MRI quality assurance and QC program is necessary for maintaining high quality, ACR MRI Accredited MR programs. A reviewable database of phantom measurements assists medical physicists with processing and monitoring of large datasets. Longitudinal data can reveal trends that although are within passing criteria indicate underlying system issues.« less

Establishment and evaluation of a theater influenza monitoring platform.

PubMed

Wang, Jian; Yang, Hui-Suo; Deng, Bing; Shi, Meng-Jing; Li, Xiang-Da; Nian, Qing-Gong; Song, Wen-Jing; Bing, Feng; Li, Qing-Feng

2017-11-20

Influenza is an acute respiratory infectious disease with a high incidence rate in the Chinese army, which directly disturbs military training and affects soldiers' health. Influenza surveillance systems are widely used around the world and play an important role in influenza epidemic prevention and control. As a theater centers for disease prevention and control, we established an influenza monitoring platform (IMP) in 2014 to strengthen the monitoring of influenza-like illness and influenza virus infection. In this study, we introduced the constitution, influenza virus detection, and quality control for an IMP. The monitoring effect was also evaluated by comparing the monitoring data with data from national influenza surveillance systems. The experiences and problems associated with the platform also were summarized. A theater IMP was established based on 3 levels of medical units, including monitoring sites, testing laboratories and a checking laboratory. A series of measures were taken to guarantee the quality of monitoring, such as technical training, a unified process, sufficient supervision and timely communication. The platform has run smoothly for 3 monitoring years to date. In the 2014-2015 and 2016-2017 monitoring years, sample amount coincided with that obtained from the National Influenza Surveillance program. In the 2015-2016 monitoring year, due to the strict prevention and control measures, an influenza epidemic peak was avoided in monitoring units, and the monitoring data did not coincide with that of the National Influenza Surveillance program. Several problems, including insufficient attention, unreasonable administrative intervention or subordination relationships, and the necessity of detection in monitoring sites were still observed. A theater IMP was established rationally and played a deserved role in the prevention and control of influenza. However, several problems remain to be solved.

Systems approach to monitoring and evaluation guides scale up of the Standard Days Method of family planning in Rwanda.

PubMed

Igras, Susan; Sinai, Irit; Mukabatsinda, Marie; Ngabo, Fidele; Jennings, Victoria; Lundgren, Rebecka

2014-05-01

There is no guarantee that a successful pilot program introducing a reproductive health innovation can also be expanded successfully to the national or regional level, because the scaling-up process is complex and multilayered. This article describes how a successful pilot program to integrate the Standard Days Method (SDM) of family planning into existing Ministry of Health services was scaled up nationally in Rwanda. Much of the success of the scale-up effort was due to systematic use of monitoring and evaluation (M&E) data from several sources to make midcourse corrections. Four lessons learned illustrate this crucially important approach. First, ongoing M&E data showed that provider training protocols and client materials that worked in the pilot phase did not work at scale; therefore, we simplified these materials to support integration into the national program. Second, triangulation of ongoing monitoring data with national health facility and population-based surveys revealed serious problems in supply chain mechanisms that affected SDM (and the accompanying CycleBeads client tool) availability and use; new procedures for ordering supplies and monitoring stockouts were instituted at the facility level. Third, supervision reports and special studies revealed that providers were imposing unnecessary medical barriers to SDM use; refresher training and revised supervision protocols improved provider practices. Finally, informal environmental scans, stakeholder interviews, and key events timelines identified shifting political and health policy environments that influenced scale-up outcomes; ongoing advocacy efforts are addressing these issues. The SDM scale-up experience in Rwanda confirms the importance of monitoring and evaluating programmatic efforts continuously, using a variety of data sources, to improve program outcomes.

Systems approach to monitoring and evaluation guides scale up of the Standard Days Method of family planning in Rwanda

PubMed Central

Igras, Susan; Sinai, Irit; Mukabatsinda, Marie; Ngabo, Fidele; Jennings, Victoria; Lundgren, Rebecka

2014-01-01

There is no guarantee that a successful pilot program introducing a reproductive health innovation can also be expanded successfully to the national or regional level, because the scaling-up process is complex and multilayered. This article describes how a successful pilot program to integrate the Standard Days Method (SDM) of family planning into existing Ministry of Health services was scaled up nationally in Rwanda. Much of the success of the scale-up effort was due to systematic use of monitoring and evaluation (M&E) data from several sources to make midcourse corrections. Four lessons learned illustrate this crucially important approach. First, ongoing M&E data showed that provider training protocols and client materials that worked in the pilot phase did not work at scale; therefore, we simplified these materials to support integration into the national program. Second, triangulation of ongoing monitoring data with national health facility and population-based surveys revealed serious problems in supply chain mechanisms that affected SDM (and the accompanying CycleBeads client tool) availability and use; new procedures for ordering supplies and monitoring stockouts were instituted at the facility level. Third, supervision reports and special studies revealed that providers were imposing unnecessary medical barriers to SDM use; refresher training and revised supervision protocols improved provider practices. Finally, informal environmental scans, stakeholder interviews, and key events timelines identified shifting political and health policy environments that influenced scale-up outcomes; ongoing advocacy efforts are addressing these issues. The SDM scale-up experience in Rwanda confirms the importance of monitoring and evaluating programmatic efforts continuously, using a variety of data sources, to improve program outcomes. PMID:25276581

The Hepatitis Testing and Linkage-to-Care Data Review Process: An Approach to Ensuring the Quality of Program Data.

PubMed

Mezzo, Jennifer L; Lamia, Tamara L; Danelski, Lisa L; Schipani, Anne Marie; Stokes, Scott A; Jacobs-Ware, Elizabeth D

2016-01-01

CDC's 2012 Hepatitis Testing and Linkage to Care (HepTLC) initiative was a nationally coordinated effort to conduct hepatitis B and hepatitis C screening, posttest counseling, and linkage to care at 34 U.S. sites. This project provided support for data management and monthly data reviews between awardees and a data manager, which facilitated monitoring of awardee progress and regular program improvement opportunities. CDC provided technical assistance to awardees for testing processes and program improvement, including Internet-based data submission, reporting software and data management to awardees, offering assistance with submitting, and reviewing data in real time. We describe how one awardee, AIDS Resource Center of Wisconsin (ARCW), used the data management process to improve data quality, inform testing processes and implementation, and measure and report missing variables from an online database. From October 2012 through July 2014, ARCW performed 2,255 HCV antibody (anti-HCV) tests and 244 HCV ribonucleic acid (RNA) tests as part of the HepTLC initiative. Participants who tested HCV RNA positive (n=189) were referred to medical care. At the end of the study, no records were missing for the anti-HCV test result or HCV RNA test result variables, and only one record was missing for those who were referred to medical care. Regular data review and monitoring by awardees and CDC-supported data managers provided opportunities for data quality and program improvement. Through regular data review, ARCW reduced the amount of missing data and promoted timely follow-up with participants testing positive for HCV to ensure receipt of results and linkage to care. Other programs can adopt a similar data management model.

Home medical monitoring network based on embedded technology

NASA Astrophysics Data System (ADS)

Liu, Guozhong; Deng, Wenyi; Yan, Bixi; Lv, Naiguang

2006-11-01

Remote medical monitoring network for long-term monitoring of physiological variables would be helpful for recovery of patients as people are monitored at more comfortable conditions. Furthermore, long-term monitoring would be beneficial to investigate slowly developing deterioration in wellness status of a subject and provide medical treatment as soon as possible. The home monitor runs on an embedded microcomputer Rabbit3000 and interfaces with different medical monitoring module through serial ports. The network based on asymmetric digital subscriber line (ADSL) or local area network (LAN) is established and a client - server model, each embedded home medical monitor is client and the monitoring center is the server, is applied to the system design. The client is able to provide its information to the server when client's request of connection to the server is permitted. The monitoring center focuses on the management of the communications, the acquisition of medical data, and the visualization and analysis of the data, etc. Diagnosing model of sleep apnea syndrome is built basing on ECG, heart rate, respiration wave, blood pressure, oxygen saturation, air temperature of mouth cavity or nasal cavity, so sleep status can be analyzed by physiological data acquired as people in sleep. Remote medical monitoring network based on embedded micro Internetworking technology have advantages of lower price, convenience and feasibility, which have been tested by the prototype.

Longitudinal assessment of spirometry in the World Trade Center medical monitoring program.

PubMed

Skloot, Gwen S; Schechter, Clyde B; Herbert, Robin; Moline, Jacqueline M; Levin, Stephen M; Crowley, Laura E; Luft, Benjamin J; Udasin, Iris G; Enright, Paul L

2009-02-01

Multiple studies have demonstrated an initial high prevalence of spirometric abnormalities following World Trade Center (WTC) disaster exposure. We assessed prevalence of spirometric abnormalities and changes in spirometry between baseline and first follow-up evaluation in participants in the WTC Worker and Volunteer Medical Monitoring Program. We also determined the predictors of spirometric change between the two examinations. Prebronchodilator and postbronchodilator spirometry, demographics, occupational history, smoking status, and respiratory symptoms and exposure onset were obtained at both examinations (about 3 years apart). At the second examination, 24.1% of individuals had abnormal spirometry findings. The predominant defect was a low FVC without obstruction (16.1%). Between examinations, the majority of individuals did not have a greater-than-expected decline in lung function. The mean declines in prebronchodilator FEV(1) and FVC were 13 mL/yr and 2 mL/yr, respectively (postbronchodilator results were similar and not reported). Significant predictors of greater average decline between examinations were lack of bronchodilator responsiveness at examination 1 and weight gain [corrected]. Elevated rates of spirometric abnormalities were present at both examinations, with reduced FVC most common. Although the majority had a normal decline in lung function, lack of bronchodilator response at examination 1 and weight gain were significantly associated with greater-than-normal lung function declines [corrected]. Due to the presence of spirometric abnormalities > 5 years after the disaster in many exposed individuals, longer-term monitoring of WTC responders is essential.

Microbiological Monitoring for the Constellation Program: Current Requirements and Future Considerations

NASA Technical Reports Server (NTRS)

Ott, C. Mark

2007-01-01

Microbiological requirements for spaceflight are based on assessments of infectious disease risk which could impact crew health or mission success. The determination of risk from infectious disease is composed of several factors including (1) crew susceptibility, (2) crew exposure to the infectious disease agent, (3) the concentration of the infectious agent, and (4) the characteristics of the infectious agent. As a result of the Health Stabilization Program, stringent monitoring, and cleaning protocols, in-flight environmental microbial monitoring is not necessary for short-duration spaceflights. However, risk factors change for long-duration missions, as exemplified by the presence of medically significant organisms in the environments of both the Mir and International Space Station (ISS). Based upon this historical evidence, requirements for short duration usage aboard the Orion Crew Exploration Vehicle and Lunar Lander Vehicle will not require in-flight monitoring; however, as mission duration increases with a Lunar Outpost, an ability to detect microbial hazard will be necessary. The nature of the detection requirements will depend on the maturity of technology in a rapidly evolving marketplace. Regardless, the hardware will still need to maximize information to discipline experts and the crew, while minimizing the size, mass, power consumption, and crew time usage. The refinement of these monitors will be a major goal in our efforts to travel successfully to Mars.

The Medical Education Partnership Initiative (MEPI), a collaborative paradigm for institutional and human resources capacity building between high- and low- and middle-income countries: the Mozambique experience

PubMed Central

Noormahomed, Emilia Virginia; Carrilho, Carla; Ismail, Mamudo; Noormahomed, Sérgio; Nguenha, Alcido; Benson, Constance A.; Mocumbi, Ana Olga; Schooley, Robert T.

2017-01-01

ABSTRACT Background: Collaborations among researchers based in lower and middle income countries (LMICs) and high income countries (HICs) have made major discoveries related to diseases disproportionately affecting LMICs and have been vital to the development of research communities in LMICs. Such collaborations have generally been scientifically and structurally driven by HICs. Objectives: In this report we outline a paradigm shift in collaboration, exemplified by the Medical Education Partnership Initiative (MEPI), in which the formulation of priorities and administrative infrastructure reside in the LMIC. Methods: This descriptive report outlines the critical features of the MEPI partnership. Results: In the MEPI, LMIC program partners translate broad program goals and define metrics into priorities that are tailored to local conditions. Program funds flow to a LMIC-based leadership group that contracts with peers from HICs to provide technical and scientific advice and consultation in a 'reverse funds flow' model. Emphasis is also placed on strengthening administrative capacity within LMIC institutions. A rigorous monitoring and evaluation process modifies program priorities on the basis of evolving opportunities to maximize program impact. Conclusions: Vesting LMIC partners with the responsibility for program leadership, and building administrative and fiscal capacity in LMIC institutions substantially enhances program relevance, impact and sustainability. PMID:28452653

Future of Military Health Care Final Report

DTIC Science & Technology

2007-12-20

Population Health Navigator. Service programs are supported by the Military Health System Population Health Portal (MHSPHP), a centralized, secure...planning is due to Congress on March 1, 2008.66 64 Air Force Medical Support Agency, Population Health Support Division. MHS Population Health Portal ...MTFs are monitoring HEDIS metrics using the MHS Population Health Portal and reporting in the service systems and the Tri- Service Business Planning

Prescription Drug Monitoring Programs and Pharmacist Orientation Toward Dispensing Controlled Substances.

PubMed

Fendrich, Michael; Bryan, Janelle K; Hooyer, Katinka

2018-01-03

We sought to understand how pharmacists viewed and used a newly implemented prescription drug monitoring program (PDMP). We also sought to understand pharmacist orientation toward dispensing of controlled substances and the people who obtain them. We conducted three mini focus groups. The focus group findings were used to inform the design of a structured survey. We emailed a survey to 160 pharmacists who were employed in one statewide community chain store; we obtained 48 survey responses. Focus groups findings suggested that, in relation to the dispensing of scheduled prescription medication, pharmacists were either "healthcare" oriented, "law-enforcement" oriented, or an orientation that combined these two perspectives. Surveys suggested that pharmacists found PDMPs easy to use and that they used them frequently - often to contact physicians directly. Surveys suggested that pharmacists were typically either "healthcare" oriented or "mixed" (combined perspectives). Pharmacist orientation was associated with the frequency with which they counseled patients about medication risk and the frequency with which they used the PDMP as the basis for contacting prescribers. Ongoing tracking of pharmacists' use of PDMPs is important both at the implementation stage and as PDMPs develop over time. The orientation construct developed here is useful in understanding pharmacist behavior and attitudes towards patients potentially at risk for misuse of controlled substance medications. Further research on this construct could shed light on barriers and incentives for pharmacist PDMP participation and use and provide guidance for pharmacist training, ultimately enhancing patient care.

An HTML Tool for Production of Interactive Stereoscopic Compositions.

PubMed

Chistyakov, Alexey; Soto, Maria Teresa; Martí, Enric; Carrabina, Jordi

2016-12-01

The benefits of stereoscopic vision in medical applications were appreciated and have been thoroughly studied for more than a century. The usage of the stereoscopic displays has a proven positive impact on performance in various medical tasks. At the same time the market of 3D-enabled technologies is blooming. New high resolution stereo cameras, TVs, projectors, monitors, and head mounted displays become available. This equipment, completed with a corresponding application program interface (API), could be relatively easy implemented in a system. Such complexes could open new possibilities for medical applications exploiting the stereoscopic depth. This work proposes a tool for production of interactive stereoscopic graphical user interfaces, which could represent a software layer for web-based medical systems facilitating the stereoscopic effect. Further the tool's operation mode and the results of the conducted subjective and objective performance tests will be exposed.

Student and staff experiences of attendance monitoring in undergraduate obstetrics and gynecology: a cross-sectional survey

PubMed Central

Deane, Richard P; Murphy, Deirdre J

2016-01-01

Background Despite the widespread introduction of active learning strategies to engage students across modern medical curricula, student attendance and attendance monitoring remain a challenging issue for medical educators. In addition, there is little published evidence available to medical educators regarding the use of attendance monitoring systems. The aim of this study was to evaluate the opinions of students and staff about the use of a paper-based student logbook to record student attendance across all clinical and classroom-based learning activities within an undergraduate clinical rotation in obstetrics and gynecology (OBGYN). Methods Each student undertaking the clinical rotation in OBGYN was required to complete a paper-based logbook in a booklet format that listed every clinical and classroom-based activity that the student was expected to attend. A cross-sectional survey evaluating the acceptability, practicality, and effect on access to learning opportunities of using the logbook was undertaken. The survey was conducted among all medical students who completed their OBGYN rotation over a full academic year and staff who taught on the program. Results The response rate was 87% (n=128/147) among students and 80% (n=8/10) among staff. Monitoring attendance was widely acceptable to students (n=107/128, 84%) and staff (n=8/8, 100%). Most students (n=95/128, 74%) and staff (n=7/8, 88%) recommended that attendance should be mandatory during rotations. Almost all staff felt that attendance should contribute toward academic credit (n=7/8, 88%), but students were divided (n=73/128, 57%). Students (n=94/128, 73%) and staff (n=6/8, 75%) reported that the use of the logbook to record attendance with tutor signatures was a satisfactory system, although students questioned the need for recording attendance at every classroom-based activity. Most students felt that the logbook facilitated access to learning experiences during the rotation (n=90/128, 71%). Staff felt that the process of signing logbooks improved their interaction with students (n=6/8, 75%). Conclusion The survey showed that the use of a paper-based logbook to record medical student attendance with tutor signatures across all clinical and classroom-based learning activities was acceptable and practical for students and staff and was felt to facilitate access to learning opportunities. The study provides medical educators with evidence to support monitoring of attendance within clinical rotations. PMID:27099545

Student and staff experiences of attendance monitoring in undergraduate obstetrics and gynecology: a cross-sectional survey.

PubMed

Deane, Richard P; Murphy, Deirdre J

2016-01-01

Despite the widespread introduction of active learning strategies to engage students across modern medical curricula, student attendance and attendance monitoring remain a challenging issue for medical educators. In addition, there is little published evidence available to medical educators regarding the use of attendance monitoring systems. The aim of this study was to evaluate the opinions of students and staff about the use of a paper-based student logbook to record student attendance across all clinical and classroom-based learning activities within an undergraduate clinical rotation in obstetrics and gynecology (OBGYN). Each student undertaking the clinical rotation in OBGYN was required to complete a paper-based logbook in a booklet format that listed every clinical and classroom-based activity that the student was expected to attend. A cross-sectional survey evaluating the acceptability, practicality, and effect on access to learning opportunities of using the logbook was undertaken. The survey was conducted among all medical students who completed their OBGYN rotation over a full academic year and staff who taught on the program. The response rate was 87% (n=128/147) among students and 80% (n=8/10) among staff. Monitoring attendance was widely acceptable to students (n=107/128, 84%) and staff (n=8/8, 100%). Most students (n=95/128, 74%) and staff (n=7/8, 88%) recommended that attendance should be mandatory during rotations. Almost all staff felt that attendance should contribute toward academic credit (n=7/8, 88%), but students were divided (n=73/128, 57%). Students (n=94/128, 73%) and staff (n=6/8, 75%) reported that the use of the logbook to record attendance with tutor signatures was a satisfactory system, although students questioned the need for recording attendance at every classroom-based activity. Most students felt that the logbook facilitated access to learning experiences during the rotation (n=90/128, 71%). Staff felt that the process of signing logbooks improved their interaction with students (n=6/8, 75%). The survey showed that the use of a paper-based logbook to record medical student attendance with tutor signatures across all clinical and classroom-based learning activities was acceptable and practical for students and staff and was felt to facilitate access to learning opportunities. The study provides medical educators with evidence to support monitoring of attendance within clinical rotations.

DoD-GEIS Rift Valley Fever Monitoring and Prediction System as a Tool for Defense and US Diplomacy

NASA Technical Reports Server (NTRS)

Anyamba, Assaf; Tucker, Compton J.; Linthicum, Kenneth J.; Witt, Clara J.; Gaydos, Joel C.; Russell, Kevin L.

2011-01-01

Over the last 10 years the Armed Forces Health Surveillance Center's Global Emerging Infections Surveillance and Response System (GEIS) partnering with NASA'S Goddard Space Flight Center and USDA's USDA-Center for Medical, Agricultural & Veterinary Entomology established and have operated the Rift Valley fever Monitoring and Prediction System to monitor, predict and assess the risk of Rift Valley fever outbreaks and other vector-borne diseases over Africa and the Middle East. This system is built on legacy DoD basic research conducted by Walter Reed Army Institute of Research overseas laboratory (US Army Medical Research Unit-Kenya) and the operational satellite environmental monitoring by NASA GSFC. Over the last 10 years of operation the system has predicted outbreaks of Rift Valley fever in the Horn of Africa, Sudan, South Africa and Mauritania. The ability to predict an outbreak several months before it occurs provides early warning to protect deployed forces, enhance public health in concerned countries and is a valuable tool use.d by the State Department in US Diplomacy. At the international level the system has been used by the Food and Agricultural Organization (FAD) and the World Health Organization (WHO) to support their monitoring, surveillance and response programs in the livestock sector and human health. This project is a successful testament of leveraging resources of different federal agencies to achieve objectives of force health protection, health and diplomacy.

Educational Outreach to Opioid Prescribers: The Case for Academic Detailing.

PubMed

Trotter Davis, Margot; Bateman, Brian; Avorn, Jerry

2017-02-01

Nonmedical use of opioid medications constitutes a serious health threat as the rates of addiction, overdoses, and deaths have risen in recent years. Increasingly, inappropriate and excessively liberal prescribing of opioids by physicians is understood to be a central part of the crisis. Public health officials, hospital systems, and legislators are developing programs and regulations to address the problem in sustained and systematic ways that both insures effective treatment of pain and appropriate limits on the availability of opioids. Three approaches have obtained prominence as means of avoiding excessive and inappropriate prescribing, including: providing financial incentives to physicians to change their clinical decision through pay-for-performance contracts, monitoring patient medications through Prescription Drug Monitoring Programs, and educational outreach to physicians. A promising approach to educational outreach to physicians is an intervention known as "academic detailing." It was developed in the 1980s to provide one-on-one educational outreach to physicians using similar methods as the pharmaceutical industry that sends "detailers" to market their products to physician practices. Core to academic detailing, however, is the idea that medical decisions should be based on evidence-based information, including managing conditions with updated assessment measures, behavioral, and nonpharmacological interventions. With the pharmaceutical industry spending billions of dollars to advertise their products, individual practitioners can have difficulty gathering unbiased information, especially as the number of approved medications grows each year. Academic detailing has successfully affected the management of health conditions, such as atrial fibrillation, chronic obstructive pulmonary disease, and recently, has targeted physicians who prescribe opioids. This article discusses the approach as a potentially effective preventative intervention to address the epidemic of opioid overuse.Key words: Opioid abuse, opioid misuse, academic detailing, health policy, interactive education,prevention.

A New Approach to Identify High Burnout Medical Staffs by Kernel K-Means Cluster Analysis in a Regional Teaching Hospital in Taiwan.

PubMed

Lee, Yii-Ching; Huang, Shian-Chang; Huang, Chih-Hsuan; Wu, Hsin-Hung

2016-01-01

This study uses kernel k-means cluster analysis to identify medical staffs with high burnout. The data collected in October to November 2014 are from the emotional exhaustion dimension of the Chinese version of Safety Attitudes Questionnaire in a regional teaching hospital in Taiwan. The number of effective questionnaires including the entire staffs such as physicians, nurses, technicians, pharmacists, medical administrators, and respiratory therapists is 680. The results show that 8 clusters are generated by kernel k-means method. Employees in clusters 1, 4, and 5 are relatively in good conditions, whereas employees in clusters 2, 3, 6, 7, and 8 need to be closely monitored from time to time because they have relatively higher degree of burnout. When employees with higher degree of burnout are identified, the hospital management can take actions to improve the resilience, reduce the potential medical errors, and, eventually, enhance the patient safety. This study also suggests that the hospital management needs to keep track of medical staffs' fatigue conditions and provide timely assistance for burnout recovery through employee assistance programs, mindfulness-based stress reduction programs, positivity currency buildup, and forming appreciative inquiry groups. © The Author(s) 2016.

A proposal for funding and monitoring medical education supervision in expanded clinical settings--a 'meducation' card.

PubMed

DeWitt, D E; McColl, G J

2011-01-01

Entry to practice medical programs (graduate- and undergraduate-entry) in Australia are under considerable pressure to provide clinical training as a result of increased student numbers. At the same time modern medical curricula require the development of active placements in expanded settings to achieve graduate medical practitioners who are clinically able. These dual imperatives require a mechanism to fund and maintain the quality of clinical placements outside the traditional hospital setting. For teaching outside traditional teaching hospitals the Australian government's Practice Incentives Program (PIP) currently provides a student-related payment of AU$100 for each half-day teaching session in a general practice setting. This payment is not linked to the quality of the placement and does not support clinical placements in other settings, for example specialist consulting rooms or allied health practices. This short communication proposes a 'meducation' card as an efficient funding mechanism to facilitate an expansion of quality clinical placements in expanded settings including specialist and allied health practices. This student meducation card would use current Medicare Australia infrastructure to facilitate the payment of clinical teachers in expanded settings. Meducation payments would only be available to practitioners and practices that maintain quality teaching practices certified by medical or allied health schools.

Improving BP control through electronic communications: an economic evaluation.

PubMed

Fishman, Paul A; Cook, Andrea J; Anderson, Melissa L; Ralston, James D; Catz, Sheryl L; Carrell, David; Carlson, James; Green, Beverly B

2013-09-01

Web-based collaborative approaches to managing chronic illness show promise for both improving health outcomes and increasing the efficiency of the healthcare system. Analyze the cost-effectiveness of the Electronic Communications and Home Blood Pressure Monitoring to Improve Blood Pressure Control (e-BP) study, a randomized controlled trial that used a patient-shared electronic medical record, home blood pressure (BP) monitoring, and web-based pharmacist care to improve BP control (<140/90 mm Hg). Incremental cost-effectiveness analysis conducted from a health plan perspective. Cost-effectiveness of home BP monitoring and web-based pharmacist care estimated for percent change in patients with controlled BP and cost per mm Hg in diastolic and systolic BP relative to usual care and home BP monitoring alone. A 1% improvement in number of patients with controlled BP using home BP monitoring and web-based pharmacist care-the e-BP program-costs $16.65 (95% confidence interval: 15.37- 17.94) relative to home BP monitoring and web training alone. Each mm HG reduction in systolic and diastolic BP achieved through the e-BP program costs $65.29 (59.91-70.67) relativeto home BP monitoring and web tools only. Life expectancy was increased at an incremental cost of $1850 (1635-2064) and $2220 (1745-2694) per year of life saved for men and women, respectively. Web-based collaborative care can be used to achieve BP control at a relatively low cost. Future research should examine the cost impact of potential long-term clinical improvements.

TH-E-209-01: Fluoroscopic Dose Monitoring and Patient Follow-Up Program at Massachusetts General Hospital

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

Liu, B.

2016-06-15

Radiation dose monitoring solutions have opened up new opportunities for medical physicists to be more involved in modern clinical radiology practices. In particular, with the help of comprehensive radiation dose data, data-driven protocol management and informed case follow up are now feasible. Significant challenges remain however and the problems faced by medical physicists are highly heterogeneous. Imaging systems from multiple vendors and a wide range of vintages co-exist in the same department and employ data communication protocols that are not fully standardized or implemented making harmonization complex. Many different solutions for radiation dose monitoring have been implemented by imaging facilitiesmore » over the past few years. Such systems are based on commercial software, home-grown IT solutions, manual PACS data dumping, etc., and diverse pathways can be used to bring the data to impact clinical practice. The speakers will share their experiences with creating or tailoring radiation dose monitoring/management systems and procedures over the past few years, which vary significantly in design and scope. Topics to cover: (1) fluoroscopic dose monitoring and high radiation event handling from a large academic hospital; (2) dose monitoring and protocol optimization in pediatric radiology; and (3) development of a home-grown IT solution and dose data analysis framework. Learning Objectives: Describe the scope and range of radiation dose monitoring and protocol management in a modern radiology practice Review examples of data available from a variety of systems and how it managed and conveyed. Reflect on the role of the physicist in radiation dose awareness.« less

Feasibility and Usability of Tele-interview for Medical Residency Interview

PubMed Central

Pourmand, Ali; Lee, Hayoung; Fair, Malika; Maloney, Kaylah; Caggiula, Amy

2018-01-01

Every year in the United States, medical students and residency programs dedicate millions of dollars to the residency matching process. On-site interviews for training positions involve tremendous financial investment, and time spent detracts from educational pursuits and clinical responsibilities. Students are usually required to fund their own travel and accommodations, adding additional financial burdens to an already costly medical education. Similarly, residency programs allocate considerable funds to interview-day meals, tours, staffing, and social events. With the rapid onslaught of innovations and advancements in the field of telecommunication, technology has become ubiquitous in the practice of medicine. Internet applications have aided our ability to deliver appropriate, evidence-based care at speeds previously unimagined. Wearable medical tech allows physicians to monitor patients from afar, and telemedicine has emerged as an economical means by which to provide care to all corners of the world. It is against this backdrop that we consider the integration of technology into the residency application process. This article aims to assess the implementation of technology in the form of web-based interviewing as a viable means by which to reduce the costs and productivity losses associated with traditional in-person interview days. PMID:29383060

Changing Medical School IT to Support Medical Education Transformation.

PubMed

Spickard, Anderson; Ahmed, Toufeeq; Lomis, Kimberly; Johnson, Kevin; Miller, Bonnie

2016-01-01

Many medical schools are modifying curricula to reflect the rapidly evolving health care environment, but schools struggle to provide the educational informatics technology (IT) support to make the necessary changes. Often a medical school's IT support for the education mission derives from isolated work units employing separate technologies that are not interoperable. We launched a redesigned, tightly integrated, and novel IT infrastructure to support a completely revamped curriculum at the Vanderbilt School of Medicine. This system uses coordinated and interoperable technologies to support new instructional methods, capture students' effort, and manage feedback, allowing the monitoring of students' progress toward specific competency goals across settings and programs. The new undergraduate medical education program at Vanderbilt, entitled Curriculum 2.0, is a competency-based curriculum in which the ultimate goal is medical student advancement based on performance outcomes and personal goals rather than a time-based sequence of courses. IT support was essential in the creation of Curriculum 2.0. In addition to typical learning and curriculum management functions, IT was needed to capture data in the learning workflow for analysis, as well as for informing individual and programmatic success. We aligned people, processes, and technology to provide the IT infrastructure for the organizational transformation. Educational IT personnel were successfully realigned to create the new IT system. The IT infrastructure enabled monitoring of student performance within each competency domain across settings and time via personal student electronic portfolios. Students use aggregated performance data, derived in real time from the portfolio, for mentor-guided performance assessment, and for creation of individual learning goals and plans. Poorly performing students were identified earlier through online communication systems that alert the appropriate instructor or coach of low quiz grades or missed learning goals. Graphical and narrative displays of a student's competency performance across courses and clinical experiences informed high-stake decisions made about student progress by the promotions committee. Similarly, graphical display of aggregate student outcomes provided education leaders with information needed to adjust and improve the curriculum. With the alignment of people, processes, and technology, educational IT can facilitate transformational steps in the training of medical students.

Work reintegration and cardiovascular disease: medical and rehabilitation influences.

PubMed

O'Hagan, F T; Coutu, M F; Thomas, S G; Mertens, D J

2012-06-01

Research into work reintegration following cardiovascular disease onset is limited in its clinical and individual focus. There is no research examining worker experience in context during the return to work process. Qualitative case study method informed by applied ethnography. Worker experience was assessed through longitudinal in-depth interviews with 12 workers returning to work following disabling cardiac illness. Workplace context (Canadian auto manufacturing plant) was assessed through site visits and meetings with stakeholders including occupational health personnel. Data was analyzed using constant comparison and progressive coding. Twelve men (43-63 years) participated in the study. Results revealed that unyielding production demands and performance monitoring pushed worker capacities and caused "insidious stress". Medical reassurance was important in the workers' decisions to return to work and stay on the job but medical restrictions were viewed as having limited relevance owing to limited understanding of work demands. Medical sanction was important for transient absence from the workplace as well as permanent disability. Cardiac rehabilitation programs were beneficial for lifestyle modification and building exercise capacity, but had limited benefit on work reintegration. Occupational health provided monitoring and support during work reintegration. Medical reassurance can be an important influence on worker representations of disease threat. Medical advice as it pertained to work activities was less valued as it lacked considerations of work conditions. Cardiac rehabilitation lacked intensity and relevance to work demands. Occupational health was reassuring for workers and played an important role in developing return to work plans.

Summer research program (1992). Summer faculty research program (SFRP) reports. Volume 6. Arnold Engineering Development Center, Civil Engineering Laboratory, Frank J. Seiler research laboratory, Wilford Hall Medical Center. Annual report, 1 September 1991-31 August 1992

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

Moore, G.

1992-12-28

The following Topics were among those completed at the Air Force Faculty Research Summer Program: Experiences using Model-Based Techniques for the Development of a Large Parallel Instrumentation System; Data Reduction of Laser Induced Fluorescence in Rocket Motor Exhausts; Feasibility of Wavelet Analysis for Plume Data Study; Characterization of Seagrass Meadows in St. Andrew (Crooked Island) Sound, Northern Gulf of Mexico; A Preliminary Study of the Weathering of Jet Fuels in Soil Monitored by SFE with GC Analysis; Preliminary Numerical model of Groundwater Flow at the MADE2 Site.

Strengthening the Role of Nurses in Medical Device Development.

PubMed

Castner, Jessica; Sullivan, Suzanne S; Titus, Albert H; Klingman, Karen J

2016-01-01

Medical devices and innovative technology promise to revolutionize health care. Despite the importance of involving nurses in the collaborative medical device development processes, there are few learning opportunities in nursing programs. The purpose of this article is to provide a conceptual guide for nurse educators and researchers to engage nursing expertise in medical device development processes. A review of the literature guided the creation of the "Strengthening the Role of Nurses in Medical Device Development Roadmap" model. The model was used to describe how nurses can be engaged in multidisciplinary design of medical devices. An academic transdisciplinary team piloted the application of the model. The model includes the stages of needs assessment, planned brainstorm, feasibility determination, concept design, and prototype building. A transdisciplinary team case study of improving an asthma home-monitoring devices illustrates effective application of the model. Nurse leaders in the academic setting can effectively use the "Strengthening the Role of Nurses in Medical Device Development Roadmap" to inform their engagement of nurses in early medical device development and innovation processes. Copyright © 2016 Elsevier Inc. All rights reserved.

Using Six Sigma to reduce medication errors in a home-delivery pharmacy service.

PubMed

Castle, Lon; Franzblau-Isaac, Ellen; Paulsen, Jim

2005-06-01

Medco Health Solutions, Inc. conducted a project to reduce medication errors in its home-delivery service, which is composed of eight prescription-processing pharmacies, three dispensing pharmacies, and six call-center pharmacies. Medco uses the Six Sigma methodology to reduce process variation, establish procedures to monitor the effectiveness of medication safety programs, and determine when these efforts do not achieve performance goals. A team reviewed the processes in home-delivery pharmacy and suggested strategies to improve the data-collection and medication-dispensing practices. A variety of improvement activities were implemented, including a procedure for developing, reviewing, and enhancing sound-alike/look-alike (SALA) alerts and system enhancements to improve processing consistency across the pharmacies. "External nonconformances" were reduced for several categories of medication errors, including wrong-drug selection (33%), wrong directions (49%), and SALA errors (69%). Control charts demonstrated evidence of sustained process improvement and actual reduction in specific medication error elements. Establishing a continuous quality improvement process to ensure that medication errors are minimized is critical to any health care organization providing medication services.

Obesity Prevention and Weight Maintenance After Loss.

PubMed

German, Alexander James

2016-09-01

Obesity is one of the most prevalent medical diseases in pets. Outcomes are often disappointing; many animals either fail to reach target weight or regain weight. This article discusses managing obesity, focusing on prevention. It gives guidance on establishing monitoring programs that use regular body weight and condition assessments to identify animals at risk of inappropriate weight gain, enabling early intervention. Weight management in obese animals is a lifelong process. Regular weight and body condition monitoring are key to identifying animals that rebound early, while continuing to feed a therapeutic weight loss diet can help prevent it from happening. Copyright © 2016 Elsevier Inc. All rights reserved.

A cloud-based electronic medical record for scheduling, tracking, and documenting examinations and treatment of retinopathy of prematurity.

PubMed

Arnold, Robert W; Jacob, Jack; Matrix, Zinnia

2012-01-01

Screening by neonatologists and staging by ophthalmologists is a cost-effective intervention, but inadvertent missed examinations create a high liability. Paper tracking, bedside schedule reminders, and a computer scheduling and reminder program were compared for speed of input and retrospective missed examination rate. A neonatal intensive care unit (NICU) process was then programmed for cloud-based distribution for inpatient and outpatient retinopathy of prematurity monitoring. Over 11 years, 367 premature infants in one NICU were prospectively monitored. The initial paper system missed 11% of potential examinations, the Windows server-based system missed 2%, and the current cloud-based system missed 0% of potential inpatient and outpatient examinations. Computer input of examinations took the same or less time than paper recording. A computer application with a deliberate NICU process improved the proportion of eligible neonates getting their scheduled eye examinations in a timely manner. Copyright 2012, SLACK Incorporated.

Disease management programs for the underserved.

PubMed

Horswell, Ronald; Butler, Michael K; Kaiser, Michael; Moody-Thomas, Sarah; McNabb, Shannon; Besse, Jay; Abrams, Amir

2008-06-01

Disease management has become an important tool for improving population patient outcomes. The Louisiana State University Health Care Services Division (HCSD) has used this tool to provide care to a largely uninsured population for approximately 10 years. Eight programs currently exist within the HCSD focusing on diabetes, asthma, congestive heart failure, HIV, cancer screening, smoking cessation, chronic kidney disease, and diet, exercise, and weight control. These programs operate at hospital and clinic sites located in 8 population centers throughout southern Louisiana. The programs are structured to be managed at the system level with a clinical expert for each area guiding the scope of the program and defining new goals. Care largely adheres to evidence-based guidelines set forth by professional organizations. To monitor quality of care, indicators are defined within each area and benchmarked to achieve the most effective measures in our population. For example, hemoglobin A1c levels have shown improvements with nearly 54% of the population <7.0%. To support these management efforts, HCSD utilizes an electronic data repository that allows physicians to track patient labs and other tests as well as reminders. To ensure appropriate treatment, patients are able to enroll in the Medication Assistance program. This largely improves adherence to medications for those patients unable to afford them otherwise.

Implications of prescription drug monitoring and medical cannabis legislation on opioid overdose mortality.

PubMed

Phillips, Elyse; Gazmararian, Julie

To determine whether specific state legislation has an effect on opioid overdose mortality rates compared to states without those types of legislation. Ecological study estimating opioid-related mortality in states with and without a prescription drug monitoring program (PDMP) and/or medical cannabis legislation. Opioid-related mortality rates for 50 states and Washington DC from 2011 to 2014 were obtained from CDC WONDER. PDMP data were obtained from the National Alliance for Model State Drug Laws, and data on medical cannabis legislation from the National Organization for the Reform of Marijuana Laws. The relationship between PDMPs with mandatory access provisions, medical cannabis legislation, and opioid-related mortality rates. Multivariate repeated measures analysis performed with software and services. Medical cannabis laws were associated with an increase of 21.7 percent in mean age-adjusted opioid-related mortality (p < 0.0001). PDMPs were associated with an increase of 11.4 percent in mean age-adjusted opioid-related mortality (p = 0.005). For every additional year since enactment, mean age-adjusted opioid-related mortality rate increased by 1.7 percent in states with medical cannabis (p = 0.049) and 5.8 percent for states with a PDMP (p = 0.005). Interaction between both types of legislation produced a borderline significant decrease of 10.1 percent (p = 0.055). For every year states had both types of legislation, interaction resulted in a 0.6 percent decrease in rate (p = 0.013). When combined with the availability of medical cannabis as an alternative analgesic therapy, PDMPs may be more effective at decreasing opioid-related mortality.

SU-F-P-04: Implementation of Dose Monitoring Software: Successes and Pitfalls

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

Och, J

2016-06-15

Purpose: to successfully install a dose monitoring software (DMS) application to assist in CT protocol and dose management. Methods: Upon selecting the DMS, we began our implementation of the application. A working group composed of Medical Physics, Radiology Administration, Information Technology, and CT technologists was formed. On-site training in the application was supplied by the vendor. The decision was made to apply the process for all the CT protocols on all platforms at all facilities. Protocols were painstakingly mapped to the correct masters, and the system went ‘live’. Results: We are routinely using DMS as a tool in our Clinicalmore » Performance CT QA program. It is useful in determining the effectiveness of revisions to existing protocols, and establishing performance baselines for new units. However, the implementation was not without difficulty. We identified several pitfalls and obstacles which frustrated progress. Including: Training deficiencies, Nomenclature problems, Communication, DICOM variability. Conclusion: Dose monitoring software can be a potent tool for QA. However, implementation of the program can be problematic and requires planning, organization and commitment.« less

Radiological protection for pregnant women at a large academic medical Cancer Center.

PubMed

Chu, Bae; Miodownik, Daniel; Williamson, Matthew J; Gao, Yiming; St Germain, Jean; Dauer, Lawrence T

2017-11-01

Most radiation protection programs, regulations and guidance apply specific restrictions to the occupational exposure of pregnant workers. The aim of this study was to compile data from the declared pregnant woman (DPW) radiation protection program over more than 5years at a large, high-volume, comprehensive oncology academic/medical institution and to evaluate for effectiveness against existing regulations and guidance. A retrospective review was performed of the data collected as part of the DPW radiation protection program from January 2010 through May 2016, including the number of declared pregnancies, worker category, personal and fetal dosimetry monitoring measurements, workplace modifications, as well as the monthly and total recorded badge results during the entire pregnancy. 245 pregnancies were declared. The mean monthly fetal radiation dosimetry result was 0.009mSv with a median of 0.005mSv and a maximum of 0.39mSv. The mean total dose over the entire pregnancy was estimated to be 0.08mSv with a median of 0.05mSv and a maximum of 0.89mSv. Only 8 (3.2%) of the 245 declared pregnancies required that workplace modifications be implemented for the worker. The implementation of a declared pregnancy and fetal assessment program, careful planning, an understanding of the risks, and minimization of radiation dose by employing appropriate radiation safety measures as needed, can allow medical staff to perform procedures and normal activities without incurring significant risks to the conceptus, or significant interruptions of job activities for most medical workers. Copyright © 2017. Published by Elsevier Ltd.

New technology in electrophysiology: FDA process and perspective.

PubMed

Selzman, Kimberly A; Fellman, Mark; Farb, Andrew; de Del Castillo, Sergio; Zuckerman, Bram

2016-10-01

The Food and Drug Administration (FDA) is a large regulatory agency that monitors everything from food, tobacco, and veterinary medicine to pharmaceutical drugs and medical devices. The Mission statement of the CDRH, one of the Centers of the FDA, in its most succinct form is to protect and promote public health. This is accomplished through timely and continued access to safe, effective, and high quality medical devices. This paper aims to review the overarching principles of the Agency's review process for cardiac devices as well as highlight some of the newer programs that FDA has engaged in to facilitate innovation, device development, research, and timely market approval.

