Feasibility and acceptability of a decision aid designed for people facing advanced or terminal illness: a pilot randomized trial.

PubMed

Matlock, Dan D; Keech, Tarah A E; McKenzie, Marlene B; Bronsert, Michael R; Nowels, Carolyn T; Kutner, Jean S

2014-02-01

Patients nearing the end of their lives face an array of difficult decisions. This study was designed to assess the feasibility and acceptability of a decision aid (DA) designed for patients facing advanced or terminal illness. We conducted a pilot randomized clinical trial of Health Dialog's Looking Ahead: choices for medical care when you're seriously ill DA (booklet and DVD) applied to patients on a hospital-based palliative care (PC) service. University of Colorado Hospital - December 2009 and May 2010. All adult, English-speaking patients or their decision makers were potentially eligible. Patients were not approached if they were in isolation, did not speak English or if any provider felt that they were not appropriate because of issues such as family conflict or actively dying. All participants received a standard PC consultation. Participants in the intervention arm also received a copy of the DA. Measurements Primary outcomes included decision conflict and knowledge. Participants in the intervention arm also completed an acceptability questionnaire and qualitative exit interviews. Of the 239 patients or decision makers, 51(21%) enrolled in the trial. The DA had no significant effect on decision conflict or knowledge. Exit interviews indicated it was acceptable and empowering, although they wished they had access to the DA earlier. While the DA was acceptable, feasibility was limited by late-life illness challenges. Future trials of this DA should be performed on patients earlier in their illness trajectory and should include additional outcome measures such as self-efficacy and confidence. © 2011 John Wiley & Sons Ltd.

"They're homeless in a home": Retaining homeless-experienced consumers in supported housing.

PubMed

Gabrielian, Sonya; Hamilton, Alison B; Alexandrino, Adrian; Hellemann, Gerhard; Young, Alexander S

2017-05-01

Permanent, community-based housing with supportive services ("supported housing") has numerous favorable outcomes for homeless-experienced consumers. Little is known, however, about consumers who attain but subsequently lose their supported housing. Using mixed methods, we compared persons who retained their supported housing for at least 1 year ("stayers") with those who lost their supported housing within 1 year of move-in ("exiters"). Among persons housed through the VA Supported Housing (VASH) program at the VA Greater Los Angeles between 2011 and 2012, we queried VA homeless registry data to identify stayers (n = 1,558) and exiters (n = 85). We reviewed the medical records of 85 randomly selected stayers and all 85 exiters to compare demographics, homelessness chronicity, era of service, income, presence or absence of a serious mental illness, and health service utilization. From this subsample, we purposively selected 20 stayers and 20 exiters for semistructured, qualitative interviews, and more detailed medical record review. We also performed qualitative interviews and focus groups with VASH staff/leadership (n = 15). Recursive partitioning identified quantitative variables that best-differentiated stayers from exiters. Thematic analyses were performed on qualitative data. Interrelated factors were associated with exiting supported housing: chronic homelessness; low intrinsic motivation; unmet needs for mental health care, substance abuse treatment, and independent living skills; poor primary care engagement; frequent emergency department use; and recent mental health hospitalizations. These findings suggest the value of clinical interventions that address these factors-for example, motivational interviewing or social skills training-adapted to the setting and context of supported housing. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

An item response theory analysis of the Executive Interview and development of the EXIT8: A Project FRONTIER Study.

PubMed

Jahn, Danielle R; Dressel, Jeffrey A; Gavett, Brandon E; O'Bryant, Sid E

2015-01-01

The Executive Interview (EXIT25) is an effective measure of executive dysfunction, but may be inefficient due to the time it takes to complete 25 interview-based items. The current study aimed to examine psychometric properties of the EXIT25, with a specific focus on determining whether a briefer version of the measure could comprehensively assess executive dysfunction. The current study applied a graded response model (a type of item response theory model for polytomous categorical data) to identify items that were most closely related to the underlying construct of executive functioning and best discriminated between varying levels of executive functioning. Participants were 660 adults ages 40 to 96 years living in West Texas, who were recruited through an ongoing epidemiological study of rural health and aging, called Project FRONTIER. The EXIT25 was the primary measure examined. Participants also completed the Trail Making Test and Controlled Oral Word Association Test, among other measures, to examine the convergent validity of a brief form of the EXIT25. Eight items were identified that provided the majority of the information about the underlying construct of executive functioning; total scores on these items were associated with total scores on other measures of executive functioning and were able to differentiate between cognitively healthy, mildly cognitively impaired, and demented participants. In addition, cutoff scores were recommended based on sensitivity and specificity of scores. A brief, eight-item version of the EXIT25 may be an effective and efficient screening for executive dysfunction among older adults.

Understanding the Patient Experience with Carcinoid Syndrome: Exit Interviews from a Randomized, Placebo-controlled Study of Telotristat Ethyl.

PubMed

Anthony, Lowell; Ervin, Claire; Lapuerta, Pablo; Kulke, Matthew H; Kunz, Pamela; Bergsland, Emily; Hörsch, Dieter; Metz, David C; Pasieka, Janice; Pavlakis, Nick; Pavel, Marianne; Caplin, Martyn; Öberg, Kjell; Ramage, John; Evans, Emily; Yang, Qi Melissa; Jackson, Shanna; Arnold, Karie; Law, Linda; DiBenedetti, Dana B

2017-11-01

Telotristat ethyl, an oral tryptophan hydroxylase inhibitor, is intended to treat carcinoid syndrome by reducing serotonin production. Telotristat ethyl was evaluated in TELESTAR, a Phase III study for patients who had carcinoid syndrome with at least 4 bowel movements (BMs) per day and who were receiving somatostatin analogue therapy. This interview substudy was conducted to provide insight into the patient experience in TELESTAR and to help understand whether reductions in BM frequency (the primary end point) and other symptoms were clinically meaningful. Participating sites were asked to invite (before randomization) all eligible patients to telephone interviews scheduled at the end of the double-blind treatment period. Patients and interviewers were blinded to treatment. All 35 interviewed participants reported diarrhea and/or excessive BMs at baseline. Patients reported that these symptoms negatively affected emotional, social, physical, and occupational well-being. Prespecified criteria for treatment response (achieving ≥30% reduction in BM frequency for at least 50% of the days) were met by 8 of 26 patients taking telotristat ethyl and 1 of 9 patients taking placebo. All 8 patients taking telotristat ethyl described clinically meaningful reductions in BM frequency and were very satisfied with the ability of the study drug to control their carcinoid syndrome symptoms. Overall, reports of being very satisfied were observed in 12 patients taking telotristat ethyl and 0 taking placebo. Patient interviews revealed that TELESTAR patients, at baseline, were significantly affected by their high BM frequency. Patient reports of their clinical trial experience supported the significance of the primary end point and clinical responder analysis in TELESTAR, helping identify and understand clinically meaningful change produced by telotristat ethyl. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Patient satisfaction with HIV and TB treatment in a public programme in rural KwaZulu-Natal: evidence from patient-exit interviews.

PubMed

Chimbindi, Natsayi; Bärnighausen, Till; Newell, Marie-Louise

2014-01-23

Patient satisfaction is a determinant of treatment uptake, adherence and retention, and an important health systems outcome. Queues, health worker-patient contact time, staff attitudes, and facility cleanliness may affect patient satisfaction. We quantified dimensions of patient satisfaction among HIV and TB patients in a rural sub-district of KwaZulu-Natal, South Africa, and identified underlying satisfaction factors that explained the data. We conducted patient-exit interviews with 300 HIV and 300 TB patients who were randomly selected using a two-stage cluster random sampling approach with primary sampling units (primary healthcare clinics) selected with probability-proportional-to-size sampling. We performed factor analysis to investigate underlying patient satisfaction factors. We compared the satisfaction with HIV and TB services and examined the relationships between patient satisfaction and patients' socio-demographic characteristics in multivariable regression. Almost all patients (95% HIV, 97% TB) reported to be globally satisfied with the healthcare services received on the day of the interview. However, patient satisfaction with specific concrete aspects of the health services was substantially lower: 52% of HIV and 40% of TB patients agreed that some staff did not treat patients with sufficient respect (p = 0.02 for difference between the two patient groups); 65% of HIV and 40% of TB patients agreed that health worker queues were too long (p < 0.001). Based on factor analysis, we identified five factors underlying the HIV data and the TB data (availability, accommodation, acceptability and communication for HIV and TB patients; health worker preference for HIV patients only; and global satisfaction for TB patients only). The level of satisfaction did not vary significantly with patients' socio-demographic characteristics. In this rural area, HIV and TB patients' evaluations of specific aspects of health services delivery revealed substantial dissatisfaction hidden in the global assessments of satisfaction. A wide range of patient satisfaction variables could be reduced to a few underlying factors that align broadly with concepts previously identified in the literature as affecting access to healthcare. Increases in health systems resources for HIV and TB, but also improvements in facility maintenance, staff attitudes and communication, are likely to substantially improve HIV and TB patients' satisfaction with the care they receive in public-sector treatment programmes in rural communities in South Africa.

Evaluating reasons for nursing turnover: comparison of exit interview and panel data.

PubMed

Weisman, C S; Alexander, C S; Chase, G A

1981-06-01

Data from a study of nursing turnover are used to compare findings based on two techniques for evaluating the reasons for resignations within the same population of hospital nurses during one year. The techniques are: (1) exit interviews, in which resigning nurses were asked to report in an open-ended format their major reasons for leaving their jobs; and (2) a prospective panel study, in which nurses who resigned are compared with nurses who remained, and actual turnover is predicted. Results show that due to the absence of a comparison group of remaining nurses and of baseline data, causal inferences based on exit interview data alone are overly simplistic and misleading for management purposes. Results of the panel study are more informative, although implications for hospital management are more complex. Use of the prospective panel design is recommended for hospitals concerned with evaluating nursing job conditions during a period of high turnover and staff nurse shortages.

Effect of patient navigation on colorectal cancer screening in a community-based randomized controlled trial of urban African American adults

PubMed Central

Phelan-Emrick, Darcy F.; Pollack, Craig E.; Markakis, Diane; Wenzel, Jennifer; Ahmed, Saifuddin; Garza, Mary A.; Shapiro, Gary R.; Bone, Lee R.; Johnson, Lawrence B.; Ford, Jean G.

2015-01-01

Purpose In recent years, colorectal cancer (CRC) screening rates have increased steadily in the USA, though racial and ethnic disparities persist. In a community-based randomized controlled trial, we investigated the effect of patient navigation on increasing CRC screening adherence among older African Americans. Methods Participants in the Cancer Prevention and Treatment Demonstration were randomized to either the control group, receiving only printed educational materials (PEM), or the intervention arm where they were assigned a patient navigator in addition to PEM. Navigators assisted participants with identifying and overcoming screening barriers. Logistic regression analyses were used to assess the effect of patient navigation on CRC screening adherence. Up-to-date with screening was defined as self-reported receipt of colonoscopy/sigmoidoscopy in the previous 10 years or fecal occult blood testing (FOBT) in the year prior to the exit interview. Results Compared with controls, the intervention group was more likely to report being up-to-date with CRC screening at the exit interview (OR 1.55, 95 % CI 1.07–2.23), after adjusting for select demographics. When examining the screening modalities separately, the patient navigator increased screening for colonoscopy/sigmoidoscopy (OR 1.53, 95 % CI 1.07–2.19), but not FOBT screening. Analyses of moderation revealed stronger effects of navigation among participants 65–69 years and those with an adequate health literacy level. Conclusions In a population of older African Americans adults, patient navigation was effective in increasing the likelihood of CRC screening. However, more intensive navigation may be necessary for adults over 70 years and individuals with low literacy levels. PMID:25516073

Effect of patient navigation on colorectal cancer screening in a community-based randomized controlled trial of urban African American adults.

PubMed

Horne, Hisani N; Phelan-Emrick, Darcy F; Pollack, Craig E; Markakis, Diane; Wenzel, Jennifer; Ahmed, Saifuddin; Garza, Mary A; Shapiro, Gary R; Bone, Lee R; Johnson, Lawrence B; Ford, Jean G

2015-02-01

In recent years, colorectal cancer (CRC) screening rates have increased steadily in the USA, though racial and ethnic disparities persist. In a community-based randomized controlled trial, we investigated the effect of patient navigation on increasing CRC screening adherence among older African Americans. Participants in the Cancer Prevention and Treatment Demonstration were randomized to either the control group, receiving only printed educational materials (PEM), or the intervention arm where they were assigned a patient navigator in addition to PEM. Navigators assisted participants with identifying and overcoming screening barriers. Logistic regression analyses were used to assess the effect of patient navigation on CRC screening adherence. Up-to-date with screening was defined as self-reported receipt of colonoscopy/sigmoidoscopy in the previous 10 years or fecal occult blood testing (FOBT) in the year prior to the exit interview. Compared with controls, the intervention group was more likely to report being up-to-date with CRC screening at the exit interview (OR 1.55, 95 % CI 1.07-2.23), after adjusting for select demographics. When examining the screening modalities separately, the patient navigator increased screening for colonoscopy/sigmoidoscopy (OR 1.53, 95 % CI 1.07-2.19), but not FOBT screening. Analyses of moderation revealed stronger effects of navigation among participants 65-69 years and those with an adequate health literacy level. In a population of older African Americans adults, patient navigation was effective in increasing the likelihood of CRC screening. However, more intensive navigation may be necessary for adults over 70 years and individuals with low literacy levels.

Patient satisfaction in Turkey: differences between public and private hospitals.

PubMed

Tengilimoglu, D; Kisa, A; Dziegielewski, S F

1999-02-01

This article reports the results of a patient-satisfaction survey administered by interview to 2045 adults discharged from several major public and private hospitals in Turkey. The direct measurement of patient-satisfaction is a new phenomenon for this country. An instrument was designed similar to those available in the United States and administered during exit interviews. Two primary areas of analyses were determined in comparing services provided by these public and private hospitals: demographic factors with regard to accessibility and consumer perceptions of the quality of service provided. Relationships and percentages within and among the five public and two private hospitals are reported. Several statistically significant differences were found between the hospitals, with the private hospitals achieving the greatest satisfaction on most of the quality of services issues examined. Future recommendations outline the need to take into account the public's perception of these hospitals and enhancing customer satisfaction as a means of increasing service utilization.

Prospective Evaluation of Pretreatment Executive Cognitive Impairment and Depression in Patients Referred for Radiotherapy

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

Fuller, Clifton D.; Graduate Division of Radiological Sciences, University of Texas Health Science Center at San Antonio, San Antonio, TX; Department of Radiation Medicine, Oregon Health and Science University, Portland, OR

Purpose: Cancer patients are at risk of cognitive impairment and depression. We sought to ascertain the prevalence of executive, visuospatial, memory, and general cognitive performance deficits before radiotherapy in a radiation oncology clinic referral population and correlate the neurocognitive measures with the depression symptom burden. Methods and Materials: A total of 122 sequential patients referred for radiotherapy evaluation were administered a test battery composed of the Executive Interview (EXIT25), Executive Clock Drawing Task (CLOX1 and CLOX2), Mini Mental State Examination (MMSE), Memory Impairment Screen (MIS), and Geriatric Depression Scale (GDS). The mean age {+-} standard deviation was 58 {+-} 17more » years. Of 122 patients, 24 (20%) had been referred for breast cancer, 21 (17%) for gastrointestinal cancer, 17 (14%) for genitourinary disease, and 8 (7%) for brain lesions; the rest were a variety of tumor sites. The cognitive performance among the tumor cohorts was compared using Bonferroni-corrected analysis of variance and Tukey-Kramer tests. Pearson correlation coefficients were determined between each cognitive instrument and the GDS. Results: Of the 122 patients, 52 (43%) exhibited a detectable executive cognition decrement on one or more test measures. Five percent had poor memory performance (MIS), 18% had poor visuospatial performance (CLOX2), and 13% had poor global cognition (MMSE). Patients with brain tumors performed substantially worse on the EXIT25. No between-group differences were found for CLOX1, CLOX2, MIS, or GDS performance. The EXIT25 scores correlated significantly with the GDS scores (r = 0.26, p = 0.005). Conclusions: The results of this study have shown that patients referred for radiotherapy exhibit cognitive impairment profiles comparable to those observed in acutely ill medical inpatients. Executive control impairment appears more prevalent than global cognitive deficits, visuospatial impairment, or depression.« less

Using SERVQUAL for assessing and improving patient satisfaction at a rural health facility in Pakistan.

PubMed

Shaikh, B T; Mobeen, N; Azam, S I; Rabbani, F

2008-01-01

A cross-sectional study of patient satisfaction with care was conducted over a period of 1 year from March 2004 to March 2005 in a secondary-level hospital in a peri-urban area of Karachi, Pakistan. Using the SERVQUAL tool and exit interviews, data were collected quarterly from a total of 1533 patients. Results sharing and capacity-building workshops were arranged during the 4 phases of the survey to sensitize the staff of the hospital to work towards improving patient satisfaction. The level of satisfaction of the patients with the outpatient health services provided showed a gradual increase from 34.4% to 82.0% over the 1-year period.

Integrating a Narrative Medicine Telephone Interview with Online Life Review Education for Cancer Patients: Lessons Learned and Future Directions

PubMed Central

Wise, Meg; Marchand, Lucille; Cleary, James F.; Aeschlimann, Elizabeth; Causier, Daniel

2012-01-01

We describe an online narrative and life review education program for cancer patients and the results of a small implementation test to inform future directions for further program development and full-scale evaluation research. The intervention combined three types of psycho-oncology narrative interventions that have been shown to help patients address emotional and existential issues: 1) a physician-led dignity-enhancing telephone interview to elicit the life narrative and delivery of an edited life manuscript, 2) life review education, delivered via 3) a website self-directed instructional materials and expert consultation to help people revise and share their story. Eleven cancer patients tested the intervention and provided feedback in an in-depth exit interview. While everyone said telling and receiving the edited story manuscript was helpful and meaningful, only people with high death salience and prior computer experience used the web tools to enhance and share their story. Computer users prodded us to provide more sophisticated tools and older (>70 years) users needed more staff and family support. We conclude that combining a telephone expert-led interview with online life review education can extend access to integrative oncology services, are most feasible for computer-savvy patients with advanced cancer, and must use platforms that allow patients to upload files and invite their social network. PMID:19476731

Perceptions of health care providers and patients on quality of care in maternal and neonatal health in fourteen Bangladesh government healthcare facilities: a mixed-method study.

PubMed

Islam, Farzana; Rahman, Aminur; Halim, Abdul; Eriksson, Charli; Rahman, Fazlur; Dalal, Koustuv

2015-06-19

Bangladesh has achieved remarkable progress in healthcare with a steady decline in maternal and under-5 child mortality rates in efforts to achieve Millennium Development Goals 4 and 5. However, the mortality rates are still very high compared with high-income countries. The quality of healthcare needs improve to reduce mortality rates further. It is essential to investigate the current quality of healthcare before implementing any interventions. The study was conducted to explore the perception of healthcare providers about the quality of maternal and neonatal health (MNH) care. The study also investigated patient satisfaction with the MNH care received from district and sub-district hospitals. Both qualitative and quantitative methods were used in the study. Two district and 12 sub-district hospitals in Thakurgaon and Jamalpur in Bangladesh were the study settings. Fourteen group discussions and 56 in-depth interviews were conducted among the healthcare providers. Client exit interviews were conducted with 112 patients and their attendants from maternity, labor, and neonatal wards before being discharged from the hospitals. Eight physicians and four anthropologists collected data between November and December 2011 using pretested guidelines. The hospital staff identified several key factors that affected the quality of patient care: shortage of staff and logistics; lack of laboratory support; under use of patient-management protocols; a lack of training; and insufficient supervision. Doctors were unable to provide optimal care because of the high volume of patients. The exit interviews revealed that 85 % of respondents were satisfied with the hospital services received. Seven out of 14 respondents were satisfied with the cleanliness of the hospital facilities. More than half of the respondents were satisfied with the drugs they received. In half of the facilities, patients did not get an opportunity to ask the healthcare providers questions about their health conditions and treatments. The quality of healthcare is poor in district and sub-district hospitals in Bangladesh because of the lack of healthcare personnel and logistic support. An integrated quality improvement approach is needed to improve MNH care service in district and sub-district hospitals in Bangladesh.

34 CFR 674.42 - Contact with the borrower.

Code of Federal Regulations, 2012 CFR

2012-07-01

... half-time study at the institution or during the exit interview. If the borrower enters the repayment... exit counseling is conducted shortly before the borrower ceases at least half-time study at the institution. As an alternative, in the case of a student enrolled in a correspondence program or a study...

34 CFR 674.42 - Contact with the borrower.

Code of Federal Regulations, 2010 CFR

2010-07-01

... half-time study at the institution or during the exit interview. If the borrower enters the repayment... exit counseling is conducted shortly before the borrower ceases at least half-time study at the institution. As an alternative, in the case of a student enrolled in a correspondence program or a study...

34 CFR 674.42 - Contact with the borrower.

Code of Federal Regulations, 2013 CFR

2013-07-01

... half-time study at the institution or during the exit interview. If the borrower enters the repayment... exit counseling is conducted shortly before the borrower ceases at least half-time study at the institution. As an alternative, in the case of a student enrolled in a correspondence program or a study...

34 CFR 674.42 - Contact with the borrower.

Code of Federal Regulations, 2014 CFR

2014-07-01

... half-time study at the institution or during the exit interview. If the borrower enters the repayment... exit counseling is conducted shortly before the borrower ceases at least half-time study at the institution. As an alternative, in the case of a student enrolled in a correspondence program or a study...

34 CFR 674.42 - Contact with the borrower.

Code of Federal Regulations, 2011 CFR

2011-07-01

... half-time study at the institution or during the exit interview. If the borrower enters the repayment... exit counseling is conducted shortly before the borrower ceases at least half-time study at the institution. As an alternative, in the case of a student enrolled in a correspondence program or a study...

Twitter-Delivered Behavioral Weight-Loss Interventions: A Pilot Series.

PubMed

Pagoto, Sherry L; Waring, Molly E; Schneider, Kristin L; Oleski, Jessica L; Olendzki, Effie; Hayes, Rashelle B; Appelhans, Bradley M; Whited, Matthew C; Busch, Andrew M; Lemon, Stephenie C

2015-10-23

Lifestyle interventions are efficacious at reducing risk for diabetes and cardiovascular disease but have not had a significant public health impact given high cost and patient and provider burden. Online social networks may reduce the burden of lifestyle interventions to the extent that they displace in-person visits and may enhance opportunities for social support for weight loss. We conducted an iterative series of pilot studies to evaluate the feasibility and acceptability of using online social networks to deliver a lifestyle intervention. In Study 1 (n=10), obese participants with depression received lifestyle counseling via 12 weekly group visits and a private group formed using the online social network, Twitter. Mean weight loss was 2.3 pounds (SD 7.7; range -19.2 to 8.2) or 1.2% (SD 3.6) of baseline weight. A total of 67% (6/9) of participants completing exit interviews found the support of the Twitter group at least somewhat useful. In Study 2 (n=11), participants were not depressed and were required to be regular users of social media. Participants lost, on average, 5.6 pounds (SD 6.3; range -15 to 0) or 3.0% (SD 3.4) of baseline weight, and 100% (9/9) completing exit interviews found the support of the Twitter group at least somewhat useful. To explore the feasibility of eliminating in-person visits, in Study 3 (n=12), we delivered a 12-week lifestyle intervention almost entirely via Twitter by limiting the number of group visits to one, while using the same inclusion criteria as that used in Study 2. Participants lost, on average, 5.4 pounds (SD 6.4; range -14.2 to 3.9) or 3.0% (SD 3.1) of baseline weight, and 90% (9/10) completing exit interviews found the support of the Twitter group at least somewhat useful. Findings revealed that a private Twitter weight-loss group was both feasible and acceptable for many patients, particularly among regular users of social media. Future research should evaluate the efficacy and cost-effectiveness of online social network-delivered lifestyle interventions relative to traditional modalities.

Twitter-Delivered Behavioral Weight-Loss Interventions: A Pilot Series

PubMed Central

Waring, Molly E; Schneider, Kristin L; Oleski, Jessica L; Olendzki, Effie; Hayes, Rashelle B; Appelhans, Bradley M; Whited, Matthew C; Busch, Andrew M; Lemon, Stephenie C

2015-01-01

Background Lifestyle interventions are efficacious at reducing risk for diabetes and cardiovascular disease but have not had a significant public health impact given high cost and patient and provider burden. Objective Online social networks may reduce the burden of lifestyle interventions to the extent that they displace in-person visits and may enhance opportunities for social support for weight loss. Methods We conducted an iterative series of pilot studies to evaluate the feasibility and acceptability of using online social networks to deliver a lifestyle intervention. Results In Study 1 (n=10), obese participants with depression received lifestyle counseling via 12 weekly group visits and a private group formed using the online social network, Twitter. Mean weight loss was 2.3 pounds (SD 7.7; range -19.2 to 8.2) or 1.2% (SD 3.6) of baseline weight. A total of 67% (6/9) of participants completing exit interviews found the support of the Twitter group at least somewhat useful. In Study 2 (n=11), participants were not depressed and were required to be regular users of social media. Participants lost, on average, 5.6 pounds (SD 6.3; range -15 to 0) or 3.0% (SD 3.4) of baseline weight, and 100% (9/9) completing exit interviews found the support of the Twitter group at least somewhat useful. To explore the feasibility of eliminating in-person visits, in Study 3 (n=12), we delivered a 12-week lifestyle intervention almost entirely via Twitter by limiting the number of group visits to one, while using the same inclusion criteria as that used in Study 2. Participants lost, on average, 5.4 pounds (SD 6.4; range -14.2 to 3.9) or 3.0% (SD 3.1) of baseline weight, and 90% (9/10) completing exit interviews found the support of the Twitter group at least somewhat useful. Findings revealed that a private Twitter weight-loss group was both feasible and acceptable for many patients, particularly among regular users of social media. Conclusions Future research should evaluate the efficacy and cost-effectiveness of online social network-delivered lifestyle interventions relative to traditional modalities. PMID:26500186

76 FR 54732 - Proposed Information Collection; Comment Request: Field Representative/Decennial Field Staff Exit...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-02

... on data quality, the retention of trained field interviewing staff is a major concern for the Census... interviewers, the Census Bureau collects data on the reasons interviewers voluntarily quit their jobs with the... the Census Bureau might have done, or can do, to influence interviewers not to leave their jobs. The...

42 CFR 60.61 - Responsibilities of a HEAL school.

Code of Federal Regulations, 2010 CFR

2010-10-01

... documentation of the exit interview, including the personal information collected for skiptracing activities... document an entrance interview with each student (individually or in groups) no later than prior to the... loan. The school must inform the loan recipient during the entrance interview of his or her rights and...

77 FR 29350 - Agency Forms Undergoing Paperwork Reduction Act Review

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-17

... using audio computer assisted self-interview (ACASI). The ACASI interview includes questions about... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention [30Day-12-12EL... Exit Interview 10 1 30/60 Kimberly S. Lane, Deputy Director, Office of Science Integrity, Office of the...

Preparing Student Nurses as Parent-based Adolescent Sexual Health Educators: Results of a Pilot Study.

PubMed

Santa Maria, Diane; Markham, Christine; Crandall, Stacy; Guilamo-Ramos, Vincent

2017-03-01

While health promotion and patient education are central to the scope of practice of professional nurses, they often feel ill-equipped to assume the role of sexual health educator and lack adequate knowledge and skills to effectively engage parents in adolescent sexual and reproductive health efforts. Employing a mixed-methods study consisting of both pre- and post-test survey and exit interviews, a pilot study was conducted to assess the impact of implementing a parent-based adolescent sexual health intervention on baccalaureate nursing student outcomes (N = 31). We found statistically significant improvements in student outcome expectancies of parenting strategies, barriers to sexual health communication, self-efficacy, and sexual health counseling experience. Using thematic content analysis of exit interview content, emerging themes were (1) need for increased sexual and reproductive health (SRH) preparation, (2) wanting greater experience and opportunity for involvement in nursing research, and (3) educational gaps in family-focused community public health. Incorporating adolescent sexual health education into public health nursing clinical training can prepare nurses as parent-based adolescent sexual health educators, a core competency for nurses working with families in communities and across all health care delivery settings. © 2016 Wiley Periodicals, Inc.

Impact of Repeatedly Failing a High School Exit Exam: Voices of English Language Learners

ERIC Educational Resources Information Center

Kruger, Louis J.; Li, Chieh; Kimble, Edward; Ruah, Rachel; Stoianov, Diana; Krishnan, Kalyani

2016-01-01

This qualitative study explored the perceived psychological impact of repeated failures on a high school exit examination (HSEE). We interviewed eight self-identified English language learners (ELLs), whose ages ranged from 20 to 29. All participants were attending tutoring HSEE programs at urban community colleges in New England. Using a modified…

Developing and Pilot Testing a Spanish Translation of CollaboRATE for Use in the United States.

PubMed

Forcino, Rachel C; Bustamante, Nitzy; Thompson, Rachel; Percac-Lima, Sanja; Elwyn, Glyn; Pérez-Arechaederra, Diana; Barr, Paul J

2016-01-01

Given the need for access to patient-facing materials in multiple languages, this study aimed to develop and pilot test an accurate and understandable translation of CollaboRATE, a three-item patient-reported measure of shared decision-making, for Spanish-speaking patients in the United States (US). We followed the Translate, Review, Adjudicate, Pre-test, Document (TRAPD) survey translation protocol. Cognitive interviews were conducted with Spanish-speaking adults within an urban Massachusetts internal medicine clinic. For the pilot test, all patients with weekday appointments between May 1 and May 29, 2015 were invited to complete CollaboRATE in either English or Spanish upon exit. We calculated the proportion of respondents giving the best score possible on CollaboRATE and compared scores across key patient subgroups. Four rounds of cognitive interviews with 26 people were completed between January and April 2015. Extensive, iterative refinements to survey items between interview rounds led to final items that were generally understood by participants with diverse educational backgrounds. Pilot data collection achieved an overall response rate of 73 percent, with 606 (49%) patients completing Spanish CollaboRATE questionnaires and 624 (51%) patients completing English CollaboRATE questionnaires. The proportion of respondents giving the best score possible on CollaboRATE was the same (86%) for both the English and Spanish versions of the instrument. Our translation method, guided by emerging best practices in survey and health measurement translation, encompassed multiple levels of review. By conducting four rounds of cognitive interviews with iterative item refinement between each round, we arrived at a Spanish language version of CollaboRATE that was understandable to a majority of cognitive interview participants and was completed by more than 600 pilot questionnaire respondents.

Learning from the Failures of Others: The Effects of Post-Exit Knowledge Spillovers on Recipient Firms

ERIC Educational Resources Information Center

Amankwah-Amoah, Joseph

2011-01-01

Purpose: The purpose of this study is to examine the effects of post-exit knowledge diffusion created by departed firms on recipient firms. Design/methodology/approach: This is an inductive and exploratory study which tries to understand questions of how and why. The research used a qualitative interview methodology and data analysis using within…

76 FR 78333 - Information Collection Activities: Submission for the Office of Management and Budget (OMB...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-16

... interview will be split such that questions will be asked of each respondent both during entry and exit from....: NHTSA Forms 1121 and 1122. Type of Review: Regular. Respondents: Telephone interviews will be.... In-person interviews will be conducted in each of the five selected communities with bar patrons age...

Evidence of superficial knowledge regarding antibiotics and their use: Results of two cross-sectional surveys in an urban informal settlement in Kenya

PubMed Central

Omulo, Sylvia; Thumbi, Samuel M.; Lockwood, Svetlana; Verani, Jennifer R.; Bigogo, Godfrey; Masyongo, Geoffrey

2017-01-01

We assessed knowledge and practices related to antibiotic use in Kibera, an urban informal settlement in Kenya. Surveys was employed at the beginning (entry) and again at the end (exit) of a 5-month longitudinal study of AMR. Two-hundred households were interviewed at entry, of which 149 were also interviewed at exit. The majority (>65%) of respondents in both surveys could name at least one antibiotic, with amoxicillin and cotrimoxazole jointly accounting for 85% and 77% of antibiotics mentioned during entry and exit, respectively. More than 80% of respondents felt antibiotics should not be shared or discontinued following the alleviation of symptoms. Nevertheless, 66% and 74% of respondents considered antibiotics effective for treating colds and flu in the entry and exit surveys, respectively. There was a high (87%, entry; 70% exit) level of reported antibiotic use (past 12 months) mainly for colds/flu, coughs and fever, with >80% of respondents obtaining antibiotics from health facilities and pharmacies. Less than half of respondents remembered getting information on the correct use of antibiotics, although 100% of those who did reported improved attitudes towards antibiotic use. Clinicians and community pharmacists were highly trusted information sources. Paired household responses (n = 149) generally showed improved knowledge and attitudes by the exit survey although practices were largely unchanged. Weak agreement (κ = -0.003 to 0.22) between survey responses suggest both that unintended learning had not occurred, and that participant responses were not based on established knowledge or behaviors. Targeted public education regarding antibiotics is needed to address this gap. PMID:28968447

Evidence of superficial knowledge regarding antibiotics and their use: Results of two cross-sectional surveys in an urban informal settlement in Kenya.

PubMed

Omulo, Sylvia; Thumbi, Samuel M; Lockwood, Svetlana; Verani, Jennifer R; Bigogo, Godfrey; Masyongo, Geoffrey; Call, Douglas R

2017-01-01

We assessed knowledge and practices related to antibiotic use in Kibera, an urban informal settlement in Kenya. Surveys was employed at the beginning (entry) and again at the end (exit) of a 5-month longitudinal study of AMR. Two-hundred households were interviewed at entry, of which 149 were also interviewed at exit. The majority (>65%) of respondents in both surveys could name at least one antibiotic, with amoxicillin and cotrimoxazole jointly accounting for 85% and 77% of antibiotics mentioned during entry and exit, respectively. More than 80% of respondents felt antibiotics should not be shared or discontinued following the alleviation of symptoms. Nevertheless, 66% and 74% of respondents considered antibiotics effective for treating colds and flu in the entry and exit surveys, respectively. There was a high (87%, entry; 70% exit) level of reported antibiotic use (past 12 months) mainly for colds/flu, coughs and fever, with >80% of respondents obtaining antibiotics from health facilities and pharmacies. Less than half of respondents remembered getting information on the correct use of antibiotics, although 100% of those who did reported improved attitudes towards antibiotic use. Clinicians and community pharmacists were highly trusted information sources. Paired household responses (n = 149) generally showed improved knowledge and attitudes by the exit survey although practices were largely unchanged. Weak agreement (κ = -0.003 to 0.22) between survey responses suggest both that unintended learning had not occurred, and that participant responses were not based on established knowledge or behaviors. Targeted public education regarding antibiotics is needed to address this gap.

Prescription practices and availability of artemisinin monotherapy in India: where do we stand?

PubMed Central

2011-01-01

Background The World Health Organization has urged all member states to deploy artemisinin-based combination therapy and progressively withdraw oral artemisinin monotherapies from the market due to their high recrudescence rates and to reduce the risk of drug resistance. Prescription practices by physicians and the availability of oral artemisinin monotherapies with pharmacists directly affect the pattern of their use. Thus, treatment practices for malaria, with special reference to artemisinin monotherapy prescription, in selected states of India were evaluated. Methods Structured, tested questionnaires were used to conduct convenience surveys of physicians and pharmacists in eleven purposively selected districts across six states in 2008. In addition, exit interviews of patients with a diagnosis of uncomplicated malaria or a prescription for an anti-malarial drug were also performed. Logistic regression was used to determine patient clinical care, and institutional factors associated with artemisinin monotherapy prescription. Results Five hundred and eleven physicians from 196 health facilities, 530 pharmacists, and 1, 832 patients were interviewed. Artemisinin monotherapy was available in 72.6% of pharmacies and was prescribed by physicians for uncomplicated malaria in all study states. Exit interviews among patients confirmed the high rate of use of artemisinin monotherapy with 14.8% receiving such a prescription. Case management, i.e. method of diagnosis and overall treatment, varied by state and public or private sector. Treatment in the private sector (OR 8.0, 95%CI: 3.8, 17) was the strongest predictor of artemisinin monotherapy prescription when accounting for other factors. Use of the combination therapy recommended by the national drug policy, artesunate + sulphadoxine-pyrimethamine, was minimal (4.9%), with the exception of one state. Conclusions Artemisinin monotherapy use was widespread across India in 2008. The accessible sale of oral artemisinin monotherapy in retail market and an inadequate supply of recommended drugs in the public sector health facilities promoted its prescription. This study resulted in notifications to all state drug controllers in India to withdraw the oral artemisinin formulations from the market. In 2010, artesunate + sulphadoxine-pyrimethamine became the universal first-line treatment for confirmed Plasmodium falciparum malaria and was deployed at full scale. PMID:22166073

"I Wish to Be Self-Reliant": Aspiration for Self-Reliance, Need and Life Satisfaction, and Exit Dilemma of Welfare Recipients in Hong Kong

ERIC Educational Resources Information Center

Wong, Chack-Kie; Lou, Vivian Wei-Qun

2010-01-01

This qualitative study explores the welfare recipients' experiences of and attitudes toward the welfare benefit system in Hong Kong. A sample of 19 welfare recipients from six main recipient groups was interviewed, some twice. This study finds that the recipients have strong aspirations to exit the welfare benefit system. The welfare application…

Cardiovascular disease, diabetes and early exit from paid employment in Europe; the impact of work-related factors.

PubMed

Kouwenhoven-Pasmooij, T A; Burdorf, A; Roos-Hesselink, J W; Hunink, M G M; Robroek, S J W

2016-07-15

The aims of the study were to examine (i) the association between cardiovascular disease (CVD) or diabetes and exit from paid employment via disability benefits, unemployment, early retirement or other exit routes; and (ii) the impact of work-related factors on exit from paid employment among individuals with CVD or diabetes. Respondents of the longitudinal Survey of Health and Retirement in Europe (SHARE) were included if they were aged >50years, had paid employment at baseline, and a known employment status after 2 or 6years (n=5182). A baseline-interview provided information on the presence of diagnosed CVD and diabetes, and physical and psychosocial work-related factors. During follow-up interviews information on work status was collected. Multinomial regression analyses were used to investigate the association between CVD, diabetes and exit from paid employment, and the impact of work-related factors. Workers with CVD or diabetes had significantly increased probabilities of disability benefits (OR 2.50, 95% CI 1.69-3.70) and early retirement (OR 1.34, 95% CI 1.05-1.74), but a comparable probability of unemployment (OR 1.10, 95% CI 0.71-1.71). Regarding disability benefits, individuals who had a stroke had the highest probability (OR 3.48, 95% CI 1.31-9.23). Perceived high job demands with low rewards or with low control at work further increased the probability of early exit among individuals with CVD or diabetes. Our study shows a prominent role of CVD and diabetes in premature losses to the workforce, and it shows that optimizing psychosocial work-related factors could be beneficial in people with CVD or diabetes. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Visual Barriers to Prevent Ambulatory ALzheimer's Patients from Exiting through an Emergency Door.

ERIC Educational Resources Information Center

Namazi, Kevan H.; And Others

1989-01-01

Conducted study on Alzheimer's unit to test seven different visual barrier conditions for reducing patient exits. Findings indicated that exiting was eliminated under two conditions. Results suggest visual agnosia, the inability to interpret what the eye sees, may be used as tool in managing wandering behavior of Alzheimer's patients. (Author/NB)

77 FR 31306 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-25

... minutes. Needs and Uses: Retention of trained field interviewing staff is a major concern for the Census... their Census Bureau jobs. The exit questionnaires are the instruments we use to collect turnover data... important that we continue to examine the interviewers' concerns about their job. Information provided by...

An Epidemiological Model of Transition and Postschool Outcomes

ERIC Educational Resources Information Center

Flexer, Robert W.; Daviso, Alfred W., III; Baer, Robert M.; Queen, Rachel McMahan; Meindl, Richard S.

2011-01-01

This longitudinal transition study was conducted in collaboration with teachers who interviewed students who graduated from 177 school districts in a Great Lakes state. Special education students were interviewed at exit and 1 year following graduation using a survey based on the National Longitudinal Transition Study. The data were analyzed using…

An assessment of quality of home-based HIV counseling and testing performed by lay counselors in a rural sub-district of KwaZulu-Natal, South Africa.

PubMed

Magasana, Vuyolwethu; Zembe, Wanga; Tabana, Hanani; Naik, Reshma; Jackson, Debra; Swanevelder, Sonja; Doherty, Tanya

2016-12-01

HIV counseling and testing (HCT) has been prioritized as one of the prevention strategies for HIV/AIDS, and promoted as an essential tool in scaling up and improving access to treatment, care and support especially in community settings. Home-based HCT (HBHCT) is a model that has consistently been found to be highly acceptable and has improved HCT coverage and uptake in low- and middle-income countries since 2002. It involves trained lay counselors going door-to-door offering pre-test counseling and providing HCT services to consenting eligible household members. Currently, there are few studies reporting on the quality of HBHCT services offered by lay counselors especially in Sub-Saharan Africa, including South Africa. This is a quantitative descriptive sub-study of a community randomized trial (Good Start HBHCT trial) which describes the quality of HBHCT provided by lay counselors. Quality of HBHCT was measured as scores comparing observed practice to prescribed protocols using direct observation. Data were collected through periodic observations of HCT sessions and exit interviews with clients. Counselor quality scores for pre-test counseling and post-test counseling sessions were created to determine the level of quality. For the client exit interviews a continuous score was created to assess how satisfied the clients were with the counseling session. A total of 196 (3%) observational assessments and 406 (6%) client exit interviews were completed. Overall, median scores for quality of counseling and testing were high for both HIV-negative and HIV-positive clients. For exit interviews all 406 (100%) clients had overall satisfaction with the counseling and testing services they received, however 11% were concerned about the counselor keeping their discussion confidential. Of all 406 clients, 393 (96.8%) intended to recommend the service to other people. In ensuring good quality HCT services, ongoing quality assessments are important to monitor quality of HCT after training.

Health coaching for glaucoma care: a pilot study using mixed methods

PubMed Central

Vin, Anita; Schneider, Suzanne; Muir, Kelly W; Rosdahl, Jullia A

2015-01-01

Introduction Adherence to glaucoma medications is essential for successful treatment of the disease but is complex and difficult for many of our patients. Health coaching has been used successfully in the treatment of other chronic diseases. This pilot study explores the use of health coaching for glaucoma care. Methods A mixed methods study design was used to assess the health coaching intervention for glaucoma patients. The health coaching intervention consisted of four to six health coaching sessions with a certified health coach via telephone. Quantitative measures included demographic and health information, adherence to glaucoma medications (using the visual analog adherence scale and medication event monitoring system), and an exit survey rating the experience. Qualitative measures included a precoaching health questionnaire, notes made by the coach during the intervention, and an exit interview with the subjects at the end of the study. Results Four glaucoma patients participated in the study; all derived benefits from the health coaching. Study subjects demonstrated increased glaucoma drop adherence in response to the coaching intervention, in both visual analog scale and medication event monitoring system. Study subjects’ qualitative feedback reflected a perceived improvement in both eye and general health self-care. The subjects stated that they would recommend health coaching to friends or family members. Conclusion Health coaching was helpful to the glaucoma patients in this study; it has the potential to improve glaucoma care and overall health. PMID:26604666

Bacterial colonization patterns in daily chlorhexidine care at the exit site in peritoneal dialysis patients-A prospective, randomized controlled trial.

PubMed

Wang, Hsi-Hao; Hung, Shih-Yuan; Chang, Min-Yu; Lee, Yi-Che; Lin, Hsiu-Fang; Lin, Tsun-Mei; Yang, Su-Pen; Lin, Hsi-Hsun; Yang, Su-Ching; Wang, Jiun-Ling

2017-01-01

Bacterial colonization patterns in daily chlorhexidine care at the exit site in peritoneal dialysis (PD) patients were not known. We performed a prospective, randomized controlled trial enrolling 89 PD patients. After stratification by initial Staphylococcus aureus (SA) carrier status, patients were randomly assigned to receive daily 4% chlorhexidine care (intervention group) or normal saline (control group) at the exit site. Monthly, we cultured bacteria from the exit site and nasal swabs for 1 year. The SA colonization rates at exit site at 6 and 12 months were significantly lower in the intervention group than the control group (5.0% vs. 22.9%, p = 0.023 and 8.6% vs. 28.1%, p = 0.037 for 6 and 12 months, respectively). The Methicillin-resistant SA (MRSA) colonization rate at exit site at 6 months was similar (5.7% vs. 2.5%,p = 0.596) in control and intervention group, but significantly lower in the intervention group than the control group at exit site at 12months (0% vs. 12.5%, p = 0.047). The gram-negative bacilli (GNB) colonization rates were similar between the intervention and control groups at 6 and 12 months. Genotyping of all MRSA isolates showed ST (sequence type) 59 was the most predominant clone. In conclusion, chlorhexidine care at the exit site in PD patients may be a good strategy for SA and MRSA decolonization. ClinicalTrials.gov NCT02446158.

Insomnia as a predictor of job exit among middle-aged and older adults: results from the Health and Retirement Study.

PubMed

Dong, Liming; Agnew, Jacqueline; Mojtabai, Ramin; Surkan, Pamela J; Spira, Adam P

2017-08-01

Poor health is a recognised predictor of workforce exit, but little is known about the role of insomnia in workforce exit. We examined the association between insomnia symptoms and subsequent job exit among middle-aged and older adults from the Health and Retirement Study (HRS). The study sample consisted of 5746 respondents aged between 50 and 70 who were working for pay when interviewed in the HRS 2004 and were followed up in the HRS 2006. Multinomial logistic regression was used to determine the association between number of insomnia symptoms (0, 1-2, 3-4) and job exit (no exit, health-related exit or exit due to other reasons). In models adjusting for demographic characteristics, baseline health status and baseline job characteristics, compared with respondents with no insomnia symptoms, those with 3-4 insomnia symptoms had approximately twice the odds of leaving the workforce due to poor health (adjusted relative risk ratio=1.93, 95% CI 1.04 to 3.58, p=0.036). There was no association between insomnia and job exit due to non-health reasons. An elevated number of insomnia symptoms is independently associated with leaving paid employment. Workplace screening for and treatment of insomnia symptoms may prolong labour force participation of middle-aged and older adults. 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/.

Exit-Site Dressing and Infection in Peritoneal Dialysis: A Randomized Controlled Pilot Trial.

PubMed

Mushahar, Lily; Mei, Lim Wei; Yusuf, Wan Shaariah; Sivathasan, Sudhaharan; Kamaruddin, Norilah; Idzham, Nor Juliana Mohd

2016-01-01

♦ Peritoneal dialysis (PD)-related infection is a common cause of catheter loss and the main reason for PD drop-out. Exit-site infection (ESI) is a pathway to developing tunnel infection and peritonitis, hence rigorous exit-site care has always been emphasized in PD therapy. The aim of this study was to evaluate the effect of exit-site dressing vs non-dressing on the rate of PD-related infection. ♦ A prospective randomized controlled study was conducted in prevalent PD patients at the Hospital Tuanku Jaafar Seremban, Negeri Sembilan, Malaysia, from April 2011 until April 2013. All patients were required to perform daily washing of the exit site with antibacterial soap during a shower. In the dressing group (n = 54), patients were required to clean their exit site using povidone-iodine after drying, followed by topical mupirocin antibiotic application to the exit site. The exit site was then covered with a sterile gauze dressing and the catheter immobilized with tape. In the non-dressing group (n = 54), patients were not required to do any further dressing after drying. They were only required to apply mupirocin cream to the exit site and then left the exit site uncovered. The catheter was immobilized with tape. The primary outcome was ESI. The secondary outcomes were evidence of tunnel infection or peritonitis. ♦ A total of 97 patients completed the study. There were a total of 12 ESI episodes: 4 episodes in 4 patients in the dressing group vs 8 episodes in 4 patients in the non-dressing group. This corresponds to 1 episode per 241.3 patient-months vs 1 episode per 111.1 patient-months in the dressing and non-dressing groups respectively. Median time to first ESI episode was shorter in the non-dressing than in the dressing group, but not significant (p = 0.25). The incidence of gram-positive ESI in both groups was similar. There were no gram-negative ESI in the non-dressing group compared with 2 in the dressing group. The peritonitis rate was 1 per 37.1 patient-month in the dressing group and 1 per 44.4 patient-months in the non-dressing group. Median time to first peritonitis episode was significantly shorter in the dressing group compared to non-dressing (p = 0.03). There was no impact of dressing disruptions in the occurrence of major PD catheter-related infection. ♦ Use of a non-dressing technique with only prophylactic topical mupirocin cream application is effective in preventing PD-related infection. The non-dressing technique is more cost-effective and convenient for PD patients, with fewer disposables. Copyright © 2016 International Society for Peritoneal Dialysis.

Expanding perspective on music therapy for symptom management in cancer care.

PubMed

Potvin, Noah; Bradt, Joke; Kesslick, Amy

2015-01-01

Symptom management is a frequently researched treatment topic in music therapy and cancer care. Representations in the literature of music interventions for symptom management, however, have often overlooked the human experiences shaping those symptoms. This may result in music therapy being perceived as a linear intervention process that does not take into account underlying experiences that contribute to symptom experiences. This study explored patient experiences underlying symptoms and symptom management in cancer care, and examined the role of music therapy in that clinical process. This study analyzed semi-structured, open-ended exit interviews obtained from 30 participants during a randomized controlled trial investigating the differential impact of music therapy versus music medicine interventions on symptom management in participants with cancer. Interviews were conducted by a research assistant not involved with the clinical interventions. Exit interview transcripts for 30 participants were analyzed using an inductive, latent, constructivist method of thematic analysis. Three themes-Relaxation, Therapeutic relationship, and Intrapersonal relating-capture elements of the music therapy process that (a) modified participants' experiences of adjustments in their symptoms and (b) highlighted the depth of human experience shaping their symptoms. These underlying human experiences naturally emerged in the therapeutic setting, requiring the music therapist's clinical expertise for appropriate support. Symptom management extends beyond fluctuation in levels and intensity of a surface-level symptom to incorporate deeper lived experiences. The authors provide recommendations for clinical work, entry-level training as related to symptom management, implications for evidence-based practice in music therapy, and methodology for future mixed methods research. © the American Music Therapy Association 2015. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Reading Sacred Texts in the Classroom: The Alignment between Students and Their Teacher's Interpretive Stances When Reading the Hebrew Bible

ERIC Educational Resources Information Center

Hassenfeld, Ziva R.

2016-01-01

This study investigated the voices of students interpreting Hebrew Bible texts in one fourth-grade classroom. Through think-alouds on the Biblical text with each student, exit interviews, teacher interviews, and classroom observations, this study found that those students whose interpretive stances were more aligned with the teacher's were given…

Usability Evaluation of an Unstructured Clinical Document Query Tool for Researchers.

PubMed

Hultman, Gretchen; McEwan, Reed; Pakhomov, Serguei; Lindemann, Elizabeth; Skube, Steven; Melton, Genevieve B

2018-01-01

Natural Language Processing - Patient Information Extraction for Researchers (NLP-PIER) was developed for clinical researchers for self-service Natural Language Processing (NLP) queries with clinical notes. This study was to conduct a user-centered analysis with clinical researchers to gain insight into NLP-PIER's usability and to gain an understanding of the needs of clinical researchers when using an application for searching clinical notes. Clinical researcher participants (n=11) completed tasks using the system's two existing search interfaces and completed a set of surveys and an exit interview. Quantitative data including time on task, task completion rate, and survey responses were collected. Interviews were analyzed qualitatively. Survey scores, time on task and task completion proportions varied widely. Qualitative analysis indicated that participants found the system to be useful and usable in specific projects. This study identified several usability challenges and our findings will guide the improvement of NLP-PIER 's interfaces.

Patients' Perceptions and Experiences of a mHealth Diabetes Self-management System.

PubMed

Georgsson, Mattias; Staggers, Nancy

2017-03-01

Chronic diseases, including diabetes, constitute a substantial disease burden around the world. Mobile self-management systems now play a significant and increasingly important role in patients' disease management. Yet, patients' perceptions of these systems after longer-term use are largely unexplored. A random sample of 10 diabetes patients was assessed immediately after they exited a larger, 6-month randomized controlled trial on the use of a mHealth system called Care4Life. This descriptive, exploratory study assessed patients' perceptions and experiences of mHealth using a questionnaire and semistructured interview whose development was guided by the Technology Acceptance Model. Results indicated that patients saw clear benefits in using the technology and had favorable behavioral disease outcomes after using Care4Life. Suggestions for improving the system were highly individual despite the apparent homogeneity of the patient group. The study begins to fill the gap about the longer-term use of mHealth systems in chronic disease management and reflects the significance of individual needs for mHealth systems.

Views of a Cal/OSHA Inspector.

PubMed

Oudiz, Jack

2009-01-01

Retiring CAL/OSHA Industrial Hygienist and Senior Safety Engineer Jack Oudiz offers his thoughts in the nature of a voluntary "exit interview" on his years working for the agency and its performance in its mission.

Association Between Health Plan Exit From Medicaid Managed Care and Quality of Care, 2006-2014

PubMed Central

Schpero, William L.; Schlesinger, Mark J.; Trivedi, Amal N.

2017-01-01

Importance State Medicaid programs have increasingly contracted with insurers to provide medical care services for enrollees (Medicaid managed care plans). Insurers that provide these plans can exit Medicaid programs each year, with unclear effects on quality of care and health care experiences. Objective To determine the frequency and interstate variation of health plan exit from Medicaid managed care and evaluate the relationship between health plan exit and market-level quality. Design, Setting, and Participants Retrospective cohort of all comprehensive Medicaid managed care plans (N = 390) during the interval 2006-2014. Exposures Plan exit, defined as the withdrawal of a managed care plan from a state’s Medicaid program. Main Outcomes and Measures Eight measures from the Healthcare Effectiveness Data and Information Set were used to construct 3 composite indicators of quality (preventive care, chronic disease care management, and maternity care). Four measures from the Consumer Assessment of Healthcare Providers and Systems were combined into a composite indicator of patient experience, reflecting the proportion of beneficiaries rating experiences as 8 or above on a 0-to-10–point scale. Outcome data were available for 248 plans (68% of plans operating prior to 2014, representing 78% of beneficiaries). Results Of the 366 comprehensive Medicaid managed care plans operating prior to 2014, 106 exited Medicaid. These exiting plans enrolled 4 848 310 Medicaid beneficiaries, with a mean of 606 039 beneficiaries affected by plan exits annually. Six states had a mean of greater than 10% of Medicaid managed care recipients enrolled in plans that exited, whereas 10 states experienced no plan exits. Plans that exited from a state’s Medicaid market performed significantly worse prior to exiting than those that remained in terms of preventive care (57.5% vs 60.4%; difference, 2.9% [95% CI, 0.3% to 5.5%]), maternity care (69.7% vs 73.6%; difference, 3.8% [95% CI, 1.7% to 6.0%]), and patient experience (73.5% vs 74.8%; difference, 1.3% [95% CI, 0.6% to 1.9%]). There was no significant difference between exiting and nonexiting plans for the quality of chronic disease care management (76.2% vs 77.1%; difference, 1.0% [95% CI, −2.1% to 4.0%]). There was also no significant change in overall market performance before and after the exit of a plan: 0.7–percentage point improvement in preventive care quality (95% CI, −4.9 to 6.3); 0.2–percentage point improvement in chronic disease care management quality (95% CI, −5.8 to 6.2); 0.7–percentage point decrease in maternity care quality (95% CI, −6.4 to 5.0]); and a 0.6–percentage point improvement in patient experience ratings (95% CI, −3.9 to 5.1). Medicaid beneficiaries enrolled in exiting plans had access to coverage for a higher-quality plan, with 78% of plans in the same county having higher quality for preventive care, 71.1% for chronic disease management, 65.5% for maternity care, and 80.8% for patient experience. Conclusions and Relevance Between 2006 and 2014, health plan exit from the US Medicaid program was frequent. Plans that exited generally had lower quality ratings than those that remained, and the exits were not associated with significant overall changes in quality or patient experience in the plans in the Medicaid market. PMID:28655014

Association Between Health Plan Exit From Medicaid Managed Care and Quality of Care, 2006-2014.

PubMed

Ndumele, Chima D; Schpero, William L; Schlesinger, Mark J; Trivedi, Amal N

2017-06-27

State Medicaid programs have increasingly contracted with insurers to provide medical care services for enrollees (Medicaid managed care plans). Insurers that provide these plans can exit Medicaid programs each year, with unclear effects on quality of care and health care experiences. To determine the frequency and interstate variation of health plan exit from Medicaid managed care and evaluate the relationship between health plan exit and market-level quality. Retrospective cohort of all comprehensive Medicaid managed care plans (N = 390) during the interval 2006-2014. Plan exit, defined as the withdrawal of a managed care plan from a state's Medicaid program. Eight measures from the Healthcare Effectiveness Data and Information Set were used to construct 3 composite indicators of quality (preventive care, chronic disease care management, and maternity care). Four measures from the Consumer Assessment of Healthcare Providers and Systems were combined into a composite indicator of patient experience, reflecting the proportion of beneficiaries rating experiences as 8 or above on a 0-to-10-point scale. Outcome data were available for 248 plans (68% of plans operating prior to 2014, representing 78% of beneficiaries). Of the 366 comprehensive Medicaid managed care plans operating prior to 2014, 106 exited Medicaid. These exiting plans enrolled 4 848 310 Medicaid beneficiaries, with a mean of 606 039 beneficiaries affected by plan exits annually. Six states had a mean of greater than 10% of Medicaid managed care recipients enrolled in plans that exited, whereas 10 states experienced no plan exits. Plans that exited from a state's Medicaid market performed significantly worse prior to exiting than those that remained in terms of preventive care (57.5% vs 60.4%; difference, 2.9% [95% CI, 0.3% to 5.5%]), maternity care (69.7% vs 73.6%; difference, 3.8% [95% CI, 1.7% to 6.0%]), and patient experience (73.5% vs 74.8%; difference, 1.3% [95% CI, 0.6% to 1.9%]). There was no significant difference between exiting and nonexiting plans for the quality of chronic disease care management (76.2% vs 77.1%; difference, 1.0% [95% CI, -2.1% to 4.0%]). There was also no significant change in overall market performance before and after the exit of a plan: 0.7-percentage point improvement in preventive care quality (95% CI, -4.9 to 6.3); 0.2-percentage point improvement in chronic disease care management quality (95% CI, -5.8 to 6.2); 0.7-percentage point decrease in maternity care quality (95% CI, -6.4 to 5.0]); and a 0.6-percentage point improvement in patient experience ratings (95% CI, -3.9 to 5.1). Medicaid beneficiaries enrolled in exiting plans had access to coverage for a higher-quality plan, with 78% of plans in the same county having higher quality for preventive care, 71.1% for chronic disease management, 65.5% for maternity care, and 80.8% for patient experience. Between 2006 and 2014, health plan exit from the US Medicaid program was frequent. Plans that exited generally had lower quality ratings than those that remained, and the exits were not associated with significant overall changes in quality or patient experience in the plans in the Medicaid market.

Quality of life and functioning of Hispanic patients with Major Depressive Disorder before and after treatment.

PubMed

López, Enrique; Steiner, Alexander J; Manier, Karra; Shapiro, Bryan B; Vanle, Brigitte; Parisi, Thomas; Dang, Jonathan; Chang, Tiffany; Ganjian, Shaina; Mirocha, James; Danovitch, Itai; IsHak, Waguih William

2018-01-01

Similar rates of remission from Major Depressive Disorder (MDD) have been documented between ethnic groups in response to antidepressant treatment. However, ethnic differences in functional outcomes, including patient-reported quality of life (QOL) and functioning, have not been well-characterized. We compared symptomatic and functional outcomes of antidepressant treatment in Hispanic and non-Hispanic patients with MDD. We analyzed 2280 nonpsychotic treatment-seeking adults with MDD who received citalopram monotherapy in Level 1 of the Sequenced Treatment Alternatives to Relieve Depression study. All subjects (239 Hispanic, 2041 non-Hispanic) completed QOL, functioning, and depressive symptom severity measures at entry and exit. Hispanic participants had significantly worse QOL scores at entry and exit (p < 0.01). However, after controlling for baseline QOL, there was no difference between Hispanic and non-Hispanic patients' QOL at exit (p = 0.21). There were no significant between-group differences at entry or at exit for depressive symptom severity or functioning. Both groups had significant improvements in depressive symptom severity, QOL, and functioning from entry to exit (all p values < 0.01). Patients with private insurance had lower depressive symptom severity, greater QOL, and better functioning at exit compared to patients without private insurance. This study was a retrospective data analysis, and the Hispanic group was relatively small compared to the non-Hispanic group. Hispanic and non-Hispanic participants with MDD had similar responses to antidepressant treatment as measured by depressive symptom severity scores, quality of life, and functioning. Nevertheless, Hispanic patients reported significantly worse quality of life at entry. Copyright © 2017 Elsevier B.V. All rights reserved.

Exit-Site Infection of Peritoneal Catheter is Reduced by the Use of Polyhexanide. Results of a Prospective Randomized Trial

PubMed Central

Núñez-Moral, M.; Sánchez-Álvarez, E.; González-Díaz, I.; Peláez-Requejo, B.; Fernández-Viña, A.; Quintana-Fernández, A.; Rodríguez-Suárez, C.

2014-01-01

♦ Background: One of the most common and severe complications affecting peritoneal dialysis (PD) patients is exit-site infection of the peritoneal catheter; it is therefore of vital importance to prevent it. This complication has a negative impact on the success of the technique. In spite of this, there are no clear guidelines concerning how to take care of the exit site. The objective of this study was to assess the efficacy of polyhexanide in preventing exit-site infection over a 12-month period. ♦ Methods: We designed a single-center, prospective, open-labeled, randomized controlled clinical trial with parallel groups. Requirements for participation in the study included implantation of the peritoneal catheter at least six weeks before entering the study and no infectious complications requiring either hospital admission or antibiotic treatment for at least three months before entering into the study. Patients were randomized to be daily cured as follows: Group A: traditional care with saline serum and povidone-iodine; and Group B: polyhexanide solution. Exit sites were evaluated at baseline and every four to six weeks or if any event occurred, according to the Twardowski criteria. ♦ Results: Of the 60 included patients, 46 completed the 12-month follow-up period. Six underwent transplantation, five died and three were transferred to hemodialysis (HD). The treatment was well tolerated, with no side effects nor abandonments due to such effects. Throughout the study period, six patients (20%) undergoing traditional care and only two (6,7%) receiving polyhexanide developed an exit-site infection (p = 0.032). There were a total number of 12 infections; nine occurred in patients following the traditional approach and only three in patients treated with polyhexanide (p = 0.037). The germs responsible for the infections were: S. aureus (six cases), Corynebacterium jeikeium (two cases) and P. aeruginosa (one case) in the saline serum and povidone-iodine group and P. aeruginosa (three cases) in the polyhexanide group. The mean rate of exit-site infection was 1 episode/36.6 patient-months for the traditional care group and 1 episode/102.7 patient-months for the polyhexanide group (p = 0.017). Patients following the traditional treatment required fewer days to get infected than those using polyhexanide (p = 0.033; log rank: 4.2). ♦ Conclusions: These results show that using polyhexanide is efficient for the prevention of exit-site infections. Patients treated with this product suffer from fewer infections and need more time to become infected. Polyhexanide application is painless, no allergies have been described and it is well tolerated by patients. We therefore propose that it may be used routinely from now on for the care of healthy exit site. PMID:24497599

Management of fear of radiation exposure in carers of outpatients treated with iodine-131.

PubMed

Calais, Phillipe J; Page, Andrew C; Turner, J Harvey

2012-07-01

To characterise potential fear of radiation exposure in a normal population of individuals who have volunteered to care for a radioactive family member or friend after outpatient radioimmunotherapy (RIT) treatment for cancer, and obtain their knowing and willing acceptance of the risk. Over 750 carers of 300 patients confined to their homes for 1 week following outpatient iodine-131 rituximab RIT of lymphoma were interviewed by a nuclear medicine physicist according to a multi-visit integrated protocol designed to minimise radiation exposure, define risk and gain informed consent. Median radiation exposure of carers was 0.49 mSv (range 0.01-3.7 mSv) which is below the Western Australian regulatory limit of 5 mSv for consenting adult carers of radioactive patients. After signing a declaration of consent, only 2 carers of 750 abrogated their responsibility and none of those who carried out their duties expressed residual concerns at the end of the exit interview with respect to their radiation exposure. Fear of radiation exposure in a normal population may be characterised as a normal emotional response. In the special case of carers of radioactive patients, this fear may be successfully managed by rational, authoritative and empathic explanation to define the risk and gain willing acceptance within the context of domiciliary patient care.

The process of exiting vegetarianism: an exploratory study.

PubMed

Menzies, Kenneth; Sheeshka, Judy

2012-01-01

The experience, reasons, and contexts associated with leaving vegetarianism were explored. Interviews were conducted with a convenience sample of 19 ex-vegetarians and 15 continuing vegetarians. Exiting vegetarianism is similar to the process of leaving other important individual identities, including exiting diets containing meat. It is a process, not an event, and partially a response to inconvenience, particularly when the person's table companions were not vegetarians. Major life changes and declines in self-perceived health provided occasions to reassess life choices, including the vegetarian commitment. Ex-vegetarians interpreted their vegetarianism as a transition to a new, healthier diet. Including a comparison group of continuing vegetarians revealed that the ex-vegetarians were more likely to have become vegetarians as a result of concern about the well-being of animals and the environment, not animal rights, a value more difficult to compromise. Exiting processes show the five central food values of taste, health, time, cost, and social relationships undermine people's commitment to a diet chosen largely for moral reasons.

Pathways to labor force exit: work transitions and work instability.

PubMed

Mutchler, J E; Burr, J A; Pienta, A M; Massagli, M P

1997-01-01

The purpose of this study is to examine alternative pathways to labor force exit among older men. Based on the life course perspective, we distinguish between crisp exits from the labor force, which are characterized as being unidirectional, and blurred transition patterns, which include repeated exists, entrances, and unemployment spells. Using longitudinal data from the 1984 Survey of Income and Program Participation, we find that one-quarter of the sample of men aged 55 to 74 at first interview experienced at least one transition in labor force status over a 28-month observation period. Fewer than half of these can be characterized as crisp exists from the labor force. Our multivariate analysis suggests that blurred transition patterns are likely part of an effort to maintain economic status in later life.

Fever case management at private health facilities and private pharmacies on the Kenyan coast: analysis of data from two rounds of client exit interviews and mystery client visits.

PubMed

Poyer, Stephen; Musuva, Anne; Njoki, Nancy; Okara, Robi; Cutherell, Andrea; Sievers, Dana; Lussiana, Cristina; Memusi, Dorothy; Kiptui, Rebecca; Ejersa, Waqo; Dolan, Stephanie; Charman, Nicole

2018-03-13

Private sector availability and use of malaria rapid diagnostic tests (RDTs) lags behind the public sector in Kenya. Increasing channels through which quality malaria diagnostic services are available can improve access to testing and help meet the target of universal diagnostic testing. Registered pharmacies are currently not permitted to perform blood tests, and evidence of whether malaria RDTs can be used by non-laboratory private providers in line with the national malaria control guidelines is required to inform ongoing policy discussions in Kenya. Two rounds of descriptive cross-sectional exit interviews and mystery client surveys were conducted at private health facilities and registered pharmacies in 2014 and 2015, 6 and 18 months into a multi-country project to prime the private sector market for the introduction of RDTs. Data were collected on reported RDT use, medicines received and prescribed, and case management of malaria test-negative mystery clients. Analysis compared outcomes at facilities and pharmacies independently for the two survey rounds. Across two rounds, 534 and 633 clients (including patients) from 130 and 120 outlets were interviewed, and 214 and 250 mystery client visits were completed. Reported testing by any malaria diagnostic test was higher in private health facilities than registered pharmacies in both rounds (2014: 85.6% vs. 60.8%, p < 0.001; 2015: 85.3% vs. 56.3%, p < 0.001). In registered pharmacies, testing by RDT was 52.1% in 2014 and 56.3% in 2015. At least 75% of test-positive patients received artemisinin-based combination therapy (ACT) in both rounds, with no significant difference between outlet types in either round. Provision of any anti-malarial for test-negative patients ranged from 0 to 13.9% across outlet types and rounds. In 2015, mystery clients received the correct (negative) diagnosis and did not receive an anti-malarial in 75.5% of visits to private health facilities and in 78.4% of visits to registered pharmacies. Non-laboratory staff working in registered pharmacies in Kenya can follow national guidelines for diagnosis with RDTs when provided with the same level of training and supervision as private health facility staff. Performance and compliance to treatment recommendations are comparable to diagnostic testing outcomes recorded in private health facilities.

Dental students' attitudes towards digital textbooks.

PubMed

Strother, Elizabeth A; Brunet, Darlene P; Bates, Michael L; Gallo, John R

2009-12-01

Dental students at the Louisiana State University School of Dentistry (LSUSD) have participated in the VitalSource Bookshelf digital textbook program for the last four years. The Bookshelf, a collection of downloadable textbooks, includes the Contemporary Dental Library (CDL), a basic package of sixty books, plus additional titles selected by course directors. A survey was sent to students in the four LSUSD classes to assess satisfaction with the program. Eighty-two (34.2 percent) students completed the survey. In addition, exit interviews of graduating seniors contained a question on the Bookshelf. In both the survey and the exit interview, LSUSD students overwhelmingly expressed dissatisfaction with reading extensive amounts of text online and indicated a preference for printed books. Some students also resented paying for books in the CDL that were not required by instructors and felt that, considering how infrequently they used the Bookshelf, the cost was too high.

The demonstration of a theory-based approach to the design of localized patient safety interventions

PubMed Central

2013-01-01

Background There is evidence of unsafe care in healthcare systems globally. Interventions to implement recommended practice often have modest and variable effects. Ideally, selecting and adapting interventions according to local contexts should enhance effects. However, the means by which this can happen is seldom systematic, based on theory, or made transparent. This work aimed to demonstrate the applicability, feasibility, and acceptability of a theoretical domains framework implementation (TDFI) approach for co-designing patient safety interventions. Methods We worked with three hospitals to support the implementation of evidence-based guidance to reduce the risk of feeding into misplaced nasogastric feeding tubes. Our stepped process, informed by the TDF and key principles from implementation literature, entailed: involving stakeholders; identifying target behaviors; identifying local factors (barriers and levers) affecting behavior change using a TDF-based questionnaire; working with stakeholders to generate specific local strategies to address key barriers; and supporting stakeholders to implement strategies. Exit interviews and audit data collection were undertaken to assess the feasibility and acceptability of this approach. Results Following audit and discussion, implementation teams for each Trust identified the process of checking the positioning of nasogastric tubes prior to feeding as the key behavior to target. Questionnaire results indicated differences in key barriers between organizations. Focus groups generated innovative, generalizable, and adaptable strategies for overcoming barriers, such as awareness events, screensavers, equipment modifications, and interactive learning resources. Exit interviews identified themes relating to the benefits, challenges, and sustainability of this approach. Time trend audit data were collected for 301 patients over an 18-month period for one Trust, suggesting clinically significant improved use of pH and documentation of practice following the intervention. Conclusions The TDF is a feasible and acceptable framework to guide the implementation of patient safety interventions. The stepped TDFI approach engages healthcare professionals and facilitates contextualization in identifying the target behavior, eliciting local barriers, and selecting strategies to address those barriers. This approach may be of use to implementation teams and policy makers, although our promising findings confirm the need for a more rigorous evaluation; a balanced block evaluation is currently underway. PMID:24131864

Exit-site infections by non-diphtheria corynebacteria in CAPD.

PubMed

Schiffl, Helmut; Mücke, Claudia; Lang, Susanne M

2004-01-01

Non-diphtheria corynebacteria species cause disease in risk populations such as immunocompromised patients and patients with indwelling medical devices. Despite reports of exit-site infection and peritonitis caused by non-diphtheria corynebacteria, these organisms are frequently dismissed as contaminants. During a 10-year observation period, we prospectively identified 8 cases of exit-site/tunnel infections caused by 2 different species of corynebacteria (Corynebacterium striatum in 5 and C. jeikeium in 3 cases). Four patients experienced a second episode of exit-site infection 3 months (2 cases), 25 months, and 40 months, respectively, after termination of an oral cephalosporin therapy of 4 to 6 weeks' duration. Non-diphtheria corynebacteria accounted for 9% of all exit-site infections during the study period. All catheter-related infections healed; no catheter had to be removed. The diagnosis of catheter-related non-diphtheria corynebacteria infection may be suspected when Gram stain shows gram-positive rods and with colony morphology and commercial biochemical identification systems. Susceptibility of non-diphtheria corynebacteria to antibiotics may vary, especially in C. jeikeium. Virtually all Corynebacterium species are sensitive to vancomycin. Empirical antibiotic therapy with vancomycin should be initiated while antibiotic susceptibility testing is being carried out. Oral cephalosporin may be an alternative treatment regimen for exit-site infections if sensitive. This study highlights the importance of non-diphtheria corynebacteria as emerging nosocomial pathogens in the population of end-stage renal disease patients on on continuous ambulatory peritoneal dialysis.

75 FR 30914 - Proposed Information Collection (Six-Month Post-Exit Focus Interview of Former VHA Employees...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-02

... data collected will be used to develop talent management strategies to enhance workforce recruitment... Federal Docket Management System (FDMS) at http://www.Regulations.gov ; or to Mary Stout, Veterans Health...

Status of the use and compliance with malaria rapid diagnostic tests in formal private health facilities in Nigeria.

PubMed

Mokuolu, Olugbenga A; Ntadom, Godwin N; Ajumobi, Olufemi O; Alero, Roberts A; Wammanda, Robinson D; Adedoyin, Olanrewaju T; Okafor, Henrietta U; Alabi, Adekunle D; Odey, Friday A; Agomo, Chimere O; Edozieh, Kate U; Fagbemi, Tolulope O; Njidda, Ahmad M; Babatunde, Seye; Agbo, Emmanuel C; Nwaneri, Nnamdi B; Shekarau, Emmanuel D; Obasa, Temitope O; Ezeigwe, Nnenna M

2016-01-04

Nigeria has the largest number of malaria-related deaths, accounting for a third of global malaria deaths. It is important that the country attains universal coverage of key malaria interventions, one of which is the policy of universal testing before treatment, which the country has recently adopted. However, there is a dearth of data on its implementation in formal private health facilities, where close to a third of the population seek health care. This study identified the level of use of malaria rapid diagnostic testing (RDT), compliance with test results and associated challenges in the formal private health facilities in Nigeria. A cross-sectional study that involved a multi-stage, random sampling of 240 formal private health facilities from the country's six geo-political zones was conducted from July to August 2014. Data were collected using health facility records, healthcare workers' interviews and an exit survey of febrile patients seen at the facilities, in order to determine fever prevalence, level of testing of febrile patience, compliance with test results, and health workers' perceptions to RDT use. Data from the 201 health facilities analysed indicated a fever prevalence of 38.5% (112,521/292,430). Of the 2077 exit interviews for febrile patients, malaria testing was ordered in 73.8% (95% CI 71.7-75.7%). Among the 1270 tested, 61.8% (719/1270) were tested with microscopy and 38.2% (445/1270) with RDT. Compliance to malaria test result [administering arteminisin-based combination therapy (ACT) to positive patients and withholding ACT from negative patients] was 80.9% (95% CI 78.7-83%). Compliance was not influenced by the age of patients or type of malaria test. The health facilities have various cadres of the health workers knowledgeable on RDT with 70% knowing the meaning, while 84.5% knew what it assesses. However, there was clearly a preference for microscopy as only 20% reported performing only RDT. In formal private health facilities in Nigeria there is a high rate of malaria testing for febrile patients, high level of compliance with test results but relatively low level of RDT utilization. This calls for improved engagement of the formal private health sector with a view to achieving universal coverage targets on malaria testing.

