Experience with a pharmacy technician medication history program.

PubMed

Cooper, Julie B; Lilliston, Michelle; Brooks, DeAnne; Swords, Bruce

2014-09-15

The implementation and outcomes of a pharmacy technician medication history program are described. An interprofessional medication reconciliation team, led by a clinical pharmacist and a clinical nurse specialist, was charged with implementing a new electronic medication reconciliation system to improve compliance with medication reconciliation at discharge and capture compliance-linked reimbursement. The team recommended that the pharmacy department be allocated new pharmacy technician full-time-equivalent positions to assume ownership of the medication history process. Concurrent with the implementation of this program, a medication history standard was developed to define rules for documentation of what a patient reports he or she is actually taking. The standard requires a structured interview with the patient or caregiver and validation with outside sources as indicated to determine which medications to document in the medication history. The standard is based on four medication administration category rules: scheduled, as-needed, short-term, and discontinued medications. The medication history standard forms the core of the medication history technician training and accountability program. Pharmacy technicians are supervised by pharmacists, using a defined accountability plan based on a set of medical staff approved rules for what medications comprise a best possible medication history. Medication history accuracy and completeness rates have been consistently over 90% and rates of provider compliance with medication reconciliation rose from under 20% to 100% since program implementation. A defined medication history based on a medication history standard served as an effective foundation for a pharmacy technician medication history program, which helped improve provider compliance with discharge medication reconciliation. Copyright © 2014 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Ambulatory Medication Reconciliation in Dialysis Patients: Benefits and Community Practitioners’ Perspectives

PubMed Central

Wilson, Jo-Anne S; Ladda, Matthew A; Tran, Jaclyn; Wood, Marsha; Poyah, Penelope; Soroka, Steven; Rodrigues, Glenn; Tennankore, Karthik

2017-01-01

Background Ambulatory medication reconciliation can reduce the frequency of medication discrepancies and may also reduce adverse drug events. Patients receiving dialysis are at high risk for medication discrepancies because they typically have multiple comorbid conditions, are taking many medications, and are receiving care from many practitioners. Little is known about the potential benefits of ambulatory medication reconciliation for these patients. Objectives To determine the number, type, and potential level of harm associated with medication discrepancies identified through ambulatory medication reconciliation and to ascertain the views of community pharmacists and family physicians about this service. Methods This retrospective cohort study involved patients initiating hemodialysis who received ambulatory medication reconciliation in a hospital renal program over the period July 2014 to July 2016. Discrepancies identified on the medication reconciliation forms for study patients were extracted and categorized by discrepancy type and potential level of harm. The level of harm was determined independently by a pharmacist and a nurse practitioner using a defined scoring system. In the event of disagreement, a nephrologist determined the final score. Surveys were sent to 52 community pharmacists and 44 family physicians involved in the care of study patients to collect their opinions and perspectives on ambulatory medication reconciliation. Results Ambulatory medication reconciliation was conducted 296 times for a total of 147 hemodialysis patients. The mean number of discrepancies identified per patient was 1.31 (standard deviation 2.00). Overall, 30% of these discrepancies were deemed to have the potential to cause moderate to severe patient discomfort or clinical deterioration. Survey results indicated that community practitioners found ambulatory medication reconciliation valuable for providing quality care to dialysis patients. Conclusions This study has provided evidence that ambulatory medication reconciliation can increase patient safety and potentially prevent adverse events associated with medication discrepancies. PMID:29299004

Medication reconciliation service in Tan Tock Seng Hospital.

PubMed

Yi, Sia Beng; Shan, Janice Chan Pei; Hong, Goh Lay

2013-01-01

Medication reconciliation is integral to every hospital. Approximately 60 percent of all hospital medication errors occur at admission, intra-hospital transfer or discharge. Effectively and consistently performing medication reconciliation at care-interfaces continues to be a challenge. Tan Tock Seng Hospital (TTSH) averages 4,700 admissions monthly. Many patients are elderly (> 65 years old) at risk from poly-pharmacy. As part of a medication safety initiative, pharmacy staff started a medication reconciliation service in 2007, which expanded to include all patients in October 2009. This article aims to describe the TTSH medication reconciliation system and to highlight common medication errors occurring following incomplete medication reconciliation. Where possible, patients admitted into TTSH are seen by pharmacy staff within 24 hours of admission. A form was created to document their medications, which is filed into the case sheets for referencing purposes. Any discrepancies in medicines are brought to doctors' attention. Patients are also counseled about changes to their medications. Errors picked up were captured in an Excel database. The most common medication error was prescribers missing out medications. The second commonest was recording different doses and regimens. The reason was mainly due to doctors transcribing medications inaccurately. This is a descriptive study and no statistical tests were carried out. Data entry was done by different pharmacy staff, and not a dedicated person; hence, data might be under-reported. The findings demonstrate the importance of medication reconciliation on admission. Accurate medication reconciliation can help to reduce transcription errors and improve service quality. The article highlights medication reconciliation's importance and has implications for healthcare professionals in all countries.

Pharmacist-managed inpatient discharge medication reconciliation: a combined onsite and telepharmacy model.

PubMed

Keeys, Christopher; Kalejaiye, Bamidele; Skinner, Michelle; Eimen, Mandana; Neufer, Joann; Sidbury, Gisele; Buster, Norman; Vincent, Joan

2014-12-15

The development, implementation, and pilot testing of a discharge medication reconciliation service managed by pharmacists with offsite telepharmacy support are described. Hospitals' efforts to prepare legible, complete, and accurate medication lists to patients prior to discharge continue to be complicated by staffing and time constraints and suboptimal information technology. To address these challenges, the pharmacy department at a 324-bed community hospital initiated a quality-improvement project to optimize patients' discharge medication lists while addressing problems that often resulted in confusing, incomplete, or inaccurate lists. A subcommittee of the hospital's pharmacy and therapeutics committee led the development of a revised medication reconciliation process designed to streamline and improve the accuracy and utility of discharge medication documents, with subsequent implementation of a new service model encompassing both onsite and remote pharmacists. The new process and service were evaluated on selected patient care units in a 19-month pilot project requiring collaboration by physicians, nurses, case managers, pharmacists, and an outpatient prescription drug database vendor. During the pilot testing period, 6402 comprehensive reconciled discharge medication lists were prepared; 634 documented discrepancies or medication errors were detected. The majority of identified problems were in three categories: unreconciled medication orders (31%), order clarification (25%), and duplicate orders (12%). The most problematic medications were the opioids, cardiovascular agents, and anticoagulants. A pharmacist-managed medication reconciliation service including onsite pharmacists and telepharmacy support was successful in improving the final discharge lists and documentation received by patients. Copyright © 2014 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

[Prospective study in 2 hospitals].

PubMed

Jiménez-Buñuales, M T; Martínez-Sáenz, M S; González-Diego, P; Vallejo-García, M; Gallardo-Anciano, J; Cestafe-Martínez, A

2016-06-01

The purpose of this study is to know the incidence rate of medication reconciliation at admission and discharge in patients of La Rioja and to improve the patient safety on medication reconciliation. An observational prospective study, part of the Joint Action PaSQ, Work Package 5, European Union Network for Patient Safety and Quality of Care. The study has taken into account the definitions of the Institute for Safe Medication Practices. Any unintended discrepancy in medication between chronic treatment and the treatment prescribed in the hospital was considered as a reconciliation error. A total of 750 patients were included, 9 (1.2%) of whom showed at least one discrepancy. The patients had a total of 3,156 mediations registered: 2,313 prescriptions (73.4%) showed no differences, while 821 prescriptions (26%) were intended discrepancies and 21 prescriptions (0.6%) unintended discrepancies were considered by the physician as reconciliation errors. A percentage of 1.2 of the patients, which represents 0.6% of the medicines (one in 166 medications registered) had reconciliation errors during their hospital stay. A proceeding has been implemented by means of the physician doing the medication reconciliation and reviewing it with the help of a medication reconciliation form. The medication reconciliation is a priority strategic objective to improve the safety of patients. Copyright © 2016 SECA. Published by Elsevier Espana. All rights reserved.

Taking a unified approach to teaching and implementing quality improvements across multiple residency programs: the Atlantic Health experience.

PubMed

Daniel, Donna M; Casey, Donald E; Levine, Jeffrey L; Kaye, Susan T; Dardik, Raquel B; Varkey, Prathibha; Pierce-Boggs, Kimberly

2009-12-01

The Accreditation Council for Graduate Medical Education recently emphasized the importance of systems-based practice and systems-based learning; however, successful models of collaborative quality improvement (QI) initiatives in residency training curricula are not widely available. Atlantic Health successfully conceptualized and implemented a QI collaborative focused on medication safety across eight residency training programs representing 219 residents. During a six-month period, key faculty and resident leaders from 8 (of 10) Atlantic Health residency training programs participated in three half-day collaborative learning sessions focused on improving medication reconciliation. Each session included didactic presentations from a multidisciplinary team of clinical experts as well as the application of principles that identified challenges, barriers, and solutions to QI initiatives. The learning sessions emphasized the fundamental principles of medication reconciliation, its critical importance as a vital part of patient handoff in all health care settings, and the challenges of achieving successful medication reconciliation improvement in light of work hours restrictions and patient loads. Each residency program developed a detailed implementation and measurement plan for individual "action learning" projects, using the Plan-Do-Study-Act method of improvement. Each program then implemented its QI project, and expert faculty (e.g., physicians, nurses, pharmacists, QI staff) provided mentoring between learning sessions. Several projects resulted in permanent changes in medication reconciliation processes, which were then adopted by other programs. The structure, process, and outcomes of this effort are described in detail.

[Pharmacological treatment conciliation methodology in patients with multiple conditions].

PubMed

Alfaro-Lara, Eva Rocío; Vega-Coca, María Dolores; Galván-Banqueri, Mercedes; Nieto-Martín, María Dolores; Pérez-Guerrero, Concepción; Santos-Ramos, Bernardo

2014-02-01

To carry out a bibliographic review in order to identify the different methodologies used along the reconciliation process of drug therapy applicable to polypathological patients. We performed a literature review. Data sources The bibliographic review (February 2012) included the following databases: Pubmed, EMBASE, CINAHL, PsycINFO and Spanish Medical Index (IME). The different methodologies, identified on those databases, to measure the conciliation process in polypathological patients, or otherwise elderly patients or polypharmacy, were studied. Study selection Two hundred and seventy three articles were retrieved, of which 25 were selected. Data extraction Specifically: the level of care, the sources of information, the use of registration forms, the established time, the medical professional in charge and the registered variables such as errors of reconciliation. Most of studies selected when the patient was admitted into the hospital and after the hospital discharge of the patient. The main sources of information to be highlighted are: the interview and the medical history of the patient. An established time is not explicitly stated on most of them, nor the registration form is used. The main professional in charge is the clinical pharmacologist. Apart from the home medication, the habits of self-medication and phytotherapy are also identified. The common errors of reconciliation vary from the omission of drugs to different forms of interaction with other medicinal products (drugs interactions). There is a large heterogeneity of methodologies used for reconciliation. There is not any work done on the specific figure of the polypathological patient, which precisely requires a standardized methodology due to its complexity and its susceptibility to errors of reconciliation. Copyright © 2012 Elsevier España, S.L. All rights reserved.

Using an electronic prescribing system to ensure accurate medication lists in a large multidisciplinary medical group.

PubMed

Stock, Ron; Scott, Jim; Gurtel, Sharon

2009-05-01

Although medication safety has largely focused on reducing medication errors in hospitals, the scope of adverse drug events in the outpatient setting is immense. A fundamental problem occurs when a clinician lacks immediate access to an accurate list of the medications that a patient is taking. Since 2001, PeaceHealth Medical Group (PHMG), a multispecialty physician group, has been using an electronic prescribing system that includes medication-interaction warnings and allergy checks. Yet, most practitioners recognized the remaining potential for error, especially because there was no assurance regarding the accuracy of information on the electronic medical record (EMR)-generated medication list. PeaceHealth developed and implemented a standardized approach to (1) review and reconcile the medication list for every patient at each office visit and (2) report on the results obtained within the PHMG clinics. In 2005, PeaceHealth established the ambulatory medication reconciliation project to develop a reliable, efficient process for maintaining accurate patient medication lists. Each of PeaceHealth's five regions created a medication reconciliation task force to redesign its clinical practice, incorporating the systemwide aims and agreed-on key process components for every ambulatory visit. Implementation of the medication reconciliation process at the PHMG clinics resulted in a substantial increase in the number of accurate medication lists, with fewer discrepancies between what the patient is actually taking and what is recorded in the EMR. The PeaceHealth focus on patient safety, and particularly the reduction of medication errors, has involved a standardized approach for reviewing and reconciling medication lists for every patient visiting a physician office. The standardized processes can be replicated at other ambulatory clinics-whether or not electronic tools are available.

Improving admission medication reconciliation compliance using the electronic tool in admitted medical patients.

PubMed

Taha, Haytham; Abdulhay, Dana; Luqman, Neama; Ellahham, Samer

2016-01-01

Sheikh Khalifa Medical City (SKMC) in Abu Dhabi is the main tertiary care referral hospital in the United Arab Emirates (UAE) with 560 bed capacity that is fully occupied most of the time. SKMC senior management has made a commitment to make quality and patient safety a top priority. Our governing body Abu Dhabi Health Services Company has identified medication reconciliation as a critical patient safety measure and key performance indicator (KPI). The medication reconciliation electronic form a computerized decision support tool was introduced to improve medication reconciliation compliance on transition of care at admission, transfer and discharge of patients both in the inpatient and outpatient settings. In order to improve medication reconciliation compliance a multidisciplinary task force team was formed and led this quality improvement project. The purpose of this publication is to indicate the quality improvement interventions implemented to enhance compliance with admission medication reconciliation and the outcomes of those interventions. We chose to conduct the pilot study in general medicine as it is the busiest department in the hospital, with an average of 390 patients admitted per month during the study period. The study period was from April 2014 till October 2015 and a total of 8576 patients were evaluated. The lessons learned were disseminated throughout the hospital. Our aim was to improve admission medication reconciliation compliance using the electronic form in order to ensure patient safety and reduce preventable harm in terms of medication errors. Admission medication reconciliation compliance improved in general medicine from 40% to above 85%, and this improvement was sustained for the last four months of the study period.

Medication details documented on hospital discharge: cross-sectional observational study of factors associated with medication non-reconciliation

PubMed Central

Grimes, Tamasine C; Duggan, Catherine A; Delaney, Tim P; Graham, Ian M; Conlon, Kevin C; Deasy, Evelyn; Jago-Byrne, Marie-Claire; O' Brien, Paul

2011-01-01

AIMS Movement into or out of hospital is a vulnerable period for medication safety. Reconciling the medication a patient is using before admission with the medication prescribed on discharge, and documenting any changes (medication reconciliation) is recommended to improve safety. The aims of the study were to investigate the factors contributing to medication reconciliation on discharge, and identify the prevalence of non-reconciliation. METHODS The study was a cross-sectional, observational survey using consecutive discharges from purposively selected services in two acute public hospitals in Ireland. Medication reconciliation, potential for harm and unplanned re-admission were investigated. RESULTS Medication non-reconciliation was identified in 50% of 1245 inpatient episodes, involving 16% of 9569 medications. The majority of non-reconciled episodes had potential to result in moderate (63%) or severe (2%) harm. Handwritten rather than computerized discharges (adjusted odds ratio (adjusted OR) 1.60, 95% CI 1.11, 2.99), increasing number of medications (adjusted OR 1.26, 95% CI 1.21, 1.31) or chronic illness (adjusted OR 2.08, 95% CI 1.33, 3.24) were associated with non-reconciliation. Omission of endocrine, central nervous system and nutrition and blood drugs was more likely on discharge, whilst omission on admission and throughout inpatient care, without documentation, was more likely for obstetric, gynaecology and urinary tract (OGU) or respiratory drugs. Documentation in the discharge communication that medication was intentionally stopped during inpatient care was less likely for cardiovascular, musculoskeletal and OGU drugs. Errors involving the dose were most likely for respiratory drugs. CONCLUSIONS The findings inform strategies to facilitate medication reconciliation on discharge from acute hospital care. PMID:21284705

Using novel Canadian resources to improve medication reconciliation at discharge: study protocol for a randomized controlled trial.

PubMed

Tamblyn, Robyn; Huang, Allen R; Meguerditchian, Ari N; Winslade, Nancy E; Rochefort, Christian; Forster, Alan; Eguale, Tewodros; Buckeridge, David; Jacques, André; Naicker, Kiyuri; Reidel, Kristen E

2012-08-27

Adverse drug events are responsible for up to 7% of all admissions to acute care hospitals. At least 58% of these are preventable, resulting from incomplete drug information, prescribing or dispensing errors, and overuse or underuse of medications. Effective implementation of medication reconciliation is considered essential to reduce preventable adverse drug events occurring at transitions between community and hospital care. An electronically enabled discharge reconciliation process represents an innovative approach to this problem. Participants will be recruited in Quebec and are eligible for inclusion if they are using prescription medication at admission, covered by the Quebec drug insurance plan, admitted from the community, 18 years or older, admitted to a general or intensive care medical or surgical unit, and discharged alive. A sample size of 3,714 will be required to detect a 5% reduction in adverse drug events. The intervention will comprise electronic retrieval of the community drug list, combined with an electronic discharge reconciliation module and an electronic discharge communication module. The primary outcomes will be adverse drug events occurring 30 days post-discharge, identified by a combination of patient self-report and chart abstraction. All emergency room visits and hospital readmission during this period will be measured as secondary outcomes. A cluster randomization approach will be used to allocate 16 medical and 10 surgical units to electronic discharge reconciliation and communication versus usual care. An intention-to-treat approach will be used to analyse data. Logistic regression will be undertaken within a generalized estimating equation framework to account for clustering within units. The goal of this prospective trial is to determine if electronically enabled discharge reconciliation will reduce the risk of adverse drug events, emergency room visits and readmissions 30 days post-discharge compared with usual care. We expect that this intervention will improve adherence to medication reconciliation at discharge, the accuracy of the community-based drug history and effective communication of hospital-based treatment changes to community care providers. The results may support policy-directed investments in computerizing and training of hospital staff, generate key requirements for future hospital accreditation standards, and highlight functional requirements for software vendors. NCT01179867.

Creating and evaluating an opportunity for medication reconciliation in the adult population of South Africa to improve patient care.

PubMed

Naicker, Pranusha; Schellack, Natalie; Godman, Brian; Bronkhorst, Elmien

2018-04-16

Adverse drug events (ADEs) are a major cause of morbidity and mortality, with more than 50% of ADEs being preventable. Adverse Drug Reactions (ADRs) are typically the result of an incomplete medication history, prescribing or dispensing error, as well as over- or under-use of prescribed pharmacotherapy. Medication reconciliation is the process of creating the most accurate list of medications a patient is taking and subsequently comparing the list against the different transitions of care. It is used to reduce medication discrepancies, and thereby ultimately decreasing ADEs. However, little is known about medicine reconciliation activities among public hospitals in South Africa. Prospective quantitative, descriptive design among Internal and Surgical wards in a leading public hospital in South Africa. 145 study participants were enrolled. Over 1300 (1329) medicines were reviewed of which there was a significant difference (p = 0.006) when comparing the medications that the patient was taking before or during hospitalisation. A total of 552 (41.53%) interventions were undertaken and the majority of patients had at least 3.96 medication discrepancies. The most common intervention upon admission was transcribing the home medication onto the hospital prescription (65.2%) followed by medication duplication (13.44%). During patient's hospital stay, interventions included patient counselling (32.5%) and stopping the previous treatment (37.5%). To ensure continuity of patient care, medication reconciliation should be implemented throughout patients' hospital stay. This involves all key professionals in hospitals.

Quality improvement through implementation of discharge order reconciliation.

PubMed

Lu, Yun; Clifford, Pamela; Bjorneby, Andreas; Thompson, Bruce; VanNorman, Samuel; Won, Katie; Larsen, Kevin

2013-05-01

A coordinated multidisciplinary process to reduce medication errors related to patient discharges to skilled-nursing facilities (SNFs) is described. After determining that medication errors were a frequent cause of readmission among patients discharged to SNFs, a medical center launched a two-phase quality-improvement project focused on cardiac and medical patients. Phase one of the project entailed a three-month failure modes and effects analysis of existing procedures discharge, followed by the development and pilot testing of a multidisciplinary, closed-loop workflow process involving staff and resident physicians, clinical nurse coordinators, and clinical pharmacists. During pilot testing of the new workflow process, the rate of discharge medication errors involving SNF patients was tracked, and data on medication-related readmissions in a designated intervention group (n = 87) and a control group of patients (n = 1893) discharged to SNFs via standard procedures during a nine-month period were collected, with the data stratified using severity of illness (SOI) classification. Analysis of the collected data indicated a cumulative 30-day medication-related readmission rate for study group patients in the minor, moderate, and major SOI categories of 5.4% (4 of 74 patients), compared with a rate of 9.5% (169 of 1780 patients) in the control group. In phase 2 of the project, the revised SNF discharge medication reconciliation procedure was implemented throughout the hospital; since hospitalwide implementation of the new workflow, the readmission rate for SNF patients has been maintained at about 6.7%. Implementing a standardized discharge order reconciliation process that includes pharmacists led to decreased readmission rates and improved care for patients discharged to SNFs.

Automated medication reconciliation and complexity of care transitions.

PubMed

Silva, Pamela A Bozzo; Bernstam, Elmer V; Markowitz, Eliz; Johnson, Todd R; Zhang, Jiajie; Herskovic, Jorge R

2011-01-01

Medication reconciliation is a National Patient Safety Goal (NPSG) from The Joint Commission (TJC) that entails reviewing all medications a patient takes after a health care transition. Medication reconciliation is a resource-intensive, error-prone task, and the resources to accomplish it may not be routinely available. Computer-based methods have the potential to overcome these barriers. We designed and explored a rule-based medication reconciliation algorithm to accomplish this task across different healthcare transitions. We tested our algorithm on a random sample of 94 transitions from the Clinical Data Warehouse at the University of Texas Health Science Center at Houston. We found that the algorithm reconciled, on average, 23.4% of the potentially reconcilable medications. Our study did not have sufficient statistical power to establish whether the kind of transition affects reconcilability. We conclude that automated reconciliation is possible and will help accomplish the NPSG.

Computerized pharmaceutical intervention to reduce reconciliation errors at hospital discharge in Spain: an interrupted time-series study.

PubMed

García-Molina Sáez, C; Urbieta Sanz, E; Madrigal de Torres, M; Vicente Vera, T; Pérez Cárceles, M D

2016-04-01

It is well known that medication reconciliation at discharge is a key strategy to ensure proper drug prescription and the effectiveness and safety of any treatment. Different types of interventions to reduce reconciliation errors at discharge have been tested, many of which are based on the use of electronic tools as they are useful to optimize the medication reconciliation process. However, not all countries are progressing at the same speed in this task and not all tools are equally effective. So it is important to collate updated country-specific data in order to identify possible strategies for improvement in each particular region. Our aim therefore was to analyse the effectiveness of a computerized pharmaceutical intervention to reduce reconciliation errors at discharge in Spain. A quasi-experimental interrupted time-series study was carried out in the cardio-pneumology unit of a general hospital from February to April 2013. The study consisted of three phases: pre-intervention, intervention and post-intervention, each involving 23 days of observations. At the intervention period, a pharmacist was included in the medical team and entered the patient's pre-admission medication in a computerized tool integrated into the electronic clinical history of the patient. The effectiveness was evaluated by the differences between the mean percentages of reconciliation errors in each period using a Mann-Whitney U test accompanied by Bonferroni correction, eliminating autocorrelation of the data by first using an ARIMA analysis. In addition, the types of error identified and their potential seriousness were analysed. A total of 321 patients (119, 105 and 97 in each phase, respectively) were included in the study. For the 3966 medicaments recorded, 1087 reconciliation errors were identified in 77·9% of the patients. The mean percentage of reconciliation errors per patient in the first period of the study was 42·18%, falling to 19·82% during the intervention period (P = 0·000). When the intervention was withdrawn, the mean percentage of reconciliation errors increased again to 27·72% (P = 0·008). The difference between the percentages of pre- and post-intervention periods was statistically significant (P = 0·000). Most reconciliation errors were due to omission (46·7%) or incomplete prescription (43·8%), and 35·3% of which could have caused harm to the patient. A computerized pharmaceutical intervention is shown to reduce reconciliation errors in the context of a high incidence of such errors. © 2016 John Wiley & Sons Ltd.

Rationale and design of the Multicenter Medication Reconciliation Quality Improvement Study (MARQUIS).

PubMed

Salanitro, Amanda H; Kripalani, Sunil; Resnic, Joanne; Mueller, Stephanie K; Wetterneck, Tosha B; Haynes, Katherine Taylor; Stein, Jason; Kaboli, Peter J; Labonville, Stephanie; Etchells, Edward; Cobaugh, Daniel J; Hanson, David; Greenwald, Jeffrey L; Williams, Mark V; Schnipper, Jeffrey L

2013-06-25

Unresolved medication discrepancies during hospitalization can contribute to adverse drug events, resulting in patient harm. Discrepancies can be reduced by performing medication reconciliation; however, effective implementation of medication reconciliation has proven to be challenging. The goals of the Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS) are to operationalize best practices for inpatient medication reconciliation, test their effect on potentially harmful unintentional medication discrepancies, and understand barriers and facilitators of successful implementation. Six U.S. hospitals are participating in this quality improvement mentored implementation study. Each hospital has collected baseline data on the primary outcome: the number of potentially harmful unintentional medication discrepancies per patient, as determined by a trained on-site pharmacist taking a "gold standard" medication history. With the guidance of their mentors, each site has also begun to implement one or more of 11 best practices to improve medication reconciliation. To understand the effect of the implemented interventions on hospital staff and culture, we are performing mixed methods program evaluation including surveys, interviews, and focus groups of front line staff and hospital leaders. At baseline the number of unintentional medication discrepancies in admission and discharge orders per patient varies by site from 2.35 to 4.67 (mean=3.35). Most discrepancies are due to history errors (mean 2.12 per patient) as opposed to reconciliation errors (mean 1.23 per patient). Potentially harmful medication discrepancies averages 0.45 per patient and varies by site from 0.13 to 0.82 per patient. We discuss several barriers to implementation encountered thus far. In the end, we anticipate that MARQUIS tools and lessons learned have the potential to decrease medication discrepancies and improve patient outcomes. Clinicaltrials.gov identifier NCT01337063.

Rationale and design of the Multicenter Medication Reconciliation Quality Improvement Study (MARQUIS)

PubMed Central

2013-01-01

Background Unresolved medication discrepancies during hospitalization can contribute to adverse drug events, resulting in patient harm. Discrepancies can be reduced by performing medication reconciliation; however, effective implementation of medication reconciliation has proven to be challenging. The goals of the Multi-Center Medication Reconciliation Quality Improvement Study (MARQUIS) are to operationalize best practices for inpatient medication reconciliation, test their effect on potentially harmful unintentional medication discrepancies, and understand barriers and facilitators of successful implementation. Methods Six U.S. hospitals are participating in this quality improvement mentored implementation study. Each hospital has collected baseline data on the primary outcome: the number of potentially harmful unintentional medication discrepancies per patient, as determined by a trained on-site pharmacist taking a “gold standard” medication history. With the guidance of their mentors, each site has also begun to implement one or more of 11 best practices to improve medication reconciliation. To understand the effect of the implemented interventions on hospital staff and culture, we are performing mixed methods program evaluation including surveys, interviews, and focus groups of front line staff and hospital leaders. Discussion At baseline the number of unintentional medication discrepancies in admission and discharge orders per patient varies by site from 2.35 to 4.67 (mean=3.35). Most discrepancies are due to history errors (mean 2.12 per patient) as opposed to reconciliation errors (mean 1.23 per patient). Potentially harmful medication discrepancies averages 0.45 per patient and varies by site from 0.13 to 0.82 per patient. We discuss several barriers to implementation encountered thus far. In the end, we anticipate that MARQUIS tools and lessons learned have the potential to decrease medication discrepancies and improve patient outcomes. Trial registration Clinicaltrials.gov identifier NCT01337063 PMID:23800355

Effect of medication reconciliation on medication costs after hospital discharge in relation to hospital pharmacy labor costs.

PubMed

Karapinar-Çarkit, Fatma; Borgsteede, Sander D; Zoer, Jan; Egberts, Toine C G; van den Bemt, Patricia M L A; van Tulder, Maurits

2012-03-01

Medication reconciliation aims to correct discrepancies in medication use between health care settings and to check the quality of pharmacotherapy to improve effectiveness and safety. In addition, medication reconciliation might also reduce costs. To evaluate the effect of medication reconciliation on medication costs after hospital discharge in relation to hospital pharmacy labor costs. A prospective observational study was performed. Patients discharged from the pulmonology department were included. A pharmacy team assessed medication errors prevented by medication reconciliation. Interventions were classified into 3 categories: correcting hospital formulary-induced medication changes (eg, reinstating less costly generic drugs used before admission), optimizing pharmacotherapy (eg, discontinuing unnecessary laxative), and eliminating discrepancies (eg, restarting omitted preadmission medication). Because eliminating discrepancies does not represent real costs to society (before hospitalization, the patient was also using the medication), these medication costs were not included in the cost calculation. Medication costs at 1 month and 6 months after hospital discharge and the associated labor costs were assessed using descriptive statistics and scenario analyses. For the 6-month extrapolation, only medication intended for chronic use was included. Two hundred sixty-two patients were included. Correcting hospital formulary changes saved €1.63/patient (exchange rate: EUR 1 = USD 1.3443) in medication costs at 1 month after discharge and €9.79 at 6 months. Optimizing pharmacotherapy saved €20.13/patient in medication costs at 1 month and €86.86 at 6 months. The associated labor costs for performing medication reconciliation were €41.04/patient. Medication cost savings from correcting hospital formulary-induced changes and optimizing of pharmacotherapy (€96.65/patient) outweighed the labor costs at 6 months extrapolation by €55.62/patient (sensitivity analysis €37.25-71.10). Preventing medication errors through medication reconciliation results in higher benefits than the costs related to the net time investment.

Medication reconciliation in acute care: ensuring an accurate drug regimen on admission and discharge.

PubMed

Rodehaver, Claire; Fearing, Deb

2005-07-01

Several factors contribute to the potential for patient confusion regarding his or her medication regimen, including multiple names for a single drug and formulary variations when the patient receives medications from more than one pharmacy. A 68-year-old woman was discharged from the hospital on a HMG-CoA reductase inhibitor (statin) and resumed her home statin. Eleven days later she returned to the hospital with a diagnosis of severe rhabdomyolysis due to statin overdose. IMPLEMENTING SOLUTIONS: Miami Valley Hospital, Dayton, Ohio, implemented a reconciliation process and order form at admission and discharge to reduce the likelihood that this miscommunication would recur. Initial efforts were trialed on a 44-bed orthopedic unit, with spread of the initiative to the cardiac units and finally to the remaining 22 nursing units. The team successfully implemented initiation of the order sheet, yet audits indicated the need for improvement in reconciling the medications within 24 hours of admission and in reconciling the home medications at the point of discharge. Successful implementation of the order sheet to drive reconciliation takes communication, perseverance, and a multidisciplinary team approach.

Impact of pharmacy technician-centered medication reconciliation on optimization of antiretroviral therapy and opportunistic infection prophylaxis in hospitalized patients with HIV/AIDS.

PubMed

Siemianowski, Laura A; Sen, Sanchita; George, Jomy M

2013-08-01

This study aimed to examine the role of a pharmacy technician-centered medication reconciliation (PTMR) program in optimization of medication therapy in hospitalized patients with HIV/AIDS. A chart review was conducted for all inpatients that had a medication reconciliation performed by the PTMR program. Adult patients with HIV and antiretroviral therapy (ART) and/or the opportunistic infection (OI) prophylaxis listed on the medication reconciliation form were included. The primary objective is to describe the (1) number and types of medication errors and (2) the percentage of patients who received appropriate ART. The secondary objective is a comparison of the number of medication errors between standard mediation reconciliation and a pharmacy-led program. In the PTMR period, 55 admissions were evaluated. In all, 50% of the patients received appropriate ART. In 27of the 55 admissions, there were 49 combined ART and OI-related errors. The most common ART-related errors were drug-drug interactions. The incidence of ART-related medication errors that included drug-drug interactions and renal dosing adjustments were similar between the pre-PTMR and PTMR groups (P = .0868). Of the 49 errors in the PTMR group, 18 were intervened by a medication reconciliation pharmacist. A PTMR program has a positive impact on optimizing ART and OI prophylaxis in patients with HIV/AIDS.

Impact of a pharmacy technician-centered medication reconciliation program on medication discrepancies and implementation of recommendations.

PubMed

Kraus, Sarah K; Sen, Sanchita; Murphy, Michelle; Pontiggia, Laura

2017-01-01

To evaluate the impact of a pharmacy-technician centered medication reconciliation (PTMR) program by identifying and quantifying medication discrepancies and outcomes of pharmacist medication reconciliation recommendations. A retrospective chart review was performed on two-hundred patients admitted to the internal medicine teaching services at Cooper University Hospital in Camden, NJ. Patients were selected using a stratified systematic sample approach and were included if they received a pharmacy technician medication history and a pharmacist medication reconciliation at any point during their hospital admission. Pharmacist identified medication discrepancies were analyzed using descriptive statistics, bivariate analyses. Potential risk factors were identified using multivariate analyses, such as logistic regression and CART. The priority level of significance was set at 0.05. Three-hundred and sixty-five medication discrepancies were identified out of the 200 included patients. The four most common discrepancies were omission (64.7%), non-formulary omission (16.2%), dose discrepancy (10.1%), and frequency discrepancy (4.1%). Twenty-two percent of pharmacist recommendations were implemented by the prescriber within 72 hours. A PTMR program with dedicated pharmacy technicians and pharmacists identifies many medication discrepancies at admission and provides opportunities for pharmacist reconciliation recommendations.

Impact of a pharmacy technician-centered medication reconciliation program on medication discrepancies and implementation of recommendations

PubMed Central

2016-01-01

Objectives: To evaluate the impact of a pharmacy-technician centered medication reconciliation (PTMR) program by identifying and quantifying medication discrepancies and outcomes of pharmacist medication reconciliation recommendations. Methods: A retrospective chart review was performed on two-hundred patients admitted to the internal medicine teaching services at Cooper University Hospital in Camden, NJ. Patients were selected using a stratified systematic sample approach and were included if they received a pharmacy technician medication history and a pharmacist medication reconciliation at any point during their hospital admission. Pharmacist identified medication discrepancies were analyzed using descriptive statistics, bivariate analyses. Potential risk factors were identified using multivariate analyses, such as logistic regression and CART. The priority level of significance was set at 0.05. Results: Three-hundred and sixty-five medication discrepancies were identified out of the 200 included patients. The four most common discrepancies were omission (64.7%), non-formulary omission (16.2%), dose discrepancy (10.1%), and frequency discrepancy (4.1%). Twenty-two percent of pharmacist recommendations were implemented by the prescriber within 72 hours. Conclusion: A PTMR program with dedicated pharmacy technicians and pharmacists identifies many medication discrepancies at admission and provides opportunities for pharmacist reconciliation recommendations. PMID:28690691

[Structured medication management in primary care - a tool to promote medication safety].

PubMed

Mahler, Cornelia; Freund, Tobias; Baldauf, Annika; Jank, Susanne; Ludt, Sabine; Peters-Klimm, Frank; Haefeli, Walter Emil; Szecsenyi, Joachim

2014-01-01

Patients with chronic disease usually need to take multiple medications. Drug-related interactions, adverse events, suboptimal adherence, and self-medication are components that can affect medication safety and lead to serious consequences for the patient. At present, regular medication reviews to check what medicines have been prescribed and what medicines are actually taken by the patient or the structured evaluation of drug-related problems rarely take place in Germany. The process of "medication reconciliation" or "medication review" as developed in the USA and the UK aim at increasing medication safety and therefore represent an instrument of quality assurance. Within the HeiCare(®) project a structured medication management was developed for general practice, with medical assistants playing a major role in the implementation of the process. Both the structured medication management and the tools developed for the medication check and medication counselling will be outlined in this article; also, findings on feasibility and acceptance in various projects and experiences from a total of 200 general practices (56 HeiCare(®), 29 HiCMan,115 PraCMan) will be described. The results were obtained from questionnaires and focus group discussions. The implementation of a structured medication management intervention into daily routine was seen as a challenge. Due to the high relevance of medication reconciliation for daily clinical practice, however, the checklists - once implemented successfully - have been applied even after the end of the project. They have led to the regular review and reconciliation of the physicians' documentation of the medicines prescribed (medication chart) with the medicines actually taken by the patient. Copyright © 2013. Published by Elsevier GmbH.

An Insurer's Care Transition Program Emphasizes Medication Reconciliation, Reduces Readmissions And Costs.

PubMed

Polinski, Jennifer M; Moore, Janice M; Kyrychenko, Pavlo; Gagnon, Michael; Matlin, Olga S; Fredell, Joshua W; Brennan, Troyen A; Shrank, William H

2016-07-01

Adverse drug events and the challenges of clarifying and adhering to complex medication regimens are central drivers of hospital readmissions. Medication reconciliation programs can reduce the incidence of adverse drug events after discharge, but evidence regarding the impact of medication reconciliation on readmission rates and health care costs is less clear. We studied an insurer-initiated care transition program based on medication reconciliation delivered by pharmacists via home visits and telephone and explored its effects on high-risk patients. We examined whether voluntary program participation was associated with improved medication use, reduced readmissions, and savings net of program costs. Program participants had a 50 percent reduced relative risk of readmission within thirty days of discharge and an absolute risk reduction of 11.1 percent. The program saved $2 for every $1 spent. These results represent real-world evidence that insurer-initiated, pharmacist-led care transition programs, focused on but not limited to medication reconciliation, have the potential to both improve clinical outcomes and reduce total costs of care. Project HOPE—The People-to-People Health Foundation, Inc.

Simulated Order Verification and Medication Reconciliation during an Introductory Pharmacy Practice Experience.

PubMed

Metzger, Nicole L; Chesson, Melissa M; Momary, Kathryn M

2015-09-25

Objective. To create, implement, and assess a simulated medication reconciliation and an order verification activity using hospital training software. Design. A simulated patient with medication orders and home medications was built into existing hospital training software. Students in an institutional introductory pharmacy practice experience (IPPE) reconciled the patient's medications and determined whether or not to verify the inpatient orders based on his medical history and laboratory data. After reconciliation, students identified medication discrepancies and documented their rationale for rejecting inpatient orders. Assessment. For a 3-year period, the majority of students agreed the simulation enhanced their learning, taught valuable clinical decision-making skills, integrated material from previous courses, and stimulated their interest in institutional pharmacy. Overall feedback from student evaluations about the IPPE also was favorable. Conclusion. Use of existing hospital training software can affordably simulate the pharmacist's role in order verification and medication reconciliation, as well as improve clinical decision-making.

Positive recognition program increases compliance with medication reconciliation by resident physicians in an outpatient clinic.

PubMed

Neufeld, Nathan J; González Fernández, Marlís; Christo, Paul J; Williams, Kayode A

2013-01-01

The purpose of this study was to determine if well-understood, positive reinforcement performance improvement models can successfully improve compliance by resident physicians with medication reconciliation in an outpatient clinical setting. During the preintervention phase, 36 anesthesiology residents who rotate in an outpatient pain clinic were instructed in the medication reconciliation process. During the postintervention phase, instruction was given, and then improvement was recognized publicly. Data on physician compliance were collected monthly. The authors performed a secondary analysis of the audit database, which contained 1733 patient charts. The data were divided into preintervention and postintervention phases for comparison. A 4-fold increase in compliance was found. When logistic regression was used to adjust for adaptation of resident physicians over time and year, the odds of reconciling were 82% higher postintervention. By the consistent application of this effective tool, the authors have demonstrated that sustained performance of a tedious but important task can be achieved.

Role of Social Knowledge Networking technology in facilitating meaningful use of Electronic Health Record medication reconciliation.

PubMed

Rangachari, Pavani

2016-06-01

Despite the federal policy impetus towards EHR Medication Reconciliation, hospital adherence has lagged for one chief reason; low physician engagement, which in turn emanates from lack of consensus in regard to which physician is responsible for managing a patient's medication list, and the importance of medication reconciliation as a tool for improving patient safety and quality of care. The Technology-in-Practice (TIP) framework stresses the role of human action in enacting structures of technology use or "technologies-in-practice." Applying the TIP framework to the EHR Medication Reconciliation context, helps frame the problem as one of low physician engagement in performing EHR Medication Reconciliation, translating to limited-use-EHR-in-practice. Concurrently, the problem suggests a hierarchical network structure, reflecting limited communication among hospital administrators and clinical providers on the importance of EHR Medication Reconciliation in improving patient safety. Integrating the TIP literature with the more recent knowledge-in-Practice (KIP) literature suggests that EHR-in-practice could be transformed from "limited use" to "meaningful use" through the use of Social Knowledge Networking (SKN) Technology to create new social network structures, and enable engagement, learning, and practice change. Correspondingly, the objectives of this paper are to: 1) Conduct a narrative review of the literature on "technology use," to understand how technologies-in-practice may be transformed from limited use to meaningful use; 2) Conduct a narrative review of the literature on "organizational change implementation," to understand how changes in technology use could be successfully implemented and sustained in a healthcare organizational context; and 3) Apply lessons learned from the narrative literature reviews to identify strategies for the meaningful use and successful implementation of EHR Medication Reconciliation technology.

Medication reconciliation accuracy and patient understanding of intended medication changes on hospital discharge.

PubMed

Ziaeian, Boback; Araujo, Katy L B; Van Ness, Peter H; Horwitz, Leora I

2012-11-01

Adverse drug events after hospital discharge are common and often serious. These events may result from provider errors or patient misunderstanding. To determine the prevalence of medication reconciliation errors and patient misunderstanding of discharge medications. Prospective cohort study Patients over 64 years of age admitted with heart failure, acute coronary syndrome or pneumonia and discharged to home. We assessed medication reconciliation accuracy by comparing admission to discharge medication lists and reviewing charts to resolve discrepancies. Medication reconciliation changes that did not appear intentional were classified as suspected provider errors. We assessed patient understanding of intended medication changes through post-discharge interviews. Understanding was scored as full, partial or absent. We tested the association of relevance of the medication to the primary diagnosis with medication accuracy and with patient understanding, accounting for patient demographics, medical team and primary diagnosis. A total of 377 patients were enrolled in the study. A total of 565/2534 (22.3 %) of admission medications were redosed or stopped at discharge. Of these, 137 (24.2 %) were classified as suspected provider errors. Excluding suspected errors, patients had no understanding of 142/205 (69.3 %) of redosed medications, 182/223 (81.6 %) of stopped medications, and 493 (62.0 %) of new medications. Altogether, 307 patients (81.4 %) either experienced a provider error, or had no understanding of at least one intended medication change. Providers were significantly more likely to make an error on a medication unrelated to the primary diagnosis than on a medication related to the primary diagnosis (odds ratio (OR) 4.56, 95 % confidence interval (CI) 2.65, 7.85, p<0.001). Patients were also significantly more likely to misunderstand medication changes unrelated to the primary diagnosis (OR 2.45, 95 % CI 1.68, 3.55), p<0.001). Medication reconciliation and patient understanding are inadequate in older patients post-discharge. Errors and misunderstandings are particularly common in medications unrelated to the primary diagnosis. Efforts to improve medication reconciliation and patient understanding should not be disease-specific, but should be focused on the whole patient.

Effect of therapeutic interchange on medication reconciliation during hospitalization and upon discharge in a geriatric population

PubMed Central

Wang, Jessica S.; Fogerty, Robert L.

2017-01-01

Background Therapeutic interchange of a same class medication for an outpatient medication is a widespread practice during hospitalization in response to limited hospital formularies. However, therapeutic interchange may increase risk of medication errors. The objective was to characterize the prevalence and safety of therapeutic interchange. Methods and findings Secondary analysis of a transitions of care study. We included patients over age 64 admitted to a tertiary care hospital between 2009–2010 with heart failure, pneumonia, or acute coronary syndrome who were taking a medication in any of six commonly-interchanged classes on admission: proton pump inhibitors (PPIs), histamine H2-receptor antagonists (H2 blockers), hydroxymethylglutaryl CoA reductase inhibitors (statins), angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and inhaled corticosteroids (ICS). There was limited electronic medication reconciliation support available. Main measures were presence and accuracy of therapeutic interchange during hospitalization, and rate of medication reconciliation errors on discharge. We examined charts of 303 patients taking 555 medications at time of admission in the six medication classes of interest. A total of 244 (44.0%) of medications were therapeutically interchanged to an approved formulary drug at admission, affecting 64% of the study patients. Among the therapeutically interchanged drugs, we identified 78 (32.0%) suspected medication conversion errors. The discharge medication reconciliation error rate was 11.5% among the 244 therapeutically interchanged medications, compared with 4.2% among the 311 unchanged medications (relative risk [RR] 2.75, 95% confidence interval [CI] 1.45–5.19). Conclusions Therapeutic interchange was prevalent among hospitalized patients in this study and elevates the risk for potential medication errors during and after hospitalization. Improved electronic systems for managing therapeutic interchange and medication reconciliation may be valuable. PMID:29049325

Rethinking the outpatient medication list: increasing patient activation and education while architecting for centralization and improved medication reconciliation.

PubMed

Pandolfe, Frank; Wright, Adam; Slack, Warner V; Safran, Charles

2018-05-17

Identify barriers impacting the time consuming and error fraught process of medication reconciliation. Design and implement an electronic medication management system where patient and trusted healthcare proxies can participate in establishing and maintaining an inclusive and up-to-date list of medications. A patient-facing electronic medication manager was deployed within an existing research project focused on elder care management funded by the AHRQ, InfoSAGE, allowing patients and patients' proxies the ability to build and maintain an accurate and up-to-date medication list. Free and open-source tools available from the U.S. government were used to embed the tenets of centralization, interoperability, data federation, and patient activation into the design. Using patient-centered design and free, open-source tools, we implemented a web and mobile enabled patient-facing medication manager for complex medication management. Patient and caregiver participation are essential to improve medication safety. Our medication manager is an early step towards a patient-facing medication manager that has been designed with data federation and interoperability in mind.

A Quantitative Evaluation of Medication Histories and Reconciliation by Discipline

PubMed Central

Stewart, Michael R.; Fogg, Sarah M.; Schminke, Brandon C.; Zackula, Rosalee E.; Nester, Tina M.; Eidem, Leslie A.; Rosendale, James C.; Ragan, Robert H.; Bond, Jack A.; Goertzen, Kreg W.

2014-01-01

Abstract Background/Objective: Medication reconciliation at transitions of care decreases medication errors, hospitalizations, and adverse drug events. We compared inpatient medication histories and reconciliation across disciplines and evaluated the nature of discrepancies. Methods: We conducted a prospective cohort study of patients admitted from the emergency department at our 760-bed hospital. Eligible patients had their medication histories conducted and reconciled in order by the admitting nurse (RN), certified pharmacy technician (CPhT), and pharmacist (RPh). Discharge medication reconciliation was not altered. Admission and discharge discrepancies were categorized by discipline, error type, and drug class and were assigned a criticality index score. A discrepancy rating system systematically measured discrepancies. Results: Of 175 consented patients, 153 were evaluated. Total admission and discharge discrepancies were 1,461 and 369, respectively. The average number of medications per participant at admission was 8.59 (1,314) with 9.41 (1,374) at discharge. Most discrepancies were committed by RNs: 53.2% (777) at admission and 56.1% (207) at discharge. The majority were omitted or incorrect. RNs had significantly higher admission discrepancy rates per medication (0.59) compared with CPhTs (0.36) and RPhs (0.16) (P < .001). RPhs corrected significantly more discrepancies per participant than RNs (6.39 vs 0.48; P < .001); average criticality index reduction was 79.0%. Estimated prevented adverse drug events (pADEs) cost savings were $589,744. Conclusions: RPhs committed the fewest discrepancies compared with RNs and CPhTs, resulting in more accurate medication histories and reconciliation. RPh involvement also prevented the greatest number of medication errors, contributing to considerable pADE-related cost savings. PMID:25477614

Impact of medication reconciliation and review and counselling, on adverse drug events and healthcare resource use.

PubMed

Al-Hashar, Amna; Al-Zakwani, Ibrahim; Eriksson, Tommy; Sarakbi, Alaa; Al-Zadjali, Badriya; Al Mubaihsi, Saif; Al Zaabi, Mohammed

2018-05-12

Background Adverse drug events from preventable medication errors can result in patient morbidity and mortality, and in cost to the healthcare system. Medication reconciliation can improve communication and reduce medication errors at transitions in care. Objective Evaluate the impact of medication reconciliation and counselling intervention delivered by a pharmacist for medical patients on clinical outcomes 30 days after discharge. Setting Sultan Qaboos University Hospital, Muscat, Oman. Methods A randomized controlled study comparing standard care with an intervention delivered by a pharmacist and comprising medication reconciliation on admission and discharge, a medication review, a bedside medication counselling, and a take-home medication list. Medication discrepancies during hospitalization were identified and reconciled. Clinical outcomes were evaluated by reviewing electronic health records and telephone interviews. Main outcome measures Rates of preventable adverse drug events as primary outcome and healthcare resource utilization as secondary outcome at 30 days post discharge. Results A total of 587 patients were recruited (56 ± 17 years, 57% female); 286 randomized to intervention; 301 in the standard care group. In intervention arm, 74 (26%) patients had at least one discrepancy on admission and 100 (35%) on discharge. Rates of preventable adverse drug events were significantly lower in intervention arm compared to standard care arm (9.1 vs. 16%, p = 0.009). No significant difference was found in healthcare resource use. Conclusion The implementation of an intervention comprising medication reconciliation and counselling by a pharmacist has significantly reduced the rate of preventable ADEs 30 days post discharge, compared to the standard care. The effect of the intervention on healthcare resource use was insignificant. Pharmacists should be included in decentralized, patient-centred roles. The findings should be interpreted in the context of the study's limitations.

Patient Summary and medicines reconciliation: application of the ISO/CEN EN 13606 standard in clinical practice.

PubMed

Farfán Sedano, Francisco J; Terrón Cuadrado, Marta; Castellanos Clemente, Yolanda; Serrano Balazote, Pablo; Moner Cano, David; Robles Viejo, Montserrat

2011-01-01

The comparison of the patient's current medication list with the medication being ordered when admitted to Hospital, identifying omissions, duplications, dosing errors, and potential interactions, constitutes the core process of medicines reconciliation. Access to the medication the patient is taking at home could be unfeasible as this information is frequently stored in various locations and in diverse proprietary formats. The lack of interoperability between those information systems, namely the Primary Care and the Specialized Electronic Health Records (EHRs), facilitates medication errors and endangers patient safety. Thus, the development of a Patient Summary that includes clinical data from different electronic systems will allow doctors access to relevant information enabling a safer and more efficient assistance. Such a collection of data from heterogeneous and distributed systems has been achieved in this Project through the construction of a federated view based on the ISO/CEN EN13606 Standard for architecture and communication of EHRs.

Towards a Collaborative Filtering Approach to Medication Reconciliation

PubMed Central

Hasan, Sharique; Duncan, George T.; Neill, Daniel B.; Padman, Rema

2008-01-01

A physician’s prescribing decisions depend on knowledge of the patient’s medication list. This knowledge is often incomplete, and errors or omissions could result in adverse outcomes. To address this problem, the Joint Commission recommends medication reconciliation for creating a more accurate list of a patient’s medications. In this paper, we develop techniques for automatic detection of omissions in medication lists, identifying drugs that the patient may be taking but are not on the patient’s medication list. Our key insight is that this problem is analogous to the collaborative filtering framework increasingly used by online retailers to recommend relevant products to customers. The collaborative filtering approach enables a variety of solution techniques, including nearest neighbor and co-occurrence approaches. We evaluate the effectiveness of these approaches using medication data from a long-term care center in the Eastern US. Preliminary results suggest that this framework may become a valuable tool for medication reconciliation. PMID:18998834

Towards a collaborative filtering approach to medication reconciliation.

PubMed

Hasan, Sharique; Duncan, George T; Neill, Daniel B; Padman, Rema

2008-11-06

A physicians prescribing decisions depend on knowledge of the patients medication list. This knowledge is often incomplete, and errors or omissions could result in adverse outcomes. To address this problem, the Joint Commission recommends medication reconciliation for creating a more accurate list of a patients medications. In this paper, we develop techniques for automatic detection of omissions in medication lists, identifying drugs that the patient may be taking but are not on the patients medication list. Our key insight is that this problem is analogous to the collaborative filtering framework increasingly used by online retailers to recommend relevant products to customers. The collaborative filtering approach enables a variety of solution techniques, including nearest neighbor and co-occurrence approaches. We evaluate the effectiveness of these approaches using medication data from a long-term care center in the Eastern US. Preliminary results suggest that this framework may become a valuable tool for medication reconciliation.

[Medication reconciliation: an innovative experience in an internal medicine unit to decrease errors due to inacurrate medication histories].

PubMed

Pérennes, Maud; Carde, Axel; Nicolas, Xavier; Dolz, Manuel; Bihannic, René; Grimont, Pauline; Chapot, Thierry; Granier, Hervé

2012-03-01

An inaccurate medication history may prevent the discovery of a pre-admission iatrogenic event or lead to interrupted drug therapy during hospitalization. Medication reconciliation is a process that ensures the transfer of medication information at admission to the hospital. The aims of this prospective study were to evaluate the interest in clinical practice of this concept and the resources needed for its implementation. We chose to include patients aged 65 years or over admitted in the internal medicine unit between June and October 2010. We obtained an accurate list of each patient's home medications. This list was then compared with medication orders. All medication variances were classified as intended or unintended. An internist and a pharmacist classified the clinical importance of each unintended variance. Sixty-one patients (mean age: 78 ± 7.4 years) were included in our study. We identified 38 unintended discrepancies. The average number of unintended discrepancies was 0.62 per patient. Twenty-five patients (41%) had one or more unintended discrepancies at admission. The contact with the community pharmacist permitted us to identify 21 (55%) unintended discrepancies. The most common errors were the omission of a regularly used medication (76%) and an incorrect dosage (16%). Our intervention resulted in order changes by the physician for 30 (79%) unintended discrepancies. Fifty percent of the unintended variances were judged by the internist and 76% by the pharmacist to be clinically significant. The admission to the hospital is a critical transition point for the continuity of care in medication management. Medication reconciliation can identify and resolve errors due to inaccurate medication histories. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

Medication reconciliation in pediatric cardiology performed by a pharmacy technician: a prospective cohort comparison study.

PubMed

Chan, Carol; Woo, Renée; Seto, Winnie; Pong, Sandra; Gilhooly, Tessie; Russell, Jennifer

2015-01-01

Medication reconciliation reduces potential medication discrepancies and adverse drug events. The role of pharmacy technicians in obtaining best possible medication histories (BPMHs) and performing reconciliation at the admission and transfer interfaces of care for pediatric patients has not been described. To compare the completeness and accuracy of BPMHs and reconciliation conducted by a pharmacy technician (pilot study) and by nurses and/or pharmacists (baseline). The severity of identified unintentional discrepancies was rated to determine their clinical importance. This prospective cohort comparison study involved patients up to 18 years of age admitted to and/or transferred between the Cardiology ward and the Cardiac Critical Care Unit of a pediatric tertiary care teaching hospital. A pharmacy resident conducted two 3-week audits: the first to assess the completeness and accuracy of BPMHs and reconciliation performed by nurses and/or pharmacists and the second to assess the completeness and accuracy of BPMHs and reconciliation performed by a pharmacy technician. The total number of patients was 38 in the baseline phase and 46 in the pilot period. There were no statistically significant differences between the baseline and pilot audits in terms of completion of BPMH (82% [28/34] versus 78% [21/27], p = 0.75) or completion of reconciliation (70% [23/33] versus 75% [15/20], p = 0.76) within 24 h of admission. Completeness of transfer reconciliation was significantly higher during the pilot study than at baseline (91% [31/34] versus 61% [11/18], p = 0.022). No significant differences between the baseline and pilot audits were found in the proportions of patients with at least one BPMH discrepancy (38% [13/34] versus 22% [6/27], p = 0.27), at least one unintentional discrepancy upon admission (21% [7/33] versus 10% [2/20], p = 0.46), or at least one unintentional discrepancy at the transfer interface (6% [1/18] versus 3% [1/34], p = 0.58). None of the 16 unintentional discrepancies were rated as causing severe patient discomfort or clinical deterioration. A trained pharmacy technician can perform admission and transfer medication reconciliation for pediatric patients with completeness and accuracy comparable to those of nurses and pharmacists. Future studies should explore the sustainability and cost-effectiveness of this practice model.

Medication Reconciliation in Pediatric Cardiology Performed by a Pharmacy Technician: A Prospective Cohort Comparison Study

PubMed Central

Chan, Carol; Woo, Renée; Seto, Winnie; Pong, Sandra; Gilhooly, Tessie; Russell, Jennifer

2015-01-01

Background: Medication reconciliation reduces potential medication discrepancies and adverse drug events. The role of pharmacy technicians in obtaining best possible medication histories (BPMHs) and performing reconciliation at the admission and transfer interfaces of care for pediatric patients has not been described. Objectives: To compare the completeness and accuracy of BPMHs and reconciliation conducted by a pharmacy technician (pilot study) and by nurses and/or pharmacists (baseline). The severity of identified unintentional discrepancies was rated to determine their clinical importance. Methods: This prospective cohort comparison study involved patients up to 18 years of age admitted to and/or transferred between the Cardiology ward and the Cardiac Critical Care Unit of a pediatric tertiary care teaching hospital. A pharmacy resident conducted two 3-week audits: the first to assess the completeness and accuracy of BPMHs and reconciliation performed by nurses and/or pharmacists and the second to assess the completeness and accuracy of BPMHs and reconciliation performed by a pharmacy technician. Results: The total number of patients was 38 in the baseline phase and 46 in the pilot period. There were no statistically significant differences between the baseline and pilot audits in terms of completion of BPMH (82% [28/34] versus 78% [21/27], p = 0.75) or completion of reconciliation (70% [23/33] versus 75% [15/20], p = 0.76) within 24 h of admission. Completeness of transfer reconciliation was significantly higher during the pilot study than at baseline (91% [31/34] versus 61% [11/18], p = 0.022). No significant differences between the baseline and pilot audits were found in the proportions of patients with at least one BPMH discrepancy (38% [13/34] versus 22% [6/27], p = 0.27), at least one unintentional discrepancy upon admission (21% [7/33] versus 10% [2/20], p = 0.46), or at least one unintentional discrepancy at the transfer interface (6% [1/18] versus 3% [1/34], p = 0.58). None of the 16 unintentional discrepancies were rated as causing severe patient discomfort or clinical deterioration. Conclusions: A trained pharmacy technician can perform admission and transfer medication reconciliation for pediatric patients with completeness and accuracy comparable to those of nurses and pharmacists. Future studies should explore the sustainability and cost-effectiveness of this practice model. PMID:25762814

Automated Communication Tools and Computer-Based Medication Reconciliation to Decrease Hospital Discharge Medication Errors.

PubMed

Smith, Kenneth J; Handler, Steven M; Kapoor, Wishwa N; Martich, G Daniel; Reddy, Vivek K; Clark, Sunday

2016-07-01

This study sought to determine the effects of automated primary care physician (PCP) communication and patient safety tools, including computerized discharge medication reconciliation, on discharge medication errors and posthospitalization patient outcomes, using a pre-post quasi-experimental study design, in hospitalized medical patients with ≥2 comorbidities and ≥5 chronic medications, at a single center. The primary outcome was discharge medication errors, compared before and after rollout of these tools. Secondary outcomes were 30-day rehospitalization, emergency department visit, and PCP follow-up visit rates. This study found that discharge medication errors were lower post intervention (odds ratio = 0.57; 95% confidence interval = 0.44-0.74; P < .001). Clinically important errors, with the potential for serious or life-threatening harm, and 30-day patient outcomes were not significantly different between study periods. Thus, automated health system-based communication and patient safety tools, including computerized discharge medication reconciliation, decreased hospital discharge medication errors in medically complex patients. © The Author(s) 2015.