Development of the OMPAT Neuropsychological/Psychomotor Performance Evaluation and OMPAT Data and Timing Support Programs

DTIC Science & Technology

1993-12-31

effect of Ritalin on attention and traumatically brain injured adults and the issues concerning repeated measures using computer based testing with...heat, cold and fatigue on neurological functions, as well as, the interactive and independent effects of chemical agents and pharmaceuticals. 5) A...serial manner was becoming an increasingly important task in neuropsychology. Serial assessment was important for monitoring medication effects

Clinical Investigation Program, RCS MED-300 (RI).

DTIC Science & Technology

1984-10-01

temperature/dry. Technical Approach: 1) Experimental desion: a post-test only, equivalent - group experimental design will be used in this study. Random...5650 * It. CONTROLLING OFFICE NAME AND ADDRESS 12. REPORT DATE Commander October 1984 Dwight David Eisenhower Army Medical Center 1s. NUMBEROFPAGES...Fort Gordon, Georgia 30905-5650 210 14. MONITORING AGENCY NAME I ADORESS(11 different from Controlling Offce) IS. SECURITY CLASS. (of tAle MP*H

[A novel serial port auto trigger system for MOSFET dose acquisition].

PubMed

Luo, Guangwen; Qi, Zhenyu

2013-01-01

To synchronize the radiation of microSelectron-HDR (Nucletron afterloading machine) and measurement of MOSFET dose system, a trigger system based on interface circuit was designed and corresponding monitor and trigger program were developed on Qt platform. This interface and control system was tested and showed stable operate and reliable work. This adopted serial port detect technique may expand to trigger application of other medical devices.

An Effective Health and Medical Technical Authority

NASA Technical Reports Server (NTRS)

Fogarty, Jennifer A.

2009-01-01

The NASA Governance model directed the formation of three Technical Authorities, Engineering; Safety and Mission Assurance; and Health and Medical, to ensure that risks are identified and adjudicated efficiently and transparently in concert with the spaceflight programs and projects. The Health and Medical Technical Authority (HMTA) has been implemented at the Johnson Space Center (JSC) and consists of the Chief Medical Office (CMO), the Deputy CMO, and HMTA Delegates. The JSC HMTA achieves the goals of risk identification and adjudication through the discharge of the appropriate technical expertise to human space flight programs and projects and the escalation of issues within program and technical authority boards. The JSC HMTA relies on subject matter experts (SMEs) in the Space Life Sciences Directorate at JSC as well as experts from other Centers to work crew health and performance issues at the technical level, develop requirements, oversee implementation and validation of requirements, and identify risks and non-compliances. Once a risk or potential noncompliance has been identified and reported to the programs or projects, the JSC HMTA begins to track it and closely monitor the program's or project's response. As a risk is developed or a non-compliance negotiated, positions from various levels of decision makers are sought at the program and project control boards. The HMTA may support a program or project position if it is satisfied with the decision making and vetting processes (ex. the subject matter expert voiced his/her concerns and all dissenting opinions were documented) and finds that the position both acknowledges the risk and cost of the mitigation and resolves the issue without changing NASA risk posture. The HMTA may disagree with a program or project position if the NASA risk posture has been elevated or obfuscated. If the HMTA does disagree with the program or project position, it will appeal to successively higher levels of authority so that risk acceptance and risk trades will be acknowledged and sanctioned at the highest appropriate level; this includes Program Managers, Mission Directorate Associate Administrators and the Agency Administrator.

[Post-marketing surveillance systems for psychoactive prescription drug abuse].

PubMed

Nordmann, Sandra; Frauger, Elisabeth; Pauly, Vanessa; Rouby, Frank; Mallaret, Michel; Micallef, Joëlle; Thirion, Xavier

2011-01-01

Drugs affecting the central nervous system form a unique group of products for surveillance because they could be misused, abused or diverted. Considering the characteristics of this behaviour that is often concealed, specific post-marketing surveillance systems have been developed to monitor abuse of prescription drugs in some countries. The purpose of this review is to list and to describe post-marketing surveillance systems, according their methodology, in France and in foreign countries. These programs are based on adverse effect notifications, medical or legal consequences of abuse, general or specific population-based survey, professional networks or medication databases. Some programs use simultaneously several information sources. In conclusion, the multifaceted nature, the diversity and the inventiveness of post-marketing surveillance systems reflects the complexity of the abuse issue. © 2011 Société Française de Pharmacologie et de Thérapeutique.

The Healthy Workplace Project: results of a hygiene-based approach to employee wellness.

PubMed

Thompson, Sanna J; Rew, Lynn

2015-01-01

An employee wellness program was evaluated to assess changes in germ transmission, absenteeism, and cost of infection-related illness among office-based employees. One-group pretest-posttest design, with intervention delivered for 90 days and measurement conducted over 1 year. Employees of a large office space in Georgia. One thousand six hundred forty-five employees. The Healthy Workplace Project is a 90-day wellness program aimed to increase health and productivity of employees through educational and engagement activities focusing on improving awareness, recognizing infection-related illnesses, and reducing the spread of germs in the workplace. Three types of data were collected: (1) bacterial audits through use of adenosine triphosphate monitoring of various work spaces; (2) self-report absenteeism data using the World Health Organization's Health and Work Performance Questionnaire; and (3) participant employees' medical claims/costs of infection-related minor illnesses. Frequencies and bacterial audit data; Wilcoxon signed ranks tests to determine changes in rates on absenteeism and health care costs. Bacterial audits demonstrated a reduction in contamination levels of 33% across all measured spaces. Absenteeism rates were reduced by 13%. Medical service utilization costs were not significantly reduced for individual employees over the project year. Educational strategies and individual monitoring of germ transmission appears effective in improving employees' health and decreasing absenteeism.

Computers in medical education 1: evaluation of a problem-orientated learning package.

PubMed

Devitt, P; Palmer, E

1998-04-01

A computer-based learning package has been developed, aimed at expanding students' knowledge base, as well as improving data-handling abilities and clinical problem-solving skills. The program was evaluated by monitoring its use by students, canvassing users' opinions and measuring its effectiveness as a learning tool compared to tutorials on the same material. Evaluation was undertaken using three methods: initially, by a questionnaire on computers as a learning tool and the applicability of the content: second, through monitoring by the computer of student use, decisions and performance; finally, through pre- and post-test assessment of fifth-year students who either used a computer package or attended a tutorial on equivalent material. Most students provided positive comments on the learning material and expressed a willingness to see computer-aided learning (CAL) introduced into the curriculum. Over a 3-month period, 26 modules in the program were used on 1246 occasions. Objective measurement showed a significant gain in knowledge, data handling and problem-solving skills. Computer-aided learning is a valuable learning resource that deserves better attention in medical education. When used appropriately, the computer can be an effective learning resource, not only for the delivery of knowledge. but also to help students develop their problem-solving skills.

Enhanced Performance of Community Health Service Centers during Medical Reforms in Pudong New District of Shanghai, China: A Longitudinal Survey.

PubMed

Sun, Xiaoming; Li, Yanting; Liu, Shanshan; Lou, Jiquan; Ding, Ye; Liang, Hong; Gu, Jianjun; Jing, Yuan; Fu, Hua; Zhang, Yimin

2015-01-01

The performance of community health service centers (CHSCs) has not been well monitored and analysed since China's latest community health reforms in 2009. The aim of the current investigation was to evaluate the performing trends of the CHSCs and to analyze the main factors that could affect the performance in Pudong new district of Shanghai, China. A regional performance assessment indicator system was applied to the evaluation of Pudong CHSCs' performance from 2011 to 2013. All of the data were sorted out by a panel, and analyzed using descriptive statistics and a generalized estimating equation model. We found that the overall performance increased annually, with a growing number of CHSCs achieving high scores. Significant differences were observed in institutional management, public health services, basic medical services and comprehensive satisfaction during the period of three years. However, we found no differences in the service scores of Chinese traditional medicine (CTM). The investigation also demonstrated that the key factors affecting performance were the location, information system level, family GP program and medical association program rather than the size of the center. However, the medical association participation appeared to have a significant negative effect on performance. It can be concluded from the three-year investigation that the overall performance was improved, but that it could have been further enhanced, especially in institutional management and basic medical service; therefore, it is imperative that CHSCs undertake approaches such as optimizing the resource allocation and utilization, reinforcing the establishment of the information system level, extending the family GP program to more local communities, and promoting the medical association initiative.

Use of telescience for biomedical research during space flight

NASA Technical Reports Server (NTRS)

Huntoon, Carolyn L.; Schneider, Howard J.; Karamanos, Gayle M.

1991-01-01

When the U.S. first embarked on a manned space flight program, NASA's use of medical telescience was focused on crew health monitoring. In recent years, medical telescience use has been expanded to include support of basic research in space medicine. It enables ground support personnel to assist on-board crews in the performance of experiments and improves the quality and quantity of data return. NASA is continuing to develop its telescience capabilities. Future plans include telemedicine that will enable physicians on Earth to support crewmembers during flight and telescience that will enable investigators at their home institutions to support and conduct in-flight medical research. NASA's use of telescience for crew safety and biomedical research from Project Mercury to the present is described and NASA's plans for the future are presented.

Assessment for Systems Learning: A Holistic Assessment Framework to Support Decision Making Across the Medical Education Continuum.

PubMed

Bowe, Constance M; Armstrong, Elizabeth

2017-05-01

Viewing health care from a systems perspective-that is, "a collection of different things which, working together, produce a result not achievable by the things alone"-raises awareness of the complex interrelationships involved in meeting society's goals for accessible, cost-effective, high-quality health care. This perspective also emphasizes the far-reaching consequences of changes in one sector of a system on other components' performance. Medical education promotes this holistic view of health care in its curricula and competency requirements for graduation at the undergraduate and graduate training levels. But how completely does medical education apply a systems lens to itself?The continuum of medical training has undergone a series of changes that have moved it more closely to a systems organizational model. Competency assessment criteria have been expanded and more explicitly defined for learners at all levels of training. Outcomes data, in multiple domains, are monitored by external reviewers for program accreditation. However, translating increasing amounts of individual outcomes into actionable intelligence for decision making poses a formidable information management challenge.Assessment in systems is designed to impart a "big picture" of overall system performance through the synthesis, analysis, and interpretation of outcomes data to provide actionable information for continuous systems improvement, innovation, and long-term planning. A systems-based framework is presented for use across the medical education continuum to facilitate timely improvements in individual curriculum components, continuous improvement in overall program performance, and program decision making on changes required to better address society's health care needs.

Physician-directed software design: the role of utilization statistics and user input in enhancing HELP results review capabilities.

PubMed

Michael, P A

1993-01-01

The M.D. Rounds Report program was developed and implemented in June of 1992 as an adjunct to the HELP System at Rex Hospital. The program facilitates rapid access to information on allergies and current medications, laboratory results, radiology reports and therapist notes for a list of patients without physicians having to make additional menu or submenu selections. In planning for an upgrade of the program, utilization statistics and user feedback provided valuable information in terms of frequency of access, features used and unused, and the value of the program as a reporting tool in comparison to other online results reporting applications. A brief description of the functionality of the M.D. Rounds Report, evaluation of the program audit trail and user feedback, planned enhancements to the program, and a discussion of the prototyping and monitoring experience and the impact on future physician subsystem development will be presented.

Assessing the Development of Medical Students’ Personal and Professional Skills by Portfolio

PubMed Central

Yielder, Jill; Moir, Fiona

2016-01-01

The introduction of a new domain of learning for Personal and Professional Skills in the medical program at the University of Auckland in New Zealand has involved the compilation of a portfolio for assessment. This departure from the traditional assessment methods predominantly used in the past has been challenging to design, introduce, and maintain as a relevant and authentic assessment method. We present the portfolio format along with the process for its introduction and appraise the challenges, strengths, and limitations of the approach within the context of the current literature. We then outline a cyclical model of evaluation used to monitor and fine-tune the portfolio tasks and implementation process, in response to student and assessor feedback. The portfolios have illustrated the level of insight, maturity, and synthesis of personal and professional qualities that students are capable of achieving. The Auckland medical program strives to foster these qualities in its students, and the portfolio provides an opportunity for students to demonstrate their reflective abilities. Moreover, the creation of a Personal and Professional Skills domain with the portfolio as its key assessment emphasizes the importance of reflective practice and personal and professional development and gives a clear message that these are fundamental longitudinal elements of the program. PMID:29349315

Assessing the Development of Medical Students' Personal and Professional Skills by Portfolio.

PubMed

Yielder, Jill; Moir, Fiona

2016-01-01

The introduction of a new domain of learning for Personal and Professional Skills in the medical program at the University of Auckland in New Zealand has involved the compilation of a portfolio for assessment. This departure from the traditional assessment methods predominantly used in the past has been challenging to design, introduce, and maintain as a relevant and authentic assessment method. We present the portfolio format along with the process for its introduction and appraise the challenges, strengths, and limitations of the approach within the context of the current literature. We then outline a cyclical model of evaluation used to monitor and fine-tune the portfolio tasks and implementation process, in response to student and assessor feedback. The portfolios have illustrated the level of insight, maturity, and synthesis of personal and professional qualities that students are capable of achieving. The Auckland medical program strives to foster these qualities in its students, and the portfolio provides an opportunity for students to demonstrate their reflective abilities. Moreover, the creation of a Personal and Professional Skills domain with the portfolio as its key assessment emphasizes the importance of reflective practice and personal and professional development and gives a clear message that these are fundamental longitudinal elements of the program.

Medical waste management in Jordan: A study at the King Hussein Medical Center

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

Oweis, Rami; Al-Widyan, Mohamad; Al-Limoon, Ohood

2005-07-01

As in many other developing countries, the generation of regulated medical waste (RMW) in Jordan has increased significantly over the last few decades. Despite the serious impacts of RMW on humans and the environment, only minor attention has been directed to its proper handling and disposal. This study was conducted in the form of a case study at one of Jordan's leading medical centers, namely, the King Hussein Medical Center (KHMC). Its purpose was to report on the current status of medical waste management at KHMC and propose possible measures to improve it. In general, it was found that themore » center's administration was reasonably aware of the importance of medical waste management and practiced some of the measures to adequately handle waste generated at the center. However, it was also found that significant voids were present that need to be addressed in the future including efficient segregation, the use of coded and colored bags, better handling and transfer means, and better monitoring and tracking techniques, as well as the need for training and awareness programs for the personnel.« less

Monitoring Outpatient Care

NASA Technical Reports Server (NTRS)

2003-01-01

Each year, health care costs for managing chronically ill patients increase as the life expectancy of Americans continues to grow. To handle this situation, many hospitals, doctors practices, and home care providers are turning to disease management, a system of coordinated health care interventions and communications, to improve outpatient care. By participating in daily monitoring programs, patients with congestive heart failure, chronic obstructive pulmonary disease, diabetes, and other chronic conditions requiring significant self-care are facing fewer emergency situations and hospitalizations. Cybernet Medical, a division of Ann Arbor, Michigan-based Cybernet Systems Corporation, is using the latest communications technology to augment the ways health care professionals monitor and assess patients with chronic diseases, while at the same time simplifying the patients interaction with technology. Cybernet s newest commercial product for this purpose evolved from research funded by NASA, the National Institute of Mental Health, and the Advanced Research Projects Agency. The research focused on the physiological assessment of astronauts and soldiers, human performance evaluation, and human-computer interaction. Cybernet Medical's MedStar Disease Management Data Collection System is an affordable, widely deployable solution for improving in-home-patient chronic disease management. The system's battery-powered and portable interface device collects physiological data from off-the-shelf instruments.

Electronic fetal monitoring: a Canadian survey.

PubMed Central

Davies, B L; Niday, P A; Nimrod, C A; Drake, E R; Sprague, A E; Trépanier, M J

1993-01-01

OBJECTIVES: To determine the current status of electronic fetal monitoring (EFM) in Canadian teaching and nonteaching hospitals, to review the medical and nursing standards of practice for EFM and to determine the availability of EFM educational programs. DESIGN: National survey in 1989. PARTICIPANTS: The directors of nursing at the 737 hospitals providing obstetric care were sent a questionnaire and asked to have it completed by the most appropriate staff member. The response rate was 80.5% (593/737); 44 hospitals did not have deliveries in 1988 and were excluded. The remaining hospitals varied in size from 8 to 1800 (mean 162.1) beds and had 1 to 7500 (mean 617.1) births in 1988; 18.8% were teaching hospitals. RESULTS: Of the 549 hospitals 419 (76.3%) reported having at least 1 monitor (range 1 to 30; mean 2.6); the mean number of monitors per hospital was higher in the teaching hospitals than in the nonteaching hospitals (6.2 v. 1.7). Manitoba had the lowest mean number of monitors per hospital (1.1) and Ontario the highest (3.7). In 71.8% of the hospitals with monitors almost all of the obstetric patients were monitored at some point during labour. However, 21.6% of the hospitals with monitors had no policy on EFM practice. The availability of EFM educational programs for physicians and nurses varied according to hospital size, type and region. CONCLUSIONS: Most Canadian hospitals providing obstetric services have electronic fetal monitors and use them frequently. Although substantial research has questioned the benefits of EFM, further definitive research is required. In the meantime, a national committee should be established to develop multidisciplinary guidelines for intrapartum fetal assessment. PMID:8485677

The Utah Remote Monitoring Project: improving health care one patient at a time.

PubMed

Shane-McWhorter, Laura; Lenert, Leslie; Petersen, Marta; Woolsey, Sarah; McAdam-Marx, Carrie; Coursey, Jeffrey M; Whittaker, Thomas C; Hyer, Christian; LaMarche, Deb; Carroll, Patricia; Chuy, Libbey

2014-10-01

The expanding role of technology to augment diabetes care and management highlights the need for clinicians to learn about these new tools. As these tools continue to evolve and enhance improved outcomes, it is imperative that clinicians consider the role of telemonitoring, or remote monitoring, in patient care. This article describes a successful telemonitoring project in Utah. This was a nonrandomized prospective observational preintervention-postintervention study, using a convenience sample. Patients with uncontrolled diabetes and/or hypertension from four rural and two urban primary care clinics and one urban stroke center participated in a telemonitoring program. The primary clinical outcome measures were changes in hemoglobin A1C (A1C) and blood pressure. Other outcomes included fasting lipids, weight, patient engagement, diabetes knowledge, hypertension knowledge, medication adherence, and patient perceptions of the usefulness of the telemonitoring program. Mean A1C decreased from 9.73% at baseline to 7.81% at the end of the program (P<0.0001). Systolic blood pressure also declined significantly, from 130.7 mm Hg at baseline to 122.9 mm Hg at the end (P=0.0001). Low-density lipoprotein content decreased significantly, from 103.9 mg/dL at baseline to 93.7 mg/dL at the end (P=0.0263). Other clinical parameters improved nonsignificantly. Knowledge of diabetes and hypertension increased significantly (P<0.001 for both). Patient engagement and medication adherence also improved, but not significantly. Per questionnaires at study end, patients felt the telemonitoring program was useful. Telemonitoring improved clinical outcomes and may be a useful tool to help enhance disease management and care of patients with diabetes and/or hypertension.

Emergency medical kit for commercial airlines: an update.

PubMed

Thibeault, Claude

2002-06-01

As expected, the issue of medical kits for commercial airlines continues to attract attention, especially in light of the recent United States regulation on the subject. As promised in its first recommendation in 1998, the Air Transport Medicine (ATM) Committee has continued to monitor medical kit usage as well as pharmaceutical scientific developments and wishes to propose an update to its 1998 recommendation. Lists of contents are provided for emergency medical kits of two types: 1) those without defibrillator/monitor or monitor; and 2) those with defibrillator/monitor or monitor alone. Follow up and updates on this issue will be an ongoing task of the ATM Committee.

Open source software in a practical approach for post processing of radiologic images.

PubMed

Valeri, Gianluca; Mazza, Francesco Antonino; Maggi, Stefania; Aramini, Daniele; La Riccia, Luigi; Mazzoni, Giovanni; Giovagnoni, Andrea

2015-03-01

The purpose of this paper is to evaluate the use of open source software (OSS) to process DICOM images. We selected 23 programs for Windows and 20 programs for Mac from 150 possible OSS programs including DICOM viewers and various tools (converters, DICOM header editors, etc.). The programs selected all meet the basic requirements such as free availability, stand-alone application, presence of graphical user interface, ease of installation and advanced features beyond simple display monitor. Capabilities of data import, data export, metadata, 2D viewer, 3D viewer, support platform and usability of each selected program were evaluated on a scale ranging from 1 to 10 points. Twelve programs received a score higher than or equal to eight. Among them, five obtained a score of 9: 3D Slicer, MedINRIA, MITK 3M3, VolView, VR Render; while OsiriX received 10. OsiriX appears to be the only program able to perform all the operations taken into consideration, similar to a workstation equipped with proprietary software, allowing the analysis and interpretation of images in a simple and intuitive way. OsiriX is a DICOM PACS workstation for medical imaging and software for image processing for medical research, functional imaging, 3D imaging, confocal microscopy and molecular imaging. This application is also a good tool for teaching activities because it facilitates the attainment of learning objectives among students and other specialists.

Digital radiography with computerized conventional monitors compared to medical monitors in vertical root fracture diagnosis.

PubMed

Tofangchiha, Maryam; Adel, Mamak; Bakhshi, Mahin; Esfehani, Mahsa; Nazeman, Pantea; Ghorbani Elizeyi, Mojgan; Javadi, Amir

2013-01-01

Vertical root fracture (VRF) is a complication which is chiefly diagnosed radiographically. Recently, film-based radiography has been substituted with digital radiography. At the moment, there is a wide range of monitors available in the market for viewing digital images. The present study aims to compare the diagnostic accuracy, sensitivity and specificity of medical and conventional monitors in detection of vertical root fractures. In this in vitro study 228 extracted single-rooted human teeth were endodontically treated. Vertical root fractures were induced in 114 samples. The teeth were imaged by a digital charge-coupled device radiography using parallel technique. The images were evaluated by a radiologist and an endodontist on two medical and conventional liquid-crystal display (LCD) monitors twice. Z-test was used to analyze the sensitivity, accuracy and specificity of each monitor. Significance level was set at 0.05. Inter and intra observer agreements were calculated by Cohen's kappa. Accuracy, specificity and sensitivity for conventional monitor were calculated as 67.5%, 72%, 62.5% respectively; and data for medical grade monitor were 67.5%, 66.5% and 68% respectively. Statistical analysis showed no significant differences in detecting VRF between the two techniques. Inter-observer agreement for conventional and medical monitor was 0.47 and 0.55 respectively (moderate). Intra-observer agreement was 0.78 for medical monitor and 0.87 for conventional one (substantial). The type of monitor does not influence diagnosis of vertical root fractures.

[The regional model of three-level system of of medical social monitoring of children and adolescents: the pilot project in the Republic of Tatarstan].

PubMed

Al'bitskii, V Iu; Ustinova, N V; Farrakhov, A Z; Shavaliev, R F; Kulikov O V; Plaksina, L V

2014-01-01

The absence of system of medical social monitoring of children being in difficult life situations is one of main causes of preventable losses of health and life of children and adolescents. The plan of activities of the working group No3 under the Coordination council under the President of the Russian Federation of the national strategy realization of actions in interest of children for 2012-2017 includes a point: "The development and implementation of standard model of medical social monitoring of children and adolescents in the subjects of the Russian Federation". The implementation of this task is assigned to the Department of social pediatrics of The research center of children health of Moscow and the Ministry of Health of the Republic of Tatarstan. The research methods included analysis and generalization of advanced experience of medical social monitoring of children population; expertise technique; modeling. The regional model of three-level system of medical social monitoring of children population is developed and implemented. The model includes level I (consulting rooms of medical social care of children polyclinics, feldsher obstetric stations, first-aid centers), level II--inter-municipal (departments of medical social monitoring in central district hospitals, medical institutions, clinical diagnostic centers) and level III--regional (the Republican center of medical social monitoring of children and adolescents). The immediate tasks necessary for effective functioning of system of medical social monitoring were determined. Within the framework of implementation of the pilot project the legal and normative legislative acts were developed to regulate functioning of regional model of three-level system of medical social care. The other documents necessary for effective functioning of this system were elaborated. The practical significance of this system is in the implementation of effective three-level model of medical social monitoring of children and adolescents supporting decrease of morbidity, mortality and "risk behaviors" suicidal included. The model is to prevent child neglect and homelessness and cruel treatment of children and adolescents.

Effectiveness of Electronic Reminders to Improve Medication Adherence in Tuberculosis Patients: A Cluster-Randomised Trial.

PubMed

Liu, Xiaoqiu; Lewis, James J; Zhang, Hui; Lu, Wei; Zhang, Shun; Zheng, Guilan; Bai, Liqiong; Li, Jun; Li, Xue; Chen, Hongguang; Liu, Mingming; Chen, Rong; Chi, Junying; Lu, Jian; Huan, Shitong; Cheng, Shiming; Wang, Lixia; Jiang, Shiwen; Chin, Daniel P; Fielding, Katherine L

2015-09-01

Mobile text messaging and medication monitors (medication monitor boxes) have the potential to improve adherence to tuberculosis (TB) treatment and reduce the need for directly observed treatment (DOT), but to our knowledge they have not been properly evaluated in TB patients. We assessed the effectiveness of text messaging and medication monitors to improve medication adherence in TB patients. In a pragmatic cluster-randomised trial, 36 districts/counties (each with at least 300 active pulmonary TB patients registered in 2009) within the provinces of Heilongjiang, Jiangsu, Hunan, and Chongqing, China, were randomised using stratification and restriction to one of four case-management approaches in which patients received reminders via text messages, a medication monitor, combined, or neither (control). Patients in the intervention arms received reminders to take their drugs and reminders for monthly follow-up visits, and the managing doctor was recommended to switch patients with adherence problems to more intensive management or DOT. In all arms, patients took medications out of a medication monitor box, which recorded when the box was opened, but the box gave reminders only in the medication monitor and combined arms. Patients were followed up for 6 mo. The primary endpoint was the percentage of patient-months on TB treatment where at least 20% of doses were missed as measured by pill count and failure to open the medication monitor box. Secondary endpoints included additional adherence and standard treatment outcome measures. Interventions were not masked to study staff and patients. From 1 June 2011 to 7 March 2012, 4,292 new pulmonary TB patients were enrolled across the 36 clusters. A total of 119 patients (by arm: 33 control, 33 text messaging, 23 medication monitor, 30 combined) withdrew from the study in the first month because they were reassessed as not having TB by their managing doctor (61 patients) or were switched to a different treatment model because of hospitalisation or travel (58 patients), leaving 4,173 TB patients (by arm: 1,104 control, 1,008 text messaging, 997 medication monitor, 1,064 combined). The cluster geometric mean of the percentage of patient-months on TB treatment where at least 20% of doses were missed was 29.9% in the control arm; in comparison, this percentage was 27.3% in the text messaging arm (adjusted mean ratio [aMR] 0.94, 95% CI 0.71, 1.24), 17.0% in the medication monitor arm (aMR 0.58, 95% CI 0.42, 0.79), and 13.9% in the combined arm (aMR 0.49, 95% CI 0.27, 0.88). Patient loss to follow-up was lower in the text messaging arm than the control arm (aMR 0.42, 95% CI 0.18-0.98). Equipment malfunction or operation error was reported in all study arms. Analyses separating patients with and without medication monitor problems did not change the results. Initiation of intensive management was underutilised. This study is the first to our knowledge to utilise a randomised trial design to demonstrate the effectiveness of a medication monitor to improve medication adherence in TB patients. Reminders from medication monitors improved medication adherence in TB patients, but text messaging reminders did not. In a setting such as China where universal use of DOT is not feasible, innovative approaches to support patients in adhering to TB treatment, such as this, are needed. Current Controlled Trials, ISRCTN46846388.

Role for Automated Communication Strategies in Medication Adherence Management

PubMed Central

Ross, S. Michael

2008-01-01

Lack of medication adherence is a prevalent problem that causes a broad range of health-and health-economics-related issues. Adherence management is therefore an important strategy, but it also presents its own set of challenges. Interventional communication from care support teams at managed care organizations and disease management and wellness programs has proved effective at modifying patients' medication adherence and reporting behaviors. However, these communications do not work well from an economic standpoint. It is not economically feasible to scale call centers and the numbers of clinical and professional staff to communicate with the increasing number of patients with chronic diseases who require ongoing medication use. Using communication automation to augment traditional call center outreach can help to mediate patient medication-taking behaviors. Specific design criteria for the automation of this interaction are discussed in this article, offering supporting data from a recent trial of 304 elderly patients with hypertension, and showing the benefits of using such a system for effective blood pressure monitoring, at reduced costs. PMID:25126263

Role for automated communication strategies in medication adherence management.

PubMed

Ross, S Michael

2008-11-01

Lack of medication adherence is a prevalent problem that causes a broad range of health-and health-economics-related issues. Adherence management is therefore an important strategy, but it also presents its own set of challenges. Interventional communication from care support teams at managed care organizations and disease management and wellness programs has proved effective at modifying patients' medication adherence and reporting behaviors. However, these communications do not work well from an economic standpoint. It is not economically feasible to scale call centers and the numbers of clinical and professional staff to communicate with the increasing number of patients with chronic diseases who require ongoing medication use. Using communication automation to augment traditional call center outreach can help to mediate patient medication-taking behaviors. Specific design criteria for the automation of this interaction are discussed in this article, offering supporting data from a recent trial of 304 elderly patients with hypertension, and showing the benefits of using such a system for effective blood pressure monitoring, at reduced costs.

Drivers of Dashboard Development (3-D): A Curricular Continuous Quality Improvement Approach.

PubMed

Shroyer, A Laurie; Lu, Wei-Hsin; Chandran, Latha

2016-04-01

Undergraduate medical education (UME) programs are seeking systematic ways to monitor and manage their educational performance metrics and document their achievement of external goals (e.g., Liaison Committee on Medical Education [LCME] accreditation requirements) and internal objectives (institution-specific metrics). In other continuous quality improvement (CQI) settings, summary dashboard reports have been used to evaluate and improve performance. The Stony Brook University School of Medicine UME leadership team developed and implemented summary dashboard performance reports in 2009 to document LCME standards/criteria compliance, evaluate medical student performance, and identify progress in attaining institutional curricular goals and objectives. Key performance indicators (KPIs) and benchmarks were established and have been routinely monitored as part of the novel Drivers of Dashboard Development (3-D) approach to curricular CQI. The systematic 3-D approach has had positive CQI impacts. Substantial improvements over time have been documented in KPIs including timeliness of clerkship grades, midclerkship feedback, student mistreatment policy awareness, and student satisfaction. Stakeholder feedback indicates that the dashboards have provided useful information guiding data-driven curricular changes, such as integrating clinician-scientists as lecturers in basic science courses to clarify the clinical relevance of specific topics. Gaining stakeholder acceptance of the 3-D approach required clear communication of preestablished targets and annual meetings with department leaders and course/clerkship directors. The 3-D approach may be considered by UME programs as a template for providing faculty and leadership with a CQI framework to establish shared goals, document compliance, report accomplishments, enrich communications, facilitate decisions, and improve performance.

Law Panel in action.

PubMed

Odulana, J

In September 1976 the Africa Regional Council (ARC) of IPPF created a Law Panel to 1) advise the ARC on the emphasis of laws and parenthood programs in the region, 2) investigate legal obstacles to family planning and ways of removing them, 3) institute a monitoring service on laws and court decisions affecting planned parenthood, and 4) prepare a list of lawyers and legal reformers by country. The panel has 1) recommended adoption of an IPPF Central Medical Committee and Central Law Panel statement on sterilization, adolescent fertility control, and the use of medical and auxiliary personnel in family planning services with guidelines for Africa; 2) appointed National Legal Correspondents to carry on the monitoring service mentioned above in 18 countries; and 3) discussed solutions to problems in delivering family planning services with family planning associations in Tanzania, Zambia, Mauritius, Madagascar, and Kenya. Laws governing family planning education and services, marriage, divorce, and maternity benefits in these countries are summarized. In 1978 the panel will hold 2 workshops on law and the status of women.

MEDLEARN: a computer-assisted instruction (CAI) program for MEDLARS.

PubMed Central

Eisenberg, L J; Standing, R A; Tidball, C S; Leiter, J

1978-01-01

*MEDLEARN*, a second-generation computer-assisted instruction (CAI) program available (nationally) since October 1976, provides on-line training for MEDLINE, one of the National Library of Medicine's (NLM) Medical Literature Analysis and Retrieval System (MEDLARS) data base. *MEDLEARN* was developed as a joint effort between NLM and The George Washington University Medical Center. Using MEDLINE formats throughout, *MEDLEARN* combines tutorial dialogue, drill and practice, testing, and simulation. The program was designed in three tracks oriented to basic methods, advanced techniques, and new developments. Each topic is presented on two levels, permitting an alternate explanation for users encountering difficulty. *MEDLEARN*, coded in the computer language PILOT, was developed with a modular structure which promotes ease of writing and revision. A versatile control structure maximizes student control. Frequent interactions check immediate recall, general comprehension, and integration of knowledge. Two MEDLINE simulations are included, providing the student an opportunity to formulate and execute a search, have it evaluated, and then perform the search in MEDLINE. Commenting, news broadcasting, and monitoring (with permission only) capabilities are also available. Subjective field appraisals have been positive and NLM plans to expand *MEDLEARN* and produce similar programs for other data bases. PMID:342015

Spinoff 2013

NASA Technical Reports Server (NTRS)

2014-01-01

Topics covered include: Innovative Software Tools Measure Behavioral Alertness; Miniaturized, Portable Sensors Monitor Metabolic Health; Patient Simulators Train Emergency Caregivers; Solar Refrigerators Store Life-Saving Vaccines; Monitors Enable Medication Management in Patients' Homes; Handheld Diagnostic Device Delivers Quick Medical Readings; Experiments Result in Safer, Spin-Resistant Aircraft; Interfaces Visualize Data for Airline Safety, Efficiency; Data Mining Tools Make Flights Safer, More Efficient; NASA Standards Inform Comfortable Car Seats; Heat Shield Paves the Way for Commercial Space; Air Systems Provide Life Support to Miners; Coatings Preserve Metal, Stone, Tile, and Concrete; Robots Spur Software That Lends a Hand; Cloud-Based Data Sharing Connects Emergency Managers; Catalytic Converters Maintain Air Quality in Mines; NASA-Enhanced Water Bottles Filter Water on the Go; Brainwave Monitoring Software Improves Distracted Minds; Thermal Materials Protect Priceless, Personal Keepsakes; Home Air Purifiers Eradicate Harmful Pathogens; Thermal Materials Drive Professional Apparel Line; Radiant Barriers Save Energy in Buildings; Open Source Initiative Powers Real-Time Data Streams; Shuttle Engine Designs Revolutionize Solar Power; Procedure-Authoring Tool Improves Safety on Oil Rigs; Satellite Data Aid Monitoring of Nation's Forests; Mars Technologies Spawn Durable Wind Turbines; Programs Visualize Earth and Space for Interactive Education; Processor Units Reduce Satellite Construction Costs; Software Accelerates Computing Time for Complex Math; Simulation Tools Prevent Signal Interference on Spacecraft; Software Simplifies the Sharing of Numerical Models; Virtual Machine Language Controls Remote Devices; Micro-Accelerometers Monitor Equipment Health; Reactors Save Energy, Costs for Hydrogen Production; Cameras Monitor Spacecraft Integrity to Prevent Failures; Testing Devices Garner Data on Insulation Performance; Smart Sensors Gather Information for Machine Diagnostics; Oxygen Sensors Monitor Bioreactors and Ensure Health and Safety; Vision Algorithms Catch Defects in Screen Displays; and Deformable Mirrors Capture Exoplanet Data, Reflect Lasers.

Business Case Analysis: Costs of Laundry Services

DTIC Science & Technology

2006-05-01

CONTRACT NUMBER Business Case Analysis: Costs of Laundry Services 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR( S ) 5d. PROJECT NUMBER Butler...Jonathan, B, Major, MSC 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME( S ) AND ADDRESS(ES) 8. PERFORMING ORGANIZATION William Beaumont...Army Medical Center REPORT NUMBER 5005 N. Piedras Street El Paso, Texas 79920 9. SPONSORING/MONITORING AGENCY NAME( S ) AND ADDRESS(ES) 10. SPONSOR

Haditha General Hospital Under the Economic Support Fund Program, Haditha, Iraq

DTIC Science & Technology

2009-01-23

kilometers west of Baghdad, Haditha is a river-side community with an estimated population of 150,000. The hospital, located in the heart of the...medical equipment requiring electricity; specifically, several heart monitors and defibrillator machines (Site Photo 10). This equipment appeared to be...repair of the lavatory, under the re-scoped portion of the contract. However, there is a significant potential for germs and the spread of disease

Implications of measures of quality of life for policy development.

PubMed

Mosteller, F

1987-01-01

Quality of life measurements can lead to legislative programs for health, new policies for the health care system, and possibly new attitudes in the courts. Clinical decisions, public health evaluations, and advice for legislatures and courts require diverse measures. We illustrate potential use of such measures with reimbursement problems, programs like Head Start, mainstreaming the handicapped, day care and prenatal care, terminal care for the elderly, monitoring programs, and chronic disabilities. The many treatment policies discussed at the Portugal Conference show the need for quality of life measures in clinical trials. The courts, although considering quality of life, do not seem to consider quality of life measures. If scientists and medical experts wish to establish or change the positions of the courts, consensus conferences appear more effective than regulation or new legislation. To contribute more than they now do to policy, workers measuring quality of life need to develop a variety of measures and methods. They, then, must apply them to medical and health problems, build up a substantial literature, and set priorities for the research needs of the field.

The good pharmacy practice on Einstein Program at Paraisópolis Community

PubMed Central

de Oliveira, Lara Tânia de Assumpção Domingues Gonçalves; da Silva, Camila Pontes; Guedes, Maria das Vitorias; Sousa, Ana Célia de Oliveira; Sarno, Flávio

2016-01-01

ABSTRACT Objectives: To describe indicators and processes developed and implemented for pharmaceutical assistance at the Einstein Program at Paraisópolis Community pharmacy. Methods: This was a descriptive study of retrospective data from January 2012 to December 2015. Data were obtained from spreadsheets developed for monitoring the productivity and care quality provided at the pharmacy. The evaluated variables were pharmaceutical assistance to prescription, pharmaceutical intervention, orientation (standard and pharmaceutical) and pharmaceutical orientation rate. Results: The pharmacy assisted, on average, 2,308 prescriptions monthly, dispensing 4,871 items, including medications, materials and food supplements. Since March 2015, virtually, the pharmacist analyzed all prescriptions, prior to dispensing. In the analyzed period, there was an increase in monthly pharmaceutical interventions from 7 to 32 on average, and, although there was a decrease in the number of standard orientation, the pharmaceutical orientation had an increase, causing a rise of pharmaceutical orientation rate from 4 to 11%. Conclusion: The processes developed and implemented at the program pharmacy sought to follow the good pharmacy practice, and help patients to make the best use of their medications. PMID:27759833

Evaluation of the novel respiratory virus surveillance program: Pediatric Early Warning Sentinel Surveillance (PEWSS).

PubMed

Armour, Patricia A; Nguyen, Linh M; Lutman, Michelle L; Middaugh, John P

2013-01-01

Infections caused by respiratory viruses are associated with recurrent epidemics and widespread morbidity and mortality. Routine surveillance of these pathogens is necessary to determine virus activity, monitor for changes in circulating strains, and plan for public health preparedness. The Southern Nevada Health District in Las Vegas, Nevada, recruited five pediatric medical practices to serve as sentinel sites for the Pediatric Early Warning Sentinel Surveillance (PEWSS) program. Sentinel staff collected specimens throughout the year from ill children who met the influenza-like illness case definition and submitted specimens to the Southern Nevada Public Health Laboratory for molecular testing for influenza and six non-influenza viruses. Laboratory results were analyzed and reported to the medical and general communities in weekly bulletins year-round. PEWSS data were also used to establish viral respiratory seasonal baselines and in influenza vaccination campaigns. The surveillance program was evaluated using the Centers for Disease Control and Prevention's (CDC's) Updated Guidelines for Evaluating Public Health Surveillance Systems. PEWSS met three of six program usefulness criteria and seven of nine surveillance system attributes, which exceeded the CDC Guidelines evaluation criteria for a useful and complete public health surveillance program. We found that PEWSS is a useful and complete public health surveillance system that is simple, flexible, accessible, and stable.

Evaluation of the Novel Respiratory Virus Surveillance Program: Pediatric Early Warning Sentinel Surveillance (PEWSS)

PubMed Central

Nguyen, Linh M.; Lutman, Michelle L.; Middaugh, John P.

2013-01-01

Objectives Infections caused by respiratory viruses are associated with recurrent epidemics and widespread morbidity and mortality. Routine surveillance of these pathogens is necessary to determine virus activity, monitor for changes in circulating strains, and plan for public health preparedness. The Southern Nevada Health District in Las Vegas, Nevada, recruited five pediatric medical practices to serve as sentinel sites for the Pediatric Early Warning Sentinel Surveillance (PEWSS) program. Methods Sentinel staff collected specimens throughout the year from ill children who met the influenza-like illness case definition and submitted specimens to the Southern Nevada Public Health Laboratory for molecular testing for influenza and six non-influenza viruses. Results Laboratory results were analyzed and reported to the medical and general communities in weekly bulletins year-round. PEWSS data were also used to establish viral respiratory seasonal baselines and in influenza vaccination campaigns. The surveillance program was evaluated using the Centers for Disease Control and Prevention's (CDC's) Updated Guidelines for Evaluating Public Health Surveillance Systems. PEWSS met three of six program usefulness criteria and seven of nine surveillance system attributes, which exceeded the CDC Guidelines evaluation criteria for a useful and complete public health surveillance program. Conclusion We found that PEWSS is a useful and complete public health surveillance system that is simple, flexible, accessible, and stable. PMID:23997308

Long-Term Opioid Contract Use for Chronic Pain Management in Primary Care Practice. A Five Year Experience

PubMed Central

Lamb, Geoffrey C.; Neuner, Joan M.

2007-01-01

Background The use of opioid medications to manage chronic pain is complex and challenging, especially in primary care settings. Medication contracts are increasingly being used to monitor patient adherence, but little is known about the long-term outcomes of such contracts. Objective To describe the long-term outcomes of a medication contract agreement for patients receiving opioid medications in a primary care setting. Design Retrospective cohort study. Subjects All patients placed on a contract for opioid medication between 1998 and 2003 in an academic General Internal Medicine teaching clinic. Measurements Demographics, diagnoses, opiates prescribed, urine drug screens, and reasons for contract cancellation were recorded. The association of physician contract cancellation with patient factors and medication types were examined using the Chi-square test and multivariate logistic regression. Results A total of 330 patients constituting 4% of the clinic population were placed on contracts during the study period. Seventy percent were on indigent care programs. The majority had low back pain (38%) or fibromyalgia (23%). Contracts were discontinued in 37%. Only 17% were cancelled for substance abuse and noncompliance. Twenty percent discontinued contract voluntarily. Urine toxicology screens were obtained in 42% of patients of whom 38% were positive for illicit substances. Conclusions Over 60% of patients adhered to the contract agreement for opioids with a median follow-up of 22.5 months. Our experience provides insight into establishing a systematic approach to opioid administration and monitoring in primary care practices. A more structured drug testing strategy is needed to identify nonadherent patients. PMID:17372797

Medical technology management: from planning to application.