Gradual electronic health record implementation: new insights on physician and patient adaptation.

PubMed

Shield, Renée R; Goldman, Roberta E; Anthony, David A; Wang, Nina; Doyle, Richard J; Borkan, Jeffrey

2010-01-01

Although there is significant interest in implementation of electronic health records (EHRs), limited data have been published in the United States about how physicians, staff, and patients adapt to this implementation process. The purpose of this research was to examine the effects of EHR implementation, especially regarding physician-patient communication and behaviors and patients' responses. We undertook a 22-month, triangulation design, mixed methods study of gradual EHR implementation in a residency-based family medicine outpatient center. Data collection included participant observation and time measurements of 170 clinical encounters, patient exit interviews, focus groups with nurses, nurse's aides, and office staff, and unstructured observations and interviews with nursing staff and physicians. Analysis involved iterative immersion-crystallization discussion and searches for alternate hypotheses. Patient trust in the physician and security in the physician-patient relationship appeared to override most patients' concerns about information technology. Overall, staff concerns about potential deleterious consequences of EHR implementation were dispelled, positive anticipated outcomes were realized, and unexpected benefits were found. Physicians appeared to become comfortable with the "third actor" in the room, and nursing and office staff resistance to EHR implementation was ameliorated with improved work efficiencies. Unexpected advantages included just-in-time improvements and decreased physician time out of the examination room. Strong patient trust in the physician-patient relationship was maintained and work flow improved with EHR implementation. Gradual EHR implementation may help support the development of beneficial physician and staff adaptations, while maintaining positive patient-physician relationships and fostering the sharing of medical information.

Implementing Trauma-Informed Partner Violence Assessment in Family Planning Clinics.

PubMed

Decker, Michele R; Flessa, Sarah; Pillai, Ruchita V; Dick, Rebecca N; Quam, Jamie; Cheng, Diana; McDonald-Mosley, Raegan; Alexander, Kamila A; Holliday, Charvonne N; Miller, Elizabeth

2017-09-01

Intimate partner violence (IPV) and reproductive coercion (RC) are associated with poor reproductive health. Little is known about how family planning clinics implement brief IPV/RC assessment interventions in practice. We describe the uptake and impact of a brief, trauma-informed, universal IPV/RC assessment and education intervention. Intervention implementation was evaluated via a mixed methods study among women ages 18 and up receiving care at one of two family planning clinics in greater Baltimore, MD. This mixed methods study entailed a quasi-experimental, single group pretest-posttest study with family planning clinic patients (baseline and exit survey n = 132; 3-month retention n = 68; retention rate = 52%), coupled with qualitative interviews with providers and patients (total n = 35). Two thirds (65%) of women reported receiving at least one element of the intervention on their exit survey immediately following the clinic-visit. Patients reported that clinic-based IPV assessment is helpful, irrespective of IPV history. Relative to those who reported neither, participants who received either intervention element reported greater perceived caring from providers, confidence in provider response to abusive relationships, and knowledge of IPV-related resources at follow-up. Providers and patients alike described the educational card as a valuable tool. Participants described trade-offs of paper versus in-person, electronic medical record-facilitated screening, and patient reluctance to disclose current situations of abuse. In real-world family planning clinic settings, a brief assessment and support intervention was successful in communicating provider caring and increasing knowledge of violence-related resources, endpoints previously deemed valuable by IPV survivors. Results emphasize the merit of universal education in IPV/RC clinical interventions over seeking IPV disclosure.

Iowa Statewide Follow-Up Study. Changes in the Adult Adjustment of Graduates with Mental Disabilities, One vs. Three Years Out of School.

ERIC Educational Resources Information Center

Sitlington, Patricia L.; And Others

This study investigated the adult adjustment of students with mental disabilities in high-school graduating classes of 1984 and 1985, 1 and 3 years after they exited high school. Two hundred sixty students from the class of 1984 were interviewed 1 year out of high school; 166 from this same class were interviewed 3 years out of school. Three…

Ex-utero intrapartum treatment procedure for giant neck masses--fetal and maternal outcomes.

PubMed

Lazar, David A; Olutoye, Oluyinka O; Moise, Kenneth J; Ivey, R Todd; Johnson, Anthony; Ayres, Nancy; Olutoye, Olutoyin A; Rodriguez, Manuel A; Cass, Darrell L

2011-05-01

For fetuses with giant neck masses and tracheal obstruction, an ex-utero intrapartum treatment (EXIT) procedure allows for safe nonemergent airway management while on placental support. Our objective was to examine fetal and maternal outcomes after EXIT procedure specifically for giant neck masses. The medical records of all patients referred to a comprehensive fetal center for a giant neck mass between 2001 and 2010 were reviewed retrospectively. Among 24 patients referred, an EXIT procedure was performed in 12 with evidence of tracheal compression. An EXIT procedure was not performed because of minimal tracheal involvement (n = 8), elective abortion (n = 2), fetal demise (n = 1), or obstetric complication (n = 1). In all fetuses, the airway was successfully secured; tracheal intubation was achieved with rigid bronchoscopy (n = 10), direct laryngoscopy (n = 1), and tracheostomy (n = 1). Eleven patients survived to discharge, whereas 1 patient with significant pulmonary hypoplasia died 8 days after emergency EXIT procedure. Of 11 surviving infants, 10 are neurodevelopmentally intact. All mothers who desired future pregnancies have subsequently had uncomplicated deliveries (n = 6). Ex-utero intrapartum treatment procedure for giant neck mass can be performed safely for both mother and child. Most fetuses can be orotracheally intubated with minimal long-term morbidity. The potential for future pregnancies is preserved. Copyright © 2011 Elsevier Inc. All rights reserved.

Efficacy and safety of conversion to monotherapy with eslicarbazepine acetate in adults with uncontrolled partial-onset seizures: a randomized historical-control phase III study based in North America.

PubMed

Sperling, Michael R; Harvey, Jay; Grinnell, Todd; Cheng, Hailong; Blum, David

2015-04-01

To assess the efficacy and safety of eslicarbazepine acetate (ESL) as monotherapy in North American patients with partial-onset seizures (POS). This multicenter, randomized, double-blind "withdrawal to monotherapy" study used historical control data as the comparator. Adults with POS medically uncontrolled by one to two antiepileptic drugs gradually converted to ESL monotherapy. Following an 8-week baseline period, patients were randomized 2:1 to receive ESL 1,600 mg (n = 128) or 1,200 mg QD (n = 65) for 18 weeks. The primary end point was the proportion of patients meeting predefined exit criteria (signifying worsening seizure control). Treatment was considered effective if the 95% upper confidence limit (UCL) for the Kaplan-Meier estimated exit rate was lower than the exit rate threshold calculated from the historical control (65.3%). Kaplan-Meier estimated exit rates were: ESL 1,600 mg, 28.7% (95% CI 21.2-38.1%) and 1,200 mg, 44.4% (32.5-58.3%). The difference between doses was not significant (p = 0.07). For both doses, the 95% UCLs for the exit rate were ˂ 65.3%; ESL monotherapy was considered superior to the historical control. There was no statistically significant increase in the risk of study exit related to carbamazepine use. Nine (7.6%) and five patients (8.3%) remained seizure-free during the 10-week monotherapy period, while taking ESL 1,600 and 1,200 mg, respectively. The reductions in median standardized seizure frequency (seizures per 28 days) between baseline and the 18-week treatment period were: ESL 1,600 mg, 42% and 1,200 mg, 31%. Treatment-emergent adverse events (TEAEs) occurring in ≥ 10% of patients were dizziness, headache, fatigue, somnolence, nausea, and nasopharyngitis. The TEAE most frequently leading to discontinuation was hyponatremia (2.1%). ESL was efficacious and well tolerated as monotherapy in North American patients, and led to a reduction in seizure frequency. Exit rates for ESL 1,600 and 1,200 mg QD were superior to the historical control; the difference in exit rates between doses was not statistically significant. © 2015 The Authors. Epilepsia published by Wiley Periodicals, Inc. on behalf of International League Against Epilepsy.

A Prospective Study of the Impact of Current Poverty, History of Poverty, and Exiting Poverty on Accumulation of Disease Damage in Systemic Lupus Erythematosus.

PubMed

Yelin, Edward; Trupin, Laura; Yazdany, Jinoos

2017-08-01

To estimate the effect of current poverty, number of years in poverty, and exiting poverty on disease damage accumulation in systemic lupus erythematosus (SLE). For this study, 783 patients with SLE were followed up from 2003 to 2015 through annual structured interviews. Respondents were categorized in each year by whether they had a household income of ≤125% of the US federal poverty level. Linear and logistic regression analyses were used to assess the impact of poverty in 2009, number of years in poverty between 2003 and 2009, and permanent exits from poverty as of 2009 on the extent of disease damage (according to the Brief Index of Lupus Damage [BILD] score) or accumulation of a clinically meaningful increase in disease damage (defined as a minimum 2-point increase in the BILD damage score) by 2015. After adjustment for sociodemographic features, health care characteristics, and health behaviors, poverty in 2009 was associated with an increased level of accumulated disease damage in 2015 (mean difference in BILD damage score between poor and non-poor 0.62 points, 95% confidence interval [95% CI] 0.25-0.98) and increased odds of a clinically important increase in damage (odds ratio [OR] 1.67, 95% CI 0.98-2.85). Being poor in every year between 2003 and 2009 was associated with greater damage (mean change in BILD score 2.45, 95% CI 1.88-3.01) than being poor for one-half or more of those years (mean change in BILD score 1.45, 95% CI 0.97-1.93), for fewer than one-half of those years (mean change in BILD score 1.49, 95% CI 1.10-1.88), or for none of those years (mean change in BILD score 1.34, 95% CI 1.20-1.49). Those exiting poverty permanently had similar increases in disease damage (mean change in BILD score 1.30, 95% CI 0.90-1.69) as those who were never in poverty (mean change in BILD score 1.36, 95% CI 1.23-1.50) but much less damage than those who remained in poverty (mean change in BILD score 1.98, 95% CI 1.59-2.38). The effects of current poverty, "dose" of poverty, and exiting poverty suggest that poverty plays a critical role in the accumulation of damage in patients with SLE. © 2017, American College of Rheumatology.

Association between keeping home records of catheter exit-site and incidence of peritoneal dialysis-related infections.

PubMed

Iida, Hidekazu; Kurita, Noriaki; Fujimoto, Shino; Kamijo, Yuka; Ishibashi, Yoshitaka; Fukuma, Shingo; Fukuhara, Shunichi

2018-04-01

To prevent peritoneal dialysis (PD)-related infection, components of self-catheter care have been emphasized. However, studies on the effectiveness of home recording for the prevention of PD-related infections are limited. This study aimed to examine the association between keeping home records of catheter exit site and incidence of PD-related infections. Home record books were submitted by patients undergoing PD. The proportion of days on which exit-site home recording was carried out for 120 days (0-100%) was obtained. The patients were divided into the frequent home recording group (≥ 40.5%; median value) and the infrequent home recording group (< 40.5%). The associations between the recording group and the incidence rate ratios (IRRs) of PD-related infections were estimated via negative binomial regression models. A total of 67 patients participated in this study (mean age, 66.7 years). The incidence rates for exit-site infection, tunnel infection, and peritonitis were 0.42, 0.22, and 0.06 times/patient-year, respectively. The IRRs of the frequent versus infrequent home recording groups for PD-related infection were 1.58 (95% confidence interval [CI], 0.72-3.46) in the univariate analysis and 1.49 (95% CI, 0.65-3.42) in the multivariate analysis. The IRRs of the frequent versus infrequent home recording groups for composite of surgery to create a new exit site and removal of PD catheter were 0.55 (95% CI, 0.78-3.88) and 0.35 (95% CI, 0.06-1.99), respectively. This study could not prove that keeping home records of patients' catheter exit site is associated with a lower incidence of PD-related infections.

Implementation of patient charges at primary care facilities in Kenya: implications of low adherence to user fee policy for users and facility revenue

PubMed Central

Opwora, Antony; Waweru, Evelyn; Toda, Mitsuru; Noor, Abdisalan; Edwards, Tansy; Fegan, Greg; Molyneux, Sassy; Goodman, Catherine

2015-01-01

With user fees now seen as a major hindrance to universal health coverage, many countries have introduced fee reduction or elimination policies, but there is growing evidence that adherence to reduced fees is often highly imperfect. In 2004, Kenya adopted a reduced and uniform user fee policy providing fee exemptions to many groups. We present data on user fee implementation, revenue and expenditure from a nationally representative survey of Kenyan primary health facilities. Data were collected from 248 randomly selected public health centres and dispensaries in 2010, comprising an interview with the health worker in charge, exit interviews with curative outpatients, and a financial record review. Adherence to user fee policy was assessed for eight tracer conditions based on health worker reports, and patients were asked about actual amounts paid. No facilities adhered fully to the user fee policy across all eight tracers, with adherence ranging from 62.2% for an adult with tuberculosis to 4.2% for an adult with malaria. Three quarters of exit interviewees had paid some fees, with a median payment of US dollars (USD) 0.39, and a quarter of interviewees were required to purchase additional medical supplies at a later stage from a private drug retailer. No consistent pattern of association was identified between facility characteristics and policy adherence. User fee revenues accounted for almost all facility cash income, with average revenue of USD 683 per facility per year. Fee revenue was mainly used to cover support staff, non-drug supplies and travel allowances. Adherence to user fee policy was very low, leading to concerns about the impact on access and the financial burden on households. However, the potential to ensure adherence was constrained by the facilities’ need for revenue to cover basic operating costs, highlighting the need for alternative funding strategies for peripheral health facilities. PMID:24837638

SU-F-T-258: Efficacy of Exit Fluence-Based Dose Calculation for Prostate Radiation Therapy

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

Siebers, J; Gardner, J; Neal, B

Purpose: To investigate the efficacy of exit-fluence-based dose computation for prostate radiotherapy by determining if it estimates true dose more accurately than the original planning dose. Methods: Virtual exit-fluencebased dose computation was performed for 19 patients, each with 9–12 repeat CT images. For each patient, a 78 Gy treatment plan was created utilizing 5 mm CTV-to-PTV and OAR-to-PRV margins. A Monte Carlo framework was used to compute dose and exit-fluence images for the planning image and for each repeat CT image based on boney-anatomyaligned and prostate-centroid-aligned CTs. Identical source particles were used for the MC dose-computations on the planning andmore » repeat CTs to maximize correlation. The exit-fluence-based dose and image were computed by multiplying source particle weights by FC(x,y)=FP(x,y)/FT(x,y), where (x,y) are the source particle coordinates projected to the exit-fluence plane and we denote the dose/fluence from the plan by (DP,FP), from the repeat-CT as (DT,FT), and the exit-fluence computation by (DFC,FFC). DFC mimics exit-fluence backprojection through the planning image as FT=FFC. Dose estimates were intercompared to judge the efficacy of exit-fluence-based dose computation. Results: Boney- and prostate-centroid aligned results are combined as there is no statistical difference between them, yielding 420 dose comparisons per dose-volume metric. DFC is more accurate than DP for 46%, 33%, and 44% of cases in estimating CTV D98, D50, and D2 respectively. DFC improved rectum D50 and D2 estimates 54% and 49% respectively and bladder D50 and D2 47 and 49% respectively. While averaged over all patients and images DFC and DP were within 3.1% of DT, they differed from DT by as much as 22% for GTV D98, 71% for the Bladder D50, 17% for Bladder D2, 19% for Rectum D2. Conclusion: Exit-fluence based dose computations infrequently improve CTV or OAR dose estimates and should be used with caution. Research supported in part by Varian Medical Systems.« less

Integrating a Smartphone-Based Self-Management System into Usual Care of Advanced CKD.

PubMed

Ong, Stephanie W; Jassal, Sarbjit V; Miller, Judith A; Porter, Eveline C; Cafazzo, Joseph A; Seto, Emily; Thorpe, Kevin E; Logan, Alexander G

2016-06-06

Patient self-management has been shown to improve health outcomes. We developed a smartphone-based system to boost self-care by patients with CKD and integrated its use into usual CKD care. We determined its acceptability and examined changes in several clinical parameters. We recruited patients with stage 4 or 5 CKD attending outpatient renal clinics who responded to a general information newsletter about this 6-month proof-of-principle study. The smartphone application targeted four behavioral elements: monitoring BP, medication management, symptom assessment, and tracking laboratory results. Prebuilt customizable algorithms provided real-time personalized patient feedback and alerts to providers when predefined treatment thresholds were crossed or critical changes occurred. Those who died or started RRT within the first 2 months were replaced. Only participants followed for 6 months after recruitment were included in assessing changes in clinical measures. In total, 47 patients (26 men; mean age =59 years old; 33% were ≥65 years old) were enrolled; 60% had never used a smartphone. User adherence was high (>80% performed ≥80% of recommended assessments) and sustained. The mean reductions in home BP readings between baseline and exit were statistically significant (systolic BP, -3.4 mmHg; 95% confidence interval, -5.0 to -1.8 and diastolic BP, -2.1 mmHg; 95% confidence interval, -2.9 to -1.2); 27% with normal clinic BP readings had newly identified masked hypertension. One hundred twenty-seven medication discrepancies were identified; 59% were medication errors that required an intervention to prevent harm. In exit interviews, patients indicated feeling more confident and in control of their condition; clinicians perceived patients to be better informed and more engaged. Integrating a smartphone-based self-management system into usual care of patients with advanced CKD proved feasible and acceptable, and it appeared to be clinically useful. The results provide a strong rationale for a randomized, controlled trial. Copyright © 2016 by the American Society of Nephrology.

Patient satisfaction at the Muhimbili National Hospital in Dar es Salaam, Tanzania.

PubMed

Muhondwa, E P Y; Leshabari, M T; Mwangu, M; Mbembati, N; Ezekiel, M J

2008-08-01

Patients are the primary beneficiaries of the services and care that hospitals provide. The Patient Satisfaction study examined the extent to which patients at the Muhimbili National Hospital (MNH) were satisfied with the services and care they received at MNH. This was part of a baseline study that sought to determine the level of performance of the hospital before massive restructuring, reform, and renovations were undertaken. Exit interviews were the main research method used to determine patient satisfaction. Patients were interviewed as they were leaving the OPD clinics, laboratory, X-ray, pharmacy and inpatient wards. The study found that most patients were satisfied with the services and care they received. This high level of satisfaction must be viewed within the context of a hierarchical public health care delivery system, with MNH at the apex. The services and care MNH provides can only be excellent compared to that provided by lower level health facilities. Indeed, patients covered by this study perceived the services provided by MNH as superior, and this was reflected in the high level of satisfaction they reported. Some patients expressed dissatisfaction with specific aspects of the services that they received. They were particularly dissatisfied with long waiting times before receiving services, the high costs of treatment and investigations charged at MNH, poor levels of hygiene in the wards, and negative attitudes of staff towards patients. Although only a small proportion of patients expressed dissatisfaction with these aspects of the services provided, they are significant in that they constitute a call for action by the MNH management to encourage the health personnel to embrace a new staff-patient relationship ethos, in which the patient is a viewed as a customer.

Evaluation of a Community Reintegration Outpatient Program Service for Community-Dwelling Persons with Spinal Cord Injury

PubMed Central

Bain, Patricia; Hébert, Debbie; Hitzig, Sander L.

2014-01-01

Objective. To evaluate the effectiveness of a community reintegration outpatient (CROP) service for promoting well-being and community participation following spinal cord injury (SCI). Participants. Community-dwelling adults (N = 14) with traumatic and nontraumatic SCI. Interventions. The CROP service is a 12-week (1 × week; 120 minutes) interprofessional closed therapeutic education service. Main Outcome Measure(s). Moorong Self-Efficacy Scale (MSES); Impact on Participation and Autonomy (IPA); Positive Affect and Negative Affect Scale (PANAS); Coping Inventory of Stressful Situations (CISS); World Health Organization Quality of Life (WHOQOL-BREF); semistructured qualitative interviews. Methods. Twenty-one participants were recruited from two subsequent CROP services, with only 14 persons completing all data assessments. Data were collected at baseline (week 0), at exit (week 12), and at a three-month follow-up. Semistructured interviews were conducted at exit. Results. Self-efficacy (MSES) and positive affect (PANAS) improved from baseline to exit (P < .05), but the changes were not maintained at follow-up. Qualitative analysis identified four major themes related to therapeutic benefits: (1) role of self; (2) knowledge acquisition; (3) skill application; and (4) group processes. Conclusions. Participation in a therapeutic education service has the potential to improve well-being in persons with SCI, but there is a need to identify strategies to maintain long-term gains. PMID:25574397

Pre/post evaluation of a pilot prevention with positives training program for healthcare providers in North West Province, Republic of South Africa.

PubMed

Kemp, Christopher G; de Kadt, Julia; Pillay, Erushka; Gilvydis, Jennifer M; Naidoo, Evasen; Grignon, Jessica; Weaver, Marcia R

2017-05-02

Prevention interventions for people living with HIV/AIDS are an important component of HIV programs. We report the results of a pilot evaluation of a four-hour, clinic-based training for healthcare providers in South Africa on HIV prevention assessments and messages. This pre/post pilot evaluation examined whether the training was associated with providers delivering more prevention messages. Seventy providers were trained at four public primary care clinics with a high volume of HIV patients. Pre- and post-training patient exit surveys were conducted using Audio-Computer Assisted Structured Interviews. Seven provider appropriate messaging outcomes and one summary provider outcome were compared pre- and post-training using Poisson regression. Four hundred fifty-nine patients pre-training and 405 post-training with known HIV status were interviewed, including 175 and 176 HIV positive patients respectively. Among HIV positive patients, delivery of all appropriate messages by providers declined post-training. The summary outcome decreased from 56 to 50%; adjusted rate ratio 0.92 (95% CI = 0.87-0.97). Sensitivity analyses adjusting for training coverage and time since training detected fewer declines. Among HIV negative patients the summary score was stable at 32% pre- and post-training; adjusted rate ratio 1.05 (95% CI = 0.98-1.12). Surprisingly, this training was associated with a decrease in prevention messages delivered to HIV positive patients by providers. Limited training coverage and delays between training and post-training survey may partially account for this apparent decrease. A more targeted approach to prevention messages may be more effective.

Left ventricular outflow tract arrhythmias with divergent QRS morphology: mapping of different exits and ablation strategy.

PubMed

Reithmann, Christopher; Fiek, Michael

2018-01-01

Ventricular arrhythmias (VAs) from the left ventricular outflow tract (LVOT) can have multiple exits exhibiting divergent ECG features. In a series of 131 patients with VAs with LVOT origin, 10 patients presented with divergent QRS morphologies. Multisite endo- and epicardial mapping of different exit sites was performed. The earliest ventricular activity of 23 LVOT VAs in 10 patients was detected in the endocardium of the LV in 7 patients, the aortic sinuses of Valsalva (SoV) in 3 patients, the distal coronary sinus in 6 patients, the anterior interventricular vein in 3 patients, and the posterior right ventricular outflow tract (RVOT) in 4 patients. Simultaneous elimination of two divergent QRS morphologies of LVOT VAs by ablation from a single site was achieved in 5 patients (aorto-mitral continuity in 3 patients, SoV and RVOT in each 1 patient) using a mean maximum ablation energy of 46 ± 5 W. Sequential ablation from two or three different sites, including trans-pericardial and distal coronary sinus ablation in each 2 patients, led to elimination of the divergent VA QRS morphologies in the other 5 patients. During the follow-up of 28 ± 29 months, 4 of the 10 patients had recurrence of at least one LVOT VA. A 43-year-old patient with muscular dystrophy Curschmann-Steinert had recurrence of sustained LVOT VTs and died of sudden cardiac death. Multisite mapping of different exit sites of LVOT VAs can guide ablation of intramural foci but the recurrence rate after initially successful ablation was high.

Calculation of midplane dose for total body irradiation from entrance and exit dose MOSFET measurements.

PubMed

Satory, P R

2012-03-01

This work is the development of a MOSFET based surface in vivo dosimetry system for total body irradiation patients treated with bilateral extended SSD beams using PMMA missing tissue compensators adjacent to the patient. An empirical formula to calculate midplane dose from MOSFET measured entrance and exit doses has been derived. The dependency of surface dose on the air-gap between the spoiler and the surface was investigated by suspending a spoiler above a water phantom, and taking percentage depth dose measurements (PDD). Exit and entrances doses were measured with MOSFETs in conjunction with midplane doses measured with an ion chamber. The entrance and exit doses were combined using an exponential attenuation formula to give an estimate of midplane dose and were compared to the midplane ion chamber measurement for a range of phantom thicknesses. Having a maximum PDD at the surface simplifies the prediction of midplane dose, which is achieved by ensuring that the air gap between the compensator and the surface is less than 10 cm. The comparison of estimated midplane dose and measured midplane dose showed no dependence on phantom thickness and an average correction factor of 0.88 was found. If the missing tissue compensators are kept within 10 cm of the patient then MOSFET measurements of entrance and exit dose can predict the midplane dose for the patient.

Is high touch finally here?

PubMed

Kennedy, M M

1998-01-01

Can anyone single-handedly create a caring environment without adding hours to his or her work week? As turnover continues to rise, it's worth considering. Techniques managers say have worked for them are suggested, including: Monitor workloads; celebrate successes; make niceness an expectation; mentor; offer training as often as possible; stamp out problems before they go public; consider offering flexible hours and extended leaves for all; and introduce yeast to keep people stimulated. Will these strategies--all of which may not work for you--fatten your bonus this year? Probably not, unless top management is monitoring retention and doing occasional exit interviews. However, one of the byproducts is that employees don't stop with each other. They begin to treat patients better, something neither bribery nor threats may produce.

Voices of Leadership

ERIC Educational Resources Information Center

DiPaolo, Donald G.

2002-01-01

This study examines the impact of a leadership education retreat through the eyes of six undergraduate college men who participated in The Institute for Men of Principle at a midwestern college. What influences shape their definition and experience of leadership? Entry and exit interviews were conducted along with field notes from observations…

Safety and Security Concerns of Nurses Working in the Intensive Care Unit: A Qualitative Study.

PubMed

Keys, Yolanda; Stichler, Jaynelle F

Intensive care units (ICUs) exist to serve as a safe place for critically ill patients to receive care from skilled practitioners. In this qualitative study, ICU nurses shared their perspectives on elements that promote safety and security on their units. After obtaining institutional review board approval, participants participated in telephone interviews with a nurse researcher who has experience as a bedside ICU nurse. Five categories and 14 themes were identified and then confirmed using member checking. Results indicate that participants prefer to provide care in ICUs with no more than 12 to 14 beds and provide the following: visibility of patients and coworkers; more than 1 way to exit; and can be locked in case of emergency or threat. Nearly all respondents mentioned adequate staffing as the most important attribute of a safe, secure care environment for patients and families. More research is needed to identify design features that make the most impact on providing a safe, secure ICU environment.

A battery-less and wireless wearable sensor system for identifying bed and chair exits in a pilot trial in hospitalized older people.

PubMed

Shinmoto Torres, Roberto L; Visvanathan, Renuka; Abbott, Derek; Hill, Keith D; Ranasinghe, Damith C

2017-01-01

Falls in hospitals are common, therefore strategies to minimize the impact of these events in older patients and needs to be examined. In this pilot study, we investigate a movement monitoring sensor system for identifying bed and chair exits using a wireless wearable sensor worn by hospitalized older patients. We developed a movement monitoring sensor system that recognizes bed and chair exits. The system consists of a machine learning based activity classifier and a bed and chair exit recognition process based on an activity score function. Twenty-six patients, aged 71 to 93 years old, hospitalized in the Geriatric Evaluation and Management Unit participated in the supervised trials. They wore over their attire a battery-less, lightweight and wireless sensor and performed scripted activities such as getting off the bed and chair. We investigated the system performance in recognizing bed and chair exits in hospital rooms where RFID antennas and readers were in place. The system's acceptability was measured using two surveys with 0-10 likert scales. The first survey measured the change in user perception of the system before and after a trial; the second survey, conducted only at the end of each trial, measured user acceptance of the system based on a multifactor sensor acceptance model. The performance of the system indicated an overall recall of 81.4%, precision of 66.8% and F-score of 72.4% for joint bed and chair exit recognition. Patients demonstrated improved perception of the system after use with overall score change from 7.8 to 9.0 and high acceptance of the system with score ≥ 6.7 for all acceptance factors. The present pilot study suggests the use of wireless wearable sensors is feasible for detecting bed and chair exits in a hospital environment.

A battery-less and wireless wearable sensor system for identifying bed and chair exits in a pilot trial in hospitalized older people

PubMed Central

Visvanathan, Renuka; Abbott, Derek; Hill, Keith D.; Ranasinghe, Damith C.

2017-01-01

Falls in hospitals are common, therefore strategies to minimize the impact of these events in older patients and needs to be examined. In this pilot study, we investigate a movement monitoring sensor system for identifying bed and chair exits using a wireless wearable sensor worn by hospitalized older patients. We developed a movement monitoring sensor system that recognizes bed and chair exits. The system consists of a machine learning based activity classifier and a bed and chair exit recognition process based on an activity score function. Twenty-six patients, aged 71 to 93 years old, hospitalized in the Geriatric Evaluation and Management Unit participated in the supervised trials. They wore over their attire a battery-less, lightweight and wireless sensor and performed scripted activities such as getting off the bed and chair. We investigated the system performance in recognizing bed and chair exits in hospital rooms where RFID antennas and readers were in place. The system’s acceptability was measured using two surveys with 0–10 likert scales. The first survey measured the change in user perception of the system before and after a trial; the second survey, conducted only at the end of each trial, measured user acceptance of the system based on a multifactor sensor acceptance model. The performance of the system indicated an overall recall of 81.4%, precision of 66.8% and F-score of 72.4% for joint bed and chair exit recognition. Patients demonstrated improved perception of the system after use with overall score change from 7.8 to 9.0 and high acceptance of the system with score ≥ 6.7 for all acceptance factors. The present pilot study suggests the use of wireless wearable sensors is feasible for detecting bed and chair exits in a hospital environment. PMID:29016696

A simplified approach for exit dose in vivo measurements in radiotherapy and its clinical application.

PubMed

Banjade, D P; Shrestha, S L; Shukri, A; Tajuddin, A A; Bhat, M

2002-09-01

This is a study using LiF:Mg;Ti thermoluminescent dosimeter (TLD) rods in phantoms to investigate the effect of lack of backscatter on exit dose. Comparing the measured dose with anticipated dose calculated using tissue maximum ratio (TMR) or percentage depth dose (PDD) gives rise to a correction factor. This correction factor may be applied to in-vivo dosimetry results to derive true dose to a point within the patient. Measurements in a specially designed humanoid breast phantom as well as patients undergoing radiotherapy treatment were also been done. TLDs with reproducibility of within +/- 3% (1 SD) are irradiated in a series of measurements for 6 and 10 MV photon beams from a medical linear accelerator. The measured exit doses for the different phantom thickness for 6 MV beams are found to be lowered by 10.9 to 14.0% compared to the dose derived from theoretical estimation (normalized dose at dmax). The same measurements for 10 MV beams are lowered by 9.0 to 13.5%. The variations of measured exit dose for different field sizes are found to be within 2.5%. The exit doses with added backscatter material from 2 mm up to 15 cm, shows gradual increase and the saturated values agreed within 1.5% with the expected results for both beams. The measured exit doses in humanoid breast phantom as well as in the clinical trial on patients undergoing radiotherapy also agreed with the predicted results based on phantom measurements. The authors' viewpoint is that this technique provides sufficient information to design exit surface bolus to restore build down effect in cases where part of the exit surface is being considered as a target volume. It indicates that the technique could be translated for in vivo dose measurements, which may be a conspicuous step of quality assurance in clinical practice.

Assessment of exit block following pulmonary vein isolation: far-field capture masquerading as entrance without exit block.

PubMed

Vijayaraman, Pugazhendhi; Dandamudi, Gopi; Naperkowski, Angela; Oren, Jess; Storm, Randle; Ellenbogen, Kenneth A

2012-10-01

Complete electrical isolation of pulmonary veins (PVs) remains the cornerstone of ablation therapy for atrial fibrillation. Entrance block without exit block has been reported to occur in 40% of the patients. Far-field capture (FFC) can occur during pacing from the superior PVs to assess exit block, and this may appear as persistent conduction from PV to left atrium (LA). To facilitate accurate assessment of exit block. Twenty consecutive patients with symptomatic atrial fibrillation referred for ablation were included in the study. Once PV isolation (entrance block) was confirmed, pacing from all the bipoles on the Lasso catheter was used to assess exit block by using a pacing stimulus of 10 mA at 2 ms. Evidence for PV capture without conduction to LA was necessary to prove exit block. If conduction to LA was noticed, pacing output was decreased until there was PV capture without conduction to LA or no PV capture was noted to assess for far-field capture in both the upper PVs. All 20 patients underwent successful isolation (entrance block) of all 76 (4 left common PV) veins: mean age 58 ± 9 years; paroxysmal atrial fibrillation 40%; hypertension 70%, diabetes mellitus 30%, coronary artery disease 15%; left ventricular ejection fraction 55% ± 10%; LA size 42 ± 11 mm. Despite entrance block, exit block was absent in only 16% of the PVs, suggesting persistent PV to LA conduction. FFC of LA appendage was noted in 38% of the left superior PVs. FFC of the superior vena cava was noted in 30% of the right superior PVs. The mean pacing threshold for FFC was 7 ± 4 mA. Decreasing pacing output until only PV capture (loss of FFC) is noted was essential to confirm true exit block. FFC of LA appendage or superior vena cava can masquerade as persistent PV to LA conduction. A careful assessment for PV capture at decreasing pacing output is essential to exclude FFC. Copyright © 2012 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

The Role of Focus Groups with Other Performance Measurement Methods.

ERIC Educational Resources Information Center

Hart, Elizabeth

Huddersfield University Library (England) has undertaken a wide range of evaluative studies of its services and systems, using various data collection techniques such as: user surveys; exit interviews; online and CD-ROM analysis; benchmarking; user groups; staffing and staff development evaluation; suggestion sheets; student project work; group…

The Leadership Institute for Active Aging: A Volunteer Recruitment and Retention Model.

ERIC Educational Resources Information Center

Wilson, Laura; Steele, Jack; Thompson, Estina; D'heron, Cathy

2002-01-01

The Leadership Institute for Active Aging, an approach to recruiting and retaining volunteers over 50, provides training focused on community resources, aging, self-worth, and volunteering and internships in community-based organizations involving health and social services. Exit interviews and program evaluations affirmed that the leadership…

Group music therapy for patients with persistent post-traumatic stress disorder--an exploratory randomized controlled trial with mixed methods evaluation.

PubMed

Carr, Catherine; d'Ardenne, Patricia; Sloboda, Ann; Scott, Carleen; Wang, Duolao; Priebe, Stefan

2012-06-01

Not all patients with post-traumatic stress disorder (PTSD) respond to cognitive behavioural therapy (CBT). Literature suggests group music therapy might be beneficial in treating PTSD. However, feasibility and effectiveness have not been assessed. The study objectives were to assess whether group music therapy was feasible for patients who did not respond to CBT, and whether it has an effect on PTSD symptoms and depression. The study employed mixed methods comprising of an exploratory randomized controlled trial, qualitative content analysis of therapy, and patient interviews. Patients with significant PTSD symptoms (n = 17) following completion of CBT were randomly assigned to treatment (n = 9) or control groups (n = 8). The treatment group received 10 weeks of group music therapy after which exit interviews were conducted. Control group patients were offered the intervention at the end of the study. Symptoms were assessed on the Impact of Events Scale-Revised and Beck Depression Inventory II at the beginning and end of treatment. Treatment-group patients experienced a significant reduction in severity of PTSD symptoms (-20.18; 95% confidence interval [CI]: [-31.23, -9.12]) and a marginally significant reduction in depression (-11.92; 95%CI: [-24.05, 0.21]) at 10 weeks from baseline compared to the control. Patients viewed music therapy as helpful and reported experiences concur with current literature. Group music therapy appears feasible and effective for PTSD patients who have not sufficiently responded to CBT. Limitations include the small sample size and lack of blinding. Further research should address these limitations, test sustainability, and identify specific factors that address symptoms in treatment. ©2011 The British Psychological Society.

User experiences with clinical social franchising: qualitative insights from providers and clients in Ghana and Kenya.

PubMed

Sieverding, Maia; Briegleb, Christina; Montagu, Dominic

2015-02-01

Clinical social franchising is a rapidly growing delivery model in private healthcare markets in low- and middle-income countries. Despite this growth, little is known about providers' perceptions of the benefits and challenges of social franchising or clients' reasons for choosing franchised facilities over other healthcare options. We examine these questions in the context of three social franchise networks in Ghana and Kenya. We conducted in-depth interviews with a purposive sample of providers from the BlueStar Ghana, and Amua and Tunza networks in Kenya. We also conducted qualitative exit interviews with female clients who were leaving franchised facilities after a visit for a reproductive or child health reason. The total sample consists of 47 providers and 47 clients across the three networks. Providers perceived the main benefits of participation in a social franchise network to be training opportunities and access to a consistent supply of low-cost family planning commodities; few providers mentioned branding as a benefit of participation. Although most providers said that client flows for franchised services increased after joining the network, they did not associate this with improved finances for their facility. Clients overwhelmingly cited the quality of the client-provider relationship as their main motivation for attending the franchise facility. Recognition of the franchise brand was low among clients who were exiting a franchised facility. The most important benefit of social franchise programs to both providers and their clients may have more to do with training on business practices, patient counseling and customer service, than with subsidies, technical input, branding or clinical support. This finding may lead to a reconsideration of how franchise programs interact with both their member clinics and the larger health-seeking communities they serve.

Quality Assurance Audit of Technique Failure and 90-Day Mortality after Program Discharge in a Canadian Home Hemodialysis Program.

PubMed

Shah, Nikhil; Reintjes, Frances; Courtney, Mark; Klarenbach, Scott W; Ye, Feng; Schick-Makaroff, Kara; Jindal, Kailash; Pauly, Robert P

2017-07-24

Little is known about patients exiting home hemodialysis. We sought to characterize the reasons, clinical characteristics, and pre-exit health care team interactions of patients on home hemodialysis who died or underwent modality conversion (negative disposition) compared with prevalent patients and those who were transplanted (positive disposition). We conducted an audit of all consecutive patients incident to home hemodialysis from January of 2010 to December of 2014 as part of ongoing quality assurance. Records were reviewed for the 6 months before exit, and vital statistics were assessed up to 90 days postexit. Ninety-four patients completed training; 25 (27%) received a transplant, 11 (12%) died, and 23 (25%) were transferred to in-center hemodialysis. Compared with the positive disposition group, patients in the negative disposition group had a longer mean dialysis vintage (3.15 [SD=4.98] versus 1.06 [SD=1.16] years; P =0.003) and were performing conventional versus a more intensive hemodialysis prescription (23 of 34 versus 23 of 60; P <0.01). In the 6 months before exit, the negative disposition group had significantly more in-center respite dialysis sessions, had more and longer hospitalizations, and required more on-call care team support in terms of phone calls and drop-in visits (each P <0.05). The most common reason for modality conversion was medical instability in 15 of 23 (65%) followed by caregiver or care partner burnout in three of 23 (13%) each. The 90-day mortality among patients undergoing modality conversion was 26%. Over a 6-year period, approximately one third of patients exited the program due to death or modality conversion. Patients who die or transfer to another modality have significantly higher health care resource utilization ( e.g. , hospitalization, respite treatments, nursing time, etc. ). Copyright © 2017 by the American Society of Nephrology.

Convalescence care for seniors of lower Manhattan: an interdisciplinary outreach, rehabilitation, and education model.

PubMed

Moroz, Alex; Schoeb, Veronika; Fan, Grace; Vitale, Kenneth; Lee, Mathew

2004-03-01

The purpose of this study was to test the efficacy of an interdisciplinary geriatric outreach, rehabilitation, and education program for seniors. Community-dwelling Chinese seniors in lower Manhattan were recruited through outreach activities (17 educational workshops, three community health fairs, media interviews) and community physician referrals to offer rehabilitation services. The instrument administered at entry and exit included questions about pain intensity, quality of life, activities of daily living (ADLs), and an assessment of a variety of intrinsic and extrinsic barriers to life participation. The sample included 70 seniors (53 women) with a mean age of 70.5 +/- 7.48 years (range 60-93 years old) of whom 86% were Cantonese-speaking Chinese. The barriers-to-life participation assessment revealed cultural, communication, transportation, and physical environmental barriers as well as insufficient financial resources. Thirty-four patients who completed the program showed a significant improvement in quality of life. Patients' reports reflected a high degree of satisfaction with the program. Interdisciplinary team-oriented patient care, including a physiatrist, social worker, and rehabilitation staff, may result in good outcomes and high patient satisfaction in ambulatory community seniors.

Bed occupancy monitoring: data processing and clinician user interface design.

PubMed

Pouliot, Melanie; Joshi, Vilas; Goubran, Rafik; Knoefel, Frank

2012-01-01

Unobtrusive and continuous monitoring of patients, especially at their place of residence, is becoming a significant part of the healthcare model. A variety of sensors are being used to monitor different patient conditions. Bed occupancy monitoring provides clinicians a quantitative measure of bed entry/exit patterns and may provide information relating to sleep quality. This paper presents a bed occupancy monitoring system using a bed pressure mat sensor. A clinical trial was performed involving 8 patients to collect bed occupancy data. The trial period for each patient ranged from 5-10 weeks. This data was analyzed using a participatory design methodology incorporating clinician feedback to obtain bed occupancy parameters. The parameters extracted include the number of bed exits per night, the bed exit weekly average (including minimum and maximum), the time of day of a particular exit, and the amount of uninterrupted bed occupancy per night. The design of a clinical user interface plays a significant role in the acceptance of such patient monitoring systems by clinicians. The clinician user interface proposed in this paper was designed to be intuitive, easy to navigate and not cause information overload. An iterative design methodology was used for the interface design. The interface design is extendible to incorporate data from multiple sensors. This allows the interface to be part of a comprehensive remote patient monitoring system.

The Effect of Exit-Site Antibacterial Honey Versus Nasal Mupirocin Prophylaxis on the Microbiology and Outcomes of Peritoneal Dialysis-Associated Peritonitis and Exit-Site Infections: A Sub-Study of the Honeypot Trial.

PubMed

Zhang, Lei; Badve, Sunil V; Pascoe, Elaine M; Beller, Elaine; Cass, Alan; Clark, Carolyn; de Zoysa, Janak; Isbel, Nicole M; McTaggart, Steven; Morrish, Alicia T; Playford, E Geoffrey; Scaria, Anish; Snelling, Paul; Vergara, Liza A; Hawley, Carmel M; Johnson, David W

2015-12-01

♦ The HONEYPOT study recently reported that daily exit-site application of antibacterial honey was not superior to nasal mupirocin prophylaxis for preventing overall peritoneal dialysis (PD)-related infection. This paper reports a secondary outcome analysis of the HONEYPOT study with respect to exit-site infection (ESI) and peritonitis microbiology, infectious hospitalization and technique failure. ♦ A total of 371 PD patients were randomized to daily exit-site application of antibacterial honey plus usual exit-site care (N = 186) or intranasal mupirocin prophylaxis (in nasal Staphylococcus aureus carriers only) plus usual exit-site care (control, N = 185). Groups were compared on rates of organism-specific ESI and peritonitis, peritonitis- and infection-associated hospitalization, and technique failure (PD withdrawal). ♦ The mean peritonitis rates in the honey and control groups were 0.41 (95% confidence interval [CI] 0.32 - 0.50) and 0.41 (95% CI 0.33 - 0.49) episodes per patient-year, respectively (incidence rate ratio [IRR] 1.01, 95% CI 0.75 - 1.35). When specific causative organisms were examined, no differences were observed between the groups for gram-positive (IRR 0.99, 95% CI 0.66 - 1.49), gram-negative (IRR 0.71, 95% CI 0.39 - 1.29), culture-negative (IRR 2.01, 95% CI 0.91 - 4.42), or polymicrobial peritonitis (IRR 1.08, 95% CI 0.36 - 3.20). Exit-site infection rates were 0.37 (95% CI 0.28 - 0.45) and 0.33 (95% CI 0.26 - 0.40) episodes per patient-year for the honey and control groups, respectively (IRR 1.12, 95% CI 0.81 - 1.53). No significant differences were observed between the groups for gram-positive (IRR 1.10, 95% CI 0.70 - 1.72), gram-negative (IRR: 0.85, 95% CI 0.46 - 1.58), culture-negative (IRR 1.88, 95% CI 0.67 - 5.29), or polymicrobial ESI (IRR 1.00, 95% CI 0.40 - 2.54). Times to first peritonitis-associated and first infection-associated hospitalization were similar in the honey and control groups. The rates of technique failure (PD withdrawal) due to PD-related infection were not significantly different between the groups. ♦ Compared with standard nasal mupirocin prophylaxis, daily topical exit-site application of antibacterial honey resulted in comparable rates of organism-specific peritonitis and ESI, infection-associated hospitalization, and infection-associated technique failure in PD patients. Copyright © 2015 International Society for Peritoneal Dialysis.

Gender Differences in Predrinking Behavior Among Nightclubs' Patrons.

PubMed

Santos, Mariana G R; Paes, Angela T; Sanudo, Adriana; Andreoni, Solange; Sanchez, Zila M

2015-07-01

Drinking before entering nightclubs (predrinking) seems to be associated with an increase in alcohol-related harm. This study aims to investigate gender differences in predrinking behavior and to evaluate its association with risk behaviors practiced inside nightclubs. Individual-level data were collected by a portal survey of 2,422 patrons at the entrance and 1,833 patrons at the exit of 31 nightclubs located at São Paulo, Brazil. The nightclubs were selected by 2-stage sampling with probability proportional to the establishments' capacity in the first stage and a systematic sample of patrons in the entrance line in the second stage. Breath alcohol concentration (BrAC) was measured at the entrance and exit. Face-to-face interviews identified predrinking characteristics and risk behaviors. Weighted analyses were stratified by gender. Predrinking was practiced by 49.2% (95% confidence interval [CI] = 42.7 to 55.8) of the male patrons and 29.0% (95% CI = 20.6 to 38.9) of the female patrons (p < 0.001) on the day of the interview. When considering only predrinkers, men and women showed similar BrAC at entrance and exit and similar proportion of alcoholic intoxication (BrAC ≥ 0.38 mg/l). In both genders, people who practiced predrinking on the day of the interview were more likely to drink inside the nightclub, compared to those who did not practice predrinking (p < 0.001). Among men, the practice of predrinking increased the chance of "drinking and driving" after leaving the nightclub (odds ratio [OR] = 6.9, 95% CI = 4.1-11.5, p < 0.001). Among women, the practice of predrinking increased the chances of experiencing sexual harassment in the nightclub (OR = 2.9, 95% CI = 1.3 to 6.6, p = 0.010). Predrinking is more prevalent among men; however, men and women who engaged in predrinking have a similar pattern of alcohol consumption and exit BrAC. The fact that risk behaviors and illicit drug use were associated with predrinking but differ between genders suggests that a gender-specific approach should be used in tailored interventions to prevent alcohol-related harm in nightclubs. Copyright © 2015 by the Research Society on Alcoholism.

Examination of How and Why Over-the-Bed Tables Are Used: Use Cases and Needs from Healthcare Providers.

PubMed

Manganelli, Joe; Threatt, Anthony; Brooks, Johnell O; Healy, Stan; Merino, Jessica; Yanik, Paul; Walker, Ian; Green, Keith

2014-01-01

This article presents the results of an exploratory study in which 14 clinical and staff subject matter experts (SMEs) at a regional rehabilitation hospital were interviewed in order to understand how and why over-the-bed tables are used. It is important to understand how and why a device or environment is used when designing it, and not just what features and functions are preferred. This knowledge is valuable both for contextualizing user feature and function preferences and for characterizing and prioritizing design challenges and opportunities. Fourteen hospital clinical and support staff subject-matter experts participated in semi-structured interviews with scenario enactments in a medium-fidelity, full-scale mock-up of a typical patient room. During these interviews, they interacted with two personas played by actors and were asked to enact an example of a normal visit, from entering the room through treatment/service and then exiting. Data were analyzed via methodological triangulation including frequency analysis, content analysis, and affinity diagramming. The results include a use-case analysis with illustrative sketches, a list of needs statements, and final observations. Successfully using the over-the-bed table is dependent upon proper positioning, especially in bed during meals. There are fewer problems associated with over-the-bed table use while seated in a chair than when in the bed. The over-the-bed table is a key component in acute care, inpatient therapies. Clinicians are generally open to "smart" furniture in the patient room but question its cost-effectiveness, robustness, and flexibility. Evidence-based design, human factors, patient-centered care, quality care, technology.

My Kite Will Fly: Improving Communication and Understanding in Young Children When a Mother Is Diagnosed with Life-Threatening Gynecological Cancer.

PubMed

Holland, Cynthia; Hocking, Alison; Joubert, Lynette; McDermott, Fiona; Niski, Marcus D; Thomson Salo, Frances; Quinn, Michael A

2018-01-01

The My Kite Will Fly (MKWF) research program is built on the well-documented need for effective clinical communication tools and therapeutic interventions where a child's mother is diagnosed with life-threatening gynecological cancer. The Dignity Model and Child-Centered approach were two key study foundations in this pilot cohort. Quantitative survey and qualitative semistructured methods were employed to gather data from patient families at three distinct phases: Diagnosis, Treatment, and Palliative care. Participants were identified from patient groups at The Royal Women's Hospital and Peter MacCallum Cancer Center, Melbourne, Australia. A purposive sample (n = 36 children) (24 girls and 12 boys aged between 3 and 12 years) drawn from 19 families completed structured art therapy workbook activities. The principal researcher and a specialist educational assistant undertook cross-case thematic analysis of all interviews and children's drawings. Five central themes were profiled in six illustrative case studies. Interviews with all families (n = 19) showed 86.1% positive evaluation of the MKWF workbook template at diagnosis. During treatments, 66.6% of parents reported better understanding of the chemotherapy process and better communication with younger family members. At palliative care, 97.3% of families reported stabilization of family routines and improved illness coping. Exit interviews with six children and surviving parents (n = 4) showed that the program substantially prepared them for parental bereavement. Results from this pilot cohort confirm the importance of enhanced parent-child communication and stabilized family routines. Current results provide an important platform for future evaluative research among larger patient-family populations across multisite oncology settings.

Transformational Bilingual Learning: Re-Engaging Marginalized Learners through Language, Culture, Community, and Identity

ERIC Educational Resources Information Center

Tulloch, Shelley; Kusugak, Adriana; Chenier, Cayla; Pilakapsi, Quluaq; Uluqsi, Gloria; Walton, Fiona

2017-01-01

The Miqqut project was a participatory action research project through which Inuit language and literacy learning was embedded in a traditional skills program. Community-based researchers tracked learners' progress through entrance, exit, and post-program interviews and questionnaires, as well as through participant observation. Results show that…

The Role of Collaboration in Secondary Agriculture Teacher Career Satisfaction and Career Retention

ERIC Educational Resources Information Center

De Lay, Ann M.; Washburn, Shannon G.

2013-01-01

The teaching profession is not without its share of challenges. Many teachers enter the professional ranks only to immediately search for the nearest exit. Teacher socialization has been shown to improve teachers' professional outlooks, slowing the exodus. In this phenomenological study, nine interviews were conducted with three experienced,…

Tweeting and Blogging: Moving towards Education 2.0

ERIC Educational Resources Information Center

Luo, Tian; Franklin, Teresa

2015-01-01

This paper reports on an exploratory study that employed Twitter and blogs as instructional Web 2.0 tools to support student learning in an undergraduate-level class. Case study methodology entailing a usage survey, an exit survey, and 12 in-depth semi-structured interviews was sought to examine patterns and characteristics of students' usage of…

Learning from the True Customers

ERIC Educational Resources Information Center

Kaster, Gregory

2012-01-01

Madison Elementary School, a K-6 school of 335 students in Marshfield, Wisconsin, recognizes the value of student feedback and strives to learn more through monthly student meetings, whole-class sit-downs, and student exit interviews. As the principal of Madison Elementary School, the author meets with a group of students for half an hour during…

Development and Validation of E-Portfolios: The UAE Pre-Service Teachers' Experiences

ERIC Educational Resources Information Center

Forawi, Sufian A.; Almekhlafi, Abdurrahman G.; Al-Mekhlafy, Mohamed H.

2012-01-01

Research has indicated the importance of evaluating the experiences related to developing e-portfolios (electronic portfolio) to contribute to the overall excellence in teaching and learning. Researchers (instructors) of the present study used an exit e-portfolios, a questionnaire and follow up interviews to describe development and evaluation of…

Students with Intellectual Disabilities: Predictors of Transition Outcomes

ERIC Educational Resources Information Center

Baer, Robert M.; Daviso, Alfred W., III; Flexer, Robert W.; Queen, Rachel McMahan; Meindl, Richard S.

2011-01-01

This study examined the outcomes of 409 students with mental retardation or multiple disabilities from 177 school districts in a Great Lakes state. These students with intellectual disabilities were interviewed at exit and 1 year following graduation. The authors developed and tested three regression models--two to predict full-time employment and…

Echoes of Leadership Education: Reflections on Failure, Forgetting, and Our Future

ERIC Educational Resources Information Center

DiPaolo, Donald G.

2008-01-01

Despite the popularity of leadership education on college campuses, little is known about what individual participants learn and remember. This longitudinal study examines the impact of a leadership education retreat through the eyes of six undergraduate college men. Entry and exit interviews, along with intensive one and two year follow-up…

Battered Women's Process of Leaving: A 2-Year Follow-Up

ERIC Educational Resources Information Center

Brown, Chris; Trangsrud, Heather B.; Linnemeyer, Rachel M.

2009-01-01

This study is a follow-up investigation of the career and life experiences of battered women two years after shelter exit. Using consensual qualitative research, we interviewed 6 women from our original sample of 13 regarding their career and life adjustments and future aspirations. Results indicated that participants generally reported both…

The Biology Major Capstone Experience: Measurements of Accountability

ERIC Educational Resources Information Center

Davis, Thomas A.

2011-01-01

Loras College senior biology and biology research majors are required to take a comprehensive exam, give an oral presentation, write this talk into their thesis and participate in an exit interview with a non-biology faculty member before they graduate. Details of these capstone experiences will be discussed further. Other capstone experiences…

23 CFR 230.409 - Contract compliance review procedures.

Code of Federal Regulations, 2010 CFR

2010-04-01

... (Actions R-1 and R-2). (2) Contractor Notification (Action R-3). (3) Preliminary Analysis (Phase I) (Action R-4). (4) Onsite Verification and Interviews (Phase II) (Action R-5). (5) Exit Conference (Action R-6). (6) Compliance Determination and Formal Notification (Actions R-8, R-9, R-10, R-11, R-12). The...

Contributions of Middle Grade Students to the Validation Process of a National Science Assessment Study

ERIC Educational Resources Information Center

Morell, Linda

2008-01-01

This study used a national validity project to investigate specific research questions regarding the intersections among aspects of validity, educational measurement, and cognitive theory. Validity evidence was collected through traditional paper and pencil tests, surveys, think-alouds, and exit interviews of fifth and sixth grade students, as…

Student Loan Collection Procedures.

ERIC Educational Resources Information Center

National Association of College and University Business Officers, Washington, DC.

This manual on the collection of student loans is intended for the use of business officers and loan collection personnel of colleges and universities of all sizes. The introductory chapter is an overview of sound collection practices and procedures. It discusses the making of a loan, in-school servicing of the accounts, the exit interview, the…

Gaining Access: A Practical and Theoretical Guide for Qualitative Researchers.

ERIC Educational Resources Information Center

Feldman, Martha S.; Bell, Jeannine; Berger, Michele Tracy

This book offers useful, prescriptive advice on how to enter different field settings for interviewing and observation. The chapters of part 1, "Stages of Access," are: (1) "Finding Informants"; (2) "Human Subjects and Permission To Contact Informants"; (3) "Making Initial Contact"; (4) "Developing a Rapport"; and (5) "Exiting: Ending the…

Amuchina 10% solution, safe antiseptic for preventing infections of exit-site of Tenckhoff catheters, in the pediatric population of a dialysis program.

PubMed

Mendoza-Guevara, L; Castro-Vazquez, F; Aguilar-Kitsu, A; Morales-Nava, A; Rodriguez-Leyva, F; Sanchez-Barbosa, J L

2007-01-01

Although, decreasing in incidence with the disconnection systems, the first complication is still peritonitis in patients with chronic renal failure and the second is infection of Tenckhoff catheter exit-site. All efforts made to diminish the frequency of exit-site infection lower the possibility of peritonitis. The pediatric population is well-known to have a major risk of infectious complications, and making easy and safe the care of the exit-site will prevent the peritonitis that follows. The aim of the study was to evaluate the efficacy of the Amuchina 10% solution vs. pH neutral soap in children with chronic renal failure, on preventing exit-site infection. There were 60 patients who were assigned randomly to one of two groups. One group used Amuchina 10% solution for the daily cleaning of the exit-site, and the other used pH neutral soap, with 14 months of follow-up. Before the study they have to be free of infection for at least 30 days. All were taught by the same nurse how to clean their exit-site. Groups were almost identical in years, sex, and time on dialysis. We had nine infections in the soap group and none in the Amuchina 10% solution group, with an OR: 17 (p = 0.004). From these nine infections, the bacteria isolated were: 4 (13%) were caused by Pseudomona aeruginosa, 1 (3.3%) by Staphylococcus aureus, coagulase-positive staphylococci in 2 (6.6%) and Serratia marcensens in 1 (3.3%). In conclusion, Amuchina 10% solution is effective in preventing infection on the exit-site, without any secondary topical reaction.

Ethical behavior of nurses in decision-making in Iran

PubMed Central

Ebrahimi, Hossein; Nikravesh, Mansoure; Oskouie, Fatemeh; Ahmadi, Fazlollah

2015-01-01

Background: Ethical caring is an essential in nursing practice. Nurses are confronted with complex situations in which they are expected to autonomously make decisions in delivering good care to patients. Although a wide range of studies have examined ethical behavior of nurses, there are still many issues requiring further investigation. The aim of this article is to describe the ethical behavior of nurses in decision-making in patients’ care in Iran. Materials and Methods: This study was conducted through grounded theory method. Participants were 17 Iranian nurses, employed in Tabriz University of Medical Sciences hospitals. Unstructured, semi-structured, and in-depth interviews were used for data gathering. Interviews were transcribed and coded according to Strauss and Corbin method in open, axial, and selective coding. Results: Nurses showed three major approaches in ethical behavior: Beyond the legal duty and protection of the patients, which includes dedication and full availability to nurses’ job and the client, spending time for the patients and delayed exit from the workplace, and arbitrary practice; legal duty and the protection of patients and nurses, which includes caretaking for the patient, responding to the client, and implementing the physician's prescription; and below the legal duty and the protection of one's self, that is, finding evidence and having witness in case of false documentation, and shortcoming, negligence, and mistake. Conclusions: Because of the importance of the ethical behavior of nurses in decision-making, it is necessary to find ways to promote moral reasoning and moral development of nurses. Empowerment of nurses, nurse educators, and nursing students to acquire knowledge and develop ethical behavior skills is important. PMID:25709704

Clinician-Targeted Intervention and Patient-Reported Counseling on Physical Activity

PubMed Central

Winters, Paul C.; Sanders, Mechelle R.; Decker, Francesca; Ngo, Thanh; Sciamanna, Christopher N.

2014-01-01

Introduction Limited time and lack of knowledge are barriers to physical activity counseling in primary care. The objective of this study was to examine the effectiveness of a clinician-targeted intervention that used the 5As (Ask, Advise, Agree, Assist, Arrange) approach to physical activity counseling in a medically underserved patient population. Methods Family medicine clinicians at 2 community health centers were randomized to Group 1 or Group 2 intervention. Both clinician groups participated in 4 training sessions on the 5As for physical activity counseling; Group 2 training took place 8 months after Group 1 training. Both groups were trained to refer patients to a community exercise program. We used a pre–post analysis to evaluate the effectiveness of the intervention on clinician use of 5As. Eligible patients (n = 319) rated their clinicians’ counseling skills by using a modified Physical Activity Exit Interview (PAEI) survey. Clinicians (n = 10) self-assessed their use of the 5As through a survey and interviews. Results Both patient and clinician groups had similar sociodemographic characteristics. The PAEI score for both groups combined increased from 6.9 to 8.6 (on a scale of 0–15) from baseline to immediately postintervention (P = .01) and was 8.2 (P = .09) at 6-month follow-up; most of the improvement in PAEI score was due to increased use of 5As skills by Group 2 clinicians. Group 1 reported difficulty with problem solving, whereas Group 2 reported ease of referral to the community exercise program. Conclusion A clinician training intervention showed mixed results for 5As physical activity counseling. PMID:24874781

Clinician-targeted intervention and patient-reported counseling on physical activity.

PubMed

Carroll, Jennifer K; Winters, Paul C; Sanders, Mechelle R; Decker, Francesca; Ngo, Thanh; Sciamanna, Christopher N

2014-05-29

Limited time and lack of knowledge are barriers to physical activity counseling in primary care. The objective of this study was to examine the effectiveness of a clinician-targeted intervention that used the 5As (Ask, Advise, Agree, Assist, Arrange) approach to physical activity counseling in a medically underserved patient population. Family medicine clinicians at 2 community health centers were randomized to Group 1 or Group 2 intervention. Both clinician groups participated in 4 training sessions on the 5As for physical activity counseling; Group 2 training took place 8 months after Group 1 training. Both groups were trained to refer patients to a community exercise program. We used a pre-post analysis to evaluate the effectiveness of the intervention on clinician use of 5As. Eligible patients (n = 319) rated their clinicians' counseling skills by using a modified Physical Activity Exit Interview (PAEI) survey. Clinicians (n = 10) self-assessed their use of the 5As through a survey and interviews. Both patient and clinician groups had similar sociodemographic characteristics. The PAEI score for both groups combined increased from 6.9 to 8.6 (on a scale of 0-15) from baseline to immediately postintervention (P = .01) and was 8.2 (P = .09) at 6-month follow-up; most of the improvement in PAEI score was due to increased use of 5As skills by Group 2 clinicians. Group 1 reported difficulty with problem solving, whereas Group 2 reported ease of referral to the community exercise program. A clinician training intervention showed mixed results for 5As physical activity counseling.

Reduction of exit-site infections of tunnelled intravascular catheters among neutropenic patients by sustained-release chlorhexidine dressings: results from a prospective randomized controlled trial.

PubMed

Chambers, S T; Sanders, J; Patton, W N; Ganly, P; Birch, M; Crump, J A; Spearing, R L

2005-09-01

Exit-site and tunnel infections of tunnelled central intravascular catheters are a frequent source of morbidity among neutropenic patients and may necessitate catheter removal. They require antimicrobial therapy that increases healthcare costs and is associated with adverse drug reactions. A prospective randomized clinical trial was conducted among adult patients undergoing chemotherapy in a haematology unit. Tunnelled intravascular catheters were randomized to receive the control of a standard dressing regimen as recommended by the British Committee for Standards in Haematology, or to receive the intervention of a sustained-release chlorhexidine dressing. Follow-up data were available in 112 of 114 tunnelled intravascular catheters which were randomized. Exit-site or combined exit-site/tunnel infections occurred in 23 (43%) of 54 catheters in the control group, and five (9%) of 58 catheters in the intervention group [odds ratio (OR) for intervention group compared with control group =0.13, 95% confidence intervals (CI) 0.04-0.37, P<0.001]. More tunnelled intravascular catheters were prematurely removed from the control group than the intervention group for documented infections [20/54 (37%) vs 6/58 (10%), OR=0.20, 95%CI 0.53-0.07]. However, there was no difference in the numbers of tunnelled intravascular catheters removed for all proven and suspected intravascular catheter-related infections [21/54 (39%) vs 19/58 (33%)], or in the time to removal of catheters for any reason other than death or end of treatment for underlying disease. Thus chlorhexidine dressings reduced the incidence of exit-site/tunnel infections of indwelling tunnelled intravascular catheters without prolonging catheter survival in neutropenic patients, and could be considered as part of the routine management of indwelling tunnelled intravascular catheters among neutropenic patients.

Peer-based education and the integration of HIV and Sexual and Reproductive Health services for young people in Vietnam: evidence from a project evaluation.

PubMed

Ngo, Anh D; Ha, Toan H; Rule, John; Dang, Chinh V

2013-01-01

This paper reports changes in behavioral outcomes related to the use of HIV testing service of a project that employed peer-based education strategies and integration of HIV voluntary counseling and testing (VCT) and Sexual and Reproductive Health (SRH) services targeting young people aged 15-24 across 5 provinces in Vietnam. A pre-test/post-test, non-experimental evaluation design was used. Data were collected from cross-sectional surveys of youth and client exit interviews at project supported SRH clinics conducted at baseline and again at 24 months following implementation. The baseline samples consisted of 813 youth and 399 exit clients. The end line samples included 501 youths and 399 exit clients. Z test was used to assess changes in behavioral outcomes. Results show that there was a significant increase (p<0.05) in the percentage of youth who wanted to obtain a HIV test (from 33% to 51%), who had ever had a test (from 7.5% to 15%), and who had a repeat test in the last 12 months (from 54.5% to 67.5%). Exit client interviews found a nearly five-fold increase in the percentage of clients seeking HIV VCT in their current visit (5.0% vs. 24.5%) and almost two-fold increase in the percentage of those having their last test at a project supported clinic (9.3% vs. 17.8%). There were also positive changes in some aspects of youth HIV/AIDS knowledge, attitudes, and risk perceptions. This study provides preliminary evidence regarding the benefits of the integration of HIV VCT-SRH services in terms of increased access to HIV services and testing in Vietnam. Benefits of peer-based education regarding increased HIV knowledge were also identified. Further investigations, including experimental studies with assessment of health outcomes and the uptake of HIV testing services, are required to better elucidate the effectiveness and challenges of this intervention model in Vietnam.

Differences in the neural correlates of frontal lobe tests.

PubMed

Matsuoka, Teruyuki; Kato, Yuka; Imai, Ayu; Fujimoto, Hiroshi; Shibata, Keisuke; Nakamura, Kaeko; Yamada, Kei; Narumoto, Jin

2018-01-01

The Executive Interview (EXIT25), the executive clock-drawing task (CLOX1), and the Frontal Assessment Battery (FAB) are used to assess executive function at the bedside. These tests assess distinct psychometric properties. The aim of this study was to examine differences in the neural correlates of the EXIT25, CLOX1, and FAB based on magnetic resonance imaging. Fifty-eight subjects (30 with Alzheimer's disease, 10 with mild cognitive impairment, and 18 healthy controls) participated in this study. Multiple regression analyses were performed to examine the brain regions correlated with the EXIT25, CLOX1, and FAB scores. Age, gender, and years of education were included as covariates. Statistical thresholds were set to uncorrected P-values of 0.001 at the voxel level and 0.05 at the cluster level. The EXIT25 score correlated inversely with the regional grey matter volume in the left lateral frontal lobe (Brodmann areas 6, 9, 44, and 45). The CLOX1 score correlated positively with the regional grey matter volume in the right orbitofrontal cortex (Brodmann area 11) and the left supramarginal gyrus (Brodmann area 40). The FAB score correlated positively with the regional grey matter volume in the right precentral gyrus (Brodmann area 6). The left lateral frontal lobe (Brodmann area 9) and the right lateral frontal lobe (Brodmann area 46) were identified as common brain regions that showed association with EXIT25, CLOX1, and FAB based only a voxel-level threshold. The results of this study suggest that the EXIT25, CLOX1, and FAB may be associated with the distinct neural correlates of the frontal cortex. © 2018 Japanese Psychogeriatric Society.

The Impact of a Microfinance Program on Client Perceptions of the Quality of Care Provided by Private Sector Midwives in Uganda

PubMed Central

Agha, Sohail; Balal, Asma; Ogojo-Okello, Francis

2004-01-01

Objective To assess the impact of a microfinance program that provided business skills training and revolving loans to private sector midwives on perceived quality of services and client loyalty. Study Design A quasi-experimental study with a pretest, posttest design was used to evaluate the impact of the intervention. Exit interviews were conducted at 15 clinics that received the intervention and 7 clinics that did not. Baseline exit interviews were conducted between November and December 2000. Five days of business skills training were provided to midwives, and loans (averaging $454) were given during January and February 2001. A follow-up clinic visit was made to assess whether midwives were implementing what was emphasized during the training. The loans were to be repaid with interest within 6 to 12 months, at an interest rate that is standard within the local commercial market. For those who repaid the first set of loans (11 clinics), a second set of loans (averaging $742) was provided after June 2001. Follow-up exit interviews were conducted at the same clinics between February and March 2002. We assessed the effect of the intervention at both clinic and client levels. T-tests, the analysis of variance, and multivariate logistic regression analysis were conducted. Principal Findings These findings should be interpreted cautiously since secular trends were observed during the study period. The intervention was associated with improvement in clients' perceptions of the quality of care received at intervention clinics. The intervention was also associated with a higher level of client loyalty. Conclusions The enthusiastic response of midwives and the high loan repayment rate indicate that midwives were very receptive to the microfinance program. Overall, these findings suggest that microfinance may have an important role in strengthening private sector health services by increasing private providers' business skills and clients' satisfaction with services. PMID:15544645

3% Amuchina is as effective as the 50% concentration in the prevention of exit-site infection in children on chronic peritoneal dialysis.

PubMed

Grosman, Mònica D; Mosquera, Vanesa M; Hernandez, Maria G; Agostini, Silvana; Adragna, Marta; Sojo, Ernesto T

2005-01-01

In a previous communication, we demonstrated that, in the prevention of exit-site infection (ESI) in children, the cleansing agent 50% Amuchina (electrolytic chloroxidizer. Amuchina SpA, Genoa, Italy) is more effective than 10% povidone iodine and as effective as 4% chlorhexidine, but with fewer adverse secondary effects. In the present study, we assessed, in an Argentine pediatric population, whether Amuchina 3% is as effective as Amuchina 50% in preventing ESI in children on chronic peritoneal dialysis. In an open-label, single-center prospective study, 27 children (mean age: 7.2 years; range: 1.7-17 years) used 3% Amuchina as a cleansing agent for the daily care of a healthy exit site. Of the 27 children, 14 were switched from 50% Amuchina to 3% Amuchina, and 13 were using the 3% Amuchina for the first time. The control group consisted of 18 patients who had previously used 50% Amuchina as a cleansing agent. We followed the recommendations of the International Society for Peritoneal Dialysis with regard to exit-site care, which include keeping the cleansing agent out of the sinus and rinsing the exit site with sterile water. Amuchina was used from the first post-implantation care of the exit site. No adverse secondary effects were seen with the use of Amuchina at either concentration. Patients using 3% Amuchina presented an ESI rate similar to that of patients using Amuchina 50%. The cost of 3% Amuchina was significantly lower than that of the 50% concentration, and it was even lower than the cost for 10% povidone iodine or 4% chlorhexidine. Although more research trials are needed to assess the efficacy of 3% Amuchina, we conclude that 3% Amuchina is the best and most cost-effective cleansing agent for the daily care of a healthy exit site in children on chronic peritoneal dialysis.

The Mock Academic Faculty Position Competition: A Pilot Professional and Career Development Opportunity for Postdoctoral Fellows.

PubMed

Henderson, Rita Isabel; Syed, Naweed

2016-12-01

Medical educators face a dilemma in countries like Canada, where policy makers and strategic planners have prioritized highly qualified personnel and expanded recruitment of advanced trainees at a time when early-career specialists face prolonged job insecurity as they transition to professional employment. The University of Calgary Cumming School of Medicine hatched the Mock Academic Faculty Position competition to test the school's existing capacity to address the pressing career development needs of highly trained graduates. The competition was piloted in May-June 2014. Approximately 180 postdoctoral fellows were invited to compete; 34 submitted portfolios. The Postdoctoral Program Office established a longlist of 12 applicants. Through reviews, a selection committee identified 3 finalists to participate in a daylong event consisting of a research presentation and committee interview. The event was followed by approximately 70 audience members at any given time who were invited to complete anonymous evaluation forms and/or exit interviews. The selection committee deduced a vast majority of applicants did not sell their skills effectively or demonstrate research programs independent from supervisors. Exit interviews conducted with 40 audience members indicated 36 (90%) picked the same finalist as the selection committee, 34 (85%) found the process "nerve racking," and 28 (70%) had no previous idea of what goes on inside an academic committee interview. A key recommendation for future iterations is early attention to systematizing feedback to ensure more direct impact for nonfinalists. Alternative initiatives for those gearing up for industry or public-sector work are being prepared.

Implementation of patient charges at primary care facilities in Kenya: implications of low adherence to user fee policy for users and facility revenue.

PubMed

Opwora, Antony; Waweru, Evelyn; Toda, Mitsuru; Noor, Abdisalan; Edwards, Tansy; Fegan, Greg; Molyneux, Sassy; Goodman, Catherine

2015-05-01

With user fees now seen as a major hindrance to universal health coverage, many countries have introduced fee reduction or elimination policies, but there is growing evidence that adherence to reduced fees is often highly imperfect. In 2004, Kenya adopted a reduced and uniform user fee policy providing fee exemptions to many groups. We present data on user fee implementation, revenue and expenditure from a nationally representative survey of Kenyan primary health facilities. Data were collected from 248 randomly selected public health centres and dispensaries in 2010, comprising an interview with the health worker in charge, exit interviews with curative outpatients, and a financial record review. Adherence to user fee policy was assessed for eight tracer conditions based on health worker reports, and patients were asked about actual amounts paid. No facilities adhered fully to the user fee policy across all eight tracers, with adherence ranging from 62.2% for an adult with tuberculosis to 4.2% for an adult with malaria. Three quarters of exit interviewees had paid some fees, with a median payment of US dollars (USD) 0.39, and a quarter of interviewees were required to purchase additional medical supplies at a later stage from a private drug retailer. No consistent pattern of association was identified between facility characteristics and policy adherence. User fee revenues accounted for almost all facility cash income, with average revenue of USD 683 per facility per year. Fee revenue was mainly used to cover support staff, non-drug supplies and travel allowances. Adherence to user fee policy was very low, leading to concerns about the impact on access and the financial burden on households. However, the potential to ensure adherence was constrained by the facilities' need for revenue to cover basic operating costs, highlighting the need for alternative funding strategies for peripheral health facilities. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014.

Impact of 360-degree Sensor Information on Vehicle Commander Performance

DTIC Science & Technology

2011-03-01

Questionnaire .....................................3  2.2.2  The National Aeronautics and Space Administration ( NASA ) Task Load Index ( NASA - TLX ...Aeronautics and Space Administration Task Load Index ( NASA - TLX ) Questionnaire 63  Appendix D. Usability and Exit Interview Questionnaires 65  Appendix E...49  Figure 33. Mean workload rating for the NASA - TLX subscales

42 CFR 60.61 - Responsibilities of a HEAL school.

Code of Federal Regulations, 2012 CFR

2012-10-01

... depart from the school without receiving an exit interview. A school may meet this requirement through... 42 Public Health 1 2012-10-01 2012-10-01 false Responsibilities of a HEAL school. 60.61 Section 60... EDUCATION ASSISTANCE LOAN PROGRAM The School § 60.61 Responsibilities of a HEAL school. (a) A HEAL school is...