Usability evaluation of a medication reconciliation tool: Embedding safety probes to assess users' detection of medication discrepancies.

PubMed

Russ, Alissa L; Jahn, Michelle A; Patel, Himalaya; Porter, Brian W; Nguyen, Khoa A; Zillich, Alan J; Linsky, Amy; Simon, Steven R

2018-06-01

An electronic medication reconciliation tool was previously developed by another research team to aid provider-patient communication for medication reconciliation. To evaluate the usability of this tool, we integrated artificial safety probes into standard usability methods. The objective of this article is to describe this method of using safety probes, which enabled us to evaluate how well the tool supports users' detection of medication discrepancies. We completed a mixed-method usability evaluation in a simulated setting with 30 participants: 20 healthcare professionals (HCPs) and 10 patients. We used factual scenarios but embedded three artificial safety probes: (1) a missing medication (i.e., omission); (2) an extraneous medication (i.e., commission); and (3) an inaccurate dose (i.e., dose discrepancy). We measured users' detection of each probe to estimate the probability that a HCP or patient would detect these discrepancies. Additionally, we recorded participants' detection of naturally occurring discrepancies. Each safety probe was detected by ≤50% of HCPs. Patients' detection rates were generally higher. Estimates indicate that a HCP and patient, together, would detect 44.8% of these medication discrepancies. Additionally, HCPs and patients detected 25 and 45 naturally-occurring discrepancies, respectively. Overall, detection of medication discrepancies was low. Findings indicate that more advanced interface designs are warranted. Future research is needed on how technologies can be designed to better aid HCPs' and patients' detection of medication discrepancies. This is one of the first studies to evaluate the usability of a collaborative medication reconciliation tool and assess HCPs' and patients' detection of medication discrepancies. Results demonstrate that embedded safety probes can enhance standard usability methods by measuring additional, clinically-focused usability outcomes. The novel safety probes we used may serve as an initial, standard set for future medication reconciliation research. More prevalent use of safety probes could strengthen usability research for a variety of health information technologies. Published by Elsevier Inc.

Evaluation of Time Spent by Pharmacists and Nurses Based on the Location of Pharmacist Involvement in Medication History Collection.

PubMed

Chhabra, Anmol; Quinn, Andrea; Ries, Amanda

2018-01-01

Accurate history collection is integral to medication reconciliation. Studies support pharmacy involvement in the process, but assessment of global time spent is limited. The authors hypothesized the location of a medication-focused interview would impact time spent. The objective was to compare time spent by pharmacists and nurses based on the location of a medication-focused interview. Time spent by the interviewing pharmacist, admitting nurse, and centralized pharmacist verifying admission orders was collected. Patient groups were based on whether the interview was conducted in the emergency department (ED) or medical floor. The primary end point was a composite of the 3 time points. Secondary end points were individual time components and number and types of transcription discrepancies identified during medical floor interviews. Pharmacists and nurses spent an average of ten fewer minutes per ED patient versus a medical floor patient ( P = .028). Secondary end points were not statistically significant. Transcription discrepancies were identified at a rate of 1 in 4 medications. Post hoc analysis revealed the time spent by pharmacists and nurses was 2.4 minutes shorter per medication when interviewed in the ED ( P < .001). The primary outcome was statistically and clinically significant. Limitations included inability to blind and lack of cost-saving analysis. Pharmacist involvement in ED medication reconciliation leads to time savings during the admission process.

Medication Reconciliation: Work Domain Ontology, prototype development, and a predictive model.

PubMed

Markowitz, Eliz; Bernstam, Elmer V; Herskovic, Jorge; Zhang, Jiajie; Shneiderman, Ben; Plaisant, Catherine; Johnson, Todd R

2011-01-01

Medication errors can result from administration inaccuracies at any point of care and are a major cause for concern. To develop a successful Medication Reconciliation (MR) tool, we believe it necessary to build a Work Domain Ontology (WDO) for the MR process. A WDO defines the explicit, abstract, implementation-independent description of the task by separating the task from work context, application technology, and cognitive architecture. We developed a prototype based upon the WDO and designed to adhere to standard principles of interface design. The prototype was compared to Legacy Health System's and Pre-Admission Medication List Builder MR tools via a Keystroke-Level Model analysis for three MR tasks. The analysis found the prototype requires the fewest mental operations, completes tasks in the fewest steps, and completes tasks in the least amount of time. Accordingly, we believe that developing a MR tool, based upon the WDO and user interface guidelines, improves user efficiency and reduces cognitive load.

Medication Reconciliation: Work Domain Ontology, Prototype Development, and a Predictive Model

PubMed Central

Markowitz, Eliz; Bernstam, Elmer V.; Herskovic, Jorge; Zhang, Jiajie; Shneiderman, Ben; Plaisant, Catherine; Johnson, Todd R.

2011-01-01

Medication errors can result from administration inaccuracies at any point of care and are a major cause for concern. To develop a successful Medication Reconciliation (MR) tool, we believe it necessary to build a Work Domain Ontology (WDO) for the MR process. A WDO defines the explicit, abstract, implementation-independent description of the task by separating the task from work context, application technology, and cognitive architecture. We developed a prototype based upon the WDO and designed to adhere to standard principles of interface design. The prototype was compared to Legacy Health System’s and Pre-Admission Medication List Builder MR tools via a Keystroke-Level Model analysis for three MR tasks. The analysis found the prototype requires the fewest mental operations, completes tasks in the fewest steps, and completes tasks in the least amount of time. Accordingly, we believe that developing a MR tool, based upon the WDO and user interface guidelines, improves user efficiency and reduces cognitive load. PMID:22195146

Implementing AORN recommended practices for medication safety.

PubMed

Hicks, Rodney W; Wanzer, Linda J; Denholm, Bonnie

2012-12-01

Medication errors in the perioperative setting can result in patient morbidity and mortality. The AORN "Recommended practices for medication safety" provide guidance to perioperative nurses in developing, implementing, and evaluating safe medication use practices. These practices include recognizing risk points in the medication use process, collaborating with pharmacy staff members, conducting preoperative assessments and postoperative evaluations (eg, medication reconciliation), and handling hazardous medications and pharmaceutical waste. Strategies for successful implementation of the recommended practices include promoting a basic understanding of the nurse's role in the medication use process and developing a medication management plan as well as policies and procedures that support medication safety and activities to measure compliance with safe practices. Published by Elsevier Inc.

Pharmacists’ Recommendations to Improve Care Transitions

PubMed Central

Haynes, Katherine Taylor; Oberne, Alison; Cawthon, Courtney

2013-01-01

Background Increasingly, hospitals are implementing multi-faceted programs to improve medication reconciliation and transitions of care, often involving pharmacists. Objective To help delineate the optimal role of pharmacists in this context, this qualitative study assessed pharmacists’ views on their roles in hospital-based medication reconciliation and discharge counseling. We also provide pharmacists’ recommendations for improving care transitions. Methods Eleven study pharmacists at two hospitals who participated in the Pharmacist Intervention for Low Literacy in Cardiovascular Disease (PILL-CVD) study completed semi-structured one-on-one interviews, which were coded systematically in NVivo. Pharmacists provided their perspectives on admission and discharge medication reconciliation, in-hospital patient counseling, provision of simple medication adherence aids (e.g., pill box, illustrated daily medication schedule), and telephone follow-up. Results Pharmacists considered medication reconciliation, though time-consuming, to be their most important role in improving care transitions, particularly through detection of errors in the admission medication history that required correction. They also identified patients with poor understanding of their medications, who required additional counseling. Providing adherence aids was felt to be highly valuable for patients with low health literacy, though less useful for patients with adequate health literacy. Pharmacists noted that having trained administrative staff conduct the initial post-discharge follow-up call to screen for issues and triage which patients needed pharmacist follow-up was helpful and an efficient use of resources. Pharmacists’ recommendations for improving care transitions included clear communication among team members, protected time for discharge counseling, patient and family engagement in discharge counseling, and provision of patient education materials. Conclusion Pharmacists are well-positioned to participate in hospital-based medication reconciliation, identify patients with poor medication understanding or adherence, and provide tailored patient counseling to improve transitions of care. Additional studies are needed to confirm these findings in other settings, and to determine the efficacy and cost-effectiveness of different models of pharmacist involvement. PMID:22872752

Enabling Joint Commission Medication Reconciliation Objectives with the HL7 / ASTM Continuity of Care Document Standard

PubMed Central

Dolin, Robert H.; Giannone, Gay; Schadow, Gunther

2007-01-01

We sought to determine how well the HL7 / ASTM Continuity of Care Document (CCD) standard supports the requirements underlying the Joint Commission medication reconciliation recommendations. In particular, the Joint Commission emphasizes that transition points in the continuum of care are vulnerable to communication breakdowns, and that these breakdowns are a common source of medication errors. These transition points are the focus of communication standards, suggesting that CCD can support and enable medication related patient safety initiatives. Data elements needed to support the Joint Commission recommendations were identified and mapped to CCD, and a detailed clinical scenario was constructed. The mapping identified minor gaps, and identified fields present in CCD not specifically identified by Joint Commission, but useful nonetheless when managing medications across transitions of care, suggesting that a closer collaboration between the Joint Commission and standards organizations will be mutually beneficial. The nationally recognized CCD specification provides a standards-based solution for enabling Joint Commission medication reconciliation objectives. PMID:18693823

Enabling joint commission medication reconciliation objectives with the HL7 / ASTM Continuity of Care Document standard.

PubMed

Dolin, Robert H; Giannone, Gay; Schadow, Gunther

2007-10-11

We sought to determine how well the HL7/ASTM Continuity of Care Document (CCD) standard supports the requirements underlying the Joint Commission medication reconciliation recommendations. In particular, the Joint Commission emphasizes that transition points in the continuum of care are vulnerable to communication breakdowns, and that these breakdowns are a common source of medication errors. These transition points are the focus of communication standards, suggesting that CCD can support and enable medication related patient safety initiatives. Data elements needed to support the Joint Commission recommendations were identified and mapped to CCD, and a detailed clinical scenario was constructed. The mapping identified minor gaps, and identified fields present in CCD not specifically identified by Joint Commission, but useful nonetheless when managing medications across transitions of care, suggesting that a closer collaboration between the Joint Commission and standards organizations will be mutually beneficial. The nationally recognized CCD specification provides a standards-based solution for enabling Joint Commission medication reconciliation objectives.

Changes to Workflow and Process Measures in the PICU During Transition From Semi to Full Electronic Health Record.

PubMed

Salib, Mina; Hoffmann, Raymond G; Dasgupta, Mahua; Zimmerman, Haydee; Hanson, Sheila

2015-10-01

Studies showing the changes in workflow during transition from semi to full electronic medical records are lacking. This objective study is to identify the changes in workflow in the PICU during transition from semi to full electronic health record. Prospective observational study. Children's Hospital of Wisconsin Institutional Review Board waived the need for approval so this study was institutional review board exempt. This study measured clinical workflow variables at a 72-bed PICU during different phases of transition to a full electronic health record, which occurred on November 4, 2012. Phases of electronic health record transition were defined as follows: pre-electronic health record (baseline data prior to transition to full electronic health record), transition phase (3 wk after electronic health record), and stabilization (6 mo after electronic health record). Data were analyzed for the three phases using Mann-Whitney U test with a two-sided p value of less than 0.05 considered significant. Seventy-two bed PICU. All patients in the PICU were included during the study periods. Five hundred and sixty-four patients with 2,355 patient days were evaluated in the three phases. Duration of rounds decreased from a median of 9 minutes per patient pre--electronic health record to 7 minutes per patient post electronic health record. Time to final note decreased from 2.06 days pre--electronic health record to 0.5 days post electronic health record. Time to first medication administration after admission also decreased from 33 minutes pre--electronic health record and 7 minutes post electronic health record. Time to Time to medication reconciliation was significantly higher pre-electronic health record than post electronic health record and percent of medication reconciliation completion was significantly lower pre--electronic health record than post electronic health record and percent of medication reconciliation completion was significantly higher pre--electronic health record than. There was no significant change in time between placement of discharge order and physical transfer from the unit [corrected].changes clinical workflow in a PICU with decreased duration of rounds, time to final note, time to medication administration, and time to medication reconciliation completion. There was no change in the duration from medical to physical transfer.

[Impact of a software application to improve medication reconciliation at hospital discharge].

PubMed

Corral Baena, S; Garabito Sánchez, M J; Ruíz Rómero, M V; Vergara Díaz, M A; Martín Chacón, E R; Fernández Moyano, A

2014-01-01

To assess the impact of a software application to improve the quality of information concerning current patient medications and changes on the discharge report after hospitalization. To analyze the incidence of errors and to classify them. Quasi-experimental pre / post study with non-equivalent control group study. Medical patients at hospital discharge. implementation of a software application. Percentage of reconciled patient medication on discharge, and percentage of patients with more than one unjustified discrepancy. A total of 349 patients were assessed; 199 (pre-intervention phase) and 150 (post-intervention phase). Before the implementation of the application in 157 patients (78.8%) medication reconciliation had been completed; finding reconciliation errors in 99 (63.0%). The most frequent type of error, 339 (78.5%), was a missing dose or administration frequency information. After implementation, all the patient prescriptions were reconciled when the software was used. The percentage of patients with unjustified discrepancies decreased from 63.0% to 11.8% with the use of the application (p<.001). The main type of discrepancy found on using the application was confusing prescription, due to the fact that the professionals were not used to using the new tool. The use of a software application has been shown to improve the quality of the information on patient treatment on the hospital discharge report, but it is still necessary to continue development as a strategy for improving medication reconciliation. Copyright © 2014 SECA. Published by Elsevier Espana. All rights reserved.

Novel user interface design for medication reconciliation: an evaluation of Twinlist.

PubMed

Plaisant, Catherine; Wu, Johnny; Hettinger, A Zach; Powsner, Seth; Shneiderman, Ben

2015-03-01

The primary objective was to evaluate time, number of interface actions, and accuracy on medication reconciliation tasks using a novel user interface (Twinlist, which lays out the medications in five columns based on similarity and uses animation to introduce the grouping - www.cs.umd.edu/hcil/sharp/twinlist) compared to a Control interface (where medications are presented side by side in two columns). A secondary objective was to assess participant agreement with statements regarding clarity and utility and to elicit comparisons. A 1 × 2 within-subjects experimental design was used with interface (Twinlist or Control) as an independent variable; time, number of clicks, scrolls, and errors were used as dependent variables. Participants were practicing medical providers with experience performing medication reconciliation but no experience with Twinlist. They reconciled two cases in each interface (in a counterbalanced order), then provided feedback on the design of the interface. Twenty medical providers participated in the study for a total of 80 trials. The trials using Twinlist were statistically significantly faster (18%), with fewer clicks (40%) and scrolls (60%). Serious errors were noted 12 and 31 times in Twinlist and Control trials, respectively. Trials using Twinlist were faster and more accurate. Subjectively, participants rated Twinlist more favorably than Control. They valued the novel layout of the drugs, but indicated that the included animation would be valuable for novices, but not necessarily for advanced users. Additional feedback from participants provides guidance for further development and clinical implementations. Cognitive support of medication reconciliation through interface design can significantly improve performance and safety. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Medication Reconciliation and Therapy Management in Dialysis-Dependent Patients: Need for a Systematic Approach

PubMed Central

Cardone, Katie E.; Manley, Harold J.; St. Peter, Wendy L.; Shaffer, Rachel; Somers, Michael; Mehrotra, Rajnish

2013-01-01

Summary Patients with ESRD undergoing dialysis have highly complex medication regimens and disproportionately higher total cost of care compared with the general Medicare population. As shown by several studies, dialysis-dependent patients are at especially high risk for medication-related problems. Providing medication reconciliation and therapy management services is critically important to avoid costs associated with medication-related problems, such as adverse drug events and hospitalizations in the ESRD population. The Medicare Modernization Act of 2003 included an unfunded mandate stipulating that medication therapy management be offered to high-risk patients enrolled in Medicare Part D. Medication management services are distinct from the dispensing of medications and involve a complete medication review for all disease states. The dialysis facility is a logical coordination center for medication management services, like medication therapy management, and it is likely the first health care facility that a patient will present to after a care transition. A dedicated and adequately trained clinician, such as a pharmacist, is needed to provide consistent, high-quality medication management services. Medication reconciliation and medication management services that could consistently and systematically identify and resolve medication-related problems would be likely to improve ESRD patient outcomes and reduce total cost of care. Herein, this work provides a review of available evidence and recommendations for optimal delivery of medication management services to ESRD patients in a dialysis facility-centered model. PMID:23990162

Discrepancies between home medication and patient documentation in primary care.

PubMed

Rose, Olaf; Jaehde, Ulrich; Köberlein-Neu, Juliane

2018-04-01

Medication Reconciliation leads to quick detection of drug-related problems, studies in ambulatory care are scarce. The recently introduced Medication Plan in Germany serves as an ideal basis for Medication Reconciliation. The study aim was to provide accurate data on the magnitude of discrepancy between the prescription and the actually taken medicine. Clinical relevance of discrepancies was assessed to estimate the impact on medication safety. Patients were assessed at home, data was reconciled with the physician's documentation. Discrepancies were analyzed and stratified. Risk for hospitalization, risk for falls and the potential for drug-drug interactions was estimated based on literature. Drugs were tested for its origin and grouped to indication clusters. Detected DRPs at a Medication Review were linked to the results at Medication Reconciliation. Medication of 142 elderly patients from 12 practices was reconciled. 1498 drugs were found at the home assessment, 1099 (73.4%) of which were detected in the physician's documentation. 94.4% of the patients were affected by discrepancies. A total of 2.8 ± 2.4 drugs was undocumented per patient. 26.6% of missing drugs were prescribed by medical specialists, 42.5% of drugs of unknown origin were prescription drugs. 53.9% of the patients used a undocumented drug, which carried a high risk for hospitalization. 23.1% of the drugs not covered were used for treatment of cardiovascular diseases. 65.8% of the differing drugs caused at least one DRP. A high discrepancy between the drugs used by the patient and the medication documented by the primary care physician could be found. Relating drugs had a profound systemic effect and were particular relevant to medication safety. Many drugs were prescription drugs. The majority of differing drugs caused DRPs. A collaborative Medication Reconciliation as part of a Medication Management could compile the entire medication and increase patient safety. Copyright © 2017 Elsevier Inc. All rights reserved.

Direct Loan Cash Management and Data Matching (Reconciliation).

ERIC Educational Resources Information Center

Department of Education, Washington, DC.

This guide for institutions of higher education and other schools receiving funds under the William D. Ford Direct Loan Program details required and recommended procedures for the reconciliation process. The reconciliation process is explained to include cash management (the accounting for Direct Loan funds drawn down and disbursed to borrowers)…

Improved Organizational Outcomes Associated With Incorporation of Early Clinical Experiences for Second-Year Student Pharmacists at an Academic Medical Center.

PubMed

Pinelli, Nicole R; McLaughlin, Jacqueline E; Chen, Sheh-Li; Luter, David N; Arnall, Justin; Smith, Shayna; Roth, Mary T; Rodgers, Philip T; Williams, Dennis M; Amerine, Lindsey B

2017-02-01

To assess the feasibility of engaging second professional year student pharmacists in the medication reconciliation process on hospital and health system pharmacy practice outcomes. Student pharmacists in their second professional year in the Doctor of Pharmacy degree program at our institution were randomly selected from volunteers to participate. Each participant completed training prior to completing three 5-hour evening shifts. Organizational metrics, student pharmacist perception regarding quality of interactions with health care professionals, and pharmacist perceptions were collected. A total of 83 medication histories were performed on complex medical patients (57.0 ± 19.2 years, 51% female, 65% Caucasian, 12 ± 6 medications); of those, 93% were completed within 24 hours of hospital admission. Second professional student pharmacists completed on average 1.9 ± 0.6 medication histories per shift (range 1-3). Student pharmacists identified 0.9 medication-related problems per patient in collaboration with a pharmacist preceptor. Student pharmacists believed the quality of their interactions with health care professionals in the Student Medication and Reconciliation Team (SMART) program was good or excellent. The program has been well received by clinical pharmacists involved in its design and implementation. This study provides evidence that second professional year student pharmacists can assist pharmacy departments in the care of medically complex patients upon hospital admission.

Process mapping evaluation of medication reconciliation in academic teaching hospitals: a critical step in quality improvement.

PubMed

Holbrook, Anne; Bowen, James M; Patel, Harsit; O'Brien, Chris; You, John J; Tahavori, Roshan; Doleweerd, Jeff; Berezny, Tim; Perri, Dan; Nieuwstraten, Carmine; Troyan, Sue; Patel, Ameen

2016-12-30

Medication reconciliation (MedRec) has been a mandated or recommended activity in Canada, the USA and the UK for nearly 10 years. Accreditation bodies in North America will soon require MedRec for every admission, transfer and discharge of every patient. Studies of MedRec have revealed unintentional discrepancies in prescriptions but no clear evidence that clinically important outcomes are improved, leading to widely variable practices. Our objective was to apply process mapping methodology to MedRec to clarify current processes and resource usage, identify potential efficiencies and gaps in care, and make recommendations for improvement in the light of current literature evidence of effectiveness. Process engineers observed and recorded all MedRec activities at 3 academic teaching hospitals, from initial emergency department triage to patient discharge, for general internal medicine patients. Process maps were validated with frontline staff, then with the study team, managers and patient safety leads to summarise current problems and discuss solutions. Across all of the 3 hospitals, 5 general problem themes were identified: lack of use of all available medication sources, duplication of effort creating inefficiency, lack of timeliness of completion of the Best Possible Medication History, lack of standardisation of the MedRec process, and suboptimal communication of MedRec issues between physicians, pharmacists and nurses. MedRec as practised in this environment requires improvements in quality, timeliness, consistency and dissemination. Further research exploring efficient use of resources, in terms of personnel and costs, is required. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Medicare program; participation in CHAMPUS and CHAMPVA, hospital admissions for veterans, discharge rights notice, and hospital responsibility for emergency care--HCFA and OIG. Interim final rule with comment period.

PubMed

1994-06-22

We are revising requirements for Medicare participating hospitals by adding the following: A hospital must provide inpatient hospital services to individuals who have health coverage provided by either the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) or the Civilian Health and Medical Program of the Veterans Administration (CHAMPVA), subject to limitations provided by regulations that require the hospital to collect the beneficiary's cost-share and accept payment from the CHAMPUS/CHAMPVA programs as payment in full. A hospital must provide inpatient hospital services to military veterans (subject to the limitations provided in 38 CFR 17.50 ff.) and accept payment from the Department of Veterans Affairs as payment in full. A hospital must give each Medicare beneficiary (or his or her representative) at or about the time of admission, a written statement of his or her rights concerning discharge from the hospital. A hospital (including a rural primary care hospital) with an emergency department must provide, upon request and within the capabilities of the hospital or rural primary care hospital, an appropriate medical screening examination, stabilizing treatment and/or an appropriate transfer to another medical facility to any individual with an emergency medical condition, regardless of the individual's eligibility for Medicare. The statute provides for the termination of a provider's agreement for violation of any of these provisions. These revisions implement sections 9121 and 9122 of the Consolidated Omnibus Budget Reconciliation Act of 1985 (as amended by section 4009 of the Omnibus Budget Reconciliation Act of 1987), section 233 of the Veteran's Benefit Improvement and Health Care Authorization Act of 1986, sections 9305(b)(1) and 9307 of the Omnibus Budget Reconciliation Act of 1986, sections 6003(g)(3)(D)(xiv), 6018 and 6211 of the Omnibus Budget Reconciliation Act of 1989, and sections 4008(b), 4027(a), and 4027(k)(3) of the Omnibus Budget Reconciliation Act of 1990.

Moving out of Conflict into Reconciliation--"Bildung" through Philosophical Dialogue in Intercultural and Interreligious Education

ERIC Educational Resources Information Center

Helskog, Guro Hansen

2014-01-01

The empirical basis of this article is the reconciliation process in a destructive conflict between students of different cultural and religious backgrounds in upper secondary education in Norway. The Dialogos approach to dialogical philosophizing was tried out through an action research process in order to bring about reconciliation, letting the…

78 FR 19917 - Medicaid Program; Increased Federal Medical Assistance Percentage Changes Under the Affordable...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-02

... 2010 and the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the... Care and Education Reconciliation Act of 2010 (Pub. L. 111-152, enacted on March 30, 2010), and... Care Act that expand access to health coverage through improvements in Medicaid and the Children's...

Implementation and evaluation of a community-based medication reconciliation (CMR) system at the hospital-community interface of care.

PubMed

Bailey, Allan L; Moe, Grace; Moe, Jessica; Oland, Ryan

2009-01-01

The WestView community-based medication reconciliation (CMR) aims to decrease medication error risk. A clinical pharmacist visits patients' homes within 72 hours of hospital discharge and compares medications in discharge orders, family physicians' charts, community pharmacy profiles and in the home. Discrepancies are discussed and reconciled with the dispenser, hospital prescriber and follow-up care provider. The CMR demonstrates successful integration that is patient-centred and standardized, bridging the hospital-community interface and improving information flow and communication channels across a family-physician-led multi-disciplinary team. A concurrent research study will evaluate the impact of CMR on health services utilization and to develop a risk prediction model.

Implementation of a pharmacy technician-centered medication reconciliation program at an urban teaching medical center.

PubMed

Sen, Sanchita; Siemianowski, Laura; Murphy, Michelle; McAllister, Susan Coutinho

2014-01-01

An inpatient medication reconciliation (MR) program emphasizing pharmacy technicians' role in the MR process is described. As part of quality-improvement (QI) efforts focused on MR-related adverse drug events, an urban academic medical center in New Jersey implemented a pharmacy technician-centered MR (PTMR) program targeting patients on its internal medicine, oncology, and clinical decision units. The program is staffed by five full- or part-time technicians who are trained in MR methods and work under direct pharmacist supervision, interviewing newly admitted patients and using other information sources (e.g., community pharmacies, physician offices, nursing facilities) to compile an accurate and complete medication list. About 30% of all patients admitted to the hospital are served by the PTMR program, which averages more than 500 cases each month. During one three-month period, 1748 discrepancies on preadmission medication lists were identified, most of which involved the omission of drugs (65.7% of cases) and incorrect information on dose and frequency of use (14.4%). Efforts to overcome resource constraints and other program challenges (e.g., privacy concerns, delays in community pharmacy transmittal of prescription refill lists) are ongoing. To date, most research on PTMR has been conducted in emergency departments or perioperative settings; experience with the PTMR program suggests that this approach can be applied in other hospital areas to improve MR processes and, ultimately, enhance pharmacotherapy safety and effectiveness across transitions of care. Based on experience, providers' perspectives, and QI data, the PTMR program is an effective method to obtain, document, and communicate accurate MR data for patients at this institution.

The Emotional Regimes of Reconciliation in History Textbook Revision: Reflections on the Politics of Resentment and the Politics of Empathy in Post-Conflict Societies

ERIC Educational Resources Information Center

Zembylas, Michalinos

2016-01-01

The present paper focuses on the "emotional regimes" that may be invoked, molded or used in history education engagements with the past as part of reconciliation processes. In the first part, the paper examines briefly how emotions are related to the process of reconciliation and discusses the ways in which emotional regimes grow out of…

The Forgiveness Reconciliation Inventory: An Instrument to Process through Issues of Forgiveness and Conflict

ERIC Educational Resources Information Center

Balkin, Richard S.; Harris, Nephaterria A.; Freeman, Stephen J.; Huntington, Scott

2014-01-01

The Forgiveness Reconciliation Inventory is a theoretically derived instrument. Participants included individuals from clinical and nonclinical populations. Confirmatory factor analysis along with correlational designs and between-group comparisons indicate strong psychometric properties of the Forgiveness Reconciliation Inventory. The authors…

Risk Adjustment May Lessen Penalties On Hospitals Treating Complex Cardiac Patients Under Medicare's Bundled Payments.

PubMed

Markovitz, Adam A; Ellimoottil, Chandy; Sukul, Devraj; Mullangi, Samyukta; Chen, Lena M; Nallamothu, Brahmajee K; Ryan, Andrew M

2017-12-01

To reduce variation in spending, Medicare has considered implementing a cardiac bundled payment program for acute myocardial infarction and coronary artery bypass graft. Because the proposed program does not account for patient risk factors when calculating hospital penalties or rewards ("reconciliation payments"), it might unfairly penalize certain hospitals. We estimated the impact of adjusting for patients' medical complexity and social risk on reconciliation payments for Medicare beneficiaries hospitalized for the two conditions in the period 2011-13. Average spending per episode was $29,394. Accounting for medical complexity substantially narrowed the gap in reconciliation payments between hospitals with high medical severity (from a penalty of $1,809 to one of $820, or a net reduction of $989), safety-net hospitals (from a penalty of $217 to one of $87, a reduction of $130), and minority-serving hospitals (from a penalty of $70 to a reward of $56, an improvement of $126) and their counterparts. Accounting for social risk alone narrowed these gaps but had minimal incremental effects after medical complexity was accounted for. Risk adjustment may preserve incentives to care for patients with complex conditions under Medicare bundled payment programs.

Big data in pharmacy practice: current use, challenges, and the future.

PubMed

Ma, Carolyn; Smith, Helen Wong; Chu, Cherie; Juarez, Deborah T

2015-01-01

Pharmacy informatics is defined as the use and integration of data, information, knowledge, technology, and automation in the medication-use process for the purpose of improving health outcomes. The term "big data" has been coined and is often defined in three V's: volume, velocity, and variety. This paper describes three major areas in which pharmacy utilizes big data, including: 1) informed decision making (clinical pathways and clinical practice guidelines); 2) improved care delivery in health care settings such as hospitals and community pharmacy practice settings; and 3) quality performance measurement for the Centers for Medicare and Medicaid and medication management activities such as tracking medication adherence and medication reconciliation.

Big data in pharmacy practice: current use, challenges, and the future

PubMed Central

Ma, Carolyn; Smith, Helen Wong; Chu, Cherie; Juarez, Deborah T

2015-01-01

Pharmacy informatics is defined as the use and integration of data, information, knowledge, technology, and automation in the medication-use process for the purpose of improving health outcomes. The term “big data” has been coined and is often defined in three V’s: volume, velocity, and variety. This paper describes three major areas in which pharmacy utilizes big data, including: 1) informed decision making (clinical pathways and clinical practice guidelines); 2) improved care delivery in health care settings such as hospitals and community pharmacy practice settings; and 3) quality performance measurement for the Centers for Medicare and Medicaid and medication management activities such as tracking medication adherence and medication reconciliation. PMID:29354523

Automatic detection of omissions in medication lists

PubMed Central

Duncan, George T; Neill, Daniel B; Padman, Rema

2011-01-01

Objective Evidence suggests that the medication lists of patients are often incomplete and could negatively affect patient outcomes. In this article, the authors propose the application of collaborative filtering methods to the medication reconciliation task. Given a current medication list for a patient, the authors employ collaborative filtering approaches to predict drugs the patient could be taking but are missing from their observed list. Design The collaborative filtering approach presented in this paper emerges from the insight that an omission in a medication list is analogous to an item a consumer might purchase from a product list. Online retailers use collaborative filtering to recommend relevant products using retrospective purchase data. In this article, the authors argue that patient information in electronic medical records, combined with artificial intelligence methods, can enhance medication reconciliation. The authors formulate the detection of omissions in medication lists as a collaborative filtering problem. Detection of omissions is accomplished using several machine-learning approaches. The effectiveness of these approaches is evaluated using medication data from three long-term care centers. The authors also propose several decision-theoretic extensions to the methodology for incorporating medical knowledge into recommendations. Results Results show that collaborative filtering identifies the missing drug in the top-10 list about 40–50% of the time and the therapeutic class of the missing drug 50%–65% of the time at the three clinics in this study. Conclusion Results suggest that collaborative filtering can be a valuable tool for reconciling medication lists, complementing currently recommended process-driven approaches. However, a one-size-fits-all approach is not optimal, and consideration should be given to context (eg, types of patients and drug regimens) and consequence (eg, the impact of omission on outcomes). PMID:21447497

Medical identity theft: prevention and reconciliation initiatives at Massachusetts General Hospital.

PubMed

Judson, Timothy; Haas, Mark; Lagu, Tara

2014-07-01

Medical identity theft refers to the misuse of another individual's identifying medical information to receive medical care. Beyond the financial burden on patients, hospitals, health insurance companies, and government insurance programs, undetected cases pose major patient safety challenges. Inaccuracies in the medical record may persist even after the theft has been identified because of restrictions imposed by patient privacy laws. Massachusetts General Hospital (MGH; Boston) has conducted initiatives to prevent medical identity theft and to better identify and respond to cases when they occur. Since 2007, MGH has used a notification tree to standardize reporting of red flag incidents (warning signs of identity theft, such as suspicious personal identifiers or account activity). A Data Integrity Dashboard allows for tracking and reviewing of all potential incidents of medical identity theft to detect trends and targets for mitigation. An identity-checking policy, VERI-(Verify Everyone's Identity) Safe Patient Care, requires photo identification at every visit and follow-up if it is not provided. Data from MGH suggest that an estimated 120 duplicate medical records are created each month, 25 patient encounters are likely tied to identity theft or fraud each quarter, and 14 patients are treated under the wrong medical record number each year. As of December 2013, 80%-85% of patients were showing photo identification at appointments. Although an organization's policy changes and educational campaigns can improve detection and reconciliation of medical identity theft cases, national policies should be implemented to streamline the process of correcting errors in medical records, reduce the financial disincentive for hospitals to detect and report cases, and create a single point of entry to reduce the burden on individuals and providers to reconcile cases.

Automatic detection of omissions in medication lists.

PubMed

Hasan, Sharique; Duncan, George T; Neill, Daniel B; Padman, Rema

2011-01-01

Evidence suggests that the medication lists of patients are often incomplete and could negatively affect patient outcomes. In this article, the authors propose the application of collaborative filtering methods to the medication reconciliation task. Given a current medication list for a patient, the authors employ collaborative filtering approaches to predict drugs the patient could be taking but are missing from their observed list. The collaborative filtering approach presented in this paper emerges from the insight that an omission in a medication list is analogous to an item a consumer might purchase from a product list. Online retailers use collaborative filtering to recommend relevant products using retrospective purchase data. In this article, the authors argue that patient information in electronic medical records, combined with artificial intelligence methods, can enhance medication reconciliation. The authors formulate the detection of omissions in medication lists as a collaborative filtering problem. Detection of omissions is accomplished using several machine-learning approaches. The effectiveness of these approaches is evaluated using medication data from three long-term care centers. The authors also propose several decision-theoretic extensions to the methodology for incorporating medical knowledge into recommendations. Results show that collaborative filtering identifies the missing drug in the top-10 list about 40-50% of the time and the therapeutic class of the missing drug 50%-65% of the time at the three clinics in this study. Results suggest that collaborative filtering can be a valuable tool for reconciling medication lists, complementing currently recommended process-driven approaches. However, a one-size-fits-all approach is not optimal, and consideration should be given to context (eg, types of patients and drug regimens) and consequence (eg, the impact of omission on outcomes).

An observational study of the relationship between meaningful use-based electronic health information exchange, interoperability, and medication reconciliation capabilities.

PubMed

Elysee, Gerald; Herrin, Jeph; Horwitz, Leora I

2017-10-01

Stagnation in hospitals' adoption of data integration functionalities coupled with reduction in the number of operational health information exchanges could become a significant impediment to hospitals' adoption of 3 critical capabilities: electronic health information exchange, interoperability, and medication reconciliation, in which electronic systems are used to assist with resolving medication discrepancies and improving patient safety. Against this backdrop, we assessed the relationships between the 3 capabilities.We conducted an observational study applying partial least squares-structural equation modeling technique to 27 variables obtained from the 2013 American Hospital Association annual survey Information Technology (IT) supplement, which describes health IT capabilities.We included 1330 hospitals. In confirmatory factor analysis, out of the 27 variables, 15 achieved loading values greater than 0.548 at P < .001, as such were validated as the building blocks of the 3 capabilities. Subsequent path analysis showed a significant, positive, and cyclic relationship between the capabilities, in that decreases in the hospitals' adoption of one would lead to decreases in the adoption of the others.These results show that capability for high quality medication reconciliation may be impeded by lagging adoption of interoperability and health information exchange capabilities. Policies focused on improving one or more of these capabilities may have ancillary benefits.

Improving Continuity of Care via the Discharge Summary

PubMed Central

Sakaguchi, Farrant H.; Lenert, Leslie A.

2015-01-01

Discharge summaries (DCS) frequently fail to improve the continuity of care. A chart review of 188 DCS was performed to identify specific components that could be improved through health information technology. Medication reconciliations were analyzed for completeness and for medical reasoning. Documentation of pending results and follow-up details were analyzed. Patient preferences, patient goals, and the handover tone were noted. Patients were discharged on an average of 9.8 medications, only 3% of medication reconciliations were complete and medical reasoning was frequently absent. There were 358 pending results in 188 hospital discharges though only 14% were mentioned in the DCS. Documentation of clear, timely follow-up was present for less than 50% of patients. Patient preferences, patient goals, and lessons learned were rarely included. A handover tone was in only 17% of the DCS. Evaluating the DCS as a clinical handover is novel but information for safe handovers is frequently missing. PMID:26958250

Twenty years later, the cognitive portrait of openness to reconciliation in Rwanda.

PubMed

Caparos, Serge; Giroux, Sara-Valérie; Rutembesa, Eugène; Habimana, Emmanuel; Blanchette, Isabelle

2018-05-01

With this work, we intended to draw a cognitive portrait of openness to reconciliation. No study had yet examined the potential contribution of high-level cognitive functioning, in addition to psychological health, to explaining attitudes towards reconciliation in societies exposed to major trauma such as post-genocide Rwanda. We measured the contribution of general cognitive capacity, analytical thinking, and subjective judgements. Our results show that higher cognitive capacity is not associated with greater openness to reconciliation. On the other hand, proneness to think analytically about the genocide predicts more favorable attitudes towards reconciliation. The latter effect is associated with more tempered judgements about retrospective facts (e.g., number of genocide perpetrators) and prospective events (e.g., risk of genocide reoccurrence). This work establishes the importance of cognitive functioning in the aftermath of political violence: A better understanding of the influence of information processing on openness to reconciliation may help improve reconciliation policies and contribute to reducing risks of conflict reoccurrence. © 2017 The British Psychological Society.

Model-based cost-effectiveness analysis of interventions aimed at preventing medication error at hospital admission (medicines reconciliation).

PubMed

Karnon, Jonathan; Campbell, Fiona; Czoski-Murray, Carolyn

2009-04-01

Medication errors can lead to preventable adverse drug events (pADEs) that have significant cost and health implications. Errors often occur at care interfaces, and various interventions have been devised to reduce medication errors at the point of admission to hospital. The aim of this study is to assess the incremental costs and effects [measured as quality adjusted life years (QALYs)] of a range of such interventions for which evidence of effectiveness exists. A previously published medication errors model was adapted to describe the pathway of errors occurring at admission through to the occurrence of pADEs. The baseline model was populated using literature-based values, and then calibrated to observed outputs. Evidence of effects was derived from a systematic review of interventions aimed at preventing medication error at hospital admission. All five interventions, for which evidence of effectiveness was identified, are estimated to be extremely cost-effective when compared with the baseline scenario. Pharmacist-led reconciliation intervention has the highest expected net benefits, and a probability of being cost-effective of over 60% by a QALY value of pound10 000. The medication errors model provides reasonably strong evidence that some form of intervention to improve medicines reconciliation is a cost-effective use of NHS resources. The variation in the reported effectiveness of the few identified studies of medication error interventions illustrates the need for extreme attention to detail in the development of interventions, but also in their evaluation and may justify the primary evaluation of more than one specification of included interventions.

78 FR 15877 - Taxable Medical Devices; Correction

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-13

... Medical Devices; Correction AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Correction to final... on the excise tax imposed on the sale of certain medical devices, enacted by the Health Care and Education Reconciliation Act of 2010 in conjunction with the Patient Protection and Affordable Care Act...

Twinlist: novel user interface designs for medication reconciliation.

PubMed

Plaisant, Catherine; Chao, Tiffany; Wu, Johnny; Hettinger, A Zach; Herskovic, Jorge R; Johnson, Todd R; Bernstam, Elmer V; Markowitz, Eliz; Powsner, Seth; Shneiderman, Ben

2013-01-01

Medication reconciliation is an important and complex task for which careful user interface design has the potential to help reduce errors and improve quality of care. In this paper we focus on the hospital discharge scenario and first describe a novel interface called Twinlist. Twinlist illustrates the novel use of spatial layout combined with multi-step animation, to help medical providers see what is different and what is similar between the lists (e.g., intake list and hospital list), and rapidly choose the drugs they want to include in the reconciled list. We then describe a series of variant designs and discuss their comparative advantages and disadvantages. Finally we report on a pilot study that suggests that animation might help users learn new spatial layouts such as the one used in Twinlist.

Secret information reconciliation based on punctured low-density parity-check codes for continuous-variable quantum key distribution

NASA Astrophysics Data System (ADS)

Jiang, Xue-Qin; Huang, Peng; Huang, Duan; Lin, Dakai; Zeng, Guihua

2017-02-01

Achieving information theoretic security with practical complexity is of great interest to continuous-variable quantum key distribution in the postprocessing procedure. In this paper, we propose a reconciliation scheme based on the punctured low-density parity-check (LDPC) codes. Compared to the well-known multidimensional reconciliation scheme, the present scheme has lower time complexity. Especially when the chosen punctured LDPC code achieves the Shannon capacity, the proposed reconciliation scheme can remove the information that has been leaked to an eavesdropper in the quantum transmission phase. Therefore, there is no information leaked to the eavesdropper after the reconciliation stage. This indicates that the privacy amplification algorithm of the postprocessing procedure is no more needed after the reconciliation process. These features lead to a higher secret key rate, optimal performance, and availability for the involved quantum key distribution scheme.

Medication reconciliation by a pharmacy technician in a mental health assessment unit.

PubMed

Brownlie, Kay; Schneider, Carl; Culliford, Roger; Fox, Chris; Boukouvalas, Alexis; Willan, Cathy; Maidment, Ian D

2014-04-01

Medication discrepancies are common when patients cross organisational boundaries. However, little is known about the frequency of discrepancies within mental health and the efficacy of interventions to reduce discrepancies. To evaluate the impact of a pharmacy-led reconciliation service on medication discrepancies on admissions to a secondary care mental health trust. In-patient mental health services. Prospective evaluation of pharmacy technician led medication reconciliation for admissions to a UK Mental Health NHS Trust. From March to June 2012 information on any unintentional discrepancies (dose, frequency and name of medication); patient demographics;and type and cause of the discrepancy was collected. The potential for harm was assessed based on two scenarios; the discrepancy was continued into primary care, and the discrepancy was corrected during admission. Logistic regression identified factors associated with discrepancies. Mean number of discrepancies per admission corrected by the pharmacy technician. Unintentional medication discrepancies occurred in 212 of 377 admissions (56.2 %). Discrepancies involving 569 medicines (mean 1.5 medicines per admission) were corrected.The most common discrepancy was omission(n = 464). Severity was assessed for 114 discrepancies. If the discrepancy was corrected within 16 days the potential harm was minor in 71 (62.3 %) cases and moderate in 43(37.7 %) cases whereas if the discrepancy was not corrected the potential harm was minor in 27 (23.7 %) cases and moderate in 87 (76.3 %) cases. Discrepancies were associated with both age and number of medications; the stronger association was age. Medication discrepancies are common within mental health services with potentially significant consequences for patients.Trained pharmacy technicians are able to reduce the frequency of discrepancies, improving safety.

42 CFR § 512.305 - Determination of the NPRA and reconciliation process.

Code of Federal Regulations, 2010 CFR

2017-10-01

... OF HEALTH AND HUMAN SERVICES (CONTINUED) HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS EPISODE PAYMENT MODEL Pricing and Payment § 512.305 Determination of the NPRA and reconciliation process. (a... determine actual episode payments for each EPM episode for the performance year (except for episodes that...

The Task of Adventure within the Peace and Reconciliation Process.

ERIC Educational Resources Information Center

Bartle, Mike

This paper introduces the notion of a spiritual component of adventure, with reference to the potential role of adventure within the peace and reconciliation process in Northern Ireland. Influenced by tradition and culture, past constructions of adventure have often associated it with educational benefits and personal development of specific…

10 CFR 766.104 - Reconciliation, adjustments and appeals.

Code of Federal Regulations, 2010 CFR

2010-01-01

.... The filing of a notice for an adjustment shall not stay the obligation to pay. (b) DOE may request... TESS data for any discrepancies or further transactions raised during the reconciliation process. (d...

Antecedents of the attitude towards inter-group reconciliation in a setting of armed conflict.

PubMed

Alzate, Mónica; Sabucedo, José-Manuel; Durán, Mar

2013-02-01

The concept of Reconciliation as applied to inter-group conflict has come into use only recently. Throughout the history of Psychology, Reconciliation was mostly understood at the individual and inter-personal level. In the present study we shall analyse the roles played by trust, negotiating attitude, legitimacy and ethnocentric attitude over the attitude towards social reconciliation. To this end we studied a group of 188 Colombian civilians living under conditions of real socio-political conflict. A path analysis was performed using the statistical program AMOS whose fit indexes indicate a good fit of the model and a variance of .36. The results show that the variables of trust, negotiating attitude and legitimacy have a significant and positive effect on the reconciliation variable, and significant negative effect on the ethnocentric attitude variable. This study contributes to the integration of a number of variables that facilitate process of social reconciliation, as it explicitly deals with some of the perceptions, attitudes and beliefs which could change the course of a confrontation.

75 FR 81519 - Confirmation, Portfolio Reconciliation, and Portfolio Compression Requirements for Swap Dealers...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-28

... systemic risk, portfolio reconciliation should be a proactive process that delivers a consolidated view of... achieved by portfolio compression, in turn, may lessen systemic risk and enhance the overall stability of...

High performance reconciliation for continuous-variable quantum key distribution with LDPC code

NASA Astrophysics Data System (ADS)

Lin, Dakai; Huang, Duan; Huang, Peng; Peng, Jinye; Zeng, Guihua

2015-03-01

Reconciliation is a significant procedure in a continuous-variable quantum key distribution (CV-QKD) system. It is employed to extract secure secret key from the resulted string through quantum channel between two users. However, the efficiency and the speed of previous reconciliation algorithms are low. These problems limit the secure communication distance and the secure key rate of CV-QKD systems. In this paper, we proposed a high-speed reconciliation algorithm through employing a well-structured decoding scheme based on low density parity-check (LDPC) code. The complexity of the proposed algorithm is reduced obviously. By using a graphics processing unit (GPU) device, our method may reach a reconciliation speed of 25 Mb/s for a CV-QKD system, which is currently the highest level and paves the way to high-speed CV-QKD.

30 CFR 1206.363 - When is an ONRR audit, review, reconciliation, monitoring, or other like process considered final?

Code of Federal Regulations, 2012 CFR

2012-07-01

... 30 Mineral Resources 3 2012-07-01 2012-07-01 false When is an ONRR audit, review, reconciliation, monitoring, or other like process considered final? 1206.363 Section 1206.363 Mineral Resources OFFICE OF NATURAL RESOURCES REVENUE, DEPARTMENT OF THE INTERIOR NATURAL RESOURCES REVENUE PRODUCT VALUATION...

30 CFR 1206.363 - When is an ONRR audit, review, reconciliation, monitoring, or other like process considered final?

Code of Federal Regulations, 2013 CFR

2013-07-01

... 30 Mineral Resources 3 2013-07-01 2013-07-01 false When is an ONRR audit, review, reconciliation, monitoring, or other like process considered final? 1206.363 Section 1206.363 Mineral Resources OFFICE OF NATURAL RESOURCES REVENUE, DEPARTMENT OF THE INTERIOR NATURAL RESOURCES REVENUE PRODUCT VALUATION...

30 CFR 1206.363 - When is an ONRR audit, review, reconciliation, monitoring, or other like process considered final?

Code of Federal Regulations, 2014 CFR

2014-07-01

... 30 Mineral Resources 3 2014-07-01 2014-07-01 false When is an ONRR audit, review, reconciliation, monitoring, or other like process considered final? 1206.363 Section 1206.363 Mineral Resources OFFICE OF NATURAL RESOURCES REVENUE, DEPARTMENT OF THE INTERIOR NATURAL RESOURCES REVENUE PRODUCT VALUATION...

Impact of drug reconciliation at discharge and communication between hospital and community pharmacists on drug-related problems: study protocol for a randomized controlled trial.

PubMed

Pourrat, Xavier; Roux, Clarisse; Bouzige, Brigitte; Garnier, Valérie; Develay, Armelle; Allenet, Benoit; Fraysse, Martial; Halimi, Jean-Michel; Grassin, Jacqueline; Giraudeau, Bruno

2014-06-30

Patients are at risk of drug-related problems (DRPs) at transition points during hospitalization. The community pharmacist (CP) is often the first healthcare professional patients visit after discharge. CPs lack sufficient information about the patient and so they may be unable to identify problems in medications, which may lead to dispensing the wrong drugs or dosage, and/or giving wrong information. We aim to assess the impact of a complex intervention comprising of medication reconciliation performed at discharge by a hospital pharmacist (HP) with communication between the HP and CP on DRPs during the seven days following discharge. The study is a cluster randomized crossover trial involving 46 care units (each unit corresponding to a cluster) in 22 French hospitals during two consecutive 14-day periods, randomly assigned as 'experimental' or 'control' (usual care) periods. We will recruit patients older than 18 years of age and visiting the same CP for at least three months. We will exclude patients with a hospital length of stay of more than 21 days, who do not return home or those in palliative care. During the experimental period, the HP will perform a medications reconciliation that will be communicated to the patient. The HP will inform the patient's CP about the patient's drug therapy (modification in home medication, acute drugs prescribed, nonprescription treatments, and/or lab results). The primary outcome will be a composite outcome of any kind of drug misuse during the seven days following discharge assessed at day seven (±2) post-discharge by a pharmacist in charge of the study who will contact both patients and CPs by phone. The secondary outcome will be unplanned hospitalizations assessed by phone contact at day 35 (±5) after discharge. We plan to recruit 1,176 patients. This study will assess the impact of a reconciliation of medications performed at patient discharge followed by communication between the HP and the patient's CP. It will allow for identifying the type of patients in France for which the intervention is most relevant. This study was registered with ClinicalTrials.gov (number: NCT02006797) on 5 December 2013.

Preliminary physician and pharmacist survey of the National Health Insurance PharmaCloud system in Taiwan.

PubMed

Tseng, Yu-Ting; Chang, Elizabeth H; Kuo, Li-Na; Shen, Wan-Chen; Bai, Kuan-Jen; Wang, Chih-Chi; Chen, Hsiang-Yin

2017-10-01

The PharmaCloud system, a cloud-based medication system, was launched by the Taiwan National Health Insurance Administration (NHIA) in 2013 to integrate patients' medication lists among different medical institutions. The aim of the preliminary study was to evaluate satisfaction with this system among physicians and pharmacists at the early stage of system implementation. A questionnaire was developed through a review of the literature and discussion in 6 focus groups to understand the level of satisfaction, attitudes, and intentions of physicians and pharmacists using the PharmaCloud system. It was then administered nationally in Taiwan in July to September 2015. Descriptive statistics and multiple regression were performed to identify variables influencing satisfaction and intention to use the system. In total, 895 pharmacist and 105 physician questionnaires were valid for analysis. The results showed that satisfaction with system quality warranted improvement. Positive attitudes toward medication reconciliation among physicians and pharmacists, which were significant predictors of the intention to use the system (β= 0.223, p < 0.001). Most physicians and pharmacists agreed that obtaining signed patient consent was needed but preferred that it be conducted by the NHIA rather than by individual medical institutions (4.02 ± 1.19 vs. 3.49 ± 1.40, p < 0.01). The preliminary study results indicated a moderate satisfaction toward the PharmaCloud system. Hospital pharmacists had a high satisfaction rate, but neither are physicians and community pharmacists. Continuously improvement on system quality has been performing based on the results of this preliminary survey. Policies and standardization processes, including privacy protection, are still warranted further actions to make the Taiwan PharmaCloud system a convenient platform for medication reconciliation. Copyright © 2017 Elsevier B.V. All rights reserved.

Discrepancies in medication entries between anesthetic and pharmacy records using electronic databases.

PubMed

Vigoda, Michael M; Gencorelli, Frank J; Lubarsky, David A

2007-10-01

Accurate recording of disposition of controlled substances is required by regulatory agencies. Linking anesthesia information management systems (AIMS) with medication dispensing systems may facilitate automated reconciliation of medication discrepancies. In this retrospective investigation at a large academic hospital, we reviewed 11,603 cases (spanning an 8-mo period) comparing records of medications (i.e., narcotics, benzodiazepines, ketamine, and thiopental) recorded as removed from our automated medication dispensing system with medications recorded as administered in our AIMS. In 15% of cases, we found discrepancies between dispensed versus administered medications. Discrepancies occurred in both the AIMS (8% cases) and the medication dispensing system (10% cases). Although there were many different types of user errors, nearly 75% of them resulted from either an error in the amount of drug waste documented in the medication dispensing system (35%); or an error in documenting the medication in the AIMS (40%). A significant percentage of cases contained data entry errors in both the automated dispensing and AIMS. This error rate limits the current practicality of automating the necessary reconciliation. An electronic interface between an AIMS and a medication dispensing system could alert users of medication entry errors prior to finalizing a case, thus reducing the time (and cost) of reconciling discrepancies.

Improving the coordination of patients' medication management: a regional Finnish development project.

PubMed

Kivekäs, Eija; Luukkonen, Irmeli; Mykkänen, Juha; Saranto, Kaija

2014-01-01

In this paper, we present an overview of activities and results from a regional development project in Finland. The aim in this project was to analyze how healthcare providers produce and receive information on a patient's medication, and to identify opportunities to improve the quality, effectiveness, availability and collaboration of social and healthcare services in relation to medication information. The project focused on the most important points in patients' medication management such as home care and care transitions. In a regional development project, data was gathered by interviews and a multi professional workshop. The study revealed that medication information reached only some professionals and lay caregivers despite electronic patient record (EPR) systems and tools. Differences in work processes related to medication reconciliation and information management were discussed in the group meeting and were regarded as a considerable risk for patient safety.

Clinical relevance of pharmacist intervention in an emergency department.

PubMed

Pérez-Moreno, Maria Antonia; Rodríguez-Camacho, Juan Manuel; Calderón-Hernanz, Beatriz; Comas-Díaz, Bernardino; Tarradas-Torras, Jordi

2017-08-01

To evaluate the clinical relevance of pharmacist intervention on patient care in emergencies, to determine the severity of detected errors. Second, to analyse the most frequent types of interventions and type of drugs involved and to evaluate the clinical pharmacist's activity. A 6-month observational prospective study of pharmacist intervention in the Emergency Department (ED) at a 400-bed hospital in Spain was performed to record interventions carried out by the clinical pharmacists. We determined whether the intervention occurred in the process of medication reconciliation or another activity, and whether the drug involved belonged to the High-Alert Medications Institute for Safe Medication Practices (ISMP) list. To evaluate the severity of the errors detected and clinical relevance of the pharmacist intervention, a modified assessment scale of Overhage and Lukes was used. Relationship between clinical relevance of pharmacist intervention and the severity of medication errors was assessed using ORs and Spearman's correlation coefficient. During the observation period, pharmacists reviewed the pharmacotherapy history and medication orders of 2984 patients. A total of 991 interventions were recorded in 557 patients; 67.2% of the errors were detected during medication reconciliation. Medication errors were considered severe in 57.2% of cases and 64.9% of pharmacist intervention were considered relevant. About 10.9% of the drugs involved are in the High-Alert Medications ISMP list. The severity of the medication error and the clinical significance of the pharmacist intervention were correlated (Spearman's ρ=0.728/p<0.001). In this single centre study, the clinical pharmacists identified and intervened on a high number of severe medication errors. This suggests that emergency services will benefit from pharmacist-provided drug therapy services. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

The Use of TOC Reconciliation as a Means of Establishing the Degree to Which Chromatographic Screening of Plastic Material Extracts for Organic Extractables Is Complete.

PubMed

Jenke, Dennis; Couch, Thomas R; Robinson, Sarah J; Volz, Trent J; Colton, Raymond H

2014-01-01

Extracts of plastic packaging, manufacturing, and delivery systems (or their materials of construction) are analyzed by chromatographic methods to establish the system's extractables profile. The testing strategy consists of multiple orthogonal chromatographic methods, for example, gas and liquid chromatography with multiple detection strategies. Although this orthogonal testing strategy is comprehensive, it is not necessarily complete and members of the extractables profile can elude detection and/or accurate identification/quantification. Because the chromatographic methods rarely indicate that some extractables have been missed, another means of assessing the completeness of the profiling activity must be established. If the extracts are aqueous and contain no organic additives (e.g., pH buffers), then they can be analyzed for their total organic carbon content (TOC). Additionally, the TOC of an extract can be calculated based on the extractables revealed by the screening analyses. The measured and calculated TOC can be reconciled to establish the completeness and accuracy of the extractables profile. If the reconciliation is poor, then the profile is either incomplete or inaccurate and additional testing is needed to establish the complete and accurate profile. Ten test materials and components of systems were extracted and their extracts characterized for organic extractables using typical screening procedures. Measured and calculated TOC was reconciled to establish the completeness of the revealed extractables profile. When the TOC reconciliation was incomplete, the profiling was augmented with additional analytical testing to reveal the missing members of the organic extractables profile. This process is illustrated via two case studies involving aqueous extracts of sterile filters. Plastic materials and systems used to manufacture, contain, store, and deliver pharmaceutical products are extracted and the extracts analyzed to establish the materials' (or systems') organic extractables profile. Such testing typically consists of multiple chromatographic approaches whose differences help to ensure that all organic extractables are revealed, measured, and identified. Nevertheless, this rigorous screening process is not infallible and certain organic extractables may elude detection. If the extraction medium is aqueous, the process of total organic carbon (TOC) reconciliation is proposed as a means of establishing when some organic extractables elude detection. In the reconciliation, the TOC of the extracts is both directly measured and calculated from the chromatographic data. The measured and calculated TOC is compared (or reconciled), and the degree of reconciliation is an indication of the completeness and accuracy of the organic extractables profiling. If the reconciliation is poor, then the extractables profile is either incomplete or inaccurate and additional testing must be performed to establish the complete and accurate profile. This article demonstrates the TOC reconciliation process by considering aqueous extracts of 10 different test articles. Incomplete reconciliations were augmented with additional testing to produce a more complete TOC reconciliation. © PDA, Inc. 2014.

76 FR 30948 - Agency Information Collection Activities: Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-27

... Act of 1995: Proposed Project: Reconciliation Tool for the Teaching Health Center Graduate Medical Education Program--[NEW] The Teaching Health Center Graduate Medical Education (THCGME) program, Section... statute provides that eligible teaching health centers receive payments for both direct and indirect costs...

42 CFR § 512.310 - Appeals process.

Code of Federal Regulations, 2010 CFR

2017-10-01

... (CONTINUED) HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS EPISODE PAYMENT MODEL Pricing and Payment § 512.310... related to payment, a CR incentive payment, reconciliation amounts, repayment amounts, the use of quality..., CMS deems final the reconciliation report and CR incentive payment report 45 calendar days after the...