PubMed

David, Y; Jahnke, E

2005-01-01

Appropriate deployment of technological innovation contributes to improvement in the quality of healthcare delivered, the containment of cost, and access to the healthcare system. Hospitals have been allocating a significant portion of their resources to procuring and managing capital assets; they are continuously faced with demands for new medical equipment and are asked to manage existing inventory for which they are not well prepared. To objectively manage their investment, hospitals are developing medical technology management programs that need pertinent information and planning methodology for integrating new equipment into existing operations as well as for optimizing costs of ownership of all equipment. Clinical engineers can identify technological solutions based on the matching of new medical equipment with hospital's objectives. They can review their institution's overall technological position, determine strengths and weaknesses, develop equipment-selection criteria, supervise installations, train users and monitor post procurement performance to assure meeting of goals. This program, together with cost accounting analysis, will objectively guide the capital assets decision-making process. Cost accounting analysis is a multivariate function that includes determining the amount, based upon a strategic plan and financial resources, of funding to be allocated annually for medical equipment acquisition and replacement. Often this function works closely with clinical engineering to establish equipment useful life and prioritization of acquisition, upgrade, and replacement of inventory within budget confines and without conducting time consuming, individual financial capital project evaluations.

Longitudinal Patterns of Glycemic Control and Blood Pressure in Pregnant Women with Type 1 Diabetes Mellitus: Phenotypes from Functional Data Analysis.

PubMed

Szczesniak, Rhonda D; Li, Dan; Duan, Leo L; Altaye, Mekibib; Miodovnik, Menachem; Khoury, Jane C

2016-11-01

Objective  To identify phenotypes of type 1 diabetes control and associations with maternal/neonatal characteristics based on blood pressure (BP), glucose, and insulin curves during gestation, using a novel functional data analysis approach that accounts for sparse longitudinal patterns of medical monitoring during pregnancy. Methods  We performed a retrospective longitudinal cohort study of women with type 1 diabetes whose BP, glucose, and insulin requirements were monitored throughout gestation as part of a program-project grant. Scores from sparse functional principal component analysis (fPCA) were used to classify gestational profiles according to the degree of control for each monitored measure. Phenotypes created using fPCA were compared with respect to maternal and neonatal characteristics and outcome. Results  Most of the gestational profile variation in the monitored measures was explained by the first principal component (82-94%). Profiles clustered into three subgroups of high, moderate, or low heterogeneity, relative to the overall mean response. Phenotypes were associated with baseline characteristics, longitudinal changes in glycohemoglobin A1 and weight, and to pregnancy-related outcomes. Conclusion  Three distinct longitudinal patterns of glucose, insulin, and BP control were found. By identifying these phenotypes, interventions can be targeted for subgroups at highest risk for compromised outcome, to optimize diabetes management during pregnancy. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

[Information technologies: new partners in treating diabetes].

PubMed

Colombet, I; Chatellier, G

2001-10-15

The management of chronic diseases such as diabetes is becoming a crucial issue in developed countries. Innovative communication technologies should now be included as new partners in the health care system. These technologies can help both in managing patients and measuring quality of care. Internet-based health promotion programs may improve compliance with treatment. Decision systems are available on the Net to help patients monitoring their diet and insulin doses. The use of electronic medical record shared on Internet may help both physicians and patients to monitor on the long term the effect of interventions. It is now time to perform appropriate trials to determine, beside other interventions, the precise role of innovative communication technologies in diabetes management.

Quality-improvement analytics for intravenous infusion pumps.

PubMed

Skledar, Susan J; Niccolai, Cynthia S; Schilling, Dennis; Costello, Susan; Mininni, Nicolette; Ervin, Kelly; Urban, Alana

2013-04-15

The implementation of a smart-pump continuous quality-improvement (CQI) program across a large health system is described, with an emphasis on key metrics for outcomes analyses and program refinement. Three years ago, the University of Pittsburgh Medical Center health system launched a CQI initiative to help ensure the safe use of 6000 smart pumps in its 14 inpatient facilities. A centralized team led by pharmacists is responsible for the retrieval and interpretation of smart-pump data, which is continuously transmitted to a main server. CQI findings are regularly posted on the health system's interdisciplinary intranet. Monitored metrics include rates of compliance with preprogrammed infusion limits, the top 20 drugs involved in alerts, drugs associated with alert-override rates of ≥90%, numbers of alerts by infusion type, nurse responses to alerts, and alert rate per drug library update. Based on the collected CQI data and site-specific requests, four systemwide updates of the smart-pump drug library were performed during the first 18 months of the program, reducing "nuisance alerts" by about 10% per update cycle and enabling targeted interventions to reduce rapid-infusion errors, other adverse drug events (ADEs), and pump-programming workarounds. Over one 12-month period, bedside alerts prompted nurses to reprogram or cancel continuous infusions an average of 400 times per month, potentially averting i.v. medication ADEs. A smart-pump CQI program is an effective tool for enhancing the safety of i.v. medication administration. The ongoing refinement of the drug library through the development and implementation of key interventions promotes the growth and sustainability of the smart-pump initiative systemwide.

A better way to evaluate remote monitoring programs in chronic disease care: receiver operating characteristic analysis.

PubMed

Brown Connolly, Nancy E

2014-12-01

This foundational study applies the process of receiver operating characteristic (ROC) analysis to evaluate utility and predictive value of a disease management (DM) model that uses RM devices for chronic obstructive pulmonary disease (COPD). The literature identifies a need for a more rigorous method to validate and quantify evidence-based value for remote monitoring (RM) systems being used to monitor persons with a chronic disease. ROC analysis is an engineering approach widely applied in medical testing, but that has not been evaluated for its utility in RM. Classifiers (saturated peripheral oxygen [SPO2], blood pressure [BP], and pulse), optimum threshold, and predictive accuracy are evaluated based on patient outcomes. Parametric and nonparametric methods were used. Event-based patient outcomes included inpatient hospitalization, accident and emergency, and home health visits. Statistical analysis tools included Microsoft (Redmond, WA) Excel(®) and MedCalc(®) (MedCalc Software, Ostend, Belgium) version 12 © 1993-2013 to generate ROC curves and statistics. Persons with COPD were monitored a minimum of 183 days, with at least one inpatient hospitalization within 12 months prior to monitoring. Retrospective, de-identified patient data from a United Kingdom National Health System COPD program were used. Datasets included biometric readings, alerts, and resource utilization. SPO2 was identified as a predictive classifier, with an optimal average threshold setting of 85-86%. BP and pulse were failed classifiers, and areas of design were identified that may improve utility and predictive capacity. Cost avoidance methodology was developed. RESULTS can be applied to health services planning decisions. Methods can be applied to system design and evaluation based on patient outcomes. This study validated the use of ROC in RM program evaluation.

How medical education can contribute towards the reduction of maternal mortality in Angola: the teaching/learning process of Gynecology and Obstetrics.

PubMed

Mendes, M; Barbosa, J; Loureiro, E; Ferreira, M A

2014-03-01

In Angola the maternal mortality ratio is among the highest in the world. Medical students are an important target for intervention. To evaluate how students perceive the curricular unit of Gynecology and Obstetrics (G&O) in a public institution of reference in Angola. The study involved a sample of 147 students of the faculty of Medicine of the University Agostinho Neto, Luanda, Angola, attending the curricular unit of G&O in the 5th and 6th years of the medical course. Data were obtained through surveys of opinion. The information of the scales was summarized through the construction of scores from the original items using the Principal Components Analysis. Students evaluated positively the curricular unit although emphasizing the lack of human and physical resources. The 5th year scored with higher values Teacher Performance and 6th year Students' Performance. Both years considered to have insufficient skills to meet the learning objectives. Constraints were identified in the outcomes of the teaching/learning program. Several points emerged as crucial from this study: widespread the areas of teaching/learning, increase the number and quality of teaching staff, improve the monitoring of students and provide adequate infrastructures and medical equipment to support the teaching/learning program.

Needs and Problems of Posbindu Program: Community Health Volunteers Perspective

NASA Astrophysics Data System (ADS)

Putri, S. T.; Andriyani, S.

2018-01-01

Posbindu is a form of public participation to conduct early detection and monitoring of risk factors for non-communicable diseases(NCD), and where it was carried out in as an integrated manner, routine and periodic event. This paper aims to investigates the needs and problems on Posbindu Program based on community health volunteers(CHVs) perspective. This study used descriptive qualitative method by open ended questions. Content analysis using to explicating the result. There are 3 theme finding about elderly needs in Posbindu; medical care, support group community, and health education. We found four theme problems which in Posbindu program: low motivation from elderly, Inadequate of facilities, physical disability, failed communication. To be effective in Posbindu program, all the stakeholders have reached consensus on the Posbindu program as elderly need. CHVs need given wide knowledge about early detection, daily care, control disease continuously so that the elderly keep feeling the advantages of coming to the Posbindu.

Emerging Models for Mobilizing Family Support for Chronic Disease Management: A Structured Review

PubMed Central

Rosland, Ann-Marie; Piette, John D.

2015-01-01

Objectives We identify recent models for programs aiming to increase effective family support for chronic illness management and self-care among adult patients without significant physical or cognitive disabilities. We then summarize evidence regarding the efficacy for each model identified. Methods Structured review of studies published in medical and psychology databases from 1990 to the present, reference review, general Web searches, and conversations with family intervention experts. Review was limited to studies on conditions that require ongoing self-management, such as diabetes, chronic heart disease, and rheumatologic disease. Results Programs with three separate foci were identified: 1) Programs that guide family members in setting goals for supporting patient self-care behaviors have led to improved implementation of family support roles, but have mixed success improving patient outcomes. 2) Programs that train family in supportive communication techniques, such as prompting patient coping techniques or use of autonomy supportive statements, have successfully improved patient symptom management and health behaviors. 3) Programs that give families tools and infrastructure to assist in monitoring clinical symptoms and medications are being conducted, with no evidence to date on their impact on patient outcomes. Discussion The next generation of programs to improve family support for chronic disease management incorporate a variety of strategies. Future research can define optimal clinical situations for family support programs, the most effective combinations of support strategies, and how best to integrate family support programs into comprehensive models of chronic disease care. PMID:20308347

[Research and implementation of a real-time monitoring system for running status of medical monitors based on the internet of things].

PubMed

Li, Yiming; Qian, Mingli; Li, Long; Li, Bin

2014-07-01

This paper proposed a real-time monitoring system for running status of medical monitors based on the internet of things. In the aspect of hardware, a solution of ZigBee networks plus 470 MHz networks is proposed. In the aspect of software, graphical display of monitoring interface and real-time equipment failure alarm is implemented. The system has the function of remote equipment failure detection and wireless localization, which provides a practical and effective method for medical equipment management.

The accelerated residency program: the Marshall University family practice 9-year experience.

PubMed

Petrany, Stephen M; Crespo, Richard

2002-10-01

In 1989, the American Board of Family Practice (ABFP) approved the first of 12 accelerated residency programs in family practice. These experimental programs provide a 1-year experience for select medical students that combines the requirements of the fourth year of medical school with those of the first year of residency, reducing the total training time by 1 year. This paper reports on the achievements and limitations of the Marshall University accelerated residency program over a 9-year period that began in 1992. Several parameters have been monitored since the inception of the accelerated program and provide the basis for comparison of accelerated and traditional residents. These include initial resident characteristics, performance outcomes, and practice choices. A total of 16 students were accepted into the accelerated track from 1992 through 1998. During the same time period, 44 residents entered the traditional residency program. Accelerated resident tended to be older and had more career experience than their traditional counterparts. As a group, the accelerated residents scored an average of 30 points higher on the final in-training exams provided by the ABFP. All residents in both groups remained at Marshall to complete the full residency training experience, and all those who have taken the ABFP certifying exam have passed. Accelerated residents were more likely to practice in West Virginia, consistent with one of the initial goals for the program. In addition, accelerated residents were more likely to be elected chief resident and choose an academic career than those in the traditional group. Both groups opted for small town or rural practice equally. The Marshall University family practice 9-year experience with the accelerated residency track demonstrates that for carefully selected candidates, the program can provide an overall shortened path to board certification and attract students who excel academically and have high leadership potential. Reports from other accelerated programs are needed to fully assess the outcomes of this experiment in postgraduate medical education.

Adherence to Biobehavioral Recommendations in Pediatric Migraine as Measured by Electronic Monitoring: The Adherence in Migraine (AIM) Study.

PubMed

Kroon Van Diest, Ashley M; Ramsey, Rachelle; Aylward, Brandon; Kroner, John W; Sullivan, Stephanie M; Nause, Katie; Allen, Janelle R; Chamberlin, Leigh A; Slater, Shalonda; Hommel, Kevin; LeCates, Susan L; Kabbouche, Marielle A; O'Brien, Hope L; Kacperski, Joanne; Hershey, Andrew D; Powers, Scott W

2016-07-01

The purpose of this investigation was to examine treatment adherence to medication and lifestyle recommendations among pediatric migraine patients using electronic monitoring systems. Nonadherence to medical treatment is a significant public health concern, and can result in poorer treatment outcomes, decreased cost-effectiveness of medical care, and increased morbidity. No studies have systematically examined adherence to medication and lifestyle recommendations in adolescents with migraine outside of a clinical trial. Participants included 56 adolescents ages 11-17 who were presenting for clinical care. All were diagnosed with migraine with or without aura or chronic migraine and had at least 4 headache days per month. Medication adherence was objectively measured using electronic monitoring systems (Medication Event Monitoring Systems technology) and daily, prospective self-report via personal electronic devices. Adherence to lifestyle recommendations of regular exercise, eating, and fluid intake were also assessed using daily self-report on personal electronic devices. Electronic monitoring indicates that adolescents adhere to their medication 75% of the time, which was significantly higher than self-reported rates of medication adherence (64%). Use of electronic monitoring of medication detected rates of adherence that were significantly higher for participants taking once daily medication (85%) versus participants taking twice daily medication (59%). Average reported adherence to lifestyle recommendations of consistent noncaffeinated fluid intake (M = 5 cups per day) was below recommended levels of a minimum of 8 cups per day. Participants on average also reported skipping 1 meal per week despite recommendations of consistently eating three meals per day. Results suggest that intervention focused on adherence to preventive treatments (such as medication) and lifestyle recommendations may provide more optimal outcomes for children and adolescents with migraine and their families. Once daily dosing of medication may be preferred to twice daily medication for increased medication adherence among children and adolescents. © 2016 American Headache Society.

Automated monitoring of medical protocols: a secure and distributed architecture.

PubMed

Alsinet, T; Ansótegui, C; Béjar, R; Fernández, C; Manyà, F

2003-03-01

The control of the right application of medical protocols is a key issue in hospital environments. For the automated monitoring of medical protocols, we need a domain-independent language for their representation and a fully, or semi, autonomous system that understands the protocols and supervises their application. In this paper we describe a specification language and a multi-agent system architecture for monitoring medical protocols. We model medical services in hospital environments as specialized domain agents and interpret a medical protocol as a negotiation process between agents. A medical service can be involved in multiple medical protocols, and so specialized domain agents are independent of negotiation processes and autonomous system agents perform monitoring tasks. We present the detailed architecture of the system agents and of an important domain agent, the database broker agent, that is responsible of obtaining relevant information about the clinical history of patients. We also describe how we tackle the problems of privacy, integrity and authentication during the process of exchanging information between agents.

A national program for control of acute respiratory tract infections: the Philippine experience.

PubMed

Dayrit, E S

1999-02-01

Maturing programs on child immunization and diarrheal diseases, a community-based research project, and a rational drug-use program facilitated the launching in 1989 of a nationwide Philippine Control of Acute Respiratory Infections program (Phil-CARI). From 1990 to 1991 the Phil-CARI expanded rapidly, training >80% of its middle managers and frontline health care providers on the case-management protocols of the World Health Organization for acute respiratory infection. Multiple donors and good collaboration with various societies and medical schools assisted the program. However, by 1992, there were difficulties in maintaining training quality, follow-up, and supervision. Donor assistance dwindled and the health care delivery system decentralized. Government procurement systems were unable to meet the logistics demands of the program. The monitoring and evaluation system was inadequate to measure impact. The Phil-CARI provides lessons in searching for more sustainable approaches and systems to meet the various demands of a nationwide ARI control program and to create the desired impact.

[Distributions of the numbers of monitoring stations in the surveillance of infectious diseases in Japan].

PubMed

Murakami, Y; Hashimoto, S; Taniguchi, K; Nagai, M

1999-12-01

To describe the characteristics of monitoring stations for the infectious disease surveillance system in Japan, we compared the distributions of the number of monitoring stations in terms of population, region, size of medical institution, and medical specialty. The distributions of annual number of reported cases in terms of the type of diseases, the size of medical institution, and medical specialty were also compared. We conducted a nationwide survey of the pediatrics stations (16 diseases), ophthalmology stations (3 diseases) and the stations of sexually transmitted diseases (STD) (5 diseases) in Japan. In the survey, we collected the data of monitoring stations and the annual reported cases of diseases. We also collected the data on the population, served by the health center where the monitoring stations existed, from the census. First, we compared the difference between the present number of monitoring stations and the current standard established by the Ministry of Health and Welfare (MHW). Second, we compared the distribution of all medical institutions in Japan and the monitoring stations in terms of the size of the medical institution. Third, we compared the average number of annual reported cases of diseases in terms of the size of medical institution and the medical specialty. In most health centers, the number of monitoring stations achieved the current standard of MHW, while a few health centers had no monitoring station, although they had a large population. Most prefectures also achieved the current standard of MHW, but some prefectures were well below the standard. Among pediatric stations, the sampling proportion of large hospitals was higher than other categories. Among the ophthalmology stations, the sampling proportion of hospitals was higher than other categories. Among the STD stations, the sampling proportion of clinics of obstetrics and gynecology was lower than other categories. Except for some diseases, it made little difference in the average number of annual reported cases of diseases in terms of the type of medical institution. Among STD, there was a great difference in the average number of annual reported cases of diseases in terms of medical specialty.

Utilizing Smartphone-Based Machine Learning in Medical Monitor Data Collection: Seven Segment Digit Recognition

PubMed Central

Shenoy, Varun N.; Aalami, Oliver O.

2017-01-01

Biometric measurements captured from medical devices, such as blood pressure gauges, glucose monitors, and weighing scales, are essential to tracking a patient’s health. Trends in these measurements can accurately track diabetes, cardiovascular issues, and assist medication management for patients. Currently, patients record their results and date of measurement in a physical notebook. It may be weeks before a doctor sees a patient’s records and can assess the health of the patient. With a predicted 6.8 billion smartphones in the world by 20221, health monitoring platforms, such as Apple’s HealthKit2, can be leveraged to provide the right care at the right time. This research presents a mobile application that enables users to capture medical monitor data and send it to their doctor swiftly. A key contribution of this paper is a robust engine that can recognize digits from medical monitors with an accuracy of 98.2%. PMID:29854226

Utilizing Smartphone-Based Machine Learning in Medical Monitor Data Collection: Seven Segment Digit Recognition.

PubMed

Shenoy, Varun N; Aalami, Oliver O

2017-01-01

Biometric measurements captured from medical devices, such as blood pressure gauges, glucose monitors, and weighing scales, are essential to tracking a patient's health. Trends in these measurements can accurately track diabetes, cardiovascular issues, and assist medication management for patients. Currently, patients record their results and date of measurement in a physical notebook. It may be weeks before a doctor sees a patient's records and can assess the health of the patient. With a predicted 6.8 billion smartphones in the world by 2022 1 , health monitoring platforms, such as Apple's HealthKit 2 , can be leveraged to provide the right care at the right time. This research presents a mobile application that enables users to capture medical monitor data and send it to their doctor swiftly. A key contribution of this paper is a robust engine that can recognize digits from medical monitors with an accuracy of 98.2%.

Metropolitan Spokane Region Water Resources Study. Appendix H. Volume 1. Plan Formulation and Evaluation

DTIC Science & Technology

1976-01-01

Trickling Filter Fairchild A.F.B. Trickling Filter Town of Medical Lake Lagoon Town of Fairfield Lagoon Town of Millwood Activated Sludge (Extended Aeration...sewer system is subject to high levels of in- filtration. The treatment plant has ice problems in winter, trickling filter spreading arm clogging...lagoons. There is need of a routine effluent quan- tity/quality monitoring program. Tekoa. The trickling filter plant is poorly maintained to the point

Microenvironment -Programmed Metastatic Prostate Cancer Stem Cells (mPCSCs)

DTIC Science & Technology

2016-10-01

accomplished all goals in Aims 1 and 2. Our lab recently relocated from the MD Anderson Cancer Center to Roswell Park Cancer Institute in Buffalo. We ...G. Tang, M.D., Ph.D. CONTRACTING ORGANIZATION: University of Texas MD Anderson Cancer Center Houston, TX 77030 REPORT DATE: October 2016 TYPE OF... Anderson Cancer Center Houston, TX 77030 9. SPONSORING / MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSOR/MONITOR’S ACRONYM(S) U.S. Army Medical

A school-based program for control of group a streptococcal upper respiratory tract infections: a controlled trial in Southern China.

PubMed

Lin, Shuguang; Kaplan, Edward L; Rao, Xuxu; Johnson, Dwight R; Deng, Mulan; Zhuo, Qiling; Yang, Pingzhen; Mai, Jinzhuang; Dong, Taiming; Liu, Xiaoqing

2008-08-01

A prospective, school-based study included daily monitoring for incidence of symptomatic streptococcal-associated pharyngitis and monthly determinations of group A streptococcal prevalence. A treatment group received penicillin/erythromycin therapy at school for positive throat cultures; the control group sought medical care from their regular provider. Prevalence and incidence of group A streptococcal pharyngitis were significantly lower among the treatment group than in the controls.

NHI-PharmaCloud in Taiwan--A preliminary evaluation using the RE-AIM framework and lessons learned.

PubMed

Huang, San-Kuei; Wang, Pen-Jen; Tseng, Wen-Fuh; Syu, Fei-Kai; Lee, Miaw-Chwen; Shih, Ru-Liang; Sheen, Mao-Ting; Chen, Michael S

2015-10-01

The aim of this article is to present the preliminary impact of a medication monitoring program, PharmaCloud, in Taiwan and analyze the embedded factors that have contributed to the performance thereof. This article also compared PharmaCloud with similar international programs in order to draw lessons learned. The five domains of the RE-AIM framework - reach, effectiveness, adoption, implementation, and maintenance - were examined using qualitative and quantitative data. A difference-in-differences model was applied to analyze the quantitative impact of PharmaCloud on drug utilization and drug expenses. The qualitative impact was evaluated by document analysis based on field reports from the participating medical institutions. Reach and adoption: although all of the major hospitals adopted PharmaCloud and some of the hospitals had high inquiry rates, more time and incentives are needed to raise the overall inquiry rate. Effectiveness: during the study period of 3 months, the number of medications per prescription declined in the intervention group was 0.15 more than that of the general population, and the drug expense per person declined in the intervention group was NT $567 (US $18.9) more than that of the general population. The potential savings could be between 2% and 5% of the total pharmaceutical expenditure. Medication duplication was found to have decreased more in the intervention group. a variety of innovations in care delivery are being developed in which the pharmacists play a more significant role. Maintenance: the embedded National Health Insurance would lend strong support for PharmaCloud to grow and thrive. PharmaCloud owes its effectiveness to the embedded National Health Insurance (NHI) program, which is universal and provides a comprehensive benefit package including more than 16,000 prescription drugs. An effective medication program is one that operates under the principle of universality and comprehensiveness, facilitates innovations, and has a substantial level of interoperability with the intra-hospital health information systems. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

[Current state and prospects of military personnel health monitoring].

PubMed

Rezvantsev, M V; Kuznetsov, S M; Ivanov, V V; Zakurdaev, V V

2014-01-01

The current article is dedicated to some features of the Russian Federation Armed Forces military personnel health monitoring such as legal and informational provision, methodological basis of functioning, historical aspect of formation and development of the social and hygienic monitoring in the Russian Federation Armed Forces. The term "military personnel health monitoring" is defined as an analytical system of constant and long-term observation, analysis, assessment, studying of factors determined the military personnel health, these factors correlations, health risk factors management in order to minimize them. The current state of the military personnel health monitoring allows coming to the conclusion that the military health system does have forces and resources for state policy of establishing the population health monitoring system implementation. The following directions of the militarily personnel health monitoring improvement are proposed: the Russian Federation Armed Forces medical service record and report system reorganization bringing it closer to the civilian one, implementation of the integrated approach to the medical service informatisation, namely, military personnel health status and medical service resources monitoring. The leading means in this direction are development and introduction of a military serviceman individual health status monitoring system on the basis of a serviceman electronic medical record card. Also it is proposed the current Russian Federation Armed Forces social and hygienic monitoring improvement at the expense of informational interaction between the two subsystems on the basis of unified military medical service space.

Implementation of a drug-use and disease-state management program.

PubMed

Skledar, S J; Hess, M M

2000-12-15

A drug-use and disease-state management (DUDSM) program was instituted in 1996 at a teaching hospital associated with a large nonprofit health care system. The program's goals are to optimize pharmacotherapeutic regimens, evaluate health outcomes of identified disease states, and evaluate the economic impact of pharmacotherapeutic options for given disease states by developing practice guidelines. Through a re-engineering process, resources within the pharmacy department were identified that could be devoted to the DUDSM program, including the use of clinical pharmacy specialists, promotion of staff pharmacists into the DUDSM program, a pharmacy technician, and information systems support. A strength of the program is its systematic approach for developing and implementing new initiatives, as well as monitoring compliance with all initiatives on an ongoing basis. The initiative-design process incorporates continuous quality improvement principles, outcome design and evaluation, competency assessment for all pharmacists, multidisciplinary collaboration, and sophisticated information systems. Seventy-five initiatives have been implemented, ranging from simple dose-optimization strategies for specific drugs to complicated practice guidelines for managing specific disease states. Improved patient outcomes have been documented, including reduced length of stay, postsurgical wound infection, adverse drug reactions, and medication errors. Documented cost savings exceeded $4 million annually for fiscal years 1996-97 through 1999-2000. Overall compliance with DUDSM initiatives exceeds 80%, and physician service profiling has been initiated to monitor variant prescribing. The DUDSM program has successfully integrated practice guidelines into therapeutic decision-making, resulting in improved patient-care outcomes and cost savings.

["When the ad is good, the product is sold." The MonitorACAO Project and drug advertising in Brazil].

PubMed

Soares, Jussara Calmon Reis de Souza

2008-04-01

This paper presents an analysis on drug advertising in Brazil, based on the final report of the MonitorACAO Project, by the group from the Universidade Federal Fluminense, Niterói, Rio de Janeiro. Due to a partnership between the university and the National Agency for Health Surveillance (ANVISA), drug advertisements were monitored and analyzed for one year, according to the methodology defined by the Agency. The samples were collected in medical practices and hospitals, drugstores, pharmacies and in scientific magazines. TV and radio programs were monitored, in the case of OTC drugs. 159 advertisements referring to pharmaceuticals were sent to ANVISA,from a total of 263 irregular ads analyzed between October 2004 and August 2005. The main problems found were the poor quality of drug information to health professionals, as well as misleading drug use to lay population. Based on the results of this project and on other studies, the banning of drug advertising in Brazil is proposed.

[Preparation and effect of a behavioral science-based education program for sleep improvement among medical students].

PubMed

Ueda, Masumi; Adachi, Yoshiko; Hayama, Junko; Yamagami, Toshiko

2008-01-01

The present study aimed to investigate a simple education program that is effective for sleep improvement among medical students who will be medical doctors in the future. The education program applied in the present study was developed for sleep improvement based on behavioral science and changes in knowledge and sleeping habits were observed. Subjects were 6th-year medical students of 2002 and 2003. Students of 2002 attended a program including a 90-minute lecture and a 2-week practice learning session, and students of 2003 attended only the lecture. In the lecture, behavior therapy for chronic insomnia was explained using a booklet. In the practice learning session, students set a target behavior for improvement and conducted self-monitoring of their sleep and the targeted behavior. Changes in knowledge about sleep, attitude toward the therapy, sleep, and sleep-related habits were observed and compared between the 2 groups of subjects immediately and 2-weeks after the lecture. It was found that after both programs subjects had more knowledge about sleep than before. In the program including practice learning session, subjects' attitude for managing patients changed from before the lecture to after the lecture, and after the practice learning session. It was found that more than half of the students thought that they could provide sleep guidance based on the behavior therapy. Regarding the subjects' sleep, significant improvements were observed for "having nightmares upon falling asleep," "sleepiness during daytime," "sense of getting a sound sleep," and "mood upon waking up." Regarding sleep-related habits, significant improvements were observed for "taking a nap," "dozing off," and "eating breakfast." On the other hand, only the lecture subjects improved irregularity of bedtime and sleeping time. Although an increase in knowledge and improvement of sleep were observed among students who attended only the lecture, a further increase in knowledge and improvement of sleeping habits were observed among students who also attended the practice learning session. The results described herein suggest developing and providing a simple and convenient education program for sleep improvement was effective for increasing students' knowledge about sleep, developing improved coping methods regarding sleep, and improving sleep. It is also suggested that behavioral scientific instructive methods, including practice learning, are effective for medical education.

Potential North American Clinical Trials Network (NACTN) for Treatment of Spinal Cord Injury: A Consortium of Military, Veterans Administration, and Civilian Hospitals

DTIC Science & Technology

2008-05-01

invaluable to characterize the trajectory (natural history ) of individuals who have suffered a spinal cord injury. The registry was initially designed...Princeton, NJ 08540-7814 Phone: +1 609 375 2017 Fax: +1 609 375 2683 Email: Elinor.Cappuccio@afoundation.org Central Medical Monitor Steve R...continuously monitored. Every safety event will be reviewed by both the local and central Medical Monitor. The central Medical Monitor will be a

A technology-enabled adherence enhancement system for people with bipolar disorder: results from a feasibility and patient acceptance analysis

PubMed Central

Sajatovic, Martha; Davis, Michael S; Cassidy, Kristin A; Nestor, Joseph; Sams, Johnny; Fuentes-Casiano, Edna

2015-01-01

Objective As poor medication adherence is common in bipolar disorder (BD), technology-assisted approaches may help to monitor and enhance adherence. This study evaluated preliminary feasibility, patient satisfaction and effects on adherence, BD knowledge, and BD symptoms associated with the use of a multicomponent technology-assisted adherence enhancement system. Methods This prospective study tested the system in five BD patients over a 15-day period. System components included: 1) an automated pill cap with remote monitoring sensor; 2) a multimedia adherence enhancement program; and 3) a treatment incentive program. This study evaluated system usability, patient satisfaction and effects on adherence (Morisky scale), knowledge (treatment knowledge test [TKT]), and symptoms (internal state scale [ISS]). Results Mean age of the sample was 62 years, 4/5 (80%) Caucasian, and 4/5 (80%) single/divorced or widowed. Most participants (4/5, 80%) were on a single BD medication. Participants had BD for an average of 21 years. Challenges included attaching the pill sensor to standard pharmacy bottles for individuals using very large pill containers or those with multiday pill boxes. Three of five (60%) individuals completed the full 15-day period. Usability scores were high overall. Mean Morisky scores improved. Means on all four subscales of the ISS were all in the direction of improvement. On the TKT, there was a 40% increase in mean scores. Conclusion A multicomponent technology-assisted BD adherence enhancement system is feasible. Challenges include accommodating multiple types of pill containers and monitoring multiple drugs simultaneously. The system can also generate adherence information that is potentially useful for treatment planning. PMID:26089652

HIV medication therapy management services in community pharmacies

PubMed Central

Kauffman, Yardlee; Nair, Vidya; Herist, Keith; Thomas, Vasavi; Weidle, Paul J.

2015-01-01

Objectives To present a rationale and a proposed structure to support pharmacist-delivered medication therapy management (MTM) for human immunodeficiency virus (HIV) disease and to outline challenges to implementing and sustaining the service. Data sources Professional literature. Summary Historically, the effect of pharmacy services for HIV-infected persons has been demonstrated in inpatient and clinic-based settings. Developing similar programs adapted for community pharmacists could be a model of care to improve patient adherence to antiretroviral therapy and retention in care. Initiation of antiretroviral therapy and regular monitoring of CD4+ cell count, HIV RNA viral load, adverse drug events, and adherence form the backbone of successful medical management of HIV infection. Support for these services can be provided to HIV-infected patients through pharmacist-managed HIV MTM programs in community pharmacy settings in collaboration with primary providers and other health care professionals. Conclusion Community pharmacists can help meet the growing need for HIV care through provision of MTM services. Although resources have been developed, including the general MTM framework, challenges of adequate training, education, and support of community pharmacists need to be addressed in order for HIV MTM to be a successful model. PMID:23229993

Associations between statewide prescription drug monitoring program (PDMP) requirement and physician patterns of prescribing opioid analgesics for patients with non-cancer chronic pain.

PubMed

Lin, Hsien-Chang; Wang, Zhi; Boyd, Carol; Simoni-Wastila, Linda; Buu, Anne

2018-01-01

State-level prescription drug monitoring programs (PDMPs) have been implemented in most states. PDMPs enable registered prescribers to obtain real-time information on patients' prescription history to reduce non-medical use of controlled drugs. This study examined whether PDMP implementation and different levels of PDMP requirements were associated with physicians' patterns of prescribing opioid analgesics for patients with non-cancer chronic pain. This is a secondary analysis study using cross-sectional national data. Patients with non-cancer chronic pain from the 2012 National Ambulatory Medical Care Survey were included (weighted N=81,018,131; unweighted N=3295). Heckman two-step selection procedure employing two logistic regressions was used to explore the associations between PDMP requirements and physicians' prescribing behaviors, controlling for physician characteristics, patient characteristics, physician-healthcare system interaction, and physician-patient relationship, guided by the Eisenberg's model of physician decision making. State PDMP implementation status and requirement levels were not associated with physician opioid prescribing for non-cancer chronic pain treatment (p's ranged 0.30-0.32). Patients with Medicare coverage were more likely to be prescribed opioid analgesics than those with private health insurance (OR=1.55, p<0.01). Hispanic patients were less likely to be prescribed opioid analgesics than non-Hispanic white patients (OR=0.61, p<0.05). Findings indicated that the effectiveness of PDMPs on physicians' opioid prescribing tendency for non-cancer chronic pain treatment could not be supported. Policy makers should be aware of the need for redesigning PDMPs regarding requirements and enforcement for prescribers and related stakeholders. Future studies also are needed to identify characteristics contributing to PDMP effectiveness in reducing non-medical use of prescription opioids. Copyright © 2017 Elsevier Ltd. All rights reserved.

Improved Completion Rates and Characterization of Drug Reactions with an Intensive Chagas Disease Treatment Program in Rural Bolivia

PubMed Central

Tornheim, Jeffrey A.; Lozano Beltran, Daniel F.; Gilman, Robert H.; Castellon, Mario; Solano Mercado, Marco A.; Sullca, Walter; Torrico, Faustino; Bern, Caryn

2013-01-01

Background Chagas disease treatment is limited by drug availability, adverse side effect profiles of available medications, and poor adherence. Methods Adult Chagas disease patients initiating 60-days of benznidazole were randomized to weekly or twice-weekly evaluations of medication adherence and screening for adverse drug events (ADEs). Mid-week evaluations employed phone-based evaluations. Adherence was measured by self-report, pill counts with intentional over-distribution, and Medication Event Monitoring Systems (MEMS). Prospective data were compared to historical controls treated with benznidazole at the same hospital. Results 162 prospective patients were compared to 172 historical patients. Pill counts correlated well with MEMS data (R = 0.498 for 7-day intervals, R = 0.872 for intervals >7 days). Treatment completion rates were higher among prospective than historical patients (82.1% vs. 65.1%), primarily due to lower abandonment rates. Rates of ADEs were lower among prospective than historical patients (56.8% vs. 66.9%). Twice-weekly evaluations increased identification of mild ADEs, prompting higher suspension rates than weekly evaluations. While twice-weekly evaluations identified ADEs earlier, they did not reduce incidence of moderate or severe ADEs. Many dermatologic ADEs were moderately severe upon presentation (35.6%), were not reduced by use of antihistamines, occurred among adult patients of all ages, and occurred throughout treatment, rather than the first few weeks alone. Conclusions Intensive management improved completion and identified more ADEs, but did not reduce moderate or severe ADEs. Risk of dermatologic ADEs cannot be reduced by selecting younger adults or monitoring only during the first few weeks of treatment. Pill counts and phone-based encounters are reliable tools for treatment programming in rural Bolivia. PMID:24069472

Development of informational-communicative system, created to improve medical help for family medicine doctors.

PubMed

Smiianov, Vladyslav A; Dryha, Natalia O; Smiianova, Olha I; Obodyak, Victor K; Zudina, Tatyana O

2018-01-01

Introduction: Today mobile health`s protection service has no concrete meaning. As an research object it was called mHealth and named by Global observatory of electronic health`s protection as "Doctor and social health practice that can be supported by any mobile units (mobile phones or smartphones), units for patient`s health control, personal computers and other units of non-wired communication". An active usage of SMS in programs for patients` cure regimen keeping was quiet predictable. Mobile and electronic units only begin their development in medical sphere. Thus, to solve all health`s protection system reformation problems a special memorandum about cooperation in creating E-Health system in Ukraine was signed. The aim: Development of ICS for monitoring and non-infection ill patients` informing system optimization as a first level of medical help. Materials and methods: During research, we used systematical approach, meta-analysis, informational-analytical systems` schemes projection, expositive modeling. Developing the backend (server part of the site), we used next technologies: 1) the Apache web server; 2) programming language PHP; 3) Yii 2 PHP Framework. In the frontend developing were used the following technologies (client part of the site): 1) Bootstrap 3; 2) Vue JS Framework. Results and conclusions: Created duo-channel system "doctor-patient" and "patient-doctor" will allow usual doctors of family medicine (DFM) take the interactive dispensary cure and avoid uncontrolled illness progress. Doctor will monitor basic physical data of patient`s health and curing process. The main goal is to create automatic system to allow doctor regularly write periodical or non-periodical notifications, get patients` questioning answers and spread information between doctor and patient; that will optimize work of DFMs.

An inevitable wave of prescription drug monitoring programs in the context of prescription opioids: pros, cons and tensions.

PubMed

Islam, M Mofizul; McRae, Ian S

2014-08-16

In an effort to control non-medical use and/or medical abuse of prescription drugs, particularly prescription opioids, electronic prescription drug monitoring programs (PDMP) have been introduced in North-American countries, Australia and some parts of Europe. Paradoxically, there are simultaneous pressures to increase opioid prescribing for the benefit of individual patients and to reduce it for the sake of public health, and this pressure warrants a delicate balance of appropriate therapeutic uses of these drugs with the risk of developing dependence. This article discusses pros and cons of PDMP in reducing diversion of prescription opioids, without hampering access to those medications for those with genuine needs, and highlights tensions around PDMP implementation. PDMPs may help alleviate diversion, over-prescription and fraudulent prescribing/dispensing; prompt drug treatment referrals; avoid awkward drug urine test; and inform spatial changes in prescribing practices and help designing tailored interventions. Fear of legal retribution, privacy and data security, potential confusion about addiction and pseudo-addiction, and potential undue pressure of detecting misuse/diversion - are the major problems. There are tensions about unintended consequence of excessive regulatory enforcements, corresponding collateral damages particularly about inadequate prescribing for patients with genuine needs, and mandatory consultation requirements of PDMP. In this era of information technology PDMP is likely to flourish and remain with us for a long time. A clear standard of practice against which physicians' care will be judged may expedite the utilisation of PDMP. In addition, adequate training on addiction and pain management along with public awareness, point-of-supply data entry from pharmacy, point-of-care real-time access to data, increasing access to addiction treatment and appropriate regulatory enforcement preferably through healthcare administration, together, may help remove barriers to PDMP use.

An inevitable wave of prescription drug monitoring programs in the context of prescription opioids: pros, cons and tensions

PubMed Central

2014-01-01

Background In an effort to control non-medical use and/or medical abuse of prescription drugs, particularly prescription opioids, electronic prescription drug monitoring programs (PDMP) have been introduced in North-American countries, Australia and some parts of Europe. Paradoxically, there are simultaneous pressures to increase opioid prescribing for the benefit of individual patients and to reduce it for the sake of public health, and this pressure warrants a delicate balance of appropriate therapeutic uses of these drugs with the risk of developing dependence. This article discusses pros and cons of PDMP in reducing diversion of prescription opioids, without hampering access to those medications for those with genuine needs, and highlights tensions around PDMP implementation. Discussion PDMPs may help alleviate diversion, over-prescription and fraudulent prescribing/dispensing; prompt drug treatment referrals; avoid awkward drug urine test; and inform spatial changes in prescribing practices and help designing tailored interventions. Fear of legal retribution, privacy and data security, potential confusion about addiction and pseudo-addiction, and potential undue pressure of detecting misuse/diversion - are the major problems. There are tensions about unintended consequence of excessive regulatory enforcements, corresponding collateral damages particularly about inadequate prescribing for patients with genuine needs, and mandatory consultation requirements of PDMP. Summary In this era of information technology PDMP is likely to flourish and remain with us for a long time. A clear standard of practice against which physicians’ care will be judged may expedite the utilisation of PDMP. In addition, adequate training on addiction and pain management along with public awareness, point-of-supply data entry from pharmacy, point-of-care real-time access to data, increasing access to addiction treatment and appropriate regulatory enforcement preferably through healthcare administration, together, may help remove barriers to PDMP use. PMID:25127880

A protocol to evaluate drug-related workplace impairment.

PubMed

Reisfield, Gary M; Shults, Theodore; Demery, Jason; Dupont, Robert

2013-03-01

The dramatic increase in the use and abuse of prescription controlled substances, cannabis, and a rapidly evolving array of legal and illegal psychotropic drugs has led to a growing concern by employers about workplace impairment, incidents, and accidents. The Federal Workplace Drug Testing Programs, which serve as a template for most private sector programs, focus on a small group of illicit drugs, but disregard the wider spectrum of legal and illegal psychotropic drugs and prescription controlled substances. We propose a protocol for the evaluation of workplace impairment, based on comprehensive drug and alcohol testing at the time of suspected impairment, followed expeditiously by a comprehensive physician evaluation, including a focused medical history with an emphasis on controlled substance use, physical and mental status examinations, evaluation of employee adherence to prescription medication instructions, additional drug testing if indicated, use of collateral sources of information, and querying of state prescription monitoring databases. Finally, we propose suggestions for optimizing the evaluation of drug-related workplace impairment.