42 CFR 60.61 - Responsibilities of a HEAL school.

Code of Federal Regulations, 2014 CFR

2014-10-01

... depart from the school without receiving an exit interview. A school may meet this requirement through... 42 Public Health 1 2014-10-01 2014-10-01 false Responsibilities of a HEAL school. 60.61 Section 60... EDUCATION ASSISTANCE LOAN PROGRAM The School § 60.61 Responsibilities of a HEAL school. (a) A HEAL school is...

42 CFR 60.61 - Responsibilities of a HEAL school.

Code of Federal Regulations, 2013 CFR

2013-10-01

... depart from the school without receiving an exit interview. A school may meet this requirement through... 42 Public Health 1 2013-10-01 2013-10-01 false Responsibilities of a HEAL school. 60.61 Section 60... EDUCATION ASSISTANCE LOAN PROGRAM The School § 60.61 Responsibilities of a HEAL school. (a) A HEAL school is...

"Mommy That's the Exit.": Empowering Homeless Mothers to Support Their Children's Daily Literacy Experiences

ERIC Educational Resources Information Center

Di Santo, Aurelia; Timmons, Kristy; Pelletier, Janette

2016-01-01

The present study examined how a six-week family literacy programme contributed to supporting the efforts 12 mothers living in a residential shelter were making to foster their preschool children's literacy development. We compared pre- and post-programme interviews to explore whether the mothers applied the literacy strategies discussed in the…

Exploring Gender and Race amongst Female Sociologists Exiting Academia in South Africa

ERIC Educational Resources Information Center

Rabe, Marlize; Rugunanan, Pragna

2012-01-01

This article explores issues of gender and race in the academic careers of female sociologists in South Africa by focusing on selected women who left academic departments in higher education institutions. In-depth interviews were conducted with 11 participants who left various Sociology departments at different times. It was found that young black…

Improving identification and management of partner violence: examining the process of academic detailing: a qualitative study

PubMed Central

2011-01-01

Background Many physicians do not routinely inquire about intimate partner violence. Purpose This qualitative study explores the process of academic detailing as an intervention to change physician behavior with regard to intimate partner violence (IPV) identification and documentation. Method A non-physician academic detailer provided a seven-session modular curriculum over a two-and-a-half month period. The detailer noted written details of each training session. Audiotapes of training sessions and semi-structured exit interviews with each physician were recorded and transcribed. Transcriptions were qualitatively and thematically coded and analyzed using Atlas ti®. Results All three study physicians reported increased clarity with regard to the scope of their responsibility to their patients experiencing IPV. They also reported increased levels of comfort in the effective identification and appropriate documentation of IPV and the provision of ongoing support to the patient, including referrals to specialized community services. Conclusion Academic detailing, if presented by a supportive and knowledgeable academic detailer, shows promise to improve physician attitudes and practices with regards to patients in violent relationships. PMID:21679450

Conversion to lacosamide monotherapy in the treatment of focal epilepsy: Results from a historical-controlled, multicenter, double-blind study

PubMed Central

Wechsler, Robert T; Li, George; French, Jacqueline; O'Brien, Terence J; D'Cruz, O'Neill; Williams, Paulette; Goodson, Robin; Brock, Melissa

2014-01-01

Objective To evaluate the efficacy and safety of conversion to lacosamide 400 mg/day monotherapy in adults with focal epilepsy. Methods This historical-controlled, double-blind study (NCT00520741) enrolled patients aged 16–70 years on stable doses of 1–2 antiepileptic drugs (AEDs) and experiencing 2–40 partial-onset seizures per 28 days during the 8-week prospective Baseline. Patients were randomized to lacosamide 400 or 300 mg/day (3:1 ratio), starting at 200 mg/day and titrated over 3 weeks to randomized dose. Patients then withdrew background AEDs over 6 weeks and entered a 10-week Monotherapy Phase. The primary assessment was the Kaplan-Meier–predicted percentage of patients on 400 mg/day in the full analysis set (FAS) meeting ≥1 predefined seizure-related exit criterion by day 112, compared with the historical-control threshold (65.3%). Results Four hundred twenty-five patients were enrolled and were eligible for safety analyses (400 mg/day, n = 319; 300 mg/day, n = 106). A total of 271 (63.8%) of 425 patients completed the Lacosamide Maintenance Phase (combined AED Withdrawal and Monotherapy Phases). Among 284 patients in the 400 mg/day group in the FAS, 82 (28.9%) met ≥1 exit criterion; the Kaplan-Meier–predicted exit percentage at day 112 for 400 mg/day (30.0%; 95% confidence interval [CI] 24.6–35.5%) was lower than the historical control. When exit events, withdrawal due to treatment-emergent adverse events (TEAEs), and withdrawal due to lack of efficacy were summed (n = 90), the predicted exit percentage (32.3%; 95% CI 26.8–37.8%) was also lower than the historical control. Most patients receiving 400 mg/day reported some improvement on the Clinical Global Impression of Change (75.4%) and Patient Global Impression of Change (74.3%). Overall, the most common (>10%) TEAEs were dizziness (24.0%), headache (14.4%), nausea (13.4%), convulsion (11.5%), somnolence (10.4%), and fatigue (10.1%); most (74.1%) were mild-to-moderate in intensity. Seventy-two patients (16.9%) discontinued due to TEAEs. Seventeen patients (4%, all receiving 400 mg/day) experienced serious AEs. Significance Lacosamide 400 mg/day monotherapy was effective, with a favorable safety profile in patients with focal epilepsy. PMID:24915838

Conversion to lacosamide monotherapy in the treatment of focal epilepsy: results from a historical-controlled, multicenter, double-blind study.

PubMed

Wechsler, Robert T; Li, George; French, Jacqueline; O'Brien, Terence J; D'Cruz, O'Neill; Williams, Paulette; Goodson, Robin; Brock, Melissa

2014-07-01

To evaluate the efficacy and safety of conversion to lacosamide 400 mg/day monotherapy in adults with focal epilepsy. This historical-controlled, double-blind study (NCT00520741) enrolled patients aged 16-70 years on stable doses of 1-2 antiepileptic drugs (AEDs) and experiencing 2-40 partial-onset seizures per 28 days during the 8-week prospective Baseline. Patients were randomized to lacosamide 400 or 300 mg/day (3:1 ratio), starting at 200 mg/day and titrated over 3 weeks to randomized dose. Patients then withdrew background AEDs over 6 weeks and entered a 10-week Monotherapy Phase. The primary assessment was the Kaplan-Meier-predicted percentage of patients on 400 mg/day in the full analysis set (FAS) meeting ≥ 1 predefined seizure-related exit criterion by day 112, compared with the historical-control threshold (65.3%). Four hundred twenty-five patients were enrolled and were eligible for safety analyses (400 mg/day, n = 319; 300 mg/day, n = 106). A total of 271 (63.8%) of 425 patients completed the Lacosamide Maintenance Phase (combined AED Withdrawal and Monotherapy Phases). Among 284 patients in the 400 mg/day group in the FAS, 82 (28.9%) met ≥ 1 exit criterion; the Kaplan-Meier-predicted exit percentage at day 112 for 400 mg/day (30.0%; 95% confidence interval [CI] 24.6-35.5%) was lower than the historical control. When exit events, withdrawal due to treatment-emergent adverse events (TEAEs), and withdrawal due to lack of efficacy were summed (n = 90), the predicted exit percentage (32.3%; 95% CI 26.8-37.8%) was also lower than the historical control. Most patients receiving 400 mg/day reported some improvement on the Clinical Global Impression of Change (75.4%) and Patient Global Impression of Change (74.3%). Overall, the most common (>10%) TEAEs were dizziness (24.0%), headache (14.4%), nausea (13.4%), convulsion (11.5%), somnolence (10.4%), and fatigue (10.1%); most (74.1%) were mild-to-moderate in intensity. Seventy-two patients (16.9%) discontinued due to TEAEs. Seventeen patients (4%, all receiving 400 mg/day) experienced serious AEs. Lacosamide 400 mg/day monotherapy was effective, with a favorable safety profile in patients with focal epilepsy. Wiley Periodicals, Inc. © 2014 International League Against Epilepsy.

Feasibility of a Mobile Application to Enhance Swallowing Therapy for Patients Undergoing Radiation-Based Treatment for Head and Neck Cancer.

PubMed

Starmer, Heather M; Abrams, Rina; Webster, Kimberly; Kizner, Jennifer; Beadle, Beth; Holsinger, F Christopher; Quon, Harry; Richmon, Jeremy

2018-04-01

Dysphagia following treatment for head and neck cancer is one of the most significant morbidities impacting quality of life. Despite the value of prophylactic exercises to mitigate the impact of radiation on long-term swallowing function, adherence to treatment is limited. The purpose of this investigation was to explore the feasibility of a mobile health application to support patient adherence to swallowing therapy during radiation-based treatment. 36 patients undergoing radiation therapy were provided with the Vibrent™ mobile application as an adjunct to standard swallowing therapy. The application included exercise videos, written instructions, reminders, exercise logging, and educational content. 80% of participants used the app during treatment and logged an average of 102 exercise sessions over the course of treatment. 25% of participants logged at least two exercise sessions per day over the 7-week treatment period, and 53% recorded at least one session per day. Exit interviews regarding the patient experience with the Vibrent™ mobile application were largely positive, but also provided actionable strategies to improve future versions of the application. The Vibrent™ mobile application appears to be a tool that can be feasibly integrated into existing patient care practices and may assist patients in adhering to treatment recommendations and facilitate communication between patients and providers between encounters.

Cerebrospinal Fluid Leak at Percutaneous Exit of Ventricular Catheter as a Crucial Risk Factor for External Ventricular Drainage-Related Infection in Adult Neurosurgical Patients.

PubMed

Park, Jaechan; Choi, Yeon-Ju; Ohk, Boram; Chang, Hyun-Ha

2018-01-01

The placement of a ventricular catheter for temporary cerebrospinal fluid (CSF) diversion is associated with a considerable risk of CSF infection. The authors investigated the effect of a CSF leak on CSF-related infection and the predisposing factors for a CSF leak. Fifty-two patients who underwent external ventricular drainage (EVD) for acute hydrocephalus associated with a subarachnoid hemorrhage or intraventricular hemorrhage (IVH) were enrolled in this prospective study. A CSF leak-detection paper (small sterilized filter paper) was applied at the percutaneous catheter exit site to check for any bloody CSF leak. In addition, radiologic and clinical data were collected. Four of the 52 patients (7.7%) developed an EVD-related CSF infection from organisms including Staphylococcus epidermidis (n = 3) and Staphylococcus hominis (n = 1). A prolonged CSF leak >1 day was detected in 9 patients (17.3%) and revealed as a significant risk factor for CSF infection with a 44.4% positive predictive value. Moreover, an IVH >10 mL was found in 11 patients (21.2%) and revealed as a significant predisposing factor for a CSF leak at the percutaneous catheter exit. A prolonged CSF leak for >1 day at the percutaneous catheter exit site is a crucial risk factor for EVD-related CSF infection and an IVH >10 mL is a predisposing factor for a CSF leak. Copyright © 2017 Elsevier Inc. All rights reserved.

Developing Governance for Federated Community-based EHR Data Sharing

PubMed Central

Lin, Ching-Ping; Stephens, Kari A.; Baldwin, Laura-Mae; Keppel, Gina A.; Whitener, Ron J.; Echo-Hawk, Abigail; Korngiebel, Diane

2014-01-01

Bi-directional translational pathways between scientific discoveries and primary care are crucial for improving individual patient care and population health. The Data QUEST pilot project is a program supporting data sharing amongst community based primary care practices and is built on a technical infrastructure to share electronic health record data. We developed a set of governance requirements from interviewing and collaborating with partner organizations. Recommendations from our partner organizations included: 1) partner organizations can physically terminate the link to the data sharing network and only approved data exits the local site; 2) partner organizations must approve or reject each query; 3) partner organizations and researchers must respect local processes, resource restrictions, and infrastructures; and 4) partner organizations can be seamlessly added and removed from any individual data sharing query or the entire network. PMID:25717404

Exit, Voice, and Loyalty in the Italian Public Health Service: Macroeconomic and Corporate Implications

PubMed Central

Impagliazzo, Cira; Zoccoli, Paola

2013-01-01

The paper analyses how customers of public health organizations can express their dissatisfaction for the services offered to them. The main aim is to evaluate the effects that possible dissatisfaction of Italian public health service customers can have on public health organizations. We adopted the methodological scheme developed by Hirschman with exit, voice, and loyalty, considering the macroeconomic and corporate implications that it causes for Italian public health organizations. The study investigated the effects developed by exit of the patients on the system of financing of local health authorities considering both the corporate level of analysis and the macroeconomic level. As a result, local health authority management is encouraged to pay greater attention to the exit phenomena through the adoption of tools that promote loyalty, such as the promotion of voice, even if exit is not promoting, at a macroeconomic level, considerable attention to this phenomenon. PMID:24348148

Exit, voice, and loyalty in the Italian public health service: macroeconomic and corporate implications.

PubMed

Ippolito, Adelaide; Impagliazzo, Cira; Zoccoli, Paola

2013-01-01

The paper analyses how customers of public health organizations can express their dissatisfaction for the services offered to them. The main aim is to evaluate the effects that possible dissatisfaction of Italian public health service customers can have on public health organizations. We adopted the methodological scheme developed by Hirschman with exit, voice, and loyalty, considering the macroeconomic and corporate implications that it causes for Italian public health organizations. The study investigated the effects developed by exit of the patients on the system of financing of local health authorities considering both the corporate level of analysis and the macroeconomic level. As a result, local health authority management is encouraged to pay greater attention to the exit phenomena through the adoption of tools that promote loyalty, such as the promotion of voice, even if exit is not promoting, at a macroeconomic level, considerable attention to this phenomenon.

A mindfulness-based intervention to control weight after bariatric surgery: Preliminary results from a randomized controlled pilot trial.

PubMed

Chacko, Sara A; Yeh, Gloria Y; Davis, Roger B; Wee, Christina C

2016-10-01

This study aimed to develop and test a novel mindfulness-based intervention (MBI) designed to control weight after bariatric surgery. Randomized, controlled pilot trial. Beth Israel Deaconess Medical Center, Boston, MA, USA. Bariatric patients 1-5 years post-surgery (n=18) were randomized to receive a 10-week MBI or a standard intervention. Primary outcomes were feasibility and acceptability of the MBI. Secondary outcomes included changes in weight, eating behaviors, psychosocial outcomes, and metabolic and inflammatory biomarkers. Qualitative exit interviews were conducted post-intervention. Major themes were coded and extracted. Attendance was excellent (6 of 9 patients attended ≥7 of 10 classes). Patients reported high satisfaction and overall benefit of the MBI. The intervention was effective in reducing emotional eating at 6 months (-4.9±13.7 in mindfulness vs. 6.2±28.4 in standard, p for between-group difference=0.03) but not weight. We also observed a significant increase in HbA1C (0.34±0.38 vs. -0.06±0.31, p=0.03). Objective measures suggested trends of an increase in perceived stress and symptoms of depression, although patients reported reduced stress reactivity, improved eating behaviors, and a desire for continued mindfulness-based support in qualitative interviews. This novel mindfulness-based approach is highly acceptable to bariatric patients post-surgery and may be effective for reducing emotional eating, although it did not improve weight or glycemic control in the short term. Longer-term studies of mindfulness-based approaches may be warranted in this population. ClinicalTrials.gov identifier NCT02603601. Copyright © 2016 Elsevier Ltd. All rights reserved.

Addressing the double-burden of diabetes and tuberculosis: lessons from Kyrgyzstan.

PubMed

Skordis-Worrall, Jolene; Round, Jeff; Arnold, Matthias; Abdraimova, Aida; Akkazieva, Baktygul; Beran, David

2017-03-15

The incidence of diabetes and tuberculosis co-morbidity is rising, yet little work has been done to understand potential implications for health systems, healthcare providers and individuals. Kyrgyzstan is a priority country for tuberculosis control and has a 5% prevalence of diabetes in adults, with many health system challenges for both conditions. Patient exit interviews collected data on demographic and socio-economic characteristics, health spending and care seeking for people with diabetes, tuberculosis and both diabetes and tuberculosis. Qualitative data were collected through semi-structured interviews with healthcare workers involved in diabetes and tuberculosis care, to understand delivery of care and how providers view effectiveness of care. The experience of co-affected individuals within the health system is different than those just with tuberculosis or diabetes. Co-affected patients do not receive more care and also have different care for their tuberculosis than people with only tuberculosis. Very high levels of catastrophic spending are found among all groups despite these two conditions being included in the Kyrgyz state benefit package especially for medicines. This study highlights that different patterns of service provision by disease group are found. Although Kyrgyzstan has often been cited as an example in terms of health reforms and developing Primary Health Care, this study highlights the challenge of managing conditions that are viewed as "too complicated" for non-specialists and the impact this has on costs and management of individuals.

Impact of a smoke-free hospital campus policy on employee and consumer behavior.

PubMed

Wheeler, J Gary; Pulley, LeaVonne; Felix, Holly C; Bursac, Zoran; Siddiqui, Nadia J; Stewart, M Kathryn; Mays, Glen P; Gauss, C Heath

2007-01-01

Although smoke-free hospital campuses can provide a strong health message and protect patients, they are few in number due to employee retention and public relations concerns. We evaluated the effects of implementing a clean air policy on employee attitudes, recruitment, and retention; hospital utilization; and consumer satisfaction in 2003 through 2005. We conducted research at a university hospital campus with supplemental data from an affiliated hospital campus. Our evaluation included (1) measurement of employee attitudes during the year before and year after policy implementation using a cross-sectional, anonymous survey; (2) focus group discussions held with supervisors and security personnel; and (3) key informant interviews conducted with administrators. Secondary analysis included review of employment records and exit interviews, and monitoring of hospital utilization and patient satisfaction data. Employee attitudes toward the policy were supportive (83.3%) at both institutions and increased significantly (89.8%) at post-test at the university hospital campus. Qualitatively, administrator and supervisor attitudes were similarly favorable. There was no evidence on either campus of an increase in employee separations or a decrease in new hiring after the policy was implemented. On neither campus was there a change in bed occupancy or mean daily census. Standard measures of consumer satisfaction were also unchanged at both sites. A campus-wide smoke-free policy had no detrimental effect on measures of employee or consumer attitudes or behaviors.

Trajectories of Depression Symptoms among Older Youths Exiting Foster Care

ERIC Educational Resources Information Center

Munson, Michelle R.; McMillen, Curtis

2010-01-01

The purpose of this study was to determine the trajectories of depressive symptoms as older youths from the foster care system mature while also examining the correlates of these trajectories. Data came from a longitudinal study of 404 youths from the foster care system in Missouri, who were interviewed nine times between their 17th and 19th…

When Teachers Give Up: Teacher Burnout, Teacher Turnover and Their Impact on Children.

ERIC Educational Resources Information Center

Dworkin, Anthony Gary

A large-scale sociological study of teacher burnout in the public schools is summarized. Data presented in the study consist of: a sample of 3,500 teachers in Houston, whose attitudes were monitored in 1977; exit interviews of every teacher in the initial sample who subsequently quit teaching over a 5-year period; achievement and attendance…

The Use of Transitional Child Care: Analysis and Recommendations for New York City's Program.

ERIC Educational Resources Information Center

Peck, Laura; And Others

New York City's Transitional Child Care (TCC) program, for families exiting Aid to Families with Dependent Children (AFDC), has an application rate of 20 percent. This study sought to determine both the causes of the low rate and possible solutions. The situation was evaluated by means of surveys, interviews, analysis of data collected by the…

A Study of Use of the New York State Library by Visitors.

ERIC Educational Resources Information Center

Lipetz, Ben-Ami

Based on data gathered during a full 5-day, 40-hour week of visiting time, this study determined various characteristics of visitors to the New York State Library (NYSL) main facility; e.g., traffic rates, user intent, and user status. Visitors exiting the library were counted, short interviews were conducted with 25 percent of the total visitors…

76 FR 37167 - Agency Information Collection Activities; Request for Comments on a New Information Collection...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-24

...-board monitoring system (OBMS), as a part of a Field Operational Test (FOT) study. On March 29, 2011... Response: 20 minutes for the pre-study questionnaire, 15 minutes for during- and post-study questionnaires, and 20 minutes for the exit interview at the end of the study. Expiration Date: N/A. Frequency of...

A Case Study of Career Emegency Medical Technicians: Factors That Influenced Their Decision to Stay

ERIC Educational Resources Information Center

Miller, Denine V.

2013-01-01

This case study (Stake, 1995) examined the perceptions of long-term Emergency Medical Technicians (EMTs) to identify factors influencing their decision to remain employed as EMTs for the duration of a career. EMT retention plans frequently utilize data from either employee exit interviews or workers with intent to leave, and since privacy law…

Pregabalin monotherapy in patients with partial-onset seizures

PubMed Central

Kwan, Patrick; Fakhoury, Toufic; Pitman, Verne; DuBrava, Sarah; Knapp, Lloyd; Yurkewicz, Lorraine

2014-01-01

Objective: To assess pregabalin monotherapy for partial-onset seizures using a historical-controlled conversion-to-monotherapy design. Methods: Adults with inadequately controlled partial-onset seizures while receiving 1 or 2 antiepileptic drugs during an 8-week prospective baseline were randomized to double-blind monotherapy with pregabalin 600 or 150 mg/d (4:1) for 20 weeks (8-week conversion and 12-week monotherapy period). The primary endpoint was the seizure-related exit rate for pregabalin 600 mg/d, based on discontinuations due to predefined criteria. Efficacy was declared if the upper limit of the 95% confidence interval for the exit rate was below a historical-control threshold of 74%, with stepwise evaluation using a threshold of 68%. Results: The trial was stopped early for positive efficacy after an interim analysis in 125 patients. The full study population included 161 patients, with 148 evaluable for efficacy. The mean time since epilepsy diagnosis was 14 years. Overall, 54.3% (600 mg/d) and 46.9% (150 mg/d) of patients completed 20 weeks of double-blind treatment. Seizure-related exit rate in the 600 mg/d group (27.5%; 95% confidence interval, 17.8%–37.2%) was significantly below the 74% and 68% thresholds (p < 0.001 for both). Eight patients on 600 mg/d and 2 on 150 mg/d were seizure-free throughout pregabalin monotherapy. Pregabalin's overall safety profile was consistent with prior trials. Conclusions: Pregabalin monotherapy was safe and efficacious for patients with inadequately controlled partial-onset seizures. Classification of evidence: This study provides Class III evidence that patients with inadequately controlled partial-onset seizures switched to pregabalin monotherapy have fewer seizure-related exit events compared with historical controls switched to pseudo-placebo monotherapy. PMID:24415567

Substance Abuse-Specific Knowledge Transfer or Loss? Treatment Program Turnover versus Professional Turnover among Substance Abuse Clinicians

PubMed Central

Eby, Lillian T.; Curtis, Sara L.

2014-01-01

This longitudinal study investigated the extent to which substance abuse (SA) clinician turnover is associated with SA-specific knowledge loss due to change in professions (professional turnover) versus SA-specific knowledge transfer due to movement from one SA clinical setting to another (treatment program turnover). For this study, clinicians had to voluntarily leave their current treatment program. Eligible clinicians completed a quantitative survey while employed and a qualitative post-employment exit interview 1 year later. Compared to those that exited the SA profession (N = 99), clinicians who changed treatment programs (N = 120) had greater SA-specific formal knowledge and were more likely to be personally in recovery. No differences were found between the two groups in terms of SA-specific practical knowledge. PMID:25115318

Medicare payment reform and provider entry and exit in the post-acute care market.

PubMed

Huckfeldt, Peter J; Sood, Neeraj; Romley, John A; Malchiodi, Alessandro; Escarce, José J

2013-10-01

To understand the impacts of Medicare payment reform on the entry and exit of post-acute providers. Medicare Provider of Services data, Cost Reports, and Census data from 1991 through 2010. We examined market-level changes in entry and exit after payment reforms relative to a preexisting time trend. We also compared changes in high Medicare share markets relative to lower Medicare share markets and for freestanding relative to hospital-based facilities. We calculated market-level entry, exit, and total stock of home health agencies, skilled nursing facilities, and inpatient rehabilitation facilities from Provider of Services files between 1992 and 2010. We linked these measures with demographic information from the Census and American Community Survey, information on Certificate of Need laws, and Medicare share of facilities in each market drawn from Cost Report data. Payment reforms reducing average and marginal payments reduced entries and increased exits from the market. Entry effects were larger and more persistent than exit effects. Entry and exit rates fluctuated more for home health agencies than skilled nursing facilities. Effects on number of providers were consistent with entry and exit effects. Payment reform affects market entry and exit, which in turn may affect market structure, access to care, quality and cost of care, and patient outcomes. Policy makers should consider potential impacts of payment reforms on post-acute care market structure when implementing these reforms. © Health Research and Educational Trust.

Medicare Payment Reform and Provider Entry and Exit in the Post-Acute Care Market

PubMed Central

Huckfeldt, Peter J; Sood, Neeraj; Romley, John A; Malchiodi, Alessandro; Escarce, José J

2013-01-01

Objective To understand the impacts of Medicare payment reform on the entry and exit of post-acute providers. Data Sources Medicare Provider of Services data, Cost Reports, and Census data from 1991 through 2010. Study Design We examined market-level changes in entry and exit after payment reforms relative to a preexisting time trend. We also compared changes in high Medicare share markets relative to lower Medicare share markets and for freestanding relative to hospital-based facilities. Data Extraction Methods We calculated market-level entry, exit, and total stock of home health agencies, skilled nursing facilities, and inpatient rehabilitation facilities from Provider of Services files between 1992 and 2010. We linked these measures with demographic information from the Census and American Community Survey, information on Certificate of Need laws, and Medicare share of facilities in each market drawn from Cost Report data. Principal Findings Payment reforms reducing average and marginal payments reduced entries and increased exits from the market. Entry effects were larger and more persistent than exit effects. Entry and exit rates fluctuated more for home health agencies than skilled nursing facilities. Effects on number of providers were consistent with entry and exit effects. Conclusions Payment reform affects market entry and exit, which in turn may affect market structure, access to care, quality and cost of care, and patient outcomes. Policy makers should consider potential impacts of payment reforms on post-acute care market structure when implementing these reforms. PMID:23557215

Sexual counselling for patients with cardiovascular disease: protocol for a pilot study of the CHARMS sexual counselling intervention

PubMed Central

Mc Sharry, Jenny; Casey, Dympna; Doherty, Sally; Gillespie, Paddy; Jaarsma, Tiny; Murphy, Andrew W; Newell, John; O'Donnell, Martin; Steinke, Elaine E; Toomey, Elaine; Byrne, Molly

2016-01-01

Introduction Sexual problems are common with cardiovascular disease, and can negatively impact quality of life. To address sexual problems, guidelines have identified the importance of sexual counselling during cardiac rehabilitation, yet this is rarely provided. The Cardiac Health and Relationship Management and Sexuality (CHARMS) intervention aims to improve the provision of sexual counselling in cardiac rehabilitation in Ireland. Methods and analysis This is a multicentre pilot study for the CHARMS intervention, a complex, multilevel intervention delivered within hospital-based cardiac rehabilitation programmes. The intervention includes (1) training in sexual counselling for staff, (2) a staff-led patient education and support intervention embedded within the cardiac rehabilitation programme, (3) a patient information booklet and (4) an awareness raising poster. The intervention will be delivered in two randomly selected cardiac rehabilitation centres. In each centre 30 patients will be recruited, and partners will also be invited to participate. Data will be collected from staff and patients/partners at T1 (study entry), T2 (3-month follow-up) and T3 (6-month follow-up). The primary outcome for patients/partners will be scores on the Sexual Self-Perception and Adjustment Questionnaire. Secondary outcomes for patients/partners will include relationship satisfaction; satisfaction with and barriers to sexual counselling in services; sexual activity, functioning and knowledge; physical and psychological well-being. Secondary outcomes for staff will include sexuality-related practice; barriers to sexual counselling; self-ratings of capability, opportunity and motivation; sexual attitudes and beliefs; knowledge of cardiovascular disease and sex. Fidelity of intervention delivery will be assessed using trainer self-reports, researcher-coded audio recordings and exit interviews. Longitudinal feasibility data will be gathered from patients/partners and staff via questionnaires and interviews. Ethics and dissemination This study is approved by the Research Ethics Committee (REC) of the National University of Ireland, Galway. Findings will be disseminated to cardiac rehabilitation staff, patients/partners and relevant policymakers via appropriate publications and presentations. PMID:27342240

'I Got it off my Chest': An Examination of how Research Participation Improved the Mental Health of Women Engaging in Transactional Sex.

PubMed

Felsher, Marisa; Wiehe, Sarah E; Gunn, Jayleen K L; Roth, Alexis M

2018-02-01

Ecologic momentary assessment (EMA) is a form of close-ended diary writing. While it has been shown that participating in a study that incorporates EMA improves mental health of participants, no study to date has examined the pathways through which benefits may occur. For 4-weeks, twice-daily EMAs and weekly interviews captured mood, daily activities and HIV risk behavior of 25 women who engage in transactional sex. Qualitative analysis of exit interviews was performed to examine how participation impacted women's mental health. The majority of participants felt that EMAs heightened awareness of emotions and behavior. Most reported experiencing catharsis from the interviews; specifically, from having a non-judgmental, trusting listener. Participants felt responsible for completing tasks, a sense of accomplishment for completing the study, and altruism. This study demonstrates there are direct benefits associated with participation in an EMA and interview study.

A randomized controlled trial comparing mupirocin and polysporin triple ointments in peritoneal dialysis patients: the MP3 Study.

PubMed

McQuillan, Rory F; Chiu, Ernest; Nessim, Sharon; Lok, Charmaine E; Roscoe, Janet M; Tam, Paul; Jassal, Sarbjit Vanita

2012-02-01

Infectious complications remain a significant cause of peritoneal dialysis (PD) technique failure. Topical ointments seem to reduce peritonitis; however, concerns over resistance have led to a quest for alternative agents. This study examined the effectiveness of applying topical Polysporin Triple ointment (P(3)) against mupirocin in a multi-centered, double-blind, randomized controlled trial. PD patients routinely applied either P(3) or mupirocin ointment to their exit site. Patients were followed for 18 months or until death or catheter removal. The primary study outcome was a composite endpoint of exit-site infection (ESI), tunnel infection, or peritonitis. Seventy-five of 201 randomized patients experienced a primary outcome event (51 peritonitis episodes, 24 ESIs). No difference was seen in the time to first event for P(3) (13.2 months; 95% confidence interval, 11.9-14.5) and mupirocin (14.0 months; 95% confidence interval, 12.7-15.4) (P=0.41). Twice as many patients reported redness at the exit site in the P(3) group (14 versus 6, P=0.10). Over the complete study period, a higher rate per year of fungal ESIs was seen in patients using P(3) (0.07 versus 0.01; P=0.02) with a corresponding increase in fungal peritonitis (0.04 versus 0.00, respectively; P<0.05). This study shows that P(3) is not superior to mupirocin in the prophylaxis of PD-related infections. Colonization of the exit site with fungal organisms is of concern and warrants further study. As such, the use of P(3) over mupirocin is not advocated in the prophylaxis of PD-related infections.

Disability Grant: a precarious lifeline for HIV/AIDS patients in South Africa.

PubMed

Govender, Veloshnee; Fried, Jana; Birch, Stephen; Chimbindi, Natsayi; Cleary, Susan

2015-06-09

In South Africa, HIV/AIDS remains a major public health problem. In a context of chronic unemployment and deepening poverty, social assistance through a Disability Grant (DG) is extended to adults with HIV/AIDS who are unable to work because of a mental or physical disability. Using a mixed methods approach, we consider 1) inequalities in access to the DG for patients on ART and 2) implications of DG access for on-going access to healthcare. Data were collected in exit interviews with 1200 ART patients in two rural and two urban health sub-districts in four different South African provinces. Additionally, 17 and 18 in-depth interviews were completed with patients on ART treatment and ART providers, respectively, in three of the four sites included in the quantitative phase. Grant recipients were comparatively worse off than non-recipients in terms of employment (9.1 % vs. 29.9 %) and wealth (58.3 % in the poorest half vs. 45.8 %). After controlling for socioeconomic and demographic factors, site, treatment duration, adherence and concomitant TB treatment, the regression analyses showed that the employed were significantly less likely to receive the DG than the unemployed (p < 0.001). Also, patients who were longer on treatment and receiving concomitant treatment (i.e., ART and tuberculosis care) were more likely to receive the DG (significant at the 5 % level). The qualitative analyses indicated that the DG alleviated the burden of healthcare related costs for ART patients. Both patients and healthcare providers spoke of the complexity of the grants process and eligibility criteria as a barrier to accessing the grant. This impacted adversely on patient-provider relationships. These findings highlight the appropriateness of the DG for people living with HIV/AIDS. However, improved collaboration between the Departments of Social Development and Health is essential for preparing healthcare providers who are at the interface between social security and potential recipients.

Quality of Malaria Case Management in Malawi: Results from a Nationally Representative Health Facility Survey

PubMed Central

Steinhardt, Laura C.; Chinkhumba, Jobiba; Wolkon, Adam; Luka, Madalitso; Luhanga, Misheck; Sande, John; Oyugi, Jessica; Ali, Doreen; Mathanga, Don; Skarbinski, Jacek

2014-01-01

Background Malaria is endemic throughout Malawi, but little is known about quality of malaria case management at publicly-funded health facilities, which are the major source of care for febrile patients. Methods In April–May 2011, we conducted a nationwide, geographically-stratified health facility survey to assess the quality of outpatient malaria diagnosis and treatment. We enrolled patients presenting for care and conducted exit interviews and re-examinations, including reference blood smears. Moreover, we assessed health worker readiness (e.g., training, supervision) and health facility capacity (e.g. availability of diagnostics and antimalarials) to provide malaria case management. All analyses accounted for clustering and unequal selection probabilities. We also used survey weights to produce estimates of national caseloads. Results At the 107 facilities surveyed, most of the 136 health workers interviewed (83%) had received training on malaria case management. However, only 24% of facilities had functional microscopy, 15% lacked a thermometer, and 19% did not have the first-line artemisinin-based combination therapy (ACT), artemether-lumefantrine, in stock. Of 2,019 participating patients, 34% had clinical malaria (measured fever or self-reported history of fever plus a positive reference blood smear). Only 67% (95% confidence interval (CI): 59%, 76%) of patients with malaria were correctly prescribed an ACT, primarily due to missed malaria diagnosis. Among patients without clinical malaria, 31% (95% CI: 24%, 39%) were prescribed an ACT. By our estimates, 1.5 million of the 4.4 million malaria patients seen in public facilities annually did not receive correct treatment, and 2.7 million patients without clinical malaria were inappropriately given an ACT. Conclusions Malawi has a high burden of uncomplicated malaria but nearly one-third of all patients receive incorrect malaria treatment, including under- and over-treatment. To improve malaria case management, facilities must at minimum have basic case management tools, and health worker performance in diagnosing malaria must be improved. PMID:24586497

Quality of malaria case management in Malawi: results from a nationally representative health facility survey.

PubMed

Steinhardt, Laura C; Chinkhumba, Jobiba; Wolkon, Adam; Luka, Madalitso; Luhanga, Misheck; Sande, John; Oyugi, Jessica; Ali, Doreen; Mathanga, Don; Skarbinski, Jacek

2014-01-01

Malaria is endemic throughout Malawi, but little is known about quality of malaria case management at publicly-funded health facilities, which are the major source of care for febrile patients. In April-May 2011, we conducted a nationwide, geographically-stratified health facility survey to assess the quality of outpatient malaria diagnosis and treatment. We enrolled patients presenting for care and conducted exit interviews and re-examinations, including reference blood smears. Moreover, we assessed health worker readiness (e.g., training, supervision) and health facility capacity (e.g. availability of diagnostics and antimalarials) to provide malaria case management. All analyses accounted for clustering and unequal selection probabilities. We also used survey weights to produce estimates of national caseloads. At the 107 facilities surveyed, most of the 136 health workers interviewed (83%) had received training on malaria case management. However, only 24% of facilities had functional microscopy, 15% lacked a thermometer, and 19% did not have the first-line artemisinin-based combination therapy (ACT), artemether-lumefantrine, in stock. Of 2,019 participating patients, 34% had clinical malaria (measured fever or self-reported history of fever plus a positive reference blood smear). Only 67% (95% confidence interval (CI): 59%, 76%) of patients with malaria were correctly prescribed an ACT, primarily due to missed malaria diagnosis. Among patients without clinical malaria, 31% (95% CI: 24%, 39%) were prescribed an ACT. By our estimates, 1.5 million of the 4.4 million malaria patients seen in public facilities annually did not receive correct treatment, and 2.7 million patients without clinical malaria were inappropriately given an ACT. Malawi has a high burden of uncomplicated malaria but nearly one-third of all patients receive incorrect malaria treatment, including under- and over-treatment. To improve malaria case management, facilities must at minimum have basic case management tools, and health worker performance in diagnosing malaria must be improved.

Can health insurance improve access to quality care for the Indian poor?

PubMed

Michielsen, Joris; Criel, Bart; Devadasan, Narayanan; Soors, Werner; Wouters, Edwin; Meulemans, Herman

2011-08-01

Recently, the Indian government launched health insurance schemes for the poor both to protect them from high health spending and to improve access to high-quality health services. This article aims to review the potentials of health insurance interventions in order to improve access to quality care in India based on experiences of community health insurance schemes. PubMed, Ovid MEDLINE (R), All EBM Reviews, CSA Sociological Abstracts, CSA Social Service Abstracts, EconLit, Science Direct, the ISI Web of Knowledge, Social Science Research Network and databases of research centers were searched up to September 2010. An Internet search was executed. One thousand hundred and thirty-three papers were assessed for inclusion and exclusion criteria. Twenty-five papers were selected providing information on eight schemes. A realist review was performed using Hirschman's exit-voice theory: mechanisms to improve exit strategies (financial assets and infrastructure) and strengthen patient's long voice route (quality management) and short voice route (patient pressure). All schemes use a mix of measures to improve exit strategies and the long voice route. Most mechanisms are not effective in reality. Schemes that focus on the patients' bargaining position at the patient-provider interface seem to improve access to quality care. Top-down health insurance interventions with focus on exit strategies will not work out fully in the Indian context. Government must actively facilitate the potential of CHI schemes to emancipate the target group so that they may transform from mere passive beneficiaries into active participants in their health.

"I'm on a Journey I Never Thought I'd Be On": Using Process Drama Pedagogy for the Literacy Programme

ERIC Educational Resources Information Center

Wells, Trish; Sandretto, Susan

2017-01-01

This paper argues that process drama is a productive pedagogy with multiple affordances for multiliteracies. We describe an exploratory study in which two teachers from a rural New Zealand primary school used process drama pedagogy in the literacy programme. Analysis of the initial and exit teacher interviews, lesson transcripts and transcripts of…

A phase 2a multicenter, double-blind, placebo-controlled, crossover trial to investigate the efficacy, safety, and toleration of CP-866,087 (a high-affinity mu-opioid receptor antagonist) in premenopausal women diagnosed with female sexual arousal disorder (FSAD).

PubMed

Orri, Miguel; Abraham, Lucy; Giraldi, Annamaria

2013-10-01

Female sexual arousal disorder (FSAD) is a condition that can affect women of all ages and have a significant negative impact on emotional well-being. The aim of this study is to prospectively evaluate the effects of CP-866,087, a selective mu-opioid receptor antagonist, in premenopausal women with FSAD. The study included 51 women (20-45 years of age) with FSAD. All women received placebo and two of three planned doses of CP-866,087 (1, 3, and 10 mg) for 6 weeks in each of three double-blind treatment periods. Efficacy was determined through a series of measures to assess sexual functioning, sexual activity, sexual distress, and perceived meaningful benefit as a result of treatment. In addition, a semi-structured exit interview was conducted at the end of the fourth treatment period or withdrawal to provide a more in-depth, qualitative description of the participants' symptoms, response to treatment, and treatment satisfaction to augment the quantitative assessments. The within-subject differences from placebo in the change from baseline were compared across a range of measures of sexual function. Summary statistics and 90% confidence intervals were calculated. A qualitative analysis of the exit interview was conducted based on grounded theory methods. Although improvements were seen with CP-866,087 in the key efficacy end points, there was no clinical treatment benefit over placebo. The exit interview analysis suggested that being part of the study and taking positive action to search for a solution to the women's sexual disorder may have been a significant factor in the behavioral changes that were seen, as opposed to the drug treatment itself. Discerning the potential benefit of pharmacotherapy in a heterogeneous condition such as FSAD is challenging. Participation in a clinical trial combined with a commitment to actively engage in sexual activity may in itself create an environment that is conducive to symptom improvement. © 2013 International Society for Sexual Medicine.

Launching into adulthood from institutional care with a serious mental health condition.

PubMed

Klodnick, Vanessa Vorhies; Davis, Kristin E; Fagan, Marc A; Elias, Allison

2014-02-01

This qualitative study explores the experiences of emerging adults with serious mental health conditions (e.g., bipolar disorder, posttraumatic stress disorder) before and after they emancipate from the child welfare system and exit a transitional living program. Sixteen participants were interviewed before and 13 were interviewed after aging out. Findings suggest that transitional living programs services were appreciated for the relationships and safety net they fostered. Future plans were positive, but vague, and worries about the future were prevalent. Struggles with independence post-emancipation were common despite adult service use. Additional research is needed to understand how to best support these at-risk emerging adults.

Senior doctor triage (SDT), a qualitative study of clinicians' views on senior doctors' involvement in triage and early assessment of emergency patients.

PubMed

Abdulwahid, Maysam Ali; Turner, Janette; Mason, Suzanne M

2018-07-01

Despite the focus during the last decade on introducing interventions such as senior doctor initial assessment or senior doctor triage (SDT) to reduce emergency department (ED) crowding, there has been little attempt to identify the views of emergency healthcare professionals on such interventions. The aim of this study was to gain an understanding of SDT from the perspective of emergency hospital staff. A secondary aim of this study was to develop a definition of SDT based on the interview findings and the available literature on this process. Qualitative semi-structured telephone interviews were conducted with participants of different backgrounds including senior doctors, nurses, paramedics and ED managers. Textual data were analysed using a template analysis approach. 27 participants from 13 EDs across England were interviewed. SDT was viewed as a safety mechanism and a measure to control patient flow. The most prominent positive aspect was the ability to initiate early investigations and treatment. Various shortcomings of SDT were described such as the lack of standardisation of the process and its cost implications. Participants identified a number of barriers to this process including insufficient resources and exit block, and called for solutions focused on these issues. A proposed definition of an 'ideal' SDT was developed where it is described as a systematic brief assessment of patients arriving at the ED by a senior doctor-led team, which takes place in a dedicated unit. The aim of this assessment is to facilitate early investigation and management of patients, early patient disposition and guide junior staff to deliver safe and high-quality clinical care. This is the first national study to explore the opinions of various emergency and managerial staff on the SDT model. It revealed variable interpretations of this model and what it can and cannot offer. This has led to a standard definition of the SDT process, which can be useful for clinicians and researchers in emergency care. © 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.

Feasibility and usability of a text message-based program for diabetes self-management in an urban African-American population.

PubMed

Dick, Jonathan J; Nundy, Shantanu; Solomon, Marla C; Bishop, Keisha N; Chin, Marshall H; Peek, Monica E

2011-09-01

We pilot-tested a text message-based diabetes care program in an urban African-American population in which automated text messages were sent to participants with personalized medication, foot care, and appointment reminders and text messages were received from participants on adherence. Eighteen patients participated in a 4-week pilot study. Baseline surveys collected data about demographics, historical cell phone usage, and adherence to core diabetes care measures. Exit interview surveys (using close-coded and open-ended questions) were administered to patients at the end of the program. A 1-month follow-up interview was conducted surveying patients on perceived self-efficacy. Wilcoxon signed-rank tests were used to compare baseline survey responses about self-management activities to those at the pilot's end and at 1-month follow-up. Eighteen urban African-American participants completed the pilot study. The average age was 55 and the average number of years with diabetes was 8. Half the participants were initially uncomfortable with text messaging. Example messages include "Did you take your diabetes medications today" and "How many times did you check your feet for wounds this week?" Participants averaged 220 text messages with the system, responded to messages 80% of the time, and on average responded within 6 minutes. Participants strongly agreed that text messaging was easy to perform and helped with diabetes self-care. Missed medication doses decreased from 1.6 per week to 0.6 (p = .003). Patient confidence in diabetes self-management was significantly increased during and 1 month after the pilot (p = .002, p = .008). Text messaging may be a feasible and useful approach to improve diabetes self-management in urban African Americans. © 2011 Diabetes Technology Society.

Peritonitis and exit-site infection in pediatric automated peritoneal dialysis.

PubMed

Chiu, Man-Chun; Tong, Pak-Chiu; Lai, Wai-Ming; Lau, Shing-Chi

2008-06-01

We reviewed 30 patients in an automated peritoneal dialysis (APD) program from 2002 to 2006 for peritonitis. Patients were 11.6 +/- 5.5 years old at initiation of peritoneal dialysis (PD) and had a total of 976 PD months. The overall peritonitis rate was 1 episode in 54.2 patient-months, for a rate of 0.22 episode annually. The rate was considered low, which other than being an APD program, may be attributed to adherence to guidelines and in-charge nurse policy. A total of 17 episodes of peritonitis were identified in 9 patients, and the distribution of patient-specific peritonitis incidence appeared bimodal: 87% patients had no or only 1 episode of peritonitis, and 4 patients accounted for 12 episodes, with an average peritonitis rate of 1.0 annually. Causative organisms included Staphylococcus aureus, coagulase-negative Staphylococcus, methicillin-resistant S. aureus (MRSA), Pseudomonas aeruginosa, enterococci, alpha-hemolytic Streptococcus. Five episodes had concurrent exit-site infection with the same organism. During the same period in these 30 patients, 40 episodes of exit-site infection (ESI) were recorded in 23 patients. The overall ESI rate was 1 episode in 24.4 PD months. S. aureus and Pseudomonas aeruginosa were the two most common pathogens, accounting for 70% of the infections. Nasal carriage of MRSA was found in 4 patients, and MRSA ESIs in 2. The ESI rate was not low as that observed in peritonitis, which may be attributed to the humid climate.

Promoting Patient Phronesis: Communication Patterns in an Online Lifestyle Program Coordinated with Primary Care

PubMed Central

Rief, John J.; Mitchell, Gordon R.; Zickmund, Susan L.; Bhargava, Tina D.; Bryce, Cindy L.; Fischer, Gary S.; Hess, Rachel; Kolb, N. Randall; Simkin-Silverman, Laurey R.; McTigue, Kathleen M.

2013-01-01

Phronesis, or practical wisdom developed through experience, is an Aristotelian concept that can shed light on the capacities of patients to make health-related decisions and engage in healthy behaviors. In this article, the authors develop a conceptual framework for understanding the role of phronesis in lifestyle change as well as its relationship to patient activation, which is considered to be a critical component of the Chronic Care Model and patient education in general. The authors develop the concept of phronesis by analyzing qualitatively the comments made by 35 participants working to manage chronic health issues in a weight-loss study. The authors iteratively coded transcribed passages of exit interviews for phronesis and patient activation. These passages provide experientially grounded content for evaluating the use of phronesis and its development among individuals engaging in lifestyle change. Phronesis is expressed in 31% of participant responses to questions regarding the relationship between the online lifestyle intervention, participant health, and participant readiness to engage in productive clinical encounters with health care practitioners. Of those responses, 73% express some level of patient activation. The authors conclude that phronesis may be an important new tool for understanding successful self-management support, with potential usefulness in the creation of tailored lifestyle interventions, the development of patient activation, and the ability of participants to enact health-related behaviors. PMID:22984212

Substance abuse treatment engagement, completion and short-term outcomes in the Western Cape province, South Africa: Findings from the Service Quality Measures Initiative.

PubMed

Myers, Bronwyn; Williams, Petal Petersen; Govender, Rajen; Manderscheid, Ron; Koch, J Randy

2018-04-01

Optimizing the effectiveness of substance use disorder (SUD) treatment is critical in low-and middle-income countries (LMICs) with limited opportunities for SUD treatment. This is the first study to identify targets for interventions to improve the quality of SUD treatment in a LMIC. We explored correlates of three indicators of treatment quality (treatment engagement, completion and abstinence at treatment exit) using data from a SUD performance measurement system implemented in the Western Cape Province of South Africa. The sample included data from 1094 adult treatment episodes representing 53% of the treatment episodes in 2016. Using multivariate logistic regression analyses, we modeled socio-demographic, substance use and program correlates of treatment engagement, completion, and abstinence at treatment exit. Overall, 59% of patients completed treatment (48% of patients from outpatient services). Treatment completion was associated with greater likelihood of abstinence at treatment exit. Patients were more likely to complete treatment if they engaged in treatment, were older, and had more severe drug problems (characterized by daily drug use and heroin problems) and attended programs of shorter duration. Residential treatment was associated with greater likelihood of treatment engagement, completion, and abstinence at treatment exit. Improving rates of outpatient treatment completion will enhance the effectiveness of South Africa's SUD treatment system. Interventions that promote engagement in treatment, particularly among younger patients; reduce program length through referral to step-down continuing care; and ensure better matching of drug problem to treatment level and type could improve rates of treatment completion. Copyright © 2018 Elsevier B.V. All rights reserved.

Correlation Between Glycemic Control and the Incidence of Peritoneal and Catheter Tunnel and Exit-Site Infections in Diabetic Patients Undergoing Peritoneal Dialysis

PubMed Central

Rodríguez-Carmona, Ana; Pérez-Fontán, Miguel; López-Muñiz, Andrés; Ferreiro-Hermida, Tamara; García-Falcón, Teresa

2014-01-01

♦ Background: Diabetes mellitus, especially if complicated by poor glycemic control, portends an increased risk of infection. The significance of this association in the case of diabetic patients undergoing peritoneal dialysis (PD) has not been assessed. ♦ Methods: Using a retrospective observational design, we analyzed the association between glycemic control at the start of PD (estimated from glycosylated hemoglobin levels) and the risk of peritoneal and catheter tunnel and exit-site infections during follow-up in 183 incident patients on PD. We used the median value of glycosylated hemoglobin to classify patients into good (group A) or poor (group B) glycemic control groups. We applied multivariate strategies of analysis to control for other potential predictors of PD-related infection. ♦ Results: Groups A and B differed significantly in age, dialysis vintage, use of insulin, and rate of Staphylococcus aureus carriage. Neither the incidence (0.60 episodes in group A vs 0.56 episodes in group B per patient-year) nor the time to a first peritoneal infection (median: 42 months vs 38 months) differed significantly between the study groups. In contrast, group B had a significantly higher incidence of catheter tunnel and exit-site infections (0.23 episodes vs 0.12 episodes per patient-year) and shorter time to a first infection episode (64 months vs 76 months, p = 0.004). The difference persisted in multivariate analysis (adjusted hazard ratio: 2.65; 95% confidence interval: 1.13 to 6.05; p = 0.013). We observed no differences between the study groups in the spectrum of causative organisms or in the outcomes of PD-related infections. ♦ Conclusions: Poor glycemic control is a consistent predictor of subsequent risk of catheter tunnel and exit-site infection, but not of peritoneal infection, among diabetic patients starting PD therapy. PMID:23818005

Private sector role, readiness and performance for malaria case management in Uganda, 2015.

PubMed

Kaula, Henry; Buyungo, Peter; Opigo, Jimmy

2017-05-25

Several interventions have been put in place to promote access to quality malaria case management services in Uganda's private sector, where most people seek treatment. This paper describes evidence using a mixed-method approach to examine the role, readiness and performance of private providers at a national level in Uganda. These data will be useful to inform strategies and policies for improving malaria case management in the private sector. The ACTwatch national anti-malarial outlet survey was conducted concurrently with a fever case management study. The ACTwatch nationally representative anti-malarial outlet survey was conducted in Uganda between May 18th 2015 and July 2nd 2015. A representative sample of sub-counties was selected in 14 urban and 13 rural clusters with probability proportional to size and a census approach was used to identify outlets. Outlets eligible for the survey met at least one of three criteria: (1) one or more anti-malarials were in stock on the day of the survey; (2) one or more anti-malarials were in stock in the 3 months preceding the survey; and/or (3) malaria blood testing (microscopy or RDT) was available. The fever case management study included observations of provider-patient interactions and patient exit interviews. Data were collected between May 20th and August 3rd, 2015. The fever case management study was implemented in the private sector. Potential outlets were identified during the main outlet survey and included in this sub-sample if they had both artemisinin-based combination therapy (ACT) [artemether-lumefantrine (AL)], in stock on the day of survey as well as diagnostic testing available. A total of 9438 outlets were screened for eligibility in the ACTwatch outlet survey and 4328 outlets were found to be stocking anti-malarials and were interviewed. A total of 9330 patients were screened for the fever case management study and 1273 had a complete patient observation and exit interview. Results from the outlet survey illustrate that the majority of anti-malarials were distributed through the private sector (54.3%), with 31.4% of all anti-malarials distributed through drug stores and 14.4% through private for-profit health facilities. Availability of different anti-malarials and diagnostic testing in the private sector was: ACT (80.7%), quality-assured (QA) ACT (72.0%), sulfadoxine-pyrimethamine (SP) (47.1%), quinine (73.2%) and any malaria blood testing (32.9%). Adult QAACT ($1.62) was three times more expensive than SP ($0.48). The results from the fever case management study found 44.4% of respondents received a malaria test, and among those who tested positive for malaria, 60.0% received an ACT, 48.5% received QAACT; 14.4% a non-artemisinin therapy; 14.9% artemether injection, and 42.5% received an antibiotic. The private sector plays an important role in malaria case management in Uganda. While several private sector initiatives have improved availability of QAACT, there are gaps in malaria diagnosis and distribution of non-artemisinin monotherapies persists. Further private sector strategies, including those focusing on drug stores, are needed to increase coverage of parasitological testing and removal of non-artemisinin therapies from the marketplace.

Psychosocial Factors Predict Nonadherence to PD Treatment: A Hong Kong Survey.

PubMed

Fung, Timothy K F; Ng, Yu Leung; Lam, Man Fai; Lee, Kelvin K W

2017-01-01

♦ BACKGROUND: Nonadherence to hand hygiene and aseptic regimen, dialysis environment guidelines, and catheter and exit-site care guidelines are risk factors of peritonitis. However, little is known about the psychosocial factors that account for the nonadherent behavior of patients undergoing peritoneal dialysis (PD). Applying the health belief model, this study seeks to enhance the understanding of psychosocial influences on patients' nonadherent behavior to the 3 regimen components. ♦ METHODS: Through referrals by 7 Hong Kong renal patient support groups, we surveyed patients undergoing PD treatment. ♦ RESULTS: A total of 244 Hong Kong PD patients completed the questionnaires. About 90% of the patients reported no deviation from catheter and exit-site care guidelines. However, the nonadherence rates of hand hygiene and aseptic regimen and of dialysis environment guidelines were 30.3% and 23%, respectively. Longer time on PD treatment and lower family monthly income were associated with nonadherence to dialysis environment guidelines. Employed patients tended toward nonadherence to catheter and exit-site care guidelines twice as much as unemployed patients. Of the 5 health beliefs, perceived benefits, perceived barriers, and efficacy belief were significant predictors of nonadherence to the 3 regimen components. ♦ CONCLUSIONS: The findings of this study inform the design of intervention to change patients' behavior in regimen nonadherence for preventing peritonitis. To identify the target audience for adherence intervention based on the 3 regimen components, the results suggest dividing patients into subgroups according to their sociodemographic background. To foster behavioral change, health communicators should address patients' health beliefs when formulating intervention strategies. Copyright © 2017 International Society for Peritoneal Dialysis.

Ex utero intrapartum treatment for an infant with cerebro-costo-mandibular syndrome.

PubMed

Ogasawara, Kei; Honda, Yoshinobu; Hosoya, Mitsuaki

2014-08-01

Cerebro-costo-mandibular syndrome (CCMS) is a rare disorder characterized by multiple rib abnormalities, micrognathia described as Pierre-Robin sequence, and cerebral involvement. Appropriate management of respiratory distress immediately after birth is crucial to rescue these patients. A boy, having a mother with Pierre-Robin sequence and a sister with CCMS, was diagnosed prenatally with CCMS and successfully treated with ex utero intrapartum treatment (EXIT) at 36 weeks 6 days of gestation. EXIT would be an effective option for rescuing patients with prenatally diagnosed CCMS and preventing neonatal hypoxia. © 2014 Japan Pediatric Society.

Exit examination: a survey of UK psychiatrists' views

PubMed Central

Hughes, Nicholas S.; Haselgrove, Angela; Tovey, Matthew S.; Khokhar, Waqqas A.; Husain, Muj; Osman-Hicks, Victoria C.

2015-01-01

Aims and method The Royal College of Psychiatrists is considering how best to introduce a post-MRCPsych-examination assessment (‘exit examination’) in anticipation of external pressures to ensure patient safety through the use of such assessments. The Psychiatric Trainees' Committee conducted an online survey to gather the views of psychiatrists regarding the possible format and content of this examination in the hope that this information can be used to design a satisfactory assessment. Results Of the 2082 individuals who started the survey, 1735 completed all sections (83.3%). Participants included consultants and trainees from a range of subspecialties. There was general agreement that the content and structure of the exit examination should include assessment of clinical and communication skills. Clinical implications UK psychiatrists believe that an exit assessment should focus on clinical and communication skills. It should assess both generic and subspecialty-specific competencies and incorporate a mixture of assessment techniques. PMID:26755972

Effectiveness of a Batteryless and Wireless Wearable Sensor System for Identifying Bed and Chair Exits in Healthy Older People

PubMed Central

Shinmoto Torres, Roberto Luis; Visvanathan, Renuka; Hoskins, Stephen; van den Hengel, Anton; Ranasinghe, Damith C.

2016-01-01

Aging populations are increasing worldwide and strategies to minimize the impact of falls on older people need to be examined. Falls in hospitals are common and current hospital technological implementations use localized sensors on beds and chairs to alert caregivers of unsupervised patient ambulations; however, such systems have high false alarm rates. We investigate the recognition of bed and chair exits in real-time using a wireless wearable sensor worn by healthy older volunteers. Fourteen healthy older participants joined in supervised trials. They wore a batteryless, lightweight and wireless sensor over their attire and performed a set of broadly scripted activities. We developed a movement monitoring approach for the recognition of bed and chair exits based on a machine learning activity predictor. We investigated the effectiveness of our approach in generating bed and chair exit alerts in two possible clinical deployments (Room 1 and Room 2). The system obtained recall results above 93% (Room 2) and 94% (Room 1) for bed and chair exits, respectively. Precision was >78% and 67%, respectively, while F-score was >84% and 77% for bed and chair exits, respectively. This system has potential for real-time monitoring but further research in the final target population of older people is necessary. PMID:27092506

Understanding Patterns of Social Support and Their Relationship to an ART Adherence Intervention Among Adults in Rural Southwestern Uganda.

PubMed

Atukunda, Esther C; Musiimenta, Angella; Musinguzi, Nicholas; Wyatt, Monique A; Ashaba, Justus; Ware, Norma C; Haberer, Jessica E

2017-02-01

SMS is a widely used technology globally and may also improve ART adherence, yet SMS notifications to social supporters following real-time detection of missed doses showed no clear benefit in a recent pilot trial. We examine the demographic and social-cultural dynamics that may explain this finding. In the trial, 63 HIV-positive individuals initiating ART received a real-time adherence monitor and were randomized to two types of SMS reminder interventions versus a control (no SMS). SMS notifications were also sent to 45 patient-identified social supporters for sustained adherence lapses. Like participants, social supporters were interviewed at enrollment, following their matched participant's adherence lapse and at exit. Social supporters with regular income (RR = 0.27, P = 0.001) were significantly associated with fewer adherence lapses. Instrumental support was associated with fewer adherence lapses only among social supporters who were food secure (RR = 0.58, P = 0.003). Qualitative interview data revealed diverse and complex economic and relationship dynamics, affecting social support. Resource availability in emotionally positive relationships seemingly facilitated helpful support, while limited resources prevented active provision of support for many. Effective social support appeared subject to social supporters' food security, economic stability and a well-functioning social network dependent on trust and supportive disclosure.

“It Was Very Rewarding for Me …”: Senior Volunteers’ Experiences With Implementing a Reminiscence and Creative Activity Intervention

PubMed Central

Allen, Rebecca S.; Azuero, Casey B.; Csikai, Ellen L.; Parmelee, Patricia A.; Shin, Hae Jung; Kvale, Elizabeth; Durkin, Daniel W.; Burgio, Louis D.

2016-01-01

Purpose of the Study: To describe the experience of recruiting, training, and retaining retired senior volunteers (RSVs) as interventionists delivering a successful reminiscence and creative activity intervention to community-dwelling palliative care patients and their caregivers. Design and Methods: A community-based participatory research framework involved Senior Corps RSV programs. Recruitment meetings and feedback groups yielded interested volunteers, who were trained in a 4-hr session using role plays and real-time feedback. Qualitative descriptive analysis identified themes arising from: (a) recruitment/feedback groups with potential RSV interventionists; and (b) individual interviews with RSVs who delivered the intervention. Results: Themes identified within recruitment/feedback groups include questions about intervention process, concerns about patient health, positive perceptions of the intervention, and potential characteristics of successful interventionists. Twelve RSVs achieved 89.8% performance criterion in treatment delivery. Six volunteers worked with at least one family and 100% chose to work with additional families. Salient themes identified from exit interviews included positive and negative aspects of the experience, process recommendations, reactions to the Interventionist Manual, feelings arising during work with patient/caregiver participants, and personal reflections. Volunteers reported a strong desire to recommend the intervention to others as a meaningful volunteer opportunity. Implications: RSVs reported having a positive impact on palliative care dyads and experiencing personal benefit via increased meaning in life. Two issues require further research attention: (a) further translation of this cost-effective mode of treatment delivery for palliative dyads and (b) further characterization of successful RSVs and the long-term impact on their own physical, cognitive, and emotional functioning. PMID:26035882

"It Was Very Rewarding for Me …": Senior Volunteers' Experiences With Implementing a Reminiscence and Creative Activity Intervention.

PubMed

Allen, Rebecca S; Azuero, Casey B; Csikai, Ellen L; Parmelee, Patricia A; Shin, Hae Jung; Kvale, Elizabeth; Durkin, Daniel W; Burgio, Louis D

2016-04-01

To describe the experience of recruiting, training, and retaining retired senior volunteers (RSVs) as interventionists delivering a successful reminiscence and creative activity intervention to community-dwelling palliative care patients and their caregivers. A community-based participatory research framework involved Senior Corps RSV programs. Recruitment meetings and feedback groups yielded interested volunteers, who were trained in a 4-hr session using role plays and real-time feedback. Qualitative descriptive analysis identified themes arising from: (a) recruitment/feedback groups with potential RSV interventionists; and (b) individual interviews with RSVs who delivered the intervention. Themes identified within recruitment/feedback groups include questions about intervention process, concerns about patient health, positive perceptions of the intervention, and potential characteristics of successful interventionists. Twelve RSVs achieved 89.8% performance criterion in treatment delivery. Six volunteers worked with at least one family and 100% chose to work with additional families. Salient themes identified from exit interviews included positive and negative aspects of the experience, process recommendations, reactions to the Interventionist Manual, feelings arising during work with patient/caregiver participants, and personal reflections. Volunteers reported a strong desire to recommend the intervention to others as a meaningful volunteer opportunity. RSVs reported having a positive impact on palliative care dyads and experiencing personal benefit via increased meaning in life. Two issues require further research attention: (a) further translation of this cost-effective mode of treatment delivery for palliative dyads and (b) further characterization of successful RSVs and the long-term impact on their own physical, cognitive, and emotional functioning. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Sexual counselling for patients with cardiovascular disease: protocol for a pilot study of the CHARMS sexual counselling intervention.

PubMed

Murphy, Patrick J; Mc Sharry, Jenny; Casey, Dympna; Doherty, Sally; Gillespie, Paddy; Jaarsma, Tiny; Murphy, Andrew W; Newell, John; O'Donnell, Martin; Steinke, Elaine E; Toomey, Elaine; Byrne, Molly

2016-06-24

Sexual problems are common with cardiovascular disease, and can negatively impact quality of life. To address sexual problems, guidelines have identified the importance of sexual counselling during cardiac rehabilitation, yet this is rarely provided. The Cardiac Health and Relationship Management and Sexuality (CHARMS) intervention aims to improve the provision of sexual counselling in cardiac rehabilitation in Ireland. This is a multicentre pilot study for the CHARMS intervention, a complex, multilevel intervention delivered within hospital-based cardiac rehabilitation programmes. The intervention includes (1) training in sexual counselling for staff, (2) a staff-led patient education and support intervention embedded within the cardiac rehabilitation programme, (3) a patient information booklet and (4) an awareness raising poster. The intervention will be delivered in two randomly selected cardiac rehabilitation centres. In each centre 30 patients will be recruited, and partners will also be invited to participate. Data will be collected from staff and patients/partners at T1 (study entry), T2 (3-month follow-up) and T3 (6-month follow-up). The primary outcome for patients/partners will be scores on the Sexual Self-Perception and Adjustment Questionnaire. Secondary outcomes for patients/partners will include relationship satisfaction; satisfaction with and barriers to sexual counselling in services; sexual activity, functioning and knowledge; physical and psychological well-being. Secondary outcomes for staff will include sexuality-related practice; barriers to sexual counselling; self-ratings of capability, opportunity and motivation; sexual attitudes and beliefs; knowledge of cardiovascular disease and sex. Fidelity of intervention delivery will be assessed using trainer self-reports, researcher-coded audio recordings and exit interviews. Longitudinal feasibility data will be gathered from patients/partners and staff via questionnaires and interviews. This study is approved by the Research Ethics Committee (REC) of the National University of Ireland, Galway. Findings will be disseminated to cardiac rehabilitation staff, patients/partners and relevant policymakers via appropriate publications and presentations. 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/

Evaluation of Sensor Technology to Detect Fall Risk and Prevent Falls in Acute Care.

PubMed

Potter, Patricia; Allen, Kelly; Costantinou, Eileen; Klinkenberg, William Dean; Malen, Jill; Norris, Traci; O'Connor, Elizabeth; Roney, Wilhemina; Tymkew, Heidi Hahn; Wolf, Laurie

2017-08-01

Sensor technology that dynamically identifies hospitalized patients' fall risk and detects and alerts nurses of high-risk patients' early exits out of bed has potential for reducing fall rates and preventing patient harm. During Phase 1 (August 2014-January 2015) of a previously reported performance improvement project, an innovative depth sensor was evaluated on two inpatient medical units to study fall characteristics. In Phase 2 (April 2015-January 2016), a combined depth and bed sensor system designed to assign patient fall probability, detect patient bed exits, and subsequently prevent falls was evaluated. Fall detection depth sensors remained in place on two medicine units; bed sensors used to detect patient bed exits were added on only one of the medicine units. Fall rates and fall with injury rates were evaluated on both units. During Phase 2, the designated evaluation unit had 14 falls, for a fall rate of 2.22 per 1,000 patient-days-a 54.1% reduction compared with the Phase 1 fall rate. The difference in rates from Phase 1 to Phase 2 was statistically significant (z = 2.20; p = 0.0297). The comparison medicine unit had 30 falls-a fall rate of 4.69 per 1,000 patient-days, representing a 57.9% increase as compared with Phase 1. A fall detection sensor system affords a level of surveillance that standard fall alert systems do not have. Fall prevention remains a complex issue, but sensor technology is a viable fall prevention option. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

A social marketing approach to quality improvement in family planning services: a case study from Rawalpindi, Pakistan.

PubMed

Gulzar, Jamshaid; Ali, Moazzam; Kuroiwa, Chushi

2008-02-01

In the 1990s, social marketing approach was introduced in Pakistan to improve the quality and accessibility of family planning methods involving private practitioners. This study measured six quality elements using a Bruce-Jain framework. Cross-sectional survey data were collected from 29 randomly selected Green Star clinics. The study's four components were 1) an inventory of each outlet (infrastructure, equipment, and supplies); 2) an observation guide for interaction between family planning clients and service providers; 3) exit interviews with clients attending the outlet; and 4) interviews with providers at the outlet. Of the 29 clients participating in the exit interviews, 72% were new users of family planning. The clients' mean age was 32 years; all clients were married; 93% had received formal education. Housework was the principal activity of 93% of clients. The mean number of children reported was three. Both hormonal and intrauterine contraceptives (IUCDs) were available in all facilities; 86% of the clients reported being able to obtain their contraceptive of choice. Most facilities had the equipment and supplies needed to deliver services; service personnel were trained and regularly supervised; the service outlets emphasized mechanisms to ensure continuity of use. Notable shortcomings included a shortage of information on alternative methods, contraindications, and side-effect management, as well as a dearth of registration records. In conclusion, this is a good example of public-private partnership involving private practitioners using a social marketing approach. The quality components of a Bruce-Jain framework were achieved, resulting in a satisfied clientele. Involvement of private service outlets increased the accessibility and enhanced the use of services. Social marketing may be expanded to improve quality and access by involving further components of health care.

Using programme theory to assess the feasibility of delivering micronutrient Sprinkles through a food-assisted maternal and child health and nutrition programme in rural Haiti.

PubMed

Loechl, Cornelia U; Menon, Purnima; Arimond, Mary; Ruel, Marie T; Pelto, Gretel; Habicht, Jean-Pierre; Michaud, Lesly

2009-01-01

This paper uses programme theory to assess, in the context of an effectiveness evaluation, the feasibility and acceptability of distributing micronutrient Sprinkles through a food-assisted maternal and child health and nutrition programme in rural Haiti. We laid out the steps related to programme delivery and household utilization of Sprinkles and used qualitative and quantitative methods to gather data on these steps. Methods included structured observations, checks of beneficiary ration cards, exit interviews, focus group discussions (FGD), individual interviews and survey data from the effectiveness evaluation. Results are as follows: (1) information on use of Sprinkles was provided before mothers first received them, as planned; (2) Sprinkles were re-packaged and distributed as planned and in the appropriate amount; (3) almost all mothers (96%) received two monthly rations of Sprinkles and received timely information on their use; (4) mothers understood instructions about use of Sprinkles and acceptance was high, and no selling of the product was reported or observed; and (5) mothers reported using Sprinkles as instructed, every day (63% in survey; 86% at exit interviews), and for the child only (99%). FGD with staff highlighted the acceptance of the intervention, with a reported 'modest' increase in workload. Within this well-established programme, it proved feasible to distribute Sprinkles and to ensure appropriate use by beneficiary mothers. Existing programme venues were suitable for distributing Sprinkles and educating mothers about their use. Use of programme theory helped to assess feasibility and acceptability of the Sprinkles intervention and provided useful information for programme replication or scale-up.

Assessing the impact of a web-based comprehensive somatic and mental health screening tool in pediatric primary care.

PubMed

Fothergill, Kate E; Gadomski, Anne; Solomon, Barry S; Olson, Ardis L; Gaffney, Cecelia A; Dosreis, Susan; Wissow, Lawrence S

2013-01-01

To evaluate how parents and physicians perceive the utility of a comprehensive, electronic previsit screener, and to assess its impact on the visit. A mixed methods design was used. English-speaking parents were recruited from 3 primary care systems (urban MD and rural NY and VT) when they presented for a well-child visit with a child 4 to 10 years of age. Parents completed an electronic previsit screen, which included somatic concerns, health risks, and 4 mental health tools (SCARED5, PHQ-2, SDQ Impact, and PSC-17). Parents completed an exit survey, and a subset were interviewed. All primary care providers (PCPs) were interviewed. A total of 120 parents and 16 PCPs participated. The exit surveys showed that nearly 90% of parents agreed or strongly agreed that the screener was easy to use and maintained confidentiality. During interviews, parents noted that the screener helped with recall, validated concerns, reframed issues they thought might not be appropriate for primary care, and raised new questions. PCPs thought that the screener enabled them to normalize sensitive issues, and it permitted them to simultaneously focus and be comprehensive during the visit. Parents and PCPs agreed that the screener helped guide discussion, promoted in-depth exchange, and increased efficiency. Findings were consistent across quantitative and qualitative methods and between parents and PCPs. A comprehensive electronic previsit screening tool is an acceptable and practical strategy to facilitate well-child visits. It may help with problem identification as well as with setting agendas, engaging the family, and balancing attention between somatic and psychosocial concerns. Copyright © 2013 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Improving clinic- and neighborhood-based smoking cessation services within federally qualified health centers serving low-income, minority neighborhoods.

PubMed

Fisher, Edwin; Musick, Judy; Scott, Catina; Miller, J Philip; Gram, Richard; Richardson, Veronica; Clark, Jane; Pachalla, Vani

2005-04-01

Within federally qualified health centers serving low-income, African American audiences, participatory approaches to system changes were organized through multidisciplinary committees that (a) drew on evidence-based guidelines, (b) guided system changes including the requirement of documenting smoking status and readiness to quit in encounter forms, (c) tested and refined practice improvements prior to their general adoption, and (d) guided development of neighborhood-based resources and supports for smoking cessation that were linked to clinic-based services. Documentation of smoking status or readiness to quit increased from 2% of encounter forms in the first 3 months to 94.3% in the last 3 months of the 24-month program. This rate remained over 90% throughout the following year. Exit interviews also indicated increased key clinic-based services, including "explained importance of quitting" (to 78% and 82% of interview respondents in the two intervention clinics in year 2), "tell you that you should quit" (to 80% in each), "tell you about nicotine gum...or other medications" (to 69% and 58%), "offer to help you quit" (to 61% and 64%), and "tell you about programs or help in your neighborhood" (to 51% and 56%). These rates exceeded those in one comparison clinic and equaled those in a second that also had launched a smoking cessation initiative. From exit interviews, improvements in neighborhood resources and support (e.g., people and activities that encourage nonsmoking) also exceeded those in comparison clinics. Thus, participatory approaches to system changes and quality improvement can enhance clinic- and neighborhood-based smoking cessation services within health centers serving low-income, minority populations.

Using a Medical Intranet of Things System to Prevent Bed Falls in an Acute Care Hospital: A Pilot Study.