7 CFR 274.4 - Reconciliation and reporting.

Code of Federal Regulations, 2014 CFR

2014-01-01

... basis and consist of: (1) Information on how the system operates relative to its performance standards..., shall be submitted by each State agency operating an issuance system. The report shall be prepared at... reconciliation process. The EBT system shall provide reports and documentation pertaining to the following: (1...

Cash Management/Data Matching. Training Guide.

ERIC Educational Resources Information Center

Office of Student Financial Assistance (ED), Washington, DC.

This training guide for financial aid staff explains the process of direct loan reconciliation and suggests appropriate cash management accounting practices. Chapter 1 explains the importance of cash management, the role of data matching, and reviews basic reconciliation concepts and terms and direct loan reporting requirements. Chapter 2 reviews…

Limited Health Literacy is a Barrier to Medication Reconciliation in Ambulatory Care

PubMed Central

Persell, Stephen D.; Osborn, Chandra Y.; Richard, Robert; Skripkauskas, Silvia

2007-01-01

Background Limited health literacy may influence patients’ ability to identify medications taken; a serious concern for ambulatory safety and quality. Objective To assess the relationship between health literacy, patient recall of antihypertensive medications, and reconciliation between patient self-report and the medical record. Design In-person interviews, literacy assessment, medical records abstraction. Participants Adults with hypertension at three community health centers. Measurement We measured health literacy using the short-form Test of Functional Health Literacy in Adults. Patients were asked about the medications they took for blood pressure. Their responses were compared with the medical record. Results Of 119 participants, 37 (31%) had inadequate health literacy. Patients with inadequate health literacy were less able to name any of their antihypertensive medications compared to those with adequate health literacy (40.5% vs 68.3%, p = 0.005). After adjusting for age and income, this difference remained (adjusted odds ratio [OR] = 2.9, 95% confidence interval [95%CI] = 1.3–6.7). Agreement between patient reported medications and the medical record was low: 64.9% of patients with inadequate and 37.8% with adequate literacy had no medications common to both lists. Conclusions Limited health literacy was associated with a greater number of unreconciled medications. Future studies should investigate how this may impact safety and hypertension control. PMID:17786521

The Budget Reconciliation Process: The Senate’s Byrd Rule

DTIC Science & Technology

2010-07-02

reconciliation process. The Democratic leadership in the Senate was concerned, in particular, that passage of the proposals in the Senate could be...did not.) In early 2010, the Democratic leadership in the Senate found an altered political situation; a special election held in Massachusetts in...the Democratic leadership faced a dilemma: the Democrats no longer held the 60-seat majority necessary to thwart a filibuster (and Republican

Blending in the Rainbow Nation: The Racial Integration of Schools and Its Implications for Reconciliation in Post-Apartheid South Africa

ERIC Educational Resources Information Center

Tihanyi, Krisztina

2006-01-01

This book takes a critical and detailed look at the young generation in post-Apartheid South Africa and examines ways in which members of the group relate to and engage with the post-Apartheid process of social and political reconciliation. To investigate whether and to what extent such processes are in fact taking place, Tihanyi focuses on the…

Inferring duplications, losses, transfers and incomplete lineage sorting with nonbinary species trees.

PubMed

Stolzer, Maureen; Lai, Han; Xu, Minli; Sathaye, Deepa; Vernot, Benjamin; Durand, Dannie

2012-09-15

Gene duplication (D), transfer (T), loss (L) and incomplete lineage sorting (I) are crucial to the evolution of gene families and the emergence of novel functions. The history of these events can be inferred via comparison of gene and species trees, a process called reconciliation, yet current reconciliation algorithms model only a subset of these evolutionary processes. We present an algorithm to reconcile a binary gene tree with a nonbinary species tree under a DTLI parsimony criterion. This is the first reconciliation algorithm to capture all four evolutionary processes driving tree incongruence and the first to reconcile non-binary species trees with a transfer model. Our algorithm infers all optimal solutions and reports complete, temporally feasible event histories, giving the gene and species lineages in which each event occurred. It is fixed-parameter tractable, with polytime complexity when the maximum species outdegree is fixed. Application of our algorithms to prokaryotic and eukaryotic data show that use of an incomplete event model has substantial impact on the events inferred and resulting biological conclusions. Our algorithms have been implemented in Notung, a freely available phylogenetic reconciliation software package, available at http://www.cs.cmu.edu/~durand/Notung. mstolzer@andrew.cmu.edu.

Towards the Reconciliation of Knowledge Management and e-Collaboration Systems

ERIC Educational Resources Information Center

Le Dinh, Thang; Rinfret, Louis; Raymond, Louis; Dong Thi, Bich-Thuy

2013-01-01

Purpose: The purpose of this paper is to propose an intelligent infrastructure for the reconciliation of knowledge management and e-collaboration systems. Design/Methodology/Approach:Literature on e-collaboration, information management, knowledge management, learning process, and intellectual capital is mobilised in order to build the conceptual…

Implementing a Social Knowledge Networking (SKN) system to enable meaningful use of an EHR medication reconciliation system.

PubMed

Rangachari, Pavani

2018-01-01

Despite the regulatory impetus toward meaningful use of electronic health record (EHR) Medication Reconciliation (MedRec) to prevent medication errors during care transitions, hospital adherence has lagged for one chief reason: low physician engagement, stemming from lack of consensus about which physician is responsible for managing a patient's medication list. In October 2016, Augusta University received a 2-year grant from the Agency for Healthcare Research and Quality to implement a Social Knowledge Networking (SKN) system for enabling its health system (AU Health) to progress from "limited use" of EHR MedRec technology to "meaningful use." The hypothesis is that SKN would bring together a diverse group of practitioners, to facilitate tacit knowledge exchange on issues related to EHR MedRec, which in turn is expected to increase practitioners' engagement in addressing those issues and enable meaningful use of EHR. The specific aims are to examine: 1) user-engagement in the SKN system, and 2) associations between "SKN use" and "meaningful use" of EHR. The 2-year project uses an exploratory mixed-method design and consists of three phases: 1) development; 2) SKN implementation; and 3) analysis. Phase 1, completed in May 2017, sought to identify a comprehensive set of issues related to EHR MedRec from practitioners directly involved in the MedRec process. This process facilitated development of a "Reporting Tool" on issues related to EHR MedRec, which, along with an existing "SKN/Discussion Tool," was integrated into the EHR at AU Health. Phase 2 (launched in June 2017) involves implementing the EHR-integrated SKN system over a 52-week period in inpatient and outpatient medicine units. The prospective implementation design is expected to generate context-sensitive strategies for meaningful use and successful implementation of EHR MedRec and thereby make substantial contributions to the patient safety and risk management literature. From a health care policy perspective, if the hypothesis holds, federal vendors could be encouraged to incorporate SKN features into EHR systems.

Medication safety.

PubMed

Keohane, Carol A; Bates, David W

2008-03-01

Patient safety is a state of mind, not a technology. The technologies used in the medical setting represent tools that must be properly designed, used well, and assessed on an on-going basis. Moreover, in all settings, building a culture of safety is pivotal for improving safety, and many nontechnologic approaches, such as medication reconciliation and teaching patients about their medications, are also essential. This article addresses the topic of medication safety and examines specific strategies being used to decrease the incidence of medication errors across various clinical settings.

The alarming reality of medication error: a patient case and review of Pennsylvania and National data.

PubMed

da Silva, Brianna A; Krishnamurthy, Mahesh

2016-01-01

A 71-year-old female accidentally received thiothixene (Navane), an antipsychotic, instead of her anti-hypertensive medication amlodipine (Norvasc) for 3 months. She sustained physical and psychological harm including ambulatory dysfunction, tremors, mood swings, and personality changes. Despite the many opportunities for intervention, multiple health care providers overlooked her symptoms. Errors occurred at multiple care levels, including prescribing, initial pharmacy dispensation, hospitalization, and subsequent outpatient follow-up. This exemplifies the Swiss Cheese Model of how errors can occur within a system. Adverse drug events (ADEs) account for more than 3.5 million physician office visits and 1 million emergency department visits each year. It is believed that preventable medication errors impact more than 7 million patients and cost almost $21 billion annually across all care settings. About 30% of hospitalized patients have at least one discrepancy on discharge medication reconciliation. Medication errors and ADEs are an underreported burden that adversely affects patients, providers, and the economy. Medication reconciliation including an 'indication review' for each prescription is an important aspect of patient safety. The decreasing frequency of pill bottle reviews, suboptimal patient education, and poor communication between healthcare providers are factors that threaten patient safety. Medication error and ADEs cost billions of health care dollars and are detrimental to the provider-patient relationship.

Milestones: a rapid assessment method for the Clinical Competency Committee

PubMed Central

Nabors, Christopher; Forman, Leanne; Peterson, Stephen J.; Gennarelli, Melissa; Aronow, Wilbert S.; DeLorenzo, Lawrence; Chandy, Dipak; Ahn, Chul; Sule, Sachin; Stallings, Gary W.; Khera, Sahil; Palaniswamy, Chandrasekar; Frishman, William H.

2016-01-01

Introduction Educational milestones are now used to assess the developmental progress of all U.S. graduate medical residents during training. Twice annually, each program’s Clinical Competency Committee (CCC) makes these determinations and reports its findings to the Accreditation Council for Graduate Medical Education (ACGME). The ideal way to conduct the CCC is not known. After finding that deliberations reliant upon the new milestones were time intensive, our internal medicine residency program tested an approach designed to produce rapid but accurate assessments. Material and methods For this study, we modified our usual CCC process to include pre-meeting faculty ratings of resident milestones progress with in-meeting reconciliation of their ratings. Data were considered largely via standard report and presented in a pre-arranged pattern. Participants were surveyed regarding their perceptions of data management strategies and use of milestones. Reliability of competence assessments was estimated by comparing pre-/post-intervention class rank lists produced by individual committee members with a master class rank list produced by the collective CCC after full deliberation. Results Use of the study CCC approach reduced committee deliberation time from 25 min to 9 min per resident (p < 0.001). Committee members believed milestones improved their ability to identify and assess expected elements of competency development (p = 0.026). Individual committee member assessments of trainee progress agreed well with collective CCC assessments. Conclusions Modification of the clinical competency process to include pre-meeting competence ratings with in-meeting reconciliation of these ratings led to shorter deliberation times, improved evaluator satisfaction and resulted in reliable milestone assessments. PMID:28144272

Using an Electronic Medication Refill System to Improve Provider Productivity in an Accountable Care Setting.

PubMed

Schoenhaus, Robert; Lustig, Adam; Rivas, Silvia; Monrreal, Victor; Westrich, Kimberly D; Dubois, Robert W

2016-03-01

Even within fully integrated health care systems, primary care providers (PCPs) often lack support for medication management. Because challenges with conducting medication reconciliation, improving adherence, and achieving optimal patient outcomes continue to be prevalent nationally, it is critical that PCPs are provided the resources and support they need to provide high-quality, patient-centered care in an accountable care environment. Sharp Rees-Stealy Medical Group uses a fully electronic medication refill system that allows for a centralized team to manage all incoming requests. Over time, 16 disease-specific protocols were created that allowed the pharmacy team to absorb approximately 80% of incoming refill requests for all enrolled PCPs. The refill clinic assessed all clinic information that a PCP would normally review in order to approve a refill. Tasks performed by the clinical pharmacists included medication reconciliation, dosage adjustment, and coordination of distribution from external mail order and retail pharmacies. In 2014, the number of tasks related to refill management reviewed by the refill/medication therapy management service totaled 302,592, resulting in 140,350 refill authorizations and multiple interventions related to medication use. Physicians have estimated that the service provides between 20 and 30 minutes of time savings per day. Assuming an annual PCP salary of around $200,000, 20 to 30 minutes per day would amount to $33 to $50 saved per day per physician. The savings is even higher when time savings from other clinical staff is included. The development of this electronic medication refill service has provided the following important lessons: (a) organizations rely on a leader or champion to push through process reforms--this program started with reluctant physicians first to determine best practices; (b) the lack of clinical pharmacist profiles within electronic health records (EHR) is a serious concern, since the creation of these profiles may not be easy or timely; and (c) PCPs working within an EHR environment will quickly embrace the idea of a service that can save them up to 30 minutes per day. With PCPs continuing to take on additional population health management tasks in accountable care organizations, pharmacists can provide workload offsets by meaningfully contributing to medication-related care.

Utility of an Algorithm to Increase the Accuracy of Medication History in an Obstetrical Setting.

PubMed

Corbel, Aline; Baud, David; Chaouch, Aziz; Beney, Johnny; Csajka, Chantal; Panchaud, Alice

2016-01-01

In an obstetrical setting, inaccurate medication histories at hospital admission may result in failure to identify potentially harmful treatments for patients and/or their fetus(es). This prospective study was conducted to assess average concordance rates between (1) a medication list obtained with a one-page structured medication history algorithm developed for the obstetrical setting and (2) the medication list reported in medical records and obtained by open-ended questions based on standard procedures. Both lists were converted into concordance rate using a best possible medication history approach as the reference (information obtained by patients, prescribers and community pharmacists' interviews). The algorithm-based method obtained a higher average concordance rate than the standard method, with respectively 90.2% [CI95% 85.8-94.3] versus 24.6% [CI95%15.3-34.4] concordance rates (p<0.01). Our algorithm-based method strongly enhanced the accuracy of the medication history in our obstetric population, without using substantial resources. Its implementation is an effective first step to the medication reconciliation process, which has been recognized as a very important component of patients' drug safety.

An Integrated Computerized Triage System in the Emergency Department

PubMed Central

Aronsky, Dominik; Jones, Ian; Raines, Bill; Hemphill, Robin; Mayberry, Scott R; Luther, Melissa A; Slusser, Ted

2008-01-01

Emergency department (ED) triage is a fast-paced process that prioritizes the allocation of limited health care resources to patients in greatest need. This paper describes the experiences with an integrated, computerized triage application. The system exchanges information with other information systems, including the ED patient tracking board, the longitudinal electronic medical record, the computerized provider order entry, and the medication reconciliation application. The application includes decision support capabilities such as assessing the patient’s acuity level, age-dependent alerts for vital signs, and clinical reminders. The browser-based system utilizes the institution’s controlled vocabulary, improves data completeness and quality, such as compliance with capturing required data elements and screening questions, initiates clinical processes, such as pneumococcal vaccination ordering, and reminders to start clinical pathways, issues alerts for clinical trial eligibility, and facilitates various reporting needs. The system has supported the triage documentation of >290,000 pediatric and adult patients. PMID:18999190

[Prevention of medication errors in healthcare transition of patients treated with apomorphine].

PubMed

Ucha Sanmartin, M; Martín Vila, A; López Vidal, C; Caaamaño Barreiro, M; Piñeiro Corrales, G

2014-05-01

The transition of patients between different levels of care process is a particular risk in the production of medication errors. The aim of this paper is to analyze the role of the pharmacist in preventing errors transition care to ensure a safe and cross pharmacotherapy of patients.Transversal, observational and descriptive study in a University Hospital that has a pharmacy service that integrates specialized inpatient care and health centers. Transition of care a patient treated with Apormorfina was analyzed to determine the keypoints of action of the pharmacist. Demographics, disease and medication history, and care transition episodes were collected through the pharmacy program and electronics history.The pharmacist did tasks adapting, reconciliation, management and reporting of medication to the health care team to prevent medication errors in care transition of patients treated with drugs requiring special handling .In conclusion, this work represents perfectly the key role of the pharmacist as coordinator of safe and transverse pharmacotherapy of patients. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Expansion of a residency program through provision of second-shift decentralized services.

PubMed

Host, Brian D; Anderson, Michael J; Lucas, Paul D

2014-12-15

The rationale for and logistics of the expansion of a postgraduate year 1 (PGY1) residency program in a community hospital are described. Baptist Health Lexington, a nonprofit community hospital in Lexington, Kentucky, sought to expand the PGY1 program by having residents perform second-shift decentralized pharmacist functions. Program expansion was predicated on aligning resident staffing functions with current hospitalwide initiatives involving medication reconciliation and patient education. The focus was to integrate residents into the workflow while allowing them more time to practice as pharmacists and contribute to departmental objectives. The staffing function would increase residents' overall knowledge of departmental operations and foster their sense of independence and ownership. The decentralized functions would include initiation of clinical pharmacokinetic consultations, admission medication reconciliation, discharge teaching for patients with heart failure, and order-entry support from decentralized locations. The program grew from three to five residents and established a staffing rotation for second-shift decentralized coverage. The increased time spent staffing did not detract from the time allotted to previously established learning experiences and enhanced overall continuity of the staffing experience. The change also emphasized to the residents the importance of integration of distributive and clinical functions within the department. Pharmacist participation in admission and discharge medication reconciliation activities has also increased patient satisfaction, evidenced by follow-up surveys conducted by the hospital. A PGY1 residency program was expanded through the provision of second-shift decentralized clinical services, which helped provide residents with increased patient exposure and enhanced staffing experience. Copyright © 2014 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

[Medication reconciliation at hospital admission: Results and identification of target patients].

PubMed

San José Ruiz, B; Serrano De Lucas, L; López-Giménez, L R; Baza Martínez, B; Sautua Larreategi, S; Bustinza Txertudi, A; Sebastián Leza, Á; Chirivella Ramón, M T; Fonseca Legrand, J L; de Miguel Cascon, M

2016-06-01

To quantify and to classify the discrepancies between the admission treatment and the usual patient treatment. To determine the variables that predict those patients that will have more benefit from medication reconciliation. A prospective medication reconciliation study was conducted in the Vascular Surgery Unit from March 2014 to December 2014. When the patients were admitted to the Vascular Surgery Unit, they were informed about the study and asked to prepare information about their chronic treatment. The pharmacist then checked their clinical records, outpatient prescriptions, and also interviewed the patient, obtaining the best pharmacotherapeutic history available. The discrepancies with the admission treatment were written into the patient electronic clinical records. Finally, the physician classified the discrepancies, and changed the treatment, if needed. The statistical analysis included a comparison between patients with and without a non-justified discrepancy (NJD). The statistically different characteristics were used to plot Receiver Operating Characteristic curves, in order to determine the sensitivity and the specificity of these variables to select patients with discrepancies. A total of 380 patients were included. There were 845 non-justified, 600 justified non-documented, and 439 justified documented discrepancies. At least one NJD was identified in 293 patients (77%), with 65 patients (17%) having only justified discrepancies, and 22 patients (6%) having no discrepancies. NJD were: different dose, route or schedule (51%), omission (39%), wrong drug (8%) and commission (2%). The variables associated with discrepancies were number of chronic medications drugs and provider of information. In most studies, omission is the most frequent error. In contrast, in our study the most frequent error is different dose, route, or schedule. The variable that allows selecting patients at higher risk of discrepancies is the number of chronic drugs. This risk is also increased if the patients are not the manager of their own medication. Copyright © 2016 SECA. Published by Elsevier Espana. All rights reserved.

The effect of the COACH program (Continuity Of Appropriate pharmacotherapy, patient Counselling and information transfer in Healthcare) on readmission rates in a multicultural population of internal medicine patients.

PubMed

Karapinar-Carkit, Fatma; Borgsteede, Sander D; Zoer, Jan; Siegert, Carl; van Tulder, Maurits; Egberts, Antoine C G; van den Bemt, Patricia M L A

2010-02-16

Medication errors occur frequently at points of transition in care. The key problems causing these medication errors are: incomplete and inappropriate medication reconciliation at hospital discharge (partly arising from inadequate medication reconciliation at admission), insufficient patient information (especially within a multicultural patient population) and insufficient communication to the next health care provider. Whether interventions aimed at the combination of these aspects indeed result in less discontinuity and associated harm is uncertain. Therefore the main objective of this study is to determine the effect of the COACH program (Continuity Of Appropriate pharmacotherapy, patient Counselling and information transfer in Healthcare) on readmission rates in patients discharged from the internal medicine department. An experimental study is performed at the internal medicine ward of a general teaching hospital in Amsterdam, which serves a multicultural population. In this study the effects of the COACH program is compared with usual care using a pre-post study design. All patients being admitted with at least one prescribed drug intended for chronic use are included in the study unless they meet one of the following exclusion criteria: no informed consent, no medication intended for chronic use prescribed at discharge, death, transfer to another ward or hospital, discharge within 24 hours or out of office hours, discharge to a nursing home and no possibility to counsel the patient.The intervention consists of medication reconciliation, patient counselling and communication between the hospital and primary care healthcare providers.The following outcomes are measured: the primary outcome readmissions within six months after discharge and the secondary outcomes number of interventions, adherence, patient's attitude towards medicines, patient's satisfaction with medication information, costs, quality of life and finally satisfaction of general practitioners and community pharmacists.Interrupted time series analysis is used for data-analysis of the primary outcome. Descriptive statistics is performed for the secondary outcomes. An economic evaluation is performed according to the intention-to-treat principle. This study will be able to evaluate the clinical and cost impact of a comprehensive program on continuity of care and associated patient safety. Dutch trial register: NTR1519.

Structural redundancy of data from wastewater treatment systems. Determination of individual balance equations.

PubMed

Spindler, A

2014-06-15

Although data reconciliation is intensely applied in process engineering, almost none of its powerful methods are employed for validation of operational data from wastewater treatment plants. This is partly due to some prerequisites that are difficult to meet including steady state, known variances of process variables and absence of gross errors. However, an algorithm can be derived from the classical approaches to data reconciliation that allows to find a comprehensive set of equations describing redundancy in the data when measured and unmeasured variables (flows and concentrations) are defined. This is a precondition for methods of data validation based on individual mass balances such as CUSUM charts. The procedure can also be applied to verify the necessity of existing or additional measurements with respect to the improvement of the data's redundancy. Results are given for a large wastewater treatment plant. The introduction aims at establishing a link between methods known from data reconciliation in process engineering and their application in wastewater treatment. Copyright © 2014 Elsevier Ltd. All rights reserved.

Form reconciles meds, but doctor buy-in difficult.

PubMed

2006-02-01

One ED has developed a medication reconciliation form to meet the National Patient Safety Goal of reconciling medications across the continuum of care. The form does require additional staff time to complete. Staff and physicians need training so they understand the importance of meeting the safety goal. Physicians may resist giving orders on previously prescribed meds and may see the form as redundant.

Medication safety infrastructure in critical-access hospitals in Florida.

PubMed

Winterstein, Almut G; Hartzema, Abraham G; Johns, Thomas E; De Leon, Jessica M; McDonald, Kathie; Henshaw, Zak; Pannell, Robert

2006-03-01

The medication safety infrastructure of critical-access hospitals (CAHs) in Florida was evaluated. Qualitative assessments, including a self-administered survey and site visits, were conducted in seven of nine CAHs between January and June 2003. The survey consisted of the Institute for Safe Medication Practices Medication Safety Self-assessment, the 2003 Joint Commission on Accreditation of Healthcare Organizations patient safety goals, health information technology (HIT) questions, and medication-use-process flow charts. On-site visits included interviews of CAH personnel who had safety responsibility and inspections of pharmacy facilities. The findings were compiled into a matrix reflecting structural and procedural components of the CAH medication safety infrastructure. The nine characteristics that emerged as targets for quality improvement (QI) were medication accessibility and storage, sterile product compounding, access to drug information, access to and utilization of patient information in medication order review, advanced safety technology, drug formularies and standardized medication protocols, safety culture, and medication reconciliation. Based on weighted importance and feasibility, QI efforts in CAHs should focus on enhancing medication order review systems, standardizing procedures for handling high-risk medications, promoting an appropriate safety culture, involvement in seamless care, and investment in HIT.

Reconciliation and psychosocial understanding

PubMed Central

2015-01-01

‘Reconciliation’ generally means the development of good relations where they have never truly existed before. This paper refers principally to the example of Northern Ireland and the Irish peace process. Psychiatrists should examine what really contributes to ‘large group’ reconciliation, as the absence of the psychiatric perspective would be a serious loss in the search for post-conflict well-being at the communal level. PMID:29093855

An African Perspective on Peace Education: Ubuntu Lessons in Reconciliation

NASA Astrophysics Data System (ADS)

Murithi, Tim

2009-05-01

This essay examines the value of educating for peace. It does this through a consideration of the African cultural world-view known as ubuntu, which highlights the essential unity of humanity and emphasises the importance of constantly referring to the principles of empathy, sharing and cooperation in efforts to resolve our common problems. The essay is not based on field research, but rather on a discussion of the issues pertaining to ubuntu and peace education. The discussion focuses on how Desmond Tutu utilised the principles of ubuntu during his leadership of the South African Truth and Reconciliation Commission. It also outlines the five stages of the peacemaking process found among ubuntu societies: acknowledging guilt; showing remorse and repenting; asking for and giving forgiveness; and paying compensation or reparations as a prelude to reconciliation. Potential lessons for educating for peace and reconciliation are highlighted based on the premise that the ubuntu approach to human relationship-building can offer an example to the world.

Incorporating medication indications into the prescribing process.

PubMed

Kron, Kevin; Myers, Sara; Volk, Lynn; Nathan, Aaron; Neri, Pamela; Salazar, Alejandra; Amato, Mary G; Wright, Adam; Karmiy, Sam; McCord, Sarah; Seoane-Vazquez, Enrique; Eguale, Tewodros; Rodriguez-Monguio, Rosa; Bates, David W; Schiff, Gordon

2018-04-19

The incorporation of medication indications into the prescribing process to improve patient safety is discussed. Currently, most prescriptions lack a key piece of information needed for safe medication use: the patient-specific drug indication. Integrating indications could pave the way for safer prescribing in multiple ways, including avoiding look-alike/sound-alike errors, facilitating selection of drugs of choice, aiding in communication among the healthcare team, bolstering patient understanding and adherence, and organizing medication lists to facilitate medication reconciliation. Although strongly supported by pharmacists, multiple prior attempts to encourage prescribers to include the indication on prescriptions have not been successful. We convened 6 expert panels to consult high-level stakeholders on system design considerations and requirements necessary for building and implementing an indications-based computerized prescriber order-entry (CPOE) system. We summarize our findings from the 6 expert stakeholder panels, including rationale, literature findings, potential benefits, and challenges of incorporating indications into the prescribing process. Based on this stakeholder input, design requirements for a new CPOE interface and workflow have been identified. The emergence of universal electronic prescribing and content knowledge vendors has laid the groundwork for incorporating indications into the CPOE prescribing process. As medication prescribing moves in the direction of inclusion of the indication, it is imperative to design CPOE systems to efficiently and effectively incorporate indications into prescriber workflows and optimize ways this can best be accomplished. Copyright © 2018 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Implementing a Social Knowledge Networking (SKN) system to enable meaningful use of an EHR medication reconciliation system

PubMed Central

Rangachari, Pavani

2018-01-01

Background Despite the regulatory impetus toward meaningful use of electronic health record (EHR) Medication Reconciliation (MedRec) to prevent medication errors during care transitions, hospital adherence has lagged for one chief reason: low physician engagement, stemming from lack of consensus about which physician is responsible for managing a patient’s medication list. In October 2016, Augusta University received a 2-year grant from the Agency for Healthcare Research and Quality to implement a Social Knowledge Networking (SKN) system for enabling its health system (AU Health) to progress from “limited use” of EHR MedRec technology to “meaningful use.” The hypothesis is that SKN would bring together a diverse group of practitioners, to facilitate tacit knowledge exchange on issues related to EHR MedRec, which in turn is expected to increase practitioners’ engagement in addressing those issues and enable meaningful use of EHR. The specific aims are to examine: 1) user-engagement in the SKN system, and 2) associations between “SKN use” and “meaningful use” of EHR. Methods The 2-year project uses an exploratory mixed-method design and consists of three phases: 1) development; 2) SKN implementation; and 3) analysis. Phase 1, completed in May 2017, sought to identify a comprehensive set of issues related to EHR MedRec from practitioners directly involved in the MedRec process. This process facilitated development of a “Reporting Tool” on issues related to EHR MedRec, which, along with an existing “SKN/Discussion Tool,” was integrated into the EHR at AU Health. Phase 2 (launched in June 2017) involves implementing the EHR-integrated SKN system over a 52-week period in inpatient and outpatient medicine units. Discussion The prospective implementation design is expected to generate context-sensitive strategies for meaningful use and successful implementation of EHR MedRec and thereby make substantial contributions to the patient safety and risk management literature. From a health care policy perspective, if the hypothesis holds, federal vendors could be encouraged to incorporate SKN features into EHR systems. PMID:29618941

Code Status Reconciliation to Improve Identification and Documentation of Code Status in Electronic Health Records.

PubMed

Jain, Viral G; Greco, Peter J; Kaelber, David C

2017-03-08

Code status (CS) of a patient (part of their end-of-life wishes) can be critical information in healthcare delivery, which can change over time, especially at transitions of care. Although electronic health record (EHR) tools exist for medication reconciliation across transitions of care, much less attention is given to CS, and standard EHR tools have not been implemented for CS reconciliation (CSR). Lack of CSR creates significant potential patient safety and quality of life issues. To study the tools, workflow, and impact of clinical decision support (CDS) for CSR. We established rules for CS implementation in our EHR. At admission, a CS is required as part of a patient's admission order set. Using standard CDS tools in our EHR, we built an interruptive alert for CSR at discharge if a patient did not have the same inpatient (current) CS at discharge as that prior to admission CS. Of 80,587 admissions over a four year period (2 years prior to and post CSR implementation), CS discordance was seen in 3.5% of encounters which had full code status prior to admission, but Do Not Resuscitate (DNR) CS at discharge. In addition, 1.4% of the encounters had a different variant of the DNR CS at discharge when compared with CS prior to admission. On pre-post CSR implementation analysis, DNR CS per 1000 admissions per month increased significantly among patients discharged and in patients being admitted (mean ± SD: 85.36 ± 13.69 to 399.85 ± 182.86, p<0.001; and 1.99 ± 1.37 vs 16.70 ± 4.51, p<0.001, respectively). EHR enabled CSR is effective and represents a significant informatics opportunity to help honor patients' end-of-life wishes. CSR represents one example of non-medication reconciliation at transitions of care that should be considered in all EHRs to improve care quality and patient safety.

Implementation of a medication reconciliation process in an ambulatory internal medicine clinic

PubMed Central

Nassaralla, Claudia L; Naessens, James M; Chaudhry, Rajeev; Hansen, Melanie A; Scheitel, Sidna M

2007-01-01

Objective To evaluate the causes of medication list inaccuracy, implement intervention to enhance overall accuracy of medication lists and measure the sustainability of the intervention. Methods A prospective study of patients seen in an academic, ambulatory primary care internal medicine clinic. Before the intervention, baseline data were analysed, assessing completeness of medication documentation in the electronic medical record. The intervention consisted of standardising the entire visit process from scheduling of the appointment to signing of the final clinical note by the physician. Each healthcare team member was instructed in her role to enhance accuracy of the documented medication list. Immediately after the intervention, a second data collection was undertaken to assess the effectiveness of the intervention on the accuracy of individual medications and medication lists. Finally, a year later, a third data collection was undertaken to assess the sustainability of the intervention. Results Completeness of individual medications improved from 9.7% to 70.7% (p<0.001). However, completeness of the entire medication lists improved only from 7.7% to 18.5%. The incomplete documentation of medication lists was mostly due to lack of route (85.8%) and frequency (22.3%) for individual medications within a medication list. Also, documentation of over‐the‐counter and “as needed” medications was often incomplete. The incorrectness in a medication list was mostly due to misreporting of medications by patients or failure of clinicians to update the medication list when changes were made. Conclusion To improve the accuracy of medication lists, active participation of all members of the healthcare team and the patient is needed. PMID:17403752

Utilization of Pharmacy Technicians to Increase the Accuracy of Patient Medication Histories Obtained in the Emergency Department

PubMed Central

Pisupati, Radhika; Nerenberg, Steven F.

2016-01-01

Purpose: The purpose of this study is to determine the accuracy of a pharmacy technician–collected medication history pilot program in the emergency department. This was completed by reviewing all elements of the technician activity by direct observation and by verifying the technician-collected medication list through a second phone call by a pharmacist to the outpatient pharmacy. Methods: This was a retrospective, single-center study conducted from March to April 2015. Four certified pharmacy technicians were trained by a postgraduate year 1 (PGY1) pharmacy practice resident on how to collect, verify, and accurately enter medication histories into the electronic medical record. Accuracy of pharmacy technician–collected medication histories was verified by a pharmacist through observation of their patient interviews, review of technician-completed medication history forms, and by contacting the patient's outpatient pharmacy. Results: The pharmacy technician–completed medication histories resulted in an absolute risk reduction of errors of 50% and a relative risk reduction of errors of 77% (p < .001) in comparison to medication histories collected by non-pharmacy personnel. Conclusion: With high accuracy rates, pharmacy technicians proved to be a valuable asset to the medication history process and can enhance patient safety during care transitions. The results of this study further support the Pharmacy Practice Model Initiative vision to advance the pharmacy technician role to improve the process of medication history taking and reconciliation within the health care system. PMID:27303094

Amnesty, Reconciliation and Reintegration: The International Community and the Rwandan Process

DTIC Science & Technology

2008-05-22

Egypt, the Secretary General of the OAU, Dr. Salim Ahmed SALIM, the Secretary General of the United Nations, Dr. Boutros Boutros GHALI and Observers...the Mediator, His Excellency Faustin BIRINDWA, Prime Minister of Zaire; - Dr. Salim Ahmed SALIM, Secretary General of the OAU; - The...2005. Disarmament as Part of Reconciliation in Rwanda. Institute of Security Studies 108 (June): 1-16. Ali- Dinar , Ali B. PhD Ed. 1999. DRC

A Medication Safety Model: A Case Study in Thai Hospital

PubMed Central

Rattanarojsakul, Phichai; Thawesaengskulthai, Natcha

2013-01-01

Reaching zero defects is vital in medication service. Medication error can be reduced if the causes are recognized. The purpose of this study is to search for a conceptual framework of the causes of medication error in Thailand and to examine relationship between these factors and its importance. The study was carried out upon an in-depth case study and survey of hospital personals who were involved in the drug use process. The structured survey was based on Emergency Care Research Institute (ECRI) (2008) questionnaires focusing on the important factors that affect the medication safety. Additional questionnaires included content to the context of Thailand's private hospital, validated by five-hospital qualified experts. By correlation Pearson analysis, the result revealed 14 important factors showing a linear relationship with drug administration error except the medication reconciliation. By independent sample t-test, the administration error in the hospital was significantly related to external impact. The multiple regression analysis of the detail of medication administration also indicated the patient identification before administration of medication, detection of the risk of medication adverse effects and assurance of medication administration at the right time, dosage and route were statistically significant at 0.05 level. The major implication of the study is to propose a medication safety model in a Thai private hospital. PMID:23985110

A medication safety model: a case study in Thai hospital.

PubMed

Rattanarojsakul, Phichai; Thawesaengskulthai, Natcha

2013-06-12

Reaching zero defects is vital in medication service. Medication error can be reduced if the causes are recognized. The purpose of this study is to search for a conceptual framework of the causes of medication error in Thailand and to examine relationship between these factors and its importance. The study was carried out upon an in-depth case study and survey of hospital personals who were involved in the drug use process. The structured survey was based on Emergency Care Research Institute (ECRI) (2008) questionnaires focusing on the important factors that affect the medication safety. Additional questionnaires included content to the context of Thailand's private hospital, validated by five-hospital qualified experts. By correlation Pearson analysis, the result revealed 14 important factors showing a linear relationship with drug administration error except the medication reconciliation. By independent sample t-test, the administration error in the hospital was significantly related to external impact. The multiple regression analysis of the detail of medication administration also indicated the patient identification before administration of medication, detection of the risk of medication adverse effects and assurance of medication administration at the right time, dosage and route were statistically significant at 0.05 level. The major implication of the study is to propose a medication safety model in a Thai private hospital.

Home culture, science, school and science learning: is reconciliation possible?

NASA Astrophysics Data System (ADS)

Tan, Aik-Ling

2011-09-01

In response to Meyer and Crawford's article on how nature of science and authentic science inquiry strategies can be used to support the learning of science for underrepresented students, I explore the possibly of reconciliation between the cultures of school, science, school science as well as home. Such reconciliation is only possible when science teachers are cognizant of the factors affecting the cultural values and belief systems of underrepresented students. Using my experience as an Asian learner of WMS, I suggest that open and honest dialogues in science classrooms will allow for greater clarity of the ideals that WMS profess and cultural beliefs of underrepresented students. This in-depth understanding will eliminate guesswork and unrealistic expectations and in the process promote tolerance and acceptance of diversity in ways of knowing.

Five challenges to reconcile agricultural land use and forest ecosystem services in Southeast Asia.

PubMed

Carrasco, L R; Papworth, S K; Reed, J; Symes, W S; Ickowitz, A; Clements, T; Peh, K S-H; Sunderland, T

2016-10-01

Southeast Asia possesses the highest rates of tropical deforestation globally and exceptional levels of species richness and endemism. Many countries in the region are also recognized for their food insecurity and poverty, making the reconciliation of agricultural production and forest conservation a particular priority. This reconciliation requires recognition of the trade-offs between competing land-use values and the subsequent incorporation of this information into policy making. To date, such reconciliation has been relatively unsuccessful across much of Southeast Asia. We propose an ecosystem services (ES) value-internalization framework that identifies the key challenges to such reconciliation. These challenges include lack of accessible ES valuation techniques; limited knowledge of the links between forests, food security, and human well-being; weak demand and political will for the integration of ES in economic activities and environmental regulation; a disconnect between decision makers and ES valuation; and lack of transparent discussion platforms where stakeholders can work toward consensus on negotiated land-use management decisions. Key research priorities to overcome these challenges are developing easy-to-use ES valuation techniques; quantifying links between forests and well-being that go beyond economic values; understanding factors that prevent the incorporation of ES into markets, regulations, and environmental certification schemes; understanding how to integrate ES valuation into policy making processes, and determining how to reduce corruption and power plays in land-use planning processes. © 2016 Society for Conservation Biology.

Analysis of the healthcare process of patients with type 2 diabetes mellitus and associated comorbidity treated in Spain's National Health System: A perspective of medical professionals. IMAGINE study.

PubMed

Gómez-Huelgas, R; Artola-Menéndez, S; Menéndez-Torre, E

2016-04-01

To analyse the care received by patients with type 2 diabetes mellitus (DM2) and comorbidity in Spain's National Health System. Cross-sectional study using an online survey. A total of 302 family physicians, internists and endocrinologists participated in the study. The participants were recruited voluntarily by their respective scientific societies and received no remuneration. Patients with DM2 and comorbidity are mostly treated in Primary Care (71.8%). Forty percent are referred to hospital care, mainly due to renal failure, poor glycaemic control and for a retinopathy assessment. Only 52% of those surveyed conducted medication reconciliation in the transition between healthcare levels. Fifty-eight percent reported conducting interconsultations, clinical meetings or consultancies between healthcare levels. The 3 main factors identified for improving the follow-up and control of DM2 with comorbidity were the multidisciplinary study (80.8%), the continuing education of health professionals (72.3%) and therapeutic education programmes (72%). A lack of time, a lack of qualified personnel for lifestyle interventions and organisational shortcomings were mentioned as the main obstacles for improving the care of these patients. Most patients with DM2 and comorbidity are treated in Primary Care. Promoting multidisciplinary care and training programmes for practitioners and patients can help improve the quality of care. Therapy reconciliation represents a priority area for improvement in this population. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

The Patient Protection and Affordable Care Act: implications for pediatric pharmacy practice.

PubMed

Vallejos, Ximena; Benavides, Sandra

2013-01-01

The impact of the Patient Protection and Affordable Care Act on the pediatric health care landscape includes expanded health insurance coverage and health care delivery improvements by increasing implementation of patient-centered medical homes and accountable care organizations. These offer opportunities for pharmacists to assume responsibility for the medication-related needs of pediatric patients through pharmacotherapy selection, medication therapy management performance, and medication reconciliation at each transition of care. Medically complex children with at least 2 chronic disease states may be the target population. Studies demonstrating the positive outcomes and cost-effectiveness of pharmacists in pediatric ambulatory care settings are needed.

Exploring challenges in the patient's discharge process from the internal medicine service: A qualitative study of patients' and providers' perceptions.

PubMed

Pinelli, Vincent; Stuckey, Heather L; Gonzalo, Jed D

2017-09-01

In hospital-based medicine units, patients have a wide range of complex medical conditions, requiring timely and accurate communication between multiple interprofessional providers at the time of discharge. Limited work has investigated the challenges in interprofessional collaboration and communication during the patient discharge process. In this study, authors qualitatively assessed the experiences of internal medicine providers and patients about roles, challenges, and potential solutions in the discharge process, with a phenomenological focus on the process of collaboration. Authors conducted interviews with 87 providers and patients-41 providers in eight focus-groups, 39 providers in individual interviews, and seven individual patient interviews. Provider roles included physicians, nurses, therapists, pharmacists, care coordinators, and social workers. Interviews were audio-recorded and transcribed verbatim, followed by iterative review of transcripts using qualitative coding and content analysis. Participants identified several barriers related to interprofessional collaboration during the discharge process, including systems insufficiencies (e.g., medication reconciliation process, staffing challenges); lack of understanding others' roles (e.g., unclear which provider should be completing the discharge summary); information-communication breakdowns (e.g., inaccurate information communicated to the primary medical team); patient issues (e.g., patient preferences misaligned with recommendations); and poor collaboration processes (e.g., lack of structured interprofessional rounds). These results provide context for targeting improvement in interprofessional collaboration in medicine units during patient discharges. Implementing changes in care delivery processes may increase potential for accurate and timely coordination, thereby improving the quality of care transitions.

Key Value Considerations for Consultant Pharmacists.

PubMed

Meyer, Lee; Perry, Ronald G; Rhodus, Susan M; Stearns, Wendy

2016-07-01

Managing the efficiency and costs of residents' drug regimens outside the acute-care hospital and through transitions of care requires a toolbox filled with cost-control tools and careful collaboration among the pharmacy provider(s), facility staff, and the consultant/senior care pharmacist. This article will provide the reader with key long-term care business strategies that affect the profitability of the pharmacy provider in various care settings while, at the same time, ensuring optimal therapy for residents as they transition across levels of care. Readers can take away ideas on how to access critical information, what they can do with this information, and how they can improve the overall care process. Four experts in various aspects of pharmacy management share their insights on pharmacy practice issues including formulary management, performance metrics, short-cycle dispensing challenges/solutions, cost-control measures, facility surveys, billing practices, medication reconciliation, prospective medication reviews, and transitions of care.

Fostering students' reflection about bias in healthcare: cognitive dissonance and the role of personal and normative standards.

PubMed

Hernandez, Rachael A; Haidet, Paul; Gill, Anne C; Teal, Cayla R

2013-04-01

To reduce cognitive dissonance about one's beliefs or behavior, individuals may compare their behavior to personal and/or normative standards. The details of this reflection process are unclear. We examined how medical students compare their behavior or beliefs to standards in discussions about implicit bias, and explored if and how different reflective pathways (preserving vs. reconciling) are associated with each standard. Third-year students engaged in a small-group discussion about bias. Some students and group facilitators also participated in a debriefing about the experience. Using qualitative methods, the transcripts from these 11 sessions were analyzed for evidence of student comparison to a standard and of reflection pathways. Of 557 text units, 75.8% could be coded with a standard and/or a path of reflection. Students referenced personal and normative standards about equally, and preserved or reconciled existing beliefs about equally. Uses of normative standards were associated with preservation-type reflection, and uses of personal standards with reconciliation-type reflection. Normative expectations of physicians are sometimes used to provoke students' consideration of implicit biases about patients. To encourage critical reflection and reconciliation of biased beliefs or behavior, educators should frame reflective activities as a personal exercise rather than as a requirement.

Medication errors: an overview for clinicians.

PubMed

Wittich, Christopher M; Burkle, Christopher M; Lanier, William L

2014-08-01

Medication error is an important cause of patient morbidity and mortality, yet it can be a confusing and underappreciated concept. This article provides a review for practicing physicians that focuses on medication error (1) terminology and definitions, (2) incidence, (3) risk factors, (4) avoidance strategies, and (5) disclosure and legal consequences. A medication error is any error that occurs at any point in the medication use process. It has been estimated by the Institute of Medicine that medication errors cause 1 of 131 outpatient and 1 of 854 inpatient deaths. Medication factors (eg, similar sounding names, low therapeutic index), patient factors (eg, poor renal or hepatic function, impaired cognition, polypharmacy), and health care professional factors (eg, use of abbreviations in prescriptions and other communications, cognitive biases) can precipitate medication errors. Consequences faced by physicians after medication errors can include loss of patient trust, civil actions, criminal charges, and medical board discipline. Methods to prevent medication errors from occurring (eg, use of information technology, better drug labeling, and medication reconciliation) have been used with varying success. When an error is discovered, patients expect disclosure that is timely, given in person, and accompanied with an apology and communication of efforts to prevent future errors. Learning more about medication errors may enhance health care professionals' ability to provide safe care to their patients. Copyright © 2014 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Reconciliation and Pedagogy. Postcolonial Politics

ERIC Educational Resources Information Center

Ahluwalia, Pal, Ed.; Atkinson, Stephen, Ed.; Bishop, Peter, Ed.; Christie, Pam, Ed.; Hattam, Robert, Ed.; Matthews, Julie, Ed.

2012-01-01

Reconciliation is one of the most significant contemporary challenges in the world today. In this innovative new volume, educational academics and practitioners across a range of cultural and political contexts examine the links between reconciliation and critical pedagogy, putting forward the notion that reconciliation projects should be regarded…

On the Complexity of Duplication-Transfer-Loss Reconciliation with Non-Binary Gene Trees.

PubMed

Kordi, Misagh; Bansal, Mukul S

2017-01-01

Duplication-Transfer-Loss (DTL) reconciliation has emerged as a powerful technique for studying gene family evolution in the presence of horizontal gene transfer. DTL reconciliation takes as input a gene family phylogeny and the corresponding species phylogeny, and reconciles the two by postulating speciation, gene duplication, horizontal gene transfer, and gene loss events. Efficient algorithms exist for finding optimal DTL reconciliations when the gene tree is binary. However, gene trees are frequently non-binary. With such non-binary gene trees, the reconciliation problem seeks to find a binary resolution of the gene tree that minimizes the reconciliation cost. Given the prevalence of non-binary gene trees, many efficient algorithms have been developed for this problem in the context of the simpler Duplication-Loss (DL) reconciliation model. Yet, no efficient algorithms exist for DTL reconciliation with non-binary gene trees and the complexity of the problem remains unknown. In this work, we resolve this open question by showing that the problem is, in fact, NP-hard. Our reduction applies to both the dated and undated formulations of DTL reconciliation. By resolving this long-standing open problem, this work will spur the development of both exact and heuristic algorithms for this important problem.

Evaluation of Patient and Family Engagement Strategies to Improve Medication Safety.

PubMed

Kim, Julia M; Suarez-Cuervo, Catalina; Berger, Zackary; Lee, Joy; Gayleard, Jessica; Rosenberg, Carol; Nagy, Natalia; Weeks, Kristina; Dy, Sydney

2018-04-01

Patient and family engagement (PFE) is critical for patient safety. We systematically reviewed types of PFE strategies implemented and their impact on medication safety. We searched MEDLINE, EMBASE, reference lists and websites to August 2016. Two investigators independently reviewed all abstracts and articles, and articles were additionally reviewed by two senior investigators for selection. One investigator abstracted data and two investigators reviewed the data for accuracy. Study quality was determined by consensus. Investigators developed a framework for defining the level of patient engagement: informing patients about medications (Level 1), informing about engagement with health care providers (Level 2), empowering patients with communication tools and skills (Level 3), partnering with patients in their care (Level 4), and integrating patients as full care team members (Level 5). We included 19 studies that mostly targeted older adults taking multiple medications. The median level of engagement was 2, ranging from 2-4. We identified no level 5 studies. Key themes for patient engagement strategies impacting medication safety were patient education and medication reconciliation, with a subtheme of patient portals. Most studies (84%) reported implementation outcomes. The most commonly reported medication safety outcomes were medication errors, including near misses and discrepancies (47%), and medication safety knowledge (37%). Most studies (63%) were of medium to low quality, and risk of bias was generally moderate. Among the 11 studies with control groups, 55% (n = 6) reported statistically significant improvement on at least one medication safety outcome. Further synthesis of medication safety measures was limited due to intervention and outcome heterogeneity. Key strategies for engaging patients in medication safety are education and medication reconciliation. Patient engagement levels were generally low, as defined by a novel framework for determining levels of patient engagement. As more patient engagement studies are conducted, this framework should be evaluated for associations with patient outcomes.

78 FR 27984 - Modification of the National Customs Automation Program Test (NCAP) Regarding Reconciliation for...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-13

... Customs Automation Program Test (NCAP) Regarding Reconciliation for Filing Certain Post-Importation Claims... Automation Program (NCAP) Reconciliation prototype test to include the filing of post-importation [[Page... notices. DATES: The test is modified to allow Reconciliation of post-importation preferential tariff...

Reconciliation in Practice. Peaceworks No. 111

ERIC Educational Resources Information Center

McKone, Kelly

2015-01-01

This report addresses a critical knowledge gap between reconciliation theory and practice in post-conflict settings. Spearheaded by the Center for Applied Research on Conflict at the United States Institute of Peace (USIP), the larger project goal is to map reconciliation practices to better understand how reconciliation is conceived, what…

77 FR 67399 - State Street Corporation, Putnam Cash Reconciliations Team, Including On-Site Leased Workers From...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-09

..., Putnam Cash Reconciliations Team, Including On-Site Leased Workers From APC Workforce Solutions II, LLC... Corporation, Putnam Cash Reconciliation Team, Quincy, Massachusetts. The workers were engaged in activities... employed on-site at State Street Corporation, Putnam Cash Reconciliation Team, Quincy, Massachusetts. The...

Best practice strategies to safeguard drug prescribing and drug administration: an anthology of expert views and opinions.

PubMed

Seidling, Hanna M; Stützle, Marion; Hoppe-Tichy, Torsten; Allenet, Benoît; Bedouch, Pierrick; Bonnabry, Pascal; Coleman, Jamie J; Fernandez-Llimos, Fernando; Lovis, Christian; Rei, Maria Jose; Störzinger, Dominic; Taylor, Lenka A; Pontefract, Sarah K; van den Bemt, Patricia M L A; van der Sijs, Heleen; Haefeli, Walter E

2016-04-01

While evidence on implementation of medication safety strategies is increasing, reasons for selecting and relinquishing distinct strategies and details on implementation are typically not shared in published literature. We aimed to collect and structure expert information resulting from implementing medication safety strategies to provide advice for decision-makers. Medication safety experts with clinical expertise from thirteen hospitals throughout twelve European and North American countries shared their experience in workshop meetings, on-site-visits and remote structured interviews. We performed an expert-based, in-depth assessment of implementation of best-practice strategies to improve drug prescribing and drug administration. Workflow, variability and recommended medication safety strategies in drug prescribing and drug administration processes. According to the experts, institutions chose strategies that targeted process steps known to be particularly error-prone in the respective setting. Often, the selection was channeled by local constraints such as the e-health equipment and critically modulated by national context factors. In our study, the experts favored electronic prescribing with clinical decision support and medication reconciliation as most promising interventions. They agreed that self-assessment and introduction of medication safety boards were crucial to satisfy the setting-specific differences and foster successful implementation. While general evidence for implementation of strategies to improve medication safety exists, successful selection and adaptation of a distinct strategy requires a thorough knowledge of the institute-specific constraints and an ongoing monitoring and adjustment of the implemented measures.

Identification of the benefits, enablers and barriers to integrating junior pharmacists into the ward team within one UK-based hospital

PubMed Central

Hung, Man Yui; Wright, David John; Blacklock, Jeanette; Needle, Richard John

2017-01-01

Introduction A high nurse-vacancy rate combined with high numbers of applications for junior pharmacist roles resulted in Colchester Hospital University National Health System Foundation Trust trial employing junior pharmacists into traditional nursing posts with the aim of integrating pharmacists into the ward team and enhancing local medicines optimization. The aim of the evaluation was to describe the implementation process and practice of the integrated care pharmacists (ICPs) in order to inform future innovations of a similar nature. Methods Four band 6 ward-based ICPs were employed on two wards funded within current ward staffing expenditure. With ethical committee approval, interviews were undertaken with the ICPs and focus groups with ward nurses, senior ward nurses and members of the medical team. Data were analyzed thematically to identify service benefits, barriers and enablers. Routine ward performance data were obtained from the two ICP wards and two wards selected as comparators. Appropriate statistical tests were performed to identify differences in performance. Results Four ICPs were interviewed, and focus groups were undertaken with three junior nurses, four senior nurses and three medical practitioners. Service enablers were continuous ward time, undertaking drug administration, positive feedback and use of effective communication methods. Barriers were planning, funding model, career development, and interprofessional working and social isolation. ICPs were believed to save nurse time and improve medicines safety. The proportion of patients receiving medicine reconciliation within 24 hours increased significantly in the ICP wards. All ICPs had resigned from their role within 12 months. Discussion It was believed that by locating pharmacists on the ward full time and allowing them to undertake medicines administration and medicines reconciliation, the nursing time would be saved and medicines safety improved. There was however significant learning to be derived from the implementation process, which may enable similar future models to be introduced more successfully. PMID:29354565

Identification of the benefits, enablers and barriers to integrating junior pharmacists into the ward team within one UK-based hospital.

PubMed

Hung, Man Yui; Wright, David John; Blacklock, Jeanette; Needle, Richard John

2017-01-01

A high nurse-vacancy rate combined with high numbers of applications for junior pharmacist roles resulted in Colchester Hospital University National Health System Foundation Trust trial employing junior pharmacists into traditional nursing posts with the aim of integrating pharmacists into the ward team and enhancing local medicines optimization. The aim of the evaluation was to describe the implementation process and practice of the integrated care pharmacists (ICPs) in order to inform future innovations of a similar nature. Four band 6 ward-based ICPs were employed on two wards funded within current ward staffing expenditure. With ethical committee approval, interviews were undertaken with the ICPs and focus groups with ward nurses, senior ward nurses and members of the medical team. Data were analyzed thematically to identify service benefits, barriers and enablers. Routine ward performance data were obtained from the two ICP wards and two wards selected as comparators. Appropriate statistical tests were performed to identify differences in performance. Four ICPs were interviewed, and focus groups were undertaken with three junior nurses, four senior nurses and three medical practitioners. Service enablers were continuous ward time, undertaking drug administration, positive feedback and use of effective communication methods. Barriers were planning, funding model, career development, and interprofessional working and social isolation. ICPs were believed to save nurse time and improve medicines safety. The proportion of patients receiving medicine reconciliation within 24 hours increased significantly in the ICP wards. All ICPs had resigned from their role within 12 months. It was believed that by locating pharmacists on the ward full time and allowing them to undertake medicines administration and medicines reconciliation, the nursing time would be saved and medicines safety improved. There was however significant learning to be derived from the implementation process, which may enable similar future models to be introduced more successfully.

Comparison and alignment of an academic medical center's strategic goals with ASHP initiatives.

PubMed

Engels, Melanie J; Chaffee, Bruce W; Clark, John S

2015-12-01

An academic medical center's strategic goals were compared and aligned with the 2015 ASHP Health-System Pharmacy Initiative and the Pharmacy Practice Model Initiative (PPMI). The department's pharmacy practice model steering committee identified potential solutions to narrow prioritized gaps using a modified nominal group technique and a multivoting dot technique. Five priority solutions were identified and assigned to work groups to develop business plans, which included admission medication history and reconciliation for high-risk patients and those with complex medication regimens, pharmacist provision of discharge counseling to high-risk patients and those with complex medication regimens, improved measurement and reporting of the impact of PPMI programs on patient outcomes, implementation of a departmentwide formalized peer review and evaluation process, and the greeting of every patient at some time during his or her visit by a pharmacy team member. Stakeholders evaluated the business plans based on feasibility, financial return on investment, and anticipated safety enhancements. The solution that received the highest priority ranking and was subsequently implemented was "improved measurement and reporting of the impact of PPMI programs on patient outcomes." A defined process was followed for identifying gaps among current practices at an academic medical center and the 2015 ASHP Health-System Pharmacy Initiative and the PPMI. A key priority to better document the impact of pharmacists on patient care was identified for our department by using a nominal group technique brainstorming process and a multivoting dot technique and creating standardized business plans for five potential priority projects. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

[Moral responsibility of hospital management].

PubMed

Schmidt-Wilcke, Heinrich Alyosius

2009-03-15

The self-concept of hospitals today includes the role of service providers, and so they act accordingly. This attitude is chiefly held by hospital administrators. It means that at management level there is a shift of values toward business ethics. However, hospital management is responsible not only for the business aspects of the hospital but also for the provision of adequate medical care to patients. Therefore, hospitals as service providers must be governed by the principles of medical as well as of business ethics. These principles, although from different areas, can be made to largely coincide, but can also lead to divergent positions within a hospital. The result is what within the scope of medical ethics, too, is experienced as a conflict of principles, e.g., the principle of beneficence versus the principle of autonomy. A reconciliation of such divergent moral positions can often be effected by analyzing the actual conflict situation and thus reaching consensus. The conflict between the principles of medical ethics and business ethics takes place chiefly within the sphere of activity of those providing medical and nursing care. As a consequence, a necessary business decision taken by the management to improve the productivity of medical and nursing activities can lead to serious deficits on the staff side. In terms of business ethics, this is a lack of beneficence toward individual staff members that are perhaps overtaxed, and at the same time, in terms of medical ethics, a potential lack of beneficence toward hospital patients is implicitly accepted. In general, management has the responsibility for bringing about, in the day-to-day operation of a hospital, a plausible reconciliation of the ethical principles of two spheres of activity that are only apparently independent of each other.

42 CFR § 510.620 - Waiver of deductible and coinsurance that otherwise apply to reconciliation payments or repayments.

Code of Federal Regulations, 2010 CFR

2017-10-01

... model for CJR participant hospitals. (b) Reconciliation payments or repayments. Reconciliation payments... apply to reconciliation payments or repayments. § 510.620 Section § 510.620 Public Health CENTERS FOR... INFRASTRUCTURE AND MODEL PROGRAMS COMPREHENSIVE CARE FOR JOINT REPLACEMENT MODEL Waivers § 510.620 Waiver of...

Improving the Interagency Conflict Assessment Framework (ICAF) with Intellectual Habits

DTIC Science & Technology

2012-06-08

27 Figure 4. Parson’s Fundamental Matrix of Explanation of Action .................................32 Figure...peace building process. Reconciliation, which is the process by which relationships are built between conflicting groups, must manage three paradoxes

Reconciling research and community priorities in participatory trials: application to Padres Informados/Jovenes Preparados.

PubMed

Allen, Michele L; Garcia-Huidobro, Diego; Bastian, Tiana; Hurtado, G Ali; Linares, Roxana; Svetaz, María Veronica

2017-06-01

Participatory research (PR) trials aim to achieve the dual, and at times competing, demands of producing an intervention and research process that address community perspectives and priorities, while establishing intervention effectiveness. To identify research and community priorities that must be reconciled in the areas of collaborative processes, study design and aim and study implementation quality in order to successfully conduct a participatory trial. We describe how this reconciliation was approached in the smoking prevention participatory trial Padres Informados/Jovenes Preparados (Informed Parents/Prepared Youth) and evaluate the success of our reconciled priorities. Data sources to evaluate success of the reconciliations included a survey of all partners regarding collaborative group processes, intervention participant recruitment and attendance and surveys of enrolled study participants assessing intervention outcomes. While we successfully achieved our reconciled collaborative processes and implementation quality goals, we did not achieve our reconciled goals in study aim and design. Due in part to the randomized wait-list control group design chosen in the reconciliation process, we were not able to demonstrate overall efficacy of the intervention or offer timely services to families in need of support. Achieving the goals of participatory trials is challenging but may yield community and research benefits. Innovative research designs are needed to better support the complex goals of participatory trials. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Electronic tools to support medication reconciliation: a systematic review.