Linking India Global Health Professions Student Survey data to the World Health Organization Framework Convention on Tobacco Control.

PubMed

Sinha, D N; Singh, G; Gupta, P C; Pednekar, M; Warrn, C W; Asma, S; Lee, J

2010-07-01

The 2003 India Tobacco Control Act (ITCA) includes provisions designed to reduce tobacco consumption and protect citizens from exposure to secondhand smoke. India ratified the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) on February 27, 2005. The WHO FCTC is the world's first public health treaty that aims to promote and protect public health and reduce the devastating health and economic impact of tobacco. The Global Health Professions Student Survey (GHPSS) was developed to track tobacco use among third-year dental, medical, nursing, and pharmacy students across countries. Data from the dental (2005), medical (2006), nursing(2007), and pharmacy (2008) GHPSS conducted in India showed high prevalence of tobacco use and a general lack of training by health professionals in patient cessation counseling techniques. The Ministry of Health and Family Welfare could use this information to monitor and evaluate the existing tobacco control program effort in India as well as to develop and implement new tobacco control program initiatives.

Programmable control means for providing safe and controlled medication infusion

NASA Technical Reports Server (NTRS)

Fischell, Robert E. (Inventor)

1988-01-01

An implantable programmable infusion pump (IPIP) is disclosed and generally includes: a fluid reservoir filled with selected medication; a pump for causing a precise volumetric dosage of medication to be withdrawn from the reservoir and delivered to the appropriate site within the body; and, a control means for actuating the pump in a safe and programmable manner. The control means includes a microprocessor, a permanent memory containing a series of fixed software instructions, and a memory for storing prescription schedules, dosage limits and other data. The microprocessor actuates the pump in accordance with programmable prescription parameters and dosage limits stored in the memory. A communication link allows the control means to be remotely programmed. The control means incorporates a running integral dosage limit and other safety features which prevent an inadvertent or intentional medication overdose. The control means also monitors the pump and fluid handling system and provides an alert if any improper or potentially unsafe operation is detected.

Addressing medical coding and billing part II: a strategy for achieving compliance. A risk management approach for reducing coding and billing errors.

PubMed Central

Adams, Diane L.; Norman, Helen; Burroughs, Valentine J.

2002-01-01

Medical practice today, more than ever before, places greater demands on physicians to see more patients, provide more complex medical services and adhere to stricter regulatory rules, leaving little time for coding and billing. Yet, the need to adequately document medical records, appropriately apply billing codes and accurately charge insurers for medical services is essential to the medical practice's financial condition. Many physicians rely on office staff and billing companies to process their medical bills without ever reviewing the bills before they are submitted for payment. Some physicians may not be receiving the payment they deserve when they do not sufficiently oversee the medical practice's coding and billing patterns. This article emphasizes the importance of monitoring and auditing medical record documentation and coding application as a strategy for achieving compliance and reducing billing errors. When medical bills are submitted with missing and incorrect information, they may result in unpaid claims and loss of revenue to physicians. Addressing Medical Audits, Part I--A Strategy for Achieving Compliance--CMS, JCAHO, NCQA, published January 2002 in the Journal of the National Medical Association, stressed the importance of preparing the medical practice for audits. The article highlighted steps the medical practice can take to prepare for audits and presented examples of guidelines used by regulatory agencies to conduct both medical and financial audits. The Medicare Integrity Program was cited as an example of guidelines used by regulators to identify coding errors during an audit and deny payment to providers when improper billing occurs. For each denied claim, payments owed to the medical practice are are also denied. Health care is, no doubt, a costly endeavor for health care providers, consumers and insurers. The potential risk to physicians for improper billing may include loss of revenue, fraud investigations, financial sanction, disciplinary action and exclusion from participation in government programs. Part II of this article recommends an approach for assessing potential risk, preventing improper billing, and improving financial management of the medical practice. Images p432-a PMID:12078924

A model to begin to use clinical outcomes in medical education.

PubMed

Haan, Constance K; Edwards, Fred H; Poole, Betty; Godley, Melissa; Genuardi, Frank J; Zenni, Elisa A

2008-06-01

The latest phase of the Accreditation Council for Graduate Medical Education (ACGME) Outcome Project challenges graduate medical education (GME) programs to select meaningful clinical quality indicators by which to measure trainee performance and progress, as well as to assess and improve educational effectiveness of programs. The authors describe efforts to measure educational quality, incorporating measurable patient-care outcomes to guide improvement. University of Florida College of Medicine-Jacksonville education leaders developed a tiered framework for selecting clinical indicators whose outcomes would illustrate integration of the ACGME competencies and their assessment with learning and clinical care. In order of preference, indicators selected should align with a specialty's (1) national benchmarked consensus standards, (2) national specialty society standards, (3) standards of local, institutional, or regional quality initiatives, or (4) top-priority diagnostic and/or therapeutic categories for the specialty, based on areas of high frequency, impact, or cost. All programs successfully applied the tiered process to clinical indicator selection and then identified data sources to track clinical outcomes. Using clinical outcomes in resident evaluation assesses the resident's performance as reflective of his or her participation in the health care delivery team. Programmatic improvements are driven by clinical outcomes that are shown to be below benchmark across the residents. Selecting appropriate clinical indicators-representative of quality of care and of graduate medical education-is the first step toward tracking educational outcomes using clinical data as the basis for evaluation and improvement. This effort is an important aspect of orienting trainees to using data for monitoring and improving care processes and outcomes throughout their careers.

Effectiveness of a Unique Support Group for Physicians in a Physician Health Program.

PubMed

Sanchez, Luis T; Candilis, Philip J; Arnstein, Fredrick; Eaton, Judith; Barnes Blood, Diana; Chinman, Gary A; Bresnahan, Linda R

2016-01-01

State Physician Health Programs (PHPs) assess, support, and monitor physicians with mental, behavioral, medical, and substance abuse problems. Since their formation in the 1970s, PHPs have offered support groups following the 12-step model for recovery from substance use disorders (SUDs). However, few programs have developed support groups for physicians without SUDs. This study at the Massachusetts PHP (Physician Health Services Inc.) represents the first effort to survey physician attitudes concerning a unique support group that goes beyond classic addiction models. The group was initiated because of the observation that physicians with problems other than SUDs did not fit easily into the 12-step framework. It was hypothesized that such a group would be effective in helping participants control workplace stress, improve professional and personal relationships, and manage medical and psychiatric difficulties. With a response rate of 43% (85 respondents), the survey identified a strong overall impact of the Physician Health Services Inc. support group, identifying positive effects in all areas of personal and professional life: family and friends, wellness, professional relationships, and career. Respondents identified the role of the facilitator as particularly important, underscoring the facilitator's capacity to welcome participants, manage interactions, set limits, and maintain a supportive emotional tone. The implications for physician health extend from supporting a broader application of this model to using a skilled facilitator to manage groups intended to reduce the stress and burnout of present-day medical practice. The results encourage PHPs, hospitals, medical practices, and physician groups to consider implementing facilitated support groups as an additional tool for maintaining physician health.

Successful Nicotine Intake in Medical Assisted Use of E-Cigarettes: A Pilot Study

PubMed Central

Pacifici, Roberta; Pichini, Simona; Graziano, Silvia; Pellegrini, Manuela; Massaro, Giuseppina; Beatrice, Fabio

2015-01-01

The electronic cigarette (e-cig) has gained popularity as an aid in smoking cessation programs mainly because it maintains the gestures and rituals of tobacco smoking. However, it has been shown in inexperienced e-cig users that ineffective nicotine delivery can cause tobacco craving that could be responsible for unsuccessful smoking reduction/cessation. Moreover, the incorrect use of an e-cig could also led to potential nicotine overdosage and intoxication. Medically assisted training on the proper use of an e-cig plus behavioral support for tobacco dependence could be a pivotal step in avoiding both issues. We performed an eight-month pilot study of adult smokers who started e-cig use after receiving a multi-component medically assisted training program with monitoring of nicotine intake as a biomarker of correct e-cig use. Participants were tested during follow-up for breath carbon monoxide (CO), plasma cotinine and trans-3’-hydroxycotinine, and number of tobacco cigarettes smoked. At the end of the first, fourth, and eighth month of follow-up, 91.1, 73.5, and 76.5% of participants respectively were e-cig users (‘only e-cig’ and ‘dual users’). They showed no significant variation in plasma cotinine and trans-3’-hydroxycotinine with respect to the start of the study when they smoked only tobacco cigarettes, but a significant reduction in breath CO. The proposed medically assisted training program of e-cig use led to a successful nicotine intake, lack of typical cigarette craving and overdosage symptoms and a significant decrease in the biomarker of cigarette combustion products. PMID:26184244

Successful Nicotine Intake in Medical Assisted Use of E-Cigarettes: A Pilot Study.

PubMed

Pacifici, Roberta; Pichini, Simona; Graziano, Silvia; Pellegrini, Manuela; Massaro, Giuseppina; Beatrice, Fabio

2015-07-08

The electronic cigarette (e-cig) has gained popularity as an aid in smoking cessation programs mainly because it maintains the gestures and rituals of tobacco smoking. However, it has been shown in inexperienced e-cig users that ineffective nicotine delivery can cause tobacco craving that could be responsible for unsuccessful smoking reduction/cessation. Moreover, the incorrect use of an e-cig could also led to potential nicotine overdosage and intoxication. Medically assisted training on the proper use of an e-cig plus behavioral support for tobacco dependence could be a pivotal step in avoiding both issues. We performed an eight-month pilot study of adult smokers who started e-cig use after receiving a multi-component medically assisted training program with monitoring of nicotine intake as a biomarker of correct e-cig use. Participants were tested during follow-up for breath carbon monoxide (CO), plasma cotinine and trans-3'-hydroxycotinine, and number of tobacco cigarettes smoked. At the end of the first, fourth, and eighth month of follow-up, 91.1, 73.5, and 76.5% of participants respectively were e-cig users ('only e-cig' and 'dual users'). They showed no significant variation in plasma cotinine and trans-3'-hydroxycotinine with respect to the start of the study when they smoked only tobacco cigarettes, but a significant reduction in breath CO. The proposed medically assisted training program of e-cig use led to a successful nicotine intake, lack of typical cigarette craving and overdosage symptoms and a significant decrease in the biomarker of cigarette combustion products.

In-flight medical incidents in the NASA-Mir program.

PubMed

Gontcharov, Igor B; Kovachevich, Irina V; Pool, Sam L; Navinkov, Oleg L; Barratt, Michael R; Bogomolov, Valery V; House, Nancy

2005-07-01

This paper summarizes medical experience during the six NASA-Mir flights from March 14, 1995, to June 4, 1998. There were 7 U.S. astronauts who were part of 6 Mir space crews and worked jointly with 12 Russian cosmonauts. Advances in space medicine have created a safer environment; however, experience shows that crewmembers experience traumatic injuries and illnesses of diverse etiologies during spaceflight. During these joint flights both Russian and U.S. medical kits were available to crewmembers who could access either medical kit as appropriate. The Russian medical team had primary responsibility for monitoring and care of all crewmembers and analyzing medical results. When medical incidents occurred, the appropriate Russian or U.S. medical team determined the plan for diagnosis and treatment. Each team kept the other informed regarding medical situations during the flights and strictly observed the principles of medical confidentiality. A summary of medical incidents by programmatic element is described as experienced by the crewmembers and the ground support medical teams. The most frequent medical cases were small traumatic injuries to the skin and mucous membranes and fluctuations in the cardiovascular system, manifesting primarily in the form of cardiac dysrhythmias. The ability to use both the Russian medical aids and the U.S. medical kit significantly increased the effectiveness and reliability of therapeutic and prophylactic care. The degree of medical care and cooperation established precedents for integrating these systems for the medical support of expeditions on the International Space Station.

AMON: a wearable multiparameter medical monitoring and alert system.

PubMed

Anliker, Urs; Ward, Jamie A; Lukowicz, Paul; Tröster, Gerhard; Dolveck, François; Baer, Michel; Keita, Fatou; Schenker, Eran B; Catarsi, Fabrizio; Coluccini, Luca; Belardinelli, Andrea; Shklarski, Dror; Alon, Menachem; Hirt, Etienne; Schmid, Rolf; Vuskovic, Milica

2004-12-01

This paper describes an advanced care and alert portable telemedical monitor (AMON), a wearable medical monitoring and alert system targeting high-risk cardiac/respiratory patients. The system includes continuous collection and evaluation of multiple vital signs, intelligent multiparameter medical emergency detection, and a cellular connection to a medical center. By integrating the whole system in an unobtrusive, wrist-worn enclosure and applying aggressive low-power design techniques, continuous long-term monitoring can be performed without interfering with the patients' everyday activities and without restricting their mobility. In the first two and a half years of this EU IST sponsored project, the AMON consortium has designed, implemented, and tested the described wrist-worn device, a communication link, and a comprehensive medical center software package. The performance of the system has been validated by a medical study with a set of 33 subjects. The paper describes the main concepts behind the AMON system and presents details of the individual subsystems and solutions as well as the results of the medical validation.

A simple and reliable health monitoring system for shoulder health: proposal.

PubMed

Liu, Shuo-Fang; Lee, Yann-Long

2014-02-26

The current health care system is complex and inefficient. A simple and reliable health monitoring system that can help patients perform medical self-diagnosis is seldom readily available. Because the medical system is vast and complex, it has hampered or delayed patients in seeking medical advice or treatment in a timely manner, which may potentially affect the patient's chances of recovery, especially those with severe sicknesses such as cancer, and heart disease. The purpose of this paper is to propose a methodology in designing a simple, low cost, Internet-based health-screening platform. This health-screening platform will enable patients to perform medical self-diagnosis over the Internet. Historical data has shown the importance of early detection to ensure patients receive proper treatment and speedy recovery. The platform is designed with special emphasis on the user interface. Standard Web-based user-interface design is adopted so the user feels ease to operate in a familiar Web environment. In addition, graphics such as charts and graphs are used generously to help users visualize and understand the result of the diagnostic. The system is developed using hypertext preprocessor (PHP) programming language. One important feature of this system platform is that it is built to be a stand-alone platform, which tends to have better user privacy security. The prototype system platform was developed by the National Cheng Kung University Ergonomic and Design Laboratory. The completed prototype of this system platform was submitted to the Taiwan Medical Institute for evaluation. The evaluation of 120 participants showed that this platform system is a highly effective tool in health-screening applications, and has great potential for improving the medical care quality for the general public.

Continuous glucose monitoring technology for personal use: an educational program that educates and supports the patient.

PubMed

Evert, Alison; Trence, Dace; Catton, Sarah; Huynh, Peter

2009-01-01

The purpose of this article is to describe the development and implementation of an educational program for the initiation of real-time continuous glucose monitoring (CGM) technology for personal use, not 3-day CGMS diagnostic studies. The education program was designed to meet the needs of patients managing their diabetes with either diabetes medications or insulin pump therapy in an outpatient diabetes education center using a team-based approach. Observational research, complemented by literature review, was used to develop an educational program model and teaching strategies. Diabetes educators, endocrinologists, CGM manufacturer clinical specialists, and patients with diabetes were also interviewed for their clinical observations and experience. The program follows a progressive educational model. First, patients learn in-depth about real-time CGM technology by attending a group presensor class that provides detailed information about CGM. This presensor class facilitates self-selection among patients concerning their readiness to use real-time CGM. If the patient decides to proceed with real-time CGM use, CGM initiation is scheduled, using a clinic-centered protocol for both start-up and follow-up. Successful use of real-time CGM involves more than just patient enthusiasm or interest in a new technology. Channeling patient interest into a structured educational setting that includes the benefits and limitations of real-time CGM helps to manage patient expectations.

Processing speed can monitor stimulant-medication effects in adults with attention deficit disorder with hyperactivity.

PubMed

Nielsen, Niels Peter; Wiig, Elisabeth H; Bäck, Svante; Gustafsson, Jan

2017-05-01

Treatment responses to methylphenidate by adults with ADHD are generally monitored against DSM-IV/DSM-V symptomatology, rating scales or interviews during reviews. To evaluate the use of single- and dual-dimension processing-speed and efficiency measures to monitor the effects of pharmacological treatment with methylphenidate after a short period off medication. A Quick Test of Cognitive Speed (AQT) monitored the effects of immediate-release methylphenidate in 40 previously diagnosed and medicated adults with ADHD. Processing speed was evaluated with prior prescription medication, without medication after a 2-day period off ADHD medication, and with low-dose (10/20 mg) and high-dose (20/40 mg) methylphenidate hydrochloride (Medikinet IR). Thirty-three participants responded to the experimental treatments. One-way ANOVA with post-hoc analysis (Scheffe) indicated significant main effects for single dimension colour and form and dual-dimension colour-form naming. Post-hoc analysis indicated statistical differences between the no- and high-dose medication conditions for colour and form, measures of perceptual speed. For colour-form naming, a measure of cognitive speed, there was a significant difference between no- and low-dose medication and between no- and high-dose medications, but not between low- and high-dose medications. Results indicated that the AQT tests effectively monitored incremental effects of the methylphenidate dose on processing speed after a 2-day period off medication. Thus, perceptual (colour and form) and cognitive speed (two-dimensional colour-form naming) and processing efficiency (lowered shift costs) increased measurably with high-dose medication. These preliminary findings warrant validation with added measures of associated behavioural and cognitive changes.

Physician-directed software design: the role of utilization statistics and user input in enhancing HELP results review capabilities.

PubMed Central

Michael, P. A.

1993-01-01

The M.D. Rounds Report program was developed and implemented in June of 1992 as an adjunct to the HELP System at Rex Hospital. The program facilitates rapid access to information on allergies and current medications, laboratory results, radiology reports and therapist notes for a list of patients without physicians having to make additional menu or submenu selections. In planning for an upgrade of the program, utilization statistics and user feedback provided valuable information in terms of frequency of access, features used and unused, and the value of the program as a reporting tool in comparison to other online results reporting applications. A brief description of the functionality of the M.D. Rounds Report, evaluation of the program audit trail and user feedback, planned enhancements to the program, and a discussion of the prototyping and monitoring experience and the impact on future physician subsystem development will be presented. PMID:8130443

The Prevalence of Employed Nurses Identified or Enrolled in Substance Use Monitoring Programs

PubMed Central

Monroe, Todd B.; Kenaga, Heidi; Dietrich, Mary S.; Carter, Michael A.; Cowan, Ronald L.

2017-01-01

Background For over 100 years, nurses’ particular work conditions have been anecdotally associated with increases in substance abuse. Reasons include job-related stress and easy access to medications. Current research has suggested that prevalence of nurses with substance use problems is actually similar to, if not less than, that seen in the general population. However, given nurses’ proximity to critical patient care, the potential threat to public health, as well as the current shortage of practitioners and problems related to retention, the lack of research on the effectiveness of the two existing treatment protocols (disciplinary and alternative-to-discipline [ATD]) is a pressing issue of concern to the nursing profession. Objectives The aims of this study were to estimate the 1-year prevalence of employed nurses requiring an intervention for substance use problems in the United States and the 1-year prevalence of nurses enrolled in substance abuse monitoring programs and to compare the sum total of nurses identified in disciplinary and alternative programs with the general population. Methods This was a balanced stratified sampling design study. Measurements included the National Council of State Boards of Nursing 2010 Survey of Regulatory Boards Disciplinary Actions on Nurses, the 2009 annual reports of alternative programs, the 2008 National Sample Survey of Registered Nurses, and the 2009 National Survey on Drug Use and Health. Results The 2009 1-year prevalence of employed nurses identified with substance use problems in the United States and its territories was 17,085 or 0.51% of the employed nursing population. The 1-year prevalence of nurses newly enrolled in substance abuse monitoring programs in the United States and its territories was 12,060 or 0.36%. Although every National Council of State Boards of Nursing jurisdiction has a disciplinary monitoring program, only 73% (n = 43) of these jurisdictions have alternative programs. Despite this, on average, alternative programs had nearly 75% more new enrollees (9,715) when compared with disciplinary programs (2,345). The prevalence of nurses identified with a substance use problem requiring an intervention (and likely treatment) is lower than the prevalence of those who report receiving substance abuse treatment in the general population (0.51% vs. 1.0%). Conclusions The ATD programs potentially have a greater impact on protecting the public than disciplinary programs because ATD programs identify and/or enroll more nurses with substance use problems, thereby initially removing more nurses with substance use problems from direct patient care. PMID:22960589

Overview of medical errors and adverse events

PubMed Central

2012-01-01

Safety is a global concept that encompasses efficiency, security of care, reactivity of caregivers, and satisfaction of patients and relatives. Patient safety has emerged as a major target for healthcare improvement. Quality assurance is a complex task, and patients in the intensive care unit (ICU) are more likely than other hospitalized patients to experience medical errors, due to the complexity of their conditions, need for urgent interventions, and considerable workload fluctuation. Medication errors are the most common medical errors and can induce adverse events. Two approaches are available for evaluating and improving quality-of-care: the room-for-improvement model, in which problems are identified, plans are made to resolve them, and the results of the plans are measured; and the monitoring model, in which quality indicators are defined as relevant to potential problems and then monitored periodically. Indicators that reflect structures, processes, or outcomes have been developed by medical societies. Surveillance of these indicators is organized at the hospital or national level. Using a combination of methods improves the results. Errors are caused by combinations of human factors and system factors, and information must be obtained on how people make errors in the ICU environment. Preventive strategies are more likely to be effective if they rely on a system-based approach, in which organizational flaws are remedied, rather than a human-based approach of encouraging people not to make errors. The development of a safety culture in the ICU is crucial to effective prevention and should occur before the evaluation of safety programs, which are more likely to be effective when they involve bundles of measures. PMID:22339769

Interprofessional training: Start with the youngest! A program for undergraduate healthcare students in Geneva, Switzerland.

PubMed

van Gessel, Elisabeth; Picchiottino, Patricia; Doureradjam, Robert; Nendaz, Mathieu; Mèche, Petra

2018-03-08

Demography of patients and complexity in the management of multimorbid conditions has made collaborative practice a necessity for the future, also in Switzerland. Since 2012, the University of Applied Sciences (UAS) and its Healthcare School as well as the University of Geneva (UG) with its Medical Faculty have joined forces to implement a training program in collaborative practice, using simulation as one of the main learning/teaching process. The actual program consists of three sequential modules and totalizes 300 h of teaching and learning for approximately 1400-1500 students from six tracks (nutritionists, physiotherapists, midwives, nurses, technologists in medical radiology, physicians); in 2019 another hundred pharmacists will also be included. The main issues addressed by the modules are Module 1: the Swiss healthcare system and collaborative tools. Module 2: roles and responsibilities of the different health professionals, basic tools acquisition in team working (situation monitoring, mutual support, communication). Module 3: the axis of quality and safety of care through different contexts and cases. A very first evaluation of the teaching and learning and particularly on the aspects of acquisition of collaborative tools shows positive attitudes of students towards the implementation of this new training program. Furthermore, a pre-post questionnaire on teamwork aspects reveals significant modifications.

Design and implementation of a wearable healthcare monitoring system.

PubMed

Sagahyroon, Assim; Raddy, Hazem; Ghazy, Ali; Suleman, Umair

2009-01-01

A wearable healthcare monitoring unit that integrates various technologies was developed to provide patients with the option of leading a healthy and independent life without risks or confinement to medical facilities. The unit consists of various sensors integrated to a microcontroller and attached to the patient's body, reading vital signs and transmitting these readings via a Bluetooth link to the patient's mobile phone. Short-Messaging-Service (SMS) is incorporated in the design to alert a physician in emergency cases. Additionally, an application program running on the mobile phone uses the internet to update (at regular intervals) the patient records in a hospital database with the most recent readings. To reduce development costs, the components used were both off-the-shelf and affordable.

Monitoring of electric-cardio signals based on DSP

NASA Astrophysics Data System (ADS)

Yan, Yi-xin; Sun, Hui-nan; Lv, Shuang

2008-10-01

Monitoring of electric-cardio signals is the most direct method of discovering heart diseases. This article presents an electric-cardio signal acquisition and processing system based on DSP. According to the features of electric-cardio signals, the proposed system uses the AgCl electrode as electric-cardio signals sensor, and acquires analog signals with AD620 as the prepositional amplifier, and the digital system equipped is with TMS320LF2407A DSP. The design of digital filter and the analysis of heart rate variation are realized by programming in the DSP. Finally the ECG is obtained with P and T waves along with obvious QRS multi-wave characteristics. The system has low power dissipation, low cost and high precision, which meets the requirements for medical instruments.

A matched-cohort study of health services utilization and financial outcomes for a heart failure disease-management program in elderly patients.

PubMed

Berg, Gregory D; Wadhwa, Sandeep; Johnson, Alan E

2004-10-01

To investigate the utilization and financial outcomes of a telephonic nursing disease-management program for elderly patients with heart failure. A 1-year concurrent matched-cohort study employing propensity score matching. Medicare+Choice recipients residing in Ohio, Kentucky, and Indiana. A total of 533 program participants aged 65 and older matched to nonparticipants. Disease-management heart failure program employing a structured, evidence-based, telephonic nursing intervention designed to provide patient education, counseling, and monitoring services. Medical service utilization, including hospitalizations, emergency department visits, medical doctor visits, skilled nursing facility (SNF) days, selected clinical indicators, and financial effect. The intervention group had considerably and significantly lower rates of acute service utilization than the control group, including 23% fewer hospitalizations, 26% fewer inpatient bed days, 22% fewer emergency department visits, 44% fewer heart failure hospitalizations, 70% fewer 30-day readmissions, and 45% fewer SNF bed days. Claims costs were 1,792 dollars per person lower in the intervention group than in the control group (inclusive of intervention costs), and the return on investment was calculated to be 2.31. The study demonstrates that a commercially delivered heart failure disease-management program significantly reduced hospitalizations, emergency department visits, and SNF days. The intervention group had 17% lower costs than the control group; when intervention costs were included, the intervention group had 10% lower costs.

Use of electronic monitoring in clinical nursing research.

PubMed

Ailinger, Rita L; Black, Patricia L; Lima-Garcia, Natalie

2008-05-01

In the past decade, the introduction of electronic monitoring systems for monitoring medication adherence has contributed to the dialog about what works and what does not work in monitoring adherence. The purpose of this article is to describe the use of the Medication Event Monitoring System (MEMS) in a study of patients receiving isoniazid for latent tuberculosis infection. Three case examples from the study illustrate the data that are obtained from the electronic device compared to self-reports and point to the disparities that may occur in electronic monitoring. The strengths and limitations of using the MEMS and ethical issues in utilizing this technology are discussed. Nurses need to be aware of these challenges when using electronic measuring devices to monitor medication adherence in clinical nursing practice and research.

Home blood pressure monitoring, secure electronic messaging and medication intensification for improving hypertension control: a mediation analysis.

PubMed

Ralston, J D; Cook, A J; Anderson, M L; Catz, S L; Fishman, P A; Carlson, J; Johnson, R; Green, B B

2014-01-01

We evaluated the role of home monitoring, communication with pharmacists, medication intensification, medication adherence and lifestyle factors in contributing to the effectiveness of an intervention to improve blood pressure control in patients with uncontrolled essential hypertension. We performed a mediation analysis of a published randomized trial based on the Chronic Care Model delivered over a secure patient website from June 2005 to December 2007. Study arms analyzed included usual care with a home blood pressure monitor and usual care with home blood pressure monitor and web-based pharmacist care. Mediator measures included secure messaging and telephone encounters; home blood pressure monitoring; medications intensification and adherence and lifestyle factors. Overall fidelity to the Chronic Care Model was assessed with the Patient Assessment of Chronic Care (PACIC) instrument. The primary outcome was percent of participants with blood pressure (BP) <140/90 mm Hg. At 12 months follow-up, patients in the web-based pharmacist care group were more likely to have BP <140/90 mm Hg (55%) compared to patients in the group with home blood pressure monitors only (37%) (p = 0.001). Home blood pressure monitoring accounted for 30.3% of the intervention effect, secure electronic messaging accounted for 96%, and medication intensification for 29.3%. Medication adherence and self-report of fruit and vegetable intake and weight change were not different between the two study groups. The PACIC score accounted for 22.0 % of the main intervention effect. The effect of web-based pharmacist care on improved blood pressure control was explained in part through a combination of home blood pressure monitoring, secure messaging, and antihypertensive medication intensification.

A continuous quality improvement approach to improving clinical practice in the areas of sedation, analgesia, and neuromuscular blockade.

PubMed

Arbour, Richard

2003-01-01

Practice concerns associated with the medical prescription and nurses' administration and monitoring of sedatives, analgesics, and neuromuscular blocking agents were identified by the clinical nurse specialist within a surgical intensive care unit of a large, tertiary-care referral center. These concerns were identified using a variety of needs assessment strategies. Results of the needs assessment were used to develop a program of care, including a teaching initiative, specific to these practice areas. The teaching initiative incorporated principles of andragogy, the theory of adult learning. Educational techniques included inservice education, bedside instruction using "teaching moments," competency-based education modules, and integration of instruction into critical care orientation. Content and approach were based on the background and level of experience of participants. Educational program outcomes included increased consistency in monitoring neuromuscular blockade by clinical assessment and peripheral nerve stimulation. A second outcome was more accurate patient assessment leading to the provision of drug therapy specific to the patients' clinical states, including anxiety or pain. The continuous quality improvement approach offers a model for improving patient care using individualized needs assessment, focused educational interventions, and program evaluation strategies.

Skylab

NASA Image and Video Library

1973-01-01

This chart details Skylab's In-Flight Lower Body Negative Pressure experiment facility, a medical evaluation designed to monitor changes in astronauts' cardiovascular systems during long-duration space missions. This experiment collected in-flight data for predicting the impairment of physical capacity and the degree of orthostatic intolerance to be expected upon return to Earth. Data to be collected were blood pressure, heart rate, body temperature, vectorcardiogram, lower body negative pressure, leg volume changes, and body mass. The Marshall Space Flight Center had program management responsibility for the development of Skylab hardware and experiments.

Skylab

NASA Image and Video Library

1970-01-01

This 1970 photograph shows Skylab's In-Flight Lower Body Negative Pressure experiment facility, a medical evaluation designed to monitor changes in astronauts' cardiovascular systems during long-duration space missions. This experiment collected in-flight data for predicting the impairment of physical capacity and the degree of orthostatic intolerance to be expected upon return to Earth. Data to be collected were blood pressure, heart rate, body temperature, vectorcardiogram, lower body negative pressure, leg volume changes, and body mass. The Marshall Space Flight Center had program management responsibility for the development of Skylab hardware and experiments.

The Symbiosis of Combat Casualty Care and Civilian Trauma Care: 1914-2007

DTIC Science & Technology

2008-02-01

in the Korean conflict by the Army Medical Service Grad- uate School Surgical Research Team organized by Colonel William S . Stone, and in the Vietnam...PROGRAM ELEMENT NUMBER 6. AUTHOR( S ) 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME( S ) AND ADDRESS(ES...NUMBER 9. SPONSORING/MONITORING AGENCY NAME( S ) AND ADDRESS(ES) 10. SPONSOR/MONITOR’S ACRONYM( S ) 11. SPONSOR/MONITOR’S REPORT NUMBER( S ) 12

Monitoring and improving the effectiveness of surface cleaning and disinfection.

PubMed

Rutala, William A; Weber, David J

2016-05-02

Disinfection of noncritical environmental surfaces and equipment is an essential component of an infection prevention program. Noncritical environmental surfaces and noncritical medical equipment surfaces may become contaminated with infectious agents and may contribute to cross-transmission by acquisition of transient hand carriage by health care personnel. Disinfection should render surfaces and equipment free of pathogens in sufficient numbers to prevent human disease (ie, hygienically clean). Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

The Value of Continued Followup in a Preventive Medicine Program

NASA Technical Reports Server (NTRS)

Villafana, C.; Mockbee, J.

1970-01-01

Continued monitoring of hypertension and cholesterol levels in NASA employees by regularly scheduled medical examinations prevents an increase in employee disability and cardiovascular mortality rates. Adequate therapeutic control for younger hypertensive employees is demonstrated by records on mortality and heart diseases over a period of 28 months. It confirmed the importance of systolic blood pressure as diagnostic tool for the inherent risk factor. The prevalence of additional coronary risk factors among employees with hypercholesterolemia is considerably less than in employees with hypertension.

[Lübeck University Model for Physiotherapy].

PubMed

Bretin, Annette; Großmann, Kirsten; Schulz, ArndtPeter

2018-02-19

The aim of this paper is to describe the development of an innovative bachelor's degree program for physiotherapy directly affiliated with the medical department, which is a unique approach to making physiotherapy an academic course in Germany. The previous system for qualifying as a physiotherapist was amended by the adaption of qualification objectives resulting in a model that links scientific and vocational knowledge from the beginning of the study. Several lectures support interprofessionality. The vocational training is fully integrated into the curriculum. The exemplary concept is monitored by an extensive quality management program. The approach meets general recommendations of experts and can serve as a model for other universities. © Georg Thieme Verlag KG Stuttgart · New York.

Developing policy, standard orders, and quality-assurance monitoring for palliative sedation therapy.

PubMed

Ghafoor, Virginia L; Silus, Lauren S

2011-03-15

The development of a policy, evidence-based standard orders, and monitoring for palliative sedation therapy (PST) is described. Concerns regarding PST at the University of Minnesota Medical Center (UMMC) arose and needed to be addressed in a formal process. A multidisciplinary group consisting of palliative care physicians, nurse practitioners, clinical nurse specialists, and clinical pharmacy specialists reached consensus on the practice model and medications to be used for PST. Major elements of the plan included the development and implementation of an institutional policy for palliative sedation; standard orders for patient care, sedation, and monitoring; education for staff, patients, and patients' family members; and quality-assurance monitoring. A literature review was performed to identify research and guidelines defining the practice of PST. Policy content includes the use of a standard order set linking patient care, medication administration, the monitoring of sedation, and symptom management. Approval of the policy involved several UMMC committees. An evaluation matrix was used to determine critical areas for PST monitoring and to guide development of a form to monitor quality. A retrospective chart audit using the quality-assurance monitoring form assessed baseline sedation medication and patient outcomes. Assessment of compliance began in the fall of 2008, after the policy and standard orders were approved by the UMMC medical executive committee. In 2008, two cases of PST were monitored using the standardized form. PST cases will be continually monitored and analyzed. Development of policy, standard orders, and quality-assurance monitoring for PST required a formal multidisciplinary process. A process-improvement process is critical to defining institutional policy, educational goals, and outcome metrics for PST.

An Architecture for Continuous Data Quality Monitoring in Medical Centers.

PubMed

Endler, Gregor; Schwab, Peter K; Wahl, Andreas M; Tenschert, Johannes; Lenz, Richard

2015-01-01

In the medical domain, data quality is very important. Since requirements and data change frequently, continuous and sustainable monitoring and improvement of data quality is necessary. Working together with managers of medical centers, we developed an architecture for a data quality monitoring system. The architecture enables domain experts to adapt the system during runtime to match their specifications using a built-in rule system. It also allows arbitrarily complex analyses to be integrated into the monitoring cycle. We evaluate our architecture by matching its components to the well-known data quality methodology TDQM.

Formal verification of medical monitoring software using Z language: a representative sample.

PubMed

Babamir, Seyed Morteza; Borhani, Mehdi

2012-08-01

Medical monitoring systems are useful aids assisting physicians in keeping patients under constant surveillance; however, taking sound decision by the systems is a physician concern. As a result, verification of the systems behavior in monitoring patients is a matter of significant. The patient monitoring is undertaken by software in modern medical systems; so, software verification of modern medial systems have been noticed. Such verification can be achieved by the Formal Languages having mathematical foundations. Among others, the Z language is a suitable formal language has been used to formal verification of systems. This study aims to present a constructive method to verify a representative sample of a medical system by which the system is visually specified and formally verified against patient constraints stated in Z Language. Exploiting our past experience in formal modeling Continuous Infusion Insulin Pump (CIIP), we think of the CIIP system as a representative sample of medical systems in proposing our present study. The system is responsible for monitoring diabetic's blood sugar.

Monitoring Bone Health after Spaceflight: Data Mining to Support an Epidemiological Analysis of Age-related Bone Loss in Astronauts

NASA Technical Reports Server (NTRS)

Baker, K. S,; Amin, S.; Sibonga, Jean D.

2009-01-01

Through the epidemiological analysis of bone data, HRP is seeking evidence as to whether the prolonged exposure to microgravity of low earth orbit predisposes crewmembers to an earlier onset of osteoporosis. While this collaborative Epidemiological Project may be currently limited by the number of ISS persons providing relevant spaceflight medical data, a positive note is that it compares medical data of astronauts to data of an age-matched (not elderly) population that is followed longitudinally with similar technologies. The inclusion of data from non-ISS and non-NASA crewmembers is also being pursued. The ultimate goal of this study is to provide critical information for NASA to understand the impact of low physical or minimal weight-bearing activity on the aging process as well as to direct its development of countermeasures and rehabilitation programs to influence skeletal recovery. However, in order to optimize these results NASA needs to better define the requirements for long term monitoring and encourage both active and retired astronauts to contribute to a legacy of data that will define human health risks in space.

Evaluating the Impact of the Medical Education Partnership Initiative at the University of Zimbabwe College of Health Sciences Using the Most Significant Change Technique.

PubMed

Connors, Susan C; Nyaude, Shemiah; Challender, Amelia; Aagaard, Eva; Velez, Christine; Hakim, James

2017-09-01

In medical education, evaluating outcomes from programs intended to transform attitudes or influence career trajectories using conventional methods of monitoring is often difficult. To address this problem, the authors adapted the most significant change (MSC) technique to gain a more comprehensive understanding of the impact of the Medical Education Partnership Initiative (MEPI) program at the University of Zimbabwe College of Health Sciences. In 2014-2015, the authors applied the MSC to systematically examine the personal significance and level of positive transformation that individuals attributed to their MEPI participation. Interviews were conducted with 28 participants nominated by program leaders. The authors coded results inductively for prevalent themes in participants' stories and prepared profiles with representative quotes to place the stories in context. Stakeholders selected 9 themes and 18 stories to illustrate the most significant changes. Six themes (or outcomes) were expected, as they aligned with MEPI goals-becoming a better teacher, becoming a better clinician, increased interest in teaching, increased interest in research, new career pathways (including commitment to practice in Zimbabwe), and improved research skills. Three themes were unexpected-increased confidence, expanded interprofessional networks, and improved interpersonal interactions. The authors found the MSC to be a useful and systematic evaluation approach for large, complex, and transformative initiatives like MEPI. The MSC seemed to encourage participant reflection, support values inquiry by program leaders, and provide insights into the personal and cultural impacts of MEPI. Additional trial applications of the MSC technique in academic medicine are warranted.

Evaluation of a Computerized Clinical Information System (Micromedex).

PubMed Central

Lundsgaarde, H. P.; Moreshead, G. E.

1991-01-01

This paper summarizes data collected as part of a project designed to identify and assess the technical and organizational problems associated with the implementation and evaluation of a Computerized Clinical Information System (CCIS), Micromedex, in three U.S. Department of Veterans Affairs Medical Centers (VAMCs). The study began in 1987 as a national effort to implement decision support technologies in the Veterans Administration Decentralized Hospital Computer Program (DHCP). The specific objectives of this project were to (1) examine one particular decision support technology, (2) identify the technical and organizational barriers to the implementation of a CCIS in the VA host environment, (3) assess the possible benefits of this system to VA clinicians in terms of therapeutic decision making, and (4) develop new methods for identifying the clinical utility of a computer program designed to provide clinicians with a new information tool. The project was conducted intermittently over a three-year period at three VA medical centers chosen as implementation and evaluation test sites for Micromedex. Findings from the Kansas City Medical Center in Missouri are presented to illustrate some of the technical problems associated with the implementation of a commercial database program in the DHCP host environment, the organizational factors influencing clinical use of the system, and the methods used to evaluate its use. Data from 4581 provider encounters with the CCIS are summarized. Usage statistics are presented to illustrate the methodological possibilities for assessing the "benefits and burdens" of a computerized information system by using an automated collection of user demographics and program audit trails that allow evaluators to monitor user interactions with different segments of the database. PMID:1807583

Evaluation of a Computerized Clinical Information System (Micromedex).

PubMed

Lundsgaarde, H P; Moreshead, G E

1991-01-01

This paper summarizes data collected as part of a project designed to identify and assess the technical and organizational problems associated with the implementation and evaluation of a Computerized Clinical Information System (CCIS), Micromedex, in three U.S. Department of Veterans Affairs Medical Centers (VAMCs). The study began in 1987 as a national effort to implement decision support technologies in the Veterans Administration Decentralized Hospital Computer Program (DHCP). The specific objectives of this project were to (1) examine one particular decision support technology, (2) identify the technical and organizational barriers to the implementation of a CCIS in the VA host environment, (3) assess the possible benefits of this system to VA clinicians in terms of therapeutic decision making, and (4) develop new methods for identifying the clinical utility of a computer program designed to provide clinicians with a new information tool. The project was conducted intermittently over a three-year period at three VA medical centers chosen as implementation and evaluation test sites for Micromedex. Findings from the Kansas City Medical Center in Missouri are presented to illustrate some of the technical problems associated with the implementation of a commercial database program in the DHCP host environment, the organizational factors influencing clinical use of the system, and the methods used to evaluate its use. Data from 4581 provider encounters with the CCIS are summarized. Usage statistics are presented to illustrate the methodological possibilities for assessing the "benefits and burdens" of a computerized information system by using an automated collection of user demographics and program audit trails that allow evaluators to monitor user interactions with different segments of the database.

Monitoring attentional style and medical regimen adherence in hemodialysis patients.

PubMed

Christensen, A J; Moran, P J; Lawton, W J; Stallman, D; Voigts, A L

1997-05-01

Previous research involving individuals facing chronic health problems suggests that an attentional style characterized by pronounced monitoring of threat-relevant information is associated with poorer behavioral and emotional adjustment. This study examined the hypothesis that a pronounced monitoring style would be associated with poorer medical regimen adherence in a sample of 51 chronic hemodialysis patients. Hierarchical regression analyses (controlling for demographic factors and trait anxiety) revealed that "high monitors" exhibited higher interdialysis weight gains and higher serum K values reflecting poorer adherence to fluid-intake and dietary restrictions. However, monitoring was not associated with a measure of medication adherence. Partial support was found for a model suggesting that a lack of perceived control is responsible for the relationship between higher monitoring and poorer adherence.

Monitoring and regulation of learning in medical education: the need for predictive cues.