PubMed

Balaguera, Henri U; Wise, Diana; Ng, Chun Yin; Tso, Han-Wen; Chiang, Wan-Lin; Hutchinson, Aimee M; Galvin, Tracy; Hilborne, Lee; Hoffman, Cathy; Huang, Chi-Cheng; Wang, C Jason

2017-05-04

Hospitalized patients in the United States experience falls at a rate of 2.6 to 17.1 per 1000 patient-days, with the majority occurring when a patient is moving to, from, and around the bed. Each fall with injury costs an average of US $14,000. The aim was to conduct a technology evaluation, including feasibility, usability, and user experience, of a medical sensor-based Intranet of things (IoT) system in facilitating nursing response to bed exits in an acute care hospital. Patients 18 years and older with a Morse fall score of 45 or greater were recruited from a 35-bed medical-surgical ward in a 317-bed Massachusetts teaching hospital. Eligible patients were recruited between August 4, 2015 and July 31, 2016. Participants received a sensor pad placed between the top of their mattress and bed sheet. The sensor pad was positioned to monitor movement from patients' shoulders to their thighs. The SensableCare System was evaluated for monitoring patient movement and delivering timely alerts to nursing staff via mobile devices when there appeared to be a bed-exit attempt. Sensor pad data were collected automatically from the system. The primary outcomes included number of falls, time to turn off bed-exit alerts, and the number of attempted bed-exit events. Data on patient falls were collected by clinical research assistants and confirmed with the unit nurse manager. Explanatory variables included room locations (zones 1-3), day of the week, nursing shift, and Morse Fall Scale (ie, positive fall history, positive secondary diagnosis, positive ambulatory aid, weak impaired gait/transfer, positive IV/saline lock, mentally forgets limitations). We also assessed user experience via nurse focus groups. Qualitative data regarding staff interactions with the system were collected during two focus groups with 25 total nurses, each lasting approximately 1.5 hours. A total of 91 patients used the system for 234.0 patient-days and experienced no bed falls during the study period. On average, patients were assisted/returned to bed 46 seconds after the alert system was triggered. Response times were longer during the overnight nursing shift versus day shift (P=.005), but were independent of the patient's location on the unit. Focus groups revealed that nurses found the system integrated well into the clinical nursing workflow and the alerts were helpful in patient monitoring. A medical IoT system can be integrated into the existing nursing workflow and may reduce patient bed fall risk in acute care hospitals, a high priority but an elusive patient safety challenge. By using an alerting system that sends notifications directly to nurses' mobile devices, nurses can equally respond to unassisted bed-exit attempts wherever patients are located on the ward. Further study, including a fully powered randomized controlled trial, is needed to assess effectiveness across hospital settings. ©Henri U Balaguera, Diana Wise, Chun Yin Ng, Han-Wen Tso, Wan-Lin Chiang, Aimee M Hutchinson, Tracy Galvin, Lee Hilborne, Cathy Hoffman, Chi-Cheng Huang, C Jason Wang. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 04.05.2017.

Encouraging smoking cessation among disadvantaged groups: a qualitative study of the financial aspects of cessation.

PubMed

Bonevski, Billie; Bryant, Jamie; Paul, Christine

2011-07-01

This study aimed to explore perceptions about financial aspects of smoking cessation among a group of disadvantaged welfare agency clients and their carers. Qualitative focus groups and in-depth interviews were supplemented with participant exit surveys about preferred smoking cessation strategies. Each discussion was audiotaped, transcribed and analysed using a thematic analysis. The setting was six non-government community welfare service organisations operating in New South Wales, Australia. Eleven social services offered by these organisations participated. Thirty two clients participated in six client focus groups, 35 staff participated in six staff focus groups and eight manager telephone interviews were conducted. Clients indicated that the cost of nicotine replacement therapy was a barrier to its use and that financial incentives were acceptable. Of the 16 possible strategies listed in the exit survey, the three selected as the most preferred by clients incorporated financial or non-financial assistance. By contrast, staff and managers selected financial and non-financial incentives as the least preferred and least feasible strategies. The study found high acceptance of incentives as a smoking cessation strategy among a disadvantaged group of non-government welfare service clients. The comparatively low level of desirability and feasibility from the perspective of service staff and managers suggests implementation of such an approach within the community service setting requires careful further testing. © 2010 Australasian Professional Society on Alcohol and other Drugs.

Antimicrobial agents for preventing peritonitis in peritoneal dialysis patients.

PubMed

Campbell, Denise; Mudge, David W; Craig, Jonathan C; Johnson, David W; Tong, Allison; Strippoli, Giovanni Fm

2017-04-08

Peritoneal dialysis (PD) is an important therapy for patients with end-stage kidney disease and is used in more than 200,000 such patients globally. However, its value is often limited by the development of infections such as peritonitis and exit-site and tunnel infections. Multiple strategies have been developed to reduce the risk of peritonitis including antibiotics, topical disinfectants to the exit site and antifungal agents. However, the effectiveness of these strategies has been variable and are based on a small number of randomised controlled trials (RCTs). The optimal preventive strategies to reduce the occurrence of peritonitis remain unclear.This is an update of a Cochrane review first published in 2004. To evaluate the benefits and harms of antimicrobial strategies used to prevent peritonitis in PD patients. We searched the Cochrane Kidney and Transplant's Specialised Register to 4 October 2016 through contact with the Information Specialist using search terms relevant to this review. Studies contained in the Specialised Register are identified through search strategies specifically designed for CENTRAL, MEDLINE, and EMBASE; handsearching conference proceedings; and searching the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. RCTs or quasi-RCTs in patients receiving chronic PD, which evaluated any antimicrobial agents used systemically or locally to prevent peritonitis or exit-site/tunnel infection were included. Two authors independently assessed risk of bias and extracted data. Summary estimates of effect were obtained using a random-effects model, and results were expressed as risk ratio (RR) with 95% confidence intervals (CI). Thirty-nine studies, randomising 4435 patients, were included. Twenty additional studies have been included in this update. The risk of bias domains were often unclear or high; risk of bias was judged to be low in 19 (49%) studies for random sequence generation, 12 (31%) studies for allocation concealment, 22 (56%) studies for incomplete outcome reporting, and in 12 (31%) studies for selective outcome reporting. Blinding of participants and personnel was considered to be at low risk of bias in 8 (21%) and 10 studies (26%) for blinding of outcome assessors. It should be noted that blinding of participants and personnel was not possible in many of the studies because of the nature of the intervention or control treatment.The use of oral or topical antibiotic compared with placebo/no treatment, had uncertain effects on the risk of exit-site/tunnel infection (3 studies, 191 patients, low quality evidence: RR 0.45, 95% CI 0.19 to 1.04) and the risk of peritonitis (5 studies, 395 patients, low quality evidence: RR 0.82, 95% CI 0.57 to 1.19).The use of nasal antibiotic compared with placebo/no treatment had uncertain effects on the risk of exit-site/tunnel infection (3 studies, 338 patients, low quality evidence: RR 1.34, 95% CI 0.62 to 2.87) and the risk of peritonitis (3 studies, 338 patients, low quality evidence: RR 0.94, 95% CI 0.67 to 1.31).Pre/perioperative intravenous vancomycin compared with no treatment may reduce the risk of early peritonitis (1 study, 177 patients, low quality evidence: RR 0.08, 95% CI 0.01 to 0.61) but has an uncertain effect on the risk of exit-site/tunnel infection (1 study, 177 patients, low quality evidence: RR 0.36, 95% CI 0.10 to 1.32).The use of topical disinfectant compared with standard care or other active treatment (antibiotic or other disinfectant) had uncertain effects on the risk of exit-site/tunnel infection (8 studies, 973 patients, low quality evidence, RR 1.00, 95% CI 0.75 to 1.33) and the risk of peritonitis (6 studies, 853 patients, low quality evidence: RR 0.83, 95% CI 0.65 to 1.06).Antifungal prophylaxis with oral nystatin/fluconazole compared with placebo/no treatment may reduce the risk of fungal peritonitis occurring after a patient has had an antibiotic course (2 studies, 817 patients, low quality evidence: RR 0.28, 95% CI 0.12 to 0.63).No intervention reduced the risk of catheter removal or replacement. Most of the available studies were small and of suboptimal quality. Only six studies enrolled 200 or more patients. In this update, we identified limited data from RCTs and quasi-RCTs which evaluated strategies to prevent peritonitis and exit-site/tunnel infections. This review demonstrates that pre/peri-operative intravenous vancomycin may reduce the risk of early peritonitis and that antifungal prophylaxis with oral nystatin or fluconazole reduces the risk of fungal peritonitis following an antibiotic course. However, no other antimicrobial interventions have proven efficacy. In particular, the use of nasal antibiotic to eradicate Staphylococcus aureus, had an uncertain effect on the risk of peritonitis and raises questions about the usefulness of this approach. Given the large number of patients on PD and the importance of peritonitis, the lack of adequately powered and high quality RCTs to inform decision making about strategies to prevent peritonitis is striking.

Equity and the Sun Quality Health Private Provider Social Franchise: comparative analysis of patient survey data and a nationally representative TB prevalence survey.

PubMed

Montagu, Dominic; Sudhinaraset, May; Lwin, Thandar; Onozaki, Ikushi; Win, Zaw; Aung, Tin

2013-01-10

Since 2004, the Sun Quality Health (SQH) franchise network has provided TB care in Myanmar through a network of established private medical clinics. This study compares the wealth distribution of the TB patients to non-TB patients to determine if TB is most common among the poor, and compares the wealth of all TB patients to SQH TB patients to assess whether the franchise achieves its goal of serving the poor. The study uses data from two sources: 1) Myanmar's first nationally representative TB prevalence study conducted in 2009, and 2) client exit interviews from TB patients from SQH clinics. In total, 1,114 TB-positive individuals were included in the study, including 739 from the national sample and 375 from the SQH sample. TB patients at SQH clinics were poorer than TB-positive individuals in the overall population, though not at a statistically significant level (p > 0.05). After stratification we found that in urban areas, TB patients at SQH clinics were more likely to be in the poorest quartile compared to general TB positive population (16.8% vs. 8.6%, respectively; p < 0.05). In rural areas, there was no statistically significant difference between the wealth distribution of SQH clinic patients and general TB positive individuals (p > 0.05). Franchised clinics in Myanmar are reaching poor populations of TB patients in urban areas; more efforts are needed in order to reach the most vulnerable in rural areas.

Equity and the Sun Quality Health Private Provider Social Franchise: comparative analysis of patient survey data and a nationally representative TB prevalence survey

PubMed Central

2013-01-01

Introduction Since 2004, the Sun Quality Health (SQH) franchise network has provided TB care in Myanmar through a network of established private medical clinics. This study compares the wealth distribution of the TB patients to non-TB patients to determine if TB is most common among the poor, and compares the wealth of all TB patients to SQH TB patients to assess whether the franchise achieves its goal of serving the poor. Methods The study uses data from two sources: 1) Myanmar’s first nationally representative TB prevalence study conducted in 2009, and 2) client exit interviews from TB patients from SQH clinics. In total, 1,114 TB-positive individuals were included in the study, including 739 from the national sample and 375 from the SQH sample. Results TB patients at SQH clinics were poorer than TB-positive individuals in the overall population, though not at a statistically significant level (p > 0.05). After stratification we found that in urban areas, TB patients at SQH clinics were more likely to be in the poorest quartile compared to general TB positive population (16.8% vs. 8.6%, respectively; p < 0.05). In rural areas, there was no statistically significant difference between the wealth distribution of SQH clinic patients and general TB positive individuals (p > 0.05). Conclusion Franchised clinics in Myanmar are reaching poor populations of TB patients in urban areas; more efforts are needed in order to reach the most vulnerable in rural areas. PMID:23305063

Availability of essential medicines in Ethiopia: an efficiency-equity trade-off?

PubMed

Carasso, Barbara S; Lagarde, Mylene; Tesfaye, Addis; Palmer, Natasha

2009-11-01

To investigate the availability and cost of essential medicines in health centres in rural Ethiopia, and to explore if the fee waiver system protects patients from having to pay for medicines. The study took place in five health centres in rural Ethiopia. Availability and price of selected key essential medicines was established in the budget and special pharmacy of the health centre, as well as private outlets. Information on availability and cost of prescribed drugs was obtained through patient exit-interviews. Availability based of essential drugs at facility level was 91% based on a list of selected drugs vs. 84% based on prescriptions filled. However, less than half the prescribed drugs were obtained from the budget pharmacy, and one in six patients was forced to purchase drugs in the private sector, where drugs are roughly twice as expensive. The waiver system did not safeguard against having to pay for medicines. A revolving drug fund system in Ethiopia seems to improve availability of medicines, and can improve affordability by protecting people from purchasing drugs in the private sector. However, it may result in a parallel system, whereby the poor cannot access drugs if these are not available in the budget pharmacy. Equity is a concern in the absence of an adequate mechanism to protect the poor from catastrophic health expenditure.

The efficacy of interviewing young drug users through online chat.

PubMed

Barratt, Monica J

2012-06-01

Despite the fact that most young people who use 'party drugs' also use the Internet, accounts of drugs research involving qualitative interviewing using real-time instant messaging or online chat are yet to be published. This paper assesses the efficacy of conducting qualitative research interviews with young party drug users through instant messaging. In 2007-2008, 837 Australian residents who reported recent use of psychostimulants and/or hallucinogens and participated in online drug discussion completed a web survey and a subsample of 27 completed online interviews (median age 21, range 17-37, 59% male). Experienced drug users were more likely to volunteer to be interviewed than novices. The time and space flexibility provided by the online interviews was convenient; however, interviews were more prone to interruption. Establishing legitimacy, personal disclosure, appropriate linguistic style and humour facilitated the development of rapport and enabled the production of more detailed and in-depth data. These strategies were not successful in all cases and when unsuccessful, interviewees were more easily able to exit the interview by choosing not to respond. Young drug users already using the Internet to chat about drugs find online interviewing an acceptable and convenient way to contribute to research. With adequate preparation to develop technical and cultural competencies, online interviewing offers an effective way of engaging with young people that is worthy of consideration by researchers in the alcohol and other drug field. © 2011 Australasian Professional Society on Alcohol and other Drugs.

A novel method for patient exit and entrance dose prediction based on water equivalent path length measured with an amorphous silicon electronic portal imaging device.

PubMed

Kavuma, Awusi; Glegg, Martin; Metwaly, Mohamed; Currie, Garry; Elliott, Alex

2010-01-21

In vivo dosimetry is one of the quality assurance tools used in radiotherapy to monitor the dose delivered to the patient. Electronic portal imaging device (EPID) images for a set of solid water phantoms of varying thicknesses were acquired and the data fitted onto a quadratic equation, which relates the reduction in photon beam intensity to the attenuation coefficient and material thickness at a reference condition. The quadratic model is used to convert the measured grey scale value into water equivalent path length (EPL) at each pixel for any material imaged by the detector. For any other non-reference conditions, scatter, field size and MU variation effects on the image were corrected by relative measurements using an ionization chamber and an EPID. The 2D EPL is linked to the percentage exit dose table, for different thicknesses and field sizes, thereby converting the plane pixel values at each point into a 2D dose map. The off-axis ratio is corrected using envelope and boundary profiles generated from the treatment planning system (TPS). The method requires field size, monitor unit and source-to-surface distance (SSD) as clinical input parameters to predict the exit dose, which is then used to determine the entrance dose. The measured pixel dose maps were compared with calculated doses from TPS for both entrance and exit depth of phantom. The gamma index at 3% dose difference (DD) and 3 mm distance to agreement (DTA) resulted in an average of 97% passing for the square fields of 5, 10, 15 and 20 cm. The exit dose EPID dose distributions predicted by the algorithm were in better agreement with TPS-calculated doses than phantom entrance dose distributions.

A novel method for patient exit and entrance dose prediction based on water equivalent path length measured with an amorphous silicon electronic portal imaging device

NASA Astrophysics Data System (ADS)

Kavuma, Awusi; Glegg, Martin; Metwaly, Mohamed; Currie, Garry; Elliott, Alex

2010-01-01

In vivo dosimetry is one of the quality assurance tools used in radiotherapy to monitor the dose delivered to the patient. Electronic portal imaging device (EPID) images for a set of solid water phantoms of varying thicknesses were acquired and the data fitted onto a quadratic equation, which relates the reduction in photon beam intensity to the attenuation coefficient and material thickness at a reference condition. The quadratic model is used to convert the measured grey scale value into water equivalent path length (EPL) at each pixel for any material imaged by the detector. For any other non-reference conditions, scatter, field size and MU variation effects on the image were corrected by relative measurements using an ionization chamber and an EPID. The 2D EPL is linked to the percentage exit dose table, for different thicknesses and field sizes, thereby converting the plane pixel values at each point into a 2D dose map. The off-axis ratio is corrected using envelope and boundary profiles generated from the treatment planning system (TPS). The method requires field size, monitor unit and source-to-surface distance (SSD) as clinical input parameters to predict the exit dose, which is then used to determine the entrance dose. The measured pixel dose maps were compared with calculated doses from TPS for both entrance and exit depth of phantom. The gamma index at 3% dose difference (DD) and 3 mm distance to agreement (DTA) resulted in an average of 97% passing for the square fields of 5, 10, 15 and 20 cm. The exit dose EPID dose distributions predicted by the algorithm were in better agreement with TPS-calculated doses than phantom entrance dose distributions.

The effect of hyperkalaemia on cardiac rhythm devices.

PubMed

Barold, S Serge; Herweg, Bengt

2014-04-01

In patients with pacemakers, hyperkalaemia causes three important abnormalities that usually become manifest when the K level exceeds 7 mEq/L: (i) widening of the paced QRS complex from delayed intraventricular conduction velocity, (ii) Increased atrial and ventricular pacing thresholds that may cause failure to capture. In this respect, the atria are more susceptible to loss of capture than the ventricles, and (iii) Increased latency (usually with ventricular pacing) manifested by a greater delay of the interval from the pacemaker stimulus to the onset of depolarization. First-degree ventricular pacemaker exit block may progress to second-degree Wenckebach (type I) exit block characterized by gradual prolongation of the interval from the pacemaker stimulus to the onset of the paced QRS complex ultimately resulting in an ineffectual stimulus. The disturbance may then progress to 2 : 1, 3 : 1 pacemaker exit block, etc., and eventually to complete exit block with total lack of capture. Ventricular undersensing is uncommonly observed because of frequent antibradycardia pacing. During managed ventricular pacing, hyperkalaemia-induced marked first-degree atrioventricular block may induce a pacemaker syndrome. With implantable cardioverter-defibrillators (ICDs) oversensing of the paced or spontaneous T-wave may occur. The latter may cause inappropriate shocks. A raised impedance from the right ventricular coil to the superior vena cava coil may become an important sign of hyperkalaemia in the asymptomatic or the minimally symptomatic ICD patient.

Hunger, waiting time and transport costs: time to confront challenges to ART adherence in Africa.

PubMed

Hardon, A P; Akurut, D; Comoro, C; Ekezie, C; Irunde, H F; Gerrits, T; Kglatwane, J; Kinsman, J; Kwasa, R; Maridadi, J; Moroka, T M; Moyo, S; Nakiyemba, A; Nsimba, S; Ogenyi, R; Oyabba, T; Temu, F; Laing, R

2007-05-01

Adherence levels in Africa have been found to be better than those in the US. However around one out of four ART users fail to achieve optimal adherence, risking drug resistance and negative treatment outcomes. A high demand for 2nd line treatments (currently ten times more expensive than 1st line ART) undermines the sustainability of African ART programs. There is an urgent need to identify context-specific constraints to adherence and implement interventions to address them. We used rapid appraisals (involving mainly qualitative methods) to find out why and when people do not adhere to ART in Uganda, Tanzania and Botswana. Multidisciplinary teams of researchers and local health professionals conducted the studies, involving a total of 54 semi-structured interviews with health workers, 73 semi-structured interviews with ARTusers and other key informants, 34 focus group discussions, and 218 exit interviews with ART users. All the facilities studied in Botswana, Tanzania and Uganda provide ARVs free of charge, but ART users report other related costs (e.g. transport expenditures, registration and user fees at the private health facilities, and lost wages due to long waiting times) as main obstacles to optimal adherence. Side effects and hunger in the initial treatment phase are an added concern. We further found that ART users find it hard to take their drugs when they are among people to whom they have not disclosed their HIV status, such as co-workers and friends. The research teams recommend that (i) health care workers inform patients better about adverse effects; (ii) ART programmes provide transport and food support to patients who are too poor to pay; (iii) recurrent costs to users be reduced by providing three-months, rather than the one-month refills once optimal adherence levels have been achieved; and (iv) pharmacists play an important role in this follow-up care.

Direct facility funding as a response to user fee reduction: implementation and perceived impact among Kenyan health centres and dispensaries

PubMed Central

Opwora, Antony; Kabare, Margaret; Molyneux, Sassy; Goodman, Catherine

2010-01-01

There is increasing pressure for reduction of user fees, but this can have adverse effects by decreasing facility-level funds. To address this, direct facility funding (DFF) was piloted in Coast Province, Kenya, with health facility committees (HFCs) responsible for managing the funds. We evaluated the implementation and perceived impact 2.5 years after DFF introduction. Quantitative data collection at 30 public health centres and dispensaries included a structured interview with the in-charge, record reviews and exit interviews. In addition, in-depth interviews were conducted with the in-charge and HFC members at 12 facilities, and with district staff and other stakeholders. DFF procedures were well established: HFCs met regularly and accounting procedures were broadly followed. DFF made an important contribution to facility cash income, accounting for 47% in health centres and 62% in dispensaries. The main items of expenditure were wages for support staff (32%), travel (21%), and construction and maintenance (18%). DFF was perceived to have a highly positive impact through funding support staff such as cleaners and patient attendants, outreach activities, renovations, patient referrals and increasing HFC activity. This was perceived to have improved health worker motivation, utilization and quality of care. A number of problems were identified. HFC training was reportedly inadequate, and no DFF documentation was available at facility level, leading to confusion. Charging user fees above those specified in the national policy remained common, and understanding of DFF among the broader community was very limited. Finally, relationships between HFCs and health workers were sometimes characterized by mistrust and resentment. Relatively small increases in funding may significantly affect facility performance when the funds are managed at the periphery. Kenya plans to scale up DFF nationwide. Our findings indicate this is warranted, but should include improved training and documentation, greater emphasis on community engagement, and insistence on user fee adherence. PMID:20211967

Direct facility funding as a response to user fee reduction: implementation and perceived impact among Kenyan health centres and dispensaries.

PubMed

Opwora, Antony; Kabare, Margaret; Molyneux, Sassy; Goodman, Catherine

2010-09-01

There is increasing pressure for reduction of user fees, but this can have adverse effects by decreasing facility-level funds. To address this, direct facility funding (DFF) was piloted in Coast Province, Kenya, with health facility committees (HFCs) responsible for managing the funds. We evaluated the implementation and perceived impact 2.5 years after DFF introduction. Quantitative data collection at 30 public health centres and dispensaries included a structured interview with the in-charge, record reviews and exit interviews. In addition, in-depth interviews were conducted with the in-charge and HFC members at 12 facilities, and with district staff and other stakeholders. DFF procedures were well established: HFCs met regularly and accounting procedures were broadly followed. DFF made an important contribution to facility cash income, accounting for 47% in health centres and 62% in dispensaries. The main items of expenditure were wages for support staff (32%), travel (21%), and construction and maintenance (18%). DFF was perceived to have a highly positive impact through funding support staff such as cleaners and patient attendants, outreach activities, renovations, patient referrals and increasing HFC activity. This was perceived to have improved health worker motivation, utilization and quality of care. A number of problems were identified. HFC training was reportedly inadequate, and no DFF documentation was available at facility level, leading to confusion. Charging user fees above those specified in the national policy remained common, and understanding of DFF among the broader community was very limited. Finally, relationships between HFCs and health workers were sometimes characterized by mistrust and resentment. Relatively small increases in funding may significantly affect facility performance when the funds are managed at the periphery. Kenya plans to scale up DFF nationwide. Our findings indicate this is warranted, but should include improved training and documentation, greater emphasis on community engagement, and insistence on user fee adherence.

Prediction of efficacy for conversion from adjunctive therapy to monotherapy with eslicarbazepine acetate 800 mg once daily for partial-onset epilepsy

PubMed Central

Sunkaraneni, Soujanya; Passarell, Julie A; Ludwig, Elizabeth A; Fiedler-Kelly, Jill; Pitner, Janet K; Grinnell, Todd A; Blum, David

2017-01-01

Purpose Eslicarbazepine acetate (ESL) is a once-daily (QD) oral antiepileptic drug (AED) indicated for partial-onset seizures (POS). Clinical studies of gradual conversion to ESL 1,200 and 1,600 mg QD monotherapies were previously conducted in patients with POS who were not well-controlled by 1 or 2 AEDs. This report describes modeling and simulation of plasma eslicarbazepine (primary active metabolite of ESL) concentrations and time to monotherapy study exit to predict efficacy for conversion to ESL monotherapy at a lower dose of 800 mg, as an option for patients requiring or not tolerating higher doses since this regimen is effective in adjunctive therapy for POS. Patients and methods A previously developed population pharmacokinetic model for ESL monotherapy was used to predict minimum plasma eslicarbazepine concentration (Cmin) in 1,500 virtual patients taking 1 (n=1,000) or 2 (n=500) AEDs at baseline, treated with ESL 400 mg QD for 1 week, followed by 800 mg QD for 17 weeks (similar to ESL monotherapy trials where the other AEDs were withdrawn during the first 6 weeks following titration to the randomized ESL dose). Model-predicted Cmin as a time-varying covariate and number of baseline AEDs were used to determine the weekly probability of each patient meeting exit criteria (65.3% threshold) indicative of worsening seizure control in 500 simulated ESL monotherapy trials. A previously developed extended Cox proportional hazards exposure–response model was used to relate time-varying eslicarbazepine exposure to the time to study exit. Results For virtual patients receiving ESL monotherapy (800 mg QD), the 95% upper prediction limit for exit rate at 112 days of 34.9% in patients taking 1 AED at baseline was well below the 65.3% threshold from historical control trials, while the estimate for patients taking 2 AEDs (70.6%) was slightly above the historical control threshold. Conclusion This model-based assessment supports conversion to ESL 800 mg QD monotherapy for POS in adults taking 1 AED. For patients taking 2 concomitant AEDs, however, prescribers should consider maintenance doses of 1,200 or 1,600 mg ESL QD to reduce the likelihood of seizure worsening if conversion to ESL monotherapy is contemplated. PMID:28721105

Perceptions of Primary Care-Based Breastfeeding Promotion Interventions: Qualitative Analysis of Randomized Controlled Trial Participant Interviews

PubMed Central

Bonuck, Karen; Barnett, Josephine; Lischewski-Goel, Jennifer

2012-01-01

Abstract Objective This study examined women's perceptions and reported effects of routine, primary care-based interventions to increase breastfeeding. Subjects and Methods A subsample (n=67) of participants in randomized controlled trials (RCTs) completed semistructured exit interviews at 6 months postpartum. RCT arms included the following: (a) routine pre-/postnatal lactation consultant (LC) support (LC group); (b) electronic prompts (EP) guiding providers to discuss breastfeeding during prenatal care visits (EP group); (c) a combined intervention (LC+EP group); and (d) controls. Interview transcripts were coded and analyzed in MAX.qda. Results Key findings included the following: (1) Brief, non-directive assessment of feeding via postpartum interviews focused attention upon feeding practices. When coupled with breastfeeding promotion interventions, interviews promoted breastfeeding. (2) The EP and LC interventions were complementary: EPs influenced initiation, while LCs helped overcome barriers and sustain breastfeeding. (3) Prenatal intent to feed both breastmilk and formula was associated with the greatest receptivity to study messages. Conclusions Findings underscore the need for interventions across the continuum of care. Trained LCs in prenatal/postpartum settings and prenatal care providers play important complementary roles that, when coupled with brief telephone feeding assessments, may improve breastfeeding rates. PMID:22621223

Perceptions of primary care-based breastfeeding promotion interventions: qualitative analysis of randomized controlled trial participant interviews.

PubMed

Andaya, Elise; Bonuck, Karen; Barnett, Josephine; Lischewski-Goel, Jennifer

2012-12-01

This study examined women's perceptions and reported effects of routine, primary care-based interventions to increase breastfeeding. A subsample (n=67) of participants in randomized controlled trials (RCTs) completed semistructured exit interviews at 6 months postpartum. RCT arms included the following: (a) routine pre-/postnatal lactation consultant (LC) support (LC group); (b) electronic prompts (EP) guiding providers to discuss breastfeeding during prenatal care visits (EP group); (c) a combined intervention (LC+EP group); and (d) controls. Interview transcripts were coded and analyzed in MAX.qda. Key findings included the following: (1) Brief, non-directive assessment of feeding via postpartum interviews focused attention upon feeding practices. When coupled with breastfeeding promotion interventions, interviews promoted breastfeeding. (2) The EP and LC interventions were complementary: EPs influenced initiation, while LCs helped overcome barriers and sustain breastfeeding. (3) Prenatal intent to feed both breastmilk and formula was associated with the greatest receptivity to study messages. Findings underscore the need for interventions across the continuum of care. Trained LCs in prenatal/postpartum settings and prenatal care providers play important complementary roles that, when coupled with brief telephone feeding assessments, may improve breastfeeding rates.

A new practice environment measure based on the reality and experiences of nurses working lives.

PubMed

Webster, Joan; Flint, Anndrea; Courtney, Mary

2009-01-01

To explore the underlying organizational issues affecting a nurses' decision to leave and to develop a contemporary practice environment measure based on the experiences of nurses working lives. Turnover had reached an unacceptable level in our organization but underlying reasons for leaving were unknown. In-depth interviews were conducted with 13 nurses who had resigned. Transcripts were analysed using the constant comparative method. Information from the interviews informed the development a new practice environment tool, which has undergone initial testing using the Content Validity Index and Chronbach's alpha. Two domains ('work life' and 'personal life/professional development') and five themes ('feeling safe', 'feeling valued', 'getting things done', 'professional development' and 'being flexible') emerged from the interviews. A content validity score for the new instrument was 0.79 and Chronbach's alpha 0.93. The new practice environment tool has shown useful initial reliability and validity but requires wider testing in other settings. The reality and experiences of nurses working lives can be identified through exit interviews conducted by an independent person. Information from such interviews is useful in identifying an organization's strength and weaknesses and to develop initiatives to support retention.

The impact of osteoarthritis on early exit from work: results from a population-based study.

PubMed

Laires, Pedro A; Canhão, Helena; Rodrigues, Ana M; Eusébio, Mónica; Gouveia, Miguel; Branco, Jaime C

2018-04-11

Osteoarthritis (OA) is a leading cause of pain and disability, which may be a source of productivity losses. The objectives of this study were to describe the impact of OA, namely through pain and physical disability, on early exit from work and to calculate its economic burden. We analysed data from the national, cross-sectional, population-based EpiReumaPt study (Sep2011-Dec2013) in which 10,661 individuals were randomly surveyed in order to capture all cases of rheumatic diseases. We used all participants aged 50-64, near the official retirement age, who were clinically validated by experienced rheumatologists (n = 1286), including OA cases. A national database was used to calculate productivity values by gender, age and region, using the human capital approach. The impact of OA on the likelihood of early exit from work and the population attributable fractions used to calculate due economic burden (indirect costs) were obtained at the individual level by logistic regression. All results were based on weighted data. Almost one third of the Portuguese population aged 50-64 had OA (29.7%; men: 16.2% and women: 43.5%) and more than half were out of paid work (51.8%). Only knee OA is associated with early exit from work (OR: 2.25; 95%CI: 1.42-3.59; p = 0.001), whereas other OA locations did not reach any statistical difference. Furthermore, we observed an association between self-reported longstanding musculoskeletal pain (OR: 1.55; 95%CI: 1.07-2.23; p = 0.02) and pain interference (OR: 1.35; 95%CI: 1.13-1.62; p = 0.001) with early exit from work. We also detected a clear relationship between levels of disability, measured by the Health Assessment Questionnaire (HAQ), and the probability of work withdrawal. The estimated annual cost of early exit from work attributable to OA was €656 million (€384 per capita; €1294 per OA patient and €2095 per OA patient out-of-work). In this study, we observed an association between OA and early exit from work, largely dependent on pain and disability. This relationship translates into a meaningful economic burden amounting to approximately 0.4% of the national Gross Domestic Product (GDP). The high prevalence and the impact of this disabling chronic disease highlight the need to prioritize policies targeting early exit from work in OA.

Paediatric in-patient care in a conflict-torn region of Somalia: are hospital outcomes of acceptable quality?

PubMed Central

Zachariah, R.; Hinderaker, S. G.; Khogali, M.; Manzi, M.; van Griensven, J.; Ayada, L.; Jemmy, J. P.; Maalim, A.; Amin, H.

2013-01-01

Setting: A district hospital in conflict-torn Somalia. Objective: To report on in-patient paediatric morbidity, case fatality and exit outcomes as indicators of quality of care. Design: Cross-sectional study. Results: Of 6211 children, lower respiratory tract infections (48%) and severe acute malnutrition (16%) were the leading reasons for admission. The highest case-fatality rate was for meningitis (20%). Adverse outcomes occurred in 378 (6%) children, including 205 (3.3%) deaths; 173 (2.8%) absconded. Conclusion: Hospital exit outcomes are good even in conflict-torn Somalia, and should boost efforts to ensure that such populations are not left out in the quest to achieve universal health coverage. PMID:26393014

Beta Testing a Novel Smartphone Application to Improve Medication Adherence.

PubMed

Sarzynski, Erin; Decker, Brian; Thul, Aaron; Weismantel, David; Melaragni, Ronald; Cholakis, Elizabeth; Tewari, Megha; Beckholt, Kristy; Zaroukian, Michael; Kennedy, Angie C; Given, Charles

2017-04-01

We developed and beta-tested a patient-centered medication management application, PresRx optical character recognition (OCR), a mobile health (m-health) tool that auto-populates drug name and dosing instructions directly from patients' medication labels by OCR. We employed a single-subject design study to evaluate PresRx OCR for three outcomes: (1) accuracy of auto-populated medication dosing instructions, (2) acceptability of the user interface, and (3) patients' adherence to chronic medications. Eight patients beta-tested PresRx OCR. Five patients used the software for ≥6 months, and four completed exit interviews (n = 4 completers). At baseline, patients used 3.4 chronic prescription medications and exhibited moderate-to-high adherence rates. Accuracy of auto-populated information by OCR was 95% for drug name, 98% for dose, and 96% for frequency. Study completers rated PresRx OCR 74 on the System Usability Scale, where scores ≥70 indicate an acceptable user interface (scale 0-100). Adherence rates measured by PresRx OCR were high during the first month of app use (93%), but waned midway through the 6-month testing period (78%). Compared with pharmacy fill rates, PresRx OCR underestimated adherence among completers by 3%, while it overestimated adherence among noncompleters by 8%. Results suggest smartphone applications supporting medication management are feasible and accurately assess adherence compared with objective measures. Future efforts to improve medication-taking behavior using m-health tools should target specific patient populations and leverage common application programming interfaces to promote generalizability. Our medication management application PresRx OCR is innovative, acceptable for patient use, and accurately tracks medication adherence.

‘Contexts of Exit in the Migration of Russian Speakers from the Baltic Countries to Ireland’

PubMed Central

Aptekar, Sofya

2013-01-01

Recently, Ireland has become a major destination for migrants from Estonia, Latvia, and Lithuania. Many of these migrants are members of Russian-speaking minorities leaving a context of restrictive citizenship and language laws and varying degrees of ethnic tension. This paper draws on interviews collected in Ireland to examine the role played by the contexts of exit in decisions to migrate among Russian-speaking minorities from the Baltics. The results suggest that Russian speakers from Estonia migrate because of their experiences as minorities, while those from Latvia and Lithuania migrate to escape low wages and irregular employment. This is so despite equally restrictive language and citizenship laws in Estonia and Latvia. I argue that the effect of state policy as a push factor for minority emigration is mediated by other contextual aspects, such as levels of contact, timbre of ethnic relations, and the degree of intersection between economic stratification and ethnicity. PMID:24363609

Benefits of Student Engagement in Intervention Research.

PubMed

Schwartz, Jaclyn K; Smith, Roger O

2015-01-01

Accreditation standards require entry-level occupational therapy students to understand, critique, and design research. However, the extent to which students should be embedded in research projects is unclear. The purpose of this study was to understand the benefits of student immersion in research for student learning and research quality. Using a multiple case study design, the principal investigator trained six occupational therapy students to implement a manualized intervention with research participants. Learning quizzes, video analysis of research activities, a practical exam, student documentation, an exit interview, and an exit survey identified student learning and research outcomes. Students successfully implemented the study protocols with good reliability (intraclass correlation coefficient = .89) and fidelity (99%). Students also reported improvements in comfort with client interactions, confidence in practice skills, self-efficacy in research, and clinical reasoning. Student participation in hands-on research supports researchers in attaining their research goals and provides students with valuable learning experiences. Copyright © 2015 by the American Occupational Therapy Association, Inc.

Prediction of efficacy for conversion from adjunctive therapy to monotherapy with eslicarbazepine acetate 800 mg once daily for partial-onset epilepsy.

PubMed

Sunkaraneni, Soujanya; Passarell, Julie A; Ludwig, Elizabeth A; Fiedler-Kelly, Jill; Pitner, Janet K; Grinnell, Todd A; Blum, David

2017-01-01

Eslicarbazepine acetate (ESL) is a once-daily (QD) oral antiepileptic drug (AED) indicated for partial-onset seizures (POS). Clinical studies of gradual conversion to ESL 1,200 and 1,600 mg QD monotherapies were previously conducted in patients with POS who were not well-controlled by 1 or 2 AEDs. This report describes modeling and simulation of plasma eslicarbazepine (primary active metabolite of ESL) concentrations and time to monotherapy study exit to predict efficacy for conversion to ESL monotherapy at a lower dose of 800 mg, as an option for patients requiring or not tolerating higher doses since this regimen is effective in adjunctive therapy for POS. A previously developed population pharmacokinetic model for ESL monotherapy was used to predict minimum plasma eslicarbazepine concentration ( C min ) in 1,500 virtual patients taking 1 (n=1,000) or 2 (n=500) AEDs at baseline, treated with ESL 400 mg QD for 1 week, followed by 800 mg QD for 17 weeks (similar to ESL monotherapy trials where the other AEDs were withdrawn during the first 6 weeks following titration to the randomized ESL dose). Model-predicted C min as a time-varying covariate and number of baseline AEDs were used to determine the weekly probability of each patient meeting exit criteria (65.3% threshold) indicative of worsening seizure control in 500 simulated ESL monotherapy trials. A previously developed extended Cox proportional hazards exposure-response model was used to relate time-varying eslicarbazepine exposure to the time to study exit. For virtual patients receiving ESL monotherapy (800 mg QD), the 95% upper prediction limit for exit rate at 112 days of 34.9% in patients taking 1 AED at baseline was well below the 65.3% threshold from historical control trials, while the estimate for patients taking 2 AEDs (70.6%) was slightly above the historical control threshold. This model-based assessment supports conversion to ESL 800 mg QD monotherapy for POS in adults taking 1 AED. For patients taking 2 concomitant AEDs, however, prescribers should consider maintenance doses of 1,200 or 1,600 mg ESL QD to reduce the likelihood of seizure worsening if conversion to ESL monotherapy is contemplated.

A randomized controlled trial comparing mupirocin versus Polysporin Triple for the prevention of catheter-related infections in peritoneal dialysis patients (the MP3 study).

PubMed

Jassal, Sarbjit V; Lok, Charmaine E

2008-01-01

Peritonitis remains the most serious complication of peritoneal dialysis (PD). Gram-positive organisms are among the most common causes of PD peritonitis; however, recent trends show increasing rates of gram-negative and fungal infections. Strategies to prevent peritonitis include the use of prophylactic topical mupirocin at the site where the PD catheter exits from the abdominal wall; however, mupirocin does not afford protection against gram-negative or fungal infections. The aim of this study is to determine if the incidence of catheter-related infections (exit-site infection, tunnel infection, or peritonitis) is significantly reduced by the routine application of Polysporin Triple antibiotic ointment (Pfizer Canada, Markham, Ontario, Canada) in comparison to mupirocin ointment. The Mupirocin Versus Polysporin Triple Study (MP3) is a multicenter, randomized, double-blinded controlled study comparing Polysporin Triple (P3) against the current standard of care. The aim of the study is to recruit 200 patients being treated with or starting on PD and randomize them to receive either mupirocin or P3 at the catheter exit site. Patients will be followed for 18 months or until death or transfer from PD to an alternate treatment modality. The primary outcome will be the time to first catheter-related infection. Catheter-related infections will be strictly defined using current guidelines and categorized into exit-site infections, infective peritonitis, or tunnel infections. The primary analysis will be an intention-to-treat analysis. The results of this study will help determine if the use of P3 is superior to mupirocin ointment in the prevention of catheter-related infections and will help guide evidence-based best practices.

In vivo semiconductor dosimetry as part of routine quality assurance.

PubMed

Millwater, C J; MacLeod, A S; Thwaites, D I

1998-06-01

This paper describes the initial physics testing necessary before diodes can be used for in vivo dosimetry as well as the development of a protocol for clinical use in head and neck treatment and the preliminary results acquired. 50 patients were entered into the pilot study. A total of 300 treatment set-ups were measured (184 entrance doses and 116 exit doses). Wedged and unwedged components of each field were measured separately, making the total number of entrance doses 284 and total number of exit doses 207. There was no significant systematic deviation in the measured entrance dose compared with the expected (mean +0.4%, SD 2.7%). Discrepancies between the observed and expected entrance doses of greater than 5% were recorded in 6% (16/284) of measurements. The mean of the measured exit doses was 2.4% lower than expected (SD 4.8%). Discrepancies between the observed and expected exist doses of greater than 5% were recorded in 32% (67/207) of measurements. Possible causes for these discrepancies are discussed. Overall analysis of the data for individual patients suggest that in one patient out of the 50 there may have been a delivered target volume dose discrepancy of greater than 5% (+6.5%). The significance of the results and the implications for routine use are discussed.

Entrance and exit dose measurements with semiconductors and thermoluminescent dosemeters: a comparison of methods and in vivo results.

PubMed

Loncol, T; Greffe, J L; Vynckier, S; Scalliet, P

1996-11-01

In order to compare diodes and TLD for in vivo dosimetry, systematic measurements of entrance and exit doses were performed with semiconductor detectors and thermoluminescent dosemeters for brain and head and neck patients treated isocentrically with external photon beam therapy. Scanditronix EDP-20 diodes and 7LiF thermoluminescent chips, irradiated in a 8 MV linac, were studied with similar build-up cap geometries and materials in order to assure an equivalent electronic equilibrium. Identical calibration methodology was applied to both detectors for the dose determination in clinical conditions. For the entrance dose evaluation over 249 field measurements, the ratio of the measured dose to the expected dose, calculated from tabulated tissue maximum ratios, was equal to 1.010 +/- 0.028 (1 s.d.) from diodes and 1.013 +/- 0.041 from thermoluminescent crystals. For the exit dose measurements, these ratios were equal to 0.998 +/- 0.049 and 1.016 +/- 0.070 for diodes and TLDs, respectively, after application of a simple inhomogeneity correction to the calculation of the expected exit dose. Thermoluminescence and semiconductors led to identical results for entrance and exit dose evaluation but TLDs were characterised by a lower reproducibility inherent to the TL process itself and to the acquisition and annihilation procedures.

Missiles in the cardiovascular system.

PubMed

Symbas, P N; Symbas, P J

1997-05-01

A missile in the cardiovascular system is a rare complication of a projectile wound. A missile in the heart should be suspected in the patient with a projectile wound of the thorax and in whom, on chest radiography, a missile is seen in the cardiac silhouette. A missile should be suspected in the patient with a projectile wound elsewhere with similar radiographic findings, no exit wound, and no missile in the area of injury. A missile in the arterial system should be suspected when no exit wound and no projectile are seen in the traumatized area. In such a case, radiography of the entire body should be done. The diagnosis of a suspected missile in the cardiovascular system is confirmed by echocardiography or angiography. Treatment should be individualized according to the clinical manifestations of the patient and the site of the missile.

SU-F-T-229: A Novel Method for EPID-Based In-Vivo Exit Dose Verification for Intensity Modulated Radiotherapy

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

Wu, Z; Wang, J; Peng, J

Purpose: Electronic portal imaging device (EPID) can be used to acquire a two-dimensional exit dose distribution during treatment delivery, thus allowing the in-vivo verification of the dose delivery through a comparison of measured portal images to predicted portal dose images (PDI). The aim of this study was to present a novel method to easily and accurately predict PDI, and to establish an EPID-based in-vivo dose verification method during IMRT treatments. Methods: We developed a model to determine the predicted portal dose at the same plane of the EPID detector location. The Varian EPID (aS1000) positions at 150cm source-to-detector-distance (SDD), andmore » can be used to acquire in-vivo exit dose using Portal Dosimetry (PD) function. Our model was generated to make an equivalent water thickness represent the buildup plate of EPID. The exit dose at extend SDD plane with patient CT data in the beam can be calculated as the predicted PDI in the treatment planning system (TPS). After that, the PDI was converted to the fluence at SDD of 150cm using the inverse square law coded in MATLAB. Five head-and-neck and prostate IMRT patient plans contain 32 fields were investigated to evaluate the feasibility of this new method. The measured EPID image was compared with PDI using the gamma analysis. Results: The average results for cumulative dose comparison were 81.9% and 91.6% for 3%, 3mm and 4%, 4mm gamma criteria, respectively. Results indicate that the patient transit dosimetry predicted algorithm compares well with EPID measured PD doses for test situations. Conclusion: Our new method can be used as an easy and feasible tool for online EPID-based in-vivo dose delivery verification for IMRT treatments. It can be implemented for fast detecting those obvious treatment delivery errors for individual field and patient quality assurance.« less

Clinical and functional outcomes of patients who experience partial response to citalopram: secondary analysis of STAR*D.

PubMed

Dennehy, Ellen B; Marangell, Lauren B; Martinez, James; Balasubramani, G K; Wisniewski, Stephen R

2014-05-01

We analyzed the public STAR*D database to better characterize the baseline clinical characteristics and functional outcomes of patients with major depressive disorder (MDD) who experienced partial response in order to better understand the burden associated with this outcome. Patients (n=2,876) received treatment with citalopram. The last available Quick Inventory of Depressive Symptoms (QIDS-SR) from the 12-week treatment period was used to assign subjects to one of three groups: remitters QIDS-SR≤5; non-responders QIDS-SR >5 and <25% reduction from baseline; and partial responders QIDS-SR >5 and ≥25% reduction from baseline. Baseline sociodemographic and clinical characteristics were compared across groups, as well as functional outcomes at Level 1 exit. RESULTS. Of the 2,876 patients, 943 patients (33%) were classified as remitters, 1069 (37%) as partial responders, and 854 (30%) as non-responders. The groups differed on a number of pre-treatment course of illness variables and comorbidities. In addition, remitters, partial responders, and non-responders all separated on posttreatment quality of life and functional outcomes at Level 1 exit. Partial responders demonstrated significant functional impairment at Level 1 exit, differing significantly from the patients who remitted on quality of life, mental and physical functioning, and social and work-related impairment. Adjusted outcomes showed similar differences. Differences in baseline rates of suicidality, comorbidity, and atypical presentations of depression were also observed between outcome groups. Given the substantial clinical and economic burden associated with functional impairment in depression, the need to fully treat partially responding patients to achieve depression remission and restoration of functioning is highlighted by this work.

Understanding the Impact of Treatment on the Dimensions of Childhood Depression.

PubMed

Isa, Ameena; Bernstein, Ira; Trivedi, Madhukar; Mayes, Taryn; Kennard, Betsy; Emslie, Graham

2017-03-01

Childhood depression is often chronic and recurrent, with only modest improvements after optimal treatments. Novel approaches are needed for accurate diagnosis, timely selection of the best treatment for childhood depression, and improvement of remission rates. An important part of diagnosis is to determine how many consistent dimensions underlie childhood depression and what impact treatment may have on these dimensions. The goal of the current study is evaluate the consistency of the number of depressive symptom dimensions and examine the effect of depression treatment on the change in dimensions by seeing if this dimensional structure is the same for groups that were given a placebo and groups that were given an active drug, fluoxetine. We examined a combined sample of three clinical trials data sets with a total of 269 placebo patients and 261 fluoxetine patients at baseline, and 253 placebo patients and 249 fluoxetine patients at exit. Principal components analysis with associated parallel analysis followed by a ProMax oblique rotation was conducted on each week's scores. The similarity of the rotated structures between treatments and between weeks was then assessed using Wrigley and Neuhaus' (1955) degree of factorial similarity measure, which is a correlation-like statistic that takes two solutions based upon the same measures and assesses how similar they are. Preliminary analysis indicated that mean scores of both treatment groups declined from baseline to exit, but the decline was greater for the fluoxetine group. There were four dimensions at baseline and two dimensions at exit in each treatment group. Hence the numbers of dimensions were the same in the two groups, whereas the content of the components was the same at baseline for the two groups, but was different at exit. Basically, the factorial similarities of the rotated factors were very high at baseline between the two groups for both factors (Ψ = 0.97 for factor I and 0.94 for factor II) before they were treated differently. However, at exit, the respective similarities dropped to 0.58 and -0.04 for factors I and II. Therefore, time had a large effect in changing both groups' factor structure, but it was especially large when there was an active treatment. In comparing the baseline and exit dimensions in a forced two factor solution of two treatment groups, it was revealed that treatment did have an impact on the change in dimensions. These results further the generality of the simplification of the factor structure of the Childhood Depression Rating Scale- Revised (CDRS-R) over time. In addition, these results show the effect of time and therapy on the factor structures. The fluoxetine group followed the trend of the content of the dimensions revealed in a previous study, whereas the placebo group had a less distinct change over time.

Who stops selling? A systematic analysis of ex-tobacco retailers.

PubMed

Feletto, Eleonora; Burton, Suzan; Williams, Kelly; Fry, Rae; Sutton, Clare; Bagus, Lachlan; Egger, Sam

2016-03-09

There is evidence that wide distribution of cigarettes contributes to smoking, and multiple commentators have called for a review of tobacco retailing. This study analyses retailers who stop selling cigarettes, why they do so, and discusses the implications for tobacco control. An audit of tobacco retailers in the Australian state of NSW was used to identify retailers who had stopped selling tobacco, and they were then compared with current retailers to determine how many, and what types of outlets stop selling tobacco. Attempts were made to contact and interview all former tobacco retailers identified in three audited regions. In-depth interviews were conducted with 13 ex-tobacco retailers, or 31% of the subset of ex-tobacco retailers. Low-volume outlet types were over-represented as a proportion of retailers exiting the market, and some had resumed selling within 18 months of the audit. Low profits were often cited as a contributor to stopping; however, in all but one case, the decision to stop selling was also influenced by a significant change in business circumstances-either legislative or other business changes. Few retailers stop selling tobacco while continuing in the same business, and those who stop disproportionately represent retailer types with low sales volume. The results suggest that legislative changes provide a window where retailers could be prompted to exit the market. 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/

Shaping the future medical workforce: take care with selection tools.

PubMed

Poole, Phillippa; Shulruf, Boaz

2013-12-01

Medical school selection is a first step in developing a general practice workforce. To determine the relationship between medical school selection scores and intention to pursue a career in general practice. A longitudinal cohort study of students selected in 2006 and 2007 for The University of Auckland medical programme, who completed an exit survey on career intentions. Students are ranked for selection into year 2 of a six-year programme by combining grade point average from prior university achievement (60%), interview (25%) and Undergraduate Medicine and Health Sciences Admission Test (UMAT) scores (15%). The main outcome measure was level of interest in general practice at exit. Logistic regression assessed whether any demographic variables or admission scores predicted a 'strong' interest in general practice. None of interview scores, grade point average, age, gender, or entry pathway predicted a 'strong' interest in general practice. Only UMAT scores differentiated between those with a 'strong' interest versus those with 'some' or 'no' interest, but in an inverse fashion. The best predictor of a 'strong' interest in general practice was a low UMAT score of between 45 and 55 on all three UMAT sections (OR 3.37, p=0.020). Yet, the academic scores at entry of students with these UMAT scores were not lower than those of their classmates. Setting inappropriately high cut-points for medical school selection may exclude applicants with a propensity for general practice. These findings support the use of a wider lens through which to view medical school selection tools.

Development of Teachers as Scientists in Research Experiences for Teachers Programs

NASA Astrophysics Data System (ADS)

Faber, Courtney; Hardin, Emily; Klein-Gardner, Stacy; Benson, Lisa

2014-11-01

This study examined the teachers' development as scientists for participants in three National Science Foundation Research Experiences for Teachers. Participants included secondary science and math teachers with varying levels of education and experience who were immersed in research environments related to engineering and science topics. Teachers' functionality as scientists was assessed in terms of independence, focus, relationships with mentors, structure, and ability to create new concepts. Hierarchies developed within these constructs allowed tracking of changes in functionality throughout the 6-week programs. Themes were further identified in teachers' weekly journal entries and exit interviews through inductive coding. Increases in functionality as scientists were observed for all teachers who completed both the program and exit interview ( n = 27). Seven of the 27 teachers reached high science functionality; however, three of the teachers did not reach high functionality in any of the constructs during the program. No differences were observed in demographics or teaching experience between those who did and did not reach high functionality levels. Inductive coding revealed themes such as teachers' interactions with mentors and connections made between research and teaching, which allowed for descriptions of experiences for teachers at high and low levels of functionality. Teachers at high functionality levels adjusted to open-ended environments, transitioned from a guided experience to freedom, felt useful in the laboratory, and were self-motivated. In contrast, teachers at low functionality levels did not have a true research project, primarily focused on teaching aspects of the program, and did not display a transition of responsibilities.

Substituting sugar confectionery with fruit and healthy snacks at checkout - a win-win strategy for consumers and food stores? a study on consumer attitudes and sales effects of a healthy supermarket intervention.

PubMed

Winkler, Lise L; Christensen, Ulla; Glümer, Charlotte; Bloch, Paul; Mikkelsen, Bent E; Wansink, Brian; Toft, Ulla

2016-11-22

The widespread use of in-store marketing strategies to induce unhealthy impulsive purchases has implications for shopping experience, food choice and possibly adverse health outcomes. The aim of this study was to examine consumer attitudes and evaluate sales effects of a healthy checkout supermarket intervention. The study was part of Project Sundhed & Lokalsamfund (Project SoL); a Danish participatory community-based health promotion intervention. Consumer attitudes towards unhealthy snack exposure in supermarkets were examined in a qualitative pre-intervention study (29 short in-store interviews, 11 semi-structured interviews and three focus group interviews). Findings were presented to food retailers and informed the decision to test a healthy checkout intervention. Sugar confectionery at one checkout counter was substituted with fruit and healthy snacking items in four stores for 4 weeks. The intervention was evaluated by 48 short exit interviews on consumer perceptions of the intervention and by linear mixed model analyses of supermarket sales data from the intervention area and a matched control area. The qualitative pre-intervention study identified consumer concern and annoyance with placement and promotion of unhealthy snacks in local stores. Store managers were willing to respond to local consumer concern and a healthy checkout intervention was therefore implemented. Exit interviews found positive attitudes towards the intervention, while intervention awareness was modest. Most participants believed that the intervention could help other consumers make healthier choices, while fewer expected to be influenced by the intervention themselves. Statistical analyses suggested an intervention effect on sales of carrot snack packs when compared with sales before the intervention in Bornholm control stores (P < 0.05). No significant intervention effect on sales of other intervention items or sugar confectionery was found. The present study finds that the healthy checkout intervention was positively evaluated by consumers and provided a 'responsible' branding opportunity for supermarkets, thus representing a win-win strategy for store managers and consumers in the short term. However, the intervention was too modest to draw conclusions on long-term sales and health implications of this initiative. More research is needed to assess whether retailer-researcher collaborations on health promotion can be a winning strategy for public health.

TLD extrapolation for skin dose determination in vivo.

PubMed

Kron, T; Butson, M; Hunt, F; Denham, J

1996-11-01

Prediction of skin reactions requires knowledge of the dose at various depths in the human skin. Using thermoluminescence dosimeters of three different thicknesses, the dose can be extrapolated to the surface and interpolated between the different depths. A TLD holder was designed for these TLD extrapolation measurements on patients during treatment which allowed measurements of entrance and exit skin dose with a day to day variability of +/-7% (S.D. of mean reading). In a pilot study on 18 patients undergoing breast irradiation, it was found that the angle of incidence of the radiation beam is the most significant factor influencing skin entrance dose. In most of these measurements the beam exit dose contributed 50% more to the surface dose than the entrance dose.

A Randomized Controlled Trial of Acupuncture in Stable Ischemic Heart Disease Patients

PubMed Central

Mehta, Puja K.; Polk, Donna M.; Zhang, Xiao; Li, Ning; Painovich, Jeannette; Kothawade, Kamlesh; Kirschner, Joan; Qiao, Yi; Ma, Xiuling; Chen, Yii-Der Ida; Brantman, Anna; Shufelt, Chrisandra; Minissian, Margo; Bairey Merz, C. Noel

2014-01-01

Background Heart rate variability (HRV) is reduced in stable ischemic heart disease (SIHD) patients and is associated with sudden cardiac death (SCD). We evaluated the impact of traditional acupuncture (TA) on cardiac autonomic function measured by HRV in SIHD patients. Methods We conducted a randomized controlled study of TA, sham acupuncture (SA), and waiting control (WC) in 151 SIHD subjects. TA group received needle insertion at acupuncture sites, SA group received a sham at non-acupuncture sites, while WC received nothing. TA and SA received 3 treatments/week for 12 wks. 24-hour, mental arithmetic stress, and cold pressor (COP) HRV was collected at entry and exit, along with BP, lipids, insulin resistance, hs-CRP, salivary cortisol, peripheral endothelial function by tonometry(PAT), and psychosocial variables. Results Mean age was 63±10; 50% had prior myocardial infarction. Comparison of WC and SA groups demonstrated differences consistent with the unblinded WC status; therefore by design, the control groups were not merged. Exit mental stress HRV was higher in TA vs. SA for markers of parasympathetic tone (p≤0.025), including a 17% higher vagal activity (p=0.008). There were no differences in exit 24-hour or COP HRV, BP, lipids, insulin resistance, hs-CRP, salivary cortisol, PAT, or psychosocial variables. Conclusions TA results in intermediate effects on autonomic function in SIHD patients. TA effect on HRV may be clinically relevant and should be explored further. These data document feasibility and provide sample size estimation for a clinical trial of TA in SIHD patients for prevention of SCD. PMID:25103909

The relationship between substance use and exit security on psychiatric wards.

PubMed

Simpson, Alan; Bowers, Len; Haglund, Kristina; Muir-Cochrane, Eimear; Nijman, Henk; Van der Merwe, Marie

2011-03-01

In this paper we report on the rates of drug/alcohol use on acute psychiatric wards in relation to levels and intensity of exit security measures. Many inpatient wards have become permanently locked, with staff concerned about the risk of patients leaving the ward and harming themselves or others, and of people bringing illicit substances into the therapeutic environment. In 2004/2005, a cross sectional survey on 136 acute psychiatric wards across three areas of England was undertaken. A comprehensive range of data including door locking and drug/alcohol use were collected over 6 months on each ward. In 2006, supplementary data on door locking and exit security were collected. Door locking, additional exit security measures and substance misuse rates of the 136 wards were analysed and the associations between these were investigated. No consistent relationships were found with exit security features, intensity of drug/alcohol monitoring procedures, or the locking of the ward door. There were indications that use of breath testing for alcohol might reduce usage and that the use of 'sniffer' dogs was associated with greater alcohol use. Greater exit security or locking of the ward door had no influence on rates of use of alcohol or illicit drugs by inpatients and thus cannot form part of any strategy to control substance use by inpatients. There are some grounds to believe that a greater use of screening might help reduce the frequency of alcohol/substance use on wards and may lead to a reduction in verbal abuse. © 2010 The Authors. Journal of Advanced Nursing © 2010 Blackwell Publishing Ltd.

Improving operative flow during pediatric airway evaluation: a quality-improvement initiative.

PubMed

Prager, Jeremy D; Ruiz, Amanda G; Mooney, Kristin; Gao, Dexiang; Szolnoki, Judit; Shah, Rahul K

2015-03-01

Microlaryngoscopy and bronchoscopy procedures (MLBs) are short-duration, high-acuity procedures that carry risk. Poor case flow and communication exacerbate such potential risk. Efficient operative flow is critical for patient safety and resource expenditure. To identify areas for improvement and evaluate the effectiveness of a multidisciplinary quality-improvement (QI) initiative. A QI project using the "Plan-Do-Study-Act" (PDSA) cycle was implemented to assess MLBs performed on pediatric patients in a tertiary academic children's hospital. Forty MLBs were audited using a QI evaluation tool containing 144 fields. Each MLB was evaluated for flow, communication, and timing. Opportunities for improvement were identified. Subsequently, QI interventions were implemented in an iterative cycle, and 66 MLBs were audited after the intervention. Specific QI interventions addressed issues of personnel frequently exiting the operating room (OR) and poor preoperative preparation, identified during QI audit as areas for improvement. Interventions included (1) conducting "huddles" between surgeon and OR staff to discuss needed equipment; (2) implementing improvements to surgeon case ordering and preference cards review; (3) posting an OR door sign to limit traffic during airway procedures; and (4) discouraging personnel breaks during airway procedures. Operating room exiting behavior of OR personnel, preoperative preparation, and case timing were assessed and compared before and after the QI intervention. Personnel exiting the OR during the MLB was identified as a preintervention issue, with the surgical technologist, circulator, or surgeon exiting the room in 55% of cases (n = 22). The surgical technologist and circulator left the room to retrieve equipment in 40% of cases (n = 16), which indicated the need for increased preoperative preparation to improve case timing and operative flow. The QI interventions implemented to address these concerns included education regarding break timing, improvements in communication, and improvements in ordering and preparation of equipment. After the QI intervention, the surgical technologist exiting rate decreased from 20% (n = 8) to 8% (n = 5), and the circulator exiting rate decreased from 38% (n = 15) to 27% (n = 17). In addition, the rate of surgeon exiting decreased significantly (from 25% [n = 10 of 40] to 9% [n = 6 of 66]) (P = .03). The surgical technologist and circulating nurse remaining in the room were significantly associated with decreased operating time (1.84-minute decrease for surgical technologist [P = .04] and 1.95-minute decrease for circulating nurse [P = .001]). Gains were made in personnel exiting behavior and case timing after implementation of the QI interventions, potentially leading to decreased risk. This process is easily reproduced and is widely accepted by stakeholders.

Configuring balanced scorecards for measuring health system performance: evidence from 5 years' evaluation in Afghanistan.

PubMed

Edward, Anbrasi; Kumar, Binay; Kakar, Faizullah; Salehi, Ahmad Shah; Burnham, Gilbert; Peters, David H

2011-07-01

In 2004, Afghanistan pioneered a balanced scorecard (BSC) performance system to manage the delivery of primary health care services. This study examines the trends of 29 key performance indicators over a 5-year period between 2004 and 2008. Independent evaluations of performance in six domains were conducted annually through 5,500 patient observations and exit interviews and 1,500 provider interviews in >600 facilities selected by stratified random sampling in each province. Generalized estimating equation (GEE) models were used to assess trends in BSC parameters. There was a progressive improvement in the national median scores scaled from 0-100 between 2004 and 2008 in all six domains: patient and community satisfaction of services (65.3-84.5, p<0.0001); provider satisfaction (65.4-79.2, p<0.01); capacity for service provision (47.4-76.4, p<0.0001); quality of services (40.5-67.4, p<0.0001); and overall vision for pro-poor and pro-female health services (52.0-52.6). The financial domain also showed improvement until 2007 (84.4-95.7, p<0.01), after which user fees were eliminated. By 2008, all provinces achieved the upper benchmark of national median set in 2004. The BSC has been successfully employed to assess and improve health service capacity and service delivery using performance benchmarking during the 5-year period. However, scorecard reconfigurations are needed to integrate effectiveness and efficiency measures and accommodate changes in health systems policy and strategy architecture to ensure its continued relevance and effectiveness as a comprehensive health system performance measure. The process of BSC design and implementation can serve as a valuable prototype for health policy planners managing performance in similar health care contexts. Please see later in the article for the Editors' Summary.

Physicians' tobacco intervention counseling in a tertiary care hospital of South India.

PubMed

Akshaya, K M; Majra, J P

2014-10-01

The tobacco epidemic is one of the biggest public health threats in the present world with a substantial contribution to mortality and morbidity. Patients' visits to their doctors for illnesses and health check-ups offer a great opportunity to screen them for tobacco use and also counsel them to quit tobacco use. This cross sectional study was carried out in out-patient departments of General Medicine and Pulmonary Medicine of a tertiary care medical college teaching hospital in Dakshina Kannada district of Karnataka state of India between April 2012 and July 2012 among the patients aged 18 years or above who were diagnosed as suffering from tobacco related diseases. Exit interview was conducted on the patients after obtaining a written informed consent using a pre designed semi-structured questionnaire. Data was entered, analyzed using SPSS v17 and Descriptive statistics, Fisher Exact test, Bivariate and multivariable logistic regression analyses were used. The present study reveals that 305 (87.1 %), 281 (80.3 %) and 257 (73.1 %) of the 350 participants were asked, assessed and advised respectively by the treating physicians to quit tobacco use where as only 18 (15.1 %) were assisted in their efforts to quit tobacco. Physician's counseling inventions were significantly associated with patient's age, sex, education, marital status and socio economic status of the patients as well as the treating physician's experience of more than 3 years. There is a need to incorporate tobacco history taking as a vital sign during medical history taking and this should be made as a routine in medical schools.

Designing an audio computer-assisted self-interview (ACASI) system in a multisite trial: a brief report.

PubMed

2008-09-01

To describe the advantages and limitations of an audio computer-assisted self-interview (ACASI) system in a multisite trial with African American couples and to present the steps in designing, testing, and implementing a system. The ACASI system evolved from a paper and pencil interview that was pilot tested. Based on this initial work, the paper and pencil interview was translated into storyboards that were the basis of the development of ACASI system. Storyboards consisted of 1 page per question and provided the programmers with the test of the question, valid responses, and any instructions that were to be read to the participants. Storyboards were further translated into flow diagrams representing each module of the survey and illustrating the skip patterns used to navigate a participant through the survey. Provisions were also made to insert a face-to-face interview, into the ACASI assessment process, to elicit sexual abuse history data, which typically requires specially trained data collectors with active listening skills to help participants reframe and coordinate times, places and, emotionally difficult memories. The ACASI was successfully developed and implemented in the main trial. During an exit interview, respondents indicated that they liked using the ACASI and indicating that they favored it as the method to answer questions. It is feasible to implement an ACASI system in a multisite study in a timely and efficient way.

Computational study of haemodynamic effects of entry- and exit-tear coverage in a DeBakey type III aortic dissection: technical report.

PubMed

Karmonik, C; Bismuth, J; Shah, D J; Davies, M G; Purdy, D; Lumsden, A B

2011-08-01

Outcome prediction in DeBakey Type III aortic dissections (ADs) remains challenging. Large variations in AD morphology, physiology and treatment exist. Here, we investigate if computational fluid dynamics (CFD) can provide an initial understanding of pressure changes in an AD computational model when covering entry and exit tears and removing the intra-arterial septum (IS). A computational mesh was constructed from magnetic resonance images from one patient (one entrance and one exit tear) and CFD simulations performed (scenario #1). Additional meshes were derived by virtually (1) covering the exit tear (false lumen (FL) thrombus progression) (scenario #2), (2) covering the entrance tear (thoracic endovascular treatment, TEVAR) (scenario #3) and (3) completely removing the IS (fenestration) (scenario #4). Changes in flow patterns and pressures were quantified relative to the initial mesh. Systolic pressures increased for #2 (300 Pa increase) with largest inter-luminal differences distally (2500 Pa). In #3, false lumen pressure decreased essentially to zero. In #4, systolic pressure in combined lumen reduced from 2400 to 800 Pa. CFD results from computational models of a DeBakey type III AD representing separate coverage of entrance and exit tears correlated with clinical experience. The reported results present a preliminary look at a complex clinical problem. Copyright © 2011 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

STS-108 and Expedition 4 crews during media interview

NASA Technical Reports Server (NTRS)

2001-01-01

KENNEDY SPACE CENTER, Fla. -- The STS-108 crew and Expedition 4 crew answer questions from the media during an interview session. With the microphone is Commander Dominic L. Gorie. From left are STS-108 Pilot Mark E. Kelly, Mission Specialists Daniel M. Tani and Linda A. Godwin, and Gorie; Expedition 4 Commander Yuri Onufrienko, Carl E. Walz and Daniel W. Bursch. The crews are at KSC for Terminal Countdown Demonstration Test activities that include emergency exit training from the orbiter and launch pad and a simulated launch countdown. STS-108 is a Utilization Flight that will carry the replacement Expedition 4 crew to the International Space Station, as well as the Multi-Purpose Logistics Module Raffaello, filled with supplies and equipment. The l1-day mission is scheduled for launch Nov. 29 on Space Shuttle Endeavour.

STS-108 and Expedition 4 crews during media interview

NASA Technical Reports Server (NTRS)

2001-01-01

KENNEDY SPACE CENTER, Fla. -- The STS-108 crew and Expedition 4 crew answer questions from the media during an interview session. With the microphone is Expedition 4 Commander Yuri Onufrienko. From left are STS-108 Pilot Mark E. Kelly, Mission Specialists Daniel M. Tani and Linda A. Godwin, and Commander Dominic L. Gorie; Onufrienko and Expedition 4 members Carl E. Walz and Daniel W. Bursch. The crews are at KSC for Terminal Countdown Demonstration Test activities that include emergency exit training from the orbiter and launch pad and a simulated launch countdown. STS-108 is a Utilization Flight that will carry the replacement Expedition 4 crew to the International Space Station, as well as the Multi-Purpose Logistics Module Raffaello, filled with supplies and equipment. The l1-day mission is scheduled for launch Nov. 29 on Space Shuttle Endeavour.

Deciding Not to Un-Do the "I Do:" Therapy Experiences of Women Who Consider Divorce But Decide to Remain Married.

PubMed

Kanewischer, Erica J W; Harris, Steven M

2015-07-01

This study explores women's experience of marital therapy while they navigated decision making around divorce. A qualitative method was used to gain a deeper understanding of the participants' therapy and relationship decision-making experiences. How are women's decisions whether or not to exit their marriage affected by therapy? The researchers interviewed 15 women who had considered initiating divorce before they turned 40 and had attended at least five marital therapy sessions but ultimately decided not to divorce. In general, participants reported that the therapy was helpful to them, their decision-making process and their marriages. Five main themes emerged from the interviews: Women Initiated Therapy, Therapist Was Experienced as Unbiased, Therapy was Helpful, Importance of Extra-therapeutic Factors, and Gradual Process. © 2014 American Association for Marriage and Family Therapy.

Letting go: How newly graduated registered nurses in Western Canada decide to exit the nursing profession.

PubMed

Chachula, Kathryn M; Myrick, Florence; Yonge, Olive

2015-07-01

The Canadian Nurses Association (CNA) estimates a nursing shortage in Canada will rise to 60,000 registered nurses by 2022. Further compounding this crisis is the approximate 14-61% of new nursing graduates who will change nursing roles or exit the profession. To explore the factors and basic psychosocial process involved in the decisions of newly graduated registered nurses in Western Canada who permanently exit the nursing profession within five years. Data was collected through unstructured and semi-structured interviews using the Glaserian grounded theory method. Participants were found to be in a process of letting go of nursing that commenced as students and continued as they entered practice as registered nurses. Four major themes were identified. 1) Navigating constraints of the healthcare system and workplace: participants encountered difficulties adjusting to shiftwork and workload. 2) Negotiating social relationships, hierarchies, and troublesome behaviors; specifically hierarchal and horizontal violence. 3) Facing fears, traumas and challenges. 4) Weighing competing rewards and tensions which resulted in leaving the nursing profession. Students and subsequently new nursing graduates require a variety of supports to establish a nursing identity and remain in the profession. These supports include a manageable workload; meaningful orientation; interprofessional teamwork; and engagement within transformational and authentic leadership constructs. New nurses require a sense of being welcomed, valued, respected and accepted into the workplace environment, as well as constructive feedback, emotional support and debriefing to face workplace challenges. Copyright © 2015 Elsevier Ltd. All rights reserved.

Factors affecting physician loyalty and exit: a longitudinal analysis of physician-hospital relationships.

PubMed Central

Burns, L R; Wholey, D R

1992-01-01

This article examines forces that influence physicians to change the percentage of their admissions to a hospital (loyalty) and to cease admitting patients to a hospital altogether (exit). Because physicians are both members of a hospital and consumers of its services, their admitting patterns can be described using models of employee commitment and consumer buying behavior. We test several hypotheses drawn from these literatures using data on physician admissions at hospitals over a two-year period. Results indicate that admitting patterns are explained primarily by convenience and inertia processes characteristic of consumer behavior. On the other hand, factors believed to influence organizational commitment (e.g., decision-making involvement, conflict, economic investments) have little effect on loyalty and exit. The findings question the utility of hospital strategies to improve the climate of physician-hospital relations, and suggest several qualifications for research on the commitment of professionals. PMID:1563950

A rapidly changing global medicines environment: How adaptable are funding decision-making systems?

PubMed

Leopold, Christine; Morgan, Steven G; Wagner, Anita K

2017-06-01

With the launch of very highly priced therapies and sudden price increases of generics, pressures on health systems have drastically increased. We aimed to elicit opinions of key decision makers responsible for national assessment and funding decisions on their experiences to adapt to these new realities. Through interviews with decision makers of pharmaceutical assessment and/or funding agencies, we describe the challenges systems are currently facing, systems' responses and systems' characteristics facilitating or hindering responses to changes and overarching topics for the future. Among the most common challenges are increased funding pressures, increased uncertainty and lack of transparency in decision-making. Systems' responses include utilization management, changing of assessment processes, stakeholder engagement and a focus on outcomes and on coordinated negotiations. Integrated delivery systems, fixed health care budgets and geographic and historical characteristics facilitate or sometimes hinder responses to change. Future policy emphasis lays on expanding data structures, managing the exit of drugs funded early, and implementing processes for communications with patients and the public. Going forward emphasis has to be given to structured communications with all stakeholders with a specific emphasis on the broader public and patients about financial limits and priority setting in health care. Copyright © 2017 Elsevier B.V. All rights reserved.

Conversion to eslicarbazepine acetate monotherapy

PubMed Central

French, Jacqueline; Jacobson, Mercedes P.; Pazdera, Ladislav; Gough, Mallory; Cheng, Hailong; Grinnell, Todd; Blum, David

2016-01-01

Objective: To assess the efficacy and safety of eslicarbazepine acetate (ESL) monotherapy. Methods: This post hoc pooled analysis of 2 randomized double-blind studies (093-045 and -046) included adults with partial-onset seizures medically uncontrolled by 1 or 2 antiepileptic drugs (AEDs). Following the baseline period (8 weeks), eligible patients were randomized 2:1 to receive ESL 1,600 mg or 1,200 mg once daily for 18 weeks; the primary endpoint was study exit by meeting predefined exit criteria (signifying worsening seizure control). In each study, treatment was considered effective if the upper 95% confidence limit for exit rate was lower than the historical control threshold (65.3%). Results: Pooled exit rates were as follows: ESL 1,600 mg = 20.6% (95% confidence interval: 15.6%–26.8%); ESL 1,200 mg = 30.8% (23.0%–40.5%). Use of 2 baseline AEDs or rescue medication, US location, epilepsy duration ≥20 years, and higher maximum baseline seizure frequency were associated with higher exit risks. Median percent reductions in standardized seizure frequency between baseline and the 18-week double-blind period were as follows: ESL 1,600 mg = 43.2%; ESL 1,200 mg = 35.7%; baseline carbamazepine use was associated with smaller reductions. Safety profiles were similar between ESL doses. Conclusions: Exit rates for ESL monotherapy (1,600 mg and 1,200 mg once daily) were lower than the historical control threshold, irrespective of baseline AED use and region, with no additional safety concerns identified. Clinical factors and location clearly influence treatment responses in conversion-to-monotherapy trials. Classification of evidence: This pooled analysis provides Class IV evidence that for adults with medically uncontrolled partial-onset seizures, ESL monotherapy is well tolerated and effective. PMID:26911639

Conversion to eslicarbazepine acetate monotherapy: A pooled analysis of 2 phase III studies.