PubMed

Marien, Sophie; Krug, Bruno; Spinewine, Anne

2017-01-01

Medication reconciliation (MedRec) is essential for reducing patient harm caused by medication discrepancies across care transitions. Electronic support has been described as a promising approach to moving MedRec forward. We systematically reviewed the evidence about electronic tools that support MedRec, by (a) identifying tools; (b) summarizing their characteristics with regard to context, tool, implementation, and evaluation; and (c) summarizing key messages for successful development and implementation. We searched PubMed, the Cumulative Index to Nursing and Allied Health Literature, Embase, PsycINFO, and the Cochrane Library, and identified additional reports from reference lists, reviews, and patent databases. Reports were included if the electronic tool supported medication history taking and the identification and resolution of medication discrepancies. Two researchers independently selected studies, evaluated the quality of reporting, and extracted data. Eighteen reports relative to 11 tools were included. There were eight quality improvement projects, five observational effectiveness studies, three randomized controlled trials (RCTs) or RCT protocols (ie, descriptions of RCTs in progress), and two patents. All tools were developed in academic environments in North America. Most used electronic data from multiple sources and partially implemented functionalities considered to be important. Relevant information on functionalities and implementation features was frequently missing. Evaluations mainly focused on usability, adherence, and user satisfaction. One RCT evaluated the effect on potential adverse drug events. Successful implementation of electronic tools to support MedRec requires favorable context, properly designed tools, and attention to implementation features. Future research is needed to evaluate the effect of these tools on the quality and safety of healthcare. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Expeditious reconciliation for practical quantum key distribution

NASA Astrophysics Data System (ADS)

Nakassis, Anastase; Bienfang, Joshua C.; Williams, Carl J.

2004-08-01

The paper proposes algorithmic and environmental modifications to the extant reconciliation algorithms within the BB84 protocol so as to speed up reconciliation and privacy amplification. These algorithms have been known to be a performance bottleneck 1 and can process data at rates that are six times slower than the quantum channel they serve2. As improvements in single-photon sources and detectors are expected to improve the quantum channel throughput by two or three orders of magnitude, it becomes imperative to improve the performance of the classical software. We developed a Cascade-like algorithm that relies on a symmetric formulation of the problem, error estimation through the segmentation process, outright elimination of segments with many errors, Forward Error Correction, recognition of the distinct data subpopulations that emerge as the algorithm runs, ability to operate on massive amounts of data (of the order of 1 Mbit), and a few other minor improvements. The data from the experimental algorithm we developed show that by operating on massive arrays of data we can improve software performance by better than three orders of magnitude while retaining nearly as many bits (typically more than 90%) as the algorithms that were designed for optimal bit retention.

Reconciliation and consolation in captive bonobos (Pan paniscus).

PubMed

Palagi, Elisabetta; Paoli, Tommaso; Tarli, Silvana Borgognini

2004-01-01

Although reconciliation in bonobos (Pan paniscus) has previously been described, it has not been analyzed heretofore by the postconflict (PC) match-control (MC) method. Furthermore, although reconciliation has been investigated before in this species, consolation has not. In this study we analyzed agonistic and affiliative contacts in all sex-class combinations to clarify and reevaluate the occurrence of reconciliation in bonobos via the PC-MC method. We also investigated the occurrence of consolation by analyzing the victims' triadic contact tendency (TCT), the influence of the sex of victims, and the relative occurrence of consolation and reconciliation. We collected 167 pairs of PC-MC observations in a captive group of bonobos (in Apeldoorn, The Netherlands). The conciliatory tendency (CCT) we obtained was tendentially lower than the mean value previously found for Yerkes captive chimpanzees. Close relationships, which were present in all female-female (FF) and some male-female (MF) dyads, positively affected reconciliation rates. When only adult PC-MC pairs (157) were considered, the mean TCTs and CCTs did not differ significantly. When we focused on types of PC affiliative contact, in the case of consolation we found a striking preference for sociosexual patterns. As to the relative occurrence of consolation and reconciliation, the highest level of the former was found in the absence of the latter. When reconciliation took place, consolation generally preceded it, suggesting that consolation may be a substitutive behavior. Our findings suggest that even if reconciliation remains the best option, consolation may be an alternative substitute for reconciliation that is used to buffer the tension originating from an unresolved conflict. Reconciliation and consolation are complex phenomena that are probably related to the life history of a group. Given that few studies have been conducted on this subject, we can not at this time make any generalizations regarding conflict resolution in certain species by comparing results among studies. Copyright 2004 Wiley-Liss, Inc.

The impact of working memory and the “process of process modelling” on model quality: Investigating experienced versus inexperienced modellers

NASA Astrophysics Data System (ADS)

Martini, Markus; Pinggera, Jakob; Neurauter, Manuel; Sachse, Pierre; Furtner, Marco R.; Weber, Barbara

2016-05-01

A process model (PM) represents the graphical depiction of a business process, for instance, the entire process from online ordering a book until the parcel is delivered to the customer. Knowledge about relevant factors for creating PMs of high quality is lacking. The present study investigated the role of cognitive processes as well as modelling processes in creating a PM in experienced and inexperienced modellers. Specifically, two working memory (WM) functions (holding and processing of information and relational integration) and three process of process modelling phases (comprehension, modelling, and reconciliation) were related to PM quality. Our results show that the WM function of relational integration was positively related to PM quality in both modelling groups. The ratio of comprehension phases was negatively related to PM quality in inexperienced modellers and the ratio of reconciliation phases was positively related to PM quality in experienced modellers. Our research reveals central cognitive mechanisms in process modelling and has potential practical implications for the development of modelling software and teaching the craft of process modelling.

The impact of working memory and the “process of process modelling” on model quality: Investigating experienced versus inexperienced modellers

PubMed Central

Martini, Markus; Pinggera, Jakob; Neurauter, Manuel; Sachse, Pierre; Furtner, Marco R.; Weber, Barbara

2016-01-01

A process model (PM) represents the graphical depiction of a business process, for instance, the entire process from online ordering a book until the parcel is delivered to the customer. Knowledge about relevant factors for creating PMs of high quality is lacking. The present study investigated the role of cognitive processes as well as modelling processes in creating a PM in experienced and inexperienced modellers. Specifically, two working memory (WM) functions (holding and processing of information and relational integration) and three process of process modelling phases (comprehension, modelling, and reconciliation) were related to PM quality. Our results show that the WM function of relational integration was positively related to PM quality in both modelling groups. The ratio of comprehension phases was negatively related to PM quality in inexperienced modellers and the ratio of reconciliation phases was positively related to PM quality in experienced modellers. Our research reveals central cognitive mechanisms in process modelling and has potential practical implications for the development of modelling software and teaching the craft of process modelling. PMID:27157858

The impact of working memory and the "process of process modelling" on model quality: Investigating experienced versus inexperienced modellers.

PubMed

Martini, Markus; Pinggera, Jakob; Neurauter, Manuel; Sachse, Pierre; Furtner, Marco R; Weber, Barbara

2016-05-09

A process model (PM) represents the graphical depiction of a business process, for instance, the entire process from online ordering a book until the parcel is delivered to the customer. Knowledge about relevant factors for creating PMs of high quality is lacking. The present study investigated the role of cognitive processes as well as modelling processes in creating a PM in experienced and inexperienced modellers. Specifically, two working memory (WM) functions (holding and processing of information and relational integration) and three process of process modelling phases (comprehension, modelling, and reconciliation) were related to PM quality. Our results show that the WM function of relational integration was positively related to PM quality in both modelling groups. The ratio of comprehension phases was negatively related to PM quality in inexperienced modellers and the ratio of reconciliation phases was positively related to PM quality in experienced modellers. Our research reveals central cognitive mechanisms in process modelling and has potential practical implications for the development of modelling software and teaching the craft of process modelling.

Medicare patients' use of overpriced procedures before and after the Omnibus Budget Reconciliation Act of 1987.

PubMed Central

Escarce, J J

1993-01-01

OBJECTIVES. Under the Omnibus Budget Reconciliation Act of 1987, Medicare reduced physician fees for 12 procedures identified as overprices. This paper describes trends in the use of these procedures and other physician services by Medicare patients during the 4-year period surrounding the implementation of the 1987 budget act. METHODS. Medicare physician claims files were used to develop trends in physician-services use from 1986 to 1989. Services were grouped into four categories: overpriced procedures, other surgery, medical care, and ancillary tests. RESULTS. Growth in the volume of overpriced procedures slowed substantially after the 1987 budget act was implemented. Moreover, the reduction in the rate of volume growth for these procedures differed little among specialities or areas. In comparison, the rate of volume growth fell modestly for other surgery, was unchanged for medical care, and increased for ancillary tests. CONCLUSIONS. Increases do not necessarily occur in the volume of surgical procedures whose Medicare fees are reduced. Although the conclusions that may be drawn from a descriptive analysis are limited, these findings suggest that concerns that the resource-based Medicare fee schedule will lead to higher surgery rates may be unwarranted. PMID:8438971

Research on patient safety: falls and medications.

PubMed

Boddice, Sandra Dawn; Kogan, Polina

2009-10-01

Below you will find summaries of published research describing investigations into patient safety issues related to falls and medications. The first summary provides details on the incidence of falls associated with the use of walkers and canes. This is followed by a summary of a fall-prevention intervention study that evaluated the effectiveness of widespread dissemination of evidence-based strategies in a community in Connecticut. The third write up provides information on three classes of medications that are associated with a significant number of emergency room visits. The last summary describes a pharmacist-managed medication reconciliation intervention pilot program. For additional details about the study findings and interventions, we encourage readers to review the original articles.

42 CFR 417.598 - Annual enrollment reconciliation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HEALTH CARE PREPAYMENT PLANS Medicare Payment: Risk Basis § 417.598 Annual enrollment reconciliation. CMS... conducts this reconciliation as necessary to ensure that the payments made do not exceed or fall short of...

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.

Exact Algorithms for Duplication-Transfer-Loss Reconciliation with Non-Binary Gene Trees.

PubMed

Kordi, Misagh; Bansal, Mukul S

2017-06-01

Duplication-Transfer-Loss (DTL) reconciliation is a powerful method for studying gene family evolution in the presence of horizontal gene transfer. DTL reconciliation seeks to reconcile gene trees with species trees by postulating speciation, duplication, transfer, and loss events. Efficient algorithms exist for finding optimal DTL reconciliations when the gene tree is binary. In practice, however, gene trees are often non-binary due to uncertainty in the gene tree topologies, and DTL reconciliation with non-binary gene trees is known to be NP-hard. In this paper, we present the first exact algorithms for DTL reconciliation with non-binary gene trees. Specifically, we (i) show that the DTL reconciliation problem for non-binary gene trees is fixed-parameter tractable in the maximum degree of the gene tree, (ii) present an exponential-time, but in-practice efficient, algorithm to track and enumerate all optimal binary resolutions of a non-binary input gene tree, and (iii) apply our algorithms to a large empirical data set of over 4700 gene trees from 100 species to study the impact of gene tree uncertainty on DTL-reconciliation and to demonstrate the applicability and utility of our algorithms. The new techniques and algorithms introduced in this paper will help biologists avoid incorrect evolutionary inferences caused by gene tree uncertainty.

Unintended Medication Discrepancies Associated with Reliance on Prescription Databases for Medication Reconciliation on Admission to a General Medical Ward

PubMed Central

Kalb, Kelli; Shalansky, Stephen; Legal, Michael; Khan, Nadia; Ma, Irene; Hunte, Garth

2009-01-01

Background: In a recent study, 50% of the patients who were admitted to a hospital’s general medicine ward had at least one error in medication orders at the time of admission related to inaccuracies in the medication history. The use of computerized prescription databases has been suggested as a way to improve medication reconciliation at the time of admission. Objective: To quantify and describe unintended discrepancies between a best possible medication history and medications ordered on admission to the general medicine ward in a hospital with routine access to a provincial outpatient prescription database (British Columbia’s PharmaNet). Methods: This prospective study involved 20 patients who were regularly using at least 4 prescription medications before admission to hospital. The best possible medication history for each patient (based on a review of the medical chart and the PharmaNet record and an interview with the patient) was compared with the physician’s admission orders to identify any discrepancies. The frequency and perceived severity of discrepancies, graded independently by 3 physicians, were compared with observations from a similar study conducted at a hospital where a prescription database was not available. Results: The 20 patients were recruited between September 2005 and January 2006. For 8 patients (40%), information in the PharmaNet database was consistent with the prescription medication list obtained during the best possible medication history at the time of admission. For the other 12 patients, a total of 30 unintended discrepancies were identified, 13 (43%) of which were classified as having potential for moderate or severe harm. The proportion of patients with unintended discrepancies was similar to that for the comparison cohort (60% versus 54%). Although the percentage of discrepancies involving omissions was lower than in the comparison population (37% versus 46%), these results were offset by a higher proportion of commission discrepancies (27% versus 0%). Conclusion: Unintended discrepancies were frequent, despite use of the PharmaNet database at the time of admission. Inconsistencies between the PharmaNet record and patients’ actual medication use, coupled with failure to verify PharmaNet data with patients, were likely contributing factors. PMID:22478906

Symmetric Blind Information Reconciliation for Quantum Key Distribution

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

Kiktenko, Evgeniy O.; Trushechkin, Anton S.; Lim, Charles Ci Wen

Quantum key distribution (QKD) is a quantum-proof key-exchange scheme which is fast approaching the communication industry. An essential component in QKD is the information reconciliation step, which is used for correcting the quantum-channel noise errors. The recently suggested blind-reconciliation technique, based on low-density parity-check codes, offers remarkable prospectives for efficient information reconciliation without an a priori quantum bit error rate estimation. We suggest an improvement of the blind-information-reconciliation protocol promoting a significant increase in the efficiency of the procedure and reducing its interactivity. Finally, the proposed technique is based on introducing symmetry in operations of parties, and the consideration ofmore » results of unsuccessful belief-propagation decodings.« less

Symmetric Blind Information Reconciliation for Quantum Key Distribution

DOE PAGES

Kiktenko, Evgeniy O.; Trushechkin, Anton S.; Lim, Charles Ci Wen; ...

2017-10-27

Quantum key distribution (QKD) is a quantum-proof key-exchange scheme which is fast approaching the communication industry. An essential component in QKD is the information reconciliation step, which is used for correcting the quantum-channel noise errors. The recently suggested blind-reconciliation technique, based on low-density parity-check codes, offers remarkable prospectives for efficient information reconciliation without an a priori quantum bit error rate estimation. We suggest an improvement of the blind-information-reconciliation protocol promoting a significant increase in the efficiency of the procedure and reducing its interactivity. Finally, the proposed technique is based on introducing symmetry in operations of parties, and the consideration ofmore » results of unsuccessful belief-propagation decodings.« less

Symmetric Blind Information Reconciliation for Quantum Key Distribution

NASA Astrophysics Data System (ADS)

Kiktenko, E. O.; Trushechkin, A. S.; Lim, C. C. W.; Kurochkin, Y. V.; Fedorov, A. K.

2017-10-01

Quantum key distribution (QKD) is a quantum-proof key-exchange scheme which is fast approaching the communication industry. An essential component in QKD is the information reconciliation step, which is used for correcting the quantum-channel noise errors. The recently suggested blind-reconciliation technique, based on low-density parity-check codes, offers remarkable prospectives for efficient information reconciliation without an a priori quantum bit error rate estimation. We suggest an improvement of the blind-information-reconciliation protocol promoting a significant increase in the efficiency of the procedure and reducing its interactivity. The proposed technique is based on introducing symmetry in operations of parties, and the consideration of results of unsuccessful belief-propagation decodings.

Outcomes of a Seven Practice Pilot in a Pay For Performance (P4P)-Based Program in Pennsylvania

PubMed Central

Johnson, Rhonda M.; Johnson, Twyla; Zimmerman, Sarah D.; Marsh, Gary M.; Garcia-Dominic, Oralia

2014-01-01

Objectives To examine how a targeted six-month interventions impacted Best Practice/Patient Outcomes for minority patients receiving primary care in physician practices participating in a pay-for-performance (P4P) program. Methods P4P Practices were invited to participate in a pilot intervention study designed to improve care for minority patients with hypertension, diabetes or pediatric asthma. Patient medical records were reviewed to assess how the interventions impacted (n=7 practices): Body mass index, diet and exercise, smoking, compliance with visits as recommended, blood pressure, sodium intake and weight management counseling, medication reconciliation, HbA1c testing, annual lipid profile, and anti-inflammatory medications. Results Significant improvements in various clinical quality measures were observed in all seven practices. Of the 19 specified interventions, 13 were statistically significant at α=0.05 level and 14 met the target proportion. This suggests that the best practice intervention had a significant impact on some of the health care processes in the physician practices. Conclusions The most impactful interventions were those related to face-to-face educational discussions, patient medical chart documentations rather than those pertaining to medication adherence. Improvements in measuring reporting and recording of data at post-intervention were also observed. PMID:25893158

Development of clinical pharmacy key performance indicators for hospital pharmacists using a modified Delphi approach.

PubMed

Fernandes, Olavo; Gorman, Sean K; Slavik, Richard S; Semchuk, William M; Shalansky, Steve; Bussières, Jean-François; Doucette, Douglas; Bannerman, Heather; Lo, Jennifer; Shukla, Simone; Chan, Winnie W Y; Benninger, Natalie; MacKinnon, Neil J; Bell, Chaim M; Slobodan, Jeremy; Lyder, Catherine; Zed, Peter J; Toombs, Kent

2015-06-01

Key performance indicators (KPIs) are quantifiable measures of quality. There are no published, systematically derived clinical pharmacy KPIs (cpKPIs). A group of hospital pharmacists aimed to develop national cpKPIs to advance clinical pharmacy practice and improve patient care. A cpKPI working group established a cpKPI definition, 8 evidence-derived cpKPI critical activity areas, 26 candidate cpKPIs, and 11 cpKPI ideal attributes in addition to 1 overall consensus criterion. Twenty-six clinical pharmacists and hospital pharmacy leaders participated in an internet-based 3-round modified Delphi survey. Panelists rated 26 candidate cpKPIs using 11 cpKPI ideal attributes and 1 overall consensus criterion on a 9-point Likert scale. A meeting was facilitated between rounds 2 and 3 to debate the merits and wording of candidate cpKPIs. Consensus was reached if 75% or more of panelists assigned a score of 7 to 9 on the consensus criterion during the third Delphi round. All panelists completed the 3 Delphi rounds, and 25/26 (96%) attended the meeting. Eight candidate cpKPIs met the consensus definition: (1) performing admission medication reconciliation (including best-possible medication history), (2) participating in interprofessional patient care rounds, (3) completing pharmaceutical care plans, (4) resolving drug therapy problems, (5) providing in-person disease and medication education to patients, (6) providing discharge patient medication education, (7) performing discharge medication reconciliation, and (8) providing bundled, proactive direct patient care activities. A Delphi panel of hospital pharmacists was successful in determining 8 consensus cpKPIs. Measurement and assessment of these cpKPIs will serve to advance clinical pharmacy practice and improve patient care. © The Author(s) 2015.

Tax savings for your practice. New tax law accelerates depreciation write-off.

PubMed

Dennis-Escoffier, Shirley; Quintana, Olga

2004-04-01

The Jobs and Growth Tax Relief Reconciliation Act of 2003 provides benefits for your medical group practice by quadrupling the expensing deduction and increasing additional first-year bonus depreciation. These increases are not permanent--some expire as soon as the end of 2004. So now is the time to start planning to maximize the tax-saving benefits for your practice.

42 CFR § 510.310 - Appeals process.

Code of Federal Regulations, 2010 CFR

2016-10-01

... (CONTINUED) HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS COMPREHENSIVE CARE FOR JOINT REPLACEMENT MODEL Pricing and Payment § 510.310 Appeals process. (a) Notice of calculation error (first level of appeal... dispute the calculation that involves a matter related to payment, reconciliation amounts, repayment...

42 CFR § 510.310 - Appeals process.

Code of Federal Regulations, 2010 CFR

2017-10-01

... (CONTINUED) HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS COMPREHENSIVE CARE FOR JOINT REPLACEMENT MODEL Pricing and Payment § 510.310 Appeals process. (a) Notice of calculation error (first level of appeal... dispute calculations involving a matter related to payment, reconciliation amounts, repayment amounts, the...

Pareto-optimal phylogenetic tree reconciliation

PubMed Central

Libeskind-Hadas, Ran; Wu, Yi-Chieh; Bansal, Mukul S.; Kellis, Manolis

2014-01-01

Motivation: Phylogenetic tree reconciliation is a widely used method for reconstructing the evolutionary histories of gene families and species, hosts and parasites and other dependent pairs of entities. Reconciliation is typically performed using maximum parsimony, in which each evolutionary event type is assigned a cost and the objective is to find a reconciliation of minimum total cost. It is generally understood that reconciliations are sensitive to event costs, but little is understood about the relationship between event costs and solutions. Moreover, choosing appropriate event costs is a notoriously difficult problem. Results: We address this problem by giving an efficient algorithm for computing Pareto-optimal sets of reconciliations, thus providing the first systematic method for understanding the relationship between event costs and reconciliations. This, in turn, results in new techniques for computing event support values and, for cophylogenetic analyses, performing robust statistical tests. We provide new software tools and demonstrate their use on a number of datasets from evolutionary genomic and cophylogenetic studies. Availability and implementation: Our Python tools are freely available at www.cs.hmc.edu/∼hadas/xscape. Contact: mukul@engr.uconn.edu Supplementary information: Supplementary data are available at Bioinformatics online. PMID:24932009

The Electronic Health Record Objective Structured Clinical Examination: Assessing Student Competency in Patient Interactions While Using the Electronic Health Record.

PubMed

Biagioli, Frances E; Elliot, Diane L; Palmer, Ryan T; Graichen, Carla C; Rdesinski, Rebecca E; Ashok Kumar, Kaparaboyna; Galper, Ari B; Tysinger, James W

2017-01-01

Because many medical students do not have access to electronic health records (EHRs) in the clinical environment, simulated EHR training is necessary. Explicitly training medical students to use EHRs appropriately during patient encounters equips them to engage patients while also attending to the accuracy of the record and contributing to a culture of information safety. Faculty developed and successfully implemented an EHR objective structured clinical examination (EHR-OSCE) for clerkship students at two institutions. The EHR-OSCE objectives include assessing EHR-related communication and data management skills. The authors collected performance data for students (n = 71) at the first institution during academic years 2011-2013 and for students (n = 211) at the second institution during academic year 2013-2014. EHR-OSCE assessment checklist scores showed that students performed well in EHR-related communication tasks, such as maintaining eye contact and stopping all computer work when the patient expresses worry. Findings indicated student EHR skill deficiencies in the areas of EHR data management including medical history review, medication reconciliation, and allergy reconciliation. Most students' EHR skills failed to improve as the year progressed, suggesting that they did not gain the EHR training and experience they need in clinics and hospitals. Cross-institutional data comparisons will help determine whether differences in curricula affect students' EHR skills. National and institutional policies and faculty development are needed to ensure that students receive adequate EHR education, including hands-on experience in the clinic as well as simulated EHR practice.

Reconciling after civil conflict increases social capital but decreases individual well-being.

PubMed

Cilliers, Jacobus; Dube, Oeindrila; Siddiqi, Bilal

2016-05-13

Civil wars divide nations along social, economic, and political cleavages, often pitting one neighbor against another. To restore social cohesion, many countries undertake truth and reconciliation efforts. We examined the consequences of one such effort in Sierra Leone, designed and implemented by a Sierra Leonean nongovernmental organization called Fambul Tok. As a part of this effort, community-level forums are set up in which victims detail war atrocities, and perpetrators confess to war crimes. We used random assignment to study its impact across 200 villages, drawing on data from 2383 individuals. We found that reconciliation had both positive and negative consequences. It led to greater forgiveness of perpetrators and strengthened social capital: Social networks were larger, and people contributed more to public goods in treated villages. However, these benefits came at a substantial cost: The reconciliation treatment also worsened psychological health, increasing depression, anxiety, and posttraumatic stress disorder in these same villages. For a subset of villages, we measured outcomes both 9 months and 31 months after the intervention. These results show that the effects, both positive and negative, persisted into the longer time horizon. Our findings suggest that policy-makers need to restructure reconciliation processes in ways that reduce their negative psychological costs while retaining their positive societal benefits. Copyright © 2016, American Association for the Advancement of Science.

7 CFR 274.5 - Record retention and forms security.

Code of Federal Regulations, 2014 CFR

2014-01-01

... reconciliation process. (c) Accountable documents. (1) EBT cards shall be considered accountable documents. The... validation of inventory controls and records by parties not otherwise involved in maintaining control records...

7 CFR 274.5 - Record retention and forms security.

Code of Federal Regulations, 2013 CFR

2013-01-01

... reconciliation process. (c) Accountable documents. (1) EBT cards shall be considered accountable documents. The... validation of inventory controls and records by parties not otherwise involved in maintaining control records...

7 CFR 274.5 - Record retention and forms security.

Code of Federal Regulations, 2012 CFR

2012-01-01

... reconciliation process. (c) Accountable documents. (1) EBT cards shall be considered accountable documents. The... validation of inventory controls and records by parties not otherwise involved in maintaining control records...

77 FR 21586 - Agency Information Collection Activities; Submission for OMB Review; Comment Request...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-10

... for OMB Review; Comment Request; Consolidated Omnibus Budget Reconciliation Act Health Benefits... Reconciliation Act Health Benefits Subsidy Under the American Recovery and Reinvestment Act of 2009 Evaluation... health benefits under the Consolidated Omnibus Budget Reconciliation Act (COBRA) that the American...

42 CFR 417.598 - Annual enrollment reconciliation.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false Annual enrollment reconciliation. 417.598 Section 417.598 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... HEALTH CARE PREPAYMENT PLANS Medicare Payment: Risk Basis § 417.598 Annual enrollment reconciliation. CMS...

7 CFR 272.10 - ADP/CIS Model Plan.

Code of Federal Regulations, 2012 CFR

2012-01-01

... authorizations for benefits in issuance systems employing ATP's, direct mail, or online issuance and store all... and replacement; (2) FNS-250—Reconciliation of redeemed ATPs with reported authorized coupon issuance. (B) Reconciliation: FNS-46—ATP Reconciliation Report. (vii) Generate data necessary to meet other...

7 CFR 272.10 - ADP/CIS Model Plan.

Code of Federal Regulations, 2013 CFR

2013-01-01

... authorizations for benefits in issuance systems employing ATP's, direct mail, or online issuance and store all... and replacement; (2) FNS-250—Reconciliation of redeemed ATPs with reported authorized coupon issuance. (B) Reconciliation: FNS-46—ATP Reconciliation Report. (vii) Generate data necessary to meet other...

7 CFR 272.10 - ADP/CIS Model Plan.

Code of Federal Regulations, 2014 CFR

2014-01-01

... authorizations for benefits in issuance systems employing ATP's, direct mail, or online issuance and store all... and replacement; (2) FNS-250—Reconciliation of redeemed ATPs with reported authorized coupon issuance. (B) Reconciliation: FNS-46—ATP Reconciliation Report. (vii) Generate data necessary to meet other...

From miracle to reconciliation: a hermeneutic phenomenological study exploring the experience of living with Parkinson's disease following deep brain stimulation.

PubMed

Haahr, Anita; Kirkevold, Marit; Hall, Elisabeth O C; Ostergaard, Karen

2010-10-01

Deep Brain Stimulation for Parkinson's disease is a promising treatment for patients who can no longer be treated satisfactorily with L-dopa. Deep Brain Stimulation is known to relieve motor symptoms of Parkinson's disease and improve quality of life. Focusing on how patients experience life when treated with Deep Brain Stimulation can provide essential information on the process patients go through when receiving a treatment that alters the body and changes the illness trajectory. The aim of this study was to explore and describe the experience of living with Parkinson's disease when treated with Deep Brain Stimulation. The study was designed as a longitudinal study and data were gathered through qualitative in-depth interviews three times during the first year of treatment. Nine patients participated in the study. They were included when they had accepted treatment with Deep Brain Stimulation for Parkinson's disease. Data collection and data analysis were inspired by the hermeneutic phenomenological methodology of Van Manen. The treatment had a major impact on the body. Participants experienced great bodily changes and went through a process of adjustment in three phases during the first year of treatment with Deep Brain Stimulation. These stages were; being liberated: a kind of miracle, changes as a challenge: decline or opportunity and reconciliation: re-defining life with Parkinson's disease. The course of the process was unique for each participant, but dominant was that difficulties during the adjustment of stimulation and medication did affect the re-defining process. Patients go through a dramatic process of change following Deep Brain Stimulation. A changing body affects their entire lifeworld. Some adjust smoothly to changes while others are affected by loss of control, uncertainty and loss of everyday life as they knew it. These experiences affect the process of adjusting to life with Deep Brain Stimulation and re-define life with Parkinson's disease. It is of significant importance that health care professionals are aware of these dramatic changes in the patients' life and offer support during the adjustment process following Deep Brain Stimulation. Copyright (c) 2010 Elsevier Ltd. All rights reserved.

Danish version of the Tilburg Frailty Indicator--translation, cross-cultural adaption and validity pretest by cognitive interviewing.

PubMed

Andreasen, Jane; Sørensen, Erik E; Gobbens, Robbert J J; Lund, Hans; Aadahl, Mette

2014-01-01

The Tilburg Frailty Indicator (TFI) is a self-administered questionnaire with a bio-psycho-social integrated approach that measures the degree of frailty in elderly persons. The TFI was developed in the Netherlands and tested in a population of elderly Dutch men and women. The aim of this study was to translate and culturally adapt the TFI to a Danish context, and to test face validity of the Danish version by cognitive interviewing. An internationally recognized procedure was applied as a basis for the translation process. The primary tasks were forward translation, reconciliation, back translation, harmonization and pretest. Pretest and review of the preliminary version by cognitive interviewing, were performed at a local community center and in an acute medical ward at the University Hospital in Aalborg, Denmark respectively. A large agreement regarding meaning of the items in the forward translation and reconciliation process was seen. Minor discrepancies were solved by consensus. Back translation revealed unclear wording in one matter. The harmonization committee agreed on a version for cognitive interviewing after revision of minor issues and thirty-four participants were interviewed. Two issues became evident and these were revised. The cognitive interviews and final lay-out resulted in minor adjustments as text type size, specific font, and lining for optimizing readability. In conclusion, we consider the TFI to be translated in such rigorous manner that the instrument can be further tested in clinical practice. The overall objective of the questionnaire being to identify frailty and improve the interventions relating to frail elderly persons in Denmark. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Emotion Understanding and Reconciliation in Overt and Relational Conflict Scenarios among Preschoolers

ERIC Educational Resources Information Center

Liao, Zongqing; Li, Yan; Su, Yanjie

2014-01-01

This study examined emotion understanding and reconciliation in 47 (24 girls) 4-6-year-old preschool children. Participants first completed emotion recognition tasks and then answered questions regarding reconciliation tendencies and affective perspective-taking in a series of overt and relational aggressive conflict scenarios. Children's teachers…

Digital Narratives as a Means of Shifting Settler-Teacher Horizons toward Reconciliation

ERIC Educational Resources Information Center

Bissell, Alexandra; Korteweg, Lisa

2016-01-01

The Truth and Reconciliation Commission's "Calls to Action" report (2015), in the section "Education for Reconciliation" (p. 7, #62-63), calls for the integration of Indigenous knowledge and teaching methods into the curriculum and for better preparation of teachers to deliver Indigenous content. Settler-teachers, however, have…

Museum, Memorial and Mall: Postcolonialism, Pedagogies, Racism and Reconciliation

ERIC Educational Resources Information Center

Crowley, Vicki; Matthews, Julie

2006-01-01

Through museum and shopping mall and the possibilities, subtleties, banalities and disparities of reconciliation in South Africa and Australia, this paper immerses itself in the question of pedagogies and in particular the pedagogies of reconciliation, public spaces and postcolonialism. In both Australia and South Africa postcolonialism as theory…

RANGER-DTL 2.0: Rigorous Reconstruction of Gene-Family Evolution by Duplication, Transfer, and Loss.

PubMed

Bansal, Mukul S; Kellis, Manolis; Kordi, Misagh; Kundu, Soumya

2018-04-24

RANGER-DTL 2.0 is a software program for inferring gene family evolution using Duplication-Transfer-Loss reconciliation. This new software is highly scalable and easy to use, and offers many new features not currently available in any other reconciliation program. RANGER-DTL 2.0 has a particular focus on reconciliation accuracy and can account for many sources of reconciliation uncertainty including uncertain gene tree rooting, gene tree topological uncertainty, multiple optimal reconciliations, and alternative event cost assignments. RANGER-DTL 2.0 is open-source and written in C ++ and Python. Pre-compiled executables, source code (open-source under GNU GPL), and a detailed manual are freely available from http://compbio.engr.uconn.edu/software/RANGER-DTL/. mukul.bansal@uconn.edu.

RH-LLW Disposal Facility Project CD-2/3 to Design/Build Proposal Reconciliation Report

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

Annette L. Schafer

2012-06-01

A reconciliation plan was developed and implemented to address potential gaps and responses to gaps between the design/build vendor proposals and the Critical Decision-2/3 approval request package for the Remote-Handled Low Level Waste Disposal Facility Project. The plan and results of the plan implementation included development of a reconciliation team comprised of subject matter experts from Battelle Energy Alliance and the Department of Energy Idaho Operations Office, identification of reconciliation questions, reconciliation by the team, identification of unresolved/remaining issues, and identification of follow-up actions and subsequent approvals of responses. The plan addressed the potential for gaps to exist in themore » following areas: • Department of Energy Order 435.1, “Radioactive Waste Management,” requirements, including the performance assessment, composite analysis, monitoring plan, performance assessment/composite analysis maintenance plan, and closure plan • Environmental assessment supporting the National Environmental Policy Act • Nuclear safety • Safeguards and security • Emplacement operations • Requirements for commissioning • General project implementation. The reconciliation plan and results of the plan implementation are provided in a business-sensitive project file. This report provides the reconciliation plan and non-business sensitive summary responses to identified gaps.« less

Factors associated with medication information in diabetes care: differences in perceptions between patients and health care professionals

PubMed Central

Längst, Gerda; Seidling, Hanna Marita; Stützle, Marion; Ose, Dominik; Baudendistel, Ines; Szecsenyi, Joachim; Wensing, Michel; Mahler, Cornelia

2015-01-01

Purpose This qualitative study in patients with type 2 diabetes and health care professionals (HCPs) aimed to investigate which factors they perceive to enhance or impede medication information provision in primary care. Similarities and differences in perspectives were explored. Methods Eight semistructured focus groups were conducted, four with type 2 diabetes patients (n=25) and four with both general practitioners (n=13) and health care assistants (n=10). Sessions were audio and video recorded, transcribed verbatim, and subjected to computer-aided qualitative content analysis. Results Diabetes patients and HCPs broadly highlighted similar factors as enablers for satisfactory medication information delivery. Perceptions substantially differed regarding impeding factors. Both patients and HCPs perceived it to be essential to deliver tailored information, to have a trustful and continuous patient–provider relationship, to regularly reconcile medications, and to provide tools for medication management. However, substantial differences in perceptions related to impeding factors included the causes of inadequate information, the detail required for risk-related information, and barriers to medication reconciliation. Medication self-management was a prevalent topic among patients, whereas HCPs’ focus was on fulfilling therapy and medication management responsibilities. Conclusion The findings suggest a noteworthy gap in perceptions between information provision and patients’ needs regarding medication-related communication. Medication safety and adherence may be improved if HCPs collaborate more closely with diabetes patients in managing their medication, in particular by incorporating the patients’ perspective. Health care systems need to be structured in a way that supports this process. PMID:26508840

Home Culture, Science, School and Science Learning: Is Reconciliation Possible?

ERIC Educational Resources Information Center

Tan, Aik-Ling

2011-01-01

In response to Meyer and Crawford's article on how nature of science and authentic science inquiry strategies can be used to support the learning of science for underrepresented students, I explore the possibly of reconciliation between the cultures of school, science, school science as well as home. Such reconciliation is only possible when…

Knowledge, Narrative and National Reconciliation: Storied Reflections on the South African Truth and Reconciliation Commission

ERIC Educational Resources Information Center

Walker, Melanie; Unterhalter, Elaine

2004-01-01

This paper considers the educational work that narrative does. Against the context of the South African Truth and Reconciliation Commission that examined the crimes of apartheid, it discusses the narrative implications of South African poet Antjie Krog's multi-layered text of Truth Commission testimony, and autobiographical and philosophical…

Reconciliation Sentiment among Victims of Genocide in Rwanda: Conceptualizations, and Relationships with Mental Health

ERIC Educational Resources Information Center

Mukashema, Immaculee; Mullet, Etienne

2010-01-01

In two studies that were conducted in Rwanda, we have examined the conceptualizations held by people who have experienced genocide with regard to reconciliation sentiment and quantitatively assessed the relationship between reconciliation sentiment and mental health. It was found that the participants have articulated conceptualizations regarding…

42 CFR § 510.315 - Composite quality scores for determining reconciliation payment eligibility and quality incentive...

Code of Federal Regulations, 2010 CFR

2016-10-01

... INFRASTRUCTURE AND MODEL PROGRAMS COMPREHENSIVE CARE FOR JOINT REPLACEMENT MODEL Pricing and Payment § 510.315 Composite quality scores for determining reconciliation payment eligibility and quality incentive payments... reconciliation payment eligibility and quality incentive payments. § 510.315 Section § 510.315 Public Health...

42 CFR § 512.315 - Composite quality scores for determining reconciliation payment eligibility and effective and...

Code of Federal Regulations, 2010 CFR

2017-10-01

... (CONTINUED) HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS EPISODE PAYMENT MODEL Pricing and Payment § 512.315... and suppresses the measure value. (5) Establishing SHFFT model reconciliation payment eligibility and... factor for reconciliation payments. (A) A 3.0 percentage point effective discount factor for SHFFT model...

42 CFR § 510.315 - Composite quality scores for determining reconciliation payment eligibility and quality incentive...

Code of Federal Regulations, 2010 CFR

2017-10-01

... INFRASTRUCTURE AND MODEL PROGRAMS COMPREHENSIVE CARE FOR JOINT REPLACEMENT MODEL Pricing and Payment § 510.315 Composite quality scores for determining reconciliation payment eligibility and quality incentive payments... reconciliation payment eligibility and quality incentive payments. § 510.315 Section § 510.315 Public Health...

Tensions between Policy and Practice: Reconciliation Agendas in the Australian Curriculum English

ERIC Educational Resources Information Center

Exley, Beryl; Chan, Mui Yoke,

2014-01-01

In various parts of the world, Indigenous and non-Indigenous peoples are actively working towards Reconciliation. In Australia, the context in which we each undertake our work as educationalists and researchers, the Reconciliation agenda has been pushed into schools and English teachers have been called on to share responsibility for facilitating…

Teachers' Understanding of Reconciliation and Inclusion in Mixed Schools of Four Troubled Societies

ERIC Educational Resources Information Center

Zembylas, Michalinos; Bekerman, Zvi; McGlynn, Claire; Ferreira, Ana

2009-01-01

In this article, the authors examine how teachers in four troubled societies--Israel, Cyprus, Northern Ireland and South Africa--understand and implement reconciliation in light of the increasing diversity of these societies. The authors particularly pay attention to a dialogical encounter between reconciliation and inclusion, as they look for…

Difficulties of care-work reconciliation: employed and nonemployed mothers of children with intellectual disability.

PubMed

Chou, Yueh-Ching; Fu, Li-Yeh; Pu, Cheng-Yun; Chang, Heng-Hao

2012-09-01

Whether employed and nonemployed mothers of children with intellectual disability (ID) have different experiences with reconciliation between care and work has rarely been explored. A survey was conducted in a county in Taiwan and 487 mothers aged younger than 65 and having a child with ID were interviewed face to face at their homes to explore whether there are different factors related to the reconciliation between care and work among employed and nonemployed mothers. Except for the common ground of mothers' health and care demands, logistic regression revealed work flexibility and care support were important for employed mothers. In contrast, the success of reconciliation for nonemployed mothers was determined by their individual characteristics (i.e., age, marital status, family income). Reconciliation policies for mothers with different employment statuses need to use different strategies.

South Africa after Apartheid: Recent Developments and Future Prospects.

ERIC Educational Resources Information Center

Brook, Diane L.

1997-01-01

Profiles the process of South Africa's transformation into a democracy. Outlines the many characteristics of the transition from white to majority rule, such as the attempt to achieve catharsis and bury the apartheid past through a process of amnesty and reconciliation. Describes the remaining obstacles to that transition. (MJP)

Efficiency of coherent-state quantum cryptography in the presence of loss: Influence of realistic error correction

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

Heid, Matthias; Luetkenhaus, Norbert

2006-05-15

We investigate the performance of a continuous-variable quantum key distribution scheme in a practical setting. More specifically, we take a nonideal error reconciliation procedure into account. The quantum channel connecting the two honest parties is assumed to be lossy but noiseless. Secret key rates are given for the case that the measurement outcomes are postselected or a reverse reconciliation scheme is applied. The reverse reconciliation scheme loses its initial advantage in the practical setting. If one combines postselection with reverse reconciliation, however, much of this advantage can be recovered.

Patient dumping, COBRA, and the public psychiatric hospital.

PubMed

Elliott, R L

1993-02-01

Serious clinical and risk management problems arise when indigent patients with acute medical conditions are transferred from general medical hospitals or emergency departments to public psychiatric hospitals that are ill equipped to provide medical care. To combat such practices, referred to as dumping, Congress included measures in the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) prohibiting such transfers. Because physicians and administrators in public psychiatric hospitals are generally not aware of the potential usefulness of COBRA in reducing dumping, this paper describes its important provisions. The key to preventing dumping is to educate referral sources to limitations on the medical care available at the receiving hospital and to discourage negligent patient transfers by enforcing COBRA. Public hospital staff and legal counsel who become familiar with COBRA's provisions can develop an antidumping strategy.

Policing Matters: Addressing the Controversial Issue of Policing Through Education for Reconciliation

NASA Astrophysics Data System (ADS)

Cusack, Mella

2009-05-01

Policing is widely held to constitute a contentious issue in classrooms on both sides of the border on the island of Ireland, despite the fact that the ongoing peace process has led to a normalising of cross-border policing relationships. The Education for Reconciliation Project works with teachers and members of the two police services to produce teaching/learning modules on law and policing for use in Citizenship Education classrooms. This paper examines the commonly-held teacher perception of policing as a controversial issue and the reasons why these perceptions exist. It takes into consideration the opinion that it is time for schools to begin work on policing, and investigates the implications for practice.

Doves, Rainbows and an Uneasy Peace: Student Images of Reconciliation in a Post-Conflict Society

ERIC Educational Resources Information Center

Ferreira, Ana; Janks, Hilary

2009-01-01

In this article we draw on data from a two-cycle action research project, in which ways of teaching reconciliation in post-apartheid secondary school classrooms are explored. We undertake a detailed analysis of a selection of artefacts produced by South African students representing their understandings of reconciliation. Initially students' work…

The Morning after Canada's Truth and Reconciliation Commission Report: Decolonisation through Hybridity, Ambivalence and Alliance

ERIC Educational Resources Information Center

Chung, Stan

2016-01-01

In Canada, 2015 will be remembered for the publication of the "Truth and Reconciliation Commission Report" which related to all Canadians the impacts of the Indian residential school system. The Commission invokes the United Nations Declaration on the Rights of Indigenous Peoples and uses the term reconciliation as a national strategy…

RecPhyloXML - a format for reconciled gene trees.

PubMed

Duchemin, Wandrille; Gence, Guillaume; Arigon Chifolleau, Anne-Muriel; Arvestad, Lars; Bansal, Mukul S; Berry, Vincent; Boussau, Bastien; Chevenet, François; Comte, Nicolas; Davín, Adrián A; Dessimoz, Christophe; Dylus, David; Hasic, Damir; Mallo, Diego; Planel, Rémi; Posada, David; Scornavacca, Celine; Szöllosi, Gergely; Zhang, Louxin; Tannier, Éric; Daubin, Vincent

2018-05-14

A reconciliation is an annotation of the nodes of a gene tree with evolutionary events-for example, speciation, gene duplication, transfer, loss, etc-along with a mapping onto a species tree. Many algorithms and software produce or use reconciliations but often using different reconciliation formats, regarding the type of events considered or whether the species tree is dated or not. This complicates the comparison and communication between different programs. Here, we gather a consortium of software developers in gene tree species tree reconciliation to propose and endorse a format that aims to promote an integrative-albeit flexible-specification of phylogenetic reconciliations. This format, named recPhyloXML, is accompanied by several tools such as a reconciled tree visualizer and conversion utilities. http://phylariane.univ-lyon1.fr/recphyloxml/. wandrille.duchemin@univ-lyon1.fr. There is no supplementary data associated with this publication.

High-efficiency Gaussian key reconciliation in continuous variable quantum key distribution

NASA Astrophysics Data System (ADS)

Bai, ZengLiang; Wang, XuYang; Yang, ShenShen; Li, YongMin

2016-01-01

Efficient reconciliation is a crucial step in continuous variable quantum key distribution. The progressive-edge-growth (PEG) algorithm is an efficient method to construct relatively short block length low-density parity-check (LDPC) codes. The qua-sicyclic construction method can extend short block length codes and further eliminate the shortest cycle. In this paper, by combining the PEG algorithm and qua-si-cyclic construction method, we design long block length irregular LDPC codes with high error-correcting capacity. Based on these LDPC codes, we achieve high-efficiency Gaussian key reconciliation with slice recon-ciliation based on multilevel coding/multistage decoding with an efficiency of 93.7%.

High-efficiency reconciliation for continuous variable quantum key distribution

NASA Astrophysics Data System (ADS)

Bai, Zengliang; Yang, Shenshen; Li, Yongmin

2017-04-01

Quantum key distribution (QKD) is the most mature application of quantum information technology. Information reconciliation is a crucial step in QKD and significantly affects the final secret key rates shared between two legitimate parties. We analyze and compare various construction methods of low-density parity-check (LDPC) codes and design high-performance irregular LDPC codes with a block length of 106. Starting from these good codes and exploiting the slice reconciliation technique based on multilevel coding and multistage decoding, we realize high-efficiency Gaussian key reconciliation with efficiency higher than 95% for signal-to-noise ratios above 1. Our demonstrated method can be readily applied in continuous variable QKD.

The pharmacist and the EHR.

PubMed

Nelson, Scott D; Poikonen, John; Reese, Thomas; El Halta, David; Weir, Charlene

2017-01-01

The adoption of electronic health records (EHRs) across the United States has impacted the methods by which health care professionals care for their patients. It is not always recognized, however, that pharmacists also actively use advanced functionality within the EHR. As critical members of the health care team, pharmacists utilize many different features of the EHR. The literature focuses on 3 main roles: documentation, medication reconciliation, and patient evaluation and monitoring. As health information technology proliferates, it is imperative that pharmacists' workflow and information needs are met within the EHR to optimize medication therapy quality, team communication, and patient outcomes. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

An earlier de motu cordis.

PubMed Central

Daly, Walter J.

2004-01-01

Thirteenth century medical science, like medieval scholarship in general, was directed at reconciliation of Greek philosophy/science with prevailing medieval theology and philosophy. Peter of Spain [later Pope John XXI] was the leading medical scholar of his time. Peter wrote a long book on the soul. Imbedded in it was a chapter on the motion of the heart. Peter's De Motu was based on his own medical experience and Galen's De Usu Partium and De Usu Respirationis and De Usu Pulsuum. This earlier De Motu defines a point on the continuum of intellectual development leading to us and into the future. Thirteenth century scholarship relied on past authority to a degree that continues to puzzle and beg explanation. Images Fig. 1 PMID:17060956

Practical considerations in the development of hemoglobin-based oxygen therapeutics.

PubMed

Kim, Hae Won; Estep, Timothy N

2012-09-01

The development of hemoglobin based oxygen therapeutics (HBOCs) requires consideration of a number of factors. While the enabling technology derives from fundamental research on protein biochemistry and biological interactions, translation of these research insights into usable medical therapeutics demands the application of considerable technical expertise and consideration and reconciliation of a myriad of manufacturing, medical, and regulatory requirements. The HBOC development challenge is further exacerbated by the extremely high intravenous doses required for many of the indications contemplated for these products, which in turn implies an extremely high level of purity is required. This communication discusses several of the important product configuration and developmental considerations that impact the translation of fundamental research discoveries on HBOCs into usable medical therapeutics.

Conflict and reconciliation behavior trends of the bottlenose dolphin (Tursiops truncatus).

PubMed

Holobinko, Anastasia; Waring, George H

2010-01-01

Wild bottlenose dolphin (Tursiops truncatus) populations display societal structures characterized by numerous and frequent changes in group composition, complex social relationships, and high levels of cooperation, attributes also observed in human and nonhuman primate cultures. Maintaining social relationships under such elemental conditions can frequently create conflict--and the opportunity for reconciliation--among group members. The conflict and reconciliation behavior patterns of the chimpanzee (Pan troglodytes) have been studied extensively; trends are well-documented in the wild and in captivity. Apparent cultural similarities have prompted several analogous studies on wild and captive bottlenose dolphins. This research attempted to corroborate previous efforts by analyzing the social behavior of seven captive bottlenose dolphins to determine the effects of sex and age on the frequency of conflict and reconciliation, and to investigate the incidence of consolatory behavior within the group. A total of 3,428 interactions involving focal animals, 414 of which were conflict episodes, were documented during 261 hr of videotaped observations. Although the sample size precluded meaningful statistical evaluation of the influence of sex on conflict and reconciliation, participant age was a significant determinant of conflict frequency. Conversely, age did not impact frequency of reconciliation, which only occurred after 18% of all conflict interactions. Little to no definitive evidence of consolation was apparent within the study group. While results partially support the findings of previous dolphin reconciliation research, extensive behavioral studies of wild populations should be conducted before generating broad comparisons between human terms and nonhuman behavioral interactions. © 2009 Wiley-Liss, Inc.

Machine Learning to Predict, Detect, and Intervene Older Adults Vulnerable for Adverse Drug Events in the Emergency Department.

PubMed

Ouchi, Kei; Lindvall, Charlotta; Chai, Peter R; Boyer, Edward W

2018-06-01

Adverse drug events (ADEs) are common and have serious consequences in older adults. ED visits are opportunities to identify and alter the course of such vulnerable patients. Current practice, however, is limited by inaccurate reporting of medication list, time-consuming medication reconciliation, and poor ADE assessment. This manuscript describes a novel approach to predict, detect, and intervene vulnerable older adults at risk of ADE using machine learning. Toxicologists' expertise in ADE is essential to creating the machine learning algorithm. Leveraging the existing electronic health records to better capture older adults at risk of ADE in the ED may improve their care.

77 FR 6565 - Proposed Information Collection Activity; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-08

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Administration for Children and Families Proposed... Report, and Reasonable Cause/Corrective Action Documentation Process- Final. OMB No.: 0970-0215... Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA), mandates that federally recognized...

Coercion and Reconciliation: Post-Conflict Resolution After the American Civil War

DTIC Science & Technology

2016-05-26

Approved for public release; distribution is unlimited Coercion and Reconciliation: Post -Conflict Resolution After the American Civil War A...Reconciliation: Post -Conflict Resolution After 5a. CONTRACT NUMBER The American Civil War 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6...policies. The conclusion is that during post -conflict resolution, having a moderate coercive body to maintain security, while allowing for political

Health Care and Education Reconciliation Act of 2010 (Public Law 111-152)

ERIC Educational Resources Information Center

US Congress, 2010

2010-01-01

The Health Care and Education Reconciliation Act of 2010 (Public Law 111-152) was put in place to provide for reconciliation pursuant to Title II of the concurrent resolution on the budget for fiscal year 2010 (S. Con. Res. 13). The table of contents for this Act is as follows: (1) Sec. 1. Short title; table of contents. (A) Title--Coverage,…

Collectivistic Self-Construal and Forgiveness

ERIC Educational Resources Information Center

Hook, Joshua N.; Worthington, Everett L., Jr.; Utsey, Shawn O.; Davis, Don E.; Burnette, Jeni L.

2012-01-01

This study tested a theoretical model of the relationship between collectivism and forgiveness. Participants (N= 298) completed measures of collectivistic self-construal, forgiveness, and forgiveness-related constructs. A collectivistic self-was related to understanding forgiveness as an interpersonal process that involved reconciliation.…

Bridging the Gap: Prospects for Reform and Reconciliation in Post-Conflict Sri Lanka

DTIC Science & Technology

2016-12-01

Province governor’s post , held by an ex -military officer, with a civilian administrator. The international community, along with the Tamil political...GAP: PROSPECTS FOR REFORM AND RECONCILIATION IN POST -CONFLICT SRI LANKA by Chaminda Arjuna Bandara Tennakoon December 2016 Thesis Advisor...RECONCILIATION IN POST -CONFLICT SRI LANKA 5. FUNDING NUMBERS 6. AUTHOR(S) Chaminda Arjuna Bandara Tennakoon 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS

Trauma and PTSD symptoms in Rwanda: implications for attitudes toward justice and reconciliation.

PubMed

Pham, Phuong N; Weinstein, Harvey M; Longman, Timothy

2004-08-04

The 1994 genocide in Rwanda led to the loss of at least 10% of the country's 7.7 million inhabitants, the destruction of much of the country's infrastructure, and the displacement of nearly 4 million people. In seeking to rebuild societies such as Rwanda, it is important to understand how traumatic experience may shape the ability of individuals and groups to respond to judicial and other reconciliation initiatives. To assess the level of trauma exposure and the prevalence of posttraumatic stress disorder (PTSD) symptoms and their predictors among Rwandans and to determine how trauma exposure and PTSD symptoms are associated with Rwandans' attitudes toward justice and reconciliation. Multistage, stratified cluster random survey of 2091 eligible adults in selected households in 4 communes in Rwanda in February 2002. Rates of exposure to trauma and symptom criteria for PTSD using the PTSD Checklist-Civilian Version; attitudes toward judicial responses (Rwandan national and gacaca local trials and International Criminal Tribunal for Rwanda [ICTR]) and reconciliation (belief in community, nonviolence, social justice, and interdependence with other ethnic groups). Of 2074 respondents with data on exposure to trauma, 1563 (75.4%) were forced to flee their homes, 1526 (73.0%) had a close member of their family killed, and 1472 (70.9%) had property destroyed or lost. Among the 2091 total participants, 518 (24.8%) met symptom criteria for PTSD. The adjusted odds ratio (OR) of meeting PTSD symptom criteria for each additional traumatic event was 1.43 (95% CI, 1.33-1.55). More respondents supported the local judicial responses (90.8% supported gacaca trials and 67.8% the Rwanda national trials) than the ICTR (42.1% in support). Respondents who met PTSD symptom criteria were less likely to have positive attitudes toward the Rwandan national trials (OR, 0.77; 95% CI, 0.61-0.98), belief in community (OR, 0.76; 95% CI, 0.60-0.97), and interdependence with other ethnic groups (OR, 0.71; 95% CI, 0.56-0.90). Respondents with exposure to multiple trauma events were more likely to have positive attitudes toward the ICTR (OR, 1.10; 95% CI, 1.04-1.17) and less likely to support the Rwandan national trials (OR, 0.90; 95% CI, 0.84-0.96), the local gacaca trials (OR, 0.80; 95% CI, 0.72-0.89), and 3 factors of openness to reconciliation: belief in nonviolence (OR, 0.92; 95% CI, 0.87-0.97), belief in community (OR, 0.92; 95% CI, 0.87-0.98), and interdependence with other ethnic groups (OR, 0.86; 95% CI, 0.81-0.92). Other variables that were associated with attitudes toward judicial processes and openness to reconciliation were educational level, ethnicity, perception of change in poverty level and access to security compared with 1994, and ethnic distance. This study demonstrates that traumatic exposure, PTSD symptoms, and other factors are associated with attitudes toward justice and reconciliation. Societal interventions following mass violence should consider the effects of trauma if reconciliation is to be realized.

The Reinforcement of Ableism: Normality, the Medical Model of Disability, and Humanism in Applied Behavior Analysis and ASD.

PubMed

Shyman, Eric

2016-10-01

The field of educating individuals with Autism Spectrum Disorder has ever been rife with controversy regarding issues ranging from etiology and causation to effective intervention and education options. One such basis for controversy has been between humanism, and humanistic philosophical concepts, and its fundamental differences with behaviorism, and behavioristic philosophical concepts. These differences have long been debated, and the belief that the two orientations are generally mutually exclusive has been largely maintained. Recently, however, there has been some resurgence of interest in reconciling some of the fundamental humanistic and behavioristic tenets. Most of these discussions, however, center on specific interventional methodologies as its basis without delving more deeply into the underlying philosophical issues. This article will explore some fundamental humanistic concepts that ought to be reconciled in order for behaviorism to be considered a humanistic practice. While the notion that the possibility of reconciliation is maintained, the central argument maintains that much work needs to be done on the part of behaviorism both philosophically and methodologically in order for such reconciliation to be achieved.

ENA study cites barriers to NPSG compliance.

PubMed

2009-04-01

There are many barriers to compliance with the National Patient Safety Goals, as a recent study shows. However, emergency medicine experts say there are several strategies you can adopt to help overcome those barriers. Send the right message to your staff by establishing a culture of shared responsibility for safety. Establish scripts for talking with patients. Standardization will help ensure they are getting the correct information. Put standardized abbreviations on posters in your department, and list them on your medication reconciliation form.

Posttraumatic stress disorder, trauma, and reconciliation in South Sudan.

PubMed

Ng, Lauren C; López, Belkys; Pritchard, Matthew; Deng, David

2017-06-01

South Sudan is embroiled in a conflict that erupted in December 2013. This study examines what people in South Sudan think is necessary to achieve reconciliation and how trauma exposure and PTSD are associated with those beliefs. 1525 participants (51.0% female) were selected using random and purposive sampling in six states and Abyei. Participants reported on traumatic events, PTSD symptoms, and attitudes towards reconciliation mechanisms. Results indicated that 40.7% met symptom criteria for probable PTSD. Most participants thought reconciliation was not possible without prosecuting perpetrators or compensating victims and did not support amnesty. Participants with probable PTSD were more likely to endorse confessions (OR 2.42 [1.75, 3.35]), apologies (OR 2.04 [1.46, 2.83]), and amnesty (OR 1.58 [1.21, 2.08]), and to report that compensation (OR 2.32 [1.80, 3.00]) and prosecution (OR 1.47 [1.15, 1.89]) were not necessary for reconciliation. The more traumatic events people experienced, the more they endorsed criminal punishment for perpetrators (OR 1.07 [1.04, 1.10]) and the less they endorsed confessions (OR 0.97 [0.95, 0.99]). People with PTSD may prioritize ending violence via opportunities for reconciliation, while those with more trauma exposure may support more punitive mechanisms. Policy makers should take mental health treatment and trauma into account when designing conflict mitigation, peace building, and justice mechanisms.

Urban reconciliation ecology: the potential of living roofs and walls.