PubMed

de Bruin, Anique B H; Dunlosky, John; Cavalcanti, Rodrigo B

2017-06-01

Being able to accurately monitor learning activities is a key element in self-regulated learning in all settings, including medical schools. Yet students' ability to monitor their progress is often limited, leading to inefficient use of study time. Interventions that improve the accuracy of students' monitoring can optimise self-regulated learning, leading to higher achievement. This paper reviews findings from cognitive psychology and explores potential applications in medical education, as well as areas for future research. Effective monitoring depends on students' ability to generate information ('cues') that accurately reflects their knowledge and skills. The ability of these 'cues' to predict achievement is referred to as 'cue diagnosticity'. Interventions that improve the ability of students to elicit predictive cues typically fall into two categories: (i) self-generation of cues and (ii) generation of cues that is delayed after self-study. Providing feedback and support is useful when cues are predictive but may be too complex to be readily used. Limited evidence exists about interventions to improve the accuracy of self-monitoring among medical students or trainees. Developing interventions that foster use of predictive cues can enhance the accuracy of self-monitoring, thereby improving self-study and clinical reasoning. First, insight should be gained into the characteristics of predictive cues used by medical students and trainees. Next, predictive cue prompts should be designed and tested to improve monitoring and regulation of learning. Finally, the use of predictive cues should be explored in relation to teaching and learning clinical reasoning. Improving self-regulated learning is important to help medical students and trainees efficiently acquire knowledge and skills necessary for clinical practice. Interventions that help students generate and use predictive cues hold the promise of improved self-regulated learning and achievement. This framework is applicable to learning in several areas, including the development of clinical reasoning. © 2017 The Authors Medical Education published by Association for the Study of Medical Education and John Wiley & Sons Ltd.

Unité de Coordination Clinique des Services Préhospitaliers d'Urgence: A clinical telemedicine platform that improves prehospital and community health care for rural citizens.

PubMed

Bussières, Sylvain; Tanguay, Alain; Hébert, Denise; Fleet, Richard

2017-01-01

Access to health care in Canada's rural areas is a challenge. The Unité de Coordination Clinique des Services Préhospitaliers d'Urgence (UCCSPU) is a telemedicine program designed to improve health care in the Chaudiere-Appalaches and Quebec City regions of Canada. Remote medical services are provided by nurses and by an emergency physician based in a clinical unit at the Alphonse-Desjardins Community Health and Social Services Center. The interventions were developed to meet two objectives. The first is to enhance access to quality health care. To this end, Basic Life Support paramedics and nurses were taught interventions outside of their field of expertise. Prehospital electrocardiograms were used to remotely diagnose ST segment elevation myocardial infarction and to monitor patients who were en route by ambulance to the nearest catheterization facility or emergency department. Basic Life Support paramedics received extended medical authorization that allowed them to provide opioid analgesia via telemedicine physician orders. Nurses from community health centres without physician coverage were able to request medical assistance via a video telemedicine system. The second objective is to optimize medical resources. To this end, remote death certifications were implemented to avoid unnecessary transport of deceased persons to hospitals. This paper presents the telemedicine program and some results.

78 FR 68853 - International Medical Device Regulators Forum; Medical Device Single Audit Program International...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-15

...] International Medical Device Regulators Forum; Medical Device Single Audit Program International Coalition Pilot... Drug Administration (FDA) is announcing participation in the Medical Device Single Audit Program International Coalition Pilot Program. The Medical Device Single Audit Program (MDSAP) was designed and...

A prototype Crew Medical Restraint System (CMRS) for Space Station Freedom

NASA Technical Reports Server (NTRS)

Johnston, S. L.; Eichstadt, F. T.; Billica, R. D.

1992-01-01

The Crew Medical Restrain System (CMRS) is a prototype system designed and developed for use as a universally deployable medical restraint/workstation on Space Station Freedom (SSF), the Shuttle Transportation System (STS), and the Assured Crew Rescue Vehicle (ACRV) for support of an ill or injured crewmember requiring stabilization and transportation to Earth. The CMRS will support all medical capabilities of the Health Maintenance Facility (HMF) by providing a restraint/interface system for all equipment (advance life support packs, defibrillator, ventilator, portable oxygen supply, IV pump, transport monitor, transport aspirator, and intervenous fluids delivery system) and personnel (patient and crew medical officers). It must be functional within the STS, ACRV, and all SSF habitable volumes. The CMRS will allow for medical capabilities within CPR, ACLS and ATLS standards of care. This must all be accomplished for a worst case transport time scenario of 24 hours from SSF to a definitive medical care facility on Earth. A presentation of the above design prototype with its subsequent one year SSF/HMF and STS/ACRV high fidelity mock-up ground based simulation testing will be given. Also, parabolic flight and underwater Weightless Test Facility evaluations will be demonstrated for various medical contingencies. The final design configuration to date will be discussed with future space program impact considerations.

Prescription Monitoring Program Trends Among Individuals Arrested in Maine for Trafficking Prescription Drugs in 2014.

PubMed

McCall, Kenneth; Nichols, Stephanie D; Holt, Christina; Ochs, Leslie; Cattabriga, Gary; Tu, Chunhao

2016-06-01

To evaluate controlled substance prescribing trends available in the Maine Prescription Monitoring Program (PMP) among individuals arrested for prescription drug "trafficking." The demographic characteristics of the individuals who had matching prescription records in the PMP within 90 days of the arrest were identified. A population-based, retrospective cohort study using data from the Maine Diversion Alert Program (DAP) and the Maine PMP. The study population consisted of persons arrested for trafficking prescription drugs in Maine during the 2014 calendar year from January 1 to December 31. There were 594 trafficking arrests reported by the Maine DAP in 2014. The study population consisted of the 235 persons (40%) with arrests involving controlled prescription medications. The mean age of these persons was 33 years (range 18-77 yrs), and 156 (66%) were male. Arrests involved 154 prescription opioids (65%), seven stimulants (3%), seven benzodiazepines (3%), and 77 unspecified controlled prescription drugs (33%). A minority of individuals (n=57, 24%) had a prescription record in the PMP that matched the substance involved in the arrest. Only one person with matching PMP and arrest records utilized ≥ 5 prescribers, while none used ≥ 5 pharmacies within 90 days before the arrest. Payment methods for matching prescriptions were commercial insurance (n=28, 49%), Medicaid (n=19, 33%), Medicare (n=5, 9%), and cash (n=5, 9%). The majority (76%) of persons arrested for prescription drug trafficking did not have PMP records and did not directly obtain the diverted medication from a licensed pharmacy. Traditional red flags, like cash payment and using multiple prescribers or pharmacies, were uncommon. Therefore, arrest records for diversion and PMPs are distinct and complementary tools for identifying individuals at risk for substance misuse. © 2016 Pharmacotherapy Publications, Inc.

A Statewide Evaluation of the California Medical Supervision Program Using Cholinesterase Electronic Laboratory Reporting Data

PubMed Central

Laribi, Ouahiba; Malig, Brian; Sutherland-Ashley, Katherine; Broadwin, Rachel; Wieland, Walker; Salocks, Charles

2017-01-01

The California Medical Supervision program is designed to protect workers who regularly mix, load, or apply the highly toxic Category I and II organophosphates and carbamates from overexposure by monitoring cholinesterase (ChE) inhibition in plasma and red blood cells. Since January 2011, testing laboratories are required to report test results electronically to the California Department of Pesticide Regulation who shares it with the Office of Environmental Health Hazard Assessment for evaluation. The purpose of this study is to assess the utility of this reporting in evaluating the effectiveness of the Program for illness surveillance and prevention. From 2011 to 2013, we received more than 90 000 test results. Despite data gaps and data quality issues, we were able to perform spatial and temporal analyses and developed a screening tool to identify individuals potentially at risk of overexposure. The data analysis provided some evidence that the Program is effective in protecting agricultural workers handling the most toxic ChE-inhibiting pesticides even though it also identified some areas of potential concerns with individuals that appeared lacking corrective actions in the workplace in response to excessive ChE depressions and parts of the state with disproportionately at-risk individuals. However, changes to the electronic reporting are needed to more accurately identify tests related to the Program and therefore improve the utility of the data received. Moreover, data analysis also revealed that electronic reporting has its limitation in evaluating the Program.

42 CFR 88.16 - Reimbursement for medically necessary treatment, outpatient prescription pharmaceuticals...

Code of Federal Regulations, 2014 CFR

2014-10-01

..., outpatient prescription pharmaceuticals, monitoring, initial health evaluations, and travel expenses. 88.16... for medically necessary treatment, outpatient prescription pharmaceuticals, monitoring, initial health... pharmaceuticals. (1) The costs of providing medically necessary treatment or services for a WTC-related health...

42 CFR 88.16 - Reimbursement for medically necessary treatment, outpatient prescription pharmaceuticals...

Code of Federal Regulations, 2011 CFR

2011-10-01

..., outpatient prescription pharmaceuticals, monitoring, initial health evaluations, and travel expenses. 88.16... for medically necessary treatment, outpatient prescription pharmaceuticals, monitoring, initial health... pharmaceuticals. (1) The costs of providing medically necessary treatment or services for a WTC-related health...

42 CFR 88.16 - Reimbursement for medically necessary treatment, outpatient prescription pharmaceuticals...

Code of Federal Regulations, 2013 CFR

2013-10-01

..., outpatient prescription pharmaceuticals, monitoring, initial health evaluations, and travel expenses. 88.16... for medically necessary treatment, outpatient prescription pharmaceuticals, monitoring, initial health... pharmaceuticals. (1) The costs of providing medically necessary treatment or services for a WTC-related health...

42 CFR 88.16 - Reimbursement for medically necessary treatment, outpatient prescription pharmaceuticals...

Code of Federal Regulations, 2012 CFR

2012-10-01

..., outpatient prescription pharmaceuticals, monitoring, initial health evaluations, and travel expenses. 88.16... for medically necessary treatment, outpatient prescription pharmaceuticals, monitoring, initial health... pharmaceuticals. (1) The costs of providing medically necessary treatment or services for a WTC-related health...

Jennerian vaccination and the creation of a national public health agenda in Japan, 1850-1900.

PubMed

Jannetta, Ann

2009-01-01

Vaccination played a leading role in transforming the social and political status of medicine in Japanese society in the second half of the nineteenth century. The process began well before the Meiji Restoration of 1868 created a centralized government under the Japanese emperor. At the beginning of the century, medicine was a private business. There was no oversight from an interested government, and there were no medical societies or journals in which to debate and formulate opinion about medical practice. Medical knowledge was transmitted privately through personal lineage structures whose members jealously guarded their medical techniques. For almost a half century before live vaccine could be imported, knowledge of vaccination was limited to a small group of Japanese physicians who could read Dutch. This special knowledge created a medical elite whose members managed the transmission of vaccination after the vaccine arrived, and dominated the new medical and public health bureaucracies created by the Meiji state. By the end of the century, a rigorous vaccination program was in place, smallpox mortality had fallen, and Japan's Western-oriented physicians were in control of a national public health bureaucracy that could monitor the vaccination status of individuals in households throughout Japan.

Patient Dose Management: Focus on Practical Actions

PubMed Central

2016-01-01

Medical radiation is a very important part of modern medicine, and should be only used when needed and optimized. Justification and optimization of radiation examinations must be performed. The first step of reduction of medical exposure is to know the radiation dose in currently performed examinations. This review covers radiation units, how various imaging modalities report dose, and the current status of radiation dose reports and legislation. Also, practical tips that can be applied to clinical practice are introduced. Afterwards, the importance of radiology exposure related education is emphasized and the current status of education for medical personal and the public is explained, and appropriate education strategies are suggested. Commonly asked radiation dose related example questions and answers are provided in detail to allow medical personnel to answer patients. Lastly, we talk about computerized programs that can be used in medical facilities for managing patient dose. While patient dose monitoring and management should be used to decrease and optimize overall radiation dose, it should not be used to assess individual cancer risk. One must always remember that medically justified examinations should always be performed, and unneeded examinations should be avoided in the first place. PMID:26908988

Virtual groups for patient WBAN monitoring in medical environments.

PubMed

Ivanov, Stepan; Foley, Christopher; Balasubramaniam, Sasitharan; Botvich, Dmitri

2012-11-01

Wireless body area networks (WBAN) provide a tremendous opportunity for remote health monitoring. However, engineering WBAN health monitoring systems encounters a number of challenges including efficient WBAN monitoring information extraction, dynamically fine tuning the monitoring process to suit the quality of data, and to allow the translation of high-level requirements of medical officers to low-level sensor reconfiguration. This paper addresses these challenges, by proposing an architecture that allows virtual groups to be formed between devices of patients, nurses, and doctors in order to enable remote analysis of WBAN data. Group formation and modification is performed with respect to patients' conditions and medical officers' requirements, which could be easily adjusted through high-level policies. We also propose, a new metric called the Quality of Health Monitoring, which allows medical officers to provide feedback on the quality of WBAN data received. The WBAN data gathered are transmitted to the virtual group members through an underlying environmental sensor network. The proposed approach is evaluated through a series of simulation.

Networking and data management for health care monitoring of mobile patients.

PubMed

Amato, Giuseppe; Chessa, Stefano; Conforti, Fabrizio; Macerata, Alberto; Marchesi, Carlo

2005-01-01

The problem of medical devices and data integration in health care is discussed and a proposal for remote monitoring of patients based on recent developments in networking and data management is presented. In particular the paper discusses the benefits of the integration of personal medical devices into a Medical Information System and how wireless sensor networks and open protocols could be employed as building blocks of a patient monitoring system.

Possible designs of medication monitors. Final report

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

Moulding, T.S.

A medication monitor is a device which utilizes radioactive material and photographic film to determine when patients remove medication from a dispenser. The material presents multiple, largely mechanical, ideas for making this type of dispenser so it can be used for a wide range of medication regimens. The description includes using the idea of a digital clock and memory chips for the time recording system. It also includes details on (1) choice of radioactive source and method of sealing source, (2) methods of locking or sealing medication monitors, (3) detailed instructions for using existing devices, (4) a simplified film developmentmore » system, (5) a mechanical and electronic means for creating a dispenser to reduce the chance of suicidal overdosage, and (6) an electronic means to allow a patient to compensate for medication forgotten without taking an excessive dose of medication.« less

Evaluation of Florida physicians' knowledge and attitudes toward accessing the state prescription drug monitoring program as a prescribing tool.

PubMed

Gershman, Jennifer A; Gershman, Jason A; Fass, Andrea D; Popovici, Ioana

2014-12-01

The purpose of this study is to assess Florida physicians' attitudes and knowledge toward accessing the state's prescription drug monitoring program (PDMP). Five thousand medical doctors and osteopathic physicians licensed in Florida were randomly selected for a voluntary and anonymous 15-question self-administered survey approved by the Institutional Review Board. Surveys were distributed through U.S. postal service mail. Likert-scale questions were used to assess prior knowledge (1 = none to 5 = excellent) and attitudes toward accessing the PDMP (1 = strongly disagree to 5 = strongly agree). The study yielded a response rate of 7.8%, 71.5% of whom agreed or strongly agreed that the PDMP is a useful tool. Among participants that have access and answered the PDMP usefulness question, 94.8% agree or strongly agree that it is a useful tool. There were 63 out of 64 physicians (98.4%) who conducted 25 or more searches who agreed or strongly agreed that the PDMP is a useful tool for monitoring patients' controlled substance histories. There were 72.5% of participants with access that answered the "doctor shopping" question who agreed that "doctor shopping" will decrease. Among the 64 most frequent PDMP users, 69.4% agreed or strongly agreed that they have prescribed fewer controlled substances after accessing the PDMP. The study revealed that a majority of participants believe that the PDMP is a useful tool for monitoring patients' controlled substance histories. More continuing education programs should be provided to Florida physicians to enhance their knowledge regarding PDMPs. Wiley Periodicals, Inc.

Kaiser Permanente National Hand Hygiene Program

PubMed Central

Barnes, Sue; Barron, Dana; Becker, Linda; Canola, Teresa; Salemi, Charles

2004-01-01

Objective: Hand hygiene has historically been identified as an important intervention for preventing infection acquired in health care settings. Recently, the advent of waterless, alcohol-based skin degermer and elimination of artificial nails have been recognized as other important interventions for preventing infection. Supplied with this information, the National Infection Control Peer Group convened a KP Hand Hygiene Work Group, which, in August 2001, launched a National Hand Hygiene Program initiative titled “Infection Control: It’s In Our Hands” to increase compliance with hand hygiene throughout the Kaiser Permanente (KP) organization. Design: The infection control initiative was designed to include employee and physician education as well as to implement standard hand hygiene products (eg, alcohol degermers), eliminate use of artificial nails, and monitor outcomes. Results: From 2001 through September 2003, the National KP Hand Hygiene Work Group coordinated implementation of the Hand Hygiene initiative throughout the KP organization. To date, outcome monitoring has shown a 26% increase in compliance with hand hygiene as well as a decrease in the number of bloodstream infections and methycillin-resistant Staphylococcus aureus (MRSA) infections. As of May 2003, use of artificial nails had been reduced by 97% nationwide. Conclusions: Endorsement of this Hand Hygiene Program initiative by KP leadership has led to implementation of the initiative at all medical centers throughout the KP organization. Outcome indicators to date suggest that the initiative has been successful; final outcome monitoring will be completed in December 2003. PMID:26704605

The monitoring and managing application of cloud computing based on Internet of Things.

PubMed

Luo, Shiliang; Ren, Bin

2016-07-01

Cloud computing and the Internet of Things are the two hot points in the Internet application field. The application of the two new technologies is in hot discussion and research, but quite less on the field of medical monitoring and managing application. Thus, in this paper, we study and analyze the application of cloud computing and the Internet of Things on the medical field. And we manage to make a combination of the two techniques in the medical monitoring and managing field. The model architecture for remote monitoring cloud platform of healthcare information (RMCPHI) was established firstly. Then the RMCPHI architecture was analyzed. Finally an efficient PSOSAA algorithm was proposed for the medical monitoring and managing application of cloud computing. Simulation results showed that our proposed scheme can improve the efficiency about 50%. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Improving management and effectiveness of home blood pressure monitoring: a qualitative UK primary care study.

PubMed

Grant, Sabrina; Greenfield, Sheila M; Nouwen, Arie; McManus, Richard J

2015-11-01

Self-monitoring blood pressure (SMBP) is becoming an increasingly prevalent practice in UK primary care, yet there remains little conceptual understanding of why patients with hypertension engage in self-monitoring. To identify psychological factors or processes prompting the decision to self-monitor blood pressure. A qualitative study of patients previously participating in a survey study about SMBP from four general practices in the West Midlands. Taped and transcribed in-depth interviews with 16 patients (6 currently monitoring, 2 used to self-monitor, and 8 had never self-monitored). Thematic analysis was undertaken. Three main themes emerged: 'self' and 'living with hypertension' described the emotional element of living with an asymptomatic condition; 'self-monitoring behaviour and medication' described overall views about self-monitoring, current practice, reasons for monitoring, and the impact on medication adherence; and 'the GP-patient transaction' described the power relations affecting decisions to self-monitor. Self-monitoring was performed by some as a protective tool against the fears of a silent but serious condition, whereas others self-monitor simply out of curiosity. People who self-monitored tended not to discuss this with their nurse or GP, partly due to perceiving minimal or no interest from their clinician about home monitoring, and partly due to fear of being prescribed additional medication. The decision to self-monitor appeared often to be an individual choice with no schedule or systems to integrate it with other medical care. Better recognition by clinicians that patients are self-monitoring, perhaps utilising the results in shared decision-making, might help integrate it into daily practice. © British Journal of General Practice 2015.

Impact of a Mandatory Prescription Drug Monitoring Program on Prescription of Opioid Analgesics by Dentists.

PubMed

Rasubala, Linda; Pernapati, Lavanya; Velasquez, Ximena; Burk, James; Ren, Yan-Fang

2015-01-01

Prescription Drug Monitoring Programs (PDMP) are statewide databases that collect data on prescription of controlled substances. New York State mandates prescribers to consult the PDMP registry before prescribing a controlled substance such as opioid analgesics. The effect of mandatory PDMP on opioid drug prescriptions by dentists is not known. This study investigates the impact of mandatory PDMP on frequency and quantity of opioid prescriptions by dentists in a dental urgent care center. Based on the sample size estimate, we collected patient records of a 3-month period before and two consecutive 3-month periods after the mandatory PDMP implementation and analyzed the data on number of visits, treatment types and drug prescriptions using Chi-square tests. For patients who were prescribed pain medications, 452 (30.6%), 190 (14.1%), and 140 (9.6%) received opioid analgesics in the three study periods respectively, signifying a statistically significant reduction in the number of opioid prescriptions after implementation of the mandatory PDMP (p<0.05). Total numbers of prescribed opioid pills in a 3-month period decreased from 5096 to 1120, signifying a 78% reduction in absolute quantity. Prescriptions for non-opioid analgesics acetaminophen increased during the same periods (p<0.05). We conclude that the mandatory PDMP significantly affected the prescription pattern for pain medications by dentists. Such change in prescription pattern represents a shift towards the evidence-based prescription practices for acute postoperative pain.

Impact of a Mandatory Prescription Drug Monitoring Program on Prescription of Opioid Analgesics by Dentists

PubMed Central

Rasubala, Linda; Pernapati, Lavanya; Velasquez, Ximena; Burk, James; Ren, Yan-Fang

2015-01-01

Prescription Drug Monitoring Programs (PDMP) are statewide databases that collect data on prescription of controlled substances. New York State mandates prescribers to consult the PDMP registry before prescribing a controlled substance such as opioid analgesics. The effect of mandatory PDMP on opioid drug prescriptions by dentists is not known. This study investigates the impact of mandatory PDMP on frequency and quantity of opioid prescriptions by dentists in a dental urgent care center. Based on the sample size estimate, we collected patient records of a 3-month period before and two consecutive 3-month periods after the mandatory PDMP implementation and analyzed the data on number of visits, treatment types and drug prescriptions using Chi-square tests. For patients who were prescribed pain medications, 452 (30.6%), 190 (14.1%), and 140 (9.6%) received opioid analgesics in the three study periods respectively, signifying a statistically significant reduction in the number of opioid prescriptions after implementation of the mandatory PDMP (p<0.05). Total numbers of prescribed opioid pills in a 3-month period decreased from 5096 to 1120, signifying a 78% reduction in absolute quantity. Prescriptions for non-opioid analgesics acetaminophen increased during the same periods (p<0.05). We conclude that the mandatory PDMP significantly affected the prescription pattern for pain medications by dentists. Such change in prescription pattern represents a shift towards the evidence-based prescription practices for acute postoperative pain. PMID:26274819

Processing Diabetes Mellitus Composite Events in MAGPIE.

PubMed

Brugués, Albert; Bromuri, Stefano; Barry, Michael; Del Toro, Óscar Jiménez; Mazurkiewicz, Maciej R; Kardas, Przemyslaw; Pegueroles, Josep; Schumacher, Michael

2016-02-01

The focus of this research is in the definition of programmable expert Personal Health Systems (PHS) to monitor patients affected by chronic diseases using agent oriented programming and mobile computing to represent the interactions happening amongst the components of the system. The paper also discusses issues of knowledge representation within the medical domain when dealing with temporal patterns concerning the physiological values of the patient. In the presented agent based PHS the doctors can personalize for each patient monitoring rules that can be defined in a graphical way. Furthermore, to achieve better scalability, the computations for monitoring the patients are distributed among their devices rather than being performed in a centralized server. The system is evaluated using data of 21 diabetic patients to detect temporal patterns according to a set of monitoring rules defined. The system's scalability is evaluated by comparing it with a centralized approach. The evaluation concerning the detection of temporal patterns highlights the system's ability to monitor chronic patients affected by diabetes. Regarding the scalability, the results show the fact that an approach exploiting the use of mobile computing is more scalable than a centralized approach. Therefore, more likely to satisfy the needs of next generation PHSs. PHSs are becoming an adopted technology to deal with the surge of patients affected by chronic illnesses. This paper discusses architectural choices to make an agent based PHS more scalable by using a distributed mobile computing approach. It also discusses how to model the medical knowledge in the PHS in such a way that it is modifiable at run time. The evaluation highlights the necessity of distributing the reasoning to the mobile part of the system and that modifiable rules are able to deal with the change in lifestyle of the patients affected by chronic illnesses.

Development of GUI Type On-Line Condition Monitoring Program for a Turboprop Engine Using Labview

NASA Astrophysics Data System (ADS)

Kong, Changduk; Kim, Keonwoo

2011-12-01

Recently, an aero gas turbine health monitoring system has been developed for precaution and maintenance action against faults or performance degradations of the advanced propulsion system which occurs in severe environments such as high altitude, foreign object damage particles, hot and heavy rain and snowy atmospheric conditions. However to establish this health monitoring system, the online condition monitoring program is firstly required, and the program must monitor the engine performance trend through comparison between measured engine performance data and base performance results calculated by base engine performance model. This work aims to develop a GUI type on-line condition monitoring program for the PT6A-67 turboprop engine of a high altitude and long endurance operation UAV using LabVIEW. The base engine performance of the on-line condition monitoring program is simulated using component maps inversely generated from the limited performance deck data provided by engine manufacturer. The base engine performance simulation program is evaluated because analysis results by this program agree well with the performance deck data. The proposed on-line condition program can monitor the real engine performance as well as the trend through precise comparison between clean engine performance results calculated by the base performance simulation program and measured engine performance signals. In the development phase of this monitoring system, a signal generation module is proposed to evaluate the proposed online monitoring system. For user friendly purpose, all monitoring program are coded by LabVIEW, and monitoring examples are demonstrated using the proposed GUI type on-condition monitoring program.

[Automatic tracing of conversion scales from conventional units to the SI system of units].

PubMed

Besozzi, M; Bianchi, P; Agrifoglio, L

1988-01-01

American medical journals, as the Journal of the American Medical Association (JAMA), and the American Journal of Clinical Pathology (AJCP), the Journal of the American Society of Clinical Pathologists (ASCP), are shifting to selected SI (Système International d'Unités) units for reporting measurements. Further discussion by the AMA, the ASCP and other organizations is required before consensus in the US medical community can be reached as to the extent of and time frame for conversion to SI for reporting clinical laboratory measurements: however this decision will certainly greatly speed up the process of conversion in European countries too. Transition to SI units will require the use of different reference ranges, and there will be a potential for serious misinterpretation of laboratory data unless well-planned educational programs are instituted before the change. A simple program written in Microsoft Basic for automatically tracing on one's personal computer (PC) monitor a dual scale, in the conventional and in the SI system of units, is presented here. The program may be easily implemented and run on every PC operating under MS-DOS, equipped with a CGA or an AT&T6300 graphic card: through the operating system the scales may also be printed on a dot-matrix graphic printer. We believe that this, and other tools of this kind, will be useful in the thorough educational process of those reading the reports, and will be an important factor in the success of conversion to SI reporting.

Transforming the Primary Care Training Clinic: New York State's Hospital Medical Home Demonstration Pilot.

PubMed

Angelotti, Marietta; Bliss, Kathryn; Schiffman, Dana; Weaver, Erin; Graham, Laura; Lemme, Thomas; Pryor, Veronica; Gesten, Foster C

2015-06-01

Training in patient-centered medical home (PCMH) settings may prepare new physicians to measure quality of care, manage the health of populations, work in teams, and include cost information in decision making. Transforming resident clinics to PCMHs requires funding for additional staff, electronic health records, training, and other resources not typically available to residency programs. Describe how a 1115 Medicaid waiver was used to transform the majority of primary care training sites in New York State to the PCMH model and improve the quality of care provided. The 2013-2014 Hospital Medical Home Program provided awards to 60 hospitals and 118 affiliated residency programs (training more than 5000 residents) to transform outpatient sites into PCMHs and provide high-quality, coordinated care. Site visits, coaching calls, resident surveys, data reporting, and feedback were used to promote and monitor change in resident continuity and quality of care. Descriptive analyses measured improvements in these areas. A total of 156 participating outpatient sites (100%) received PCMH recognition. All sites enhanced resident education using PCMH principles through patient empanelment, development of quality dashboards, and transforming resident scheduling and training. Clinical quality outcomes showed improvement across the demonstration, including better performance on colorectal and breast cancer screening rates (rate increases of 13%, P≤.001, and 11%, P=.011, respectively). A 1115 Medicaid waiver is a viable mechanism for states to transform residency clinics to reflect new primary care models. The PCMH transformation of 156 sites led to improvements in resident continuity and clinical outcomes.

[2011 after-service customer satisfaction survey of monitoring devices in Shanghai area].

PubMed

Wang, Lijun; Li, Bin; Qian, Jianguo; Cao, Shaoping; He, Dehua; Zheng, Yunxin

2013-01-01

In 2011, Shanghai Medical Equipment Management Quality Control Center launched the fifth after-sale service satisfaction survey for medical devices in Shanghai area. There are 8 classes medical devices involving in the survey. This paper demonstrates the investigation results of monitoring devices which are from different manufacturers.

A new Web-based medical tool for assessment and prevention of comprehensive cardiovascular risk

PubMed Central

Franchi, Daniele; Cini, Davide; Iervasi, Giorgio

2011-01-01

Background: Multifactor cardiovascular disease is the leading cause of death; besides well-known cardiovascular risk factors, several emerging factors such as mental stress, diet type, and physical inactivity, have been associated to cardiovascular disease. To date, preventive strategies are based on the concept of absolute risk calculated by different algorithms and scoring systems. However, in general practice the patient’s data collection represents a critical issue. Design: A new multipurpose computer-based program has been developed in order to:1) easily calculate and compare the absolute cardiovascular risk by the Framingham, Procam, and Progetto Cuore algorithms; 2) to design a web-based computerized tool for prospective collection of structured data; 3) to support the doctor in the decision-making process for patients at risk according to recent international guidelines. Methods: During a medical consultation the doctor utilizes a common computer connected by Internet to a medical server where all the patient’s data and software reside. The program evaluates absolute and relative cardiovascular risk factors, personalized patient’s goals, and multiparametric trends, monitors critical parameter values, and generates an automated medical report. Results: In a pilot study on 294 patients (47% males; mean age 60 ± 12 years [±SD]) the global time to collect data at first consultation was 13 ± 11 minutes which declined to 8 ± 7 minutes at the subsequent consultation. In 48.2% of cases the program revealed 2 or more primary risk factor parameters outside guideline indications and gave specific clinical suggestions to return altered parameters to target values. Conclusion: The web-based system proposed here may represent a feasible and flexible tool for clinical management of patients at risk of cardiovascular disease and for epidemiological research. PMID:21445280

Risk of Adverse Health Outcomes and Decrements in Performance Due to In-flight Medical Conditions

NASA Technical Reports Server (NTRS)

Antonsen,Erik

2017-01-01

The drive to undertake long-duration space exploration missions at greater distances from Earth gives rise to many challenges concerning human performance under extreme conditions. At NASA, the Human Research Program (HRP) has been established to investigate the specific risks to astronaut health and performance presented by space exploration, in addition to developing necessary countermeasures and technology to reduce risk and facilitate safer, more productive missions in space (NASA Human Research Program 2009). The HRP is divided into five subsections, covering behavioral health, space radiation, habitability, and other areas of interest. Within this structure is the ExMC Element, whose research contributes to the overall development of new technologies to overcome the challenges of expanding human exploration and habitation of space. The risk statement provided by the HRP to the ExMC Element states: "Given that medical conditions/events will occur during human spaceflight missions, there is a possibility of adverse health outcomes and decrements in performance in mission and for long term health" (NASA Human Research Program 2016). Within this risk context, the Exploration Medical Capabilities (ExMC) Element is specifically concerned with establishing evidenced-based methods of monitoring and maintaining astronaut health. Essential to completing this task is the advancement in techniques that identify, prevent, and treat any health threats that may occur during space missions. The ultimate goal of the ExMC Element is to develop and demonstrate a pathway for medical system integration into vehicle and mission design to mitigate the risk of medical issues. Integral to this effort is inclusion of an evidence-based medical and data handling system appropriate for long-duration, exploration-class missions. This requires a clear Concept of Operations, quantitative risk metrics or other tools to address changing risk throughout a mission, and system scoping and system engineering. Because of the novel nature of the risks involved in exploration missions, new and complex ethical challenges are likely to be encountered. This document describes the relevant background and evidence that informs the development of an exploration medical system.

Peer-to-Peer JXTA Architecture for Continuing Mobile Medical Education Incorporated in Rural Public Health Centers.

PubMed

Rajasekaran, Rajkumar; Iyengar, Nallani Chackravatula Sriman Narayana

2013-04-01

Mobile technology helps to improve continuing medical education; this includes all aspects of public health care as well as keeping one's knowledge up-to-date. The program of continuing medical and health education is intertwined with mobile health technology, which forms an imperative component of national strategies in health. Continuing mobile medical education (CMME) programs are designed to ensure that all medical and health-care professionals stay up-to-date with the knowledge required through mobile JXTA to appraise modernized strategies so as to achieve national goals of health-care information distribution. In this study, a 20-item questionnaire was distributed to 280 health professionals practicing traditional training learning methodologies (180 nurses, 60 doctors, and 40 health inspectors) in 25 rural hospitals. Among the 83% respondents, 56% are eager to take new learning methodologies as part of their evaluation, which is considered for promotion to higher grades, increments, or as part of their work-related activities. The proposed model was executed in five public health centers in which nurses and health inspectors registered in the JXTA network were referred to the record peer group by administrators. A mobile training program on immunization was conducted through the ADVT, with the lectures delivered on their mobiles. Credits are given after taking the course and completing an evaluation test. The system is faster compared with traditional learning. Medical knowledge management and mobile-streaming application support the CMME system through JXTA. The mobile system includes online lectures and practice quizzes, as well as assignments and interactions with health professionals. Evaluation and assessments are done online and credits certificates are provided based on the score the student obtains. The acceptance of mobile JXTA peer-to-peer learning has created a drastic change in learning methods among rural health professionals. The professionals undergo training and should pass an exam in order to obtain the credits. The system is controlled and monitored by the administrator peer group, which makes it more flexible and structured. Compared with traditional learning system, enhanced study improves cloud-based mobile medical education technology.

Peer-to-Peer JXTA Architecture for Continuing Mobile Medical Education Incorporated in Rural Public Health Centers

PubMed Central

Rajasekaran, Rajkumar; Iyengar, Nallani Chackravatula Sriman Narayana

2013-01-01

Objectives: Mobile technology helps to improve continuing medical education; this includes all aspects of public health care as well as keeping one’s knowledge up-to-date. The program of continuing medical and health education is intertwined with mobile health technology, which forms an imperative component of national strategies in health. Continuing mobile medical education (CMME) programs are designed to ensure that all medical and health-care professionals stay up-to-date with the knowledge required through mobile JXTA to appraise modernized strategies so as to achieve national goals of health-care information distribution. Methods: In this study, a 20-item questionnaire was distributed to 280 health professionals practicing traditional training learning methodologies (180 nurses, 60 doctors, and 40 health inspectors) in 25 rural hospitals. Among the 83% respondents, 56% are eager to take new learning methodologies as part of their evaluation, which is considered for promotion to higher grades, increments, or as part of their work-related activities. Results: The proposed model was executed in five public health centers in which nurses and health inspectors registered in the JXTA network were referred to the record peer group by administrators. A mobile training program on immunization was conducted through the ADVT, with the lectures delivered on their mobiles. Credits are given after taking the course and completing an evaluation test. The system is faster compared with traditional learning. Conclusion: Medical knowledge management and mobile-streaming application support the CMME system through JXTA. The mobile system includes online lectures and practice quizzes, as well as assignments and interactions with health professionals. Evaluation and assessments are done online and credits certificates are provided based on the score the student obtains. The acceptance of mobile JXTA peer-to-peer learning has created a drastic change in learning methods among rural health professionals. The professionals undergo training and should pass an exam in order to obtain the credits. The system is controlled and monitored by the administrator peer group, which makes it more flexible and structured. Compared with traditional learning system, enhanced study improves cloud-based mobile medical education technology. PMID:24159539

Mentoring program design and implementation in new medical schools

PubMed Central

Fornari, Alice; Murray, Thomas S.; Menzin, Andrew W.; Woo, Vivian A.; Clifton, Maurice; Lombardi, Marion; Shelov, Steven

2014-01-01

Purpose Mentoring is considered a valuable component of undergraduate medical education with a variety of programs at established medical schools. This study presents how new medical schools have set up mentoring programs as they have developed their curricula. Methods Administrators from 14 US medical schools established since 2006 were surveyed regarding the structure and implementation of their mentoring programs. Results The majority of new medical schools had mentoring programs that varied in structure and implementation. Although the programs were viewed as valuable at each institution, challenges when creating and implementing mentoring programs in new medical schools included time constraints for faculty and students, and lack of financial and professional incentives for faculty. Conclusions Similar to established medical schools, there was little uniformity among mentoring programs at new medical schools, likely reflecting differences in curriculum and program goals. Outcome measures are needed to determine whether a best practice for mentoring can be established. PMID:24962112

AI based HealthCare Platform for Real Time, Predictive and Prescriptive Analytics using Reactive Programming

NASA Astrophysics Data System (ADS)

Kaur, Jagreet; Singh Mann, Kulwinder, Dr.

2018-01-01

AI in Healthcare needed to bring real, actionable insights and Individualized insights in real time for patients and Doctors to support treatment decisions., We need a Patient Centred Platform for integrating EHR Data, Patient Data, Prescriptions, Monitoring, Clinical research and Data. This paper proposes a generic architecture for enabling AI based healthcare analytics Platform by using open sources Technologies Apache beam, Apache Flink Apache Spark, Apache NiFi, Kafka, Tachyon, Gluster FS, NoSQL- Elasticsearch, Cassandra. This paper will show the importance of applying AI based predictive and prescriptive analytics techniques in Health sector. The system will be able to extract useful knowledge that helps in decision making and medical monitoring in real-time through an intelligent process analysis and big data processing.

Effective Documentation Tools

NASA Technical Reports Server (NTRS)

Sleboda, Claire

1997-01-01

Quality assurance programs provide a very effective means to monitor and evaluate medical care. Quality assurance involves: (1) Identify a problem; (2) Determine the source and nature of the problem; (3) Develop policies and methods to effect improvement; (4) Implement those polices; (5) Monitor the methods applied; and (6) Evaluate their effectiveness. Because this definition of quality assurance so closely resembles the Nursing Process, the health unit staff was able to use their knowledge of the nursing process to develop many forms which improve the quality of patient care. These forms include the NASA DFRC Service Report, the occupational injury form (Incident Report), the patient survey (Pre-hospital Evaluation/Care Report), the Laboratory Log Sheet, the 911 Run Sheet, and the Patient Assessment Stamp. Examples and steps which are followed to generate these reports are described.

Controlled Substance Lock-In Programs: Examining An Unintended Consequence Of A Prescription Drug Abuse Policy.

PubMed

Roberts, Andrew W; Farley, Joel F; Holmes, G Mark; Oramasionwu, Christine U; Ringwalt, Chris; Sleath, Betsy; Skinner, Asheley C

2016-10-01

Controlled substance lock-in programs are garnering increased attention from payers and policy makers seeking to combat the epidemic of opioid misuse. These programs require high-risk patients to visit a single prescriber and pharmacy for coverage of controlled substance medication services. Despite high prevalence of the programs in Medicaid, we know little about their effects on patients' behavior and outcomes aside from reducing controlled substance-related claims. Our study was the first rigorous investigation of lock-in programs' effects on out-of-pocket controlled substance prescription fills, which circumvent the programs' restrictions and mitigate their potential public health benefits. We linked claims data and prescription drug monitoring program data for the period 2009-12 for 1,647 enrollees in North Carolina Medicaid's lock-in program and found that enrollment was associated with a roughly fourfold increase in the likelihood and frequency of out-of-pocket controlled substance prescription fills. This finding illuminates weaknesses of lock-in programs and highlights the need for further scrutiny of the appropriate role, optimal design, and potential unintended consequences of the programs as tools to prevent opioid abuse. Project HOPE—The People-to-People Health Foundation, Inc.

SMS-Based Medical Diagnostic Telemetry Data Transmission Protocol for Medical Sensors

PubMed Central

Townsend, Ben; Abawajy, Jemal; Kim, Tai-Hoon

2011-01-01

People with special medical monitoring needs can, these days, be sent home and remotely monitored through the use of data logging medical sensors and a transmission base-station. While this can improve quality of life by allowing the patient to spend most of their time at home, most current technologies rely on hardwired landline technology or expensive mobile data transmissions to transmit data to a medical facility. The aim of this paper is to investigate and develop an approach to increase the freedom of a monitored patient and decrease costs by utilising mobile technologies and SMS messaging to transmit data from patient to medico. To this end, we evaluated the capabilities of SMS and propose a generic communications protocol which can work within the constraints of the SMS format, but provide the necessary redundancy and robustness to be used for the transmission of non-critical medical telemetry from data logging medical sensors. PMID:22163845

Integration of outpatient infectious diseases clinic pharmacy services and specialty pharmacy services for patients with HIV infection.

PubMed

Gilbert, Elise M; Gerzenshtein, Lana

2016-06-01

The integration of specialty pharmacy services and existing outpatient clinical pharmacy services within an infectious diseases (ID) clinic to optimize the care of patients with human immunodeficiency virus (HIV) infection is described. The management of HIV-infected patients is a highly specialized area of practice, often requiring use of complex medication regimens for reduction of HIV-associated morbidity and mortality prophylaxis and treatment of opportunistic infections, and prevention of HIV transmission. To maximize the effectiveness and safety of treatment with antiretroviral agents and associated pharmacotherapies, an interdisciplinary team is often involved in patient care. At Chicago-based Northwestern Medicine (NM), the outpatient ID clinic has long worked with an interdisciplinary care team including physicians, clinical pharmacists, nurses, and social workers to care for patients with HIV infection. In April 2014, specialty pharmacy services for patients with HIV infection were added to the NM ID clinic's care model to help maintain continuity of care and enhance patient follow-up. The care model includes well-defined roles for clinical pharmacists, pharmacy residents and students on rotation, and licensed pharmacy technicians. Specialty pharmacy services, including medication education, prescription fulfillment, assistance with medication access (e.g., navigation of financial assistance programs, completion of prior-authorization requests), and treatment monitoring, allow for closed-loop medication management of the HIV-infected patient population. Integration of specialty pharmacy services with the interdisciplinary care provided in the outpatient NM ID clinic has enhanced continuity of care for patients with HIV infection in terms of prescription filling, medication counseling, and adherence monitoring. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Classification and disease prediction via mathematical programming

NASA Astrophysics Data System (ADS)

Lee, Eva K.; Wu, Tsung-Lin

2007-11-01

In this chapter, we present classification models based on mathematical programming approaches. We first provide an overview on various mathematical programming approaches, including linear programming, mixed integer programming, nonlinear programming and support vector machines. Next, we present our effort of novel optimization-based classification models that are general purpose and suitable for developing predictive rules for large heterogeneous biological and medical data sets. Our predictive model simultaneously incorporates (1) the ability to classify any number of distinct groups; (2) the ability to incorporate heterogeneous types of attributes as input; (3) a high-dimensional data transformation that eliminates noise and errors in biological data; (4) the ability to incorporate constraints to limit the rate of misclassification, and a reserved-judgment region that provides a safeguard against over-training (which tends to lead to high misclassification rates from the resulting predictive rule) and (5) successive multi-stage classification capability to handle data points placed in the reserved judgment region. To illustrate the power and flexibility of the classification model and solution engine, and its multigroup prediction capability, application of the predictive model to a broad class of biological and medical problems is described. Applications include: the differential diagnosis of the type of erythemato-squamous diseases; predicting presence/absence of heart disease; genomic analysis and prediction of aberrant CpG island meythlation in human cancer; discriminant analysis of motility and morphology data in human lung carcinoma; prediction of ultrasonic cell disruption for drug delivery; identification of tumor shape and volume in treatment of sarcoma; multistage discriminant analysis of biomarkers for prediction of early atherosclerois; fingerprinting of native and angiogenic microvascular networks for early diagnosis of diabetes, aging, macular degeneracy and tumor metastasis; prediction of protein localization sites; and pattern recognition of satellite images in classification of soil types. In all these applications, the predictive model yields correct classification rates ranging from 80% to 100%. This provides motivation for pursuing its use as a medical diagnostic, monitoring and decision-making tool.