PubMed

Sperling, Michael R; French, Jacqueline; Jacobson, Mercedes P; Pazdera, Ladislav; Gough, Mallory; Cheng, Hailong; Grinnell, Todd; Blum, David

2016-03-22

To assess the efficacy and safety of eslicarbazepine acetate (ESL) monotherapy. This post hoc pooled analysis of 2 randomized double-blind studies (093-045 and -046) included adults with partial-onset seizures medically uncontrolled by 1 or 2 antiepileptic drugs (AEDs). Following the baseline period (8 weeks), eligible patients were randomized 2:1 to receive ESL 1,600 mg or 1,200 mg once daily for 18 weeks; the primary endpoint was study exit by meeting predefined exit criteria (signifying worsening seizure control). In each study, treatment was considered effective if the upper 95% confidence limit for exit rate was lower than the historical control threshold (65.3%). Pooled exit rates were as follows: ESL 1,600 mg = 20.6% (95% confidence interval: 15.6%-26.8%); ESL 1,200 mg = 30.8% (23.0%-40.5%). Use of 2 baseline AEDs or rescue medication, US location, epilepsy duration ≥20 years, and higher maximum baseline seizure frequency were associated with higher exit risks. Median percent reductions in standardized seizure frequency between baseline and the 18-week double-blind period were as follows: ESL 1,600 mg = 43.2%; ESL 1,200 mg = 35.7%; baseline carbamazepine use was associated with smaller reductions. Safety profiles were similar between ESL doses. Exit rates for ESL monotherapy (1,600 mg and 1,200 mg once daily) were lower than the historical control threshold, irrespective of baseline AED use and region, with no additional safety concerns identified. Clinical factors and location clearly influence treatment responses in conversion-to-monotherapy trials. This pooled analysis provides Class IV evidence that for adults with medically uncontrolled partial-onset seizures, ESL monotherapy is well tolerated and effective. © 2016 American Academy of Neurology.

Should we pay the student? A randomised trial of financial incentives in medical education.

PubMed

Raupach, Tobias; Brown, Jamie; Wieland, Anna; Anders, Sven; Harendza, Sigrid

2013-09-01

Financial incentives are effective in moderating physician and patient behaviour, but they have not been studied in the context of medical education. This study assessed whether financial incentives can motivate students to acquire electrocardiogram (ECG) interpretation skills. Students enrolled for a cardio-respiratory teaching module (n = 121) were randomised to an intervention (financial incentive) or a control (book voucher raffle) condition. All students took three validated exams of ECG interpretation skills (at module entry, module exit and seven weeks later). Only the exit exam was financially incentivised in the intervention group. The primary outcome was the proportion of students who correctly identified ≥60% of clinically important diagnoses in the exit exam. Financial incentives more than doubled the odds of correctly identifying ≥60% of diagnoses in the exit exam (adjusted odds ratio 2.44, 95% confidence interval 1.05-5.67) and significantly increased student learning time. However, there was no significant effect on performance levels in the retention exam. Financial incentives increase reported learning time and examination results in the short-term. The lack of a sustained effect on performance suggests that financial incentives may foster a superficial or strategic rather than a deep approach to learning.

Changes in need satisfaction and motivation orientation as predictors of psychological and behavioural outcomes in exercise referral.

PubMed

Rahman, Rachel Jane; Thogersen-Ntoumani, Cecilie; Thatcher, Joanne; Doust, Jonathan

2011-11-01

Employing Self-Determination Theory (Deci & Ryan, 1985) as a theoretical framework, this study examined psychological need satisfaction and motivational regulations as predictors of psychological and behavioural outcomes in exercise referral (ER). ER patients (N = 293; mean age 54.49) completed the measures of motivational regulations, psychological need satisfaction, health-related quality of life, life satisfaction, anxiety, depression and physical activity at entry, exit and 6 months following the end of a supervised exercise programme. Change in (Δ) intrinsic motivation during the scheme significantly predicted adherence and Δ habitual physical activity. Δ psychological need satisfaction from entry to exit significantly predicted Δ habitual physical activity from exit to 6-month follow-up. Δ psychological need satisfaction significantly predicted Δ motivational regulation and Δ psychological outcomes. Contrary to expectations, Δ self-determined regulation did not significantly predict Δ psychological outcomes during the structured part of the scheme, however, it did significantly predict Δ in psychological outcomes from exit to 6-month follow-up. These findings expand on cross-sectional research to demonstrate that psychological need satisfaction during supervised ER longitudinally predicts motivational regulation and psychological outcomes up to 6 months after a structured programme.

Cognitive Performance in Suicidal Depressed Elderly: Preliminary Report

PubMed Central

Dombrovski, Alexandre Y.; Butters, Meryl A.; Reynolds, Charles F.; Houck, Patricia R.; Clark, Luke; Mazumdar, Sati; Szanto, Katalin

2009-01-01

Objective Deficits in executive functions may play an important role in late-life suicide; however the association is understudied. This study examined cognitive function in general and executive functioning specifically in depressed elderly with and without suicidal ideation and attempts. Design Case-control study. Setting University-affiliated psychiatric hospital. Participants We compared 32 suicidal depressed participants aged 60 and older with 32 non-suicidal depressed participants equated for age, education, and gender. Measurements We assessed global cognitive function and executive function with the Dementia Rating Scale (DRS) and the Executive Interview (EXIT25), respectively. Results Suicidal and non-suicidal depressed groups were comparable in terms of severity of depression and burden of physical illness. Suicidal participants performed worse on the EXIT25, and on the DRS total scale, as well as on Memory and Attention subscales. The differences were not explained by the presence of dementia, substance use, medication exposure, or brain injury from suicide attempts. Conclusions Poor performance on tests of executive function, attention, and memory is associated with suicidal behavior in late-life depression. PMID:18239196

Acceptability and Use of the Diaphragm and Replens® Lubricant Gel for HIV Prevention in Southern Africa

PubMed Central

Cheng, Helen; van der Straten, Ariane; Chidanyika, Agnes C.; Lince, Naomi; Blanchard, Kelly; Ramjee, Gita; Nkala, Busisiwe; Padian, Nancy S.

2009-01-01

The acceptability and use of the diaphragm and lubricant gel were assessed as part of a large randomized controlled trial to determine the effectiveness of the methods in women’s HIV acquisition. 2,452 intervention-arm women were enrolled at five Southern African clinics and followed quarterly for 12–24 months. Acceptability and use data were collected by face-to-face interviews at Month 3 and Exit. Participants were “very comfortable” with the physical mechanics of diaphragm use throughout the trial, and approval of the gel consistency, quantity and the applicator was high. At Exit, consistent disclosure of use (AOR 1.97, 95% CI: 1.10–3.55); an overall high diaphragm rating (AOR 1.84, 95% CI: 1.45–2.34) and perception of partner approval (AOR 1.75, 95% CI: 1.35–2.26) were the most significant acceptability factors independently associated with consistent use. Despite being female-initiated, disclosure of use to male partners and his perceived approval of the products were factors significantly associated with their consistent use. PMID:19757018

Quality of antenatal and childbirth care in selected rural health facilities in Burkina Faso, Ghana and Tanzania: similar finding.

PubMed

Duysburgh, E; Zhang, W-H; Ye, M; Williams, A; Massawe, S; Sié, A; Williams, J; Mpembeni, R; Loukanova, S; Temmerman, M

2013-05-01

To measure pre-intervention quality of routine antenatal and childbirth care in rural districts of Burkina Faso, Ghana and Tanzania and to identify shortcomings. In each country, we selected two adjoining rural districts. Within each district, we randomly sampled 6 primary healthcare facilities. Quality of care was assessed through health facility surveys, direct observation of antenatal and childbirth care, exit interviews and review of patient records. By and large, quality of antenatal and childbirth care in the six districts was satisfactory, but we did identify some critical gaps common to the study sites in all three countries. Counselling and health education practices are poor; laboratory investigations are often not performed; examination and monitoring of mother and newborn during childbirth are inadequate; partographs are not used. Equipment required to provide assisted vaginal deliveries (vacuum extractor or forceps) was absent in all surveyed facilities. Quality of care in the three study sites can be improved with the available human resources and without major investments. This improvement could reduce maternal and neonatal mortality and morbidity. © 2013 Blackwell Publishing Ltd.

The quality of hospital-based antenatal care in Istanbul.

PubMed

Turan, Janet Molzan; Bulut, Ayşpen; Nalbant, Hacer; Ortayli, Nuriye; Akalin, A Arzu Koloğlu

2006-03-01

The aim of this study was to gather comprehensive data from three hospitals in Istanbul, Turkey, in order to gain in-depth understanding of the quality of antenatal care in this setting. The Bruce-Jain framework for quality of care was adapted for use in evaluating antenatal care. Methods included examination of hospital records, in-depth interviews, exit questionnaires, and structured observations. The study revealed deficiencies in the quality of antenatal care being delivered at the study hospitals in all six elements of the quality-of-care framework. The technical content of visits varied greatly among the hospitals, and an overuse of technology was accompanied by neglect of some essential components of antenatal care. Although at the private hospital some problems with the technical content of care were identified, client satisfaction was higher there, where the care included good interpersonal relations, information provision, and continuity. Providers at all three hospitals felt constrained by heavy patient loads and a lack of resources. Multifaceted approaches are needed to improve the quality of antenatal care in this setting.

The impact of music therapy versus music medicine on psychological outcomes and pain in cancer patients: a mixed methods study.

PubMed

Bradt, Joke; Potvin, Noah; Kesslick, Amy; Shim, Minjung; Radl, Donna; Schriver, Emily; Gracely, Edward J; Komarnicky-Kocher, Lydia T

2015-05-01

The purpose of this study was to compare the impact of music therapy (MT) versus music medicine (MM) interventions on psychological outcomes and pain in cancer patients and to enhance understanding of patients' experiences of these two types of music interventions. This study employed a mixed methods intervention design in which qualitative data were embedded within a randomized cross-over trial. Thirty-one adult cancer patients participated in two sessions that involved interactive music making with a music therapist (MT) and two sessions in which they listened to pre-recorded music without the presence of a therapist (MM). Before and after each session, participants reported on their mood, anxiety, relaxation, and pain by means of visual analogue and numeric rating scales. Thirty participants completed an exit interview. The quantitative data suggest that both interventions were equally effective in enhancing target outcomes. However, 77.4 % of participants expressed a preference for MT sessions. The qualitative data indicate that music improves symptom management, embodies hope for survival, and helps connect to a pre-illness self, but may also access memories of loss and trauma. MT sessions helped participants tap into inner resources such as playfulness and creativity. Interactive music making also allowed for emotional expression. Some participants preferred the familiarity and predictability of listening to pre-recorded music. The findings of this study advocate for the use of music in cancer care. Treatment benefits may depend on patient characteristics such as outlook on life and readiness to explore emotions related to the cancer experience.

Can an app help identify psychomotor function impairments during drinking occasions in the real world? A mixed-method pilot study.

PubMed

Suffoletto, Brian; Goyal, Akash; Puyana, Juan Carlos; Chung, Tammy

2017-01-01

Being able to measure the acute effects of alcohol consumption on psychomotor functions in natural settings could be useful in injury prevention interventions. This study examined the feasibility and acceptability of collecting app-based measures of information processing, working memory, and gait stability during times of typical alcohol consumption among young adults. Ten young adults (aged 21-26) with hazardous drinking completed a baseline assessment and ecological momentary assessments (EMA) on 4 consecutive Fridays and Saturdays, every hour from 8 pm to 12 am. EMA assessed alcohol consumption and perceived intoxication, followed by a digit symbol substitution task (DSST), a visuospatial working memory task (VSWMT), and a 5-step tandem gait task (TGT). Exit interviews probed user experiences. Multilevel models explored relationships between estimated blood alcohol concentration (eBAC; mg/dL) and DSST and VSWMT performance. Participants completed 32% of EMA. Higher rates of noninitiation occurred later in the evening and over time. In multilevel models, higher eBAC was associated with lower DSST scores. Eight out of 10 individuals had at least 1 drinking occasion when they did not perceive any intoxication. Lower DSST scores would identify impairment in 45% of these occasions. Exit interviews indicated that adding real-time feedback on task performance could increase awareness of alcohol effects. Collecting app-based psychomotor performance data from young adults during drinking occasions is feasible and acceptable, but strategies to reduce barriers to task initiation are needed. Mobile DSST is sensitive to eBAC levels and could identify occasions when an individual may not perceive impairments.

Assessing the quality of reproductive health services in Egypt via exit interviews.

PubMed

Zaky, Hassan H M; Khattab, Hind A S; Galal, Dina

2007-05-01

This study assesses the quality of reproductive health services using client satisfaction exit interviews among three groups of primary health care units run by the Ministry of Health and Population of Egypt. Each group applied a different model of intervention. The Ministry will use the results in assessing its reproductive health component in the health sector reform program, and benefits from the strengths of other models of intervention. The sample was selected in two stages. First, a stratified random sampling procedure was used to select the health units. Then the sample of female clients in each health unit was selected using the systematic random approach, whereby one in every two women visiting the unit was approached. All women in the sample coming for reproductive health services were included in the analysis. The results showed that reproductive health beneficiaries at the units implementing the new health sector reform program were more satisfied with the quality of services. Still there were various areas where clients showed significant dissatisfaction, such as waiting time, interior furnishings, cleanliness of the units and consultation time. The study showed that the staff of these units did not provide a conductive social environment as other interventions did. A significant proportion of women expressed their intention to go to private physicians owing to their flexible working hours and variety specializations. Beneficiaries were generally more satisfied with the quality of health services after attending the reformed units than the other types of units, but the generalization did not fully apply. Areas of weakness are identified.

A qualitative approach exploring the acceptability of yoga for minorities living with arthritis: 'Where are the people who look like me?'

PubMed

Middleton, Kimberly R; Magaña López, Miriam; Haaz Moonaz, Steffany; Tataw-Ayuketah, Gladys; Ward, Michael M; Wallen, Gwenyth R

2017-04-01

To examine the acceptability of yoga research tailored to recruit and retain a minority population (both English and Spanish speaking) with arthritis. Yoga research for arthritis often underrepresents minorities and acceptability for this population has not previously been investigated. Acceptability was evaluated using retention, adherence, journals, and semi-structured exit interviews from twelve participants with osteoarthritis or rheumatoid arthritis undergoing an 8-week yoga intervention. Journal quotes were analyzed using content analysis techniques. NVivo software was used to organize transcripts and assemble themes. Two methods of triangulation (data and investigator) were used to overcome potential bias from a single-perspective interpretation. Exit interview comments were content analyzed using a card sort method. The study was designed with a cultural infrastructure including a multicultural research team, translators, and bilingual materials and classes, to facilitate trust and acceptability for primarily Hispanic and Black/African-American adults. Washington, D.C. metropolitan area, USA. On average participants attended 10 of 16 classes, with home practice 2-3days a week. All who completed were still practicing yoga three-months later. Qualitative narrative analysis identified major themes related to facilitating factors and barriers for yoga practice, self-efficacy, and support. Participant comments indicated that offering an arthritis-based yoga intervention and using a culturally congruent research design was found to be acceptable. As yoga research grows, there is a need to understand and promote acceptability for typically under-represented populations. This study attempts to inform the expansion of multicultural research designed to recruit and retain those from diverse backgrounds. Published by Elsevier Ltd.

Patients satisfaction with laboratory services at antiretroviral therapy clinics in public hospitals, Addis Ababa, Ethiopia.

PubMed

Mindaye, Tedla; Taye, Bineyam

2012-07-04

Despite the fact that Ethiopia has scale up antiretroviral treatment (ART) program, little is known about the patient satisfaction with ART monitoring laboratory services in health facilities. We therefore aimed to assess patient satisfaction with laboratory services at ART clinics in public hospitals. Hospital based, descriptive cross sectional study was conducted from October to November 2010 among clients attending in nine public hospitals ART clinics in Addis Ababa Ethiopia. Patients' satisfaction towards laboratory services was assessed using exit interview structured questionnaire. Data were coded and entered using EPI info 2002 (Centers for Disease Control and Prevention Atlanta, GA) and analyzed using SPSS version 15 software (SPSS INC, Chicago, IL, USA). A total of 406 clients were involved in the study. Of these 255(62.8%) were females. The overall satisfaction rate for ART monitoring laboratory services was (85.5%). Patients were satisfied with measures taken by health care providers to keep confidentiality and ability of the person drawing blood to answer question (98.3% and 96.3% respectively). Moreover, the finding of this study revealed, statistical significant associations between the overall patients' satisfaction with waiting time to get blood drawing service, availability of ordered laboratory tests and waiting time to get laboratory result with (p < 0.05). Patients receiving blood drawing service less than 30 minute were 7.59 times (95% CI AOR: 3.92-14.70) to be more satisfied with ART monitoring laboratory services compared to those who underwent for more than 30 minutes. Overall, the satisfaction survey showed, most respondents were satisfied with ART monitoring laboratory services. However, factors such as improving accessibility and availability of latrines should be taken into consideration in order to improve the overall satisfaction.

"Getting out of downtown": a longitudinal study of how street-entrenched youth attempt to exit an inner city drug scene.

PubMed

Knight, Rod; Fast, Danya; DeBeck, Kora; Shoveller, Jean; Small, Will

2017-05-02

Urban drug "scenes" have been identified as important risk environments that shape the health of street-entrenched youth. New knowledge is needed to inform policy and programing interventions to help reduce youths' drug scene involvement and related health risks. The aim of this study was to identify how young people envisioned exiting a local, inner-city drug scene in Vancouver, Canada, as well as the individual, social and structural factors that shaped their experiences. Between 2008 and 2016, we draw on 150 semi-structured interviews with 75 street-entrenched youth. We also draw on data generated through ethnographic fieldwork conducted with a subgroup of 25 of these youth between. Youth described that, in order to successfully exit Vancouver's inner city drug scene, they would need to: (a) secure legitimate employment and/or obtain education or occupational training; (b) distance themselves - both physically and socially - from the urban drug scene; and (c) reduce their drug consumption. As youth attempted to leave the scene, most experienced substantial social and structural barriers (e.g., cycling in and out of jail, the need to access services that are centralized within a place that they are trying to avoid), in addition to managing complex individual health issues (e.g., substance dependence). Factors that increased youth's capacity to successfully exit the drug scene included access to various forms of social and cultural capital operating outside of the scene, including supportive networks of friends and/or family, as well as engagement with addiction treatment services (e.g., low-threshold access to methadone) to support cessation or reduction of harmful forms of drug consumption. Policies and programming interventions that can facilitate young people's efforts to reduce engagement with Vancouver's inner-city drug scene are critically needed, including meaningful educational and/or occupational training opportunities, 'low threshold' addiction treatment services, as well as access to supportive housing outside of the scene.

Safety of coitally administered tenofovir 1% gel, a vaginal microbicide, in chronic hepatitis B virus carriers: Results from the CAPRISA 004 trial

PubMed Central

BAXTER, Cheryl; YENDE-ZUMA, Nonhlanhla; TSHABALALA, Phindile; KARIM, Quarraisha ABDOOL; KARIM, Salim S ABDOOL

2013-01-01

Tenofovir disoproxil fumarate, a licensed oral treatment for both HIV and Hepatitis B virus (HBV) infections, has been associated with severe rebound hepatic flares when treatment is interrupted. A gel formulation of tenofovir is currently being assessed as a microbicide against HIV. If licensed, it is possible that tenofovir gel could be used either intentionally or unintentionally by HBV carriers. The purpose of this study was to establish the safety of tenofovir gel use in this patient group participating in the CAPRISA 004 tenofovir gel trial. HBV infection status was assessed at enrolment and study exit. Liver function testing was performed at enrolment, study months 3, 12, 24, study exit, and two months after exiting the study. At enrolment, 34 women were identified as being HBV carriers and 22 women acquired HBV infections during follow-up; 14 and 8 in the tenofovir and placebo gel arms respectively (p=0.21). Intermittent tenofovir gel use did not cause an increase in hepatic flares or impact on viral load suppression in women with HBV infection. There were 2 hepatic flares in each gel arm during follow-up and none two months after cessation of gel at study exit. The mean HBV DNA levels were similar at enrolment and exit in both study arms. Tenofovir gel, when used intermittently, was safe to use in women with HBV infection. PMID:23832086

Health insurance and quality of care: Comparing perceptions of quality between insured and uninsured patients in Ghana's hospitals.

PubMed

Abuosi, Aaron A; Domfeh, Kwame Ameyaw; Abor, Joshua Yindenaba; Nketiah-Amponsah, Edward

2016-05-12

The introduction of health insurance in Ghana in 2003 has resulted in a tremendous increase in utilization of health services. However, concerns are being raised about the quality of patient care. Some of the concerns include long waiting times, verbal abuse of patients by health care providers, inadequate physical examination by doctors and discrimination of insured patients. The study compares perceptions of quality of care between insured and uninsured out-patients in selected hospitals in Ghana to determine whether there is any unequal treatment between insured and uninsured patients in terms of quality of care, as empirical and anecdotal evidence seem to suggest. A cross-sectional survey of 818 out-patients was conducted in 17 general hospitals from three regions of Ghana. These are the Upper East, Brong Ahafo and Central Regions. Convenience sampling was employed to select the patients in exit interviews. Descriptive statistics, including frequency distributions, means and standard deviations, were used to describe socio-economic and demographic characteristics of respondents. Factor analysis was used to determine distinct quality of care constructs; t-test statistic was used to test for differences in quality perceptions between the insured and uninsured patients; and regression analysis was used to test the association between health insurance and quality of care. Overall, there was no significant difference in perceptions of quality between insured and uninsured patients. However, there was a significant difference between insured and uninsured patients in respect of financial access to care. The major quality of care concern affecting all patients was the problem of inadequate resources, especially lack of doctors, lack of drugs and other basic supplies and equipment to work with. It was concluded that generally, insured and uninsured patients are not treated unequally, contrary to prevailing anecdotal and empirical evidence. On the contrary, quality of care is a concern of both insured and uninsured patients.

Costs Associated with Malaria in Pregnancy in the Brazilian Amazon, a Low Endemic Area Where Plasmodium vivax Predominates

PubMed Central

Bôtto-Menezes, Camila; Bardají, Azucena; dos Santos Campos, Giselane; Fernandes, Silke; Hanson, Kara; Martínez-Espinosa, Flor Ernestina; Menéndez, Clara; Sicuri, Elisa

2016-01-01

Background Information on costs associated with malaria in pregnancy (MiP) in low transmission areas where Plasmodium vivax predominates is so far missing. This study estimates health system and patient costs of MiP in the Brazilian Amazon. Methods/Principal Findings Between January 2011 and March 2012 patient costs for the treatment of MiP were collected through an exit survey at a tertiary referral hospital and at a primary health care centre in the Manaus metropolitan area, Amazonas state. Pregnant and post-partum women diagnosed with malaria were interviewed after an outpatient consultation or at discharge after admission. Seventy-three interviews were included in the analysis. Ninety-six percent of episodes were due to P. vivax and 4% to Plasmodium falciparum. In 2010, the total median costs from the patient perspective were estimated at US $45.91 and US $216.29 for an outpatient consultation and an admission, respectively. When multiple P. vivax infections during the same pregnancy were considered, patient costs increased up to US $335.85, representing the costs of an admission plus an outpatient consultation. Provider direct and overhead cost data were obtained from several sources. The provider cost associated with an outpatient case, which includes several consultations at the tertiary hospital was US $103.51 for a P. vivax malaria episode and US $83.59 for a P. falciparum malaria episode. The cost of an inpatient day and average admission of 3 days was US $118.51 and US $355.53, respectively. Total provider costs for the diagnosis and treatment of all malaria cases reported in pregnant women in Manaus in 2010 (N = 364) were US $17,038.50, of which 92.4% (US$ 15,741.14) due to P. vivax infection. Conclusion Despite being an area of low risk malaria transmission, MiP is responsible for a significant economic burden in Manaus. Especially when multiple infections are considered, costs associated with P. vivax are higher than costs associated with P. falciparum. The information generated may help health policy decisions for the current control and future elimination of malaria in the area. PMID:27031515

Treatment-seeking patterns for malaria in pharmacies in five sub-Saharan African countries.

PubMed

Ladner, Joël; Davis, Ben; Audureau, Etienne; Saba, Joseph

2017-08-29

Artemisinin-based combination therapy (ACT) is recommended as the first-line anti-malarial treatment strategy in sub-Saharan African countries. WHO policy recommends parasitological confirmation by microscopy or rapid diagnostic test (RDT) in all cases of suspected malaria prior to treatment. Gaps remain in understanding the factors that influence patient treatment-seeking behaviour and anti-malarial drug purchase decisions in the private sector. The objective of this study was to identify patient treatment-seeking behaviour in Ghana, Kenya, Nigeria, Tanzania, and Uganda. Face-to-face patient interviews were conducted at a total of 208 randomly selected retail outlets in five countries. At each outlet, exit interviews were conducted with five patients who indicated they had come seeking anti-malarial treatment. The questionnaire was anonymous and standardized in the five countries and collected data on different factors, including socio-demographic characteristics, history of illness, diagnostic practices (i.e. microscopy or RDT), prescription practices and treatment purchase. The price paid for the treatment was also collected from the outlet vendor. A total of 994 patients were included from the five countries. Location of malaria diagnosis was significantly different in the five countries. A total of 484 blood diagnostic tests were performed, (72.3% with microscopy and 27.7% with RDT). ACTs were purchased by 72.5% of patients who had undergone blood testing and 86.5% of patients without a blood test, regardless of whether the test result was positive or negative (p < 10 -4 ). A total of 531 patients (53.4%) had an anti-malarial drug prescription, of which 82.9% were prescriptions for an ACT. There were significant differences in prescriptions by country. A total of 923 patients (92.9%) purchased anti-malarial drugs in an outlet, including 79.1% of patients purchasing an ACT drug: 98.0% in Ghana, 90.5% in Kenya, 80.4% in Nigeria, 69.2% in Tanzania, and 57.7% in Uganda (p < 10 -4 ). Having a drug prescription was not a significant predictive factor associated with an ACT drug purchase (except in Kenya). The number of ACT drugs purchased with a prescription was greater than the number purchased without a prescription in Kenya, Nigeria and Tanzania. This study highlights differences in drug prescription and purchase patterns in five sub-Saharan African countries. The private sector is playing an increasingly important role in fever case management in sub-Saharan Africa. Understanding the characteristics of private retail outlets and the role they play in providing anti-malaria drugs may support the design of effective malaria interventions.

An Online Learning Module to Increase Self-Efficacy and Involvement in Care for Patients With Advanced Lung Cancer: Research Protocol.

PubMed

Janssen, Anna; Shaw, Tim; Nagrial, Adnan; Pene, Christopher; Rabbets, Melanie; Carlino, Matteo; Zachulski, Clare; Phillips, Jane; Birnbaum, Robert; Gandhi, Tejal; Harnett, Paul

2016-08-08

Improving patient care for individuals with lung cancer is a priority due to the increasing burden of the disease globally. One way this can be done is by improving patient self-management capabilities through increasing their self-efficacy. This can improve positive outcomes for patients with chronic conditions and increase their ability to manage the challenges of such illnesses. Unfortunately, patients with chronic conditions often struggle to travel far from home to engage with patient education events, a common means of improving self-efficacy. The development of more accessible tools for improving patient self-efficacy is required to increase quality of life for patients with chronic conditions. To evaluate the feasibility of delivering symptom identification and management information to patients with advanced lung cancer using an online program. This article describes a pre-post test study to evaluate a Qstream online learning platform to improve patient self-efficacy for managing advanced lung cancer symptoms. Undertaking this program should increase participant knowledge about the side-effects they may experience as a result of their treatment and in turn increase help-seeking behavior and self-efficacy for the participant cohort. Quantitative data collected by the Qstream platform on the completion rates of participants will be used as a tool to evaluate the intervention. Additionally, validated scales will be used to collect data on patient self-efficacy. Qualitative data will also be collected via an exit survey and thematic content analysis of semi-structured interviews. The research is in the preliminary stages but thus far a protocol has been approved in support of the project. Additionally, advisory committee members have been identified and initial meetings have been undertaken. Development of new approaches for increasing patient understanding of their care is important to ensure high quality care continues to be delivered in the clinical setting.

The NASOROSSO (Rednose) Project: An Italian Study on Alcohol Consumption in Recreational Places

PubMed Central

Pacifici, Roberta; Pierantozzi, Andrea; Di Giovannandrea, Rita; Palmi, Ilaria; Mastrobattista, Luisa; Mortali, Claudia; Pichini, Simona

2013-01-01

The Nasorosso project of the Italian Youth Department and the National Institute of Health, aimed to raise awareness about drinking and driving under the influence of alcohol among club goers with a series of initiatives. Within the framework of the project, blood alcohol concentration (BAC) was measured on 106,406 individuals before and after clubbing in 66 different recreational sites from 11 Italian provinces, over 16 months. Participating individuals were interviewed regarding sociodemographic and environmental characteristics and alcohol intoxicated people were offered to be taken home. The BAC median at the club entry was 0.26 g/L with 65.3% subjects showing a BAC value under the driving legal limit of 0.5g/L. At the exit from clubs, BAC median value rose to 0.44 g/L and subjects with BAC value under the legal limit decreased to 54.9%. Being male, aged between 18 and 34 years with a diploma, being a drinker and entering the disco with a BAC already beyond the legal limit predicted a BAC value beyond 0.5 g/L at exit from the recreational place. Conversely, being a driver, being a student and exiting from the disco before 4 a.m. reduced the probability of having a BAC higher than 0.5 g/L at the end of the night. Health policies to prevent harmful use of alcohol in young people should continue to offer targeted information/ prevention; in order to steadily increase the awareness of the dangers and the damages of excessive use of alcohol. PMID:23615454

The relationship between group size, intoxication and continuing to drink after bar attendance.

PubMed

Reed, Mark B; Clapp, John D; Martell, Brandi; Hidalgo-Sotelo, Alexandra

2013-11-01

The present study was undertaken to explore multilevel determinants of planning to continue to drink alcohol after leaving public drinking events. We assessed whether individual-level factors, group-related factors, or event-level bar characteristics were associated with post-bar drinking. We recruited a total of 642 participants from 30 participating bars in urban Southern California. Groups who arrived to patron a bar were interviewed upon their entrance and exit. Given data nesting, we employed a multilevel modeling approach to data analysis. More than one-third (40%) of our sample reported the intention to continue drinking as they exited the bar. Results of our multilevel model indicated eight individual-level variables significantly associated with intending to continue to drink. Time of night moderated the relationship between BrAC change and intentions to continue to drink. Although none of the group factors were significant in our model, a significant cross-level interaction between BrAC change and number of group members indicated the effect of intoxication on planning to continue to drink increases as group members increase. At the bar level, the presence of temporary bars and server offers of non-alcoholic drinks significantly decreased intentions to continue to drink. Given the large percentage of participants who reported the intention to continue drinking after exiting a bar, this study draws attention to the fact that field studies of drinking behavior may assess drinking mid-event rather than at the end of a drinking event. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Movie smoking and urge to smoke among adult smokers.

PubMed

Sargent, James D; Morgenstern, Matthis; Isensee, Barbara; Hanewinkel, Reiner

2009-09-01

Few studies have assessed the association between exposure to movie smoking and urge to smoke under real-world conditions. We conducted exit interviews with 4,073 movie patrons, of whom 2,817 were aged 18 years or older. Some 536 were smokers and had complete data. Subjects had exited 26 movies, of which 12 contained smoking. We used least squares regression to assess the association between exposure to movie smoking and urge to smoke (scale range 0-10), controlling for movie rating, age, sex, heaviness of smoking index (HSI, range 0-6), and time since last cigarette smoked. Median age was 27 years and 52% were female. Median urge to smoke level at movie exit was 7. The dose-response between higher categories of movie smoking and median urge to smoke was one point for two lower categories (1-11 and 11-54 s) and two for the highest category (>or=55 s), but these differences were not statistically significant. In the multivariate analysis, attendance of a movie with smoking was associated with a 0.81-point increase (95% CI = 0.46-1.16) in urge to smoke. For comparison, an HSI score of 3 (vs. 0) was associated with a 2-point increase in urge to smoke. In this sample of adult smokers, exposure to movie smoking was associated with higher urge to smoke after the movie, independent of movie rating. The effect size was consistent with responses seen in cue reactivity experiments. Exposure to movie smoking may affect urge to smoke among adult smokers.

Movie smoking and urge to smoke among adult smokers

PubMed Central

Sargent, James D.; Morgenstern, Matthis; Isensee, Barbara

2009-01-01

Introduction Few studies have assessed the association between exposure to movie smoking and urge to smoke under real-world conditions. Methods We conducted exit interviews with 4,073 movie patrons, of whom 2,817 were aged 18 years or older. Some 536 were smokers and had complete data. Subjects had exited 26 movies, of which 12 contained smoking. We used least squares regression to assess the association between exposure to movie smoking and urge to smoke (scale range 0–10), controlling for movie rating, age, sex, heaviness of smoking index (HSI, range 0–6), and time since last cigarette smoked. Results Median age was 27 years and 52% were female. Median urge to smoke level at movie exit was 7. The dose–response between higher categories of movie smoking and median urge to smoke was one point for two lower categories (1–11 and 11–54 s) and two for the highest category (≥55 s), but these differences were not statistically significant. In the multivariate analysis, attendance of a movie with smoking was associated with a 0.81-point increase (95% CI = 0.46–1.16) in urge to smoke. For comparison, an HSI score of 3 (vs. 0) was associated with a 2-point increase in urge to smoke. Discussion In this sample of adult smokers, exposure to movie smoking was associated with higher urge to smoke after the movie, independent of movie rating. The effect size was consistent with responses seen in cue reactivity experiments. Exposure to movie smoking may affect urge to smoke among adult smokers. PMID:19542516

Translation, cross-cultural adaptation and applicability of the Brazilian version of the Frontotemporal Dementia Rating Scale (FTD-FRS)

PubMed Central

Lima-Silva, Thais Bento; Bahia, Valéria Santoro; Carvalho, Viviane Amaral; Guimarães, Henrique Cerqueira; Caramelli, Paulo; Balthazar, Márcio; Damasceno, Benito; Bottino, Cássio Machado de Campos; Brucki, Sônia Maria Dozzi; Mioshi, Eneida; Nitrini, Ricardo; Yassuda, Mônica Sanches

2013-01-01

BACKGROUND Staging scales for dementia have been devised for grading Alzheimer's disease (AD) but do not include the specific symptoms of frontotemporal lobar degeneration (FTLD). OBJECTIVE To translate and adapt the Frontotemporal Dementia Rating Scale (FTD-FRS) to Brazilian Portuguese. METHODS The cross-cultural adaptation process consisted of the following steps: translation, back-translation (prepared by independent translators), discussion with specialists, and development of a final version after minor adjustments. A pilot application was carried out with 12 patients diagnosed with bvFTD and 11 with AD, matched for disease severity (CDR=1.0). The evaluation protocol included: Addenbrooke's Cognitive Examination-Revised (ACE-R), Mini-Mental State Examination (MMSE), Executive Interview (EXIT-25), Neuropsychiatric Inventory (NPI), Frontotemporal Dementia Rating Scale (FTD-FRS) and Clinical Dementia Rating scale (CDR). RESULTS The Brazilian version of the FTD-FRS seemed appropriate for use in this country. Preliminary results revealed greater levels of disability in bvFTD than in AD patients (bvFTD: 25% mild, 50% moderate and 25% severe; AD: 36.36% mild, 63.64% moderate). It appears that the CDR underrates disease severity in bvFTD since a relevant proportion of patients rated as having mild dementia (CDR=1.0) in fact had moderate or severe levels of disability according to the FTD-FRS. CONCLUSION The Brazilian version of the FTD-FRS seems suitable to aid staging and determining disease progression. PMID:29213863

Exit site and tunnel infections in children on chronic peritoneal dialysis: findings from the Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) Collaborative.

PubMed

Swartz, Sarah J; Neu, Alicia; Skversky Mason, Amy; Richardson, Troy; Rodean, Jonathan; Lawlor, John; Warady, Bradley; Somers, Michael J G

2018-06-01

The Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) Collaborative is a quality improvement initiative to reduce dialysis-associated infections. The frequency of peritoneal dialysis (PD) catheter exit site infection (ESI) and variables influencing its development and end result are unclear. We sought to determine ESI rates, to elucidate the epidemiology, risk factors, and outcomes for ESI, and to assess for association between provider compliance with care bundles and ESI risk. We reviewed demographic, dialysis and ESI data, and care bundle adherence and outcomes for SCOPE enrollees from October 2011 to September 2014. ESI involved only the exit site, only the subcutaneous catheter tunnel, or both. A total of 857 catheter insertions occurred in 734 children over 10,110 cumulative months of PD provided to these children. During this period 207 ESIs arose in 124 children or 0.25 ESIs per dialysis year. Median time to ESI was 392 days, with 69% of ESIs involving exit site only, 23% involving the tunnel only, and 8% involving both sites. Peritonitis developed in 6%. ESI incidence was associated with age (p = 0.003), being the lowest in children aged < 2 years and highest in those aged 6-12 years, and with no documented review of site care or an exit site score  of > 0 at prior month's visit (p < 0.001). Gender, race, end stage renal disease etiology, exit site orientation, catheter cuff number or mobilization, and presence of G-tube, stoma, or vesicostomy were unassociated with ESI incidence. Of the ESIs reported, 71% resolved with treatment, 24% required hospitalization, and 9% required catheter removal, generally secondary to tunnel infection. Exit site infections occur at an annualized rate of 0.25, typically well into the dialysis course. Younger patient age and documented review of site care are associated with lower ESI rates. Although most ESIs resolve, hospitalization is frequent, and tunnel involvement/catheter loss complicate outcomes.

Carbon monoxide poisoning in children riding in the back of pickup trucks.

PubMed

Hampson, N B; Norkool, D M

OBJECTIVE - To describe the case characteristics of a series of children poisoned with carbon monoxide while traveling in the back of pickup trucks. DESIGN - Pediatric cases referred for treatment of carbon monoxide poisoning with hyperbaric oxygen between 1986 and 1991 were reviewed. Those cases that occurred during travel in the back of pickup trucks were selected. Clinical follow-up by telephone interview ranged from 2 to 55 months. SETTING - A private, urban, tertiary care center in Seattle, Wash. PATIENTS - Twenty children ranging from 4 to 16 years of age. INTERVENTION - All patients were treated with hyperbaric oxygen. MAIN OUTCOME MEASURES - Characteristics of the poisoning incident and clinical patient outcome. RESULTS - Of 68 pediatric patients treated for accidental carbon monoxide poisoning, 20 cases occurred as children rode in the back of pickup trucks. In 17 of these, the children were riding under a rigid closed canopy on the rear of the truck, while three episodes occurred as children rode beneath a tarpaulin. Average carboxyhemoglobin level on emergency department presentation was 18.2% +/- 2.4% (mean +/- SEM; range, 1.6% to 37.0%). Loss of consciousness occurred in 15 of the 20 children. One child died of cerebral edema, one had permanent neurologic deficits, and 18 had no recognizable sequelae related to the episode. In all cases, the truck exhaust system had a previously known leak or a tail pipe that exited at the rear rather than at the side of the pickup truck. CONCLUSIONS - Carbon monoxide poisoning is a significant hazard for children who ride in the back of pickup trucks. If possible, this practice should be avoided.

Employee retention: an issue of survival in healthcare.

PubMed

Collins, Sandra K; Collins, Kevin S

2004-01-01

Successful healthcare organizations emphasize attracting human resource assets and aggressively seek to resolve and prevent high employee turnover. Understanding the key components surrounding the importance of measuring employee turnover, learning how it affects patient care, and realizing what is needed to retain quality employees is central to the resolution. Measuring employee turnover in a healthcare department is fundamental to the success of the organization and the quality of care it delivers. Some studies indicate the cost of turnover can average 150% of the employee's annual salary. Furthermore, when employees leave, their duties are shifted to the remaining personnel who feel obligated to shoulder the additional burden. The most important impact of employee turnover may be the effect on patient care. Generally, all patients prefer to be cared for by the same members of a healthcare team each time they require treatment. This involves building relationships between the patients and their respective healthcare organizations. These relationships are important to the success of the facility, especially in cases where the same treatment/care can be received elsewhere. Creating an organizational environment that is dedicated to the retention of talented personnel is the first step in reducing employee turnover. Determining why employees are leaving an organization is an important part of developing an effective strategy. One way this information can be obtained is by conducting detailed exit interviews. Organizations should focus on the following issues in order to maintain their qualified workforce in the long term: communication; decision making; compensation, benefits, and career development; recruitment; appreciation and understanding; and management.

Choice architecture to promote fruit and vegetable purchases by families participating in the Special Supplemental Program for Women, Infants, and Children (WIC): randomized corner store pilot study.

PubMed

Thorndike, Anne N; Bright, Oliver-John M; Dimond, Melissa A; Fishman, Ronald; Levy, Douglas E

2017-05-01

To conduct a pilot study to determine if improving the visibility and quality of fresh produce (choice architecture) in corner stores would increase fruit/vegetable purchases by families participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Six stores were randomly assigned to choice architecture intervention or control. Store-level WIC sales data were provided by the state. Primary outcomes were WIC fruit/vegetable voucher and non-fruit/vegetable voucher sales, comparing trends from baseline (December 2012-October 2013) with the five-month intervention period (December 2013-April 2014). Secondary outcomes were differences in customer self-reported fruit/vegetable purchases between baseline and end of the intervention. Chelsea, MA, USA, a low-income urban community. Adult customers (n 575) completing store exit interviews. During baseline, WIC fruit/vegetable and non-fruit/vegetable sales decreased in both intervention and control stores by $US 16/month. During the intervention period, WIC fruit/vegetable sales increased in intervention stores by $US 40/month but decreased in control stores by $US 23/month (difference in trends: $US 63/month; 95 % CI 4, 121 $US/month; P=0·036); WIC non-fruit/vegetable sales were not different (P=0·45). Comparing baseline and intervention-period exit interview responses by customers participating in WIC (n 134), intervention store customers reported increased fruit/vegetable purchases compared with control store customers (18 v. -2 %), but this did not achieve statistical significance (P=0·11). Placement of fruits/vegetables near the front of corner stores increased purchase of produce by customers using WIC. New policies that incentivize stores to stock and prominently display good-quality produce could promote healthier food choices of low-income families.

Evaluation of service quality in family planning clinics in Lusaka, Zambia.

PubMed

Hancock, Nancy L; Vwalika, Bellington; Sitali, Elizabeth Siyama; Mbwili-Muleya, Clara; Chi, Benjamin H; Stuart, Gretchen S

2015-10-01

To determine the quality of contraceptive services in family planning clinics in Lusaka, Zambia, using a standardized approach. We utilized the Quick Investigation of Quality, a cross-sectional survey tool consisting of a facility assessment, client-provider observation and client exit interview, in public-sector family planning clinics. Data were collected on availability of seven contraceptive methods, information given to clients, interpersonal relations between providers and clients, providers' technical competence and mechanisms for continuity and follow-up. Data were collected from five client-provider observations and client exit interviews in each of six public-sector family planning clinics. All clinics had at least two contraceptive methods continuously available for the preceding 6 months. Most providers asked clients about concerns with their contraceptive method (80%) and told clients when to return to the clinic (87%). Most clients reported that the provider advised what to do if a problem develops (93%), described possible side effects (89%), explained how to use the method effectively (85%) and told them when to come for follow-up (83%). Clients were satisfied with services received (93%). This application of the Quick Investigation of Quality showed that the participating family planning clinics in Lusaka, Zambia, were prepared to offer high-quality services with the available commodities and that clients were satisfied with the received services. Despite the subjective client satisfaction, quality improvement efforts are needed to increase contraceptive availability. Although clients perceived the quality of care received to be high, family planning service quality could be improved to continuously offer the full spectrum of contraceptive options. The Quick Investigation of Quality was easily implemented in Lusaka, Zambia, and this simple approach could be utilized in a variety of settings as a modality for quality improvement. Copyright © 2015 Elsevier Inc. All rights reserved.

Improving childhood malaria treatment and referral practices by training patent medicine vendors in rural south-east Nigeria

PubMed Central

2009-01-01

Background Malaria remains a major cause of morbidity and mortality among children under five years of age in Nigeria. Most of the early treatments for fever and malaria occur through self-medication with anti-malarials bought over-the-counter (OTC) from untrained drug vendors. Self-medication through drug vendors can be ineffective, with increased risks of drug toxicity and development of drug resistance. Global malaria control initiatives highlights the potential role of drug vendors to improve access to early effective malaria treatment, which underscores the need for interventions to improve treatment obtained from these outlets. This study aimed to determine the feasibility and impact of training rural drug vendors on community-based malaria treatment and advice with referral of severe cases to a health facility. Methods A drug vendor-training programme was carried out between 2003 and 2005 in Ugwuogo-Nike, a rural community in south-east Nigeria. A total of 16 drug vendors were trained and monitored for eight months. The programme was evaluated to measure changes in drug vendor practice and knowledge using exit interviews. In addition, home visits were conducted to measure compliance with referral. Results The intervention achieved major improvements in drug selling and referral practices and knowledge. Exit interviews confirmed significant increases in appropriate anti-malarial drug dispensing, correct history questions asked and advice given. Improvements in malaria knowledge was established and 80% compliance with referred cases was observed during the study period, Conclusion The remarkable change in knowledge and practices observed indicates that training of drug vendors, as a means of communication in the community, is feasible and strongly supports their inclusion in control strategies aimed at improving prompt effective treatment of malaria with referral of severe cases. PMID:19930561

Improving childhood malaria treatment and referral practices by training patent medicine vendors in rural south-east Nigeria.

PubMed

Okeke, Theodora A; Uzochukwu, Benjamin S C

2009-11-20

Malaria remains a major cause of morbidity and mortality among children under five years of age in Nigeria. Most of the early treatments for fever and malaria occur through self-medication with anti-malarials bought over-the-counter (OTC) from untrained drug vendors. Self-medication through drug vendors can be ineffective, with increased risks of drug toxicity and development of drug resistance. Global malaria control initiatives highlights the potential role of drug vendors to improve access to early effective malaria treatment, which underscores the need for interventions to improve treatment obtained from these outlets. This study aimed to determine the feasibility and impact of training rural drug vendors on community-based malaria treatment and advice with referral of severe cases to a health facility. A drug vendor-training programme was carried out between 2003 and 2005 in Ugwuogo-Nike, a rural community in south-east Nigeria. A total of 16 drug vendors were trained and monitored for eight months. The programme was evaluated to measure changes in drug vendor practice and knowledge using exit interviews. In addition, home visits were conducted to measure compliance with referral. The intervention achieved major improvements in drug selling and referral practices and knowledge. Exit interviews confirmed significant increases in appropriate anti-malarial drug dispensing, correct history questions asked and advice given. Improvements in malaria knowledge was established and 80% compliance with referred cases was observed during the study period, The remarkable change in knowledge and practices observed indicates that training of drug vendors, as a means of communication in the community, is feasible and strongly supports their inclusion in control strategies aimed at improving prompt effective treatment of malaria with referral of severe cases.

Coping and compromise: a qualitative study of how primary health care providers respond to health reform in China.

PubMed

Zhang, Mingji; Wang, Wei; Millar, Ross; Li, Guohong; Yan, Fei

2017-08-04

Health reform in China since 2009 has emphasized basic public health services to enhance the function of Community Health Services as a primary health care facility. A variety of studies have documented these efforts, and the challenges these have faced, yet up to now the experience of primary health care (PHC) providers in terms of how they have coped with these changes remains underdeveloped. Despite the abundant literature on psychological coping processes and mechanisms, the application of coping research within the context of human resources for health remains yet to be explored. This research aims to understand how PHC providers coped with the new primary health care model and the job characteristics brought about by these changes. Semi-structured interviews with primary health care workers were conducted in Jinan city of Shandong province in China. A maximum variation sampling method selected 30 PHC providers from different specialties. Thematic analysis was used drawing on a synthesis of theories related to the Job Demands-Resources model, work adjustment, and the model of exit, voice, loyalty and neglect to understand PHC providers' coping strategies. Our interviews identified that the new model of primary health care significantly affected the nature of primary health work and triggered a range of PHC providers' coping processes. The results found that health workers perceived their job as less intensive than hospital medical work but often more trivial, characterized by heavy workload, blurred job description, unsatisfactory income, and a lack of professional development. However, close relationship with community and low work pressure were satisfactory. PHC providers' processing of job demands and resources displayed two ways of interaction: aggravation and alleviation. Processing of job demands and resources led to three coping strategies: exit, passive loyalty, and compromise with new roles and functions. Primary health care providers employed coping strategies of exit, passive loyalty, and compromise to deal with changes in primary health work. In light of these findings, our paper concludes that it is necessary for the policymakers to provide further job resources for CHS, and involve health workers in policy-making. The introduction of particular professional training opportunities to support job role orientation for PHC providers is advocated.

Patient satisfaction and perceived quality of care: evidence from a cross-sectional national exit survey of HIV and non-HIV service users in Zambia.

PubMed

Dansereau, Emily; Masiye, Felix; Gakidou, Emmanuela; Masters, Samuel H; Burstein, Roy; Kumar, Santosh

2015-12-30

To examine the associations between perceived quality of care and patient satisfaction among HIV and non-HIV patients in Zambia. Patient exit survey conducted at 104 primary, secondary and tertiary health clinics across 16 Zambian districts. 2789 exiting patients. Five dimensions of perceived quality of care (health personnel practice and conduct, adequacy of resources and services, healthcare delivery, accessibility of care, and cost of care). Respondent, visit-related, and facility characteristics. Patient satisfaction measured on a 1-10 scale. Indices of perceived quality of care were modelled using principal component analysis. Statistical associations between perceived quality of care and patient satisfaction were examined using random-effect ordered logistic regression models, adjusting for demographic, socioeconomic, visit and facility characteristics. Average satisfaction was 6.9 on a 10-point scale for non-HIV services and 7.3 for HIV services. Favourable perceptions of health personnel conduct were associated with higher odds of overall satisfaction for non-HIV (OR=3.53, 95% CI 2.34 to 5.33) and HIV (OR=11.00, 95% CI 3.97 to 30.51) visits. Better perceptions of resources and services were also associated with higher odds of satisfaction for both non-HIV (OR=1.66, 95% CI 1.08 to 2.55) and HIV (OR=4.68, 95% CI 1.81 to 12.10) visits. Two additional dimensions of perceived quality of care--healthcare delivery and accessibility of care--were positively associated with higher satisfaction for non-HIV patients. The odds of overall satisfaction were lower in rural facilities for non-HIV patients (OR 0.69; 95% CI 0.48 to 0.99) and HIV patients (OR=0.26, 95% CI 0.16 to 0.41). For non-HIV patients, the odds of satisfaction were greater in hospitals compared with health centres/posts (OR 1.78; 95% CI 1.27 to 2.48) and lower at publicly-managed facilities (OR=0.41, 95% CI=0.27 to 0.64). Perceived quality of care is an important driver of patient satisfaction with health service delivery in Zambia. 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/

Phases-of-illness paradigm: better communication, better outcomes

DTIC Science & Technology

2011-11-28

ILP) 2. Hold continuous sedation at 0600 ( nurse ) 3. Notify RT when the patient is ‘awake’ ( nurse ) 4. Perform breathing trial (RT) CVP, central...recovery phases. Patients transitioned to palliative care would exit this model into a palliative care ‘phase’ that is distinct because it is blind...patient-driven standardization of supportive care elements, such as types of monitoring, frequency and type of laboratory assessment, sedation

Patient-centered communication and health assessment with youth.

PubMed

Martyn, Kristy K; Munro, Michelle L; Darling-Fisher, Cynthia S; Ronis, David L; Villarruel, Antonia M; Pardee, Michelle; Faleer, Hannah E; Fava, Nicole M

2013-01-01

Patient-centered communication is fundamental to individualizing healthcare, but there has been limited evaluation of provider communication with youth. The aim was to compare communication outcomes after use of an event history calendar (EHC) and Guidelines for Adolescent Preventive Services (GAPS) to structure interactions during a clinic visit. Patient and provider descriptions of EHC and GAPS communication experiences were also obtained. This is a secondary analysis of data obtained during a randomized controlled trial. A sequential explanatory mixed-methods approach was used. A split-plot design with one between factor (EHC, GAPS) and one within factor (pretest, posttest) was used for the quantitative portion. Qualitative data were collected from open-ended questions, audiotaped visits, and exit interviews. Providers (n = 9) at three clinics were assigned at random and trained to implement either the EHC or GAPS protocol. Male and female youth (n = 186) were randomly assigned to the EHC or GAPS intervention. Before their clinic visit, youth completed assessments of past communication experiences with healthcare providers (pretest); communication during the current visit was assessed immediately after the visit (posttest). Communication outcomes from pretest to posttest improved for youth in both the EHC and GAPS groups. Post hoc subgroup analysis suggested that men and Arab Americans derived more benefit from the EHC intervention in some aspects of communication. Qualitatively, the EHC group identified improved outcomes in validating patient perspective, being viewed in context, reaching a shared understanding of needs and preferences, and being helped to share power in the healthcare interaction. EHC and GAPS provided effective frameworks for structuring communication during a clinic visit. Compared with GAPS, the integrated time-linked assessment captured by the EHC enhanced patient-centered communication in select groups.

Electronic patient-reported outcomes from home in patients recovering from major gynecologic cancer surgery: A prospective study measuring symptoms and health-related quality of life.

PubMed

Cowan, Renee A; Suidan, Rudy S; Andikyan, Vaagn; Rezk, Youssef A; Einstein, M Heather; Chang, Kaity; Carter, Jeanne; Zivanovic, Oliver; Jewell, Elizabeth J; Abu-Rustum, Nadeem R; Basch, Ethan; Chi, Dennis S

2016-11-01

We previously reported on the feasibility of a Web-based system to capture patient-reported outcomes (PROs) in the immediate postoperative period. The purpose of this study was to update the experience of these patients and assess patient and provider satisfaction and feedback regarding the system. This is a prospective cohort study of patients scheduled to undergo laparotomy for presumed gynecologic malignancy. Patients completed a Web-based Symptom Tracking and Reporting (STAR) questionnaire preoperatively and weekly during a 6-week postoperative period. Email alerts were sent to study nurses when concerning patient responses were entered. The patient and the nurse assessments of STAR's usefulness were measured via an exit survey. The study enrolled 96 eligible patients. Of these, 71 patients (74%) completed at least four of seven total sessions. Of the patients who completed the exit satisfaction survey, 98% found STAR easy to use; 84% found it useful; and 82% would recommend it to other patients. Despite positive feedback from patients, clinical personnel found that the STAR system increased their current workload without enhancing patient care. Application of an electronic program for PROs in those recovering from major gynecologic cancer surgery is feasible, and acceptable to most patients. While most clinicians did not find STAR clinically helpful, the majority of patients reported a positive experience with the system and would recommend its use. The program helped many patients feel more empowered in their postoperative recovery. Copyright © 2016 Elsevier Inc. All rights reserved.

KNOWLEDGE, ATTITUDE AND PERCEPTION REGARDING ANTIBIOTICS AMONG POLISH PATIENTS.

PubMed

2015-01-01

Antibiotics are drugs often used. This drugs used without legitimate indications or incorrectly may cause not satisfactory clinical results. It is therefore important for the society members to be aware of what is an antibiotic and which benefits and risks its use may bring. The survey was conducted in 2010. Objective of the study was to obtain information on the current knowledge and beliefs about antibiotic therapy of Poles. The research material consisted of 609 questionnaires and interviews, conducted among the adult population residing in the Lublin voivodeship. The study shows that rural inhabitants don't know the term herbal medicine or antibiotic more often than inhabitants in the city. Similarly, they more often don't know the action of antibiotics as well as use them less frequently. Poles treat them as an emergency exit if they are not helped by home treatments. There was a problem of overuse of antibiotics, related to young people, which were busy and have no time for illness. Self-medication in the antibiotic therapy also occurs and is caused, among others, by undisciplined patients. The respondents admited that they have antibiotics from the previous treatment, from pharmacy, or from family or friends. However, residents of rural areas using an antibiotic most frequently, cited a pharmacy as the source of this drug. Other issues dealt within this study generally doesn't differ for rural inhabitants from the data obtained among the urban population.

SU-F-T-300: Impact of Electron Density Modeling of ArcCHECK Cylindricaldiode Array On 3DVH Patient Specific QA Software Tool Analysis

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

Patwe, P; Mhatre, V; Dandekar, P

Purpose: 3DVH software is a patient specific quality assurance tool which estimates the 3D dose to the patient specific geometry with the help of Planned Dose Perturbation algorithm. The purpose of this study is to evaluate the impact of HU value of ArcCHECK phantom entered in Eclipse TPS on 3D dose & DVH QA analysis. Methods: Manufacturer of ArcCHECK phantom provides CT data set of phantom & recommends considering it as a homogeneous phantom with electron density (1.19 gm/cc or 282 HU) close to PMMA. We performed this study on Eclipse TPS (V13, VMS) & trueBEAM STx VMS Linac &more » ArcCHECK phantom (SNC). Plans were generated for 6MV photon beam, 20cm×20cm field size at isocentre & SPD (Source to phantom distance) of 86.7 cm to deliver 100cGy at isocentre. 3DVH software requires patients DICOM data generated by TPS & plan delivered on ArcCHECK phantom. Plans were generated in TPS by assigning different HU values to phantom. We analyzed gamma index & the dose profile for all plans along vertical down direction of beam’s central axis for Entry, Exit & Isocentre dose. Results: The global gamma passing rate (2% & 2mm) for manufacturer recommended HU value 282 was 96.3%. Detector entry, Isocentre & detector exit Doses were 1.9048 (1.9270), 1.00(1.0199) & 0.5078(0.527) Gy for TPS (Measured) respectively.The global gamma passing rate for electron density 1.1302 gm/cc was 98.6%. Detector entry, Isocentre & detector exit Doses were 1.8714 (1.8873), 1.00(0.9988) & 0.5211(0.516) Gy for TPS (Measured) respectively. Conclusion: Electron density value assigned by manufacturer does not hold true for every user. Proper modeling of electron density of ArcCHECK in TPS is essential to avoid systematic error in dose calculation of patient specific QA.« less

Responding to Young People's Health Risks in Primary Care: A Cluster Randomised Trial of Training Clinicians in Screening and Motivational Interviewing.

PubMed

Sanci, Lena; Chondros, Patty; Sawyer, Susan; Pirkis, Jane; Ozer, Elizabeth; Hegarty, Kelsey; Yang, Fan; Grabsch, Brenda; Shiell, Alan; Cahill, Helen; Ambresin, Anne-Emmanuelle; Patterson, Elizabeth; Patton, George

2015-01-01

To evaluate the effectiveness of a complex intervention implementing best practice guidelines recommending clinicians screen and counsel young people across multiple psychosocial risk factors, on clinicians' detection of health risks and patients' risk taking behaviour, compared to a didactic seminar on young people's health. Pragmatic cluster randomised trial where volunteer general practices were stratified by postcode advantage or disadvantage score and billing type (private, free national health, community health centre), then randomised into either intervention or comparison arms using a computer generated random sequence. Three months post-intervention, patients were recruited from all practices post-consultation for a Computer Assisted Telephone Interview and followed up three and 12 months later. Researchers recruiting, consenting and interviewing patients and patients themselves were masked to allocation status; clinicians were not. General practices in metropolitan and rural Victoria, Australia. General practices with at least one interested clinician (general practitioner or nurse) and their 14-24 year old patients. This complex intervention was designed using evidence based practice in learning and change in clinician behaviour and general practice systems, and included best practice approaches to motivating change in adolescent risk taking behaviours. The intervention involved training clinicians (nine hours) in health risk screening, use of a screening tool and motivational interviewing; training all practice staff (receptionists and clinicians) in engaging youth; provision of feedback to clinicians of patients' risk data; and two practice visits to support new screening and referral resources. Comparison clinicians received one didactic educational seminar (three hours) on engaging youth and health risk screening. Primary outcomes were patient report of (1) clinician detection of at least one of six health risk behaviours (tobacco, alcohol and illicit drug use, risks for sexually transmitted infection, STI, unplanned pregnancy, and road risks); and (2) change in one or more of the six health risk behaviours, at three months or at 12 months. Secondary outcomes were likelihood of future visits, trust in the clinician after exit interview, clinician detection of emotional distress and fear and abuse in relationships, and emotional distress at three and 12 months. Patient acceptability of the screening tool was also described for the intervention arm. Analyses were adjusted for practice location and billing type, patients' sex, age, and recruitment method, and past health risks, where appropriate. An intention to treat analysis approach was used, which included multilevel multiple imputation for missing outcome data. 42 practices were randomly allocated to intervention or comparison arms. Two intervention practices withdrew post allocation, prior to training, leaving 19 intervention (53 clinicians, 377 patients) and 21 comparison (79 clinicians, 524 patients) practices. 69% of patients in both intervention (260) and comparison (360) arms completed the 12 month follow-up. Intervention clinicians discussed more health risks per patient (59.7%) than comparison clinicians (52.7%) and thus were more likely to detect a higher proportion of young people with at least one of the six health risk behaviours (38.4% vs 26.7%, risk difference [RD] 11.6%, Confidence Interval [CI] 2.93% to 20.3%; adjusted odds ratio [OR] 1.7, CI 1.1 to 2.5). Patients reported less illicit drug use (RD -6.0, CI -11 to -1.2; OR 0.52, CI 0.28 to 0.96), and less risk for STI (RD -5.4, CI -11 to 0.2; OR 0.66, CI 0.46 to 0.96) at three months in the intervention relative to the comparison arm, and for unplanned pregnancy at 12 months (RD -4.4; CI -8.7 to -0.1; OR 0.40, CI 0.20 to 0.80). No differences were detected between arms on other health risks. There were no differences on secondary outcomes, apart from a greater detection of abuse (OR 13.8, CI 1.71 to 111). There were no reports of harmful events and intervention arm youth had high acceptance of the screening tool. A complex intervention, compared to a simple educational seminar for practices, improved detection of health risk behaviours in young people. Impact on health outcomes was inconclusive. Technology enabling more efficient, systematic health-risk screening may allow providers to target counselling toward higher risk individuals. Further trials require more power to confirm health benefits. ISRCTN.com ISRCTN16059206.

The use of computer simulations in whole-class versus small-group settings

NASA Astrophysics Data System (ADS)

Smetana, Lara Kathleen

This study explored the use of computer simulations in a whole-class as compared to small-group setting. Specific consideration was given to the nature and impact of classroom conversations and interactions when computer simulations were incorporated into a high school chemistry course. This investigation fills a need for qualitative research that focuses on the social dimensions of actual classrooms. Participants included a novice chemistry teacher experienced in the use of educational technologies and two honors chemistry classes. The study was conducted in a rural school in the south-Atlantic United States at the end of the fall 2007 semester. The study took place during one instructional unit on atomic structure. Data collection allowed for triangulation of evidence from a variety of sources approximately 24 hours of video- and audio-taped classroom observations, supplemented with the researcher's field notes and analytic journal; miscellaneous classroom artifacts such as class notes, worksheets, and assignments; open-ended pre- and post-assessments; student exit interviews; teacher entrance, exit and informal interviews. Four web-based simulations were used, three of which were from the ExploreLearning collection. Assessments were analyzed using descriptive statistics and classroom observations, artifacts and interviews were analyzed using Erickson's (1986) guidelines for analytic induction. Conversational analysis was guided by methods outlined by Erickson (1982). Findings indicated (a) the teacher effectively incorporated simulations in both settings (b) students in both groups significantly improved their understanding of the chemistry concepts (c) there was no statistically significant difference between groups' achievement (d) there was more frequent exploratory talk in the whole-class group (e) there were more frequent and meaningful teacher-student interactions in the whole-class group (f) additional learning experiences not measured on the assessment resulted from conversations and interactions in the whole-class setting (g) the potential benefits of exploratory talk in the whole-class setting were not fully realized. These findings suggest that both whole-class and small-group settings are appropriate for using computer simulations in science. The effective incorporation of simulations into whole-class instruction may provide a solution to the dilemma of technology penetration versus integration in today's classrooms.

Increased access to care and appropriateness of treatment at private sector drug shops with integrated management of malaria, pneumonia and diarrhoea: a quasi-experimental study in Uganda.

PubMed

Awor, Phyllis; Wamani, Henry; Tylleskar, Thorkild; Jagoe, George; Peterson, Stefan

2014-01-01

Drug shops are a major source of care for children in low income countries but they provide sub-standard care. We assessed the feasibility and effect on quality of care of introducing diagnostics and pre-packaged paediatric-dosage drugs for malaria, pneumonia and diarrhoea at drug shops in Uganda. We adopted and implemented the integrated community case management (iCCM) intervention within registered drug shops. Attendants were trained to perform malaria rapid diagnostic tests (RDTs) in each fever case and count respiratory rate in each case of cough with fast/difficult breathing, before dispensing recommended treatment. Using a quasi-experimental design in one intervention and one non-intervention district, we conducted before and after exit interviews for drug seller practices and household surveys for treatment-seeking practices in May-June 2011 and May-June 2012. Survey adjusted generalized linear models and difference-in-difference analysis was used. 3759 (1604 before/2155 after) household interviews and 943 (163 before/780 after) exit interviews were conducted with caretakers of children under-5. At baseline, no child at a drug shop received any diagnostic testing before treatment in both districts. After the intervention, while no child in the non-intervention district received a diagnostic test, 87.7% (95% CI 79.0-96.4) of children with fever at the intervention district drug shops had a parasitological diagnosis of malaria, prior to treatment. The prevalence ratios of the effect of the intervention on treatment of cough and fast breathing with amoxicillin and diarrhoea with ORS/zinc at the drug shop were 2.8 (2.0-3.9), and 12.8 (4.2-38.6) respectively. From the household survey, the prevalence ratio of the intervention effect on use of RDTs was 3.2 (1.9-5.4); Artemisinin Combination Therapy for malaria was 0.74 (0.65-0.84), and ORS/zinc for diarrhoea was 2.3 (1.2-4.7). iCCM can be utilized to improve access and appropriateness of care for children at drug shops.

TU-AB-303-09: Investigation of Simple Method to Guide Adaptive Radiotherapy of Head-And-Neck Treatment Using Portal Imager

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

Al Etreby, M; Elshemey, W; El Sherbini, N

2015-06-15

Purpose: Planned dose distribution for IMRT or VMAT could be altered by tissue changes during treatment course as in head and neck patients. Thus the aim of our study is to investigate a simple method that guides decision for re-planning. We will correlate changes in exit fluence tracked through entire treatment course with the anatomical changes. Methods: Fifteen patients were planned for IMRT; weekly CT scan was registered to original CT. Volume changes of different structures were assessed for each week. Frequently integrated images were acquired for all fields twice weekly via portal imager. The delivered fluences were compared withmore » reference images. Gamma analysis (3% and 3 mm) including maximum γ, and percentage of points with γ≥ 1, were calculated for all fields. Results: Continuous reduction in GTV, CTV1 and parotids volumes during treatment was found [median value of 5.3 (1.3–20.8), 23.8 (3.0–128.7) and 1.7 (0.5–6.3) cm3 respectively] with significant change on week 2 (p= < 0.005). Also the value of gamma area >1 parameter continued to increase, significantly (P < 0.005), starting from second week (1.8 ± 1.9%) reaching 4.1 ± 1.6% by the end of treatment. Most of these changes in the exit fluences are significantly correlated to patient anatomy variations. Pearson correlation coefficient was −0.984 (P = 0.002) and −0.984 (P = 0.014) for the maximum gamma value and the value of gamma area >1, respectively. Conclusion: The changes in exit fluences are reflecting the corresponding anatomical changes. We proposed a method to track the changes in the averaged maximum gamma value and the gamma area > 1 value for the exit fluences during treatment. Maximum gamma value of 2.6% and Maximum gamma area > 1 value of 1.8% would be useful boarder lines that if exceeded a re-planning would be recommended.« less

29 CFR 1917.122 - Employee exits.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 7 2010-07-01 2010-07-01 false Employee exits. 1917.122 Section 1917.122 Labor Regulations...) MARINE TERMINALS Terminal Facilities § 1917.122 Employee exits. (a) Employee exits shall be clearly marked. (b) If an employee exit is not visible from employees' work stations, directional signs...

Advanced Diesel Oil Fuel Processor Development

DTIC Science & Technology

1986-06-01

water exit 29 sample quencher: gas sample line inlet 30 sample quencher: gas sample line exit 31 sample quencher: cooling water inlet 32 desulfuriser ...exit line 33, 34 desulfurimer 35 heat exchanger: process gas exit (to desulfuriser ) 38 shift reactor inlet (top) 37 shift reactor: cooling air exit

Time and Money: The True Costs of Health Care Utilization for Patients Receiving "Free" HIV/Tuberculosis Care and Treatment in Rural KwaZulu-Natal.

PubMed

Chimbindi, Natsayi; Bor, Jacob; Newell, Marie-Louise; Tanser, Frank; Baltussen, Rob; Hontelez, Jan; de Vlas, Sake J; Lurie, Mark; Pillay, Deenan; Bärnighausen, Till

2015-10-01

HIV and tuberculosis (TB) services are provided free of charge in many sub-Saharan African countries, but patients still incur costs. Patient-exit interviews were conducted in primary health care clinics in rural South Africa with representative samples of 200 HIV-infected patients enrolled in a pre-antiretroviral treatment (pre-ART) program, 300 patients receiving antiretroviral treatment (ART), and 300 patients receiving TB treatment. For each group, we calculated health expenditures across different spending categories, time spent traveling to and using services, and how patients financed their spending. Associations between patient group and costs were assessed in multivariate regression models. Total monthly health expenditures [1 USD = 7.3 South African Rand (ZAR)] were ZAR 171 [95% confidence interval (CI): 134 to 207] for pre-ART, ZAR 164 (95% CI: 141 to 187) for ART, and ZAR 122 (95% CI: 105 to 140) for TB patients (P = 0.01). Total monthly time costs (in hours) were 3.4 (95% CI: 3.3 to 3.5) for pre-ART, 5.0 (95% CI: 4.7 to 5.3) for ART, and 3.2 (95% CI: 2.9 to 3.4) for TB patients (P < 0.01). Although overall patient costs were similar across groups, pre-ART patients spent on average ZAR 29.2 more on traditional healers and ZAR 25.9 more on chemists and private doctors than ART patients, whereas ART patients spent ZAR 34.0 more than pre-ART patients on transport to clinics (P < 0.05 for all results). Thirty-one percent of pre-ART, 39% of ART, and 41% of TB patients borrowed money or sold assets to finance health care. Patients receiving nominally free care for HIV/TB face large private costs, commonly leading to financial distress. Subsidized transport, fewer clinic visits, and drug pick-up points closer to home could reduce costs for ART patients, potentially improving retention and adherence. Large expenditure on alternative care among pre-ART patients suggests that transitioning patients to ART earlier, as under HIV treatment-as-prevention policies, may not substantially increase patients' financial burden.

Time and money: the true costs of health care utilization for patients receiving ‘free’ HIV/TB care and treatment in rural KwaZulu-Natal

PubMed Central

Chimbindi, Natsayi; Bor, Jacob; Newell, Marie-Louise; Tanser, Frank; Baltusen, Rob; Hontelez, Jan; de Vlas, Sake; Lurie, Mark; Pillay, Deenan; Bärnighausen, Till

2015-01-01

Background HIV and TB services are provided free-of-charge in many sub-Saharan African countries, but patients still incur costs. Methods Patient-exit interviews were conducted with a representative sample of 200 HIV-infected patients not yet on ART (pre-ART), 300 ART patients, and 300 TB patients receiving public sector care in rural South Africa. For each group, we calculated health expenditures across different spending categories, time spent traveling to and utilizing services, and how patients financed their spending. Associations between patient group and costs were assessed in multivariate regression models. Results Total monthly health expenditures (1 USD = 7.3 South African Rand, ZAR) were: ZAR 171 (95% CI 134, 207) for pre-ART, ZAR 164 (95% CI 141, 187) for ART, and ZAR 122 (95% CI 105, 140) for TB patients (p=0.01). Total monthly time costs (in hours) were: 3.4 (95% CI 3.3, 3.5) for pre-ART, 5.0 (95% CI 4.7, 5.3) for ART and 3.2 (95% CI 2.9, 3.4) for TB patients (p<0.01). Though overall patient costs were similar across groups, pre-ART patients spent on average ZAR 29.2 more on traditional healers and ZAR 25.9 more on chemists and private doctors than ART patients, while ART patients spent ZAR 34.0 more than pre-ART patients on transport to clinics (p<0.05 for all results). 31% of pre-ART, 39% of ART and 41% of TB patients borrowed money or sold assets to finance health costs. Conclusions Patients receiving nominally free care for HIV/TB face large private costs, commonly leading to financial distress. Subsidized transport, fewer clinic visits, and drug pickup points closer to home could reduce costs for ART patients, potentially improving retention and adherence. Large expenditure on alternative care among pre-ART patients suggests that transitioning patients to ART earlier, as under HIV treatment-as-prevention policies, may not substantially increase patients’ financial burden. PMID:26371611

The effect of contact precautions on healthcare worker activity in acute care hospitals.

PubMed

Morgan, Daniel J; Pineles, Lisa; Shardell, Michelle; Graham, Margaret M; Mohammadi, Shahrzad; Forrest, Graeme N; Reisinger, Heather S; Schweizer, Marin L; Perencevich, Eli N

2013-01-01

Contact precautions are a cornerstone of infection prevention but have also been associated with less healthcare worker (HCW) contact and adverse events. We studied how contact precautions modified HCW behavior in 4 acute care facilities. Prospective cohort study. Four acute care facilities in the United States performing active surveillance for methicillin-resistant Staphylococcus aureus. Trained observers performed "secret shopper" monitoring of HCW activities during routine care, using a standardized collection tool and fixed 1-hour observation periods. A total of 7,743 HCW visits were observed over 1,989 hours. Patients on contact precautions had 36.4% fewer hourly HCW visits than patients not on contact precautions (2.78 vs 4.37 visits per hour; [Formula: see text]) as well as 17.7% less direct patient contact time with HCWs (13.98 vs 16.98 minutes per hour; [Formula: see text]). Patients on contact precautions tended to have fewer visitors (23.6% fewer; [Formula: see text]). HCWs were more likely to perform hand hygiene on exiting the room of a patient on contact precautions (63.2% vs 47.4% in rooms of patients not on contact precautions; [Formula: see text]). Contact precautions were found to be associated with activities likely to reduce transmission of resistant pathogens, such as fewer visits and better hand hygiene at exit, while exposing patients on contact precautions to less HCW contact, less visitor contact, and potentially other unintended outcomes.