PubMed

Francis, Robert A; Lorimer, Jamie

2011-06-01

Reconciling human and non-human use of urban regions to support biological conservation represents a major challenge for the 21st century. The concept of reconciliation ecology, by which the anthropogenic environment may be modified to encourage non-human use and biodiversity preservation without compromising societal utilization, potentially represents an appropriate paradigm for urban conservation given the generally poor opportunities that exist for reserve establishment and ecological restoration in urban areas. Two habitat improvement techniques with great potential for reconciliation ecology in urban areas are the installation of living roofs and walls, which have been shown to support a range of taxa at local scales. This paper evaluates the reconciliation potential of living roofs and walls, in particular highlighting both ecological and societal limitations that need to be overcome for application at the landscape scale. We further consider that successful utilization of living roofs and walls for urban reconciliation ecology will rely heavily on the participation of urban citizens, and that a 'citizen science' model is needed to facilitate public participation and support and to create an evidence base to determine their effectiveness. Living roofs and walls are just one aspect of urban reconciliation ecology, but are particularly important 'bottom-up' techniques for improving urban biodiversity that can be performed directly by the citizenry. Copyright © 2011 Elsevier Ltd. All rights reserved.

Identification of unmeasured variables in the set of model constraints of the data reconciliation in a power unit

NASA Astrophysics Data System (ADS)

Szega, Marcin; Nowak, Grzegorz Tadeusz

2013-12-01

In generalized method of data reconciliation as equations of conditions beside substance and energy balances can be used equations which don't have precisely the status of conservation lows. Empirical coefficients in these equations are traded as unknowns' values. To this kind of equations, in application of the generalized method of data reconciliation in supercritical power unit, can be classified: steam flow capacity of a turbine for a group of stages, adiabatic internal efficiency of group of stages, equations for pressure drop in pipelines and equations for heat transfer in regeneration heat exchangers. Mathematical model of a power unit was developed in the code Thermoflex. Using this model the off-design calculation has been made in several points of loads for the power unit. Using these calculations identification of unknown values and empirical coefficients for generalized method of data reconciliation used in power unit has been made. Additional equations of conditions will be used in the generalized method of data reconciliation which will be used in optimization of measurement placement in redundant measurement system in power unit for new control systems

Teaching medical ethics to undergraduate students in post‐apartheid South Africa, 2003–2006

PubMed Central

Moodley, Keymanthri

2007-01-01

The apartheid ideology in South Africa had a pervasive influence on all levels of education including medical undergraduate training. The role of the health sector in human rights abuses during the apartheid era was highlighted in 1997 during the Truth and Reconciliation Commission hearings. The Health Professions Council of South Africa (HPCSA) subsequently realised the importance of medical ethics education and encouraged the introduction of such teaching in all medical schools in the country. Curricular reform at the University of Stellenbosch in 1999 presented an unparalleled opportunity to formally introduce ethics teaching to undergraduate students. This paper outlines the introduction of a medical ethics programme at the Faculty of Health Sciences from 2003 to 2006, with special emphasis on the challenges encountered. It remains one of the most comprehensive undergraduate medical ethics programmes in South Africa. However, there is scope for expanding the curricular time allocated to medical ethics. Integrating the curriculum both horizontally and vertically is imperative. Implementing a core curriculum for all medical schools in South Africa would significantly enhance the goals of medical education in the country. PMID:17971474

Teaching medical ethics to undergraduate students in post-apartheid South Africa, 2003 2006.

PubMed

Moodley, Keymanthri

2007-11-01

The apartheid ideology in South Africa had a pervasive influence on all levels of education including medical undergraduate training. The role of the health sector in human rights abuses during the apartheid era was highlighted in 1997 during the Truth and Reconciliation Commission hearings. The Health Professions Council of South Africa (HPCSA) subsequently realised the importance of medical ethics education and encouraged the introduction of such teaching in all medical schools in the country. Curricular reform at the University of Stellenbosch in 1999 presented an unparalleled opportunity to formally introduce ethics teaching to undergraduate students. This paper outlines the introduction of a medical ethics programme at the Faculty of Health Sciences from 2003 to 2006, with special emphasis on the challenges encountered. It remains one of the most comprehensive undergraduate medical ethics programmes in South Africa. However, there is scope for expanding the curricular time allocated to medical ethics. Integrating the curriculum both horizontally and vertically is imperative. Implementing a core curriculum for all medical schools in South Africa would significantly enhance the goals of medical education in the country.

Transformational Leadership in the Planning of a Doctoral Program.

ERIC Educational Resources Information Center

Martinez, Bobby J.; Slater, Charles L.

2000-01-01

The process of developing a doctoral program at the University of the Incarnate Word demonstrates the use of both transformational leadership (empowerment, advocacy, reconciliation) and transactional leadership (power brokering, making legitimate decisions). The contemporary environment needs multiple leaders who exercise different types of…

Thinking like an expert: surgical decision making as a cyclical process of being aware.

PubMed

Cristancho, Sayra M; Apramian, Tavis; Vanstone, Meredith; Lingard, Lorelei; Ott, Michael; Forbes, Thomas; Novick, Richard

2016-01-01

Education researchers are studying the practices of high-stake professionals as they learn how to better train for flexibility under uncertainty. This study explores the "Reconciliation Cycle" as the core element of an intraoperative decision-making model of how experienced surgeons assess and respond to challenges. We analyzed 32 semistructured interviews using constructivist grounded theory to develop a model of intraoperative decision making. Using constant comparison analysis, we built on this model with 9 follow-up interviews about the most challenging cases described in our dataset. The Reconciliation Cycle constituted an iterative process of "gaining" and "transforming information." The cyclical nature of surgeons' decision making suggested that transforming information requires a higher degree of awareness, not yet accounted by current conceptualizations of situation awareness. This study advances the notion of situation awareness in surgery. This characterization will support further investigations on how expert and nonexpert surgeons implement strategies to cope with unexpected events. Copyright © 2016 Elsevier Inc. All rights reserved.

Reconciling reintegration: the complexity of economic and social reintegration of ex-combatants in Burundi.

PubMed

Willems, Rens; van Leeuwen, Mathijs

2015-04-01

The extent to which disarmament, demobilisation and reintegration (DDR) programmes initiated by state or multilateral agencies can realise the reintegration of ex-combatants remains debated. While some consider that DDR should have the ambition to result in long-term reintegration, others argue that DDR should focus on short-term goals. This paper explores experiences with the reintegration of ex-combatants in Burundi. It shows the interconnectedness of economic and social reintegration processes, and demonstrates that the reintegration of ex-combatants cannot be seen in isolation from the wider recovery and development context in which DDR is taking place. Moreover, the case demonstrates that reconciliation and social reintegration are deeply interconnected, to the extent that social reintegration may fail if reconciliation is not taken into account. Rather than a debate between long- and short-term goals, the focus should therefore be on increasing the understanding of reintegration processes and finding ways in which programmes can contribute to those. © 2015 The Author(s). Disasters © Overseas Development Institute, 2015.

Reclaiming reconciliation through community education for the Muslims and Tamils of post-war Jaffna, Sri Lanka

PubMed Central

Duncan, Ross; Cardozo, Mieke Lopes

2017-01-01

This paper explores the possibilities and challenges for ethno-religious reconciliation through secondary school education in post-war Sri Lanka, with a specific focus on the Muslim and Tamil communities in the Northern city of Jaffna. In doing so, we position our paper within the growing field of ‘education, conflict and emergencies’ of which there has been a growing body of literature discussing this contentious relationship. The paper draws from an interdisciplinary and critical theoretical framework that aims to analyse the role of education for peacebuilding, through a multi-scalar application of four interconnected dimensions of social justice: redistribution, recognition, representation and reconciliation (or 4 R’s, Novelli, Lopes Cardozo and Smith, 2015). We apply this framework to interpret primary data collected through an ethnographic study of two under-studied communities that have been disproportionately affected by the 1983 to 2009 civil war and displacement: the Northern Sri Lankan Muslims and Northern Sri Lankan Tamils. We find that structural inequalities in society are replicated in formal secondary school education and are perceived to be perpetuating ethno-religious conflict between Muslim and Tamil; second, through a multi-scalar analysis, formal peace education is perceived by respondents not to be meeting the needs of communities; and third, we observe how in response to failings of state peace education, an ‘unofficial’ Tamil–Muslim community education incorporating a social justice-based approach has emerged. This has facilitated a process of cross-community reconciliation between Muslim and Tamil through individual (teachers, students) and community (Muslim–Tamil community based organisations) agency. The paper concludes by offering suggestions for peace education policy and future research. PMID:28690667

Reclaiming reconciliation through community education for the Muslims and Tamils of post-war Jaffna, Sri Lanka.

PubMed

Duncan, Ross; Cardozo, Mieke Lopes

2017-03-01

This paper explores the possibilities and challenges for ethno-religious reconciliation through secondary school education in post-war Sri Lanka, with a specific focus on the Muslim and Tamil communities in the Northern city of Jaffna. In doing so, we position our paper within the growing field of 'education, conflict and emergencies' of which there has been a growing body of literature discussing this contentious relationship. The paper draws from an interdisciplinary and critical theoretical framework that aims to analyse the role of education for peacebuilding, through a multi-scalar application of four interconnected dimensions of social justice: redistribution, recognition, representation and reconciliation (or 4 R's, Novelli, Lopes Cardozo and Smith, 2015). We apply this framework to interpret primary data collected through an ethnographic study of two under-studied communities that have been disproportionately affected by the 1983 to 2009 civil war and displacement: the Northern Sri Lankan Muslims and Northern Sri Lankan Tamils. We find that structural inequalities in society are replicated in formal secondary school education and are perceived to be perpetuating ethno-religious conflict between Muslim and Tamil; second, through a multi-scalar analysis, formal peace education is perceived by respondents not to be meeting the needs of communities; and third, we observe how in response to failings of state peace education, an 'unofficial' Tamil-Muslim community education incorporating a social justice-based approach has emerged. This has facilitated a process of cross-community reconciliation between Muslim and Tamil through individual (teachers, students) and community (Muslim-Tamil community based organisations) agency. The paper concludes by offering suggestions for peace education policy and future research.

Patients' Experiences With Communication-and-Resolution Programs After Medical Injury.

PubMed

Moore, Jennifer; Bismark, Marie; Mello, Michelle M

2017-11-01

Dissatisfaction with medical malpractice litigation has stimulated interest by health care organizations in developing alternatives to meet patients' needs after medical injury. In communication-and-resolution programs (CRPs), hospitals and liability insurers communicate with patients about adverse events, use investigation findings to improve patient safety, and offer compensation when substandard care caused harm. Despite increasing interest in this approach, little is known about patients' and family members' experiences with CRPs. To explore the experiences of patients and family members with medical injuries and CRPs to understand different aspects of institutional responses to injury that promoted and impeded reconciliation. From January 6 through June 30, 2016, semistructured interviews were conducted with patients (n = 27), family members (n = 3), and staff (n = 10) at 3 US hospitals that operate CRPs. Patients and families were eligible for participation if they experienced a CRP, spoke English, and could no longer file a malpractice claim because they had accepted a settlement or the statute of limitations had expired. The CRP administrators identified hospital and insurer staff who had been involved in a CRP event and had a close relationship with the injured patient and/or family. They identified patients and families by applying the inclusion criteria to their CRP databases. Of 66 possible participants, 40 interviews (61%) were completed, including 30 of 50 invited patients and families (60%) and 10 of 16 invited staff (63%). Patients' reported satisfaction with disclosure and reconciliation efforts made by hospitals. A total of 40 participants completed interviews (15 men and 25 women; mean [range] age, 46 [18-67] years). Among the 30 patients and family members interviewed, 27 patients experienced injuries attributed to error and received compensation. The CRP experience was positive overall for 18 of the 30 patients and family members, and 18 patients continued to receive care at the hospital. Satisfaction was highest when communications were empathetic and nonadversarial, including compensation negotiations. Patients and families expressed a strong need to be heard and expected the attending physician to listen without interrupting during conversations about the event. Thirty-five of the 40 respondents believed that including plaintiffs' attorneys in these discussions was helpful. Sixteen of the 30 patients and family members deemed their compensation to be adequate but 17 reported that the offer was not sufficiently proactive. Patients and families strongly desired to know what the hospital did to prevent recurrences of the event, but 24 of 30 reported receiving no information about safety improvement efforts. As hospitals strive to provide more patient-centered care, opportunities exist to improve institutional responses to injuries and promote reconciliation.

42 CFR 422.310 - Risk adjustment data.

Code of Federal Regulations, 2013 CFR

2013-10-01

... include financial penalties for failure to submit complete data. (e) Validation of risk adjustment data... records for the validation of risk adjustment data, as required by CMS. There may be penalties for... the prior December 31. (2) CMS allows a reconciliation process to account for late data submissions...

42 CFR 422.310 - Risk adjustment data.

Code of Federal Regulations, 2012 CFR

2012-10-01

... include financial penalties for failure to submit complete data. (e) Validation of risk adjustment data... records for the validation of risk adjustment data, as required by CMS. There may be penalties for... the prior December 31. (2) CMS allows a reconciliation process to account for late data submissions...

Roosters, Robins, and Alarm Clocks: Aptness and Conventionality in Metaphor Comprehension

ERIC Educational Resources Information Center

Jones, Lara L.; Estes, Zachary

2006-01-01

Bowdle and Gentner (2005) proposed a reconciliation of the comparison and categorization models of metaphor comprehension. Their career of metaphor model posits that, as a metaphorical term becomes more conventional, its mode of processing shifts from comparison to categorization. However, other recent studies (Chiappe, Kennedy, & Chiappe, 2003;…

42 CFR § 510.305 - Determination of the NPRA and reconciliation process.

Code of Federal Regulations, 2010 CFR

2017-10-01

... OF HEALTH AND HUMAN SERVICES (CONTINUED) HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS COMPREHENSIVE CARE FOR JOINT REPLACEMENT MODEL Pricing and Payment § 510.305 Determination of the NPRA and... final payment amounts to participant hospitals for CJR episodes for a given performance year. Following...

42 CFR § 510.305 - Determination of the NPRA and reconciliation process.

Code of Federal Regulations, 2010 CFR

2016-10-01

... OF HEALTH AND HUMAN SERVICES (CONTINUED) HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS COMPREHENSIVE CARE FOR JOINT REPLACEMENT MODEL Pricing and Payment § 510.305 Determination of the NPRA and... final payment amounts to participant hospitals for CJR episodes for a given performance year. Following...

Democratic Nation-Building in South Africa.

ERIC Educational Resources Information Center

Rhoodie, Nic, Ed.; Liebenberg, Ian, Ed.

This book is a collection of essays by 50 eminent experts/analysts representing a broad range of ideological perspectives and interest groups. Its aim is to contribute to the process of democratic nation-building and the creation of a culture of tolerance by educating South Africans about the intricacies of community reconciliation and…

Implementation and Reauthorization of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. Hearing before the Committee on Indian Affairs on the Implementation and Reauthorization of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 in Indian Country. United States Senate, One Hundred Seventh Congress, Second Session.

ERIC Educational Resources Information Center

Congress of the U.S., Washington, DC. Senate Committee on Indian Affairs.

A Senate committee hearing received testimony on the implementation of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 in American Indian and Alaska Native tribal communities. The act provided authority for tribal governments to administer welfare programs formerly administered by the states but did not provide funds to…

The Significance of Emotions and Professional Relations for Accommodating a Web-Based Ulcer Record and Improving Home-Based Care

PubMed Central

Ekeland, Anne G.

2015-01-01

Evidence of technological performance, medical improvements and economic effectiveness is generally considered sufficient for judging advances in healthcare. In this paper, I aim to add knowledge about the ways human emotions and professional relations play roles in the processes of accommodating new technologies for quality improvements. A newly-implemented, web-based ulcer record service for patients with chronic skin ulcers constitutes the case. After one year, only a few home care nurses were using the service, interacting with a specialist team. The result was disappointing, but the few users were enthusiastic. An explorative, qualitative study was initiated to understand the users, the processes that accounted for use and how improvements were enacted. In the paper, I expose the emotional aspects of the record accommodation by analyzing the ways emotions were translated in the process and how they influenced the improvements. I contend that use came about through a heterogeneous assemblage of ethical engagement and compassionate emotions stemming from frustration, combined with technological affordances and relations between different professionals. Certain aspects of the improvements are exposed. These are discussed as: (1) reconciliations between the medical facts and rational judgments, on one side, and the emotional and subjective values for judging quality, on the other; and (2) mediation between standardized and personalized care. The healing of ulcers was combined with a sense of purpose and wellbeing to validate improvements. Emotions were strongly involved, and the power of evaluative emotions and professional relations should be further explored to add to the understanding of innovation processes and to validate quality improvements. PMID:27417745

The Significance of Emotions and Professional Relations for Accommodating a Web-Based Ulcer Record and Improving Home-Based Care.

PubMed

Ekeland, Anne G

2015-01-22

Evidence of technological performance, medical improvements and economic effectiveness is generally considered sufficient for judging advances in healthcare. In this paper, I aim to add knowledge about the ways human emotions and professional relations play roles in the processes of accommodating new technologies for quality improvements. A newly-implemented, web-based ulcer record service for patients with chronic skin ulcers constitutes the case. After one year, only a few home care nurses were using the service, interacting with a specialist team. The result was disappointing, but the few users were enthusiastic. An explorative, qualitative study was initiated to understand the users, the processes that accounted for use and how improvements were enacted. In the paper, I expose the emotional aspects of the record accommodation by analyzing the ways emotions were translated in the process and how they influenced the improvements. I contend that use came about through a heterogeneous assemblage of ethical engagement and compassionate emotions stemming from frustration, combined with technological affordances and relations between different professionals. Certain aspects of the improvements are exposed. These are discussed as: (1) reconciliations between the medical facts and rational judgments, on one side, and the emotional and subjective values for judging quality, on the other; and (2) mediation between standardized and personalized care. The healing of ulcers was combined with a sense of purpose and wellbeing to validate improvements. Emotions were strongly involved, and the power of evaluative emotions and professional relations should be further explored to add to the understanding of innovation processes and to validate quality improvements.

Implications of involving pharmacy technicians in obtaining a best possible medication history from the perspectives of pharmaceutical, medical and nursing staff: a qualitative study.

PubMed

Niederhauser, Andrea; Zimmermann, Chantal; Fishman, Liat; Schwappach, David L B

2018-05-17

In recent years, the involvement of pharmacy technicians in medication reconciliation has increasingly been investigated. The aim of this study was to assess the implications on professional roles and collaboration when a best possible medication history (BPMH) at admission is obtained by pharmacy technicians. Qualitative study with semistructured interviews. Data were analysed using a qualitative content analysis approach. Internal medicine units in two mid-sized Swiss hospitals. 21 staff members working at the two sites (6 pharmacy technicians, 2 pharmacists, 6 nurses, 5 physician residents and 2 senior physicians). Pharmacy technicians generally appreciated their new tasks in obtaining a BPMH. However, they also experienced challenges associated with their new role. Interviewees reported unease with direct patient interaction and challenges with integrating the new BPMH tasks into their regular daily duties. We found that pharmacists played a key role in the BPMH process, since they act as coaches for pharmacy technicians, transmit information to the physicians and reconcile preadmission medication lists with admission orders. Physicians stated that they benefitted from the delegation of administrative tasks to pharmacy technicians. Regarding the interprofessional collaboration, we found that pharmacy technicians in the study acted on a preliminary administrative level and did not become part of the larger treatment team. There was no direct interaction between pharmacy technicians and physicians, but rather, the supervising pharmacists acted as intermediaries. The tasks assumed by pharmacy technicians need to be clearly defined and fully integrated into existing processes. Engaging pharmacy technicians may generate new patient safety risks and inefficiencies due to process fragmentation. Communication and information flow at the interfaces between professional groups therefore need to be well organised. More research is needed to understand if and under which circumstances such a model can be efficient and contribute to improving medication safety. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Transitional Justice and National Reconciliation

DTIC Science & Technology

2014-01-01

reform of the state “security services” requires the reform of the army, police, judiciary, customs, immigration control, intelligence services, and...Committee in South Africa, the Equity and Reconciliation Committee in Morocco, and similar entities in Chile and Peru. 3. Achieving community dialogue

Shared Education in Northern Ireland: School Collaboration in Divided Societies

ERIC Educational Resources Information Center

Gallagher, Tony

2016-01-01

During the years of political violence in Northern Ireland many looked to schools to contribute to reconciliation. A variety of interventions were attempted throughout those years, but there was little evidence that any had produced systemic change. The peace process provided an opportunity for renewed efforts. This paper outlines the experience…

A Long Walk to Citizenship: Morality, Justice and Faith in the Aftermath of Apartheid

ERIC Educational Resources Information Center

Swartz, Sharlene

2006-01-01

Numerous initiatives, such as the Truth and Reconciliation Commission, the Race and Values in Education process of the Department of Education, the government-initiated (but now civic-led) Moral Regeneration Movement and the pervasive indigenous African philosophy of "ubuntu" have, over the past twelve years since South Africa's…

Rhetorical Dimensions of the Post-September Eleventh Grief Process

ERIC Educational Resources Information Center

Schwartzman, Roy; Tibbles, David

2005-01-01

This essay examines Presidential rhetoric and popular culture practices in light of the stages of grief enumerated by Elisabeth Kubler-Ross. The authors find a consistent retrenchment of grief into the anger phase, where the pain of losing national invulnerability is transferred to externalized aggression. Reconciliation is suggested by means of…

Race, Gender, and Leadership Identity: An Autoethnography of Reconciliation

ERIC Educational Resources Information Center

McClellan, Patrice

2012-01-01

This article is an autoethnography of the author's journey researching Black men. She highlights two critical incidents during the research process that aided in the formation of her identity as a leader. Drawing on Hill Collins' "Black Feminist Thought" the author also identifies key women leaders whose examples fueled her commitment to…

Social Theory, Sacred Text, and Sing-Sing Prison: A Sociology of Community-Based Reconciliation.

ERIC Educational Resources Information Center

Erickson, Victoria Lee

2002-01-01

Examines the sociological component of the urban community-based professional education programs at New York Theological Seminary offered at Sing-Sing Prison. Explores the simultaneous use of social theory and sacred texts as teaching tools and intervention strategies in the educational and personal transformation processes of men incarcerated for…

Reducing hospital readmission rates: current strategies and future directions.

PubMed

Kripalani, Sunil; Theobald, Cecelia N; Anctil, Beth; Vasilevskis, Eduard E

2014-01-01

New financial penalties for institutions with high readmission rates have intensified efforts to reduce rehospitalization. Several interventions that involve multiple components (e.g., patient needs assessment, medication reconciliation, patient education, arranging timely outpatient appointments, and providing telephone follow-up) have successfully reduced readmission rates for patients discharged to home. The effect of interventions on readmission rates is related to the number of components implemented; single-component interventions are unlikely to reduce readmissions significantly. For patients discharged to postacute care facilities, multicomponent interventions have reduced readmissions through enhanced communication, medication safety, advanced care planning, and enhanced training to manage medical conditions that commonly precipitate readmission. To help hospitals direct resources and services to patients with greater likelihood of readmission, risk-stratification methods are available. Future work should better define the roles of home-based services, information technology, mental health care, caregiver support, community partnerships, and new transitional care personnel.

Experiences of non-progressive and augmented labour among nulliparous women: a qualitative interview study in a Grounded Theory approach

PubMed Central

Kjaergaard, Hanne; Foldgast, Anne Maria; Dykes, Anna-Karin

2007-01-01

Background Non-progressive labour is the most common complication in nulliparas and is primarily treated by augmentation. Augmented labour is often terminated by instrumental delivery. Little qualitative research has addressed experiences of non-progressive and augmented deliveries. The aim of this study was to gain a deeper understanding of the experience of non-progressive and augmented labour among nulliparas and their experience of the care they received. Methods A qualitative study was conducted using individual interviews. Data was collected and analysed according to the Grounded Theory method. The participants were a purposive sample of ten women. The interviews were conducted 4–15 weeks after delivery. Results The women had contrasting experiences during the birth process. During labour there was a conflict between the expectation of having a natural delivery and actually having a medical delivery. The women experienced a feeling of separation between mind and body. Interacting with the midwife had a major influence on feelings of losing and regaining control. Reconciliation between the contrasting feelings during labour was achieved. The core category was named Dialectical Birth Process and comprised three categories: Balancing natural and medical delivery, Interacting, Losing and regaining control. Conclusion A dialectical process was identified in these women's experiences of non-progressive labour. The process is susceptible to interaction with the midwife; especially her support to the woman's feeling of being in control. Midwives should secure that the woman's recognition of the fact that the labour is non-progressive and augmentation is required is handled with respect for the dialectical process. Augmentation of labour should be managed as close to the course of natural labour and delivery as possible. PMID:17662152

10 CFR 766.104 - Reconciliation, adjustments and appeals.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 10 Energy 4 2011-01-01 2011-01-01 false Reconciliation, adjustments and appeals. 766.104 Section 766.104 Energy DEPARTMENT OF ENERGY URANIUM ENRICHMENT DECONTAMINATION AND DECOMMISSIONING FUND; PROCEDURES FOR SPECIAL ASSESSMENT OF DOMESTIC UTILITIES Procedures for Special Assessment § 766.104...

10 CFR 766.104 - Reconciliation, adjustments and appeals.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 10 Energy 4 2012-01-01 2012-01-01 false Reconciliation, adjustments and appeals. 766.104 Section 766.104 Energy DEPARTMENT OF ENERGY URANIUM ENRICHMENT DECONTAMINATION AND DECOMMISSIONING FUND; PROCEDURES FOR SPECIAL ASSESSMENT OF DOMESTIC UTILITIES Procedures for Special Assessment § 766.104...

10 CFR 766.104 - Reconciliation, adjustments and appeals.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 10 Energy 4 2014-01-01 2014-01-01 false Reconciliation, adjustments and appeals. 766.104 Section 766.104 Energy DEPARTMENT OF ENERGY URANIUM ENRICHMENT DECONTAMINATION AND DECOMMISSIONING FUND; PROCEDURES FOR SPECIAL ASSESSMENT OF DOMESTIC UTILITIES Procedures for Special Assessment § 766.104...

78 FR 21045 - Confirmation, Portfolio Reconciliation, Portfolio Compression, and Swap Trading Relationship...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-09

... COMMODITY FUTURES TRADING COMMISSION 17 CFR Part 23 RIN 3038-AC96 Confirmation, Portfolio Reconciliation, Portfolio Compression, and Swap Trading Relationship Documentation Requirements for Swap Dealers..., portfolio compression, and swap trading relationship documentation for Swap Dealers and Major Swap...

Reconciliation of ontology and terminology to cope with linguistics.

PubMed

Baud, Robert H; Ceusters, Werner; Ruch, Patrick; Rassinoux, Anne-Marie; Lovis, Christian; Geissbühler, Antoine

2007-01-01

To discuss the relationships between ontologies, terminologies and language in the context of Natural Language Processing (NLP) applications in order to show the negative consequences of confusing them. The viewpoints of the terminologist and (computational) linguist are developed separately, and then compared, leading to the presentation of reconciliation among these points of view, with consideration of the role of the ontologist. In order to encourage appropriate usage of terminologies, guidelines are presented advocating the simultaneous publication of pragmatic vocabularies supported by terminological material based on adequate ontological analysis. Ontologies, terminologies and natural languages each have their own purpose. Ontologies support machine understanding, natural languages support human communication, and terminologies should form the bridge between them. Therefore, future terminology standards should be based on sound ontology and do justice to the diversities in natural languages. Moreover, they should support local vocabularies, in order to be easily adaptable to local needs and practices.

Natural Language Processing and Its Implications for the Future of Medication Safety: A Narrative Review of Recent Advances and Challenges.

PubMed

Wong, Adrian; Plasek, Joseph M; Montecalvo, Steven P; Zhou, Li

2018-06-09

The safety of medication use has been a priority in the United States since the late 1930s. Recently, it has gained prominence due to the increasing amount of data suggesting that a large amount of patient harm is preventable and can be mitigated with effective risk strategies that have not been sufficiently adopted. Adverse events from medications are part of clinical practice, but the ability to identify a patient's risk and to minimize that risk must be a priority. The ability to identify adverse events has been a challenge due to limitations of available data sources, which are often free text. The use of natural language processing (NLP) may help to address these limitations. NLP is the artificial intelligence domain of computer science that uses computers to manipulate unstructured data (i.e., narrative text or speech data) in the context of a specific task. In this narrative review, we illustrate the fundamentals of NLP and discuss NLP's application to medication safety in four data sources: electronic health records, Internet-based data, published literature, and reporting systems. Given the magnitude of available data from these sources, a growing area is the use of computer algorithms to help automatically detect associations between medications and adverse effects. The main benefit of NLP is in the time savings associated with automation of various medication safety tasks such as the medication reconciliation process facilitated by computers, as well as the potential for near-real time identification of adverse events for postmarketing surveillance such as those posted on social media that would otherwise go unanalyzed. NLP is limited by a lack of data sharing between health care organizations due to insufficient interoperability capabilities, inhibiting large-scale adverse event monitoring across populations. We anticipate that future work in this area will focus on the integration of data sources from different domains to improve the ability to identify potential adverse events more quickly and to improve clinical decision support with regard to a patient's estimated risk for specific adverse events at the time of medication prescription or review. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

42 CFR 417.598 - Annual enrollment reconciliation.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 3 2013-10-01 2013-10-01 false Annual enrollment reconciliation. 417.598 Section 417.598 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... PLANS, AND HEALTH CARE PREPAYMENT PLANS Medicare Payment: Risk Basis § 417.598 Annual enrollment...

42 CFR 417.598 - Annual enrollment reconciliation.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false Annual enrollment reconciliation. 417.598 Section 417.598 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... PLANS, AND HEALTH CARE PREPAYMENT PLANS Medicare Payment: Risk Basis § 417.598 Annual enrollment...

42 CFR 417.598 - Annual enrollment reconciliation.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 3 2014-10-01 2014-10-01 false Annual enrollment reconciliation. 417.598 Section 417.598 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... PLANS, AND HEALTH CARE PREPAYMENT PLANS Medicare Payment: Risk Basis § 417.598 Annual enrollment...

42 CFR 405.2466 - Annual reconciliation.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 2 2011-10-01 2011-10-01 false Annual reconciliation. 405.2466 Section 405.2466 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE..., payment for pneumococcal and influenza vaccine and their administration is 100 percent of Medicare...

42 CFR 405.2466 - Annual reconciliation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 2 2010-10-01 2010-10-01 false Annual reconciliation. 405.2466 Section 405.2466 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE..., payment for pneumococcal and influenza vaccine and their administration is 100 percent of Medicare...

19 CFR 146.25 - Annual reconciliation.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 19 Customs Duties 2 2010-04-01 2010-04-01 false Annual reconciliation. 146.25 Section 146.25 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT OF THE TREASURY (CONTINUED) FOREIGN TRADE ZONES Inventory Control and Recordkeeping System § 146.25 Annual...

Efficient Exploration of the Space of Reconciled Gene Trees

PubMed Central

Szöllősi, Gergely J.; Rosikiewicz, Wojciech; Boussau, Bastien; Tannier, Eric; Daubin, Vincent

2013-01-01

Gene trees record the combination of gene-level events, such as duplication, transfer and loss (DTL), and species-level events, such as speciation and extinction. Gene tree–species tree reconciliation methods model these processes by drawing gene trees into the species tree using a series of gene and species-level events. The reconstruction of gene trees based on sequence alone almost always involves choosing between statistically equivalent or weakly distinguishable relationships that could be much better resolved based on a putative species tree. To exploit this potential for accurate reconstruction of gene trees, the space of reconciled gene trees must be explored according to a joint model of sequence evolution and gene tree–species tree reconciliation. Here we present amalgamated likelihood estimation (ALE), a probabilistic approach to exhaustively explore all reconciled gene trees that can be amalgamated as a combination of clades observed in a sample of gene trees. We implement the ALE approach in the context of a reconciliation model (Szöllősi et al. 2013), which allows for the DTL of genes. We use ALE to efficiently approximate the sum of the joint likelihood over amalgamations and to find the reconciled gene tree that maximizes the joint likelihood among all such trees. We demonstrate using simulations that gene trees reconstructed using the joint likelihood are substantially more accurate than those reconstructed using sequence alone. Using realistic gene tree topologies, branch lengths, and alignment sizes, we demonstrate that ALE produces more accurate gene trees even if the model of sequence evolution is greatly simplified. Finally, examining 1099 gene families from 36 cyanobacterial genomes we find that joint likelihood-based inference results in a striking reduction in apparent phylogenetic discord, with respectively. 24%, 59%, and 46% reductions in the mean numbers of duplications, transfers, and losses per gene family. The open source implementation of ALE is available from https://github.com/ssolo/ALE.git. [amalgamation; gene tree reconciliation; gene tree reconstruction; lateral gene transfer; phylogeny.] PMID:23925510

76 FR 81490 - Agency Information Collection Activities; Proposed Collection; Comment Request; Contractor...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-28

... Activities; Proposed Collection; Comment Request; Contractor Cumulative Claim and Reconciliation (Renewal... identify the Docket ID Number EPA-HQ-OARM-2011-0997, Contractor Cumulative Claim and Reconciliation. Hand... information collection activity or ICR does this apply to? Affected entities: All contractors who have...

7 CFR 274.4 - Reconciliation and reporting.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 4 2010-01-01 2010-01-01 false Reconciliation and reporting. 274.4 Section 274.4 Agriculture Regulations of the Department of Agriculture (Continued) FOOD AND NUTRITION SERVICE, DEPARTMENT OF... knowledge and belief. (ii) Coupon issuers and bulk storage points shall submit supporting documentation to...

Ravens reconcile after aggressive conflicts with valuable partners.

PubMed

Fraser, Orlaith N; Bugnyar, Thomas

2011-03-25

Reconciliation, a post-conflict affiliative interaction between former opponents, is an important mechanism for reducing the costs of aggressive conflict in primates and some other mammals as it may repair the opponents' relationship and reduce post-conflict distress. Opponents who share a valuable relationship are expected to be more likely to reconcile as for such partners the benefits of relationship repair should outweigh the risk of renewed aggression. In birds, however, post-conflict behavior has thus far been marked by an apparent absence of reconciliation, suggested to result either from differing avian and mammalian strategies or because birds may not share valuable relationships with partners with whom they engage in aggressive conflict. Here, we demonstrate the occurrence of reconciliation in a group of captive subadult ravens (Corvus corax) and show that it is more likely to occur after conflicts between partners who share a valuable relationship. Furthermore, former opponents were less likely to engage in renewed aggression following reconciliation, suggesting that reconciliation repairs damage caused to their relationship by the preceding conflict. Our findings suggest not only that primate-like valuable relationships exist outside the pair bond in birds, but that such partners may employ the same mechanisms in birds as in primates to ensure that the benefits afforded by their relationships are maintained even when conflicts of interest escalate into aggression. These results provide further support for a convergent evolution of social strategies in avian and mammalian species.

Preservice Teachers' Reconciliation of an Epistemological Issue in an Integrated Mathematics/Science Methods Course

ERIC Educational Resources Information Center

Cormas, Peter C.

2017-01-01

Preservice teachers in six sections (n = 87) of a sequenced, methodological and process-integrated elementary mathematics/science methods course were able to reconcile an issue centered on a similar area of epistemology. Preservice teachers participated in a science inquiry lesson on biological classification and a mathematics problem-solving…

25 CFR 542.42 - What are the minimum internal control standards for internal audit for Tier C gaming operations?

Code of Federal Regulations, 2010 CFR

2010-04-01

... reconciliation process; (ii) Pull tabs, including but not limited to, statistical records, winner verification... 25 Indians 2 2010-04-01 2010-04-01 false What are the minimum internal control standards for... COMMISSION, DEPARTMENT OF THE INTERIOR HUMAN SERVICES MINIMUM INTERNAL CONTROL STANDARDS § 542.42 What are...

Respect, Recognition and Reconciliation: Emerging Models of Integrated Education in Regions of Conflict

ERIC Educational Resources Information Center

Ben-Nun, Merav

2009-01-01

A comparative case study of integrated schools in two regions of conflict, this study addresses the potential and limitations of education to promote individual and societal processes of change and peace building. In modern societies, education is expected to play a central function in socializing young generations into their culture and the…

Balancing the Societal Dimensions of Venezuela and Colombia through the Amnesty, Reconciliation, and Reintegration (AR2) Process

DTIC Science & Technology

2008-05-22

reason these groups traditionally hold the most power is that economically, Colombia has historically been an agricultural-based economy with coffee ...as its major crop until oil replaced it as the nation’s leading legal export. Colombia, however, is also known for its production of heroin, cannabis

The Digital Drag and Drop Pillbox

PubMed Central

Granger, Bradi B.; Locke, Susan C.; Bowers, Margaret; Sawyer, Tenita; Shang, Howard; Abernethy, Amy P.; Bloomfield, Richard A.; Gilliss, Catherine L.

2017-01-01

Objective: We present the design and feasibility testing for the “Digital Drag and Drop Pillbox” (D-3 Pillbox), a skill-based educational approach that engages patients and providers, measures performance, and generates reports of medication management skills. Methods: A single-cohort convenience sample of patients hospitalized with heart failure was taught pill management skills using a tablet-based D-3 Pillbox. Medication reconciliation was conducted, and aptitude, performance (% completed), accuracy (% correct), and feasibility were measured. Results: The mean age of the sample (n = 25) was 59 (36–89) years, 50% were women, 62% were black, 46% were uninsured, 46% had seventh-grade education or lower, and 31% scored very low for health literacy. However, most reported that the D-3 Pillbox was easy to read (78%), easy to repeat-demonstrate (78%), and comfortable to use (tablet weight) (75%). Accurate medication recognition was achieved by discharge in 98%, but only 25% reported having a “good understanding of my responsibilities.” Conclusions: The D-3 Pillbox is a feasible approach for teaching medication management skills and can be used across clinical settings to reinforce skills and medication list accuracy. PMID:28282304

Creating a foundation for implementing an electronic health records (EHR)-integrated Social Knowledge Networking (SKN) system on medication reconciliation.

PubMed

Rangachari, P; Dellsperger, K C; Fallaw, D; Davis, I; Sumner, M; Ray, W; Fiedler, S; Nguyen, T; Rethemeyer, R

2018-04-01

In fall 2016, Augusta University received a two-year grant from AHRQ, to implement a Social Knowledge Networking (SKN) system for enabling its health system, AU-Health, to progress from "limited use" of EHR Medication Reconciliation (MedRec) Technology, to "meaningful use." Phase 1 sought to identify a comprehensive set of issues related to EHR MedRec encountered by practitioners at AU-Health. These efforts helped develop a Reporting Tool , which, along with a Discussion Tool , was incorporated into the AU-Health EHR, at the end of Phase 1. Phase 2 (currently underway), comprises a 52-week pilot of the EHR-integrated SKN system in outpatient and inpatient medicine units. The purpose of this paper is to describe the methods and results of Phase 1. Phase 1 utilized an exploratory mixed-method approach, involving two rounds of data collection. This included 15 individual interviews followed by a survey of 200 practitioners, i.e., physicians, nurses, and pharmacists, based in the outpatient and inpatient medicine service at AU Health. Thematic analysis of interviews identified 55 issue-items related to EHR MedRec under 9 issue-categories. The survey sought practitioners' importance-rating of all issue-items identified from interviews. A total of 127 (63%) survey responses were received. Factor analysis served to validate the following 6 of the 9 issue-categories, all of which, were rated "Important" or higher (on average), by over 70% of all respondents: 1) Care-Coordination (CCI); 2) Patient-Education (PEI); 3) Ownership-and-Accountability (OAI); 4) Processes-of-Care (PCI); 5) IT-Related (ITRI); and 6) Workforce-Training (WTI). Significance-testing of importance-rating by professional affiliation revealed no statistically significant differences for CCI and PEI; and some statistically significant differences for OAI, PCI, ITRI, and WTI. There were two key gleanings from the issues related to EHR MedRec unearthed by this study: 1) there was an absence of shared understanding among practitioners, of the value of EHR MedRec in promoting patient safety, which contributed to workarounds, and suboptimal use of the EHR MedRec system; and 2) there was a socio-technical dimension to many of the issues, creating an added layer of complexity. These gleanings in turn, provide insights into best practices for managing both clinical transitions-of-care in the EHR MedRec process; and socio-technical challenges encountered in EHR MedRec implementation.

Creating a foundation for implementing an electronic health records (EHR)-integrated Social Knowledge Networking (SKN) system on medication reconciliation

PubMed Central

Rangachari, P.; Dellsperger, K.C; Fallaw, D.; Davis, I.; Sumner, M.; Ray, W.; Fiedler, S.; Nguyen, T.; Rethemeyer, R.

2018-01-01

Background In fall 2016, Augusta University received a two-year grant from AHRQ, to implement a Social Knowledge Networking (SKN) system for enabling its health system, AU-Health, to progress from “limited use” of EHR Medication Reconciliation (MedRec) Technology, to “meaningful use.” Phase 1 sought to identify a comprehensive set of issues related to EHR MedRec encountered by practitioners at AU-Health. These efforts helped develop a Reporting Tool, which, along with a Discussion Tool, was incorporated into the AU-Health EHR, at the end of Phase 1. Phase 2 (currently underway), comprises a 52-week pilot of the EHR-integrated SKN system in outpatient and inpatient medicine units. The purpose of this paper is to describe the methods and results of Phase 1. Methods Phase 1 utilized an exploratory mixed-method approach, involving two rounds of data collection. This included 15 individual interviews followed by a survey of 200 practitioners, i.e., physicians, nurses, and pharmacists, based in the outpatient and inpatient medicine service at AU Health. Results Thematic analysis of interviews identified 55 issue-items related to EHR MedRec under 9 issue-categories. The survey sought practitioners’ importance-rating of all issue-items identified from interviews. A total of 127 (63%) survey responses were received. Factor analysis served to validate the following 6 of the 9 issue-categories, all of which, were rated “Important” or higher (on average), by over 70% of all respondents: 1) Care-Coordination (CCI); 2) Patient-Education (PEI); 3) Ownership-and-Accountability (OAI); 4) Processes-of-Care (PCI); 5) IT-Related (ITRI); and 6) Workforce-Training (WTI). Significance-testing of importance-rating by professional affiliation revealed no statistically significant differences for CCI and PEI; and some statistically significant differences for OAI, PCI, ITRI, and WTI. Conclusion There were two key gleanings from the issues related to EHR MedRec unearthed by this study: 1) there was an absence of shared understanding among practitioners, of the value of EHR MedRec in promoting patient safety, which contributed to workarounds, and suboptimal use of the EHR MedRec system; and 2) there was a socio-technical dimension to many of the issues, creating an added layer of complexity. These gleanings in turn, provide insights into best practices for managing both clinical transitions-of-care in the EHR MedRec process; and socio-technical challenges encountered in EHR MedRec implementation. PMID:29682132

Evolution and personal religious belief: Christian biology-related majors' search for reconciliation at a Christian university

NASA Astrophysics Data System (ADS)

Winslow, Mark William

The goal of this study was to explore how Christian biology-related majors at a Christian university perceive the apparent conflicts between their understanding of evolution and their religious beliefs, and how their faith, as a structural-developmental system for ordering and making meaning of the world, plays a role in the mediating process. This naturalistic study utilized a case study design of 15 participants specified as undergraduate biology-related majors or recent biology-related graduates from a midwestern Christian university who had completed an upper-level course on evolution. Data were collected through semi-structured interviews that investigated participants' faith and their views on creationism and evolution. Fowler's theory of faith development and Parks' model of college students' faith was extensively used. Additional data were collected through an Evolution Attitudes Survey and a position paper on evolution as an assignment in the evolution course. Data analysis revealed patterns that were organized into themes and sub-themes that were the major outcomes of the study. Most participants were raised to believe in creationism, but came to accept evolution through an extended process of evaluating the scientific evidence in support of evolution, negotiating the literalness of Genesis, recognizing evolution as a non-salvation issue, and observing professors as role models of Christians who accept evolution. Participants remained committed to their personal religious beliefs despite apprehension that accompanied the reconciliation process in accepting evolution. Most participants operated from the perspective that science and religion are separate and interacting domains. Faith played an important role in how participants reconciled their understanding of evolution and their personal religious beliefs. Participants who operated in conventional faith dismissed contentious issues or collapsed dichotomies in an effort to avoid ambiguity and perceived tensions. Participants who operated in young adult and adult faith tended to confront their perceived tensions and worked towards reconciling their understanding of evolution and their personal religious beliefs. The rich description of this naturalistic study lends heuristic insight to researchers and educators seeking an understanding of the complex processes by which Christian biology-related majors approach learning about evolution and seek reconciliation between their understanding of evolution and their personal religious beliefs.

Power through Testimony: Reframing Residential Schools in the Age of Reconciliation

ERIC Educational Resources Information Center

Capitaine, Brieg, Ed.; Vanthuyne, Karine, Ed.

2017-01-01

"Power through Testimony" documents how survivors are remembering and reframing our understanding of residential schools in the wake of the 2007 Indian Residential Schools Settlement Agreement and the Truth and Reconciliation Commission (TRC), a forum for survivors, families, and communities to share their memories and stories with the…

Reconciliation--A Rhetorical Concept/ion

ERIC Educational Resources Information Center

Doxtader, Erik

2003-01-01

What is reconciliation? A source of historical puzzlement and contemporary controversy over how to make history, this question asks after those words which constitute a beginning (again), that moment in which endless cycles of conflict give way to the hope for "unity in difference." Concerned with the dynamics of its operation, the present essay…

Helping Older Adults Improve Their Medication Experience (HOME) by Addressing Medication Regimen Complexity in Home Healthcare.

PubMed

Sheehan, Orla C; Kharrazi, Hadi; Carl, Kimberly J; Leff, Bruce; Wolff, Jennifer L; Roth, David L; Gabbard, Jennifer; Boyd, Cynthia M

In skilled home healthcare (SHHC), communication between nurses and physicians is often inadequate for medication reconciliation and needed changes to the medication regimens are rarely made. Fragmentation of electronic health record (EHR) systems, transitions of care, lack of physician-nurse in-person contact, and poor understanding of medications by patients and their families put patients at risk for serious adverse outcomes. The aim of this study was to develop and test the HOME tool, an informatics tool to improve communication about medication regimens, share the insights of home care nurses with physicians, and highlight to physicians and nurses the complexity of medication schedules. We used human computer interaction design and evaluation principles, automated extraction from standardized forms, and modification of existing EHR fields to highlight key medication-related insights that had arisen during the SHHC visit. Separate versions of the tool were developed for physicians/nurses and patients/caregivers. A pilot of the tool was conducted using 20 SHHC encounters. Home care nurses and physicians found the tool useful for communication. Home care nurses were able to implement the HOME tool into their clinical workflow and reported improved communication with physicians about medications. This simple and largely automated tool improves understanding and communication around medications in SHHC.

Creative nonfiction: narrative and revelation.

PubMed

Hart, Curtis W

2009-06-01

Creative nonfiction and the illness narrative are recently identified approaches to literary expression. They are particularly well suited to the genre of memoir where psychological issues such as mourning and attachment and loss may be explored. The recent memoirs of Sue Erikson Bloland and Honor Moore fulfill the description of creative nonfiction. They offer their readers an opportunity to explore with them the theological and existential issues of revelation, reconciliation, and forgiveness. This paper was first presented for the Working Group on Psychoanalysis and the Arts of the Richardson Research Seminar in the History of Psychiatry at Weill Cornell Medical College.

Beyond technology acceptance to effective technology use: a parsimonious and actionable model.

PubMed

Holahan, Patricia J; Lesselroth, Blake J; Adams, Kathleen; Wang, Kai; Church, Victoria

2015-05-01

To develop and test a parsimonious and actionable model of effective technology use (ETU). Cross-sectional survey of primary care providers (n = 53) in a large integrated health care organization that recently implemented new medication reconciliation technology. Surveys assessed 5 technology-related perceptions (compatibility with work values, implementation climate, compatibility with work processes, perceived usefulness, and ease of use) and 1 outcome variable, ETU. ETU was measured as both consistency and quality of technology use. Compatibility with work values and implementation climate were found to have differential effects on consistency and quality of use. When implementation climate was strong, consistency of technology use was high. However, quality of technology use was high only when implementation climate was strong and values compatibility was high. This is an important finding and highlights the importance of users' workplace values as a key determinant of quality of use. To extend our effectiveness in implementing new health care information technology, we need parsimonious models that include actionable determinants of ETU and account for the differential effects of these determinants on the multiple dimensions of ETU. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

[Infrastructure and contents of clinical data management plan].

PubMed

Shen, Tong; Xu, Lie-dong; Fu, Hai-jun; Liu, Yan; He, Jia; Chen, Ping-yan; Song, Yu-fei

2015-11-01

Establishment of quality management system (QMS) plays a critical role in the clinical data management (CDM). The objectives of CDM are to ensure the quality and integrity of the trial data. Thus, every stage or element that may impact the quality outcomes of clinical studies should be in the controlled manner, which is referred to the full life cycle of CDM associated with the data collection, handling and statistical analysis of trial data. Based on the QMS, this paper provides consensus on how to develop a compliant clinical data management plan (CDMP). According to the essential requirements of the CDM, the CDMP should encompass each process of data collection, data capture and cleaning, medical coding, data verification and reconciliation, database monitoring and management, external data transmission and integration, data documentation and data quality assurance and so on. Creating and following up data management plan in each designed data management steps, dynamically record systems used, actions taken, parties involved will build and confirm regulated data management processes, standard operational procedures and effective quality metrics in all data management activities. CDMP is one of most important data management documents that is the solid foundation for clinical data quality.

Barriers to discharge from inpatient rehabilitation: a teamwork approach.

PubMed

Cruz, Lisanne Catherine; Fine, Jeffrey S; Nori, Subhadra

2017-03-13

Purpose In order to prevent adverse events during the discharge process, coordinating appropriate community resources, medication reconciliation, and patient education needs to be implemented before the patient leaves the hospital. This coordination requires communication and effective teamwork amongst staff members. In order to address these concerns, the purpose of this paper is to incorporate the TeamSTEPPS principles to develop a discharge plan that would best meet the needs of the patients as they return to the community. Design/methodology/approach Through a gap analysis, barriers to discharge were identified from the following disciplines: nursing, social work, physical and occupational therapy, psychology, and rehabilitation physician. To improve communication, weekly meetings and twice-weekly huddles were implemented so that concerns regarding discharge obstacles could be identified and resolved. Visibility of discharge dates were improved by use of graduation certificates in patient rooms and green ribbons on patient wheelchairs. Findings After implementation of this discharge intervention, length of stay was reduced providing cost savings to the hospital, patient satisfaction on HCAHP surveys improved and demonstrated patient satisfaction with the discharge process, and readmission rates improved. Originality/value This study demonstrated that effective teamwork and communication can improve patient safety and satisfaction during the discharge period.

Improvement in Herpes Zoster Vaccination in Patients with Rheumatoid Arthritis: A Quality Improvement Project.

PubMed

Sheth, Heena; Moreland, Larry; Peterson, Hilary; Aggarwal, Rohit

2017-01-01

To improve herpes zoster (HZ) vaccination rates in high-risk patients with rheumatoid arthritis (RA) being treated with immunosuppressive therapy. This quality improvement project was based on the pre- and post-intervention design. The project targeted all patients with RA over the age of 60 years while being treated with immunosuppressive therapy (not with biologics) seen in 13 rheumatology outpatient clinics. The study period was from July 2012 to June 2013 for the pre-intervention and February 2014 to January 2015 for the post-intervention phase. The electronic best practice alert (BPA) for HZ vaccination was developed; it appeared on electronic medical records during registration and medication reconciliation of the eligible patient by the medical assistant. The BPA was designed to electronically identify patient eligibility and to enable the physician to order the vaccine or to document refusal or deferral reason. Education regarding vaccine guidelines, BPA, vaccination process, and feedback were crucial components of the project interventions. The vaccination rates were compared using the chi-square test. We evaluated 1823 and 1554 eligible patients with RA during the pre-intervention and post-intervention phases, respectively. The HZ vaccination rates, reported as patients vaccinated among all eligible patients, improved significantly from the pre-intervention period of 10.1% (184/1823) to 51.7% (804/1554) during the intervention phase (p < 0.0001). The documentation rates (vaccine received, vaccine ordered, patient refusal, and deferral reasons) increased from 28% (510/1823) to 72.9% (1133/1554; p < 0.0001). The HZ infection rates decreased significantly from 2% to 0.3% (p = 0.002). Electronic identification of vaccine eligibility and BPA significantly improved HZ vaccination rates. The process required minimal modification of clinic work flow and did not burden the physician's time, and has the potential for self-sustainability and generalizability.

Reinventing the political role of health professionals in conflict prevention & reconciliation: the Sudanese model.

PubMed

Salih, Alaaddin M; Ahmed, Jasim M; Mohamed, Jamal F; Alfaki, Musaab M

2016-01-01

Given the persistent recurrence of armed conflict, influential actors owe it to the affected communities to take action. The legitimacy of health professionals to mitigate the effects of conflict relates to their ability to save lives and address the physical and mental consequences of armed conflict during which thousands of lives may be lost. Medical professionals have unique and potentially far-reaching skills. These become crucial during wartime and disasters in terms of providing medical services and humanitarian aid. However, they are insufficiently used in one area: involvement in politics as a tool to foster peace. Despite this, Sudanese individuals from medical backgrounds have participated actively in conflict resolution and peace-building processes. In fact, their political actions throughout the last six decades have aimed to prevent conflict at four different levels, which are described by Yusuf et al. in their article on the political involvement of health professionals in prevention. Their stand against President Nimeiri's Sharia laws was primordial prevention of religious conflict at the national level. Their leading role in the second Sudanese Intifada uprising was a key factor in saving the country from civil war, and another example of primary prevention. Sudanese physicians were also involved in secondary prevention by being influentially involved in almost all national peace agreements. Avoiding disputes at the tertiary level represents the weakest link in their repeated efforts. This paper outlines the different roles Sudanese medical personnel have taken in peacemaking. It also critically evaluates them in order to consider new methods of political involvement that suit future challenges.

3 CFR 8343 - Proclamation 8343 of January 20, 2009. National Day of Renewal and Reconciliation, 2009

Code of Federal Regulations, 2010 CFR

2010-01-01

... 3 The President 1 2010-01-01 2010-01-01 false Proclamation 8343 of January 20, 2009. National Day of Renewal and Reconciliation, 2009 8343 Proclamation 8343 Presidential Documents Proclamations... in the words of President Abraham Lincoln, let us remember that: “The mystic chords of memory...

Reconciliation and the Academy: Experience at a Small Institution in Northern Manitoba

ERIC Educational Resources Information Center

Smith, Dan

2017-01-01

This article accepts a definition of reconciliation that includes a need for fundamental change in society. The article argues that "knowledge" is critical to the business of the academic enterprise and that the relationship the academy has with knowledge is fundamental; for the academy to truly reconcile, then, changing that…

Reconciliation, Constructivism, and Ecological Sustainability: A Review Essay

ERIC Educational Resources Information Center

Van Brummelen, Harro

2007-01-01

This article reviews and explores the links between Chet Bowers' recent book on constructivist theories of learning and the paper by Gormas, Koole, and Vryhof on learning for reconciliation published in this journal (Spring 2006). The reviewer holds that Bowers' critique of constructivism has merit, but that his emphasis on eco-justice leaves gaps…

Postconflict History Curriculum Revision as an "Intergroup Encounter" Promoting Interethnic Reconciliation among Burmese Migrants and Refugees in Thailand

ERIC Educational Resources Information Center

Metro, Rosalie

2013-01-01

Recent literature shows that revising history curricula in postconflict settings can either worsen or ameliorate identity conflict. I conceptualize history curriculum revision workshops as intergroup encounters (IGEs) and analyze the conditions under which reconciliation emerges. I conducted participant observation with multiethnic groups of…

45 CFR 287.35 - What grant amounts are available under the Personal Responsibility and Work Opportunity...

Code of Federal Regulations, 2010 CFR

2010-10-01

... NATIVE EMPLOYMENT WORKS (NEW) PROGRAM NEW Program Funding § 287.35 What grant amounts are available under the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) for the NEW... Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) for the NEW Program? 287...

Attaining Moral Knowledge in the Church and Models of Adult Learning

ERIC Educational Resources Information Center

Shields, Richard

2009-01-01

The sacrament of reconciliation has fallen into disuse among Roman Catholics. For the Holy See this signifies a loss of a sense of sin and reconciliation, rightly connecting moral consciousness and faith in salvation with sacramental celebration. Cultural studies underscore the importance of ritual practices as an essential element of religion's…

Unconditional security proof of long-distance continuous-variable quantum key distribution with discrete modulation.

PubMed

Leverrier, Anthony; Grangier, Philippe

2009-05-08

We present a continuous-variable quantum key distribution protocol combining a discrete modulation and reverse reconciliation. This protocol is proven unconditionally secure and allows the distribution of secret keys over long distances, thanks to a reverse reconciliation scheme efficient at very low signal-to-noise ratio.

Understanding the Complexity of Reconciliation, Reintegration and Amnesty for the Enemy in Counterinsurgency Warfare

DTIC Science & Technology

2013-06-14

whereas the military focuses more on projects with immediate short term returns .53 A comprehensive reconciliation plan led by the host nation is a...to allow leaders to develop creative plans adapted to their circumstances. It is useful to take principles as themes in order to determine if these...

Recultivating Intergenerational Resilience: Possibilities for "Scaling DEEP" through Disruptive Pedagogies of Decolonization and Reconciliation

ERIC Educational Resources Information Center

Williams, Lewis; Claxton, Nick

2017-01-01

In the face of declining human-ecological systems, as well as intercultural and interspecies trauma, we are currently witnessing a renaissance of activist-orientated environmental education. In Canada, this work is increasingly viewed as part of a broader healing response of "DEEP" reconciliation work between Indigenous and…

40 CFR 80.1164 - What are the attest engagement requirements under the RFS program?

Code of Federal Regulations, 2010 CFR

2010-07-01

... volumes, contained in the inventory reconciliation analysis under § 80.133, and verify that the volumes reported to EPA agree with the volumes in the inventory reconciliation analysis. (iv) Compute and report as... reported to EPA. (v) Obtain the database, spreadsheet, or other documentation for all RINs used for...

40 CFR 80.1164 - What are the attest engagement requirements under the RFS program?

Code of Federal Regulations, 2011 CFR

2011-07-01

... volumes, contained in the inventory reconciliation analysis under § 80.133, and verify that the volumes reported to EPA agree with the volumes in the inventory reconciliation analysis. (iv) Compute and report as... reported to EPA. (v) Obtain the database, spreadsheet, or other documentation for all RINs used for...

Reconciliation of Gene and Species Trees

PubMed Central

Rusin, L. Y.; Lyubetskaya, E. V.; Gorbunov, K. Y.; Lyubetsky, V. A.

2014-01-01

The first part of the paper briefly overviews the problem of gene and species trees reconciliation with the focus on defining and algorithmic construction of the evolutionary scenario. Basic ideas are discussed for the aspects of mapping definitions, costs of the mapping and evolutionary scenario, imposing time scales on a scenario, incorporating horizontal gene transfers, binarization and reconciliation of polytomous trees, and construction of species trees and scenarios. The review does not intend to cover the vast diversity of literature published on these subjects. Instead, the authors strived to overview the problem of the evolutionary scenario as a central concept in many areas of evolutionary research. The second part provides detailed mathematical proofs for the solutions of two problems: (i) inferring a gene evolution along a species tree accounting for various types of evolutionary events and (ii) trees reconciliation into a single species tree when only gene duplications and losses are allowed. All proposed algorithms have a cubic time complexity and are mathematically proved to find exact solutions. Solving algorithms for problem (ii) can be naturally extended to incorporate horizontal transfers, other evolutionary events, and time scales on the species tree. PMID:24800245

Building a peaceful society: origins, prevention, and reconciliation after genocide and other group violence.