Statistical Techniques to Analyze Pesticide Data Program Food Residue Observations.

PubMed

Szarka, Arpad Z; Hayworth, Carol G; Ramanarayanan, Tharacad S; Joseph, Robert S I

2018-06-26

The U.S. EPA conducts dietary-risk assessments to ensure that levels of pesticides on food in the U.S. food supply are safe. Often these assessments utilize conservative residue estimates, maximum residue levels (MRLs), and a high-end estimate derived from registrant-generated field-trial data sets. A more realistic estimate of consumers' pesticide exposure from food may be obtained by utilizing residues from food-monitoring programs, such as the Pesticide Data Program (PDP) of the U.S. Department of Agriculture. A substantial portion of food-residue concentrations in PDP monitoring programs are below the limits of detection (left-censored), which makes the comparison of regulatory-field-trial and PDP residue levels difficult. In this paper, we present a novel adaption of established statistical techniques, the Kaplan-Meier estimator (K-M), the robust regression on ordered statistic (ROS), and the maximum-likelihood estimator (MLE), to quantify the pesticide-residue concentrations in the presence of heavily censored data sets. The examined statistical approaches include the most commonly used parametric and nonparametric methods for handling left-censored data that have been used in the fields of medical and environmental sciences. This work presents a case study in which data of thiamethoxam residue on bell pepper generated from registrant field trials were compared with PDP-monitoring residue values. The results from the statistical techniques were evaluated and compared with commonly used simple substitution methods for the determination of summary statistics. It was found that the maximum-likelihood estimator (MLE) is the most appropriate statistical method to analyze this residue data set. Using the MLE technique, the data analyses showed that the median and mean PDP bell pepper residue levels were approximately 19 and 7 times lower, respectively, than the corresponding statistics of the field-trial residues.

Quality assurance in postgraduate pathology training the Dutch way: regular assessment, monitoring of training programs but no end of training examination.

PubMed

van der Valk, Paul

2016-01-01

It might seem self-evident that in the transition from a supervised trainee to an independent professional who is no longer supervised, formal assessment of whether the trainee knows his/her trade well enough to function independently is necessary. This would then constitute an end of training examination. Such examinations are practiced in several countries but a rather heterogeneous situation exists in the EU countries. In the Netherlands, the training program is not concluded by a summative examination and reasons behind this situation are discussed. Quality assurance of postgraduate medical training in the Netherlands has been developed along two tracks: (1) not a single testing moment but continuous evaluation of the performance of the trainee in 'real time' situations and (2) monitoring of the quality of the offered training program through regular site-visits. Regular (monthly and/or yearly) evaluations should be part of every self-respecting training program. In the Netherlands, these evaluations are formative only: their intention is to provide the trainee a tool by which he or she can see whether they are on track with their training schedule. In the system in the Netherlands, regular site-visits to training programs constitute a crucial element of quality assurance of postgraduate training. During the site-visit, the position and perceptions of the trainee are key elements. The perception by the trainee of the training program, the institution (or department) offering the training program, and the professionals involved in the training program is explicitly solicited and systematically assessed. With this two-tiered approach high-quality postgraduate training is assured without the need for an end of training examination.

A Wireless Physiological Signal Monitoring System with Integrated Bluetooth and WiFi Technologies.

PubMed

Yu, Sung-Nien; Cheng, Jen-Chieh

2005-01-01

This paper proposes a wireless patient monitoring system which integrates Bluetooth and WiFi wireless technologies. A wireless portable multi-parameter device was designated to acquire physiological signals and transmit them to a local server via Bluetooth wireless technology. Four kinds of monitor units were designed to communicate via the WiFi wireless technology, including a local monitor unit, a control center, mobile devices (personal digital assistant; PDA), and a web page. The use of various monitor units is intending to meet different medical requirements for different medical personnel. This system was demonstrated to promote the mobility and flexibility for both the patients and the medical personnel, which further improves the quality of health care.

Global health diplomacy, national integration, and regional development through the monitoring and evaluation of HIV/AIDS programs in Papua New Guinea, Vanuatu, and Samoa.

PubMed

Kevany, Sebastian; Gildea, Amy; Garae, Caleb; Moa, Serafi; Lautusi, Avaia

2015-04-27

The South Pacific countries of Vanuatu, Samoa, and Papua New Guinea have ascended rapidly up the development spectrum in recent years, refining an independent and post-colonial economic and political identity that enhances their recognition on the world stage. All three countries have overcome economic, political and public health challenges in order to stake their claim to sovereignty. In this regard, the contributions of national and international programs for the diagnosis, treatment and prevention of HIV/AIDS, with specific reference to their monitoring and evaluation (M&E) aspects, have contributed not just to public health, but also to broader political and diplomatic goals such as 'nation-building'. This perspective describes the specific contributions of global health programs to the pursuit of national integration, development, and regional international relations, in Vanuatu, Samoa and Papua New Guinea, respectively, based on in-country M&E activities on behalf of the Global Fund to Fight AIDS, Tuberculosis (TB) and Malaria and the Australian Department of Foreign Affairs and Trade (DFAT) during 2014 and 2015. Key findings include: (1) that global health programs contribute to non-health goals; (2) that HIV/AIDS programs promote international relations, decentralized development, and internal unity; (3) that arguments in favour of the maintenance and augmentation of global health funding may be enhanced on this basis; and (4) that "smart" global health approaches have been successful in South Pacific countries. © 2015 by Kerman University of Medical Sciences.

Removing the interview for medical school selection is associated with gender bias among enrolled students.

PubMed

Wilkinson, David; Casey, Mavourneen G; Eley, Diann S

2014-02-03

To report, and determine reasons for, a change in the gender ratio observed among enrolled medical students after removal of the interview from the selection process. Cross-sectional study of 4051 students admitted to the medical program at the University of Queensland between 2004 and 2012. Students are enrolled either directly as graduates or via a school-leaver pathway. Change in proportions of male and female students over time, and gender-specific scores in the three sections of the GAMSAT (Graduate Medical School Admissions Test). Between 2004 and 2008 (when an interview was part of the selection process), 891 enrolled students (51.4%) were male, whereas between 2009 and 2012 (no interview), 1134 (57.7%; P < 0.001) were male. This change in gender ratio was limited to domestic direct graduate-entry students, and the male proportion in this group rose from 50.9% (705 students) before the interview was removed to 64.0% (514 students; P < 0.001) after removal of the interview (reaching 73.8% in 2012). Between 2004 and 2012, male students consistently performed better than female students on GAMSAT section III (mean score, 71.5 v 68.5; P < 0.001). The proportion of males enrolled in the medical program at this university increased markedly after removal of the interview from the selection process. This change is limited to domestic direct graduate-entry students, and seems to be due to higher scores by male students in section III of the GAMSAT. The interview may play an important role in ensuring gender equity in selection, and medical schools should carefully monitor the consequences of changes to selection policy.

Using a medical volunteer program to motivate medical freshmen.

PubMed

Na, Beag Ju; Hur, Yera; Yun, Jungmin; Kang, Jaegu; Han, Seungyeon; Whang, Wonmin; Lee, Keumho; Lee, Jungmin

2013-09-01

A task force identified 4 core properties of motivation-related improvement and developed a medical volunteer program for 63 medical freshmen in 2012. Three overarching topics were examined: What were the contents of the program? Did students' motivation improve? Were the students satisfied with the course? Pretest and posttest motivation levels and program evaluation forms were analyzed. We organized a series of committee meetings and identified 4 core factors of motivation. The program was conducted for 63 medical freshmen in March 2012. The program evaluation form was analyzed using SPSS 17.0. The core factors of motivation were interest in medical studies, volunteer-mindedness, medical humanities, and self-management. The program was composed of lectures, medical volunteer hours, and program evaluation and feedback sessions. Students' motivation differed significantly with regard to interest in medical studies (t=-2.40, p=0.020) and volunteer-mindedness (t=-3.45, p=0.001). Ninety percent of students were satisfied with the program, 67.8% of students were satisfied with the medical volunteer activity, and the feedback session of the program was meaningful (66.1%). The medical volunteer program, held in the first month of the medical education year, was meaningful, but the reasons for dissatisfaction with the program should be examined. We should also develop a system that has lasting beneficial effects on academic achievement and career selection.

Cost effectiveness of virtual reality graded exposure therapy with physiological monitoring for the treatment of combat related post traumatic stress disorder.

PubMed

Wood, Dennis Patrick; Murphy, Jennifer; McLay, Robert; Koffman, Robert; Spira, James; Obrecht, Robert E; Pyne, Jeff; Wiederhold, Brenda K

2009-01-01

Virtual Reality Graded Exposure Therapy (VRGET) is an effective treatment for combat-related PTSD. We summarize the outcomes of a VRGET pilot study with 12 participants who completed one to multiple combat tours in support of the War on Terrorism and who were subsequently diagnosed with combat-related PTSD. Details of the collaborative program amongst the Virtual Reality Medical Center (VRMC), Office of Naval Research, the Naval Medical Center San Diego (NMCSD) and the Navy Hospital Camp Pendleton are discussed as is the VRGET outcomes of significant reductions in PTSD symptoms severity. We also described the estimated cost-effectiveness of VRGET for the treatment of combat-related PTSD, as contrasted to Treatment as Usual (TAU) for combat-related PTSD.

[Bone metabolism in human space flight and bed rest study].

PubMed

Ohshima, Hiroshi; Mukai, Chiaki

2008-09-01

Japanese Experiment Module "KIBO" is Japan's first manned space facility and will be operated as part of the international space station (ISS) . KIBO operations will be monitored and controlled from Tsukuba Space Center. In Japan, after the KIBO element components are fully assembled and activated aboard the ISS, Japanese astronauts will stay on the ISS for three or more months, and full-scale experiment operations will begin. Bone loss and renal stone are significant medical concerns for long duration human space flight. This paper will summarize the results of bone loss, calcium balance obtained from the American and Russian space programs, and ground-base analog bedrest studies. Current in-flight training program, nutritional recommendations and future countermeasure plans for station astronauts are also described.

Challenges of space medical operations and life sciences management

NASA Technical Reports Server (NTRS)

Haddad, S. G.

1992-01-01

The Kennedy Space Center (KSC) has been the premier launch and landing site for America's space program since the early 1960s. Visitors are cognizant of space vehicles, processing facilities and launch pads which are treasured national resources. However, most are unaware of the unique organization which supports launch and landing activities and manages the center's occupational medicine, environmental health, ecological and environmental monitoring functions, as well as human and plant research programs. Management of this multifaceted organization can be complex because funding its different functions comes from a number of sources. Additionally the diverse disciplines of personnel present a special challenge in maintaining professional competencies while assuring efficiency in cyclical operations. This article explains the organization's structure and reviews some of its accomplishments.

Pre-departure training and the social accountability of International Medical Electives.

PubMed

Wallace, Lauren J; Webb, Allison

2014-01-01

Due to widespread awareness of global inequities in health and development, participation and interest in International Medical Electives has grown. However, it has been suggested that the benefits of these electives for students and communities may not outweigh the harms. Pre-departure training (PDT) has been proposed as a route through which participants can adequately prepare for their elective experience. Through a review of the current literature, this article explores the ethics of international medical electives using a social accountability framework and assesses the success of PDT in mitigating harms for students and communities. We find that the literature on PDT is limited. What is clear from completed studies is that the focus of PDT has often been centered on the clinical experience, while theories of development and health inequity remain minor topics. We argue that a greater benefit for students and communities could be gained from framing health inequity from a critical perspective, and integrating mandatory global health education into medical school curricula. We suggest that attention to only PDT is not enough. In a socially accountable program, community partnerships must be bilateral and respect communities as primary stakeholders in the training of students and in program evaluation. Unfortunately, research to-date has focused on the student experience; further studies of the community perspective would help to elicit how PDT and partnership models can be strengthened, improving the experiences of both students and communities. Finally, individual medical schools and organizations that offer global health elective experiences must ensure that they take responsibility for monitoring PDT.

A mobile phone application for the assessment and management of youth mental health problems in primary care: a randomised controlled trial.

PubMed

Reid, Sophie C; Kauer, Sylvia D; Hearps, Stephen J C; Crooke, Alexander H D; Khor, Angela S; Sanci, Lena A; Patton, George C

2011-11-29

Over 75% of mental health problems begin in adolescence and primary care has been identified as the target setting for mental health intervention by the World Health Organisation. The mobiletype program is a mental health assessment and management mobile phone application which monitors mood, stress, coping strategies, activities, eating, sleeping, exercise patterns, and alcohol and cannabis use at least daily, and transmits this information to general practitioners (GPs) via a secure website in summary format for medical review. We conducted a randomised controlled trial in primary care to examine the mental health benefits of the mobiletype program. Patients aged 14 to 24 years were recruited from rural and metropolitan general practices. GPs identified and referred eligible participants (those with mild or more mental health concerns) who were randomly assigned to either the intervention group (where mood, stress, and daily activities were monitored) or the attention comparison group (where only daily activities were monitored). Both groups self-monitored for 2 to 4 weeks and reviewed the monitoring data with their GP. GPs, participants, and researchers were blind to group allocation at randomisation. Participants completed pre-, post-, and 6-week post-test measures of the Depression, Anxiety, Stress Scale and an Emotional Self Awareness (ESA) Scale. Of the 163 participants assessed for eligibility, 118 were randomised and 114 participants were included in analyses (intervention group n = 68, comparison group n = 46). Mixed model analyses revealed a significant group by time interaction on ESA with a medium size of effect suggesting that the mobiletype program significantly increases ESA compared to an attention comparison. There was no significant group by time interaction for depression, anxiety, or stress, but a medium to large significant main effect for time for each of these mental health measures. Post-hoc analyses suggested that participation in the RCT lead to enhanced GP mental health care at pre-test and improved mental health outcomes. Monitoring mental health symptoms appears to increase ESA and implementing a mental health program in primary care and providing frequent reminders, clinical resources, and support to GPs substantially improved mental health outcomes for the sample as a whole. ClinicalTrials.gov NCT00794222.

A national program for nondirected kidney donation from living unrelated donors: the Philippine experience.

PubMed

Manauis, M N; Pilar, K A; Lesaca, R; de Belen Uriarte, R; Danguilan, R; Ona, E

2008-09-01

The objectives of this study are to describe the mechanism of the program and to present initial donor outcome. This is a descriptive study evaluating the performance of a national program for nondirected kidney donation from living unrelated donors (LURDs) in the Philippines in its 3-year implementation. It explains the mechanism of the program and socioeconomic and clinical profiling of donors. Frequencies and percentages were used to measure donor demographic data, medical follow-up compliance rate, and employment predonation and postdonation. Diagnostic laboratory criteria were required to show donor clinical profiles. In 2002, the local Health Department issued an administrative order to create a National Transplant Ethics Committee (NTEC) to address issues of rampant organ sale and donor exploitation. It also set guidelines and intended to oversee transplantation from LURDs. Salient points to the program are as follows: (1) prohibition of sale; (2) accreditation of transplantation centers; (3) enrollment of waitlisted patients in both deceased donor and nondirected LURD program; (4) ethics committee evaluation of LURDs; (5) creation of a national kidney transplant wait list and live donor registry allowing centralized, nondirected kidney allocation; (6) 10% cap on allocation to foreigners; (7) creation of a kidney donor monitoring unit with free 10-year annual medical follow-up for feedback evaluation on donor outcome; and (8) allowance of gratitudinal gifts such as health and life insurance, reimbursement for lost income, educational plan, and job placement to LURDs run by a foundation. From 2004 to 2006, 695 potential donors enrolled; 97 were accepted and deemed medically fit to donate. The remaining 598 were rejected due to demand for outright sale (103), medical unsuitability (77), disapproval by the Ethics Committee (12), and retracted consent (406). Of the 97 qualified donors, 79 had donated, 9 were being evaluated, and 9 await allocation at the end of 2006. Donor demographics show the following: 54% (381) single, 77% (538) males, and 70% (488) aged 21-40 years old. Sixty-eight of 79 became small-scale entrepreneurs postdonation. Also, 53% (42 of 79) complied with medical follow-up requirements. Mean serum creatinine level at 6 months, 1 years, and 2 years were 1.3, 1.33, and 1.05 mg/dL, respectively. Two donors had trace protein and 1 had (+1) protein. The majority of the donors are single males, aged 21-40 years with blue collar jobs. Major reasons for dropouts are retracted consent and medical unsuitability. Donors have improved socioeconomic status. In this study, 53% complied with expected medical follow-up, showing mean serum creatinine within normal range. Proteinuria appeared in 2 of 79 donors. This regulated approach provides a rational, accessible, and equitable donor allocation program. It safeguards the rights of donors and avoids donor exploitation and proliferation of unregulated organ sale. Data collection on their postoperative renal function will show long-term outcome of kidney donation from live donors.

Laboratory Safety Monitoring of Chronic Medications in Ambulatory Care Settings

PubMed Central

Hurley, Judith S; Roberts, Melissa; Solberg, Leif I; Gunter, Margaret J; Nelson, Winnie W; Young, Linda; Frost, Floyd J

2005-01-01

OBJECTIVE To evaluate laboratory safety monitoring in patients taking selected chronic prescription drugs. DESIGN Retrospective study using 1999–2001 claims data to calculate rates of missed laboratory tests (potential laboratory monitoring errors). Eleven drugs/drug groups and 64 laboratory tests were evaluated. SETTING Two staff/network model health maintenance organizations. PATIENTS Continuously enrolled health plan members age≥19 years taking ≥1 chronic medications. MEASUREMENTS AND MAIN RESULTS Among patients taking chronic medications (N=29,823 in 1999, N=32,423 in 2000, and N=36,811 in 2001), 47.1% in 1999, 45.0% in 2000, and 44.0% in 2001 did not receive ≥1 test recommended for safety monitoring. Taking into account that patients were sometimes missing more than 1 test for a given drug and that patients were frequently taking multiple drugs, the rate of all potential laboratory monitoring errors was 849/1,000 patients/year in 1999, 810/1,000 patients/year in 2000, and 797/1,000 patients/year in 2001. Rates of potential laboratory monitoring errors varied considerably across individual drugs and laboratory tests. CONCLUSIONS Lapses in laboratory monitoring of patients taking selected chronic medications were common. Further research is needed to determine whether, and to what extent, this failure to monitor patients is associated with adverse clinical outcomes. PMID:15857489

Proceedings from the 6th Annual University of Calgary Leaders in Medicine Research Symposium.

PubMed

Roberts, Jodie I; Beatty, Jennifer K; Peplowski, Michael A; Keough, Michael B; Yipp, Bryan G; Hollenberg, Morley D; Beck, Paul L

2015-12-04

On November 14, 2014, the Leaders in Medicine (LIM) program at the Cumming School of Medicine, University of Calgary hosted its 6th Annual Research Symposium. Dr. Danuta Skowronski, Epidemiology Lead for Influenza and Emerging Respiratory Pathogens at the British Columbia Centre for Disease Control (BCCDC), was the keynote speaker and presented a lecture entitled "Rapid response research during emerging public health crises: influenza and reflections from the five year anniversary of the 2009 pandemic". The LIM symposium provides a forum for both LIM and non-LIM medical students to present their research work, either as an oral or poster presentation. There were a total of six oral presentations and 77 posters presented. 
The oral presentations included: Swathi Damaraju, "The role of cell communication and 3D Cell-Matrix environment in a stem cell-based tissue engineering strategy for bone repair"; Menglin Yang, "The proteolytic activity of Nepenthes pitcher fluid as a therapeutic for the treatment of celiac disease"; Amelia Kellar, "Monitoring pediatric inflammatory bowel disease - a retrospective analysis of transabdominal ultrasound"; Monica M. Faria-Crowder, "The design and application of a molecular profiling strategy to identify polymicrobial acute sepsis infections"; Waleed Rahmani, "Hair follicle dermal stem cells regenerate the dermal sheath, repopulate the dermal papilla and modulate hair type"; and, Laura Palmer, "A novel role for amyloid beta protein during hypoxia/ischemia". 
The article on the University of Calgary Leaders in Medicine Program, "A Prescription that Addresses the Decline of Basic Science Education in Medical School," in a previous issue of CIM (2014 37(5):E292) provides more details on the program. Briefly, the LIM Research Symposium has the following objectives: (1) to showcase the impressive variety of projects undertaken by students in the LIM Program as well as University of Calgary medical students; (2) to encourage medical student participation in research and special projects; and, (3) to inform students and faculty about the diversity of opportunities available for research and special projects during medical school and beyond.

The following abstracts were submitted for publication.

The use of a prescription drug monitoring program to develop algorithms to identify providers with unusual prescribing practices for controlled substances.

PubMed

Ringwalt, Christopher; Schiro, Sharon; Shanahan, Meghan; Proescholdbell, Scott; Meder, Harold; Austin, Anna; Sachdeva, Nidhi

2015-10-01

The misuse, abuse and diversion of controlled substances have reached epidemic proportion in the United States. Contributing to this problem are providers who over-prescribe these substances. Using one state's prescription drug monitoring program, we describe a series of metrics we developed to identify providers manifesting unusual and uncustomary prescribing practices. We then present the results of a preliminary effort to assess the concurrent validity of these algorithms, using death records from the state's vital records database pertaining to providers who wrote prescriptions to patients who then died of a medication or drug overdose within 30 days. Metrics manifesting the strongest concurrent validity with providers identified from these records related to those who co-prescribed benzodiazepines (e.g., valium) and high levels of opioid analgesics (e.g., oxycodone), as well as those who wrote temporally overlapping prescriptions. We conclude with a discussion of a variety of uses to which these metrics may be put, as well as problems and opportunities related to their use.

The response to September 11: a disaster case study.

PubMed

Crane, Michael A; Levy-Carrick, Nomi C; Crowley, Laura; Barnhart, Stephanie; Dudas, Melissa; Onuoha, Uchechukwu; Globina, Yelena; Haile, Winta; Shukla, Gauri; Ozbay, Fatih

2014-01-01

The response to 9/11 continues into its 14th year. The World Trade Center Health Program (WTCHP), a long-term monitoring and treatment program now funded by the Zadroga Act of 2010, includes >60,000 World Trade Center (WTC) disaster responders and community members ("survivors"). The aim of this review is to identify several elements that have had a critical impact on the evolution of the WTC response and, directly or indirectly, the health of the WTC-exposed population. It further explores post-disaster monitoring efforts, recent scientific findings from the WTCHP, and some implications of this experience for ongoing and future environmental disaster response. Transparency and responsiveness, site safety and worker training, assessment of acute and chronic exposure, and development of clinical expertise are interconnected elements determining efficacy of disaster response. Even in a relatively well-resourced environment, challenges regarding allocation of appropriate attention to vulnerable populations and integration of treatment response to significant medical and mental health comorbidities remain areas of ongoing programmatic development. Copyright © 2014 Icahn School of Medicine at Mount Sinai. All rights reserved.

Quality of Voluntary Medical Male Circumcision Services during Scale-Up: A Comparative Process Evaluation in Kenya, South Africa, Tanzania and Zimbabwe

PubMed Central

Jennings, Larissa; Bertrand, Jane; Rech, Dino; Harvey, Steven A.; Hatzold, Karin; Samkange, Christopher A.; Omondi Aduda, Dickens S.; Fimbo, Bennett; Cherutich, Peter; Perry, Linnea; Castor, Delivette; Njeuhmeli, Emmanuel

2014-01-01

Background The rapid expansion of voluntary medical male circumcision (VMMC) has raised concerns whether health systems can deliver and sustain VMMC according to minimum quality criteria. Methods and Findings A comparative process evaluation was used to examine data from SYMMACS, the Systematic Monitoring of the Voluntary Medical Male Circumcision Scale-Up, among health facilities providing VMMC across two years of program scale-up. Site-level assessments examined the availability of guidelines, supplies and equipment, infection control, and continuity of care services. Direct observation of VMMC surgeries were used to assess care quality. Two sample tests of proportions and t-tests were used to examine differences in the percent of facilities meeting requisite preparedness standards and the mean number of directly-observed surgical tasks performed correctly. Results showed that safe, high quality VMMC can be implemented and sustained at-scale, although substantial variability was observed over time. In some settings, facility preparedness and VMMC service quality improved as the number of VMMC facilities increased. Yet, lapses in high performance and expansion of considerably deficient services were also observed. Surgical tasks had the highest quality scores, with lower performance levels in infection control, pre-operative examinations, and post-operative patient monitoring and counseling. The range of scale-up models used across countries additionally underscored the complexity of delivering high quality VMMC. Conclusions Greater efforts are needed to integrate VMMC scale-up and quality improvement processes in sub-Saharan African settings. Monitoring of service quality, not just adverse events reporting, will be essential in realizing the full health impact of VMMC for HIV prevention. PMID:24801073

Impact of an academic-community partnership in medical education on community health: evaluation of a novel student-based home visitation program.

PubMed

Rock, John A; Acuña, Juan M; Lozano, Juan Manuel; Martinez, Iveris L; Greer, Pedro J; Brown, David R; Brewster, Luther; Simpson, Joe L

2014-04-01

Current US healthcare delivery systems do not adequately address healthcare demands. Physicians are integral but rarely emphasize prevention as a primary tool to change health outcomes. Home visitation is an effective method for changing health outcomes in some populations. The Florida International University Herbert Wertheim College of Medicine Green Family Foundation NeighborhoodHELP service-learning program assigns medical students to be members of interprofessional teams that conduct household visits to determine their healthcare needs. We performed a prospective evaluation of 330 households randomly assigned to one of two groups: visitation from a student team (intervention group) or limited intervention (control group). The program design allowed randomly selected control households to replace intervention-group households that left the program of their own volition. All of the households were surveyed at baseline and after 1 year of participation in the study. After 1 year in the program and after adjustment for confounders, intervention group households proved more likely (P ≤ 0.05) than control households to have undergone physical examinations, blood pressure monitoring, and cervical cytology screenings. Cholesterol screenings and mammograms were borderline significant (P = 0.05 and P = 0.06, respectively). This study supports the value of home visitation by interprofessional student teams as an effective way to increase the use of preventive health measures. The study underscores the important role interprofessional student teams may play in improving the health of US communities, while students concurrently learn about primary prevention and primary care.

Volunteer water monitoring: A guide for state managers

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

Not Available

1990-08-01

Contents: executive summary; volunteers in water monitoring; planning a volunteer monitoring program; implementing a volunteer monitoring program; providing credible information; costs and funding; and descriptions of five successful programs.

Integrated medication management in mHealth applications.

PubMed

Ebner, Hubert; Modre-Osprian, Robert; Kastner, Peter; Schreier, Günter

2014-01-01

Continuous medication monitoring is essential for successful management of heart failure patients. Experiences with the recently established heart failure network HerzMobil Tirol show that medication monitoring limited to heart failure specific drugs could be insufficient, in particular for general practitioners. Additionally, some patients are confused about monitoring only part of their prescribed drugs. Sometimes medication will be changed without informing the responsible physician. As part of the upcoming Austrian electronic health record system ELGA, the eMedication system will collect prescription and dispensing data of drugs and these data will be accessible to authorized healthcare professionals on an inter-institutional level. Therefore, we propose two concepts on integrated medication management in mHealth applications that integrate ELGA eMedication and closed-loop mHealth-based telemonitoring. As a next step, we will implement these concepts and analyze--in a feasibility study--usability and practicability as well as legal aspects with respect to automatic data transfer from the ELGA eMedication service.

Psychotropic Drug Use among College Students: Patterns of Use, Misuse, and Medical Monitoring

ERIC Educational Resources Information Center

Oberleitner, Lindsay M. S.; Tzilos, Golfo K.; Zumberg, Kathryn M.; Grekin, Emily R.

2011-01-01

Objective: To assess whether college students who use psychotropic drugs are (1) aware of potential side effects, (2) appropriately monitored by prescribing physicians, and (3) taking medications as prescribed. Participants: Fifty-five college students, currently taking psychotropic medications, were recruited between Summer 2008 and Fall 2009.…

WOSMIP II- Workshop on Signatures of Medical and Industrial Isotope Production

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

Matthews, Murray; Achim, Pascal; Auer, M.

2011-11-01

Medical and industrial fadioisotopes are fundamental tools used in science, medicine and industry with an ever expanding usage in medical practice where their availability is vital. Very sensitive environmental radionuclide monitoring networks have been developed for nuclear-security-related monitoring [particularly Comprehensive Test-Ban-Treaty (CTBT) compliance verification] and are now operational.

An Agile Behavioral Model for Monitoring the Effects of Stimulant Medication in School Settings

ERIC Educational Resources Information Center

Volpe, Robert J.; Heick, Patrick F.; Guerasko-Moore, David

2005-01-01

Students are increasingly being prescribed stimulant medication to treat the symptoms of attention-deficit/hyperactivity disorder (ADHD). Although several authors have advocated specific procedures for monitoring the effects of this medication in school settings, recent evidence suggests that these procedures are not being used adequately. In this…

American Association of Diabetes Educators

MedlinePlus

... Blood Glucose Monitoring Resources Medication Taking Resources Insulin Infusion Set Resources Diabetes and CVD Resources AADE in ... Blood Glucose Monitoring Resources Medication Taking Resources Insulin Infusion Set Resources Diabetes and CVD Resources AADE in ...

Organization, Management and Function of International Space Station (ISS) Multilateral Medical Operations

NASA Technical Reports Server (NTRS)

Duncan, James M.; Bogomolov, V. V.; Castrucci, F.; Koike, Y.; Comtois, J. M.; Sargsyan, A. E.

2007-01-01

Long duration crews have inhabited the ISS since November of 2000. The favorable medical outcomes of its missions can be largely attributed to sustained collective efforts of all ISS Partners medical organizations. In-flight medical monitoring and support, although crucial, is just a component of the ISS system of Joint Medical Operations. The goal of this work is to review the principles, design, and function of the multilateral medical support of the ISS Program. The governing documents, which describe the relationships among all ISS partner medical organizations, were evaluated, followed by analysis of the roles, responsibilities, and decision-making processes of the ISS medical boards, panels, and working groups. The degree of integration of the medical support system was evaluated by reviewing the multiple levels of the status reviews and mission assurance activities carried out throughout the last six years. The Integrated Medical Group, consisting of physicians and other essential personnel in the mission control centers represents the front-line medical support of the ISS. Data from their day-to-day activities are presented weekly at the Space Medicine Operations Team (SMOT), where known or potential concerns are addressed by an international group of physicians. A broader status review is conducted monthly to project the state of crew health and medical support for the following month, and to determine measures to return to nominal state. Finally, a comprehensive readiness review is conducted during preparations for each ISS mission. The Multilateral Medical Policy Board (MMPB) issues medical policy decisions and oversees all health and medical matters. The Multilateral Space Medicine Board (MSMB) certifies crewmembers and visitors for training and space flight to the Station, and physicians to practice space medicine for the ISS. The Multilateral Medical Operations Panel (MMOP) develops medical requirements, defines and supervises implementation of operational countermeasures, environmental monitoring, medical care, and emergency medical services. MMOP assures the medical readiness of the Station for each subsequent mission or critical event. All boards and panels have functioned effectively and without interruptions even in various challenging circumstances. Based on the experience of the authors, consensus has prevailed as the primary nature of decisions made by all ISS medical groups, at all levels. The six first years of piloted operation have demonstrated the ability of the ISS medical authority groups and the medical infrastructure to implement medical policies and requirements, effectively interface with non-medical groups, and maintain the health and productivity of the crew in an integrated, multilaterally coordinated fashion. The medical support system appears to be mature and ready for further expansion of all Partners roles, and for the anticipated increase in the size of ISS crews.

A knowledge authoring tool for clinical decision support.

PubMed

Dunsmuir, Dustin; Daniels, Jeremy; Brouse, Christopher; Ford, Simon; Ansermino, J Mark

2008-06-01

Anesthesiologists in the operating room are unable to constantly monitor all data generated by physiological monitors. They are further distracted by clinical and educational tasks. An expert system would ideally provide assistance to the anesthesiologist in this data-rich environment. Clinical monitoring expert systems have not been widely adopted, as traditional methods of knowledge encoding require both expert medical and programming skills, making knowledge acquisition difficult. A software application was developed for use as a knowledge authoring tool for physiological monitoring. This application enables clinicians to create knowledge rules without the need of a knowledge engineer or programmer. These rules are designed to provide clinical diagnosis, explanations and treatment advice for optimal patient care to the clinician in real time. By intelligently combining data from physiological monitors and demographical data sources the expert system can use these rules to assist in monitoring the patient. The knowledge authoring process is simplified by limiting connective relationships between rules. The application is designed to allow open collaboration between communities of clinicians to build a library of rules for clinical use. This design provides clinicians with a system for parameter surveillance and expert advice with a transparent pathway of reasoning. A usability evaluation demonstrated that anesthesiologists can rapidly develop useful rules for use in a predefined clinical scenario.

Effect of a health system's medical error disclosure program on gastroenterology-related claims rates and costs.

PubMed

Adams, Megan A; Elmunzer, B Joseph; Scheiman, James M

2014-04-01

In 2001, the University of Michigan Health System (UMHS) implemented a novel medical error disclosure program. This study analyzes the effect of this program on gastroenterology (GI)-related claims and costs. This was a review of claims in the UMHS Risk Management Database (1990-2010), naming a gastroenterologist. Claims were classified according to pre-determined categories. Claims data, including incident date, date of resolution, and total liability dollars, were reviewed. Mean total liability incurred per claim in the pre- and post-implementation eras was compared. Patient encounter data from the Division of Gastroenterology was also reviewed in order to benchmark claims data with changes in clinical volume. There were 238,911 GI encounters in the pre-implementation era and 411,944 in the post-implementation era. A total of 66 encounters resulted in claims: 38 in the pre-implementation era and 28 in the post-implementation era. Of the total number of claims, 15.2% alleged delay in diagnosis/misdiagnosis, 42.4% related to a procedure, and 42.4% involved improper management, treatment, or monitoring. The reduction in the proportion of encounters resulting in claims was statistically significant (P=0.001), as was the reduction in time to claim resolution (1,000 vs. 460 days) (P<0.0001). There was also a reduction in the mean total liability per claim ($167,309 pre vs. $81,107 post, 95% confidence interval: 33682.5-300936.2 pre vs. 1687.8-160526.7 post). Implementation of a novel medical error disclosure program, promoting transparency and quality improvement, not only decreased the number of GI-related claims per patient encounter, but also dramatically shortened the time to claim resolution.

Achieving the HIV Prevention Impact of Voluntary Medical Male Circumcision: Lessons and Challenges for Managing Programs

PubMed Central

Sgaier, Sema K.; Reed, Jason B.; Thomas, Anne; Njeuhmeli, Emmanuel

2014-01-01

Voluntary medical male circumcision (VMMC) is capable of reducing the risk of sexual transmission of HIV from females to males by approximately 60%. In 2007, the WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS) recommended making VMMC part of a comprehensive HIV prevention package in countries with a generalized HIV epidemic and low rates of male circumcision. Modeling studies undertaken in 2009–2011 estimated that circumcising 80% of adult males in 14 priority countries in Eastern and Southern Africa within five years, and sustaining coverage levels thereafter, could avert 3.4 million HIV infections within 15 years and save US$16.5 billion in treatment costs. In response, WHO/UNAIDS launched the Joint Strategic Action Framework for accelerating the scale-up of VMMC for HIV prevention in Southern and Eastern Africa, calling for 80% coverage of adult male circumcision by 2016. While VMMC programs have grown dramatically since inception, they appear unlikely to reach this goal. This review provides an overview of findings from the PLOS Collection “Voluntary Medical Male Circumcision for HIV Prevention: Improving Quality, Efficiency, Cost Effectiveness, and Demand for Services during an Accelerated Scale-up.” The use of devices for VMMC is also explored. We propose emphasizing management solutions to help VMMC programs in the priority countries achieve the desired impact of averting the greatest possible number of HIV infections. Our recommendations include advocating for prioritization and funding of VMMC, increasing strategic targeting to achieve the goal of reducing HIV incidence, focusing on programmatic efficiency, exploring the role of new technologies, rethinking demand creation, strengthening data use for decision-making, improving governments' program management capacity, strategizing for sustainability, and maintaining a flexible scale-up strategy informed by a strong monitoring, learning, and evaluation platform. PMID:24800840

Achieving the HIV prevention impact of voluntary medical male circumcision: lessons and challenges for managing programs.

PubMed

Sgaier, Sema K; Reed, Jason B; Thomas, Anne; Njeuhmeli, Emmanuel

2014-05-01

Voluntary medical male circumcision (VMMC) is capable of reducing the risk of sexual transmission of HIV from females to males by approximately 60%. In 2007, the WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS) recommended making VMMC part of a comprehensive HIV prevention package in countries with a generalized HIV epidemic and low rates of male circumcision. Modeling studies undertaken in 2009-2011 estimated that circumcising 80% of adult males in 14 priority countries in Eastern and Southern Africa within five years, and sustaining coverage levels thereafter, could avert 3.4 million HIV infections within 15 years and save US$16.5 billion in treatment costs. In response, WHO/UNAIDS launched the Joint Strategic Action Framework for accelerating the scale-up of VMMC for HIV prevention in Southern and Eastern Africa, calling for 80% coverage of adult male circumcision by 2016. While VMMC programs have grown dramatically since inception, they appear unlikely to reach this goal. This review provides an overview of findings from the PLOS Collection "Voluntary Medical Male Circumcision for HIV Prevention: Improving Quality, Efficiency, Cost Effectiveness, and Demand for Services during an Accelerated Scale-up." The use of devices for VMMC is also explored. We propose emphasizing management solutions to help VMMC programs in the priority countries achieve the desired impact of averting the greatest possible number of HIV infections. Our recommendations include advocating for prioritization and funding of VMMC, increasing strategic targeting to achieve the goal of reducing HIV incidence, focusing on programmatic efficiency, exploring the role of new technologies, rethinking demand creation, strengthening data use for decision-making, improving governments' program management capacity, strategizing for sustainability, and maintaining a flexible scale-up strategy informed by a strong monitoring, learning, and evaluation platform.

Impact of managed MediCal on California family practice programs.

PubMed

Zweifler, J A

2001-05-01

An important source of patients for California's family practice program is MediCal. During the past 5 years, MediCal has established a variety of capitated managed care plans. To assess the impact of California's managed MediCal program on the state's 38 family practice training programs. A cross-sectional, retrospective descriptive survey. A 3-page, 11-question survey was developed by family practice residency directors and staff from the California Academy of Family Physicians, San Francisco. The 38 family practice programs in existence in California in September 1997 were stratified by type of managed MediCal in their county and by type of sponsoring institution--university, county, community based, staff-model health maintenance organization, or managed care system. Of the 38 family practice programs, 27 responded; 19 of 27 programs participated in managed MediCal. The total number of family health center patients, and the percentage of MediCal patients (48%-60%) at family practice programs was similar when stratified by programs with and without managed MediCal and by type of sponsorship. Most programs reported that they were able to compete effectively, although most also reported increased administrative, nursing, and front office costs. Managed MediCal patients were directly assigned to residents in only 3 of 19 programs. The introduction of managed MediCal has not adversely affected the number of patients cared for in California's family practice programs. Continued vigilance regarding California family practice programs' involvement in managed MediCal, including collection of accurate data on the number of MediCal patients and the financial and educational implications for California's family practice programs, is warranted.

Exploring dimensions of access to medical care.

PubMed Central

Andersen, R M; McCutcheon, A; Aday, L A; Chiu, G Y; Bell, R

1983-01-01

This paper examines the dimensions of the access concept with particular attention to the extent to which more parsimonious indicators of access can be developed. This process is especially useful to health policy makers, planners and researchers in need of cost-effective social indicators of access to monitor the need for and impact of innovative health care programs. Three stages of data reduction are used in the analysis, resulting in a reduced set of key indicators of the concept. Implication for subsequent data collection and measurement of access are discussed. PMID:6841113

Components of practical clinical detox programs--sauna as a therapeutic tool.

PubMed

Crinnion, Walter

2007-01-01

Saunas can be used very effectively for certain cardiovascular problems and as a means to enhance the mobilization of fat-soluble xenobiotics. When saunas are used to reduce blood pressure and enhance blood flow and cardiac functioning, only short sauna sessions (15 minutes) are necessary. When one wants to enhance the mobilization of heavy metals and chemical xenobiotics, longer sessions are needed and those should be medically monitored. But, for either use, saunas are safe and effective and should be used more frequently to benefit the health of our patients and ourselves.

In-Flight Lower Body Negative Pressure - Skylab Experiment M092

NASA Technical Reports Server (NTRS)

1973-01-01

This chart details Skylab's In-Flight Lower Body Negative Pressure experiment facility, a medical evaluation designed to monitor changes in astronauts' cardiovascular systems during long-duration space missions. This experiment collected in-flight data for predicting the impairment of physical capacity and the degree of orthostatic intolerance to be expected upon return to Earth. Data to be collected were blood pressure, heart rate, body temperature, vectorcardiogram, lower body negative pressure, leg volume changes, and body mass. The Marshall Space Flight Center had program management responsibility for the development of Skylab hardware and experiments.

[Automated anesthesia record system].

PubMed

Zhu, Tao; Liu, Jin

2005-12-01

Based on Client/Server architecture, a software of automated anesthesia record system running under Windows operation system and networks has been developed and programmed with Microsoft Visual C++ 6.0, Visual Basic 6.0 and SQL Server. The system can deal with patient's information throughout the anesthesia. It can collect and integrate the data from several kinds of medical equipment such as monitor, infusion pump and anesthesia machine automatically and real-time. After that, the system presents the anesthesia sheets automatically. The record system makes the anesthesia record more accurate and integral and can raise the anesthesiologist's working efficiency.

In-Suit Doppler Technology Assessment

NASA Technical Reports Server (NTRS)

Schulze, Arthur E.; Greene, Ernest R.; Nadeau, John J.

1991-01-01

The objective of this program was to perform a technology assessment survey of non-invasive air embolism detection utilizing Doppler ultrasound methodologies. The primary application of this technology will be a continuous monitor for astronauts while performing extravehicular activities (EVA's). The technology assessment was to include: (1) development of a full understanding of all relevant background research; and (2) a survey of the medical ultrasound marketplace for expertise, information, and technical capability relevant to this development. Upon completion of the assessment, LSR was to provide an overview of technological approaches and R&D/manufacturing organizations.