Health facility committees and facility management - exploring the nature and depth of their roles in Coast Province, Kenya

PubMed Central

2011-01-01

Background Community participation has been emphasized internationally as a way of enhancing accountability, as well as a means to enhance health goals in terms of coverage, access and effective utilization. In rural health facilities in Kenya, initiatives to increase community accountability have focused on Health Facility Committees (HFCs). In Coast Province the role of HFCs has been expanded with the introduction of direct funding of rural facilities. We explored the nature and depth of managerial engagement of HFCs at the facility level in two rural districts in this Coastal setting, and how this has contributed to community accountability Methods We conducted structured interviews with the health worker in-charge and with patients in 30 health centres and dispensaries. These data were supplemented with in-depth interviews with district managers, and with health workers and HFC members in 12 health centres and dispensaries. In-depth interviews with health workers and HFC members included a participatory exercise to stimulate discussion of the nature and depth of their roles in facility management. Results HFCs were generally functioning well and played an important role in facility operations. The breadth and depth of engagement had reportedly increased after the introduction of direct funding of health facilities which allowed HFCs to manage their own budgets. Although relations with facility staff were generally good, some mistrust was expressed between HFC members and health workers, and between HFC members and the broader community, partially reflecting a lack of clarity in HFC roles. Moreover, over half of exit interviewees were not aware of the HFC's existence. Women and less well-educated respondents were particularly unlikely to know about the HFC. Conclusions There is potential for HFCs to play an active and important role in health facility management, particularly where they have control over some facility level resources. However, to optimise their contribution, efforts are needed to improve their training, clarify their roles, and improve engagement with the wider community. PMID:21936958

Health facility committees and facility management - exploring the nature and depth of their roles in Coast Province, Kenya.

PubMed

Goodman, Catherine; Opwora, Antony; Kabare, Margaret; Molyneux, Sassy

2011-09-22

Community participation has been emphasized internationally as a way of enhancing accountability, as well as a means to enhance health goals in terms of coverage, access and effective utilization. In rural health facilities in Kenya, initiatives to increase community accountability have focused on Health Facility Committees (HFCs). In Coast Province the role of HFCs has been expanded with the introduction of direct funding of rural facilities. We explored the nature and depth of managerial engagement of HFCs at the facility level in two rural districts in this Coastal setting, and how this has contributed to community accountability We conducted structured interviews with the health worker in-charge and with patients in 30 health centres and dispensaries. These data were supplemented with in-depth interviews with district managers, and with health workers and HFC members in 12 health centres and dispensaries. In-depth interviews with health workers and HFC members included a participatory exercise to stimulate discussion of the nature and depth of their roles in facility management. HFCs were generally functioning well and played an important role in facility operations. The breadth and depth of engagement had reportedly increased after the introduction of direct funding of health facilities which allowed HFCs to manage their own budgets. Although relations with facility staff were generally good, some mistrust was expressed between HFC members and health workers, and between HFC members and the broader community, partially reflecting a lack of clarity in HFC roles. Moreover, over half of exit interviewees were not aware of the HFC's existence. Women and less well-educated respondents were particularly unlikely to know about the HFC. There is potential for HFCs to play an active and important role in health facility management, particularly where they have control over some facility level resources. However, to optimise their contribution, efforts are needed to improve their training, clarify their roles, and improve engagement with the wider community.

Effects of nozzle exit geometry and pressure ratio on plume shape for nozzles exhausting into quiescent air

NASA Technical Reports Server (NTRS)

Scallion, William I.

1991-01-01

The effects of varying the exit geometry on the plume shapes of supersonic nozzles exhausting into quiescent air at several exit-to-ambient pressure ratios are given. Four nozzles having circular throat sections and circular, elliptical and oval exit cross sections were tested and the exit plume shapes are compared at the same exit-to-ambient pressure ratios. The resulting mass flows were calculated and are also presented.

Configuring Balanced Scorecards for Measuring Health System Performance: Evidence from 5 Years' Evaluation in Afghanistan

PubMed Central

Edward, Anbrasi; Kumar, Binay; Kakar, Faizullah; Salehi, Ahmad Shah; Burnham, Gilbert; Peters, David H.

2011-01-01

Background In 2004, Afghanistan pioneered a balanced scorecard (BSC) performance system to manage the delivery of primary health care services. This study examines the trends of 29 key performance indicators over a 5-year period between 2004 and 2008. Methods and Findings Independent evaluations of performance in six domains were conducted annually through 5,500 patient observations and exit interviews and 1,500 provider interviews in >600 facilities selected by stratified random sampling in each province. Generalized estimating equation (GEE) models were used to assess trends in BSC parameters. There was a progressive improvement in the national median scores scaled from 0–100 between 2004 and 2008 in all six domains: patient and community satisfaction of services (65.3–84.5, p<0.0001); provider satisfaction (65.4–79.2, p<0.01); capacity for service provision (47.4–76.4, p<0.0001); quality of services (40.5–67.4, p<0.0001); and overall vision for pro-poor and pro-female health services (52.0–52.6). The financial domain also showed improvement until 2007 (84.4–95.7, p<0.01), after which user fees were eliminated. By 2008, all provinces achieved the upper benchmark of national median set in 2004. Conclusions The BSC has been successfully employed to assess and improve health service capacity and service delivery using performance benchmarking during the 5-year period. However, scorecard reconfigurations are needed to integrate effectiveness and efficiency measures and accommodate changes in health systems policy and strategy architecture to ensure its continued relevance and effectiveness as a comprehensive health system performance measure. The process of BSC design and implementation can serve as a valuable prototype for health policy planners managing performance in similar health care contexts. Please see later in the article for the Editors' Summary PMID:21814499

14 CFR 27.805 - Flight crew emergency exits.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 1 2011-01-01 2011-01-01 false Flight crew emergency exits. 27.805 Section... § 27.805 Flight crew emergency exits. (a) For rotorcraft with passenger emergency exits that are not convenient to the flight crew, there must be flight crew emergency exits, on both sides of the rotorcraft or...

14 CFR 29.805 - Flight crew emergency exits.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 1 2011-01-01 2011-01-01 false Flight crew emergency exits. 29.805 Section... Accommodations § 29.805 Flight crew emergency exits. (a) For rotorcraft with passenger emergency exits that are not convenient to the flight crew, there must be flight crew emergency exits, on both sides of the...

14 CFR 29.805 - Flight crew emergency exits.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 1 2014-01-01 2014-01-01 false Flight crew emergency exits. 29.805 Section... Accommodations § 29.805 Flight crew emergency exits. (a) For rotorcraft with passenger emergency exits that are not convenient to the flight crew, there must be flight crew emergency exits, on both sides of the...

14 CFR 27.805 - Flight crew emergency exits.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 1 2014-01-01 2014-01-01 false Flight crew emergency exits. 27.805 Section... § 27.805 Flight crew emergency exits. (a) For rotorcraft with passenger emergency exits that are not convenient to the flight crew, there must be flight crew emergency exits, on both sides of the rotorcraft or...

Integrating Retired Registered Nurses Into a New Graduate Orientation Program.

PubMed

Baldwin, Kathleen M; Black, Denice L; Normand, Lorrie K; Bonds, Patricia; Townley, Melissa

2016-01-01

The project goal of was to decrease new graduate nurse (NGN) attrition during the first year of employment by improving communication skills and providing additional mentoring for NGNs employed in a community hospital located in a rural area. All NGNs participate in the Versant Residency Program. Even with this standardized residency program, exit interviews of NGNs who resigned during their first year of employment revealed 2 major issues: communication problems with patients and staff and perceived lack of support/mentoring from unit staff. A clinical nurse specialist-led nursing team developed an innovative program integrating retired nurses, Volunteer Nurse Ambassadors (VNAs), into the Versant Residency Program to address both of those issues. All NGNs mentored by a retired nurse remain employed in the hospital (100% retention). Before the VNA program, the retention rate was 37.5%. Both the NGNs and VNAs saw value in their mentor-mentee relationship. There have been no critical incidences or failure to rescue events involving NGNs mentored by a VNA. Use of VNAs to support NGNs as they adjust to the staff nurse role can prevent attrition during their first year of nursing practice by providing additional support to the NGN.

Ventricular tachycardia storm originating from interventricular septum successfully treated with surgical cryoablation with electroanatomic and electrophysiological mapping before dual valve replacement.

PubMed

Kawamura, Iwanari; Fukamizu, Seiji; Miyazawa, Satoshi; Hojo, Rintaro; Ito, Fusahiko; Watanabe, Masazumi; Nishizaki, Mitsuhiro; Sakurada, Harumizu; Hiraoka, Masayasu

2018-02-01

A 58-year-old man with dilated cardiomyopathy was admitted with heart failure. He had a history of two catheter ablation procedures for ventricular tachycardia (VT) originating from the intraventricular septum (IVS). Before dual valve replacement (DVR), he suffered a VT storm. An electrophysiological study revealed an extended low-voltage area at the IVS with the exit of the induced VT at the anterior side. Radiofrequency application was performed at the VT exit as a landmark for surgical cryoablation (SA). During the DVR, SA was performed at the IVS using this landmark. After SA, the patient had no ventricular tachyarrhythmia.

Urinary incontinence, depression, and economic outcomes in a cohort of women between the ages of 54 and 65 years.

PubMed

Hung, Kristin J; Awtrey, Christopher S; Tsai, Alexander C

2014-04-01

To estimate the association between urinary incontinence (UI) and probable depression, work disability, and workforce exit. The analytic sample consisted of 4,511 women enrolled in the population-based Health and Retirement Study cohort. The analysis baseline was 1996, the year that questions about UI were added to the survey instrument, and at which time study participants were 54-65 years of age. Women were followed-up with biennial interviews until 2010-2011. Outcomes of interest were onset of probable depression, work disability, and workforce exit. Urinary incontinence was specified in different ways based on questions about experience and frequency of urine loss. We fit Cox proportional hazards regression models to the data, adjusting the estimates for baseline sociodemographic and health status variables previously found to confound the association between UI and the outcomes of interest. At baseline, 727 participants (survey-weighted prevalence, 16.6%; 95% confidence interval [CI] 15.4-18.0) reported any UI, of which 212 (survey-weighted prevalence, 29.2%; 95% CI 25.4-33.3) reported urine loss on more than 15 days in the past month; and 1,052 participants were categorized as having probable depression (survey-weighted prevalence, 21.6%; 95% CI 19.8-23.6). Urinary incontinence was associated with increased risks for probable depression (adjusted hazard ratio, 1.43; 95% CI 1.27-1.62) and work disability (adjusted hazard ratio, 1.21; 95% CI 1.01-1.45), but not workforce exit (adjusted hazard ratio, 1.06; 95% CI 0.93-1.21). In a population-based cohort of women between ages 54 and 65 years, UI was associated with increased risks for probable depression and work disability. Improved diagnosis and management of UI may yield significant economic and psychosocial benefits.

Patient's perceptions of an anesthesia preoperative computerized patient interview.

PubMed

Vitkun, S A; Halpern-Lewis, J G; Williams, S A; Gage, J S; Poppers, P J

1999-12-01

Our desire to elicit a more complete medical history from our patients led to the implementation of a preoperative computerized interview. We previously demonstrated the effectiveness of the interview by computing its mean completion time for the overall patient population (n = 120), and further examined the effects of age, gender, and educational level. In this study, we investigated patient perception of the interview itself. Before and after taking the computer interview, we asked the patients to complete a paper and pencil questionnaire comprised of sixteen questions, expressing their feelings toward the computer interview. Responses elicited prior to taking the computer interview were compared with those obtained afterward. The Stuart-Maxwell test was used to determine statistically significant differences in answers before and after the interview. Initial questionnaire responses reflected a positive attitude toward computer usage which became even stronger after the interview. The only negative responses elicited were really more "doctor positive" than "computer negative." We conclude that patients looked favorably upon participating in a computerized medical interview provided that physician-patient contact is maintained.

Clinical implementation of an exit detector-based dose reconstruction tool for helical tomotherapy delivery quality assurance.

PubMed

Deshpande, Shrikant; Xing, Aitang; Metcalfe, Peter; Holloway, Lois; Vial, Philip; Geurts, Mark

2017-10-01

The aim of this study was to validate the accuracy of an exit detector-based dose reconstruction tool for helical tomotherapy (HT) delivery quality assurance (DQA). Exit detector-based DQA tool was developed for patient-specific HT treatment verification. The tool performs a dose reconstruction on the planning image using the sinogram measured by the HT exit detector with no objects in the beam (i.e., static couch), and compares the reconstructed dose to the planned dose. Vendor supplied (three "TomoPhant") plans with a cylindrical solid water ("cheese") phantom were used for validation. Each "TomoPhant" plan was modified with intentional multileaf collimator leaf open time (MLC LOT) errors to assess the sensitivity and robustness of this tool. Four scenarios were tested; leaf 32 was "stuck open," leaf 42 was "stuck open," random leaf LOT was closed first by mean values of 2% and then 4%. A static couch DQA procedure was then run five times (once with the unmodified sinogram and four times with modified sinograms) for each of the three "TomoPhant" treatment plans. First, the original optimized delivery plan was compared with the original machine agnostic delivery plan, then the original optimized plans with a known modification applied (intentional MLC LOT error) were compared to the corresponding error plan exit detector measurements. An absolute dose comparison between calculated and ion chamber (A1SL, Standard Imaging, Inc., WI, USA) measured dose was performed for the unmodified "TomoPhant" plans. A 3D gamma evaluation (2%/2 mm global) was performed by comparing the planned dose ("original planned dose" for unmodified plans and "adjusted planned dose" for each intentional error) to exit detector-reconstructed dose for all three "Tomophant" plans. Finally, DQA for 119 clinical (treatment length <25 cm) and three cranio-spinal irradiation (CSI) plans were measured with both the ArcCHECK phantom (Sun Nuclear Corp., Melbourne, FL, USA) and the exit detector DQA tool to assess the time required for DQA and similarity between two methods. The measured ion chamber dose agreed to within 1.5% of the reconstructed dose computed by the exit detector DQA tool on a cheese phantom for all unmodified "Tomophant" plans. Excellent agreement in gamma pass rate (>95%) was observed between the planned and reconstructed dose for all "Tomophant" plans considered using the tool. The gamma pass rate from 119 clinical plan DQA measurements was 94.9% ± 1.5% and 91.9% ± 4.37% for the exit detector DQA tool and ArcCHECK phantom measurements (P = 0.81), respectively. For the clinical plans (treatment length <25 cm), the average time required to perform DQA was 24.7 ± 3.5 and 39.5 ± 4.5 min using the exit detector QA tool and ArcCHECK phantom, respectively, whereas the average time required for the 3 CSI treatments was 35 ± 3.5 and 90 ± 5.2 min, respectively. The exit detector tool has been demonstrated to be faster for performing the DQA with equivalent sensitivity for detecting MLC LOT errors relative to a conventional phantom-based QA method. In addition, comprehensive MLC performance evaluation and features of reconstructed dose provide additional insight into understanding DQA failures and the clinical relevance of DQA results. © 2017 American Association of Physicists in Medicine.

Do spouses coordinate their work exits? A combined survey and register analysis from Norway.

PubMed

Syse, Astri; Solem, Per Erik; Ugreninov, Elisabeth; Mykletun, Reidar; Furunes, Trude

2014-09-01

Research on spouses' joint work exits is scarce, although household factors such as spouses' work status, marital quality, and caregiving burdens are likely to affect seniors' work engagement. We therefore examine whether the work exit probability of one spouse affects that of the other. Discrete-time hazard regression analyses of survey data linked to later registry information including all gainfully employed married respondents aged 50-74 with a working spouse (N = 1,764) were used to assess subsequent work exits. A spouse's work exit is a strong predictor of a respondent's work exit (hazard ratio 3.1, 95% confidence interval [2.5, 4.0]). Educational attainment, poor marital quality, and spouses' health and care needs do not predict work exits. Surprisingly, no gender differences are observed. Research on larger survey samples to distinguish different work exit routes and reasons for spouses' joint work exits appears warranted. To account for cultural and welfare state characteristics, cross-national studies ought to be undertaken. © The Author(s) 2013.

The Unanticipated Benefits of Behavioral Assessments and Interviews on Anxiety, Self-Esteem and Depression Among Women Engaging in Transactional Sex.

PubMed

Gunn, Jayleen K L; Roth, Alexis M; Center, Katherine E; Wiehe, Sarah E

2016-11-01

Women engaging in transactional sex have disproportional mental health co-morbidity and face substantial barriers to accessing social services. We hypothesized that participation in a longitudinal research study, with no overt intervention, would lead to short-term mental health improvements. For 4-weeks, 24 women disclosed information about their lives via twice daily cell-phone diaries and weekly interviews. We used t tests to compare self-esteem, anxiety, and depression at baseline and exit. Tests were repeated for hypothesized effect modifiers (e.g., substance abuse severity; age of sex work debut). For particularly vulnerable women (e.g., less educated, histories of abuse, younger initiation of sex work) participation in research conferred unanticipated mental health benefits. Positive interactions with researchers, as well as discussing lived experiences, may explain these effects. Additional studies are needed to confirm findings and identify mechanisms of change. This work contributes to the growing body of literature documenting that study participation improves mental health.

Do public health services in Egypt help young married women exercise their reproductive rights?

PubMed

Abdel-Tawab, Nahla; Rabie, Tamer; Boehmova, Zuzana; Hawkins, Loraine; Saher, Sally; El Shitany, Atef

2015-08-01

To assess supply and demand of family planning services from a reproductive rights perspective among young married women (YMW) in Egypt. Data sources related to family planning included structured interviews with service providers (n=216); an inventory of equipment and supplies (n=40); exit interviews with YMW (n=147); and focus group discussions (n=12) with YMW, husbands, and mothers and/or mothers in law. YMW, husbands and mothers in law were not necessarily related. Although family planning services were readily available and affordable, YMW had limited access to information and services. Shortfalls were noted regarding respect for privacy, choice of family planning method, access to fertility services, and premarital counseling. Few YMW had sufficient autonomy to make informed reproductive decisions. Effective accountability mechanisms and processes for redress were also lacking. Implementation of a rights-based approach and structural changes to family planning service delivery are recommended to empower YMW in Egypt to demand and exercise their reproductive rights. Copyright © 2015. Published by Elsevier Ireland Ltd.

Quality of life assessment software for computer-inexperienced older adults: multimedia utility elicitation for activities of daily living.

PubMed Central

Goldstein, M. K.; Miller, D. E.; Davies, S.; Garber, A. M.

2002-01-01

Functional status as measured by dependencies in the Activities of Daily Living (ADLs) is an important indicator of overall health for older adults. Methodologies for outcomes-based medical-decision-making for public policy, such as decision modeling and cost-effectiveness analysis, require utilities for outcome health states. Utilities have been reported for many disease states, but have not been indexed by functional status, which is a strong predictor of outcome in geriatrics. We describe here a utility elicitation program developed specifically for use with computer-inexperienced older adults: Functional Limitation And Independence Rating (FLAIR1). FLAIR1 design features address common physical problems of the aged and computer attitudes of inexperienced users that could impede computer acceptance. We interviewed 400 adults ages 65 years and older with FLAIR1. In exit interviews with 154 respondents, 118 (76%) found FLAIR1 easy to use. Design features in FLAIR1 can be applied to other software for older adults PMID:12463834

Interpersonal relations between health care workers and young clients: barriers to accessing sexual and reproductive health care.

PubMed

Alli, Farzana; Maharaj, Pranitha; Vawda, Mohammed Yacoob

2013-02-01

Interpersonal relations between health care providers and young clients have long being cited as an important element for improving client up take of services, satisfaction and overall health outcomes. In an era of HIV and AIDS this forms a critical determinant to young people accessing sexual and reproductive health care. This study explores to what extent interpersonal relations form a barrier to young peoples access to and satisfaction of health services. The study draws on data from 200 client exit interviews and four in-depth interviews conducted with university students and university health care staff in Kwazulu-Natal, South Africa. While young people are aware of the importance of utilising STI, HIV and family planning services they experienced barriers in their relationship with providers. This served as a deterrent to their use of the health facility. Adequate training in interpersonal relations for youth-friendly service provision is essential in helping overcome communication problems and enabling providers to interact with young clients at a more personal level.

Internet Delivered Support for Tobacco Control in Dental Practice: Randomized Controlled Trial

PubMed Central

Richman, Joshua S; Ray, Midge N; Allison, Jeroan J; Gilbert, Gregg H; Shewchuk, Richard M; Kohler, Connie L; Kiefe, Catarina I

2008-01-01

Background The dental visit is a unique opportunity for tobacco control. Despite evidence of effectiveness in dental settings, brief provider-delivered cessation advice is underutilized. Objective To evaluate an Internet-delivered intervention designed to increase implementation of brief provider advice for tobacco cessation in dental practice settings. Methods Dental practices (N = 190) were randomized to the intervention website or wait-list control. Pre-intervention and after 8 months of follow-up, each practice distributed exit cards (brief patient surveys assessing provider performance, completed immediately after the dental visit) to 100 patients. Based on these exit cards, we assessed: whether patients were asked about tobacco use (ASK) and, among tobacco users, whether they were advised to quit tobacco (ADVISE). All intervention practices with follow-up exit card data were analyzed as randomized regardless of whether they participated in the Internet-delivered intervention. Results Of the 190 practices randomized, 143 (75%) dental practices provided follow-up data. Intervention practices’ mean performance improved post-intervention by 4% on ASK (29% baseline, adjusted odds ratio = 1.29 [95% CI 1.17-1.42]), and by 11% on ADVISE (44% baseline, OR = 1.55 [95% CI 1.28-1.87]). Control practices improved by 3% on ASK (Adj. OR 1.18 [95% CI 1.07-1.29]) and did not significantly improve in ADVISE. A significant group-by-time interaction effect indicated that intervention practices improved more over the study period than control practices for ADVISE (P = 0.042) but not for ASK. Conclusion This low-intensity, easily disseminated intervention was successful in improving provider performance on advice to quit. Trial Registration clinicaltrials.gov NCT00627185; http://clinicaltrials.gov/ct2/show/NCT00627185 (Archived by WebCite at http://www.webcitation.org/5c5Kugvzj) PMID:18984559

Quality of Life, Functioning, and Depressive Symptom Severity in Older Adults With Major Depressive Disorder Treated With Citalopram in the STAR*D Study.

PubMed

Steiner, Alexander J; Recacho, Jennifer; Vanle, Brigitte; Dang, Jonathan; Wright, Stephanie M; Miller, Justin S; Kauzor, Kaitlyn; Reid, Mark; Bashmi, Luma E; Mirocha, James; Danovitch, Itai; IsHak, Waguih William

2017-07-01

Major depressive disorder (MDD) can substantially worsen patient-reported quality of life (QOL) and functioning. Prior studies have examined the role of age in MDD by comparing depressive symptom severity or remission rates between younger and older adults. This study examines these outcomes before and after SSRI treatment. On the basis of prior research, we hypothesized that older adults would have worse treatment outcomes in QOL, functioning, and depressive symptom severity and that nonremitters would have worse outcomes. A retrospective secondary data analysis was conducted from the National Institute of Mental Health-funded Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study (July 2001-September 2006). We analyzed data for 2,280 nonpsychotic adults with DSM-IV-TR-defined MDD who received citalopram monotherapy. Older adults were classified as adults aged 65 years and above. All subjects completed patient-reported QOL, functioning, and depressive symptom severity measures at entry and exit. Subjects included 106 older adults and 2,174 adults < 65. MDD remission status posttreatment was also determined. Both older adults and adults < 65 experienced significant improvements and medium to large treatment responses across QOL, functioning, and depressive symptom severity (P < .001). Older adults had smaller treatment effect sizes for all outcomes, particularly functioning. Conversely, mean change scores from entry to exit were equivalent across all outcomes. Remitters at exit had significantly better responses to treatment than nonremitters for the majority of outcomes. Findings suggest that older adults and younger adults have comparable treatment responses to citalopram monotherapy, with significant improvements in patient-reported depressive symptom severity, functioning, and QOL. ClinicalTrials.gov identifier: NCT00021528. © Copyright 2017 Physicians Postgraduate Press, Inc.

Peritoneal dialysis associated infections: An update on diagnosis and management

PubMed Central

Akoh, Jacob A

2012-01-01

Peritoneal dialysis (PD) is associated with a high risk of infection of the peritoneum, subcutaneous tunnel and catheter exit site. Although quality standards demand an infection rate < 0.67 episodes/patient/year on dialysis, the reported overall rate of PD associated infection is 0.24-1.66 episodes/patient/year. It is estimated that for every 0.5-per-year increase in peritonitis rate, the risk of death increases by 4% and 18% of the episodes resulted in removal of the PD catheter and 3.5% resulted in death. Improved diagnosis, increased awareness of causative agents in addition to other measures will facilitate prompt management of PD associated infection and salvage of PD modality. The aims of this review are to determine the magnitude of the infection problem, identify possible risk factors and provide an update on the diagnosis and management of PD associated infection. Gram-positive cocci such as Staphylococcus epidermidis, other coagulase negative staphylococcoci, and Staphylococcus aureus (S. aureus) are the most frequent aetiological agents of PD-associated peritonitis worldwide. Empiric antibiotic therapy must cover both gram-positive and gram-negative organisms. However, use of systemic vancomycin and ciprofloxacin administration for example, is a simple and efficient first-line protocol antibiotic therapy for PD peritonitis - success rate of 77%. However, for fungal PD peritonitis, it is now standard practice to remove PD catheters in addition to antifungal treatment for a minimum of 3 wk and subsequent transfer to hemodialysis. To prevent PD associated infections, prophylactic antibiotic administration before catheter placement, adequate patient training, exit-site care, and treatment for S. aureus nasal carriage should be employed. Mupirocin treatment can reduce the risk of exit site infection by 46% but it cannot decrease the risk of peritonitis due to all organisms. PMID:24175248

Performance Characteristics of Flush and Shielded Auxiliary Exits at Mach Numbers of 1.5 to 2.0

NASA Technical Reports Server (NTRS)

Abdalla, Kaleel L.

1959-01-01

The performance characteristics of several flush and shielded auxiliary exits were investigated at Mach numbers of 1.5 to 2.0, and jet pressure ratios from jet off to 10. The results indicate that the shielded configurations produced better overall performance than the corresponding flush exits over the Mach-number and pressure-ratio ranges investigated. Furthermore, the full-length shielded exit was highest in performance of all the configurations. The flat-exit nozzle block provided considerably improved performance compared with the curved-exit nozzle block.

Antibiotic prescribing practice for acute, uncomplicated respiratory tract infections in primary care settings in New Delhi, India.

PubMed

Kotwani, Anita; Holloway, Kathleen

2014-07-01

To obtain information on prescribing rates and choice of antibiotics for acute, uncomplicated respiratory tract infections (RTIs) in the community. Antibiotic use in acute, uncomplicated RTIs consisting of common cold/sore throat/cough for not more than five days was surveyed in the community (December 2007-November 2008) using patient exit interviews at public and private facilities from four localities in New Delhi. Data were collected from 10 public sector facilities and 20 private clinics over one year. The percentage of acute, uncomplicated RTIs patients receiving antibiotics in general and using the Anatomical Therapeutic Chemical classification and the Defined Daily Dose (ATS/DDD) were analysed. At public and private facilities, 45% (746/1646) and 57% (259/457) of acute, uncomplicated RTI patients were prescribed at least one antibiotic, respectively. The main antibiotic class calculated as percentage of total antibiotics DDDs/1000 prescribed to acute, uncomplicated RTI patients at private clinics was cephalosporins, J01DA (39%), followed by fluoroquinolones, J01MA (24%), penicillins, J01C (19%) and macrolides, J01FA (15%). Newer members from each class were prescribed; older antibiotics such as co-trimoxazole or tetracyclines were rarely prescribed. At public facilities, the main class of antibiotic prescribed was penicillins (31%), followed by macrolides (25%), fluoroquinolones (20%) and cephalosporins (10%). Study clearly shows overuse and inappropriate choice of antibiotics for the treatment of acute, uncomplicated RTIs which are mainly due to virus and do not require antibiotic treatment. Results of the study warrant interventional strategies to promote rational use of antibiotics to decrease the overgrowing threat of antibiotic resistance. © 2014 John Wiley & Sons Ltd.

The community comes to campus: the Patient and Community Fair.

PubMed

Towle, Angela; Godolphin, William; Kline, Cathy

2015-08-01

Community-based learning connects students with local communities so that they learn about the broad context in which health and social care is provided; however, students usually interact with only one or a few organisations that serve a particular population. One example of a community-based learning activity is the health fair in which students provide health promotion and screening for local communities. We adapted the health fair concept to develop a multi-professional educational event at which, instead of providing service, students learn from and about the expertise and resources of not-for-profit organisations. The fair is an annual 1-day event that students can attend between, or in place of, classes. Each community organisation has a booth to display information. One-hour 'patient panels' are held on a variety of topics throughout the day. Evaluation methods include questionnaires, exit interviews and visitor tracking sheets. Over 5 years (2009-2013), the fair increased in size with respect to estimated attendance, number of participating organisations, number of patient panels and number of students for whom the fair is a required curriculum component. Students learn about a range of patient experiences and community resources, and information about specific diseases or conditions. The fair is an efficient way for students to learn about a range of community organisations. It fosters university-community engagement through continuing connections between students, faculty members and community organisations. Lessons learned include the need for community organisations to have techniques to engage students, and ways to overcome challenges of evaluating an informal 'drop-in' event. The fair is an efficient way for students to learn about a range of community organisations. © 2015 John Wiley & Sons Ltd.

Can favourable psychosocial working conditions in midlife moderate the risk of work exit for chronically ill workers? A 20-year follow-up of the Whitehall II study.

PubMed

Fleischmann, Maria; Carr, Ewan; Stansfeld, Stephen A; Xue, Baowen; Head, Jenny

2018-03-01

To investigate if favourable psychosocial working conditions can reduce the risk of work exit and specifically for workers with chronic disease. Men and women (32%) aged 35-55, working and having no chronic disease at baseline of the Whitehall II study of London-based civil servants were selected (n=9040). We observed participants' exit from work through retirement, health-related exit and unemployment, new diagnosis of chronic disease (ie, coronary heart disease, diabetes, stroke and cancer) and their psychosocial working conditions in midlife. Using cause-specific Cox models, we examined the association of chronic disease and favourable psychosocial working conditions and their interaction, with the three types of work exit. We adjusted for gender, occupational grade, educational level, remaining in civil service, spouse's employment status and mental health. Chronic disease significantly increased the risk of any type of work exit (HR 1.27) and specifically the risk of health-related exit (HR 2.42). High skill discretion in midlife reduced the risk of any type of work exit (HR 0.90), retirement (HR 0.91) and health-related exit (HR 0.68). High work social support in midlife decreased the risk of health-related exit (HR 0.79) and unemployment (HR 0.71). Favourable psychosocial working conditions in midlife did not attenuate the association between chronic disease and work exit significantly. The chronically ill have increased risks of work exit, especially through health-related exit routes. Chronic disease is an obstacle to extended working lives. Favourable working conditions directly relate to reduced risks of work exit. © 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.

A Computerized Family Planning Counseling Aid: A Pilot Study Evaluation of Smart Choices.

PubMed

Koo, Helen P; Wilson, Ellen K; Minnis, Alexandra M

2017-03-01

Resource constraints may make it challenging for family planning clinics to provide comprehensive contraceptive counseling; technological tools that help providers follow recommended practices without straining resources merit evaluation. A pilot study using a two-group, posttest-only experimental design evaluated Smart Choices, a computer-based tool designed to help providers offer more patient-centered counseling and enable patients to participate proactively in the counseling session. In two North Carolina family planning clinics, 214 women received usual counseling in March-May 2013, and 126 women used Smart Choices in May-July 2013. Exit interviews provided data for the evaluation. Multivariate Poisson and multinomial logistic regression analyses were performed to examine group differences in counseling outcomes. Three of 12 hypotheses tested were supported: Compared with controls, women in the intervention group knew more contraceptive methods (adjusted mean, 11.1 vs. 10.7); discussed more topics related to sexual health during counseling (1.2 vs. 0.9 among those reporting any discussion); and rated counseling as more patient-centered, an indication of how well they felt providers understood their family planning circumstances and ideas (3.9 vs. 3.7 on a scale of 1-4). Contrary to another hypothesis, controls were more likely than women in the intervention group to choose IUDs and implants. Computerized counseling aids like Smart Choices are in an early stage of development. Future research is warranted to develop tools that lead to more productive and individualized clinic visits and, ultimately, to more effective contraceptive use and reduced levels of unintended pregnancy. Copyright © 2017 by the Guttmacher Institute.

Changing the navigator's course: How the increasing rationalization of healthcare influences access for undocumented immigrants under the Affordable Care Act.

PubMed

López-Sanders, Laura

2017-04-01

A number of researchers have shown that brokers (e.g., navigators and street-level bureaucrats) bridge access to healthcare services and information for immigrant patients through rich personal relationships and a mission of ethical care. An open question remains concerning how the increasing rationalization of healthcare over the past few decades influences brokerage for undocumented immigrant patients. Drawing from fieldwork and interviews conducted in California, as the Affordable Care Act (ACA) was implemented, I develop the concept of the "double-embedded-liaison." While other studies treat brokers as acting either as gatekeepers or patient representatives, this study explains how brokers simultaneously operate on multiple planes when new roles are added. I argue that with more formalization and scrutiny at health centers, the impact of brokerage is destabilized and, subsequently, diminished. Two consequences of the double-embedded-liaison brokerage form are: (1) some brokers become disillusioned and exit -resulting in the loss of valuable resources at the health centers, and (2) immigrants move away from the health centers that historically served them. In looking at brokers' simultaneous performance as gatekeepers and representatives, this research extends brokerage typologies and street-level bureaucracy arguments that largely treat brokerage in a mono-planar rather than in a bi-planar mode. Furthermore, in examining the risks and opportunities brokerage brings to addressing health disparities, the study provides insights into the effects of replacing the ACA or repealing it all together in the Post-Obama era. Copyright © 2017 Elsevier Ltd. All rights reserved.

Adolescents Exiting Homelessness Over Two Years: The Risk Amplification and Abatement Model

PubMed Central

Milburn, Norweeta G.; Rice, Eric; Rotheram-Borus, Mary Jane; Mallett, Shelley; Rosenthal, Doreen; Batterham, Phillip; May, Susanne J.; Witkin, Andrea; Duan, Naihua

2014-01-01

The Risk Amplification and Abatement Model (RAAM), demonstrates that negative contact with socializing agents amplify risk, while positive contact abates risk for homeless adolescents. To test this model, the likelihood of exiting homelessness and returning to familial housing at 2 years and stably exiting over time are examined with longitudinal data collected from 183 newly homeless adolescents followed over 2 years in Los Angeles, CA. In support of RAAM, unadjusted odds of exiting at 2 years and stably exiting over2 years revealed that engagement with pro-social peers, maternal social support, and continued school attendance all promoted exiting behaviors. Simultaneously, exposure to family violence and reliance on shelter services discouraged stably exiting behaviors. Implications for family-based interventions are proposed. PMID:25067896

Accuracy of a real-time surgical navigation system for the placement of quad zygomatic implants in the severe atrophic maxilla: A pilot clinical study.

PubMed

Hung, Kuo-Feng; Wang, Feng; Wang, Hao-Wei; Zhou, Wen-Jie; Huang, Wei; Wu, Yi-Qun

2017-06-01

A real-time surgical navigation system potentially increases the accuracy when used for quad-zygomatic implant placement. To evaluate the accuracy of a real-time surgical navigation system when used for quad zygomatic implant placement. Patients with severely atrophic maxillae were prospectively recruited. Four trajectories for implants were planned, and zygomatic implants were placed using a real-time surgical navigation system. The planned-placed distance deviations at entry (entry deviation）points, exit (exit deviation) points, and angle deviation of axes (angle deviation) were measured on fused operation images. The differences of all the deviations between different groups, classified based on the lengths and locations of implants, were analysed. A P value of < 0.05 indicated statistical significance. Forty zygomatic implants were placed as planned in 10 patients. The entry deviation, exit deviation and angle deviation were 1.35 ± 0.75 mm, 2.15 mm ± 0.95 mm, and 2.05 ± 1.02 degrees, respectively. The differences of all deviations were not significant, irrespective of the lengths (P = .259, .158, and .914, respectively) or locations of the placed implants (P = .698, .072, and .602, respectively). A real-time surgical navigation system used for the placement of quad zygomatic implants demonstrated a high level of accuracy with only minimal planned-placed deviations, irrespective of the lengths or locations of the implants. © 2017 Wiley Periodicals, Inc.

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

Breault, Ronald W.; Monazam, Esmail R.; Shadle, Lawrence J.

Riser hydrodynamics are a function of the flow rates of gas and solids as well as the exit geometry, particularly when operated above the upper transport velocity. This work compares the exit voidage for multiple geometries and two different solids: Geldart group A glass beads and Geldart group B coke. Geometries were changed by modifying the volume of an abrupt T-shaped exit above the lateral riser exit. This was accomplished by positioning a plunger at various heights above the exit from zero to 0.38 m. A dimensionless expression used to predict smooth exit voidage was modified to account for themore » effect of the depth of the blind-T. The new correlation contains the solids-gas load ratio, solids-to-gas density ratio, bed-to-particle diameter ratio, gas Reynolds Number, as well as a term for the exit geometry. This study also found that there was a minimum riser roof height above the blind-T exit beyond which the riser exit voidage was not affected by the exit geometry. A correlation for this minimum riser roof height has also been developed in this study. This study covered riser superficial gas velocities of 4.35 to 7.7 m/s and solids circulation rates of 1.3 to 11.5 kg/s.« less

Influence of drill helical direction on exit damage development in drilling carbon fiber reinforced plastic

NASA Astrophysics Data System (ADS)

Bai, Y.; Jia, Z. Y.; Wang, F. J.; Fu, R.; Guo, H. B.; Cheng, D.; Zhang, B. Y.

2017-06-01

Drilling is inevitable for CFRP components’ assembling process in the aviation industry. The exit damage frequently occurs and affects the load carrying capacity of components. Consequently, it is of great urgency to enhance drilling exit quality on CFRP components. The article aims to guide the reasonable choice of drill helical direction and effectively reduce exit damage. Exit observation experiments are carried out with left-hand helical, right-hand helical and straight one-shot drill drilling T800S CFRP laminates separately. The development rules of exit damage and delamination factor curves are obtained. Combined with loading conditions and fracture modes of push-out burrs, and thrust force curves, the influence of drill helical direction on exit damage development is derived. It is found that the main fracture modes for left-hand helical, right-hand helical, and straight one-shot drill are mode I, extrusive fracture, mode III respectively. Among them, mode III has the least effect on exit damage development. Meanwhile, the changing rate of thrust force is relative slow for right-hand helical and straight one-shot drill in the thrust force increasing phase of stage II, which is disadvantaged for exit damage development. Therefore, straight one-shot drill’s exit quality is the best.

Application of instant messaging software in the follow-up of patients using peritoneal dialysis, a randomised controlled trial.

PubMed

Cao, Fang; Li, Lanfei; Lin, Miao; Lin, Qinyu; Ruan, Yiping; Hong, Fuyuan

2018-04-20

This study aims to investigate the application value of Internet-based instant messaging software in the follow-up of patients using peritoneal dialysis. Peritoneal dialysis is an effective renal replacement treatment for end-stage renal disease. The clinical usefulness of Internet-based instant messaging software in the follow-up of peritoneal dialysis patients, including the incidence of peritonitis and exit-site infection, the levels of albumin and electrolytes and the degree of patients' satisfaction, remains unknown. Between January 2009-April 2016, a total of 160 patients underwent continuous peritoneal dialysis in the Department of Nephrology, Fujian Provincial Hospital were invited to participate voluntarily in this study. The patients were randomly assigned to the instant messenger (QQ) follow-up group (n = 80) and the traditional follow-up group (n = 80). The differences in death, hospitalisation, peritonitis, exit-site infection, and patients' satisfaction were investigated during 1 year of follow-up. The mean follow-up duration is 11.4 ± 1.5 months. Compared with the patients in the traditional follow-up group, patients in the QQ follow-up group showed higher levels of serum albumin (p = .009) and haemoglobin (p = .009), lower levels of phosphorus (p < .001) and calcium-phosphorus product (p = .001), and better degree of satisfaction (p < .001). Internet-based follow-up by instant messaging software appears to be a feasible and acceptable method of delivering peritoneal dialysis treatment for patients with end-stage renal disease. © 2018 John Wiley & Sons Ltd.

Effect of the patient's knowledge on peritonitis rates in peritoneal dialysis.

PubMed

Sayed, Suheir A M; Abu-Aisha, Hasan; Ahmed, Magda E; Elamin, Sarra

2013-01-01

After a training period, patients maintained on continuous ambulatory peritoneal dialysis (CAPD) assume responsibility for their own treatment. With the aid of appropriate tools, home visits help with ongoing evaluation and training for these patients. We conducted a home visit survey of 50 patients maintained on CAPD in Sudan between April 2009 and June 2010. Housing conditions, home environment, and patient's or caregiver's knowledge about peritoneal dialysis and the exchange procedure were evaluated using structured data collection sheets. Scores were compared with infection rates in the patients before the home visit. Patients were maintained on CAPD for a median duration of 11 months. Their mean age was 42 ± 23 years; 70% were male; and 14% had diabetes. Only 34% of patients had suitable housing conditions, and 56% required assisted PD. Of the autonomous patients and assisting family members, 11.6% were illiterate. The median achieved knowledge score was 11.5 of 35 points. The median achieved exchange score was 15 of 20 points. Knowledge and exchange scores were positively and significantly correlated (R = 0.5, p = 0.00). More patients in the upper quartile than in the middle and lower quartiles of knowledge scores were adherent to daily exit-site care (33.3% vs 5.3%, p = 0.02). Compared with patients in the middle and lower quartiles of knowledge score, patients in the upper quartile had lower rates of peritonitis, exit-site infection, and hospitalization. The proposed evaluation form is a valid and reliable assessment tool for the follow-up of CAPD patients. Patients in the upper quartile of knowledge score demonstrated better adherence to the recommended treatment protocols and lower infection rates.

Patient-Centered Communication and Health Assessment with Youth

PubMed Central

Munro, Michelle L.; Darling-Fisher, Cynthia S.; Ronis, David L.; Villarruel, Antonia M.; Pardee, Michelle; Faleer, Hannah; Fava, Nicole M.

2014-01-01

Background Patient-centered communication is the hallmark of care that incorporates the perspective of patients to provide tailored care that meets their needs and desires. However, at this time there has been limited evaluation of patient-provider communication involving youth. Objectives This manuscript will report on results from secondary analysis of data obtained during a participatory research-based randomized control trial designed to test a sexual risk event history calendar intervention with youth to address the following research questions: (a) Based on the event history calendar’s (EHC) inclusion of contextual factors, does the EHC demonstrate improved communication outcomes (i.e., amount, satisfaction, mutuality, client involvement, client satisfaction, patient-provider interaction, and patient-centeredness) when compared to the Guidelines for Adolescent Preventive Services (GAPS) tool? and (b) How do patients and providers describe the characteristics of each tool in regards to patient-centered communication? Method This report will utilize a sequential explanatory mixed methods approach to evaluate communication. A split plot design with one between factor (i.e., communication structure between EHC and GAPS) and one within factor (i.e., time between pretest and posttest) was used for analyses of data collection from male and female youth (n=186) and providers (n=9). Quantitative analysis of survey data evaluated changes in communication from pre-test to post-test. Qualitative data collected from open-ended questions, audio-taped visits, and exit interviews was employed to enhance interpretation of quantitative findings. Results Patient-centered communication using assessment tools (EHC and GAPS) with youth demonstrated improved communication outcomes both quantitatively and qualitatively. Additional analyses with subgroups of males and Arab-Americans demonstrated better post-intervention scores among the EHC group in certain aspects of communication. Qualitative results revealed that the EHC demonstrated improved outcomes in the four components of patient-centered communication including: validation of the patient’s perspective; viewing the patient within context; reaching a shared understanding on needs and preferences; and helping the patient share power in the healthcare interaction. Discussion Though both tools provided a framework from which to conduct a clinical visit, the integrated time-linked assessment captured by the EHC enhanced the patient-centered communication in select groups compared to GAPS. PMID:24165214

Large Eddy Simulation in a Channel with Exit Boundary Conditions

NASA Technical Reports Server (NTRS)

Cziesla, T.; Braun, H.; Biswas, G.; Mitra, N. K.

1996-01-01

The influence of the exit boundary conditions (vanishing first derivative of the velocity components and constant pressure) on the large eddy simulation of the fully developed turbulent channel flow has been investigated for equidistant and stretched grids at the channel exit. Results show that the chosen exit boundary conditions introduce some small disturbance which is mostly damped by the grid stretching. The difference between the fully developed turbulent channel flow obtained with LES with periodicity condition and the inlet and exit and the LES with fully developed flow at the inlet and the exit boundary condition is less than 10% for equidistant grids and less than 5% for the case grid stretching. The chosen boundary condition is of interest because it may be used in complex flows with backflow at exit.

Emergency Department Real Time Location System Patient and Equipment Tracking

DTIC Science & Technology

2014-10-01

accomplishments/Reportable Outcomes Patient Tagging: Getting staff to embrace the change in their workflow and apply the RFID tag and band as well as getting...goes on if a patient passes the exit with a RFID tag still on. We have received the device however the vendor is researching how best to utilize the...technology to meet the need. The ability to limit the range for reading an RFID tag to prevent false alerts is presently being worked on. Tag

Stability of Facial Affective Expressions in Schizophrenia

PubMed Central

Fatouros-Bergman, H.; Spang, J.; Merten, J.; Preisler, G.; Werbart, A.

2012-01-01

Thirty-two videorecorded interviews were conducted by two interviewers with eight patients diagnosed with schizophrenia. Each patient was interviewed four times: three weekly interviews by the first interviewer and one additional interview by the second interviewer. 64 selected sequences where the patients were speaking about psychotic experiences were scored for facial affective behaviour with Emotion Facial Action Coding System (EMFACS). In accordance with previous research, the results show that patients diagnosed with schizophrenia express negative facial affectivity. Facial affective behaviour seems not to be dependent on temporality, since within-subjects ANOVA revealed no substantial changes in the amount of affects displayed across the weekly interview occasions. Whereas previous findings found contempt to be the most frequent affect in patients, in the present material disgust was as common, but depended on the interviewer. The results suggest that facial affectivity in these patients is primarily dominated by the negative emotions of disgust and, to a lesser extent, contempt and implies that this seems to be a fairly stable feature. PMID:22966449

EOS Terra Terra Constellation Exit/Future Maneuver Plans Update

NASA Technical Reports Server (NTRS)

Mantziaras, Dimitrios

2016-01-01

This EOS Terra Constellation Exit/Future Maneuver Plans Update presentation will discuss brief history of Terra EOM work; lifetime fuel estimates; baseline vs. proposed plan origin; resultant exit orbit; baseline vs. proposed exit plan; long term orbit altitude; revised lifetime proposal and fallback options.

The Role of Drosophila Merlin in the Control of Mitosis Exit and Development

DTIC Science & Technology

2007-07-01

presenta- tion would be severe and consistent with the con- ventional form of NF2. Schwannomatosis , a recently defined form of neu- rofibromatosis, is...characterized by multiple sch- wannomas without any NF2-associated vestibular schwannomas. Patients with schwannomatosis fre- quently present with...approximately one-third of patients with schwannomatosis had tumors in an anatomically lim- ited distribution, such as a single limb, several con- tiguous

Reasons for (not) signing the state registry: surveying Department of Motor Vehicles customers in New York state.

PubMed

Feeley, Thomas Hugh; Reynolds-Tylus, Tobias; Anker, Ashley E; Evans, Melanie

2014-03-01

Prior research examining rationales for enrolling as an organ donor is biased because of its reliance on college student samples and retrospective recall. To characterize New York state residents' registry enrollment decisions in close proximity to a registration opportunity. -Surveys were conducted with customers exiting Department of Motor Vehicle offices. A total of 1325 customers were surveyed upon exiting 1 of 18 Department of Motor Vehicle offices spanning 9 counties. Customers making donation-relevant transactions (ie, license renewal/registration) reported whether they had registered as a donor that day, and all other customers reported whether they had registered as a donor in the past. Customers reported reasons to justify their enrollment decision through short interview questions. Among current donation-relevant transactions (n = 299), 27% reported enrolling in the registry. Of remaining customers, 39% reported enrolling in the state registry in the past. For those who elected not to enroll, many failed to communicate a reason for their decision, or reported a lack of opportunity to sign or decisional uncertainty. Among enrollees, reasons for registration included the altruistic benefits of donation, prior registration, personal experience with donation, and rational arguments for donation. The value of point-of-decision survey data are discussed in relation to strategic efforts to promote organ donor registration.

Development and Feasibility of a Cell Phone-Based Transitional Intervention for Women Prisoners with Comorbid Substance Use and Depression

PubMed Central

Johnson, Jennifer E.; Williams, Collette; Zlotnick, Caron

2013-01-01

This article describes the development and feasibility testing of a cell phone-based intervention (Sober Network IPT) among 22 women with comorbid substance use and depressive disorders transitioning from prison to surrounding communities. Feasibility/acceptability measures included phone logs, exit interviews, and pre-post measures of substance use and depressive symptoms up to 9 months post-release. Results indicated that phone-based transitional treatment is feasible and acceptable. Participants valued the opportunity to maintain contact with familiar prison treatment providers by phone after release, and used the cell phones for help with service linkage, support, and crisis management. We describe relational and practical lessons learned. PMID:26508805

Aircraft evacuations through type-III exits I : effects of seat placement at the exit.

DOT National Transportation Integrated Search

1995-07-01

Simulated emergency egress from Type III over-wing exits was studied to support regulatory action by the FAA. Passageway width and seat encroachment distance adjacent to the Type-III exit were the major variables of interest. : Methods. Two subject g...

29 CFR 1910.36 - Design and construction requirements for exit routes.

Code of Federal Regulations, 2012 CFR

2012-07-01

....36 Section 1910.36 Labor Regulations Relating to Labor (Continued) OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR OCCUPATIONAL SAFETY AND HEALTH STANDARDS Exit Routes and Emergency Planning... of exit routes necessary for your workplace, consult NFPA 101-2000, Life Safety Code. (c) Exit...

Safety and operational performance evaluation of four types of exit ramps on Florida's freeways (final report).

DOT National Transportation Integrated Search

2010-12-01

This project mainly focuses on exit ramp performance analysis of safety and operations. In addition, issues of advance guide sign for exit ramp are also mentioned. : Safety analysis evaluates safety performances of different exit ramps used in Florid...

Process for Considering Special Exit Criteria from Bilingual/English as a Second Language (ESL) Services under 19 TAC §89.1225(k). School Year: 2013-2014, Grades 1-12

ERIC Educational Resources Information Center

Texas Education Agency, 2014

2014-01-01

Under Texas Administrative Code (TAC) §89.1225(h), districts are required to use the exit criteria represented in the chart titled "2013-2014 English Proficiency Exit Criteria Chart" found at (http://www.tea.state.tx.us/index2.aspx?id=4098) to exit English language learners (ELLs) from bilingual/ESL programs. The exit criteria under TAC…

The effect of riser end geometry on gas-solid hydrodynamics in a CFB riser operating in the core annular and dilute homogeneous flow regimes

DOE PAGES

Breault, Ronald W.; Monazam, Esmail R.; Shadle, Lawrence J.; ...

2017-02-12

Riser hydrodynamics are a function of the flow rates of gas and solids as well as the exit geometry, particularly when operated above the upper transport velocity. This work compares the exit voidage for multiple geometries and two different solids: Geldart group A glass beads and Geldart group B coke. Geometries were changed by modifying the volume of an abrupt T-shaped exit above the lateral riser exit. This was accomplished by positioning a plunger at various heights above the exit from zero to 0.38 m. A dimensionless expression used to predict smooth exit voidage was modified to account for themore » effect of the depth of the blind-T. The new correlation contains the solids-gas load ratio, solids-to-gas density ratio, bed-to-particle diameter ratio, gas Reynolds Number, as well as a term for the exit geometry. This study also found that there was a minimum riser roof height above the blind-T exit beyond which the riser exit voidage was not affected by the exit geometry. A correlation for this minimum riser roof height has also been developed in this study. This study covered riser superficial gas velocities of 4.35 to 7.7 m/s and solids circulation rates of 1.3 to 11.5 kg/s.« less

Molecular diagnosis of Pseudoterranova decipiens s.s in human, France.

PubMed

Brunet, Julie; Pesson, Bernard; Royant, Maude; Lemoine, Jean-Philippe; Pfaff, Alexander W; Abou-Bacar, Ahmed; Yera, Hélène; Fréalle, Emilie; Dupouy-Camet, Jean; Merino-Espinosa, Gema; Gómez-Mateos, Magdalena; Martin-Sanchez, Joaquina; Candolfi, Ermanno

2017-06-06

Anisakis and Pseudoterranova are the main genera involved in human infections caused by nematodes of the Anisakidae family. Species identification is complicated due to the lack of differential morphological characteristics at the larval stage, thus requiring molecular differentiation. Pseudoterranova larvae ingested through raw fish are spontaneously eliminated in most cases, but mechanical removal by means of endoscopy might be required. To date, only very few cases of Pseudoterranova infection have been reported in France. A 19-year-old woman from Northeastern France detected, while brushing her teeth, a larva exiting through her mouth. The patient who presented with headache, diarrhea, and abdominal cramps reported having eaten baked cod. The worm was a fourth-stage larva with a size of 22 × 0.9 mm, and molecular biology identified it as Pseudoterranova decipiens sensu stricto (s. s.). In a second P. decipiens infection case, occurring a few months later, a worm exited through the patient's nose after she had eaten raw sea bream. These two cases demonstrate that Pseudoterranova infection is not uncommon among French patients. Therefore, molecular techniques should be more widely applied for a better characterization of anisakidosis epidemiology in France.

Factors Associated With Premature Exits From Supported Housing.

PubMed

Gabrielian, Sonya; Burns, Alaina V; Nanda, Nupur; Hellemann, Gerhard; Kane, Vincent; Young, Alexander S

2016-01-01

Many homeless consumers who enroll in supported housing programs--which offer subsidized housing and supportive services--disengage prematurely, before placement in permanent community-based housing. This study explored factors associated with exiting a supported housing program before achieving housing placement. With the use of administrative data, a roster was obtained for consumers enrolled in the Veterans Affairs (VA) Greater Los Angeles supported housing program from 2011 to 2012. Fewer (4%) consumers exited this program before achieving housing ("exiters") compared with consumers described in national VA figures (18%). Exiters with available demographic data (N=51) were matched 1:1 on age, gender, marital status, and race-ethnicity with consumers housed through this program ("stayers," N=51). Medical records were reviewed to compare diagnoses, health care utilization, housing histories, vocational history, and criminal justice involvement of exiters versus stayers. Exiters' housing outcomes were identified. Recursive partitioning identified variables that best differentiated exiters from stayers. Several factors were associated with premature exits from this supported housing program: residing in temporary housing on hospital grounds during program enrollment, poor adherence to outpatient care, substance use disorders, hepatitis C, chronic pain, justice involvement, frequent emergency department utilization, and medical-surgical admissions. The first of these factors and poor adherence to outpatient medical-surgical care best differentiated exiters from stayers. Moreover, >50% of exiters became street homeless or incarcerated after leaving the program. In that diverse social factors, diagnoses, and health care utilization patterns were associated with premature disengagement from supported housing, future research is needed to implement and evaluate rehabilitative services that address these factors, adapted to the context of supported housing.

34 CFR 682.604 - Required exit counseling for borrowers.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 34 Education 4 2014-07-01 2014-07-01 false Required exit counseling for borrowers. 682.604 Section... counseling for borrowers. (a) Exit counseling. (1) A school must ensure that exit counseling is conducted... ensure that this counseling is conducted shortly before the student borrower ceases at least half-time...

14 CFR 27.1557 - Miscellaneous markings and placards.

Code of Federal Regulations, 2011 CFR

2011-01-01

...; (iii) For turbine engine powered rotorcraft, the permissible fuel designations; and (iv) For pressure...) Emergency exit placards. Each placard and operating control for each emergency exit must be red. A placard must be near each emergency exit control and must clearly indicate the location of that exit and its...

14 CFR 27.1557 - Miscellaneous markings and placards.

Code of Federal Regulations, 2013 CFR

2013-01-01

...; (iii) For turbine engine powered rotorcraft, the permissible fuel designations; and (iv) For pressure...) Emergency exit placards. Each placard and operating control for each emergency exit must be red. A placard must be near each emergency exit control and must clearly indicate the location of that exit and its...

14 CFR 27.1557 - Miscellaneous markings and placards.

Code of Federal Regulations, 2012 CFR

2012-01-01

...; (iii) For turbine engine powered rotorcraft, the permissible fuel designations; and (iv) For pressure...) Emergency exit placards. Each placard and operating control for each emergency exit must be red. A placard must be near each emergency exit control and must clearly indicate the location of that exit and its...

14 CFR 27.1557 - Miscellaneous markings and placards.

Code of Federal Regulations, 2014 CFR

2014-01-01

...; (iii) For turbine engine powered rotorcraft, the permissible fuel designations; and (iv) For pressure...) Emergency exit placards. Each placard and operating control for each emergency exit must be red. A placard must be near each emergency exit control and must clearly indicate the location of that exit and its...

36 CFR 13.1318 - Location of the EGDA.

Code of Federal Regulations, 2013 CFR

2013-07-01

... NATIONAL PARK SYSTEM UNITS IN ALASKA Special Regulations-Kenai Fjords National Park Exit Glacier Developed... boundary to Exit Glacier Campground Entrance Road, all park areas within 350 meters (383 yards) of the centerline of the Exit Glacier Road; (2) From Exit Glacier Campground Entrance Road to the end of the main...

36 CFR 13.1318 - Location of the EGDA.

Code of Federal Regulations, 2011 CFR

2011-07-01

... NATIONAL PARK SYSTEM UNITS IN ALASKA Special Regulations-Kenai Fjords National Park Exit Glacier Developed... boundary to Exit Glacier Campground Entrance Road, all park areas within 350 meters (383 yards) of the centerline of the Exit Glacier Road; (2) From Exit Glacier Campground Entrance Road to the end of the main...

36 CFR 13.1318 - Location of the EGDA.

Code of Federal Regulations, 2014 CFR

2014-07-01

... NATIONAL PARK SYSTEM UNITS IN ALASKA Special Regulations-Kenai Fjords National Park Exit Glacier Developed... boundary to Exit Glacier Campground Entrance Road, all park areas within 350 meters (383 yards) of the centerline of the Exit Glacier Road; (2) From Exit Glacier Campground Entrance Road to the end of the main...

Information on actual medication use and drug-related problems in older patients: questionnaire or interview?

PubMed

Willeboordse, Floor; Grundeken, Lucienne H; van den Eijkel, Lisanne P; Schellevis, François G; Elders, Petra J M; Hugtenburg, Jacqueline G

2016-04-01

Information on medication use and drug-related problems is important in the preparation of clinical medication reviews. Critical information can only be provided by patients themselves, but interviewing patients is time-consuming. Alternatively, patient information could be obtained with a questionnaire. In this study the agreement between patient information on medication use and drug-related problems in older patients obtained with a questionnaire was compared with information obtained during an interview. General practice in The Netherlands. A questionnaire was developed to obtain information on actual medication use and drug-related problems. Two patient groups ≥65 years were selected based on general practitioner electronic medical records in nine practices; I. polypharmacy and II. ≥1 predefined general geriatric problems. Eligible patients were asked to complete the questionnaire and were interviewed afterwards. Agreement on information on medication use and drug-related problems collected with the questionnaire and interview was calculated. Ninety-seven patients participated. Of all medications used, 87.6 % (95 % CI 84.7-90.5) was reported identically in the questionnaire and interview. Agreement for the complete medication list was found for 45.4 % (95 % CI 35.8-55.3) of the patients. On drug-related problem level, agreement between questionnaire and interview was 75 %. Agreement tended to be lower in vulnerable patients characterized by ≥4 chronic diseases, ≥10 medications used and low health literacy. Information from a questionnaire showed reasonable agreement compared with interviewing. The patients reported more medications and drug-related problems in the interview than the questionnaire. Taking the limitations into account, a questionnaire seems a suitable tool for medication reviews that may replace an interview for most patients.

Challenges in implementing uncomplicated malaria treatment in children: a health facility survey in rural Malawi.

PubMed

Kabaghe, Alinune N; Phiri, Mphatso D; Phiri, Kamija S; van Vugt, Michèle

2017-10-18

Prompt and effective malaria treatment are key in reducing transmission, disease severity and mortality. With the current scale-up of artemisinin-based combination therapy (ACT) coverage, there is need to focus on challenges affecting implementation of the intervention. Routine indicators focus on utilization and coverage, neglecting implementation quality. A health system in rural Malawi was assessed for uncomplicated malaria treatment implementation in children. A cross-sectional health facility survey was conducted in six health centres around the Majete Wildlife Reserve in Chikwawa district using a health system effectiveness approach to assess uncomplicated malaria treatment implementation. Interviews with health facility personnel and exit interviews with guardians of 120 children under 5 years were conducted. Health workers appropriately prescribed an ACT and did not prescribe an ACT to 73% (95% CI 63-84%) of malaria rapid diagnostic test (RDT) positive and 98% (95% CI 96-100%) RDT negative children, respectively. However, 24% (95% CI 13-37%) of children receiving artemisinin-lumefantrine had an inappropriate dose by weight. Health facility findings included inadequate number of personnel (average: 2.1 health workers per 10,000 population), anti-malarial drug stock-outs or not supplied, and inconsistent health information records. Guardians of 59% (95% CI 51-69%) of children presented within 24 h of onset of child's symptoms. The survey presents an approach for assessing treatment effectiveness, highlighting bottlenecks which coverage indicators are incapable of detecting, and which may reduce quality and effectiveness of malaria treatment. Health service provider practices in prescribing and dosing anti-malarial drugs, due to drug stock-outs or high patient load, risk development of drug resistance, treatment failure and exposure to adverse effects.

Caregiver satisfaction with paediatric HIV treatment and care in Nigeria and equity implications for children living with HIV.

PubMed

Chamla, Dick; Asadu, Chukwuemeka; Adejuyigbe, Ebun; Davies, Abiola; Ugochukwu, Ebele; Umar, Lawal; Oluwafunke, Ilesanmi; Hassan-Hanga, Fatimah; Onubogu, Chinyere; Tunde-Oremodu, Immaculata; Madubuike, Chinelo; Umeadi, Esther; Epundu, Obed; Omosun, Adenike; Anigilaje, Emmanuel; Adeyinka, Daniel

2016-03-01

Caregiver satisfaction has the potential to promote equity for children living with HIV, by influencing health-seeking behaviour. We measured dimensions of caregiver satisfaction with paediatric HIV treatment in Nigeria, and discuss its implications for equity by conducting facility-based exit interviews for caregivers of children receiving antiretroviral therapy in 20 purposively selected facilities within 5 geopolitical zones. Descriptive analysis and factor analysis were performed. Due to the hierarchical nature of the data, multilevel regression modelling was performed to investigate relationships between satisfaction factors and socio-demographic variables. Of 1550 caregivers interviewed, 63% (95% CI: 60.6-65.4) reported being very satisfied overall; however, satisfaction varied in some dimensions: only 55.6% (53.1-58.1) of caregivers could talk privately with health workers, 56.9% (54.4-59.3) reported that queues to see health workers were too long, and 89.9% (88.4-91.4) said that some health workers did not treat patients living with HIV with sufficient respect. Based on factor analysis, two underlying factors, labelled Availability and Attitude, were identified. In multilevel regression, the satisfaction with availability of services correlated with formal employment status (p < .01), whereas caregivers receiving care in private facilities were less likely satisfied with both availability (p < .01) and attitude of health workers (p < .05). State and facility levels influenced attitudes of the health workers (p < .01), but not availability of services. We conclude that high levels of overall satisfaction among caregivers masked dissatisfaction with some aspects of services. The two underlying satisfaction factors are part of access typology critical for closing equity gaps in access to HIV treatment between adults and children, and across socio-economic groups.

Caregiver satisfaction with paediatric HIV treatment and care in Nigeria and equity implications for children living with HIV

PubMed Central

Chamla, Dick; Asadu, Chukwuemeka; Adejuyigbe, Ebun; Davies, Abiola; Ugochukwu, Ebele; Umar, Lawal; Oluwafunke, Ilesanmi; Hassan-Hanga, Fatimah; Onubogu, Chinyere; Tunde-Oremodu, Immaculata; Madubuike, Chinelo; Umeadi, Esther; Epundu, Obed; Omosun, Adenike; Anigilaje, Emmanuel; Adeyinka, Daniel

2016-01-01

ABSTRACT Caregiver satisfaction has the potential to promote equity for children living with HIV, by influencing health-seeking behaviour. We measured dimensions of caregiver satisfaction with paediatric HIV treatment in Nigeria, and discuss its implications for equity by conducting facility-based exit interviews for caregivers of children receiving antiretroviral therapy in 20 purposively selected facilities within 5 geopolitical zones. Descriptive analysis and factor analysis were performed. Due to the hierarchical nature of the data, multilevel regression modelling was performed to investigate relationships between satisfaction factors and socio-demographic variables. Of 1550 caregivers interviewed, 63% (95% CI: 60.6–65.4) reported being very satisfied overall; however, satisfaction varied in some dimensions: only 55.6% (53.1–58.1) of caregivers could talk privately with health workers, 56.9% (54.4–59.3) reported that queues to see health workers were too long, and 89.9% (88.4–91.4) said that some health workers did not treat patients living with HIV with sufficient respect. Based on factor analysis, two underlying factors, labelled Availability and Attitude, were identified. In multilevel regression, the satisfaction with availability of services correlated with formal employment status (p < .01), whereas caregivers receiving care in private facilities were less likely satisfied with both availability (p < .01) and attitude of health workers (p < .05). State and facility levels influenced attitudes of the health workers (p < .01), but not availability of services. We conclude that high levels of overall satisfaction among caregivers masked dissatisfaction with some aspects of services. The two underlying satisfaction factors are part of access typology critical for closing equity gaps in access to HIV treatment between adults and children, and across socio-economic groups. PMID:27392010

Integrating Intimate Partner Violence Screening and Counseling in a Family Planning Clinic: Evaluation of a Pilot Project in Conakry, Guinea.

PubMed

Samandari, Ghazaleh; Delamou, Alexandre; Traore, Pernamou; Diallo, Fatoumata Guilinty; Millimono, Sita; Camara, Bienvenu Salim; Laffe, Kira; Verani, Fabio; Tolliver, Maimouna

2016-06-01

Few programs exist to address Intimate Partner Violence (IPV) in Guinea. In 2014, Engender Health, in partnership with the local health authorities in Conakry, Guinea, piloted an integrated approach to IPV screening and counseling, within an existing family planning clinic. This article describes both the process of formulating and implementing this approach, as well as the results of an evaluation of the program. From January to June of 2014, Engender Health staff trained midwives at the Conakry International Planned Parenthood Federation family planning clinic staff in screening and counseling client for IPV. Program evaluators used project records, interview with program staff (n=3), midwives (n=3) and client exit interviews (n=53) to measure the outcomes of this pilot project. Regardless of their IPV status, clients appreciated having a venue in which to discuss IPV. Program staff also felt empowered by the additional training and support for IPV screening. The evaluation yielded valuable suggestions for improvement, including more time for staff training and mock client interview practice, additional skills in counseling, and stronger referral links for women who screen positive for IPV. Integrating IPV screening into family planning services is an important and feasible method for reaching vulnerable women with IPV services.

An advocacy intervention program for women with abusive partners: six-month follow-up.

PubMed

Sullivan, C M; Campbell, R; Angelique, H; Eby, K K; Davidson, W S

1994-02-01

Presented the 6-month follow-up findings of an experimental intervention designed to provide postshelter advocacy services to women with abusive partners. The intervention involved randomly assigning half the research participants to receive the free services of an advocate, 4 to 6 hours per week, for the first 10 weeks postshelter. One hundred forty-one battered women were interviewed about their experiences immediately upon their exit from a domestic violence shelter: 95% of the sample were interviewed 10 weeks thereafter (postintervention), and 93% were successfully tracked and interviewed 6 months later. At the 6-month follow-up, participants in both groups reported increased social support, increased quality of life, less depression, less emotional attachment to their assailants, and an increased sense of personal power. Although women in both groups reported some decrease in physical abuse over time, there were no statistically significant differences between those with and those without advocates, and abuse continued to be a problem for many women. Those who were still involved with their assailants continued to experience higher levels of abuse and had been more economically dependent upon the men prior to entering the shelter. Women who had worked with advocates continued to report being more satisfied with their overall quality of life than did the women in the control group.

Identification of Targets for Prevention of Peritoneal Catheter Tunnel and Exit-Site Infections in Low Incidence Settings.

PubMed

Santos, Clara; Pérez-Fontán, Miguel; Rodríguez-Carmona, Ana; Calvo-Rodríguez, María; López-Muñiz, Andrés; López-Calviño, Beatriz; García-Falcón, Teresa

2016-01-01

♦ Peritoneal catheter tunnel and exit-site infection (TESI) complicates the clinical course of peritoneal dialysis (PD) patients. Adherence to recommendations for catheter insertion, exit-site care, and management of Staphylococcus aureus (SAu) carriage reduces, but does not abrogate the risk of these infections. ♦ To reappraise the risk profile for TESI in an experienced center with a long-term focus on management of SAu carriage and a low incidence of these infections. ♦ Following a retrospective, observational design, we investigated 665 patients incident on PD. The main study variable was survival to the first episode of TESI. We considered selected demographic, clinical, and technical variables, applying multivariate strategies of analysis. ♦ The overall incidence of TESI was 1 episode/68.5 patient-months. Staphylococcus aureus carriage disclosed at inception of PD (but not if observed sporadically during follow-up) (hazard ratio [HR] 1.53, p = 0.009), PD started shortly after catheter insertion (HR 0.98 per day, p = 0.011), PD after kidney transplant failure (HR 2.18, p = 0.017), lower hemoglobin levels (HR 0.88 per g/dL, p = 0.013) and fast peritoneal transport rates (HR 2.92, p = 0.03) portended an increased risk of TESI. Delaying PD ≥ 30 days after catheter insertion markedly improved the probability of TESI. Carriage of methicillin-resistant SAu since the start of PD was associated with a high incidence of TESI by these bacteria. On the contrary, resistance to mupirocin did not predict such a risk, probably due to the use of an alternative regime in affected patients. ♦ Adherence to current recommendations results in a low incidence of TESI in PD patients. Interventions on specific risk subsets have a potential to bring incidence close to negligible levels. Despite systematic screening and management, SAu carriage is still a predictor of TESI. Antibiotic susceptibility patterns may help to refine stratification of the risk of TESI by these bacteria. Early insertion of the peritoneal catheter should be considered whenever possible, to reduce the risk of later TESI. Copyright © 2016 International Society for Peritoneal Dialysis.

Use of exit examinations: a criterion for graduation?

PubMed

Cullen, P D

1997-01-01

This study sought to measure the use of exit examinations in nursing schools at Historically Black Colleges and Universities (HBCU). Fifteen participants from HBCU nursing schools throughout the United States were surveyed to determine current practices related to exit exams. Overall, fourteen schools (93.33%) used an exit exam at the end of their nursing program. However, 73.33% of the participants (11 schools) reported it was mandatory for students to pass the exam as a requirement for graduation. Almost 47% of the participants (7 schools) reported the use of the exit exam was related to NCLEX-RN pass rates, while others reported identification of student needs as the primary reason for using an exit exam. Most participants were very helpful by sharing their innovations. While this small study provided some information on the use of exit examinations, more research is needed to substantiate both the appropriateness and usefulness of their use in baccalaureate degree nursing programs.

Spatial signals link exit from mitosis to spindle position.

PubMed

Falk, Jill Elaine; Tsuchiya, Dai; Verdaasdonk, Jolien; Lacefield, Soni; Bloom, Kerry; Amon, Angelika

2016-05-11

In budding yeast, if the spindle becomes mispositioned, cells prevent exit from mitosis by inhibiting the mitotic exit network (MEN). The MEN is a signaling cascade that localizes to spindle pole bodies (SPBs) and activates the phosphatase Cdc14. There are two competing models that explain MEN regulation by spindle position. In the 'zone model', exit from mitosis occurs when a MEN-bearing SPB enters the bud. The 'cMT-bud neck model' posits that cytoplasmic microtubule (cMT)-bud neck interactions prevent MEN activity. Here we find that 1) eliminating cMT- bud neck interactions does not trigger exit from mitosis and 2) loss of these interactions does not precede Cdc14 activation. Furthermore, using binucleate cells, we show that exit from mitosis occurs when one SPB enters the bud despite the presence of a mispositioned spindle. We conclude that exit from mitosis is triggered by a correctly positioned spindle rather than inhibited by improper spindle position.

46 CFR 185.606 - Escape hatches and emergency exits.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 7 2012-10-01 2012-10-01 false Escape hatches and emergency exits. 185.606 Section 185... 100 GROSS TONS) OPERATIONS Markings Required § 185.606 Escape hatches and emergency exits. All escape hatches and other emergency exits used as means of escape must be marked on both sides in clearly legible...

46 CFR 169.745 - Escape hatches and emergency exits.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 7 2013-10-01 2013-10-01 false Escape hatches and emergency exits. 169.745 Section 169... VESSELS Vessel Control, Miscellaneous Systems, and Equipment Markings § 169.745 Escape hatches and emergency exits. Each escape hatch and other emergency exit must be marked on both sides using at least 1...

46 CFR 185.606 - Escape hatches and emergency exits.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 7 2010-10-01 2010-10-01 false Escape hatches and emergency exits. 185.606 Section 185... 100 GROSS TONS) OPERATIONS Markings Required § 185.606 Escape hatches and emergency exits. All escape hatches and other emergency exits used as means of escape must be marked on both sides in clearly legible...

46 CFR 169.745 - Escape hatches and emergency exits.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 7 2011-10-01 2011-10-01 false Escape hatches and emergency exits. 169.745 Section 169... VESSELS Vessel Control, Miscellaneous Systems, and Equipment Markings § 169.745 Escape hatches and emergency exits. Each escape hatch and other emergency exit must be marked on both sides using at least 1...

46 CFR 185.606 - Escape hatches and emergency exits.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 7 2014-10-01 2014-10-01 false Escape hatches and emergency exits. 185.606 Section 185... 100 GROSS TONS) OPERATIONS Markings Required § 185.606 Escape hatches and emergency exits. All escape hatches and other emergency exits used as means of escape must be marked on both sides in clearly legible...

46 CFR 185.606 - Escape hatches and emergency exits.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 7 2011-10-01 2011-10-01 false Escape hatches and emergency exits. 185.606 Section 185... 100 GROSS TONS) OPERATIONS Markings Required § 185.606 Escape hatches and emergency exits. All escape hatches and other emergency exits used as means of escape must be marked on both sides in clearly legible...

46 CFR 169.745 - Escape hatches and emergency exits.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 7 2014-10-01 2014-10-01 false Escape hatches and emergency exits. 169.745 Section 169... VESSELS Vessel Control, Miscellaneous Systems, and Equipment Markings § 169.745 Escape hatches and emergency exits. Each escape hatch and other emergency exit must be marked on both sides using at least 1...

46 CFR 169.745 - Escape hatches and emergency exits.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 7 2012-10-01 2012-10-01 false Escape hatches and emergency exits. 169.745 Section 169... VESSELS Vessel Control, Miscellaneous Systems, and Equipment Markings § 169.745 Escape hatches and emergency exits. Each escape hatch and other emergency exit must be marked on both sides using at least 1...

46 CFR 169.745 - Escape hatches and emergency exits.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 7 2010-10-01 2010-10-01 false Escape hatches and emergency exits. 169.745 Section 169... VESSELS Vessel Control, Miscellaneous Systems, and Equipment Markings § 169.745 Escape hatches and emergency exits. Each escape hatch and other emergency exit must be marked on both sides using at least 1...