PubMed

Staub, Ervin

2013-10-01

The 20th century was a century of genocide and other great violence between groups within societies. Already at the beginning of the 21st century, there have been mass killings, civil wars, violent conflict, and terrorism. This article summarizes influences that tend to lead to intense group violence. It then considers prevention, stressing early prevention--and reconciliation as an aspect of prevention--and focusing on central principles and practices. The principles include developing positive orientations to previously devalued groups; healing from past victimization and promoting altruism born of suffering; moderating respect for authority; creating constructive ideologies; promoting understanding of the origins of violence, its impact, and avenues to prevention; promoting truth, justice, and a shared history; and raising inclusively caring, morally courageous children. Practices related to all of these are also discussed. The article stresses the role of progressive change, that is, of psychological, behavioral, and social evolution, in both extreme violence and positive relations between groups; the role of passive bystanders in the unfolding of violence; and the role of active bystandership in the prevention of violence, in the promotion of reconciliation, and in the development of harmonious societies. It emphasizes psychological processes but notes the importance of creating societal institutions. The author cites findings from both laboratory research and case studies, reviews interventions and their evaluation in Rwanda, and points to the need for further research. PsycINFO Database Record (c) 2013 APA, all rights reserved

Multiattribute Decision Modeling Techniques: A Comparative Analysis

DTIC Science & Technology

1988-08-01

Analytic Hierarchy Process ( AHP ). It is structurally similar to SMART, but elicitation methods are different and there are several algorithms for...reconciliation of inconsistent judgments and for consistency checks that are not available in any of the utility procedures. The AHP has been applied...of commercially available software packages that implement the AHP algorithms. Elicitation Methods. The AHP builds heavily on value trees, which

Reconciliation and Transformation through Mutual Learning: Outlining a Framework for Arts-Based Service Learning with Indigenous Communities in Australia

ERIC Educational Resources Information Center

Bartleet, Brydie-Leigh; Bennett, Dawn; Marsh, Kathryn; Power, Anne; Sunderland, Naomi

2014-01-01

Service learning is described as a socially just educational process that develops two-way learning and social outcomes for community and student participants. Despite the focus on mutuality in service learning, very little of this literature specifically deals with the intense importance of mutuality and reciprocity when working with Indigenous…

Educating for Peace and Justice: Religious Dimensions, K-6. 8th Edition.

ERIC Educational Resources Information Center

McGinnis, James

This revised teacher's manual focuses on the need to develop compassionate concern in students if they are to be moved to action. The 12-step processes in the 8 units promote a personal relationship or friendship with the persons or groups involved. The units include: (1) "Of Dreams and Vision"; (2) "Interpersonal Peacemaking/Reconciliation"; (3)…

25 CFR 542.22 - What are the minimum internal control standards for internal audit for Tier A gaming operations?

Code of Federal Regulations, 2010 CFR

2010-04-01

... but not limited to, bingo card control, payout procedures, and cash reconciliation process; (ii) Pull... 25 Indians 2 2010-04-01 2010-04-01 false What are the minimum internal control standards for... COMMISSION, DEPARTMENT OF THE INTERIOR HUMAN SERVICES MINIMUM INTERNAL CONTROL STANDARDS § 542.22 What are...

25 CFR 542.32 - What are the minimum internal control standards for internal audit for Tier B gaming operations?

Code of Federal Regulations, 2010 CFR

2010-04-01

... but not limited to, bingo card control, payout procedures, and cash reconciliation process; (ii) Pull... 25 Indians 2 2010-04-01 2010-04-01 false What are the minimum internal control standards for... COMMISSION, DEPARTMENT OF THE INTERIOR HUMAN SERVICES MINIMUM INTERNAL CONTROL STANDARDS § 542.32 What are...

Congress Expands Access to Postsecondary Education and Training for Low-Income Adults

ERIC Educational Resources Information Center

Duke, Amy-Ellen; Strawn, Julie

2007-01-01

On September 7, 2007, Congress enacted H.R. 2669, the College Cost Reduction and Access Act, which will raise the maximum Pell Grant to $5,400 over five years and halve interest rates on subsidized student loans. The act is part of the budget reconciliation process, which secured billions of dollars for increasing Pell Grants and for reducing…

A Critical Evaluation of the Literature of the Troubles Project: Philosophy, Methodology, Findings/Outcomes

ERIC Educational Resources Information Center

Hanratty, Brian Robert

2013-01-01

The paper presents a critical evaluation of the Literature of the Troubles Project which was aimed at using literature in an educational context to help cement the process of peace and reconciliation between Northern Ireland's divided communities. The Project, funded by the Esmée Fairbairn Foundation, ran from September 2007 to August 2009. Its…

The Military Role in Reconciliation

DTIC Science & Technology

2010-05-01

Between victims and offenders, this entails the ability to distinguish degrees of guilt among the perpetrators and to disaggregate individual and...Justice mechanisms, such as courts of law, can individualize guilt in order to detract from a generalized perception of guilt for entire groups. During...individualizes guilt , strengthens legitimacy and the process of democratization, and breaks the cycle of impunity.51 Critics of retributive justice contend

Military Role in Reconciliation

DTIC Science & Technology

2010-05-21

Between victims and offenders, this entails the ability to distinguish degrees of guilt among the perpetrators and to disaggregate individual and...Justice mechanisms, such as courts of law, can individualize guilt in order to detract from a generalized perception of guilt for entire groups. During...individualizes guilt , strengthens legitimacy and the process of democratization, and breaks the cycle of impunity.51 Critics of retributive justice contend

The Digital Drag and Drop Pillbox: Design and Feasibility of a Skill-based Education Model to Improve Medication Management.

PubMed

Granger, Bradi B; Locke, Susan C; Bowers, Margaret; Sawyer, Tenita; Shang, Howard; Abernethy, Amy P; Bloomfield, Richard A; Gilliss, Catherine L

We present the design and feasibility testing for the "Digital Drag and Drop Pillbox" (D-3 Pillbox), a skill-based educational approach that engages patients and providers, measures performance, and generates reports of medication management skills. A single-cohort convenience sample of patients hospitalized with heart failure was taught pill management skills using a tablet-based D-3 Pillbox. Medication reconciliation was conducted, and aptitude, performance (% completed), accuracy (% correct), and feasibility were measured. The mean age of the sample (n = 25) was 59 (36-89) years, 50% were women, 62% were black, 46% were uninsured, 46% had seventh-grade education or lower, and 31% scored very low for health literacy. However, most reported that the D-3 Pillbox was easy to read (78%), easy to repeat-demonstrate (78%), and comfortable to use (tablet weight) (75%). Accurate medication recognition was achieved by discharge in 98%, but only 25% reported having a "good understanding of my responsibilities." The D-3 Pillbox is a feasible approach for teaching medication management skills and can be used across clinical settings to reinforce skills and medication list accuracy.

Effect of a Real-Time Pediatric ICU Safety Bundle Dashboard on Quality Improvement Measures.

PubMed

Shaw, Susanna J; Jacobs, Brian; Stockwell, David C; Futterman, Craig; Spaeder, Michael C

2015-09-01

Patient daily goal sheets have been shown to improve compliance with hospital policies but might not represent the dynamic nature of care delivery in the pediatric ICU (PICU) setting. A study was conducted at Children's National Health System (Washington, DC) to determine the effect of a visible, unitwide, real-time dashboard on timeliness of compliance with quality and safety measures. An automated electronic health record (EHR)- querying tool was created to assess compliance with a PICU Safety Bundle. Querying of the EHR for compliance and updating of the dashboard automatically occurred every five minutes. A real-time visual display showed data on presence of consent for treatment, restraint orders, presence of urinary catheters, deep venous thrombosis (DVT) prophylaxis, Braden Q score, and medication reconciliation. Baseline compliance and duration of noncompliance was established during three time periods: the first, before activation of the dashboard; the second, at one month following activation of the dashboard; and the third, at three months after activation. A total of 450 patients were included in the analysis. Between the first and third time periods, the median time from PICU admission to obtaining treatment consent decreased by 49%, from 393 to 202 minutes (p=.05). The number of patients with urinary catheters in place>96 hours decreased from 16 (32%) in Period 1 to 11 (19%) for Periods 2 and 3 combined (p=.01). Completion of medication reconciliation improved from 80% in the first time period to 93% and 92%, respectively, in the subsequent two periods (p=.002). There was no difference between the three periods in presence of restraint orders, DVT prophylaxis, or development or worsening of pressure ulcers. A unitwide dashboard can increase awareness for potential interventions, affecting patient safety in the PICU in a dynamic manner.

Medication Review and Transitions of Care: A Case Report of a Decade-Old Medication Error.

PubMed

Comer, Rachel; Lizer, Mitsi

2017-10-01

A 69-year-old Caucasian male with a 25-year history of paranoid schizophrenia was brought to the emergency department because of violence toward the staff in his nursing facility. He was diagnosed with a urinary tract infection and was admitted to the behavioral health unit for medication stabilization. History included a five-year state psychiatric hospital admission and nursing facility placement. Because of poor cognitive function, the patient was unable to corroborate medication history, so the pharmacy student on rotation performed an in-depth chart review. The review revealed a transcription error in 2003 deleting amantadine 100 mg twice daily and adding amiodarone 100 mg twice daily. Subsequent hospitalization resulted in another transcription error increasing the amiodarone to 200 mg twice daily. All electrocardiograms conducted were negative for atrial fibrillation. Once detected, the consulted cardiologist discontinued the amiodarone, and the primary care provider was notified via letter and discharge papers. An admission four months later revealed that the nursing facility restarted the amiodarone. Amiodarone was discontinued and the facility was again notified. This case reviews how a 10-year-old medication error went undetected in the electronic medical records through numerous medication reconciliations, but was uncovered when a single comprehensive medication review was conducted.

The Reconciliation of W. Edwards Deming and John Dewey: An Exploration of Similarities in Motivation Theory.

ERIC Educational Resources Information Center

Towns, William C.

1996-01-01

Interrogates similarities and misconceptions common to W. Edwards Deming and John Dewey, examining a reconciliation of the two within the context of motivation theory and concluding that Deming and Dewey are very similar in general outlook and the shared belief in the integrity of the individual within the social system. (SM)

Post-War Trauma and Reconciliation in Bosnia-Herzegovina: Observations, Experiences, and Implications for Marriage and Family Therapy.

ERIC Educational Resources Information Center

Nelson, Briana S.

2003-01-01

The 1992-1995 war in Bosnia-Herzegovina caused mush devastation in that region of the world. This article describes the themes and issues that emerged from information gained from interviews with Bosnian professionals through a project entitled "Trauma and Reconciliation in Bosnia-Herzegovina." Recommendations and implications for family…

Ontologies and Possibilities of Human Rights: Exploring Dissensus to Facilitate Reconciliation in Post-Conflict Education Contexts

ERIC Educational Resources Information Center

du Preez, Petro; Becker, Anne

2016-01-01

In light of growing critique of human rights and human rights education, this article explores ontologies of human rights, the possibilities they present for dissensus and how this could influence human rights education in post-conflict education contexts towards reconciliation. We draw on Dembour's (2010) categorisation of the different schools…

Towards Reconciliation through Language Planning for Indigenous Languages in Canadian Universities

ERIC Educational Resources Information Center

Sterzuk, Andrea; Fayant, Russell

2016-01-01

The Truth and Reconciliation Commission of Canada (TRC) began in June, 2008 as a response to the Indian Residential School legacy. The commission concluded with a 2015 report which includes 94 calls to action. Some of these calls pertain to higher education including the following example "We call upon post-secondary institutions to create…

History Education and Reconciliation: Comparative Perspectives on East Asia

ERIC Educational Resources Information Center

Han, Un-suk, Ed.; Kondo, Takahiro, Ed.; Yang, Biao, Ed.; Pingel, Falk, Ed.

2012-01-01

The legacy of crimes committed during the Second World War in East Asia is still a stumbling block for reconciliation and trustful cultural relations between South Korea, China and Japan. The presentation of this issue in history school books is in the focus of a heated public and academic debate. This book written by historians and pedagogues…

Developing Outdoor and Adventurous Activities for Co-Existence and Reconciliation in Israel: An Anglo-German Approach

ERIC Educational Resources Information Center

Stidder, Gary; Haasner, Adrian

2007-01-01

Conflict resolution between different social groups is an issue that has continued to gain high profile news coverage both nationally and in a global context. In this respect, it has been shown that carefully designed and managed physical activity programmes can make a small but nonetheless invaluable contribution to reconciliation and…

Patriotism and Democratic Citizenship Education in South Africa: On the (im) Possibility of Reconciliation and Nation Building

ERIC Educational Resources Information Center

Waghid, Yusef

2009-01-01

In this article, I shall evaluate critically the democratic citizenship education project in South Africa to ascertain whether the patriotic sentiments expressed in the "Manifesto on Values, Education and Democracy" (2001) are in conflict with the achievement of reconciliation and nation building (specifically peace and friendship) after…

Reconciliation or Racialization? Contemporary Discourses about Residential Schools in the Canadian Prairies

ERIC Educational Resources Information Center

Gebhard, Amanda

2017-01-01

The residential school system is one of the darkest examples of Canada's colonial policy. Education about the residential schools is believed to be the path to reconciliation; that is, the restoration of equality between Aboriginal and non-Aboriginal peoples in Canada. While the acquisition of the long-ignored history of residential schools has…

20 CFR 411.536 - Under what circumstances can we make a reconciliation payment under the outcome-milestone payment...

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 2 2014-04-01 2014-04-01 false Under what circumstances can we make a reconciliation payment under the outcome-milestone payment system? 411.536 Section 411.536 Employees' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Employment Network Payment...

20 CFR 411.536 - Under what circumstances can we make a reconciliation payment under the outcome-milestone payment...

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Under what circumstances can we make a reconciliation payment under the outcome-milestone payment system? 411.536 Section 411.536 Employees' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Employment Network Payment...

20 CFR 411.536 - Under what circumstances can we make a reconciliation payment under the outcome-milestone payment...

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 2 2011-04-01 2011-04-01 false Under what circumstances can we make a reconciliation payment under the outcome-milestone payment system? 411.536 Section 411.536 Employees' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Employment Network Payment...

20 CFR 411.536 - Under what circumstances can we make a reconciliation payment under the outcome-milestone payment...

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 2 2013-04-01 2013-04-01 false Under what circumstances can we make a reconciliation payment under the outcome-milestone payment system? 411.536 Section 411.536 Employees' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Employment Network Payment...

20 CFR 411.536 - Under what circumstances can we make a reconciliation payment under the outcome-milestone payment...

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 2 2012-04-01 2012-04-01 false Under what circumstances can we make a reconciliation payment under the outcome-milestone payment system? 411.536 Section 411.536 Employees' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Employment Network Payment...

Getting even or moving on? Power, procedural justice, and types of offense as predictors of revenge, forgiveness, reconciliation, and avoidance in organizations.

PubMed

Aquino, Karl; Tripp, Thomas M; Bies, Robert J

2006-05-01

A field study and an experimental study examined relationships among organizational variables and various responses of victims to perceived wrongdoing. Both studies showed that procedural justice climate moderates the effect of organizational variables on the victim's revenge, forgiveness, reconciliation, or avoidance behaviors. In Study 1, a field study, absolute hierarchical status enhanced forgiveness and reconciliation, but only when perceptions of procedural justice climate were high; relative hierarchical status increased revenge, but only when perceptions of procedural justice climate were low. In Study 2, a laboratory experiment, victims were less likely to endorse vengeance or avoidance depending on the type of wrongdoing, but only when perceptions of procedural justice climate were high.

Redefining the Practice of Peer Review Through Intelligent Automation-Part 3: Automated Report Analysis and Data Reconciliation.

PubMed

Reiner, Bruce I

2018-02-01

One method for addressing existing peer review limitations is the assignment of peer review cases on a completely blinded basis, in which the peer reviewer would create an independent report which can then be cross-referenced with the primary reader report of record. By leveraging existing computerized data mining techniques, one could in theory automate and objectify the process of report data extraction, classification, and analysis, while reducing time and resource requirements intrinsic to manual peer review report analysis. Once inter-report analysis has been performed, resulting inter-report discrepancies can be presented to the radiologist of record for review, along with the option to directly communicate with the peer reviewer through an electronic data reconciliation tool aimed at collaboratively resolving inter-report discrepancies and improving report accuracy. All associated report and reconciled data could in turn be recorded in a referenceable peer review database, which provides opportunity for context and user-specific education and decision support.

Policy reconciliation for access control in dynamic cross-enterprise collaborations

NASA Astrophysics Data System (ADS)

Preuveneers, D.; Joosen, W.; Ilie-Zudor, E.

2018-03-01

In dynamic cross-enterprise collaborations, different enterprises form a - possibly temporary - business relationship. To integrate their business processes, enterprises may need to grant each other limited access to their information systems. Authentication and authorization are key to secure information handling. However, access control policies often rely on non-standardized attributes to describe the roles and permissions of their employees which convolutes cross-organizational authorization when business relationships evolve quickly. Our framework addresses the managerial overhead of continuous updates to access control policies for enterprise information systems to accommodate disparate attribute usage. By inferring attribute relationships, our framework facilitates attribute and policy reconciliation, and automatically aligns dynamic entitlements during the evaluation of authorization decisions. We validate our framework with a Industry 4.0 motivating scenario on networked production where such dynamic cross-enterprise collaborations are quintessential. The evaluation reveals the capabilities and performance of our framework, and illustrates the feasibility of liberating the security administrator from manually provisioning and aligning attributes, and verifying the consistency of access control policies for cross-enterprise collaborations.

Early Clinical Experiences for Second-Year Student Pharmacists at an Academic Medical Center.

PubMed

McLaughlin, Jacqueline E; Amerine, Lindsey B; Chen, Sheh-Li; Luter, David N; Arnall, Justin; Smith, Shayna; Roth, Mary T; Rodgers, Philip T; Williams, Dennis M; Pinelli, Nicole R

2015-11-25

To examine student outcomes associated with the Student Medication and Reconciliation Team (SMART) program, which was designed to provide second-year student pharmacists at the University of North Carolina (UNC) Eshelman School of Pharmacy direct patient care experience at UNC Medical Center. Twenty-two second-year student pharmacists were randomly selected from volunteers, given program training, and scheduled for three 5-hour evening shifts in 2013-2014. Pre/post surveys and reflection statements were collected from 19 students. Data were analyzed with a mixed methods approach. Survey results revealed an increase in student self-efficacy (p<0.05) and positive perceptions of SMART. Qualitative findings suggest the program provided opportunities for students to develop strategies for practice, promoted an appreciation for the various roles pharmacists play in health care, and fostered an appreciation for the complexity of real-world practice. Early clinical experiences can enhance student learning and development while fostering an appreciation for pharmacy practice.

Ensuring effective medication reconciliation in home healthcare.

PubMed

Fuji, Kevin T; Abbott, Amy A

2014-10-01

A patient was readmitted two days after discharge with severe hypoglycemia. The treating team discharged the patient on a new insulin regimen without realizing that the patient also had insulin 70/30 at home. The patient continued to take her previous regimen as well as the new one, and was found unresponsive by her husband. The patient was in the ICU with the incident likely resulting in permanent neurological deficits. ()A patient was admitted to a hospital from a home health agency. The list of medications provided by the agency did not completely match the list provided by the patient's family physician (i.e., the antihypertensive agent metoprolol tartrate [Lopressor] was not listed by the agency as one of the medications that the patient was currently taking). Therefore, metoprolol tartrate was not initially ordered. The patient developed atrial fibrillation shortly after hospital admission and required a transfer to the ICU [intensive care unit]. A diltiazem (Cardizem) infusion was started and the patient's family physician became aware that the patient had not been receiving their antihypertensive medication and initiated an order for the metoprolol tartrate ().

Controlled Substance Reconciliation Accuracy Improvement Using Near Real-Time Drug Transaction Capture from Automated Dispensing Cabinets.

PubMed

Epstein, Richard H; Dexter, Franklin; Gratch, David M; Perino, Michael; Magrann, Jerry

2016-06-01

Accurate accounting of controlled drug transactions by inpatient hospital pharmacies is a requirement in the United States under the Controlled Substances Act. At many hospitals, manual distribution of controlled substances from pharmacies is being replaced by automated dispensing cabinets (ADCs) at the point of care. Despite the promise of improved accountability, a high prevalence (15%) of controlled substance discrepancies between ADC records and anesthesia information management systems (AIMS) has been published, with a similar incidence (15.8%; 95% confidence interval [CI], 15.3% to 16.2%) noted at our institution. Most reconciliation errors are clerical. In this study, we describe a method to capture drug transactions in near real-time from our ADCs, compare them with documentation in our AIMS, and evaluate subsequent improvement in reconciliation accuracy. ADC-controlled substance transactions are transmitted to a hospital interface server, parsed, reformatted, and sent to a software script written in Perl. The script extracts the data and writes them to a SQL Server database. Concurrently, controlled drug totals for each patient having care are documented in the AIMS and compared with the balance of the ADC transactions (i.e., vending, transferring, wasting, and returning drug). Every minute, a reconciliation report is available to anesthesia providers over the hospital Intranet from AIMS workstations. The report lists all patients, the current provider, the balance of ADC transactions, the totals from the AIMS, the difference, and whether the case is still ongoing or had concluded. Accuracy and latency of the ADC transaction capture process were assessed via simulation and by comparison with pharmacy database records, maintained by the vendor on a central server located remotely from the hospital network. For assessment of reconciliation accuracy over time, data were collected from our AIMS from January 2012 to June 2013 (Baseline), July 2013 to April 2014 (Next Day Reports), and May 2014 to September 2015 (Near Real-Time Reports) and reconciled against pharmacy records from the central pharmacy database maintained by the vendor. Control chart (batch means) methods were used between successive epochs to determine if improvement had taken place. During simulation, 100% of 10,000 messages, transmitted at a rate of 1295 per minute, were accurately captured and inserted into the database. Latency (transmission time to local database insertion time) was 46.3 ± 0.44 milliseconds (SEM). During acceptance testing, only 1 of 1384 transactions analyzed had a difference between the near real-time process and what was in the central database; this was for a "John Doe" patient whose name had been changed subsequent to data capture. Once a transaction was entered at the ADC workstation, 84.9% (n = 18 bins; 95% CI, 78.4% to 91.3%) of these transactions were available in the database on the AIMS server within 2 minutes. Within 5 minutes, 98.2% (n = 18 bins; 95% CI, 97.2% to 99.3%) were available. Among 145,642 transactions present in the central pharmacy database, only 24 were missing from the local database table (mean = 0.018%; 95% CI, 0.002% to 0.034%). Implementation of near real-time reporting improved the controlled substance reconciliation error rate compared to the previous Next Day Reports epoch, from 8.8% to 5.2% (difference = -3.6%; 95% CI, -4.3% to -2.8%; P < 10). Errors were distributed among staff, with 50% of discrepancies accounted for by 12.4% of providers and 80% accounted for by 28.5% of providers executing transactions during the Near Real-Time Reports epoch. The near real-time system for the capture of transactional data flowing over the hospital network was highly accurate, reliable, and exhibited acceptable latency. This methodology can be used to implement similar data capture for transactions from their drug ADCs. Reconciliation accuracy improved significantly as a result of implementation. Our approach may be of particular utility at facilities with limited pharmacy resources to audit anesthesia records for controlled substance administration and reconcile them against dispensing records.

Quantum key distillation from Gaussian states by Gaussian operations.

PubMed

Navascués, M; Bae, J; Cirac, J I; Lewestein, M; Sanpera, A; Acín, A

2005-01-14

We study the secrecy properties of Gaussian states under Gaussian operations. Although such operations are useless for quantum distillation, we prove that it is possible to distill a secret key secure against any attack from sufficiently entangled Gaussian states with nonpositive partial transposition. Moreover, all such states allow for key distillation, when Eve is assumed to perform finite-size coherent attacks before the reconciliation process.

A Model to Transform NATO’s Operational Level Military Capabilities

DTIC Science & Technology

2008-05-01

stabilization operations include security, economic recovery, social well-being, justice and reconciliation, and public participation in governance. Jean ... Millet and Murray define military effectiveness as the process by which a military converts its available resources into fighting power. Contemporary...Failure. New York: Metropolitan Books, 1996. Durfourcq, Jean and David S. Yost. “NATO-EU Cooperation in Post Conflict Operations.” Research Paper, NATO

Reclaiming Reconciliation through Community Education for the Muslims and Tamils of Post-War Jaffna, Sri Lanka

ERIC Educational Resources Information Center

Duncan, Ross; Cardozo, Mieke Lopes

2017-01-01

This paper explores the possibilities and challenges for ethno-religious reconciliation through secondary school education in post-war Sri Lanka, with a specific focus on the Muslim and Tamil communities in the Northern city of Jaffna. In doing so, we position our paper within the growing field of "education, conflict and emergencies" of…

Relationship Churning in Emerging Adulthood: On/Off Relationships and Sex with an Ex

ERIC Educational Resources Information Center

Halpern-Meekin, Sarah; Manning, Wendy D.; Giordano, Peggy C.; Longmore, Monica A.

2013-01-01

We build on the emerging adulthood literature to examine two forms of relationship instability, reconciliations and sex with an ex; we term these forms of relationship churning. Analyzing recent data on emerging adult daters and cohabitors (n = 792), we find that nearly half report a reconciliation (a breakup followed by reunion) and over half of…

42 CFR § 512.620 - Waiver of deductible and coinsurance that otherwise apply to reconciliation payments or repayments.

Code of Federal Regulations, 2010 CFR

2017-10-01

... INFRASTRUCTURE AND MODEL PROGRAMS EPISODE PAYMENT MODEL Waivers § 512.620 Waiver of deductible and coinsurance... on the NPRA that reflect the episode payment methodology under the final payment model for EPM... apply to reconciliation payments or repayments. § 512.620 Section § 512.620 Public Health CENTERS FOR...

Reconciliation Agendas in the Australian Curriculum English: Using Postcolonial Theory to Enter the Fray

ERIC Educational Resources Information Center

Wood, Megan; Exley, Beryl; Knight, Linda

2017-01-01

This article begins by discussing the Australian Curriculum: English and its remit to contribute to this nation's reconciliation agenda. Ever cognisant of our individual identities as non-Indigenous teachers and teacher educators and our relations to this topic, we hone in on one Content Description from Year 10, and analyse one stimulus text, an…

Difficulties of Care-Work Reconciliation: Employed and Nonemployed Mothers of Children with Intellectual Disability

ERIC Educational Resources Information Center

Chou, Yueh-Ching; Fu, Li-Yeh; Pu, Cheng-Yun; Chang, Heng-Hao

2012-01-01

Background: Whether employed and nonemployed mothers of children with intellectual disability (ID) have different experiences with reconciliation between care and work has rarely been explored. Method: A survey was conducted in a county in Taiwan and 487 mothers aged younger than 65 and having a child with ID were interviewed face to face at their…

Effect of teaching and checklist implementation on accuracy of medication history recording at hospital admission.

PubMed

Lea, Marianne; Barstad, Ingeborg; Mathiesen, Liv; Mowe, Morten; Molden, Espen

2016-02-01

Medication discrepancies at hospital admission is an extensive problem and knowledge is limited regarding improvement strategies. To investigate the effect of teaching and checklist implementation on accuracy of medication history recording during hospitalization. Patients admitted to an internal medicine ward were prospectively included in two consecutive periods. Between the periods, non-mandatory teaching lessons were provided and a checklist assisting medication history recording implemented. Discrepancies between the recorded medications at admission and the patient's actual drug use, as revealed by pharmacist-conducted medication reconciliation, were compared between the periods. The primary endpoint was difference between the periods in proportion of patients with minimum one discrepancy. Difference in median number of discrepancies was included as a secondary endpoint. 56 and 119 patients were included in period 1 (P1) and period 2 (P2), respectively. There was no significant difference in proportion of patients with minimum one discrepancy in P2 (68.9 %) versus P1 (76.8 %, p = 0.36), but a tendency of lower median number of discrepancies was observed in P2 than P1, i.e. 1 and 2, respectively (p = 0.087). More powerful strategies than non-mandatory teaching activities and checklist implementation are required to achieve sufficient improvements in medication history recording during hospitalization.

Battered women: dilemmas and care.

PubMed

Tabak, N; Ehrenfeld, M

1998-01-01

Domestic violence is a complex problem, and its victims are women from all social classes and positions. The "cycle of beating" where tension accumulates, and then assault is followed by excuses and reconciliation, puts the battered women in dilemma. One conflict is that of exposure of intimate family details, and the other the guilt for the consequences of external intervention in family situations. The modern society has several tools to treat domestic violence and to assist battered wives. They include the police, legislation, courts and probation officers, besides shelters, legal aid and social services. Specific training of nursing and medical personnel is pivotal for the proper identification of women is such distress.

An adaptive modeling and simulation environment for combined-cycle data reconciliation and degradation estimation

NASA Astrophysics Data System (ADS)

Lin, Tsungpo

Performance engineers face the major challenge in modeling and simulation for the after-market power system due to system degradation and measurement errors. Currently, the majority in power generation industries utilizes the deterministic data matching method to calibrate the model and cascade system degradation, which causes significant calibration uncertainty and also the risk of providing performance guarantees. In this research work, a maximum-likelihood based simultaneous data reconciliation and model calibration (SDRMC) is used for power system modeling and simulation. By replacing the current deterministic data matching with SDRMC one can reduce the calibration uncertainty and mitigate the error propagation to the performance simulation. A modeling and simulation environment for a complex power system with certain degradation has been developed. In this environment multiple data sets are imported when carrying out simultaneous data reconciliation and model calibration. Calibration uncertainties are estimated through error analyses and populated to performance simulation by using principle of error propagation. System degradation is then quantified by performance comparison between the calibrated model and its expected new & clean status. To mitigate smearing effects caused by gross errors, gross error detection (GED) is carried out in two stages. The first stage is a screening stage, in which serious gross errors are eliminated in advance. The GED techniques used in the screening stage are based on multivariate data analysis (MDA), including multivariate data visualization and principal component analysis (PCA). Subtle gross errors are treated at the second stage, in which the serial bias compensation or robust M-estimator is engaged. To achieve a better efficiency in the combined scheme of the least squares based data reconciliation and the GED technique based on hypotheses testing, the Levenberg-Marquardt (LM) algorithm is utilized as the optimizer. To reduce the computation time and stabilize the problem solving for a complex power system such as a combined cycle power plant, meta-modeling using the response surface equation (RSE) and system/process decomposition are incorporated with the simultaneous scheme of SDRMC. The goal of this research work is to reduce the calibration uncertainties and, thus, the risks of providing performance guarantees arisen from uncertainties in performance simulation.

Fast, efficient error reconciliation for quantum cryptography

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

Buttler, W.T.; Lamoreaux, S.K.; Torgerson, J.R.

2003-05-01

We describe an error-reconciliation protocol, which we call Winnow, based on the exchange of parity and Hamming's 'syndrome' for N-bit subunits of a large dataset. The Winnow protocol was developed in the context of quantum-key distribution and offers significant advantages and net higher efficiency compared to other widely used protocols within the quantum cryptography community. A detailed mathematical analysis of the Winnow protocol is presented in the context of practical implementations of quantum-key distribution; in particular, the information overhead required for secure implementation is one of the most important criteria in the evaluation of a particular error-reconciliation protocol. The increasemore » in efficiency for the Winnow protocol is largely due to the reduction in authenticated public communication required for its implementation.« less

Fundamental finite key limits for one-way information reconciliation in quantum key distribution

NASA Astrophysics Data System (ADS)

Tomamichel, Marco; Martinez-Mateo, Jesus; Pacher, Christoph; Elkouss, David

2017-11-01

The security of quantum key distribution protocols is guaranteed by the laws of quantum mechanics. However, a precise analysis of the security properties requires tools from both classical cryptography and information theory. Here, we employ recent results in non-asymptotic classical information theory to show that one-way information reconciliation imposes fundamental limitations on the amount of secret key that can be extracted in the finite key regime. In particular, we find that an often used approximation for the information leakage during information reconciliation is not generally valid. We propose an improved approximation that takes into account finite key effects and numerically test it against codes for two probability distributions, that we call binary-binary and binary-Gaussian, that typically appear in quantum key distribution protocols.

Outdoors Environmental Education for the Service of Peace: Lessons from a 2-Year Youth Program for Reconciliation in Cyprus

ERIC Educational Resources Information Center

Kadis, Costas; Avraamidou, Lucy

2008-01-01

This paper examines the merits of the proposition that outdoors environmental education can be used as a means to promote reconciliation, and in essence peace, among communities in Cyprus. It does so through an examination of an outdoors youth program called CAFE (Camping, Fitness, and Education) that aimed to promote the awareness of members of…

The Personal Responsibility and Work Opportunity Reconciliation Act of 1996: An Examination of Its Impact on Legal Immigrants and Refugees in Rhode Island.

ERIC Educational Resources Information Center

Serpa, Fernando A.

This report describes a 1998 consultation conducted to examine the impact of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 on legal immigrants and refugees in Rhode Island. The Personal Responsibility and Work Opportunity Act restricted access of documented immigrants to a wide range of government programs such as…

The irresistible fascination of medical theories about opposites.

PubMed

Angeletti, L R; Frati, L

1989-01-01

Theurgical medicine was a part of the eternal fight between good and evil and health was reconciliation with the gods. This duality characterized ancient medicine, i.e. Greek medicine after the Homeric age or Chinese traditional medicine. In the passage to medicine of observation due to the School of Cos duel between good and evil becomes substrate of new medicine and the balances between*opposites represented by elements and qualities were the fundaments of the humoralism. Fascination of opposites continues for centuries up to now, both in western and far eastern medicine: yin/yang, antibody/antigen, cAMP/cGMP, oncogene/antioncogene are examples of this attractive theory. Although fundaments of biological and medical observations are the basis of theories of opposites, the trend is to overcome reality and today represents, following idealism in the 19th century, an inconscious ancestral reminiscence of theurgical philosophy and medicine.

The Concept of Withdrawal of Divorce Petition Based on the Theory of Planned Behavior: A Qualitative Study.

PubMed

Morowatisharifabad, Mohammad Ali; Mazloomi-Mahmoodabad, Seyed Saied; Afshani, Seyed Alireza; Ardian, Nahid; Vaezi, Ali; Refahi, Seyed Ali Asghar

2018-05-20

The present study sought to explore the experiences of participants in divorce process according to the theory of planned behaviour. This qualitative study was conducted using content analysis method. In this research, 27 participants involved in the divorce process were selected. The data were coded, and the qualitative content analysis was performed. Based on four constructs of the theory of planned behaviour, the subcategories of instrumental attitude were "Divorce as the last solution" and "Divorce as damage for individuals and society". From the perceived behavioural control theme, two subcategories of behavioural control and self-efficacy were drawn; the first subtheme included "Others' meddling in the married life", "Social problems reducing behavioural control power" and "Personality characteristics affecting the behavioural control power"; and the second one included: "Education as a means for developing self-efficacy" and "barriers to self-efficacy". The injunctive norms theme included three subcategories of "Others help to reconcile", "Others meddling and lack of reconciliation", and "Families support to reconcile". The descriptive norms theme was "High divorce rate and misuse of satellite channels and social networks as factors making reconciliation difficult". It seems that education and counselling, within a predefined framework, such as applied theories, can be useful.

Periodic, On-Demand, and User-Specified Information Reconciliation

NASA Technical Reports Server (NTRS)

Kolano, Paul

2007-01-01

Automated sequence generation (autogen) signifies both a process and software used to automatically generate sequences of commands to operate various spacecraft. Autogen requires fewer workers than are needed for older manual sequence-generation processes and reduces sequence-generation times from weeks to minutes. The autogen software comprises the autogen script plus the Activity Plan Generator (APGEN) program. APGEN can be used for planning missions and command sequences. APGEN includes a graphical user interface that facilitates scheduling of activities on a time line and affords a capability to automatically expand, decompose, and schedule activities.

Stability Operations in Somalia 1992-1993: A Case Study

DTIC Science & Technology

2016-07-01

164 Appendix N : Addis Ababa Agreement of the First Session of the Conference on National Reconciliation in Somalia (March 27, 1993...adopted the Addis Abba Agreement of the First Session of the Conference on National Reconciliation in Soma- lia (Appendix N ). In the agreement, all...reaches the starving inland town of Baidoa. December 21, 1992 A mine near Bardera kills Lawrence N . Freedman, a U.S. government civilian employee and

Continuous-variable quantum key distribution with Gaussian source noise

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

Shen Yujie; Peng Xiang; Yang Jian

2011-05-15

Source noise affects the security of continuous-variable quantum key distribution (CV QKD) and is difficult to analyze. We propose a model to characterize Gaussian source noise through introducing a neutral party (Fred) who induces the noise with a general unitary transformation. Without knowing Fred's exact state, we derive the security bounds for both reverse and direct reconciliations and show that the bound for reverse reconciliation is tight.

Thermodynamic Constraints Improve Metabolic Networks.

PubMed

Krumholz, Elias W; Libourel, Igor G L

2017-08-08

In pursuit of establishing a realistic metabolic phenotypic space, the reversibility of reactions is thermodynamically constrained in modern metabolic networks. The reversibility constraints follow from heuristic thermodynamic poise approximations that take anticipated cellular metabolite concentration ranges into account. Because constraints reduce the feasible space, draft metabolic network reconstructions may need more extensive reconciliation, and a larger number of genes may become essential. Notwithstanding ubiquitous application, the effect of reversibility constraints on the predictive capabilities of metabolic networks has not been investigated in detail. Instead, work has focused on the implementation and validation of the thermodynamic poise calculation itself. With the advance of fast linear programming-based network reconciliation, the effects of reversibility constraints on network reconciliation and gene essentiality predictions have become feasible and are the subject of this study. Networks with thermodynamically informed reversibility constraints outperformed gene essentiality predictions compared to networks that were constrained with randomly shuffled constraints. Unconstrained networks predicted gene essentiality as accurately as thermodynamically constrained networks, but predicted substantially fewer essential genes. Networks that were reconciled with sequence similarity data and strongly enforced reversibility constraints outperformed all other networks. We conclude that metabolic network analysis confirmed the validity of the thermodynamic constraints, and that thermodynamic poise information is actionable during network reconciliation. Copyright © 2017 Biophysical Society. Published by Elsevier Inc. All rights reserved.

"If They Don't Start Listening to Us, the Future Is Going to Look the Same as the Past": Young People and Reconciliation in Northern Ireland and Bosnia and Herzegovina

ERIC Educational Resources Information Center

Magill, Clare; Hamber, Brandon

2011-01-01

This article, based on empirical research from Northern Ireland and Bosnia and Herzegovina, explores how young people conceptualize reconciliation and examines the meaning this concept holds for them. Qualitative data are collected through one-to-one interviews with young people aged 16 to 18 living in Northern Ireland (N = 15) and Bosnia and…

The Efficiency of Musical Emotions for the Reconciliation of Conceptual Dissonances

DTIC Science & Technology

2013-10-24

Final/Annual/Midterm Report for AOARD Grant 114103 "The efficiency of musical emotions for the reconciliation of conceptual...and will be added to a searchable DoD database. In the present project, PI developed theoretical foundation for the evolution of music in...which was experimentally created in 4-year-old children, who obeyed an experimenter’s warning not to play with a desired toy. Without exposure to music

DOD Financial Management: Ongoing Challenges with Reconciling Navy and Marine Corps Fund Balance with Treasury

DTIC Science & Technology

2011-12-01

significant deficiencies, that results in more than a remote likelihood that a material misstatement of the financial statements will not be prevented or...reconciliations of FBWT collection and disbursement activity, the amount of funds available for expenditure may contain material misstatements ; related...10 GAO-12-132 Fund Balance Reconciliations misstated , and the Department of the Navy is at increased risk of Antideficiency Act violations.31 • The

Quantum key distribution using basis encoding of Gaussian-modulated coherent states

NASA Astrophysics Data System (ADS)

Huang, Peng; Huang, Jingzheng; Zhang, Zheshen; Zeng, Guihua

2018-04-01

The continuous-variable quantum key distribution (CVQKD) has been demonstrated to be available in practical secure quantum cryptography. However, its performance is restricted strongly by the channel excess noise and the reconciliation efficiency. In this paper, we present a quantum key distribution (QKD) protocol by encoding the secret keys on the random choices of two measurement bases: the conjugate quadratures X and P . The employed encoding method can dramatically weaken the effects of channel excess noise and reconciliation efficiency on the performance of the QKD protocol. Subsequently, the proposed scheme exhibits the capability to tolerate much higher excess noise and enables us to reach a much longer secure transmission distance even at lower reconciliation efficiency. The proposal can work alternatively to strengthen significantly the performance of the known Gaussian-modulated CVQKD protocol and serve as a multiplier for practical secure quantum cryptography with continuous variables.

Colchicine in Pericardial Disease: from the Underlying Biology and Clinical Benefits to the Drug-Drug Interactions in Cardiovascular Medicine.

PubMed

Schenone, Aldo L; Menon, Venu

2018-06-14

This is an in-depth review on the mechanism of action, clinical utility, and drug-drug interactions of colchicine in the management of pericardial disease. Recent evidence about therapeutic targets on pericarditis has demonstrated that NALP3 inflammasome blockade is the cornerstone in the clinical benefits of colchicine. Such benefits extend from acute and recurrent pericarditis to transient constriction and post-pericardiotomy syndrome. Despite the increased utilization of colchicine in cardiovascular medicine, safety concerns remains unsolved regarding the long-term use of colchicine in the cardiac patient. Moreover, recent evidence has demonstrated that numerous cardiovascular medications, ranging from antihypertensive medication to antiarrhythmics, are known to interact with the CYP3A4 and/or P-gp system increasing the toxicity potential of colchicine. The use of adjunctive colchicine in the management of inflammatory pericardial diseases is standard of care in current practice. It is advised that a careful medication reconciliation with emphasis on pharmacokinetic is completed before prescribing colchicine in order to avoid harmful interaction by finding an alternative regimen or adjusting colchicine dosing.

A pilot study of a Medication Rationalization (MERA) intervention

PubMed Central

Whitty, Rachel; Porter, Sandra; Battu, Kiran; Bhatt, Pranjal; Koo, Ellen; Kalocsai, Csilla; Wu, Peter; Delicaet, Kendra; Bogoch, Isaac I.; Wu, Robert; Downar, James

2018-01-01

Background: Many seriously ill and frail inpatients receive potentially inappropriate or harmful medications and do not receive medications for symptoms of advanced illness. We developed and piloted an interprofessional Medication Rationalization (MERA) approach to deprescribing inappropriate medications and prescribing appropriate comfort medications. Methods: We conducted a single-centre pilot study of inpatients at risk of 6-month mortality from advanced age or morbidity. The MERA team reviewed the patients' medications and made recommendations on the basis of guidelines. We measured end points for feasibility, acceptability, efficiency and effectiveness. Results: We enrolled 61 of 115 (53%) eligible patients with a mean age of 79.6 years (standard deviation [SD] 11.7 yr). Patients were taking an average of 11.5 (SD 5.2) medications before admission and had an average of 2.1 symptoms with greater than 6/10 severity on the revised Edmonton Symptom Assessment System. The MERA team recommended 263 medication changes, of which 223 (85%) were accepted by both the medical team and the patient. MERA team's recommendations resulted in the discontinuation of 162 medications (mean 3.1 per patient), dose changes for 48 medications (mean 0.9 per patient) and the addition of 13 medications (mean 0.2 per patient). Patients who received the MERA intervention stopped significantly more inappropriate medications than similar non-MERA comparison patients for whom data were collected retrospectively (3.1 v. 0.9 medications per patient, p < 0.01). The MERA approach was highly acceptable to patients and medical team members. Interpretation: The MERA intervention is feasible, acceptable, efficient and possibly effective for changing medication use among seriously ill and frail elderly inpatients. Scalability and effectiveness may be improved through automation and integration with medication reconciliation programs. PMID:29467186

The Soviet Withdrawal from Afghanistan: Three Key Decisions that Shaped the 40th Army’s Operational Withdrawal Plan

DTIC Science & Technology

2014-05-22

embrace National Reconciliation was the most important, because in doing so, he wasted a full year in Afghanistan with little to show for his efforts...results of National Reconciliation suggest that Gorbachev and his political advisers did not, thereby wasting a full calendar year in Afghanistan...the fall of 1986, they may have well avoided the frustration, wasted effort, and lost lives suffered throughout 1987.49 UNILATERAL WITHDRAWAL

The Efficacy of Musical Emotions Provoked by Mozart’s Music for the Reconciliation of Cognitive Dissonance

DTIC Science & Technology

2012-09-25

The efficacy of musical emotions provoked by Mozart’s music for the reconciliation of cognitive dissonance Nobuo Masataka1 & Leonid Perlovsky2...scientists argue thatmusic itself plays no adaptive role in human evolution, others suggest that music clearly has an evolutionary role, and point to music’s...universality. A recent hypothesis suggested that a fundamental function of music has been to help mitigating cognitive dissonance, which is a

Development and implementation of a postdischarge home-based medication management service.

PubMed

Pherson, Emily C; Shermock, Kenneth M; Efird, Leigh E; Gilmore, Vi T; Nesbit, Todd; LeBlanc, Yvonne; Brotman, Daniel J; Deutschendorf, Amy; Swarthout, Meghan Davlin

2014-09-15

The development and implementation of a postdischarge home-based, pharmacist-provided medication management service are described. A work group composed of pharmacy administrators, clinical specialists, physicians, and nursing leadership developed the structure and training requirements to implement the service. Eligible patients were identified during their hospital admission by acute care pharmacists and consented for study participation. Pharmacists and pharmacy residents visited the patient at home after discharge and conducted medication reconciliation, provided patient education, and completed a comprehensive medication review. Recommendations for medication optimization were communicated to the patient's primary care provider, and a reconciled medication list was faxed to the patient's community pharmacy. Demographic and medication-related data were collected to characterize patients receiving the home-based service. A total of 50 patients were seen by pharmacists in the home. Patient education provided by the home-based pharmacists included monitoring instructions, adherence reinforcement, therapeutic lifestyle changes, administration instructions, and medication disposal instructions. Pharmacists provided the following recommendations to providers to optimize medication regimens: adjust dosage, suggest laboratory tests, add medication, discontinue medication, need prescription for refills, and change product formulation. Pharmacists identified a median of two medication discrepancies per patient and made a median of two recommendations for medication optimization to patients' primary care providers. The implementation of a post-discharge, pharmacist-provided home-based medication management service enhanced the continuity of patient care during the transition from hospital to home. Pharmacists identified and resolved medication discrepancies, educated patients about their medications, and provided primary care providers and community pharmacies with a complete and reconciled medication list. Copyright © 2014 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Effect of the Tool to Reduce Inappropriate Medications on Medication Communication and Deprescribing.

PubMed

Fried, Terri R; Niehoff, Kristina M; Street, Richard L; Charpentier, Peter A; Rajeevan, Nallakkandi; Miller, Perry L; Goldstein, Mary K; O'Leary, John R; Fenton, Brenda T

2017-10-01

To examine the effect of the Tool to Reduce Inappropriate Medications (TRIM), a web tool linking an electronic health record (EHR) to a clinical decision support system, on medication communication and prescribing. Randomized clinical trial. Primary care clinics at a Veterans Affairs Medical Center. Veterans aged 65 and older prescribed seven or more medications randomized to receipt of TRIM or usual care (N = 128). TRIM extracts information on medications and chronic conditions from the EHR and contains data entry screens for information obtained from brief chart review and telephonic patient assessment. These data serve as input for automated algorithms identifying medication reconciliation discrepancies, potentially inappropriate medications (PIMs), and potentially inappropriate regimens. Clinician feedback reports summarize discrepancies and provide recommendations for deprescribing. Patient feedback reports summarize discrepancies and self-reported medication problems. Primary: subscales of the Patient Assessment of Care for Chronic Conditions (PACIC) related to shared decision-making; clinician and patient communication. Secondary: changes in medications. 29.7% of TRIM participants and 15.6% of control participants provided the highest PACIC ratings; this difference was not significant. Adjusting for covariates and clustering of patients within clinicians, TRIM was associated with significantly more-active patient communication and facilitative clinician communication and with more medication-related communication among patients and clinicians. TRIM was significantly associated with correction of medication discrepancies but had no effect on number of medications or reduction in PIMs. TRIM improved communication about medications and accuracy of documentation. Although there was no association with prescribing, the small sample size provided limited power to examine medication-related outcomes. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

The Angry Dying Patient.

PubMed

Houston, Robert E.

1999-02-01

Over 25 years ago, Kubler-Ross identified anger as a predictable part of the dying process. When the dying patient becomes angry in the clinical setting, all types of communication become strained. Physicians can help the angry dying patient through this difficult time by using 10 rules of engagement. When physicians engage and empathize with these patients, they improve the patient's response to pain and they reduce patient suffering. When physicians educate patients on their normal responses to dying and enlist them in the process of family reconciliation, they can impact the end-of-life experience in a positive way.

The Angry Dying Patient

PubMed Central

Houston, Robert E.

1999-01-01

Over 25 years ago, Kubler-Ross identified anger as a predictable part of the dying process. When the dying patient becomes angry in the clinical setting, all types of communication become strained. Physicians can help the angry dying patient through this difficult time by using 10 rules of engagement. When physicians engage and empathize with these patients, they improve the patient's response to pain and they reduce patient suffering. When physicians educate patients on their normal responses to dying and enlist them in the process of family reconciliation, they can impact the end-of-life experience in a positive way. PMID:15014699

Impact of a transition-of-care pharmacist during hospital discharge.

PubMed

Balling, Lauren; Erstad, Brian L; Weibel, Kurt

2015-01-01

To assess the impact of a transition-of-care pharmacist during hospital discharge. An academic medical center in southern Arizona. One pharmacist coordinated patient discharges in two inpatient units from August 2012 through July 2013. The pharmacist attended interdisciplinary discharge coordination meetings, ensured appropriate discharge orders, facilitated the filling of medications, and educated patients on discharge medications. The implementation of a transition-of-care pharmacist to provide discharge medication reconciliation and education. Readmission rates and medication interventions made by the pharmacist at discharge. The pharmacist was involved in the education of 1,011 patients and performed 452 interventions. There were more readmissions per month in the control year versus the year of pharmacist involvement (median 27.5 vs. 25, P = 0.0369). Interventions made by the pharmacist to improve discharge management included starting an omitted medication (23.5%), preventing multiple discharge problems (16.4%), avoiding duplication of therapy (15.7%), correcting insurance issues related to medication coverage (12.2%), changing an improper medication dose or quantity (11.3%), changing an inappropriate prescription for a medication (5.1%), preventing a drug interaction (3.3%), and resolving other problems (12.6%). The most common medication classes involved were antimicrobial agents (9.1%), anticoagulants (8%), antihyperglycemic agents (3.8%), other drug classes (24%), and multiple drug classes (35%). A transition-of-care pharmacist is in a unique position to educate patients on hospital discharge, to intercept a substantial number of medication errors, and to resolve insurance issues that may lead to adherence problems. These improvements in care may result in reduced hospital readmission rates.

Amnesty, Reconciliation and Reintegration: Conflict Termination in Counterinsurgency

DTIC Science & Technology

2010-04-15

study and examine the conditions that allowed elements of AR2 to prevail. Having identified these conditions conducive to AR2 it will examine how ...26 In the case of Sierra Leone, the process of DDR was the result of a peace agreement, not a precursor to it. In the next example, I will show how ...ideology and violence perpetrated by the Shining Path movement and how the oppressive and reactionary nature of the government’s response undermined

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

Zhang, Z.; Pike, R.W.; Hertwig, T.A.

An effective approach for source reduction in chemical plants has been demonstrated using on-line optimization with flowsheeting (ASPEN PLUS) for process optimization and parameter estimation and the Tjao-Biegler algorithm implemented in a mathematical programming language (GAMS/MINOS) for data reconciliation and gross error detection. Results for a Monsanto sulfuric acid plant with a Bailey distributed control system showed a 25% reduction in the sulfur dioxide emissions and a 17% improvement in the profit over the current operating conditions. Details of the methods used are described.

Towards a framework for the elicitation of dilemmas.

PubMed

Burger, Marc J C

2008-08-01

This paper covers the main findings of the doctoral research that was concerned with seeking to extend aspects of dilemma theory. In professional practice, the Trompenaars Hampden-Turner Dilemma Reconciliation Process(TM) is a vehicle delivering dilemma theory in application. It informs a manager or leader on how to explore the dilemmas they face, how to reconcile the tensions that result, and how to structure the action steps for implementing the reconciled solutions. This vehicle forms the professional practice of the author who seeks to bring more rigor to consulting practice and thereby also contribute to theory development in the domain. The critical review of dilemma theory reveals that previous authors are inconsistent and variously invalid in their use of the terms 'dilemma theory,' 'dilemma methodology,' 'dilemma process,' 'dilemma reconciliation,' etc., and therefore an attempt is made to resolve these inconsistencies by considering whether 'dilemmaism' at the meta-level might be positioned as a new paradigm of inquiry for (management) research that embodies ontological, epistemological, and methodical premises that frame an approach to the resolution of real world business problems in (multi) disciplinary; (multi) functional and (multi) cultural business environments. This research offers contributions to knowledge, professional practice and theory development from the exploration of the SPID model as a way to make the elicitation of dilemmas more rigorous and structured and in the broader context of exploring 'dilemmaism' as a new paradigm of inquiry.

[Problem areas and examples of best practice in intersectoral medication treatment--a literature review].

PubMed

Mehrmann, Lena; Ollenschläger, Günter

2014-01-01

Transitions between the outpatient and inpatient sector are a critical phase in medication treatment. This article provides an overview of published problem areas and examples of best practice in the intersectoral medication treatment. Data with regard to related problem areas and examples of best practice was collected in August 2011 by a systematic literature research. The relevant literature was identified using the following databases and search engines: MEDLINE, The Cochrane Library, EMBASE, Google, and Google Scholar. Additionally, a hand search was done on the websites of SpringerLink and Thieme Connect. The initial search yielded a total of 4,409 records which were further selected in two screening steps and analysed according to their relevance. Of the remaining 63 records, 3 exclusively described problem areas, 11 of them examples of best practice, and 49 provided information on both problem areas and examples of best practice with regard to intersectoral medication treatment. Among other things, problem areas include varying legal regulations in inpatient and outpatient medication treatment, drug therapy interruptions after hospital discharge, or deficits in communication and continuity of care. Examples of best practice are projects, programmes, initiatives, recommendations, and points to consider with respect to medication reconciliation, pharmaceutical support, or transitions of care. Problem areas as well as examples of best practice are mainly focused on the transition from inpatient to outpatient care. Copyright © 2013. Published by Elsevier GmbH.

Experimental Studies on the Efficiency of Musical Emotions for the Reconciliation of Conceptual Dissonances

DTIC Science & Technology

2012-08-20

Final Report for AOARD Grant FA2386-11-1-4103 “Experimental studies on the efficiency of musical emotions for the reconciliation of conceptual...Performance: 01/09/2011 – 10/08/2012 Abstract: Debates on the origin and function of music have a long history. While some scientists argue that... music itself plays no adaptive role in human evolution, others suggest that music clearly has an evolutionary role, and point to music’s universality1

Direct and reverse secret-key capacities of a quantum channel.

PubMed

Pirandola, Stefano; García-Patrón, Raul; Braunstein, Samuel L; Lloyd, Seth

2009-02-06

We define the direct and reverse secret-key capacities of a memoryless quantum channel as the optimal rates that entanglement-based quantum-key-distribution protocols can reach by using a single forward classical communication (direct reconciliation) or a single feedback classical communication (reverse reconciliation). In particular, the reverse secret-key capacity can be positive for antidegradable channels, where no forward strategy is known to be secure. This property is explicitly shown in the continuous variable framework by considering arbitrary one-mode Gaussian channels.

Noise-enhanced CVQKD with untrusted source

NASA Astrophysics Data System (ADS)

Wang, Xiaoqun; Huang, Chunhui

2017-06-01

The performance of one-way and two-way continuous variable quantum key distribution (CVQKD) protocols can be increased by adding some noise on the reconciliation side. In this paper, we propose to add noise at the reconciliation end to improve the performance of CVQKD with untrusted source. We derive the key rate of this case and analyze the impact of the additive noise. The simulation results show that the optimal additive noise can improve the performance of the system in terms of maximum transmission distance and tolerable excess noise.

Channel-Based Key Generation for Encrypted Body-Worn Wireless Sensor Networks.

PubMed

Van Torre, Patrick

2016-09-08

Body-worn sensor networks are important for rescue-workers, medical and many other applications. Sensitive data are often transmitted over such a network, motivating the need for encryption. Body-worn sensor networks are deployed in conditions where the wireless communication channel varies dramatically due to fading and shadowing, which is considered a disadvantage for communication. Interestingly, these channel variations can be employed to extract a common encryption key at both sides of the link. Legitimate users share a unique physical channel and the variations thereof provide data series on both sides of the link, with highly correlated values. An eavesdropper, however, does not share this physical channel and cannot extract the same information when intercepting the signals. This paper documents a practical wearable communication system implementing channel-based key generation, including an implementation and a measurement campaign comprising indoor as well as outdoor measurements. The results provide insight into the performance of channel-based key generation in realistic practical conditions. Employing a process known as key reconciliation, error free keys are generated in all tested scenarios. The key-generation system is computationally simple and therefore compatible with the low-power micro controllers and low-data rate transmissions commonly used in wireless sensor networks.

76 FR 73025 - Medicare Program; Payment Policies Under the Physician Fee Schedule, Five-Year Review of Work...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-28

...This final rule with comment period addresses changes to the physician fee schedule and other Medicare Part B payment policies to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services. It also addresses, implements or discusses certain statutory provisions including provisions of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008. In addition, this final rule with comment period discusses payments for Part B drugs; Clinical Laboratory Fee Schedule: Signature on Requisition; Physician Quality Reporting System; the Electronic Prescribing (eRx) Incentive Program; the Physician Resource-Use Feedback Program and the value modifier; productivity adjustment for ambulatory surgical center payment system and the ambulance, clinical laboratory, and durable medical equipment prosthetics orthotics and supplies (DMEPOS) fee schedules; and other Part B related issues.

The effect of medication therapy management service combined with a national PharmaCloud system for polypharmacy patients.

PubMed

Chen, Chang-Ming; Kuo, Li-Na; Cheng, Kuei-Ju; Shen, Wan-Chen; Bai, Kuan-Jen; Wang, Chih-Chi; Chiang, Yi-Chun; Chen, Hsiang-Yin

2016-10-01

This study evaluated a medication therapy management service using the Taiwan National Health Insurance Administration's PharmaCloud system in a medical center in Taiwan. The new PharmaCloud System, launched in 2013, links a complete list of prescribed and dispensed medication from different hospitals, clinics, and pharmacies for all insured patients. The study included patients with polypharmacy (≥5 drugs) at a medication therapy management service from March 2013 to March 2014. A structured questionnaire was designed to collect patients' baseline data and record patients' knowledge, attitudes, and practice scores before and after the service intervention. Phone follow-ups for practice and adherence scores on medication use were performed after 3 months. There were 152 patients recruited in the study. Scores for medication use attitudes and practice significantly increased after the service (attitudes: 40.06 ± 0.26 to 43.07 ± 0.19, p <0.001; practice: 33.42 ± 0.30 to 40.37 ± 0.30, p <0.001). The scores for medication adherence also increased from 3.02 ± 0.07 to 3.92 ± 0.02 (p <0.001). The PharmaCloud system facilitates accurate and efficient medication reconciliation for pharmacists in the medication therapy management service. The model improved patients' attitudes and practice of the rational use of medications and adherence with medications. Further studies are warranted to evaluate human resources, executing costs, and the cost-benefit ratio of this medication therapy management service with the PharmaCloud system. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

A multi-disciplinary approach to medication safety and the implication for nursing education and practice.