A practical guide to exercise training for heart failure patients.

PubMed

Smart, Neil; Fang, Zhi You; Marwick, Thomas H

2003-02-01

Exercise training has been shown to improve exercise capacity in patients with heart failure. We sought to examine the optimal strategy of exercise training for patients with heart failure. Review of the published data on the characteristics of the training program, with comparison of physiologic markers of exercise capacity in heart failure patients and healthy individuals and comparison of the change in these characteristics after an exercise training program. Many factors, including the duration, supervision, and venue of exercise training; the volume of working muscle; the delivery mode (eg, continuous vs. intermittent exercise), training intensity; and the concurrent effects of medical treatments may influence the results of exercise training in heart failure. Starting in an individually prescribed and safely monitored hospital-based program, followed by progression to an ongoing and progressive home program of exercise appears to be the best solution to the barriers of anxiety, adherence, and "ease of access" encountered by the heart failure patient. Various exercise training programs have been shown to improve exercise capacity and symptom status in heart failure, but these improvements may only be preserved with an ongoing maintenance program.

Access to Archived Astronaut Data for Human Research Program Researchers: Update on Progress and Process Improvements

NASA Technical Reports Server (NTRS)

Lee, L. R.; Montague, K. A.; Charvat, J. M.; Wear, M. L.; Thomas, D. M.; Van Baalen, M.

2016-01-01

Since the 2010 NASA directive to make the Life Sciences Data Archive (LSDA) and Lifetime Surveillance of Astronaut Health (LSAH) data archives more accessible by the research and operational communities, demand for astronaut medical data has increased greatly. LSAH and LSDA personnel are working with Human Research Program on many fronts to improve data access and decrease lead time for release of data. Some examples include the following: Feasibility reviews for NASA Research Announcement (NRA) data mining proposals; Improved communication, support for researchers, and process improvements for retrospective Institutional Review Board (IRB) protocols; Supplemental data sharing for flight investigators versus purely retrospective studies; Work with the Multilateral Human Research Panel for Exploration (MHRPE) to develop acceptable data sharing and crew consent processes and to organize inter-agency data coordinators to facilitate requests for international crewmember data. Current metrics on data requests crew consenting will be presented, along with limitations on contacting crew to obtain consent. Categories of medical monitoring data available for request will be presented as well as flow diagrams detailing data request processing and approval steps.

A protocol for bladder cancer screening and medical surveillance among high-risk groups: The Drake Health Registry experience

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

Marsh, G.M.; Callahan, C.; Pavlock, D.

In 1986, the Drake Health Registry Study initiated bladder cancer screening for 366 persons at high risk because of occupational exposure to beta-naphthylamine. The Drake Health Registry Study screening protocol consists of urinalysis, Papanicolaou cytology, and quantitative fluorescence image analysis. A positive screening test qualifies participants for a full diagnostic evaluation. The screening protocol has been modified during the first 3 years of the program's existence to address unexpected patterns of test results and to incorporate advances in screening technology. The current protocol, which has a two-tiered screening schedule, has been utilized successfully for 15 months. Of the 26 positivemore » results to date most have been based on abnormal Papanicolaou cytology and/or quantitative fluorescence image analysis. Bladder abnormalities were cited among most of the 18 study members who underwent diagnostic evaluation, including chronic cystitis, inflammation, hyperplasia, and dysplasia. We conclude that the screening program is detecting very early changes in a relatively young cohort and that these persons must be monitored over a number of years to ensure adequate medical surveillance.« less

Wearable technologies for soldier first responder assessment and remote monitoring (Conference Presentation)

NASA Astrophysics Data System (ADS)

Lee, Stephen

2017-05-01

Embedded combat medical personnel require accurate and timely biometric data to ensure appropriate life saving measures. Injured warfighter's operating in remote environments require both assessment and monitoring often while still engaged with enemy forces. Small wearable devices that can be placed on injured personnel capable of collecting essential biometric data, including the capacity to remotely deliver collected data in real-time, would allow additional medical monitoring and triage that will greatly help the medic in the battlefield. These new capabilities will provide a force multiplier through remote assessment, increased survivability, and in freeing engaged warfighter's from direct monitoring thus improving combat effectiveness and increasing situational awareness. Key questions around what information does the medic require and how effective it can be relayed to support personnel are at their early stages of development. A low power biometric wearable device capable of reliable electrocardiogram (EKG) rhythm, temperature, pulse, and other vital data collection which can provide real-time remote monitoring are in development for the Soldier.

The burden of allergies--and the capacity of medications to reduce this burden-in a heavy manufacturing environment.

PubMed

Bunn, William B; Pikelny, Dan B; Paralkar, Sadhna; Slavin, Thomas; Borden, Spencer; Allen, Harris M

2003-09-01

This article addresses the observational findings of the first systematic study undertaken by a manufacturer to address the impact of allergies and use of allergy medications on health, safety, and productivity. It provides background for 3 other papers from the same project, including an evaluation of an intervention to promote appropriate medication use among affected employees, which appear in this issue. The observational data are developed on 10,714 employees from: 1) 2 employee surveys; 2) administrative databases monitoring employee absenteeism, workers compensation, short-term disability, and group health. The results show that health, productivity, absenteeism, workplace injury, and workers compensation measures register consistent declines as allergy severity levels increase. This pattern is present but less pronounced for the short-term disability and group health measures. In addition, among the 16 measures registering a significant allergy burden, 6 posted significant advantages for the use of nonsedating antihistamines relative to other medication regimens that included sedative antihistamines. These results document the burden of allergies and the capacity of medications to reduce this burden. Effective intervention programs that target this condition can achieve improved health, productivity, and related outcomes.

E-health blood pressure control program.

PubMed

Ahern, David K; Stinson, Lynda J; Uebelacker, Lisa A; Wroblewski, Joseph P; McMurray, Jerome H; Eaton, Charles B

2012-01-01

Both technological and human factors design requirements for integration of home blood pressure monitoring (HBPM) into a patient centered medical home (PCMH) model primary care practice are described. Patients with uncontrolled hypertension were given home blood pressure (BP) monitors, and after a three-month run-in period introduced to either a high-tech only (HBPM connectivity to personal health record and tailored Web portal access) or a high-tech/"high-touch" (high-tech solution plus patient navigator [PN]) solution. Features of the Web portal included: BP graphing function, traffic-light feedback system of BP goal attainment, economic incentives for self-monitoring, and dual patient-facing and care-team-facing dashboard functions. The e-health BP control system with PN support was well received by patients, providers, and the healthcare team. Current e-health technology and limited technological literacy of many patients suggest that a PN or some other personnel resource may be required for the adoption of patient-facing technology in primary care.

Monitoring of Vital Signs with Flexible and Wearable Medical Devices.

PubMed

Khan, Yasser; Ostfeld, Aminy E; Lochner, Claire M; Pierre, Adrien; Arias, Ana C

2016-06-01

Advances in wireless technologies, low-power electronics, the internet of things, and in the domain of connected health are driving innovations in wearable medical devices at a tremendous pace. Wearable sensor systems composed of flexible and stretchable materials have the potential to better interface to the human skin, whereas silicon-based electronics are extremely efficient in sensor data processing and transmission. Therefore, flexible and stretchable sensors combined with low-power silicon-based electronics are a viable and efficient approach for medical monitoring. Flexible medical devices designed for monitoring human vital signs, such as body temperature, heart rate, respiration rate, blood pressure, pulse oxygenation, and blood glucose have applications in both fitness monitoring and medical diagnostics. As a review of the latest development in flexible and wearable human vitals sensors, the essential components required for vitals sensors are outlined and discussed here, including the reported sensor systems, sensing mechanisms, sensor fabrication, power, and data processing requirements. © 2016 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

The UCLA Alzheimer’s and Dementia Care Program for Comprehensive, Coordinated, Patient-centered Care: Preliminary Data

PubMed Central

Reuben, David B.; Evertson, Leslie Chang; Wenger, Neil S.; Serrano, Katherine; Chodosh, Joshua; Ercoli, Linda; Tan, Zaldy S.

2013-01-01

Dementia is a chronic disease that requires both medical and social services to provide high quality of care and prevent complications. As a result of time constraints in practice, lack of systems-based approaches, and poor integration of community-based organizations (CBOs), the quality of care for dementia is poor compared to other diseases that affect older persons. The UCLA Alzheimer’s and Dementia Care (UCLA ADC) program partners with CBOs to provide comprehensive, coordinated, patient-centered care for patients with Alzheimer’s disease and other dementias. The goals of the program are to maximize patient function, independence and dignity, minimize caregiver strain and burnout and reduce unnecessary costs. The UCLA ADC program consists of five key components: patient recruitment and a dementia registry, structured needs assessments of patients in the registry and their caregivers, creation and implementation of individualized dementia care plans based on needs assessments and input from the primary care physicians, monitoring and revising care plans, as needed, and access 24/7, 365 days a year for assistance and advice. The program uses a co-management model with a nurse practitioner Dementia Care Manager working with primary care physicians and CBOs. Based on the first 150 patients served, the most common recommendations in the initial care plans were referrals to support groups (73%), Alzheimer’s Association Safe Return (73%), caregiver training (45%), and medication adjustment (41%). The program will be evaluated on its ability to achieve the triple aim of better care for individuals, better health for populations, and lower costs. PMID:24329821

Providing Tobacco Treatment in a Community Mental Health Setting: A Pilot Study.

PubMed

Okoli, Chizimuzo T C; Mason, Dia A; Brumley-Shelton, Angela; Robertson, Heather

Individuals with mental illnesses (MIs) are disproportionately affected by tobacco-related disease burden because of higher tobacco use prevalence and poor tobacco treatment outcomes. This pilot study examines the outcomes of delivering an evidence-based tobacco treatment program (the Cooper-Clayton program) in a community mental health setting. A prospective nonequivalent group design was used to assess outcomes. This study included 47 participants, of which 19 were in a community mental health setting and 28 were from two non-mental-health settings. Information on sociodemographic (gender, age, educational level, and current life stressors) and medical, MI, substance use, and tobacco use and cessation histories were obtained. Program completion and smoking cessation at the end of treatment (verified with expired carbon monoxide monitoring) were assessed. The program consists of combining behavioral counseling with nicotine replacement therapy for 12 weeks. Participants from the mental health setting were significantly less educated, had greater medical comorbidities, had greater psychiatric and mental health histories, and had greater perceived secondhand tobacco smoke exposure as compared with those from the non-mental-health settings. Thirty-two percent of the participants (6/19) completed the program in the mental health site as compared with 68% (19/28) from the non-mental-health site. None of those from the mental health site achieved cessation as compared with 68% of those from non-mental-health sites. The differential outcomes of evidence-based tobacco treatment programs in non-mental-health versus mental health settings may suggest the need to modify existing tobacco treatment approaches for those with MIs in community settings.

Progress of the National Pediatric Free Antiretroviral Therapy program in China.

PubMed

Zhao, Yan; Sun, Xin; He, Yun; Tang, Zhirong; Peng, Guoping; Liu, Aiwen; Qiao, Xiaochun; Li, Huiqin; Chen, Zhiqiang; Dou, Zhihui; Ma, Ye; Liu, Zhongfu; Zhang, Fujie

2010-10-01

In 2003, the Chinese Government initiated a free antiretroviral therapy (ART) program focusing on adult AIDS patients. Pediatric antiretroviral (ARV) formulations were yet unavailable. It was not until July 2005, with the initiation of a two-stage program implemented by the Chinese Ministry of Health, that pediatric formulations became accessible in China. Initially, the pediatric ART program was piloted in six provinces with the highest incidences of pediatric HIV/AIDS. The pilot stage allowed the Chinese Center for Disease Control and Prevention (CCDC) to finalize entry criteria, treatment regimen, and patient monitoring and follow-up procedures. The second stage commenced at the end of 2006 when the program was scaled-up nationally. In order to guarantee treatment of pediatric patients, extensive training in the selection of appropriate ARV drug regimen and dosage was provided to doctors, often through on-site collaboration with domestic and international experts. The CCDC simultaneously established a pediatric ARV management system and a pediatric ART information system. CD4 count and other laboratory tests are being routinely performed on these pediatric patients. By the end of June 2009, 1529 pediatric patients had received ARV under the national program. However, challenges remain. Firstly, many children infected with HIV/AIDS live in rural areas where the treatment quality is hindered by the limited number of medical facilities and skilled medical workers. Secondly, much of the pediatric ARV drug supply depends on donation. An effort needs to be made by the Chinese Government to establish China's own drug procurement and supply system.

Real-Time Monitoring and Evaluation of a Visual-Based Cervical Cancer Screening Program Using a Decision Support Job Aid.

PubMed

Peterson, Curtis W; Rose, Donny; Mink, Jonah; Levitz, David

2016-05-16

In many developing nations, cervical cancer screening is done by visual inspection with acetic acid (VIA). Monitoring and evaluation (M&E) of such screening programs is challenging. An enhanced visual assessment (EVA) system was developed to augment VIA procedures in low-resource settings. The EVA System consists of a mobile colposcope built around a smartphone, and an online image portal for storing and annotating images. A smartphone app is used to control the mobile colposcope, and upload pictures to the image portal. In this paper, a new app feature that documents clinical decisions using an integrated job aid was deployed in a cervical cancer screening camp in Kenya. Six organizations conducting VIA used the EVA System to screen 824 patients over the course of a week, and providers recorded their diagnoses and treatments in the application. Real-time aggregated statistics were broadcast on a public website. Screening organizations were able to assess the number of patients screened, alongside treatment rates, and the patients who tested positive and required treatment in real time, which allowed them to make adjustments as needed. The real-time M&E enabled by "smart" diagnostic medical devices holds promise for broader use in screening programs in low-resource settings.

A model of influences on the clinical learning environment: the case for change at one U.S. medical school.

PubMed

Fleit, Howard B; Iuli, Richard J; Fischel, Janet E; Lu, Wei-Hsin; Chandran, Latha

2017-03-23

The learning environment within a school of medicine influences medical students' values and their professional development. Despite national requirements to monitor the learning environment, mistreatment of medical students persists. We designed a program called WE SMILE: We can Eradicate Student Mistreatment In the Learning Environment with a vision to enhance trainee and faculty awareness and ultimately eliminate medical student mistreatment. We provide a description of our program and early outcomes. The program has enhanced student awareness of what constitutes mistreatment and how to report it. Faculty members are also aware of the formal processes and procedures for review of such incidents. Our proposed model of influences on the learning environment and the clinical workforce informs the quality of trainee education and safety of patient care. Institutional leadership and culture play a prominent role in this model. Our integrated institutional response to learning environment concerns is offered as a strategy to improve policy awareness, reporting and management of student mistreatment concerns. Our WE SMILE program was developed to enhance education and awareness of what constitutes mistreatment and to provide multiple pathways for student reporting, with clear responsibilities for review, adjudication and enforcement. The program is demonstrating several signs of early success and is offered as a strategy for other schools to adopt or adapt. We have recognized a delicate balance between preserving student anonymity and informing them of specific actions taken. Providing students and other stakeholders with clear evidence of institutional response and accountability remains a key challenge. Multiple methods of reporting have been advantageous in eliciting information on learning environment infringements. These routes and types of reporting have enhanced our understanding of student perceptions and the specific contexts in which mistreatment occurs, allowing for targeted interventions. A common platform across the healthcare professions to report and review concerns has afforded us opportunities to deal with interprofessional issues in a respectful and trustworthy manner. We offer a model of learning environment influences with leadership and institutional culture at the helm, as a way to frame a comprehensive perspective on this challenging and complex concern.

40 CFR 264.99 - Compliance monitoring program.

Code of Federal Regulations, 2011 CFR

2011-07-01

... be based on a compliance monitoring program developed to meet the requirements of this section. (i... 40 Protection of Environment 26 2011-07-01 2011-07-01 false Compliance monitoring program. 264.99... Releases From Solid Waste Management Units § 264.99 Compliance monitoring program. An owner or operator...

Biological and Medical Experiments on the Space Shuttle, 1981 - 1985

NASA Technical Reports Server (NTRS)

Halstead, Thora W. (Editor); Dufour, Patricia A. (Editor)

1986-01-01

This volume is the first in a planned series of reports intended to provide a comprehensive record of all the biological and medical experiments and samples flown on the Space Shuttle. Experiments described have been conducted over a five-year period, beginning with the first plant studies conducted on STS-2 in November 1981, and extending through STS 61-C, the last mission to fly before the tragic Challenger accident of January 1986. Experiments were sponsored within NASA not only by the Life Sciences Division of the Office of Space Science and Applications, but also by the Shuttle Student Involvement Program (SSIP) and the Get Away Special (GAS) Program. Independent medical studies were conducted as well on the Shuttle crew under the auspices of the Space Biomedical Research Institute at Johnson Space Center. In addition, cooperative agreements between NASA and foreign government agencies led to a number of independent experiments and also paved the way for the joint US/ESA Spacelab 1 mission and the German (DFVLR) Spacelab D-1. Experiments included: (1) medically oriented studies of the crew aimed at identifying, preventing, or treating health problems due to space travel; (2) projects to study morphological, physiological, or behavioral effects of microgravity on animals and plants; (3) studies of the effects of microgravity on cells and tissues; and (4) radiation experiments monitoring the spacecraft environment with chemical or biological dosimeters or testing radiation effects on simple organisms and seeds.

[Prescribing monitoring in clinical practice: from enlightened empiricism to rational strategies].

PubMed

Buclin, Thierry; Herzig, Lilli

2013-05-15

Monitoring of a medical condition is the periodic measurement of one or several physiological or biological variables to detect a signal regarding its clinical progression or its response to treatment. We distinguish different medical situations between diagnostic, clinical and therapeutic process to apply monitoring. Many clinical, variables can be used for monitoring, once their intrinsic properties (normal range, critical difference, kinetics, reactivity) and external validity (pathophysiological importance, predictive power for clinical outcomes) are established. A formal conceptualization of monitoring is being developed and should support the rational development of monitoring strategies and their validation through appropriate clinical trials.

Guatemala -- strength is NGO cooperation.

PubMed

1999-04-01

In early 1999, representations of the UN Population Fund, JOICFP, and APROFAM met in Guatemala to monitor progress of an integrated program promoting reproductive health (RH) and family planning (FP) among Mayans in the Department of Solola. The team observed field activities, such as training, and assessed information, education, and communication (IEC) promotion; service delivery; institutional coordination; and adolescent health programs. The program is training traditional birth attendants (TBAs) to provide RH/FP and general medical services. At one site, a TBA acquires counseling for her clients from a physician via the telephone. This activity will be facilitated with the addition of radio receivers. Resources have been maximized by increasing collaboration among the project, the government, and local nongovernmental organizations. Referrals are being facilitated with improved communication tools and provision of a boat and ambulance for transporting clients. Cooperative efforts are also being made to promote community health and development, health education, and adolescent health.

Medical qualification of a commercial spaceflight participant: not your average astronaut.

PubMed

Jennings, Richard T; Murphy, David M F; Ware, David L; Aunon, Serena M; Moon, Richard E; Bogomolov, Valery V; Morgun, Valeri V; Voronkov, Yuri I; Fife, Caroline E; Boyars, Michael C; Ernst, Randy D

2006-05-01

Candidates for commercial spaceflight may be older than the typical astronaut and more likely to have medical problems that place them at risk during flight. Since the effects of microgravity on many medical conditions are unknown, physicians have little guidance when evaluating and certifying commercial spaceflight participants. This dynamic new era in space exploration may provide important data for evaluating medical conditions, creating appropriate medical standards, and optimizing treatment alternatives for long-duration spaceflight. A 57-yr-old spaceflight participant for an ISS mission presented with medical conditions that included moderately severe bullous emphysema, previous spontaneous pneumothorax with talc pleurodesis, a lung parenchymal mass, and ventricular and atrial ectopy. The medical evaluation required for certification was extensive and included medical studies and monitoring conducted in analogue spaceflight environments including altitude chambers, high altitude mixed-gas simulation, zero-G aircraft, and high-G centrifuge. To prevent recurrence of pneumothorax, we performed video-assisted thoracoscopic pleurodesis, and to assess lung masses, several percutaneous or direct biopsies. The candidate's 10-d mission was without incident. Non-career astronauts applying for commercial suborbital and orbital spaceflight will, at least in the near future, challenge aerospace physicians with unknowns regarding safety during training and flight, and highlight important ethical and risk-assessment problems. The information obtained from this new group of space travelers will provide important data for the evaluation and in-flight treatment of medical problems that space programs have not yet addressed systematically, and may improve the medical preparedness of exploration-class missions.

Protecting the Health of Astronauts: Enhancing Occupational Health Monitoring and Surveillance for Former NASA Astronauts to Understand Long-Term Outcomes of Spaceflight-Related Exposures

NASA Technical Reports Server (NTRS)

Rossi, Meredith; Lee, Lesley; Wear, Mary; Van Baalen, Mary; Rhodes, Bradley

2017-01-01

The astronaut community is unique, and may be disproportionately exposed to occupational hazards not commonly seen in other communities. The extent to which the demands of the astronaut occupation and exposure to spaceflight-related hazards affect the health of the astronaut population over the life course is not completely known. A better understanding of the individual, population, and mission impacts of astronaut occupational exposures is critical to providing clinical care, targeting occupational surveillance efforts, and planning for future space exploration. The ability to characterize the risk of latent health conditions is a significant component of this understanding. Provision of health screening services to active and former astronauts ensures individual, mission, and community health and safety. Currently, the NASA-Johnson Space Center (JSC) Flight Medicine Clinic (FMC) provides extensive medical monitoring to active astronauts throughout their careers. Upon retirement, astronauts may voluntarily return to the JSC FMC for an annual preventive exam. However, current retiree monitoring includes only selected screening tests, representing an opportunity for augmentation. The potential long-term health effects of spaceflight demand an expanded framework of testing for former astronauts. The need is two-fold: screening tests widely recommended for other aging populations are necessary to rule out conditions resulting from the natural aging process (e.g., colonoscopy, mammography); and expanded monitoring will increase NASA's ability to better characterize conditions resulting from astronaut occupational exposures. To meet this need, NASA has begun an extensive exploration of the overall approach, cost, and policy implications of e an Astronaut Occupational Health program to include expanded medical monitoring of former NASA astronauts. Increasing the breadth of monitoring services will ultimately enrich the existing evidence base of occupational health risks to astronauts. Such an expansion would therefore improve the understanding of the health of the astronaut population as a whole, and the ability to identify, mitigate, and manage such risks in preparation for deep space exploration missions.

Medical application and clinical validation for reliable and trustworthy physiological monitoring using functional textiles: experience from the HeartCycle and MyHeart project.

PubMed

Reiter, Harald; Muehlsteff, Jens; Sipilä, Auli

2011-01-01

Functional textiles are seen as promising technology to enable healthcare services and medical care outside hospitals due to their ability to integrate textile-based sensing and monitoring technologies into the daily life. In the past much effort has been spent onto basic functional textile research already showing that reliable monitoring solutions can be realized. The challenge remains to find and develop suited medical application and to fulfil the boundary conditions for medical endorsement and exploitation. The HeartCycle vest described in this abstract will serve as an example for a functional textile carefully developed according to the requirements of a specific medical application, its clinical validation, the related certification aspects and the next improvement steps towards exploitation.

Village doctor-assisted case management of rural patients with schizophrenia: protocol for a cluster randomized control trial.

PubMed

Gong, Wenjie; Xu, Dong; Zhou, Liang; Brown, Henry Shelton; Smith, Kirk L; Xiao, Shuiyuan

2014-01-16

Strict compliance with prescribed medication is the key to reducing relapses in schizophrenia. As villagers in China lack regular access to psychiatrists to supervise compliance, we propose to train village 'doctors' (i.e., villagers with basic medical training and currently operating in villages across China delivering basic clinical and preventive care) to manage rural patients with schizophrenia with respect to compliance and monitoring symptoms. We hypothesize that with the necessary training and proper oversight, village doctors can significantly improve drug compliance of villagers with schizophrenia. We will conduct a cluster randomized controlled trial in 40 villages in Liuyang, Hunan Province, China, home to approximately 400 patients with schizophrenia. Half of the villages will be randomized into the treatment group (village doctor, or VD model) wherein village doctors who have received training in a schizophrenia case management protocol will manage case records, supervise drug taking, educate patients and families on schizophrenia and its treatment, and monitor patients for signs of relapse in order to arrange prompt referral. The other 20 villages will be assigned to the control group (case as usual, or CAU model) wherein patients will be visited by psychiatrists every two months and receive free antipsychotic medications under an on-going government program, Project 686. These control patients will receive no other management or follow up from health workers. A baseline survey will be conducted before the intervention to gather data on patient's socio-economic status, drug compliance history, and clinical and health outcome measures. Data will be re-collected 6 and 12 months into the intervention. A difference-in-difference regression model will be used to detect the program effect on drug compliance and other outcome measures. A cost-effectiveness analysis will also be conducted to compare the value of the VD model to that of the CAU group. Lack of specialists is a common problem in resource-scarce areas in China and other developing countries. The results of this experiment will provide high level evidence on the role of health workers with relatively limited medical training in managing severe psychiatric disease and other chronic conditions in developing countries. ChiCTR-TRC-13003263.

How does use of a prescription monitoring program change medical practice?

PubMed

Green, Traci C; Mann, Marita R; Bowman, Sarah E; Zaller, Nickolas; Soto, Xaviel; Gadea, John; Cordy, Catherine; Kelly, Patrick; Friedmann, Peter D

2012-10-01

  The objectives of this study were to test for differences in prescription monitoring program (PMP) use between two states, Connecticut (CT) and Rhode Island (RI), with a different PMP accessibility; to explore use of PMP reports in clinical practice; and to examine associations between PMP use and clinician's responses to suspected diversion or "doctor shopping" (i.e., multiple prescriptions from multiple providers).   From March to August 2011, anonymous surveys were emailed to providers licensed to prescribe Schedule II medications in CT (N = 16,924) and RI (N = 5,567).   PMP use, use of patient reports in clinical practice, responses to suspected doctor shopping, or diversion.   Responses from 1,385 prescribers were received: 998 in CT and 375 in RI. PMP use was greater in CT, where an electronic PMP is available (43.9% vs 16.3%, χ(2)  = 85.2, P < 0.0001). PMP patient reports were used to screen for drug abuse (36.2% CT vs 10.0% RI, χ(2)  = 60.9, P < 0.0001) and detect doctor shopping (43.9% CT vs 18.5% RI, χ(2)  = 68.3, P < 0.0001). Adjusting for potential confounders, responses by PMP users to suspicious medication use behavior were more likely to entail clinical response (i.e., refer to another provider odds ratio, OR, 1.75 [95% confidence interval, CI, 1.10, 2.80]; screen for drug abuse OR 1.93 [1.39, 2.68]; revisit pain/treatment agreement OR 1.97 [1.45, 2.67]; conduct urine screen OR 1.82 [1.29, 2.57]; refer to substance abuse treatment OR 1.30 [0.96, 1.75]) rather than legal intervention (OR 0.45 [0.21, 0.94]) or inaction (OR 0.09 [0.01, 0.70]).   Prescribers' use of an electronic PMP may influence medical practice, especially opioid abuse detection, and is associated with clinical responses to suspected doctor shopping or diversion. Wiley Periodicals, Inc.

[Theoretical model study about the application risk of high risk medical equipment].

PubMed

Shang, Changhao; Yang, Fenghui

2014-11-01

Research for establishing a risk monitoring theoretical model of high risk medical equipment at applying site. Regard the applying site as a system which contains some sub-systems. Every sub-system consists of some risk estimating indicators. After quantizing of each indicator, the quantized values are multiplied with corresponding weight and then the products are accumulated. Hence, the risk estimating value of each subsystem is attained. Follow the calculating method, the risk estimating values of each sub-system are multiplied with corresponding weights and then the product is accumulated. The cumulative sum is the status indicator of the high risk medical equipment at applying site. The status indicator reflects the applying risk of the medical equipment at applying site. Establish a risk monitoring theoretical model of high risk medical equipment at applying site. The model can monitor the applying risk of high risk medical equipment at applying site dynamically and specially.

Understanding Program Monitoring: The Relationships among Outcomes, Indicators, Measures, and Targets. REL 2014-011

ERIC Educational Resources Information Center

Malone, Nolan; Mark, Lauren; Narayan, Krishna

2014-01-01

This guide offers educators, program managers, administrators, and researchers a resource for building capacity for monitoring program outcomes. It provides concise definitions of program monitoring components and a framework for assessing program progress. Examples demonstrate the relationships among program components: outcomes, indicators,…

Building capacity for awareness and risk factor identification in the community: the blood pressure assessment program of the Calgary Fire Department.

PubMed

Campbell, N R; Jeffrey, P; Kiss, K; Jones, C; Anton, A R

2001-12-01

In 1995, the Calgary Fire Department developed a program to assess blood pressure in community fire stations, selected businesses and public venues. The program has gradually expanded. Currently, all 30 fire stations across Calgary, Alberta assess blood pressures for the public seven days per week throughout the year. Since 1995, there have been 10,883 measurements in 3477 people. Most people (2106) assessed had hypertensive readings, and 72 had readings greater than 220 mmHg systolic or greater than 120 mmHg diastolic, and were referred for immediate medical assessment. The program has been recently integrated into a more global vision for the prevention and control of cardiovascular disease in Calgary. Future plans include offering lipid assessments, assisting other communities to adopt the program and using the program to provide physical measures (of blood pressure, glucose, total and high density lipoprotein cholesterol, height and weight) to an ongoing questionnaire that surveys the health of Calgarians. The history of the program, its training methods, quality control, preliminary results and future plans are presented in detail to provide an example of a community-based program that could aid in the detection, monitoring and awareness of hypertension.

Investigation of health care waste management in Binzhou District, China

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

Ruoyan, Gai; Xu Lingzhong; Li Huijuan

In China, national regulations and standards for health care waste management were implemented in 2003. To investigate the current status of health care waste management at different levels of health care facilities (HCF) after the implementation of these regulations, one tertiary hospital, one secondary hospital, and four primary health care centers from Binzhou District were visited and 145 medical staff members and 24 cleaning personnel were interviewed. Generated medical waste totaled 1.22, 0.77, and 1.17 kg/bed/day in tertiary, secondary, and primary HCF, respectively. The amount of medical waste generated in primary health care centers was much higher than that inmore » secondary hospitals, which may be attributed to general waste being mixed with medical waste. This study found that the level of the HCF, responsibility for medical waste management in departments and wards, educational background and training experience can be factors that determine medical staff members' knowledge of health care waste management policy. Regular training programs and sufficient provision of protective measures are urgently needed to improve occupational safety for cleaning personnel. Financing and administrative monitoring by local authorities is needed to improve handling practices and the implementation of off-site centralized disposal in primary health care centers.« less

How we used a patient visit tracker tool to advance experiential learning in systems-based practice and quality improvement in a medical student clinic.

PubMed

Chen, Chen Amy; Park, Ryan J; Hegde, John V; Jun, Tomi; Christman, Mitalee P; Yoo, Sun M; Yamasaki, Alisa; Berhanu, Aaron; Vohra-Khullar, Pamela; Remus, Kristin; Schwartzstein, Richard M; Weinstein, Amy R

2016-01-01

Poorly designed healthcare systems increase costs and preventable medical errors. To address these issues, systems-based practice (SBP) education provides future physicians with the tools to identify systemic errors and implement quality improvement (QI) initiatives to enhance the delivery of cost-effective, safe and multi-disciplinary care. Although SBP education is being implemented in residency programs and is mandated by the Accreditation Council for Graduate Medical Education (ACGME) as one of its core competencies, it has largely not been integrated into undergraduate medical education. We propose that Medical Student-Faculty Collaborative Clinics (MSFCCs) may be the ideal environment in which to train medical students in SBPs and QI initiatives, as they allow students to play pivotal roles in project development, administration, and management. Here we describe a process of experiential learning that was developed within a newly established MSFCC, which challenged students to identify inefficiencies, implement interventions, and track the results. After identifying bottlenecks in clinic operations, our students designed a patient visit tracker tool to monitor clinic flow and implemented solutions to decrease patient visit times. Our model allowed students to drive their own active learning in a practical clinical setting, providing early and unique training in crucial QI skills.

78 FR 18855 - World Trade Center Health Program Eligibility Requirements for Shanksville, Pennsylvania and...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-28

...Title I of the James Zadroga 9/11 Health and Compensation Act of 2010 amended the Public Health Service Act (PHS Act) by adding Title XXXIII, which establishes the World Trade Center (WTC) Health Program. The WTC Health Program is administered by the Director of the National Institute for Occupational Safety and Health (NIOSH), within the Centers for Disease Control and Prevention (CDC), in the Department of Health and Human Services (HHS), and provides medical monitoring and treatment to eligible firefighters and related personnel, law enforcement officers, and rescue, recovery, and cleanup workers who responded to the September 11, 2001, terrorist attacks in New York City, Shanksville, Pennsylvania, and at the Pentagon, and to eligible survivors of the New York City attacks. Section 3311(a)(2)(C) of the PHS Act requires the WTC Program Administrator (Administrator) to develop eligibility criteria for enrollment of Shanksville, Pennsylvania and Pentagon responders. This interim final rule establishes those eligibility criteria.

Family communication coordination: a program to increase organ donation.

PubMed

Linyear, A S; Tartaglia, A

1999-09-01

To improve organ donation performance, the Medical College of Virginia Hospitals implemented a comprehensive family support and communication program, consisting of a standard family communications protocol, a hospital-based team from the Department of Pastoral Care, targeted staff education, and an ongoing quality assurance measuring and monitoring system. The 3 best-demonstrated request practices, private setting, "decoupling," and collaboration in the request between the organ procurement organization and hospital staff, were incorporated into the program. Improvement in the consent and donation rate was evident in the second calendar year of the program; the consent rate was 72% and the donation rate was 50%. During the second year, there was also a positive correlation between "decoupling," appropriate requestor, and the consent rate. Implementation of a hospital-based team and a standard protocol facilitated the clarification of roles and responsibilities toward clearer and more consistent family communication and support. Data suggest that staff experience is a major contributor to a positive donation outcome.

Establishing a national biological laboratory safety and security monitoring program.

PubMed

Blaine, James W

2012-12-01

The growing concern over the potential use of biological agents as weapons and the continuing work of the Biological Weapons Convention has promoted an interest in establishing national biological laboratory biosafety and biosecurity monitoring programs. The challenges and issues that should be considered by governments, or organizations, embarking on the creation of a biological laboratory biosafety and biosecurity monitoring program are discussed in this article. The discussion focuses on the following questions: Is there critical infrastructure support available? What should be the program focus? Who should be monitored? Who should do the monitoring? How extensive should the monitoring be? What standards and requirements should be used? What are the consequences if a laboratory does not meet the requirements or is not willing to comply? Would the program achieve the results intended? What are the program costs? The success of a monitoring program can depend on how the government, or organization, responds to these questions.

Participants’ Perceptions of a Group Based Program Incorporating Hands-On Meal Preparation and Pedometer-Based Self-Monitoring in Type 2 Diabetes

PubMed Central

Dasgupta, Kaberi; Jarvandi, Soghra; De Civita, Mirella; Pillay, Sabrina; Hajna, Samantha; Gougeon, Rejeanne; Bader, Abeer; Da Costa, Deborah

2014-01-01

Background Nutrition education (portion sizes, balanced meals) is a cornerstone of diabetes management; however, moving from information to behavior change is challenging. Through a single arm intervention study, we recently demonstrated that combining education with group-based meal preparation training has measureable effects on weight, eating behaviour, and glycemic control in adults with type 2 diabetes. In the present study, we conducted an in-depth examination of participants’ perceptions of this strategy, through focus group discussion, to delineate effective elements of the strategy from participants’ perspectives. Methods Participants who had completed the nutrition education/meal preparation training program were invited to attend one of four focus group discussions. These were led by experienced facilitators and guided by questions addressing experiences during the intervention and their perceived impact. Audiotapes were transcribed and qualitative content analysis of transcripts was performed. We report herein themes that achieved saturation across the four discussions. Results Twenty-nine (80.6%, 29/36) attended a focus group discussion. The program elements perceived as effective by participants included the hands-on interactive learning approach to meal preparation, the grocery store tour, pedometer-based self-monitoring, experiencing the link between food consumption/physical activity and glucose changes during the program, and peer support. Discussants reported changes in eating and walking behaviour, greater confidence in ability to self-manage diabetes, reductions in glucose levels and/or need for glucose-lowering medications, and, in some cases, weight loss. Family members and friends were facilitators for some and barriers for others in terms of achieving health behavior changes. Conclusions Among adults with type 2 diabetes, a group based program that included hands-on meal preparation and pedometer-based self-monitoring was perceived as effective in conveying information, developing skills, building confidence, and changing health behaviors. PMID:25536068

Roadmap for creating an accelerated three-year medical education program

PubMed Central

Leong, Shou Ling; Cangiarella, Joan; Fancher, Tonya; Dodson, Lisa; Grochowski, Colleen; Harnik, Vicky; Hustedde, Carol; Jones, Betsy; Kelly, Christina; Macerollo, Allison; Reboli, Annette C.; Rosenfeld, Melvin; Rundell, Kristen; Thompson, Tina; Whyte, Robert; Pusic, Martin

2017-01-01

ABSTRACT Medical education is undergoing significant transformation. Many medical schools are moving away from the concept of seat time to competency-based education and introducing flexibility in the curriculum that allows individualization. In response to rising student debt and the anticipated physician shortage, 35% of US medical schools are considering the development of accelerated pathways. The roadmap described in this paper is grounded in the experiences of the Consortium of Accelerated Medical Pathway Programs (CAMPP) members in the development, implementation, and evaluation of one type of accelerated pathway: the three-year MD program. Strategies include developing a mission that guides curricular development – meeting regulatory requirements, attaining institutional buy-in and resources necessary to support the programs, including student assessment and mentoring – and program evaluation. Accelerated programs offer opportunities to innovate and integrate a mission benefitting students and the public. Abbreviations: CAMPP: Consortium of accelerated medical pathway programs; GME: Graduate medical education; LCME: Liaison committee on medical education; NRMP: National residency matching program; UME: Undergraduate medical education PMID:29117817

Roadmap for creating an accelerated three-year medical education program.

PubMed

Leong, Shou Ling; Cangiarella, Joan; Fancher, Tonya; Dodson, Lisa; Grochowski, Colleen; Harnik, Vicky; Hustedde, Carol; Jones, Betsy; Kelly, Christina; Macerollo, Allison; Reboli, Annette C; Rosenfeld, Melvin; Rundell, Kristen; Thompson, Tina; Whyte, Robert; Pusic, Martin

2017-01-01

Medical education is undergoing significant transformation. Many medical schools are moving away from the concept of seat time to competency-based education and introducing flexibility in the curriculum that allows individualization. In response to rising student debt and the anticipated physician shortage, 35% of US medical schools are considering the development of accelerated pathways. The roadmap described in this paper is grounded in the experiences of the Consortium of Accelerated Medical Pathway Programs (CAMPP) members in the development, implementation, and evaluation of one type of accelerated pathway: the three-year MD program. Strategies include developing a mission that guides curricular development - meeting regulatory requirements, attaining institutional buy-in and resources necessary to support the programs, including student assessment and mentoring - and program evaluation. Accelerated programs offer opportunities to innovate and integrate a mission benefitting students and the public. CAMPP: Consortium of accelerated medical pathway programs; GME: Graduate medical education; LCME: Liaison committee on medical education; NRMP: National residency matching program; UME: Undergraduate medical education.

The current status of education and career paths of students after completion of medical physicist programs in Japan: a survey by the Japanese Board for Medical Physicist Qualification.

PubMed

Kadoya, Noriyuki; Karasawa, Kumiko; Sumida, Iori; Arimura, Hidetaka; Yamada, Syogo

2015-07-01

To standardize educational programs and clinical training for medical physics students, the Japanese Board for Medical Physicist Qualification (JBMP) began to accredit master's, doctorate, and residency programs for medical physicists in 2012. At present, 16 universities accredited by the JBMP offer 22 courses. In this study, we aimed to survey the current status of educational programs and career paths of students after completion of the medical physicist program in Japan. A questionnaire was sent in August 2014 to 32 universities offering medical physicist programs. The questionnaire was created and organized by the educational course certification committee of the JBMP and comprised two sections: the first collected information about the university attended, and the second collected information about characteristics and career paths of students after completion of medical physicist programs from 2008 to 2014. Thirty universities (16 accredited and 14 non-accredited) completed the survey (response rate 94 %). A total of 209, 40, and 3 students graduated from the master's, doctorate, and residency programs, respectively. Undergraduates entered the medical physicist program constantly, indicating an interest in medical physics among undergraduates. A large percentage of the students held a bachelor's degree in radiological technology (master's program 94 %; doctorate program 70 %); graduates obtained a national radiological technologist license. Regarding career paths, although the number of the graduates who work as medical physicist remains low, 7 % with a master's degree and 50 % with a doctorate degree worked as medical physicists. Our results could be helpful for improving the medical physicist program in Japan.

Remote personal health monitoring with radio waves

NASA Astrophysics Data System (ADS)

Nguyen, Andrew

2008-03-01

We present several techniques utilizing radio-frequency identification (RFID) technology for personal health monitoring. One technique involves using RFID sensors external to the human body, while another technique uses both internal and external RFID sensors. Simultaneous monitoring of many patients in a hospital setting can also be done using networks of RFID sensors. All the monitoring are done wirelessly, either continuously or periodically in any interval, in which the sensors collect information on human parts such as the lungs or heart and transmit this information to a router, PC or PDA device connected to the internet, from which patient's condition can be diagnosed and viewed by authorized medical professionals in remote locations. Instantaneous information allows medical professionals to intervene properly and timely to prevent possible catastrophic effects to patients. The continuously monitored information provides medical professionals more complete and long-term studies of patients. All of these result in not only enhancement of the health treatment quality but also significant reduction of medical expenditure. These techniques demonstrate that health monitoring of patients can be done wirelessly at any time and any place without interfering with the patients' normal activities. Implementing the RFID technology would not only help reduce the enormous and significantly growing medical costs in the U.S.A., but also help improve the health treatment capability as well as enhance the understanding of long-term personal health and illness.

Worker Alienation and Compensation at the Savannah River Site.

PubMed

Ashwood, Loka; Wing, Steve

2016-05-01

Corporations operating U.S. nuclear weapons plants for the federal government began tracking occupational exposures to ionizing radiation in 1943. However, workers, scholars, and policy makers have questioned the accuracy and completeness of radiation monitoring and its capacity to provide a basis for workers' compensation. We use interviews to explore the limitations of broad-scale, corporate epidemiological surveillance through worker accounts from the Savannah River Site nuclear weapons plant. Interviewees report inadequate monitoring, overbearing surveillance, limited venues to access medical support and exposure records, and administrative failure to report radiation and other exposures at the plant. The alienation of workers from their records and toil is relevant to worker compensation programs and the accuracy of radiation dose measurements used in epidemiologic studies of occupational radiation exposures at the Savannah River Site and other weapons plants. © The Author(s) 2016.