46 CFR 185.606 - Escape hatches and emergency exits.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 7 2013-10-01 2013-10-01 false Escape hatches and emergency exits. 185.606 Section 185... 100 GROSS TONS) OPERATIONS Markings Required § 185.606 Escape hatches and emergency exits. All escape hatches and other emergency exits used as means of escape must be marked on both sides in clearly legible...

An Entrance to Exit Polling: Strategies for Using Exit Polls as Experiential Learning Projects

ERIC Educational Resources Information Center

Berry, Michael J.; Robinson, Tony

2012-01-01

Engaging students in the design, administration, and postelection analysis of an exit poll can be an excellent experiential learning activity. Lelieveldt and Rossen (2009) argue that exit polls are a "perfect teaching tool" because they provide students with a cooperative (rather than competitive) learning experience; help students…

40 CFR 63.3176 - What definitions apply to this subpart?

Code of Federal Regulations, 2011 CFR

2011-07-01

... automobiles or light-duty trucks, including coating facilities and processes. Bake oven air seal means an entry or entry vestibule to or an exit or exit vestibule from a bake oven which isolates the bake oven... exit or exit vestibule) the bake oven. No significant VOC generating activity takes place in a bake...

Exit Cards: Creating a Dialogue for Continuous Evaluation

ERIC Educational Resources Information Center

Patka, Mazna; Wallin-Ruschman, Jennifer; Wallace, Tenille; Robbins, Candice

2016-01-01

This study explored the use of Exit Cards, which are formative evaluations of student knowledge and instruction undertaken at every class meeting. Its results are based on Exit Card data from two undergraduate research methods courses. Thematic analysis indicated that students used Exit Cards to communicate (1) what they learned, (2) challenges…

8 CFR 215.9 - Temporary Worker Visa Exit Program.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 8 Aliens and Nationality 1 2011-01-01 2011-01-01 false Temporary Worker Visa Exit Program. 215.9... ALIENS DEPARTING FROM THE UNITED STATES § 215.9 Temporary Worker Visa Exit Program. An alien admitted on certain temporary worker visas at a port of entry participating in the Temporary Worker Visa Exit Program...

8 CFR 215.9 - Temporary Worker Visa Exit Program.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 8 Aliens and Nationality 1 2010-01-01 2010-01-01 false Temporary Worker Visa Exit Program. 215.9... ALIENS DEPARTING FROM THE UNITED STATES § 215.9 Temporary Worker Visa Exit Program. An alien admitted on certain temporary worker visas at a port of entry participating in the Temporary Worker Visa Exit Program...

8 CFR 215.9 - Temporary Worker Visa Exit Program.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 8 Aliens and Nationality 1 2013-01-01 2013-01-01 false Temporary Worker Visa Exit Program. 215.9... ALIENS DEPARTING FROM THE UNITED STATES § 215.9 Temporary Worker Visa Exit Program. An alien admitted on certain temporary worker visas at a port of entry participating in the Temporary Worker Visa Exit Program...

8 CFR 215.9 - Temporary Worker Visa Exit Program.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 8 Aliens and Nationality 1 2012-01-01 2012-01-01 false Temporary Worker Visa Exit Program. 215.9... ALIENS DEPARTING FROM THE UNITED STATES § 215.9 Temporary Worker Visa Exit Program. An alien admitted on certain temporary worker visas at a port of entry participating in the Temporary Worker Visa Exit Program...

8 CFR 215.9 - Temporary Worker Visa Exit Program.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 8 Aliens and Nationality 1 2014-01-01 2014-01-01 false Temporary Worker Visa Exit Program. 215.9... ALIENS DEPARTING FROM THE UNITED STATES § 215.9 Temporary Worker Visa Exit Program. An alien admitted on certain temporary worker visas at a port of entry participating in the Temporary Worker Visa Exit Program...

Exit Exam as Academic Performance Indicator

ERIC Educational Resources Information Center

Al Ahmad, Mahmoud; Al Marzouqi, Ali H.; Hussien, Mousa

2014-01-01

This paper focuses on the impact of exit exams on different elements of the educational process, namely: curriculum development, students and instructors. A 50-question multiple-choice Exit Exam was prepared by Electrical Engineering (EE) faculty members covering a poll of questions from EE core courses. A copy of the Exit Exam applied during each…

A linguistic study of patient-centered interviewing: emergent interactional effects.

PubMed

Hesson, Ashley M; Sarinopoulos, Issidoros; Frankel, Richard M; Smith, Robert C

2012-09-01

To evaluate interactional effects of patient-centered interviewing (PCI) compared to isolated clinician-centered interviewing (CCI). We conducted a pilot study comparing PCI (N=4) to CCI (N=4) for simulated new-patient visits. We rated interviews independently and measured patient satisfaction with the interaction via a validated questionnaire. We conducted interactional sociolinguistic analysis on the interviews and compared across three levels of analysis: turn, topic, and interaction. We found significant differences between PCI and CCI in physician responses to patients' psychosocial cues and concerns. The number and type of physician questions also differed significantly across PCI and CCI sets. Qualitatively, we noted several indicators of physician-patient attunement in the PCI interviews that were not present in the CCI interviews. They spanned diverse aspects of physician and patient speech, suggesting interactional accommodation on the part of both participants. This small pilot study highlights a variety of interactional variables that may underlie the effects associated with patient-centered interviewing (e.g., positive relationships, health outcomes). Question form, phonological accommodation processes, and use of stylistic markers are relatively unexplored in controlled studies of physician-patient interaction. This study characterizes several interactional variables for larger scale studies and contributes to models of patient-centeredness in practice. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

DESIGN ANALYSIS OF RADIAL INFLOW TURBINES

NASA Technical Reports Server (NTRS)

Glassman, A. J.

1994-01-01

This program performs a velocity-diagram analysis required for determining geometry and estimating performance for radial-inflow turbines. Input design requirements are power, mass flow rate, inlet temperature and pressure, and rotative rate. The design variables include stator-exit angle, rotor-exit-tip to rotor-inlet radius ratio, rotor-exit-hub to tip radius ratio, and the magnitude and radial distribution of rotor-exit tangential velocity. The program output includes diameters, total and static efficiences, all absolute and relative temperatures, pressures, and velocities, and flow angles at stator inlet, stator exit, rotor inlet, and rotor exit. Losses accounted for in this program by the internal loss model are three-dimensional (profile plus end wall) viscous losses in the stator and the rotor, the disk-friction loss on the back side of the rotor, the loss due to the clearance between the rotor tip and the outer casing, and the exit velocity loss. The flow analysis is one-dimensional at the stator inlet, stator exit, and rotor inlet, each of these calculation stations being at a constant radius. At the rotor exit where there is a variation in flow-field radius, an axisymmetric two-dimensional analysis is made using constant height sectors. Simple radial equilibrium is used to establish the static pressure gradient at the rotor exit. This program is written in FORTRAN V and has been implemented on a UNIVAC 1100 series computer with a memory requirement of approximately 22K of 36 bit words.

Occupational and educational inequalities in exit from employment at older ages: evidence from seven prospective cohorts.

PubMed

Carr, Ewan; Fleischmann, Maria; Goldberg, Marcel; Kuh, Diana; Murray, Emily T; Stafford, Mai; Stansfeld, Stephen; Vahtera, Jussi; Xue, Baowen; Zaninotto, Paola; Zins, Marie; Head, Jenny

2018-05-01

Past studies have identified socioeconomic inequalities in the timing and route of labour market exit at older ages. However, few studies have compared these trends cross-nationally and existing evidence focuses on specific institutional outcomes (such as disability pension and sickness absence) in Nordic countries. We examined differences by education level and occupational grade in the risks of work exit and health-related work exit. Prospective longitudinal data were drawn from seven studies (n=99 164). Participants were in paid work at least once around age 50. Labour market exit was derived based on reductions in working hours, changes in self-reported employment status or from administrative records. Health-related exit was ascertained by receipt of health-related benefit or pension or from the reported reason for stopping work. Cox regression models were estimated for each study, adjusted for baseline self-rated health and birth cohort. There were 50 003 work exits during follow-up, of which an average of 14% (range 2-32%) were health related. Low level education and low occupational grade were associated with increased risks of health-related exit in most studies. Low level education and occupational grade were also associated with an increased risk of any exit from work, although with less consistency across studies. Workers with low socioeconomic position have an increased risk of health-related exit from employment. Policies that extend working life may disadvantage such workers disproportionally, especially where institutional support for those exiting due to poor health is minimal. © 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.

Choice architecture to promote fruit and vegetable purchases by families participating in the Special Supplemental Program for Women, Infants and Children (WIC): randomized corner store pilot study

PubMed Central

Thorndike, Anne N.; Bright, Oliver-John M.; Dimond, Melissa A.; Fishman, Ronald; Levy, Douglas E.

2017-01-01

Objective Conduct a pilot study to determine if improving the visibility and quality of fresh produce (choice architecture) in corner stores would increase fruit/vegetable purchases by families participating in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). Design Six stores were randomly assigned to choice architecture intervention or control. Store-level WIC sales data were provided by the state. Primary outcomes were WIC fruit/vegetable voucher and non-fruit/vegetable voucher sales, comparing trends from baseline (December 2012–October 2013) to the five month intervention period (December 2013–April 2014). Secondary outcomes were differences in customer self-reported fruit/vegetable purchases between baseline and the end of intervention. Setting Chelsea, Massachusetts, a low-income urban community. Subjects 575 adult customers completing store exit interviews. Results During baseline, WIC fruit/vegetable and non-fruit/vegetable sales decreased in both the intervention and control stores by $16/month. During the intervention period, WIC fruit/vegetable sales increased in intervention stores by $40/month but decreased in control stores by $23/month (difference in trends $63/month, 95% CI, $4–121/month; p=0.036); WIC non-fruit/vegetable sales were not different (p=0.45). Comparing baseline to intervention period exit interview responses by customers participating in WIC (N=134), intervention store customers reported increased fruit/vegetable purchases compared to control store customers (18% vs. −2%), but this did not achieve statistical significance (p=0.11). Conclusions Placement of fruit/vegetables near the front of corner stores increased purchase of produce by customers using WIC. New policies that incentivize stores to stock and prominently display good quality produce could promote healthier food choices of low-income families. PMID:27890020

Jeopardizing quality at the frontline of healthcare: prevalence and risk factors for disrespect and abuse during facility-based childbirth in Ethiopia

PubMed Central

Karim, Ali M; Ratcliffe, Hannah L; Betemariam, Wuleta; Langer, Ana

2018-01-01

Abstract Disrespect and abuse (D&A) experienced by women during facility-based childbirth has gained global recognition as a threat to eliminating preventable maternal mortality and morbidity. This study explored the frequency and associated factors of D&A in four rural health centres in Ethiopia. Experiences of women who delivered in these facilities were captured by direct observation of client-provider interaction (N = 193) and exit interview at time of discharge (N = 204). Incidence of D&A was observed in each facility, with failure to ask woman for preferred birth position most commonly observed [n = 162, 83.9%, 95% confidence interval (95% CI) 78.0–88.5%]. During exit interviews, 21.1% (n = 43, 95% CI 15.4–26.7%) of respondents reported at least one occurrence of D&A. Bivariate models using client characteristics and index birth experience showed that women’s reporting of D&A was significantly associated with childbirth complications [odds ratio (OR) = 7.98, 95% CI 3.70, 17.22], weekend delivery (OR = 0.17, 95% CI 0.05, 0.63) and no previous delivery at the facility (OR = 3.20, 95% CI 1.27, 8.05). Facility-level fixed-effect models found that experience of complications (OR = 15.51, 95% CI 4.38, 54.94) and weekend delivery (OR = 0.05, 95% CI 0.01–0.32) remained significantly and most strongly associated with self-reported D&A. These data suggest that addressing D&A in health centres in Ethiopia will require a sustained effort to improve infrastructure, support the health workforce in rural settings, enforce professional standards and target interventions to improve women’s experiences as part of quality of care initiatives. PMID:29309598

Counseling and Knowledge of Danger Signs of Pregnancy Complications in Haiti, Malawi, and Senegal.

PubMed

Assaf, Shireen

2018-06-23

Objectives Providing counseling on danger signs of pregnancy complications as part of visits for antenatal care (ANC) can raise expecting women's awareness so that if danger signs occur they can seek assistance in time. The study examines the level of agreement in counseling on danger signs between observation of the provider during the ANC visit and the client's report in the exit interview, and the association of this agreement with the client's level of knowledge on danger signs. Methods The analysis used data from service provision and assessment (SPA) surveys in Haiti, Malawi, and Senegal. Agreement between the observation and client's report was measured by Cohen's kappa and percent agreement. Regressions were performed on the number of danger signs the client knew, with the level of agreement on the counseling on danger signs as the main independent variable. Results The study found little agreement between the observation of counseling and the client's report that the counseling occurred, despite the fact that the exit interview with the client was performed immediately following the ANC visit with the provider. The level of positive agreement between observation and client's report was 17% in Haiti, 33% in Malawi, and 23% in Senegal. Clients' overall knowledge of danger signs was low; in all three countries the mean number of danger signs known was 1.5 or less. The regression analysis found that, in order to show a significant increase in knowledge of danger signs, it was important for the client to report that it took place. Conclusions Ideally, there should be 100% positive agreement that counseling occurred. To achieve this level requires raising both the level of counseling on danger signs of pregnancy complications and its quality. While challenges exist, providing counseling that is more client-centered and focuses on the client's needs could improve quality and thus could increase the client's knowledge of danger signs.

Differences in Student Achievement between Early-Exit and Late-Exit Bilingual Programs: A Multiyear, Statewide Investigation

ERIC Educational Resources Information Center

Martinez, Rosa Maria

2014-01-01

Purpose The purpose of this study was to examine the difference between two bilingual program types: traditional early-exit and late-exit bilingual programs and academic achievement using archival data from the Texas Education Agency Public Education Information Management System. An examination of academic achievement rates across a 3-year period…

Relationship between cattle temperament as determined by exit velocity carcass merit in beef cattle

USDA-ARS?s Scientific Manuscript database

The objective of this trial was to use cattle temperament, as determined by exit velocity only, as a means to evaluate the impact of temperament on carcass merit and the possible utilization of exit velocity alone as a sorting tool within the feedlot. At the time of processing, exit velocity and bod...

Exit Strategies: How Low-Performing High Schools Respond to High School Exit Examination Requirements

ERIC Educational Resources Information Center

Holme, Jennifer Jellison

2013-01-01

Background: Over the past several decades, a significant number of states have either adopted or increased high school exit examination requirements. Although these policies are intended to generate improvement in schools, little is known about how high schools are responding to exit testing pressures. Purpose: This study examined how five…

24 CFR 3280.106 - Exit facilities; egress windows and devices.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 24 Housing and Urban Development 5 2010-04-01 2010-04-01 false Exit facilities; egress windows and... § 3280.106 Exit facilities; egress windows and devices. (a) Every room designed expressly for sleeping purposes, unless it has an exit door (see § 3280.105), shall have at least one outside window or approved...

Exit Exams: Decreases or Increases the Dropout Rate

ERIC Educational Resources Information Center

Barnes, Teresa A.

2009-01-01

The purpose of this paper was to examine the impact of exit exams on the dropout rate. Data was gathered from several research articles. The most impressionable research revealed exit exams have a negative effect on minorities, especially black males. Results indicate by 2012, that exit exams in 25 states will affect 81 percent of minority high…

Rotor with Flattened Exit Pressure Profile

NASA Technical Reports Server (NTRS)

Baltas, Constantine (Inventor); Prasad, Dilip (Inventor); Gallagher, Edward J. (Inventor)

2015-01-01

A rotor blade comprises an airfoil extending radially from a root section to a tip section and axially from a leading edge to a trailing edge, the leading and trailing edges defining a curvature therebetween. The curvature determines a relative exit angle at a relative span height between the root section and the tip section, based on an incident flow velocity at the leading edge of the airfoil and a rotational velocity at the relative span height. In operation of the rotor blade, the relative exit angle determines a substantially flat exit pressure ratio profile for relative span heights from 75% to 95%, wherein the exit pressure ratio profile is constant within a tolerance of 10% of a maximum value of the exit pressure ratio profile.

Evaluation of the Performance and Flow in an Axial Compressor.

DTIC Science & Technology

1982-10-01

A Exit Rake P 11.00-P tP noz P2noz -PA SP-1 PHub - PA Exit Rake Pt11.50-Pt p - PA SP-1 PTip - PA Exit Rake Pt2.00-PPtpipe ATp Att Pspipe - PA SP-2...PTip - PA Exit Rake Pt6.50-Pt Inlet Rake Pt14.40-PA SP-8 PTip - PA Exit Rake Pt 17.00-Pt Inlet Rake Pt 1.30-PA SP-8 PHub - PA Exit Rake Pt17.50-Pt...Determination from Probe Pressures Pt (1) =((Pt=(1) + Phub ) + (Pt(1) + Pt(2)))/3 P t(2) P t(2) Pt (3) = t(3) P t(4) = (P t(3) + P t(4))/2 P t(5) =P t(4) Pt

Mean-field theory for pedestrian outflow through an exit.

PubMed

Yanagisawa, Daichi; Nishinari, Katsuhiro

2007-12-01

The average pedestrian flow through an exit is one of the most important indices in evaluating pedestrian dynamics. In order to study the flow in detail, the floor field model, which is a crowd model using cellular automata, is extended by taking into account realistic behavior of pedestrians around the exit. The model is studied by both numerical simulations and cluster analysis to obtain a theoretical expression for the average pedestrian flow through the exit. It is found quantitatively that the effects of exit door width, the wall, and the pedestrian mood of competition or cooperation significantly influence the average flow. The results show that there is a suitable width and position of the exit according to the pedestrians' mood.

A system to track skin dose for neuro-interventional cone-beam computed tomography (CBCT)

NASA Astrophysics Data System (ADS)

Vijayan, Sarath; Xiong, Zhenyu; Rudin, Stephen; Bednarek, Daniel R.

2016-03-01

The skin-dose tracking system (DTS) provides a color-coded illustration of the cumulative skin-dose distribution on a closely-matching 3D graphic of the patient during fluoroscopic interventions in real-time for immediate feedback to the interventionist. The skin-dose tracking utility of DTS has been extended to include cone-beam computed tomography (CBCT) of neurointerventions. While the DTS was developed to track the entrance skin dose including backscatter, a significant part of the dose in CBCT is contributed by exit primary radiation and scatter due to the many overlapping projections during the rotational scan. The variation of backscatter inside and outside the collimated beam was measured with radiochromic film and a curve was fit to obtain a scatter spread function that could be applied in the DTS. Likewise, the exit dose distribution was measured with radiochromic film for a single projection and a correction factor was determined as a function of path length through the head. Both of these sources of skin dose are added for every projection in the CBCT scan to obtain a total dose mapping over the patient graphic. Results show the backscatter to follow a sigmoidal falloff near the edge of the beam, extending outside the beam as far as 8 cm. The exit dose measured for a cylindrical CTDI phantom was nearly 10 % of the entrance peak skin dose for the central ray. The dose mapping performed by the DTS for a CBCT scan was compared to that measured with radiochromic film and a CTDI-head phantom with good agreement.

Operating unit time use is associated with anaesthesia type in below-knee surgery in adults.

PubMed

Lohela, T J; Chase, R P; Hiekkanen, T A; Kontinen, V K; Hynynen, M J

2017-03-01

Peripheral nerve blocks could reduce the operating unit and theatre time spent on high-risk patients who are particularly vulnerable to complications of general anaesthesia or have medications that prevent application of central neuraxial blocks. Medical record data of 617 and 254 elderly adults undergoing below-knee surgery in Jorvi and Meilahti hospitals (Helsinki University Hospital) between January 2010 and December 2012 were used to investigate the influence of anaesthetic technique on operating theatre times and on operating unit times using flexible parametric survival models. We report operating theatre and unit exit ratios (i.e. hazard ratios but using ratios of exit rates) for different types of anaesthesia. Adjusted analyses: In Jorvi Hospital, anaesthesia type was associated with large initial differentials in operating theatre times. The theatre exit ratios remained lower for general anaesthesia and central neuraxial blocks compared to peripheral nerve blocks until 30 min. In Meilahti Hospital, anaesthesia type did not influence theatre time, but was the best predictor of operating unit times. Compared to peripheral nerve blocks, the exit ratio remained lower for general anaesthesia until five operating unit hours in both hospitals and for central neuraxial blocks until 1 h in Meilahti Hospital and until 3 h in Jorvi Hospital. Holding area was used more in Jorvi Hospital compared to Meilahti Hospital. Peripheral nerve block anaesthesia reduces time spent in the operating unit and can reduce time spent in the operating theatre if induced in holding area outside of theatre. © 2017 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

Exit competencies in pathology and laboratory medicine for graduating medical students: the Canadian approach.

PubMed

Ford, Jason; Pambrun, Chantale

2015-05-01

Physicians in every medical and surgical field must be able to use pathology concepts and skills in their practice: for example, they must order and interpret the correct laboratory tests, they must use their understanding of pathogenesis to diagnose and treat, and they must work with the laboratory to care for their patients. These important concepts and skills may be ignored by medical schools and even national/international organizations setting graduation expectations for medical students. There is an evolving international consensus about the importance of exit competencies for medical school graduates, which define the measurable or observable behaviors each graduate must be able to demonstrate. The Canadian Association of Pathologists (CAP) Education Group set out to establish the basic competencies in pathology and laboratory medicine which should be expected of every medical graduate: not competencies for pathologists, but for medical graduates who intend to enter any residency program. We defined 4 targets for pathology and laboratory medicine exit competencies: that they represent only measurable behaviors, that they be clinically focused, that they be generalizable to every medical graduate, and that the final competency document be user-friendly. A set of competencies was developed iteratively and underwent final revision at the 2012 CAP annual meeting. These competencies were subsequently endorsed by the CAP executive and the Canadian Leadership Council on Laboratory Medicine. This clinically focused consensus document provides the first comprehensive list of exit competencies in pathology and laboratory medicine for undergraduate medical education. Copyright © 2015 Elsevier Inc. All rights reserved.

Neutral beamline with improved ion energy recovery

DOEpatents

Kim, Jinchoon

1984-01-01

A neutral beamline employing direct energy recovery of unneutralized residual ions is provided which enhances the energy recovery of the full energy ion component of the beam exiting the neutralizer cell, and thus improves the overall neutral beamline efficiency. The unneutralized full energy ions exiting the neutralizer are deflected from the beam path and the electrons in the cell are blocked by a magnetic field applied transverse to the beam direction in the neutral izer exit region. The ions which are generated at essentially ground potential and accelerated through the neutralizer cell by a negative acceleration voltage are collected at ground potential. A neutralizer cell exit end region is provided which allows the magnetic and electric fields acting on the exiting ions to be loosely coupled. As a result, the fractional energy ions exiting the cell are reflected onto and collected at an interior wall of the neutralizer formed by the modified end geometry, and thus do not detract from the energy recovery efficiency of full energy ions exiting the cell. Electrons within the neutralizer are prevented from exiting the neutralizer end opening by the action of crossed fields drift (ExB) and are terminated to a collector collar around the downstream opening of the neutralizer. The correct combination of the extended neutralizer end structure and the magnet region is designed so as to maximize the exit of full energy ions and to contain the fractional energy ions.

Influences of exit and stair conditions on human evacuation in a dormitory

NASA Astrophysics Data System (ADS)

Lei, Wenjun; Li, Angui; Gao, Ran; Wang, Xiaowei

2012-12-01

Evacuation processes of students are investigated by experiment and simulation. The experiment is performed for students evacuating from a dormitory with an exit and stairs. FDS+Evac is proposed to simulate the exit and stair dynamics of occupant evacuation. Concerning the exit and stair widths, we put forward some useful standpoints. Good agreement is achieved between the predicted results and experimental results. With the increase of exit width, a significant stratification phenomenon will be found in flow rate. Stratification phenomenon is that two different stable flow rates will emerge during the evacuation. And the flow rate curve looks like a ladder. The larger the exit width, the earlier the stratification phenomenon appears. When exit width is more than 2.0 m, the flow rate of each exit width is divided into two stable stages, and the evacuation times show almost no change. The judgment that the existence of stairs causes flow stratification is reasonable. By changing the width of the stairs, we proved that judgment. The smaller the width of BC, the earlier the stratification appears. We found that scenario 5 is the most adverse circumstance. Those results are helpful in performance-based design of buildings.

Maltreatment histories of aging out foster youth: A comparison of official investigated reports and self-reports of maltreatment prior to and during out-of-home care.

PubMed

Havlicek, Judy; Courtney, Mark E

2016-02-01

This study compared official investigated reports of child maltreatment with retrospective self-reports prior to and during out-of-home care for a sample of foster youth who reached the age of majority in out-of-home care in Illinois. Using matched administrative and self-reported data for 474 youth who completed a baseline interview in the Midwest Evaluation of Adult Functioning of Former Foster Youth (i.e. the Midwest study) at ages 17-18, and 386 youth who completed a follow up interview at age 19, this study finds that official reports and self-reports of maltreatment prior to and during out-of-home care differ significantly. Findings from this study add insight into measurement discrepancies, and help to inform understanding of the extent of maltreatment experienced by this sub-sample of young people exiting out-of-home care in adulthood. Study findings have implications for independent living policy and practice in child welfare. Copyright © 2015 Elsevier Ltd. All rights reserved.

Catalytic reactor for low-Btu fuels

DOEpatents

Smith, Lance; Etemad, Shahrokh; Karim, Hasan; Pfefferle, William C.

2009-04-21

An improved catalytic reactor includes a housing having a plate positioned therein defining a first zone and a second zone, and a plurality of conduits fabricated from a heat conducting material and adapted for conducting a fluid therethrough. The conduits are positioned within the housing such that the conduit exterior surfaces and the housing interior surface within the second zone define a first flow path while the conduit interior surfaces define a second flow path through the second zone and not in fluid communication with the first flow path. The conduit exits define a second flow path exit, the conduit exits and the first flow path exit being proximately located and interspersed. The conduits define at least one expanded section that contacts adjacent conduits thereby spacing the conduits within the second zone and forming first flow path exit flow orifices having an aggregate exit area greater than a defined percent of the housing exit plane area. Lastly, at least a portion of the first flow path defines a catalytically active surface.

Spatial signals link exit from mitosis to spindle position

PubMed Central

Falk, Jill Elaine; Tsuchiya, Dai; Verdaasdonk, Jolien; Lacefield, Soni; Bloom, Kerry; Amon, Angelika

2016-01-01

In budding yeast, if the spindle becomes mispositioned, cells prevent exit from mitosis by inhibiting the mitotic exit network (MEN). The MEN is a signaling cascade that localizes to spindle pole bodies (SPBs) and activates the phosphatase Cdc14. There are two competing models that explain MEN regulation by spindle position. In the 'zone model', exit from mitosis occurs when a MEN-bearing SPB enters the bud. The 'cMT-bud neck model' posits that cytoplasmic microtubule (cMT)-bud neck interactions prevent MEN activity. Here we find that 1) eliminating cMT– bud neck interactions does not trigger exit from mitosis and 2) loss of these interactions does not precede Cdc14 activation. Furthermore, using binucleate cells, we show that exit from mitosis occurs when one SPB enters the bud despite the presence of a mispositioned spindle. We conclude that exit from mitosis is triggered by a correctly positioned spindle rather than inhibited by improper spindle position. DOI: http://dx.doi.org/10.7554/eLife.14036.001 PMID:27166637

Neutral beamline with improved ion energy recovery

DOEpatents

Dagenhart, William K.; Haselton, Halsey H.; Stirling, William L.; Whealton, John H.

1984-01-01

A neutral beamline generator with unneutralized ion energy recovery is provided which enhances the energy recovery of the full energy ion component of the beam exiting the neutralizer cell of the beamline. The unneutralized full energy ions exiting the neutralizer are deflected from the beam path and the electrons in the cell are blocked by a magnetic field applied transverse to the beamline in the cell exit region. The ions, which are generated at essentially ground potential and accelerated through the neutralizer cell by a negative acceleration voltage, are collected at ground potential. A neutralizer cell exit end region is provided which allows the magnetic and electric fields acting on the exiting ions to be closely coupled. As a result, the fractional energy ions exiting the cell with the full energy ions are reflected back into the gas cell. Thus, the fractional energy ions do not detract from the energy recovery efficiency of full energy ions exiting the cell which can reach the ground potential interior surfaces of the beamline housing.

Challenges of NGO-to-state Referral in the Delivery of HIV Prevention Programs in Ukraine Supported by the Global Fund

PubMed Central

McGill, Svetlana

2015-01-01

Background: Ukraine has one of the world’s fastest growing HIV rates and was one of the largest recipients of funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria (GF). The objective of this study was to close the gaps in the literature on the delivery of HIV prevention services by NGOs and the perceptions of NGO delivered services, using as an example HIV prevention programs in Ukraine funded by the GF. Methods: The aim of this qualitative study was to determine how NGO-based services were implemented in the context of a state-owned healthcare system of Ukraine. An ethnographic study, which included 50 participant interviews, was conducted in three oblasts in Ukraine and in the capital, Kyiv, between 2011 and 2013. This article presents some of the findings that emerged from the analysis. Results: Participants reported that NGOs were focused more on reporting numbers of rapid tests, and less on motivating clients to continue onto treatment. The role division between NGOs and the state in HIV services was largely perceived by participants as unclear and challenging. Overall, lack of clarity on the role of government healthcare providers and NGOs in providing HIV services compromised the process of finding, referring, and retaining HIV patients in care. Conclusions: Gaps in linking HIV patients to the HIV care continuum have been identified as a potentially problematic issue in delivery of HIV prevention services by GF funded NGOs. With an anticipated GF exit from Ukraine, the lack of clearly defined NGO-to-state referrals of HIV patients complicates the transition of NGO run services into state funding. Further steps to improve referral systems are necessary to ensure a smooth transition and enable Ukraine to fight its HIV epidemic effectively. PMID:29138720

Clinical value of the cultural formulation interview in Pune, India

PubMed Central

Paralikar, Vasudeo P.; Sarmukaddam, Sanjeev B.; Patil, Kanak V.; Nulkar, Amit D.; Weiss, Mitchell G.

2015-01-01

Context: Development of the cultural formulation interview (CFI) in DSM-5 required validation for cross-cultural and global use. Aims: To assess the overall value (OV) of CFI in the domains of feasibility, acceptability, and utility from the vantage points of clinician-interviewers, patients and accompanying relatives. Settings and Design: We conducted cross-sectional semi-structured debriefing interviews in a psychiatric outpatient clinic of a general hospital. Materials and Methods: We debriefed 36 patients, 12 relatives and eight interviewing clinicians following the audio-recorded CFI. We transformed their Likert scale responses into ordinal values – positive for agreement and negative for disagreement (range +2 to −2). Statistical Analysis: We compared mean ratings of patients, relatives and clinician-interviewers using nonparametric tests. Clinician-wise grouping of patients enabled assessment of clinician effects, inasmuch as patients were randomly interviewed by eight clinicians. We assessed the influence of the presence of relatives, clinical diagnosis and interview characteristics by comparing means. Patient and clinician background characteristics were also compared. Results: Patients, relatives and clinicians rated the CFI positively with few differences among them. Patients with serious mental disorders gave lower ratings. Rating of OV was lower for patients and clinicians when relatives were present. Clinician effects were minimal. Clinicians experienced with culturally diverse patients rated the CFI more positively. Narratives clarified the rationale for ratings. Conclusions: Though developed for the American DSM-5, the CFI was valued by clinicians, patients and relatives in out-patient psychiatric assessment in urban Pune, India. Though relatives may add information and other value, their presence in the interview may impose additional demands on clinicians. Our findings contribute to cross-cultural evaluation of the CFI. PMID:25657458

My favorite tips for engaging the difficult patient on consultation-liaison psychiatry services.

PubMed

Knesper, David J

2007-06-01

Disengagement is the main enemy for the consultation-liaison psychiatrist. The goal of the first interview is to transform the unwilling, uncooperative, and often difficult and hostile patient into an engaged interview participant. Otherwise, the interview is an unproductive interrogation and an unpleasant power struggle. Once the difficult patient is engaged, the more typical psychiatric interview can begin. The three interview-engagement tips or techniques described are among the author's favorite ways to overcome the impediments to engagement most often associated with difficult patients.

Motivational interviewing in inflammatory bowel disease patients: a useful tool for outpatient counselling.

PubMed

Mocciaro, Filippo; Di Mitri, Roberto; Russo, Giuseppina; Leone, Salvo; Quercia, Valerio

2014-10-01

Most inflammatory bowel disease patients miss follow-up visits and are non-adherent to therapy due to the lack of an engaging patient-physician relationship. Motivational interviewing is a patient-centred counselling method used to elicit/strengthen motivation towards change. The aim of this study was to assess the role of motivational interviewing in patients affected by inflammatory bowel disease. The study included consecutive patients with inflammatory bowel disease presenting for the first consultation (June 2012-February 2013). All consultations were carried out applying the motivational interviewing approach. After each consultation, patients filled out a questionnaire asking demographic data, and their past and current experience. Overall, 23 males (51.1%) and 22 females (48.9%), mean age 36.1±15.2 years, were enrolled. Before and after experiencing the motivational interviewing approach (mean visit duration 41.5±8.7min) "overall satisfaction rate", "physician's communication skills", and "perceived empathy" were 60% vs 100%, 40% vs 95.6%, and 40% vs 100%, respectively. Satisfaction was lower in patients affected by indeterminate colitis (p=0.004), and of younger age (p=0.02). The motivational interview approach is appreciated by inflammatory bowel disease patients. Despite being time-consuming, the motivational interview appears considerably worthwhile at the first visit and in younger patients. Motivational interviewing can help physicians to deal with their patients, moving from "cure" to "care". Copyright © 2014 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Creating history: documents and patient participation in nurse-patient interviews.

PubMed

Jones, Aled

2009-09-01

Strongly worded directives regarding the need for increased patient participation during nursing interaction with patients have recently appeared in a range of 'best-practice' documents. This paper focuses on one area of nurse-patient communication, the hospital admission interview, which has been put forward as an ideal arena for increased patient participation. It uses data from a total of 27 admission interviews, extensive periods of participant observation and analysis of nursing records to examine how hospital admission interviews are performed by nurses and patients. Analysis shows that topics discussed during admission closely follow the layout of the admission document which nurses complete during the interview. Whilst it is tempting to describe the admission document as a 'super technological power' in influencing the interaction and restricting patient participation, this analysis attempts a more rounded reading of the data. Findings demonstrate that, whilst opportunities for patient participation were rare, admission interviews are complex interactional episodes that often belie simplistic or prescriptive guidance regarding interaction between nurses and patients. In particular, issue is taken with the lack of contextual and conceptual clarity with which best-practice guidelines are written.

36 CFR 13.1326 - Snowmachines.

Code of Federal Regulations, 2014 CFR

2014-07-01

... NATIONAL PARK SYSTEM UNITS IN ALASKA Special Regulations-Kenai Fjords National Park Exit Glacier Developed...) On Exit Glacier Road; (b) In parking areas; (c) On a designated route through the Exit Glacier...

36 CFR 13.1326 - Snowmachines.

Code of Federal Regulations, 2011 CFR

2011-07-01

... NATIONAL PARK SYSTEM UNITS IN ALASKA Special Regulations-Kenai Fjords National Park Exit Glacier Developed...) On Exit Glacier Road; (b) In parking areas; (c) On a designated route through the Exit Glacier...

36 CFR 13.1326 - Snowmachines.

Code of Federal Regulations, 2013 CFR

2013-07-01

... NATIONAL PARK SYSTEM UNITS IN ALASKA Special Regulations-Kenai Fjords National Park Exit Glacier Developed...) On Exit Glacier Road; (b) In parking areas; (c) On a designated route through the Exit Glacier...

36 CFR 13.1326 - Snowmachines.

Code of Federal Regulations, 2010 CFR

2010-07-01

... NATIONAL PARK SYSTEM UNITS IN ALASKA Special Regulations-Kenai Fjords National Park Exit Glacier Developed...) On Exit Glacier Road; (b) In parking areas; (c) On a designated route through the Exit Glacier...

Video Elicitation Interviews: A Qualitative Research Method for Investigating Physician-Patient Interactions

PubMed Central

Henry, Stephen G.; Fetters, Michael D.

2012-01-01

We describe the concept and method of video elicitation interviews and provide practical guidance for primary care researchers who want to use this qualitative method to investigate physician-patient interactions. During video elicitation interviews, researchers interview patients or physicians about a recent clinical interaction using a video recording of that interaction as an elicitation tool. Video elicitation is useful because it allows researchers to integrate data about the content of physician-patient interactions gained from video recordings with data about participants’ associated thoughts, beliefs, and emotions gained from elicitation interviews. This method also facilitates investigation of specific events or moments during interactions. Video elicitation interviews are logistically demanding and time consuming, and they should be reserved for research questions that cannot be fully addressed using either standard interviews or video recordings in isolation. As many components of primary care fall into this category, high-quality video elicitation interviews can be an important method for understanding and improving physician-patient interactions in primary care. PMID:22412003

Video elicitation interviews: a qualitative research method for investigating physician-patient interactions.

PubMed

Henry, Stephen G; Fetters, Michael D

2012-01-01

We describe the concept and method of video elicitation interviews and provide practical guidance for primary care researchers who want to use this qualitative method to investigate physician-patient interactions. During video elicitation interviews, researchers interview patients or physicians about a recent clinical interaction using a video recording of that interaction as an elicitation tool. Video elicitation is useful because it allows researchers to integrate data about the content of physician-patient interactions gained from video recordings with data about participants' associated thoughts, beliefs, and emotions gained from elicitation interviews. This method also facilitates investigation of specific events or moments during interactions. Video elicitation interviews are logistically demanding and time consuming, and they should be reserved for research questions that cannot be fully addressed using either standard interviews or video recordings in isolation. As many components of primary care fall into this category, high-quality video elicitation interviews can be an important method for understanding and improving physician-patient interactions in primary care.

Exit Site Infection due to Mycobacterium chelonae in an Elderly Patient on Peritoneal Dialysis.

PubMed

Hibi, Arata; Kasugai, Takahisa; Kamiya, Keisuke; Ito, Chiharu; Kominato, Satoru; Miura, Toshiyuki; Koyama, Katsushi

2018-01-01

Nontuberculous mycobacteria (NTM) are rarely isolated from peritoneal dialysis (PD)-associated catheter infections. However, NTM infection is usually difficult to treat and leads to catheter loss. Prompt diagnosis is essential for appropriate treatment. A 70-year-old Japanese man who had been on PD for 2 years and with a medical history of 2 episodes of exit site infections (ESIs) due to methicillin-resistant Staphylococcus aureus was admitted to the hospital due to suspected ESI recurrence. However, Gram staining of the pus revealed no gram-positive cocci. Instead, weakly stained gram-positive rods were observed after 7 days of incubation, which were also positive for acid-fast staining. Rapidly growing NTM Mycobacterium chelonae was isolated on day 14. Despite administering a combination antibiotic therapy, ESI could not be controlled, and catheter removal surgery was performed on day 21. Although PD was discontinued temporarily, the patient did not require hemodialysis, without any uremic symptoms. The catheter was reinserted on day 48, and PD was reinitiated on day 61. The patient was discharged on day 65. Antibiotic therapy was continued for 3 months after discharge, with no indications of recurrent infections observed. It is important to consider the risk of NTM infections in patients on PD. Acid-fast staining could be a key test for prompt diagnosis and provision of an appropriate treatment.

Evaluation of Two Methods of Prompting Drivers to Use Specific Exits on Conflicts between Vehicles at the Critical Exit

ERIC Educational Resources Information Center

Van Houten, Ron; Malenfant, J. E. Louis; Zhao, Nan; Ko, Byungkon; Van Houten, Jonathan

2005-01-01

The Florida Department of Transportation used a series of changeable-message signs that functioned as freeway guide signs to divert traffic to Universal Theme Park via one of two eastbound exits based on traffic congestion at the first of the two exits. An examination of crashes along the entire route indicated a statistically significant increase…

To Leave or Not to Leave? A Regression Discontinuity Analysis of the Impact of Failing High School Exit Exam. CEE DP 107

ERIC Educational Resources Information Center

Ou, Dongshu

2009-01-01

This paper presents new empirical evidence on whether failing the high school exit exam increases the chance of exiting from high school "prior to high school completion". More importantly, the author discusses the potentially different impacts of failing the High School Exit Exams (HSEE) on students with limited English proficiency,…

Solar concentrator with restricted exit angles

DOEpatents

Rabl, Arnulf; Winston, Roland

1978-12-19

A device is provided for the collection and concentration of radiant energy and includes at least one reflective side wall. The wall directs incident radiant energy to the exit aperture thereof or onto the surface of energy absorber positioned at the exit aperture so that the angle of incidence of radiant energy at the exit aperture or on the surface of the energy absorber is restricted to desired values.

Impact of a pharmacist-driven beta-lactam allergy interview on inpatient antimicrobial therapy: A pilot project.

PubMed

Sigona, Nicholas S; Steele, Jeffrey M; Miller, Christopher D

To determine the impact of a pharmacist-driven beta-lactam allergy interview on antimicrobial therapy. Tertiary care academic medical center. Clarification of beta-lactam allergy may expand treatment options for patients and potentially improve outcomes, reduce toxicity, and reduce costs. At our institution, a pilot service using a pharmacy resident and infectious diseases clinical pharmacist was implemented to clarify beta-lactam allergy information and, where appropriate, recommend a change to the patient's antibiotic therapy. Adult patients with a documented beta-lactam allergy who had received non-penicillin antibiotics and who had undergone a beta-lactam allergy interview were identified via pharmacy intervention data. A pharmacist interviewed these patients with the use of an internally developed allergy questionnaire. Recommendations for beta-lactam therapy were made to the patient's primary medical team based on the results of the allergy interview and factors including infection type and culture results. The primary objectives were to determine the percentage of patients successfully switched to beta-lactam therapy as a result of the drug allergy interview, to identify allergy discrepancies between the electronic medical record (EMR) and pharmacist's interview, and to quantify the acceptance rate of the pharmacist's antimicrobial recommendations after drug allergy clarification. Thirty-two patients were interviewed, and 24 were candidates for a beta-lactam recommendation. As a result of the interview, 21 patients (65.6%) were successfully switched from a non-penicillin antibiotic to a cephalosporin, carbapenem, or penicillin. A discrepancy between the EMR-reported allergy and history obtained on interview was identified in 11 patients (34.4%). Medical providers accepted 87.5% of pharmacists' antimicrobial recommendations. A pharmacist-driven beta-lactam allergy interview was effective in switching eligible patients to beta-lactam therapy and identifying discrepancies between EMR-documented allergies and confirmed allergies. Antimicrobial recommendations were well received by medical providers with a high acceptance rate. Copyright © 2016 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

Exploring service delivery in occupational therapy: The use of convergent interviewing.

PubMed

van Biljon, Hester; du Toit, Sanetta H J; Masango, July; Casteleijn, Daleen

2017-01-01

Occupational therapy clinicians working in South Africa's public healthcare had views on what patients thought about their vocational rehabilitation services that were based on anecdotal evidence. However evidence-based practice requires more than that. Reliable information is important in patient-centred practice and in the assessment of service quality. Clinical occupational therapists used the convergent interviewing technique to explore patients' views of the vocational rehabilitation services on offer in public hospitals. An Action Learning Action Research (ALAR) approach was used to explore the vocational rehabilitation services occupational therapy clinicians provided over a two week period in three settings. The majority (96%) of patients interviewed were not aware that occupational therapists offered vocational rehabilitation services. The convergent interview technique allowed continued unrestricted discussion of their vocational rehabilitation concerns and provided evidence that patients had significant concerns about work. Critical reflection on the interview experience and technique indicated that therapists were in favour of using convergent interviewing to obtain their patients views about the services offered. Therapists found the convergent interview technique easy to apply in clinical practice. Establishing patients' views of a clinical service have multiple values. However it is meaningless unless clinicians use the knowledge to improve service delivery to the patients who provided the views. Convergent interviewing was a valuable technique for occupational therapy clinicians to incorporate patients' views of their services into service development.

Stepping Into and Out of the Void: Funding Dynamics of Human Embryonic Stem Cell Research in California, Sweden, and South Korea.

PubMed

Weinryb, Noomi; Bubela, Tania

2016-02-01

Nonprofit organizations and philanthropists stepped into a funding void caused by controversies over public funding of human embryonic stem cell (hESC) research. Based on interviews of 83 representatives of 53 funders, we examine the motivations and accountability structures of public agencies, corporations, fundraising dependent nonprofit organizations and philanthropic organizations that funded hESC research in three jurisdictions: California, Sweden, and South Korea. While non-traditional forms of funding are essential in the early stages of research advancement, they are unreliable for the long timeframes necessary to advance cell therapies. Such funding sources may enter the field based on high expectations, but may exit just as rapidly based on disappointing rates of progress.

The effects of exit from work on health across different socioeconomic groups: A systematic literature review.

PubMed

Schaap, Rosanne; de Wind, Astrid; Coenen, Pieter; Proper, Karin; Boot, Cécile

2018-02-01

Exit from work leads to different effects on health, partially depending on the socioeconomic status (SES) of people in the work exit. Several studies on the effects of exit from work on health across socioeconomic groups have been performed, but results are conflicting. The aim of this review is to systematically review the available evidence regarding the effects of exit from work on health in high and low socioeconomic groups. A systematic literature search was conducted using Pubmed, Embase, Web of Science, CINAHL and PsycINFO. Search terms related to exit from work, health, SES and design (prospective or retrospective). Articles were included if they focused on: exit from work (early/statutory retirement, unemployment or disability pension); health (general, physical or mental health and/or health behaviour); SES (educational, occupational and/or income level); and inclusion of stratified or interaction analyses to determine differences across socioeconomic groups. This search strategy resulted in 22 studies. For general, physical or mental health and health behaviour, 13 studies found more positive effects of exit from work on health among employees with a higher SES compared to employees with a lower SES. These effects were mainly found after early/statutory retirement. In conclusion, the effects of exit from work, or more specific the effects of early/statutory retirement on health are different across socioeconomic groups. However, the findings of this review should be interpreted with caution as the studies used heterogeneous health outcomes and on each health outcome a limited number of studies was included. Yet, the positive effects of exit from work on health are mainly present in higher socioeconomic groups. Therefore, public health policies should focus on improving health of employees with a lower SES, in particular after exit from work to decrease health inequalities. Copyright © 2017 Elsevier Ltd. All rights reserved.

Suicide, Canadian law, and Exit International's "peaceful pill".

PubMed

Ogden, Russel D

2010-11-01

Australia's Exit International ("Exit") is probably the most visible and controversial right-to-die organization in the world. Founded by Dr. Philip Nitschke, Exit is known for do-it-yourself ("DIY") suicide workshops and a book banned in Australia: The Peaceful Pill Handbook. In 2009, Exit held its first workshop in Canada. Due to legal concerns, the Vancouver Public Library reneged on a commitment to give Exit a venue, so the workshop proceeded in the sanctuary of a church hall. This article summarizes the history of suicide law in Canada and gives an overview of the emerging DIY movement. A case report describes how a Canadian woman studied Exit's literature and learned how to import veterinary pentobarbital. In accordance with Exit's information, she ended her life. Ethical and legal implications for researching DIY suicide are discussed and it is argued that prohibition contributes to an undesirable situation of uncontrolled and unregulated suicide. Whether they are prohibited, permitted, or tolerated, suicide and assisted suicide are controversial. Their legal treatment in Canada is conflicting because suicide is not a crime but it is a serious offense to assist, encourage, or counsel someone to suicide. Individuals can lawfully take their lives, but they must act independently. This legal situation has given rise to a do-it-yourself ("DIY") right-to-die movement dedicated to technologies and information to enhance the possibilities for planned and humane suicide, while limiting the legal exposure of sympathetic third parties (Martin, 2010; Ogden 2001). My aim is to summarize the legal history of suicide in Canada and discuss the emerging social movement for DIY suicide and assistance in suicide. Exit International ("Exit"), based in Australia, is a leading organization in this movement. I present a case report that describes how a Canadian woman ended her life using DIY techniques learned from Exit. Some ethical and legal implications for researching DIY suicide are discussed. I argue that the DIY movement is an undesirable consequence of prohibition.

Outcome of stand-alone thoracoscopic epicardial left atrial posterior box isolation with bipolar radiofrequency energy for longstanding persistent atrial fibrillation.

PubMed

Compier, M G; Braun, J; Tjon, A; Zeppenfeld, K; Klautz, R J M; Schalij, M J; Trines, S A

2016-02-01

Catheter ablation of longstanding (> 1 year) persistent atrial fibrillation (AF) is associated with poor outcome. This might be due to remodelling and fibrosis formation, mainly located in the posterior left atrial (LA) wall. Therefore, we adopted a thoracoscopic epicardial box isolation of the posterior left atrium using bipolar RF energy with intraoperative testing of conduction block. Bilateral thoracoscopic box isolation was performed with a bipolar RF clamp. Entrance block was defined as absence of a conducted electrogram within the box, while exit block was confirmed by pacing at 10.0 V/2 ms. Ablation outcome was evaluated after 3, 6, 12 and 24 months with 12-lead ECGs and 24-hour Holter recordings. Twenty-five consecutive patients were included (58 ± 7 years, persistent AF duration 1.8 ± 0.9 years). Entrance block was achieved in all patients and exit block confirmed if sinus rhythm was achieved. After 17 ± 7 months, 76 % of the patients (n = 19) were free of AF recurrence. One patient died within 1 month and was considered an ablation failure. Four patients with AF recurrences regained sinus rhythm with additional catheter ablation or antiarrhythmic drugs. Treatment of longstanding persistent AF with thoracoscopic epicardial LA posterior box isolation using bipolar RF energy with intraoperative testing of conduction block is feasible and highly effective.

Transgenic C. elegans dauer larvae expressing hookworm phospho null DAF-16/FoxO exit dauer.

PubMed

Gelmedin, Verena; Brodigan, Thomas; Gao, Xin; Krause, Michael; Wang, Zhu; Hawdon, John M

2011-01-01

Parasitic hookworms and the free-living model nematode Caenorhabtidis elegans share a developmental arrested stage, called the dauer stage in C. elegans and the infective third-stage larva (L3) in hookworms. One of the key transcription factors that regulate entrance to and exit from developmental arrest is the forkhead transcription factor DAF-16/FoxO. During the dauer stage, DAF-16 is activated and localized in the nucleus. DAF-16 is negatively regulated by phosphorylation by the upstream kinase AKT, which causes DAF-16 to localize out of the nucleus and the worm to exit from dauer. DAF-16 is conserved in hookworms, and hypothesized to control recovery from L3 arrest during infection. Lacking reverse genetic techniques for use in hookworms, we used C. elegans complementation assays to investigate the function of Ancylostoma caninum DAF-16 during entrance and exit from L3 developmental arrest. We performed dauer switching assays and observed the restoration of the dauer phenotype when Ac-DAF-16 was expressed in temperature-sensitive dauer defective C. elegans daf-2(e1370);daf-16(mu86) mutants. AKT phosphorylation site mutants of Ac-DAF-16 were also able to restore the dauer phenotype, but surprisingly allowed dauer exit when temperatures were lowered. We used fluorescence microscopy to localize DAF-16 during dauer and exit from dauer in C. elegans DAF-16 mutant worms expressing Ac-DAF-16, and found that Ac-DAF-16 exited the nucleus during dauer exit. Surprisingly, Ac-DAF-16 with mutated AKT phosphorylation sites also exited the nucleus during dauer exit. Our results suggest that another mechanism may be involved in the regulation DAF-16 nuclear localization during recovery from developmental arrest.

Factors Associated With Premature Exits From Supported Housing

PubMed Central

Gabrielian, Sonya; Burns, Alaina V.; Nanda, Nupur; Hellemann, Gerhard; Kane, Vincent; Young, Alexander S.

2015-01-01

Objective Many homeless consumers who enroll in supported housing programs—which offer subsidized housing and supportive services—disengage prematurely, before placement in permanent community-based housing. This study explored factors associated with exiting a supported housing program before achieving housing placement. Methods With the use of administrative data, a roster was obtained for consumers enrolled in the Veterans Affairs (VA) Greater Los Angeles supported housing program from 2011 to 2012. Fewer (4%) consumers exited this program before achieving housing (“exiters”) compared with consumers described in national VA figures (18%). Exiters with available demographic data (N=51) were matched 1:1 on age, gender, marital status, and race-ethnicity with consumers housed through this program (“stayers,” N=51). Medical records were reviewed to compare diagnoses, health care utilization, housing histories, vocational history, and criminal justice involvement of exiters versus stayers. Exiters' housing outcomes were identified. Recursive partitioning identified variables that best differentiated exiters from stayers. Results Several factors were associated with premature exits from this supported housing program: residing in temporary housing on hospital grounds during program enrollment, poor adherence to outpatient care, substance use disorders, hepatitis C, chronic pain, justice involvement, frequent emergency department utilization, and medical-surgical admissions. The first of these factors and poor adherence to outpatient medical-surgical care best differentiated exiters from stayers. Moreover, >50% of exiters became street homeless or incarcerated after leaving the program. Conclusions In that diverse social factors, diagnoses, and health care utilization patterns were associated with premature disengagement from supported housing, future research is needed to implement and evaluate rehabilitative services that address these factors, adapted to the context of supported housing. PMID:26467908

The Impact of Price-cap Regulations on Exit by Generic Pharmaceutical Firms.

PubMed

Zhang, Wei; Guh, Daphne; Sun, Huiying; Marra, Carlo A; Lynd, Larry D; Anis, Aslam H

2016-09-01

In 1998, the Province of Ontario in Canada adopted price-cap "70/90" regulations whereby the first generic entrant was required to be priced at ≤70% of the associated brand-name product and subsequent generics were priced at ≤90% of the first generic price. The price-caps were further lowered to 50% in 2006 and 25% in 2010. This study assessed the impact of such price-cap regulations on exit by generic drug firms. Formulary (2003-2012) listings of prescription drugs covered under the Ontario Drug Benefit program were used. The formulary tracks the "status" (on formulary, discontinued by manufacturer, and delisted for other reasons) for each drug. Markets were defined based on unique active ingredient and form within Ontario. Firm exit occurred when a manufacturer discontinued all its generic drugs within a market. The exit rate was defined as the number of generic firm-market exits divided by total generic firm-market follow-up years. Poisson regression was used to compare the exit rates during the 3 policy periods ("25," "50," and "70/90"). A total of 1126 generic manufacturers paired with 290 markets were identified. The exit rate ratio during the 25% price-cap period compared with the 70%/90% period was 2.42 (95% confidence interval, 1.56-3.77). A small manufacturer or a manufacturer in a market with ≥3 competitors or in an older market was more likely to exit. Lowering the price-cap level is associated with a higher incidence of generic firm exit from markets. Continuously reducing price-caps may have the unintended consequence of forcing generic firms to exit.

Young women selling sex online – narratives on regulating feelings

PubMed Central

Jonsson, Linda S; Svedin, Carl Göran; Hydén, Margareta

2015-01-01

The current study concerns young women’s life stories of their experiences selling sex online before the age of 18. The aim was to gain an understanding of young women’s perceptions of the reasons they started, continued, and stopped selling sex. The study included interviews with 15 young women between the ages of 15 and 25 (M=18.9). Thematic analysis was used to identify similarities and differences in the narratives. Three themes and eight sub-themes were identified in relation to different stages in their lives in the sex trade. The themes were organized into three parts, each with its own storyline: “Entering – adverse life experiences”; traumatic events: feeling different and being excluded. “Immersion – using the body as a tool for regulating feelings”; being seen: being touched: being in control: affect regulation and self-harming. “Exiting – change or die”; living close to death: the process of quitting. The informants all had stable social lives in the sense that they had roofs over their heads, food to eat, and no substance-abuse issues. None had a third party who arranged the sexual contacts and none were currently trafficked. They described how their experiences of traumatic events and of feeling different and excluded had led them into the sex trade. Selling sex functioned as a way to be seen, to handle traumatic events, and to regulate feelings. Professionals working with young people who sell sex online need to understand the complex web of mixed feelings and emotional needs that can play a role in selling sex. Young people selling sex might need guidance in relationship building as well as help processing traumatic experiences and ending self-harming behavior. Further studies are needed on the functions of online sex selling and on the exit process for young people, in order to prevent entrance and facilitate exiting. PMID:25733944

Young women selling sex online - narratives on regulating feelings.

PubMed

Jonsson, Linda S; Svedin, Carl Göran; Hydén, Margareta

2015-01-01

The current study concerns young women's life stories of their experiences selling sex online before the age of 18. The aim was to gain an understanding of young women's perceptions of the reasons they started, continued, and stopped selling sex. The study included interviews with 15 young women between the ages of 15 and 25 (M=18.9). Thematic analysis was used to identify similarities and differences in the narratives. Three themes and eight sub-themes were identified in relation to different stages in their lives in the sex trade. The themes were organized into three parts, each with its own storyline: "Entering - adverse life experiences"; traumatic events: feeling different and being excluded. "Immersion - using the body as a tool for regulating feelings"; being seen: being touched: being in control: affect regulation and self-harming. "Exiting - change or die"; living close to death: the process of quitting. The informants all had stable social lives in the sense that they had roofs over their heads, food to eat, and no substance-abuse issues. None had a third party who arranged the sexual contacts and none were currently trafficked. They described how their experiences of traumatic events and of feeling different and excluded had led them into the sex trade. Selling sex functioned as a way to be seen, to handle traumatic events, and to regulate feelings. Professionals working with young people who sell sex online need to understand the complex web of mixed feelings and emotional needs that can play a role in selling sex. Young people selling sex might need guidance in relationship building as well as help processing traumatic experiences and ending self-harming behavior. Further studies are needed on the functions of online sex selling and on the exit process for young people, in order to prevent entrance and facilitate exiting.

The interview with a patient on dialysis: feeling, emotions and fears.

PubMed

Brunori, Francesco; Dozio, Beatrice; Colzani, Sara; Pozzi, Marco; Pisano, Lucia; Galassi, Andrea; Santorelli, Gennaro; Auricchio, Sara; Busnelli, Luisa; Di Carlo, Angela; Viganò, Monica; Calabrese, Valentina; Mariani, Laura; Mossa, Monica; Longoni, Stefania; Scanziani, Renzo

2016-01-01

This study has been performed in the Nephrology and Dialysis Unit, in Desio Hospital, Italy. The aim of this study is to evaluate, starting from research questions, which information is given to patient in the pre-dialysis colloquia for his/her chosen dialysis methods. Moreover, the study evaluated feelings, emotions and fears since the announcement of the necessity of dialysis treatment. The objective of the study was reached through the interview with patients on dialysis. The fact-finding survey was based on the tools of social research, as the semi-structured interview. Instead of using the questionnaire, even though it make it easier to collect larger set of data, the Authors decided to interview patients in person, since the interview allows direct patient contact and to build a relationship of trust with the interviewer, in order to allow patient explain better his/her feeling.

14 CFR 25.811 - Emergency exit marking.

Code of Federal Regulations, 2011 CFR

2011-01-01

... passenger emergency exit, or at another overhead location if it is more practical because of low headroom... divider that prevents fore and aft vision along the passenger cabin to indicate emergency exits beyond and...

14 CFR 25.811 - Emergency exit marking.

Code of Federal Regulations, 2013 CFR

2013-01-01

... passenger emergency exit, or at another overhead location if it is more practical because of low headroom... divider that prevents fore and aft vision along the passenger cabin to indicate emergency exits beyond and...

14 CFR 25.811 - Emergency exit marking.

Code of Federal Regulations, 2014 CFR

2014-01-01

... passenger emergency exit, or at another overhead location if it is more practical because of low headroom... divider that prevents fore and aft vision along the passenger cabin to indicate emergency exits beyond and...

14 CFR 25.811 - Emergency exit marking.

Code of Federal Regulations, 2012 CFR

2012-01-01

... passenger emergency exit, or at another overhead location if it is more practical because of low headroom... divider that prevents fore and aft vision along the passenger cabin to indicate emergency exits beyond and...

14 CFR 25.811 - Emergency exit marking.

Code of Federal Regulations, 2010 CFR

2010-01-01

... passenger emergency exit, or at another overhead location if it is more practical because of low headroom... divider that prevents fore and aft vision along the passenger cabin to indicate emergency exits beyond and...

Effect of exit locations on ants escaping a two-exit room stressed with repellent

NASA Astrophysics Data System (ADS)

Wang, Shujie; Cao, Shuchao; Wang, Qiao; Lian, Liping; Song, Weiguo

2016-09-01

In order to investigate the effect of the distance between two exits on ant evacuation efficiency and the behavior of ants escaping from a two-exit room, we conducted ant egress experiments using Camponotus japonicus in multiple situations. We found that the ants demonstrated the phenomenon of "symmetry breaking" in this stress situation. It was also shown that different locations for the exits obviously affected the ants' egress efficiency by measuring the time intervals between individual egress and flow rate in eight repeated experiments, each of which contained five different distance between the two exits. In addition, it is demonstrated that there are differences between the predictions of Social Force Model of pedestrians and the behaviors of ants in stress conditions through comparing some important behavioral features, including position, trajectory, velocity, and density map.

Aggregating job exit statuses of a plurality of compute nodes executing a parallel application

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

Aho, Michael E.; Attinella, John E.; Gooding, Thomas M.

Aggregating job exit statuses of a plurality of compute nodes executing a parallel application, including: identifying a subset of compute nodes in the parallel computer to execute the parallel application; selecting one compute node in the subset of compute nodes in the parallel computer as a job leader compute node; initiating execution of the parallel application on the subset of compute nodes; receiving an exit status from each compute node in the subset of compute nodes, where the exit status for each compute node includes information describing execution of some portion of the parallel application by the compute node; aggregatingmore » each exit status from each compute node in the subset of compute nodes; and sending an aggregated exit status for the subset of compute nodes in the parallel computer.« less

Assessing the performance, practices and roles of drug sellers/dispensers and mothers'/guardians' behaviour for common childhood conditions in Kibaha district, Tanzania.

PubMed

Nsimba, S E D

2007-10-01

In most third world countries, self-medication is common and pharmacies, drug stores and drug shops are important providers of health advice and inexpensive medicines. We used exit interviews to assess drug sellers'/dispensers' roles and consumers' behaviour in Kibaha district, Coast region, Tanzania. Exit interviews with mothers/guardians reported the following childhood conditions treated with or without prescriptions at drug shops: respiratory infections (34%), fever (21%), a combination of diarrhoea, acute respiratory infection (ARI) and fever (14%), diarrhoea alone (13%) and other conditions (17%). The majority of drug sellers/dispensers prescribed or dispensed branded drugs (85%) for most mothers/guardians who visited these drug shops. In addition, antibiotics in total were prescribed for 31% of the mothers/guardians. Of the antibiotics dispensed, 38% were not prescribed by clinicians. In total, oral rehydration salts (ORSs) (3%), antimalarials (sulphadoxine/pyrimethamine) (24%) and antipyretics (11%), were prescribed in 20% but were bought by only 9%; multivitamins (6%), cough mixtures (4%) and other drugs (2%) (antihelminthics, benzylbenzoate emulsions, ear and eye drops) were also purchased from these facilities. Of the diarrhoea case histories presented by simulated clients at the drug shops, only 35% of the bloody diarrhoea scenarios were accurately diagnosed for getting antibiotics as compared with 44% for watery diarrhoea for which the use of antibiotics were wrongly advised (P<0.01). Furthermore, drug sellers/dispensers in these drug shops recommended use of ORS less frequently (3%) for a combination of diarrhoea, ARI and fever, and 2% for ARI alone than for watery (29%) and bloody diarrhoea (32%), respectively, for children under five years of age (P<0.001). Antimicrobial agents were advised for ARI (38%), watery diarrhoea (44%) and bloody diarrhoea (35%), respectively, with no significant difference among the three common childhood conditions. Antipyretics were advised in almost all childhood conditions but were least in watery (2%) and bloody diarrhoea (4%). This study demonstrates that antibiotics are overused in both the urban and rural settings of Kibaha district and that this is due to both clinicians'and drug sellers'prescribing practices in public and private facilities. The use of branded drugs was more common than that of generic drugs in private pharmacies, drug stores and ordinary shops. It is hereby proposed that any intervention should focus on training both facilities in the district on selectively prescribing and rational use of antibiotics for ARI and diarrhoea, and also to prescribe and dispense generic drugs so that it costs patients less when they buy drugs in shops. There is a need to increase awareness in recommending the use of ORS for clients to manage watery and bloody diarrhoea, and ARI in children under five years of age.

Effect of slotted exit orifice on performance of plasma synthetic jet actuator

NASA Astrophysics Data System (ADS)

Zong, Haohua; Kotsonis, Marios

2017-03-01

This study experimentally investigates the influence of exit orifice shape on the performance characteristics of a three-electrode plasma synthetic jet actuator. High-speed Schlieren imaging system and phase-locked two-component PIV measurements are used for flowfield characterisation in quiescent conditions. Two actuator configurations with the same exit area but different exit orifice shape (round orifice and slot orifice) are studied. Results indicate a close correspondence between the shapes of the starting vortex ring with the shapes of the respective exit orifices. For the slot orifice, the elongated starting vortex ring gradually expands during propagation, while its ends become warped. A distinct K-H instability structure is observed, inducing continuous oscillation of the high-speed jet. Compared with the jet from the round orifice, the slot jet has a higher entrainment rate of surrounding air, thus resulting in a lower propagation velocity of the jet front. The exit velocity of PSJA within one period initially shows a rapid increase, then persists at a relatively high level (100-130 m/s), and finally drops with some small-scale oscillations. The oscillation amplitude is less than 10 m/s, and the oscillation period is approximately 600 µs. Under conditions of same exit area, orifice shape has little influence on the variation of the exit velocity.

Sensitivity of Runway Occupancy Time (ROT) to Various Rollout and Turnoff (ROTO) Factors. Volume 1

NASA Technical Reports Server (NTRS)

Goldthorpe, S. H.

1997-01-01

The Terminal Area Productivity (TAP) research program was initiated by NASA to increase the airport capacity for transport aircraft operations. One element of the research program is called Low Visibility Landing and Surface Operations (LVLASO). A goal of the LVLASO research is to develop transport aircraft technologies which reduce Runway Occupancy Time (ROT) so that it does not become the limiting factor in the terminal area operations that determine the capacity of a runway. Under LVLASO, the objective of this study was to determine the sensitivity of ROT to various factors associated with the Rollout and Turnoff (ROTO) operation for transport aircraft. The following operational factors were studied and are listed in the order of decreasing ROT sensitivity: ice/flood runway surface condition, exit entrance ground speed, number of exits, high-speed exit locations and spacing, aircraft type, touchdown ground speed standard deviation, reverse thrust and braking method, accurate exit prediction capability, maximum reverse thrust availability, spiral-arc vs. circle-arc exit geometry, dry/slush/wet/snow runway surface condition, maximum allowed deceleration, auto asymmetric braking on exit, do not stow reverse thrust before the exit, touchdown longitudinal location standard deviation, flap setting, anti-skid efficiency, crosswind conditions, stopping on the exit and touchdown lateral offset.

Sensitivity of Runway Occupancy Time (ROT) to Various Rollout and Turnoff (ROTO) Factors. Volume 2; Complete Set of Plotted Data

NASA Technical Reports Server (NTRS)

Goldthorpe, S. H.

1997-01-01

The Terminal Area Productivity (TAP) research program was initiated by NASA to increase the airport capacity for transport aircraft operations. One element of the research program is called Low Visibility Landing and Surface Operations (LVLASO). A goal of the LVLASO research is to develop transport aircraft technologies which reduce Runway Occupancy Time (ROT) so that it does not become the limiting factor in the terminal area operations that determine the capacity of a runway. Under LVLASO, the objective of this study was to determine the sensitivity of ROT to various factors associated with the Rollout and Turnoff (ROTO) operation for transport aircraft. The following operational factors were studied and are listed in the order of decreasing ROT sensitivity: ice/flood runway surface condition, exit entrance ground speed, number of exits, high-speed exit locations and spacing, aircraft type, touchdown ground speed standard deviation, reverse thrust and braking method, accurate exit prediction capability, maximum reverse thrust availability, spiral-arc vs. circle-arc exit geometry, dry/slush/wet/snow runway surface condition, maximum allowed deceleration, auto asymmetric braking on exit, do not stow reverse thrust before the exit, touchdown longitudinal location standard deviation, flap setting, anti-skid efficiency, crosswind conditions, stopping on the exit and touchdown lateral offset.

Method for Making Measurements of the Post-Combustion Residence Time in a Gas Turbine Engine

NASA Technical Reports Server (NTRS)

Miles, Jeffrey H. (Inventor)

2017-01-01

A method of measuring a residence time in a gas-turbine engine is disclosed that includes measuring a combustor pressure signal at a combustor entrance and a turbine exit pressure signal at a turbine exit. The method further includes computing a cross-spectrum function between the combustor pressure signal and the turbine exit pressure signal, calculating a slope of the cross-spectrum function, shifting the turbine exit pressure signal an amount corresponding to a time delay between the measurement of the combustor pressure signal and the turbine exit pressure signal, and recalculating the slope of the cross-spectrum function until the slope reaches zero.

Supporting 'medicine at a distance' for delivery of hospital services in war-torn Somalia: how well are we doing?

PubMed

Maalim, Abdisalan M; Zachariah, Rony; Khogali, Mohamed; Van Griensven, Johan; Van den Bergh, Rafael; Tayler-Smith, Katherine; Kizito, Walter; Baruani, Bienvenu; Osoble, Abdirahman; Abdirahman, Faiza; Ayada, Latifa; Mohamed, Abdinoor H

2014-03-01

We describe an innovative strategy implemented to support national staff at Istarlin Hospital in the conflict setting of Somalia; and report on inpatient morbidities, mortality and adverse hospital exit outcomes. This was a retrospective analysis of hospital data for 2011. Of 8584 admitted patients, the largest numbers were for lower respiratory tract infections (LRTI) (2114; 25%), normal deliveries (1355; 16%) and diarrhoeal diseases (715; 8%). The highest contributors to mortality were gunshot wounds in surgery (18/30; 60%), LRTIs in internal medicine (6/32; 19%) and malnutrition in paediatrics (30/81; 37%). Adverse hospital exit outcomes (deaths and absconded) were well within thresholds set by Médecins Sans Frontières. With a support package, satisfactory standards of care were met for hospital care in Somalia.

Barriers to prompt and effective malaria treatment among the poorest population in Kenya.

PubMed

Chuma, Jane; Okungu, Vincent; Molyneux, Catherine

2010-05-27

Prompt access to effective malaria treatment is central to the success of malaria control worldwide, but few fevers are treated with effective anti-malarials within 24 hours of symptoms onset. The last two decades saw an upsurge of initiatives to improve access to effective malaria treatment in many parts of sub-Saharan Africa. Evidence suggests that the poorest populations remain least likely to seek prompt and effective treatment, but the factors that prevent them from accessing interventions are not well understood. With plans under way to subsidize ACT heavily in Kenya and other parts of Africa, there is urgent need to identify policy actions to promote access among the poor. This paper explores access barriers to effective malaria treatment among the poorest population in four malaria endemic districts in Kenya. The study was conducted in the poorest areas of four malaria endemic districts in Kenya. Multiple data collection methods were applied including: a cross-sectional survey (n=708 households); 24 focus group discussions; semi-structured interviews with health workers (n=34); and patient exit interviews (n=359). Multiple factors related to affordability, acceptability and availability interact to influence access to prompt and effective treatment. Regarding affordability, about 40 percent of individuals who self-treated using shop-bought drugs and 42 percent who visited a formal health facility reported not having enough money to pay for treatment, and having to adopt coping strategies including borrowing money and getting treatment on credit in order to access care. Other factors influencing affordability were seasonality of illness and income sources, transport costs, and unofficial payments. Regarding acceptability, the major interrelated factors identified were provider patient relationship, patient expectations, beliefs on illness causation, perceived effectiveness of treatment, distrust in the quality of care and poor adherence to treatment regimes. Availability barriers identified were related to facility opening hours, organization of health care services, drug and staff shortages. Ensuring that all individuals suffering from malaria have prompt access to effective treatment remains a challenge for resource constrained health systems. Policy actions to address the multiple barriers of access should be designed around access dimensions, and should include broad interventions to revitalize the public health care system. Unless additional efforts are directed towards addressing access barriers among the poor and vulnerable, malaria will remain a major cause of morbidity and mortality in sub-Saharan Africa.

Computerised therapy for depression with clinician vs. assistant and brief vs. extended phone support: study protocol for a randomised controlled trial.

PubMed

Gega, Lina; Swift, Louise; Barton, Garry; Todd, Gillian; Reeve, Nesta; Bird, Kelly; Holland, Richard; Howe, Amanda; Wilson, Jon; Molle, Jo

2012-08-27

Computerised cognitive behaviour therapy (cCBT) involves standardised, automated, interactive self-help programmes delivered via a computer. Randomised controlled trials (RCTs) and observational studies have shown than cCBT reduces depressive symptoms as much as face-to-face therapy and more than waiting lists or treatment as usual. cCBT's efficacy and acceptability may be influenced by the "human" support offered as an adjunct to it, which can vary in duration and can be offered by people with different levels of training and expertise. This is a two-by-two factorial RCT investigating the effectiveness, cost-effectiveness and acceptability of cCBT supplemented with 12 weekly phone support sessions are either brief (5-10 min) or extended (20-30 min) and are offered by either an expert clinician or an assistant with no clinical training. Adults with non-suicidal depression in primary care can self-refer into the study by completing and posting to the research team a standardised questionnaire. Following an assessment interview, eligible referrals have access to an 8-session cCBT programme called Beating the Blues and are randomised to one of four types of support: brief-assistant, extended-assistant, brief-clinician or extended-clinician.A sample size of 35 per group (total 140) is sufficient to detect a moderate effect size with 90% power on our primary outcome measure (Work and Social Adjustment Scale); assuming a 30% attrition rate, 200 patients will be randomised. Secondary outcome measures include the Beck Depression and Anxiety Inventories and the PHQ-9 and GAD-7. Data on clinical outcomes, treatment usage and patient experiences are collected in three ways: by post via self-report questionnaires at week 0 (randomisation) and at weeks 12 and 24 post-randomisation; electronically by the cCBT system every time patients log-in; by phone during assessments, support sessions and exit interviews. The study's factorial design increases its efficiency by allowing the concurrent investigation of two types of adjunct support for cCBT with a single sample of participants. Difficulties in recruitment, uptake and retention of participants are anticipated because of the nature of the targeted clinical problem (depression impairs motivation) and of the studied interventions (lack of face-to-face contact because referrals, assessments, interventions and data collection are completed by phone, computer or post). Current Controlled Trials ISRCTN98677176.

Contribution of Patient Interviews as Part of a Comprehensive Approach to the Identification of Drug-Related Problems on Geriatric Wards.