PubMed

Adhikari, Radha; Tocher, Jennifer; Smith, Pam; Corcoran, Janet; MacArthur, Juliet

2014-02-01

Medication management is a complex multi-stage and multi-disciplinary process, involving doctors, pharmacists, nurses and patients. Errors can occur at any stage from prescribing, dispensing and administering, to recording and reporting. There are a number of safety mechanisms built into the medication management system and it is recognised that nurses are the final stage of defence. However, medication error still remains a major challenge to patient safety globally. This paper aims to illustrate two main aspects of medication safety practices that have been elicited from an action research study in a Scottish Health Board and three local Higher Education Institutions: firstly current medication safety practices in two clinical settings; and secondly pre and post-registration nursing education and teaching on medication safety. This paper is based on Phase One and Two of an Action Research project. An ethnography-style observational method, influenced by an Appreciative Inquiry (AI) approach was adapted to study the everyday medication management systems and practices of two hospital wards. This was supplemented by seven in-depth interviews with nursing staff, numerous informal discussions with healthcare professionals, two focus-groups, one peer-interview and two in-depth individual interviews with final year nursing students from three Higher Education Institutions in Scotland. This paper highlights the current positive practical efforts in medication safety practices in the chosen clinical areas. Nursing staff do employ the traditional 'five right' principles - right patient, right medication, right dose, right route and right time - for safe administration. Nursing students are taught these principles in their pre-registration nursing education. However, there are some other challenges remaining: these include the establishment of a complete medication history (reconciliation) when patients come to hospital, the provision of an in-depth training in pharmacological knowledge to junior nursing staff and pre-registration nursing students. This paper argues that the 'five rights' principle during medication administration is not enough for holistic medication safety and explains two reasons why there is a need for strengthened multi-disciplinary team-work to achieve greater patient safety. To accomplish this, nurses need to have sufficient knowledge of pharmacology and medication safety issues. These findings have important educational implications and point to the requirement for the incorporation of medication management and pharmacology in to the teaching curriculum for nursing students. There is also a call for continuing professional development opportunities for nurses working in clinical settings. © 2014.

A Nexus Model of the Temporal-Parietal Junction

PubMed Central

Carter, R. McKell; Huettel, Scott A.

2013-01-01

The temporal-parietal junction (TPJ) has been proposed to support either specifically social functions or non-specific processes of cognition like memory and attention. To account for diverse prior findings, we propose a Nexus Model for TPJ function: overlap of basic processes produces novel secondary functions at their convergence. We present meta-analytic evidence that is consistent with the anatomical convergence of attention, memory, language, and social processing in the TPJ – leading to a higher-order role in the creation of a social context for behavior. The Nexus Model accounts for recent examples of TPJ contributions specifically to decision making in a social context, and it provides a potential reconciliation for competing claims about TPJ function. PMID:23790322

An Empirical Analysis of the Cascade Secret Key Reconciliation Protocol for Quantum Key Distribution

DTIC Science & Technology

2011-09-01

performance with the parity checks within each pass increasing and as a result, the processing time is expected to increase as well. A conclusion is drawn... timely manner has driven efforts to develop new key distribution methods. The most promising method is Quantum Key Distribution (QKD) and is...thank the QKD Project Team for all of the insight and support they provided in such a short time period. Thanks are especially in order for my

MRIVIEW: An interactive computational tool for investigation of brain structure and function

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

Ranken, D.; George, J.

MRIVIEW is a software system which uses image processing and visualization to provide neuroscience researchers with an integrated environment for combining functional and anatomical information. Key features of the software include semi-automated segmentation of volumetric head data and an interactive coordinate reconciliation method which utilizes surface visualization. The current system is a precursor to a computational brain atlas. We describe features this atlas will incorporate, including methods under development for visualizing brain functional data obtained from several different research modalities.

Czech-German Sudeten Relations: Reconciliation Process Between Two Nations

DTIC Science & Technology

2000-03-01

succession in the Bohemian lands remained by law.14 The first union between Bohemian and German lands under Rudolf EH in 1306- 1307 was an important...California Press, 1974), p.3. 14 elected as a king, Rudolf of Habsburg. Ottokar II’s aspirations to the Holy Roman Empire ended by the great battle...of Dürnkrut in 1278, his defeat by Rudolf , the joint accession of Rudolfs son in the Austrian lands and in Styria in 1282, and the following

Development and perceived effects of an educational programme on quality and safety in medication handling in residential facilities.

PubMed

Mygind, Anna; El-Souri, Mira; Rossing, Charlotte; Thomsen, Linda Aagaard

2018-04-01

To develop and test an educational programme on quality and safety in medication handling for staff in residential facilities for the disabled. The continuing pharmacy education instructional design model was used to develop the programme with 22 learning objectives on disease and medicines, quality and safety, communication and coordination. The programme was a flexible, modular seven + two days' course addressing quality and safety in medication handling, disease and medicines, and medication supervision and reconciliation. The programme was tested in five Danish municipalities. Municipalities were selected based on their application for participation; each independently selected a facility for residents with mental and intellectual disabilities, and a facility for residents with severe mental illnesses. Perceived effects were measured based on a questionnaire completed by participants before and after the programme. Effects on motivation and confidence as well as perceived effects on knowledge, skills and competences related to medication handling, patient empowerment, communication, role clarification and safety culture were analysed conducting bivariate, stratified analyses and test for independence. Of the 114 participants completing the programme, 75 participants returned both questionnaires (response rate = 66%). Motivation and confidence regarding quality and safety in medication handling significantly improved, as did perceived knowledge, skills and competences on 20 learning objectives on role clarification, safety culture, medication handling, patient empowerment and communication. The programme improved staffs' motivation and confidence and their perceived ability to handle residents' medication safely through improved role clarification, safety culture, medication handling and patient empowerment and communication skills. © 2017 Royal Pharmaceutical Society.

Public mental health. III: Hatred and reconciliation.

PubMed

Curle, A

1997-01-01

In today's often crazily chaotic conflicts it is particularly important to consider the aftermath of direct violence. Although a ceasefire may have been arranged-or imposed as in Bosnia-the emotions of anger and hatred may still dominate the minds of most people. It is therefore vital to pay great attention to the process of reconciliation. This has not been given the same attention as diplomacy and negotiation in arranging the ceasefire that ended the fighting-but often not the conflict of interests. Health workers are particularly suited for this work for three main reasons. Firstly, their altruistic humanitarian function is very widely appreciated; there is little need for them, as there is for others, to prove their good will and impartiality. Secondly, their work brings them into contact with all levels of society. This is particularly important, since experience shows that arrangements made by leaders are by no means always accepted by the people, upon whom ultimately the creation of a peaceful society depends. Thirdly, the relationships they form are often more long-lasting than those of peace-making negotiators or mediators, and therefore more likely to lead to constructive changes of perception.

Application of a data reconciliation method to the stoichiometric analysis of Fibrobacter succinogenes growth.

PubMed

Guiavarch, Erell; Pons, Agnes; Creuly, Catherine; Dussap, Claude-Gilles

2008-12-01

Fibrobacter succinogenes S85, a strictly anaerobic Gram-negative bacterium, was grown in continuous culture in a bioreactor at different dilution rates (0.02 to 0.092 h(-1)) on a fully synthetic culture medium with glucose as carbon source. Glucose and ammonium sulfate consumption, as well as biomass, succinate, acetate, formate, and carbohydrate production were regularly measured. The relevant biomass elemental compositions were established for each dilution rate. Robustness of the experimental information was checked by C and N mass balances estimation, which were satisfactory. A detailed overall stoichiometry analysis of the process, including all substrates and products of the culture, was proposed. Online and off-line parameters measured during the culture brought a large number of data which were weighted by their respective variance associated to the measured value. The material balance resulted in an overdetermined linear system of equations made of weighted relationships including experimental data, elemental balances (C, H, O, N, S, Na), and an additional constraint. The mass balances involved in stoichiometric equations were solved using data reconciliation and linear algebra methods to take into account error measurements. This methodology allowed to establish the overall stoichiometric equation for each dilution rate studied.

Living with an adult family member using advanced medical technology at home.

PubMed

Fex, Angelika; Flensner, Gullvi; Ek, Anna-Christina; Söderhamn, Olle

2011-12-01

Living with an adult family member using advanced medical technology at home An increased number of chronically ill adults perform self-care while using different sorts of advanced medical technology at home. This hermeneutical study aimed to gain a deeper understanding of the meaning of living with an adult family member using advanced medical technology at home. Eleven next of kin to adults performing self-care at home, either using long-term oxygen from a cylinder or ventilator, or performing peritoneal or haemodialysis, were interviewed. The qualitative interviews were analysed using a Gadamerian methodology. The main interpretation explained the meaning as rhythmical patterns of connectedness versus separation, and of sorrow versus reconciliation. Dependence on others was shown in the need for support from healthcare professionals and significant others. In conclusion, next of kin took considerable responsibility for dependent-care. All next of kin were positive to the idea of bringing the technology home, even though their own needs receded into the background, while focusing on the best for the patient. The results were discussed in relation to dependent-care and transition, which may have an influence on the self-care of next of kin and patients. The study revealed a need for further nursing attention to next of kin in this context. © 2011 Blackwell Publishing Ltd.

Prioritizing interventions to manage polypharmacy in Australian aged care facilities.

PubMed

Jokanovic, Natali; Wang, Kate N; Dooley, Michael J; Lalic, Samanta; Tan, Edwin Ck; Kirkpatrick, Carl M; Bell, J Simon

Polypharmacy is highly prevalent in residential aged care facilities (RACFs). Although polypharmacy is sometimes unavoidable, polypharmacy has been associated with increased morbidity and mortality. To identify and prioritize a range of potential interventions to manage polypharmacy in RACFs from the perspectives of health care professionals, health policy and consumer representatives. Two nominal group technique (NGT) sessions were convened in August 2015. A purposive sample (n = 19) of clinicians, researchers, managers and representatives of consumer, professional and health policy organizations were asked to nominate interventions to address the prevalence and appropriateness of medication use. Participants were then asked to prioritize five interventions suitable for possible implementation at the system level. Six of 16 potential interventions were prioritized highest for possible implementation in clinical practice, with two interventions prioritized as second highest. The top interventions in rank order were 'implementation of a pharmacist-led medication reconciliation service for new residents,' 'conduct facility-level audits and feedback to staff and health care professionals,' 'develop deprescribing scripts to assist clinician-resident discussion,' 'develop or revise prescribing guidelines specific to older people with multimorbidity in RACFs,' 'implement electronic medication charts and records' and 'better support Medication Advisory Committees (MACs) to address medication appropriateness.' This study prioritized a range of potential interventions that may be used to assist clinicians and policy makers develop a comprehensive strategy to manage polypharmacy in RACFs. Copyright © 2016 Elsevier Inc. All rights reserved.

Meaningful Use of Electronic Health Records: Experiences From the Field and Future Opportunities.

PubMed

Slight, Sarah Patricia; Berner, Eta S; Galanter, William; Huff, Stanley; Lambert, Bruce L; Lannon, Carole; Lehmann, Christoph U; McCourt, Brian J; McNamara, Michael; Menachemi, Nir; Payne, Thomas H; Spooner, S Andrew; Schiff, Gordon D; Wang, Tracy Y; Akincigil, Ayse; Crystal, Stephen; Fortmann, Stephen P; Bates, David W

2015-09-18

With the aim of improving health care processes through health information technology (HIT), the US government has promulgated requirements for "meaningful use" (MU) of electronic health records (EHRs) as a condition for providers receiving financial incentives for the adoption and use of these systems. Considerable uncertainty remains about the impact of these requirements on the effective application of EHR systems. The Agency for Healthcare Research and Quality (AHRQ)-sponsored Centers for Education and Research in Therapeutics (CERTs) critically examined the impact of the MU policy relating to the use of medications and jointly developed recommendations to help inform future HIT policy. We gathered perspectives from a wide range of stakeholders (N=35) who had experience with MU requirements, including academicians, practitioners, and policy makers from different health care organizations including and beyond the CERTs. Specific issues and recommendations were discussed and agreed on as a group. Stakeholders' knowledge and experiences from implementing MU requirements fell into 6 domains: (1) accuracy of medication lists and medication reconciliation, (2) problem list accuracy and the shift in HIT priorities, (3) accuracy of allergy lists and allergy-related standards development, (4) support of safer and effective prescribing for children, (5) considerations for rural communities, and (6) general issues with achieving MU. Standards are needed to better facilitate the exchange of data elements between health care settings. Several organizations felt that their preoccupation with fulfilling MU requirements stifled innovation. Greater emphasis should be placed on local HIT configurations that better address population health care needs. Although MU has stimulated adoption of EHRs, its effects on quality and safety remain uncertain. Stakeholders felt that MU requirements should be more flexible and recognize that integrated models may achieve information-sharing goals in alternate ways. Future certification rules and requirements should enhance EHR functionalities critical for safer prescribing of medications in children.

Impact of a pharmacy student-driven medication delivery service at hospital discharge.

PubMed

Rogers, Jacalyn; Pai, Vinita; Merandi, Jenna; Catt, Char; Cole, Justin; Yarosz, Shannon; Wehr, Allison; Durkin, Kayla; Kaczor, Chet

2017-03-01

A pharmacy student-driven discharge service developed for patients to reduce the number of medication errors on after-visit summaries (AVSs) is discussed. An audit of AVS documents was conducted before the implementation period (September 3 to October 23, 2013) to identify medication errors. As part of the audit, a pharmacist review of the discharge medication list was completed to determine the number and types of errors that occurred. A student-driven discharge service with AVS review was developed in collaboration with nursing and medical residents. Students reviewed a patient's AVS, delivered the discharge prescriptions to bedside, and conducted medication reconciliation with the patient and family. The AVS audit was conducted after implementation of these services to assess the impact on medication errors. It was observed that 72% (108 of 150) of AVSs contained at least 1 error before discharge and AVS review. During the 2-month postimplementation period (September 3 to October 23, 2014), this decreased to 27% (34 of 127), resulting in a 52% absolute reduction in the number of AVSs with at least 1 medication error ( p < 0.0001). The most common error was as-needed medication with no indication, which decreased from 55% in the preimplementation audit to 16% in the postimplementation audit. Prescribing to Nationwide Children's Hospital's outpatient pharmacy increased from 57% in the preimplementation period to 73% in the postimplementation period for the general pediatrics service. A pharmacy student-driven discharge and medication delivery service reduced the number of AVSs and increased access to medications for patients. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Medical professionalism and the social contract.

PubMed

Reid, Lynette

2011-01-01

Conceptions of professionalism in medicine draw on social contract theory; its strengths and weaknesses play out in how we reason about professionalism. The social contract metaphor may be a heuristic device prompting reflection on social responsibility, and as such is appealing: it encourages reasoning about privilege and responsibility, the broader context and consequences of action, and diverse perspectives on medical practice. However, when this metaphor is elevated to the status of a theory, it has well-known limits: the assumed subject position of contractors engenders blind spots about privilege, not critical reflection; its tendency to dress up the status quo in the trappings of a theoretical agreement may limit social negotiation; its attempted reconciliation of social obligation and self-interest fosters the view that ethics and self-interest should coincide; it sets up false expectations by identifying appearance and reality in morality; and its construal of prima facie duties as conditional misdirects ethical attention in particular situations from current needs to supposed past agreements or reciprocities. Using philosophical ideas as heuristic devices in medical ethics is inevitable, but we should be conscious of their limitations. When they limit the ethical scope of debate, we should seek new metaphors.

Langley's views on NEMS

NASA Technical Reports Server (NTRS)

George, J. W.

1984-01-01

The views of the Langley Research Center regarding the NASA Equipment Management System (EMS) are discussed. One of Langley's greatest concerns is with the reconciliation between NEMS and the General Ledger. Langley's accounting system tracks cost data to the penny level. NEMS deals in whole dollar amounts. Therefore, Langley has no way of reconciling the two. The only approach that is acceptable to Langley, unless requirements for reconciliation are changed, is for the NEMS files and the reports involved in the process be at the penny level. All other NEMS reports can remain whole dollars. Also to reconcile, Langley needs data to show the difference between the previous cost and the new cost for the month. On an input record, the adjustment amount is added to the cost and recorded as total amount. The adjusted cost is not captured. In order to establish a control between the prior months and the current month, a new field needs to be added to capture the adjusted cost (debits And credits). Langley has not reconciled the Equipment account with the General Ledger since February 1984. Problems with NEMS regular production runs cause concern. Production at Langley is run on the second and/or third shift. If a run(s) terminates and/or abends in a particular module, Langley must wait until the next day to resolve NEMS problems after consultation with Headquarters personnel. For a successful installation, Langley must have a good data base to convert to NEMS and users and the data processing staff must work together.

Influence of dominance rank and affiliation relationships on self-directed behavior in female Tibetan macaques (Macaca thibetana).

PubMed

Zhang, Qi-Xin; Li, Jin-Hua; Xia, Dong-Po; Zhu, Yong; Wang, Xi; Zhang, Dao

2014-05-01

Self-directed behavior (SDB) is characterized as an indicator of anxiety, frustration and stress in nonhuman primates. In this study, we collected self-directed behavior data from one group of free-ranging Tibetan macaques (Macaca thibetana) at Mt. Huangshan, China (September 2012-May 2013) using a combination of behavioral sampling methods including focal animal sampling, behavioral sampling, continuous sampling and instantaneous sampling. Our results showed that females engaged in significantly higher rates of self-directed behavior when they were in proximity to dominant individuals compared to subordinate ones. Conflict losers significantly increased their SDB rates after agonistic episodes, indicating that SDB might also serve as an index of anxiety in M. thibetana. We further found that females significantly increased their SDB rates when focal individual was proximity to weakly affiliation relationship higher rank members than to strongly affiliation relationship higher rank members. If conflicts were not reconciled, the postconflict SDB rates of losers were higher when they stayed with strongly affiliation opponents; if conflicts were reconciled, victims of strongly affiliation relationships opponents engaged in more SDB rates before reconciliation than after reconciliation, while victims of moderately affiliation relationships opponents did not engaged in more SDB rates before reconciliation than after reconciliation. We conclude that both of dominance rank and affiliation relationships might both influence the SDB rates of female Tibetan macaques significantly, suggesting that SDB is not only an index of anxiety in Tibetan macaques, but also can provide a new insight into evaluation of social relationships between individuals.

Behavioural patterns of conflict resolution strategies in preschool boys with language impairment in comparison with boys with typical language development.

PubMed

Horowitz, Laura; Jansson, Liselotte; Ljungberg, Tomas; Hedenbro, Monica

2005-01-01

Children with language impairment (LI) experience social difficulties, including conflict management. This paper is therefore motivated to examine behavioural processes guiding preschool peer conflict progression, which ultimately contributes to overall development. To describe behavioural sequences in conflicts between children with typically developing language (TL) and between children with LI. Attention is particularly focused on the conflict resolution strategy reconciliation, i.e. friendly contact between former opponents shortly following conflict termination. It is hypothesized that children with LI, with weaker language skills, experience difficulties attaining effective reconciliation. Unstructured play of 11 boys with LI (4-7-years-old), at a specialized language preschool, and 20 TL boys (4-6-years-old), at mainstream preschools, were video filmed. Conflicts were identified and recorded according to a validated coding system. Recorded conflict details included behavioural sequences constituting conflict cause (conflict period) and in the post-conflict period, reconciliatory behaviours that were classified into six 'categories' (Invitation to play, Body contact, Object offer, Verbal apology, Self-ridicule, Cognition, i.e. offering privileges/negotiating) and the verbal character of accepted behaviours were determined. The mean proportion of individual target children's conflicts in which specific behavioural sequences had occurred were calculated and thereafter compared between and within the groups. Boys with LI reconcile fewer conflicts than TL boys (LI: 47.3 +/- 4.5%; TL: 63.6 +/- 2.0%). Contributory factors include the occurrence of conflicts caused by aberrance, i.e. conflicts initiated by inappropriate behavioural play intensities (i.e. 'a pillow fight' where one partner swings so intensively the other partner cannot participate as a player in the game) and protests that are no longer directed to the opponent within reciprocal exchanges, but escalate to screaming/physical ranting. Aberrant caused conflicts were rarely observed as the conflict cause for TL boys, but represent nearly 15% of LI conflicts and aberrant caused conflicts are reconciled at lower rates than conflicts not caused by aberrance. Displayed reconciliatory behaviours were accepted by opponents at similar rates in both groups and the distribution of reconciliatory behavioural 'categories' was similar between the groups. However, boys with LI attempt reconciliation in relatively fewer conflicts. In addition, the individual boys with LI attain reconciliation with strictly verbal reconciliatory behaviours in a smaller proportion of conflicts. The findings suggest that in addition to traditional psycholinguistic remediation, intervention programmes for children with LI should address that learned language and communication skills are applied effectively in initiating and maintaining naturalistic peer interactions.

[Desirable medical technologists in a community support hospital].

PubMed

Takeda, Kyoko

2008-07-01

Recently, there have been marked advances in the technological strategies employed in medical examinations. The educational concept to nurture highly capable medical technologists is considered to be a priority issue by not only educators but also employers, even though the medical educational levels have markedly improved in every college and university. It is commonly acknowledged that the results of any examination in the clinical laboratory should be accurate and fed back to medical doctors as soon as possible. The business outline of medical technologists in our hospital is becoming more extensive because we act as a core hospital in the area, and so knowledge regarding many kinds of chemical and transfusion examinations is required in operations performed around the clock. Furthermore, medical doctors, clerical workers, nurses, and volunteers comprise a team of sophisticated workers in our hospital. To accomplish our daily work, character traits such as accuracy, honesty, perseverance, and ability to follow instruction manuals, are the most fundamental and valuable. To nurture a highly career-oriented medical technologist, we propose that the following should be focused on: self-responsibility, reduction of malpractices, economic profitability, brainstorming, education of subsequent generations, and the spirit of cooperativeness and reconciliation. Additionally, it is another basic requirement of competent medical technologists to learn to adapt to laboratory-based changes in their work throughout their career. In conclusion, how to adapt to any social demand and learn strategies in any era should be taught in college or university as well as after graduation because each hospital and institute has a different philosophy and requirements of newcomers. It is important for medical technologists and doctors to develop flexible ways of thinking, although we sometimes might accede to traditional ways.

A broadcast-based key agreement scheme using set reconciliation for wireless body area networks.

PubMed

Ali, Aftab; Khan, Farrukh Aslam

2014-05-01

Information and communication technologies have thrived over the last few years. Healthcare systems have also benefited from this progression. A wireless body area network (WBAN) consists of small, low-power sensors used to monitor human physiological values remotely, which enables physicians to remotely monitor the health of patients. Communication security in WBANs is essential because it involves human physiological data. Key agreement and authentication are the primary issues in the security of WBANs. To agree upon a common key, the nodes exchange information with each other using wireless communication. This information exchange process must be secure enough or the information exchange should be minimized to a certain level so that if information leak occurs, it does not affect the overall system. Most of the existing solutions for this problem exchange too much information for the sake of key agreement; getting this information is sufficient for an attacker to reproduce the key. Set reconciliation is a technique used to reconcile two similar sets held by two different hosts with minimal communication complexity. This paper presents a broadcast-based key agreement scheme using set reconciliation for secure communication in WBANs. The proposed scheme allows the neighboring nodes to agree upon a common key with the personal server (PS), generated from the electrocardiogram (EKG) feature set of the host body. Minimal information is exchanged in a broadcast manner, and even if every node is missing a different subset, by reconciling these feature sets, the whole network will still agree upon a single common key. Because of the limited information exchange, if an attacker gets the information in any way, he/she will not be able to reproduce the key. The proposed scheme mitigates replay, selective forwarding, and denial of service attacks using a challenge-response authentication mechanism. The simulation results show that the proposed scheme has a great deal of adoptability in terms of security, communication overhead, and running time complexity, as compared to the existing EKG-based key agreement scheme.

Overlapping of Serotonin Syndrome with Neuroleptic Malignant Syndrome due to Linezolid-Fluoxetine and Olanzapine-Metoclopramide Interactions: A Case Report of Two Serious Adverse Drug Effects Caused by Medication Reconciliation Failure on Hospital Admission.

PubMed

Mazhar, Faizan; Akram, Shahzad; Haider, Nafis; Ahmed, Rafeeque

2016-01-01

Antipsychotic and antidepressant are often used in combination for the treatment of neuropsychiatric disorders. The concomitant use of antipsychotic and/or antidepressant with drugs that may interact can lead to rare, life-threatening conditions such as serotonin syndrome and neuroleptic malignant syndrome. We describe a patient who has a history of taking two offending drugs that interact with drugs given during the course of hospital treatment which leads to the development of serotonin syndrome overlapped with neuroleptic malignant syndrome. The physician should be aware that both NMS and SS can appear as overlapping syndrome especially when patients use a combination of both antidepressants and antipsychotics.

Analysis of limiting information characteristics of quantum-cryptography protocols

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

Sych, D V; Grishanin, Boris A; Zadkov, Viktor N

2005-01-31

The problem of increasing the critical error rate of quantum-cryptography protocols by varying a set of letters in a quantum alphabet for space of a fixed dimensionality is studied. Quantum alphabets forming regular polyhedra on the Bloch sphere and the continual alphabet equally including all the quantum states are considered. It is shown that, in the absence of basis reconciliation, a protocol with the tetrahedral alphabet has the highest critical error rate among the protocols considered, while after the basis reconciliation, a protocol with the continual alphabet possesses the highest critical error rate. (quantum optics and quantum computation)

Interprofessional care collaboration for patients with heart failure.

PubMed

Boykin, Amanda; Wright, Danielle; Stevens, Lydia; Gardner, Lauren

2018-01-01

An innovative collaborative care model to improve transitions of care (TOC) for patients with heart failure (HF) is described. As part of a broad effort by New Hanover Regional Medical Center (NHRMC) to reduce avoidable 30-day hospital readmissions and decrease associated healthcare costs through a team-centered, value-based approach to patient care, an interprofessional team was formed to help reduce hospital readmissions among discharged patients with HF. The team consists of 5 TOC pharmacists, 4 community paramedics, and 4 advanced care practitioners (ACPs) who collaborate to coordinate care and prevent 30-day readmissions among patients with HF transitioning from the hospital to the community setting. Each team member plays an integral role in providing high-quality postdischarge care. The TOC pharmacist ensures that patients have access to all needed medications, provides in-home medication reconciliation services, makes medication recommendations, and alerts the team of potential medication-related issues. Community paramedics conduct home visits consisting of physical and mental health assessments, diet and disease state education, reviews of medication bottles and education on proper medication use, and administration of i.v. diuretics to correct volume status under provider orders. The ACPs offer close clinic follow-up (typically initiated within 7 days of discharge) as well as long-term HF management and education. At NHRMC, collaboration among healthcare professionals, including a TOC pharmacist, community paramedics, and ACPs, has assisted in the growth and expansion of services provided to patients with HF. Copyright © 2018 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Unintentional Pharmaceutical-Related Medication Errors Caused by Laypersons Reported to the Toxicological Information Centre in the Czech Republic.

PubMed

Urban, Michal; Leššo, Roman; Pelclová, Daniela

2016-07-01

The purpose of the article was to study unintentional pharmaceutical-related poisonings committed by laypersons that were reported to the Toxicological Information Centre in the Czech Republic. Identifying frequency, sources, reasons and consequences of the medication errors in laypersons could help to reduce the overall rate of medication errors. Records of medication error enquiries from 2013 to 2014 were extracted from the electronic database, and the following variables were reviewed: drug class, dosage form, dose, age of the subject, cause of the error, time interval from ingestion to the call, symptoms, prognosis at the time of the call and first aid recommended. Of the calls, 1354 met the inclusion criteria. Among them, central nervous system-affecting drugs (23.6%), respiratory drugs (18.5%) and alimentary drugs (16.2%) were the most common drug classes involved in the medication errors. The highest proportion of the patients was in the youngest age subgroup 0-5 year-old (46%). The reasons for the medication errors involved the leaflet misinterpretation and mistaken dose (53.6%), mixing up medications (19.2%), attempting to reduce pain with repeated doses (6.4%), erroneous routes of administration (2.2%), psychiatric/elderly patients (2.7%), others (9.0%) or unknown (6.9%). A high proportion of children among the patients may be due to the fact that children's dosages for many drugs vary by their weight, and more medications come in a variety of concentrations. Most overdoses could be prevented by safer labelling, proper cap closure systems for liquid products and medication reconciliation by both physicians and pharmacists. © 2016 Nordic Association for the Publication of BCPT (former Nordic Pharmacological Society).

Doctor Shopping Behavior for Zolpidem Among Insomnia Patients in Taiwan: A Nationwide Population-Based Study.

PubMed

Lu, Tzu-Hsuan; Lee, Yen-Ying; Lee, Hsin-Chien; Lin, You-Meei

2015-07-01

Although zolpidem is listed as a controlled drug in Taiwan, patients' behavior has not been restricted and has led to the problem of doctor shopping behavior (DSB), leading to overutilization of medical resources and excess spending. The National Health Insurance Administration in Taiwan has instituted a new policy to regulate physicians' prescribing behavior and decrease DSB. This retrospective study aimed to analyze the DSB for zolpidem by insomnia patients and assess related factors. Data were extracted from the Longitudinal Health Insurance Database in Taiwan. Individuals with a diagnosis of insomnia who received more than one prescription of zolpidem in 2008 were followed for 24 mo. Doctor shopping was defined as ≥ 2 prescriptions by different doctors within ≥ 1 day overlapping in the duration of therapy. The percentage of zolpidem obtained through doctor shopping was used as an indicator of the DSB of each patient. Among the 6,947 insomnia patients who were prescribed zolpidem, 1,652 exhibited DSB (23.78%). The average dose of zolpidem dispensed for each patient during 24 mo was 244.21 daily defined doses. The doctor shopping indicator (DSI) was 0.20 (standard deviation, 0.23) among patients with DSB. Younger age, chronic diseases, high number of diseases, higher premium status, high socioeconomic status, and fewer people served per practicing physicians were all factors significantly related to doctor shopping behavior. Doctor shopping for zolpidem appears to be an important issue in Taiwan. Implementing a proper referral system with efficient data exchange by physician or pharmacist-led medication reconciliation process might reduce DSB. © 2015 Associated Professional Sleep Societies, LLC.

Forgiveness and justice: a research agenda for social and personality psychology.

PubMed

Exline, Julie Juola; Worthington, Everett L; Hill, Peter; McCullough, Michael E

2003-01-01

Forgiveness and related constructs (e.g., repentance, mercy, reconciliation) are ripe for study by social and personality psychologists, including those interested in justice. Current trends in social science, law, management, philosophy, and theology suggest a need to expand existing justice frameworks to incorporate alternatives or complements to retribution, including forgiveness and related processes. In this article, we raise five challenging empirical questions about forgiveness. For each question, we briefly review representative research, raise hypotheses, and suggest specific ways in which social and personality psychologists could make distinctive contributions.

Security of coherent-state quantum cryptography in the presence of Gaussian noise

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

Heid, Matthias; Luetkenhaus, Norbert

2007-08-15

We investigate the security against collective attacks of a continuous variable quantum key distribution scheme in the asymptotic key limit for a realistic setting. The quantum channel connecting the two honest parties is assumed to be lossy and imposes Gaussian noise on the observed quadrature distributions. Secret key rates are given for direct and reverse reconciliation schemes including post-selection in the collective attack scenario. The effect of a nonideal error correction and two-way communication in the classical post-processing step is also taken into account.

Bonobos respond to distress in others: consolation across the age spectrum.

PubMed

Clay, Zanna; de Waal, Frans B M

2013-01-01

How animals respond to conflict provides key insights into the evolution of socio-cognitive and emotional capacities. Evidence from apes has shown that, after social conflicts, bystanders approach victims of aggression to offer stress-alleviating contact behavior, a phenomenon known as consolation. This other-orientated behavior depends on sensitivity to the other's emotional state, whereby the consoler acts to ameliorate the other's situation. We examined post-conflict interactions in bonobos (Pan paniscus) to identify the determinants of consolation and reconciliation. Thirty-six semi-free bonobos of all ages were observed at the Lola ya Bonobo Sanctuary, DR Congo, using standardized Post-conflict/Matched Control methods. Across age and sex classes, bonobos consoled victims and reconciled after conflicts using a suite of affiliative and socio-sexual behaviors including embracing, touching, and mounting. Juveniles were more likely to console than adults, challenging the assumption that comfort-giving rests on advanced cognitive mechanisms that emerge only with age. Mother-reared individuals were more likely to console than orphans, highlighting the role of rearing in emotional development. Consistent with previous studies, bystanders were more likely to console relatives or closely bonded partners. Effects of kinship, affiliation and rearing were similarly indicated in patterns of reconciliation. Nearby bystanders were significantly more likely to contact victims than more distal ones, and consolation was more likely in non-food contexts than during feeding. The results did not provide convincing evidence that bystander contacts served for self-protection or as substitutes for reconciliation. Overall, results indicate that a suite of social, developmental and contextual factors underlie consolation and reconciliation in bonobos and that a sensitivity to the emotions of others and the ability to provide appropriate consolatory behaviors emerges early in development.

Gene-Tree Reconciliation with MUL-Trees to Resolve Polyploidy Events.

PubMed

Gregg, W C Thomas; Ather, S Hussain; Hahn, Matthew W

2017-11-01

Polyploidy can have a huge impact on the evolution of species, and it is a common occurrence, especially in plants. The two types of polyploids-autopolyploids and allopolyploids-differ in the level of divergence between the genes that are brought together in the new polyploid lineage. Because allopolyploids are formed via hybridization, the homoeologous copies of genes within them are at least as divergent as orthologs in the parental species that came together to form them. This means that common methods for estimating the parental lineages of allopolyploidy events are not accurate, and can lead to incorrect inferences about the number of gene duplications and losses. Here, we have adapted an algorithm for topology-based gene-tree reconciliation to work with multi-labeled trees (MUL-trees). By definition, MUL-trees have some tips with identical labels, which makes them a natural representation of the genomes of polyploids. Using this new reconciliation algorithm we can: accurately place allopolyploidy events on a phylogeny, identify the parental lineages that hybridized to form allopolyploids, distinguish between allo-, auto-, and (in most cases) no polyploidy, and correctly count the number of duplications and losses in a set of gene trees. We validate our method using gene trees simulated with and without polyploidy, and revisit the history of polyploidy in data from the clades including both baker's yeast and bread wheat. Our re-analysis of the yeast data confirms the allopolyploid origin and parental lineages previously identified for this group. The method presented here should find wide use in the growing number of genomes from species with a history of polyploidy. [Polyploidy; reconciliation; whole-genome duplication.]. © The Author(s) 2017. Published by Oxford University Press, on behalf of the Society of Systematic Biologists. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Students' reasoning about "high-energy bonds" and ATP: A vision of interdisciplinary education

NASA Astrophysics Data System (ADS)

Dreyfus, Benjamin W.; Sawtelle, Vashti; Turpen, Chandra; Gouvea, Julia; Redish, Edward F.

2014-06-01

As interdisciplinary courses are developed, instructors and researchers have to grapple with questions of how students should make connections across disciplines. We explore the issue of interdisciplinary reconciliation (IDR): how students reconcile seemingly contradictory ideas from different disciplines. While IDR has elements in common with other frameworks for the reconciliation of ideas across contexts, it differs in that each disciplinary idea is considered canonically correct within its own discipline. The setting for the research is an introductory physics course for biology majors that seeks to build greater interdisciplinary coherence and therefore includes biologically relevant topics such as adenosine triphosphate (ATP) and chemical bond energy. In our case-study data, students grapple with the apparent contradiction between the energy released when the phosphate bond in ATP is broken and the idea that an energy input is required to break a bond. We see students justifying context-dependent modeling choices, showing nuance in articulating how system choices may be related to disciplinary problems of interest. This represents a desired end point of IDR, in which students can build coherent connections between concepts from different disciplines while understanding each concept in its own disciplinary context. Our case study also illustrates elements of the instructional environment that play roles in the process of IDR.

Translation and cultural adaptation of a specific instrument for measuring asthma control and asthma status: the Asthma Control and Communication Instrument

PubMed Central

Tavares, Michelle Gonçalves de Souza; Brümmer, Carolina Finardi; Nicolau, Gabriela Valente; de Melo, José Tavares; Nazário, Nazaré Otilia; Steidle, Leila John Marques; Patino, Cecília Maria; Pizzichini, Marcia Margaret Menezes; Pizzichini, Emílio

2017-01-01

ABSTRACT Objective: To translate the Asthma Control and Communication Instrument (ACCI) to Portuguese and adapt it for use in Brazil. Methods: The ACCI was translated to Portuguese and adapted for use in Brazil in accordance with internationally accepted guidelines. The protocol included the following steps: permission and rights of use granted by the original author; translation of the ACCI from English to Portuguese; reconciliation; back-translation; review and harmonization of the back-translation; approval from the original author; review of the Portuguese version of the ACCI by an expert panel; cognitive debriefing (the clarity, understandability, and acceptability of the translated version being tested in a sample of the target population); and reconciliation and preparation of the final version. Results: During the cognitive debriefing process, 41 asthma patients meeting the inclusion criteria completed the ACCI and evaluated the clarity of the questions/statements. The clarity index for all ACCI items was > 0.9, meaning that all items were considered to be clear. Conclusions: The ACCI was successfully translated to Portuguese and culturally adapted for use in Brazil, the translated version maintaining the psychometric properties of the original version. The ACCI can be used in clinical practice because it is easy to understand and easily applied. PMID:29365000

Medical exclusion of sick children from child care centers: a plea for reconciliation.

PubMed

Pappas, D E; Schwartz, R H; Sheridan, M J; Hayden, G F

2000-06-01

Policies for excluding ill children from child care can affect parental absenteeism from the workplace and the utilization of pediatric health care resources. We surveyed a representative sample of 310 child care centers throughout Virginia to assess policies for excluding children with fever, common upper respiratory tract illnesses, or head lice. Of the 183 center directors (59%) who returned completed surveys, 119 (69%) considered a temperature of 100.0 degrees F to 100.4 degrees F to represent fever, but methods for measuring temperature varied widely. Most centers excluded children with low-grade fever, even in the absence of changes in their behavior. Other low-threshold policies could exclude afebrile children with white nasal or eye discharge and children with hair nits, even after treated with a pediculicidal shampoo. Exclusion policies among child care centers in Virginia vary widely and often are inconsistent with current standards of medical practice. More uniform implementation of exclusion policies established by national consensus panels of experts is needed to reduce unnecessary exclusion of children from child care centers.

Are Military and Medical Ethics Necessarily Incompatible? A Canadian Case Study.

PubMed

Rochon, Christiane; Williams-Jones, Bryn

2016-12-01

Military physicians are often perceived to be in a position of 'dual loyalty' because they have responsibilities towards their patients but also towards their employer, the military institution. Further, they have to ascribe to and are bound by two distinct codes of ethics (i.e., medical and military), each with its own set of values and duties, that could at first glance be considered to be very different or even incompatible. How, then, can military physicians reconcile these two codes of ethics and their distinct professional/institutional values, and assume their responsibilities towards both their patients and the military institution? To clarify this situation, and to show how such a reconciliation might be possible, we compared the history and content of two national professional codes of ethics: the Defence Ethics of the Canadian Armed Forces and the Code of Ethics of the Canadian Medical Association. Interestingly, even if the medical code is more focused on duties and responsibility while the military code is more focused on core values and is supported by a comprehensive ethical training program, they also have many elements in common. Further, both are based on the same core values of loyalty and integrity, and they are broad in scope but are relatively flexible in application. While there are still important sources of tension between and limits within these two codes of ethics, there are fewer differences than may appear at first glance because the core values and principles of military and medical ethics are not so different.

Discharge counseling for patients with heart failure or myocardial infarction: a best practices model developed by members of the American College of Clinical Pharmacy's Cardiology Practice and Research Network based on the Hospital to Home (H2H) Initiative.

PubMed

Wiggins, Barbara S; Rodgers, Jo E; DiDomenico, Robert J; Cook, Abigail M; Page, Robert L

2013-05-01

Hospital to Home is a quality-based initiative led by the American College of Cardiology and the Institute for Healthcare Improvement, aimed at reducing 30-day hospital readmission rates for patients with heart failure or myocardial infarction. Several factors have been shown to attribute to early readmission for these conditions including comorbidities, environmental factors, insufficient discharge planning, lack of health literacy, and nonadherence to drug therapy. Pharmacists play a significant role in reducing readmissions by ensuring that appropriate evidence-based pharmacotherapy regimens have been prescribed during hospitalization; monitoring for drug duplications, medication errors, and adverse reactions; and performing medication reconciliation. Studies have demonstrated the role of pharmacists in reducing medication-related visits to the emergency department as well as hospital readmissions, solely by preventing adverse drug events. Although all of these factors impact early readmissions, providing quality counseling to the patient as well as the patients' caregiver(s) at discharge is critical in order to optimize adherence as well as outcomes. In order to accomplish the goal of reducing readmissions, health care providers must partner together across the continuum of care and include pharmacists as pivotal members of the health care team. In this best practice statement, we summarize key components of discharge counseling for patients with heart failure or myocardial infarction including medication use, medication dose and frequency, drug interactions, medications to avoid, common adverse effects, role of the medication in the disease state, signs and symptoms of the disease, diet, the patient's role in self-care (lifestyle modifications), and when patients should seek medical advice. © 2013 Pharmacotherapy Publications, Inc.

D'Eichthal and Urbain's "Lettres sur la race noire et la race blanche": race, gender, and reconciliation after slave emancipation.

PubMed

Andrews, Naomi J

2011-01-01

This article is a close reading of Gustave D'Eichthal and Ishmayl Urbain's Lettres sur la race noire et la race blanche (1839), written during the decade prior to the "second" French emancipation in 1848. The article argues that the hierarchical gendering of race described in the letters is reflective of metropolitan concerns about potential for social disorder accompanying slave emancipation in the French colonies. In arguing for social reconciliation through interracial marriage and its offspring, the symbolically charged figure of the mulatto, the authors deployed gendered and familial language to describe a stable post-emancipation society.

The green roof dilemma - discussion of Francis and Lorimer (2011).

PubMed

Henry, Alexandre; Frascaria-Lacoste, Nathalie

2012-08-15

Urban ecosystems are the most complex mosaics of vegetative land cover that can be found. In a recent paper, Francis and Lorimer (2011) evaluated the reconciliation potential of living roofs and walls. For these authors, these two techniques for habitat improvement have strong potential for urban reconciliation ecology. However they have some ecological and societal limitations such as the physical extreme environmental characteristics, the monetary investment and the cultural perceptions of urban nature. We are interested in their results and support their conclusions. However, for a considerable time, green roofs have been designed to provide urban greenery for buildings and the green roof market has only focused on extensive roof at a restricted scale within cities. Thus, we have strong doubts about the relevance of their use as possible integrated elements of the network. Furthermore, without dynamic progress in research and the implementation of well-thought-out policies, what will be the real capital gain from green roofs with respect to land-use complementation in cities? If we agree with Francis and Lorimer (2011) considering that urban reconciliation ecology between nature and citizens is a current major challenge, then "adaptive collaborative management" is a fundamental requirement. Copyright © 2012 Elsevier Ltd. All rights reserved.

Outcomes of an Interdisciplinary Transitional Care Quality Improvement Project on Self-Management and Health Care Use in Patients With Heart Failure.

PubMed

Hoover, Carrie; Plamann, Joy; Beckel, Jean

2017-01-01

Heart failure (HF) accounts for most U.S. Medicare hospital admissions. The purpose of the current study was to evaluate the effectiveness of a care transitions quality improvement (QI) intervention on self-management and readmission rates in older adults with HF. A quasi-experimental, descriptive study was conducted with 66 patients with HF in three medical units in a 489-bed Midwestern acute care hospital. The intervention included a nurse coach visit and follow up, pharmacy medication education and reconciliation, and HF clinic referral. Outcomes were assessed within 48 hours of admission and 30 days after discharge using the Self-Care of Heart Failure Index and medical record review. Following implementation, readmission rates decreased from 24% to 13%. Participants demonstrated a greater improvement in use of self-management strategies to control symptoms than the non-intervention group (p < 0.02) and more readily identified their symptoms of HF (p < 0.04). The evolution of population health, with increasing numbers of older adults living at home with complex chronic conditions, will require establishment of active partnerships among pharmacists, physicians, nurse specialists, home care nurses, and patients. [Journal of Gerontological Nursing, 43(1), 23-31.]. Copyright 2016, SLACK Incorporated.

Employer-provided health insurance and the incidence of job lock: a literature review and empirical test.

PubMed

Rashad, Inas; Sarpong, Eric

2008-12-01

The incidence of 'job lock' in the health insurance context has long been viewed as a potential problem with employer-provided health insurance, a concept that was instrumental in the passage of the United States Consolidated Omnibus Budget Reconciliation Act of 1986, and later, the Health Insurance Portability and Accountability Act in 1996. Several recent developments in healthcare in the USA include declining healthcare coverage and a noticeable shift in the burden of medical care costs to employees. If these developments cause employees with employer-provided health insurance to feel locked into their jobs, optimal job matches in the labor force may not take place. A summary of the seminal papers in the current literature on the topic of job lock is given, followed by an empirical exercise using single individuals from the National Health Interview Survey (1997-2003) and the 1979 cohort of the National Longitudinal Survey of Youth (1989-2000). Econometric methods used include difference in differences, ordinary least squares and individual fixed effects models, in gauging the potential effect that employer-provided health insurance may have on job tenure and voluntary job departure. Our findings are consistent with recent assertions that there is some evidence of job lock. Individuals with employer-provided health insurance stay on the job 16% longer and are 60% less likely to voluntarily leave their jobs than those with insurance that is not provided by their employers. Productivity may not be optimal if incentives are altered owing to the existence of fringe benefits, such as health insurance. Further research in this area should determine whether legislation beyond the Consolidated Omnibus Budget Reconciliation Act and Health Insurance Portability and Accountability Act laws is needed.

Current perspectives on the role of the pharmacist in heart failure management

PubMed Central

Cheng, Judy WM

2017-01-01

Pharmacists play an important role within a multidisciplinary health care team in the care of patients with heart failure (HF). It has been evaluated and documented that pharmacists providing medication reconciliation especially during transition of care, educating patients on their medications, and providing collaborative medication management lead to positive changes in the patient outcomes, including but not limited to decreasing in hospitalizations and read-missions. It is foreseeable that pharmacist roles will continue to expand as new treatment and innovative care are developed for HF patients. I reviewed published role of pharmacists in the care of HF patients. MEDLINE and Current Content database (both from 1966 – December 31, 2017) were utilized to identify peer-reviewed clinical trials, descriptive studies, and review articles published in English using the following search terms: pharmacists, clinical pharmacy, HF, and cardiomyopathy. Citations from available articles were also reviewed for additional references. Preliminary search revealed 31 studies and 55 reviews. They were further reviewed by title and abstract as well as full text to remove irrelevant articles. At the end, 24 of these clinical trials and systematic reviews are described in the following text and Table 1 summarizes 16 pertinent clinical trials. Some roles that are currently being explored include medication management in patients with mechanical circulatory support for end-stage HF, where pharmacokinetics and pharmacodynamics of medications can change, medication management in ambulatory intravenous diuretic clinics, and comprehensive medication management in patients’ home settings. Pharmacists should continue to explore and prospectively evaluate their role in the care of this patient population, including documenting their interventions, and impact to economic and patient outcomes. PMID:29594034

Medication discrepancies across multiple care transitions: A retrospective longitudinal cohort study in Italy.

PubMed

Bonaudo, Marco; Martorana, Maria; Dimonte, Valerio; D'Alfonso, Alessandra; Fornero, Giulio; Politano, Gianfranco; Gianino, Maria Michela

2018-01-01

Medication discrepancies are defined as unexplained differences among regimens across different sites of care. The problem of medication discrepancies that occur during the entire care pathway from hospital admission to a local care setting discharge (namely all types of settings dedicated to formal care other than hospitals) has received little attention in the medical literature. The present study aims to (1) determine the prevalence of medication discrepancies that occur during the entire care pathway from hospital admission to local care setting discharge, (2) describe the discrepancy and medication type, and (3) identify potential risk factors for experiencing medication discrepancies in patient care transitions. Evidence from an integrated health care system, such as the Italian one, may explain results from other studies in different healthcare systems. A retrospective longitudinal cohort study of patients admitted from July 2015 to July 2016 to the Giovanni Bosco Hospital serving Turin, Italy and its surrounding territory was performed. Discrepancies were recorded at the following four care transitions: T1: Hospital admission; T2: Hospital discharge; T3: Admission into local care settings; T4: Discharge from local care settings. All evaluations were based on documented regimens and were performed by a team (doctor, nurse and pharmacists). Of 366 included patients, 25.68% had at least one discrepancy. The most frequent type of discrepancy was from medication omission (N = 74; 71.15%). Only discharge from a long-stay care setting (T4) was significantly associated with the onset of discrepancies (p = 0.045). When considering a lack of adequate documentation, not as missing data but as a discrepancy, 43.72% of patients had at least one discrepancy. This study suggests that an integrated health care system, such as Italian system, may influence the prevalence of discrepancies, thus highlighting the need for structured multidisciplinary and, if possible, computerized medication reconciliation to prevent medication discrepancies and improve the quality of medical documentation.

Identification of priorities for improvement of medication safety in primary care: a PRIORITIZE study.

PubMed

Tudor Car, Lorainne; Papachristou, Nikolaos; Gallagher, Joseph; Samra, Rajvinder; Wazny, Kerri; El-Khatib, Mona; Bull, Adrian; Majeed, Azeem; Aylin, Paul; Atun, Rifat; Rudan, Igor; Car, Josip; Bell, Helen; Vincent, Charles; Franklin, Bryony Dean

2016-11-16

Medication error is a frequent, harmful and costly patient safety incident. Research to date has mostly focused on medication errors in hospitals. In this study, we aimed to identify the main causes of, and solutions to, medication error in primary care. We used a novel priority-setting method for identifying and ranking patient safety problems and solutions called PRIORITIZE. We invited 500 North West London primary care clinicians to complete an open-ended questionnaire to identify three main problems and solutions relating to medication error in primary care. 113 clinicians submitted responses, which we thematically synthesized into a composite list of 48 distinct problems and 45 solutions. A group of 57 clinicians randomly selected from the initial cohort scored these and an overall ranking was derived. The agreement between the clinicians' scores was presented using the average expert agreement (AEA). The study was conducted between September 2013 and November 2014. The top three problems were incomplete reconciliation of medication during patient 'hand-overs', inadequate patient education about their medication use and poor discharge summaries. The highest ranked solutions included development of a standardized discharge summary template, reduction of unnecessary prescribing, and minimisation of polypharmacy. Overall, better communication between the healthcare provider and patient, quality assurance approaches during medication prescribing and monitoring, and patient education on how to use their medication were considered the top priorities. The highest ranked suggestions received the strongest agreement among the clinicians, i.e. the highest AEA score. Clinicians identified a range of suggestions for better medication management, quality assurance procedures and patient education. According to clinicians, medication errors can be largely prevented with feasible and affordable interventions. PRIORITIZE is a new, convenient, systematic, and replicable method, and merits further exploration with a view to becoming a part of a routine preventative patient safety monitoring mechanism.

The Unicellular State as a Point Source in a Quantum Biological System

PubMed Central

Torday, John S.; Miller, William B.

2016-01-01

A point source is the central and most important point or place for any group of cohering phenomena. Evolutionary development presumes that biological processes are sequentially linked, but neither directed from, nor centralized within, any specific biologic structure or stage. However, such an epigenomic entity exists and its transforming effects can be understood through the obligatory recapitulation of all eukaryotic lifeforms through a zygotic unicellular phase. This requisite biological conjunction can now be properly assessed as the focal point of reconciliation between biology and quantum phenomena, illustrated by deconvoluting complex physiologic traits back to their unicellular origins. PMID:27240413

Emotions in conflicts: understanding emotional processes sheds light on the nature and potential resolution of intractable conflicts.

PubMed

Halperin, Eran; Tagar, Michal Reifen

2017-10-01

In recent years, researchers have been making substantial advances in understanding the central role of emotions in intractable conflict. We now know that discrete emotions uniquely shape policy preferences in conflict through their unique emotional goals and action tendencies in all stages of conflict including conflict management, conflict resolution and reconciliation. Drawing on this understanding, recent research also points to emotion regulation as a path to reduce conflict and advance peace, exploring both direct and indirect strategies of emotion regulation. Copyright © 2017 Elsevier Ltd. All rights reserved.

Drug therapy problems and medication discrepancies during care transitions in super-utilizers.

PubMed

Surbhi, Satya; Munshi, Kiraat D; Bell, Paula C; Bailey, James E

First, to investigate the prevalence and types of drug therapy problems and medication discrepancies among super-utilizers, and associated patient characteristics. Second, to examine the outcomes of pharmacist recommendations and estimated cost avoidance through care transitions support focused on medication management. Retrospective analysis of the pharmacist-led interventions as part of the SafeMed Program. A large nonprofit health care system serving the major medically underserved areas in Memphis, Tennessee. Three hundred seventy-four super-utilizing SafeMed participants with multiple chronic conditions and polypharmacy. Comprehensive medication review, medication therapy management, enhanced discharge planning, home visits, telephone follow-up, postdischarge medication reconciliation, and care coordination with physicians. Types of drug therapy problems, outcomes of pharmacist recommendations, estimated cost avoided, medication discrepancies, and self-reported medication adherence. Prevalence of drug therapy problems and postdischarge medication discrepancies was 80.7% and 75.4%, respectively. The most frequently occurring drug therapy problems were enrollee not receiving needed medications (33.4%), underuse of medications (16.9%), and insufficient dose or duration (11.2%). Overall 50.8% of the pharmacist recommendations were accepted by physicians and patients, resulting in an estimated cost avoidance of $293.30 per drug therapy problem identified. Multivariate analysis indicated that participants with a higher number of comorbidities were more likely to have medication discrepancies (odds ratio 1.23 [95% CI 1.05-1.44]). Additional contributors to postdischarge medication discrepancies were difficulty picking up and paying for medications and not being given necessary prescriptions before discharge. Drug therapy problems and medication discrepancies are common in super-utilizers with multiple chronic conditions and polypharmacy during transitions of care, and greater levels of comorbidity magnify risk. Pharmacist-led interventions in the SafeMed Program have demonstrated success in resolving enrollees' medication-related issues, resulting in substantial estimated cost savings. Preliminary evidence suggests that the SafeMed model's focus on medication management has great potential to improve outcomes while reducing costs for vulnerable super-utilizing populations nationwide. Copyright © 2016 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

System identification of the JPL micro-precision interferometer truss - Test-analysis reconciliation

NASA Technical Reports Server (NTRS)

Red-Horse, J. R.; Marek, E. L.; Levine-West, M.

1993-01-01

The JPL Micro-Precision Interferometer (MPI) is a testbed for studying the use of control-structure interaction technology in the design of space-based interferometers. A layered control architecture will be employed to regulate the interferometer optical system to tolerances in the nanometer range. An important aspect of designing and implementing the control schemes for such a system is the need for high fidelity, test-verified analytical structural models. This paper focuses on one aspect of the effort to produce such a model for the MPI structure, test-analysis model reconciliation. Pretest analysis, modal testing, and model refinement results are summarized for a series of tests at both the component and full system levels.

Doctor Shopping Behavior for Zolpidem Among Insomnia Patients in Taiwan: A Nationwide Population-Based Study

PubMed Central

Lu, Tzu-Hsuan; Lee, Yen-Ying; Lee, Hsin-Chien; Lin, You-Meei

2015-01-01

Objectives: Although zolpidem is listed as a controlled drug in Taiwan, patients' behavior has not been restricted and has led to the problem of doctor shopping behavior (DSB), leading to overutilization of medical resources and excess spending. The National Health Insurance Administration in Taiwan has instituted a new policy to regulate physicians' prescribing behavior and decrease DSB. This retrospective study aimed to analyze the DSB for zolpidem by insomnia patients and assess related factors. Design and Participants: Data were extracted from the Longitudinal Health Insurance Database in Taiwan. Individuals with a diagnosis of insomnia who received more than one prescription of zolpidem in 2008 were followed for 24 mo. Doctor shopping was defined as ≥ 2 prescriptions by different doctors within ≥ 1 day overlapping in the duration of therapy. The percentage of zolpidem obtained through doctor shopping was used as an indicator of the DSB of each patient. Results: Among the 6,947 insomnia patients who were prescribed zolpidem, 1,652 exhibited DSB (23.78%). The average dose of zolpidem dispensed for each patient during 24 mo was 244.21 daily defined doses. The doctor shopping indicator (DSI) was 0.20 (standard deviation, 0.23) among patients with DSB. Younger age, chronic diseases, high number of diseases, higher premium status, high socioeconomic status, and fewer people served per practicing physicians were all factors significantly related to doctor shopping behavior. Conclusion: Doctor shopping for zolpidem appears to be an important issue in Taiwan. Implementing a proper referral system with efficient data exchange by physician or pharmacist-led medication reconciliation process might reduce DSB. Citation: Lu TH, Lee YY, Lee HC, Lin YM. Doctor shopping behavior for zolpidem among insomnia patients in Taiwan: a nationwide population-based study. SLEEP 2015;38(7):1039–1044. PMID:25761979

A national survey of emergency pharmacy practice in the United States.

PubMed

Thomas, Michael C; Acquisto, Nicole M; Shirk, Mary Beth; Patanwala, Asad E

2016-03-15

The results of a survey to characterize pharmacy practice in emergency department (ED) settings are reported. An electronic survey was sent to all members of the American Society of Health-System Pharmacists' Emergency Medicine Connect group and the American College of Clinical Pharmacy's Emergency Medicine Practice and Research Network. Approximately 400 nontrainee pharmacy practitioners were invited to participate in the survey, which was open for 30 days. Descriptive statistics were used for all analyses. Two hundred thirty-three responses to the survey that were at least partially completed were received. After the removal of duplicate responses and null records, 187 survey responses were retained. The majority of respondents were from community hospitals (59.6%) or academic medical centers (36.1%). A pharmacist's presence in the ED of more than eight hours per day on weekdays and weekends was commonly reported (68.7% of respondents); 49.4% of institutions provided more than eight hours of coverage daily. Nearly one in three institutions (34.8%) provided no weekend ED staffing. The most frequently reported hours of coverage were during the 1 p.m.-midnight time frame. The distribution of ED pharmacist activities, by category, was as follows (data are median reported time commitments): clinical, 25% (interquartile range [IQR], 15-40%); emergency response, 15% (IQR, 10-20%); order processing, 15% (IQR, 5-25%); medication reconciliation/history-taking, 10% (IQR, 5-25%); teaching, 10% (IQR, 5-15%); administrative, 5% (IQR, 3-10%); and scholarly endeavors, 0% (IQR, 0-5%). Pharmacists from academic and community EDs perform a variety of clinical, educational, and administrative activities. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Development of a clinical pharmacy model within an Australian home nursing service using co-creation and participatory action research: the Visiting Pharmacist (ViP) study

PubMed Central

Lee, Cik Yin; Beanland, Christine; Goeman, Dianne P; Petrie, Neil; Petrie, Barbara; Vise, Felicity; Gray, June

2017-01-01

Objective To develop a collaborative, person-centred model of clinical pharmacy support for community nurses and their medication management clients. Design Co-creation and participatory action research, based on reflection, data collection, interaction and feedback from participants and other stakeholders. Setting A large, non-profit home nursing service in Melbourne, Australia. Participants Older people referred to the home nursing service for medication management, their carers, community nurses, general practitioners (GPs) and pharmacists, a multidisciplinary stakeholder reference group (including consumer representation) and the project team. Data collection and analysis Feedback and reflections from minutes, notes and transcripts from: project team meetings, clinical pharmacists’ reflective diaries and interviews, meetings with community nurses, reference group meetings and interviews and focus groups with 27 older people, 18 carers, 53 nurses, 15 GPs and seven community pharmacists. Results The model was based on best practice medication management standards and designed to address key medication management issues raised by stakeholders. Pharmacist roles included direct client care and indirect care. Direct care included home visits, medication reconciliation, medication review, medication regimen simplification, preparation of medication lists for clients and nurses, liaison and information sharing with prescribers and pharmacies and patient/carer education. Indirect care included providing medicines information and education for nurses and assisting with review and implementation of organisational medication policies and procedures. The model allowed nurses to refer directly to the pharmacist, enabling timely resolution of medication issues. Direct care was provided to 84 older people over a 15-month implementation period. Ongoing feedback and consultation, in line with participatory action research principles, informed the development and refinement of the model and identification of enablers and challenges. Conclusions A collaborative, person-centred clinical pharmacy model that addressed the needs of clients, carers, nurses and other stakeholders was successfully developed. The model is likely to have applicability to home nursing services nationally and internationally. PMID:29102998

Need for multiscale planning for conservation of urban bats.