Establishing benchmarks and metrics for disruptive technologies, inappropriate and obsolete tests in the clinical laboratory.

PubMed

Kiechle, Frederick L; Arcenas, Rodney C; Rogers, Linda C

2014-01-01

Benchmarks and metrics related to laboratory test utilization are based on evidence-based medical literature that may suffer from a positive publication bias. Guidelines are only as good as the data reviewed to create them. Disruptive technologies require time for appropriate use to be established before utilization review will be meaningful. Metrics include monitoring the use of obsolete tests and the inappropriate use of lab tests. Test utilization by clients in a hospital outreach program can be used to monitor the impact of new clients on lab workload. A multi-disciplinary laboratory utilization committee is the most effective tool for modifying bad habits, and reviewing and approving new tests for the lab formulary or by sending them out to a reference lab. Copyright © 2013 Elsevier B.V. All rights reserved.

TAILOR - tapered discontinuation versus maintenance therapy of antipsychotic medication in patients with newly diagnosed schizophrenia or persistent delusional disorder in remission of psychotic symptoms: study protocol for a randomized clinical trial.

PubMed

Stürup, Anne Emilie; Jensen, Heidi Dorthe; Dolmer, Signe; Birk, Merete; Albert, Nikolai; Nielsen, Mai; Hjorthøj, Carsten; Eplov, Lene; Ebdrup, Bjørn H; Mors, Ole; Nordentoft, Merete

2017-09-29

The aim of the TAILOR trial is to investigate the effect of closely monitored tapering/discontinuation versus maintenance therapy with antipsychotic medication in patients with newly diagnosed schizophrenia or persistent delusional disorder and with minimum 3 months' remission of psychotic symptoms. Two hundred and fifty patients will be included from the psychiatric early intervention program, OPUS, in two regions in Denmark. Inclusion criteria are: ICD-10 diagnoses schizophrenia (F20, except F20.6) or persistent delusional disorder (F22), minimum 3 months' remission of psychotic symptoms and in treatment with antipsychotic medication (except clozapine). The patients will be randomized to maintenance therapy or tapering/discontinuation with antipsychotic medication in a 1-year intervention. The tapering/discontinuation group will be using a smartphone application to monitor early warning signs of psychotic relapse. Patients will be assessed at baseline, 1-, 2- and 5-year follow-up regarding psychotic and negative symptoms, side-effects of antipsychotic medication, social functioning, cognitive functioning, perceived health status, patient satisfaction, substance and alcohol use, sexual functioning and quality of life. The primary outcome will be remission of psychotic symptoms and no antipsychotic medication after 1 year. Secondary outcome measures will include: co-occurrence of remission of psychotic symptoms and 0-1-mg haloperidol equivalents of antipsychotic medication after 1-year intervention; antipsychotic dose; antipsychotic side effects; negative symptoms; social functioning; cognitive functioning; and patient satisfaction. Exploratory outcomes will include remission, clinical recovery, substance and alcohol use, sexual functioning, quality of life, self-beliefs of coping and user experience of support from health workers. Safety measures will include death, admissions to psychiatric hospital, severe self-harm and psychotic relapses. The TAILOR trial will contribute knowledge about the effect of tapering/discontinuation of antipsychotic medication in the early phases of schizophrenia and related disorders and the results may guide future clinical treatment regimens of antipsychotic treatment. EU Clinical Trials Register - EudraCT number: 2016-000565-23 . Registered on 5 February 2016.

The efficacy and stability of an information and communication technology-based centralized monitoring system of adherence to immunosuppressive medication in kidney transplant recipients: study protocol for a randomized controlled trial.

PubMed

Jung, Hee-Yeon; Seong, Sook Jin; Choi, Ji-Young; Cho, Jang-Hee; Park, Sun-Hee; Kim, Chan-Duck; Yoon, Young-Ran; Kim, Hyung-Kee; Huh, Seung; Yoon, Se-Hee; Lee, Jong Soo; Kim, Yong-Lim

2017-10-16

Immunosuppression non-adherence in kidney transplant recipients (KTRs) not only increases the risk of medical intervention due to acute rejection and graft loss but burdens the socioeconomic system in the form of increased healthcare costs. An aggressive preemptive effort by healthcare professionals, geared to ensure adherence to immunosuppressants in KTRs, is significant and imperative. This study was designed as a prospective, open-label, multicenter, randomized controlled study aimed at evaluating the efficacy and stability of an information and communication technology (ICT)-based centralized monitoring system in boosting medication adherence in KTRs. One hundred fourteen KTRs registered throughout the year 2017 to 2018 are randomized into either the ICT-based centralized home monitoring system or to ambulatory follow-up. The planned follow-up duration is 6 months. The ICT-based centralized home monitoring system described consists of a smart pill box equipped with personal identification system, a home monitoring system, an electronic Case Report Form (eCRF) system, and a comprehensive clinical trial management system (CTMS). It alerts both patients and medical staff with texts and pill box alarms if there is a dosage/dosing time error or a missed dose. Medication adherence and transplant outcomes for the follow-up period are compared between the two groups, while patient satisfaction as well as the stability and cost-effectiveness of the ICT-based monitoring system are to be evaluated. This on-going study is expected to determine if consistent use of the ICT-based centralized monitoring system described could maximize mediation adherence and subsequently enhance transplant outcomes in KTRs. Further, it would lay the foundation for successful implementation of this ICT-based monitoring system for effective management of medication adherence in KTRs. ClinicalTrials.gov, Identifier: NCT03136588 . Registered on 20 April 2017.

40 CFR 122.48 - Requirements for recording and reporting of monitoring results (applicable to State programs, see...

Code of Federal Regulations, 2013 CFR

2013-07-01

... representative of the monitored activity including, when appropriate, continuous monitoring; (c) Applicable... reporting of monitoring results (applicable to State programs, see § 123.25). 122.48 Section 122.48... recording and reporting of monitoring results (applicable to State programs, see § 123.25). All permits...

40 CFR 122.48 - Requirements for recording and reporting of monitoring results (applicable to State programs, see...

Code of Federal Regulations, 2014 CFR

2014-07-01

... representative of the monitored activity including, when appropriate, continuous monitoring; (c) Applicable... reporting of monitoring results (applicable to State programs, see § 123.25). 122.48 Section 122.48... recording and reporting of monitoring results (applicable to State programs, see § 123.25). All permits...

40 CFR 122.48 - Requirements for recording and reporting of monitoring results (applicable to State programs, see...

Code of Federal Regulations, 2012 CFR

2012-07-01

... representative of the monitored activity including, when appropriate, continuous monitoring; (c) Applicable... reporting of monitoring results (applicable to State programs, see § 123.25). 122.48 Section 122.48... recording and reporting of monitoring results (applicable to State programs, see § 123.25). All permits...

40 CFR 122.48 - Requirements for recording and reporting of monitoring results (applicable to State programs, see...

Code of Federal Regulations, 2010 CFR

2010-07-01

... representative of the monitored activity including, when appropriate, continuous monitoring; (c) Applicable... reporting of monitoring results (applicable to State programs, see § 123.25). 122.48 Section 122.48... recording and reporting of monitoring results (applicable to State programs, see § 123.25). All permits...

40 CFR 122.48 - Requirements for recording and reporting of monitoring results (applicable to State programs, see...

Code of Federal Regulations, 2011 CFR

2011-07-01

... representative of the monitored activity including, when appropriate, continuous monitoring; (c) Applicable... reporting of monitoring results (applicable to State programs, see § 123.25). 122.48 Section 122.48... recording and reporting of monitoring results (applicable to State programs, see § 123.25). All permits...

ASHP national survey of pharmacy practice in hospital settings: monitoring and patient education--2003.

PubMed

Pedersen, Craig A; Schneider, Philip J; Scheckelhoff, Douglas J

2004-03-01

Results of the 2003 ASHP national survey of pharmacy practice in hospital settings that pertain to monitoring and patient education are presented. A stratified random sample of pharmacy directors at 1173 general and children's medical-surgical hospitals in the United States was surveyed by mail. SMG Marketing Group, Inc., supplied data on hospital characteristics; the survey sample was drawn from SMG's hospital database. The response rate was 47.1%. Virtually all hospitals (95.3%) had pharmacists regularly monitoring medication therapy in some capacity. Patient monitoring has improved since 2000; fewer respondents reported monitoring less than 25% of patients in the hospital, and most hospitals reported an increase in the amount of time pharmacists devoted to monitoring activities. Pharmacists were provided computer access to laboratory information in 78% of hospitals to facilitate this function. Detection and reporting of adverse drug events (ADEs) have substantially increased since 1999, with an increase of 42% in events reported internally. Strategies to improve ADE reporting were in place in 84% of hospitals, indicating that pharmacists are adopting the widely recommended philosophy of learning from errors. Errors were less widely reported externally, limiting the value of aggregated data for improving the medication-use process. Most hospitals (85.5%) had an interprofessional infrastructure in place to discuss and learn from voluntary reports of ADEs. Medication counseling continued to be relatively infrequent, with nearly three fourths of hospitals reporting fewer than 26% of inpatients received medication education. Pharmacist staffing in hospitals has risen significantly, from an average of 8.6 full-time equivalents (FTEs) in 2002 to 9.4 FTEs per hospital. Vacancy rates for pharmacists decreased from 7.3% in 2002 to 43%. It is now estimated that there are 1846 vacancies in hospital pharmacies. Notable improvements in hospital pharmacy practice have been made. The percentage of patients whose medication therapy is monitored by pharmacists has increased, and most hospitals reported that the amount of time pharmacists spent monitoring patients' medication therapy had increased. Internal and external reporting of ADEs has increased, and pharmacist vacancies have decreased from 2002. Staffing has also improved, suggesting an abatement of the critical shortage of pharmacists in the hospital setting.

A comparison of the temporally integrated monitoring of ecosystems and Adirondack Long Term-Monitoring programs in the Adirondack Mountain region of New Yrok

EPA Science Inventory

This paper compares lake chemistry in the Adirondack region of New York measured by the Temporally Integrated Monitoring of Ecosystems (TIME) and Adirondack Long-Term Monitoring (ALTM) programs by examining the data from six lakes common to both programs. Both programs were initi...

The Effect of a Statewide Mandatory Prescription Drug Monitoring Program on Opioid Prescribing by Emergency Medicine Providers Across 15 Hospitals in a Single Health System.

PubMed

Suffoletto, Brian; Lynch, Michael; Pacella, Charissa B; Yealy, Donald M; Callaway, Clifton W

2018-04-01

Prescription drug monitoring programs (PDMPs) enable registered prescribers to obtain real-time information on patients' prescription history of controlled medications. We sought to describe the effect of a state-mandated PDMP on opioid prescribing by emergency medicine providers. We retrospectively analyzed electronic medical records of 122,732 adult patients discharged with an opioid prescription from 15 emergency departments in a single health system in Pennsylvania from July 2015 to March, 2017. We used an interrupted time series design to evaluate the percentage of patients discharged each month with an opioid prescription before and after state law-mandated PDMP use on August 25, 2016. From August (pre-PDMP) to September, 2016 (post-PDMP), the opioid prescribing rate decreased from 12.4% (95% confidence interval [CI], 10.8%-14.1%) to 10.2% (95% CI, 8.8%-11.8%). For each month between September 2016 to March 2017, there was a mean decline of .46% (95% CI, -.38% to -.53%) in the percentage of patients discharged with an opioid prescription. There was heterogeneity in opioid prescribing across hospitals as well as according to patient diagnosis. This study examined the effect of a state-mandated PDMP on opioid prescribing among emergency medicine providers from 15 different hospitals in a single health system. Findings support current PDMP mandates in reducing opioid prescriptions, which could curb the prescription opioid epidemic and may ultimately reduce abuse, misuse, and overdose death. Copyright © 2017 The American Pain Society. Published by Elsevier Inc. All rights reserved.

Innovation and entrepreneurship programs in US medical education: a landscape review and thematic analysis

PubMed Central

Niccum, Blake A; Sarker, Arnab; Wolf, Stephen J; Trowbridge, Matthew J

2017-01-01

ABSTRACT Background: Training in innovation and entrepreneurship (I&E) in medical education has become increasingly prevalent among medical schools to train students in complex problem solving and solution design. Objective: We aim to characterize I&E education in US allopathic medical schools to provide insight into the features and objectives of this growing field. Design: I&E programs were identified in 2016 via structured searches of 158 US allopathic medical school websites. Program characteristics were identified from public program resources and structured phone interviews with program directors. Curricular themes were identified via thematic analysis of program resources, and themes referenced by >50% of programs were analyzed. Results: Thirteen programs were identified. Programs had a median age of four years, and contained a median of 13 students. Programs were led by faculty from diverse professional backgrounds, and all awarded formal recognition to graduates. Nine programs spanned all four years of medical school and ten programs required a capstone project. Thematic analysis revealed seven educational themes (innovation, entrepreneurship, technology, leadership, healthcare systems, business of medicine, and enhanced adaptability) and two teaching method themes (active learning, interdisciplinary teaching) referenced by >50% of programs. Conclusions: The landscape of medical school I&E programs is rapidly expanding to address newfound skills needed by physicians due to ongoing changes in healthcare, but programs remain relatively few and small compared to class size. This landscape analysis is the first review of I&E in medical education and may contribute to development of a formal educational framework or competency model for current or future programs. Abbreviations: AAMC: American Association of Medical Colleges; AMA: American Medical Association; I&E: Innovation and entrepreneurship PMID:28789602

Innovation and entrepreneurship programs in US medical education: a landscape review and thematic analysis.

PubMed

Niccum, Blake A; Sarker, Arnab; Wolf, Stephen J; Trowbridge, Matthew J

2017-01-01

Training in innovation and entrepreneurship (I&E) in medical education has become increasingly prevalent among medical schools to train students in complex problem solving and solution design. We aim to characterize I&E education in US allopathic medical schools to provide insight into the features and objectives of this growing field. I&E programs were identified in 2016 via structured searches of 158 US allopathic medical school websites. Program characteristics were identified from public program resources and structured phone interviews with program directors. Curricular themes were identified via thematic analysis of program resources, and themes referenced by >50% of programs were analyzed. Thirteen programs were identified. Programs had a median age of four years, and contained a median of 13 students. Programs were led by faculty from diverse professional backgrounds, and all awarded formal recognition to graduates. Nine programs spanned all four years of medical school and ten programs required a capstone project. Thematic analysis revealed seven educational themes (innovation, entrepreneurship, technology, leadership, healthcare systems, business of medicine, and enhanced adaptability) and two teaching method themes (active learning, interdisciplinary teaching) referenced by >50% of programs. The landscape of medical school I&E programs is rapidly expanding to address newfound skills needed by physicians due to ongoing changes in healthcare, but programs remain relatively few and small compared to class size. This landscape analysis is the first review of I&E in medical education and may contribute to development of a formal educational framework or competency model for current or future programs. AAMC: American Association of Medical Colleges; AMA: American Medical Association; I&E: Innovation and entrepreneurship.

[The supervisor has a crucial role in the medical student's degree projects. Experiences from seven semesters at Karolinska Institutet].

PubMed

Möller, Riitta; Shoshan, Maria; Ponzer, Sari

2015-01-13

In Sweden degree projects have a central role in evaluation of higher education, wherefore significant resources are spent on developing students' research competence. The undergraduate medical program at Karolinska Institutet introduced its degree project course in 2010. This paper gives an overview of the course and summarizes experiences from the first seven terms. In order to finalize their projects within one term, most students need substantial support. A highly structured course and frequent progress monitoring are advantageous. Other crucial factors are the quality of the supervision and students' verbal skills as well as support in scientific writing. In addition, increased awareness of the learning outcomes already at the beginning of the course may help students to achieve the expected results. Finally, students need to recognize their own responsibility for learning. 

A framework for fibromyalgia management for primary care providers.

PubMed

Arnold, Lesley M; Clauw, Daniel J; Dunegan, L Jean; Turk, Dennis C

2012-05-01

Fibromyalgia is a chronic widespread pain disorder commonly associated with comorbid symptoms, including fatigue and nonrestorative sleep. As in the management of other chronic medical disorders, the approach for fibromyalgia management follows core principles of comprehensive assessment, education, goal setting, multimodal treatment including pharmacological (eg, pregabalin, duloxetine, milnacipran) and nonpharmacological therapies (eg, physical activity, behavioral therapy, sleep hygiene, education), and regular education and monitoring of treatment response and progress. Based on these core management principles, this review presents a framework for primary care providers through which they can develop a patient-centered treatment program for patients with fibromyalgia. This proactive and systematic treatment approach encourages ongoing education and patient self-management and is designed for use in the primary care setting. Copyright © 2012 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Humanities for medical students? A qualitative study of a medical humanities curriculum in a medical school program

PubMed Central

Wachtler, Caroline; Lundin, Susanne; Troein, Margareta

2006-01-01

Background Today, there is a trend towards establishing the medical humanities as a component of medical education. However, medical humanities programs that exist within the context of a medical school can be problematic. The aim of this study was to explore problems that can arise with the establishment of a medical humanities curriculum in a medical school program. Methods Our theoretical approach in this study is informed by derridean deconstruction and by post-structuralist analysis. We examined the ideology of the Humanities and Medicine program at Lund University, Sweden, the practical implementation of the program, and how ideology and practice corresponded. Examination of the ideology driving the humanities and medicine program was based on a critical reading of all available written material concerning the Humanities and Medicine project. The practice of the program was examined by means of a participatory observation study of one course, and by in-depth interviews with five students who participated in the course. Data was analysed using a hermeneutic editing approach. Results The ideological language used to describe the program calls it an interdisciplinary learning environment but at the same time shows that the conditions of the program are established by the medical faculty's agenda. In practice, the "humanities" are constructed, defined and used within a medical frame of reference. Medical students have interesting discussions, acquire concepts and enjoy the program. But they come away lacking theoretical structure to understand what they have learned. There is no place for humanities students in the program. Conclusion A challenge facing cross-disciplinary programs is creating an environment where the disciplines have equal standing and contribution. PMID:16519815

Cost considerations for long-term ecological monitoring

USGS Publications Warehouse

Caughlan, L.; Oakley, K.L.

2001-01-01

For an ecological monitoring program to be successful over the long-term, the perceived benefits of the information must justify the cost. Financial limitations will always restrict the scope of a monitoring program, hence the program's focus must be carefully prioritized. Clearly identifying the costs and benefits of a program will assist in this prioritization process, but this is easier said than done. Frequently, the true costs of monitoring are not recognized and are, therefore, underestimated. Benefits are rarely evaluated, because they are difficult to quantify. The intent of this review is to assist the designers and managers of long-term ecological monitoring programs by providing a general framework for building and operating a cost-effective program. Previous considerations of monitoring costs have focused on sampling design optimization. We present cost considerations of monitoring in a broader context. We explore monitoring costs, including both budgetary costs--what dollars are spent on--and economic costs, which include opportunity costs. Often, the largest portion of a monitoring program budget is spent on data collection, and other, critical aspects of the program, such as scientific oversight, training, data management, quality assurance, and reporting, are neglected. Recognizing and budgeting for all program costs is therefore a key factor in a program's longevity. The close relationship between statistical issues and cost is discussed, highlighting the importance of sampling design, replication and power, and comparing the costs of alternative designs through pilot studies and simulation modeling. A monitoring program development process that includes explicit checkpoints for considering costs is presented. The first checkpoint occur during the setting of objectives and during sampling design optimization. The last checkpoint occurs once the basic shape of the program is known, and the costs and benefits, or alternatively the cost-effectiveness, of each program element can be evaluated. Moving into the implementation phase without careful evaluation of costs and benefits is risky because if costs are later found to exceed benefits, the program will fail. The costs of development, which can be quite high, will have been largely wasted. Realistic expectations of costs and benefits will help ensure that monitoring programs survive the early, turbulent stages of development and the challenges posed by fluctuating budgets during implementation.

7 CFR 246.19 - Management evaluation and monitoring reviews.

Code of Federal Regulations, 2014 CFR

2014-01-01

... SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN Monitoring and Review § 246.19 Management evaluation and monitoring reviews... reports, the development of corrective action plans to resolve Program deficiencies, the monitoring of the...

7 CFR 246.19 - Management evaluation and monitoring reviews.

Code of Federal Regulations, 2012 CFR

2012-01-01

... SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN Monitoring and Review § 246.19 Management evaluation and monitoring reviews... reports, the development of corrective action plans to resolve Program deficiencies, the monitoring of the...

7 CFR 246.19 - Management evaluation and monitoring reviews.

Code of Federal Regulations, 2013 CFR

2013-01-01

... SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN Monitoring and Review § 246.19 Management evaluation and monitoring reviews... reports, the development of corrective action plans to resolve Program deficiencies, the monitoring of the...

7 CFR 246.19 - Management evaluation and monitoring reviews.

Code of Federal Regulations, 2010 CFR

2010-01-01

... SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN Monitoring and Review § 246.19 Management evaluation and monitoring reviews... reports, the development of corrective action plans to resolve Program deficiencies, the monitoring of the...

7 CFR 246.19 - Management evaluation and monitoring reviews.

Code of Federal Regulations, 2011 CFR

2011-01-01

... SERVICE, DEPARTMENT OF AGRICULTURE CHILD NUTRITION PROGRAMS SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS AND CHILDREN Monitoring and Review § 246.19 Management evaluation and monitoring reviews... reports, the development of corrective action plans to resolve Program deficiencies, the monitoring of the...

45 CFR 2543.51 - Monitoring and reporting program performance.

Code of Federal Regulations, 2014 CFR

2014-10-01

... OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Property Standards § 2543.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award. Recipients shall monitor subawards to...

15 CFR 14.51 - Monitoring and reporting program performance.

Code of Federal Regulations, 2011 CFR

2011-01-01

...-PROFIT, AND COMMERCIAL ORGANIZATIONS Post-Award Requirements Reports and Records § 14.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award. Recipients shall monitor subawards to...

14 CFR 1260.151 - Monitoring and reporting program performance.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Records § 1260.151 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subcontract, function or activity supported by the award. Recipients shall monitor subcontracts to ensure subcontractors have met the audit requirements as delineated...

14 CFR 1260.151 - Monitoring and reporting program performance.

Code of Federal Regulations, 2013 CFR

2013-01-01

... Records § 1260.151 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subcontract, function or activity supported by the award. Recipients shall monitor subcontracts to ensure subcontractors have met the audit requirements as delineated...

15 CFR 14.51 - Monitoring and reporting program performance.

Code of Federal Regulations, 2013 CFR

2013-01-01

...-PROFIT, AND COMMERCIAL ORGANIZATIONS Post-Award Requirements Reports and Records § 14.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award. Recipients shall monitor subawards to...

45 CFR 2543.51 - Monitoring and reporting program performance.

Code of Federal Regulations, 2013 CFR

2013-10-01

... OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Property Standards § 2543.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award. Recipients shall monitor subawards to...

14 CFR 1260.151 - Monitoring and reporting program performance.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Records § 1260.151 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subcontract, function or activity supported by the award. Recipients shall monitor subcontracts to ensure subcontractors have met the audit requirements as delineated...

45 CFR 2543.51 - Monitoring and reporting program performance.

Code of Federal Regulations, 2012 CFR

2012-10-01

... OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Property Standards § 2543.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award. Recipients shall monitor subawards to...

45 CFR 2543.51 - Monitoring and reporting program performance.

Code of Federal Regulations, 2011 CFR

2011-10-01

... OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Property Standards § 2543.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award. Recipients shall monitor subawards to...

15 CFR 14.51 - Monitoring and reporting program performance.

Code of Federal Regulations, 2014 CFR

2014-01-01

...-PROFIT, AND COMMERCIAL ORGANIZATIONS Post-Award Requirements Reports and Records § 14.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award. Recipients shall monitor subawards to...

15 CFR 14.51 - Monitoring and reporting program performance.

Code of Federal Regulations, 2012 CFR

2012-01-01

...-PROFIT, AND COMMERCIAL ORGANIZATIONS Post-Award Requirements Reports and Records § 14.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award. Recipients shall monitor subawards to...

Employer Health and Productivity Roadmap™ strategy.

PubMed

Parkinson, Michael D

2013-12-01

The National Institute for Occupational Safety and Health Total Worker Health™ Program defines essential elements of an integrated health protection and health promotion model to improve the health, safety, and performance of employers and employees. The lack of a clear strategy to address the core drivers of poor health, excessive medical costs, and lost productivity has deterred a comprehensive, integrated, and proactive approach to meet these challenges. The Employer Health and Productivity Roadmap™, comprising six interrelated and integrated core elements, creates a framework of shared accountability for both employers and their health and productivity partners to implement and monitor actionable measures that improve health, maximize productivity, and reduce excessive costs. The strategy is most effective when linked to a financially incentivized health management program or consumer-directed health plan insurance benefit design.

5 CFR 339.205 - Medical evaluation programs.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 1 2013-01-01 2013-01-01 false Medical evaluation programs. 339.205 Section 339.205 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS MEDICAL QUALIFICATION DETERMINATIONS Physical and Medical Qualifications § 339.205 Medical evaluation programs. Agencies...

5 CFR 339.205 - Medical evaluation programs.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false Medical evaluation programs. 339.205 Section 339.205 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS MEDICAL QUALIFICATION DETERMINATIONS Physical and Medical Qualifications § 339.205 Medical evaluation programs. Agencies...

5 CFR 339.205 - Medical evaluation programs.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Medical evaluation programs. 339.205 Section 339.205 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS MEDICAL QUALIFICATION DETERMINATIONS Physical and Medical Qualifications § 339.205 Medical evaluation programs. Agencies...

Monitor for status epilepticus seizures

NASA Technical Reports Server (NTRS)

Johnson, Mark; Simkins, Thomas

1994-01-01

This paper describes the sensor technology and associated electronics of a monitor designed to detect the onset of a seizure disorder called status epilepticus. It is a condition that affects approximately 3-5 percent of those individuals suffering from epilepsy. This form of epilepsy does not follow the typical cycle of start-peak-end. The convulsions continue until medically interrupted and are life threatening. The mortality rate is high without prompt medical treatment at a suitable facility. The paper describes the details of a monitor design that provides an inexpensive solution to the needs of those responsible for the care of individuals afflicted with this disorder. The monitor has been designed as a cooperative research and development effort involving the United States Army Armament Research, Development, and Engineering Center's Benet Laboratories (Benet) and the Cerebral Palsy Center for the Disabled (Center), in association with the Department of Neurology at Albany Medical College (AMC). Benet has delivered a working prototype of the device for field testing, in collaboration with Albany Medical College. The Center has identified several children in need of special monitoring and has agreed to pursue commercialization of the device.

Maximum reasonable radioxenon releases from medical isotope production facilities and their effect on monitoring nuclear explosions.

PubMed

Bowyer, Theodore W; Kephart, Rosara; Eslinger, Paul W; Friese, Judah I; Miley, Harry S; Saey, Paul R J

2013-01-01

Fission gases such as (133)Xe are used extensively for monitoring the world for signs of nuclear testing in systems such as the International Monitoring System (IMS). These gases are also produced by nuclear reactors and by fission production of (99)Mo for medical use. Recently, medical isotope production facilities have been identified as the major contributor to the background of radioactive xenon isotopes (radioxenon) in the atmosphere (Stocki et al., 2005; Saey, 2009). These releases pose a potential future problem for monitoring nuclear explosions if not addressed. As a starting point, a maximum acceptable daily xenon emission rate was calculated, that is both scientifically defendable as not adversely affecting the IMS, but also consistent with what is possible to achieve in an operational environment. This study concludes that an emission of 5 × 10(9) Bq/day from a medical isotope production facility would be both an acceptable upper limit from the perspective of minimal impact to monitoring stations, but also appears to be an achievable limit for large isotope producers. Copyright © 2012 Elsevier Ltd. All rights reserved.

Review of present groundwater monitoring programs at the Nevada Test Site

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

Hershey, R.L.; Gillespie, D.

1993-09-01

Groundwater monitoring at the Nevada Test Site (NTS) is conducted to detect the presence of radionuclides produced by underground nuclear testing and to verify the quality and safety of groundwater supplies as required by the State of Nevada and federal regulations, and by U.S. Department of Energy (DOE) Orders. Groundwater is monitored at water-supply wells and at other boreholes and wells not specifically designed or located for traditional groundwater monitoring objectives. Different groundwater monitoring programs at the NTS are conducted by several DOE Nevada Operations Office (DOE/NV) contractors. Presently, these individual groundwater monitoring programs have not been assessed or administeredmore » under a comprehensive planning approach. Redundancy exists among the programs in both the sampling locations and the constituents analyzed. Also, sampling for certain radionuclides is conducted more frequently than required. The purpose of this report is to review the existing NTS groundwater monitoring programs and make recommendations for modifying the programs so a coordinated, streamlined, and comprehensive monitoring effort may be achieved by DOE/NV. This review will be accomplished in several steps. These include: summarizing the present knowledge of the hydrogeology of the NTS and the potential radionuclide source areas for groundwater contamination; reviewing the existing groundwater monitoring programs at the NTS; examining the rationale for monitoring and the constituents analyzed; reviewing the analytical methods used to quantify tritium activity; discussing monitoring network design criteria; and synthesizing the information presented and making recommendations based on the synthesis. This scope of work was requested by the DOE/NV Hydrologic Resources Management Program (HRMP) and satisfies the 1993 (fiscal year) HRMP Groundwater Monitoring Program Review task.« less

Safety of Temporary Discontinuation of Antihypertensive Medication in Patients With Difficult-to-Control Hypertension.

PubMed

Beeftink, Martine M A; van der Sande, Nicolette G C; Bots, Michiel L; Doevendans, Pieter A; Blankestijn, Peter J; Visseren, Frank L J; Voskuil, Michiel; Spiering, Wilko

2017-05-01

Successful control of blood pressure relies on identification of secondary causes and contributing factors of hypertension. As antihypertensive medication can interfere with diagnostic investigations, temporary discontinuation of medication is advised. However, there are concerns about the safety of temporary discontinuation of antihypertensive medication in patients with difficult-to-control hypertension. We assessed the occurrence of adverse cardiovascular and cerebrovascular events potentially attributable to temporary discontinuation of antihypertensive medication between February 2010 and March 2016 (n=604) in our Analysis of Complicated Hypertension screening program. A reference group (n=604) was extracted from the SMART study (Second Manifestations of Arterial Disease) cohort (comprising a similar cohort at our hospital in whom medication was not stopped) and individually matched for blood pressure, age, sex, and history of cardiovascular disease. Discontinuation of medication was well tolerated; 62% reported no complaints, 24% had mild discomfort that could be left untreated, and 14% experienced complaints that required prescription of antihypertensive escape medication. Three major adverse events were observed in the Analysis of Complicated Hypertension group between discontinuation of medication and 30 days after restart of medication (event rate=31.2 events per 1000 patient-year). In the reference cohort, 5 cardiovascular events were observed during a similar follow-up period (event rate=51.2 events per 1000 patient-year). In conclusion, discontinuation of antihypertensive medication for the diagnostic evaluation of hypertension does not increase the acute risk of cardiovascular events when performed in a well-controlled setting in specialized hospitals with appropriate protocols for monitoring safety. © 2017 American Heart Association, Inc.

Inter-observer agreement of a multi-parameter campsite monitoring program on the Dixie National Forest, Utah

Treesearch

Nicholas J. Glidden; Martha E. Lee

2007-01-01

Precision is crucial to campsite monitoring programs. Yet, little empirical research has ever been published on the level of precision of this type of monitoring programs. The purpose of this study was to evaluate the level of agreement between observers of campsite impacts using a multi-parameter campsite monitoring program. Thirteen trained observers assessed 16...

An overview of a landbird monitoring program at Tortuguero, on the Caribbean coast of Costa Rica

Treesearch

C. John Ralph; Margaret J. Widdowson; Robert I. Frey; Pablo A. Herrera; Brian P. O' Donnell

2005-01-01

Since 1994, the Tortuguero Integrated Bird Monitoring Program has been monitoring birds in a coastal lowland rain forest of northeast Costa Rica. The Program has combined the use of area searches, constanteffort mist netting, and migration counts into a longterm landbird monitoring and training program following the recommendations of the Partners In Flight &ndash...

Social safety and medical maintenance of the labour pool in surveillance areas of the nuclear power plants.

PubMed

Prylipko, V A; Ozerova, Yu Yu; Kotsubinskij, O V; Morozova, M M; Petrychenko, O O; Bondarenko, I V

2017-12-01

To study the contentment of population of NPP surveillance areas i.e. monitoring zones with specific components of quality of life, namely the social security, medical care, and socio economic compensation of risk. A sociological study of public opinion about the specific components of quality of life has been conducted in population of the NPP monitoring zone. A questionnaire with independent question blocks was developed. A non repeatable probabilistic selection was applied in population opinion poll. The sampled population was calculated on the basis of the total population living in the NPP monitoring zone. Sample error not exceeded 7.0%. A comparative assessment of the responses of various groups of the able bodied population on issues of social security, medical care, socio economic compensation of risk and analysis of statistical data for 2011-2015 on the resource potential of medical facility of the nuclear power plant overspill town has been conducted. The safety and security status is rated at below the average. Documents regulating the life safety of pop ulation of NPP monitoring zone provide them no confidence in their security. Probability estimates of man made accidents are higher in urban population and depend on education level. The socialized health care is assessed on low and average levels according to the studied parameters. Among the types of medical care the providing of nec essary medical goods, preventive examinations, scheduled medical examination service, ambulance activity, and medical psychological aid need to be improved. There was no significant change in resource potential of special ized healthcare infirmary of NPP overspill town for the last 5 years. Low rating by the monitoring zone population of work efficiency of health facilities is determined by a set of factors, some of which lies in the plane of state socio economic problems. Choice priority of the direct sub ventions in population of monitoring zone depends on the place of residence and occupation. Provisions on social security, protection and medical care of population of the NPP monitoring zones in Ukraine do not correspond to European standards and require a revision. V.A. Prylipko, Yu.Yu. Ozerova, O.V. Kotsubinskij, M.M. Morozova, O.O. Petrychenko, I.V. Bondarenko.

Physical deterioration in an acute mental health unit: A quantitative retrospective analysis of medical emergencies.

PubMed

Porter, Joanne E; Cant, Robyn; Missen, Karen; Raymond, Anita; Churchill, Anne

2018-04-27

Nursing management of physical deterioration of patients within acute mental health settings is observed, recorded, and actively managed with the use of standardized Adult Deterioration Detection System (ADDS) charts. Patient deterioration may require the urgent assistance of a hospital rapid response or Medical Emergency Team. A five-and-a-half-year (2011-2016) audit of hospital-wide Medical Emergency Team attendances was conducted in an acute mental health unit of a single large 250 bed regional hospital in Victoria, Australia. Data were extracted from the hospitals' quality and patient safety program, RISKMan, and entered into a statistical data program for analysis. A total of 140 patient records were analysed, and the 'Worried' category (34%, n = 47) was the principle reason for a Medical Emergency Team call in a mental health ward, followed by hypotension (23%, n = 31) and a low Glasgow Coma Score (16%, n = 22). Upon further investigation of the 'Worried' category, the most common conditions recorded were an altered conscious state (22%, n = 9), low oxygen saturation (20%, n = 8), or chest pain (17%, n = 7). Activation of Medical Emergency Team calls predominantly occurred in the daylight morning hours (6am-12md). When data were compared to the general hospital patients, the context of the physiological deterioration of the mental health patients was strikingly similar. Further research is recommended to ascertain the extent and frequency with which staff working in mental health units are performing vital signs monitoring as an essential component of detection of early signs of physiological deterioration. © 2018 Australian College of Mental Health Nurses Inc.

Development of a Medical Humanities Program at Dalhousie University Faculty of Medicine, Nova Scotia, Canada, 1992-2003.

PubMed

Murray, Jock

2003-10-01

The Medical Humanities Program at Dalhousie University Faculty of Medicine in Nova Scotia, Canada, was initiated in 1992 to incorporate the medical humanities into the learning and experiences of medical students. The goal of the program was to gain acceptance as an integral part of the medical school. The program assumed a broad concept of the medical humanities that includes medical history, literature, music, art, multiculturalism, philosophy, epistemology, theology, anthropology, professionalism, history of alternative therapies, writing, storytelling, health law, international medicine, and ethics. Phase I of the program has provided the same elective and research opportunities in the medical humanities that are available to the students in clinical and basic sciences, and has encouraged and legitimized the involvement of the humanities in the life and learning of the medical student through a wide array of programs and activities. Phase II will focus on further incorporation of the humanities into the curriculum. Phase III will be the development of a graduate program in medical humanities to train more faculty who will incorporate the humanities into their teaching and into the development of education programs.

28 CFR 70.51 - Monitoring and reporting program performance.

Code of Federal Regulations, 2014 CFR

2014-07-01

..., HOSPITALS AND OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Reports and Records § 70.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award. Recipients must monitor subawards...

29 CFR 95.51 - Monitoring and reporting program performance.

Code of Federal Regulations, 2012 CFR

2012-07-01

...-Award Requirements Reports and Records § 95.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award. Recipients shall monitor subawards to ensure subrecipients have met the audit...

29 CFR 95.51 - Monitoring and reporting program performance.

Code of Federal Regulations, 2011 CFR

2011-07-01

...-Award Requirements Reports and Records § 95.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award. Recipients shall monitor subawards to ensure subrecipients have met the audit...

29 CFR 95.51 - Monitoring and reporting program performance.

Code of Federal Regulations, 2013 CFR

2013-07-01

...-Award Requirements Reports and Records § 95.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award. Recipients shall monitor subawards to ensure subrecipients have met the audit...

22 CFR 226.51 - Monitoring and reporting program performance.

Code of Federal Regulations, 2014 CFR

2014-04-01

... ASSISTANCE AWARDS TO U.S. NON-GOVERNMENTAL ORGANIZATIONS Post-award Requirements Reports and Records § 226.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award. Recipients shall monitor...

22 CFR 226.51 - Monitoring and reporting program performance.

Code of Federal Regulations, 2012 CFR

2012-04-01

... ASSISTANCE AWARDS TO U.S. NON-GOVERNMENTAL ORGANIZATIONS Post-award Requirements Reports and Records § 226.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award. Recipients shall monitor...

29 CFR 95.51 - Monitoring and reporting program performance.

Code of Federal Regulations, 2014 CFR

2014-07-01

...-Award Requirements Reports and Records § 95.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award. Recipients shall monitor subawards to ensure subrecipients have met the audit...

22 CFR 226.51 - Monitoring and reporting program performance.

Code of Federal Regulations, 2013 CFR

2013-04-01

... ASSISTANCE AWARDS TO U.S. NON-GOVERNMENTAL ORGANIZATIONS Post-award Requirements Reports and Records § 226.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award. Recipients shall monitor...

28 CFR 70.51 - Monitoring and reporting program performance.

Code of Federal Regulations, 2012 CFR

2012-07-01

..., HOSPITALS AND OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Reports and Records § 70.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award. Recipients must monitor subawards...

28 CFR 70.51 - Monitoring and reporting program performance.

Code of Federal Regulations, 2011 CFR

2011-07-01

..., HOSPITALS AND OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Reports and Records § 70.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award. Recipients must monitor subawards...

28 CFR 70.51 - Monitoring and reporting program performance.

Code of Federal Regulations, 2013 CFR

2013-07-01

..., HOSPITALS AND OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Reports and Records § 70.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award. Recipients must monitor subawards...

14 CFR § 1260.151 - Monitoring and reporting program performance.

Code of Federal Regulations, 2014 CFR

2014-01-01

... Records § 1260.151 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subcontract, function or activity supported by the award. Recipients shall monitor subcontracts to ensure subcontractors have met the audit requirements as delineated...

22 CFR 226.51 - Monitoring and reporting program performance.

Code of Federal Regulations, 2011 CFR

2011-04-01

... ASSISTANCE AWARDS TO U.S. NON-GOVERNMENTAL ORGANIZATIONS Post-award Requirements Reports and Records § 226.51 Monitoring and reporting program performance. (a) Recipients are responsible for managing and monitoring each project, program, subaward, function or activity supported by the award. Recipients shall monitor...

Real-time Stack Monitoring at the BaTek Medical Isotope Production Facility

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

McIntyre, Justin I.; Agusbudiman, A.; Cameron, Ian M.

2016-04-01

Radioxenon emissions from radiopharmaceutical production are a major source of background concentrations affecting the radioxenon detection systems of the International Monitoring System (IMS). Collection of real-time emissions data from production facilities makes it possible to screen out some medical isotope signatures from the IMS radioxenon data sets. This paper describes an effort to obtain and analyze real-time stack emissions data with the design, construction and installation of a small stack monitoring system developed by a joint CTBTO-IDC, BATAN, and PNNL team at the BaTek medical isotope production facility near Jakarta, Indonesia.

Central Alaska Network vital signs monitoring plan

USGS Publications Warehouse

MacCluskie, Margaret C.; Oakley, Karen L.; McDonald, Trent; Wilder, Doug

2005-01-01

Denali National Park and Preserve, Wrangell-St. Elias National Park and Preserve, and Yukon-Charley Rivers National Preserve have been organized into the Central Alaska Network (CAKN) for the purposes of carrying out ecological monitoring activities under the National Park Services’ Vital Signs Monitoring program. The Phase III Report is the initial draft of the Vital Signs Monitoring Plan for the Central Alaska Network. It includes updated material from the Phase I and II documents. This report, and draft protocols for 11 of the network’s Vital Signs, were peer reviewed early in 2005. Review comments were incorporated into the document bringing the network to the final stage of having a Vital Signs Monitoring Plan. Implementation of the program will formally begin in FY 2006. The broad goals of the CAKN monitoring program are to: (1) better understand the dynamic nature and condition of park ecosystems; and (2) provide reference points for comparisons with other, altered environments. The focus of the CAKN program will be to monitor ecosystems in order to detect change in ecological components and in the relationships among the components. Water quality monitoring is fully integrated within the CAKN monitoring program. A monitoring program for lentic (non-moving water) has been determined, and the program for lotic systems (moving water) is under development.

49 CFR 390.105 - Medical examiner training programs.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 5 2013-10-01 2013-10-01 false Medical examiner training programs. 390.105... FEDERAL MOTOR CARRIER SAFETY REGULATIONS; GENERAL National Registry of Certified Medical Examiners § 390.105 Medical examiner training programs. An applicant for medical examiner certification must complete...

49 CFR 390.105 - Medical examiner training programs.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 5 2012-10-01 2012-10-01 false Medical examiner training programs. 390.105... FEDERAL MOTOR CARRIER SAFETY REGULATIONS; GENERAL National Registry of Certified Medical Examiners § 390.105 Medical examiner training programs. An applicant for medical examiner certification must complete...

24 CFR 266.520 - Program monitoring and compliance.

Code of Federal Regulations, 2010 CFR

2010-04-01

... AUTHORITIES HOUSING FINANCE AGENCY RISK-SHARING PROGRAM FOR INSURED AFFORDABLE MULTIFAMILY PROJECT LOANS Project Management and Servicing § 266.520 Program monitoring and compliance. HUD will monitor the...