PubMed

Stämpfli, Dominik; Boeni, Fabienne; Gerber, Andy; Bättig, Victor A D; Hersberger, Kurt E; Lampert, Markus L

2018-06-19

Inappropriate prescribing is linked to increased risks for adverse drug reactions and hospitalisation. Combining explicit and implicit criteria of inappropriate prescribing with the information obtained in patient interviews seems beneficial with regard to the identification of drug-related problems (DRPs) in hospitalised patients. We aimed to investigate the inclusion of pharmacist interviews as part of medication reviews (including the use of explicit and implicit criteria of inappropriate prescribing) to identify DRPs in older inpatients. Clinical medication reviews were performed on geriatric and associated physical and neurological rehabilitation wards in a regional secondary care hospital. Data from electronic medical records, laboratory data, and current treatment regimens were complemented with a novel structured patient interview performed by a clinical pharmacist. The structured interview questioned patients on administration issues, prescribed medication, self-medication, and allergies. The reviews included the use of current treatment guidelines, the Medication Appropriateness Index, the Screening Tool of Older People's Prescriptions (STOPP, v2), and the Screening Tool to Alert to Right Treatment (START, v2). The potential relevance of the DRPs was estimated using the German version of the CLEO tool. In 110 patients, 595 DRPs were identified, averaging 5.4 per patient (range 0-17). The structured interviews identified 249 DRPs (41.8%), of which 227 were not identified by any other source of information. The majority of DRPs (213/249, i.e. 85.5%) identified by patient interview were estimated to be of minor clinical relevance (i.e. limited adherence, knowledge, quality of life, or satisfaction). We demonstrated that structured patient interviews identified additional DRPs that other sources did not identify. Embedded within a comprehensive approach, the structured patient interviews were needed as data resource for over one-third of all DRPs.

Intelligent Exit-Selection Behaviors during a Room Evacuation

NASA Astrophysics Data System (ADS)

Zarita, Zainuddin; Lim Eng, Aik

2012-01-01

A modified version of the existing cellular automata (CA) model is proposed to simulate an evacuation procedure in a classroom with and without obstacles. Based on the numerous literature on the implementation of CA in modeling evacuation motions, it is notable that most of the published studies do not take into account the pedestrian's ability to select the exit route in their models. To resolve these issues, we develop a CA model incorporating a probabilistic neural network for determining the decision-making ability of the pedestrians, and simulate an exit-selection phenomenon in the simulation. Intelligent exit-selection behavior is observed in our model. From the simulation results, it is observed that occupants tend to select the exit closest to them when the density is low, but if the density is high they will go to an alternative exit so as to avoid a long wait. This reflects the fact that occupants may not fully utilize multiple exits during evacuation. The improvement in our proposed model is valuable for further study and for upgrading the safety aspects of building designs.

Comparison of topical mupirocin and gentamicin in the prevention of peritoneal dialysis-related infections: A systematic review and meta-analysis.

PubMed

Tsai, Chia-Chi; Yang, Po-Sheng; Liu, Chien-Liang; Wu, Chih-Jen; Hsu, Yi-Chiung; Cheng, Shih-Ping

2018-01-01

Topical antibiotics have been shown to reduce exit-site infection and peritonitis. The aim of this study was to compare infection rates between mupirocin and gentamicin. Multiple comprehensive databases were searched systematically to include relevant randomized controlled trials and observational studies. Pooled risk ratios (RRs) and 95% confidence intervals were calculated for the incidences of exit-site infection and peritonitis. Seven studies (mupirocin group n = 458, gentamicin group n = 448) were analyzed for exit-site infection. The risk of gram-positive exit-site infection was similar between the groups. Gram-negative exit-site infection rate was higher in the mupirocin group (RR = 2.125, P = 0.037). Six studies were assessed the peritonitis risk. There was no difference in the gram-positive and -negative peritonitis rate. Topical use of gentamicin is associated with fewer exit-site infections caused by gram-negative organisms. Gentamicin has comparable efficacy to mupirocin for peritonitis and gram-positive exit-site infection. Copyright © 2017 Elsevier Inc. All rights reserved.

Radiological Tenckhoff catheter insertion for peritoneal dialysis: A cost-effective approach.

PubMed

Lee, James; Mott, Nigel; Mahmood, Usman; Clouston, John; Summers, Kara; Nicholas, Pauline; Gois, Pedro Henrique França; Ranganathan, Dwarakanathan

2018-04-01

Radiological insertion of Tenckhoff catheters can be an alternative option for peritoneal dialysis access creation, as compared to surgical catheter insertion. This study will review the outcomes and complications of radiological Tenckhoff catheter insertion in a metropolitan renal service and compare costs between surgical and radiological insertion. Data were collected prospectively for all patients who had a Tenckhoff catheter insertion for peritoneal dialysis (PD) under radiological guidance at our hospital from May 2014 to November 2016. The type of catheter used and complications, including peri-catheter leak, exit site infection and peritonitis were reviewed. Follow-up data were also collected at points 3, 6 and 12 months from catheter insertion. Costing data were obtained from Queensland Health Electronic Reporting System (QHERS) data, average staff salaries and consumable contract price lists. In the 30-month evaluation period, 70 catheters were inserted. Two patients had an unsuccessful procedure due to the presence of abdominal adhesions. Seven patients had an episode of peri-catheter leak, and four patients had an exit site infection following catheter insertion. Peritonitis was observed in nine patients during the study period. The majority of patients (90%) remained on peritoneal dialysis at 3-month follow-up. The average costs of surgical and radiological insertion were noted to be AUD$7788.34 and AUD$1597.35, respectively. Radiological Tenckhoff catheter insertion for peritoneal dialysis appears to be an attractive and cost-effective option given less waiting periods for the procedure, the relatively low cost of insertion and comparable rates of complications. © 2017 The Royal Australian and New Zealand College of Radiologists.

Hearing loss and disability exit: Measurement issues and coping strategies.

PubMed

Christensen, Vibeke Tornhøj; Datta Gupta, Nabanita

2017-02-01

Hearing loss is one of the most common conditions related to aging, and previous descriptive evidence links it to early exit from the labor market. These studies are usually based on self-reported hearing difficulties, which are potentially endogenous to labor supply. We use unique representative data collected in the spring of 2005 through in-home interviews. The data contains self-reported functional and clinically-measured hearing ability for a representative sample of the Danish population aged 50-64. We estimate the causal effect of hearing loss on early retirement via disability benefits, taking into account the endogeneity of functional hearing. Our identification strategy involves the simultaneous estimation of labor supply, functional hearing, and coping strategies (i.e. accessing assistive devices at work or informing one's employer about the problem). We use hearing aids as an instrument for functional hearing. Our main empirical findings are that endogeneity bias is more severe for men than women and that functional hearing problems significantly increase the likelihood of receiving disability benefits for both men and women. However, relative to the baseline the effect is larger for men (47% vs. 20%, respectively). Availability of assistive devices in the workplace decreases the likelihood of receiving disability benefits, whereas informing an employer about hearing problems increases this likelihood. Copyright © 2016 Elsevier B.V. All rights reserved.

Motivational Interviewing to Increase Postdischarge Antibiotic Adherence in Older Adults with Pneumonia.

PubMed

Eyler, Rachel; Shvets, Kristina; Blakely, Michelle L

2016-01-01

To evaluate the impact of a pharmacist-led, motivational interviewing on antibiotic adherence following discharge in older adults with pneumonia. Inpatient medical wards in a large tertiary academic medical center. Older adults diagnosed with pneumonia were enrolled from December 1, 2013, to August 1, 2014, at Yale-New Haven Hospital. Motivational interviewing-a patient-centered method of communication-has gained recognition as a tool that can aid pharmacists in addressing negative health behaviors (e.g., medication adherence, health screenings, substance abuse during counseling sessions). However, the potential role of motivational interviewing in older adults to improve medication adherence during transitions of care is not clear. In this study, in addition to standard discharge care, older adults hospitalized with pneumonia who were randomized to the intervention group received enhanced care: pharmacist-led motivational interviewing. Evaluation of adherence to prescribed antibiotic regimens and patient satisfaction with the motivational interviewing, enhanced-care session. Ultimately, 87% of patients in the intervention group (n = 16) compared with 64% of patients in the control group (n = 14) were adherent to their antibiotic regimens. Patient satisfaction with the motivational interviewing intervention was high. Pharmacist-led motivational interviewing sessions have the potential to positively influence antibiotic adherence rates and patient satisfaction.

Python Scripts for Automation of Current-Voltage Testing of Semiconductor Devices (FY17)

DTIC Science & Technology

2017-01-01

ARL-TR-7923 ● JAN 2017 US Army Research Laboratory Python Scripts for Automation of Current- Voltage Testing of Semiconductor...manual device-testing procedures is reduced or eliminated through automation. This technical report includes scripts written in Python , version 2.7, used ...nothing. 3.1.9 Exit Program The script exits the entire program. Line 505, sys.exit(), uses the sys package that comes with Python to exit system

Third-person Diagnostic Interview on the Cognitive Insight Level of Psychotic Patients with an Insight at the Denial Level.

PubMed

Mehdizadeh, Mahsa; Rezaei, Omid

2016-01-01

According to the previous findings, the third-person technique improved the clinical insight of psychotic patients, therefore the present study aims to examine the effect of a third-person interview compared to a first-person interview on the level of cognitive insight of psychotic patients with an insight at the denial level. In this study, using interviews and questionnaires, a total number of 44 patients of Razi Psychiatric Educational and Treatment Center with an insight at the denial level being assessed using diagnostic interviews were divided randomly into two groups. Then, the two groups of patients' cognitive insights were evaluated using Beck Cognitive Insight Scale. The findings indicated that in psychotic patients with an insight at the denial level, the third-person technique of interview compared to the first-person had little effect on the improvement of overall cognitive insight and its components, including self-reflection and self-assurance; however, this effect was not strong enough to make a significant difference between the two groups of patients. According to the study findings, we can conclude that the third-person interview compared to the first-person interview has no effect on the improvement of the cognitive insight of psychotic patients with an insight at the denial level. This finding is consistent with the previous studies indicating that although the theory of mind has some correlations with the clinical insight of patients, it has no effect on their cognitive insight.

Exiting and Returning to the Parental Home for Boomerang Kids

PubMed Central

Sandberg-Thoma, Sara E.; Snyder, Anastasia R.; Jang, Bohyun Joy

2015-01-01

Young adults commonly exit from and return to the parental home, yet few studies have examined the motivation behind these exits and returns using a life course framework. Using data from the National Longitudinal Survey of Youth 1997, the authors examined associations between mental health problems and economic characteristics and exits from (n = 8,162), and returns to (n = 6,530), the parental home during the transition to adulthood. The average age of the respondents was 24 years. The authors found evidence that mental health and economic characteristics were related to home leaving and returning. Emotional distress was associated with earlier exits from, and returns to, the parental home; alcohol problems were associated with earlier returns to the parental home. The findings regarding economic resources were unexpectedly mixed. Greater economic resources were linked to delayed exits from, and earlier returns to, the parental home. The implications of these findings for young adults are discussed. PMID:26023244

Exiting and Returning to the Parental Home for Boomerang Kids.

PubMed

Sandberg-Thoma, Sara E; Snyder, Anastasia R; Jang, Bohyun Joy

2015-06-01

Young adults commonly exit from and return to the parental home, yet few studies have examined the motivation behind these exits and returns using a life course framework. Using data from the National Longitudinal Survey of Youth 1997, the authors examined associations between mental health problems and economic characteristics and exits from (n = 8,162), and returns to (n = 6,530), the parental home during the transition to adulthood. The average age of the respondents was 24 years. The authors found evidence that mental health and economic characteristics were related to home leaving and returning. Emotional distress was associated with earlier exits from, and returns to, the parental home; alcohol problems were associated with earlier returns to the parental home. The findings regarding economic resources were unexpectedly mixed. Greater economic resources were linked to delayed exits from, and earlier returns to, the parental home. The implications of these findings for young adults are discussed.

Is the qualitative research interview an acceptable medium for research with palliative care patients and carers?

PubMed Central

Gysels, Marjolein; Shipman, Cathy; Higginson, Irene J

2008-01-01

Background Contradictory evidence exists about the emotional burden of participating in qualitative research for palliative care patients and carers and this raises questions about whether this type of research is ethically justified in a vulnerable population. This study aimed to investigate palliative care patients' and carers' perceptions of the benefits and problems associated with open interviews and to understand what causes distress and what is helpful about participation in a research interview. Methods A descriptive qualitative study. The data were collected in the context of two studies exploring the experiences of care of palliative care patients and carers. The interviews ended with questions about patients' and carers' thoughts on participating in the studies and whether this had been a distressing or helpful event. We used a qualitative descriptive analysis strategy generated from the interviews and the observational and interactional data obtained in the course of the study. Results The interviews were considered helpful: sharing problems was therapeutic and being able to contribute to research was empowering. However, thinking about the future was reported to be the most challenging. Consent forms were sometimes read with apprehension and being physically unable to sign was experienced as upsetting. Interviewing patients and carers separately was sometimes difficult and not always possible. Conclusion The open interview enables the perspectives of patients and carers to be heard, unfettered from the structure of closed questions. It also enables those patients or carers to take part who would be unable to participate in other study designs. The context is at least as important as the format of the research interview taking into account the relational circumstances with carers and appropriate ways of obtaining informed consent. Retrospective consent could be a solution to enhancing participants control over the interview. PMID:18435846

A Longitudinal Study of Predictors of Housing Stability, Housing Quality, and Mental Health Functioning Among Single Homeless Individuals Staying in Emergency Shelters.

PubMed

Aubry, Tim; Duhoux, Arnaud; Klodawsky, Fran; Ecker, John; Hay, Elizabeth

2016-09-01

The current study examined risk and resilience factors at multiple levels that affect homeless individuals' ability to exit homelessness and achieve housing stability. It also examined the relationship between housing status, housing quality and mental health functioning. The methodology is a longitudinal study of single homeless individuals staying in emergency shelters in a medium-sized Canadian city who were followed for a 2 year period. Data were collected from participants at a baseline interview when they were homeless and at a 2-year follow-up. There were 329 participants interviewed at baseline and 197 (59.9%) participants interviewed at follow-up. Results from a structural equation modelling analysis found that having interpersonal and community resources were predictive of achieving housing stability. Specifically, having a larger social support network, access to subsidized housing, and greater income was related to achieving housing stability. On the other hand, having a substance use problem was a risk factor associated with a failure to achieving housing stability. Being female, feeling personally empowered, having housing that is perceived of being of higher quality were directly predictive of mental health functioning at follow-up. Findings are discussed in the context of previous research and their policy implications. © Society for Community Research and Action 2016.

Patent medicine vendors, community pharmacists and STI management in Abuja, Nigeria.

PubMed

Okonkwo, A D; Okonkwo, U P

2010-09-01

Increasingly, literature indicates that Patent Medicine Vendors (PMVs) and Community Pharmacists (CPs) provide sexual reproductive health services and products to their young patrons. This study explored the validity of literature claims, principally from CPs and PMVs perspective in Abuja, Nigeria. Participants were recruited with convenience sampling based on their willingness to participate in the study and our judgement of their professional competence. They were administered a semi-structured questionnaire, which was modelled after McCracken's long interview. We empirically assessed the validity of CPs and PMVs opinions with an exit interview of seven consenting patrons. Interviews were audio taped, transcribed verbatim and subjected to iterative thematic analysis. Participants' accounts and our observations indicate that PMVs and CPs serve young people's sexual reproductive healthcare needs in Abuja. CPs and PMVs provide young people with a seamless and non-judgemental access to contraceptives, sexual health advice and post-sexual risk exposure care. The study corroborates literature claims that CPs and PMVs provide sexual reproductive health advice, services and products to young people. However, participants contend that the current pharmacy practice laws in Nigeria constrain the scope and quality of services that young unmarried people require. Because it is unlikely that Nigeria will reinvigorate her primary healthcare system soon, we call for the formal co-option of CPs and PMVs into the sexual reproductive health management system to standardize and improve services.

'Halfway people': refugee views of reproductive health services.

PubMed

Whelan, A; Blogg, J

2007-01-01

The objective of this study was to identify factors that facilitate or hinder access to, use of, and satisfaction with reproductive health services in refugee settings, from the perspective of beneficiaries. Rapid appraisal methods included 46 focus group discussions and interviews with over 800 refugees, audits of 14 health facilities, referral hospital reviews, exit interviews with clients, and interviews with health workers. The study was conducted between February and April 2004 in 11 sites in Uganda, Republic of Congo, and Yemen. Reproductive health was clearly on the policy agenda in all countries with stable refugee sites, but problems with implementation and resources were identified. The quality of services was variable, with high staff turnover in some areas affecting relationships with refugee clients. Referral hospitals in host countries were not all equipped to deal with obstetric and other emergencies of either local or refugee populations, including deficiencies in safe blood supplies and antibiotics. Diagnosis and treatment of STIs and HIV/AIDS was frequently inadequate. Gender based violence was the least well addressed aspect of reproductive health. Interest and knowledge about family planning was high, but acceptance was low. It was concluded that progress has been made in reproductive health services for refugees since 1994, however, urgent advocacy and action is required to sustain and improve the situation. Local implementing partners need more support and supervision to develop appropriate service models and to maintain an acceptable standard of care.

Acceptability and use of a dapivirine vaginal ring in a phase III trial

PubMed Central

Montgomery, Elizabeth T.; van der Straten, Ariane; Chitukuta, Miria; Reddy, Krishnaveni; Woeber, Kubashni; Atujuna, Millicent; Bekker, Linda-Gail; Etima, Juliane; Nakyanzi, Teopista; Mayo, Ashley J.; Katz, Ariana; Laborde, Nicole; Grossman, Cynthia I.; Soto-Torres, Lydia; Palanee-Phillips, Thesla; Baeten, Jared M.

2017-01-01

Background The MTN-020/ASPIRE trial evaluated the safety and effectiveness of the dapivirine vaginal ring for prevention of HIV-1 infection among African women. A nested qualitative component was conducted at six of 15 study sites in Uganda, Malawi, Zimbabwe and South Africa to evaluate acceptability of and adherence to the ring. Method Qualitative study participants (n = 214) were interviewed with one of three modalities: single in-depth interview, up to three serial interviews or an exit Focus Group Discussion. Using semistructured guides administered in local languages, 280 interviews were audio-recorded, transcribed, translated, coded and analyzed. Results We identified three key findings: first, despite initial fears about the ring's appearance and potential side effects, participants grew to like it and developed a sense of ownership of the ring once they had used it. Second, uptake and sustained adherence challenges were generally overcome with staff and peer support. Participants developed gradual familiarity with ring use through trial progression, and most reported that it was easy to use and integrate into their lives. Using the ring in ASPIRE was akin to joining a team and contributing to a broader, communal good. Third, the actual or perceived dynamics of participants' male partner relationship(s) were the most consistently described influence (which ranged from positive to negative) on participants' acceptability and use of the ring. Conclusion It is critical that demonstration projects address challenges during the early adoption stages of ring diffusion to help achieve its potential public health impact as an effective, long-acting, female-initiated HIV prevention option addressing women's disproportionate HIV burden. PMID:28441175

Acceptability and use of a dapivirine vaginal ring in a phase III trial.

PubMed

Montgomery, Elizabeth T; van der Straten, Ariane; Chitukuta, Miria; Reddy, Krishnaveni; Woeber, Kubashni; Atujuna, Millicent; Bekker, Linda-Gail; Etima, Juliane; Nakyanzi, Teopista; Mayo, Ashley J; Katz, Ariana; Laborde, Nicole; Grossman, Cynthia I; Soto-Torres, Lydia; Palanee-Phillips, Thesla; Baeten, Jared M

2017-05-15

The MTN-020/ASPIRE trial evaluated the safety and effectiveness of the dapivirine vaginal ring for prevention of HIV-1 infection among African women. A nested qualitative component was conducted at six of 15 study sites in Uganda, Malawi, Zimbabwe and South Africa to evaluate acceptability of and adherence to the ring. Qualitative study participants (n = 214) were interviewed with one of three modalities: single in-depth interview, up to three serial interviews or an exit Focus Group Discussion. Using semistructured guides administered in local languages, 280 interviews were audio-recorded, transcribed, translated, coded and analyzed. We identified three key findings: first, despite initial fears about the ring's appearance and potential side effects, participants grew to like it and developed a sense of ownership of the ring once they had used it. Second, uptake and sustained adherence challenges were generally overcome with staff and peer support. Participants developed gradual familiarity with ring use through trial progression, and most reported that it was easy to use and integrate into their lives. Using the ring in ASPIRE was akin to joining a team and contributing to a broader, communal good. Third, the actual or perceived dynamics of participants' male partner relationship(s) were the most consistently described influence (which ranged from positive to negative) on participants' acceptability and use of the ring. It is critical that demonstration projects address challenges during the early adoption stages of ring diffusion to help achieve its potential public health impact as an effective, long-acting, female-initiated HIV prevention option addressing women's disproportionate HIV burden.

Beam and tissue factors affecting Cherenkov image intensity for quantitative entrance and exit dosimetry on human tissue

PubMed Central

Zhang, Rongxiao; Glaser, Adam K.; Andreozzi, Jacqueline; Jiang, Shudong; Jarvis, Lesley A.; Gladstone, David J.; Pogue, Brian W.

2017-01-01

This study’s goal was to determine how Cherenkov radiation emission observed in radiotherapy is affected by predictable factors expected in patient imaging. Factors such as tissue optical properties, radiation beam properties, thickness of tissues, entrance/exit geometry, curved surface effects, curvature and imaging angles were investigated through Monte Carlo simulations. The largest physical cause of variation of the correlation factor between of Cherenkov emission and dose was the entrance/exit geometry (~50%). The largest human tissue effect was from different optical properties (~45%). Beyond these, clinical beam energy varies the correlation factor significantly (~20% for x-ray beams), followed by curved surfaces (~15% for x-ray beams and ~8% for electron beams), and finally, the effect of field size (~5% for x-ray beams). Other investigated factors which caused variations less than 5% were tissue thicknesses and source to surface distance. The effect of non-Lambertian emission was negligible for imaging angles smaller than 60 degrees. The spectrum of Cherenkov emission tends to blue-shift along the curved surface. A simple normalization approach based on the reflectance image was experimentally validated by imaging a range of tissue phantoms, as a first order correction for different tissue optical properties. PMID:27507213

[Anesthetic management of the ex-utero intrapartum treatment (EXIT) procedure for giant epignathus and of the tumor excision].

PubMed

Aoyama, Tadashi; Nakata, Jun; Sakakibara, Michiko; Takahashi, Tetsuyuki; Hara, Masato; Yamaguchi, Shinya; Maseki, Megumi; Teramoto, Yuzo

2008-10-01

We report an anesthetic management of the ex-utero intrapartum treatment (EXIT) procedure performed in a fetus with giant epignathus due to laryngeal atresia at 28 weeks' gestation. Anesthesia of the mother was induced with thiamylal and vecuronium, and maintained with 4% sevoflurane in 100% oxygen before delivery. Sevoflurane provided excellent uterine relaxation. To maintain the arterial pressure, the patient received acetate Ringer and ephedrine 4mg. After hysterotomy, a pulse oxymeter and an ultrasound transducer were applied to monitor fetal Sp(O2) and heart rate. No anesthetic agents were injected into the fetus in addition to transplacental sevoflurane. Tracheostomy was performed on the fetus by pediatric surgeons on placental support. The uterine tone improved soon after discontinuing sevoflurane, intramyometrial injection of oxytocin and ergometrine infusion after delivery. Excision of the tumor was performed on day 2 of life. Pediatric surgeons tried to excise it totally, but it was hard to differentiate the tumor from the normal tissue, and partial excision was performed. After the excision, the neonate weighed 944 g and excised specimen weighed 253 g. Though the neonate was immature and the tumor was very large, no perioperative complications were associated with EXIT and the tumor excision.

Radiation dose uncertainty and correction for a mouse orthotopic and xenograft irradiation model.

PubMed

Gan, Gregory N; Altunbas, Cem; Morton, John J; Eagles, Justin; Backus, Jennifer; Dzingle, Wayne; Raben, David; Jimeno, Antonio

2016-01-01

In animal irradiation models, reported dose can vary significantly from the actual doses delivered. We describe an effective method for in vivo dose verification. Mice bearing commercially-available cell line or patient-derived tumor cell orthotopic or flank xenografts were irradiated using a 160 kVp, 25 mA X-ray source. Entrance dose was evaluated using optically-stimulated luminescence dosimeters (OSLD) and exit dose was assessed using radiochromic film dosimetry. Tumor position within the irradiation field was validated using external fiducial markers. The average entrance dose in orthotopic tumors from 10 OSLDs placed on two different animal irradiation days was 514 ± 37 cGy (range: 437-545). Exit dose measurements taken from seven radiochromic films on two separate days were 341 ± 21 cGy (a 34% attenuation). Flank tumor irradiation doses measured by OSLD were 368 ± 9 cGy compared to exit doses of 330 cGy measured by radiochromic film. Variations related to the irradiation model can lead to significant under or overdosing in vivo which can affect tumor control and/or biologic endpoints that are dose-dependent. We recommend that dose measurements be determined empirically based on the mouse model and irradiator used and dose compensation adjustments performed to ensure correct and appropriate doses.

Insights into Chronic Functional Movement Disorders: The Value of Qualitative Psychiatric Interviews.

PubMed

Epstein, Steven A; Maurer, Carine W; LaFaver, Kathrin; Ameli, Rezvan; Sinclair, Stephen; Hallett, Mark

Patients with functional movement disorders (FMDs) are commonly seen by neurologists and psychosomatic medicine psychiatrists. Research literature provides scant information about the subjective experiences of individuals with this often chronic problem. To enhance our understanding of psychologic aspects of FMDs by conducting qualitative interviews of research subjects. In total, 36 patients with FMDs were recruited from the Human Motor Control clinic at the National Institutes of Health. Each subject participated in a qualitative psychiatric interview and a structured diagnostic psychiatric interview. Of our 36 subjects, 28 had current or lifetime psychiatric disorders in addition to conversion disorder and 22 had current disorders. Qualitative interviews provided rich information on patients' understanding of their illnesses and impaired cognitive processing of emotions. Our study supports the addition of open-ended qualitative interviews to delineate emotional dynamics and conceptual frameworks among such patients. Exploratory interviews generate enhanced understanding of such complex patients, above and beyond that gained by assessing DSM diagnostic comorbidities. Copyright © 2016 The Academy of Psychosomatic Medicine. All rights reserved.

Recognizing and Addressing Limited PHarmaceutical literacy: Development of the RALPH interview guide.

PubMed

Vervloet, Marcia; van Dijk, Liset; Rademakers, Jany J D J M; Bouvy, Marcel L; De Smet, Peter A G M; Philbert, Daphne; Koster, Ellen S

2018-04-30

In the context of medication use, pharmaceutical literacy skills are crucial for appropriate and safe use of medication. Recognition of patients with inadequate pharmaceutical literacy in daily pharmacy practice is difficult. No instrument is yet available to support pharmacists herein. The aim of this study was therefore to develop an interview guide for pharmacists to Recognize and Address Limited PHarmaceutical literacy (RALPH). The RALPH interview guide was constructed in three phases: (1) development including a literature search, expert group discussion, and feasibility test with 15 patients; (2) pilot-test with 421 patients throughout 30 community pharmacies, and (3) final test with 508 patients to optimize the interview guide. The development phase resulted in a first interview guide comprising 15 questions: seven in the functional domain (understanding instructions), four in the communicative domain (finding and understanding medication information) and four in the critical domain (critically analyzing medication information). This version was pilot-tested in 30 pharmacies, with 147 patients during medication reviews and another 274 patients were interviewed while waiting to collect their medication. This test phase led to removal of questions that proved difficult to interpret and to rephrasing some questions. The second version including 11 questions was tested by 109 pharmacists trainees with 508 patients, resulting in the final RALPH interview guide comprising 10 questions, all directly linked to the patient's own medication: three in the functional, three in the communicative and four in the critical domain. Besides instructions on how to use the interview guide, recommendations are provided for pharmacists on how to support patients with limited pharmaceutical literacy skills. The practice-based RALPH interview guide supports pharmacists in recognizing patients with limited pharmaceutical literacy. With this insight, pharmacists can tailor their medication counseling to patients' pharmaceutical literacy level to better support patients in their medication use. Copyright © 2018. Published by Elsevier Inc.

Improving health care proxy documentation using a web-based interview through a patient portal

PubMed Central

Crotty, Bradley H; Kowaloff, Hollis B; Safran, Charles; Slack, Warner V

2016-01-01

Objective Health care proxy (HCP) documentation is suboptimal. To improve rates of proxy selection and documentation, we sought to develop and evaluate a web-based interview to guide patients in their selection, and to capture their choices in their electronic health record (EHR). Methods We developed and implemented a HCP interview within the patient portal of a large academic health system. We analyzed the experience, together with demographic and clinical factors, of the first 200 patients who used the portal to complete the interview. We invited users to comment about their experience and analyzed their comments using established qualitative methods. Results From January 20, 2015 to March 13, 2015, 139 of the 200 patients who completed the interview submitted their HCP information for their clinician to review in the EHR. These patients had a median age of 57 years (Inter Quartile Range (IQR) 45–67) and most were healthy. The 99 patients who did not previously have HCP information in their EHR were more likely to complete and then submit their information than the 101 patients who previously had a proxy in their health record (odds ratio 2.4, P = .005). Qualitative analysis identified several ways in which the portal-based interview reminded, encouraged, and facilitated patients to complete their HCP. Conclusions Patients found our online interview convenient and helpful in facilitating selection and documentation of an HCP. Our study demonstrates that a web-based interview to collect and share a patient’s HCP information is both feasible and useful. PMID:26568608

Effect of Chronic Blood Transfusion on Biomarkers of Coagulation Activation and Thrombin Generation in Sickle Cell Patients at Risk for Stroke

PubMed Central

Hyacinth, Hyacinth I.; Adams, Robert J.; Greenberg, Charles S.; Voeks, Jenifer H.; Hill, Allyson; Hibbert, Jacqueline M.; Gee, Beatrice E.

2015-01-01

Hypercoagulability in sickle cell disease (SCD) is associated with multiple SCD phenotypes, association with stroke risk has not been well described. We hypothesized that serum levels of biomarkers of coagulation activation correlate with high transcranial Doppler ultrasound velocity and decreases with blood transfusion therapy in SCD patients. Stored serum samples from subjects in the Stroke Prevention in Sickle Cell Anemia (STOP) trial were analyzed using ELISA and protein multiplexing techniques. 40 subjects from each treatment arm (Standard Care [SC] and Transfusion [Tx]) at three time points—baseline, study exit and one year post-trial and 10 each of age matched children with SCD but normal TCD (SNTCD) and with normal hemoglobin (HbAA) were analyzed. At baseline, median vWF, TAT and D-dimer levels were significantly higher among STOP subjects than either HbAA or SNTCD. At study exit, median hemoglobin level was significantly higher while median TCD velocity was significantly lower in Tx compared to SC subjects. Median vWF (409.6 vs. 542.9 μg/ml), TAT (24.8 vs. 40.0 ng/ml) and D-dimer (9.2 vs. 19.1 μg/ml) levels were also significantly lower in the Tx compared to the SC group at study exit. Blood levels of biomarkers coagulation activation/thrombin generation correlated positively with TCD velocity and negatively with number of blood transfusions. Biomarkers of coagulation activation/thrombin generation were significantly elevated in children with SCD, at high risk for stroke. Reduction in levels of these biomarkers correlated with reduction in stroke risk (lower TCD velocity), indicating a possible role for hypercoagulation in SCD associated stroke. PMID:26305570

Human Factors in Web-Authentication

DTIC Science & Technology

2009-02-06

47 5.2.7 Debriefing and exit survey . . . . . . . . . . . . . . . . . . . . . . 48 5.2.8 Ethics...Deployability analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 7.4.1 An SSL server survey ...102 9 Conclusion 104 Bibliography 106 A User study exit survey questions 121 B User study exit survey

A dual two dimensional electronic portal imaging device transit dosimetry model based on an empirical quadratic formalism

PubMed Central

Metwaly, M; Glegg, M; Baggarley, S P; Elliott, A

2015-01-01

Objective: This study describes a two dimensional electronic portal imaging device (EPID) transit dosimetry model that can predict either: (1) in-phantom exit dose, or (2) EPID transit dose, for treatment verification. Methods: The model was based on a quadratic equation that relates the reduction in intensity to the equivalent path length (EPL) of the attenuator. In this study, two sets of quadratic equation coefficients were derived from calibration dose planes measured with EPID and ionization chamber in water under reference conditions. With two sets of coefficients, EPL can be calculated from either EPID or treatment planning system (TPS) dose planes. Consequently, either the in-phantom exit dose or the EPID transit dose can be predicted from the EPL. The model was tested with two open, five wedge and seven sliding window prostate and head and neck intensity-modulated radiation therapy (IMRT) fields on phantoms. Results were analysed using absolute gamma analysis (3%/3 mm). Results: The open fields gamma pass rates were >96.8% for all comparisons. For wedge and IMRT fields, comparisons between predicted and TPS-computed in-phantom exit dose resulted in mean gamma pass rate of 97.4% (range, 92.3–100%). As for the comparisons between predicted and measured EPID transit dose, the mean gamma pass rate was 97.5% (range, 92.6–100%). Conclusion: An EPID transit dosimetry model that can predict in-phantom exit dose and EPID transit dose was described and proven to be valid. Advances in knowledge: The described model is practical, generic and flexible to encourage widespread implementation of EPID dosimetry for the improvement of patients' safety in radiotherapy. PMID:25969867

[Prediction and influence factors of the ramp's noise of the entrance or exit of garages].

PubMed

Di, Guo-Qing; Zhang, Bang-Jun

2005-09-01

Some typical entrances/exits of the underground garages are chosen in urban residential areas. On the basis of the optimization of the positions of the noise sampling points and the groupings of the synchronous sampling points, by means of the acoustical analysis of the noise samples, the relation of the correlative factors, among the ramps' noise of the entrances or exits of the garages, the structure, grade, shape of the ramps, upgrade and downgrade, is studied. The prediction model of the ramp's noise influence of the entrance or exit of the garage is established through amending the noise influence of the entrance or exit of the even concrete road.

Method for Making Measurements of the Post-Combustion Residence Time in a Gas Turbine Engine

NASA Technical Reports Server (NTRS)

Miles, Jeffrey H (Inventor)

2015-01-01

A system and method of measuring a residence time in a gas-turbine engine is provided, whereby the method includes placing pressure sensors at a combustor entrance and at a turbine exit of the gas-turbine engine and measuring a combustor pressure at the combustor entrance and a turbine exit pressure at the turbine exit. The method further includes computing cross-spectrum functions between a combustor pressure sensor signal from the measured combustor pressure and a turbine exit pressure sensor signal from the measured turbine exit pressure, applying a linear curve fit to the cross-spectrum functions, and computing a post-combustion residence time from the linear curve fit.

Delivery of Clinical Preventive Services in Family Medicine Offices

PubMed Central

Crabtree, Benjamin F.; Miller, William L.; Tallia, Alfred F.; Cohen, Deborah J.; DiCicco-Bloom, Barbara; McIlvain, Helen E.; Aita, Virginia A.; Scott, John G.; Gregory, Patrice B.; Stange, Kurt C.; McDaniel, Reuben R.

2005-01-01

BACKGROUND This study aimed to elucidate how clinical preventive services are delivered in family practices and how this information might inform improvement efforts. METHODS We used a comparative case study design to observe clinical preventive service delivery in 18 purposefully selected Midwestern family medicine offices from 1997 to 1999. Medical records, observation of outpatient encounters, and patient exit cards were used to calculate practice-level rates of delivery of clinical preventive services. Field notes from direct observation of clinical encounters and prolonged observation of the practice and transcripts from in-depth interviews of practice staff and physicians were systematically examined to identify approaches to delivering clinical preventive services recommended by the US Preventive Services Task Force. RESULTS Practices developed individualized approaches for delivering clinical preventive services, with no one approach being successful across practices. Clinicians acknowledged a 3-fold mission of providing acute care, managing chronic problems, and prevention, but only some made prevention a priority. The clinical encounter was a central focus for preventive service delivery in all practices. Preventive services delivery rates often appeared to be influenced by competing demands within the clinical encounter (including between different preventive services), having a physician champion who prioritized prevention, and economic concerns. CONCLUSIONS Practice quality improvement efforts that assume there is an optimal approach for delivering clinical preventive services fail to account for practices’ propensity to optimize care processes to meet local contexts. Interventions to enhance clinical preventive service delivery should be tailored to meet the local needs of practices and their patient populations. PMID:16189059

Responding to Young People’s Health Risks in Primary Care: A Cluster Randomised Trial of Training Clinicians in Screening and Motivational Interviewing

PubMed Central

Sanci, Lena; Chondros, Patty; Sawyer, Susan; Pirkis, Jane; Ozer, Elizabeth; Hegarty, Kelsey; Yang, Fan; Grabsch, Brenda; Shiell, Alan; Cahill, Helen; Ambresin, Anne-Emmanuelle; Patterson, Elizabeth; Patton, George

2015-01-01

Objective To evaluate the effectiveness of a complex intervention implementing best practice guidelines recommending clinicians screen and counsel young people across multiple psychosocial risk factors, on clinicians’ detection of health risks and patients’ risk taking behaviour, compared to a didactic seminar on young people’s health. Design Pragmatic cluster randomised trial where volunteer general practices were stratified by postcode advantage or disadvantage score and billing type (private, free national health, community health centre), then randomised into either intervention or comparison arms using a computer generated random sequence. Three months post-intervention, patients were recruited from all practices post-consultation for a Computer Assisted Telephone Interview and followed up three and 12 months later. Researchers recruiting, consenting and interviewing patients and patients themselves were masked to allocation status; clinicians were not. Setting General practices in metropolitan and rural Victoria, Australia Participants General practices with at least one interested clinician (general practitioner or nurse) and their 14–24 year old patients. Intervention This complex intervention was designed using evidence based practice in learning and change in clinician behaviour and general practice systems, and included best practice approaches to motivating change in adolescent risk taking behaviours. The intervention involved training clinicians (nine hours) in health risk screening, use of a screening tool and motivational interviewing; training all practice staff (receptionists and clinicians) in engaging youth; provision of feedback to clinicians of patients’ risk data; and two practice visits to support new screening and referral resources. Comparison clinicians received one didactic educational seminar (three hours) on engaging youth and health risk screening. Outcome Measures Primary outcomes were patient report of (1) clinician detection of at least one of six health risk behaviours (tobacco, alcohol and illicit drug use, risks for sexually transmitted infection, STI, unplanned pregnancy, and road risks); and (2) change in one or more of the six health risk behaviours, at three months or at 12 months. Secondary outcomes were likelihood of future visits, trust in the clinician after exit interview, clinician detection of emotional distress and fear and abuse in relationships, and emotional distress at three and 12 months. Patient acceptability of the screening tool was also described for the intervention arm. Analyses were adjusted for practice location and billing type, patients’ sex, age, and recruitment method, and past health risks, where appropriate. An intention to treat analysis approach was used, which included multilevel multiple imputation for missing outcome data. Results 42 practices were randomly allocated to intervention or comparison arms. Two intervention practices withdrew post allocation, prior to training, leaving 19 intervention (53 clinicians, 377 patients) and 21 comparison (79 clinicians, 524 patients) practices. 69% of patients in both intervention (260) and comparison (360) arms completed the 12 month follow-up. Intervention clinicians discussed more health risks per patient (59.7%) than comparison clinicians (52.7%) and thus were more likely to detect a higher proportion of young people with at least one of the six health risk behaviours (38.4% vs 26.7%, risk difference [RD] 11.6%, Confidence Interval [CI] 2.93% to 20.3%; adjusted odds ratio [OR] 1.7, CI 1.1 to 2.5). Patients reported less illicit drug use (RD -6.0, CI -11 to -1.2; OR 0·52, CI 0·28 to 0·96), and less risk for STI (RD -5.4, CI -11 to 0.2; OR 0·66, CI 0·46 to 0·96) at three months in the intervention relative to the comparison arm, and for unplanned pregnancy at 12 months (RD -4.4; CI -8.7 to -0.1; OR 0·40, CI 0·20 to 0·80). No differences were detected between arms on other health risks. There were no differences on secondary outcomes, apart from a greater detection of abuse (OR 13.8, CI 1.71 to 111). There were no reports of harmful events and intervention arm youth had high acceptance of the screening tool. Conclusions A complex intervention, compared to a simple educational seminar for practices, improved detection of health risk behaviours in young people. Impact on health outcomes was inconclusive. Technology enabling more efficient, systematic health-risk screening may allow providers to target counselling toward higher risk individuals. Further trials require more power to confirm health benefits. Trial Registration ISRCTN.com ISRCTN16059206. PMID:26422235

Diagnostic imaging in a patient with an acute knee injury.

PubMed

Sago, Carrie E; Labuda, Craig S

2013-01-01

The patient was a 23-year-old man, currently serving in a military airborne operations unit. During a jump training exercise, the patient's right lower extremity became entangled in his parachute equipment upon exiting the aircraft, which caused hyperextension and valgus forces upon his right knee. Due to concern for a fracture, the patient was transported to an emergency department, where conventional radiographs were completed and interpreted by a radiologist as negative for a fracture. Following further physical examination by a physical therapist, magnetic resonance imaging of the right knee was ordered, revealing ruptures of the anterior cruciate ligament and medial collateral ligament.

Assessment of dental students’ communication skills with patients

PubMed Central

MEMARPOUR, MAHTAB; BAZRAFKAN, LEILA; ZAREI, ZAHRA

2016-01-01

Introduction Establishment of effective communication between the clinician and patient is essential in order to increase the effectiveness of treatment. These skills have been less investigated among dental students. This study aimed to evaluate communication skills of dental students in Shiraz with patients through direct observation, patients' perspectives and students' self-assessments. Methods This cross-sectional study enrolled the fifth and sixth year dental students and one of each student’s patients who was chosen using simple random sampling method. We used a checklist for data collection. Students’ communication skills were assessed at three steps of the student-patient interview – at the beginning of the interview, during the interview, and at the end of the interview. The checklist was completed by three groups: 1) an observer, 2) the patient and 3) the student, as self-assessment. The validity of the checklist was confirmed by clinical professors and the reliability was determined by Cronbach's alpha test. Data were analyzed using descriptive statistics and Student’s t test. A repeated measure MANOVA was used to compare the mean communication skills in the researcher, patients, and students at each step of the patient interviews. Results There were 110 students (mean age: 22.3±8.4 years) and 110 patients (mean age: 32±8.8 years) who completed the checklists. Overall, the communication skills of dental students were rated as good according to the patients. However, the observer and student participants rated the skills at the moderate level. We observed significant differences between communication skills in all three groups and in the three steps of the patient interviews (p<0.001). According to patients' beliefs and students' self assessments, there were no differences between male and female students in communication skills in the three steps of the patient interviews (all p>0.05). However from the observer’s viewpoint, female students showed better communication skills during the interviews (p=0.001). Conclusion There was a degree of failure in communication skills of dental students with patients in the interview process. It will be necessary that communication skills be taught, particularly for students involved in clinical practice. PMID:26793724

Flow and clog in a silo with oscillating exit

NASA Astrophysics Data System (ADS)

To, Kiwing; Tai, Hsiang-Ting

2017-09-01

When grains flow out of a silo, flow rate W increases with exit size D . If D is too small, an arch may form and the flow may be blocked at the exit. To recover from clogging, the arch has to be destroyed. Here we construct a two-dimensional silo with movable exit and study the effects of exit oscillation (with amplitude A and frequency f ) on flow rate, clogging, and unclogging of grains through the exit. We find that, if exit oscillates, W remains finite even when D (measured in unit of grain diameter) is only slightly larger than one. Surprisingly, while W increases with oscillation strength Γ ≡4 π2A f2 as expected at small D , W decreases with Γ when D ≥5 due to induced random motion of the grains at the exit. When D is small and oscillation speed v ≡2 π A f is slow, temporary clogging events cause the grains to flow intermittently. In this regime, W depends only on v —a feature consistent to a simple arch breaking mechanism, and the phase boundary of intermittent flow in the D -v plane is consistent to either a power law: D ∝v-7 or an exponential form: D ∝e-D /0.55 . Furthermore, the flow time statistic is Poissonian whereas the recovery time statistic follows a power-law distribution.

Evacuation dynamic and exit optimization of a supermarket based on particle swarm optimization

NASA Astrophysics Data System (ADS)

Li, Lin; Yu, Zhonghai; Chen, Yang

2014-12-01

A modified particle swarm optimization algorithm is proposed in this paper to investigate the dynamic of pedestrian evacuation from a fire in a public building-a supermarket with multiple exits and configurations of counters. Two distinctive evacuation behaviours featured by the shortest-path strategy and the following-up strategy are simulated in the model, accounting for different categories of age and sex of the pedestrians along with the impact of the fire, including gases, heat and smoke. To examine the relationship among the progress of the overall evacuation and the layout and configuration of the site, a series of simulations are conducted in various settings: without a fire and with a fire at different locations. Those experiments reveal a general pattern of two-phase evacuation, i.e., a steep section and a flat section, in addition to the impact of the presence of multiple exits on the evacuation along with the geographic locations of the exits. For the study site, our simulations indicated the deficiency of the configuration and the current layout of this site in the process of evacuation and verified the availability of proposed solutions to resolve the deficiency. More specifically, for improvement of the effectiveness of the evacuation from the site, adding an exit between Exit 6 and Exit 7 and expanding the corridor at the right side of Exit 7 would significantly reduce the evacuation time.

The Association between Exit Site Infection and Subsequent Peritonitis among Peritoneal Dialysis Patients

PubMed Central

van Diepen, Anouk T.N.; Tomlinson, George A.

2012-01-01

Summary Background and objectives Peritonitis is the most common infectious complication seen in peritoneal dialysis (PD). Traditionally, exit site infection (ESI) has been thought to predispose PD patients to peritonitis, although the risks have not been quantified. This study aimed to quantify the risk of PD peritonitis after ESI. Design, setting, participants, & measurements Data from 203 clinically stable PD patients >18 years of age who were followed as part of a randomized controlled trial over 18 months were used to estimate the risk of developing peritonitis within 30 days of an ESI compared with individuals who did not have a recent ESI. Sensitivity analyses were performed at 15, 45, and 60 days. Results Patients were mostly male (64.5%) and Caucasian, with a mean age of 60.5±14.4 years. There were 44 ESIs and 87 peritonitis episodes during the 18-month study. Seven patients had an ESI followed by peritonitis within 30 days. Using a frailty model, patients who had an ESI had a significantly higher risk of developing peritonitis within 30 days, even if the ESI was appropriately treated. This risk was maximal early on and diminished with time, with hazard ratios (95% confidence interval) of 11.1 at 15 days (HR=11.1, 95% CI=4.9–25.1), 5.3 at 45 days (2.5–11.3), and 4.9 at 60 days (2.4–9.9). In 2.3% of patients, subsequent peritonitis was caused by the same organism as the previous ESI. Conclusions A strong association between a treated ESI and subsequent PD peritonitis was present up to 60 days after initial diagnosis. PMID:22745277

The SmartOR: a distributed sensor network to improve operating room efficiency.

PubMed

Huang, Albert Y; Joerger, Guillaume; Fikfak, Vid; Salmon, Remi; Dunkin, Brian J; Bass, Barbara L; Garbey, Marc

2017-09-01

Despite the significant expense of OR time, best practice achieves only 70% efficiency. Compounding this problem is a lack of real-time data. Most current OR utilization programs require manual data entry. Automated systems require installation and maintenance of expensive tracking hardware throughout the institution. This study developed an inexpensive, automated OR utilization system and analyzed data from multiple operating rooms. OR activity was deconstructed into four room states. A sensor network was then developed to automatically capture these states using only three sensors, a local wireless network, and a data capture computer. Two systems were then installed into two ORs, recordings captured 24/7. The SmartOR recorded the following events: any room activity, patient entry/exit time, anesthesia time, laparoscopy time, room turnover time, and time of preoperative patient identification by the surgeon. From November 2014 to December 2015, data on 1003 cases were collected. The mean turnover time was 36 min, and 38% of cases met the institutional goal of ≤30 min. Data analysis also identified outlier cases (>1 SD from mean) in the domains of time from patient entry into the OR to intubation (11% of cases) and time from extubation to patient exiting the OR (11% of cases). Time from surgeon identification of patient to scheduled procedure start time was 11 min (institution bylaws require 20 min before scheduled start time), yet OR teams required 22 min on average to bring a patient into the room after surgeon identification. The SmartOR automatically and reliably captures data on OR room state and, in real time, identifies outlier cases that may be examined closer to improve efficiency. As no manual entry is required, the data are indisputable and allow OR teams to maintain a patient-centric focus.

Improving health care proxy documentation using a web-based interview through a patient portal.

PubMed

Bajracharya, Adarsha S; Crotty, Bradley H; Kowaloff, Hollis B; Safran, Charles; Slack, Warner V

2016-05-01

Health care proxy (HCP) documentation is suboptimal. To improve rates of proxy selection and documentation, we sought to develop and evaluate a web-based interview to guide patients in their selection, and to capture their choices in their electronic health record (EHR). We developed and implemented a HCP interview within the patient portal of a large academic health system. We analyzed the experience, together with demographic and clinical factors, of the first 200 patients who used the portal to complete the interview. We invited users to comment about their experience and analyzed their comments using established qualitative methods. From January 20, 2015 to March 13, 2015, 139 of the 200 patients who completed the interview submitted their HCP information for their clinician to review in the EHR. These patients had a median age of 57 years (Inter Quartile Range (IQR) 45-67) and most were healthy. The 99 patients who did not previously have HCP information in their EHR were more likely to complete and then submit their information than the 101 patients who previously had a proxy in their health record (odds ratio 2.4, P = .005). Qualitative analysis identified several ways in which the portal-based interview reminded, encouraged, and facilitated patients to complete their HCP. Patients found our online interview convenient and helpful in facilitating selection and documentation of an HCP. Our study demonstrates that a web-based interview to collect and share a patient's HCP information is both feasible and useful. © 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.

[Early prenatal interview: implementation of a sheet link "carried" by patient. The Aurore perinatal network experience].

PubMed

Dupont, C; Gonnaud, F; Touzet, S; Luciani, F; Perié, M-A; Molenat, F; Evrard, A; Fernandez, M-P; Roy, J; Rudigoz, R-C

2008-11-01

Early prenatal interview has needed the implementation of a new communication tool between follow-up pregnancy professionals: a link sheet filled and carried by patients. To assess the utilization of link sheet by trained professionals, the contribution of the interview and the patient acceptation of the link sheet. Descriptive survey from the database of link sheets returned by professionals to Aurore perinatal network and semi-guided interviews with 100 randomized patients. One thousand one hundred and nineteen link sheets were sent to Aurore perinatal network by 55 professionals out of 78 trained. For primipare, precocious prenatal interview contribution has concerned health care security (60%) and emotional security (56%). For multipare, this contribution has concerned mainly emotional security (80%). No interviewed patient has refused link sheet principle. Link sheet principle, like implemented by Aurore perinatal network, seems pertinent to professionals and patients but it constitutes only one of the elements of network elaboration of personalized care.

Cloudy with a Chance of Pain: Engagement and Subsequent Attrition of Daily Data Entry in a Smartphone Pilot Study Tracking Weather, Disease Severity, and Physical Activity in Patients With Rheumatoid Arthritis.

PubMed

Reade, Samuel; Spencer, Karen; Sergeant, Jamie C; Sperrin, Matthew; Schultz, David M; Ainsworth, John; Lakshminarayana, Rashmi; Hellman, Bruce; James, Ben; McBeth, John; Sanders, Caroline; Dixon, William G

2017-03-24

The increasing ownership of smartphones provides major opportunities for epidemiological research through self-reported and passively collected data. This pilot study aimed to codesign a smartphone app to assess associations between weather and joint pain in patients with rheumatoid arthritis (RA) and to study the success of daily self-reported data entry over a 60-day period and the enablers of and barriers to data collection. A patient and public involvement group (n=5) and 2 focus groups of patients with RA (n=9) supported the codesign of the app collecting self-reported symptoms. A separate "capture app" was designed to collect global positioning system (GPS) and continuous raw accelerometer data, with the GPS-linking providing local weather data. A total of 20 patients with RA were then recruited to collect daily data for 60 days, with entry and exit interviews. Of these, 17 were loaned an Android smartphone, whereas 3 used their own Android smartphones. Of the 20 patients, 6 (30%) withdrew from the study: 4 because of technical challenges and 2 for health reasons. The mean completion of daily entries was 68% over 2 months. Patients entered data at least five times per week 65% of the time. Reasons for successful engagement included a simple graphical user interface, automated reminders, visualization of data, and eagerness to contribute to this easily understood research question. The main barrier to continuing engagement was impaired battery life due to the accelerometer data capture app. For some, successful engagement required ongoing support in using the smartphones. This successful pilot study has demonstrated that daily data collection using smartphones for health research is feasible and achievable with high levels of ongoing engagement over 2 months. This result opens important opportunities for large-scale longitudinal epidemiological research. ©Samuel Reade, Karen Spencer, Jamie C Sergeant, Matthew Sperrin, David M Schultz, John Ainsworth, Rashmi Lakshminarayana, Bruce Hellman, Ben James, John McBeth, Caroline Sanders, William G Dixon. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 24.03.2017.

Real time sensor for therapeutic radiation delivery

DOEpatents

Bliss, M.; Craig, R.A.; Reeder, P.L.

1998-01-06

The invention is a real time sensor for therapeutic radiation. A probe is placed in or near the patient that senses in real time the dose at the location of the probe. The strength of the dose is determined by either an insertion or an exit probe. The location is determined by a series of vertical and horizontal sensing elements that gives the operator a real time read out dose location relative to placement of the patient. The increased accuracy prevents serious tissue damage to the patient by preventing overdose or delivery of a dose to a wrong location within the body. 14 figs.

Real time sensor for therapeutic radiation delivery

DOEpatents

Bliss, Mary; Craig, Richard A.; Reeder, Paul L.

1998-01-01

The invention is a real time sensor for therapeutic radiation. A probe is placed in or near the patient that senses in real time the dose at the location of the probe. The strength of the dose is determined by either an insertion or an exit probe. The location is determined by a series of vertical and horizontal sensing elements that gives the operator a real time read out dose location relative to placement of the patient. The increased accuracy prevents serious tissue damage to the patient by preventing overdose or delivery of a dose to a wrong location within the body.

To fish or not to fish: factors at multiple scales affecting artisanal fishers' readiness to exit a declining fishery.

PubMed

Daw, Tim M; Cinner, Joshua E; McClanahan, Timothy R; Brown, Katrina; Stead, Selina M; Graham, Nicholas A J; Maina, Joseph

2012-01-01

Globally, fisheries are challenged by the combined impacts of overfishing, degradation of ecosystems and impacts of climate change, while fisheries livelihoods are further pressured by conservation policy imperatives. Fishers' adaptive responses to these pressures, such as exiting from a fishery to pursue alternative livelihoods, determine their own vulnerability, as well as the potential for reducing fishing effort and sustaining fisheries. The willingness and ability to make particular adaptations in response to change, such as exiting from a declining fishery, is influenced by economic, cultural and institutional factors operating at scales from individual fishers to national economies. Previous studies of exit from fisheries at single or few sites, offer limited insight into the relative importance of individual and larger-scale social and economic factors. We asked 599 fishers how they would respond to hypothetical scenarios of catch declines in 28 sites in five western Indian Ocean countries. We investigated how socioeconomic variables at the individual-, household- and site-scale affected whether they would exit fisheries. Site-level factors had the greatest influence on readiness to exit, but these relationships were contrary to common predictions. Specifically, higher levels of infrastructure development and economic vitality - expected to promote exit from fisheries - were associated with less readiness to exit. This may be due to site level histories of exit from fisheries, greater specialisation of fishing households, or higher rewards from fishing in more economically developed sites due to technology, market access, catch value and government subsidies. At the individual and household scale, fishers from households with more livelihood activities, and fishers with lower catch value were more willing to exit. These results demonstrate empirically how adaptive responses to change are influenced by factors at multiple scales, and highlight the importance of understanding natural resource-based livelihoods in the context of the wider economy and society.

Revisit the faster-is-slower effect for an exit at a corner

NASA Astrophysics Data System (ADS)

Chen, Jun Min; Lin, Peng; Wu, Fan Yu; Li Gao, Dong; Wang, Guo Yuan

2018-02-01

The faster-is-slower effect (FIS), which means that crowd at a high enough velocity could significantly increase the evacuation time to escape through an exit, is an interesting phenomenon in pedestrian dynamics. Such phenomenon had been studied widely and has been experimentally verified in different systems of discrete particles flowing through a centre exit. To experimentally validate this phenomenon by using people under high pressure is difficult due to ethical issues. A mouse, similar to a human, is a kind of self-driven and soft body creature with competitive behaviour under stressed conditions. Therefore, mice are used to escape through an exit at a corner. A number of repeated tests are conducted and the average escape time per mouse at different levels of stimulus are analysed. The escape times do not increase obviously with the level of stimulus for the corner exit, which is contrary to the experiment with the center exit. The experimental results show that the FIS effect is not necessary a universal law for any discrete system. The observation could help the design of buildings by relocating their exits to the corner in rooms to avoid the formation of FIS effect.

Design of ocular for optical sight with long exit pupil distance

NASA Astrophysics Data System (ADS)

Zhu, Zhongyao; Li, Yuyao; Tian, Ailing

2017-02-01

In order to solve the injury of optical sight to shooters, which is produced by recoil for using artillery or firearms, and the usage problems of shooters' eye mask, headband and gas mask, the ocular with long exit pupil distance has been designed based on optical sighting system. The optical properties and aberration characteristics of ocular with long exit pupil distance has been analyzed, the structural style with positive-positive-negative three lens groups has been put forward. According to the aberration theory and the isoplanatic image formation principle, the focal power assignment expression has been deduced by adopting analytical method. By using of optical design software ZEMAX, the ocular with long exit pupil distance has been designed, the focal length of system is 20mm, the exit pupil diameter is 4mm, the field angle is 40°, the distance of exit pupil is 41mm, and the relative eye relief is greater than 2. The design results show if this method has been adopted, the transfer functions of each field are all greater than 0.15 when the ocular with long exit pupil distance locates on 45lp/mm, which can meet the use requirements of visual optical instruments.

Third-person Diagnostic Interview on the Cognitive Insight Level of Psychotic Patients with an Insight at the Denial Level

PubMed Central

Mehdizadeh, Mahsa; Rezaei, Omid

2016-01-01

Objectives: According to the previous findings, the third-person technique improved the clinical insight of psychotic patients, therefore the present study aims to examine the effect of a third-person interview compared to a first-person interview on the level of cognitive insight of psychotic patients with an insight at the denial level. Materials and Methods: In this study, using interviews and questionnaires, a total number of 44 patients of Razi Psychiatric Educational and Treatment Center with an insight at the denial level being assessed using diagnostic interviews were divided randomly into two groups. Then, the two groups of patients' cognitive insights were evaluated using Beck Cognitive Insight Scale. Results: The findings indicated that in psychotic patients with an insight at the denial level, the third-person technique of interview compared to the first-person had little effect on the improvement of overall cognitive insight and its components, including self-reflection and self-assurance; however, this effect was not strong enough to make a significant difference between the two groups of patients. Conclusion: According to the study findings, we can conclude that the third-person interview compared to the first-person interview has no effect on the improvement of the cognitive insight of psychotic patients with an insight at the denial level. This finding is consistent with the previous studies indicating that although the theory of mind has some correlations with the clinical insight of patients, it has no effect on their cognitive insight. PMID:27335517

Tritium in Exit Signs | RadTown USA | US EPA

EPA Pesticide Factsheets

2018-05-01

Many exit signs contain tritium to light the sign without batteries or electricity, which allows it to remain lit if the power goes out. Tritium is most dangerous when it is inhaled or swallowed. Never tamper with a tritium exit sign.

Engineering Development Tests Airdrop Controlled Exit System (ACES)

DTIC Science & Technology

1980-09-01

AIRDROP CONTROLLED EXIT SYSTEM ( ACES ) RECOVERY PARACHUTES TELEMETERING DATA 20. D5TFAC c• Cat •u•u am revers e• ift n•ceesafy ad Ide•lityf by block...rTECHNICAL REPORT , NATICK /TR-82 /017 f C’n Engineering Development Tests Airdropý Controlled Exit System ( ACES ) COPY CLV40ble to DTIC doe’ io C...and,50.,,,10) s. TYPE OF REPORT A PERIOn COVEnEo Test Report ENCINEERTNG DEVELOPMENT TESTS Oct 79 - Apr 80 AIRDROP CONTROLLED EXIT SYSTEM ( ACES ) 6

Method of forming magnesium alloy sheets

DOEpatents

Mualidharan, Govindarajan; Muth, Thomas R.; Harper, David C.

2015-12-22

A machine for asymmetric rolling of a work-piece includes pair of rollers disposed in an arrangement to apply opposing, asymmetric rolling forces to roll a work-piece therebetween, wherein a surface of the work-piece is rolled faster than an opposite surface of the work-piece; and an exit constraint die rigidly disposed adjacent an exit side of the pair of rollers so that, as the work-piece exits the pair of rollers, the work-piece contacts the exit constraint die to constrain curling of the work-piece.

Jet engine nozzle exit configurations and associated systems and methods

NASA Technical Reports Server (NTRS)

Mengle, Vinod G. (Inventor)

2011-01-01

Nozzle exit configurations and associated systems and methods are disclosed. An aircraft system in accordance with one embodiment includes a jet engine exhaust nozzle having an internal flow surface and an exit aperture, with the exit aperture having a perimeter that includes multiple projections extending in an aft direction. Aft portions of individual neighboring projections are spaced apart from each other by a gap, and a geometric feature of the multiple can change in a monotonic manner along at least a portion of the perimeter.

Jet Engine Nozzle Exit Configurations and Associated Systems and Methods

NASA Technical Reports Server (NTRS)

Mengle, Vinod G. (Inventor)

2013-01-01

Nozzle exit configurations and associated systems and methods are disclosed. An aircraft system in accordance with one embodiment includes a jet engine exhaust nozzle having an internal flow surface and an exit aperture, with the exit aperture having a perimeter that includes multiple projections extending in an aft direction. Aft portions of individual neighboring projections are spaced apart from each other by a gap, and a geometric feature of the multiple can change in a monotonic manner along at least a portion of the perimeter.

Shored gunshot wound of exit. A phenomenon with identity crisis.

PubMed

Aguilar, J C

1983-09-01

Shored gunshot wound of exit is produced when the outstretched skin is impaled, sandwiched, and crushed between the outgoing bullet and the unyielding object over the exit site, thus leaving an abrasion collar on the wound margin. Proper coaptation of the wound margin is impossible because of the loss of skin just like those observed in entrance wounds. In contrast to the entrance wound, the supported exit wound shows a scalloped or punched-out abrasion collar and sharply contoured skin in between the radiating skin lacerations marginating the abrasion (Fig. 1). Should gunpowder be observed around the exit site, it is often unevenly distributed, and is not associated with searing, gunpowder stippled abrasion, tatooing, and deposition of soot.

Which medical interview skills are associated with patients' verbal indications of undisclosed feelings of anxiety and depressive feelings?

PubMed

Goto, Michiko; Takemura, Yousuke C

2016-01-01

In medical practice, obtaining information regarding patients' undisclosed "feelings of anxiety" or "depressive feelings" is important. The purpose of this study was to determine which interview skills are best suited for eliciting verbal indications of undisclosed feelings, for example anxiety or depressive feelings in patients. Our group videotaped 159 medical interviews at an outpatient department of the Department of Family Medicine, Mie University Hospital (Mie, Japan). Physicians' medical interview skills were evaluated using a Medical Interview Evaluation System and Emotional Information Check Sheet for assessing indications of "feelings of anxiety" or "depressive feelings". We analyzed the relationship between the interview skills and patients' consequent emotional disclosure using generalized linear model (GLIM). The usage of interview skills such as "open-ended questions" "asking the patient's ideas about the meaning of illness" "reflection" and "legitimization" were positively associated with the number of anxiety disclosure, whereas "close-ended questions" and "focused question" were negatively associated. On the other hand, only "respect" was positively associated with the number of depressive disclosures, whereas "surveying question" was negatively associated. The results revealed that there are several interview skills that are effective in eliciting verbal indication of undisclosed "feelings of anxiety" or "depressive feelings".

Patient-centered interviewing is associated with decreased responses to painful stimuli: an initial fMRI study.

PubMed

Sarinopoulos, Issidoros; Hesson, Ashley M; Gordon, Chelsea; Lee, Seungcheol A; Wang, Lu; Dwamena, Francesca; Smith, Robert C

2013-02-01

To identify the functional magnetic resonance imaging (fMRI) changes associated with a patient-centered interview (PCI) and a positive provider-patient relationship (PPR). Nine female patients participated, five randomly selected to undergo a replicable, evidence-based PCI, the other four receiving standard clinician-centered interviews (CCI). To verify that PCI differed from CCI, we rated the interviews and administered a patient satisfaction with the provider-patient relationship (PPR) questionnaire. Patients were then scanned as they received painful stimulation while viewing pictures of the interviewing doctor and control images (unknown doctor). Interview ratings and questionnaire results confirmed that PCIs and CCIs were performed as planned and PCIs led to a much more positive PPR. We found significantly reduced pain-related neural activation in the left anterior insula region in the PCI group when the interviewing doctor's picture was shown. This study identifies an association between a PCI that produced a positive PPR and reduced pain-related neural responses in the anterior insula. This is an initial step in understanding the neural underpinnings of a PCI. If confirmed, our results indicate one neurobiological underpinning of an effective PCI, providing an additional scientific rationale for its use clinically. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Identification and Comprehension of Symbolic Exit Signs for Small Transport-Category Airplanes

DTIC Science & Technology

2014-02-01

8 Phase Two: Self -illuminated Exit Signs...11 Self -illuminated Exit Sign Comprehension ---------------------------------------------------------------------- 12 Automatic...other sign parameters such as stroke width to height, contrast ratios, and self -illumination, fall within those recommended by 14 CFR 25.812(b)(2

Aircraft evacuations through type-III exits II : effects of individual subject differences.

DOT National Transportation Integrated Search

1995-08-01

Simulated emergency egress from Type III over-wing exits was studied to support regulatory action by the FAA. Passageway width from the aircraft center aisle to the Type-III exit was the major variable of interest; effects of individual subject attri...

Symmetry associated with symmetry break: Revisiting ants and humans escaping from multiple-exit rooms

NASA Astrophysics Data System (ADS)

Ji, Q.; Xin, C.; Tang, S. X.; Huang, J. P.

2018-02-01

Crowd panic has incurred massive injuries or deaths throughout the world, and thus understanding it is particularly important. It is now a common knowledge that crowd panic induces "symmetry break" in which some exits are jammed while others are underutilized. Amazingly, here we show, by experiment, simulation and theory, that a class of symmetry patterns come to appear for ants and humans escaping from multiple-exit rooms while the symmetry break exists. Our symmetry pattern is described by the fact that the ratio between the ensemble-averaging numbers of ants or humans escaping from different exits is equal to the ratio between the widths of the exits. The mechanism lies in the effect of heterogeneous preferences of agents with limited information for achieving the Nash equilibrium. This work offers new insights into how to improve public safety because large public areas are always equipped with multiple exits, and it also brings an ensemble-averaging method for seeking symmetry associated with symmetry breaking.

Partial polarizer filter

NASA Technical Reports Server (NTRS)

Title, A. M. (Inventor)

1978-01-01

A birefringent filter module comprises, in seriatum. (1) an entrance polarizer, (2) a first birefringent crystal responsive to optical energy exiting the entrance polarizer, (3) a partial polarizer responsive to optical energy exiting the first polarizer, (4) a second birefringent crystal responsive to optical energy exiting the partial polarizer, and (5) an exit polarizer. The first and second birefringent crystals have fast axes disposed + or -45 deg from the high transmitivity direction of the partial polarizer. Preferably, the second crystal has a length 1/2 that of the first crystal and the high transmitivity direction of the partial polarizer is nine times as great as the low transmitivity direction. To provide tuning, the polarizations of the energy entering the first crystal and leaving the second crystal are varied by either rotating the entrance and exit polarizers, or by sandwiching the entrance and exit polarizers between pairs of half wave plates that are rotated relative to the polarizers. A plurality of the filter modules may be cascaded.

Dropped out or pushed out? Insurance market exit and provider market power in Medicare Advantage.

PubMed

Pelech, Daria

2017-01-01

This paper explores how provider and insurer market power affect which markets an insurer chooses to operate in. A 2011 policy change required that certain private insurance plans in Medicare form provider networks de novo; in response, insurers cancelled two-thirds of the affected plans. Using detailed data on pre-policy provider and insurer market structure, I compare markets where insurers built networks to those they exited. Overall, insurers in the most concentrated hospital and physician markets were 9 and 13 percentage points more likely to exit, respectively, than those in the least concentrated markets. Conversely, insurers with more market power were less likely to exit than those with less, and an insurer's market power had the largest effect on exit in concentrated hospital markets. These findings suggest that concentrated provider markets contribute to insurer exit and that insurers with less market power have more difficulty surviving in concentrated provider markets. Published by Elsevier B.V.

The end-stage renal disease industry and exit strategies for nephrologists.

PubMed

Sullivan, John D

2006-01-01

The purpose of this presentation is to identify exit strategies for nephrologists under changing conditions in the dialysis market. The end-stage renal disease service provider market continues to be highly receptive to consolidation. Taking advantage of large economies of scale, large for-profit dialysis chains have surpassed independent operators in both number of clinics and total patients. With relatively low barriers to entry, new smaller clinics continue to open, serving a niche outside the larger chains. Additional competition comes in the form of medium players funded by venture capitalists with the added pressure of rapid growth and financial return. To ensure market power in both dialysis products and managed care negotiation leverage, medium and large service providers will continue to seek out attractive acquisition targets. For nephrologists to capitalize on investment, clinic and business preparation will continue to be the driving force for these divestitures.

A new bed-exiting alarm system for welfare facility residents.

PubMed

Ogawa, Hidekuni; Yonezawa, Yoshiharu; Maki, Hiromichi; Caldwell, W

2009-01-01

A newly developed alarm system detects welfare facility residents leaving their beds, and does not respond to the care staff, who wear shoes or slippers. It employs a stainless steel tape electrode, several linear integrated circuits and a low-power 8-bit single chip microcomputer. The electrode, which is used as a bed-exiting detection sensor, is attached to the floor mat to record changes in the always-present AC (alternating current) voltage induced on the patient's body by electrostatic coupling from the standard 100 volt, 60 Hz AC utility power wiring in the room walls and ceiling. The resident's body movements, before trying to get out of bed and after leaving the bed, are detected by the microcomputer from changes in the induced AC voltage. The microcomputer alerts the care staff station, via a power line communication system or PHS (personal handy phone System).

Prevention of gram-positive infections in peritoneal dialysis patients in Hong Kong: a cost-effectiveness analysis.

PubMed

Wong, Carlos; Luk, In-Wa; Ip, Margaret; You, Joyce H S

2014-04-01

Gram-positive bacteria are the major causative pathogens of peritonitis and exit site infection in patients undergoing peritoneal dialysis (PD). We investigated the cost-effectiveness of regular application of mupirocin at the exit site in PD recipients from the perspective of health care providers in Hong Kong. A decision tree was designed to simulate outcomes of incident PD patients with and without regular application of mupirocin over a 1-year period. Outcome measures included total direct medical costs, quality-adjusted life-years (QALYs) gained, and gram-positive infection-related mortality rate. Model inputs were derived from the literature. Sensitivity analyses evaluated the impact of uncertainty in all model variables. In a base case analysis, the mupirocin group had a higher expected QALY value (0.6496 vs 0.6456), a lower infection-related mortality rate (0.18% vs 1.64%), and a lower total cost per patient (US $258 vs $1661) compared with the control group. The rate of gram-positive peritonitis without mupirocin and the risk of gram-positive peritonitis with mupirocin were influential factors. In 10,000 Monte Carlo simulations, the mupirocin group had significantly lower associated costs, higher QALYs, and a lower mortality rate 99.9% of the time. Topical mupirocin appears to be a cost-effective preventive measure against gram-positive infection in incident patients undergoing PD. The cost-effectiveness of mupirocin is affected by the level of infection risk reduction and subject to resistance against mupirocin. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Evaluation of the effect of motivational interviewing counselling on hypertension care.

PubMed

Ma, Chunhua; Zhou, Ying; Zhou, Wei; Huang, Chunfeng

2014-05-01

This study tests the effectiveness of motivational interviewing compared with the usual care for Chinese hypertensive patients. A randomised controlled trial was used. One hundred and twenty eligible participants were randomly assigned to either the control group (usual care group) or the intervention group (motivational interviewing group). The results of this study demonstrated that the total scores and the mean scores for each dimension of the adherence questionnaire were increased in the intervention group (P<0.05), and the systolic blood pressure and diastolic blood pressure of the hypertensive patients greatly decreased in the intervention group during the six months of the motivational interviewing counselling (P<0.05). The application of motivational interviewing for hypertensive patients is a promising approach for sustaining the clinical benefits of adherence behaviour. Motivational interviewing should be provided to hypertensive patients at hospitals and community health centres to assist patients in controlling their BP and to enhance treatment adherence. A series of training courses on the motivational interviewing technique should be provided to nurses. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

The Differential Roles of Budding Yeast Tem1p, Cdc15p, and Bub2p Protein Dynamics in Mitotic ExitD⃞V⃞

PubMed Central

Molk, Jeffrey N.; Schuyler, Scott C.; Liu, Jenny Y.; Evans, James G.; Salmon, E. D.; Pellman, David; Bloom, Kerry

2004-01-01

In the budding yeast Saccharomyces cerevisiae the mitotic spindle must be positioned along the mother-bud axis to activate the mitotic exit network (MEN) in anaphase. To examine MEN proteins during mitotic exit, we imaged the MEN activators Tem1p and Cdc15p and the MEN regulator Bub2p in vivo. Quantitative live cell fluorescence microscopy demonstrated the spindle pole body that segregated into the daughter cell (dSPB) signaled mitotic exit upon penetration into the bud. Activation of mitotic exit was associated with an increased abundance of Tem1p-GFP and the localization of Cdc15p-GFP on the dSPB. In contrast, Bub2p-GFP fluorescence intensity decreased in mid-to-late anaphase on the dSPB. Therefore, MEN protein localization fluctuates to switch from Bub2p inhibition of mitotic exit to Cdc15p activation of mitotic exit. The mechanism that elevates Tem1p-GFP abundance in anaphase is specific to dSPB penetration into the bud and Dhc1p and Lte1p promote Tem1p-GFP localization. Finally, fluorescence recovery after photobleaching (FRAP) measurements revealed Tem1p-GFP is dynamic at the dSPB in late anaphase. These data suggest spindle pole penetration into the bud activates mitotic exit, resulting in Tem1p and Cdc15p persistence at the dSPB to initiate the MEN signal cascade. PMID:14718561

Capturing Parents' Individual and Institutional Interest Toward Involvement in Science Education

NASA Astrophysics Data System (ADS)

Kaya, Sibel; Lundeen, Cynthia

2010-11-01

Parents are generally less involved in their children’s science education (as compared to reading and mathematics) due to low self-efficacy and a lack of home-school communication. This study examined parental interest and attitudes in science as well as the nature of parent-to-child questioning during an interactive home, school, and community collaboration in the southeastern United States. Study results, compiled from observations, exit surveys, and interviews revealed largely positive family interactions and attitudes about science learning and increased parental interest toward involvement in elementary science. Parents frequently used productive questioning techniques during activities. These results imply that successful home, school, and community partnerships may elevate levels of parental participation in their children’s science education and the parents’ perception of themselves as being competent in assisting in science.