PubMed

Gallo, Travis; Lehrer, Elizabeth W; Fidino, Mason; Kilgour, R Julia; Wolff, Patrick J; Magle, Seth B

2017-11-10

For over a century there have been continual efforts to incorporate nature into urban planning. These efforts (i.e., urban reconciliation) aim to manage and create habitats that support biodiversity within cities. Given that species select habitat at different spatial scales, understanding the scale at which urban species respond to their environment is critical to the success of urban reconciliation efforts. We assessed species-habitat relationships for common bat species at 50-m, 500-m, and 1 km spatial scales in the Chicago (U.S.A.) metropolitan area and predicted bat activity across the greater Chicago region. Habitat characteristics across all measured scales were important predictors of silver-haired bat (Lasionycteris noctivagans) and eastern red bat (Lasiurus borealis) activity, and big brown bat (Eptesicus fuscus) activity was significantly lower at urban sites relative to rural sites. Open vegetation had a negative effect on silver-haired bat activity at the 50-m scale but a positive effect at the 500-m scale, indicating potential shifts in the relative importance of some habitat characteristics at different scales. These results demonstrate that localized effects may be constrained by broader spatial patterns. Our findings highlight the importance of considering scale in urban reconciliation efforts and our landscape predictions provide information that can help prioritize urban conservation work. © 2017 Society for Conservation Biology.

Second generation pressurized fluidized-bed combustion (PFBC) research and development, Phase 2 --- Task 4, carbonizer testing. Volume 2, Data reconciliation

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

Froehlich, R.; Robertson, A.; Vanhook, J.

1994-11-01

During the period beginning November 1991 and ending September 1992, a series of tests were conducted at Foster Wheeler Development Corporation in a fluidized-bed coal carbonizer to determine its performance characteristics. The carbonizer was operated for 533 hours in a jetting fluidized-bed configuration during which 36 set points (steady-state periods) were achieved. Extensive data were collected on the feed and product stream compositions, heating values, temperatures, and flow rates. With these data, elemental and energy balances were computed to evaluate and confirm accuracy of the data. The carbonizer data were not as self-consistent as could be desired (balance closure imperfection).more » A software package developed by Science Ventures, Inc., of California, called BALAID, was used to reconcile the carbonizer data; the details of the reconciliation have been given in Volume 1 of this report. The reconciled data for the carbonizer were rigorously analyzed, correlations were developed, and the model was updated accordingly. The model was then used in simulating each of the 36 steady-state periods achieved in the pilot plant. The details are given in this Volume one. This Volume 2 provides details of the carbonizer data reconciliation.« less

Assessing the Reliability of Material Flow Analysis Results: The Cases of Rhenium, Gallium, and Germanium in the United States Economy.

PubMed

Meylan, Grégoire; Reck, Barbara K; Rechberger, Helmut; Graedel, Thomas E; Schwab, Oliver

2017-10-17

Decision-makers traditionally expect "hard facts" from scientific inquiry, an expectation that the results of material flow analyses (MFAs) can hardly meet. MFA limitations are attributable to incompleteness of flowcharts, limited data quality, and model assumptions. Moreover, MFA results are, for the most part, based less on empirical observation but rather on social knowledge construction processes. Developing, applying, and improving the means of evaluating and communicating the reliability of MFA results is imperative. We apply two recently proposed approaches for making quantitative statements on MFA reliability to national minor metals systems: rhenium, gallium, and germanium in the United States in 2012. We discuss the reliability of results in policy and management contexts. The first approach consists of assessing data quality based on systematic characterization of MFA data and the associated meta-information and quantifying the "information content" of MFAs. The second is a quantification of data inconsistencies indicated by the "degree of data reconciliation" between the data and the model. A high information content and a low degree of reconciliation indicate reliable or certain MFA results. This article contributes to reliability and uncertainty discourses in MFA, exemplifying the usefulness of the approaches in policy and management, and to raw material supply discussions by providing country-level information on three important minor metals often considered critical.

Medication issues experienced by patients and carers after discharge from the intensive care unit.

PubMed

Eijsbroek, Heleen; Howell, David C J; Smith, Felicity; Shulman, Rob

2013-02-01

Medication-related problems (MRPs) frequently occur at the interfaces of care settings. We examined this further because little has been published about MRPs experienced by patients/carers after discharge from the intensive care unit (ICU). Medication history data were collected before, during, and after ICU admission and by face-to-face semistructured interviews with 21 patients and 13 carers attending the ICU Follow-up Clinic (FC) of our 35-bed adult ICU. A total of 122 drugs were prescribed regularly before ICU admission, 168 on ICU discharge, 132 at hospital discharge, and 128 at the FC. Medication-related problems were identified with hypnotics/anxiolytics, antidepressants, proton pump inhibitors, and analgesics. Good follow-up was observed in all 4 cases where the antidysrhythmic agent amiodarone was initiated on ICU. Patients/carers described 20 cases of difficulty in obtaining appropriate and timely supplies and 19 of insufficient information. These results show that our incidence of MRPs after ICU discharge was encouragingly infrequent, in which we attribute it to targeted medicine reconciliation and the availability of our FC. However, MRPs were perceived to stem from inadequate communication at the interfaces of care and the lack of opportunity for patients/carers to obtain relevant information. We recommend that FC should focus on MRPs during their consultation and that further research in this area should be performed to examine our observations further. Copyright © 2013 Elsevier Inc. All rights reserved.

Pharmaceutical orientation at hospital discharge of transplant patients: strategy for patient safety

PubMed Central

Lima, Lívia Falcão; Martins, Bruna Cristina Cardoso; de Oliveira, Francisco Roberto Pereira; Cavalcante, Rafaela Michele de Andrade; Magalhães, Vanessa Pinto; Firmino, Paulo Yuri Milen; Adriano, Liana Silveira; da Silva, Adriano Monteiro; Flor, Maria Jose Nascimento; Néri, Eugenie Desirée Rabelo

2016-01-01

ABSTRACT Objective: To describe and analyze the pharmaceutical orientation given at hospital discharge of transplant patients. Methods: This was a cross-sectional, descriptive and retrospective study that used records of orientation given by the clinical pharmacist in the inpatients unit of the Kidney and Liver Transplant Department, at Hospital Universitário Walter Cantídio, in the city of Fortaleza (CE), Brazil, from January to July, 2014. The following variables recorded at the Clinical Pharmacy Database were analyzed according to their significance and clinical outcomes: pharmaceutical orientation at hospital discharge, drug-related problems and negative outcomes associated with medication, and pharmaceutical interventions performed. Results: The first post-transplant hospital discharge involved the entire multidisciplinary team and the pharmacist was responsible for orienting about drug therapy. The mean hospital discharges/month with pharmaceutical orientation during the study period was 10.6±1.3, totaling 74 orientations. The prescribed drug therapy had a mean of 9.1±2.7 medications per patient. Fifty-nine drug-related problems were identified, in which 67.8% were related to non-prescription of medication needed, resulting in 89.8% of risk of negative outcomes associated with medications due to untreated health problems. The request for inclusion of drugs (66.1%) was the main intervention, and 49.2% of the medications had some action in the digestive tract or metabolism. All interventions were classified as appropriate, and 86.4% of them we able to prevent negative outcomes. Conclusion: Upon discharge of a transplanted patient, the orientation given by the clinical pharmacist together with the multidisciplinary team is important to avoid negative outcomes associated with drug therapy, assuring medication reconciliation and patient safety. PMID:27759824

Clinical Pharmacy Consultations Provided by American and Kenyan Pharmacy Students During an Acute Care Advanced Pharmacy Practice Experience

PubMed Central

Pastakia, Sonak D.; Manji, Imran; Kamau, Evelyn; Schellhase, Ellen M.

2011-01-01

Objective To compare the clinical consultations provided by American and Kenyan pharmacy students in an acute care setting in a developing country. Methods The documented pharmacy consultation recommendations made by American and Kenyan pharmacy students during patient care rounds on an advanced pharmacy practice experience at a referral hospital in Kenya were reviewed and classified according to type of intervention and therapeutic area. Results The Kenyan students documented more interventions than American students (16.7 vs. 12.0 interventions/day) and provided significantly more consultations regarding human immunodeficiency virus (HIV) and antibiotics. The top area of consultations provided by American students was cardiovascular diseases. Conclusions American and Kenyan pharmacy students successfully providing clinical pharmacy consultations in a resource-constrained, acute-care practice setting suggests an important role for pharmacy students in the reconciliation of prescriber orders with medication administration records and in providing drug information. PMID:21655396

Medicare program; offset of Medicare payments to individuals to collect past-due obligations arising from breach of scholarship and loan contracts--HCFA. Final rule.

PubMed

1992-05-04

This final rule sets forth the procedures to be followed for collection of past-due amounts owed by individuals who breached contracts under certain scholarship and loan programs. The programs that would be affected are the National Health Service Corps Scholarship, the Physician Shortage Area Scholarship, and the Health Education Assistance Loan. These procedures would apply to those individuals who breached contracts under the scholarship and loan programs and who-- Accept Medicare assignment for services; Are employed by or affiliated with a provider, Health Maintenance Organization, or Competitive Medical Plan that receives Medicare payment for services; or Are members of a group practice that receives Medicare payment for services. This regulation implements section 1892 of the Social Security Act, as added by section 4052 of the Omnibus Budget Reconciliation Act of 1987.

Redefining the Practice of Peer Review Through Intelligent Automation Part 1: Creation of a Standardized Methodology and Referenceable Database.

PubMed

Reiner, Bruce I

2017-10-01

Conventional peer review practice is compromised by a number of well-documented biases, which in turn limit standard of care analysis, which is fundamental to determination of medical malpractice. In addition to these intrinsic biases, other existing deficiencies exist in current peer review including the lack of standardization, objectivity, retrospective practice, and automation. An alternative model to address these deficiencies would be one which is completely blinded to the peer reviewer, requires independent reporting from both parties, utilizes automated data mining techniques for neutral and objective report analysis, and provides data reconciliation for resolution of finding-specific report differences. If properly implemented, this peer review model could result in creation of a standardized referenceable peer review database which could further assist in customizable education, technology refinement, and implementation of real-time context and user-specific decision support.

Benefits of lethal pandemics: direct impact of contagious diseases on public administration in Hungary (1867-1914).

PubMed

Palvolgyi, Balazs

2013-01-01

The reconciliation of 1867 between Austria and Hungary brought great changes to Hungarian public administration: the way towards the building up of a modern public administration had been opened. Although there was a functioning public health system and a related legislation from the late 18th century, major issues - such as balanced geographical distribution of medical personnel, fair access to medical services even in the poorer regions of the country, and the effective protection against some contagious diseases - were not resolved for decades. During the reform work of public administration since the 1870s, the lawmakers touched repeatedly the framework and functioning of the public health as well. Although the general conditions of the domain depended traditionally on the municipalities and counties due to the national importance of the matter, the government made efforts to make the functioning of the public health more efficient through centralisation. The contagious diseases continuously endangered the population, revealing the weak points in the existing public health system, thereby giving a momentum to the reforms and helping the government in its organization of prevention and clearly contributing to the legislation work.

Medicare program; payment policies under the physician fee schedule, five-year review of work relative value units, clinical laboratory fee schedule: signature on requisition, and other revisions to part B for CY 2012. Final rule with comment period.

PubMed

2011-11-28

This final rule with comment period addresses changes to the physician fee schedule and other Medicare Part B payment policies to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services. It also addresses, implements or discusses certain statutory provisions including provisions of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008. In addition, this final rule with comment period discusses payments for Part B drugs; Clinical Laboratory Fee Schedule: Signature on Requisition; Physician Quality Reporting System; the Electronic Prescribing (eRx) Incentive Program; the Physician Resource-Use Feedback Program and the value modifier; productivity adjustment for ambulatory surgical center payment system and the ambulance, clinical laboratory, and durable medical equipment prosthetics orthotics and supplies (DMEPOS) fee schedules; and other Part B related issues.

Improve SSME power balance model

NASA Technical Reports Server (NTRS)

Karr, Gerald R.

1992-01-01

Effort was dedicated to development and testing of a formal strategy for reconciling uncertain test data with physically limited computational prediction. Specific weaknesses in the logical structure of the current Power Balance Model (PBM) version are described with emphasis given to the main routing subroutines BAL and DATRED. Selected results from a variational analysis of PBM predictions are compared to Technology Test Bed (TTB) variational study results to assess PBM predictive capability. The motivation for systematic integration of uncertain test data with computational predictions based on limited physical models is provided. The theoretical foundation for the reconciliation strategy developed in this effort is presented, and results of a reconciliation analysis of the Space Shuttle Main Engine (SSME) high pressure fuel side turbopump subsystem are examined.

Long-distance continuous-variable quantum key distribution with a Gaussian modulation

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

Jouguet, Paul; SeQureNet, 23 avenue d'Italie, F-75013 Paris; Kunz-Jacques, Sebastien

2011-12-15

We designed high-efficiency error correcting codes allowing us to extract an errorless secret key in a continuous-variable quantum key distribution (CVQKD) protocol using a Gaussian modulation of coherent states and a homodyne detection. These codes are available for a wide range of signal-to-noise ratios on an additive white Gaussian noise channel with a binary modulation and can be combined with a multidimensional reconciliation method proven secure against arbitrary collective attacks. This improved reconciliation procedure considerably extends the secure range of a CVQKD with a Gaussian modulation, giving a secret key rate of about 10{sup -3} bit per pulse at amore » distance of 120 km for reasonable physical parameters.« less

Development of a computerized monitoring program to identify narcotic diversion in a pediatric anesthesia practice.

PubMed

Brenn, B Randall; Kim, Margaret A; Hilmas, Elora

2015-08-15

Development of an operational reporting dashboard designed to correlate data from multiple sources to help detect potential drug diversion by automated dispensing cabinet (ADC) users is described. A commercial business intelligence platform was used to create a dashboard tool for rapid detection of unusual patterns of ADC transactions by anesthesia service providers at a large pediatric hospital. By linking information from the hospital's pharmacy information management system (PIMS) and anesthesia information management system (AIMS) in an associative data model, the "narcotic reconciliation dashboard" can generate various reports to help spot outlier activity associated with ADC dispensing of controlled substances and documentation of medication waste processing. The dashboard's utility was evaluated by "back-testing" the program with historical data on an actual episode of diversion by an anesthesia provider that had not been detected through traditional methods of PIMS and AIMS data monitoring. Dashboard-generated reports on key metrics (e.g., ADC transaction counts, discrepancies in dispensed versus reconciled amounts of narcotics, PIMS-AIMS documentation mismatches) over various time frames during the period of known diversion clearly indicated the diverter's outlier status relative to other authorized ADC users. A dashboard program for correlating ADC transaction data with pharmacy and patient care data may be an effective tool for detecting patterns of ADC use that suggest drug diversion. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Reconciling medical expenditure estimates from the MEPS and NHEA, 2007.

PubMed

Bernard, Didem; Cowan, Cathy; Selden, Thomas; Cai, Liming; Catlin, Aaron; Heffler, Stephen

2012-01-01

Provide a comparison of health care expenditure estimates for 2007 from the Medical Expenditure Panel Survey (MEPS) and the National Health Expenditure Accounts (NHEA). Reconciling these estimates serves two important purposes. First, it is an important quality assurance exercise for improving and ensuring the integrity of each source's estimates. Second, the reconciliation provides a consistent baseline of health expenditure data for policy simulations. Our results assist researchers to adjust MEPS to be consistent with the NHEA so that the projected costs as well as budgetary and tax implications of any policy change are consistent with national health spending estimates. The Medical Expenditure Panel Survey produced by the Agency for Healthcare Research and Quality, and the National Health Center for Health Statistics and the National Health Expenditures produced by the Centers for Medicare & Medicaid Service's Office of the Actuary. In this study, we focus on the personal health care (PHC) sector, which includes the goods and services rendered to treat or prevent a specific disease or condition in an individual. The official 2007 NHEA estimate for PHC spending is $1,915 billion and the MEPS estimate is $1,126 billion. Adjusting the NHEA estimates for differences in underlying populations, covered services, and other measurement concepts reduces the NHEA estimate for 2007 to $1,366 billion. As a result, MEPS is $240 billion, or 17.6 percent, less than the adjusted NHEA total.

Adapting Western research methods to indigenous ways of knowing.

PubMed

Simonds, Vanessa W; Christopher, Suzanne

2013-12-01

Indigenous communities have long experienced exploitation by researchers and increasingly require participatory and decolonizing research processes. We present a case study of an intervention research project to exemplify a clash between Western research methodologies and Indigenous methodologies and how we attempted reconciliation. We then provide implications for future research based on lessons learned from Native American community partners who voiced concern over methods of Western deductive qualitative analysis. Decolonizing research requires constant reflective attention and action, and there is an absence of published guidance for this process. Continued exploration is needed for implementing Indigenous methods alone or in conjunction with appropriate Western methods when conducting research in Indigenous communities. Currently, examples of Indigenous methods and theories are not widely available in academic texts or published articles, and are often not perceived as valid.

Financial management and dental school equity, Part II: Tactics.

PubMed

Chambers, David W; Bergstrom, Roy

2004-04-01

Financial management includes all processes that build organizations' equity through accumulating assets in strategically important areas. The tactical aspects of financial management are budget deployment and monitoring. Budget deployment is the process of making sure that costs are fairly allocated. Budget monitoring addresses issues of effective uses and outcomes of resources. This article describes contemporary deployment and monitoring mechanisms, including revenue positive and marginal analysis, present value, program phases, options logic, activity-based costing, economic value added, cost of quality, variance reconciliation, and balanced scorecards. The way financial decisions are framed affects comparative decision-making and even influences the arithmetic of accounting. Familiarity with these concepts should make it possible for dental educators to more fully participate in discussions about the relationships between budgeting and program strategy.

Patient Protection and Affordable Care Act; standards related to essential health benefits, actuarial value and accreditation. Final rule.

PubMed

2013-02-25

This final rule sets forth standards for health insurance issuers consistent with title I of the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010, referred to collectively as the Affordable Care Act. Specifically, this final rule outlines Exchange and issuer standards related to coverage of essential health benefits and actuarial value. This rule also finalizes a timeline for qualified health plans to be accredited in Federally-facilitated Exchanges and amends regulations providing an application process for the recognition of additional accrediting entities for purposes of certification of qualified health plans.

When Patients Divorce: The Family Physician's Legal Position

PubMed Central

Mesbur, Ruth E.

1983-01-01

When divorce and family disintegration loom, the family physician is often the first outsider on the scene. The family physician may, indeed, have a critical role to play in handling the crisis; he may advise, refer to other professionals like therapists or lawyers, or appear in court as an expert witness. The physician must consider his legal position. Is reconciliation counselling confidential, privileged information? Can he recommend a lawyer for a patient? What is the physician's vulnerability as an expert witness in divorce and custody proceedings? Knowledge, understanding and skillful handling of the legal and human processes involved can limit family destruction and help maintain the physician/patient relationship. PMID:21283420

Business Process Flow Diagrams in Tissue Bank Informatics System Design, and Identification and Communication of Best Practices: The Pharmaceutical Industry Experience.

PubMed

McDonald, Sandra A; Velasco, Elizabeth; Ilasi, Nicholas T

2010-12-01

Pfizer, Inc.'s Tissue Bank, in conjunction with Pfizer's BioBank (biofluid repository), endeavored to create an overarching internal software package to cover all general functions of both research facilities, including sample receipt, reconciliation, processing, storage, and ordering. Business process flow diagrams were developed by the Tissue Bank and Informatics teams as a way of characterizing best practices both within the Bank and in its interactions with key internal and external stakeholders. Besides serving as a first step for the software development, such formalized process maps greatly assisted the identification and communication of best practices and the optimization of current procedures. The diagrams shared here could assist other biospecimen research repositories (both pharmaceutical and other settings) for comparative purposes or as a guide to successful informatics design. Therefore, it is recommended that biorepositories consider establishing formalized business process flow diagrams for their laboratories, to address these objectives of communication and strategy.

Cuba Reconciliation Act

THOMAS, 111th Congress

Rep. Serrano, Jose E. [D-NY-16

2009-01-06

House - 01/14/2009 Referred to the Subcommittee on Communications, Technology, and the Internet. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

Software control and system configuration management - A process that works

NASA Technical Reports Server (NTRS)

Petersen, K. L.; Flores, C., Jr.

1983-01-01

A comprehensive software control and system configuration management process for flight-crucial digital control systems of advanced aircraft has been developed and refined to insure efficient flight system development and safe flight operations. Because of the highly complex interactions among the hardware, software, and system elements of state-of-the-art digital flight control system designs, a systems-wide approach to configuration control and management has been used. Specific procedures are implemented to govern discrepancy reporting and reconciliation, software and hardware change control, systems verification and validation testing, and formal documentation requirements. An active and knowledgeable configuration control board reviews and approves all flight system configuration modifications and revalidation tests. This flexible process has proved effective during the development and flight testing of several research aircraft and remotely piloted research vehicles with digital flight control systems that ranged from relatively simple to highly complex, integrated mechanizations.

Impact of pharmacist interventions in older patients: a prospective study in a tertiary hospital in Germany

PubMed Central

Cortejoso, L; Dietz, RA; Hofmann, G; Gosch, M; Sattler, A

2016-01-01

Background Inappropriate pharmacotherapy among older adults remains a critical issue in our health care systems. Besides polypharmacy and multiple comorbidities, the age-related pharmacokinetic and pharmacodynamic changes may increase the risk of adverse drug reactions and medication errors. Objective The main target of this study was to describe the characteristics of pharmaceutical interventions in two geriatric wards (orthogeriatric ward and geriatric day unit) of a general teaching hospital and to evaluate the clinical significance of the detected medication errors. Materials and methods The study was conducted between August 2014 and October 2015 and was based on a triple approach that included validation of medical orders, medication reconciliation at patients’ admission, and a predischarge planning appointment with the patient. The validation of medical orders was based on analyzing the suitability of the drugs prescribed, the drug dose depending on the patient’s characteristics, the presence of contraindications and interactions between drugs, and the proposal of alternative drugs included in the hospital formulary. Results A total of 2,307 interventions associated to a medication error in 15,282 medical orders for 1,859 older patients were recorded. The greater part of the interventions carried out on the orthogeriatric ward at admission and at discharge were due to omission of a drug in the medical order (20.0%) and clinically significant interactions requiring monitoring (30.4%), respectively. The main factor triggering pharmacist’s recommendations on the geriatric day unit was clinically significant interactions (21.1%). With regard to the clinical severity of the detected errors, 68.1% were considered significant, 24.8% were of minor significance, and 7.2% were clinically serious. Conclusion Our findings show the importance of clinical pharmacist involvement in the optimization of pharmacotherapy in older adults, ensuring that they receive effective, safe, and efficient drug therapy. PMID:27713625

Etymology and Modern Linguistics

ERIC Educational Resources Information Center

Malkiel, Yakov

1975-01-01

Discusses the estrangement between etymology and modern linguistics, and concludes that a reconciliation between spatio-temporal linguistics and etymology must occur, because without it, both disciplines are doomed to inanition. (Author/AM)

Fitness extraction and the conceptual foundations of political biology.

PubMed

Boari, Mircea

2005-01-01

In well known formulations, political science, classical and neoclassical economics, and political economy have recognized as foundational a human impulse toward self-preservation. To employ this concept, modern social-sciences theorists have made simplifying assumptions about human nature and have then built elaborately upon their more incisive simplifications. Advances in biology, including advances in evolutionary theory, notably inclusive-fitness theory, have for decades now encouraged the reconsideration of such assumptions and, more ambitiously, the reconciliation of the social and life sciences. I ask if this reconciliation is feasible and test a path to the unification of politics and biology, called here "political biology." Two new notions, "fitness extraction" and "fitness exchange," are defined, then differentiated from each other, and lastly contrasted to cooperative gaming, the putative essential element of economics.

36 CFR 254.9 - Appraisals.

Code of Federal Regulations, 2013 CFR

2013-07-01

... comparative market analysis and, if more than one method of valuation is used, an analysis and reconciliation... conclusions contained in the appraisal report; and (11) Copies of relevant written reports, studies, or...

36 CFR 254.9 - Appraisals.

Code of Federal Regulations, 2011 CFR

2011-07-01

... comparative market analysis and, if more than one method of valuation is used, an analysis and reconciliation... conclusions contained in the appraisal report; and (11) Copies of relevant written reports, studies, or...

36 CFR 254.9 - Appraisals.

Code of Federal Regulations, 2014 CFR

2014-07-01

... comparative market analysis and, if more than one method of valuation is used, an analysis and reconciliation... conclusions contained in the appraisal report; and (11) Copies of relevant written reports, studies, or...

36 CFR 254.9 - Appraisals.

Code of Federal Regulations, 2012 CFR

2012-07-01

... comparative market analysis and, if more than one method of valuation is used, an analysis and reconciliation... conclusions contained in the appraisal report; and (11) Copies of relevant written reports, studies, or...

36 CFR 254.9 - Appraisals.

Code of Federal Regulations, 2010 CFR

2010-07-01

... comparative market analysis and, if more than one method of valuation is used, an analysis and reconciliation... conclusions contained in the appraisal report; and (11) Copies of relevant written reports, studies, or...

24 CFR 85.4 - Applicability.

Code of Federal Regulations, 2011 CFR

2011-04-01

... the Omnibus Budget Reconciliation Act of 1981 (Community Services; Preventive Health and Health... following programs of The Child Nutrition Act of 1966: (i) Special Milk (section 3 of the Act), and (ii...

24 CFR 85.4 - Applicability.

Code of Federal Regulations, 2014 CFR

2014-04-01

... the Omnibus Budget Reconciliation Act of 1981 (Community Services; Preventive Health and Health... following programs of The Child Nutrition Act of 1966: (i) Special Milk (section 3 of the Act), and (ii...

24 CFR 85.4 - Applicability.

Code of Federal Regulations, 2013 CFR

2013-04-01

... the Omnibus Budget Reconciliation Act of 1981 (Community Services; Preventive Health and Health... following programs of The Child Nutrition Act of 1966: (i) Special Milk (section 3 of the Act), and (ii...

24 CFR 85.4 - Applicability.

Code of Federal Regulations, 2012 CFR

2012-04-01

... the Omnibus Budget Reconciliation Act of 1981 (Community Services; Preventive Health and Health... following programs of The Child Nutrition Act of 1966: (i) Special Milk (section 3 of the Act), and (ii...

Completeness of patient records in community pharmacies post-discharge after in-patient medication reconciliation: a before-after study.

PubMed

Karapinar-Çarkıt, Fatma; van Breukelen, Ben R L; Borgsteede, Sander D; Janssen, Marjo J A; Egberts, Antoine C G; van den Bemt, Patricia M L A

2014-08-01

Transfer of discharge medication related information to community pharmacies could improve continuity of care. This requires for community pharmacies to accurately update their patient records when new information is transferred. An instruction manual that specifies how to document information regarding medication changes and clinical information (i.e. allergies/contraindications) could support community pharmacies. To explore the effect of instruction manuals sent to community pharmacies on completeness of their patient records. A before-after study was performed (July 2009-August 2010) in the St Lucas Andreas Hospital, a general teaching hospital in Amsterdam, The Netherlands. Patients discharged from the cardiology and respiratory ward were included consecutively. The intervention consisted of a training session for community pharmacies regarding documentation problems and faxing an instruction manual to community pharmacies specifying how to document discharge information in their information system. Usual care consisted of faxing a discharge medication overview to community pharmacies without additional instructions. Two weeks after discharge the medication records of community pharmacies were collected by fax. These were compared with the initial discharge overviews regarding completeness of medication changes (i.e. explicit explanation that medication had been changed) and clinical information documentation. MAIN OUTCOME MEASURE OUTCOMES: were the number and percentage of completely documented medication changes (either needing to be dispensed or not) and clinical information items. The sample size was calculated at 107 patients per measurement period. Multivariable logistic regression was used for analysis. Two hundred and eighteen patients (112 before-106 after) were included. Completeness of medication changes documentation increased marginally after the intervention (46.6 vs 56.3 %, adjusted Odds Ratio 1.4 [95 % confidence interval 1.07-1.83]). Documentation increased when medication was actually dispensed by the community pharmacy. No significant improvements were seen for allergy and contraindication documentation. The intervention is insufficient to increase the completeness of documentation by community pharmacies as marginal improvements were achieved. Future studies should evaluate whether electronic infrastructures may help in achieving updated medication records to improve continuity of pharmaceutical care.

Analysis of lawsuit cases in the Department of Surgery in Korea

PubMed Central

Jung, Ji Yun; Kim, So Yoon; Kim, Dong Gyu; Kim, Choong Bai; Chi, Kyong-Choun; Kang, Won Kyung

2018-01-01

Purpose The aim of this study is to prepare medical staff in order to prevent medical malpractice litigation through analysis of litigation cases related to the department of surgery in Korea. Methods A total of 94 litigation cases related to the department of surgery, where a certain amount of payment was ordered to the defendant between 2005 through 2010, were analyzed. We examined time of occurrence, amount claimed and awarded in damages, plaintiff claims, and court opinion. Results An average of 3.2 years was spent from the date of the incident occurring to the end of the litigation procedures. The average amount awarded in judgments for damages was 59,708,983 ± 67,307,264 (range, 1,700,000–365,201,482) Korean won. Cases were found involving the following opinion of the court: violation of duty of care (49 cases), violation of informed consent (7 cases), violation of duty of care and informed consent (5 cases), and settlement, reconciliation, and others (32 cases). By analyzing defendants' negligence in court opinions, diagnosis (30.8%) was the most common, followed by post-operation management (27.7%). Conclusion Physicians have to conduct treatment and surgery based on exact diagnosis and be careful to observe patients' conditions and symptoms after surgery. It is essential to identify the current status and characteristics of medical litigation for reducing further litigation and improving patient safety. In order to create a safe medical environment, national efforts should be made not only by individuals but also at the national level. PMID:29520344

Qualitative differences between traditional and rural-longitudinal medical student OSCE performance.

PubMed

Zink, Therese; Power, David V; Olson, Kenneth; Harris, Ilene B; Brooks, Kathleen D

2010-01-01

To ensure adequate observation, supervision, and mentoring of trainees, long-term preceptorships or apprenticeships are being reestablished in medical education. Equivalence in academic performance has been demonstrated between longitudinal students in the Rural Physician Associate Program (RPAP), who spend 9 months in a rural community during their third year of medical school, and their peers who complete their clerkships at different hospitals and clinics (traditional). We qualitatively reviewed the end of session Objective Structured Clinical Examination (OSCE) for both groups and compared their performances. The high and low performers on four OSCE scenarios (cough, dysuria in a teen, preventive care in an older male, medication reconciliation) for two cohorts of students: longitudinal (n=47) and traditional primary care clerkship students (n=60) were selected for review. These 16 videotapes were reviewed independently by three researchers. The themes and subthemes were discussed over four meetings. Both high and low scoring longitudinal students demonstrated more consistent use of rapport building skills. Longitudinal students appeared to have an effective pattern in their patient interactions and were more rehearsed at explaining preventive care recommendations such as the pros and cons of the prostate-specific antigen (PSA) test. Traditional students displayed a more complete mastery of the adolescent interview and followed a mnemonic taught during lecture. Qualitative assessment of OSCE data reveals information not captured in the quantitative scores. In this study, longitudinal students demonstrated better mastery of rapport building and content knowledge and had an effective routine to their patient encounters not evident in the traditional students' scenarios.

Enabling medication management through health information technology (Health IT).

PubMed

McKibbon, K Ann; Lokker, Cynthia; Handler, Steve M; Dolovich, Lisa R; Holbrook, Anne M; O'Reilly, Daria; Tamblyn, Robyn; J Hemens, Brian; Basu, Runki; Troyan, Sue; Roshanov, Pavel S; Archer, Norman P; Raina, Parminder

2011-04-01

The objective of the report was to review the evidence on the impact of health information technology (IT) on all phases of the medication management process (prescribing and ordering, order communication, dispensing, administration and monitoring as well as education and reconciliation), to identify the gaps in the literature and to make recommendations for future research. We searched peer-reviewed electronic databases, grey literature, and performed hand searches. Databases searched included MEDLINE®, Embase, CINAHL (Cumulated Index to Nursing and Allied Health Literature), Cochrane Database of Systematic Reviews, International Pharmaceutical Abstracts, Compendex, Inspec (which includes IEEE Xplore), Library and Information Science Abstracts, E-Prints in Library and Information Science, PsycINFO, Sociological Abstracts, and Business Source Complete. Grey literature searching involved Internet searching, reviewing relevant Web sites, and searching electronic databases of grey literatures. AHRQ also provided all references in their e-Prescribing, bar coding, and CPOE knowledge libraries. Paired reviewers looked at citations to identify studies on a range of health IT used to assist in the medication management process (MMIT) during multiple levels of screening (titles and abstracts, full text and final review for assignment of questions and data abstrction). Randomized controlled trials and cohort, case-control, and case series studies were independently assessed for quality. All data were abstracted by one reviewer and examined by one of two different reviewers with content and methods expertise. 40,582 articles were retrieved. After duplicates were removed, 32,785 articles were screened at the title and abstract phase. 4,578 full text articles were assessed and 789 articles were included in the final report. Of these, 361 met only content criteria and were listed without further abstraction. The final report included data from 428 articles across the seven key questions. Study quality varied according to phase of medication management. Substantially more studies, and studies with stronger comparative methods, evaluated prescribing and monitoring. Clinical decision support systems (CDSS) and computerized provider order entry (CPOE) systems were studied more than any other application of MMIT. Physicians were more often the subject of evaluation than other participants. Other health care professionals, patients, and families are important but not studied as thoroughly as physicians. These nonphysicians groups often value different aspects of MMIT, have diverse needs, and use systems differently. Hospitals and ambulatory clinics were well-represented in the literature with less emphasis placed on long-term care facilities, communities, homes, and nonhospital pharmacies. Most studies evaluated changes in process and outcomes of use, usability, and knowledge, skills, and attitudes. Most showed moderate to substantial improvement with implementation of MMIT. Economics studies and those with clinical outcomes were less frequently studied. Those articles that did address economics and clinical outcomes often showed equivocal findings on the effectiveness and cost-effectiveness of MMIT systems. Qualitative studies provided evidence of strong perceptions, both positive and negative, of the effects of MMIT and unintended consequences. We found little data on the effects of forms of medications, conformity, standards, and open source status. Much descriptive literature discusses implementation issues but little strong evidence exists. Interest is strong in MMIT and more groups and institutions will implement systems in the next decades, especially with the Federal Government's push toward more health IT to support better and more cost-effective health care. MMIT is well-studied, although on closer examination of the literature the evidence is not uniform across phases of medication management, groups of people involved, or types of MMIT. MMIT holds the promise of improved processes; clinical and economics studies and the understanding of sustainability issues are lacking.

49 CFR 18.4 - Applicability.

Code of Federal Regulations, 2014 CFR

2014-10-01

...) The block grants authorized by the Omnibus Budget Reconciliation Act of 1981 (Community Services... under the following programs of The Child Nutrition Act of 1966: (i) Special Milk (section 3 of the Act...

38 CFR 43.4 - Applicability.

Code of Federal Regulations, 2013 CFR

2013-07-01

... State and local hospitals. (2) The block grants authorized by the Omnibus Budget Reconciliation Act of...) Entitlement grants under the following programs of The Child Nutrition Act of 1966: (i) Special Milk (section...

Identifying barriers to medication discharge counselling by pharmacists.

PubMed

Walker, Sandra A N; Lo, Jennifer K; Compani, Sara; Ko, Emily; Le, Minh-Hien; Marchesano, Romina; Natanson, Rimona; Pradhan, Rahim; Rzyczniak, Grace; Teo, Vincent; Vyas, Anju

2014-05-01

Medication errors may occur more frequently at discharge, making discharge counselling a vital facet of medication reconciliation. Discharge counselling is a recognized patient safety initiative for which pharmacists have appropriate expertise, but data are lacking about the barriers to provision of this service to adult inpatients by pharmacists. To determine the proportion of eligible patients who received discharge counselling, to quantify perceived barriers preventing pharmacists from performing discharge counselling, and to determine the relative frequency of barriers and associated time expenditures. In this prospective study, 8 pharmacists working in general medicine, medical oncology, or nephrology wards of an acute care hospital completed a survey for each of the first 50 patients eligible for discharge counselling on their respective wards from June 2010 to February 2011. Patients discharged to another facility (rehabilitation, palliative care, or long-term care), those with hospital stay less than 48 h before discharge, and those whose medications were unchanged from hospital admission were ineligible. Discharge counselling was performed for 116 (29%) of the 403 eligible patients and involved a median preparation time of 25 min and median counselling time of 15 min per patient. At least one documented barrier to discharge counselling existed for 295 (73%) of the patients. Several barriers to discharge counselling occurred significantly more frequently on the general medicine and oncology wards than on the nephrology ward (p < 0.05). The most common barrier was failure to notify the pharmacist about impending patient discharge (130/313 [41%]). Time constraints existed for 130 (32%) of the patients, the most common related to clarification of prescriptions (96 [24%]), creation of a medication list (69 [17%]), and faxing of prescriptions (64 [16%]). This study generated objective data about the barriers to and time constraints associated with medication discharge counselling by pharmacists. These findings should raise awareness of the challenges faced by pharmacists in busy hospital positions and may support avenues of change for their hospital discharge counselling programs.

Factors Influencing Enrollment in the Medication Therapy Management Clinic at an Academic Ambulatory Care Clinic.

PubMed

Shah, Mansi; Tilton, Jessica; Kim, Shiyun

2016-04-01

In 2001, the University of Illinois Hospital and Health Sciences System (UI Health) established a pharmacist-run, referral-based medication therapy management clinic (MTMC). Referrals are obtained from any UI Health provider or by self-referral. Although there is a high volume of referrals, a large percentage of patients do not enroll. This study was designed to determine the various factors that influence patient enrollment in the MTMC. This study was a retrospective chart review of demographic and patient variable data during years 2010 and 2011. Disabilities, distance from MTMC, mode of transportation, past medical history, and appointment dates were extracted from the medical records. Results were analyzed using descriptive statistics and logistic regression analysis. A total of 103 referrals were made; however, only 17% of patients remain enrolled in MTMC. The baseline demographics included a mean age of 63 years, 68% female, 70% African American, and 81% English speaking. Patients lived an average of 8 miles from MTMC; most utilized public or government-supplemented transport services; 24% of patients reported some type of disability, most commonly utilizing a walker or a wheelchair. On average, patients were prescribed 13 medications with hypertension (70%), diabetes (56%), and hyperlipidemia (48%) being the most common chronic disease states. The reason for referral included medication management, education, medication reconciliation, and disease state management. Five patients were unable to be contacted to schedule an initial appointment. Additionally, 18 patients failed their scheduled initial appointment and did not reschedule. Logistic regression analysis demonstrated distance traveled for clinic visit, age, and history of hypertension affected the probability of patients showing for their appointments (chi-square = 19.7, P < .001). This study demonstrated that distance from MTMC is the most common barrier in patient enrollment; therefore, strategies to improve patient access are necessary. © The Author(s) 2014.

Implementation of continuous-variable quantum key distribution with discrete modulation

NASA Astrophysics Data System (ADS)

Hirano, Takuya; Ichikawa, Tsubasa; Matsubara, Takuto; Ono, Motoharu; Oguri, Yusuke; Namiki, Ryo; Kasai, Kenta; Matsumoto, Ryutaroh; Tsurumaru, Toyohiro

2017-06-01

We have developed a continuous-variable quantum key distribution (CV-QKD) system that employs discrete quadrature-amplitude modulation and homodyne detection of coherent states of light. We experimentally demonstrated automated secure key generation with a rate of 50 kbps when a quantum channel is a 10 km optical fibre. The CV-QKD system utilises a four-state and post-selection protocol and generates a secure key against the entangling cloner attack. We used a pulsed light source of 1550 nm wavelength with a repetition rate of 10 MHz. A commercially available balanced receiver is used to realise shot-noise-limited pulsed homodyne detection. We used a non-binary LDPC code for error correction (reverse reconciliation) and the Toeplitz matrix multiplication for privacy amplification. A graphical processing unit card is used to accelerate the software-based post-processing.

Adapting Western Research Methods to Indigenous Ways of Knowing

PubMed Central

Christopher, Suzanne

2013-01-01

Indigenous communities have long experienced exploitation by researchers and increasingly require participatory and decolonizing research processes. We present a case study of an intervention research project to exemplify a clash between Western research methodologies and Indigenous methodologies and how we attempted reconciliation. We then provide implications for future research based on lessons learned from Native American community partners who voiced concern over methods of Western deductive qualitative analysis. Decolonizing research requires constant reflective attention and action, and there is an absence of published guidance for this process. Continued exploration is needed for implementing Indigenous methods alone or in conjunction with appropriate Western methods when conducting research in Indigenous communities. Currently, examples of Indigenous methods and theories are not widely available in academic texts or published articles, and are often not perceived as valid. PMID:23678897

The Strengths and Limitations of South Africa's Search for Apartheid-Era Missing Persons.

PubMed

Aronson, Jay D

2011-07-01

This article examines efforts to account for missing persons from the apartheid era in South Africa by family members, civil society organizations and the current government's Missing Persons Task Team, which emerged out of the Truth and Reconciliation Commission process. It focuses on how missing persons have been officially defined in the South African context and the extent to which the South African government is able to address the current needs and desires of relatives of the missing. I make two main arguments: that family members ought to have an active role in shaping the initiatives and institutions that seek to resolve the fate of missing people, and that the South African government ought to take a more holistic 'grave-to-grave' approach to the process of identifying, returning and reburying the remains of the missing.

Continuous-variable quantum key distribution in uniform fast-fading channels

NASA Astrophysics Data System (ADS)

Papanastasiou, Panagiotis; Weedbrook, Christian; Pirandola, Stefano

2018-03-01

We investigate the performance of several continuous-variable quantum key distribution protocols in the presence of uniform fading channels. These are lossy channels whose transmissivity changes according to a uniform probability distribution. We assume the worst-case scenario where an eavesdropper induces a fast-fading process, where she chooses the instantaneous transmissivity while the remote parties may only detect the mean statistical effect. We analyze coherent-state protocols in various configurations, including the one-way switching protocol in reverse reconciliation, the measurement-device-independent protocol in the symmetric configuration, and its extension to a three-party network. We show that, regardless of the advantage given to the eavesdropper (control of the fading), these protocols can still achieve high rates under realistic attacks, within reasonable values for the variance of the probability distribution associated with the fading process.

21 CFR 203.39 - Donation of drug samples to charitable institutions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... charitable institution, or personal delivery by a licensed practitioner or an agent or employee of the... sample inventory discrepancies and reconciliation problems shall be investigated by the charitable...

21 CFR 203.39 - Donation of drug samples to charitable institutions.

Code of Federal Regulations, 2011 CFR

2011-04-01

... charitable institution, or personal delivery by a licensed practitioner or an agent or employee of the... sample inventory discrepancies and reconciliation problems shall be investigated by the charitable...

15 CFR 24.4 - Applicability.

Code of Federal Regulations, 2012 CFR

2012-01-01

... local hospitals. (2) The block grants authorized by the Omnibus Budget Reconciliation Act of 1981... under the following programs of The Child Nutrition Act of 1966: (i) Special Milk (section 3 of the Act...

13 CFR 143.4 - Applicability.

Code of Federal Regulations, 2011 CFR

2011-01-01

... local hospitals. (2) The block grants authorized by the Omnibus Budget Reconciliation Act of 1981... under the following programs of The Child Nutrition Act of 1966: (i) Special Milk (section 3 of the Act...

Development of a clinical pharmacy model within an Australian home nursing service using co-creation and participatory action research: the Visiting Pharmacist (ViP) study.

PubMed

Elliott, Rohan A; Lee, Cik Yin; Beanland, Christine; Goeman, Dianne P; Petrie, Neil; Petrie, Barbara; Vise, Felicity; Gray, June

2017-11-03

To develop a collaborative, person-centred model of clinical pharmacy support for community nurses and their medication management clients. Co-creation and participatory action research, based on reflection, data collection, interaction and feedback from participants and other stakeholders. A large, non-profit home nursing service in Melbourne, Australia. Older people referred to the home nursing service for medication management, their carers, community nurses, general practitioners (GPs) and pharmacists, a multidisciplinary stakeholder reference group (including consumer representation) and the project team. Feedback and reflections from minutes, notes and transcripts from: project team meetings, clinical pharmacists' reflective diaries and interviews, meetings with community nurses, reference group meetings and interviews and focus groups with 27 older people, 18 carers, 53 nurses, 15 GPs and seven community pharmacists. The model was based on best practice medication management standards and designed to address key medication management issues raised by stakeholders. Pharmacist roles included direct client care and indirect care. Direct care included home visits, medication reconciliation, medication review, medication regimen simplification, preparation of medication lists for clients and nurses, liaison and information sharing with prescribers and pharmacies and patient/carer education. Indirect care included providing medicines information and education for nurses and assisting with review and implementation of organisational medication policies and procedures. The model allowed nurses to refer directly to the pharmacist, enabling timely resolution of medication issues. Direct care was provided to 84 older people over a 15-month implementation period. Ongoing feedback and consultation, in line with participatory action research principles, informed the development and refinement of the model and identification of enablers and challenges. A collaborative, person-centred clinical pharmacy model that addressed the needs of clients, carers, nurses and other stakeholders was successfully developed. The model is likely to have applicability to home nursing services nationally and internationally. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

77 FR 48922 - Regulations Pertaining to the Disclosure of Return Information To Carry Out Eligibility...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-15

... Health Insurance Affordability Programs; Hearing Cancellation AGENCY: Internal Revenue Service (IRS... Health Care and Education Reconciliation Act of 2010. DATES: The public hearing, originally scheduled for...

42 CFR § 512.400 - Quality measures and reporting-general.

Code of Federal Regulations, 2010 CFR

2017-10-01

... SERVICES (CONTINUED) HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS EPISODE PAYMENT MODEL Quality Measures... EPM participant is eligible for reconciliation payments under § 512.305(d)(1)(iii), and for assigning...

17 CFR 244.100 - General rules regarding disclosure of non-GAAP financial measures.

Code of Federal Regulations, 2010 CFR

2010-04-01

... (2) A reconciliation (by schedule or other clearly understandable method), which shall be quantitative for historical non-GAAP measures presented, and quantitative, to the extent available without...

The Estate Tax Enigma.

ERIC Educational Resources Information Center

Harrison, Ellen K.

2001-01-01

Discusses the implications for planned giving of the new Economic Growth and Tax Relief Reconciliation Act of 2001. Describes changes in income, estate, generation-skipping, and gift tax regulations and their consequences for estate planning. (EV)

User experience and care for older people transitioning from hospital to home: Patients' and carers' perspectives.

PubMed

Allen, Jacqueline; Hutchinson, Alison M; Brown, Rhonda; Livingston, Patricia M

2018-04-01

Transitioning from hospital to home is challenging for many older people living with chronic health conditions. Transitional care facilitates safe and timely transfer of patients between levels of care and across care settings and includes communication between practitioners, assessment and planning, preparation, medication reconciliation, follow-up care and self-management education. To date, there is limited understanding of how to actively involve care recipient service users in transitional care. This study was part of a larger research project. The objective of this article was to report the first study phase, in which we aimed to describe user experience pertaining to patients and carers. The study design was qualitative descriptive using interviews. Patients (n = 19) and carers (n = 7) participated in semi-structured interviews about their experience of transition from hospital to home in an urban Australian health-care setting. Interview data were analysed using thematic analysis. All participants reported that they needed to become independent in transition. Participants perceived a range of social processes supported their independence at home: supportive relationships with carers, caring relationships with health-care practitioners, seeking information, discussing and negotiating the transitional care plan and learning to self-care. Findings contribute to our understanding that quality transitional care should focus on patients' need to regain independence. Social processes supporting the capacities of patients and carers should be emphasized in future initiatives. Future transitional care interventions should emphasize strategies to enable negotiation for suitable supports and assist care recipients to overcome barriers identified in this study. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.

The psychology of perpetrators of 'political' violence in South Africa--a personal experience.

PubMed

Fourie, J A

2000-01-01

My journey embarks with our daughter Lyndi's death at the Heidelberg Massacre in December 1993 and follows the tortuous route of the criminal trial at the end of 1994, through the Truth and Reconciliation Commission (TRC) Hearings in October 1997, to the discovery that there is no formal provision made by the TRC for counselling of Amnesty Seekers. My concern is for those who have received a militarist socialisation and are now being released into a society already burdened with one of the highest 'political' death rates in the world. What is the way forward? Current local models of dealing with trauma for survivors may be helpful in debriefing for those granted amnesty. However, a large-scale effort is necessary to bring about reconciliation and healing in our broken society, some suggestions are made in this regard.

What are we capable of? The motivations of perpetrators in South Africa during the Apartheid era.

PubMed

Bayntun, Claire

2005-01-01

This article attempts to explain the motivations of perpetrators who committed violent acts in South Africa during the apartheid era. The relevant psychosocial literature is reviewed and the implicit and explicit explanations given during the amnesty hearings of the Truth and Reconciliation Committee by perpetrators working for the state security forces are analysed. The mental health of the South African society during this period is considered, as is the role of the former white South African government and its authorities in shaping the climate for a violent struggle involving all groups. The issues of individual versus social and state culpability, accountability, justice and reconciliation are explored and their implications for the future prevention of reoccurrences are assessed. The aim of the article is to prompt readers to ask the question: what are we capable of?

A comparative evaluation of genome assembly reconciliation tools.

PubMed

Alhakami, Hind; Mirebrahim, Hamid; Lonardi, Stefano

2017-05-18

The majority of eukaryotic genomes are unfinished due to the algorithmic challenges of assembling them. A variety of assembly and scaffolding tools are available, but it is not always obvious which tool or parameters to use for a specific genome size and complexity. It is, therefore, common practice to produce multiple assemblies using different assemblers and parameters, then select the best one for public release. A more compelling approach would allow one to merge multiple assemblies with the intent of producing a higher quality consensus assembly, which is the objective of assembly reconciliation. Several assembly reconciliation tools have been proposed in the literature, but their strengths and weaknesses have never been compared on a common dataset. We fill this need with this work, in which we report on an extensive comparative evaluation of several tools. Specifically, we evaluate contiguity, correctness, coverage, and the duplication ratio of the merged assembly compared to the individual assemblies provided as input. None of the tools we tested consistently improved the quality of the input GAGE and synthetic assemblies. Our experiments show an increase in contiguity in the consensus assembly when the original assemblies already have high quality. In terms of correctness, the quality of the results depends on the specific tool, as well as on the quality and the ranking of the input assemblies. In general, the number of misassemblies ranges from being comparable to the best of the input assembly to being comparable to the worst of the input assembly.

The parent magma of the Nakhla (SNC) meteorite: Reconciliation of composition estimates from magmatic inclusions and element partitioning

NASA Technical Reports Server (NTRS)

Treiman, A. H.

1993-01-01

The composition of the parent magma of the Nakhla meteorite was difficult to determine, because it is accumulate rock, enriched in olivine and augite relative to a basalt magma. A parent magma composition is estimated from electron microprobe area analyses of magmatic inclusions in olivine. This composition is consistent with an independent estimate based on the same inclusions, and with chemical equilibria with the cores of Nakhla's augites. This composition reconciles most of the previous estimates of Nakhla's magma composition, and obviates the need for complex magmatic processes. Inconsistency between this composition and those calculated previously suggests that magma flowed through and crystallized into Nakhla as it cooled.

Current good manufacturing practice in manufacturing, processing, packing, or holding of drugs; revision of certain labeling controls--FDA. Final rule.

PubMed

1993-08-03

The Food and Drug Administration (FDA) is amending the current good manufacturing practice (CGMP) regulations for human and veterinary drug products to revise certain labeling control provisions. Specifically, the final rule defines the term "gang-printed labeling," specifies conditions for the use of gang-printed or cut labeling, exempts manufacturers that employ automated 100-percent labeling inspection systems from CGMP labeling reconciliation requirements, and requires manufacturers to identify filled drug product containers that are set aside and held in an unlabeled condition for future labeling operations. These changes are intended to reduce the frequency of drug product mislabeling and associated drug product recalls.

75 FR 56601 - Privacy Act of 1974: New System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-16

...The Patient Protection and Affordable Care Act (the Affordable Care Act), Public Law 111-148, was enacted on March 23, 2010; the Health Care and Education Reconciliation Act (the Reconciliation Act), Public Law 111-152, was enacted on March 30, 2010. The Affordable Care Act and implementing regulations (codified in HHS interim final rules (IFR) at 45 CFR Part 147) require that non-grandfathered health insurance plans and issuers offering group and individual coverage have effective internal claims and appeals and external review processes. The effective date for these requirements is plan or policy years beginning on or after September 23, 2010. Regarding external review, the statute requires that health plans and issuers must comply with either a state external review process or a process meeting standards issued by the Secretary of Health and Human Services (HHS) that is ``similar to'' a state process meeting requirements in section 2719 (a ``federal external review process''). The IFR includes a transition period prior to July 1, 2011, during which time HHS will work with states to assist in making any necessary changes so that the state process will meet the minimum consumer protections identified in 45 CFR 147.136 that must be met in order for the state process to apply. During this interim period, health insurance issuers in states with external review laws in effect prior to September 23, 2010 will follow that state's external review law to the extent applicable. In states that have not passed an external review law that is in effect on September 23, 2010, a health insurance issuer must follow an interim federal external review process that will be administered by the Office of Personnel Management (OPM). The system of records will be created as OPM assists HHS by providing external reviews of adverse benefit determinations and final internal adverse benefit determinations as requested by eligible claimants and their authorized representatives (``claimants''). The system of records will include any data relevant to these external reviews, and OPM proposes to add this new system of records to its inventory of records systems subject to the Privacy Act of 1974 (5 U.S.C. 552a), as amended. This action is necessary to meet the requirements of the Privacy Act to publish in the Federal Register notice of the existence and character of records maintained by the agency (5 U.S.C. 552a(e)(4)).

Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and FY 2012 rates; hospitals' FTE resident caps for graduate medical education payment. Final rules.

PubMed

2011-08-18

We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems and to implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and other legislation. We also are setting forth the update to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. We are updating the payment policy and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and implementing certain statutory changes made by the Affordable Care Act. In addition, we are finalizing an interim final rule with comment period that implements section 203 of the Medicare and Medicaid Extenders Act of 2010 relating to the treatment of teaching hospitals that are members of the same Medicare graduate medical education affiliated groups for the purpose of determining possible full-time equivalent (FTE) resident cap reductions.

Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and fiscal year 2013 rates; hospitals' resident caps for graduate medical education payment purposes; quality reporting requirements for specific providers and for ambulatory surgical centers. final rule.

PubMed

2012-08-31

We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems. Some of the changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and other legislation. These changes will be applicable to discharges occurring on or after October 1, 2012, unless otherwise specified in this final rule. We also are updating the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits will be effective for cost reporting periods beginning on or after October 1, 2012. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and implementing certain statutory changes made by the Affordable Care Act. Generally, these changes will be applicable to discharges occurring on or after October 1, 2012, unless otherwise specified in this final rule. In addition, we are implementing changes relating to determining a hospital's full-time equivalent (FTE) resident cap for the purpose of graduate medical education (GME) and indirect medical education (IME) payments. We are establishing new requirements or revised requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities (IPFs)) that are participating in Medicare. We also are establishing new administrative, data completeness, and extraordinary circumstance waivers or extension requests requirements, as well as a reconsideration process, for quality reporting by ambulatory surgical centers (ASCs) that are participating in Medicare. We are establishing requirements for the Hospital Value-Based Purchasing (VBP) Program and the Hospital Readmissions Reduction Program.

26 CFR 1.6662-0 - Table of contents.

Code of Federal Regulations, 2010 CFR

2010-04-01

... general. (ii) Principal purpose. (3) Tax shelter item. (4) Reasonable belief. (i) In general. (ii) Facts.... § 1.6662-7Omnibus Budget Reconciliation Act of 1993 changes to the accuracy-related penalty. (a) Scope...

Sequester Replacement Reconciliation Act of 2012

THOMAS, 112th Congress

Rep. Ryan, Paul [R-WI-1

2012-05-09

Senate - 05/15/2012 Read the second time. Placed on Senate Legislative Calendar under General Orders. Calendar No. 398. (All Actions) Tracker: This bill has the status Passed HouseHere are the steps for Status of Legislation:

Planning Through Incrementalism

ERIC Educational Resources Information Center

Lasserre, Ph.

1974-01-01

An incremental model of decisionmaking is discussed and compared with the Comprehensive Rational Approach. A model of reconciliation between the two approaches is proposed, and examples are given in the field of economic development and educational planning. (Author/DN)

Economic benefits of employment transportation services : final report

DOT National Transportation Integrated Search

2008-06-30

This report examines the benefits that accrue from employment transportation services implemented as a result of changes in welfare policy, namely the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996. Employment transp...

The Nigerian Crisis: An Open Reply to Lindsay Barrett

ERIC Educational Resources Information Center

Egwuonwu, L. A.

1970-01-01

An American-based Biafran takes issue with Lindsay Barrett's version of the problems of reconciliation between Nigeria and Biafra, which appeared in an article in the October, 1969 issue of "Negro Digest . (KG)

Patient experiences of transitioning from hospital to home: an ethnographic quality improvement project.

PubMed

Cain, Carol H; Neuwirth, Estee; Bellows, Jim; Zuber, Christi; Green, Jennifer

2012-01-01

Little is known about patient perspectives of the transition from hospital to home. To develop a richly detailed, patient-centered view of patient and caregiver needs in the hospital-to-home transition. An ethnographic approach including participant observation and in-depth, semi-structured video recorded interviews. Kaiser Permanente's Southern California, Colorado, and Hawaii regions. Twenty-four adult inpatients hospitalized for a range of acute and chronic conditions and characterized by variety in diagnoses, illness severity, planned or unplanned hospitalization, age, and ability to self manage. During the hospital-to-home transition, patients and caregivers expressed or demonstrated experiences in 6 domains: 1) translating knowledge into safe, health-promoting actions at home; 2) inclusion of caregivers at every step of the transition process; 3) having readily available problem-solving resources; 4) feeling connected to and trusting providers; 5) transitioning from illness-defined experience to "normal" life; and 6) anticipating needs after discharge and making arrangements to meet them. The work of transitioning occurs for patients and caregivers in the hours and days after they return home and is fraught with challenges. Reducing readmissions will remain challenging without a broadened understanding of the types of support and coaching patients need after discharge. We are piloting strategies such as risk stratification and tailoring of care, a specialized phone number for recently discharged patients, standardized same-day discharge summaries to primary care providers, medication reconciliation, follow-up phone calls, and scheduling appointments before discharge. Copyright © 2012 Society of Hospital Medicine.